The Ketogenic Diet and its Impact on Growth

Ever since Vining et al reported a decrease in growth parameters in children on the ketogenic diet (KD) this problem has been a major source of anxiety to both physicians and caregivers.

A recent report of growth markers in children with uncontrolled epilepsy treated with the KD recently highlighted this problem again.

Most prospective studies to date have been for periods ranging from 6 to 12 months. A longer period of over 24 months would be better suited to gauge this effect more scientifically.

This article studies prospectively the effect of KD on weight, height and BMI and compared the values at baseline and after 2 years on KD. Growth deceleration was seen in only 9% of the subject population. Unlike many other trials reported, where 75% RDA is administered, 100% RDA was administered.

The cause of growth delay seen in this study and in others is still unknown. Among the factors one could be calorie restriction (however in this study 100% calories were given). Another could be metabolic acidosis due to the ketones (one study did find some correlation between high ketosis and growth retardation and none occurring in those in moderate ketosis). A third could be the lowering of IGF-1.

The take-home lesson is

  1. Monitor height, weight and BMI regularly and make changes to total calories and protein intake accordingly.
  2. If lower ketosis controls seizures do not increase KD ratio, that is, use the lowest ratio required.



  1. Vining, E. P., Pyzik, P., McGrogan, J., Hladky, H., Anand, A., Kriegler, S., & Freeman, J. M. (2002). Growth of children on the ketogenic diet. Developmental medicine and child neurology44(12), 796-802.
  2. Armeno, M., Verini, A., del Pino, M., Araujo, M. B., Mestre, G., Reyes, G., & Caraballo, R. H. (2019). A Prospective Study on Changes in Nutritional Status and Growth Following Two Years of Ketogenic Diet (KD) Therapy in Children with Refractory Epilepsy. Nutrients11(7), 1596.