Is The Ketogenic Diet Bone Healthy? Here’s The Evidence-Backed Information - Save Our Bones

The ketogenic diet is a dietary plan that turns stored body-fat into energy by inducing a process known as ketosis.

The ketogenic, or “keto” diet has come under scrutiny for its extreme dietary limitations and troubling side effects, but many have found it useful for burning excess fat, losing weight, and building muscle.

In today’s article, we’ll look at the science behind the keto diet and determine whether it fits the parameters of the Osteoporosis Reversal Program.


Ketosis is a metabolic state in which the body converts stored fat into energy instead of utilizing carbohydrates.

Ketosis only occurs when the body’s preferred source of energy, glucose, is unavailable. So the ketogenic diet deprives your body of glucose and instead provides fats for conversion into energy.

To enter ketosis, you must severely restrict your intake of all forms of carbohydrates. Fasting can also trigger ketosis when your body enters a stressful starvation state.

Ketosis creates acids called ketones that build up in the blood and are eliminated in the urine. They acidify the body’s pH, and if levels get too high, a dangerous condition called ketoacidosis can occur. It is most commonly caused by illnesses that suppress insulin, problems with insulin therapy, and type 1 diabetes.


Ketosis is the body’s process of breaking down fat for energy, instead of using glucose from carbohydrates.

The Development Of The Ketogenic Diet

In the early 1900s, scientists discovered that fasting reduced seizures in people with epilepsy. Further studies determined that it was the state of ketosis, triggered by fasting, that led to this positive effect.

The ketogenic diet was first developed in the 1920s to induce ketosis as a way to manage epilepsy. It remained the most effective and popular treatment for sixty years.1

With the rising popularity of low-carb diets, the ketogenic diet has been co-opted for use as a weight-loss regimen.


The ketogenic diet was developed to treat seizures in people with epilepsy.

The Ketogenic Diet

The ketogenic diet is a low carbohydrate, moderate protein, high-fat diet that strictly dictates what foods you can and cannot eat to induce and fuel ketosis.

In a typical ketogenic diet plan, about 5% of calories are derived from carbohydrates, 20% from protein, and 75% from fat. That means that if you intend to consume 2,000 calories a day, you’ll have about 167 grams of fat, 100 grams of protein, and only 25 grams of carbohydrates. For reference, one apple contains 25 grams of carbohydrates.

To meet these restrictions, those who follow the keto diet must cut out sugars and most carbs. That means no grains and severe restriction of fruits and most vegetables.

Ideally, fats come from healthy-fat sources like avocados, eggs, nuts, and fish. However, the need to eat so much fat often leads people to consume large quantities of unhealthy fats found in animal protein and dairy foods.

Healthy individuals who follow a ketogenic diet often lose weight at first, until their body adjusts to ketosis, after which no more weight loss occurs. A similar pattern occurs with muscle growth, at first increasing and then leveling off.1 This balance of benefits and drawbacks is typical of the diet, as the following pros and cons demonstrate:

The benefits of a short-term ketogenic diet include:1,2

  • The potential for limited weight loss
  • Improved levels of HDL (high-density lipoprotein) cholesterol
  • Reduced inflammation, via a reduction of insulin secretion
  • Increased satiety (feeling full longer, due to the slower digestion of fats)
  • Reduced sugar intake and stabilized blood sugar
  • Increased and consistent energy (from stable blood sugar levels)
  • Neuroprotective qualities of ketones3

Negative effects of the keto diet include:1,2,3,4,5

Many of those flu-like side-effects are experienced for as many as two weeks as the body adjusts to the absence of carbohydrates and continual ketosis. This is sometimes known as the keto-flu.1

Although for most people it eventually subsides, for many this phase alone makes the keto diet not worthwhile.


The ketogenic diet requires cutting out sugar and dramatically restricting fruits and vegetables. It necessitates eating mostly fats, with a moderate amount of protein. The diet has benefits including limited weight loss, but also drawbacks like vitamin deficiencies and flu-like symptoms.

The Ketogenic Diet And The Osteoporosis Reversal Program

It is possible to eat a pH-balanced diet that causes ketosis, but because many alkalizing foods are excluded or reduced by the keto diet, it is challenging.

Many of the fats and proteins typically recommended for the keto diet are bone-healthy, but also acidifying, such as wild salmon and eggs. Since an 80/20 pH-balanced diet is 80% alkalizing and a keto diet consists of nearly 80% fats, to meet both conditions a majority of your meals would have to include alkalizing fats, which are scarce..

Even though that balance may be possible, the restrictions of the keto diet are not compatible with the nutritional guidelines of the Osteoporosis Reversal Program. Here are the reasons why a ketogenic diet isn’t conducive for preventing or reversing osteoporosis:

  • Ketosis generates acidifying ketones, therefore acidifying the pH, which causes bone loss.1,5,7
  • The keto diet deprives you of fiber, harming the digestive process1,5
  • Reduction in fruits and vegetables reduces antioxidant and micronutrient intake
  • The keto diet causes negative side effects1,4,5
  • The keto diet is strenuously difficult to follow
  • The keto diet depends upon restriction and self-denial, making it unsustainable
  • The keto diet often causes dehydration, which impairs the bone remodeling process1,5

The above list of detrimental side effects of the keto diet shows that its potential benefits do not outweigh the risks to bone health and overall well-being.


The keto diet can be pH-balanced, but even then, a ketogenic diet isn’t bone-healthy and doesn’t fit in the parameters of the Osteoporosis Reversal Program.

Sustainable Solutions For Improving Your Health

The ketogenic diet was developed as a medical treatment for a medical condition, not for weight loss, and most certainly not with bone health in mind.

Following an 80/20 pH-balanced diet, rich in vegetables and fruits, allows you to eat the foods you love while still taking optimal care of your bones and your overall health. It’s not a fad or a trend, or a temporary diet to lose a few pounds. It’s a sustainable dietary practice designed to help you build stronger bones and live a fuller life.

Eat Your Way to Stronger Bones!

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1 Wajeed Masood; Kalyan R. Uppaluri. “Ketogenic Diet.” StatPearls Publishing. 2019. Web.

2 A Paoli, et al. “Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets.” Eur J Clin Nutr. 2013 Aug; 67(8): 789–796. Web.

3 Maalouf M, et al. “Ketones inhibit mitochondrial production of reactive oxygen species production following glutamate excitotoxicity by increasing NADH oxidation.” Neuroscience. 2007 Mar 2;145(1):256-64. Epub 2007 Jan 18. Web.

4 Kossoff, Eric. “Danger in the pipeline for the ketogenic diet?.” Epilepsy currents vol. 14,6 (2014): 343-4. Web.

5 Kang HC, et al. “Early- and late-onset complications of the ketogenic diet for intractable epilepsy.” Epilepsia. 2004 Sep;45(9):1116-23. Web.

6 Sirikonda NS, et al. “Ketogenic diet: rapid onset of selenium deficiency-induced cardiac decompensation.” Pediatr Cardiol. 2012 Jun;33(5):834-8. Web.

7 Bergqvist AG, et al. “Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet.” Am J Clin Nutr. 2008 Dec;88(6):1678-84. Web.

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Comments on this article are closed.

  1. Barbara Montgomery

    I have to agree with Joann. I would so like the recipe book, but I too prefer hard copies. I hope you will make it available in that form some day soon.

  2. Mary Lou Williams

    What is your opinion on butter from grass-fed cows? Is grass-fed butter good for your heart? Is it good for your bones? Should it be part of a healthful diet?

  3. Jennifer

    I completely agree with Rita. I would like to add that at 56 I started a running program which I never would have been able to do at any other time in my adult life. The reason ? Because my knees hurt daily , my brain was foggy and I was tired nearly every morning. I cut out grains and lost weight ( not much just enough to lose the bloated ,sluggishness as well as the achy knees, swollen painful finger joints ). The MAIN reason I decided to cut out grains was my seasonal hay fever that was debilitating. Within 3 weeks of no grains, my lifelong hay fever was gone .
    In the last 5 years I have read everything about keto, primal , carbs , intermittent fasting and HIIT exercising. I strongly recommend that people interested in reducing or eliminating inflammation in the body look into a ketogenic/intermittent fasting lifestyle. We know inflammation causes autoimmune disease and cancer and we know grains are inflammatory , we know our ancestors did not consume large quantities of grains so why do we think we need to?

    I highly recommend searching Dr Mercola , Mark Sisson, Michael Mosley, and the cardiologist Dr Wolfson.

    Peace and health to you all.

    • Alex

      I agree with you and Rita that one can eat very healthily on a Ketogenic plan. It’s not difficult to eat loads of alkaline salads and veg – really easy in fact. There are so many absolutely beautiful oils to put on salads too – presently trying milk thistle seed oil and black sesame – really lovely. I’m not following a strict keto plan, but my diet has inclined that way more over the past few years. Grains i rarely ever eat – instinctively not done so for years. But i do have gluten free carbs like millet and sweet potatoes.
      I’ve found i am able to eat good quality cheese and yogurts again.
      I have an active life and this way of eating suits me a million times more than the carbohydrate based diet of my past that had me in many ways on the run from myself and not feeling satisfied.
      Also, lastly, to say that eating a ketogenic diet is not so difficult socially. It’s no more difficult that avoiding sugar especially in a restaurant. Just leave the chips. What’s more my dog fair better on a grain and potato -free diet and we often eat together. She just doesn’t eat salad or avocado.

      • Jennifer

        You are right , it isn’t difficult to eat primal today. Lots of folks are giving up carbs . Weight Watchers share price is dropping because people are finally figuring out that consuming carbs is not the way to lose weight.
        Interesting about your dog. I have an 11 year old GSP who runs around like he’s half that . He has been on a raw dogfood diet his entire life . He regularly gets raw bones and cleans up our leftovers. He sees a vet for injuries only but gets no vaccines. A vet once asked my husband if he brushes the dog’s teeth cause they were so healthy. After my husband stopped laughing he told him the dog eats bones and a no-grain diet. The vet was amazed. We now buy raw dogfood made for the state guide dog association . They trialed the diet a few years back discovering that their dogs had less skin issues, better sleep habits, less aggression, better teeth and were easier to train. It only makes sense – canines did not evolve eating cooked grains. They ate killed animals including the vegetable content of that animal’s stomach and it’s bones.
        I bet your dog would eat avo splashed with olive oil. I regularly give mine coconut oil and olive oil for extra good fats.
        I’m currently rereading The Primal Blueprint by Mark Sisson. It just makes so much sense .

        Peace and health.

  4. Rita

    I’m sorry you take such a negative view of the ketogenic diet. I have had a cyclical keto diet for 5 yrs, averaging about 70% fat from grass-fed beef and coconut oil, 15% protein, and 15% carbs from non-starchy vegetables (at least 10 servings/day) and a little fruit (more than 80% alkaline). Dehydration, lack of fiber, and probably acidosis has never been a problem. Granted, I am grain and dairy free to keep the carbs down but the decreased appetite allows me to maintain. I have stayed at 20-21 BMI, insulin resistance has decreased, HDL is 120, triglycerides are 60, micronutrients are good according to Chronometer with some supplementation. Cholesterol numbers are above average, the same as before keto diet, but that is good for longevity and brain function. A ketogenic diet CAN be done with enough vegetables to maintain alkalinity.

    • Vivian Goldschmidt, MA

      Just bear in mind that the keto diet was not designed with bone health in mind, Rita.

  5. Ginny

    Very informative. Thanks for the information. Really it’s a relief not to go down that path! Common sense prevails once again.

    • Vivian Goldschmidt, MA

      I’m glad you’ve found this article useful, Ginny 🙂

  6. Carmel

    Thank you so much for the article on the Ketogenic diet Vivian! I have been looking at this diet for quite a long time but had a sense not to go on for the reasons you gave on the negative effects it has on the bones and other health issues as well. I feel so much better now with that settled in my mind. Thank you again Vivian and God bless to you for the wonderful work you are doing!

    • Vivian Goldschmidt, MA

      You’re welcome, Carmel!

  7. Vida

    Hi vivian ,
    I am a member and i ordered all your books.i can’t log in to customer support. How can i email or ask questions.?..

    • Save Institute Customer Support

      Feel free to send us an email at We’re looking forward to answering your questions!

  8. JoAnn

    I would love to have your recipes, but I would like to have them in book form.
    Are you ever going to sell them in book form?
    Computers are nice but I do not want to have to print out every page or go back and forth to see certain recipes. I am old and find this to be annoying and time consuming.
    Thank you for your information and time.

    • Save Institute Customer Support

      We’re sorry that you prefer a printed book, JoAnn. For now, we will keep Bone Appetit in digital format instead of printing it. Many Savers who think like you send the digital file to companies like Office Depot and get the e-book printed for a few cents per page. It’s something you might want to consider. Please send us an email at if you need more help with this.

  9. Suzanne

    My weight loss on keto was definitely not insignificant. I lost about 14 lbs over three years and I’m keeping it off easily. I definitely am not dehydrated and I get my nutrients from food and supplements. I do cyclical keto and have a cheat day at least two-three times/month.

    • Vivian Goldschmidt, MA

      Glad to know if works for you. Just make sure that to prevent bone loss you eat plenty of alkalizing foods to balance the pH of your meals.

  10. Sharon Carr

    What is your stance on intermittent fasting?

    • Vivian Goldschmidt, MA

      Sharon, as Savers know, an acid serum pH leads to bone loss, so should you decide to fast intermittently make sure you don’t fast for very long because you want to avoid entering ketosis.

  11. Barbara PEARCE

    Vivian, I don’t follow a ketogenic diet but have been doing intermittent fasting – where you eat for 8 hours of the day and then fast for 16. Meaning after supper I don’t eat anything until breakfast the next day. So if I finish eating supper at 6:00 I eat breakfast at 10:00. This creates a ketogenic state in the body during the last … I think it’s 2 -4 hours. It takes the body 12-14 hours to fully digest food. I imagine, from your article that would mean for those 2-4 hours my body would be more acidic. What do you think about intermittent fasting?

    • Vivian Goldschmidt, MA

      The problem with intermittent fasting is, as you mention, that it can acidify the serum pH if it leads to ketosis. It is best to avoid serum acidification, of course, so perhaps you’d like to shorten the span of your fasting time.

  12. Lucy Stojko

    Thank you Vivian, your article couldn’t come in a better time, I was about to start that diet

    Your help is so much appreciated

    • Vivian Goldschmidt, MA

      Glad to know the timing was perfect for you, Lucy!

  13. Deedee

    Thanks for confirming that the Keto diet is definitely NOT for me!

    • Danna

      Ditto what Dee Dee said.

    • Vivian Goldschmidt, MA

      Yes, Deedee, knowledge is power!

  14. Ita

    Thank you, Ita.

    • Vivian Goldschmidt, MA

      You’re welcome, Ita 🙂

  15. FM

    Thanks for this very interesting article!

    • Vivian Goldschmidt, MA

      You’re welcome!

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