In 2018, the ketogenic diet was hugely popular and being touted by celebrities as diverse as the Cleveland Cavaliers’ 6-foot-9-inch LeBron James and 5-foot-1-inch singer/actress Vanessa Hudgens.

But in 2020, a Food and Health Survey of Americans found that intermittent fasting was ranked ahead of keto as Americans' favorite dietary pattern. That's good, because a new study in the journal Frontiers in Nutrition looked at the virtues vs. the vices of a keto diet and concluded that in some circumstances the vices can be greater than the benefits.

A ketogenic diet is very low in carbohydrates, modest in protein, and high in fat.

The short-term benefits include weight loss, although often folks lose more water and muscle tissue than fat; blood sugar control — but that fades; and a reduction in seizures for people with epilepsy.

And what about the potential risks? Initially, you may get the "keto flu," with headache, fatigue, gastrointestinal discomfort, and heartbeat alterations.

Then, if your keto diet means that you're loading up on saturated fats and red and processed meats, eliminating complex carbs and not taking a daily vitamin-mineral supplement, you'll boost your bad LDL cholesterol and raise your risks for chronic kidney disease, cardiovascular disease, cancer, diabetes, and Alzheimer's disease.

Also, the lack of fiber damages your gut biome, and in the longer term you can experience decreased bone mineral density, anemia, and neuropathy of the optic nerve.

What's the smart approach? Dr. Mike's book "What to Eat When" gives you a guide to healthy intermittent fasting and keto done right.