How to Avoid Micronutrient Deficiency on a Ketogenic Diet
While vitamins and minerals are considered ‘micronutrients’ due to the small amount that your body needs, they provide several vital functions, and failing to get them can wreak havoc on your health.
Alongside macronutrients, micronutrients play crucial roles in our bodies’ daily functions. Eating a balanced diet full of whole foods should provide adequate amounts of most micronutrients.
However, in the context of a ketogenic diet, many high carbohydrate foods like fruits, vegetables, and grains contain many of the 28 known essential micronutrients.
Further, when comparing the micronutrient content of varying ratios of ketogenic diets to the Institute of Medicine’s Dietary Reference Intakes (DRI) standards, it is evident that there is an association between higher fat diets and lower micronutrient density.
Over the years, there has been an increasing interest in micronutrients for their role in the prevention and treatment of disease. This interest is partially due to the increased understanding of the biochemical function of micronutrients, and interest in understanding micronutrient deficiencies associated with specific dietary interventions.
However, a number of studies have found that the ketogenic diet provides sub-optimal levels of many micronutrients determined by DRI standards. In other words, the potential for micronutrient deficiency on a ketogenic diet is significant.
That said, micronutrient deficiency on a ketogenic diet is not unexpected. Following a ketogenic diet, the balance of some micronutrients can become disturbed due to an increase in their excretion, and lowered consumption of micronutrient-rich foods such as fruits, vegetables, grains, and legumes.
And, as the intracellular concentration of micronutrients falls, metabolic pathways and particular tissues will soon begin to be affected. The serious adverse effects associated with prolonged use of the ketogenic diet may be due to its reduced micronutrient content. Thus, supplementation the vitamins and minerals, or a focus on specific vitamin-rich foods are recommended .
While this post may seem alarmist at first pass, the goal of this article is not to dissuade individuals from adopting a ketogenic diet, because the diet is known to impart many important benefits.
Instead, the goal is to help offer insight into the importance of micronutrients and to help guide keto dieters optimize their diet in a way that increases total antioxidant capacity and improves overall health.
Micronutrient Deficiency on a Ketogenic Diet
The classic ketogenic diet is a high-fat, moderate protein, carbohydrate restricted diet that forces the body into a state of ketosis. Fat comprises 80-90% of the calories of the diet, while the remaining calories are first allocated to the necessary protein requirements of the individual and secondly to carbohydrate.
In one study, a 3-day planned ketogenic diet 4:1(fat: non-fat) that selected for nutrient-dense ketogenic diet foods were analyzed for micronutrient content. Nutrient-dense foods were purposely selected for this study to optimize results.
The Dietary Reference Intakes (DRI) were utilized as standard goals for micronutrient intake. Of the 24 micronutrients evaluated, 19 were below the DRI. Of the 19 nutrients below the DRI, 11 nutrients were provided at less than 50% of the DRI.
These included Thiamin (B1), Folate (B9), Pantothenic Acid (B5), Calcium, Copper, Iron, Magnesium, Manganese, Molybdenum, Selenium, and Zinc. In addition, the omega-3 and omega-6 fatty acids were provided at 11% and 70 % of the DRI respectively .
It was also found that the 4:1 (fat: non-fat) diet contained the lowest concentration of micronutrients, meeting only three of the 28 DRIs whereas a 1:1 diet similar to the Modified Atkins Diet (MAD) contained the highest, meeting 12 of the 28 DRIs . A selection of less nutritionally dense foods would have resulted in even lower intakes of these nutrients.
Other similar studies found similar results. One study suggested that individuals following a low-carbohydrate ketogenic diet for a prolonged period may also be deficient in these micronutrients, but also deficient in vitamins Biotin (B7), Vitamin D, Vitamin E, as well as minerals including Chromium, Iodine, Potassium, and Sodium. It further suggested that the average vitamin and mineral deficiency on a ketogenic diet would be 56% .
In other words, micronutrient deficiency on a ketogenic diet is not only uncommon, it is significant. Thus, measures to avoid vitamin and mineral deficiency on a ketogenic diet should be of paramount importance and deserves open and honest discussion to ensure the health and success of the millions of keto diet adherents worldwide.
Importance of Micronutrients as Antioxidants
While prolonged use of the ketogenic diet may not be ideal for some, there are many micronutrient-dense foods that fit into a ketogenic diet plan. Knowing which vitamins and minerals are commonly deficient in the ketogenic diet can help you avoid micronutrient deficiency on a ketogenic diet.
Much of the focus on micronutrients is discussed in the context of electrolyte balance. However, many of the micronutrients are also involved in parts of the antioxidant defense mechanisms. It has been recognized that suboptimal antioxidant activity will lead to oxidative damage to tissues or parts of the cell, with potentially dangerous results.
Micronutrients play an important role in both the prevention and the treatment of an increasing range of conditions. This is because of their well-established antioxidant activity.
Antioxidants are known for their ability to protect against disease, which is why recommendations for increasing intakes of certain micronutrients is recommended even if not derived by conventional, whole food methods. A large body of scientific evidence indicates that reactive free radicals are involved in many diseases, including heart disease, and certain types of cancer [ 5, 6, 7, 8, 9, 10, ].
Dietary antioxidants are food substances that significantly decrease the adverse effects of reactive oxygen species (ROS).
It is well-established that free radicals, especially ROS like superoxide and hydrogen peroxide, are continually produced in vivo by anaerobic microorganisms. Further, the association between oxygen radicals and degenerative disease is also well-established [11, 12].
To counteract the damage caused by reactive oxidant species (ROS), aerobic tissues contain endogenously produced antioxidant enzymes such as superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase .
Some of these endogenous antioxidant mechanisms involve micronutrient utilization, or are micronutrient-dependent, or are themselves radical-scavenging compounds that exhibit synergy with other micronutrients as well .
Thus, avoiding micronutrient deficiency on a ketogenic diet is of paramount importance to a successful and healthy ketogenic diet. This article reveals the importance of the micronutrients that are being depleted on a low-carbohydrate, ketogenic diets, and the foods that the diet will need to include to avoid micronutrient deficiencies.
Important Micronutrient Targets for a Ketogenic Diet
• Vitamin B1
• Vitamin B5
• Vitamin B7
• Vitamin D
• Vitamin E
Vitamins are organic compounds that are distinctly different from fats, carbohydrates, and proteins. In whole foods, they are only present in small amounts and require metabolic activation to turn into their functional form. Unlike other nutrients like macronutrients, vitamins do not provide energy, nor do they serve a structural function.
Instead, vitamins are required for many essential physiological functions and are only needed in small amounts. Because essential vitamins are not produced by the body, obtaining adequate vitamin intake from food, multivitamin, or other dietary sources is important to prevent syndromes associated with vitamin deficiencies.
There are eight B vitamins in total. They include Thiamin (B1), Riboflavin (B2), Niacin (B3), Pantothenic acid (B5), Pyridoxine (B6), Biotin (B7), Folate (B9), and Cobalamin (B12). Though each of the B vitamins has a unique function, they generally help your body produce energy and make essential molecules in your cells (1).
Because meeting Reference Daily Intake (RDI) recommendations for Thiamin, Folate, Pantothenic Acid and Biotin on a ketogenic diet is more complicated, these B vitamins and common foods that contain them will be covered.
Thiamin (Vitamin B1)
Thiamin was first recognized in the late 1800s by C. Eijkman when he was discovered that fowl fed a diet of polished rice (lacking the outer germ and bran layer) had developed serious neurological problems called beriberi.
The substance that was later found to correct these problems was isolated in rice bran and called thiamin. Thiamin is an essential nutrient that all tissues of the body need to function correctly. Like other B vitamins, thiamin is water-soluble and helps the body turn food into energy.
Fat contains little thiamin. Thus, Thiamin deficiency on a ketogenic diet is high if thiamin is not supplemented through food or multivitamin. The relationships between thiamin, neurological health, heart health, and metabolism are notable.
Thiamin deficiency can lead to significant health problems: including beriberi and Wernicke-Korsakoff syndrome. Beriberi affects breathing, eye movements, heart function, and alertness, whereas Wernicke-Korsakoff syndrome causes visual impairments, lack of muscle coordination, and mental decline. If left untreated, Wernicke-Korsakoff can permanently impair certain functions of the brain.
While clinical thiamin deficiency is uncommon, it can affect individuals with specific medical conditions including alcoholism, Crohn’s disease, and anorexia.
Recommended Dietary Allowance for Thiamin
The Recommended Dietary Allowance (RDA) for thiamin for adult men is 1.2 mg/day and for adult women is 1.1 mg/day. However, during pregnancy and lactation, recommendations increase to 1.5 mg/day, .
Ketogenic Diet Sources of Thiamin:
• Salmon: 18% of the RDI 
• Liver: 12% of the RDI 
• Beef: 5% of the RDI [ 18 ]
• Mussels: 20% of RDI [ 19 ]
• Nutritional Yeast: 640% [ 20 ]
• Brewer’s Yeast 80% [ 21 ]
• Pork: 69% of the RDI [ 22 ]
• Trout: 28% of the RDI [ 23 ]
Pantothenic Acid (B5)
Although Pantothenic acid had been isolated in 1931, and its structure determined in 1939, it was not until 1954 when it was discovered that Pantothenic Acid (B5) was an essential B vitamin.
Like the other B-vitamins, pantothenic acid plays a role in the synthesis of fat, hormones, and carbohydrates. Pantothenic acid is also crucial in maintaining a healthy digestive tract and helps the body use other B Vitamin Complex vitamins such as vitamin B2.
Pantothenic Acid Deficiency
Luckily, clinical Pantothenic acid deficiency is extremely uncommon. And although a Pantothenic acid deficiency is not fatal, most systems in the body may be adversely affected. Lack of pantothenic acid is thought to occur more often in conjunction with multiple nutrient deficiencies, as in malnutrition.
Recommended Intake of Pantothenic Acid
The Adequate Intake (AI) recommendation for adults for pantothenic acid is 5 mg per day. Recommendations for pantothenic acid of 6 mg/day and 7 mg/day are suggested for women during pregnancy and lactation, respectively [x].
Increased excretion of the vitamin has been observed in people with Diabetes II, and absorption is likely to be impaired in individuals with inflammatory bowel diseases, and alcoholism, which may warrant increased supplementation.
Absorption may also be impaired in individuals following a ketogenic diet. Thus, supplementation is recommended to avoid B5 deficiency on a ketogenic diet. It is also recommended to source fats and proteins from quality ketogenic diet sources.
Ketogenic Diet Sources of Pantothenic Acid:
• Salmon: 19% of the RDI [ 24 ]
• Liver and Organ Meats: 69% of the RDI [ 25 ]
• Eggs: 7% of RDI [ 26 ]
• Chicken: 10% [ 27 ]
• Turkey: 14% [ x ]
• Trout: 22% of the RDI [ 28 ]
• Sunflower seeds: 20%:[ 29 ]
Folate’s and vitamin B12’s discoveries resulted from the search to cure megaloblastic anemia, a problem in the late 1870s and early 1880s. As with many of the other disease states caused by vitamin deficiencies, eating liver was shown to cure the condition.
Folate vs Folic Acid
The terms folate and folic acid are not interchangeable. Folic acid refers to the oxidized form of the vitamin found in fortified foods and supplements, whereas folate refers to the type of the vitamin found naturally in foods. The term dietary folate is used to represent food folate and folic acid in fortified foods. Total folate encompasses all dietary and supplemental exposure to folate and folic acid.
Recommended Intake of Folate
The recommendations for folate are estimated at 320 mg per day . Recommendations for folate are provided as dietary folate equivalents (DFE), which account for the high bioavailability of folic acid taken as supplements versus the lower bioavailability of folate in foods. The RDA for adults for folate is 400 μg DFE per day, although some studies suggest that increased body size and MTHFR mutations may alter needs [31, 32 ]
Adequate folate levels have been linked to various health benefits, including the prevention Neural Tube Defects [33, 34 ], prevention of stroke , and the prevention of certain cancers, including breast, gut, lung, and pancreas [36, 37, 38, 39 ].
Unfortunately, folate deficiency is one of the most common vitamin deficiencies . Research suggests that most people don’t eat enough naturally folate-rich foods to meet their total folate needs (41).
Low folate is associated with increased cancer risk and neurological disorders [ 42, 43, 44], as well as fatigue, weakness, headaches, irritability, difficulty concentrating, shortness of breath, and heart palpitations .
Improving Folate Bioavailability
Raw foods are typically higher in folate than cooked foods because of folate losses incurred with cooking. Folate is destroyed by heat, oxidation, and exposure to ultraviolet light. It is also reduced by 50% to 80% with food processing and preparation.
Thus, consuming folate-rich foods raw or after cooking them quickly with a little water can help to minimize the loss of folate. Other recommendations to avoid folate deficiency on a ketogenic diet is to supplement with liver capsules.
Ketogenic Diet Sources of Folate:
• Liver: 123% of the RDI 
• Asparagus: 68% of the RDI 
• Okra: 68% of the RDI per cup 
• Spinach: 66% of the RDI 
• Collard greens: 44% of the RDI: 
• Turnip greens: 42% of the RDI 
• Broccoli: 42% of the RDI 
The word “biotin” comes from the ancient Greek word “biotos,” which means “life” or “sustenance.” B vitamins, and specifically biotin, help keep your skin, hair, eyes, liver, and nervous system healthy. Biotin is also a crucial nutrient during pregnancy [ 53 ], as it’s essential for embryonic growth.
Biotin’s discovery was based upon research investigating the cause of what was called egg white injury. Eating raw eggs were known to result in hair loss, dermatitis, and various neuromuscular problems.
Luckily in 1931, Szent-Györgyi found a substance in the liver that could cure and prevent the condition. It was called biotin. Later it was discovered that a glucoprotein called Avidin that is found in raw egg whites, irreversibly binds biotin preventing absorption. This bond has been suggested as the tightest noncovalent bond found in nature.
Recommended Intake of Biotin
While biotin is synthesized by the gut microbiota, intestinally synthesized biotin is not sufficient to maintain normal biotin status . Therefore, humans need to obtain biotin from their diet. Adequate Intakes for biotin are 30 and 35 μg per day are recommended for women during pregnancy and lactation, respectively .
Because some biotin is synthesized by intestinal bacteria and absorbed, biotin deficiency in humans is rare. However, neurological symptoms associated with a biotin deficiency include lethargy, paresthesia in extremities (an abnormal sensation which may feel like pins and needles or numbness), hypotonia (reduced muscle tone), depression, and hallucinations.
Other symptoms include red, scaly dermatitis found around the eyes, nose, and mouth [ 56 ]. Further, anorexia, nausea, alopecia (hair loss), and muscle pain may occur in individuals with biotin deficiency.
Therapeutic doses of up to 10 mg of biotin daily are used to treat a deficiency . Biotin deficiency or poor biotin status may be present in selected populations.
Biotin status has also been shown to decline in those on anticonvulsant drug therapies such as phenobarbital, phenytoin, or carbamazepine [ 58 ].
Improving Biotin Bioavailability
People who eat raw eggs in excess amounts are likely to develop biotin deficiency due to impaired biotin absorption. To improve biotin bioavailability is important to cook your eggs.
Impaired biotin absorption also may occur with gastrointestinal disorders such as inflammatory bowel disease or in chronic consumers of excessive alcohol, which decreases biotin absorption.
Biotin deficiency on a ketogenic diet may also occur in individuals over a prolonged period of time. Thus, biotin supplementation is recommended especially for individuals who adhere to the diet for long periods of time.
Ketogenic Diet Sources of Biotin:
Fat Soluble Vitamins
There are four types of fat-soluble vitamins: Vitamins A, D, E, and K. All of the fat-soluble vitamins have a different function, but each plays a key role in metabolism. Few of the fat-soluble vitamins are actually single substances, and almost all vitamins are the generic name for families of chemically related substances, with similar biological activities.
For example, Vitamin A is the generic descriptor for compounds with the biological activity of retinol. Vitamin D is the generic descriptor for all steroids qualitatively exhibiting qualitatively the biological activity of cholecalciferol.
Vitamin E is the generic descriptor for all tocopherols and tocotrienols. And vitamin K is the generic descriptor for vitamins exhibiting the biological activity of phylloquinone.
While all of the fat-soluble vitamins are essential to human health, Vitamin D and Vitamin E are of particular interest as they are commonly deficient on a ketogenic diet.
Throughout the years, vitamin D (also known as calciferol) has been associated with skeletal growth and strong bones. This association arose because early in the 20th century it was shown that rickets, a childhood disease characterized by improper bone development, could be prevented by a fat-soluble ‘factor D’ in the diet, or by body exposure to ultraviolet light.
What is Vitamin D?
Vitamin D is a secosteroid that can be made in the skin from a cholesterol-like precursor (7-dehydrocholesterol) by exposure to sunlight producing vitamin D3 [x]. It is also closely related to the plant form known as vitamin D2.
From a nutritional perspective, the two forms are metabolized similarly in humans, are equal in potency, and can be considered equivalent.
Vitamin D is required to maintain normal serum calcium and phosphate for bone mineralization, muscle contraction, nerve conduction, and other important cellular functions. This is accomplished by way of enhancing the small intestine’s absorption efficiency for these minerals. [ 61, 62]
For this reason, any alteration in the cutaneous production of vitamin D3, the absorption of vitamin D in the intestine, or the metabolism of vitamin D to its active form can lead to a vitamin D-deficient state.
Vitamin D Deficiency
Unfortunately, Vitamin D deficiency is widespread across the United States and world . And, the lack of vitamin D is linked to several health conditions associated with inadequate mineralization or demineralization of the body’s skeletal structure.
In infants and children, vitamin D deficiency causes rickets, a condition characterized by seizures as well as growth retardation and failure of the bone to mineralize. In adults, vitamin D deficiency causes osteomalacia, a softening of the bones due to defective mineralization or metabolism.
As vitamin D gained wider recognition as being critically important for the prevention of disease, and because vitamin D status is so low and so many foods do not contain it, the United States, Canada, and other countries instituted a policy of fortifying some foods with vitamin D [ 64 ]
Fortified foods include milk, yogurt, cheese, butter, and margarine as well as some orange juice, bread, and breakfast cereals [x ].
Vitamin D Recommendations
RDA recommendations, which assume minimal sun exposure, suggest an intake of 600 IU (15 μg) of vitamin D for children (age 1 year and older), adolescents, and adults including women who are pregnant or lactating.
Recommended intakes increase to 800 IU (20 μg) of vitamin D for adults older than 70 years of age. Requirements are estimated at 400 IU (10 μg) for these age groups . Sufficient amounts of vitamin D are thought to be obtainable by exposure to sunlight for about 5 to 15 minutes between about 10 a.m. and 3 p.m. during spring, summer, and fall .
People at Risk for not getting enough Vitamin D
While exposure to sunlight can maintain adequate vitamin D nutrition for most of the world’s population, older individuals, people with insufficient sun exposure, and those with certain diseases or conditions may be at risk for vitamin D deficiency.
Impaired vitamin D absorption may occur in disorders characterized by fat malabsorption, such as Crohn’s disease, pancreatitis, and liver disease. Disorders affecting the parathyroid, liver, or kidneys impair synthesis of the active form of the vitamin. Individuals on anticonvulsant drug therapy may also develop an impaired response to vitamin D, and exhibit problems with calcium metabolism.
Infants are at risk for vitamin D deficiency due to relatively large vitamin D needs and a high rate of skeletal growth. Further, infants may be at risk for deficiency because human milk is low in vitamin D, and infants’ exposure to sunlight typically is minimal.
The elderly also represent a population that typically has insufficient vitamin D intake and low sunlight exposure. In addition, aging reduces the synthesis of cutaneous vitamin D .
Sources of Vitamin D
Dietary vitamin D, like D3, is provided primarily by a small number of foods of animal origin. Liver, especially from beef (1 μg vitamin D/3 oz) and eggs (1.1 μg/egg) represent good sources of vitamin D3. Also, the vitamin is found in fatty fish (and their oils) including herring (2.4 μg/3 oz), salmon (11 μg/3 oz), tuna (1.7 μg/3 oz), and sardines (4.1 μg/3 oz).
Cheeses (0.1–0.2 μg/oz) and butter (0.2 μg/tablespoon) contain small amounts of vitamin D3. A few foods of plant origin, such as shitake mushrooms (0.5 μg/1⁄2 cups cooked) also provide some vitamin D as D2. Sourcing Vitamin D from plants alone such as the vegan approach may lead to further micronutrient deficiency on a ketogenic diet.
Ketogenic Food Sources of Vitamin D
Cod Liver Oil 340% 
Swordfish, 142% 
Salmon (sockeye)112% 
Tuna, canned in water 39% 
Yogurt 20% 
Sardines, 4 canned 24% 
Liver, beef, cooked, 3 ounces 11% 
Egg yolk, 1 large: 10% 
Cheese, Swiss, 1 ounce: 2% 
Vitamin E is a focal point for two broad topics: biological antioxidants and lipid peroxidation damage. Lipid peroxidation is the oxidative degradation of lipids. It is the process in which free radicals “steal” electrons from the lipids in cell membranes, resulting in cell damage.
The primary role of Vitamin E is as a biological antioxidant and reducing agent that stabilizes polyunsaturated fatty acids (PUFAs) and minimizes lipid peroxidation damage. In reducing free radicals, Vitamin E protects against the potentially harmful effects of ROS, thus maintaining membrane integrity in all cells of the body.
Lipid peroxidation has been identified as a mechanism of cellular deterioration involved in the aging process, in certain phases of atherosclerosis, and other metabolic syndromes involving oxidative stress .
Diseases and deterioration may be slowed by the use of antioxidants like Vitamin E. Due to its molecular structure, Vitamin E is able to donate hydrogen ions quickly and effectively to react with a variety of free radicals before they can cause damage to cell membranes or other cell components. Of the different forms of vitamin E, α-tocopherol is the most effective .
What is Vitamin E
The term vitamin E is again a generic name that describes tocopherols and tocotrienols. ‘Tocopherol,’ is derived from the Greek word ‘tokos’ which means “childbirth,” and ‘phero’ which means “to bear or bring forth.”
This terminology is based upon the vitamin’s discovery in the early 1920s when it was found that rats were unable to reproduce when given a diet of rancid lard, but wheat germ oil provided the agent necessary to reverse their fertility issues. Later, the oil was purified, and the vitamin was extracted and named vitamin E (following the discovery of vitamin D) .
Where is Vitamin E found?
Vitamin E is synthesized by photosynthetic organisms such as plants, algae, and cyanobacteria, where it is thought to function as a protective antioxidant in germination and cold adaptation .
While vitamin E is present in most plants, it is the plant oils that are the most abundant sources. The richest food sources are plant oils are in wheat germ, sunflower, safflower, and red palm oil.
Animal tissues, on the other hand, tend to contain low amounts of Vitamin E. However, this varies in levels based on the diet of the animal. Because vitamin E occurs in fats and oils, reductions in fat intake can also be expected to reduce vitamin E intake and may lead to vitamin E deficiency . Vitamin E from animal fats alone can also lead to a deficiency on a ketogenic diet.
Vitamin E Deficiency
Because Vitamin E plays a fundamental role in the healthy metabolism of cells, Vitamin E deficiency affects many different systems of the body. Unfortunately, most people consume less than the recommended levels— not just people on a ketogenic diet.
Nevertheless, a deficiency of vitamin E in humans is rare. Only a few population groups are at risk for a clinical deficiency, including premature infants, and individuals with fat malabsorption disorders such as cystic fibrosis, and hepatobiliary system disorders.
Some symptoms of vitamin E deficiency are skeletal muscle pain and weakness, anemia, and degenerative neurological problems including peripheral neuropathy, ataxia, loss of vibratory sense, and loss of coordination.
What can lead to reduced Vitamin E absorption?
Vitamin E, like the other fat-soluble vitamins, is susceptible to destruction during food preparation and storage. The processing of some foods also significantly reduces their vitamin E content. For example, the wheat germ is removed in the milling of wheat to make white flour, and thus substantial amounts are lost.
Tocopherols are also oxidized with exposure to air. Furthermore, exposure of the vitamin to light and heat also can lead to increased destruction.
Certain medications and conditions can affect Vitamin E absorption. These include some cholesterol-lowering drugs, antacids, and conditions such as Crohn’s disease, Cystic Fibrosis, liver disease, and low-fat diets.
Recommended Daily Allowance for Vitamin E
The RDA for vitamin E for adult men and women is 15 mg (22.4 IU) of RRR α-tocopherol . While the amount recommended during pregnancy is the same, recommendations during lactation are slightly higher, with an RDA of 19 mg (28.4 IU) of α-tocopherol for women .
However, as with the other recommendations for vitamins and minerals, the amount of Vitamin E is minimal. Recommendations are a reflection of the bare minimum that an individual would need to avoid deficiency, but more and more evidence suggests that it is far from the real amount you need to reach optimal health.
Unlike other vitamins, vitamin E is not only nontoxic, but it also appears to be beneficial at dose levels that are significantly greater than those required to prevent clinical signs of deficiency.
Most notably, supra-nutritional levels of Vitamin E have been useful in reducing the oxidation of low-density lipoproteins (LDLs) and, thus, reducing the risk of atherosclerosis . The ketogenic diet is known to significantly increase cholesterol [x]. Thus, supplementation is strongly recommended to avoid Vitamin E deficiency on a ketogenic diet.
Ketogenic Diet Foods High in Vitamin E
Wheat germ oil: 100% 
Dry roasted sunflower seeds: 37% 
Dry roasted almonds: 34% 
Sunflower oil: 28% 
Safflower oil: 25% 
Hazelnuts 22: 
Peanut Butter: 15% 
Spinach, boiled: 10% 
Broccoli: 6% 
Despite the fact that minerals only constitute only about 4% of total body weight, their importance in health and nutrition cannot be overstated. Minerals provide the essential medium for normal cellular activity, determine the osmotic properties of body fluids, impart hardness to bones and teeth, and function as essential cofactors in enzymes. Major minerals, also called macrominerals, are distinguished from the trace minerals, also called microminerals, by their abundance in the body.
Major minerals include:
The major minerals are typically required by adults in amounts greater than 100 mg per day. However, the trace elements are required by adults in amounts between about 1 mg and 100 mg per day.
The major minerals of the human body include calcium, phosphorus, magnesium, sodium, potassium, and chloride. Because of the role of minerals in maintaining electrolyte balance in body fluids, mineral deficiency on a ketogenic diet can be dangerous.
While all major minerals deserve an amount of focus, the following major minerals will be discussed: calcium, magnesium, manganese, potassium, sodium.
Calcium is the most abundant divalent cation in the body, representing about 40% of the body’s mineral mass and 1.5% to 2% of total body weight, or between ∼1,000 and 1,400 grams in the human body. Roughly 99% of the total body calcium is in the skeleton, while the other 1% remains in soft tissues and extracellular fluids [x].
Calcium provides the structural component of bones and teeth; a role in cellular processes, muscle contraction, blood clotting, and enzyme activation. Thus, clinical features of calcium deficiency are a function of severity. Severity includes the rate of decrease in serum calcium and the presence or absence of other electrolyte imbalances such as magnesium or potassium deficiency.
Clinical symptoms of calcium deficiencies are typically neuromuscular and cardiovascular in nature. These manifestations include tetany, rickets, osteomalacia, and osteoporosis suggest calcium deficiency.
Calcium deficiency causes an increases neuronal excitability and may present clinically as paresthesia, tetany, laryngospasm, bronchospasm, and muscle cramps. It can also cause changes in mental status, resulting in stupor and seizure. And prolonged deficiency can result in calcifications of the central nervous system, as well as papilledema.
Some signs and symptoms, such as irritability and weakness are nonspecific.
Calcium is also critical for both myocardial contractions as well as electrical conduction. Thus, calcium deficiencies can also result in arrhythmias, bradycardia, congestive heart failure, and hypotension [x]. Other symptoms of calcium deficiency include cataract, coarse, brittle hair, and dry skin .
Causes of Calcium Deficiency
Hypoparathyroidism, autoimmune diseases, hypomagnesemia (magnesium deficiency), vitamin D deficiency, low dietary sources of calcium, malabsorption, liver disease, acute pancreatitis, sepsis, and some anticonvulsant drugs .
Recommended daily intake of Calcium
Recommendations for dietary calcium are primarily based on data derived from the developed world and are not necessarily applicable to countries with different dietary cultures, different lifestyles, and different environments for which different calculations are indicated. However, most recommendations range between 1,000mg for individuals aged 19-50 years of age .
Improving Bioavailability of Calcium
For whole food sources of calcium, content is of equal or greater importance than bioavailability. The efficiency of calcium absorption varies across foods as calcium may be poorly absorbed from foods rich in oxalic acid.
This includes even ketogenic sources, such as spinach, seeds, and nuts. Further, high sodium diets may also cause calcium excretion . To avoid calcium deficiency on a ketogenic diet, consuming animal-based sources that are low in oxalates is ideal.
Ketogenic Diet Sources of Calcium
Sardines, clams, oysters, turnip and mustard greens, and broccoli