Extensive bruising and bleeding on a ketogenic diet. N=1 and a 2001 study.

Factoid - a brief information of some interest.Factoid – a brief information of some interest.

This study is about a Factoid. I did not have the time to research the subject enough. Tentatively, one of the possible causes of bruising and bleeding on a ketogenic diet may be the abnormal mineral metabolism characteristic for ketosis. This is something that needs to be investigated further.

Below, there is a comment from the website of Ben Greenfield. The comment was written below an interview with Mark Sisson. Please note that Mark Sisson does NOT understand the physiology of ketosis. Mark Sisson’s writings and talks on ketosis should not be used as guidance.

November 14, 2018 at 4:35 pm

I’ve listened to every Keto podcast (and most of the other ones) and have not run across this issue. I just completed a 28 day ketogenic diet run and it went well. Energy levels high, and lost a couple of pounds of body fat. On the 26th day I competed in a Judo tournament and the next day I had some really terrible bruising. Up until this point it was pretty much impossible to bruise me. I have practiced Jiu-Jitsu for over a decade and combat sports my entire life. Have you heard of sudden and extensive bruising from a keto diet? Do you have any suggestions? Supplements, etc.This is the only study I was able to find referencing this issue. https://www.ncbi.nlm.nih.gov/pubmed/11198302

Love the show and your work!

Daniel Wise

Poplarville, Mississippi

The abstract of the article mentioned in the comment is below. The researchers do not mention in the abstract that they investigated mineral balance and metabolism as a possible cause of bleeding on ketogenic diet.

Bruising and the ketogenic diet: evidence for diet-induced changes in platelet function.
Berry-Kravis E1, Booth G, Taylor A, Valentino LA.
Author information
Excessive bruising is a symptom noted by parents of some children treated with the ketogenic diet for epilepsy control, although this side effect is not reported in the literature. We evaluated our cohort of current and past diet-treated patients for symptoms of bruising or bleeding through chart review and prospective screening at clinic follow-up visits. A significant increase in bruising or other minor bleeding was reported and/or observed in 16 of 51 patients (31.4%). There were no differences in sex distribution or number of anticonvulsants used between patients with bruising/bleeding and those without this symptom, although the group with bruising/bleeding was significantly younger. No specific anticonvulsant was associated with bruising/bleeding. Six patients with diet-induced bruising/bleeding underwent an investigation for bleeding diathesis. Five of these patients had prolonged bleeding times and all had diminished responsiveness to various platelet aggregating agents, with no evidence of a release defect. The abnormalities all normalized in the 1 patient tested after ceasing the diet. No patients had serious hemorrhage. One patient had mild von Willebrand disease, which had been asymptomatic before diet initiation. Some patients were Stimate responsive, suggesting a treatment for more severe bouts of symptoms. These data suggest that a ketogenic diet-related bleeding tendency occurs in about one third of treated patients owing to preexisting factors defining susceptibility in combination with diet-induced depression of platelet responsiveness, possibly related to changes in platelet membrane lipid composition and/or concentration and resultant effects on function of membrane-embedded proteins. Patients on the diet undergoing anticoagulation or surgery should be evaluated carefully for symptoms of bleeding tendency.


1. Berry-Kravis et al., Ann Neurol. 2001 Jan;49(1):98-103.

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