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Progression of fasting increases the conversion of leucine to ketone bodies and peripheral tissue is catabolised to provide leucine for ketogenesis (Kulaylat et al., 1988). There appears to be a high affinity of kidney cells for ketogenesis from leucine (Noda & Ichihara, 1976). Adverse effects resulting from a VLCKD are likely to reduce compliance and tolerability (Vining et al., 1998), and thus affect the efficacy of these diets as clinical interventions. For example, a Google search returns over 22,000 results for the term “keto-flu,” but the same term searched in MEDLINE Complete, CINAHL Complete, Alt HealthWatch, Food Science Source, SPORT Discus with Full Text, Psychology, and the EBSCO Behavioural Sciences Collection returns no results. These symptoms are often referred to in the mainstream and grey literature as ‘keto-flu’ but are not well illustrated in the scientific literature. 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