"While a ketogenic diet has been shown to decrease appetite while burning fat and maintaining muscle, it is not without risk," said Holly Pudwill, President and Clinical Dietitian at Balanced Nutrition of Jacksonville. "Ketones are a by-product of ketosis. If those build up, a condition called ketoacidosis can result." When this condition occurs, the buildup of ketones in the blood makes it too acidic and causes dehydration. In very extreme cases, this dehydration can lead to coma or death.