Is ketosis have side effects?

Some people think that ketosis is extremely dangerous.

However, they might be confusing ketosis with ketoacidosis, which is completely different.

While ketoacidosis is a serious condition caused by uncontrolled diabetes, ketosis is a natural metabolic state.

In fact, ketosis and ketogenic diets have been studied extensively and shown to have major benefits for weight loss (1Trusted Source, 2Trusted Source).

Ketogenic diets have also been shown to have therapeutic effects in epilepsy, type 2 diabetes and several other chronic conditions (3Trusted Source, 4Trusted Source, 5Trusted Source, 6Trusted Source).

Ketosis is generally considered to be safe for most people. However, it may lead to a few side effects, especially in the beginning.

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An Overview of Ketosis

First, it's necessary to understand what ketosis is.
Ketosis is a natural part of metabolism. It happens either when carbohydrate intake is very low (such as on a ketogenic diet), or when you haven't eaten for a long time.

Both of these lead to reduced insulin levels, which causes a lot of fat to be released from your fat cells. When this happens, the liver gets flooded with fat, which turns a large part of it into ketones.

During ketosis, many parts of your body are burning ketones for energy instead of carbs. This includes a large part of the brain.
However, this doesn't happen instantly. It takes your body and brain some time to "adapt" to burning fat and ketones instead of carbs.
During this adaptation phase, you may experience some temporary side effects. These are generally referred to as the "low-carb flu" or "keto flu."

Bottom Line: In ketosis, parts of the body and brain use ketones for fuel instead of carbs. It can take some time for your body to adapt to this.

The Low-Carb/Keto Flu

In the beginning of ketosis, you may experience a range of negative symptoms.

They are often referred to as "low-carb flu" or "keto flu" because they resemble symptoms of the flu.

These may include:
• Headache.
• Fatigue.
• Brain fog.
• Increased hunger.
• Poor sleep.
• Nausea.
• Decreased physical performance (7Trusted Source).
These issues may discourage people from continuing to follow a ketogenic diet, even before they start reaping all the benefits.

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However, the "low-carb flu" is usually over within a few days.
Bottom Line: The "low-carb flu" or "keto flu" is a set of symptoms that can occur in the initial stages of ketosis. While it may cause some people to discontinue the diet, it's usually over in a short amount of time.

Bad Breath Is Also Common

One of the more common side effects of ketosis is bad breath, often described as fruity and slightly sweet.

It's caused by acetone, a ketone that is a byproduct of fat metabolism.
Blood acetone levels are elevated in ketosis, and your body gets rid of some of it via your breath (8Trusted Source).

Occasionally, sweat and urine can also start to smell like acetone.
Acetone has a distinctive smell — it's the chemical that gives nail polish remover its pungent odor.

For most people, this unusual-smelling breath will go away within a few weeks.

Bottom Line: In ketosis, your breath, sweat and urine may smell like acetone. This ketone is produced by the liver from fat and increases on a ketogenic diet.

Leg Muscles May Cramp

In ketosis, some people may experience leg cramps. Although they're usually a minor problem, they're never pleasant and can be painful.
Leg cramps in ketosis are usually connected to dehydration and loss of minerals. This is because ketosis causes a reduction in water weight.
Glycogen, the storage form of glucose in muscles and liver, binds water.
This gets flushed out when you reduce carb intake, and is one of the main reasons why people lose weight rapidly in the first week of a very low-carb diet.

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That being said, there are many other potential causes of muscle cramps.

Bottom Line: Some people may experience muscle cramps in ketosis. Loss of water and minerals increases your risk of leg cramps.
Ketosis May Cause Digestive Problems
Dietary changes can sometimes lead to digestive issues.
This is also true for ketogenic diets, and constipation is a common side effect in the beginning (9Trusted Source).

This is most commonly due to not eating enough fiber and not drinking enough fluids.

Some people may also get diarrhea, but it's less common.

If you made drastic changes to your diet in order to get into ketosis, it's more likely that you'll experience digestive symptoms.

Nevertheless, digestive issues are usually over within a few weeks.
Other Side Effects of Ketosis

Other, less common side effects may include:
• Ketoacidosis: A few cases of ketoacidosis (a serious condition that occurs in uncontrolled diabetes) have been reported in breastfeeding women, likely triggered by a very low-carb diet. However, this is extremely rare (10Trusted Source, 11Trusted Source, 12Trusted Source).
• Kidney stones: Although uncommon, some epileptic children have developed kidney stones on a ketogenic diet (9Trusted Source, 13Trusted Source, 14Trusted Source, 15Trusted Source).
• Raised cholesterol levels: Some people get increased total and low-density lipoprotein (LDL) cholesterol levels (16Trusted Source, 17Trusted Source, 18Trusted Source).
Bottom Line: Less common side effects include issues for breastfeeding women, kidney stones in epileptic children and raised cholesterol levels.

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How to Minimize Potential Side Effects
Here's how to minimize the potential side effects of ketosis:
• Drink plenty of water: Make sure to drink at least 68 oz (2 liters) of water a day. A significant amount of water weight is lost in ketosis, especially in the beginning.
• Get enough salt: Sodium, a crucial electrolyte, gets excreted in large amounts when carb intake is reduced. Replenish your salt by adding it to foods or drinking broth.
• Increase mineral intake: Foods high in magnesium and potassium may help relieve leg cramps.
• Avoid intense exercise: Don't push yourself too hard while you're adapting to ketosis. Stick to moderate levels of exercise in the first week or two.
• Try a low-carb diet first: To ease the transition, it might help to reduce your carbs to a moderate amount before trying a ketogenic (very low-carb) diet.
• Eat fiber: A low-carb diet is not no-carb. Eat fiber-rich foods like nuts, seeds, berries and low-carb veggies.

What is keto and what to eat on keto diet?

The “keto” in a ketogenic diet comes from the fact that it allows the body to produce small fuel molecules called “ketones”.

This is an alternative fuel source for the body, used when blood sugar (glucose) is in short supply.

Ketones are produced if you eat very few carbs (that are quickly broken down into blood sugar) and only moderate amounts of protein (excess protein can also be converted to blood sugar).

The liver produces ketones from fat. These ketones then serve as a fuel source throughout the body, especially for the brain.

The brain is a hungry organ that consumes lots of energy every day, and it can’t run on fat directly. It can only run on glucose… or ketones.
On a ketogenic diet, your entire body switches its fuel supply to run mostly on fat, burning fat 24-7. When insulin levels become very low, fat burning can increase dramatically. It becomes easier to access your fat stores to burn them off.

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This is great if you’re trying to lose weight, but there are also other less obvious benefits, such as less hunger and a steady supply of energy. This may help keep you alert and focused.

When the body produces ketones, it enters a metabolic state called ketosis. The fastest way to get there is by fasting – not eating anything – but nobody can fast forever.

A keto diet, on the other hand, can be eaten indefinitely and also results in ketosis. It has many of the benefits of fasting – including weight loss – without having to fast.

Who should NOT do a ketogenic diet?

There are controversies and myths about a keto diet, but for most people it appears to be very safe.

There are, however, three groups that often require special consideration:
• Do you take medication for diabetes, e.g. insulin? More
• Do you take medication for high blood pressure? More
• Do you breastfeed? More
Are you a doctor or do you need your doctor to help you with medications on a keto diet? Have a look at our low carb for doctors guide.

2. What to eat on a keto diet

Here are typical foods to enjoy on a ketogenic diet. The numbers are net carbs, i.e. digestible carbs, per 100 grams.

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To remain in ketosis, lower is generally better:
The most important thing for reaching ketosis is to avoid eating too many carbs. You’ll probably need to keep carb intake under 50 grams per day of net carbs, ideally below 20 grams. The fewer carbs, the more effective it appears to be for reaching ketosis, losing weight or reversing type 2 diabetes.

Counting carbs can be helpful at first. But if you stick to our recommended foods and recipes you can stay keto even without counting.

Detailed list of what to eat on a keto diet

 Try to avoid

Here’s what you should avoid on a keto diet – carb foods containing a lot of sugar and starch. This includes starchy foods like bread, pasta, rice and potatoes. These foods are very high in carbs.

The numbers are grams of net carbs per 100 grams, unless otherwise noted.

This means that on a keto diet you’ll basically need to avoid sugary foods completely, as well as starchy foods like bread, pasta, rice and potatoes. Also avoid processed foods, and instead follow our keto diet advice.

Furthermore, the food should primarily be high in fat, and only moderately high in protein, as excess protein can be converted to blood sugar in the body. Avoid low-fat diet products. A rough guideline is about 5% energy from carbohydrates (the fewer carbs, the more effective), 15-25% from protein, and around 75% from fat.
More specific advice on what to eat – and what not to eat


What to drink

So what do you drink on a ketogenic diet? Water is the perfect drink, and coffee or tea are fine too. Ideally, use no sweeteners, especially not sugar.

A small amount of milk or cream in your coffee or tea is OK (but beware of caffe latte!). The occasional glass of wine is fine too.
The benefits of a ketogenic diet are similar to those of other low-carb and high-fat diets, but it appears to be more powerful than liberal low-carb diets.

Think of keto as a super-charged low-carb diet, maximizing the benefits. However, it can also be harder to do, and it may increase the risk of side effects a bit.

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Lose weight

Turning your body into a fat-burning machine can be beneficial for weight loss. Fat burning is significantly increased, while insulin – the fat-storing hormone – levels drop greatly.

This appears to make it far easier for body fat loss to occur, without hunger.

More than 30 high-quality scientific studies show that, compared to other diets, low-carb and keto diets result in more effective weight loss.
• How to lose weight – the full guide
• Why low carb can help you lose weight
• How to lose weight with a low-carb diet
• Top 10 weight-loss tips for women 40+
• Keto diet results: 250+ stories

Appetite control

On a keto diet you’re likely to gain a new control over your appetite. When your body burns fat 24-7, it has constant access to weeks or months of stored energy, significantly reducing feelings of hunger. It’s a very common experience, and studies prove it.

This makes it easy to eat less and lose excess weight – just wait until you’re hungry before you eat.

It also makes intermittent fasting easier, something that can super-charge efforts to reverse type 2 diabetes and speed up weight loss, beyond the effect of keto only.

Plus, you’ll save tons of time and money by not having to snack all the time. Many people only feel the need to eat twice a day on a keto diet (often skipping breakfast), and some just once a day.

Not having to fight feelings of hunger could also potentially help with problems like sugar or food addiction.

At least feeling satisfied can be part of the solution. Food can stop being an enemy and become your friend – or simply fuel, whatever you prefer.

Control blood sugar and reverse type 2 diabetes

Studies prove that a ketogenic diet is excellent for managing type 2 diabetes, sometimes even leading to complete reversal of the disease.
It makes perfect sense since keto lowers blood-sugar levels, reduces the need for medications and reduces the potentially negative impact of high insulin levels.

As a keto diet may reverse existing type 2 diabetes, it’s likely to be effective at preventing it as well as reversing pre-diabetes.

Improved health markers

There are many studies showing that low-carb diets improve several important risk factors for heart disease, including the cholesterol profile (HDL, triglycerides), while total and LDL cholesterol levels are usually impacted fairly modestly.

It’s also typical to see improved blood sugar levels, insulin levels and blood pressure.

These commonly improved markers are connected to something called “metabolic syndrome”, and improvements in weight, waist circumference, diabetes type 2 reversal etc.

My health markers after 10 years on a keto diet

Energy and mental performance

Some people use ketogenic diets specifically for increased mental performance. Also, it’s common for people to experience an increase in energy when in ketosis.

On keto, the brain doesn’t need dietary carbs. It’s fueled 24-7 by ketones, an effective brain fuel.

Therefore, ketosis results in a steady flow of fuel (ketones) to the brain, thus avoiding problems experienced with big blood sugar swings.
This may sometimes result in improved focus and concentration, and resolution of brain fog, with an improved mental clarity.

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A calmer stomach

A keto diet can result in a calmer stomach, less gas, less cramps and pains, often resulting in improvements in IBS symptoms.

For some people this is the top benefit, and it often only takes a day or two to experience it.

Increased physical endurance

Ketogenic diets can in theory increase your physical endurance by improving your access to the vast amounts of energy in your fat stores.
The body’s supply of stored carbohydrates (glycogen) only lasts for a couple of hours of intense exercise, or less. But your fat stores carry enough energy to potentially last for weeks.

Beyond this effect, another potential benefit is the reduction in body fat percentage that can be achieved on a keto diet (see weight loss, above). This reduction in body fat weight is potentially valuable in a number of competitive sports, including endurance sports.

Epilepsy

The ketogenic diet is a proven and often effective medical therapy for epilepsy that has been used since the 1920s. Traditionally it was used primarily for children, but in recent years adults have benefited from it as well.

Using a ketogenic diet in epilepsy can allow some people to take less or no anti-epileptic drugs, while potentially still remaining seizure-free. This may reduce drug side effects and thus increase mental performance.