Top 4 Mistakes When Going Keto
What You Need to Know if You’re Considering Keto
The ketogenic diet, referred to as keto, is a diet consisting of low carbohydrates, moderate protein, and high fat. The diet is considered ketogenic when the body starts producing moderate amounts of ketones. Ketones are the metabolite, or breakdown product, of fat. When fat from food or your body’s stores gets burned for the majority of the body’s calorie usage, ketones are produced as the fuel. These ketones can then be measured in the blood or urine to confirm that you are indeed in ketosis.
This diet is very popular right now. A big reason for this is that it leads to rapid weight loss. When your body burns through it’s stores of carbohydrates in the first week on the diet, it releases pounds of stored water, too. It’s also popular because you can eat cheese, steak, bacon, and all sorts of keto treats on it.
Scientifically, it’s been shown to do some pretty cool things, such as decrease seizures and other neurological disorders (1), promote health in cancer patients (2), reverse diabetes and obesity (3), and improve PCOS (4).
However, it is also slightly stressful to your body to be in a state of ketosis. The keto diet can affect hormones, gut health, sleep, energy, and more. If you’re wanting to experiment, or already following a keto diet, here are the top 4 mistakes to avoid:
Mistake 1: Not Considering Health Conditions
Not everyone is a good candidate for a keto diet. In one way, ketosis makes your body think you’re fasting, since you’re not storing carbohydrates. A fasting-like state can be problematic for some. For example, women who are pregnant or breast-feeding might want to wait. Athletes or serious exercisers who do short bursts of high-powered moves may see a decrease in performance. Anyone on insulin must be well-trained to adjust their dosing.
Those who are already very stressed and have less ability to handle stress will also likely feel worse on keto. I’ve seen patients struggle with sleep and quickly plateau in their weight loss if they fall into this category.
In addition, carbohydrates help to improve the conversion of inactive thyroid hormone T4 to active thyroid hormone T3. Those who are already struggling with low thyroid levels can see their condition worsen (5). It’s best to correct hypothyroidism first, and if you still want to try keto, get your thyroid checked a month or two into it.
Finally, those with gallbladder issues have to be careful. If you’re struggling with gallstones or sludge, or still have irregular bowel movements after having your gallbladder removed, you’ll want to correct that first. Also, if you’ve had your gallbladder out and you notice looser stools once going keto, you should speak with a functional medicine practitioner such as myself to help modify the diet and support your body.
Mistake 2: Not Preparing Your Body
If you’re eating sugary foods or drinks every day, and then suddenly deprive your body of most carbs, you should definitely expect some unpleasant withdrawal symptoms. The better option for most people is to ease into it. If someone has a very poor diet, it’s usually better to cut out the junk food for a week (you know what you’re eating that’s not good for you!) and stick with whole foods. Then in the first week that a person goes keto, if any symptoms of low blood sugar or withdrawal arise, whole fruit can be an easy and effective way to feel better. I usually start my patients on two servings of specific types of fruit per day, and only cut back more if they’re not producing sufficient ketones.
In addition, you lose electrolytes as your body releases the water that was stored with the carbohydrates (called glycogen) on your body. Magnesium, sodium, potassium, and/or calcium deficiency can give you headaches, muscle cramps, fatigue, and brain fog. To increase these minerals, some may benefit from adding a little more sea salt than usual to most meals. I also recommend a high-potassium electrolyte powder to my patients.
Mistake 3: Not Eating the Right Foods
Believe it or not, but a diet doesn’t automatically become healthy just because it’s low-carb! In addition to considering the macronutrients (carbs, fat, and protein), we should also consider the micronutrients (vitamins, minerals, antioxidants).
One way to struggle on a keto diet is to eat too much protein and not enough fat. It’s common for people to cut out the carbs, but forget to really increase the fat. This just stresses the body out more, and can cause muscle loss. Furthermore, if the protein is too high, the body can convert it to glucose and therefore dampen ketosis. All three need to be in the right ratio, which is different for each person’s unique body and lifestyle. This is a benefit of seeing a practitioner: you can learn how to customize guidelines to your specific situation and have more success, easier.
Another way to struggle is through making yourself more inflamed. You will not lose weight or feel healthy if you’re inflamed. The stereotypical foods of a keto diet are cheese, cream, processed meats, and a lot of almond meal creations (think pizza, bread, cookies, pancakes, etc). Not only can the calories easily become excessive, but also these foods may have a negative impact on health.
Dairy and pork are common food sensitivities. This means your immune system may react against them when you eat them, causing inflammation. Processed meats such as bacon and sausage may contain carcinogenic compounds, and produce toxic by-products in the intestines (6). Fat from poultry, pork, and conventional beef is high in a pro-inflammatory omega-6 fat called arachidonic acid. I test these levels in patients and almost always see it excessively high in those who eat out often (several times a week or more) or who follow a low carb diet. Therefore, focusing more on plant-based fats, avoiding dairy, eating lean meats, and sourcing 100% grass-fed beef may reduce the inflammatory potential of a keto diet.
Mistake 4: Staying on Keto For Too Long
By definition, keto is not a well-balanced diet because it limits entire food groups permanently. Therefore, supplementation is used in medical studies when keeping participants on keto long-term. Nutrients like magnesium and potassium are harder to get. Fiber tends to be on the lower side, which also means a lack of food for probiotic bacteria in your gut. The smaller quantities of prebiotics and resistant starch inherent in a ketogenic diet is one of my biggest hesitations in using it. This is why the version I wrote for my patients is heavily plant-based, to give their guts the best chances of being nourished without eating many carbs. A low-carb diet leads to a change in the living organisms in the gut, called the microbiome. This change might allow greater absorption of toxins from bacteria and a shift toward a more pro-inflammatory state.
In addition, a lack of carbs sends a signal to the brain that there’s a mild fasting state. This decreases thyroid and increases the stress hormone cortisol, which may not be a positive thing long-term.
Therefore, I recommend that after someone has become efficient at making ketones, they start to cycle in carbohydrates. This allows the body to still reap the benefits of ketosis for at least half of the week, but also reap the benefits of feeding the microbiome and not being a burden to the hormonal system. It also has the nice little benefit of making the keto follower more satisfied by their greater variety of food choices.
Before considering the keto diet, make sure you consult with a nutritionist if you have pre-existing conditions or troublesome symptoms. Once you’ve decided to try it, consider preparing your body with a healthy diet and electrolytes. Ask your nutritionist for a more plant-based version that has an anti-inflammatory focus, not just low carbs. And consider working your way towards a more balanced diet as you get healthier.
If you’ve followed a keto diet before, I’d love to hear your experience in the comments below!
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1. The Expanding Role of Ketogenic Diets in Adult Neurological Disorders. 2018.
2. Rationale, Feasibility and Acceptability of Ketogenic Diet for Cancer Treatment. 2017.
3. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. 2013.
4. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. 2005.
5. Changes of thyroid hormonal status in patients receiving ketogenic diet due to intractable epilepsy. 2017.
6. Processed meat: the real villain? 2016.