9. Should I Be Concerned About the Keto Flu?
If you’re interested in the keto diet, you have probably read about the keto flu, one not-so-fun side effect.
“The keto flu is definitely real,” says Keatley. “Your body functions really well on carbohydrates — that’s what it was designed for. When it switches to fat burning, it becomes less efficient at making energy,” he says.
On keto, you have less energy available, and you may feel sick and sluggish, as if you have the flu. It’s not a fever or a flu virus, though – the side effects are simply similar to those of the flu, often including fatigue and headache. As your body naturally adjusts to this new way of drawing energy, you will come out of it. This may take a couple of weeks, says Keatley.
10. Will the Keto Diet Give Me Kidney Stones?
“Consuming high levels of red meat and not drinking a lot of water may make stones more likely,” says Whitmire.
She adds that on a keto diet, you need to stay hydrated and replenish electrolytes (minerals like sodium, potassium, magnesium, and calcium). “If not, this can increase your risk of side effects like stones,” she says.
The researchers found that the overall incidence of kidney stones in people on the keto diet is 5.9 percent, compared with an incidence of 0.3 percent in males and 0.25 percent in females among the general population.
This doesn’t mean that you’ll definitely get kidney stones on keto. But if you have risk factors for kidney stones, like a family or personal history of stones, talk to your doctor about any precautions you should take when on the keto diet.
11. How Might the Keto Diet Affect My Period?
At the other end of the spectrum, limited evidence has found that for women with polyendocrine metabolic ovarian syndrome (PMOS), a ketogenic diet may improve their hormonal balance.
Again, talk to your doctor before starting, especially if you’re using the diet as part of your treatment.
12. How Long Do You Need to Stay on the Keto Diet to Lose Weight?
Anecdotally, many people report losing weight quickly on a keto diet, says Keatley. A study of pooled data found that dieters with obesity lost an average of 16.5 lbs after one month, 33.2 lbs over two months, and 36.9 lbs when checking in between four and six months following a very low-calorie keto diet. As with many other studies, this looked at combining ketosis with a very low calorie intake that would normally not be healthy to maintain.
Keatley suggests to clients that they spend no more than 12 weeks in ketosis because of the uncertainties of following it long term and the risk of developing nutritional deficiencies.
When people stop a keto diet and begin to incorporate more carbs into their day, they tend to regain some weight during the adjustment period, he says. They also stand to regain all the weight they lost if they return to their pre-keto eating patterns after feeling deprived while on the plan.
13. How Will the Keto Diet Affect Your Cholesterol Levels?
The interesting thing about a keto diet is that it often leads to weight loss, something that by itself can improve blood lipid levels. At the same time, you may be consuming more saturated fat than ever, in the form of butter, bacon, cream, and coconut oil.
Research has shown that some types of ketone bodies can protect the heart by improving blood vessel function, boosting nitric oxide (a compound that keeps arteries relaxed), and lowering inflammation.
However, the keto diet carries some heart health risks. Sticking to a keto diet long term can cause overall cholesterol imbalances, potential nutrient deficiencies, and increased strain on the kidneys. Individual responses vary and can include stiffer arteries in some people. So for people who already have an increased risk of heart disease, consulting a doctor before starting a keto diet (and being regularly monitored while you’re on it) remains crucial.
14. How Much Protein Will You Eat on the Keto Diet?
A typical keto diet may include 20 to 25 percent of calories coming from protein, says Keene. One common misconception is that this is a high-protein diet, when in reality it’s moderate in protein. “Too much protein can be converted and broken down as sugar to be used as an energy source,” she says. That will kick the body out of ketosis.
That said, you don’t want to go too low in protein. “You want to be able to stay in ketosis without sacrificing lean body mass (muscle) if you lose weight,” says Whitmire. This can loosely equate to 1.2 to 1.5 g of protein per kilogram of body weight. (The recommended dietary allowance is currently 0.8 g per kilogram of body weight.)
Therefore, a 140-pound woman may aim for 76 to 95 g per day. For reference, 3 oz of chicken breast offers 26 g of protein.
While a keto diet may focus on fat, that doesn’t mean you have to eat bacon and sausage all day. There is room for leaner proteins like chicken and cod. Just remember to add fat (for example, roast the chicken with olive oil) to these lower-in-fat sources, she says.
Many cuts of beef are also considered lean (less than 4.5 g saturated fat in 3.5 oz) or extra lean (less than 2 g saturated fat per 3.5 oz) when they contain 10 g or less total fat. These include eye of round roast and steak, sirloin tip side steak, top round roast and steak, bottom round roast and steak, and top sirloin steak.
15. Can the Keto Diet Reverse Type 2 Diabetes?
“Though this isn’t the first tool I’d use to help someone control their insulin — carb counting, evenly distributing carbs throughout the day, may be easier to commit to — it’s not off the table, especially with stronger emerging research,” says Keene. The keto diet may, in the short term, help people with type 2 diabetes lose weight, manage blood glucose, and reduce their dependence on medications. But looking at the bigger picture, it’s not quite so simple.
Research found that in the short term, the diet eased the workload of insulin-producing cells in the pancreas, helping to lower blood sugar levels. This was largely due to the initial weight loss. However, in another study, while up to 62 percent of participants achieved diabetes remission in their first year on a low-carb plan, staying on track long term can be tough. Remission rates dropped to just 13 percent by the fifth year as people stopped keeping up with the strict low-carb diet’s requirements.
For people with unmanaged type 1 diabetes (and, less often, type 2), entering ketosis increases the rare but possible risk of a life-threatening condition called diabetic ketoacidosis. Talk with your doctor to understand the risk and benefits of starting a restrictive eating pattern like keto if you have diabetes.
Be sure to work with your doctor if you have type 2 diabetes, and manage your expectations. Your diabetes team will be able to work with you on an approach to eating that yields long-term results. Also, bear in mind that type 2 diabetes cannot be reversed, but it can be put into remission.
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