Keto's Impact: Uncovering The Cause And Effect Of Ketosis

The keto diet is a low-carb, high-fat diet that has been associated with several health benefits, including weight loss, improved neurological conditions, and reduced risk of chronic illnesses. However, it is not without its drawbacks. The keto diet can lead to side effects such as keto breath, constipation, nutrient deficiencies, and even more serious complications like kidney stones and liver problems. As with any dietary change, it is important to consult a healthcare professional before starting the keto diet to ensure it is safe and appropriate for your individual needs.

Dehydration and kidney stones

The keto diet can cause dehydration and kidney stones. Dehydration is a common symptom of the "keto flu", which is a result of your body adjusting to using ketones and fats as its primary energy source. This can lead to flu-like symptoms such as headaches, dizziness, fatigue, nausea, and constipation. It is important to monitor these symptoms, stay hydrated, and eat foods rich in sodium, potassium, and other electrolytes.

The keto diet may also increase the risk of kidney stones, especially in those with a history of kidney stones or who are susceptible to forming them. Kidney stones are hard deposits of mineral salts that can cause severe pain and may require treatment with drugs, sonic waves, or even surgery. The majority of kidney stones are made of calcium oxalate or calcium phosphate, while a smaller percentage are formed by uric acid and struvite.

There are several factors that may increase the risk of kidney stones while on the keto diet:

• Not drinking enough water: Transitioning to a low-carb diet can lead to water loss in body tissues, and dehydration concentrates the urine and the minerals that form kidney stones.
• Consuming too many high-oxalate foods: Spinach, avocados, raspberries, turnips, tomatoes, and other high-oxalate foods can increase calcium oxalate stone formation by increasing the amount of oxalate in the blood.
• Not having enough dietary calcium: Consuming too little calcium can increase oxalate absorption, promoting calcium oxalate stone formation.
• Supplementing with high-dose vitamin C: Consuming large amounts of vitamin C supplements may increase urine oxalate concentrations and promote the formation of calcium oxalate stones.
• Magnesium deficiency: While no studies have proven this, some suggest that magnesium supplementation may prevent stone formation.
• High protein intake: A high-protein diet may increase uric acid excretion, potentially increasing uric acid stone formation, especially in those with a history of gout or a previous uric acid kidney stone. However, increased uric acid excretion may be associated with a lower risk of calcium oxalate stone formation.

If you have a history of kidney stones or are susceptible to forming them, it is important to minimize your risk by staying hydrated, limiting high-oxalate foods, ensuring adequate dietary calcium, avoiding high-dose vitamin C supplements, and monitoring your protein intake. Regular urinary studies and renal ultrasonography are recommended to detect the development of kidney stones.

Nutrient deficiencies

The keto diet is a low-carb, high-fat, moderate-protein diet that can lead to weight loss, increased energy, and the treatment of chronic illnesses. However, it can also cause nutrient deficiencies.

The keto diet restricts carbohydrates, which are found in whole grains, fruits, and vegetables. As a result, people on the keto diet may not get enough of the vitamins and minerals found in these food groups, such as selenium, magnesium, phosphorus, and vitamins B and C.

In addition, the keto diet may be lower in fiber due to the elimination of whole grains, which can lead to constipation.

Folate (Vitamin B9)

Folate is essential for life and plays a crucial role in methylation, a process that keeps our cells functioning. It also regulates neurotransmitters that control our urges and sense of contentment. Folate is found in leafy green vegetables, which are restricted on the keto diet. Folate deficiency can lead to fatigue, mood swings, and cravings.

Biotin (Vitamin B7)

Biotin is important for hair, skin, and nail health. It is also used in the processing of fatty acids while on the keto diet. Animal studies have shown that biotin deficiency can occur within a few weeks of starting a strict ketogenic diet, leading to hair loss and skin inflammation.

Selenium

Selenium is a trace mineral that acts as an antioxidant, boosts immunity, supports thyroid function, and protects against heart disease. It is found in Brazil nuts, mushrooms, oysters, tuna, liver, and meat. Selenium deficiency is a known complication of long-term ketogenic diets and can, in rare cases, lead to life-threatening conditions such as cardiomyopathy and ventricular tachycardia.

Choline

Choline is an essential nutrient for normal metabolism and the transport of fats, neurotransmitters, and homocysteine. It is also important for liver health. Choline is found in egg yolks, liver, meat, poultry, and fish. Extreme restriction of carbohydrates and protein on the keto diet can lead to choline deficiency, which is associated with fatty liver disease.

To avoid nutrient deficiencies on the keto diet, it is important to include a variety of nutrient-dense foods, such as grass-fed meat, pastured poultry, wild-caught fish, eggs, bone broth, and colorful raw vegetables. Supplementation with a highly absorbed multivitamin containing active forms of B vitamins and other essential nutrients may also be beneficial.

Gastrointestinal issues

Causes

Fibre Intake

The keto diet is low in fibrous foods like grains and legumes. High-fibre foods are an essential nutrient for digestion, helping to maintain bowel regularity. Insufficient fibre intake could increase your risk of constipation.

Gut Microbiome

The keto diet may also alter your gut microbiome. Some research notes that the keto diet could damage the concentration and composition of your gut bacteria, increasing inflammation and reducing beneficial fatty acids. One study showed that three months of the keto diet damaged the gut microbiome composition in 23 children with epilepsy.

FODMAPs

FODMAPs are specific types of fibre found in many low-carb keto staples, such as cauliflower, broccoli, garlic, onions, and cabbage. Some people can't digest FODMAPs properly, which can cause digestive issues.

MCTs

Coconut oil is rich in medium-chain triglycerides (MCTs), which are fats with properties that make them great for ketosis. However, because they're so rapidly digested, MCTs can cause abdominal cramps and diarrhoea, especially if you're not used to them.

Prevention and Treatment

Understand What's Normal

It's normal to experience changes in bowel habits when switching to keto. For example, it's common to defecate less frequently and have smaller stool volume due to eating less bulky, carb-dense food. Unless these changes are causing problems or discomfort, there's no reason for concern.

Modify Your Diet

• Fibre – While the keto diet is low in fibre overall, you can still get fibre from non-starchy vegetables and low-sugar fruits. Increasing your fibre intake can help with constipation.
• FODMAPs – If you're sensitive to FODMAPs, reducing your intake of FODMAP-rich foods like cauliflower, broccoli, garlic, onions, and cabbage may help with diarrhoea, flatulence, and bloating.
• MCTs – If MCTs are causing abdominal cramps and diarrhoea, try toning down on coconut products and other MCT-rich foods, then slowly add them back into your diet.
• Water – Drinking more water, especially mineral water, can help with constipation. Mineral water provides electrolytes, which are important on the keto diet, and can help soften stools.
• Keto-friendly foods – Avocados, leafy greens, coconut oil, butter, and fermented vegetables like kimchi and sauerkraut are gut-friendly foods that can be enjoyed as part of a healthy keto diet.

Supplements

• Probiotics and prebiotics – These can provide general digestive support and help promote the growth of good gut bacteria.
• Digestive enzymes – These may help if your food feels like it's sitting in your stomach like a brick or if you get full too fast during meals.

While the keto diet may cause gastrointestinal issues for some people, making dietary modifications and incorporating gut-friendly foods and supplements can help improve digestive health. However, if you're experiencing persistent or severe symptoms, it's important to seek medical advice.

Keto flu

The keto flu is a collection of symptoms that some people experience when they start a ketogenic diet. This happens because the body is adapting to a new diet consisting of very few carbohydrates. The symptoms can feel similar to the flu and may start appearing within the first few days of cutting back on carbs.

The symptoms of keto flu include:

• Stomach or intestinal pain
• Diarrhea
• Fatigue
• Muscle soreness
• Cravings
• Headaches
• Constipation
• Nausea
• Dizziness
• Irritability
• Cramping
• Sugar cravings
• Trouble falling asleep or staying asleep
• Poor focus and concentration
• Brain fog

These symptoms can range from mild to severe and usually last a few days to several weeks. However, in extreme cases, they can last up to a month.

To manage keto flu symptoms, it is recommended to:

• Drink plenty of water to stay hydrated
• Avoid strenuous exercise and opt for light activities like walking or yoga
• Replace electrolytes by salting food to taste and including potassium-rich, keto-friendly foods like leafy greens and avocados
• Get plenty of rest
• Eat enough fat, the primary fuel source on the ketogenic diet, to reduce cravings and keep you feeling satisfied
• Cut out carbs slowly over time, gradually reducing carbohydrate intake while increasing fat and protein intake

High cholesterol

The ketogenic diet is a high-fat, low-carbohydrate diet that has gained popularity in recent years. While it is often used for weight loss, some people with high cholesterol levels try the keto diet in the hope that it will reduce their cholesterol. However, the keto diet can be controversial, and some experts are concerned that it could do more harm than good.

The Link Between Keto and High Cholesterol

The keto diet is high in fat, with 55-60% of calories coming from fat, 30-35% from protein, and only 5-10% from carbohydrates. This means that people on the keto diet are eating a lot of fat every day, and some of this may include unhealthy choices such as butter, coconut oil, and animal fat. These are all sources of saturated fat, which has been linked to poor heart health and high cholesterol.

Some research suggests that the keto diet can increase LDL cholesterol levels, particularly if the diet includes a lot of saturated fat. A study of 17 healthy, normal-weight women who followed a keto diet rich in saturated fats for four weeks resulted in increased LDL cholesterol for all participants. Another study of a woman who followed the keto diet for 30-40 days showed a rapid increase in LDL and total cholesterol, though it was unclear if this was due to the keto diet or the cholesterol in fat tissues becoming mobilized due to rapid weight loss.

However, other studies have shown that the keto diet can improve cholesterol levels. A study of 66 obese men with high or normal cholesterol levels who followed the keto diet for 56 weeks experienced a reduction in weight and LDL cholesterol, as well as a rise in HDL cholesterol. Another study of 83 obese men and women with high cholesterol who followed the keto diet for 84 weeks also showed a reduction in total cholesterol and an increase in HDL cholesterol, as well as a significant reduction in LDL after 24 weeks.

Genetics and Keto

Genetics can also play a role in the impact of the keto diet on cholesterol levels. Some people are predisposed to high cholesterol due to a genetic mutation called familial hypercholesterolemia (FH). People with FH should not follow the keto diet, as it can cause extreme effects on LDL cholesterol levels due to their genetic factors.

Preventing High Cholesterol on Keto

To prevent high cholesterol on the keto diet, it is important to consume more polyunsaturated and monounsaturated fats, which are better for the body. Lean meats, fish like salmon, plant-based oils like sunflower and corn oil, olive oil, and peanut oil are all good choices. It is also important to speak to a doctor before starting the keto diet, especially for those with high cholesterol or other health conditions.

Frequently asked questions