Leena Watts
The ketogenic diet is a popular eating pattern that replaces most carbohydrates with fats. While this diet is effective for weight loss, it can cause several side effects, including keto headaches. These headaches are a common problem among people starting the keto diet and typically occur when the body adjusts to lower carb intakes and enters ketosis. However, there are ways to treat and prevent keto headaches, such as staying hydrated and maintaining a nutritious low-carb diet.
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Dehydration
During ketosis, the body also excretes excess water, which can contribute to dehydration. This is because glycogen, which is a stored form of carbohydrates, is bound to water molecules, and when glycogen is used up, the water is released. This is known as the diuretic effect of the keto diet, which can further dehydrate the body.
To prevent dehydration, it is important to stay hydrated by drinking plenty of water. Experts recommend drinking at least 68 ounces (2 litres) of water per day. It is also crucial to eat a nutrient-rich diet with plenty of electrolytes to maintain hydration.
In addition to water intake, avoiding intense workouts during the initial phases of the keto diet is recommended. This is because glycogen stores become depleted, leaving the body with inadequate fuel for intense physical activity, which can lead to increased stress and headaches.
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Low blood sugar
The ketogenic diet is a low-carbohydrate, high-fat diet that causes weight loss and provides numerous health benefits. It severely restricts carbohydrate intake, which lowers blood sugar levels and can lead to hypoglycaemia or low blood sugar. This is because when your carb intake is low, your blood glucose (sugar) levels will also decrease. Low blood sugar hypoglycaemia may trigger a migraine.
A rare, but potential side effect of low blood sugar called ketoacidosis can cause headaches. Ketoacidosis is when ketones build up too much, turning your blood acidic. This is more common for people with Type 1 diabetes when blood sugar levels are too high and insulin levels are inadequate, but it can also happen with Type 2 diabetes. Symptoms to look out for include excessive thirst, frequent urination, confusion, weakness and fatigue. Ketoacidosis can be life-threatening and should be treated as a medical emergency.
A study found that mice fed a ketogenic diet displayed significantly reduced fasting glucose concentrations relative to controls. Another study found that a 69-year-old woman who strictly followed a ketogenic diet for nearly a year presented with malaise, sugar cravings, and mental fogginess, and was admitted to the hospital with hypoglycaemia.
To minimise the risk of low blood sugar on a ketogenic diet, it is important to stay hydrated, eat nutritious low-carb meals, and avoid intense exercise until your body adjusts to ketosis. It is also recommended to consult a doctor to ensure that medication and insulin are balanced with your eating pattern.
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Ketoacidosis
Headaches are a common side effect of the ketogenic diet, especially when starting the diet. The keto diet involves a high-fat, low-carbohydrate intake, which shifts the body into a metabolic state called ketosis, where fat is burned as the primary source of energy. This process of keto-adaptation can cause headaches due to hypoglycemia and dehydration.
The symptoms of ketoacidosis include nausea, vomiting, and abdominal pain, muscle stiffness, rapid breathing, and fruity-smelling breath. It can also cause high blood sugar levels and a rapid increase in ketones in the urine, which can be detected through home test kits. Ketoacidosis can lead to a diabetic coma and even death if left untreated. It is crucial to seek immediate medical attention if any symptoms of ketoacidosis develop.
While headaches are a common side effect of the keto diet, they are typically milder and can be prevented or managed through proper hydration, nutrient-rich meals, and avoiding intense exercise during the initial phase of the diet. Staying hydrated is crucial as the keto diet can lead to increased urination, which can cause dehydration and, consequently, headaches. Maintaining optimal blood sugar levels through nutrient-dense meals can also help minimize headaches.
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Stress and sleep disruptions
Sleep is a critical regulator of metabolic homeostasis and oxidative stress. A ketogenic diet can affect sleep patterns and cause disruptions. Sleep deprivation has been associated with increased oxidative stress and worsening mood symptoms.
When transitioning to a ketogenic diet, blood sugar levels fluctuate as the body adapts to using fat instead of glucose for energy. These fluctuations can disrupt sleep patterns, making it difficult to fall or stay asleep. A big reduction in carbohydrate intake combined with a significant increase in fat intake can cause changes to sleep patterns. Carbohydrates increase levels of the amino acid tryptophan in the brain, which helps facilitate sleep when it converts to serotonin. Serotonin is necessary for the body to produce the sleep hormone melatonin.
Keto diets can sometimes lead to deficiencies in essential nutrients like magnesium or potassium, which are important for regulating sleep. Lack of these nutrients may result in insomnia, muscle cramps, or restlessness at night. Low-carb diets can cause the body to excrete more water, leading to a loss of electrolytes such as sodium, magnesium, and potassium. An imbalance in these electrolytes can disrupt sleep by causing dehydration, muscle cramps, or heart palpitations.
Switching to a keto diet affects hormone levels, particularly cortisol, the stress hormone, and melatonin, the sleep hormone. These hormonal shifts can make it harder to relax and fall asleep, contributing to insomnia. The dietary change, combined with the body's adaptation to ketosis, can sometimes increase stress and anxiety. Elevated stress levels, especially due to disrupted routines or diet changes, can interfere with sleep quality and contribute to insomnia.
There is some interesting emerging research showing that ketogenic diets have an effect on a brain chemical that is important to sleep regulation: adenosine. Adenosine builds up in the body throughout the day and contributes to our feeling less alert and wakeful as the day goes on, eventually helping to promote deeper slow-wave sleep at night. Studies show that a ketogenic diet promotes adenosine activity in the body, helping to relax the nervous system, reducing pain and inflammation—all of which can help improve sleep.
Research on the effects of high-protein and high-carbohydrate diets on sleep is mixed. Some studies have shown that people with sleep disorders such as insomnia and sleep apnea tend to consume fewer carbohydrates than people without these sleep disorders. Other research shows reductions to slow-wave sleep in people who consume high-carb diets compared to low-carb diets. The effects on sleep from moving from a high-carb to a low-carb diet may depend heavily on the types of carbohydrates. Diets that derive their carbohydrates from healthy, fiber-rich whole foods—as opposed to sugars and processed starches—are associated with better sleep.
The duration of ketosis insomnia can vary from person to person, but it is generally considered a temporary side effect. For most individuals, sleep disturbances tend to improve within a few weeks as their bodies adapt to the ketogenic diet. However, some may experience prolonged low-carb insomnia, in which case seeking professional guidance may be beneficial.
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Exercise
It is important to listen to your body and adjust your exercise routine accordingly when starting the keto diet. Opt for low-impact exercises such as walking, swimming, or yoga during the initial days of the diet. As your body adjusts to the diet, you can gradually increase the intensity of your workouts.
It is also important to stay hydrated and maintain proper electrolyte levels when exercising on the keto diet. Drinking plenty of water and consuming water-rich foods can help prevent dehydration, which is a common cause of headaches on the keto diet. Additionally, eating nutrient-rich, low-carb meals can help minimize your risk of headaches and ensure your body is properly fuelled for physical activity.
In the long term, research suggests that the keto diet can improve exercise performance. Once your body adapts to using ketones for fuel instead of glucose, you may experience increased energy levels and improved physical endurance. However, it is important to consult with a healthcare professional before starting any new diet or exercise routine to ensure it is safe and appropriate for you.
While the keto diet has been shown to be effective for weight loss and managing diabetes, it is not suitable for everyone. The keto diet can be restrictive and may cause social isolation or disordered eating. It is also not recommended for individuals with certain medical conditions, such as those involving the pancreas, liver, thyroid, or gallbladder. It is important to speak with a healthcare professional before starting the keto diet to ensure it is safe and appropriate for your individual needs and health goals.
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Frequently asked questions
A keto headache is a common side effect of the ketogenic diet, which occurs when the body adjusts to lower carb intakes and enters ketosis.
The keto diet drastically reduces your carb intake, replacing it with fat. This shifts your body into ketosis, a metabolic state in which your body burns fat as its primary source of energy. As your body adjusts to using ketones for fuel instead of glucose, blood sugar levels can drop, causing headaches.
A keto headache can be described as a dull, throbbing pain in the temples, often accompanied by blurred vision and "brain fog". In rare cases, symptoms can include migraine, muscle stiffness, rapid breathing, and fruity-smelling breath.
On average, a keto headache will last anywhere from 24 hours to one week. In rare cases, symptoms can persist for up to 15 days.
To prevent keto headaches, it is recommended to stay hydrated, eat nutritious low-carb meals, and avoid intense exercise until your body adjusts to ketosis. To treat a keto headache, it is suggested to drink plenty of water, eat water-rich foods, and limit alcohol consumption.
