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8 Things to Know Before Starting Keto

This entry is part 1 of 9 in the series Keto Basics

You’ve watched a bunch of videos, listened to some podcasts, lurked on a few forums, and you’ve decided you’re gonna do it: you’re gonna try this keto thing. Great! Come on in, the water’s fine! And guess what? It’s as simple as cutting sugar and starch out of your diet and keeping all other carbohydrates to a minimum. Do that, and congratulations—you’re doing keto!

But wait a minute…

Not so fast.

While it’s true that all you really need to do to get started is to eliminate the majority of carbohydrates from your diet, there are a few things to be aware of before you jump into this. Let’s take a look at what you need to know before starting keto.

  1. Make sure you understand what keto really is.

Contrary to what you might see on social media, keto isn’t about adding butter and coconut oil to everything you eat, and it’s not about eating piles of bacon covered with bacon, with a bit of bacon on the side. (Not that there’s anything wrong with that bacon part!) Rather than “keto,” think of this way of eating as very-low-carb. When you frame it that way, you put the emphasis where it belongs: on keeping your carbohydrate intake very low. This is the single most important part of a ketogenic diet. What makes a diet “keto” is not the presence of mountains of fat and oil, but the absence of the carbs.

You don’t need any special gadgets or gizmos to be successful on keto. This is a way of eating, not an erector set for a Mars excavator robot. You might’ve seen videos of people checking their blood sugar or ketone levels with special meters, and pictures of people’s kitchen counters decked out with bottles of MCT oil, keto bone broth protein powder, and keto coffee creamers. If you’re a data lover—and you have a couple of thousand extra dollars floating around—you’re welcome to use these kinds of things. But if you want to keep things low-tech and simple, know this: keto is about one thing: keeping your carbohydrate intake very low.

Your body isn’t a computer. You don’t have to have a Ph.D. in math to figure out your “macros” or how many calories you should be eating. Keto doesn’t work by magical percentages of fat, protein, and carbs in your diet. You don’t need to calculate your diet down to the last microgram so that you “hit your fat macro” or “don’t eat too much protein.” What you need to do is keep your carbohydrate intake very low. Period.

  1. Have realistic expectations.

Keto is a very powerful way of eating that can radically transform your health and physique. But keep in mind that your transformation might not be as fast as you’d like it to be. Don’t compare your results to anyone else’s. We are all unique individuals, with our own genetics, dietary and medical histories, and lifestyle habits. Use other people’s successes as motivation and inspiration, but don’t “compare and despair.” Start where you are, and follow your own path. If you do the right things, you’ll get to your goals; the journey might just take a little longer than you wish it would.

If you’re specifically in this for fat loss, heed these words and save yourself a mountain of frustration and disappointment: women, don’t compare your rate of fat loss to a man’s. Men tend to lose weight more quickly on keto, even when they’re not as strict with the diet. It’s unfair, it’s infuriating, but it’s just the way it is. You can’t fight biology. Your fat loss will come; it’ll just come more slowly than it does for the men in your life. And older folks, don’t compare your fat loss to that of someone younger. There are always exceptions, but as a general rule, younger people lose fat more quickly than older people. Younger people have faster metabolisms. You can envy them that, but look on the bright side: you probably have more than ten dollars in your checking account.

Another note about fat loss: the more you’re looking to lose, the more quickly it’ll come off—at first. If you have a substantial amount of weight to lose, a good rate of loss is about 1-2 pounds per week. People who have less to lose will probably lose more slowly. If you’re new to this way of eating, you might lose several pounds in the first week or two but then things will slow down. This is normal and to be expected, so be ready for it. If you find things going slower a few weeks into keto, don’t worry that you’re doing something wrong.

Whatever you’re looking to achieve with keto—fat loss, relief from migraines, more energy, clearer skin, lower blood sugar—some of it might happen right away, but other things will take longer. Play the long game and be patient. Be on the lookout for beneficial things keto is doing for you even if you haven’t gotten to your main goal. (See point 8).

  1. Be prepared for keto flu.

Ah yes, the dreaded “keto flu.” The truth is, most people make the transition to keto with no problems. But some people experience a few hiccups as their body adjusts to life without sugar and starch, so it’s important for you to know about these in case they happen to you. The first thing to know is, these issues will be mild and temporary. They’ll pass quickly and they’re a small price to pay to feeling great and experiencing all the benefits of keto once your body adapts.

The most common issue is headaches. You may also feel dizzy, lightheaded, nauseated, or fatigued. Most of these can be prevented by taking in more salt. As I mentioned in a previous article, ketogenic diets increase your body’s need for sodium. Skimping on salt is usually the cause of headaches, lightheadedness, and feeling sluggish on keto. Be generous with salt and sodium in your diet: either sprinkle it liberally on your foods or add it to your beverages, or be sure to incorporate salty foods into your diet—things like bacon, olives, pickles, or pepperoni. Not a fan of those? Make a cup of broth using a bouillon cube for an easy sodium boost.

If you experience muscle cramps (especially in the legs) that you can’t attribute to overexertion, extra magnesium usually helps. Magnesium also helps with constipation, which some people experience on keto. If sodium alone doesn’t help with headaches, add magnesium; it’s helpful for headaches, too. (Check out the electrolytes from Keto Chow for convenient ways to get sodium and other important minerals.)

  1. Get professional guidance on medication.

If you take medication for diabetes (either type 1 or type 2) or for high blood pressure, you must have medical supervision when you start keto. This is not negotiable! Ketogenic diets are so powerful for normalizing blood sugar and blood pressure that you may need to adjust your medication doses with days of starting. For people with type 2 diabetes, insulin injections sometimes need to be stopped on the first day of starting the diet.1 (And people with type 1 might need to adjust their dose on day one.) If you take the same amount of medication you needed when you were eating a high-carb diet, but now you’re on a very low-carb diet, you might end up overmedicated, and this comes with effects ranging from dizziness and fatigue to more dangerous things, such as passing out.

Don’t adjust medication on your own. Work with a physician or other qualified medical professional who can advise you on changing your medication safely, as needed.

  1. Get baseline blood tests.

You don’t have to have any blood tests done before starting keto, but I recommend it—you’ll want to have something to compare to after a few months so you can see how much things have improved! Your body will give you loud and clear signals about how keto’s working for you—more energy, less joint pain, no more brain fog or heartburn—but it can be rewarding to also see objective proof that eating delicious food has had a positive impact on your health. Plus, if weight loss is a bit slow or you’re not getting closer to another goal you have, seeing certain measurements go in a favorable direction can help keep you motivated to stay on plan.

For a good baseline before starting, I recommend a comprehensive metabolic panel (CMP, which includes fasting glucose and liver enzymes), complete blood count (CBC), hemoglobin A1c, fasting insulin, C-reactive protein (CRP), and a lipid panel (cholesterol & triglycerides). Most of these are pretty standard tests, but you might have to specifically request fasting insulin. It’s not a routine test, but it’s important. For the lipid panel, ask your doctor if they can order a particle size test. (This isn’t essential, but it’s nice to have if you can get it.) If you suspect you might have a thyroid problem, ask for a comprehensive thyroid panel. (It’s important to ask for a comprehensive panel. If you ask for a “thyroid test,” many doctors test just one or two things, but a comprehensive panel provides much more information about thyroid function. See here for details.) If you’ve been taking antacid medication for a while—either by prescription or over-the-counter—consider asking for a vitamin B12 test. Antacids interfere with the absorption of vitamin B12, which is critical for energy levels and healthy neurological and cognitive function.

  1. Know how to order in restaurants.

In an ideal world, everyone would cook all their meals at home from scratch. But over here in the real world, where you and I live, dining out is one of life’s small pleasures. Whether you do it because you don’t like to cook, because it’s convenient, or because it’s a kind of treat and doesn’t have to cost a fortune, chances are you’ll find yourself in a sit-down restaurant or at a fast food drive-thru sometime after starting keto. Now that bread, pasta, rice, potatoes, beans, and noodles are off-limits, what can you order?!

Dining out or grabbing food on the go is easy. Just ask to swap out starchy sides in favor of non-starchy vegetables or a salad. Most restaurants will have no problem substituting steamed broccoli or roasted brussels sprouts for a baked potato or scoop of rice. At fast food places, bun-less burgers or grilled chicken are good ways to go. (Pro tip: ask for burger patties or grilled chicken patties a la carte if you don’t want the lettuce, tomato, and other toppings. It’s cheaper to just get the meat.) Tex-Mex places will serve you meat, veggies, and cheese in a lettuce bowl instead of wrapped in a tortilla. Just skip the rice and beans.

If you’re on the road and need to grab something quick from a convenience store, you’ll have no problem finding suitable items. With string cheese, nuts, pork rinds, pepperoni, and low-sugar beef jerky, there’s practically a smorgasbord of keto-friendly foods at these places now. If you’re passing by a grocery store, it’s even easier: grab some deli counter lunchmeat, a rotisserie chicken, canned fish (with a pop-top for easy opening), and/or pre-cut vegetables from the produce department. Many supermarkets have fresh salad bars now. These are perfect for a quick keto meal: lettuce, spinach, bell peppers, cucumber, radishes, mushrooms, turkey, ham, hard-boiled egg, shredded cheese. Being in a hurry or being on the road doesn’t mean you have to sacrifice your low-carb ways. (See here for more tips on staying keto while dining out.)

  1. Go easy on yourself.

Some people sail right through transitioning to keto. What? I can eat ribeye steaks, macadamia nuts, and Gruyere cheese and lose weight? Where do I sign?! But for others, this way of eating is a struggle to get used to. When you’ve spent your entire life eating cereal, granola, bread, pasta, rice, potatoes, ice cream, fruit smoothies, and other sweet and starchy things, it can be difficult to let go of them.

When you think about it, keto really isn’t that big a deal. It’s just no sugar or starch. Other than that, you’re eating the same meat, poultry, seafood, eggs, dairy, and low-carb vegetables you’ve always eaten. However, for some people, this is a really big deal! Be patient with yourself if you don’t master keto right away. (I sure didn’t!) Do the best you can, and if you find yourself faceplanting into a cupcake six days in, make sure you faceplant into just one cupcake, and not the whole box. Get back on the plan right at your next meal. Not tomorrow, not Monday, but immediately.

If you have trouble sticking to keto, it’s okay to ease into it gradually, rather than giving up carbs cold-turkey. The best way to experience the full effect of keto is to do it full-on right from the start, but if that all-or-nothing mindset has tripped you up in the past, then make a slower transition to this way of eating. A good way to approach this is to eliminate one high-carb food category each week. For example, week one: no fruit. You can still have bread, pasta, rice, beans, etc., just no fruit. Week two: no fruit and no pasta. You can still have bread, rice, beans, potatoes, etc., just no fruit or pasta. Each week (or even every two weeks), remove a high-carb food from your diet, and eventually, you’ll be on keto. It’ll take you longer to get there this way, but if doing it slowly helps you actually do it, that’s all that matters. Better to make a gradual transition and stay with it than to jump in overnight but have to restart every two weeks.

  1. Give yourself non-weight milestones.

Weight loss is just one of many reasons people adopt a keto diet, but since it’s probably the most common one, here’s something to keep in mind if you’re doing keto to lose weight. Look beyond the scale to assess whether keto is doing anything good for you. A lower body weight is only one thing on a long list of what keto can help you achieve. Looking for positive effects unrelated to your weight can keep you motivated to stay on plan if a weight loss stall or plateau has you feeling frustrated. Do you have brain fog? Acne? Acid reflux? What about migraines, hypoglycemia, hypertension, or low energy? Keto is good for all of these, and more. Research shows that metabolic health can improve substantially—including metabolic syndrome being reversed—even when you don’t lose a significant amount of weight.2,3 Here’s a list of 14 ways to tell if keto is working for you besides weight loss.

So, yes, if you want to start keto right now, all you have to do is stop eating sugar and starch. But keeping these 8 points in mind will set you up for success and give you a boost if your enthusiasm for this way of eating starts to wane in the early days. In a future article, I’ll give you some real-world strategies for making keto simpler and easier to stick with for the long term.


  1. Westman EC, Tondt J, Maguire E, Yancy WS Jr. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Rev Endocrinol Metab. 2018;13(5):263-272.
  2. Hyde PN, Sapper TN, Crabtree CD, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. 2019;4(12):e128308.
  3. Feinman RD, Volek JS. Low carbohydrate diets improve atherogenic dyslipidemia even in the absence of weight loss. Nutr Metab (Lond). 2006;3:24.
By |2020-09-23T11:26:04-06:00September 23rd, 2020|Categories: Keto Basics|Tags: , , , , , , , |4 Comments

Can Keto Make You Tired?

This entry is part 2 of 9 in the series Keto Basics

“I can’t sit still!”

“I’m bursting with energy!”

“I don’t need an alarm to wake up anymore!”

Any of these sound familiar? Poke around keto-oriented social media and you’re bound to come across people claiming their energy is through the roof. That they started working out because they didn’t know what else to do with all that pent-up power. But what if you haven’t felt this magical energy boost? What if keto’s done the opposite for you and you feel sluggish? Can keto make you tired?

The answer to this is a definite no … and yes. Like most things when it comes to the complex and kooky human body, it depends. Fortunately, if you have found yourself dragging more than usual—physically or mentally and emotionally—it’s not keto, per se, that’s the cause, so you don’t have to abandon a diet that might be helping you lose weight1, improve PCOS2, get rid of acid reflux3, prevent migraines4, or massively improve type 2 diabetes5. What’s likely making you feel tired is the way keto affects other things in your diet and health picture.

Let’s take a look at why keto typically gives people more energy, and then address the reasons why you might have less energy than when you were eating more carbs—and most importantly, what to do about them.

Keto Usually Boosts Energy

After an initial dip during the adaptation phase, most people report an increase in energy levels when following a ketogenic diet. It’s not uncommon for formerly sedentary folks to become more active without having to force it—it happens naturally because they’re feeling more energetic. There’s no formal research published on this particular “side-effect” of keto, but it’s widely acknowledged among keto-oriented doctors and other health professionals, not to mention among patients, themselves.

What could be behind this well-noted, if anecdotal, energy boost? A couple of mechanisms potentially explain it. First, when your body’s adapted to running mostly on fat, you’re no longer subject to wild ups and downs in blood sugar—and those lows can leave you feeling sluggish, weak, or lightheaded.6 (It’s important to note, though, that very high blood sugar can also cause fatigue.) When you’re off the blood sugar rollercoaster, you have constant access to premium fuel in the form of fat and ketones. Molecule for molecule, at the cellular level, fats provide more energy than glucose does. (As ATP, the cellular “energy currency,” if you remember that from high school biology class!)

Second, ketones, themselves, may provide a bit of a lift—perhaps even just a perceived one. It has long been believed that “hitting the wall” during a grueling endurance event is a purely physical phenomenon, resulting from processes limited to the working muscles. But some researchers believe this breaking point or “bonking” may have more to do with the brain:

“Whereas prolonged intense exercise when one is dependent upon glucose/glycogen progressively depletes fuel reserves available to sustain the brain, the keto-adapted athlete may benefit from the opposite effect. As endurance exercise progresses, unlike the blood glucose concentration, the blood ketone concentration does not decline but tends to rise somewhat, ensuring a stable supply of fuels to the brain. Consistent with this improved cerebral fuel delivery, ultra-endurance athletes frequently report that mental clarity is maintained better during prolonged exercise in the keto-adapted state. This is in stark contrast to the problems of central fatigue and ‘hitting the wall’ that commonly occur in athletes who follow a high-carbohydrate fuelling strategy and to which a progressive hypoglycemia that develops during prolonged exercise may contribute to fatigue.”8

Okay, that’s great for endurance athletes, but what about we mere mortals, who aren’t regularly running marathons or doing triathlons? Well, apart from anecdotal reports of increased oomph from people following ketogenic diets, a study from 2019 showed that subjects with multiple sclerosis reported improvements in fatigue after three months of adhering to keto.9  So this way of eating appears to be beneficial even among people with severely compromised energy levels.

What If You Are Tired on Keto?

If keto hasn’t bestowed its energy blessing upon you, what gives? What might be getting in the way, and what can you do about it?

  1. Not enough sodium.

Ketogenic diets increase your body’s need for sodium. Skimping on salt is a common culprit behind fatigue, headaches, and just feeling blah on keto. Most people could use a little extra salt on keto, but this goes even more for people who live in hot climates or who work outdoors or sweat a lot, and for athletes. If you’re an athlete whose “get up and go got up and went,” and you feel like you’re dragging during workouts, get more salt.

The remedy: Be generous with your salt shaker. Don’t be afraid to go heavy on salt, especially if your diet doesn’t normally include foods that already salty, like bacon or other cured meats, pork rinds, olives, pickles, etc. If you’re not a fan of salty food, consider making a cup of broth using a bouillon cube and make that a daily habit. Keep in mind that salt is only half sodium (the other half is chloride), so to get more sodium, be liberal with salt. Concerned about salt raising your blood pressure? Don’t be. If your blood pressure is normal, consuming more salt has little to no effect on it. In fact, for some people, diets that are too low in sodium bring their own problems10, and high blood glucose and insulin levels coming from too much sugar are more likely causes of hypertension compared to a high sodium intake.11,12

  1. Check your meds.

Don’t blame keto for what your meds are doing! Many medications come with side-effects of decreased energy, drowsiness, or fatigue. Check any medications you’re taking and see if this is the case. The good news is, ketogenic diets can reduce the need for several different types of medication, so if your health is improving, you may be able to reduce your doses or eventually stop taking these drugs altogether (only under medical supervision, of course).5,13 Be especially vigilant if you’re taking medication for high blood pressure. Ketogenic diets have a powerful effect on improving blood pressure naturally, so if you combine keto with the same dose of medication you were taking on a high-carb diet, you might end up overmedicated—meaning, the medicine is now too strong for you because keto is doing the heavy lifting all by itself. Fatigue and lightheadedness are signs that your blood pressure might be too low, but your biggest tip-off might be feeling faint or woozy when you stand up quickly from having been seated or lying down.

The remedy: Work with your doctor to see if keto is helping you get to a place where you can reduce your dose of medications that are making you tired, or possibly discontinue them altogether. Never adjust meds on your own. And consider the possibility that medications that don’t normally induce fatigue might do so when combined with a ketogenic diet. (Most research on pharmaceutical drugs is done in people eating standard high-carb diets.)

  1. Mind your micronutrients.

Low levels or outright deficiencies in certain nutrients can result in low energy and feeling sluggish physically and mentally. The most likely culprit is anemia from low iron or low B12. An omnivorous keto diet that includes red meat, eggs, or seafood would provide plenty of these nutrients, but it’s not impossible for a meat-eater to be low in these. Consuming certain foods doesn’t automatically mean you’ll effectively digest them and absorb the nutrients they contain. Reproductive-age females who menstruate regularly may be at risk for low iron even if their diets include red meat and other iron-rich foods, and this applies even more to those whose diets are low in these.

The remedy: Work with a doctor to have your iron and B12 levels checked. Both are easy to measure with common blood tests. If they’re low, increase your intake of foods rich in these nutrients, or take a good quality supplement.

  1. You might need more carbs. (Eeek!)

If you work out a lot—especially weightlifting, but this might apply to anything high-intensity—you might need a bit more carbohydrate in your diet. Certainly, not everyone does—professional athletes have been going keto and some are breaking records14—but don’t feel bad if you think your performance might benefit from a hit of starch. Plenty of high-level athletes thrive by eating low-carb or keto most of the time, but including occasional carb refeeds or regularly consuming carbs after a workout. You’re not necessarily doing something wrong if you find you need some starch to reach your highest gear in intense activity. Remember, carbs aren’t the enemy. Way too many carbs, too often, is what makes people sick—not occasional infusions of starch for the specific purpose of supporting high-intensity athletics in an otherwise low-carb diet.

The remedy: Increase your carb intake in a sensible way. It’s probably not the best idea to start off with a giant stack of pancakes doused in maple syrup for breakfast first thing in the morning, but consider adding a sweet potato or a serving of black beans or rice to your evening meal on a day you trained hard. Do that consistently and you’ll know pretty quickly whether that small amount of carbohydrate is helping you perform at your best.

If keto has given you more energy and you feel a new pep in your step, great! That’s exactly what we would expect. But if things have gone in the opposite direction and cutting carbs has made you more tired than before, hopefully, you’ve found some solutions here. If none of the possibilities here seem relevant to you, work with a keto-savvy doctor or nutritionist to dig deeper and find out what might be sapping your energy.


  1. Staverosky T. Ketogenic Weight Loss: The Lowering of Insulin Levels Is the Sleeping Giant in Patient Care. J Med Pract Manage. 2016;32(1):63-66.
  2. Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond). 2005;2:35. doi:10.1186/1743-7075-2-35.
  3. Pointer SD, Rickstrew J, Slaughter JC, Vaezi MF, Silver HJ. Dietary carbohydrate intake, insulin resistance and gastro-oesophageal reflux disease: a pilot study in European- and African-American obese women. Aliment Pharmacol Ther. 2016;44(9):976-988. doi:10.1111/apt.13784.
  4. Di Lorenzo C, Coppola G, Sirianni G, et al. Migraine improvement during short lasting ketogenesis: a proof-of-concept study. Eur J Neurol. 2015;22(1):170-177. doi:10.1111/ene.12550.
  5. Westman EC, Tondt J, Maguire E, Yancy WS Jr. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Rev Endocrinol Metab. 2018;13(5):263-272. doi:10.1080/17446651.2018.1523713.
  6. Mayo Clinic. Diabetic Coma. Accessed Aug 13, 2020 from
  7. Noakes TD. Time to move beyond a brainless exercise physiology: the evidence for complex regulation of human exercise performance. Appl Physiol Nutr Metab. 2011;36(1):23-35. doi:10.1139/H10-082.
  8. Volek JS, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci. 2015;15(1):13-20. doi:10.1080/17461391.2014.959564.
  9. Brenton JN, Banwell B, Bergqvist AGC, et al. Pilot study of a ketogenic diet in relapsing-remitting MS. Neurol Neuroimmunol Neuroinflamm. 2019;6(4):e565. doi:10.1212/NXI.0000000000000565.
  10. The National Academies of Sciences, Engineering, and Medicine. Institute of Medicine, Food and Nutrition Board, Committee on the Consequences of Sodium Reduction in Populations. Studies Support Population-Based Efforts to Lower Excessive Dietary Sodium Intakes, But Raise Questions About Potential Harm From Too Little Salt Intake. Published May 14, 2013. Accessed Aug 13, 2020.
  11. DiNicolantonio JJ, Lucan SC. The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart. 2014;1(1):e000167. doi:10.1136/openhrt-2014-000167.
  12. Quiñones-Galvan A, Ferrannini E. Renal effects of insulin in man. J Nephrol. 1997;10(4):188-191.
  13. Hallberg SJ, McKenzie AL, Williams PT, et al. Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther. 2018;9(2):583-612. doi:10.1007/s13300-018-0373-9.
  14. Mestel, S. Zach Bitter Is the 100-mile American Record Holder. He Also Eats Almost No Carbs. Men’s Journal. Accessed Aug 13 2020.
By |2020-09-01T09:34:10-06:00August 14th, 2020|Categories: Keto Basics|Tags: , , , , , |0 Comments

Is Keto Dairy Free?

This entry is part 3 of 9 in the series Keto Basics

Look at pictures of food on keto social media and no one could blame you for thinking that dairy is required when you’re eating this way. Bowls are filled with cheese covered in rivers of melted cheese, with cheese sprinkled on top for good measure. People put butter in their coffee, and keto dessert cookbooks would be pretty empty if you took out all the recipes calling for cream cheese and heavy cream. But what if you’re allergic or sensitive to dairy, or you just plain don’t like the stuff? Is it possible to do dairy-free keto?

What Makes Keto Ketogenic?

Can you do dairy-free keto Yes! Ketogenic diets have more to do with what you don’t eat than what you do eat. Diets are ketogenic not based on what they include, but rather, on what they exclude. Don’t eat sugar or starch. Beyond that, what you choose to consume is up to you. The single most important thing about keto is keeping your carb intake low. Period. There are no specific foods that you need to include to make your diet “more keto” or to make it work better.

Based again on those alluring food pics, it would be easy to think that you have to eat bacon, or ribeye steak, coconut oil, almond flour cookies, or cauliflower rice to belong to the keto club. But that’s not how it works. The beauty of keto is that it’s entirely customizable. Keep your carbs very low, and get your protein and fat from whichever foods you like. Dairy certainly fits in well, but it’s not required.

Keto Without Dairy

Since keto is defined more by what’s not in your diet than by what is, you can definitely do keto without dairy—and many people do. Dairy has two main roles on ketogenic diets: first, it’s delicious, and second, it’s a great source of fat. But there’s a world of other foods that fulfill both those criteria, depending on your personal taste preferences. Guacamole, anyone? If you’re an avocado fan, you’ll have no problem getting plenty of good fats in your keto diet. Coconut more your thing? Coconut milk, coconut oil, and coconut butter provide flavor along with a big dose of healthy fat. And of course, there’s lard, tallow, schmaltz, and other traditional animal fats.

Dairy is also a protein source—one that plays a big role in lacto- or lacto-ovo-vegetarian keto diets. Meat eaters don’t have to worry about getting enough protein on keto, but those who avoid animal products except eggs and dairy might need to be a bit more careful. Cottage cheese, Greek yogurt, and whey protein shakes are all low-carb sources of protein. (Yes, cottage cheese and Greek yogurt. These might not work if you need to stay ultra-strict keto for medical reasons, but everyone’s carb threshold differs. Some people can have more carbs than others and still stay in a ketogenic state.)

But what if dairy is off-limits? If you need to avoid dairy but you’re not a vegetarian, the rest of the protein world is still open to you: beef, pork, lamb, chicken, turkey, seafood, venison, duck … there’s no shortage of protein options. If you choose to avoid these animal foods, however, getting adequate protein will be a bit tougher. If eggs are on your menu, eat them liberally. They’re phenomenal sources of protein, fat, and micronutrients.

If you’re a dairy-free vegetarian, then beyond eggs, you can use vegetarian protein sources, like pea, hemp, or rice proteins. (Always read labels and look at the carb counts. Most protein powders are low in carbs, but never assume.) If your diet can be slightly more liberal with regard to carbs, you may be able to incorporate tofu, lentils, and other lower-carb beans and pulses as protein sources. Not everyone needs to be in ketosis all the time to reap the benefits of lower-carb eating.

After all this talk about doing keto without dairy, it’s worth pointing out that some people with lactose intolerance do well-eating dairy foods that are very low in lactose, like butter, ghee, or long-aged cheeses, all of which are perfect for keto. The longer a dairy product has been aged or fermented, the more lactose the culturing bacteria consume, and the less remaining in the final product. So if you have lactose intolerance but love dairy, stick to dairy foods that are almost all fat (butter, ghee, heavy cream), and those that have been aged for a long period of time.

Does Dairy Affect Insulin?

Whether to include dairy in your diet is a personal decision. It may be true that, technically, milk is the only food specifically intended to help small mammals grow larger, and that this could potentially be a problem if you’re specifically looking to lose weight. It’s also true that dairy stimulates insulin and a similar hormone, insulin-like growth factor 1 (IGF-1)1,2,3, but neither of these means that including dairy foods in a ketogenic or low-carb diet is harmful.

A small effect on these hormones in the context of a very low-carb diet is likely different from the effect that results when dairy is included in the diet of someone with chronically high blood sugar or insulin. It must be noted that most research connecting dairy consumption to chronic cardio-metabolic disease is epidemiological in nature (meaning it can’t establish cause-and-effect), and has been conducted in populations consuming mixed—i.e. high-carb—diets. Very little research has been done investigating dairy specifically in the context of ketogenic diets.

Some people notice that dairy foods (particularly cow dairy) cause or exacerbate acne. Research looking at the evidence for the acne-promoting effects of milk and other dairy products known to stimulate insulin concluded that “restriction of milk consumption or generation of less insulinotropic milk will have an enormous impact on the prevention of epidemic western diseases like obesity, diabetes mellitus, cancer, neurodegenerative diseases, and acne.”4

The key here is to limit the consumption of fluid milk and other dairy foods that stimulate insulin more than items that are very low in carbs, like butter and cream. The work of nutrition research pioneer Weston A. Price tells us that many populations whose diets included liberal amounts of dairy foods were healthy, robust, long-lived, and free of the chronic diseases that plague us now. So it’s not dairy, per se, that’s driving these modern illnesses. It’s more likely dairy in the context of a diet that already over-stimulates insulin.5 Including cheese, butter, ghee, cream, sour cream or cream cheese in a very low-carb diet is likely fine—the evidence being many thousands of people who are doing exactly this, and whose health has improved dramatically just by cutting carbs.

A 2019 review presented evidence that consuming full-fat and fermented dairy is not associated with increased risk for cardiovascular disease or type 2 diabetes.6 Earlier research noted, “Data from RCTs [randomized controlled trials] suggest that dairy consumption has no impact on insulin resistance and glucose and insulin homeostasis in the short term, but may be beneficial in the long term.”7 (Emphasis added.) So if you’ve been including dairy regularly on your keto diet and you’re happy with your health, body size, and skin appearance, keep calm and dairy on.

Bottom Line

Do what works for you. Dairy can be a delicious and convenient part of ketogenic diets, but it’s not required. Your results won’t be compromised if you skip the butter and cheese and get your fat from meats and seafood, olive oil, avocado, nuts and seeds, and other sources. If you’re doing dairy-free keto and could use some recipe inspiration, the book Dairy-Free Keto Cooking can help breathe new life into your kitchen routine.


  1. Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Exp Dermatol. 2009;18(10):833-841. doi:10.1111/j.1600-0625.2009.00924.x.
  2. Melnik BC, John SM, Schmitz G. Over-stimulation of insulin/IGF-1 signaling by western diet may promote diseases of civilization: lessons learnt from laron syndrome. Nutr Metab (Lond). 2011;8:41. doi:10.1186/1743-7075-8-41
  3. Clatici VG, Voicu C, Voaides C, Roseanu A, Icriverzi M, Jurcoane S. Diseases of Civilization – Cancer, Diabetes, Obesity and Acne – the Implication of Milk, IGF-1 and mTORC1. Maedica (Buchar). 2018;13(4):273-281. doi:10.26574/maedica.2018.13.4.273.
  4. Melnik BC. Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Nestle Nutr Workshop Ser Pediatr Program. 2011;67:131-145. doi:10.1159/000325580.
  5. Cordain L, Eades MR, Eades MD. Hyperinsulinemic diseases of civilization: more than just Syndrome X. Comp Biochem Physiol A Mol Integr Physiol. 2003;136(1):95-112. doi:10.1016/s1095-6433(03)00011-4.
  6. Astrup A, Geiker NRW, Magkos F. Effects of Full-Fat and Fermented Dairy Products on Cardiometabolic Disease: Food Is More Than the Sum of Its Parts. Adv Nutr. 2019;10(5):924S-930S. doi:10.1093/advances/nmz069.
  7. Drouin-Chartier JP, Côté JA, Labonté MÈ, et al. Comprehensive Review of the Impact of Dairy Foods and Dairy Fat on Cardiometabolic Risk. Adv Nutr. 2016;7(6):1041-1051. doi:10.3945/an.115.011619.
By |2020-09-01T09:35:40-06:00August 26th, 2020|Categories: Keto Basics|Tags: , , , , , |0 Comments

How Keto Affects the Brain

This entry is part 4 of 9 in the series Keto Basics

Apart from the well-documented benefits ketogenic diets provide—like weight loss1, lower blood sugar and blood pressure2, and improved cardiovascular risk factors3—people commonly report sharper thinking. Brain fog disappears, and it’s smooth sailing for cognitive function. Is this—no pun intended—all in people’s heads, or is keto genuinely good for the brain?

Your Brain on Glucose & Insulin

There isn’t much published scientific research specifically studying the effects of ketogenic diets on brain function in healthy humans outside the epilepsy world, so we can’t say for certain that keto is “good” for the brain. However, we do have a pretty good idea of what’s not good for the brain: chronically high blood sugar and insulin.

Type 2 diabetes and high blood pressure—two conditions rooted in high blood sugar and/or insulin—are among the risk factors for Alzheimer’s disease (AD). In fact, researchers now regularly call AD “type 3 diabetes,” and you might also come across the term “brain insulin resistance.”4,5 The links between metabolic syndrome (driven by chronically elevated insulin) and cognitive impairment are so strong that researchers also use the phrase “metabolic-cognitive syndrome.”6

The reason AD is called “type 3 diabetes” is that the primary problem in the brain of someone with AD is that neurons in affected regions of the brain are no longer metabolizing glucose properly—that is, they cannot convert glucose into energy, so they’re basically starving for fuel. Calling AD “a brain form of diabetes”4 is helpful because it immediately makes a connection to problems with glucose, but it misses what might be an even more important factor in this energy shortage in the brain: chronically high insulin.

Millions of people have normal blood glucose (a.k.a. blood sugar) levels, but very high insulin, and having chronically high insulin—even when blood sugar is normal—is a major risk factor for AD. This is independent of family history or genetics: if you have high insulin most of the time, you have an increased risk for developing AD. According to one study, compared to people with normal insulin levels, those who had high insulin but who were not diabetic had double the risk of developing AD.7

What about when your blood sugar is just a little bit higher than normal? What if it’s slightly elevated but not so high that you’ve been diagnosed with diabetes? Here we also see some frightening data. One paper said it pretty clearly: “… even in the absence of manifest type 2 diabetes mellitus or impaired glucose tolerance, chronically higher blood glucose levels exert a negative influence on cognition, possibly mediated by structural changes in learning-relevant brain areas.”8 In plain English: people with higher blood glucose had worse cognition than people with lower glucose, and this was probably due to changes in the physical structure of the brain. This echoed earlier research which had similar findings—elevated average blood glucose may be a risk for dementia even at levels lower than the diabetic range.9

Alzheimer’s is only the most severe manifestation of the adverse effects of chronically high blood sugar and insulin on the brain. What about when things are in a much milder state? Could this be what we casually call brain fog? When your blood sugar fluctuates wildly throughout the day, it’ll reach some big highs and drop to some precipitous lows. Nervousness, anxiety, confusion, and difficulty speaking are some of the brain-related effects of acute hypoglycemia (low blood sugar).10

So if chronically high blood sugar has a negative influence on cognition11, then it’s possible that keeping blood sugar within a healthy range could have a protective influence. We can’t say this for certain, but it’s a pretty safe bet that you’re better off having normal levels of blood sugar and insulin compared to chronically high levels of either.

Fueling the Brain

Well-meaning friends and family who tried to steer you away from keto may have peppered you with arguments about the brain “needing carbs,” or perhaps a medical or nutrition professional even warned you that your brain would starve on a low-carb diet because the brain needs 120 grams of glucose every day. Let’s set the record straight on this.

It’s true that your brain needs glucose. There’s no denying that. But a need for glucose doesn’t equate to a need for lots of sweet and starchy carbohydrates in your diet—or any carbs, for that matter. The human body is the ultimate reuse and recycle machine. It’s great at converting things into other things—moving and changing things here and there like some kind of wondrous biochemical Jenga game or Rubik’s cube. (Remember those?!) One of the things your body is great at making out of many different raw materials is glucose. You can make glucose from amino acids (from protein), glycerol (from fats), and from a few other starting points—no bagels, pasta, bread, rice, or cookies required!

One thing is clear: the brain is an energy hog. Sources differ, but as a general ballpark, your brain represents only about 2% of your body weight, but it sucks up nearly 20% of your body’s energy.12 But does all this energy have to come from glucose, or can the brain use some other fuel instead?

According to researchers, the brain metabolizes about 120 grams of glucose per day “under conditions of normal glucose availability.”12 But what about under other conditions? What about in someone eating a very low-carb or ketogenic diet?

Well, as I mentioned, your body can make all the glucose it needs in-house. If your brain absolutely required a certain amount of glucose every day and your body couldn’t supply it, no one would ever survive more than a day or two of fasting. So either your body has no problem generating 120 grams of glucose in the total absence of dietary carbohydrate, or maybe your brain doesn’t need quite that much glucose if it’s being fueled by something else.

In addition to being great at recycling, your body—and brain—are like hybrid cars. They adapt to running on whatever fuel you give them. Most cells in your body can use glucose, fats, or ketones. Your brain can use glucose and just a small amount of fat, but it’s a champ at using ketones. Look at this breakdown of how much of your brain’s energy supply comes from ketones at different blood levels of beta-hydroxybutyrate (βOHB).

Blood ketone level
Proportion of Brain
Energy Supplied
0.3–0.5 mM3–5%
1.5 mM18%
5 mM60%
7 mM>60%

Data from reference 12.

Even people not on ketogenic diets could achieve a blood ketone level of 0.3–0.5 mM or higher if they do a hard workout and it’s been a few hours since their last meal. 1.5 mM is easily achievable when carbs are very low. The higher numbers in this table would likely only be seen in someone doing an extended fast, but levels in between—2.0–4.0 mM, for example—could provide a substantial amount of fuel for the brain and are not unheard of in people doing strict ketogenic diets.

Is it essential to be in ketosis, then? No. A few billion people all over the world who have a healthy cognitive function but who are not on ketogenic diets show us this implicitly. But based on the research we explored earlier, what probably is needed for healthy cognition throughout life is maintaining healthy blood sugar and insulin levels. Keto is certainly one way to do that, but everyone’s carb tolerance varies. Some people will have to stay ultra-low-carb most of the time; others can be more generous.

Exciting Research in Alzheimer’s and Traumatic Brain Injury

Getting back to the association between diabetes, metabolic syndrome (MetSyn), and cognitive impairment, some small-scale research suggests that ketogenic diets and other lifestyle interventions that help correct MetSyn may also improve cognitive function. Ketogenic diets combined with exercise, intermittent fasting, or brain training games were shown to reverse mild cognitive impairment (MCI, the precursor to Alzheimer’s) in three subjects, one with type 2 diabetes and two with MetSyn.13,14,15 The diabetes and MetSyn were also greatly improved, and while we can’t say for certain that those improvements caused the reversal of cognitive impairment, it’s a plausible hypothesis.

Most of the research looking at ketones as an alternative brain fuel to glucose in Alzheimer’s disease have used exogenous ketones or MCT oil rather than ketogenic diets. This is disappointing but understandable. It can be difficult even for young, healthy, able-bodied people to adhere to strict ketogenic diets. Now imagine someone with cognitive impairment, who might also have limited mobility and capacity to cook. Caregivers already face heavy burdens in looking after their loved ones; trying to force them to make dietary changes they’re opposed to only makes things harder. Plus, by using exogenous ketones or MCT oil without changing someone’s diet, researchers narrow down confounding issues that might cloud the results. If a subject’s cognition improves when their ketone levels are elevated from MCT oil or exogenous ketones, then it’s more likely that it’s a direct result of the ketones and not something else, like weight loss, better blood sugar control, less inflammation, or other things we know keto typically leads to.

Elevated ketones, by themselves, aren’t a slam dunk for radically improving Alzheimer’s or cognitive impairment. But let’s not dismiss even minor beneficial effects, especially considering that right now, there are no effective treatments for AD. Generally speaking, these studies show that at least some people have improved cognition when their ketone levels are elevated.16-19 In MCI, the brain energy deficit is specific to glucose, and “at least partially correcting this deficit with ketones results in cognitive improvements.”16

Ketogenic diets and exogenous ketones also show potential in improving recovery from traumatic brain injury (TBI). Almost all the research in this area has been done in animals, but it’s encouraging and holds promise for people affected by these devastating injuries. TBI and AD have a surprising amount of overlap, first and foremost, a reduced capacity of the brain to convert glucose into energy.20-22 TBI also results in increased free radicals, mitochondrial damage, an increased need for antioxidants, increased susceptibility to neuronal death, and other issues that ketones themselves or the collective effects of ketogenic diets can address.23

Using ketogenic diets or exogenous ketones as therapy in TBI is in its infancy, but one thing that has been well known for a while is that higher blood sugar is associated with worse outcomes in TBI patients. So why not adopt a nutritional strategy that keeps blood sugar in a healthy range and gives neurons an alternative fuel to glucose? Research in animals and humans suggests that a switch to a ketogenic state might help to protect damaged neurons.20,24

Spotlight on Vitamin B12 and Choline

Vitamin B12 is a crucial factor for anyone concerned about brain health and cognitive function. Outright B12 deficiency and milder subclinical insufficiency are common, particularly among older people who may be consuming fewer foods rich in B12, and whose digestive capacity may be waning, making them less able to absorb B12 from the foods they do consume. Inadequacy of this critical nutrient comes with a long list of signs and symptoms, including confusion, memory loss, dementia, dizziness, altered mental status, depression, apathy, paranoia, mania, delusions, psychosis, and hallucinations.25 So yes, it’s fair to say that suboptimal B12 status could have a major impact on the brain.

With this in mind, it’s possible that raising B12 levels is another way keto may be beneficial for the brain, entirely separate from its influence on blood glucose, insulin, and ketones. An omnivorous ketogenic diet that includes red meat, eggs, pork, seafood or shellfish, provides plenty of B12. People may have been eating these foods all along, even before keto, but when sugary and starchy carbs are off the menu, replaced by fats and proteins, it’s possible people get more B12 than they did before.

Consuming foods rich in B12 doesn’t guarantee your blood levels will increase or be maintained at healthy levels, though. As we mentioned in a previous article, eating certain foods doesn’t automatically mean you’ll digest them effectively and absorb the nutrients they contain. So if you know you have compromised digestive function, consider getting your B12 level checked (it’s a simple blood test), and take supplements if warranted. B12 is found only in foods from the animal kingdom, so lacto-ovo vegetarians can get B12 from eggs and dairy products, but strict vegans must supplement.

Choline is another nutrient critical for brain health and neurological function. It’s an essential part of all cell membranes, and is a precursor to acetylcholine, a neurotransmitter that affects “memory, mood, muscle control, and other brain and nervous system functions.”26 Patients with Alzheimer’s may have lower levels of acetylcholine compared to healthy people, and one class of drugs used to treat AD is designed to reduce the breakdown of this critical compound.27

Your body synthesizes choline, but only in small amounts—not enough to meet the full demands, so you need to get some from your diet. Some of the richest sources of choline are the foods commonly consumed on ketogenic diets: eggs, red meat, pork, seafood, plus nuts and seeds, broccoli, and Brussels sprouts. Plant foods contain choline, but animal foods are more concentrated sources. To the extent that increased dietary choline may be providing more raw material for acetylcholine, this might be another way low-carb or ketogenic diets may be beneficial for the brain.


Ketogenic diets are impressive for helping people lose weight, banish acid reflux28, reverse non-alcoholic fatty liver29, improve hormone balance in PCOS30,31, and for many other health issues. It stands to reason that this very low-carb way of eating would also be beneficial for the brain. So if you’re doing keto and you’ve noticed improved mental clarity and cognitive sharpness, it is in your head—and in the rest of your body, too.

Wondering how keto affects mental health? Stay tuned. We’ll cover that in a future article.


  1. Staverosky T. Ketogenic Weight Loss: The Lowering of Insulin Levels Is the Sleeping Giant in Patient Care. J Med Pract Manage. 2016;32(1):63-66.
  2. Westman EC, Tondt J, Maguire E, Yancy WS Jr. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Rev Endocrinol Metab. 2018;13(5):263-272. doi:10.1080/17446651.2018.1523713.
  3. Bhanpuri NH, Hallberg SJ, Williams PT, et al. Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study. Cardiovasc Diabetol. 2018;17(1):56. doi:10.1186/s12933-018-0698-8.
  4. de la Monte SM. The Full Spectrum of Alzheimer’s Disease Is Rooted in Metabolic Derangements That Drive Type 3 Diabetes. Adv Exp Med Biol. 2019;1128:45-83. doi:10.1007/978-981-13-3540-2_4.
  5. Frazier HN, Ghoweri AO, Anderson KL, Lin RL, Porter NM, Thibault O. Broadening the definition of brain insulin resistance in aging and Alzheimer’s disease. Exp Neurol. 2019;313:79-87. doi:10.1016/j.expneurol.2018.12.007.
  6. Frisardi V, Solfrizzi V, Seripa D, et al. Metabolic-cognitive syndrome: a cross-talk between metabolic syndrome and Alzheimer’s disease. Ageing Res Rev. 2010;9(4):399-417. doi:10.1016/j.arr.2010.04.007.
  7. Luchsinger JA, Tang MX, Shea S, Mayeux R. Hyperinsulinemia and risk of Alzheimer disease. Neurology. 2004;63(7):1187-1192. doi:10.1212/01.wnl.0000140292.04932.87.
  8. Kerti L, Witte AV, Winkler A, Grittner U, Rujescu D, Flöel A. Higher glucose levels associated with lower memory and reduced hippocampal microstructure. Neurology. 2013;81(20):1746-1752. doi:10.1212/
  9. Crane PK, Walker R, Hubbard RA, et al. Glucose levels and risk of dementia. N Engl J Med. 2013;369(6):540-548. doi:10.1056/NEJMoa1215740.
  10. Mayo Clinic. Diabetic Coma. Accessed Aug 31, 2020 from
  11. Saedi E, Gheini MR, Faiz F, Arami MA. Diabetes mellitus and cognitive impairments. World J Diabetes. 2016;7(17):412-422. doi:10.4239/wjd.v7.i17.412.
  12. Hashim SA, VanItallie TB. Ketone body therapy: from the ketogenic diet to the oral administration of ketone ester. J Lipid Res. 2014;55(9):1818-1826. doi:10.1194/jlr.R046599.
  13. Stoykovich S, Gibas K. APOE ε4, the door to insulin-resistant dyslipidemia and brain fog? A case study. Alzheimers Dement (Amst). 2019;11:264-269. doi:10.1016/j.dadm.2019.01.009.
  14. Dahlgren K, Gibas KJ. Ketogenic diet, high intensity interval training (HIIT) and memory training in the treatment of mild cognitive impairment: A case study. Diabetes Metab Syndr. 2018;12(5):819-822. doi:10.1016/j.dsx.2018.04.031.
  15. Brown D, Gibas KJ. Metabolic syndrome marks early risk for cognitive decline with APOE4 gene variation: A case study. Diabetes Metab Syndr. 2018;12(5):823-827. doi:10.1016/j.dsx.2018.04.030.
  16. Croteau E et al. A cross-sectional comparison of brain glucose and ketone metabolism in cognitively healthy older adults, mild cognitive impairment and early Alzheimer’s disease. Exp Gerontol. 2018 Jul 1;107:18-26.
  17. Fortier M, Castellano CA, Croteau E et al. A ketogenic drink improves brain energy and some measures of cognition in mild cognitive impairment. Alzheimers Dement. 2019 May;15(5):625-634.
  18. Cunnane SC, Courchesne-Loyer A, Vandenberghe C, et al. Can Ketones Help Rescue Brain Fuel Supply in Later Life? Implications for Cognitive Health during Aging and the Treatment of Alzheimer’s Disease. Front Mol Neurosci. 2016;9:53. doi:10.3389/fnmol.2016.00053.
  19. Cunnane SC, Courchesne-Loyer A, St-Pierre V, et al. Can ketones compensate for deteriorating brain glucose uptake during aging? Implications for the risk and treatment of Alzheimer’s disease. Ann N Y Acad Sci. 2016;1367(1):12-20. doi:10.1111/nyas.12999.
  20. Prins M. Diet, ketones, and neurotrauma. Epilepsia. 2008;49 Suppl 8(Suppl 8):111-113. doi:10.1111/j.1528-1167.2008.01852.x
  21. Bernini A, Masoodi M, Solari D, et al. Modulation of cerebral ketone metabolism following traumatic brain injury in humans. J Cereb Blood Flow Metab. 2020;40(1):177-186. doi:10.1177/0271678X18808947.
  22. Prins ML, Matsumoto JH. The collective therapeutic potential of cerebral ketone metabolism in traumatic brain injury. J Lipid Res. 2014;55(12):2450-2457. doi:10.1194/jlr.R046706.
  23. Greco T, Glenn TC, Hovda DA, Prins ML. Ketogenic diet decreases oxidative stress and improves mitochondrial respiratory complex activity. J Cereb Blood Flow Metab. 2016;36(9):1603-1613. doi:10.1177/0271678X15610584.
  24. Miller VJ, Villamena FA, Volek JS. Nutritional Ketosis and Mitohormesis: Potential Implications for Mitochondrial Function and Human Health. J Nutr Metab. 2018;2018:5157645. doi:10.1155/2018/5157645.
  25. Pacholok, S and Stuart J. Could It Be B12? An Epidemic of Misdiagnoses. Quill Driver Books, Linden Publishing, Inc. Fresno, CA, 2011.
  26. S. Department of Health and Human Services. National Institutes of Health, Office of Dietary Supplements. Choline Fact Sheet for Health Professionals. Updated July 2020. Accessed Aug 31, 2020 from
  27. Oregon State University. Linus Pauling Institute Micronutrient Information Center. Choline. Updated Jan 2015, accessed Aug 31, 2020 from
  28. Pointer SD, Rickstrew J, Slaughter JC, Vaezi MF, Silver HJ. Dietary carbohydrate intake, insulin resistance and gastro-oesophageal reflux disease: a pilot study in European- and African-American obese women. Aliment Pharmacol Ther. 2016;44(9):976-988. doi:10.1111/apt.13784.
  29. Luukkonen PK, Dufour S, Lyu K, et al. Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease. Proc Natl Acad Sci U S A. 2020;117(13):7347-7354. doi:10.1073/pnas.1922344117.
  30. Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond). 2005;2:35. doi:10.1186/1743-7075-2-35.
  31. Paoli A, Mancin L, Giacona MC, Bianco A, Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. J Transl Med. 2020;18(1):104. doi:10.1186/s12967-020-02277-0.


Comparison of electrolyte supplements and the importance of electrolytes on Keto

This entry is part 5 of 9 in the series Keto Basics

Electrolytes are super important when doing anything that lowers your insulin. That could be simply not eating a lot of sugar and refined carbohydrates, doing intermittent fasting, doing extended fasting, OR switching to a well-formulated ketogenic diet and lifestyle. By far, one of the most important electrolytes is sodium, which is funny because it’s one of the easiest to get (SALT!) and yet it’s one of the more controversial electrolytes due to decades of ignorance and misinformation. If you want the full story on salt, I’d recommend checking out the work of Dr. James DiNicolantonio – he does a far better job of explaining the science behind salt and its importance than I ever could.

The short version of why salt is so important to those lowering insulin is this: as insulin goes down, that signals to the kidneys they no longer need to un-naturally hold on to so much sodium. If your supply of sodium is low, your kidneys will start to dump potassium instead, and if potassium and sodium are low then magnesium will go “out the window” and into your toilet. From a diet and nutrition standpoint, sodium is “cheap” and plentiful. Potassium is “expensive” and harder to get. Magnesium is extremely “expensive,’ difficult to find, and even harder to find in a form that can be absorbed readily by humans. Magnesium deficiency is widespread and difficult to treat.

So: keep your salt intake adequate to preserve potassium, and especially magnesium.

Our bodies are really good at maintaining blood levels of electrolytes in a tightly controlled range, to the extent that testing the efficacy of topical (applied via skin) magnesium supplements is practically impossible (you would need to cut out a chunk of skin after application and test it for minerals BEFORE it enters the bloodstream). If and when electrolyte levels in the blood begin to drop, “reserve” electrolytes will be pulled from muscles, bones, and other tissues to maintain the blood levels of the electrolytes. This will first manifest as a headache or fatigue (the dreaded “Keto Flu!). If magnesium is low, it will often show up as muscle cramps and eventually as weakening of bones.

If you have high levels of electrolytes, your body gets to do a few things. First, it’ll store the electrolytes away for later use when levels are low. After all the storage space is full, it’ll tell your kidneys they don’t need to re-absorb as much. This is a key thing I learned from Dr. DiNicolantonio: your kidneys have to pull out all of the electrolytes, along with the toxins and water that’s being filtered out. Then, based on insulin and other signals, the electrolytes and other needed nutrients are pushed back into the blood as needed. If there isn’t a need to get back some of those minerals, it’s LESS WORK for the kidneys.

Again: an overabundance of electrolytes will generally represent LESS WORK for the kidneys. Sort of “oh, you already have enough of that stuff, OK I’ll take a break then!”

Can you overdo it on electrolytes? Yes, but the result is typically far better than a deficiency. Your sweat might be a little saltier, your urine may be a little more expensive; and in extreme cases of high electrolyte intake, you may have an extra bowel movement to clear out unabsorbed electrolytes (especially too much magnesium).

Saltier sweat vs. the prospect of headaches, fatigue, and cramps – I typically go for more electrolytes. The question becomes: how do you GET those electrolytes?

For sodium, the easiest, cheapest, and most savory (see what I did there?) is simply salt. For that, I cannot recommend Redmond Real Salt enough. It’s fantastic and it’s what we use for salt in our Keto Chow shakes (despite the issues with a bit of grittiness). Salt your food, salt your water, add extra salt to your Keto Chow shakes! If you’re doing an extended fast, you can also use the Keto Chow Fasting Drops which we created at the request of Megan Ramos from The Fasting Method.

Potassium is harder to get. You can use some “Lite Salt” (Potassium Chloride). You can eat some avocados or other foods high in potassium, or at least that historically have been high in potassium.

Magnesium is hardest of all and suffers from the same problem as potassium, but to a greater degree: the process of growing food and then shipping it away to be consumed breaks the nutrient cycle, causing modern foods to have far lower levels of magnesium, potassium, and other minerals than they typically would have had historically – that article only talks about vegetables and fruits but the meat that grows from eating plants grown in depleted soils suffers the same effects. Getting magnesium is further frustrated by the FORMS of magnesium typically found in magnesium supplements: Magnesium Oxide – it looks great on a supplement label with high amounts of magnesium… that YOU can’t use. Humans aren’t very good at absorbing magnesium that’s bound to oxygen, the efficiency is typically in the single percentages. Magnesium Citrate is absorbed easily by is also used as a potent laxative. Magnesium Chloride, Malate, and Glycinate are better with the latter two being magnesium bound to an amino acid and the former being magnesium bound into a chloride. Any magnesium supplement that doesn’t use a QUALITY magnesium you can absorb is worse than worthless – it’s a false sense of hope that you’re getting magnesium, that you simply will not.

OK, let’s compare some Electrolyte Supplements!

Prompted by an exchange on Facebook, I decided to put together a spreadsheet that would compare various electrolyte supplements, with breakdowns on exactly what you are getting for your money. How much 1000mg of potassium costs in a specific supplement. How much 1000mg of quality, bioavailable, Magnesium costs. How many total milligrams of electrolytes are you getting in each dose and what each milligram of minerals costs. You’ll find that different electrolyte supplements target wildly different doses, with some at 670mg of electrolytes in a half teaspoon, and others at 4400mg in a tablespoon! Breaking it all down is the only way to compare rock salt to rock salt.

Electrolyte Comparison Chart

In the comparison sheet, you’ll find that the least expensive supplements by cost per 1000mg of TOTAL electrolytes is sorted to the top. You can change the sorting order by going to the menus and selecting Data > Filter Views > and selecting one of the saved views. Or you can use one of these handy links to look at electrolyte supplements according to your personal electrolyte needs:

My plan is to continue to add additional electrolyte supplements to the list as I find them, and as people direct them to me, similar to the comparison of keto “meal replacement” options you’ll find elsewhere on this site.

You’ll notice that the Keto Chow Daily Minerals tend to be one of the least expensive (and usually IS the least expensive) options available for all 4 sorting methods (except sodium, it’s hard to beat Real Salt at that!). When we collaborated with Dr. Ken Berry to create the Daily Minerals, the primary purposes were to:

  1. Replace the minerals missing from modern diets due to the aforementioned depleted soils.
  2. Reduce the number of supplements people needed (frankly, I think Dr. Berry wanted fewer bottles of stuff at his house, so he had a custom supplement made just for him!).
  3. Use the best versions of the minerals possible with all pre-dissolved in their ionic state, ready for easy absorption.
  4. Not have anything added: no colors, no sweeteners, no flavors. If you want to add your own lemon juice or coffee, go for it. Want it straight because you are fasting or want to cook with it? also great.
  5. Include trace minerals, some only a few parts per million, to help with other as-yet-undocumented benefits.
  6. Price it as low as possible, while still being able to pay people to ship orders and keep the lights on.

How do the other Keto Chow Electrolyte supplements fit into the formula then?

If you’re like most people and not using the Keto Chow shakes for ALL of your 3 meals a day, we recommend using the Daily Electrolytes to establish a “baseline” of daily electrolyte intake. You’ll be “done for the day” for several with just that one dose, but you will still need more of other minerals – especially sodium and potassium. For those additional electrolytes: you can get them from the food you eat or drink. Or, if you need additional supplementation, from supplements including the Keto Chow Electrolytes. We have 3 different supplements available that you can use whenever you feel like you need more specific electrolytes:

  • Keto Chow Electrolyte Drops – designed to give a solid, balanced blend of sodium, potassium, and magnesium in high-quality forms you can actually absorb. Most people that just want to supplement electrolytes like this the best. No colors, sweeteners, or flavors. Works really well on steak or burgers, incidentally (no worries about heat degradation!).
  • Keto Chow Magnesium Drops – introduced to help Miriam stop getting headaches and muscle cramps at night, also helps her sleep better. Guess what, it’ll probably do the same for you! Uses a high-quality magnesium chloride concentrate and has a small amount of sodium and potassium, along with other trace minerals.
  • Keto Chow Fasting Drops – very high in sodium, with a workable amount of magnesium and potassium. The potassium in the Electrolyte Drops was too high for Megan Ramos of The Fasting Method, who asked us to make one that was more suited for their patients with kidney issues. Whatever Megan wants, Megan gets. The Fasting Drops are especially suited for dosing up sodium during an extended fast where insulin gets REALLY low and sodium requirements go up substantially. Still no flavors, sweeteners, or anything else to derail you while fasting, still has the same trace elements.

If you do happen to be using Keto Chow shakes 3 times a day (which isn’t required nor recommended to most people, it is POSSIBLE, however) then you will NOT need the Daily Minerals, period. You may still need some of the other electrolyte supplements as you feel necessary.

By |2021-06-28T14:15:22-06:00September 15th, 2020|Categories: Uncategorized|Tags: , , , , , , , , |5 Comments

5 Practical Tips for Starting Keto

This entry is part 6 of 9 in the series Keto Basics

My previous article walked you through a few things to know before starting a keto diet. But knowing what to do and actually doing it aren’t the same things. So now that you know the basics—what keto is, how it works, and what to focus on—here are some tips for getting started and setting yourself up for success.

As I mentioned last time, keto really isn’t that big a deal. It’s only as complicated, difficult, and expensive as you make it for yourself. The single most important thing is keeping your carbohydrate intake very low. If you have the financial means to consume solely organic produce and grass-fed or pasture-raised animal foods, that’s a great way to go. But if you’re on a tight budget and your go-to grocery shopping strategy is to get whatever’s on sale at your local supermarket or discount chain, you’ll do just fine. Keto isn’t about the provenance of your food; it’s about keeping carbs low.

But like I also said last time, even though keto is just regular ol’ food minus the sugar and starch, for many people, this is a pretty radical change. No more cereal or toast for breakfast, no more mid-afternoon latte and muffin. No more pasta dinners, no more post-workout fruit smoothies. Whether going keto will be just a mild shift from what you’re eating now, or it will be a massive overhaul of your entire diet, here’s some advice to make it easier, more convenient, and more delicious! After all, if a diet—keto or any other way of eating—is difficult, complicated, and forces you to eat things you don’t like, you’re not going to stick with it for long. So here’s to making keto simple and fun.

Give Your Kitchen a Makeover

A key factor in keto success is surrounding yourself with suitable foods, and only suitable foods. This is easy if you live alone, but more difficult if you live with family or housemates who aren’t jumping aboard the keto train with you. Let’s look at the former scenario first and tackle the latter one in a bit.

Clear out your kitchen! If you’re ready to start keto and you want to start now, get rid of everything that’s not appropriate for a ketogenic diet. Purge your pantry, cupboards, fridge, and freezer of all high-carb items. Don’t wait until you finish them all up. Ditch them now. If you’re starting keto to lose weight or improve a serious health issue, those foods aren’t doing you any favors, so why would you want to finish them? Toss ‘em! (Consider taking all sealed and non-perishable items to a local food bank or shelter.)

Depending on the style of keto you’re going for—there are lots of different ways to do it—get familiar with the foods that will become staples of your diet, and go stock up! The details will vary, but the core foods you can count on to work for any iteration of keto include fatty meats (beef, lamb, pork, poultry, bison, game meats), seafood, eggs, nuts and seeds, and non-starchy vegetables. High-fat dairy products, like cheese, butter, cream, and sour cream, are fine if you tolerate dairy.

Stock up when things are on sale. On a keto diet, your freezer is your friend. Fill the freezer with fatty meats—steaks, sausages, ground meats, pork chops, bacon, roasts, chicken thighs or drumsticks—whatever you like. Also, keep a few fatty protein options in the fridge. Having all that nice meat on hand doesn’t do you do any good if it’s frozen solid. Remember to always have a couple of options defrosted and ready to go. When the meat is defrosted, cooking may only take a few minutes depending on the cut.

Do the same with frozen vegetables. If you have space in your freezer, stock up on the ones you like. Broccoli florets, brussels sprouts, chopped spinach, blends of peppers, and mushrooms. Most supermarkets even have frozen riced cauliflower and spiralized zucchini noodles for convenient keto cooking. (When buying frozen veggies, make sure they’re plain and unseasoned, or watch out for the carb grams per serving if they do have sauce or seasoning.)

Eggs on sale? Keto jackpot! Buy several dozen. Use your own discretion, but the “expiration” or “sell by” date on an egg carton is really just a general guide. Properly refrigerated, eggs last a very long time, and they’re a gold mine of perfect fat, protein, and micronutrients for keto.

Prep Your Environment

Keto will be easier to stick to if you prepare large quantities of food ahead of time so there’s always something ready to go. Vegetables are great to have on hand, but what if you get home from work and you’re tired and hungry? You don’t want to start from scratch with peeling and chopping things when you’re exhausted after a long day. (Suddenly that pizza delivery menu will start looking really good…)

Whether you’re cooking for a crowd or just for one, never cook only enough for one meal. In most cases, it doesn’t take any longer to cook a large amount of food than it does a small one. If you’ve got the grill going anyway, don’t bother cooking just one or two steaks or chicken breasts. Grill five or six at a time—or more. You can have one for dinner and have another, cold, sliced into strips and dipped in blue cheese or ranch dressing for lunch the next day. Or use it as the protein on top of an entrée salad for dinner. Make steak & eggs later in the week for breakfast, or use pre-cooked steak and chicken in fajitas for dinner one night.

If you live in an apartment or some other arrangement where grilling isn’t feasible, use your oven in the same way. Invest in a large glass baking tray or rimmed metal baking sheet. Bake or roast eight or ten chicken legs or pork chops at a time. Most of it’s hands-off time, so while those are cooking, you can wash, peel, and chop vegetables for the week.

You can roast or steam a massive pile of broccoli or cauliflower all at once. Use it throughout the week with different seasonings each time. Using different herbs, spices, and even cooking fats, can make the same ingredients taste like an entirely new dish. Dice a mountain of onions, zucchini, and/or bell peppers. Sautee them with salt and pepper for a bit and store them in a container in the fridge. Since they’re already cooked, they’re an almost-instant side dish for any meat, or you can use them in an omelet. Just reheat and add whatever seasonings you like—curry powder, Italian seasoning, Tex-Mex, sesame ginger. The possibilities are endless, and it’s all entirely customizable to your own taste preferences.

Take advantage of the kitchen appliances and gadgets that make cooking quick and easy. Slow cookers, pressure cookers, and air fryers are good for making large pieces of meat that you can enjoy over the course of several days. (Keto pro-tip, for those who don’t want to cook every day: embrace leftovers!) Slow cookers and pressure cookers can help in the budget department, too: cuts of meat that are tough tend to be priced lower than tender, premium cuts, but when cooked using one of these tools, they end up melt-in-your-mouth soft.

Hard-boiled eggs are a common grab & go keto snack. If you’re boiling the water anyway, why bother with just a few eggs? Boil one or two dozen. You’ll thank yourself all week when hunger hits and all you have to do is open the fridge and snag one. The same goes for sausage links and bacon. Learn to enjoy certain foods cold. Cooking bacon? Don’t mess around with two or three strips. Cook the whole package; cold bacon is a dynamite keto snack. (Bake in the oven rather than frying on the stovetop for easier cleanup.) Sausage links are another ideal keto grab & go option. Fry or bake a few packages at once and fatty protein will always be handy.

What about non-perishables? This is easy since they require no preparation and no refrigeration. Keep a supply of keto-friendly foods to use as meals or snacks: canned seafood (tuna, salmon, sardines, mackerel), pork rinds, low- or zero-sugar beef jerky or meat sticks, nuts and seeds, cheese crisps, pepperoni, and salami. (These might call for refrigeration after they’re open.)

The name of the game here is, be prepared. Keto recipes abound online, and there are some incredibly creative and enticing keto cookbooks out there. Your cooking can be as intricate as you’d like. You can prepare a five-course gourmet meal every night if that’s your thing, but if keeping things simple will make it easier for you to stick to keto for the long term, all you really need to do is base your meals around a fatty protein and round out with low-carb vegetables if you choose to.

Doing Keto Alone in a Houseful of People

Getting rid of all high-carb foods is easy if you live alone. But what if you live with family or housemates, and you’re the only one doing keto? This definitely makes it harder. Your storage space will be limited if your fridge, freezer, and cupboards need to accommodate your keto-friendly foods in addition to the sugary and starchy fare the rest of your household prefers. One strategy is to have a designated cabinet, drawer, or pantry shelf that’s for you and only you. Keeping your keto goodies separate from other food might help limit your exposure to things that are off-limits.

Navigating the fridge will be more difficult. You can’t completely blind yourself from seeing others’ high-carb foods and beverages. You might just have to shore up your mental reserves and stay strong. Remind yourself often of the reasons why you’re doing keto. It’s pretty rare that anyone eats this way just for fun, so chances are you’re looking to lose a significant amount of weight or make a dent in a health problem. Whatever you’re trying to accomplish, are those foods going to help you get there, or will they only set you back?

Don’t assume it’s going to be difficult, though. Sure, you’ll be avoiding many of the foods you might have consumed daily for most of your life, but the good news is, for many people, sugar cravings disappear pretty quickly once they get carbs out of their diet. It doesn’t happen magically overnight for everyone, but many people are pleasantly surprised when they experience for themselves how much they don’t long for high-carb foods. There might, indeed, be times when you have to white knuckle it, but tell yourself that sugar cravings aren’t life-or-death emergencies. They’re not pleasant, but no actual physical harm will come to you if you power through and don’t give in to them. Remember: feeding the sugar beast doesn’t make it go away. It makes it hungrier for more. (A good way to satisfy a sweet craving, though, is to keep a Keto Chow shake in the fridge, and rather than drinking it all at once for a meal, take a swig once in a while to quench the sweet demon.)

Ketogenic diets are so good at regulating appetite that beyond weight loss and beyond better blood sugar control and other improvements in health, for some people, the best thing about keto is that—for the first time in their lives—they’re not hungry all the time. Not thinking about food constantly. Not planning lunch in the middle of breakfast, and not fantasizing about dinner before lunch is done. Intrusive thoughts of food no longer plague them 24/7. They’re freed from the shackles that kept them tethered to sugar all day. I can’t promise this will happen for you, but consider the possibility that sticking with keto will be easier than you think it will be.

As for cooking, don’t make this more complicated than it is. Family meals don’t need to change much. If you’re the “head chef” in your household, don’t become a short-order cook, making customized meals for everyone at the table. Household members who are doing keto can have fatty protein and vegetables; the others can have the same meal plus a starch or a sugary dessert. Don’t reinvent the wheel. It’s just food.

Have “The Talk” With Your Family

The physical logistics of making room for keto-friendly foods in a shared kitchen are easy compared to navigating the mental and emotional aspects of being a lone keto dieter in a home shared with carb eaters. If you have a spouse, significant other, and/or children in your home who won’t be joining you in eating keto, it’s a good idea to set some boundaries.

Ideally, your loved ones will be supportive of you implementing a lifestyle change to improve your health. They don’t have to eat the same foods you do, but they should respect you enough to understand that you have reasons for changing your diet, and they can be positive and encouraging around you.

That’s the ideal scenario, though. More likely, there’ll be someone or perhaps multiple people in your life who will feel threatened by the changes they’ll see in you and they’ll end up sabotaging you, intentionally or unintentionally. Sabotage may come in the form of “food pushing” – “Oh, you can have just this one taste,” or, “Aren’t you going to have any dessert? I made this just for you!” It can even present as passive aggression—eating your favorite high-carb foods right in front of you, on purpose.

Food triggers powerful feelings in people. Sometimes this is because those around you who are not making changes may feel like you’re judging them (even if you don’t give a hoot about what anyone else eats), and significant others may be worried that if your physique or health changes substantially, they might not be “good enough” for you anymore. These feelings have nothing to do with you and everything to do with the person expressing them. Their fears. Their insecurity. They don’t genuinely want to sabotage you; they’re just scared. They might not even be able to recognize that this is what’s going on, but you know, and now you can navigate those relationships with tact and grace.

People get awfully worked up when people close to them make changes in their life. A new job, a new diet: anything that threatens to change the status quo and alter relationship dynamics can make people uncomfortable. It’s simply human nature and none of us is immune. Spouses and significant others can feel especially threatened when their partner makes a major change—especially one that might result in significant weight loss.

If people close to you express negativity about you doing keto, consider having a polite and calm conversation about this. Let them know you understand their perspective but make it clear that you’re making these changes because you want to live a better life. If obesity or a major health issue is compromising your quality of life, then improving these things can only make you a better spouse, parent, friend, sibling, or coworker. Having a frank and honest discussion about how your health or your weight is affecting you—physically and mentally or emotionally—and sharing openly with them can provide them an opportunity to do the same. Perhaps they know their own life is limited because of similar issues but they were afraid to be honest about it. Opening the conversation can help both of you.

In other situations, it’s best to keep your mouth closed. The quickest way to turn others off to this way of eating is to proselytize about it. Don’t be “that person”—the one who can’t eat anything without commenting about how many carbs it does or doesn’t have. You don’t want people judging you or commenting on your low-carb food selections, so give them the same respect with regard to the foods they eat.

If someone expresses curiosity or specifically asks you for information, then sure, point them in the direction of some good resources. But whether it’s about diet or pretty much any other topic, one thing most people don’t like is unsolicited advice. So don’t give any. Even when you feel moved to. Even when you think keto could really help someone in your family or circle of friends. The best way to get someone interested in keto is to serve as a silent example of the incredible things this diet is capable of doing. Let your results speak for themselves and you won’t have to convince anyone to try it. They’ll come around on their own.

Be Prepared for it to be Difficult – or Not!

I explained a little about the “keto flu” in my previous article. Keto flu is the nickname for the unpleasant things some people experience as their body transitions from being fueled mostly by carbohydrates to being fueled mostly by fat. I said “some people” experience it, because despite the alarming warnings in keto circles, most people don’t go through a rocky adjustment period. Most people sail through and feel great pretty quickly on keto, but you do need to be aware of what to expect in case you’re someone who has a few hiccups.

If you ditch the carbs and have more energy, clearer thinking, and a well-controlled appetite right from the start, great. But be prepared with plenty of salt and magnesium supplements if you have headaches, muscle cramps, or feel dizzy or lightheaded. (If you’re taking medication for diabetes or high blood pressure, work with a doctor who’s on board with you trying keto, because your medications might need adjusting very quickly after starting keto. Some of what you think is keto flu might be effects of being overmedicated.)

So What Are You Waiting For? Get Started!

Now you have no more excuses. You know what to be aware of before starting keto, and you have practical tips to jump in and do it. So get going. You can radically transform your health, and all you have to do is eat delicious food! That’s right: just regular food. What you don’t need to start keto is MCT oil, bone broth and collagen powders, ketone pills, gadgets, apps, and meters. It’s fine if you want to play around with all that later on, but when you’re just starting out, use your money where it will serve you best: on your food.

By |2020-10-06T09:24:50-06:00October 7th, 2020|Categories: Keto Basics|Tags: , , , , , , , , |0 Comments

Added Fibers in Keto Foods

This entry is part 7 of 9 in the series Keto Basics

Let’s face it: for some people, following a low-carb or ketogenic diet is easy. They ditch the bread, pasta, potatoes, candy, and other starchy and sugary foods and never look back. They’re totally content sticking with fatty proteins, non-starchy vegetables, dairy foods, and nuts and seeds. For others, though, including keto-friendly sweet treats can make it easier to stick to a lower-carb way of eating for the long term. But can you trust the labels? What if some of the ingredients aren’t quite so keto-friendly? What about the added fibers used to lend sweetness and bulk to foods marketed as “keto”? Are these totally benign, or could they be interfering with you reaching your goals with this way of eating?

First Rule of Keto Club

The first rule of tweaking your diet is: “If it ain’t broke, don’t fix it.” So, however you’ve constructed your keto or low-carb diet so far, if you’re happy with the results you’re getting, keep on truckin’! If you’re satisfied with your physical and mental health, and your energy levels (or as ancestral health authority Robb Wolf often says, “How you look, feel, and perform”), then you don’t need to change anything. If you’ve got a few favorite go-to keto nutrition authorities and they’ve said something that makes you want to change something about your diet, there’s no harm in experimenting. But you are the ultimate authority on your body, and you know best how something affects you.

But what if something you’ve been eating isn’t working so well for you? If keto bars, cereals, cookies, and the like are a regular part of your diet, could the added fibers these typically contain be a problem for you?

Why Added Fibers?

There are a few different reasons why food products marketed as “keto” often contain added fibers. For starters, these various fibers contribute bulk and texture, so in some cases they’re a fundamental part of the physical structure of the product. Another reason is that some of them have a sweet taste, so they’re also used as sweetening agents. (For example, fructo-oligosaccharide, a prebiotic fiber, is about half as sweet as regular sugar.1) And third, food manufacturers have long since caught on that many people doing keto diets go by “net carbs” rather than total carbs when counting their carbs for the day. (Net carbs is the total grams of carbohydrate in a serving of food minus grams of fiber and sugar alcohol.) The higher the fiber in a food, the lower the net carb count—and the more attractive to the growing numbers of customers looking for just these kinds of things.

Okay, sounds good so far. But are there any drawbacks to cramming a bunch of extra fiber into a food product? Is there anything a savvy keto dieter should keep in mind before making these things a staple of their diet?

Two main concerns come to mind with regard to added fibers used in keto food products: effects on blood sugar, and effects on the gastrointestinal (GI) system. We’ll address both of these, but let’s start with some general info on fiber.

The US Food and Drug Administration (FDA) provided its first official definition of dietary fiber in 2016, in the rules and regulations regarding nutrition and supplement facts labels. They specified that dietary fiber is a nondigestible carbohydrate in both soluble and insoluble forms, and includes both the fibers intrinsic to whole, intact foods as well as isolated and synthetic fibers that are added during manufacturing. The FDA identified at least 15 of these isolated and synthetic nondigestible carbohydrates, many of which you’ve probably seen in ingredient lists on keto food products2:

  • cellulose
  • pectin
  • guar gum
  • locust bean gum
  • hydroxypropylmethylcellulose
  • β-glucan
  • psyllium husk
  • mixed plant cell wall fibers
  • arabinoxylan
  • alginate, inulin, and inulin-type fructans (fructooligosaccharides)
  • high-amylose starch/soluble corn fiber (resistant starch 2, RS2)
  • galactooligosaccharides
  • polydextrose
  • resistant maltodextrin/dextrin

Effects of Added Fiber on Blood Sugar

It’s important to realize that here we’re focusing specifically on fibers that are added as ingredients in food products, and not the fiber that’s intrinsic to whole food. For example, inulin or soluble corn fiber as opposed to the fiber that occurs naturally as part of the food matrix in things like broccoli, almonds, or blackberries. It’s possible that added fibers might not have the same effect as fibers that are intrinsic to a food. One of the beneficial effects of dietary fiber is that it slows the digestion of food, which may help lessen the glycemic impact of a high-carbohydrate meal (how much and how quickly it raises blood sugar). But think about it: flaxseeds are high in fiber, but how likely is it that taking a tablespoon of ground flaxseeds along with a glass of orange juice is going to make much of a difference in someone’s blood glucose?

Back to that in a bit. First, let’s take a closer look at fiber overall. Dietary fiber is a type of carbohydrate that is believed to have little to no impact on blood sugar and insulin because it’s not digestible and therefore doesn’t enter the bloodstream. The reason humans can’t digest fiber is because of the chemical bonds that make up the molecular structure of the different kinds of fiber. Our digestive enzymes are very selective and act only on certain kinds of food molecules or chemical bonds. For example, the enzyme sucrase splits apart sucrose (“table sugar”) into glucose and fructose. The lactase enzyme breaks apart lactose (“milk sugar”) into glucose and galactose. We don’t have digestive enzymes capable of breaking the bonds in most dietary fibers, so fiber passes through the GI tract to the large intestine.1,3

If fiber isn’t absorbed, then it should have zero impact whatsoever on blood glucose. Turns out this is a bit difficult to verify in humans. Research is surprisingly sparse on individual responses to these added fibers, and research on the effect of these fibers specifically in the context of a low-carb or ketogenic diet is practically nonexistent. Most studies involve adding fiber to high- and moderate-carb diets or individual meals, and they’re intended to see if the added fiber helps reduce the glycemic impact or improves biomarkers related to type 2 diabetes or insulin resistance.4-9 (They usually do on the whole, although findings are mixed.10,11) Results from those studies don’t tell us a whole lot about the effect of adding fiber to low-carb or ketogenic meals, where we’re more interested in seeing if blood glucose is raised.

To say this another way, research findings from people eating high-carb diets might not be equally applicable to people eating very low-carb diets. If fiber is filling/satiating and helps to slow the absorption of glucose, then some of the purported “benefits” of fiber—feeling full sooner, eating less food, and having a smaller blood glucose excursion after a meal—are not necessarily positive aspects of fiber, itself, but rather, the fact that these effects may be mitigating the negative effects of eating a higher carb diet! (Particularly among people who already have diabetes or pre-diabetes.)

The authors of a 2020 review looking at the effects of isolated and synthetic fibers on markers of metabolic diseases concluded that for these added fibers to have an impact powerful enough to be relevant, the doses would have to be relatively high over a long period of time, and most importantly, the best effect would come when these are used instead of, rather than in addition to, digestible carbohydrates.10 (Interestingly, in things like low-carb breads and bars, that’s precisely how these are used.)

The best way to see if added fibers are affecting your blood glucose is simply to test. You can use a glucometer to check your blood sugar before consuming something that contains these fibers, and then test again, maybe at 15 and 30 minutes after eating the test food, and then at the 1- and 2-hour marks. This is easier said than done, though. As mentioned earlier, these added fibers are consumed in things like keto bars, cookies, ice cream, cereal, chocolate, etc.—items that also typically contain sugar alcohols. So if you did see a significant change in blood sugar, it would be difficult to identify what the responsible factor was: the fibers or the sugar alcohols. With the exploding popularity of keto, though, there are food options available now that are rich in added fibers but have no sugar alcohols at all or are much lower in them, like keto breads, crackers, and wraps.

All Fibers are Not Created Equal

In theory, fiber is not broken down and absorbed at all. But the more food scientists tinker with things, the more variable people’s responses might be. For example, you might see “resistant tapioca starch” on an ingredient label. This is created by manipulating the starch molecule in order to make it “resistant” to digestion so that it has a much lower impact on blood sugar. Note that the impact is lower, not nonexistent. The many different types of fibers vary in the amount of digestible carbohydrates they contain.12 One study determined that resistant maltodextrin from tapioca starch was about 86% fiber but had a glycemic index of 59 in healthy subjects.13 (This is considered a “moderate” glycemic index.) Subjects were given a large dose of the resistant tapioca starch—larger than would typically be included in a food product—but even so, as much as 30-70% of “resistant” starch can be metabolized, so for some people, even a relatively small amount of this ingredient can affect blood sugar.13,14 Like other fibers, resistant starch might have its best effect on lowering post-meal glucose and insulin levels when it replaces conventional digestible starch, rather than being added to high-starch meals as a supplement.15

Plus, there’s a lot—a lot—of individual variability in glycemic responses to food, including resistant starch. In a 2015 study conducted in Israel, 800 subjects were observed for a week, during which they consumed nearly 47,000 meals in total.16 They wore continuous glucose monitors, which provided over 1.5 million glucose readings over a total of 130,000 hours. The results showed that the very same foods led to wildly different glycemic responses among individuals. This raises serious questions about the validity of glycemic index and glycemic load. Obviously, these are not fixed values if people have such different responses. How quickly and how high someone’s blood sugar rises after consuming a food apparently is not solely determined by the properties of the food, itself, but rather, by how an individual’s unique genetics and biochemistry prime them to handle that food.17 (Not to mention a host of lifestyle factors, such as sleep, that affect carbohydrate tolerance.18) One person’s low-glycemic high-fiber bran muffin could be another’s sugar-frosted breakfast cereal. So if someone else’s blood sugar barely moves in response to resistant starch or some other fiber, that doesn’t mean yours won’t.

Gastrointestinal Effects

Moving on from blood sugar, what about the GI effects of added fibers? It’s seen as a good thing that these fibers are not digested or are only partially absorbed in the small intestine, but for this very same reason, they can have negative effects lower down in the GI tract. The low digestibility of these fibers means they have little to no impact on blood glucose in most people. But because they’re not absorbed, they are passed along to the colon, where they serve as a food source for the bacteria that inhabit the gut. As mentioned earlier, humans lack the digestive enzymes to break apart these fibers, but our colonic bacteria break them down via fermentation. The result, for many people, is bloating, gas, and flatulence.19 Whether these are positives or negatives depends on your own level of discomfort, and whether you’re regularly in close proximity to other people!

Fibers also contribute to fecal bulking—that is, to a larger mass of stool.20 Conventional thinking says this is a good remedy for constipation, but larger, bulkier stools aren’t automatically a good thing. For example, if you have constipation, larger, bulkier stools are the last thing you want. (If your stool is already stagnating and not passing through your colon in a timely manner, why would you want there to be even more of it?) An intriguing study in subjects with constipation of unknown cause showed that following a zero-fiber diet led to increased frequency of bowel movements and complete resolution of several symptoms, like bloating and straining.21 A diet low in fiber might contribute to constipation for some people, but for others, increasing dietary fiber can make things worse.22

The news isn’t all bad, though. There might be some beneficial effects for colonic and overall health from consuming these fibers. The fermentation process generates short-chain fatty acids (SCFAs), which lowers the pH of the colon (makes it more acidic) and may help reduce the risk for colon cancer, improve mineral absorption, and reduce the growth of harmful bacterial strains in the colon.19,23 Plus, the SCFAs produced might have effects of their own, including being an energy source for colon cells, and having beneficial effects on the brain and central nervous system.23,24 Some of the supposed benefits of a higher fiber diet might be attributable to the butyrate rather than to the fiber, itself. (If “butyrate” reminds you of beta-hydroxybutyrate, one of the ketones your body produces on a ketogenic diet, pat yourself on the back! They are structurally similar and while they’re not the same molecule, they have some beneficial properties in common and there might be synergies that occur when the body has both.26,27 Small amounts of butyrate are also found in butter.)


If you’re concerned about the effect foods with a lot of added fiber are having on your blood sugar, get a glucometer (available at drugstores or online in the US), and test. This won’t give you any data on insulin, but it’s better than nothing, and it can give you helpful information to go on when deciding which kinds of fiber you’re comfortable including in your diet on a regular basis, and which ones you might prefer to avoid altogether or to have only once in a while.

And go with your gut, literally and figuratively. If fiber-fortified keto-friendly foods cause you physical discomfort, stay away from them! Don’t be bamboozled by slick marketing hype when your own body is giving you the clearest feedback you need.


  1. Punit Kumar, Kashyap Kumar Dubey (2019). Chapter 10 – Current Perspectives and Future Strategies for Fructooligosaccharides Production Through Membrane Bioreactor. Editor(s): Pratyoosh Shukla. Applied Microbiology and Bioengineering, Academic Press. p.185-202. ISBN 9780128154076.
  2. Alexander C, Swanson KS, Fahey GC, Garleb KA. Perspective: Physiologic Importance of Short-Chain Fatty Acids from Nondigestible Carbohydrate Fermentation. Adv Nutr. 2019;10(4):576-589.
  3. Roberfroid M. Dietary fiber, inulin, and oligofructose: a review comparing their physiological effects. Crit Rev Food Sci Nutr. 1993;33(2):103-48. doi: 10.1080/10408399309527616. Erratum in: Crit Rev Food Sci Nutr 1993;33(6):553.
  4. de Carvalho CM, de Paula TP, Viana LV, Machado VM, de Almeida JC, Azevedo MJ. Plasma glucose and insulin responses after consumption of breakfasts with different sources of soluble fiber in type 2 diabetes patients: a randomized crossover clinical trial. Am J Clin Nutr. 2017 Nov;106(5):1238-1245.
  5. Kamalpour M, Ghalandari H, Nasrollahzadeh J. Short-Term Supplementation of a Moderate Carbohydrate Diet with Psyllium Reduces Fasting Plasma Insulin and Tumor Necrosis Factor-α in Patients with Type 2 Diabetes Mellitus. J Diet Suppl. 2018 Jul 4;15(4):507-515.
  6. Thompson SV, Hannon BA, An R, Holscher HD. Effects of isolated soluble fiber supplementation on body weight, glycemia, and insulinemia in adults with overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2017 Dec;106(6):1514-1528.
  7. Abutair AS, Naser IA, Hamed AT. Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial). Nutr J. 2016;15(1):86.
  8. Tan WSK, Chia PFW, Ponnalagu S, Karnik K, Henry CJ. The Role of Soluble Corn Fiber on Glycemic and Insulin Response. Nutrients. 2020;12(4):961.
  9. O’Connor LE, Campbell WW. A novel fiber composite ingredient incorporated into a beverage and bar blunts postprandial serum glucose and insulin responses: a randomized controlled trial. Nutr Res. 2016 Mar;36(3):253-61.
  10. Armet AM, Deehan EC, Thöne JV, Hewko SJ, Walter J. The Effect of Isolated and Synthetic Dietary Fibers on Markers of Metabolic Diseases in Human Intervention Studies: A Systematic Review. Adv Nutr. 2020;11(2):420-438.
  11. Alexander C, Swanson KS, Fahey GC, Garleb KA. Perspective: Physiologic Importance of Short-Chain Fatty Acids from Nondigestible Carbohydrate Fermentation. Adv Nutr. 2019;10(4):576-589.
  12. Stewart ML, Nikhanj SD, Timm DA, Thomas W, Slavin JL. Evaluation of the effect of four fibers on laxation, gastrointestinal tolerance and serum markers in healthy humans. Ann Nutr Metab. 2010;56(2):91-98.
  13. Toraya-Avilés R, Segura-Campos M, Chel-Guerrero L, Betancur-Ancona D. Some Nutritional Characteristics of Enzymatically Resistant Maltodextrin from Cassava (Manihot esculenta Crantz) Starch. Plant Foods Hum Nutr. 2017 Jun;72(2):149-155.
  14. Kendall CW, Esfahani A, Hoffman AJ, Evans A, Sanders LM, Josse AR, Vidgen E, Potter SM. Effect of novel maize-based dietary fibers on postprandial glycemia and insulinemia. J Am Coll Nutr. 2008 Dec;27(6):711-8.
  15. Champ MM. Physiological aspects of resistant starch and in vivo measurements. J AOAC Int. 2004 May-Jun;87(3):749-55.
  16. Zeevi D, Korem T, Zmora N, Israeli D, Rothschild D, Weinberger A, Ben-Yacov O, Lador D, Avnit-Sagi T, Lotan-Pompan M, Suez J, Mahdi JA, Matot E, Malka G, Kosower N, Rein M, Zilberman-Schapira G, Dohnalová L, Pevsner-Fischer M, Bikovsky R, Halpern Z, Elinav E, Segal E. Personalized Nutrition by Prediction of Glycemic Responses. Cell. 2015 Nov 19;163(5):1079-1094.
  17. Doo M, Kim Y. Obesity: interactions of genome and nutrients intake. Prev Nutr Food Sci. 2015;20(1):1-7.
  18. Leproult R, Van Cauter E. Role of sleep and sleep loss in hormonal release and metabolism. Endocr Dev. 2010;17:11-21.
  19. Erickson JM, Carlson JL, Stewart ML, Slavin JL. Fermentability of Novel Type-4 Resistant Starches in In Vitro System. Foods. 2018;7(2):18.
  20. Flamm G, Glinsmann W, Kritchevsky D, Prosky L, Roberfroid M. Inulin and oligofructose as dietary fiber: a review of the evidence. Crit Rev Food Sci Nutr. 2001 Jul;41(5):353-62.
  21. Ho KS, Tan CY, Mohd Daud MA, Seow-Choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012;18(33):4593-4596.
  22. Scharlau D, Borowicki A, Habermann N, Hofmann T, Klenow S, Miene C, Munjal U, Stein K, Glei M. Mechanisms of primary cancer prevention by butyrate and other products formed during gut flora-mediated fermentation of dietary fibre. Mutat Res. 2009 Jul-Aug;682(1):39-53.
  23. Stilling RM, van de Wouw M, Clarke G, Stanton C, Dinan TG, Cryan JF. The neuropharmacology of butyrate: The bread and butter of the microbiota-gut-brain axis? Neurochem Int. 2016 Oct;99:110-132.
  24. Bourassa MW, Alim I, Bultman SJ, Ratan RR. Butyrate, neuroepigenetics and the gut microbiome: Can a high fiber diet improve brain health? Neurosci Lett. 2016;625:56-63.
  25. Newman JC, Verdin E. β-Hydroxybutyrate: A Signaling Metabolite. Annu Rev Nutr. 2017;37:51-76.
  26. Cavaleri F, Bashar E. Potential Synergies of β-Hydroxybutyrate and Butyrate on the Modulation of Metabolism, Inflammation, Cognition, and General Health. J Nutr Metab. 2018;2018:7195760.
  27. Emran B, Franco C. Butyric Acid Influences How β-Hydroxybutyrate Modulates Fatty Acid Oxidation and Ketogenesis To Support Ketosis. Curre Res Diabetes & Obes J. 2018; 8(5): 555746.
By |2021-05-03T10:30:41-06:00April 30th, 2021|Categories: Keto Basics|Tags: , , , , , , , |0 Comments

Protein Sparing Modified Fasting AKA: PSMF or “Cut fat intake and up protein to break stalls” – with or without Keto Chow

This entry is part 8 of 9 in the series Keto Basics

The concept of a “Protein Sparing Modified Fast” or PSMF can sound a bit complicated at first, but it can be a fantastic way to break through a stall and cut body fat. PSMF isn’t for everyone and, depending on how you implement it, isn’t typically used for extended periods of time. You’re doing a sort of “fast” that’s designed to keep muscle protein intact (or “spare” it) while still letting your body consume stored fat for energy. The PSMF subreddit sums it up as:

PSMF is a ketogenic diet designed to jump-start a weight loss program (either for rapid fat loss for a body builder or those with some weight to lose) or break a stall. It is a modified fast and as such is not a lifestyle. The idea is basically to only eat to prevent lean muscle loss (protein).

The Basics of PSMF

With a typical Ketogenic diet you will be getting 20-50g of carbohydrates as an upper limit, with anywhere from 90-160g of protein (depending on goals, activity, and other factors), with fat as a variable that can come from the food you consume or from your body’s fat storage. For the rest of this article, I’m going to be using numbers from Maria Emmerich’s Macro Calculator. I’m setting the calculator to give numbers for a 220 lb, 40-year-old female with 35% body fat that we will call “Jane”; YOUR numbers will be different so please make sure you pull up the page and enter in YOUR measurements. The Calculator says that if Jane wants to lose weight quickly, she should use 2 different calorie/fat/protein/carb combinations (click to embiggen!):

PSMF Calculator Results for Jane

If Jane had selected regular “Fat Loss” instead of PSMF, it would have told her to do 1659 calories with 118g of fat, 130g protein, and 20 total carbs. There are a few important points that I would like to cover here:

  1. You will notice that we are ALWAYS talking about grams of stuff, we are not using percentages for the fat/protein/carbs. Macro percentages are ONLY used for treating epilepsy and even then it’s more properly done with a 4:1 or other ratios of fat calories to other calories instead of percentages. If you’re looking at a “Keto Macro Calculator” that uses percentages it isn’t going to be useful, that’s why we consistently recommend Maria’s calculator over all others.
  2. If you have looked at other “Keto Macro” calculators, you may notice that the amount of protein recommended is WAY higher. Craig Emmerich covers a lot of the old fear that people used to have about protein and why it’s unfounded in his presentations about PSMF given at Keto Salt Lake 2021 – I highly recommend checking it out.
  3. The text above the figures reminds you that protein in a MINIMUM, get at least that much and you can go over if you stay below the calories (by getting less fat).
  4. Right there in the calculator results, it explains the basic setup of how to do PSMF “Add 1-3 days a week of PSMF to speed up fat loss or break stalls. Then Fast Fat Loss macros above on the other days. If doing this two or more weeks in a row, add an overfeeding day each week with 400-600 additional calories of protein and fat.
  5. Maria recommends you stay under 10g of TOTAL carbs. You will quickly find that 10g of total carbs and 30g of total fat will necessitate a major change in how you eat on your PSMF days (hello chicken breast!).

Lemon Meringe Nutrition PanelHow you can use Keto Chow for PSMF

OK, we’ve covered some of what PSMF is and how to do it. How can you use Keto Chow as a tool to help you be successful with PSMF? First things first: we need to address the TOTAL carbs situation.

Most flavors of Keto Chow contain around 7.6g of total carbohydrates. If you wanted to use 3 meals of Keto Chow on your PSMF days, that would be 22.8g of total carbs before you even add any other food and 22.8 is more than 10! Here’s the thing about the total carbs in Keto Chow: 5.71g of that is acacia and xanthan gum fiber (mostly acacia). Acacia gum is some REALLY cool stuff, especially for a keto diet. There’s a long explanation of the benefits of acacia gum on keto on this page, but the short version is: your body can’t digest acacia gum, but your gut bacteria DOES and it turns the former carbohydrate into short-chain fats. Carbs in -> turned into fats = happy gut biome with energy for your intestinal cells. All of this is why I, personally, do not count acacia gum (or xanthan gum) towards my total carbohydrate limit. With that acacia and xanthan gum quantity removed, the result is 1.8g of fiber and lactose carbohydrates – let’s call it 2g just for fun. 6g of carbs from 3 meals of Keto Chow still leaves me with 4g and that’ll be taken up by the incidental carbs in mostly meat that I’m eating to cover the rest of my protein goal after 3x Keto Chow meals made with 10g of butter each.

Enough about me, let’s go back to Jane and her goals! Jane needs to get 159g of protein, under 30g of fat. For Jane, that means 78.6g of protein from 3 meals of Keto Chow (or 52.4g if she uses 2 meals of Keto Chow – the number of meals of Keto Chow is entirely up to you!). Jane will be 80g of protein short doing 3x Keto Chow, but she knows that she got a full 100% of her vitamins and minerals because of the Keto Chow. How can Jane get that additional 80g?

It’s time for Cron-o-meter!

We love Cron-o-Meter around here! More info here about using Cron-o-meter to track your net carbs. The key difference between Cron-o-Meter and most other tracking programs like MyFitnessPal and Carb Manager is the Cron-o-Meter uses a curated database. That means every entry you find has been verified to be correct. I switched from MyFitnessPal after I tried entering butter into my tracking and there were 7 different entries that were wrong, one even said “butter (net carbs)” butter has 0.01g of total carbs per tablespoon, it doesn’t need a “net carbs” entry! Anyhow, the intricacies of Cron-o-Meter are beyond this particular blog post, but Jane took the numbers from Maria’s calculator and put them into Cron-o-Meter as custom targets:

Macro Targets in Cronometer

Jane goes ahead and enters the food she’s planning to eat that day. In this case, it’s 3 different flavors of Keto Chow, along with the 10g of butter that she’s having in each meal to make sure that she will be able to absorb the fat-soluble vitamins in the meals:

Food and Targets 1-Cronometer

Wait a minute: the fat is a little high when she uses 10g of butter in each shake! 10g of butter has 8.1g of fat and each of the skinless chicken breasts also 6.1g of fat. Let’s change the amount of butter in each Keto Chow to 7g. That will make for 21g of butter in total. Jane still wants to get around 10g of fat per meal so she can either have a chicken breast as part of 2 meals, or actually split up the 2 pieces of meat into 3 portions and have 2/3 of a breast with each meal. Check out Jane’s targets NOW!

Food and Targets 2That looks REALLY good. Jane is half a gram over on fat and 3g over on protein, but both are exceptionally close to her targets. For her non-PSMF days, Jane could take the approach of maybe doing 2 Keto Chow and having some beef for her 3rd meal. In fact: Jane decides to go to have 2 of the same 7g of butter Keto Chow shakes she had the previous day and then she’s going to go to Texas Roadhouse and get a 12oz Prime Rib along with a side salad.

Food and Targets 3Honestly, that’s phenomenal. Jane has a good plan in place! Additional PSMF Resources:

Is a keto diet safe for people with high blood pressure?

This entry is part 9 of 9 in the series Keto Basics

It’s no secret by now that ketogenic diets are excellent for weight loss and improving blood sugar control in people with diabetes (both type 2 and type 1). They’re also effective for reversing metabolic syndrome and helping to improve hormone balance in polycystic ovarian syndrome (PCOS). But keto diets also come with cautions about managing electrolytes—especially sodium. Can a diet that encourages a higher sodium intake be safe for people with high blood pressure? Let’s see what the science says. 


The Role of Insulin in Hypertension

Conventional thinking holds that a high sodium intake is a major contributor to high blood pressure (a.k.a. hypertension). The logic goes like this: in the human body, water follows sodium. If you eat more sodium, your body retains more water. Your blood is mostly water (almost 80%, in fact), so with more water in the body, your blood volume may increase. If you think about more water passing through the same amount of “pipe”—that is, your blood vessels—it makes sense that the pressure would go up. 

But the truth is, only a small percentage of people are sensitive to sodium in this way. Even when a large amount of sodium is consumed, properly functioning kidneys do an excellent job of holding onto just the right amount and excreting the rest with no impact on blood pressure. So what can get in the way of the kidneys being able to do this?

Insulin resistance (also called hyperinsulinemia) is a prime suspect. While insulin is most often associated with its role in lowering blood sugar, this is only one of several jobs this hormone is responsible for. Something else insulin does is cause the kidneys to hold on to sodium rather than letting go of the excess. In some people, chronically high insulin might be the primary cause of hypertension. One review article stated it in no uncertain terms: 

“Hypertensive patients have been shown to be insulin resistant, and because insulin can promote renal sodium reabsorption, several investigators have suggested that hyperinsulinemia may be involved in the pathogenesis of salt sensitivity of blood pressure.” 

A more recent review article echoed this perspective:

“Direct correlation between plasma insulin levels and blood pressure levels has been demonstrated and there is evidence to suggest a causal relationship between insulin resistance with resultant hyperinsulinemia and hypertension.”

The effect of high insulin (stimulated by a rising blood glucose level) on blood pressure is so powerful that two researchers even called salt “the wrong white crystals,” and suggested that refined sugar is a far more likely candidate compared to salt for causing high blood pressure.  


Insulin and Blood Vessels

In addition to affecting the blood, insulin also compromises healthy function of blood vessels. Think of your blood vessels as thin rubber tubes through which your blood flows. The vessels are supposed to be soft and pliant, and able to expand and contract to accommodate greater or lesser blood flow. Elevated insulin stimulates the sympathetic nervous system, which causes blood vessels to constrict. When blood flows through vessels that are constricted rather than soft and accommodating, the pressure goes up. Nitric oxide is a compound that helps blood vessels dilate and expand to let blood flow through smoothly. When insulin is high, though, this vasodilation is impaired, and it might be especially impaired in people with type 2 diabetes.       

Insulin also appears to stimulate cell growth within the blood vessels. Vessels that are thickened from excess growth may not function as well as healthier blood vessels, and they may be narrower too, both of which could result in higher blood pressure. 


What About Sodium? 

Sodium is an essential nutrient. The critical nature of sodium (from salt) is demonstrated by animals gathering around natural salt deposits and by traditional populations placing a high value on salt. It’s so highly valued, in fact, that it’s embedded in our everyday vocabulary: it’s a compliment to say someone is a “salt of the earth” person or is “worth his salt.” 

Despite the fearmongering about salt and the detrimental effects of a high sodium intake, diets that are too low in sodium might be more harmful for cardiovascular health compared to diets higher in sodium. A study published in the prestigious journal The Lancet in 2016 concluded that low sodium intake is associated with “increased risk of cardiovascular events and death” in individuals with or without hypertension—meaning even people with high blood pressure might not always benefit from reducing sodium intake, and low salt diets may also adversely affect those who are otherwise healthy. They concluded that reducing sodium intake would only benefit people with hypertension who had a high sodium intake: just 10% of the population. The remaining 90% would likely get no benefit from decreasing their sodium intake. 

What makes more sense, then? Reducing or addressing the underlying reason why the body isn’t able to properly balance its sodium level and maintain a healthy blood pressure? 


Keto and Insulin Resistance

Hypertension is included in the official diagnostic criteria for metabolic syndrome—a condition driven by chronically elevated insulin. So, researchers and medical professionals are well aware of the connection between a high insulin level and high blood pressure and have been since at least the 1980s.  

If elevated insulin is the major factor causing high blood pressure in most people, and if sodium is an essential nutrient, then rather than limiting intake of a critical electrolyte mineral, taking steps to bring insulin levels down might be more effective for improving blood pressure. And one thing we know is that ketogenic diets are highly effective for lowering insulin

A large body of clinical research shows that keto diets improve blood pressure in people with hypertension. The effect is powerful and may occur within a relatively short time after starting keto, so people taking medication for high blood pressure should be on the lookout for signs and symptoms of their blood pressure starting to get too low. This would be a signal that it’s time to talk to their doctor about reducing or stopping their medicine

There have been longstanding concerns regarding the effect of keto diets on kidney function. It’s important to know that as long as you stay sufficiently hydrated, keto not only isn’t harmful for your kidneys, but it actually appears to be beneficial. The notion that a high protein intake is damaging to the kidneys is not backed up by evidence, and recent research showed that a diet low in carbohydrates led to improved markers of kidney function in people with type 2 diabetes—including the de-prescribing of several blood pressure medicines.


Summing Up

Contrary to what some believe, keto diets aren’t dangerous for people with high blood pressure. In fact, it’s just the opposite: they may be beneficial. People taking medication for hypertension need to be aware that they may need to adjust their dose(s) or stop the medicine altogether when their blood pressure starts improving. 

By |2021-09-01T14:37:46-06:00September 1st, 2021|Categories: Keto Basics|Tags: , , |0 Comments