8 Things to Know Before Starting Keto

This entry is part 1 of 6 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

Is Keto Dairy Free?

This entry is part 3 of 6 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

Can Keto Make You Tired?

This entry is part 2 of 6 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 https://www.mayoclinic.org/diseases-conditions/diabetic-coma/symptoms-causes/syc-20371475.
  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

New Video: What is “Keto”?

This entry is part of 2 in the series Keto Chow Information Videos

What is “Keto” or a Ketogenic Diet, how do you do it? Miriam and Chris from Keto Chow sit down to talk about how to do a well-formulated ketogenic diet and set yourself up for success.

We have several other videos you should check out:

Here are Chris’ suggestions for calculating your macros:

Carbs are an upper limit, meaning do not go higher than that. You want to be as far below them as possible, approaching zero if you can.

You want to hit your protein goal. If you go over it, that’s not a big deal. There’s a thing in your body that can turn protein into glucose but it’s DEMAND driven, not supply-driven, and so long as you’re keeping your carbohydrates low, your insulin will be low as well and too much protein isn’t something to be concerned about. Too little protein is a problem. A lot of people argue about this but Dr. Benjamin Bikman settled the debate back in 2018:

Fat is more variable. If your insulin is low then your body will be able to supply fat using your body’s reserves (yay!). If you are just starting keto then your insulin is likely high enough that the fat is locked away and you will not be able to access it readily. Here’s the rub: you’re not eating carbs so you don’t have glucose; but you also can’t access stored fat so unless there’s sufficient fat on your plate, your cells will not have any sources of energy and you’re going to get hungry. Probably REALLY hungry and think this keto thing is a pack of lies. The solution is to make sure you are getting sufficient fat until your body figures out what it’s doing and can pull from storage. Especially when you’re starting up the amount of fat you’re eating. Throw some extra butter on your steak, add some more heavy cream to your diet root beer, etc… After you’ve adjusted, then you can start running a caloric deficit but you’re probably not even going to need to deliberately do it since your body should clue-in and tell you “nah, I’m full – save that for later”

Finally: this cannot be emphasized enough: get salt. Like: a lot of salt. Not to be melodramatic but everything you’ve been told about limiting salt consumption is dead wrong and has no application to a ketogenic diet with low insulin levels. Salt your food. Salt your drinks. Eat some pickles. Drink some pickle juice. Make some chicken broth. Add more salt to your food. Failure to get enough salt will result in you feeling like crap and getting “Keto Flu” – I can speak from experience.

By |2019-09-03T09:52:05-06:00September 3rd, 2019|Categories: Ketogenic|Tags: , , , , , |0 Comments