• Cause

With a sudden restriction in dietary carbs, one of the first things to happen is a drop in blood glucose levels, causing hypoglycaemia. This is a physical consequence of sudden carb removal. This occurs as the body has not yet learned to switch from burning glucose to burning fats and producing ketones.  The result is a temporary energy deficit and low blood sugar. For the most part, this is only a transient phase for as long as the body is adapting.

• Cure

Blood sugar levels will resume to normal once the transient phase is over and the body starts using ketones effectively for energy production.

You may experience cramps such as those in your legs as the body starts to suffer from carb withdrawal symptoms.

• Cause

A change in the electrolyte, water and hormone levels cause muscular crampingand aches and pains such as leg cramps. The blood levels of electrolytes such as calcium, magnesium, potassium and chloride are regulated by the kidneys. These electrolytes are crucial for maintaining body functions such as regular heartbeat and muscle contractions.

But when in ketosis, the kidneys store less water which results in dehydration and flushes out the electrolytes in the process. At the same time, glycogen which stores carbohydrates becomes depleted on the ketogenic diet. The same also traps 3 grams of water per gram of glycogen which further contributes to the reduced amount of water and electrolytes in the system. 

• Cure

The role of electrolytes is often overlooked when it comes to low-carb diets. Even if macronutrients such as carbs, proteins and fats are being managed properly, maintaining the correct balance of electrolytes is still important. Including potassium dietary sources can help manage cramping. To make up for magnesium depletion, include more leafy greens into the diet.

Digestive discomfort is not uncommon with a low carb diet, with constipation being an obvious one.

• Cause

Constipation can occur as the digestive system adapts to the transition to the keto diet. Any drastic change such as the one implemented in going keto, will eventually alter bowel movements. This effect can be aggravated by dehydration when a greater number of fluids get excreted by the kidneys. Plus, when you cut out certain high-carb but fibre-dense foods from the diet, you further contribute to constipation.

• Cure

To ward off constipation, try to include more fibre-dense foods into the diet along with drinking plenty of water. Having said that, too much fibre can also trigger constipation, so practice caution to strike a fine balance between the two. One thing to try out is use MCT oils which can help relieve constipationas the fats help push bowel movements through.

Diarrhoea is not uncommon on the keto diet either. If it happens it will be because of incorrect food choices and not the body going into ketosis.

• Cause

When cutting carbs, it can be tempting to pile on the proteins without increasing your fat. This can lead to diarrhoea. There needs to be an optimal balance between the protein/fat ratios to not only meet your energy needs but also for satiety.

• Cure

Since fat is the primary macronutrient here, pay attention to the type of fat you consume. Most of it needs to come from mono-unsaturated and saturated sources such as olive oil, coconut oil, butter, lard cream and avocadoes.

Also known as keto breath, you may experience a distinct odour or taste in the mouth that is different from ordinary bad breath. Some describe it as a metallic taste while others call it fruity tasting. Some have even equated it to smelling like nail polish remover. Where do you stand?

• Cause

Regardless of what your individual experience is with keto breath, low carb diets can cause bad breath.  This happens as the body starts to burn fats and certain chemicals get released. The good thing about this is that you know for sure that you have now entered ketosis, but on the flip side, yes, bad breath remains an issue.

• Cure

Maintaining good oral hygiene is the best way to deal with keto breath. At the same time, drink a lot of water, and use breath freshener to mask the smell until it goes away. This will typically take up to two weeks or so. You may also need to watch your protein intake as protein breakdown also releases ammonia which can aggravate the keto breath issue.

Heart palpitations refer to a racing heart which can often be a side effect of ketosis. Like many others on the list, this symptom also occurs during the initial few weeks of the ketogenic diet. This symptom may also be more noticeable in people who normally suffer from low blood pressure.

• Cause

A common cause of heart palpitations is dehydration as well as low salt intake. With a decrease in fluid levels, circulation also gets affected. Reduced circulation can trigger the heart to work slightly harder or even faster.

A word of caution for anyone with diabetes- going on the keto diet will involve making changes to your diabetes medication. Using the same dose of insulin as before can result in lower than normal blood glucose levels which could also trigger heart palpitations.

People who have hypertension may also notice heart palpitations after giving the keto diet a try.

• Cure

This issue should resolve in about one week or so and you should drink a lot of water to replenish lost fluids. Add in some salt to your foods and maybe consider a multivitamin with selenium, zinc, and magnesium to supplement any lost nutrients during adaptation.

If on diabetes medication, remember to adjust your dose accordingly. The same goes for anyone on blood pressure medication.

The initial switch to the keto diet can cause reduced physical performance. You may experience weakness, fatigue and overall tiredness. As a result, your exercise performance may also suffer.

• Cause

Feeling these effects are natural. All this happens as your muscles’ glycogen stores become depleted. Glycogen provides the main and most efficient fuel source for all forms of high-intensity exercise. But with ketosis in motion, the body starts using a different pathway to unlock the energy it needs to meet exercise demands. And this takes time. Breaking down fats as opposed to extracting energy from carbs is much harder and that’s why initially you will feel the fatigue. You may not be able to do the same number of reps as before or give in before you reach your optimal speed. But that’s okay.

• Cure

Just as your body needs time to adjust to its new fuel source so do your workouts. To deal with this decline in physical performance, you will need to scale down the intensity of your workouts as well. Instead of high-intensity workouts, that burn sugar as fuel, focus on low-intensity cardio which relies on burning more fats as fuel. This way, moving into ketosis will be much easier.

Starting a keto diet can bring about disturbed sleep and insomnia, especially in the early stages of the diet.

• Cause

The reason behind the sleep disturbances is given the low levels of serotonin and melatonin. Another aspect factoring in is the higher than usual energy levels. There is an amino acid called L-tryptophan that assists with the production of serotonin. Serotonin is a neurotransmitter known for calming the brain and contributing to better sleep and wellbeing. Serotonin is then converted into melatonin, the sleep hormone.

• Cure

To avoid sleep issues, try to have your last meal of the day earlier. This yields sufficient time to work off energy from the previous meal before going to bed. The same also provides enough fuel not to wake you up starved in the middle of the night. Once you get past the initial hump, many people report sleeping much better on the keto diet.

So how much and often do you communicate with your accountability partner? Decide between you and your accountability partner. But I would say at least report in once a day for the first 14 days, just to let them know how you are getting on. Discuss your highs and your lows, and some of the things with which you’re having difficulty. It really does help to talk to somebody. 

While not everyone may experience this symptom, some certainly will.  Experiencing hair loss after starting a new and somewhat challenging diet is nothing new and the good news is that it’s only temporary.

• Cause

Apart from age being an obvious factor, hair loss can also occur when you shift your dietary trends drastically. And this includes starting a keto diet. For the most part, this is believed to be due to a biotin deficiency. Another is because your hair goes into a system shock when you first start the keto diet. This type of instant hair loss where your scalp sheds a huge percentage of its hair is often tied to yo-yo dieting. So while your body may be in shock mode first, it gradually wears away. Once your body adjusts to your new diet, normal hair growth resumes as well. 

• Cure

If your hair loss is essentially tied to your dietary changes, then there isn’t much to worry about. After the first few weeks of change, hair growth will also return to normal as will many other functions. It is a mere waiting game, but if you’re concerned that hair loss may be due to some other reason, then there is no harm getting some professional opinion.

A rash that sometimes develops after starting a keto diet is referred to as the keto rash. While it can be annoying, itchy and extremely inconvenient, it is nothing dangerous. The rash comes out as raised and itchy skin lesions which could be brown, light pink or red coloured. It may start to resemble eczema or dermatitis and will usually appear on the neck, shoulders, chest, and back. For some, it may spread to the torso and armpits and in some rare cases, to the face.

• Cause

A few potential triggers pointing to the keto rash and ketosis connection include the high volume of ketones produced. Some other studies have shown the rash to be the cause of excessive fasting when blood glucose levels are low during fasting and the body shifts to ketosis causing the rash. And yet other studies relate a diet low in carbs causing significant weight loss in a short time to the rash.

• Cure

If you’re new to the diet, the rash may well go away on its own after a few weeks. However, if this doesn’t happen as it should, then try to reintroduce some carbs back into the diet. Monitor if carb reintroduction has any effect on the rash. If it does, you can try lowering your carb consumption and enter ketosis once again. If not, your body may be sensitive to ketones. You can then try a less restrictive low-carb diet.

There is a short-term increased risk of gout flares when initially entering nutritional ketosis. Gout is a rheumatic disease caused by an excessive production or insufficient excretion of uric acid. This causes crystal deposition in the affected joints.

• Cause

Even though the ketogenic diet boasts the lowest glycaemic index of any diet, there is a temporary increase in uric acid levels during the initial few weeks of the diet. This rise seems to go away after six or so weeks with uric acid levels coming back to baseline.

• Cure

Since the condition subsides after a few weeks, there is no real cause for concern. Recent research has also revealed that BHB, a ketone that is produced during ketosis, prevents many of the inflammatory pathways that are otherwise responsible for gout attacks and gout symptoms.

If you are predisposed to gout, then watch your consumption of meat and seafood consumption when on the keto diet.

Headaches come with any kind of change in eating habits and going into ketosis is a big one so be prepared for some to come on.

• Cause

Ketosis can bring about headaches not only due to the rapid decline in glucose levels but also due to the electrolyte imbalance and dehydration. Low insulin levels can trigger the kidneys to go into a diuretic state, so water, potassium and sodium are excreted.

• Cure

To create balance, salt and water intake should be monitored when you start a keto diet and an electrolyte supplementation considered.