Tips & Advice

Common Keto Problems and Their Solution

Below we have listed common keto problems and we will be updating this page as we go – so do check back now and then.

Here is a summary of the keto questions we’ll answer:

1. What is the “keto flu” and how do you overcome it?
2. Who should avoid the keto diet?
3. Does the keto diet cause bad breath and will “keto breath” go away?
4. The keto diet and constipation
5. Is the keto diet sustainable?
6. What to do when the keto diet stops working
7. Feeling like crap

Keto problems #1: Keto flu – what is it and what to do about it.

The keto flu is a collection of flu-like symptoms some people may experience when they first start the keto diet. It is the result of your body adapting to a very low-carb diet. This drastic reduction in carbohydrates can shock the body and may cause withdrawal-like symptoms, similar to those experienced when weaning off any addictive substance.

Whilst many people have no problem switching to the keto diet, others may have a harder time of it. Symptoms can range from mild to severe from person to person and include: 

  • Nausea, vomiting, dizziness
  • Diarrhea, constipation
  • Headache, irritability, poor concentration
  • Muscle cramps and soreness, weakness
  • Stomach pain
  • Difficulty sleeping
  • Sugar cravings

Symptoms typically last about a week, though some people may experience them for a longer period of time. While these side effects may be distressing, there are ways to reduce them.

What you can do about the keto flu

  1. Drink plenty of water. The keto diet can cause you to rapidly excrete water, increasing the risk of dehydration. Stay hydrated to avoid symptoms like fatigue and muscle cramping. This is especially important if you are experience keto-related diarrhea.
  2. Take a break from intense exercise. If you’re going through the keto flu and its associated fatigue, muscle cramps and stomach pains, it’s best to let your body rest. Give your body time to adapt to using its new fuel source (ketones). However, light exercise may improve symptoms. 
  3. Get enough sleep. Sleep is vital for wellbeing at any time but lack of sleep can worsen keto flu symptoms. To get a better night’s sleep:
    • eliminate caffeine
    • remove electronic gadgets from the bedroom (they emit blue light which disrupts sleep)
    • take a bath with epsom salts
    • take a melatonin supplement
    • retire/awake the same time each day
  4. Make sure you are eating enough fat and, yes, carbs. With keto, your new fuel source is fat, not carbs/sugar. It is therefore important to eat sufficient fat if you are to avoid feeling tired and run down. And whilst keto is a very low-carb diet – 20g of carbs a day – some may find this amount too low. If your keto flu symptoms persist beyond a week, you can try increasing this carb intake to 50g (but no more than 100g). This will be a “dirty keto diet” – but it’s still a dramatic improvement on your typical unregulated high-carb diet. Sometimes, gradually cutting back on carbs can help avoid/decrease keto flu symptoms. 
  5. Replenish your electrolytes. The key dietary electrolytes include sodium, potassium, magnesium. Sodium levels can rise in the keto diet. To maintain balance, all you need to do is salt your food according to taste. Your body will tell you what it needs. If you’re sodium deficient, you will probably crave more salt. If you have too much sodium, you’ll drink more water and want blander foods. As for potassium and magnesium – we recommend a good quality supplement. (Don’t be tempted to reach for a banana to replenish potassium. With its high sugar content, bananas are a terrible idea under keto).

How long does the keto flu last?

Most people report getting over keto flu in about a week. However, for some, it can take several times that. Fortunately, the symptoms do ease as your body gets use to converting ketones for fuel. 

The keto flu is common but if you are feeling particularly unwell and experiencing symptoms like prolonged diarrhea, fever or vomiting, it’s best to contact your doctor to rule out other causes.

Keto problems #2: The keto diet is not suitable for me

The keto diet works wonders for many people, but it’s not suitable for everyone. For example, it may not be appropriate for pregnant or breastfeeding women, children and teens, unless it’s being used therapeutically under medical supervision. 

Furthermore, the keto diet is not suitable for those with kidney disease, liver disease or pancreatic conditions.

Those with Type 2 diabetes can safely adopt the keto diet without consulting with a health professional. However, those with Type 1 diabetes should only transition to the keto diet in concert with advice from their GP.

Lastly, the keto diet may not be appropriate for individuals who are hypersensitive to dietary cholesterol.

Keto problems #3: Does the keto diet cause bad breath and will “keto breath” go away?

Some people report having bad breath – also known as “keto breath” – when starting the keto diet. It’s not so much bad breath in the same way as halitosis, but more a fruity-smelling breath similar to nail polish remover. Some people also report a metallic taste in their mouth. Keto breath is associated with your body being in ketosis and but not everyone experiences the problem. 

How to treat keto breath

Left alone your breath will generally return back to normal after 1-2 weeks as your body becomes accustomed to a low-carb diet. In the meantime, there are steps you can take to improve your breath:

  1. Drink more water.
  2. Eat less protein. As your body breaks down protein, it produces ammonia which can cause bad breath. Decreasing your protein intake and eating more healthy fats may improve your breath.
  3. Practice good oral hygiene. Brushing – but more importantly, flossing – can help with bad breath. Trapped food and dental plaque between teeth is a major cause of bad breath. Brushing only cleans about 25% of your mouth. The crevices between your teeth is where most of the dental plaque lies and to remove that you need to floss at least every other day (which cleans about 40% of your mouth).
  4. Chew gum regularly. Chewing sugar-free gum is also good for general dental health.
  5. Eat slightly more carbs. Keto breath is your body’s reaction to trying to adapt to a low-carb diet. If the adaptation is too dramatic, try going at a slower pace by reintroducing some carbs. However, don’t undo your good work: the keto diet recommends 20g carbs a day – you could increase this to 50g but not more than 100g. As the keto breath improves, you can slowly reduce the carbs again. (You may decide to increase your physical activity slightly to compensate for the increase in carbs.)

Keto breath does generally rectify itself and many believe it’s a small price to pay for some major benefits of the keto diet.

Keto problems #4: The keto diet and constipation

One side effect reported by people on the keto diet is constipation. Constipation is generally considered anything fewer than three bowel movements a week. Constipation can also be characterised by hard, lumpy, difficult-to-pass stools. 

Does the keto diet cause constipation?

Since the keto diet is a low-carb diet with a moderate amount of vegetables and virtually no fruit, constipation may be more likely – but it is perfectly avoidable. In addition, the high-fat content of the keto diet can help with regular bowel movements. But before we look at ways to avoid constipation on the keto diet, let’s see why constipation can occur with ketogenic eating:

  1. Not enough fiber. Simply put, it’s likely you’re not getting enough fiber under the keto diet. We will address this shortly.
  2. Eating low-fiber instead of high-fiber carbs. What limited carbs you are eating under keto should be high-fiber carbs (e.g. fruit, vegetables, seeds) If you opt for lower-fiber carbs (e.g. white bread, white rice, sugary snacks) you are in further fiber deficit, making it difficult for food to move through your gastrointestinal tract

So what should you do to counter and avoid constipation on the keto diet?

  1. Ensure you take full advantage of your fiber window. Here are some high-fiber keto-friendly options that you should consume regularly to avoid constipation:
    • Green smoothies (e.g. spinach, zuchinni, kale, cauliflower)
    • Leafy/collard greens
    • Seeds (chia, pumpkin, sunflower, flaxseed)
    • Cauliflower
    • Nuts (almonds, pecans)
    • Avocados
    • Berries
  2. Drink more water, drink more coffee.
  3. Take an over-the-counter stool softener
  4. If necessary, increase your carb intake up to 100g a day (max).
  5. Avoid processed/fast foods

Don’t ignore constipation – left untreated it can lead to serious complications including anal fissures, hemorrhoids and abdominal pain. If your constipation hasn’t improved over two weeks, speak to your pharmacist. Note however that they make suggest a fiber-supplement that will be high in carbs which will take you out of ketosis. But if your constipation is severe enough, this may be temporarily necessary in the interest of your overall health.  

Keto problems #5: Is the keto diet sustainable long-term?

Many people ask, “Is the keto diet sustainable long-term?” We’ve answered this in more depth but here, let’s take an overall look as to why the keto diet is sustainable.

The keto diet has only recently entered mainstream awareness in the last few years. As such, there has not been sufficient time to gather conclusive data about the long-term effects of the ketogenic diet. (In addition, it’s notoriously difficult to conduct long-term nutrition research as there are so many variables at play – some hidden or prone to inaccurate reporting/measurement over a span of years.)

With this in mind, there is no evidence that a long-term keto diet is bad for you. Let’s take a closer look.

Reasons why the keto diet is sustainable long-term

  1. Humans have the biological ability to use both ketones and glucose as fuel. Indeed, it’s likely that our hunter-gatherer ancestors lived much of their life in ketosis as food wast not always readily available. This meant eating very few carbs (humans had yet to discover mass agriculture) and fasting regularly (out of necessity). We are evolutionarily adapted to use ketones as fuel.
  2. We do not believe it’s coincidence that the keto diet offers so many benefits. Is it likely that something that’s bad for us would have improve the following?:
    • Blood glucose levels, i.e. helping manage or reverse Type 2 diabetes.
    • Lower triglyceride levels. High triglyceride levels are associated with increased risk of heart disease
    • Weight loss – keto is an effective intervention for obesity
    • Improved blood pressure. Low-carb diets improve blood pressure (as well as  weight loss and some cardiovascular risk factors) more than low-fat diets and some weight-loss drugs. 
    • Reduced inflammation. Chronic inflammation has been linked to almost every chronic disease in existence: heart disease, stroke, rheumatoid arthritis, lupus, cancer, Crohn’s and Alzheimers. The keto diet can help manage inflammation. It’s a cleaner diet, emphasising eating real foods – not highly-processed junk – as nature intended. In addition, when you’re in ketosis, you have anti-inflammation chemicals in your bloodstream.

If a diet can bring about all these benefits, is it harmful or is it possible that the mainstream opinion of what constitutes a healthy diet (e.g. low-fat) is wrong?

Keto problem #6: What to do when the keto diet stops working

This is a common keto problem: keto no longer works for you. However, whenever you say keto has “stopped working” for you, we are respectfully cautious.

Firstly, what do you mean by “keto doesn’t work anymore”? What is the standard you’re going by? For example, if weight loss is your measure of whether keto works then, of course, there will come a point where further weight loss is impossible. But that’s not to say the keto diet has stopped working. You still reap all of keto’s other health benefits.  

Secondly, when the keto diet stalls, chances are you’re doing one or more of the following to sabotage your success:

Keto problem 6.1: You’re eating too many carbs

Common among keto problems is eating too many carbs. To trigger ketosis – the metabolic state where your body starts to burn fat for energy instead of glucose – it’s crucial that carbohydrate consumption is kept extremely low (ideally 20g a day, no more than 100g).

The standard keto diet, prescribes that only 5% of your calories should come from carbs. (Contrast this with a typical Western diet where as much as 45-65% of calories is from carbohydrates). 

Carbs are addictive and so it’s not surprising that many keto beginners struggle with keto to begin with.

So, the first thing to rule out when your keto diet stalls is whether you are reducing carbs enough. (If you find the entire food tracking complex and time-consuming, check out our custom keto meal plans – designed to make the keto diet fool-proof and take all the calculations off your shoulders – just follow the plan.)  

Keto problems 6.2: You may be consuming too many calories

As keto problems go, this is easily fixed with just a little vigilance. If you’re trying to lose weight on keto, it’s essential that you maintain a calorie deficit, either through reducing your calorie intake (most realistic) or increasing your physical activity (not easily sustainable). (When it comes to losing weight, you can’t outwork a bad diet). 

Whilst keto is not concerned with counting calories or managing portion sizes, if your goal is to lose weight, you have to watch your calorie intake. This is especially important as keto-friendly foods (e.g. bacon, butter, MCT oil, oily fish etc) are high in calories so it’s easy to exceed your recommended daily calorie intake. Not to mention, if food portions are large and you’re continually snacking (to be avoided), it’s easy to see why you could be eating too many carbs.

Keto problem 6.3: You have unrealistic weight loss expectations

One of the most common keto problems. If you’re overweight or obese, it’s easier to see dramatic weight loss – simply because your have more weight to shed. However, as you lose more weight, additional weight loss is harder to come by and, inevitably, your weight loss will slow and eventually plateau. This is not failure – it’s a biological certainty! There’s only so much weight you can lose, regardless of the diet.
 
So, yes, eventually the weight-loss journey will come to an end – but that’s not a reason to give up ketogenic eating
 
In addition, you also need to have realistic expectations around weight loss. Most experts think losing 500g-1kg (approx 1-3lbs) a week is realistic and healthy. Yes, there are professional athletes who perform gruelling weight-cuts but those are neither healthy or safe. Just because a boxer can shed 9lbs in a day, that doesn’t mean you can – or should.
 
Also, bear in mind that weight loss is a lousy metric for measuring progress. (A better way would be to take measures of your waist, thighs, arms etc). The goal is fat loss, not weight loss. Weight loss fluctuates and if you’re working out, you will likely be losing fat but also gaining muscle. Most people would be delighted with that, and so “weight loss” doesn’t give you the whole picture. 

Keto problem 6.4: You are not eating enough nutritious foods

The keto diet is very flexible and sometimes that could result in a rather laidback approach to the diet, perhaps not eating as well as you should. You should take every meal as an opportunity to load up on as much nutritious food as possible. Get your vitamins, minerals, antioxidants, fiber and trace elements.
 
Try to eat as well as you can – paying a little more for better cuts of meat, non-starchy vegetables (e.g. peppers, avocados, broccoli, spinach…) and other whole foods for example. 
 
It you want a simple rule: wherever you can, choose real food over processed foods. 

Problem 6.5: You are continually snacking

The keto diet is very forgiving in that you don’t count calories;  you don’t have watch your  portion sizes, and you eat until you’re full. (“Wait, is this even a weight loss diet!?”) However, there is one thing that you need to do and that is try stop the continual snacking.
 
We advise you to have clearly defined eating times and to stick with that. Don’t eat outside of these preset times. (Many people find the 16:8 intermittent fasting window works well for them and fits naturally around the keto diet. 16 hours fasting, 8 hours eating window). Don’t eat when it’s not time to eat. And when you do eat, eat until you’re full then stop.
 
If you do snack, don’t always automatically reach for the high-calorie options (e.g. nuts, cheese, bacon, salami…) but mix in tomatoes, boiled eggs, dips, vegetables. Use some common-sense and moderation!

Problem 6.6: You aren’t exercising enough

As keto problems go, this can sometimes be overlooked because you can lose weight on keto without exercising. However, for faster results – and better health – exercise should be a part of your daily routine, especially if you’re trying to lose weight.  Exercise helps with fat loss and lowers your risk of chronic conditions such as diabetes, obesity, anxiety, depression and heart disease.  

Exercise also builds muscle which increases the amount of energy your body burns. 

Which exercise should you do? That’s up to you but we recommend that whatever you choose, you introduce an element of weight/strength-training, three times a week. Strength training helps build a leaner, more resilient, more functional body.

Problem 6.7: You’re not getting enough sleep

One of the more significant keto problems is difficult sleeping as sleep has such a huge impact on our wellbeing. Lack of sleep can negatively affect weight loss and lead to a decreased ability to manage stress. Stress produces the hormone cortisol – the “stress hormone” which can trigger fat storage in your body as it anticipates having to go into “survival mode”. If you’re chronically stressed and have difficulty getting a good night’s sleep, you may experience weight gain or difficulty losing weight.
 
Practise good sleep discipline: no caffeinated drinks after 4pm, no electronics in the bedroom, have an epsom salt bath and take a melatonin supplement, go to bed and rise at the same times each day, including weekends.

Problem 6.8: Rule out any underlying medical issues

If you have tried the above solutions without success this may be the solution to your keto problems: rule out any underlying medical cause that is preventing your weight loss. Conditions may include insulin imbalance, an under-active thyroid, polycystic ovarian syndrome (PCOS), depression and other conditions which can be ruled out by a series of tests. If you have any of these conditions, know that they can be managed.
 
So, we have looked at some of the most common problems that may arise when you’re on the keto diet and we have offered solutions to each. If you’ve been used to a high-carb diet for years, even decades, it’s only to be expected that any dramatic shift from that diet may produce some unpleasant symptoms. They can be overcome.
 
Whilst the path to keto may be trickier than you first expected, don’t give up – the payoff will be worth it!
 
If you’re still overwhelmed and not sure if you’re “doing keto right” – why not try the 28-day keto challenge where we set out everything for you – you just need to follow the plan!

Keto problem #7: Feeling like crap

Keto problems can include headaches and fatigue, nausea, coughs/sniffles and general irritability. Each of these can be traced back to distinct causes and can be treated as follows:
 
Headaches & Fatigue
Pre-keto, your body has become accustomed to burning carbs for fuel. Carbs – converted to glucose – is a very fast-burning, accessible fuel source. Fat, whilst energy dense, does not burn so quickly (until you reach ketosis). So, in the meantime – during the switch from carbs to fat – you’re going to feel tired and will likely suffer various aches and pains. It takes 2-5 days for your body to fully transition to ketosis and start burning fat. Until then, you’re effectively going cold-turkey but it will pass.
 
Nausea
The typical Western diet is low in fat after decades of low-fat propaganda and misinformation. Our bodies adapt to what we’re eating so if you’ve been on a low-fat diet, your body lacks the enzymes needed to break fat down – at least to begin with. It’s a big ask of your body to go from low-fat to a 60-80% fat-based diet. As such, excess fat goes undigested, triggering feelings of nausea – even vomiting itself. Again, it will take time to transition to transition to a high-fat diet if you’re not use to one. This is natural and your body will eventually adapt. In the meantime, consider increasing the fat intake gradually in the weeks before starting a keto diet.
 
Cough, Sniffles, & Irritability
These symptoms – similar to a common cold – can be due to dehydration and loss of electrolytes. Carbs store a lot of water and sodium so when you eliminate carbs from your diet, you will experience a fall in these, leading to the flu-like symptoms. For this reason, it’s important to stay hydrated (by drinking more water than you’re normally accustomed to) and to keep your electrolytes (potassium, magnesium, sodium, calcium, phosphorus chloride) up. To keep electrolytes topped up, eat avocados, spinach, salmon, sardines, seeds, dark chocolate, cheese – amongst other things – and salt your food to taste.
 
Irritability can be linked to disrupted sleep which is common during major lifestyle changes. Try to develop a sleep routine and schedule to improve the quality of your rest: go to sleep and rise at regular times each day; no electronic devices in the bedroom – these emit blue light which disrupts sleep; no caffeine after 4pm; take a bath of epsom salts; take a melatonin supplement.

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