Side Effects of the Keto Diet, According to Experts

Keto flu is a real thing. Cutting your carbs to the bone and going into a state of ketosis (where your body burns fat for energy) can bring on a cluster of uncomfortable symptoms, such as headaches, fatigue, muscle aches, nausea, and diarrhea. The side effects are the result of your body transitioning to using fat as its primary source of energy instead of carbs, explains Kristen Mancinelli, M.S., R.D.N., author of The Ketogenic Diet. Once it adapts to the new fuel source (usually within a week or two), you’ll start to feel better.

When you’re on a low carb diet you may not be getting the carbohydrates needed to produce serotonin, a brain chemical that helps regulate mood, as well as sleep and appetite—two other factors that can mess with your disposition, says Laura Iu, R.D., registered dietitian and nutrition therapist certified intuitive eating counselor based in New York City.

The keto diet is notorious for delivering a quick initial slim down. That’s because carbs hold on to more water than protein or fat, says Becky Kerkenbush, R.D., a clinical dietitian at Watertown Regional Medical Center. So when you stop eating them, all that extra H2O gets released through urination. As a result, the scale might read a few pounds lower, and you may look a bit leaner.

That first drop might be mostly water weight. But research suggests that the keto diet is good for fat loss, too. An Italian study of nearly 20,000 obese adults found that participants who ate keto lost around 12 pounds in 25 days. However, there aren’t many studies looking at whether the pounds will stay off long-term, researchers note. Most people find it tough to stick with such a strict eating plan, and if you veer off your diet, the pounds can easily pile back on.

Constipation is a common side effect of low-carb eating plans, including the ketogenic diet. Severely curbing your carb intake means saying goodbye to high-fiber foods like whole grains, beans, and a large proportion of fruits and vegetables, says Ginger Hultin, M.S., R.D.N., Seattle-based nutritionist and spokesperson for the Academy of Nutrition and Dietetics.

Combine that with the fact that your body is excreting more water, and you have a potential recipe for clogged pipes. You can keep things moving by getting some fiber from keto-friendly foods like avocado, nuts, and limited portions of non-starchy vegetables and berries, says David Nico, Ph.D., author of Diet Diagnosis. Upping your water intake helps, too.

“When we eat foods with fat, our liver releases bile into the digestive system to help break it down. Following a high fat diet like keto means that the liver needs to release extra bile—and bile is natural laxative, so too much can loosen stool and speed up how fast it moves through your system, leading to diarrhea,” says Iu.

When your body goes into ketosis, it will start to produce by-products called ketones. This includes acetone—yes, the same chemical found in nail polish remover, which your body actually naturally makes on its own, according to a 2015 review of research. “One of the ways ketones are released from the body is through exhaling, and breath usually has a distinct odor that’s different from the common bad breath experienced when there’s a build up of bacteria in the mouth,” says Iu.

Cutting out carbs can cause the brain to release a chemical called neuropeptide-Y (NPY), which tells the body that we need carbs; when we don’t get those carbohydrates our body needs, this chemical builds up and can intensify cravings, which can increase the risk of developing disordered eating patterns like binge eating, says Iu. “It has nothing to do with not having enough ‘will power,’ it’s more to do with the body’s biological response to deprivation,” she says.

The kidneys play an important role in metabolizing protein, and it’s possible that eating too much of the nutrient can have a negative impact on kidney function. While ketogenic diets are supposed to be much higher in fat than they are in protein, many keto eaters make the mistake of loading up on lots of meat, Mancinelli says. The result? You could end up eating way more protein than you actually need.

Here’s the tricky part: There’s no definitive answer for how much protein you’d have to eat before you run into trouble. “It really depends on how much protein a person is consuming versus how much they need, as well as the health of their kidneys at baseline,” Hultin says. That’s why it can be helpful to speak with a nutritionist or doctor who can help you tailor your diet before going keto.

Eating an ultra-low carb diet is linked to a lower rate of obesity, along with improved HDL cholesterol, all of which can translate to a lower risk for heart disease.

But your heart health might depend on what you actually eat. Research published in the New England Journal of Medicine suggests that low-carb diets based mostly on plant sources of fat and protein (like avocados or nuts) can lower heart disease risk by 30%. But those benefits didn’t hold for people who ate mostly animal-based proteins and fats. (Think: bacon, butter, and steak.)

Plus, the American Heart Association says that going overboard on saturated fat—which can be easy to do on a keto diet if you eat a lot of meat, butter, and cheese—can up your risk for heart problems. While you’re on the keto diet, you should have your cholesterol levels and heart health assessed by a doctor on a regular basis, Hultin says.

You may start to notice a difference in your skin on the keto diet, especially if you were a former sugar addict. Consuming lots of empty carbs is linked to worse acne—in part because these foods trigger inflammation and signal the release of hormones that up the production of pore-clogging oils, according to a review published in the Journal of the Academy of Nutrition and Dietetics. Some findings suggest that curbing your carb intake could help solve these problems, improving your skin as a result.

The keto diet has long been used to treat epilepsy and some research has shown that a keto diet may help with other neurological conditions like autism, Alzheimer’s disease, and brain cancers, says Melissa Prest, D.C.N., R.D.N., national media spokesperson for the Academy of Nutrition and Dietetics and member of the Prevention Medical Review Board. Newgent agrees that for people with epilepsy, “a keto diet may help to manage seizures.”

People with type 2 diabetes may have improved blood sugar levels along with weight loss, says Prest. The keto diet has become popular as a lifestyle intervention for people with obesity.

While in general Newgent doesn’t recommend following a keto diet, she says that studies suggest it may be helpful for improving insulin sensitivity or reducing hyperinsulinemia—”but anyone on diabetes medications or insulin would need close monitoring to prevent a dangerous drop in blood glucose,” she warns.