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Ketosis Side Effects

Common Ketosis Side Effects and Treatments

Ketosis Side Effects

Not everyone experiences side effects when starting a ketogenic diet, and thankfully, those who do don’t usually experience them for very long. It varies with the individual, but just to make sure all your bases are covered, we’re going to breaking down each possible side effect and go over ways to manage and alleviate them if needed.

KETOSIS SIDE EFFECT 1 – Frequent Urination

As your body burns through the stored glucose in your liver and muscles within the first day or two of starting a ketogenic diet, you’ll be releasing a lot of water in the process. Plus, your kidneys will start excreting excess sodium as the levels of your circulating insulin drop.

Basically, you might notice yourself needing to pee more often throughout the day. But no worries; this side effect of ketosis takes care of itself once your body adjusts and is no longer burning through the extra glycogen.

KETOSIS SIDE EFFECT 2 – Dizziness and Drowsiness

As the body is getting rid of this excess water, it will also be eliminating minerals like potassium, magnesium, and sodium too. This can make you feel dizzy, lightheaded, and fatigued.

Thankfully, this is also very avoidable; all it takes is a little preparation beforehand. Focus on eating foods that are rich in potassium, such as:

  • Leafy greens (aim for at least two cups each day!)
  • Broccoli
  • Dairy
  • Meat, poultry, and fish
  • Avocados

Try making a smoothie to get all your greens and healthy fats. Check out this recipe Dr. Anthony Gustin (@dranthonygustin) shared on his IG — and follow him for more!

Oh how I miss you, delicious high-fat smoothie 😫 🌿🌱🍃Day 15 on carnivore and I am feeling quite amazing though! 🥩 ~ UPDATE: I don’t have “recipes” I make food to taste but if I recall this was something like: -a handful of blueberries -half a carton of coconut milk -macadamia nuts -a couple glugs of @perfectketones MCT oil -some chunks of cacao butter -some chunks of coconut butter -half avocado -spinach, kale, cabbage -some ice and maybe a little water to get consistency right MUST use a badass blender (I use blendtec) -toppings: you can see them. Put what you like to eat on top.

A post shared by Anthony Gustin DC, MS (@dranthonygustin) on

Add salt to your foods or use salty broth when cooking too. You can also dissolve about a teaspoon of regular salt in a glass of water and increase your hydration at the same time.

Adding salt to food might be new to you, since most people are used to being told to limit salt intake. However, when you’re eating a ketogenic diet of less than 60 carbohydrates each day, you’ll need to make up for this loss of salt. That being said, those with high blood pressure who take medication should check with their doctors before making a change.

Additionally, you might also want to supplement with 400 mg of magnesium citrate before going to bed each night.

NOTE: Magnesium supplementation is recommended for a few side effects in this article. But if you have any sort of kidney problems, DO check with your doctor before taking any type of oral magnesium supplements.


Also known as hypoglycemia, low blood sugar is another common ketosis side effect when beginning a ketogenic diet, especially for people who were used to eating higher amounts of carbs each day. When your body is used to intaking more carbs, it becomes accustomed to putting a certain amount of insulin out to handle the sugar.

So, when the amount of sugar intake is drastically reduced on a keto diet, it’s possible to experience short-term episodes of low blood sugar. That can make you feel temporarily tired, hungry, or shaky until your body adjusts.

KETOSIS SIDE EFFECT 4 – Cravings for Sugar

A great long-term benefit of the ketogenic diet is reduced cravings for sugar and other unhealthy foods. However, you might initially have stronger cravings for carbs during the transition period. This can last anywhere from one to two days to around three weeks. But stick it out! At the end, you’ll be pleased with the reduced, and often eliminated, cravings.

KETOSIS SIDE EFFECT 5 – Constipation

As your digestive system adapts, you might initially experience some constipation when new to the keto diet. This is often caused by dehydration as you release more fluids (remember how we talked about going to the bathroom more?).

Remedy constipation by making sure your intake of fiber is high, eating tons of non-starchy vegetables, getting enough salt, and drink tons of water each day to moisten the contents of the colon.

If that doesn’t help completely, try cutting back on your nut and dairy consumption. You might also consider taking 400 mg of magnesium citrate.


On the flip side of the previously mentioned side effect, some people might experience minor issues with diarrhea in the first few days. This can simply be a result of your body adjusting to the macronutrient ratio change. In other cases, some people make the mistake of limiting their fat intake along with their carbs, which makes your intake of protein too high and can lead to diarrhea.

Don’t skip on your fats! Be sure the carbs you’re limiting are being replaced by full fat sources instead of proteins.

For a little extra help, you take a teaspoon of plain psyllium husk powder or sugar-free Metamucil before eating a meal to help move things along.


Loss of minerals when first starting the keto diet can cause muscle cramps, especially leg cramps, in some people. Like with other side effects we’ve mentioned, drinking lots of water and eating salt can help by preventing cramps and reducing mineral loss.

And again, if you need to, consider a supplement. Doctors Jeff Volek and Stephen Phinney, in their book The Art and Science of Low Carbohydrate Living, recommend taking three slow release magnesium tablets each day for 20 days, then reducing to one tablet each day after that.

KETOSIS SIDE EFFECT 8 – Flu-Like Symptoms

Within the first 2-4 days of beginning a keto diet, a common side effect is known as the “ketosis flu” or “induction flu” because it mimics the symptoms of an actual flu. This means you might experience:

  • Headaches
  • Tiredness or lack of motivation
  • Lethargy
  • Brain fog or confusion
  • Irritability

Although these symptoms typically go away completely within a few days, they are also completely avoidable if you stay very hydrated and increase your salt intake (seeing a pattern here?). And like always, be sure you’re eating enough fat.


Some people have reported having trouble sleeping after beginning a ketogenic diet. If this sounds like you, it could mean your serotonin and insulin levels are low.

Try having a snack right before you go to bed that contains protein as well as some carbs to increase insulin and give your brain a nice dose of tryptophan, which is the precursor for serotonin, from the protein.

Another possible reason for impaired sleep could be increased intake of food rich in histamines, which can cause more anxiety and sleeplessness in some people. You can remedy this by eating less cheeses, avocado, bacon, and eggs, which contain a lot of histamines, and replacing them with more vegetables in your diet.

KETOSIS SIDE EFFECT 10 – Smelly Breath

Some people experience the smell of acetone on their breath when eating very low carb. Acetone is one of the ketone bodies created during ketosis, and it has a characteristically fruity smell similar to nail polish remover. This is a sign your body is in ketosis, burning lots of fats and converting them to ketones for energy. That’s great news!

Plus, those who notice this smell on their breath or body (and not everyone does) report it usually going away within 1-2 weeks as the body adapts to ketosis. But if it doesn’t completely go away in this amount of time, here are some tips for resolving it:

  • Keep good oral hygiene. Keep your breath fresh by brushing your teeth well at least twice day (hopefully you’re doing this already!).
  • Increase water intake. Bad breath can be caused by less saliva from dry mouth as your body releases water in a low-carb state. Drinking plenty of water will help counteract this.
  • Use breath freshener. Although this won’t eliminate the fruity smell completely, it will mask it as you wait for it to subside.
  • Slightly increase carbs. If you wait a few more weeks and still have trouble with the ketone smell, you might consider eating slightly more carbs to reduce the ketosis. Try increasing to between 50 and 70 grams per day. You might also try combining this with intermittent fasting, such as only eating within an 8-hour window, to maintain the benefits of ketosis without the side effect of fruity breath.

KETOSIS SIDE EFFECT 11 – Heart Palpitations

In the first few weeks of eating low carb, you might notice a slight increase in heart rate. This is probably more common in those who normally have low blood pressure.

It’s often simply due to lack of salt and water, causing a reduction in the fluid circulating in the blood. This may then cause the heart to pump slightly faster or harder. So again, drink, drink, drink, and salt your foods!

This problem should go away within a week or two, but if you need to after that time, you can slightly increase your amount of carbs.

You might also want to consider a high-quality multivitamin containing zinc and selenium and a magnesium supplement to replace any nutrients lost during adaptation.

Caution for Those with Diabetes

People with diabetes should note that drastically reducing carbs can decrease the need for medicine taken to lower raised blood sugar, so taking the same amount of insulin as before could possible result in too-low blood sugar on a low-carb diet. Heart palpitations is a symptom of that.

Be sure to speak with your doctor about changes you might need to make, and test your sugar levels frequently when starting the diet.

Caution for Those with High Blood Pressure

Similar to diabetes medication, those with high blood pressure might notice that their dose becomes too strong after starting a low-carb diet, as it can improve blood pressure. Heart palpitations can also be a sign of this. Speak with your doctor about the changes and be sure to check your blood pressure at home too.

Reduced Physical Performance

You’ll likely notice a large change in physical performance when first starting a low-carb way of eating, which is often caused by dehydration, lack of salt, and your body adjusting to burning fat for fuel.

It can take weeks and sometimes months for the body to adapt to the change from burning glucose for energy to using primarily fat. This part is mostly just a waiting game, but exercising while in transition might also help your body adapt faster.

Athletes are starting to experiment more with the long-term physical performance benefits of a low-carb diet, mostly those who do endurance sports and long-distance running, because there might be real advantages in performance once the body is keto-adapted. You can read more about the ketogenic diet for physical performance here.

AVOIDING Ketosis Side Effects

Ketosis Side Effects

If you noticed the common theme in most of these side effects with the ketogenic diet, it involves the transition in and out of ketosis. This is one of the main reasons we have made Perfect Keto Base — to eliminate any of the possible side effects as possible and ease the transition into ketosis.

Additionally, as you probably noticed, most of the common ketosis side effects can be helped or eliminated by:

  • drinking more water
  • increasing your salt intake
  • and making sure you’re eating enough fat

If you do still struggle with symptoms, though, a last resort would be to slightly increase the amount of carbs you’re eating to alleviate symptoms. The downside to this is that it will make your low-carb diet effective less quickly, but sometimes that’s necessary to continue it over the long-term.

Overall, just do your best to continue following the keto guidelines while also listening to your body. You’ll be a low-carb fat-burning machine in no time!


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