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The ketogenic diet has been a treatment for epilepsy since the 1920’s, but today, the diet has become one of the most popular diets for weight loss.
Why is that?
Well, to pick up where the Atkins diet left off, low-carbohydrate diets have been shown to produce rapid weight loss in a short amount of time. The ketogenic diet promises the same, just with a different approach.
Due to this diet’s popularity, researchers are now studying the effects of this high fat diet on other conditions including diabetes mellitus and neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease.
How Keto Works
The goal of this diet is to stay under 50 grams of carbohydrates per day. How do you do this? By increasing your fat intake to three-quarters or more of your diet. The ketogenic diet is made up of 70-80% of fat, 10-20% of protein, and 5% of carbohydrates (1).
The body’s first form of fuel is glucose. Glucose is supplied to your body when you consume carbohydrates. When the body digests carbohydrates, insulin levels increase to transport glucose to our cells to produce energy.
As carbohydrate intake significantly reduces, the body begins to accumulate fat. It is not until after a few days of consuming less than 50 grams of carbohydrates per day that the body is forced to use alternative sources of fuel. The alternative source of fuel the body switches to is fat.
The body is able to survive off of ketones, which is the byproduct of using fat for energy. This is called ketogenesis which is the primary goal of the ketogenic diet.
The objective is to stay in ketosis where the body alters its fuel source from carbohydrates to fat.
Over time, insulin levels drastically reduce and the body decreases fat storage, making it optimal for anyone seeking weight loss.
Seems promising, however, the ketogenic diet may lack certain nutrients that you are unaware of.
Steps to Take
Research discussing the long-term effects of the ketogenic diet on weight loss and other conditions is often limited and contradicting. More studies are needed to come to a conclusion as to whether this diet can be effective for the masses.
The difficulty of this diet is reducing your carbohydrate intake. A normal diet often contains 50% of carbohydrates, 20% of protein, and 30% of fat. Surprisingly enough, carbohydrates can be found in many foods, making it hard to limit carbohydrates consumption to just 5% of your diet.
It is understood that the diet is significantly lower in carbohydrates; yet, no one discusses the potential deficiencies that may occur due to this restrictive diet.
Dietary sources of carbohydrates include nutrient dense foods, such as fruits, vegetables, whole grains, and legumes, and other carbohydrates containing fewer nutrients (refined carbohydrates).
These natural sources of glucose provide us with vitamins and minerals that are often best absorbed through the diet. It is important to be mindful of the nutrients you may be missing while following this diet’s strict guidelines.
8 Useful Supplements to Take on Keto
So, if you are following this diet and feel that you are missing key nutrients, you might need to consider supplementation. As always, speak with your doctor prior to taking any new supplements or making any changes to your diet.
Let’s take a look at a few supplements that are important to take while following the ketogenic diet.
Within the first few days of the diet, less insulin is produced, and your body’s response is to get rid of any excess water, resulting in quick weight loss. However, as the body is constantly told to excrete water, electrolytes are lost along the way.
Electrolytes are imperative in your diet as they play very important roles in the body. These nutrients are responsible for balancing your pH levels, moving nutrients into cells, moving waste out of your cells, monitoring the amount of fluid in the body, and allowing major systems in the body to function property, including your heart, brain, muscles, and nerves (2).
A lack of electrolytes could induce the “keto flu,” which may cause nausea, vomiting, headache, fatigue, dizziness, insomnia, and constipation (3). These symptoms may resolve within a few days to a few weeks. Adequate hydration and consumption of electrolytes may help to lessen the duration of the keto flu.
So let’s diver deeper about electrolytes.
Sodium is responsible for maintaining fluid balance and regulating blood pressure. It also helps with normal nerve and muscle function (4).
If you are an athlete and following the ketogenic diet, excess sodium may be excreted from the body while sweating. This will result in a decline in energy and performance.
Sodium is often found in many different foods and beverages. However, with the potential onset of the “keto flu,” dietary sodium should be increased in the body. Adding extra sea salt, as well as drinking broth can improve your electrolyte levels.
Taking a sodium supplement is not common, as most Americans are more concerned with dietary approaches to reduce their sodium intake. The recommended limit of sodium in the diet is to not exceed 2,300 milligrams per day, and 1,500 milligrams per day for anyone who has hypertension or prehypertension (5).
It may be easier to find a supplement that contains salt and other electrolytes. Due to any potential issue of excess salt in the diet, it is recommended that you speak with your doctor prior to changing your sodium intake.
Potassium’s responsibilities in the body are the same as sodium, and have a significant effect on muscle contractions, specifically the heart. Low levels of potassium can alter your heartbeat.
This mineral is found in fruits, vegetables, lentils, dairy products, and protein (meats, poultry, fish).
A potassium deficiency, hypokalemia, may exhibit as constipation, fatigue, and muscle weakness.
Severe hypokalemia can cause increased urination and blood sugar levels, impaired brain function, muscle paralysis, and irregular heartbeat (6). A prolonged deficiency of potassium can increase blood pressure and risk of kidney stones, as well as deplete calcium in bones.
The recommended amount of potassium is 4,700 milligrams for adults over 19 years old.
Related: The 10 best reviewed potassium products.
Like sodium and potassium, magnesium is also an electrolyte. It is needed for many of the same functions as the other electrolytes, including production of protein, bone, and DNA.
Dietary sources of magnesium include legumes, nuts, seeds, whole grains, green leafy vegetables, dairy products, and fortified foods (i.e. breakfast cereals).
A magnesium deficiency may include loss of appetite, nausea, vomiting, fatigue, and weakness. These symptoms may mimic the symptoms of other common conditions; however, an extreme magnesium deficiency can cause muscle cramps, abnormal heart rhythm, seizures, numbness and tingling (7).
The recommended amount of magnesium for adults over 19 years old is 400-420 milligrams for men and 310-320 milligrams for women.
The “keto flu” may affect your electrolytes. Maintaining adequate electrolyte levels is imperative as it plays many different roles in the body, including one of the most important, monitoring contractions of the heart.
Electrolyte supplements only contain a fraction of these nutrients’ recommended intake as over-consumption can be detrimental to your health. Discuss supplementation with your doctor prior to taking.
Related: The 10 best reviewed magnesium products.
Fatty Acids & Oils
Another risk of following the ketogenic diet can be the potential increased risk of cardiovascular disease. Since this diet is high in total fat, hyperlipidemia can occur.
Some may find this diet difficult to follow. Hiding excess fat in the diet and still finding the regiment palatable can be challenging.
Traditional ketogenic diets were mostly made up of saturated fats (8). Increased consumption of saturated fats may lead to elevated low-density lipoprotein (LDL) cholesterol. Therefore, over time, adherence to this diet has the potential to lead to cardiovascular disease.
Related: The 10 best reviewed krill oil products.
Omega-3 Fatty Acids
Today, the traditional ketogenic diet can be altered to incorporate more monounsaturated and polyunsaturated fats, such as olive oil, avocados, nuts, seeds, and so on. These are the fats that help protect your heart and lower your cholesterol.
Researchers found that manipulating the ratio of fats from saturated fats to unsaturated fats, may reduce average cholesterol and triglyceride levels in children following the ketogenic diet for treatment of epilepsy (9).
If you or a family member have ever suffered from hyperlipidemia, you may have heard about the benefits of omega-3 fatty acids and how these fatty acids can help to reduce cholesterol. Over the years, studies have confirmed the cardioprotective effects of omega-3 fatty acids in dietary sources and even in supplements.
The American Heart Association recommends two servings of fish per week for people with no history of coronary heart disease. For cardio protection, one gram of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) is recommended per day. And upper levels of two to 4 grams of omega-3 fatty acids may help to reduce triglyceride levels (10).
Further studies are needed to define the recommended dosage of omega-3 fatty acids, especially while following the ketogenic diet. However, for now, supplementation of omega-3 fatty acids may be helpful for cardioprotective reasons on such a high fat diet.
Related: The 10 best reviewed fish oil products.
Medium Chain Triglycerides (MCTs) are a type of fat that can enter your bloodstream much quicker than any other type of fat. MCTs are primarily used for individuals with strictures or partial bowel obstructions to increase daily caloric intake and serve as a vehicle for lipid-soluble nutrients.
Some individuals may choose to increase MCT oils in their diet, rather than the traditional long-chain fats, which make up most of the dietary fats in our food supply. This is because MCT oil is more concentrated and has more beneficial effects on the ketogenic diet than dietary MCTs.
MCT oil has been shown to increase ketosis more rapidly (11). This may allow you to incorporate a few more fruits, vegetables, and other starches into the diet, if supplementing with MCT oil.
Coconut oil is a dietary source of MCTs, but the amount of MCTs in coconut oil, is less than pure MCT oil. MCT oil has a better effect on fullness after a meal compared to coconut oil, therefore, MCT oil aids in satiety and reducing daily calorie intake (12).
So if you are supplementing with coconut oil instead of MCT oil on the keto diet, you may need to be a little more mindful about your total carbohydrate intake for the day and your satiety cues.
However, it should be noted that even though this fat is more easily absorbed in the body, a quick transition to a high fat diet could be troublesome for any digestive system. You should slowly and gradually increase the amount of fat in your diet to allow your body to adapt to this change.
Also, it is important to be mindful that MCT oils pack a punch in the calorie department.
MCT oil can be an important addition to the keto diet to produce ketosis more rapidly, and also, allow you to consume more carbohydrate, nutrient-rich foods, such as fruits and vegetables.
Two vitamins that are vital to bone and cardiovascular health are vitamin D and calcium. Vitamin D actually aids in the absorption of calcium, which makes it very beneficial to take these two vitamins together.
As of recently, vitamin D has become one of the most common deficiencies. We work longer hours, live a more sedentary lifestyle, spend more time indoors, and consume less vitamin D rich foods.
You may not be at an increased risk of a vitamin D deficiency when following the ketogenic diet, however, it is important to be mindful of this nutrient no matter what diet you follow.
Vitamin D has many important roles in the body. This vitamin has been suggested to be protective against musculoskeletal disorders, immune diseases, cardiovascular disease, diabetes, several types of cancer, and impaired mental health (13).
Since ketogenic diet has been associated with increased risk of cardiovascular diseases, it is imperative to find nutrients that will work against this possibility.
If you are following the recommendation and between the ages of 19 and 70, you should be consuming 600 IU of vitamin D per day (14). Vitamin D rich foods include fatty fish (salmon, tuna), beef liver, cheese, egg yolks, and fortified foods (milk, breakfast cereals).
This vitamin can also be synthesized through your skin from direct sunlight. Depending upon time of day, season, weather, and where you live, vitamin D synthesis may vary. However, you should be aware that too much sun exposure might increase your risk of skin cancer. Wearing protective clothing and sunscreen with SPF can help to reduce this risk.
Long-term vitamin D deficiency can impact your bone health and may cause osteomalacia.
Related: The 10 best reviewed vitamin D products.
As stated above, vitamin D aids in calcium absorption, therefore, it is best to take these two supplements together, despite your diet.
In general, you reduce the absorption of calcium as you age. Also, as you get older, your body reduces the production of enzymes that digest dairy products. This is why you may hear about many individuals becoming lactose intolerant later on in life. Older individuals following the ketogenic diet may be at an increased risk of a calcium deficiency due to these specific reasons.
A 2015 study found that calcium, whether from a dietary source or supplement, could reduce the progression of loss of bone mineral density in those 50 years and older. Therefore, this mineral helped to reduce risk of fracture, as well as improve and maintain bone health (15).
The recommended amount of calcium to consume every day is 1,000 milligrams for men and women aging 19 to 50 years old. Besides dairy products, other foods that contain calcium include kale, broccoli, salmon, sardines, and most grains (16).
Those following a ketogenic diet would have to be aware of consuming kale, broccoli, salmon, and sardines regularly. If these foods are not at the top of your list, supplementation is highly suggested.
In some instances, excessive calcium supplementation may cause kidney stones. Prior to taking a calcium supplement, discuss the appropriate dosage of calcium with your doctor.
Even though a deficiency of vitamin D and calcium may not occur on the keto diet, it would be important to consider taking these supplements to maintain bone health and protect against cardiovascular diseases.
Related: The 10 best reviewed calcium products.
Vitamin B Complex
If you plan your diet correctly, you may not experience any vitamin B deficiencies. However, the ketogenic diet is lower in carbohydrates, specifically whole grains, which can potentially cause a deficiency. B vitamins are water-soluble vitamins, meaning if you go months without these nutrients, you will deplete your body’s stores and become deficient.
For example, one of the B vitamins, folate, is found naturally in fruits, vegetables, beef liver, whole grains, nuts, beans, and peas. Folate is also fortified in a wide variety of foods.
Women of child bearing years, specifically following the keto diet, should think about incorporating folate-rich foods due to the risk of neural tube defects in those who have a folate deficiency (17).
Supplementing folic acid during childbearing years, prior to pregnancy, will help reduce this potential risk.
Thiamin is also another B vitamin that may be affected by the keto diet. Thiamin can be found in whole grains, fortified products, legumes, and meats. The good news is this diet is moderate in protein, however, if you are following the traditional keto diet with 80-90% of your diet containing fat, you may be consuming less thiamin than you think.
A thiamin deficiency may cause loss of appetite, confusion, memory loss, muscle weakness, and heart problems (18).
Every B vitamin plays their own unique role in the body. A vitamin B complex can be helpful to supplement with to preserve your levels of folate and thiamin, as well as the other six B vitamins, to ensure proper bodily functions.
Most individuals understand the potential short-term effects of the keto diet (weight loss, “keto flu,” loss of appetite), however, it is important to note the long-term effects.
Long-term effects of consuming a high fat diet may include risk of cardiovascular disease, gastrointestinal diseases, impairments in bone health, and nephrolithiasis (19). More research is needed to further evaluate the long-term effects of following a ketogenic diet and weight loss.
Nonetheless, the keto diet has been around for decades as a treatment for epilepsy in children and this is where most of the research comes from.
These effects may not happen to you, but it is imperative to learn about the pros and cons of any diet prior to making any changes.
Tips to Maintain the Keto Diet
Be mindful of what you’re eating and how can you incorporate nutrients you need with less room for carbohydrates. Micronutrients (vitamins and minerals) are mostly found in carbohydrates and these are usually the best sources for your body as they are most readily available for absorption.
Overall, it is very important to consume green leafy vegetables to increase fiber content and other nutrients that may be reduced due to this diet. Constipation is a common side effect that can cause discomfort. Incorporating plenty of dietary fiber can help to alleviate this symptom.
Consider supplementation of these nutrients and discuss this with your doctor. As stated above, you may be at risk for a few deficiencies, as well as cardiovascular health issues associated with a high fat intake. In this instance, supplements can be crucial to the effectiveness and longevity of this diet.
General recommendations of how long the average person should follow the ketogenic diet ranges from a few months to a few years. If you are considering this diet, it is advised you are monitored by your primary care physician prior to and during this time.
The theory that “one diet fits all” has become antiquated. Researchers are learning more and more every day about how our diets and our food supply affect our health and our genetics. It is important to keep in perspective that even if a diet worked for a friend or colleague, you may not experience the same results.
If you are unsure whether a diet is the right fit for you, you can seek help from a registered dietitian. Dietitians specialize in finding the best approaches for you to take to follow a healthy lifestyle, while considering food allergies, intolerances, medications, and other variables.
Also, you should have a discussion with your doctor prior to making any changes to your diet and/or when adding any supplements to your regimen. The reason why it is important to consult with your doctor is because everyone’s dietary needs are different. Also, you may be taking medications that can cause deficiencies in certain nutrients or interact with certain foods that may be critical to this diet.
ⓘ Any specific supplement products & brands featured on this website are not necessarily endorsed by Nicolette.
Stock Photos from SewCream / Oleksandra Naumenko / Shutterstock
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About the Author
Nicolette is a Registered Dietitian specializing in nutrition and fitness. After, she received her Bachelor of Science in Dietetics, she completed her Master of Science in Nutrition from Stony Brook University where she focused on clinical nutrition and nutrition through the life cycle. Currently, Nicolette works as a private practice dietitian and a freelance health and wellness writer. Email Nicolette.