Living with a Ketogenic Diet
In my opinion, unless there is a medical issue you are using ketogenic to address, ketogenic eating is best done as a medium-term plan. I do not see it as a way of eating/living forever, mostly because of quality of life issues. Being a fat and oil monster gets old and I think keto is best used as a lever to accomplish a goal, after which a more sustainable, balanced, and enjoyable way of eating is adopted.
During the medium-term of eating this way, though, there can be a lot of potential problems that need to be solved. Ketogenic eating, at least in my experience, has made me face several other issues around health and eating that I simply wasn’t aware of before. Almost like as soon as I cleaned up how I was eating there was nowhere left for other issues that I had to hide.
Over the course of living with the ketogenic diet, one of the best attitudes you can adopt is one of flexible determination. You don’t want to be so rigid that you require certain weight loss every week, or that you make yourself crazy micromanaging your life. All eating strategies work because improved behavior is applied over a long period of time. Your weight may fluctuate up, down, and stay the same, but what we are all going for with keto is an overall loss, and that just takes time.
Food Sensitivities: When Food Attacks
One of the interesting things about eating keto is how it can make you face chronic food sensitivity issues. Perhaps it is that you feel so much better on keto, that feeling bad because of food feels worse and is, thus, more obvious. Or, maybe it is because through cleaning up your diet your body gets more tuned and thus any defects are more obvious. Whatever the case, ketogenic eating can unearth and make people face sometimes uncomfortable, or at the very least inconvenient, food sensitivity issues.
I’ll keep this personal. When I started doing keto it became pretty obvious that I had some sort of inflammation issue going on. I would wake up stiff, with sore joints, and swollen extremities. I had other weird symptoms that seemed to follow these around as well. With these sorts of sensitivities, the most likely culprit, just by commonality, is gluten. Well, we are already gluten-free due to celiac in the house, so that’s not it. The second most likely? Dairy. I know I felt MUCH better off of gluten, especially mentally, so this makes a lot of sense. Lots of people with gluten sensitivity also are sensitive to dairy (specifically, either to whey or casein).
Turns out, that was the issue. I cut dairy out and almost immediately my weight loss stopped stalling, the swelling/joint-pain vanished, and the other issues I had disappeared. After 3-4 days off dairy, the change was not subtle. It was obvious.
Turns out, ketogenic can be a nightmare hellride without dairy. Dairy is a huge, high-caliber weapon to put (delicious) fat back into the food you eat. Cream, sour cream, butter. All good, all delicious. I thought that I could at least have ghee, but nope, that makes the issues come roaring back. Super bummer.
So, on one hand, I am glad I found this food sensitivity, which may very well have been throwing a monkey-wrench into things for me my whole life. But on the other hand, I lost a huge tool and now I need to use oil and animal fat to get my ratios right.
The bottom line here is that as you do keto, notice when you don’t feel quite right. When you stall out for no reason for a long time (e.g. weeks), or even gain weight when you know your ratios and thresholds are solid. Notice how you feel first thing in the morning, all of the weird aches, pains, swelling. Follow an elimination diet if you have a hunch something is affecting you. At the very least, look at common allergens and see how you react. For a definitive answer, eliminate the suspect item for 30 days and add it back and see how you feel. To get a quick/dirty idea, eliminate it for five days and add it back. The difference should be obvious if there is an issue. Here are common food sensitivities to look at:
- Wheat (gluten)
Help! I Can’t Poop
Constipation on the ketogenic diet is a real thing. More than any other issue this one has taken me the longest to get a handle on. Things like salt water and MCT oil can really help with this issue. In fact, in my experience, constipation has almost always been an issue with salt. It is a finicky one to manage.
To treat this, try increasing your salt intake, first with meals then as a beverage (either chicken broth or salt water). I consume about 2 teaspoons of added salt a day (above and beyond what is in my food). I drink a lot of water, but I try not to drink too much water (I drink about 80-120 oz. a day, depending on if it is a running day or not).
For constipation, do some experiments and see if salt fixes it. If not, there may be a food sensitivity or other issue. Do some experimentation and see if you can figure out the root cause and address it.
Hitting Weight-Loss Plateaus
Plateaus are a bummer, as is when weight starts increasing. The whole point of this sort of eating for most people is to lose weight and it can be maddening when that isn’t happening (or it is being undone).
When a plateau is hit, and by plateau I mean sustained lack of weight loss for least least a week, there are a few strategies that will help you. First, is simply patience. Eating keto often causes weight-loss to be a little sporadic. I can go for two weeks and stay the same and then in one week lose six pounds. Sometimes, the best and easiest thing to do is just be patient and see if the issue abates on its own.
The second thing to look at, again, are possible food sensitivities. Inflammation and general processing difficulties can derail an otherwise solid diet. Look at the most common allergens and see if there is a connection. Trust your gut, this is detective work and a big part of it is following strong hunches.
The third thing to look at are other general self-care issues. Are you sleeping enough? Are you super-stressed? Is there something that is keeping your body from being calm? Often, looking for and removing areas of stress on ourselves can get our bodies out of panic mode and allow them to release weight. In my experience, the body needs to be at peace to let weight go, to know that survival is not at stake and it is OK to let emergency stores go.
The fourth thing to look at is to ask yourself how accurately are you really tracking what you are eating? Are you actually logging everything you eat? Are there hidden carbs (especially sugar), or protein, in something you are eating? Do you know your ratios are sound, that you aren’t exceeding your macronutrient thresholds, or do you just think you’re not? Incomplete information makes troubleshooting a stab in the dark, so the first step here is to record, and look at, what you’re actually eating, every gram of it. And, if you have developed bad habits like not logging foods you would rather not have to admit having eaten, know that is not helping you. Ketogenic eating requires good, solid data, and you are the data recorder.
If you have tried all of that and things still aren’t working, and you feel like crap, there is a chance keto may not work for you. Keto does not work for everyone and there is no sense suffering for no results. Check out the When Keto Doesn’t Work page and see if any of it resonates with you.
Brain Chemistry Bingo
Most people feel amazing on keto, with tons of energy, incredible mental clarity, and generally a skip in their step. For some people, though, this style of eating can exacerbate issues with brain chemistry. Our diet provides the raw material for our neurotransmitters, and sometimes those who have problems creating just the right amount of neurotransmitters can see their issues get worse.
One of the most common problems can be with serotonin. Those who are prone to serotonin depletion (those with SAD, those who respond well to SSRI’s, etc.) may find their serotonin goes into the toilet on a ketogenic diet. Normally, carbs and insulin are critical for creating serotonin, so by taking both away, an already shaky system may just topple over.
The bottom line is, if you find yourself with feelings of depression, or other mental health issues, see someone about it. There are solutions that range from pharmaceuticals to natural remedies, but the important thing is that you do something about it. Keto should feel great, and if you feel the opposite of great, there are lots of solutions out there.
Mineral & Vitamin Deficiencies
Keto is good at exposing more than just food sensitivities, it can also make the effects of mineral and vitamin deficiencies much more obvious and palpable. In fact, some of these deficiencies can mimic brain chemistry issues.
This is an incredibly complicated topic. If you feel like you might have vitamin or mineral issues, get some help and find out. There are resources ranging from doctors to testing you can do yourself. If you feel terrible, vitamin or mineral issues might be at play (more common is probably food sensitivities, though). Some basic testing can tell you if you have anything you severely lack, which if you do, correcting will make you feel a ton better.
Getting Out of Ruts
As is true with any regimented eating strategy, it can be easy to get stuck in a rut. Fat gets gross when you just feel like you are eating a ton of it, and repeating the same meals over and over can remove all joy and novelty from eating.
To keep from getting into a rut, especially after you have been doing keto for a while and you are a ratio-calculating ninja, now is the time to get creative. See if you can adapt your favorite recipes. Look for new foods. Two of my favorites are spam and pork belly. Know that although we live in a fat-phobic society, there are hidden gems out there that won’t require you to eat six tablespoons of cream/oil at every meal. Use your label-reading skills to see what you can find. Ask your butcher to make you up some 60% lean ground beef. Make a new best friend with someone who makes their own sausage. Learn how to make killer fat-based sauces. Your creativity is a huge asset and can not only allow you to avoid ruts but you can maybe even discover some new favorite foods.
This is a bit of a controversial topic and there are tons of opinions about it. In a nutshell, cycling keto is the practice of intentionally going out of ketosis for a short amount of time. This is most often done through the consumption of carbs, although the consumption of high amount of protein can do it as well, just a little less efficiently (and probably less enjoyably).
Again, there are a million opinions about this. Some people cycle out of keto every night with a spoonful of honey before bed. Some do a cheat day every week, where they do a free-for-all all day with as many high-sugar carbs and treats as they can mash into their face holes. Still others do a cheat meal once every week or two (this is what I do).
The basic premise of what you are doing when you cycle is keeping your body from adapting to keto too much, thus removing the efficacy of it. Over time, our bodies have an incredible ability to become efficient and a certain amount of weight loss requires a bit of inefficiency. Cycling also does some interesting things hormonally and otherwise, allowing stored fat to be mobilized, and utilized, even more.
As with everything else with keto, whether or not to cycle, and how to cycle, is up to you. Some people need to cycle just to keep their sanity and will accept losing a little less weight per week in order to not go bananas. For some people, it can actually make their weight loss go faster, by introducing some intentional stress to their systems which makes their weight loss process work better.
My opinion is that cycling is probably a good idea for most people. Probably better to do a cheat meal than a cheat day, and probably better every week than every two weeks. However, this comes with some caveats, namely:
Cheat Within Reason: On cheat days, always honor food sensitivities.
Don’t Go Insane: We aren’t trying to break records, or get sick. Just have a nice meal.
Treat Yourself: Go for your favorite foods, don’t blow your cheat meal on the banal.
Honor Your Limits: If your cheat meals sabotage your weight loss, back off either in frequency or quantity.
A lot of people swear by MCT oil on a ketogenic diet. What is potentially magic about MCT oil is that it gets converted to ketones inside the body very quickly. This supplies ketones fast, which boosts energy and gets you back into ketosis if you have cycled out. The problem with MCT oil, one that I have never been able to get over, is that it causes a pretty unpleasant bathroom situation. Even at doses as small as a teaspoon I have a bathroom emergency.
For some people, MCT oil is such a potent tool that they can actually get away with a lower ratio, since MCT oil floods the system with ketones, and once fat-adapted, the body will naturally favor ketones over glucose.
My advice is to try MCT oil. A lot of people love it in their coffee with some butter. The energy is great, and if you can handle it gut-wise, it can be wonderful.
Sauces to the Rescue
Especially if you are dairy-free, sauces can save a ketogenic diet. At almost every meal I have to add fat, and I add it by adding some sort of oil or animal fat (e.g. avocado oil, lard, tallow, etc.). Just having a puddle of oil on your plate every meal is the opposite of appetizing. However, by creating simple sauces, especially emulsions, it becomes a lot easier, and more appetizing, to add fat to foods.
A simple trip to the library, or a small order of books on amazon, or an afternoon on youtube can make a big difference. A little skill in the kitchen can go a long way. Learning how to suspend fat in sauces, as well as combine other flavors, can make some truly delicious creations.
Falling Off the Wagon
Ketogenic eating is very strict and can wear on even the most diligent eater. I choose not to eat dairy due to food sensitivities, so that means I have to eat a lot of oil and mayonnaise. That gets pretty disgusting after a while. In fact, once after about six weeks of hard 3:1 ketosis eating I broke. I almost threw-up at the dinner table two days in a row and simply could not finish my meal. I just couldn’t do it anymore, the mere thought of mayonnaise made me shudder, as did having to pull out a spoon at the end of most every meal and scoop up and eat the remnant oil.
The important point here is whether you are simply broken and can’t eat like this anymore, or simply fall off the wagon for another reason, try to be easy about it. It sounds counter-intuitive, but having a little bit of self-compassion at a time like this can keep this sort of issue from becoming a permanent derailing.
If you need to bail out of ketogenic eating for a while, that’s fine. If you know the ropes you can always come back to it. The key is to not let a break take you all the way down. When I break, I give myself a week of light-duty. If I am doing 3:1, I give myself a week of 2:1. I still honor my food sensitivities and I don’t go all cookie-monster on the pantry. Often, just a week of a little slack can help get back on track and keep going.
If you have simply fallen off the wagon, or your cheat day has turned into a cheat week, the same rules apply. Give yourself a time of light-duty. Humans are really bad at predicting the future, so even though it may feel like your feelings of not being able to eat this way are permanent, they will change, and if you give them a little time, you can get back into alignment with your goals and start moving forward again. The thing you want to avoid is feeling like either this fatigue, or this “failure”, is permanent. Nothing is permanent with eating, our patterns change all the time. Give yourself a little flexibility, but stay committed to your goals. Everyone gets off track from time to time, and the important thing is not that it happened, but what you do about it over the longer-term.
In the next section I discuss when keto doesn’t work and how to properly diagnose fatal errors with the keto diet for you.