The Lowdown on the Ketogenic Diet, Part 1

The ketogenic diet is rapidly gaining new followers, so we sat down with Scott Bergman, DC to get the scoop on this popular lifestyle option. This is part one of a series, where we learned about possible issues patients might experience with the ketogenic diet. Patients experiencing extreme symptoms should refer to their healthcare practitioner. Always work with a healthcare practitioner prior to starting a new diet plan.

What tips can you provide for minimizing or avoiding the “keto flu”?

Salt. Remember that insulin increases the reabsorption of sodium into the kidneys, and that leads to increased fluid volume. When we have that drastic reduction of carbs with a ketogenic diet, we’ll reduce the insulin, and that drastic reduction of carbs and insulin acts as a diuretic. That causes a pretty aggressive flushing of fluid, and anytime we lose fluid, we’re going to lose electrolytes. Not having enough electrolytes can be a really big problem. That’s an isotonic dehydration. If we replace the water lost without replenishing the salts, we get a hyponatremic dehydration. You can get muscle aches and spasms, twitches, restlessness, sleep issues, and dizziness. So getting in the salt is probably the answer for 95% of all keto flu issues. Partnering with a healthcare practitioner is important to avoid acute hyponatremia and address keto flu, and patients should notify their healthcare practitioner of any unusual, new symptoms.

We can use exogenous ketones; a serving of exogenous ketones usually has about 1,000 milligrams of sodium, which helps right away. I will try to keep the salt conversation with patients at the forefront of our consultations and really encourage somewhere between 4,000 and 5,000 milligrams a day. I also remind patients that it’s okay to have their coffee, but a normal cup of coffee will usually deplete about 500 milligrams of sodium. It doesn’t mean don’t have your coffee; it just means that if you’re going to have coffee or caffeinated tea, that you should add an additional 500 milligrams of salt per serving of beverages causing diuresis. Sometimes patients are afraid of eating the prescribed amount of fat and simply don’t eat enough. Adding calories back into the diet will help reduce the keto flu symptoms as well.

With the ketogenic diet’s higher dietary fat intake, are patients more susceptible to GI discomfort? If so, how do you recommend they address this?

It may be possible for some at first. We often blame the fat; research is showing fat gets a bad rap.

If people are having a hard time, I look at their diet diary because they might be doing a lot more MCTs right off the bat. Sometimes taking in a large amount of caprylic acid, you’ll get GI discomfort.

Then I’ll also ask the patient where the discomfort is. If it’s right under the sternum, I think about a digestive issue in the stomach.

If it’s distress below the navel, I’ll think large intestines. If there’s discomfort between the navel and the sternum, I’ll often think small intestines. One of the things that seems to be overlooked a lot when people do switch over to a ketogenic diet is whether the liver or gallbladder is healthy enough to handle the sudden increase in dietary fats.

What are other common issues patients might experience while on the ketogenic diet?

Initially there could be some mild fatigue, there could be sugar cravings for sure, the dizziness, a little bit of brain fog. I’ll always recommend reviewing the patient’s diet diary. The easy fixes could be needing to add more fat. Maybe we need to add more calories. Maybe if they’re really struggling, we have to just add a little bit more clean carbs and let the body kind of stair-step into ketosis rather than forcing the ketosis. Definitely exogenous ketones will help. The salt will help as well. Make sure they are hydrated and they are getting at least half their body weight in fluid ounces of water minimum. Exercise will help get people into ketosis as well. But I often have a discussion with people that in the beginning of trying to get into ketosis, there’s no carbs and there’s not enough ketones to fuel the body yet, so we’re often depriving the brain and the body of fuel, so it does take some time to allow the process to happen.


About Scott Bergman:

Scott Bergman, DC is a chiropractor, board certified naturopath, and certified Functional Medicine practitioner in Walnut Creek, California. Since 1993 Dr. Bergman has been the director of Chiro Kinetics, an integrative health clinic combining Chiropractic care, rehabilitation, pilates, core yoga therapy, Functional Medicine, and biological resonance. For 25 years, Dr. Bergman has presented edifying health, nutrition and fitness information internationally in business, education, and community settings. Dr. Bergman completed his chiropractic training at Los Angeles College of Chiropractic.

Scott Bergman is a paid consultant and guest writer for Metagenics.


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