Drink lots of water. This is especially crucial on a low carb or keto diet. Why? When you eat carbohydrates, your body stores the extra as glycogen in the liver, where they are bound to water molecules. Eating low carb depletes this glycogen, which allows you to burn fat – but it also means you are storing less water, making it easier to get dehydrated. Instead of the traditional recommendation of 8 cups of water per day, aim for 16 cups when following a low carb lifestyle.

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, RD, 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.
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Ketosis was determined by measuring ketone bodies, specifically B-hydroxybutyrate (B-OHB), in capillary blood using a portable meter (GlucoMen LX Sensor, A. Menarini Diagnostics, Neuss, Germany) before measurements of anthropometric parameters. As with anthropometric assessments, all of the determinations of capillary ketonemia were made after an overnight fast of 8 to 10 hours. These measurements were performed daily by each patient during the entire VLCK diet, and the corresponding values were reviewed on the machine’s memory by the research team for managing adherence. Additionally, B-OHB levels were determined at each complete visit by the physician in charge of the patient. The measurements reported as “low value” (≤ 0.2 mmol/L) by the meter were assumed to be zero for purposes of statistical analyses.
Sleep quality was evaluated by determining sleep propensity and quality by means of the PSS and PSQI, respectively. Overall, participants showed a poor sleep condition with a total score >5 au (Table S1). Thus, a significant improvement in sleepiness (PSS) was observed when comparing the visit of reduced ketosis with baseline, a point that coincided with maximum loss of fat mass (Figure 3B). By contrast, no statistically significant effect was observed on sleep quality and duration (PSQI; Figure 3B). Accordingly, plasma levels of dopamine showed no statistically significant changes (data not shown).
First, don’t mistake a ketogenic diet (or the upgraded Bulletproof Diet) for the Atkins Diet. Whereas the Atkins Diet is extremely high in protein, a keto diet contains moderate amounts of protein. On a keto diet, large amounts of protein can turn into glucose in a process called gluconeogenesis, thus taking you out of ketosis. That’s why fatty cuts of meat are better than, say, chicken breast, which is high in protein and low in fat. Vast amounts of protein also tax the liver and lead to inflammation. By contrast, a ketogenic diet is anti-inflammatory; burning fat for fuel creates far less inflammation than burning sugar does[2], and ketones themselves turn off inflammatory pathways[3]. Because of this, ketogenic diets may in fact help prevent chronic diseases that are caused by inflammation. (Fun fact: The ketogenic diet is used to keep epileptic patients from having seizures.)
In the first week, many people report headaches, mental fogginess, dizziness, and aggravation. Most of the time, this is the result of your electrolytes being flushed out, as ketosis has a diuretic effect. Make sure you drink plenty of water and keep your sodium intake up.6One of the fathers of keto, Dr. Phinney, shows that electrolyte levels (especially sodium) can become unbalanced with low carb intake.
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