Congratulations — you’ve now made it past the really difficult part. The first few weeks of sugar withdrawal are finally behind you, and you’re starting to feel a little more normal.
Hopefully, you’ve settled in to a new routine, a new way of shopping, eating, and preparing meals. You no longer see food the same way, and have probably already started to shed a few pounds.
Your body now moves on to the next phase, where you start to see major changes.
WHAT’S HAPPENING TO YOUR BODY
Your body has now been consistently producing ketones for several weeks, assuming you haven’t been cheating. It’s still an inefficient process, but that’s okay. You’re finally tapping into your fat reserves, your blood sugar is more stable, food cravings are less severe, and your energy levels have likely returned to almost normal.
This is the induction phase, where your body is firmly in ketosis, and hopefully stays there most of the time.
WHAT TO EXPECT — THE POSITIVE
- Fat loss: As explained in the previous post, ketones are produced from fatty acids in the absence of glycogen. These fatty acids are sourced from dietary fat and/or adipose tissue (your fat stores) if dietary fat intake is insufficient. Assuming you are at a calorie deficit and in ketosis, then you’ll continue to experience weight loss. While the initial few pounds are mostly water, fat loss is more prevalent in this phase. While most people focus on weight, your waistline (measured in inches) is a much better indicator of fat loss.
- Less hunger, fewer mood swings and improved energy levels: Once you get over the initial keto flu, your body no longer freaks out when glycogen isn’t available. Since blood sugar now remains low all the time, ketone production is much more stable, providing a readily available source of energy. If you’re eating enough fat, you should feel satiated and less hungry. Your energy levels should be pretty much back to normal by now.
- Improved digestion: If you’re someone who normally ate a high-fibre diet (pre-keto), then going low-carb may actually give your digestive system a break. Contrary to popular believe, fibre puts a lot of stress on your digestive tract. Although we like to think of whole grains, legumes, and fruit as being healthy, they actually ferment and generate a lot of gas when broken down in the intestine. Gluten also destroys gut bacteria, messing up the body’s pH regulation system. Now that you’ve eliminated all the carbs, “healthy” and otherwise, your gut bacteria gets restored. Gone is the constant heartburn, indigestion and bloating.
- Less inflammation: Ketogenic diets are naturally anti-inflammatory. Inflammation can manifest itself in many ways — joint pain, acne, mucus production, skin rashes, allergies and bleeding gums are just a few examples. Inflammation is primarily caused by reactive oxygen species, which are produced through glucose metabolism. Once glucose production is minimized, all the inflammatory markers start to clear-up. Eliminate the source of the inflammation (i.e., carbohydrates), and the body magically starts to repair itself.
- Improved mental clarity and reduced brain excitability: Just as glucose produces inflammation in the body, it also has the same effect on your brain. Anecdotally, many parents complain that too much sugar makes their kids hyperactive. Although this theory has been disputed, I can honestly say I never experienced “mental quietness” until I went keto. As someone who always needed distractions and background noise, too much noise started to drive me nuts post-keto. For the first time in my life, I was able to fall asleep without the TV on. My brain is much more quiet and less distracted, making it easier for me to pay attention to what I’m doing.
- Less headaches and migraines: It’s not uncommon to experience headaches and even migraines when first transitioning to keto, likely due to the unexpected crash in blood sugar. However, once ketone production normalizes, a vast majority of people report a major reduction in migraine frequency and intensity. As someone who has lived with migraines for several decades, keto helped alleviate the severity, but not frequency, at least not at first. Since migraines were the reason I went keto in 2015, I was greatly disappointed at not being totally “cured”, but things are definitely a lot better than they used to be.
- Lighter menstrual flow and fewer cramps: Another major change for me was much lighter menstrual flow, and much less severe PMS symptoms[1]. Pre-keto, my period would last a solid 7+ days with very heavy flow. I was completely incapacitated for the first four days, unable to even go for a walk at times, despite popping extra-strength Advils every few hours. Post-keto, I get some mild stomach cramps on the first day only, and have dramatically reduced ibuprofen intake to just a couple on the first day. My flow is much lighter, my cycles last only 4 to 5 days, and my workout sessions at the gym are almost unaffected by my monthly cycle.
WHAT TO EXPECT — THE NEUTRAL
- Drop in blood pressure: A lower intake of carbohydrates equates to lower glucose production and lower water retention, since every gram of glucose binds 3 to 4 grams of water. Since blood is over 90% water, less water retention also lowers the volume of blood in your veins, which results in lower blood pressure. If you have high blood pressure, this is a welcomed side-effect. For me, this was a major problem. My blood pressure dropped from 125/85 to a low of almost 80/50, making me very sleepy during the day. This is something I started to struggle with about 2 months into my low-carb journey, and continue to struggle with many years later. The only answer is to get more sodium into your diet — way more than you think, as much as 6 grams a day which works out to 15 grams of table salt[2]. I periodically check my blood pressure when feeling run down. Both my partner and I have observed that blood pressure needs to be firmly above 90/60 in order to feel “normal”.
- Shorter sleep cycles: Many people report needing to sleep less when they shift into ketosis. This is because you enter deep sleep more quickly, so you can expect your sleep cycles to shorten. It’s important to distinguish between sleep quantity and quality[3]. Although carbs and alcohol may make it easier for you to fall asleep, sleep quality is compromised. People who regularly eat a low-carb/high-fat diet report needing only 6 hours of sleep, far less than the 8-hour norm. I battled with severe insomnia my whole life, needing about 10 hours to feel refreshed, which I never got, and therefore spent most of my life feeling sleep-deprived. Post-keto, I now average 5½ hours per night, and that works fine for me.
- Cold intolerance: I’ve been a hater of cold weather all my life. I often chastise my parents for emigrating from sunny southern-Italy to Montreal … why couldn’t they pick somewhere warmer? As my blood pressure went down post-keto, my intolerance to cold went from bad to unbearable. Indoor air conditioning became insufferable, and was a key driver for quitting my 9-to-5 office job and moving to Vancouver. If you’re someone who sweats a lot and lives in a hot climate, this might be a welcomed side-effect. However, if you live in a cold climate (hello fellow Canadians!) and have always really hated the cold, then keto will make your life a living hell.
- Smaller and less frequent bowel movements: Since high-fat/low-carb meals are more calorie dense than “traditional” diets, they tend to be smaller in volume, and have a lower fibre content. This leads to smaller and less frequent bowel movements. I think this is a good thing, but is often cited as a major strike against the keto diet.
WHAT TO EXPECT — THE NEGATIVE
- Drop in athletic performance: One of the big strikes against keto is the lack of readily-available glucose in your system, which makes it difficult to get that instant boost of energy. Pre-keto, I would always have a high-carb snack before my workouts, which would provide the glucose needed during exercise. If I tried working out in a fasted state (as commonly recommended for fat loss), I would get very dizzy and feel like I might pass out. Post-keto, there is now very little glucose in my system, but plenty of glycogen stored in my liver and muscles. Unfortunately, it takes some time to release that glycogen, providing the sugar (glucose) needed for your workout[4]. It’s therefore really important to spend more time warming up. This helps raise your blood pressure, build-up a small sweat and get the juices flowing[5]. Another common recommendation from Dr. Phinney is get some extra salt about 30 minutes before your workout (bouillon cubes and pickle juice are an easy source). It hasn’t totally fixed all my problems, but it has certainly helped a lot.
- Heart palpitations: It’s worth repeating once again … anyone following a low-carb diet must ensure they take in more sodium and potassium than the “average” non-keto person. Since low-carb diets reduce water retention, it also makes it more difficult to retain electrolytes (which are water soluble). As you run low on sodium, your liver starts to give up potassium in order to spare what little sodium is left[6], and really bad things start to happen. Two months into keto, my heart would start beating really hard, fast and erratically. I would later learn this was caused by a lack of potassium. Although potassium is commonly found in most keto-friendly foods, it’s not enough to meet the 4,000 mg/day you need when following a ketogenic diet[7]. At home, I use generous amounts of low-sodium salt[8], which is a mix of sodium and potassium chloride, to top up my potassium levels. This is in addition to regular table salt (not instead of). If you’re someone who sweats a lot or drinks a lot of water (which will flush out more electrolytes), your salt and potassium requirements may be even higher.
- Muscle cramps: I often forget my low-sodium salt when travelling or visiting family. If it’s just a few days, then no problem. After about 4 or 5 days, I start to get really painful cramps in my calves upon waking in the morning (when you tend to be most dehydrated). Again, this is an indication that your potassium levels are low. Once I restart my potassium top-up, my cramps disappear within a few days. Muscle twitching may also occur, although this tends to be mostly due to low magnesium levels. Magnesium requirements are much lower (only 400 mg per day), and much easier to get through diet alone. However, if you’re experience twitching, especially at night, you may need a magnesium supplement.
HOW LONG DOES THIS PHASE LAST?
For most people, this second phase last anywhere from 3 to 6 months. If you’re a relatively healthy person, closer to 3, but if you’re carrying a lot of extra fat and been eating a high-carb diet for several decades, it might be more like 6 to 9 months.
Phase 2 is where you see the biggest changes to your body and generally the most weight loss. Use this time to nail down your macros, establish new routines, and adjust your electrolytes to a level that’s comfortable to you.
You should be slightly hungry after a long fast (like first thing in the morning) or a heavy workout, but never stuffed and certainly not starved. If you’re still feeling hungry, adjust your fat macros higher. If you’re still feeling tired, then trying taking in more salt.
Don’t be afraid to make small adjustments, but please resist the temptation to backtrack or “cheat” during this phase. That will only delay fat adaptation, which is where you really start to see the benefits of a ketogenic diet.
And that takes us to Phase 3 — becoming keto adapted.
NOTES:
1 A less heavy, painful and prolonged menstrual cycle is part of the reason why keto is so popular among women who suffer from PCOS (polycystic ovary syndrome). PCOS is thought to be caused by too much insulin and inflammation in the body, making it more prevent among obese women.
2 Table salt is sodium chloride (NaCl) and therefore only 40% sodium (Na).
3 Matthew Walker‘s book “Why We Sleep” has a great explanation of sleep cycles, how it’s affected by carbohydrates, drugs and alcohol, as well as the effects of chronic sleep deprivation.
4 Research headed by Dr. Jeff Volek shows that muscle glycogen levels are the same for both high-carb and low-carb endurance athletes, both pre and post-exercise, despite the fact that keto-adapted athletes have “extraordinarily high rates of fat oxidation”. In other words, when in a prolonged state of ketosis, your muscles release all the glycogen you need for your workout, and you spend much more time in the “fat-burning” mode than athletes who follow a conventional high-carb diet.
5 Keto brought a huge sense of quietness and peace to my brain, which is great for focusing at work, but not great when you want to go hard and heavy at the gym. If you participate in sports that require explosiveness, like sprinting, karate or high-jumping, ingesting a small amount of carbs pre-workout (in the order of 10 grams) is recommended, but only after you’re firmly keto-adapted. This is most commonly referred to as the Targeted Ketogenic Diet. Nutritionist Alessandro Ferretti is a leading researcher in this field. Some of his findings are summarized in this interview with Luis Villasenor over at Ketogains.
6 When sodium intake is insufficient, you adrenals make aldosterone, which wastes potassium in order to preserve sodium.
7 Daily potassium requirements are 3,000 to 4,000 mg. To put that into perspective, a 100g of meat, a cup of green veggies and handful of almonds would provide only 1,000 mg, while a small avocado is 500 mg. In contrast, 4 grams of low-sodium salt adds 1,000 mg, which really helps to top up your potassium stores.
8 As noted in the previous post, Morton Lite Salt, Windsor Half Salt and Plochman’s Low Sodium Salt are three examples of low-sodium salts, containing about 20% sodium and 25% potassium.