The ketogenic diet—also known as the "keto diet" or just "keto"—is a big thing in weight-loss plans, touted by celebs like Halle Berry, Kourtney Kardashian, and Jenna Jameson. The diet involves cutting way back on carbohydrates, to 50 grams a day or less, to help the body achieve a state of ketosis, in which it has to burn fat (rather than sugar) for energy.
Doctors say that the keto diet can be helpful in treating epilepsy; it's unclear exactly why, but something about a ketogenic state seems to reduce the frequency of seizures.
A July 2021 review published in Frontiers in Nutrition confirmed the benefits ketogenic diets can have in reducing seizure frequency in individuals with drug-resistant epilepsy, in addition to reducing weight.1 However, the review also notes that without more data on long-term safety, it appears that the risks associated with this diet may outweigh the benefits.
As a general weight-loss plan, keto is controversial. Some health experts warn against it entirely, citing unpleasant side effects, health risks, and the diet's unsustainable nature. Even many keto diet proponents admit that if the diet's not done "the right way," it can be the opposite of healthy.
Here are a few things you should know about the ketogenic diet before you try it as a way to lose weight. Yes, you might drop pounds, but you should also watch out for the following side effects or complications.
"Some people report that when they start ketosis, they just feel sick," said Kristen Kizer, RD, a dietician at SportsTec Clinic in Kingston, Australia. "There can sometimes be vomit, gastrointestinal distress, a lot of fatigue, and lethargy." This so-called keto flu usually passes after a few days, said Kizer.
Josh Axe, a doctor of natural medicine and clinical nutritionist, estimates that about 25% of people who try a keto diet experience these symptoms, with fatigue being the most common. "That happens because your body runs out of sugar to burn for energy, and it has to start using fat," said Axe. "That transition alone is enough to make your body feel tired for a few days."
You may be able to minimize the effects of keto flu by drinking plenty of water and getting plenty of sleep. Axe, who sells keto-related supplements on his website, also recommends incorporating natural energy sources to battle fatigue, like matcha green tea, organic coffee, or adaptogenic herbs (herbs that may help your body deal with stress and fatigue).
If you find yourself running to the bathroom more often while on a ketogenic diet, a quick internet search will show you that you're not alone. (Yes, people are tweeting about keto diarrhea.) This may be due to the gallbladder—the organ that produces bile to help break down fat in the diet—feeling "overwhelmed," said Axe.
Diarrhea can also be due to a lack of fiber in the keto diet, said Kizer, which can happen when someone cuts way back on carbs (like whole-grain bread and pasta) and doesn't supplement with other fiber-rich foods, like vegetables. It can also be caused by an intolerance to dairy or artificial sweeteners—things you might be eating more of since switching to a high-fat, low-carb lifestyle.
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