5 of the worst keto diet side effects

The keto diet can help with weight loss, but at what cost?

  • In addition to weight loss, there are a few well-known side effects of the keto diet, some of which can be unpleasant.
  • Some side effects of the keto diet are bound to occur, though others only happen when the diet is implemented poorly.
  • The keto diet doesn't have to lead to a host of negative side effects, but anyone considering undertaking the diet over the long term should be especially careful.

The keto diet is often called a fad diet. Make no mistake: it is. But unlike other trendy diets, the keto diet is unique because it actually pushes the body into an alternate, natural metabolic state called ketosis. When this happens, you can reliably expect a few negative side effects, notably those that come with the "keto flu." But other side effects emerge only when people implement the keto diet poorly, typically by failing to eat balanced, nutrient-rich foods as a part of a high-fat, low-carb diet.

Here are a few of the worst side effects of the keto diet, most of which can be avoided with some careful planning.

​Constipation

What's likely to happen when you cut out common sources of fiber from your diet? Constipation. A 2015 study involving children on the keto diet showed that regular constipation was extremely common among participants, affecting about 65 percent of them.

"Many of the richest sources of fiber, like beans, fruit, and whole grains are restricted on the ketogenic diet," registered dietician Edwina Clark told Everyday Health. "As a result, ketogenic eaters miss out on the benefits of fiber-rich diet such as regular laxation and microbiome support. The microbiome has been implicated in everything from immune function to mental health."

Still, the keto diet doesn't need to lead to fiber deficiency: avocados, flaxseed, almonds, pecans and chia seeds can all provide fiber while still keeping you in ketosis — when consumed in the right amounts.

Vitamin deficiency

Any diet that prohibits you from eating many types of fruits, vegetables and other foods is bound to leave you vulnerable to vitamin and mineral deficiencies, and it's for this reason many doctors only advise going on the keto diet over the short term.

"Keto is not a great long-term diet, as it is not a balanced diet," Nancy Rahnama, M.D., M.S., an internal medicine and bariatric specialist, told Reader's Digest. "A diet that is devoid of fruit and vegetables will result in long-term micronutrient deficiencies that can have other consequences. The keto diet can be used for short-term fat loss, as long as it is under medical supervision."

On the keto diet, your body begins to shed fat, water and glycogen, and as this happens you lose key electrolytes, such as sodium, potassium and magnesium. When you're running low on these electrolytes, you might experience headaches or extreme fatigue. These losses are most pronounced during the first few weeks after you enter ketosis, so if you're going to start the keto diet it's best to plan ahead to make sure you get healthy amounts of these electrolytes — and other vitamins and minerals — either through supplements or a thoughtfully-designed meal plan.

​Muscle loss

Some research suggests that the keto diet can lead to the loss of lean body mass, which includes muscle protein.

"Muscle loss on the ketogenic diet is an ongoing area of research," Clark told Everyday Health. "Small studies suggest that people on the ketogenic diet lose muscle even when they continue resistance training. This may be related to the fact that protein alone is less effective for muscle building than protein and carbohydrates together after exercise."

The website sci-fit, which compiled a survey of the research on the keto diet, found:

"We generally see greater lean body mass (LBM) loss in ketogenic diet groups. Note that lean body mass contains water, glycogen, and muscle protein, by definition. It is hard to say with certainty that LBM loss implies greater "dry" muscle protein loss. "Wet" LBM can come and go quickly because it consists of water and glycogen."

In terms of gaining muscle, it seems protein alone doesn't do as well as it does when paired with complex carbs. These carbs don't become part of the muscle fiber, but they do help speed up the process, in part by helping cells regain glycogen — a key source of fuel during exercise.

The 'keto flu'

One of the most immediate side effects of the keto diet is the "keto flu," a suite of symptoms that many experience in the first couple weeks after entering ketosis. Similar to the flu, these symptoms can include fatigue, brain fog, dizziness, vomiting, nausea and stomach pain.

"The keto flu is definitely real," registered dietician Scott Keatley told Everyday Health. "Your body functions really well on carbohydrates — that's what it was designed for. When it switches to fat burning, it becomes less efficient at making energy."

The keto flu — and the accompanying sugar cravings – often leads people to give up the diet and begin scarfing down carbs, but those who stick it out usually report that the symptoms clear up after a few days or a couple weeks.

Kidney damage

Some people inflict damage on their kidneys when they switch to the kidney diet because they eat too much meat and don't drink enough water. This can lead to an increase in uric acid, which is known to cause kidney stones.

"If you're going to do keto, there's a better and a worse way to do it," registered dietician Kim Yawitz told Everyday Health. "Loading your plate with meats, and especially processed meats, may increase your risk for kidney stones and gout... High intake of animal proteins makes your urine more acidic and increases calcium and uric acid levels. This combination makes you more susceptible to kidney stones, while high uric acid can increase your risk for gout."

Of course, a responsible keto diet plan need not result in damage to the kidneys. In addition to monitoring meat consumption, a 2007 study on kidney stone development within young participants on the keto diet found that taking oral potassium citrate tablets seemed to be effective at preventing kidney stones.

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Maps show how CNN lost America to Fox News

Is this proof of a dramatic shift?

Strange Maps
  • Map details dramatic shift from CNN to Fox News over 10-year period
  • Does it show the triumph of "fake news" — or, rather, its defeat?
  • A closer look at the map's legend allows for more complex analyses

Dramatic and misleading

Image: Reddit / SICResearch

The situation today: CNN pushed back to the edges of the country.

Over the course of no more than a decade, America has radically switched favorites when it comes to cable news networks. As this sequence of maps showing TMAs (Television Market Areas) suggests, CNN is out, Fox News is in.

The maps are certainly dramatic, but also a bit misleading. They nevertheless provide some insight into the state of journalism and the public's attitudes toward the press in the US.

Let's zoom in:

  • It's 2008, on the eve of the Obama Era. CNN (blue) dominates the cable news landscape across America. Fox News (red) is an upstart (°1996) with a few regional bastions in the South.
  • By 2010, Fox News has broken out of its southern heartland, colonizing markets in the Midwest and the Northwest — and even northern Maine and southern Alaska.
  • Two years later, Fox News has lost those two outliers, but has filled up in the middle: it now boasts two large, contiguous blocks in the southeast and northwest, almost touching.
  • In 2014, Fox News seems past its prime. The northwestern block has shrunk, the southeastern one has fragmented.
  • Energised by Trump's 2016 presidential campaign, Fox News is back with a vengeance. Not only have Maine and Alaska gone from entirely blue to entirely red, so has most of the rest of the U.S. Fox News has plugged the Nebraska Gap: it's no longer possible to walk from coast to coast across CNN territory.
  • By 2018, the fortunes from a decade earlier have almost reversed. Fox News rules the roost. CNN clings on to the Pacific Coast, New Mexico, Minnesota and parts of the Northeast — plus a smattering of metropolitan areas in the South and Midwest.

"Frightening map"

Image source: Reddit / SICResearch

This sequence of maps, showing America turning from blue to red, elicited strong reactions on the Reddit forum where it was published last week. For some, the takeover by Fox News illustrates the demise of all that's good and fair about news journalism. Among the comments?

  • "The end is near."
  • "The idiocracy grows."
  • "(It's) like a spreading disease."
  • "One of the more frightening maps I've seen."
For others, the maps are less about the rise of Fox News, and more about CNN's self-inflicted downward spiral:
  • "LOL that's what happens when you're fake news!"
  • "CNN went down the toilet on quality."
  • "A Minecraft YouTuber could beat CNN's numbers."
  • "CNN has become more like a high-school production of a news show."

Not a few find fault with both channels, even if not always to the same degree:

  • "That anybody considers either of those networks good news sources is troubling."
  • "Both leave you understanding less rather than more."
  • "This is what happens when you spout bullsh-- for two years straight. People find an alternative — even if it's just different bullsh--."
  • "CNN is sh-- but it's nowhere close to the outright bullsh-- and baseless propaganda Fox News spews."

"Old people learning to Google"

Image: Google Trends

CNN vs. Fox News search terms (200!-2018)

But what do the maps actually show? Created by SICResearch, they do show a huge evolution, but not of both cable news networks' audience size (i.e. Nielsen ratings). The dramatic shift is one in Google search trends. In other words, it shows how often people type in "CNN" or "Fox News" when surfing the web. And that does not necessarily reflect the relative popularity of both networks. As some commenters suggest:

  • "I can't remember the last time that I've searched for a news channel on Google. Is it really that difficult for people to type 'cnn.com'?"
  • "More than anything else, these maps show smart phone proliferation (among older people) more than anything else."
  • "This is a map of how old people and rural areas have learned to use Google in the last decade."
  • "This is basically a map of people who don't understand how the internet works, and it's no surprise that it leans conservative."

A visual image as strong as this map sequence looks designed to elicit a vehement response — and its lack of context offers viewers little new information to challenge their preconceptions. Like the news itself, cartography pretends to be objective, but always has an agenda of its own, even if just by the selection of its topics.

The trick is not to despair of maps (or news) but to get a good sense of the parameters that are in play. And, as is often the case (with both maps and news), what's left out is at least as significant as what's actually shown.

One important point: while Fox News is the sole major purveyor of news and opinion with a conservative/right-wing slant, CNN has more competition in the center/left part of the spectrum, notably from MSNBC.

Another: the average age of cable news viewers — whether they watch CNN or Fox News — is in the mid-60s. As a result of a shift in generational habits, TV viewing is down across the board. Younger people are more comfortable with a "cafeteria" approach to their news menu, selecting alternative and online sources for their information.

It should also be noted, however, that Fox News, according to Harvard's Nieman Lab, dominates Facebook when it comes to engagement among news outlets.

CNN, Fox and MSNBC

Image: Google Trends

CNN vs. Fox (without the 'News'; may include searches for actual foxes). See MSNBC (in yellow) for comparison

For the record, here are the Nielsen ratings for average daily viewer total for the three main cable news networks, for 2018 (compared to 2017):

  • Fox News: 1,425,000 (-5%)
  • MSNBC: 994,000 (+12%)
  • CNN: 706,000 (-9%)

And according to this recent overview, the top 50 of the most popular websites in the U.S. includes cnn.com in 28th place, and foxnews.com in... 27th place.

The top 5, in descending order, consists of google.com, youtube.com, facebook.com, amazon.com and yahoo.com — the latter being the highest-placed website in the News and Media category.
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