Keto Diet Frequent Questions

Browse the FAQ below - or click to skip to a specific question:

Nutrition

Is ____ Keto?

Weight Loss and Weight Gain

Etcetera

Nutrition

Isn’t all that saturated fat and cholesterol bad for you?

When you look at nutrients like saturated fat and cholesterol, it’s valuable to go a little deeper and consider what kind of foods you’re getting those nutrients from. A hard-boiled egg and a Big Mac both contain saturated fat and cholesterol. But they’re completely different foods. The egg is a natural, unprocessed food full of essential nutrients and antioxidants; the Big Mac is hyper-processed junk food from the sugar and soybean oil in the bun (no, really! Look it up!) to the high-fructose corn syrup in the sauce.

Studies have regularly shown that people who eat more saturated fat and cholesterol get more heart disease, because people tend to eat their saturated fat more from the Big Mac end of the spectrum. But for keto or Paleo purposes, those studies aren’t really relevant, because Paleo and keto aren’t about eating Big Macs.

If you take a look at whole foods rich in saturated fat and cholesterol - like eggs, unprocessed meat, and full-fat dairy - you’ll quickly find that there’s no real evidence against them.

To focus specifically on cholesterol for a second, eating more dietary cholesterol on keto doesn’t cause any increase in blood cholesterol because dietary cholesterol is actually a very small percentage of total cholesterol. Most of the cholesterol in your blood is made by your own body. Your body can easily respond to changes in dietary cholesterol by just making less cholesterol of its own. Learn more about dietary cholesterol here.

As a final point: if eating saturated fat and cholesterol causes heart disease, then why does keto consistently improve heart health in human studies?

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What about fiber? Does fiber count as “carbs”? Can I get enough fiber on keto?

“Fiber” is a catch-all term for carbs that you can’t digest. The bacteria in your gut can digest

them, but you can’t. So a lot of people don’t count fiber when they count the number of carbs they eat. Some research also shows that adding a fiber supplement to a low-carb diet doesn’t reduce the benefits of the diet. This suggests that fiber doesn’t really “count” as a carb, so it’s likely safe to ignore it in your carb counts.

The recommended daily intake of fiber for adults is between 25 and 35 grams per day. It’s easy to get that much fiber from low-carb vegetables and other keto-friendly foods, like avocado. If you need to restrict carbs to such low levels that you can’t get enough fiber - or if you’re having trouble with constipation - a psyllium supplement might be helpful.

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Why can’t I have fruit? Isn’t fruit healthy?

Fruit is full of nutrients and antioxidants and generally good for you. It’s also higher in sugar and carbs than most keto diets can accommodate. If you’re trying to stick below 50 grams of carbs per day, an apple (30 grams of carbohydrate in one large apple) or a banana (31 grams of carbohydrate in one banana) just doesn’t fit in the plan. Even if you subtract fiber from that, you’re still getting about half your daily carb allowance in one little piece of fruit. That doesn’t leave enough room in the carb budget for the vegetables that you need to get enough nutrients.

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What if I’m a vegetarian?

It’s possible to eat keto as a vegetarian, if a bit more difficult. Remember that keto isn’t about eating a ton of animal protein - it’s about eating a lot of fat. If you can eat eggs and full-fat dairy, you’ll be able to get plenty of protein for keto. Just focus on getting at least some protein-rich foods at every meal and eating plenty of healthy fats, like olive oil and coconut oil. Some sample vegetarian keto meals:

• 3 eggs fried in 2 tbsp. butter with sauteed asparagus: 76% fat, 20% protein, 3.5% carbs (4.2 grams total carbohydrate, of which 1.7 grams are fiber)
• Salad with 1 cup of lettuce, a few olives, red onions, 1 ounce walnuts, 4 tbsp. feta cheese, and olive oil: 81% fat, 11% protein, and 8% carbs (10 grams carbohydrate, of which 3.7 are fiber)

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How can I keep track of my macros? Do I have to count everything?

Some people find it helpful to log and track all their food; other people find it exhausting. If you’re OK with it, it can be a useful tool. If you hate it, there are alternatives. Many people are OK just prioritizing fat-rich foods and focusing on meat, fat, and low-carb vegetables. This method is particularly effective if you can get into a routine that works really well for you and eat a lot of the same things every day - then there’s no wondering what’s in your food or whether it’s keto, because your daily eggs and bacon haven’t magically changed since the last time you had them.

Other people can get away with tracking food once a week or so, not every day. Or you could only count carbs and not worry about fat or protein. Macro counting isn’t an exact science anyway; there’s no need to panic over it if it’s not right for you.

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Do I need to worry about hydration? What about salt and electrolytes?

It’s important to drink enough on keto. In children who eat a keto diet to treat epilepsy, dehydration is one of the most common side effects. A good rule of thumb is to drink water until your pee is very light yellow - it shouldn’t be totally clear, but it also shouldn’t be a rich, dandelion-type color.

In terms of electrolytes, people eating keto need more salt, and other electrolytes (like potassium) may also be helpful. If you’re having muscle cramps, that’s a big sign that you may need more electrolytes. Salt your food liberally! Bouillon cubes are another great source of keto-friendly salt. If bouillon doesn’t appeal, you can buy all kinds of sugar-free electrolyte mixes at running or sports stores. Lite salt (at grocery stores next to the regular salt) is a good source of potassium.

Is ___ Keto?

(This section is arranged in alphabetical order)

Alcohol

Regardless of what you think of the alcohol itself, many types of alcohol are just too carb-dense to be keto. A bottle of beer has about 10-12 grams of carbs (none of which is fiber). To fit that into a keto diet, you’d have to cut way back on vegetables for that day, and trading vegetables for beer really isn’t a responsible nutritional strategy.

Some kinds of distilled spirits, like rum and vodka, don’t have any carbs - those could fit into a keto diet, depending on your individual alcohol tolerance. From a strict nutritional standpoint, alcohol is a Paleo “gray area” - it’s not doing your health any favors, but on the other hand, we’re all humans, not saints. Eating well should make your life better, not worse, and if the occasional rum or vodka is a worthwhile indulgence to you, it won’t throw you out of ketosis.

Artificial sweeteners

Debatable. You can read up on the research into artificial sweeteners here: the evidence suggests that they probably don’t cause weight gain, but they probably also don’t cause weight loss. On the other hand, some types of artificial sweeteners may cause gut problems in people who are sensitive to them. In general, a good rule of thumb is to minimize the amount of sweeteners you eat - it helps keep your palate used to the taste of natural whole foods.

Chocolate

Most chocolate bars have too much sugar to fit into a keto diet. For example, 1 ounce of milk chocolate (45-60%) has about 17 grams of carbs, and only 2 of those are fiber. Even dark chocolate (70-85%) has about 13 grams of carbs per ounce - and an ounce is not a lot of chocolate. Most regular-sized candy bars are closer to 2 ounces.

Cocoa powder has just over 3 grams of carbs (1.6 of which are fiber) per tablespoon. If you want a chocolate taste, it might be best to add cocoa powder to a keto-friendly food and make your own treats.

Coffee

Yes. Sugar in your coffee is a no-go, but the coffee itself is fine. Heavy cream, whole milk, coconut milk, and other keto-friendly additions are also fine.

Corn

No. Corn isn’t a vegetable, despite being included in so many “frozen vegetable” mixes. It’s a grain, so it’s not Paleo, and in any case it’s too carb-dense to really fit into a keto diet.

Dairy

If you tolerate it well. A lot of people are lactose intolerant, and those people do better staying away from dairy. If you're in the lucky lactose tolerant group, full-fat dairy (butter, ghee, full-fat yogurt, heavy cream…) is very keto-friendly. But watch out for low-fat dairy (which often has too many carbs) and added sugar! A lot of yogurt products have extra added sugar, and that’s definitely a no on keto.

Diet soft drinks (e.g. Diet Coke)

Diet soft drinks aren’t Paleo. But if you don’t care about eating Paleo, they won’t kick you out of ketosis (see the entry on “artificial sweeteners” above).

Nuts

Yes, within your carb counts. Remember that peanuts aren’t nuts; they’re legumes, so if you want to eat Paleo-keto, peanuts are off the table.

Protein powder

Not really. A small amount of protein powder could fit into a keto diet, but keto isn’t meant to be super high in protein. It’s meant to be high in fat. Eating protein powder doesn’t leave a lot of room for more nutritious protein-rich foods, like meat and eggs.

Stevia

Stevia is OK if it doesn’t cause huge sugar cravings. Some people do better with getting that sweet taste out of their diet as much as possible; other people are just fine including it. Learn more about stevia here.

Tofu

Tofu isn’t Paleo, because it’s made of soy. It’s also high in omega-6 fat, which most of us could do with a lot less of in our diets. If you don’t care about eating Paleo, tofu can fit into a keto diet.

Whole grains

No. Whole-grain foods aren’t any less carb-dense than any other kind of grains. Pick up a loaf of whole-wheat bread or a package of whole-wheat pasta and look at the carb count for yourself: there are just too many carbs in there to make it part of a keto diet. The same goes for brown rice, oatmeal, quinoa, barley, etc. None of these foods are Paleo anyway, but even if you don’t care at all about Paleo, they’re not keto because they have too many carbs.

Weight Loss and Weight Gain

How much weight will I lose on keto and when will it come off?

It’s impossible to predict anyone’s weight loss before it happens. Most people see a big initial drop of water weight in the first week, followed by slow and steady fat loss after that.

Almost everyone plateaus at some point. Sometimes, the plateau breaks on its own. Other times, the plateau is a sign that it’s time to re-evaluate something - maybe there have been too many carbs creeping into your diet or maybe you’ve reached a point where keto isn’t the best diet for your current needs.

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I’ve read that all the weight you lose on keto is water weight; is this true?

This is only true of the weight you lose in the first week of keto. Carbohydrates cause your body to retain water, so when you stop eating carbs, you shed a lot of water weight in the first week or so. This can be 8-10 pounds for some people (although for others it’s less dramatic, so if you don’t drop that much weight, don’t stress about it). If you started eating carbs again, you’d start retaining all that water again and the weight would come right back on.

After about a week, most people have lost as much water weight as they’re going to lose. Once the water weight is gone, the fat loss starts at a steady but slower pace. “It’s all water weight” only applies to the initial “whoosh,” not to the long-term fat loss.

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Can I eat keto if I don’t want to lose weight? What if I want to gain weight?

Keto isn’t just a weight-loss diet. You can also do keto to gain or maintain weight; it just takes a little fancy footwork.

• Make sure you’re eating enough food. This is harder than it looks! Because keto is so good at suppressing appetite, calorie-counting can be helpful here just to make sure you’re eating enough
• Liquid calories (like smoothies) and really delicious food (like butter) can help you get enough calories in.
• If you’re trying to gain muscle specifically, eating more protein than the average keto diet might be helpful.

If you just can’t keep the weight on with keto, switching to a moderate-carb Paleo diet might be a better way to go.

Etc.

What about eating out?

Most people actually find that it’s not a big problem. There’s something at almost every restaurant that you can have: salads with a generous amount of fat-rich dressing are usually a good bet, and at nicer restaurants you can get delicious fatty steaks slathered in butter or crispy grilled fish with aioli: yum! If your order comes with bread or potatoes or some other carb-loaded side, just ignore that part. There’s no vengeful breadstick god who will smite you if you leave the basket to the other folks at the table.

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How does keto affect sleep?

There’s not a lot of scientific evidence here - most of the research on keto and sleep is in children with epilepsy, not grown-ups trying to lose weight - but some research has found that a very low-carb diet increases the time you spend in slow wave sleep (the deepest phase) and reduces REM sleep (that’s when you dream). An older study found that eating keto significantly decreased sleep abnormalities in obese patients, suggesting that keto might help improve sleep. And interestingly, one small study found that keto helped with narcolepsy.

On the other hand, this study showed that patients eating keto initially had problems sleeping, but then everything resolved after a few weeks. Some people might have 2-3 weeks of trouble falling asleep while they adjust.

If you have trouble falling asleep on keto, try a pre-bedtime magnesium or melatonin supplement - both can be helpful for winding down at bedtime.

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Can I eat keto if I like to work out?

The short answer: yes!

• For endurance athletes (runners, cyclists, triathletes, etc.): Many people see a decrease in performance for the first couple weeks, but after they adapt to the diet, they do fine. In fact, switching to a keto diet might even be helpful for endurance exercise, because it helps you use fat more efficiently during exercise (aka avoiding the dreaded bonk and less dependence on gels and chews during long events)
• For strength athletes (powerlifters, weightlifters, highland games or strongman competitors, etc.): This study found that a ketogenic diet helped men lose fat while gaining muscle during a program of strength training, and another paper found that a keto diet was just as good as a standard diet for increasing one rep max on the squat, bench press, and deadlift. Many strength athletes use a ketogenic diet to excellent effect.

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Isn’t ketosis dangerous?

No. If you think ketosis is a life-threatening complication of diabetes, you’re thinking of ketoacidosis, not ketosis. Ketoacidosis is absolutely dangerous, but it’s not the same as diet-induced ketosis.

To get more specific about this, “ketosis” means that you’re producing ketones; “ketoacidosis” means that you’re producing so many ketones that they build up to dangerous levels in the blood. Ketoacidosis is ketosis taken to a dangerous extreme, and it’s typically caused by type 1 diabetes, not by diet.

Ketoacidosis is most common in people with type 1 diabetes and it’s usually caused by problems with the hormone insulin. Insulin regulates ketone production, but people with type 1 diabetes can’t make enough (or any) insulin, so they’re at risk of totally uncontrolled ketone production and ketoacidosis.

People eating ketogenic diets just don’t make enough ketones to get into ketoacidosis. In healthy people, ketogenic diets cause a much lower level of ketone production, because your body naturally regulates the number of ketones you produce and doesn’t make more than you need. There’s no evidence that ketogenic diets cause a dangerous overproduction of ketones in healthy people (this is why ketosis induced by a keto diet is sometimes called “nutritional ketosis” to distinguish it from ketoacidosis, which isn’t caused by diet).

If you have diabetes or any other disease, absolutely talk to a doctor before you try anything like a keto diet. If you don’t have type 1 diabetes, ketoacidosis probably isn’t a risk for you.

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Is keto the same as Atkins?

It’s similar to the induction phase of the Atkins diet, but with a focus on eating well, not just cutting carbs.

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How do I know if I’m in ketosis? How can I measure my blood ketones?

You can use a product called ketostix to measure the number of ketones in your urine, but you probably shouldn’t. Here’s why: ketostix measure one kind of ketones, called acetoacetate. But on a ketogenic diet, you primarily care about a totally different kind of ketones, called beta-hydroxybutyrate. At the very beginning of eating keto, you’ll be excreting some acetoacetate in your urine, but after you get into the swing of things, beta-hydroxybutyrate is the name of the game. After the first few weeks, it’s possible to be fully in dietary ketosis and get a very low reading on ketostix because ketostix just measure acetoacetate.

(Then why do they exist? They’re for people with diabetes who need to avoid ketoacidosis, a completely different problem that isn’t caused by eating a ketogenic diet and really has nothing to do with it except that both involve ketones)

If you really care about measuring ketones, you’ll need to either get a breath meter for ketones or test your own blood - but neither of these is necessary for most people. Most people are fine just eating a ketogenic diet - there’s no need to measure or micromanage your blood ketones.

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What's the cost of doing keto? Can it fit my budget?

Keto can be cheaper than a typical American diet, about the same cost, or more expensive, depending on how you shop and plan your meals. There are lots of keto luxuries that you can buy if you want to (lobster! Caviar! Artisanal cured meats!) but none of them are necessary. Here’s a quick list of tips for budget keto:

• Buy cheap, fatty cuts of meat. Think less “bacon” and more “pork shoulder.” Fattier cuts are often less expensive: compare chicken thighs (cheap, higher-fat) to chicken breasts (pricey, low-fat). Or compare 75/25 ground beef (cheap, higher-fat) to 92/8 ground beef (pricey, lower-fat).
• Cut back on relatively expensive optional foods, like nuts and bacon - save them for treats instead of relying on them for everyday meals.
• Avoid “low-carb” products like specially formulated low-carb bars or low-carb ice cream. You always pay more if someone else has to do a lot of work to prepare the food.
• Canned fish is typically (unless there’s a really great sale) cheaper than fresh.

Another way to make keto affordable is to maximize the amount of money you have to spend on groceries. For example, in 2016, the average American household spent $4,049 on groceries and $3,154 on restaurant meals. In other words, just under half of the food budget was spent at restaurants. Cutting back on restaurant meals is a very easy way for many people to magically get more money for the grocery budget.

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What does a basic day of food look like?

It can vary a lot, depending on your particular tastes, but here’s a sample day of keto:

• Breakfast: 3 eggs fried in 2 tbsp. butter with sauteed asparagus
• Lunch: Cucumber salad: 1 cucumber, 1 can sardines in oil, 1 tbsp. red onion, 1 tbsp. each olive oil and balsamic vinegar
• Snack: Coffee with 2 tbsp. heavy whipping cream plus 1 oz walnuts (about as many as you can hold in your hand)
• Dinner: 3 oz of pork shoulder; eggplant (2 cups raw) roasted in 1 tbsp. olive or coconut oil with curry powder

Total macros for the day: 72% fat, 20% protein, 8% carbs (33 grams carbs in total, with 12 of those being fiber). This would be enough for a relatively inactive woman (or a very short/slight man) - people who work out a lot or larger men would want to eat a little more.

For reference, on the scale of budget keto to luxury keto, this would probably be around the middle. On the one hand, there are some luxury foods, like the nuts; on the other hand, all the proteins are pretty inexpensive.

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Should I also be doing intermittent fasting?

It’s optional. Do it if you want to and if it works for you. In intermittent fasting, you either skip a full day of eating once a week or eat within a restricted window (say, 12pm to 8pm) every day. You can read up more on this here - the short version is that it works for some people but not for others.

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How do I deal with cravings?

There’s no one guaranteed way to deal with cravings - here are 8 suggestions. For keto specifically:

• Make sure you’re getting enough salt. You need more salt on keto than you otherwise would. If you’re craving potato chips, pretzels, or other salty foods, you might be able to solve the problem completely with some extra salt on your food.
• Make sure you’re eating enough food. Try adding some extra calories and see if that helps.
• Make sure you’re getting enough sleep. Poor sleep turns up cravings, especially carb cravings.

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What if I have thyroid/hormonal issues? Can/should I still do keto?

If you have hypothyroidism, hyperthyroidism, or any other kind of hormonal problem, you should talk to a doctor before you start any kind of diet. Some people with thyroid problems do just fine on keto, but those people aren’t you, and you don’t know how your particular body is going to react to a sudden drop in carbs.

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Should I be taking any supplements?

Some people do best with some supplemental nutrition; other people don’t need it. It all depends on how restrictive you are with carbs/vegetables and whether or not you eat dairy. There's not really much research on supplement needs in adults eating keto, but just based on what you can and can’t get from the diet...

• If you don’t eat dairy and also don’t eat a lot of bone-in fish, a calcium supplement may be helpful.
• If you don’t eat fatty fish and also don’t go out in the sun much, vitamin D may be helpful.
• The best way to find out what vitamins or minerals might be lacking in your diet is to plug a day or two of food into a nutrition tracker and see what you’re missing. If that sounds too laborious, there’s an easy mode: a multivitamin. Many children who eat keto for epilepsy just take a multivitamin as a matter of course, without any fuss or worry about specific nutrients. If you’re eating very few vegetables, that may be the easiest option.

In terms of supplements other than nutrients, MCT oil may be helpful for people who want to eat slightly towards the higher end of the keto carb range. MCT oil basically helps you get into ketosis more easily, so you can get away with a slightly higher number of carbs in your diet.