KCP010: Carbohydrate Withdrawal (A.k.a. Keto Flu) Show Notes
Correction: There are two corrections that I would like to make in the show notes that I did not notice until this podcast was already produced and released for publication: First, I mentioned that the recommended amount of potassium per day was 3,000 to 4,000 mg per day. According to the National Institute of Health, the actual recommended amount of potassium required each day for an adult is about 4,700 mg per day. Second, The Diet Doctor website states that most people can safely supplement their diet with up to 1000mg of potassium per day (about 13meq). These corrections have already been made to the show notes. I apologize for the inconvenience.
Terms In This Episode (0:35):
Addiction – Ia a chronic condition of “brain reward” in which a person is dependent or addicted to a particular substance. It is characterized by the inability to consistently abstain or control one’s cravings. While you can be addicted to any number of substances, for the purpose of this podcast we will be talking about carbohydrate addiction. As mentioned in an earlier episode, Gary Taubes in his book ‘The Case Against Sugar’ explains that carbohydrates and sugars stimulate the same pleasure centers of the brain that cocaine does. Thereby creating an addiction or need for more carbohydrates and sugars. While carbohydrates and sugars are in no way as destructive to your body as cocaine, they are still highly addictive substances. For most people this is not a problem. However, if you are a diabetic and or suffer from metabolic syndrome, then this addiction can cause you significant problems.
Withdrawal – Is the stopping or removal of a service or substance. In the context of the ketogenic lifestyle, withdrawal is the removal or severe restriction of dietary carbohydrates which leads us to our next definition.
Carbohydrate Withdrawal – Also known as the “Keto Flu” carbohydrate withdrawal is a series of symptoms similar to those felt by people who have contacted the flu virus. Because the symptoms of carbohydrate withdrawal mimic those of the flu, you may suffer from headaches, muscle aches and pains, chills, weakness, and irritability. While the symptoms are similar to those of the actual flu, it is important to note that you will not, or should not experience any fever.
Main Topic (2:38):
So you have been researching the keto lifestyle for some time now, and if you are like me, probably for to long. But you have finally decided to give it a try. The reasons why you chose this path are really not relevant at this point. Maybe your diabetic, suffer from metabolic syndrome, or morbid obesity. Maybe you just want to give up processed foods and sugars. There are a ton of different reasons to embrace this lifestyle, but the biggest hurdle to your journey is getting started. If you have not already listed to my previous episode KCP009 “Getting Started On Keto” then click on the hyperlink “Getting Started On Keto” to listen that episode.
So you have gathered your basic supplies and keto food stuffs and your excited about getting started. I know I was. And even though I had collected a massive amount of information about the ketogenic lifestyle, The one thing I somehow overlooked was the process of going though carbohydrate withdrawals. I am not sure if I was so focused on the benefits of this lifestyle that I did not see the forest for the trees so to speak, or if no one was simply talking about these symptoms. Nevertheless, like anyone who restricts dietary carbohydrates, I experienced these same withdrawal symptoms. For me personally the symptoms of carbohydrate withdrawal or keto flu lasted about 4 days. My wife on the other hand did not experience any symptoms of carbohydrate withdrawal. That brings us back to one of the main points that I have been making throughout this podcast. That is while we are all share the same human genome, we are individuals and our bodies each respond differently to specific foods, drugs, hormones, and stressors.
Personally, I experienced carbohydrate withdrawal symptoms for about about 4 days. I started my ketogenic journey on a Thursday night, by Saturday morning, I was experiencing all the symptoms of keto flu. Lethargy, muscle pain and aches, headaches, brain fog, and lack of energy. For me, these symptoms lasted until sometime Sunday afternoon. I remember this because I started my ketogenic journey on the weekend that I was off work, and by Saturday evening, I was really hoping that I would feel better before I had to return to work on Monday. Fortunately by Monday, I felt quite a bit better, but I was not feeling 100% until about Tuesday. My wife on the other hand, never seemed to have any symptoms of carbohydrate withdrawal. It is possible that I had these symptoms and she did not was that I used to eat a really heavy carbohydrate based diet. Probably more than 300 grams per day, and I restricted myself to 20 grams of less net carbs and continue to maintain this amount even two years later. My wife on the other hand, shot for a goal of 100 grams of net carbohydrates per day. So my carbohydrate restriction was five times greater than hers.
Did the severity of my carbohydrate restriction lead me to have these symptoms of carbohydrate withdrawal while she cruised through this transition without any effects? It’s possible. The thing is, while the majority of people will experience some of the symptoms of carbohydrate withdrawal, not everyone will. I believe there are two major factors that affect how your body reacts to the restriction of dietary carbohydrates. The first being, the amount of dietary carbohydrates you eat each day prior to starting this way of eating, and second, the severity of carbohydrate restriction you impose upon yourself.
If you are a carb-o-holic, and you consume a ton of carbohydrates each day, and you severely restrict your daily carb intake to 20 net grams of less a day. Then you are going to feel some of the effects of the “keto flu”. So there are two basic strategies that you can use to decrease the effects of carbohydrate withdrawal. The first is to start slowly and restrict your dietary carbohydrate intake to 50 – 100 grams of net carbs per day. The idea behind this strategy is, the less you restrict dietary carbs, the fewer and less severe the symptoms. The second strategy is to go what I call ‘full on keto’ and restrict your dietary carbs to less than 20 net grams per day. My personal recommendation is to go full on keto and restrict yourself to 20 grams of net carbs per day. Why? Because restricting yourself to only 50 – 100 net carbs per day does not guarantee that you will get into ketosis. It also dosen’t guarantee that you will not experience any symptoms of carbohydrate withdrawal or that they will be less severe. Remember, the choice is yours, but the sooner you get into ketosis, the sooner you will begin to reduce your symptoms of metabolic syndrome, reduce your Hgb A1c, and reduce your waistline.
So you have made the decision to start embrace the ketogenic lifestyle, you have chose a strategy of carbohydrate restriction. So what should you expect to happen next? Well, when dietary carbohydrates are restricted, the insulin levels in your circulating blood will begin to drop. As the circulating level of insulin decreases, your body begins to diuresis. In other words, you “pee more”. So as your urine output increases, your excrete more sodium. And generally, where sodium goes, potassium and magnesium follow. So your body will begin to lose sodium, potassium, and magnesium, while calcium and phosphorus levels are usually not affected. The result of this decrease in sodium, potassium, and magnesium levels in your blood creates an electrolyte imbalance which is generally harmless, it does however cause you to have flu like symptoms. Because of these symptoms the common term “keto flu” is often used when describing carbohydrate withdrawal.
So what exactly is the “keto flu”? It is simply your bodies reaction to the restriction of dietary carbohydrates. Because you are restricting the number of carbohydrates you consume, your body has less energy in the form of glucose to use for it’s metabolic functions. When your body does not have enough glucose to burn for energy, it has to find an alternative source of energy to supply your brain and other essential organs. This time frame from which your body begins the transition from being a sugar burner to one that burns ketones for energy is when you will experience the symptoms of carbohydrate withdrawals.
Most people will begin to experience the symptoms of carbohydrate withdrawal sometime around the 24 to 48 hour mark. The most common symptoms of carbohydrate withdrawal include: headaches, muscle aches and pains, chills, weakness, irritability, and dehydration. Other less common symptoms you may experience include: sugar cravings, brain fog, sore throat, nausea, insomnia, constipation or diarrhea. The severity of the symptoms vary per individual. While I experienced the more common symptoms, as I mentioned my wife did not have any symptoms of carbohydrate withdrawals. There are however a few things that you can do to help you through this transition period.
Earlier I mentioned that you will experience an increased loss of sodium, potassium, and magnesium do to the increased diuretic effect of transitioning to a ketogenic diet. One of the ways to minimize your symptoms is to actively take part in managing your electrolytes, and that is what I want to discuss next.
Common signs and symptoms of sodium deficiency include: fatigue, headaches, weakness and difficulty concentrating (aka brain fog). As you can see, these are some of the most common symptoms people experience. On average, your body needs 3,000 to 5,000mg of sodium each day. That translates to about 7 to 17 grams, or 1 – 3 teaspoons of salt depending on the type of salt. Making sure you get plenty of sodium each day while you are in this transition period is not difficult.
A few cheap and easy fixes to increasing your sodium intake is to drink one to two cups of bone broth each day, be liberal with the salt shaker when eating, and or add some common able salt to water and drink it. If you need a good bone broth recipe, click on the hyperlink for ‘The Banting Diet’. If you do not have any bone broth available you can make some instant broth or bouillon by using the powder or cubes. To make one cup of broth, you add one teaspoon of powdered chicken or beef bouillon to one cup hot water. The Knorr brand powdered chicken bouillon contains 870mgs of sodium per teaspoon, the beef 840mgs per teaspoon. Most commercial bouillon powders fall somewhere within this range. If you need to buy some for your pantry, just make sure you do not buy the ‘low sodium’ version as this kind of defeats the purpose. You could of course just mix one teaspoon of table salt which contains 2,325mg sodium in a glass of water, and drink it, but most people just do not like to do this.
Some common signs and symptoms of potassium deficiency include: muscle cramps, muscle twitching, and heart palpitations. On average, your body needs about 4,000 to 4,700mg of potassium each day. Which translates to about 4 to 4.7 grams. While the majority of your potassium should come from your diet, during this transition period the ‘Diet Doctor’ website recommends that a supplement of 1000mg per day is generally safe for most people as a dietary supplement. Most multivitamins contain about 100mg of potassium, and that is why a good multivitamin is recommended when you start on your ketogenic journey. There are a lot of different potassium supplements out there and almost all of them contain 99mg per tablet, no matter what the label on the front of the bottle states. Make sure you check the nutritional facts on the back of the bottle before you take any supplement to verify it’s strength.
Potassium supplementation is one of those things that you need to take care with, especially if you are taking a potassium sparing or potassium retaining diuretic as part of your daily medical regimen. If your potassium levels get to high you can start to have heart rhythm abnormalities. That is why at the beginning of each episode I mention that you need to see your primary care giver before starting this way of eating. For most of you the risk of this happening with potassium supplementation will not be a problem if you keep it below 400mg per day. Again, when in doubt check with your primary care giver.
Common signs and symptoms of magnesium deficiency include: muscle cramps, and muscle twitching, the same symptoms noted when you have a potassium deficiency. According to the National Institutes of Health (NIH) The recommended amount of magnesium you need each day is about 400mg a day. The majority of your daily magnesium requirements can be acquired from your diet. Foods such as green leafy vegetables, nuts, and seeds contain sufficient amounts of magnesium for most people, however some supplementation may be required. For people suffering from muscle cramps during this induction or even while on a low carbohydrate diet Phinney and Volek in their book “The Art and Science of Low Carbohydrate Living” recommend taking three (72mg) tablets for a total of 215mg of magnesium per day of “Slo-Mag” magnesium supplement. They also recommend similar generic brands such as “Mag Delay” which comes in 72mg tables and “Mag 64” which comes in 64mg tablets which are equally effective and somewhat cheaper.
Now, I have see many recipes for homemade “keto aide” on LCHF or keto forums and Facebook groups that use magnesium citrate as an ingredient to help with magnesium supplementation. On average, magnesium citrate contains about 300mg of magnesium, and 80mg of potassium per one fluid ounce. On the surface, that sounds pretty good, however, the problem with using a liquid solution such as mag citrate is that it is used to relieve constipation. In fact, on occasion, we use magnesium citrate in the hospital to relieve constipation. So in many people the liquid magnesium citrate can cause diarrhea, while the slow release magnesium tablets will not have this same effect. So if you are already at risk for dehydration during your transition, and you are drinking fluids such as a homemade “keto aide” electrolyte replacement drink made with magnesium citrate that can cause you to have diarrhea, you can become even more dehydrated. Which can increase the severity of your symptoms. This is why I do not use a magnesium supplement such as mag citrate in my recipe for a keto safe electrolyte replacement drink.
Now that we have covered electrolyte replacement, let’s look at some key things that you can do to help minimize or decrease your symptoms of carbohydrate withdrawal: 1) increase your fluid intake. Because of the diuretic effects of transitioning from a sugar burner to a fat burner causes diuresis, increasing your fluid intake is important. Good old plain water works great, try and stay away from diet drinks or energy drinks that have caffeine or other ingredients that cause diuresis until your transition period is over. If you want a good keto friendly electrolyte replacement drink, keep listening for he recipe I have been using for more than 2 years which I will be discussing in the recipe section of this podcast. 2) Increase your sodium intake. Drink some bone broth or even powdered bouillon, be liberal with the salt shaker, eat more salty foods, or you can go hard core and mix 1 teaspoon of table salt (2,325mg) in a glass of water and chug it down. Remember the recommended daily amount is 3,000 to 5,000mg of sodium a day. 3) Take a good multivitamin. This is a good and cheap way to make sure you get the necessary and additional vitamins and minerals you need during your transition period. 4) If you are having muscle cramps, or muscle twitching you may need to take a potassium or magnesium supplement. On average, your body needs about 4,700mg of potassium, but keep your supplementation at 1000mg (13.4meq) or less per day. The recommended amount of magnesium you need each day is about 400mg a day, so take no more than 200 – 215mg per day in pill form. The majority of your magnesium supplies should come from the food you eat each day. 5) Avoid strenuous exercise until your transition period is over. Exercise can increase the severity of the symptoms that you are experiencing. And 6) eat more fat.
I just want to add one word of caution here. I have talked a lot about vitamin and mineral supplementation in this episode. And yes, I do recommend a good multivitamin as part of your daily regimen and I have taken one for many years before I began keto. Having said that, before I began my ketogenic journey, I did not know about mineral supplementation and how it could possibly decrease my symptoms of carbohydrate withdrawal. So I did not supplement my diet with sodium, potassium, or magnesium. If like me you take a multivitamin, then you need to take the tie to read the label and look at the amounts of vitamins and minerals supplied. Then if you want to supplement with potassium or magnesium, you need to account for the amount of each in your daily multivitamin so that you do not take to much each day. So take your time, do a little math if necessary, and remember if you are taking any diuretics you need to consult with your medical practitioner before engaging in this lifestyle. They may not agree with your choice, but you need to at least give them the opportunity to guide you safely through this process.
Recommended Daily Electrolyte Needs for Adults:
Sodium – 3,000 to 5,000 mg per day.
Potassium – 4,000 to 4700 mg per day.
Magnesium – 400mg per day.
You’ve Got Mail (21:18):
There is no listener mail today, but I wanted to use this section of the podcast today do some house keeping work so to speak. When I first started this podcast, my goal was to create a weekly podcast, but what I have found is that over time, it takes me about 10 to 14 days to write, record, edit and produce each episode. Because I have a full time job, and a small farm to run, I simply cannot get everything done that I would like in seven days. So the Keto confidential podcast will be going to a scheduled bi-weekly release date. If and when I can produce the podcast in less than 14 days I will go ahead and release it for syndication. I just wanted to be up front and honest with you as for some people not having the podcast come out every seven days per my initial goal is somewhat inconsistent.
As I mention in episode 9 ‘The Getting Started‘ podcast, you need to set yourself goals when you embrace this lifestyle. Then you need to reevaluate your goals, and make changes as necessary to meet those goals. So following my own advice, my new goal is to produce a new episode of the keto confidential podcast every two weeks. I appreciate all the kind words and your continued support. Having said all of that. If you have any feedback regarding anything you have heard in this or other episodes of the keto confidential podcast, or you just want to drop us a line with a question or two, or you just want to share your success story with us, you can send me an email at email@example.com. Soon, I will be adding a Google voice number to our website so that you can call in and leave an audio voice message that will be incorporated into the podcast, so stay tuned for further information regarding this new feature.
Recipe Of The Episode (23:03):
This weeks recipe is my version of homemade Gatorade called “Frugalade” that I created back in 2012 way before I was keto. I has about the same electrolyte replacement as Powerade and Gatorade drinks 270mg sodium, and 55mg potassium per 20 ounces and it cost about $0.29 per gallon to make at the time. My keto friendly version which I call “Frugalade F2” has all the same electrolytes, but uses a keto friendly sweetener so it contains no carbohydrates. To make my Frugalade F2 you will need to following ingredients:
2 packages store brand or Kool-Aid powdered fruit punch
½ teaspoon liquid sucralose (or keto sweetener equivalent to ½ to 1 cup sugar)
¾ teaspoon Morton kosher salt (1440mg sodium)
1/4 teaspoon Morton Lite salt (290mg sodium, 350mg potassium)
Add the salts, sweetener and powdered drink mix or kool-aid to your one gallon container. Then heat a pint (2 cups) of water in your microwave, or ‘hot shot’. Then add the hot to the one gallon container and shake until all the salts are dissolved, then top off your container with water to make one gallon. I divide the Frugalade into old 20 ounce Gatorade bottles and refrigerate for easy portion control, but you can just leave it in the one gallon container. Once cold, drink it as you would any sports electrolyte replacement drink. That’s it, takes less than five minutes to make, and costs you less than $0.30 per gallon compared to about $6.00 for a gallon on Powerade or Gatorade
How does it compare to Gatorade or Powerade?
Frugalade F2 (20 ounces)
Calories – 0, sodium 270mg, potassium 55mg
Gatorade G2 © (20 ounces)
Calories – 0, sodium 270mg, potassium 75mg
Powerade Zero © (20 ounces)
Calories – 0, sodium 250mg, potassium 57mg
To use a sports metaphor, I think that’s a slam dunk win for my Frugalade F2 when compared to the commercially produced Gatorade G2 or Powerade Zero products. Keep in mind that if you are using my recipe or Gatorade G2 or Powerade Zero during your transition period, these drinks all contain sodium and potassium and you need to account for that if you plan on using other oral mineral supplements. For more information regarding this recipe, you can click on the following hyperlink ‘Frugalade F2’ and it will take you to the complete article on my keto food blog, ‘CulinaryYou’ where you can find step-by-step instructions as well as pictures of the recipe featured in this episode.
The End (27:05):
well guys, that’ it for this episode of the Keto Confidential podcast, if you have found this content useful, then please subscribe, and take a few seconds to rate this episode, and write a quick review about it so that others may benefit from this information. More importantly, If you know someone that is struggling with obesity, metabolic syndrome, or type 2 diabetes, then please share this podcast with them so that together we can help them reverse their diabetes, and reduce their complications of metabolic syndrome and obesity. Once again, I would like to thank you for listening. So until next time, be safe, and stay keto strong my friends.
Atkins, Robert, M.D. (1972). Dr. Atkins’ Diet Revolution: The High Calorie Way To Stay Thin Forever. New York, NY: David McKay Company Inc.
Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Living. Beyond Obesity LLC.
Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Performance. Beyond Obesity LLC.