digest
Short Summary
Main recommendation: when fatigue appears months into a keto diet, check blood pressure and medications first, and consider adding salt (sodium) rather than abandoning the diet or returning to carbs. Dr. Eric Westman describes a patient whose fatigue and low blood pressure improved once she increased salt, letting her keep losing weight on keto.
Key Points
- Dr. Westman's patient, a 55-year-old woman, started keto in January, lost weight steadily, and stopped metformin with no other blood pressure medication.
- After she resumed carbs, her fatigue eased but she regained about five pounds, and her own doctor had suggested eating more carbs and dropping the diet.
- Westman says that doctors usually receive little training in weight loss or dietary approaches, which is why such advice is common.
- The patient's blood pressure was low, and carbs improved how she felt partly because the body holds on to salt, but extra salt is another solution.
Details Worth Noting
-
Concrete instructions: Check blood pressure and any medications, and watch for over-medication, since the patient's blood pressure was low.
-
Concrete instructions: Increase salt intake (do not restrict it) by adding one or two bouillon cubes, which together provide about 800 mg of sodium, as the speaker advised. Broth can also work.
-
Concrete instructions: If fatigue persists or you have side effects, consult a clinician trained in dietary approaches rather than relying only on a general doctor.
-
Westman says he expects continued weight loss on keto when things are going well, and noted that a four-pound gain prompted him to suspect she had eaten carbs.
-
The speaker presents this as one clinical account from his practice, not as a general medical rule for all keto dieters.
Bottom Line
Fatigue on keto may come from low sodium and low blood pressure rather than the diet itself, so checking salt intake and medications is a reasonable first step before changing the plan.
