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Short Summary
Main recommendation: Be patient during keto adaptation, the transition period (usually the first week or two, sometimes longer) when the body shifts from burning carbohydrates to burning fat and ketones, and manage the common symptoms rather than abandoning the diet. Dr. Eric Westman says most transition symptoms such as hunger changes, fatigue, headache, hair thinning, and irregular bowel habits are temporary and not reasons to stop.
Key Points
- Keto adaptation is defined as the transition from relying on carbohydrates for fuel to relying on fat and ketones, and Westman says the body is "adapting to ketosis," which is the origin of the term.
- Hunger decreasing to almost nothing is, in Westman's view, the best sign that someone is keto adapted; he says patients who keep carbs very low usually don't need to measure ketones.
- Keto flu, meaning muscle aches and feeling very unwell in the first days or week, is described as uncommon in his clinic.
- Hair thinning is described as common with weight loss or diet change and stress; he attributes it to new hair pushing out old hair, with regrowth taking time.
- Early kidney findings are mentioned: one study on the keto diet for people with kidney trouble seemed to show less progression to dialysis, though Westman says this should be monitored and he is not certain.
- Shannon's cardio drop-off is linked to where she is in the adaptation timeline, with Westman citing documentaries on elite athletes suggesting peak fat-burning performance may take around six months.
Details Worth Noting
- Concrete instructions:
- Expect possible symptoms in the first few days or weeks: craving carbs, headache, fatigue.
- If exercising heavily, take a break for the first week or two and do not push as hard; do not worry about meeting previous performance goals.
- To minimize keto flu, stay strict with the program and, if you have no high blood pressure or history of heart failure, add salt back, for example in the form of bouillon.
- For constipation, eat leafy greens and vegetables every day, drink plenty of fluids, add salt if needed to help hold fluid, and Westman says one teaspoon of milk of magnesia at bedtime for a week can help.
- Westman's clinic system: eat as much meat, poultry, fish, and eggs as you want; have a cup or couple cups or fistfuls of leafy greens; one cup or fistful of a non-starchy vegetable; and limited oils, cream, mayonnaise, olives, or half an avocado.
- If you want to check ketosis, ketones can be measured with urine, blood, or breath monitors, though many patients don't need to.
- For breathing trouble, if you feel poorly, see your doctor, since Westman does not think it is diet-related.
- Westman notes rare body odor or sweat smelling like cat urine is a specific metabolic condition he has seen once in ten years.
- Itchy skin with localized bumps is not something he commonly sees; he suggests waiting it out and treating symptoms.
- Westman says he is not aware of any reason the keto diet would harm kidney trouble, though he notes others claim it does.
Bottom Line
Most early keto adaptation problems are temporary, and the practical response is to adjust activity, manage fluids and salt, and give the body time rather than quitting.
