5 Common Mistakes to Avoid in Ketogenic Diet

5 Common Mistakes to Avoid in Ketogenic Diet

The ketogenic diet focuses on eating very low amounts of carbohydrate and high amounts of fat and has gained the public’s interest for its potential role in promoting weight loss and improving metabolic health.6–8 However, with its benefits closely tied to the stringent restriction on carbohydrate intake, the ketogenic diet can easily be rendered ineffective and difficult to follow through small deviations. Here are common mistakes to avoid while following the ketogenic diet to reap its full benefits.


  1. Eating Hidden Carbs

To successfully follow the ketogenic diet, carbohydrate intake must be limited to 5-10% of daily caloric intake.1 This is to ensure that a process called ketosis, the underlying mechanism behind ketogenic diet, occurs by limiting the availability of glucose reserves. During ketosis, the body uses fat reserves as the primary source of energy instead of glucose (ie, carbohydrate), leading to increased fat oxidation and weight loss.2–4 However, there are many hidden sources of carbohydrates in foods to be aware of, especially when eating out.5,6 Condiments like ketchup, mayonnaise, syrup, and salad dressings are one of the biggest hidden sources of sugar. Asking for them on the side can help you avoid consuming more carbs than you intend while on the ketogenic diet.


  1. Eating Too Much Protein

When following the ketogenic diet, simply restricting carbohydrate intake is not enough. Similar to the concern of eating too much carbohydrate, eating too much protein can also render the ketogenic diet ineffective.1 In a ketogenic diet, protein consumption is usually limited to 30-35% of intake, or to <1 gram per pound of body weight. When consumed in large quantities especially in low-carbohydrate diets such as the ketogenic diet, protein can be converted to glucose in the body through a process called gluconeogenesis and hinder the body from entering as well as maintaining ketosis.1,7 Although certain proteins like steak, salmon, and bacon are rich sources of both protein and fat, be aware of how much protein is being consumed along with fat.


  1. Not Drinking Enough Water

Drinking enough water is an important part of the ketogenic diet that some may miss.8 Ketogenic diet is known to promote urination and can possibly lead to hypotension (ie, low blood pressure) and dehydration if fluid and electrolytes are not sufficiently replaced. Additionally, some studies report that the ketogenic diet may be associated with increased risk of nephrolithiasis, also known as kidney stones.9 Although the ketogenic diet is not associated with chronic dehydration, adequate fluid intake can help reduce the risks of short-term dehydration as well as developing kidney stones.10


  1. Quitting Too Soon

 Ketogenic diet is known for its effectiveness in promoting weight loss and improving metabolic health, but adherence is a key challenge.11 It is estimated that only half of the adults are able to adhere to a low-carbohydrate diet, substantially due to what is known as the “keto flu”. “Keto flu” is a conglomerate of short-term symptoms including fatigue, headache, dizziness, nausea, gastrointestinal discomfort, and decreased energy, and is commonly experienced during the initial period of adjustment.12,13 Not being prepared to experience short-term discomforts from keto flu and not ensuring adequate fluid, electrolyte, and nutritional intake during initial adjustment periods are common mistakes to avoid while on the ketogenic diet.


  1. Not Discussing With Your Doctor First

Embarking on the ketogenic diet without first consulting health care professionals can be a common and a potentially dangerous mistake.8 Because of the ketogenic diet’s harsh restriction on carbohydrate intake and prescription to high fat consumption, some medical conditions may not be compatible with the ketogenic diet. Studies typically warn that individuals with certain conditions, illnesses, or taking certain medications should either avoid or exercise extreme caution when starting the ketogenic diet. These conditions include liver failure, chronic kidney disease, type 1 diabetes mellitus, pregnancy or breastfeeding, certain cardiovascular (ie, heart disease) and cerebrovascular conditions (ie, stroke), cancer, use of sodium-glucose transport protein 2 inhibitors (ie, a type of diabetes medication), and more.


1. Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. In: StatPearls. StatPearls Publishing; 2022. Accessed August 9, 2022. http://www.ncbi.nlm.nih.gov/books/NBK499830/
2. Sumithran P, Proietto J. Ketogenic Diets for Weight Loss: A Review of Their Principles, Safety and Efficacy. Obes Res Clin Pract. 2008;2(1):I-II. doi:10.1016/j.orcp.2007.11.003 3. Gibson AA, Seimon RV, Lee CMY, et al. Do Ketogenic Diets Really Suppress Appetite? A Systematic Review and Meta-Analysis. Obes Rev. 2015;16(1):64-76. doi:10.1111/obr.12230
4. Zhu H, Bi D, Zhang Y, et al. Ketogenic Diet for Human Diseases: the Underlying Mechanisms and Potential for Clinical Implementations. Signal Transduct Target Ther. 2022;7:11. doi:10.1038/s41392-021-00831-w
5. Make Healthy Fast-Food Restaurant Choices | ADA. Accessed August 29, 2023. https://diabetes.org/healthy-living/recipes-nutrition/eating-well/healthy-choices-fast-food
6. Eating Out With Diabetes. Centers for Disease Control and Prevention. Published September 20, 2022. Accessed August 29, 2023. https://www.cdc.gov/diabetes/managing/eat-well/eating-out.html
7. Fromentin C, Tomé D, Nau F, et al. Dietary Proteins Contribute Little to Glucose Production, Even Under Optimal Gluconeogenic Conditions in Healthy Humans. Diabetes. 2013;62(5):1435-1442. doi:10.2337/db12-1208
8. Watanabe M, Tuccinardi D, Ernesti I, et al. Scientific Evidence Underlying Contraindications to the Ketogenic Diet: An Update. Obes Rev. 2020;21(10):e13053. doi:10.1111/obr.13053
9. Wirrell EC. Ketogenic Ratio, Calories and Fluids: Do They Matter? Epilepsia. 2008;49(Suppl 8):17-19. doi:10.1111/j.1528-1167.2008.01825.x
10. Dowis K, Banga S. The Potential Health Benefits of the Ketogenic Diet: A Narrative Review. Nutrients. 2021;13(5):1654. doi:10.3390/nu13051654
11. Cogen FR. Incorporation of the Ketogenic Diet in a Youth With Type 1 Diabetes. Clin Diabetes. 2020;38(4):412-415. doi:10.2337/cd20-0023
12. Lichtash C, Fung J, Ostoich KC, Ramos M. Therapeutic Use of Intermittent Fasting and Ketogenic Diet as an Alternative Treatment for Type 2 Diabetes in a Normal Weight Woman: a 14-Month Case Study. BMJ Case Reports CP. 2020;13(7):e234223. doi:10.1136/bcr-2019-234223
13. Bostock ECS, Kirkby KC, Taylor BV, Hawrelak JA. Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet. Front Nutr. 2020;7:20. doi:10.3389/fnut.2020.00020
14. Fuehrlein BS, Rutenberg MS, Silver JN, et al. Differential Metabolic Effects of Saturated Versus Polyunsaturated Fats in Ketogenic Diets. J Clin Endocrinol Metab. 2004;89(4):1641-1645. doi:10.1210/jc.2003-031796



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