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How to Do Ketogenic Diet Without Side Effects

author avatar Dr. Eric Berg 08/31/2023

Today, we’re going to talk about how to do the ketogenic diet without side effects. It’s a common misconception that the keto diet is “dangerous” or that it comes with a bunch of horrible side effects - and this misinformation has prevented a lot of people from starting the diet.

But here’s the thing: it’s just not true, especially if you do keto the right way.

Here’s how to avoid negative side effects and get keto right.

In this article, I will cover:


Keto Compared to the Standard American Diet (SAD)

Keto is better than the Standard American Diet

First, let’s talk about the elephant in the room here: keto vs the SAD.

Most of the time, when someone is trying to discourage you from doing the ketogenic diet by claiming it has certain “negative side effects,” the irony is that that individual is usually on a high carbohydrate diet.

High-carb and high fat diets are proven to have a slew of negative side effects. We’ve experimented on the SAD diet for decades, and we already know that:

  • It has contributed to a huge percentage of the population being pre-diabetic or diabetic.

  • Carbohydrates can trigger seizures

  • In a Yale study, a high carb and high fat diet triggered inflammatory responses in the brain and led to weight gain.

  • In another study on rats, chronic consumption of the SAD had negative effects on physiology, behavior and recovery from injury. Specifically, it increased fat mass, decreased lean mass and reduced bone mineral density.

The ketogenic diet, on the other hand, doesn’t have these effects on the body, and it can actually help where the SAD hurts. For example, it is one of the oldest forms of medical treatment for epilepsy. That’s because, while carbohydrates trigger seizures, ketones do not. It’s also been shown to lower triglycerides in the blood, help with blood sugar control, and reduce total cholesterol.


Traditional Keto Isn’t For Everyone

I will say, though, that the traditional version of the ketogenic diet is something that I don’t recommend for the average person who’s trying to get healthy or lose weight. With traditional keto, they’re going to recommend that 90% of your diet is fat.

The problem with this “standard” version of the ketogenic diet is that they don’t really emphasize the quality of food.

They even recommend things like mayonnaise, synthetic vitamins, vegetable oils from soy, and GMO. They’re also much more restrictive about your vegetable intake, which can be problematic.

The Alternative: Dr. Berg’s Healthy Keto

Instead of traditional keto, I’m going to recommend a healthy keto diet. In this version of the keto diet, we emphasize high-quality foods like grass-fed, organic meat, pasture-raised eggs, and lots of leafy greens.

We also recommend nutrient-dense foods and whole-food vitamins rather than synthetic vitamins.

Again, with most keto plans, you’re going to do 5% carbs, 20% protein, and 75% fat. Now, if we raise the carbohydrate intake to 10%, this allows us to include a lot more vegetables. We would recommend 7-10 cups of vegetables per day.

Now, you might think that this amount will throw your carbohydrate intake out of what. It won’t. Vegetables are high-fiber, high-water, and low-sugar, and we don’t really count fiber as carbohydrates - so they won’t negatively impact your carbohydrate intake.

Plus, adding these vegetables will greatly reduce the chances of you developing any of the following keto side effects.

Now let’s go through the list:


Keto Side Effects and How Healthy Keto Can Help


Keto side effects include constipation

The number one side effect of the traditional ketogenic plan is constipation. I believe the reason for this is that standard keto diets don’t recommend a lot of vegetables, so you’re low in fiber.

With healthy keto, the fiber in the vegetables will feed the microbes in your gut and allow you to have normal, regular bowel movements. Similarly, the amount of potassium in the vegetables will also help regulate your bowels.

Kidney Stones

Why would you get kidney stones on a ketogenic plan?

Well, ketones are acidic, so your body can become overly acidic. This excess acidity can trigger a bit too much uric acid and potentially cause uric acid kidney stones.

Additionally, there are several other common keto foods that are high in oxalates. Oxalates can also lead to kidney stones if you’re susceptible to them. High-oxalate foods include things like:

  • Spinach: I would recommend that you go easy on the spinach and eat other types of vegetables if you’re susceptible to kidney stones.

  • Almonds: On keto, there are tons of recipes that use almond flour. If you’re susceptible to kidney stones, you may want to steer clear of this flour alternative.

  • Lemon juice/lemons: Lemon is filled with citrates, which counter kidney stones. Make sure you’re drinking at least 2 liters of fluid per day, and the vegetables - which are alkaline - will counter the acidity from the ketogenic diet very nicely.


You could get diarrhea if you’re consuming too much MCT oil or if you’re using sugar alcohols (which are in a lot of the recipes that you’ll see on the internet). If you’re experiencing this symptom, then, you may want to start by cutting back on these ingredients.

Alternatively, your body may not be able to handle the number of vegetables that I’m recommending right away. It may not have enough microbes to deal with all the extra fiber (the microbes, when they’re there, will turn the fiber into fuel).

If this is the case, you should start off small and gradually work your way up to consuming 7-10 cups a day.


This usually happens when you’re not consuming enough minerals - which, in turn, happens because you’re not consuming enough vegetables.

Beefing up the amount of vegetables that you consume will solve this problem. You can also incorporate more electrolytes into your diet and it will help.

Keto Rash

Yes, keto rash can be a real symptom, but it usually goes away when you consume a little more vitamin B2.

So why do you get a rash to begin with?

When you’re in ketosis, your metabolism has shifted to burning more fat. This will require more B vitamins.

This is also why we recommend nutritional yeast, which you can get in tablets. This will greatly help you counter both rash and keto fatigue.

Keto Fatigue

As your body transitions from burning sugar to burning fat, you could experience keto fatigue, otherwise known as keto flu. This could include symptoms like:

  • Sugar cravings

  • Muscle cramps

  • Brain fog

  • Irritability

  • Fatigue

  • Headache

  • Dizziness

  • Nausea

  • Diarrhea

  • Exhaustion

This can resolve on its own. However, you can address it directly by making sure that you consume enough potassium and vitamin B1.

High Cholesterol

Normally, when you do the keto plan, your cholesterol is going to decrease.

For some people, though, it might go up. There’s a simple reason for this spike: you’re burning and eating more fat. The mobilization of fat contains triglycerides and some cholesterol, so you’re just mobilizing a lot more fat through your bloodstream.

The big concern here, of course, is an increase in LDL (or so-called bad cholesterol). But even if your LDL gets higher when you start keto, you don’t have to worry about it.

Don’t understand why? Well, I did an entire video about it - it’s pretty short but I highly recommend that you watch it because I explain why having high LDL is not a bad thing at all if you’re doing the ketogenic plan.

The point is that you shouldn’t worry about high cholesterol on keto. Also, remember that most people will not have high LDL. Instead, it will actually go down.

Loss of Bone

High vegetable intake combats loss of bone

There have been some studies on the classic ketogenic plan for epilepsy that suggest that there’s some loss of calcium on the ketogenic diet.

This calcium loss is usually a result of high acidity and high protein on the keto diet.

With healthy keto, you won’t have to worry about this side effect. On my healthy keto plan, I recommend a moderate amount of protein - between three and six ounces - per meal.

Also, I recommend a high vegetable intake (7-10 cups a day) which will counter the acidity that would create any problem with your bone.

Heart Rhythm Problems

Heart rhythm problems signal potassium or magnesium deficiency.

To resolve this symptom, you need to increase your vegetables and/or your electrolytes.

Dry Mouth

Dry mouth on the keto diet is a mineral deficiency.

All you have to do, again, is to add more vegetables or electrolytes to resolve this issue.


This either means that:

  • You’re consuming hidden sugars that you may not know about

  • You’re eating too frequently, which will stimulate Fat Storing Hormone

  • You’re just not doing it long enough

What you have to realize is that, when you do keto correctly, your hunger goes away within three days, you don’t crave anything, and you’re not going to have hypoglycemia.

This is because you’re no longer running on sugar; you’re running on fat fuel. But you have to keep the carbs very low, and I highly recommend intermittent fasting.

Cardiovascular disease, Diabetes, Cancer

These are not side effects of the ketogenic plan. There are no studies that show any relationship, association, or correlation between the keto diet and worsening any of these conditions.

If you read any studies that do suggest a correlation, keep in mind that they were done on mice and they weren’t even doing a diet that’s close to the ketogenic diet. Instead, they’re doing a high-fat, high-carb diet (which is closer to the SAD) and they’re calling it keto. But it’s not.

Bad Breath

“Keto breath” is a distinctive odor - different from regular bad breath or halitosis - that is often described as a metallic taste in the mouth. It can happen when you enter ketosis.

That said, you can avoid keto breath by consuming vegetables that are loaded with chlorophyll. Chlorophyll is a natural deodorizer, and it should resolve this concern right away.


Healthy Keto: Recap

In short, doing healthy keto will prevent all of these side effects and help you reach more happiness and health. Specific healthy keto solutions that you can incorporate into your diet include and are on the keto food list include foods like:

  • Lots of veggies (7-10 cups). These provide the minerals, vitamin C, folate, and fiber

  • Quality foods: Grass-fed meat, organic dairy and produce, etc.

  • Sea salt: With the ketogenic plan, you need 1-1.5 teaspoons of salt or sodium chloride. This will lessen certain side effects like weak muscles and even leg cramps.

  • Nutritional yeast: Don’t forget nutritional yeast. You can get this in a powder or a tablet

  • Electrolytes: I also recommend getting a good electrolyte powder simply because it’s really difficult, especially when it comes to potassium, to consume enough vegetables to get your recommended daily intake.

Follow these steps, and you’ll get all the benefits of keto without the drawbacks.

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Disclaimer: Our educational content is not meant or intended for medical advice or treatment.

Editor’s Note: This post has been updated for quality and relevancy.

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