6 Ways to Troubleshoot the Ketogenic Diet

Ketogenic Diet Success Checklist

The following factors determine the success of achieving our natural state of ketosis. Without addressing these physiological functions, the diet can be a stress rather than a healing.

In order to thrive on ketosis, these factors must be in place:

  1. Fat digestion. Before we burn fat, we have to digest it. We need adequate bile and lipase to convert fat into fuel.
  2. Leaky gut.  Starting keto with a leaky gut can make the condition worse. Poorly digested fats further stress the health of the gut.
  3. Adrenal support. The period of conversion between sugar-burning and fat-burning places a huge demand adrenal function
  4. Detoxification help. Converting to a fat-burning state mobilizes stored toxins in the body. Detoxification pathways must be open, so toxins leave the body.
  5. Electrolyte balance. Different people need different mineral support. Increased sodium intake is generally recommended on a ketogenic diet, but it helps only 50% of the time.
  6. Vagal tone. The vagal nerve carries messages from the brain for digestion, detoxification, and healing. Strong vagal tone is foundational to a ketogenic diet.
  1. Fat Digestion on Ketosis

With the profound increase in fats necessary to shift into ketosis, the question is whether we can digest the fats. Improperly digested fats actually become a stress rather than a healing to the body.

Fat is the macronutrient demanding the most energy to digest, and it takes longer than proteins and carbs to digest. Gallbladder issues, pancreatic lipase deficiency, and gut inflammation from allergies or infection will compromise fat digestion.

Symptoms of poor fat digestion: greasy or floating stool, pain under right rib cage, nausea.

Supplemental support: If stool is light colored, it indicates the gallbladders bile is too viscous. Bile is needed for the emulsification of fats in the small intestine. With this indication, use Beta TCP.

For those who begin the ketogenic diet and become constipated, consider the short-term (up to three weeks) addition of Beta-Plus (bile salts).

Digestive enzymes that include lipase can also be supportive. The amino acid taurine is essential for bile production, and is supportive for everyone to take in the first phase of the ketogenic diet.

2. Adrenal Support for the Ketogenic Diet

When converting from a sugar-burner to a fat-burner, for the first 6 to 12 weeks, the adrenals face an increased workload. Their role is to maintain blood sugar levels during the dramatic reduction in carbs.

With the demand on the adrenals to produce the necessary cortisol, there is the possibility of overworking the adrenals in the first phase of the ketogenic diet. If the adrenals don’t keep up with cortisol production, we experience the fatigue familiar to many during the ketogenic conversion.

Those who already struggle with adrenal insufficiency can compromise the health of their adrenals even more.

Symptoms of compromised adrenal function: Extreme fatigue, salt cravings.

Supplemental support: Vitamin B1, vitamin B5, salt, licorice tinctures, food-based vitamin C, and adrenal glandular. ADB5 Plus from Biotics Research is a multi-nutrient supplement for the adrenals.

3. Detoxification Help for Ketosis

With the inevitable weight loss from the Ketogenic diet, the toxins stored in our fat are released into the blood and distributed to our liver, kidneys and digestive system. Without sufficient liver and gut support, the mobilized toxins are redistributed throughout the body, creating a toxic effect.

Without detoxification support, the toxins mobilized during the ketogenic diet can produce symptoms known as the “Keto Flu.”

Symptoms of detoxification: Skin breakouts, irritability, headaches.

Supplemental support: chlorella (lead-free with broken cell walls) and bentonite clay are toxin binders, which remove toxins via the intestinal tract. Glutathione is critical — forms of sublingual glutathione or transdermal glutathione can be found from alternative health practitioners.  Folate, vitamin B12, choline, taurine, and inositol all help the liver optimize detoxification functions.

4. Leaky Gut and the Ketogenic Diet

Nine out of ten people have some degree of gut inflammation. Poor digestion, allergies, and infections all inflame the epithelial tissue of our gut.

This tissue damage critically diminishes digestion and immune function, and leaky gut results. Food, undigested fats, and pathogens leak into the blood stream, which puts the immune system into overdrive. In that process we develop  new food intolerances from whatever we are eating frequently.

When the gut is compromised, a high intake of fat can stress digestion even further and perpetuate leaky gut. Undigested fats are caustic to the gut lining. Support for gut healing must be in place.

Symptoms of leaky gut: Heartburn, undigested food in stool, food allergies or sensitivities, eczema, autoimmune disease.

Supplemental support: Restore, Biokult or PrescriptAssist probiotic, Reparivite from Apex Energetics (available from alternative health practitioners)

5. Electrolyte Balance and Ketosis

Ketosis has an immediate and dramatic effect on water weight and mineral levels.  Insulin encourages the body to retain water and sodium. When insulin levels drop in ketogenic state,  electrolytes are lost.

Determining specific mineral needs  is essential. The ketogenic community has determined that sodium deficiency is common.  This is especially true with adrenal insufficiency, commonly called “adrenal fatigue.” Why?

The adrenals also produce a hormone called aldosterone, whose function is to tell the kidneys to retain sodium. When the adrenals become tired, they not only become deficient in cortisol output but also aldosterone output. Now, the kidneys start excreting too much sodium.

This can lead to dehydration. Without sufficient sodium, the body cannot maintain its hydration levels.

However, sodium is depleted in 50% of my ketogenic cases. Beware of the generic keto prescription of always adding salt. Many of my clients have needed potassium, magnesium or calcium instead of sodium.

Clients who have a hyper-adrenal pattern have excess levels of aldosterone, and retain too much sodium. Those clients don’t do well with adding salt.

Symptoms of electrolyte imbalance: muscle cramps, muscle fatigue, salt cravings.

Supplemental support:  Sea salt or electrolytes. For those of you with hyper-adrenal patterns (which you can determine here), include Cortisol Brakes from Meo Energetics.

6. Vagal Tone and Ketosis


The vagal nerve is the wiring that connects the brain to the digestive system. Without vagal tone, digestion doesn’t happen.

The vagal nerve activates the branch of the autonomic nervous system called parasympathetic. Digestion, detoxification, and immune functions are only turned on when the body is in a parasympathetic state. 

There are consequences to low vagal tone: the body’s essential processes shut down. Low vagal tone leads to the challenges seen on a ketogenic diet including nausea, constipation, insomnia, exhaustion, and adrenal imbalances.

Symptoms of low vagal tone: constipation, insomnia, undigested food in stool, floating stool, discomfort in digestive tract.

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