The ketogenic (keto) diet has gained immense popularity as a weight loss and health improvement strategy. This high-fat, moderate-protein, and very low-carbohydrate diet forces the body to switch its primary fuel source from glucose to ketones, a metabolic state known as ketosis. While the keto diet can offer numerous benefits, it also requires careful attention to nutrient intake to avoid deficiencies. This article provides a detailed guide to the best vitamins and supplements for those following a keto diet.
What is the Keto Diet?
The keto diet is not just another low-carbohydrate, high-protein diet. The keto (pronounced KEY-toe) diet was first developed to treat diabetes in the 19th century. It involves drastically reducing carbohydrate intake and replacing it with fat. This reduction in carbs puts your body into a metabolic state called ketosis.
When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain (6). Ketogenic diets can cause significant reductions in blood sugar and insulin levels. This, along with the increased ketones, has some health benefits (6, 7, 8).
How Keto Works
Glucose is our bodies' main source of energy. When we deprive the body of glucose (found in abundance in carbohydrates), our body's cells turn instead to "ketones," chemical sources of fuel the liver produces from stored fat. When you cut out carbohydrates in your diet, or if you've been fasting, your body first takes glucose from stores in the liver. The idea behind keto is that carbohydrates, those easy sources of glucose, are severely restricted and replaced by a higher intake of meats and fats. When health care providers prescribe this diet, they often customize it to each patient.
Types of Ketogenic Diets
There are several versions of the ketogenic diet, and what you eat depends on the type. They include:
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- Standard ketogenic diet (SKD): This is a very low carb, moderate protein, and high fat diet. It typically contains 70% fat, 20% protein, and only 10% carbs (9).
- Cyclical ketogenic diet (CKD): This diet involves periods of higher carb refeeds, such as 5 ketogenic days followed by 2 high carb days.
- Targeted ketogenic diet (TKD): This diet allows you to add carbs around workouts.
- High protein ketogenic diet: This is similar to a standard ketogenic diet, but includes more protein. The ratio is often 60% fat, 35% protein, and 5% carbs.
However, only the standard and high protein ketogenic diets have been studied extensively. Cyclical or targeted ketogenic diets are more advanced methods and primarily used by bodybuilders or athletes.
Achieving and Monitoring Ketosis
Ketosis is a metabolic state in which your body uses fat for fuel instead of carbs. It occurs when you significantly reduce your consumption of carbohydrates, limiting your body’s supply of glucose (sugar), which is the main source of energy for the cells. Following a ketogenic diet is the most effective way to enter ketosis. Generally, this involves limiting carb consumption to around 20 to 50 grams per day and filling up on fats, such as meat, fish, eggs, nuts, and healthy oils (6). It’s also important to moderate your protein consumption. This is because protein can be converted into glucose if consumed in high amounts, which may slow your transition into ketosis (10).
Blood, urine, and breath tests are available, which can help determine whether you’ve entered ketosis by measuring the amount of ketones produced by your body. Certain symptoms may also indicate that you’ve entered ketosis, including increased thirst, dry mouth, frequent urination, and decreased hunger or appetite (12).
Why Consider Supplements on Keto?
While the keto diet can be very effective, it inherently restricts many nutrient-dense foods like fruits, whole grains, and certain vegetables. This can lead to potential nutrient deficiencies if not carefully managed. Supplements can help bridge these nutritional gaps and support overall health while on the keto diet.
Potential Nutrient Deficiencies
The ketogenic diet restricts carbohydrates, limiting the amount of nutrients you may get. You may develop nutrient deficiencies while on the keto diet. One of the long-term impacts of the keto diet is nutrient deficiencies. Carbohydrates contain many essential nutrients.
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- Fiber: By cutting out fruits and whole grains, a keto diet removes key sources of fiber.
- Magnesium: Many high-magnesium foods, like whole grains, bananas, and beans, contain too many carbs to be keto-friendly.
- Calcium: Similarly, calcium-fortified orange juice and tofu are both good sources of calcium, but are not keto-friendly.
- Iron: Iron is the fuel that allows every body cell to function correctly. Eating meat can give you enough iron. However, iron deficiency is still possible, especially for women.
- Vitamin D: Fatty fish, such as salmon and tuna, and eggs are good sources of vitamin D if you're on the keto diet.
- B Vitamins, Potassium, and Vitamin A: The keto diet and other low-carbohydrate diets are typically low in many vitamins and minerals, including B vitamins, magnesium, iron, vitamin A, and potassium.
Addressing the "Keto Flu"
Some people experience the "keto flu" when first starting the keto diet. In the first weeks of starting the keto diet, symptoms like fatigue, dehydration, and upset stomach may occur due to the sudden, drastic diet changes.
Recommended Vitamins and Supplements for Keto Dieters
It’s important to remember that keto diet recommendations should come from your health care provider and may differ from person to person. Here are some of the best vitamins and supplements recommended for keto dieters:
MCT Oil
MCT oil is a type of fat that may help you produce ketones and achieve ketosis. MCT oil is easily digested and absorbed, making it readily available to make ketones. Your body can use MCT oil as a source of fat to make more ketones and stay in a state of ketosis. Research shows that the body may convert MCT oil to energy more easily, making it an almost immediate energy source. Added to drinks or yogurt, MCT oil provides energy and helps increase ketone levels.
Electrolytes
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Electrolytes may get low while on the keto diet, in which case a supplement may help. Electrolytes help maintain fluid balance and are essential to numerous reactions in your body. Electrolytes, like calcium, potassium, magnesium, and sodium, help your body move nutrients into cells and remove waste as needed. A ketogenic diet can also change the water and mineral balance of your body, so adding extra salt to your meals or taking mineral supplements may help.
- Sodium: Unless a person has high blood pressure requiring continued medication, it is recommended to start right out consuming 4-5 grams per day to prevent symptoms of “keto flu”, and then continue this sodium intake as long as you are following a ketogenic diet. You can easily increase your sodium intake by salting your food and drinking 1-2 cups of broth or bouillon.
- Magnesium: Magnesium affects muscles, nerves, your immune system, and many chemical reactions throughout the body. An important mineral for nerve and muscle function that is found in meats, leafy greens and nuts. If you experience any muscle cramps, fatigue, and possibly an abnormal heart rhythm it may be time to add in a magnesium supplement. Women need 310-320 milligrams (mg) of magnesium daily, while men need 400-420 milligrams. Taking a magnesium supplement can help fill in any nutritional gaps. Talk to a healthcare provider about taking a magnesium supplement.
- Potassium: An important mineral that is also an electrolyte, potassium has several functions including maintenance of blood pressure, fluid balance, muscle contractions, and nerve function. While potassium is notably found in bananas it is also found in meat, non-starchy vegetables, and avocados! Just be sure to keep the broth/drippings from your meat and to steam veggies rather than boil because potassium (and magnesium) can leach out into the liquid while cooking.
Fiber
Fiber is essential for digestive health and helps manage weight. Most sources of fiber come from whole grains, fruits, legumes, and vegetables, all of which are carbohydrates. Some fiber-rich foods are lower in carbohydrates. Eating only these low-carb sources of fiber may not be enough, so a daily fiber supplement could help you meet your daily fiber needs.
Calcium
Adults aged 19-50 need 1,000 milligrams of calcium daily. Calcium serves many purposes. Without enough calcium and vitamin D, your bones may not be as strong. This can increase your risk for osteoporosis (bone loss).
Vitamin D
Adults aged 19-70 should aim for 600 international units (IUs) of vitamin D daily. A daily vitamin D supplement can help you meet your needs.
Iron
Men aged 19-50 need 8 milligrams of iron daily, while women aged 19-50 need 18 milligrams. However, iron deficiency is still possible, especially for women.
Omega-3 Fatty Acids
This is an essential fatty acid that is required for normal well-being and function. Cold-water fish like salmon, tuna, herring, mackerel, and sardines are great sources of omega-3s, as are omega-3 rich eggs. It is generally recommended to consume fish 3 times a week or 2 omega-3 rich eggs daily. If you do not regularly eat fish or purchase these specialty eggs you may want to consider taking a fish oil or flaxseed oil supplement.
Protein Powder
A low-carbohydrate protein powder may help keto dieters maintain muscle mass and get enough protein. Protein powder may help you meet your protein needs on the keto diet. Protein powder may help preserve muscle mass. According to one study, consuming protein powder alongside a resistance training program may promote muscle growth and strength. Research shows that the body may convert MCT oil to energy more easily, making it an almost immediate energy source. Whey. Use half a scoop of whey protein in shakes or yogurt to increase your daily protein intake (48, 49).
Keto Salts
Keto salts are exogenous ketones that some believe may increase ketone levels in your body. Research shows that ketone supplements (like ketone salts and ketone esters) may increase ketone levels in people following a keto diet. Evidence suggests that taking medium-chain triglyceride (MCT) oil and ketone supplements may also enhance ketone production.
Creatine
Creatine has been linked to minor improvements in body mass, fat-free mass, and body fat percentages. Creatine provides numerous benefits for health and performance. This can help if you are combining a ketogenic diet with exercise (47).
BHB supplements
Some people on the keto diet may struggle to maintain their energy, especially when first starting the diet. Beta-hydroxybutyrate (BHB) is a type of ketone your body produces naturally. You can also take it in supplement form. BHB supplements may help maintain energy levels while on the keto diet.
BCAAs
BCAAs are amino acids, which are the building blocks of proteins. Other supplements, like beta-alanine and creatine, may also help preserve muscle mass.
Supplements to Approach with Caution
Keto "Fat Burners"
Keto "fat burners" are promoted as keto supplements for weight loss. However, these supplements are not well-researched, making many weight-loss claims baseless. This means keto "fat burners" may be unnecessary and unsafe.
Are Keto Supplements Necessary for Everyone on a Keto Diet?
Supplements may fill nutrition gaps: Certain supplements may help you get any nutrients that may be missing from the keto diet. A multivitamin may be especially helpful in filling nutrition gaps. Supplements may reduce the risk of keto flu: Some people experience the "keto flu" when first starting the keto diet.
How to Choose the Best Keto Supplements
You may wonder how to choose the best keto supplements for your goals. Here are some considerations:
Supplement Form: Keto supplements come in many forms, including powders, capsules, keto gummies, liquid extracts, and chewable tablets. You can purchase keto supplements online or at certain grocery stores or nutrition shops.
Quality: Supplement brands may have their products reviewed for quality by third parties. These third parties, like NSF International and the USP, ensure that products are properly manufactured and contain the ingredients listed on the label. However, third-party testing doesn't ensure effectiveness.
Ingredients: Some keto supplements may contain unnecessary ingredients like fillers, binders, and flavors. Some people may also be allergic to specific ingredients, so always read the ingredient list on the supplement label before purchasing.
Safety: Not all keto supplements are safe for everyone. Specific supplements may interact with medications or other supplements you use. Some people, like those who are pregnant or have certain medical conditions, may need to limit or avoid keto supplements.
Potential Risks and Side Effects
Keto supplements may present some risks and side effects. Dietary supplements come with the risk of side effects. You may be more likely to experience side effects if you misuse supplements or take high doses. Common side effects of supplements include upset stomach, headache, fatigue, and skin reactions.
Precautions
Some people should take precautions when taking keto supplements. You should consult with a healthcare provider if you are pregnant, breastfeeding, or thinking about giving keto supplements to your child.
Interactions
If you take medications or other supplements, you should be aware of potential interactions with keto supplements. Herbal supplements, in particular, are known to interact with medications, including blood thinners and medications taken for depression. Multivitamins may also interact with blood thinners.
Consulting with Healthcare Professionals
Keep in mind that the FDA does not fully regulate dietary supplements. Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian nutritionist (RD or RDN), pharmacist, or healthcare provider. Before starting any new supplement, it's always wise to talk with a healthcare provider.
Emphasizing Whole Foods
It is well known that whole foods should be emphasized over dietary supplements because essential vitamins and minerals found in foods are usually better absorbed than those found in supplements (Lichtenstein, 2005). By nature, the ketogenic diet is best comprised mostly of whole, unprocessed foods that meet most of, if not all your nutritional needs. Thus, if you make the right food choices and eat an appropriate number of calories, you will be at a low risk of nutrient deficiencies.