Not many people connect their diet to their quality of sleep, yet the nutrition we provide our bodies plays a crucial role in determining how well we rest. While various diets can help with weight loss or overall health, transitioning to a new eating plan often impacts sleep. The ketogenic, or keto, diet is a popular, effective way to lose weight and improve your health. Many people consider the keto diet a popular option for weight loss. Keto dieters reduce the intake of simple carbohydrates such as sugar, white bread, and pasta, tailoring meals to include moderate protein and higher fat. Eating plans also impact other aspects of your life. For example, some people experience a condition called “keto insomnia” on this program.
Keto insomnia refers to sleep disturbances that some people experience when starting a ketogenic diet. It’s essential to understand that our food choices significantly influence how well we rest. Certain foods can enhance sleep quality, while others, particularly those high in sugar, carbohydrates, or heavily processed, can disrupt it. Sleep quality acts as a barometer for overall health; sufficient and uninterrupted sleep typically signals positive well-being. Conversely, poor sleep quality often reveals underlying health issues or nutritional deficiencies. Understanding the connection between diet and sleep can help individuals make informed choices about their nutrition and overall well-being.
What is the Keto Diet?
The ketogenic diet has gained immense popularity in recent years, touted for its ability to facilitate weight loss and promote fat burning. This diet primarily involves drastically reducing carbohydrate intake while substantially increasing the consumption of healthy fats, proteins, and low-starch vegetables. The term “keto” originates from the small molecules called ketones generated in the liver when carbohydrates and proteins are minimal. In typical circumstances, carbohydrates convert into glucose-fuel for the body. When your body burns fat instead of glucose, this leads to elevated ketone levels, which is called ketosis. When followed correctly, this low carb, high fat diet will raise your blood levels of ketones. Ketones are chemical byproducts that provide a new fuel source for your cells. They’re responsible for most of the unique health impact of the keto diet.
Many people find the keto diet appealing due to its rapid fat-burning capabilities and the potential to mitigate hunger while simultaneously boosting metabolism. Ketosis occurs when there is an overproduction of ketones in the body due to insufficient carbohydrate intake, pushing the metabolism to rely primarily on fat for energy. When someone embarks on a ketogenic diet, the initial phase is often marked by various side effects, including diarrhea, fatigue, muscle cramps, decreased appetite, and notably, insomnia. The keto diet should be avoided if you have certain medical conditions, including pancreatitis, liver failure, fat metabolism disorders and others (2, 5).
The Keto-Insomnia Connection
When someone embarks on a ketogenic diet, the initial phase is often marked by various side effects, including diarrhea, fatigue, muscle cramps, decreased appetite, and notably, insomnia. The link between ketosis and insomnia can be traced back to the diminished carbohydrate intake. Carbohydrates are not only a primary energy source; they also contribute to the brain’s availability of L-tryptophan, an amino acid essential for producing serotonin, a hormone that fosters relaxation and well-being. In the early stages of a ketogenic diet, reduced carbohydrates lead to lower levels of L-tryptophan, which subsequently hinders serotonin and melatonin production. This hormonal imbalance can result in sleep difficulties.
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Another reason why keto affects sleep is because it can make dieters feel a little nibbly. “When we’re hungry, it’s difficult to feel rested enough to fall asleep,” she says. “Some people may be midnight snackers, too,” Casey adds. “They wake up in the middle of the night to eat a snack or a meal. This may cause more arousal (also known as wakefulness).
Understanding the Science Behind Keto and Sleep
On a keto diet, your body undergoes many biological adaptations. This includes a reduction in insulin levels and the increased breakdown of fat (3, 4). When this happens, your liver starts producing high numbers of ketones to supply energy for your brain.
Experts have long suspected that what a person eats can impact their sleep, but limited research is available to explain why some individuals experience better or worse sleep while on the keto diet.
The Role of Adenosine
There’s some very interesting emerging research showing that ketogenic diets have an effect on a brain chemical that is important to sleep regulation: adenosine. Adenosine builds up in the body throughout the day. It contributes to our feeling increasingly less alert and wakeful as the day goes on, and eventually helps to promote deeper slow-wave sleep at night. Caffeine’s ability to block the effects of adenosine is one important way it delivers us that stimulating, alertness-producing mental boost.
We need to see more research to better understand the relationship of ketogenic diets to adenosine, and to sleep directly.
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Carbohydrates, Tryptophan, Serotonin, and Melatonin
“Diet can impact the quality and quantity of sleep both positively and negatively,” Richards says. “In short, we need carbs to sleep better. [It] helps the body produce L-tryptophan, the amino acid responsible for production of the relaxation hormone serotonin. Unfortunately, there are few other foods which contain natural melatonin. Carbohydrates increase levels of the amino acid tryptophan in the brain, which helps facilitate sleep when it converts to serotonin. Serotonin is necessary for the body to produce the sleep hormone melatonin.
The Impact of High-Protein Intake
High protein diets have also shown both benefits and drawbacks for sleep. Some studies show consuming greater amounts of protein is linked to longer sleep times, more consistent sleep patterns, and higher sleep quality. Other research suggests higher protein intake is linked to shorter sleep amounts.
Protein, on the other hand, increases levels of tyrosine, an amino acid that triggers the production of stimulating, alerting brain chemicals, including epinephrine and norepinephrine. Research on the effects to sleep of high-protein and high-carbohydrate diets is mixed.
Keto Flu and Insomnia
Are you new to the keto diet? If so, you’ve most likely felt the flu-like side effects of the diet. Not everyone experiences trouble sleeping on keto, but those who do feel the consequences, such as daytime fatigue and poor focus. Keto can interrupt your sleep at night. It’s a common symptom of changing your diet from high-carb to very low-carb. However, remember that insomnia eventually goes away on its own as you keep sticking to the keto diet. In fact, many people who properly implement keto (which we’ll get into in a while) find that their sleep has improved over time.
Keto insomnia is a temporary problem in which a new keto dieter has difficulty falling or staying asleep. Unfortunately, this is also the same period wherein you experience other side effects of going keto, which makes the whole keto transition extremely challenging. Symptoms can include changes in the way your breath smells, appetite, and energy levels.
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What Causes Keto-Related Insomnia?
A number of things happen when you’re going keto, from having low glucose levels, to possible electrolyte imbalances and digestive issues. Low blood glucose levels during the night can lead to sleep issues, whether or not a person has diabetes (*). Since you’re reducing carbs, your blood sugar lowers naturally. Electrolyte imbalances, such as sodium, potassium, and magnesium, occur as a result of low insulin levels. Being low on electrolytes can also contribute to sleep problems by causing muscle cramps, muscle twitching, and headaches. Digestive issues like diarrhea and constipation also happen at the start of the keto diet. Last but not least, certain foods and beverages that are keto-friendly may sabotage your sleep. For instance, drinking black coffee (to stay alert and suppress appetite) later in the day can make it difficult to fall asleep. Spicy foods, such as chili peppers, may trigger heartburn and acid reflux.
Strategies to Mitigate Keto Insomnia
While you might eat fewer carbs on the keto diet, the design of your plan could make all the difference in sleep quality. Meal ingredients and timing may help offset keto insomnia by promoting the essential qualities needed for better rest. Managing keto insomnia involves adopting strategies to ease the transition and support good sleep hygiene. Gradual changes to the diet, adequate hydration, and incorporating sleep-friendly practices are among the best approaches to mitigate the potential impacts of the keto diet on sleep.
Here are some strategies to consider:
- Ease into the Keto Diet Gradually: You can get into ketosis by cutting out carbs completely. Reduce feelings of discomfort by gradually reducing carbs. You can start eliminating only one type of high-carb food, such as grains, for a few days or weeks. In order to not feel deprived on keto, swap out those high-carb foods for low-carb options.
- Strategic Carbohydrate Consumption: “Those having issues with keto insomnia may benefit from saving their carbs for later in the day,” she says. You might feel fuller and avoid late-night ‘fridge trips by including non-starchy vegetable carbohydrates in your last meal before bedtime, such as broccoli, cauliflower, and mushrooms. You might have heard of the advice to save your carbs for later in the day. The explanation is that eating carbs before bed helps with sleep since carbs increase brain tryptophan. Tryptophan is then metabolized into serotonin and melatonin. The same rule applies: Focus on keto-friendly carb sources, such as cauliflower, nuts, and avocados. (Eating all of your carbs later in the day may also help with weight loss and muscle gain.
- Prioritize Electrolyte Balance: Electrolyte imbalances as a result of running on very few carbohydrates can trigger keto flu symptoms and insomnia. The easiest and most convenient way to restore electrolytes and prevent imbalances is by eating a variety of electrolyte-rich foods. Speak with your doctor as well about the medications you’re currently taking (both prescription and over-the-counter). Electrolytes are often lost because of the rapid reduction in your body’s water content (4). When adding these supplements, make sure to include sodium, potassium, and magnesium.
- Incorporate Sleep-Inducing Foods: In addition to saving your carbs for later in the day, you can also incorporate sleep-inducing foods into your diet. “Bananas are unique in that they’re also rich in L-tryptophan and magnesium,” she says. “Magnesium is a natural muscle relaxant which can help the body and mind wind down before going to sleep.” There are plenty of low-carb foods that can address insomnia since they contain nutrients that improve sleep. Other foods rich in magnesium include avocados, nuts, and tofu. We have snack ideas that encourage better shuteye, too.
- Maintain a Consistent Sleep Schedule: Keto flu isn’t the only factor that’s affecting your sleep. The key is to decide on a sleep schedule and stick to it.
- Avoid Evening Exercise: For those with insomnia, it’s best to stop exercising at least 4 hours before bedtime. Tip: See how your workouts are affecting your sleep by recording them in a sleep and exercise diary.
- Establish a Relaxing Bedtime Routine: Wind down before bed by following a relaxing routine. This should incorporate activities that allow you to relax. For instance, reading a good book while playing soft music in the background.
- Limit Caffeine Intake: Because caffeine increases wakefulness and brain activity, taking it close to bedtime isn’t a good idea.
- Minimize Screen Time Before Bed: It can be tempting to immerse ourselves in social media and work late into the night; however, doing so can negatively affect our sleep. For people who cannot avoid electronic devices at night, a good piece of advice is to use blue light-blocking glasses.
- Consider Avoiding Intermittent Fasting Initially: Intermittent fasting is often used in combination with the keto diet to reach ketosis faster. Although intermittent fasting may improve your sleep over time, it might be a good idea to avoid extended fasting for now.
How Long Does Keto Insomnia Last?
The duration of keto insomnia depends on how soon a person adapts to the keto diet. This is especially true for those who are coming off a high-carbohydrate diet. Since keto insomnia is only a short-term problem, these symptoms will resolve as your body becomes used to its new macros.
Keto Diet and Mental Health: A Potential Link Through Sleep
Sleep is a critical regulator of metabolic homeostasis and oxidative stress. Disruption of sleep and circadian rhythms contribute to the onset and progression of bipolar disorder and schizophrenia and these disorders often coexist with sleep disorders. Furthermore, sleep deprivation has been associated with increased oxidative stress and worsening mood symptoms.
Dysfunctional brain metabolism can be improved by fatty acid derived ketones as the brain readily uses both ketones and glucose as fuel. Ketones have been helpful in many neurological disorders including epilepsy and Alzheimer’s disease. Recent clinical trials using the ketogenic diet suggest positive improvement in symptoms for bipolar disorder and schizophrenia as well. The improvement in psychiatric symptoms from the ketogenic diet is thought to be linked, in part, to restoration of mitochondrial function. These findings encourage further randomized controlled clinical trials, as well as biochemical and mechanistic investigation into the role of metabolism and sleep in psychiatric disorders.
Metabolic Abnormalities in Bipolar Disorder and Schizophrenia
In contemporary metabolomics, emerging insights into bipolar disorder reveal notable pathologies, encompassing mitochondrial dysfunction, perturbed energy synthesis, and abnormal mitochondrial morphology (6, 32-35). Mitochondria, the primary contributors to adenosine triphosphate (ATP) synthesis, play a pivotal role in reactive oxygen species generation, apoptosis, and calcium homeostasis (36-39). Among individuals with bipolar disorder, mitochondrial dysfunction leads to diminished energy production (6, 40). This mitochondrial dysfunction coincides with heightened apoptosis, increased reactive oxygen species, oxidative damage, hyperexcitability (41, 42), and a demonstrated elevation in proinflammatory cytokine levels associated with bipolar disorder (41, 43). Beyond mitochondrial dysfunction, structural aberrations in mitochondria have been documented in bipolar disorder patients, manifesting in anomalous mitochondrial structure in the prefrontal cortex, fibroblasts, and lymphocytes (34).
Calcium homeostasis, a critical determinant of apoptosis, is regulated by mitochondria through the modulation of intracellular calcium ion concentrations across the mitochondrial membrane. This regulation governs energy production rates, apoptosis, and neuronal excitability (45-47). Notably, bipolar disorder patients exhibit elevated intracellular calcium ion levels during both manic and depressive phases, indicating a connection between bipolar disorder pathophysiology and calcium signaling (48). Furthermore, calcium homeostasis holds significance for neuronal excitability, a crucial element in synaptic plasticity and maintaining excitatory/inhibitory balance (49). Consequently, dysregulation of calcium plays a pivotal role in the pathophysiology of bipolar disorder (50).
Schizophrenia is also rooted in dysfunctional cerebral bioenergetics, arising from disruptions in brain cell function, neuroplasticity, and brain circuits, often associated with impaired energy metabolism (56-58). Recent studies have revealed consistent trends in metabolic dysfunction in schizophrenia, including compromised insulin signaling, impaired glucose metabolism (59-62), and dysfunctional astrocyte-neuron coupling leading to impaired lactate shuttling and glycolysis (63-67). Moreover, alterations in neurotransmitter systems are evident in schizophrenia patients, characterized by low serotonin, dopamine, and GABA levels in the prefrontal cortex (69-71). Hypofunction of inhibitory GABAergic interneurons is implicated in an imbalance between inhibitory and excitatory processes, a key aspect of schizophrenia pathophysiology (72, 73).
Oxidative Stress and Redox Dysregulation
Emerging research provides growing evidence supporting oxidative stress as an underlying mechanism in bipolar disorder (4, 5). Reactive oxidative species, natural byproducts of energy metabolism and cellular function, can lead to oxidative stress and cellular damage if not properly eliminated (80). This oxidative stress can also result in mitochondrial dysfunction, another potential factor in bipolar disorder (5, 6). Redox homeostasis is crucial not only for containing tissue damage over time but also for maintaining appropriate signaling in specific biochemical pathways (81). Redox dysregulation is also notably regarded as a pivotal environmental risk factor in the neurodevelopmental context of schizophrenia (7).
Fast-spiking PVI neurons, rely on heightened metabolic activity and oxidative phosphorylation to support high-frequency discharge (87), exhibit heightened vulnerability to redox dysregulation. Mounting evidence suggests the involvement of mitochondrial dysfunction and augmented reactive oxygen species production in the pathophysiology of schizophrenia (88-90).
Ketogenic Diet as a Potential Therapeutic Intervention
Intriguingly, common underlying pathophysiology exists between epilepsy and bipolar disorder, with biochemical, structural, and functional abnormalities found in primary bipolar disorder potentially occurring secondarily to seizure disorders, both of which are treated with anticonvulsants (93). Ketogenic diet metabolic therapy, which promotes a metabolic state of nutritional ketosis by low-carbohydrate and high-fat intake, has long been established as an adjunctive treatment for epilepsy. The ketogenic diet effectively reduces seizure frequency and severity in drug-resistant epilepsy across pediatric and adult populations (8, 9).
Emerging evidence suggests potential positive effects of the ketogenic diet on bipolar disorder and schizophrenia. Case reports document significant improvements in bipolar disorder symptoms, including mood stabilization and decreased anxiety, following ketogenic interventions (15-17). Patients with schizoaffective disorder also have experienced mood and psychotic symptom improvements within a month or achieving remission of psychotic symptoms upon initiating the ketogenic diet (19, 20). Additionally, a cohort study reports symptom improvements and reduced psychotropic medication dosages in patients with bipolar disorder, major depressive disorder, and schizophrenia adhering to a ketogenic diet (18). Another recent cohort study conducted by Needham et al. (21) demonstrated feasibility of the ketogenic diet intervention in patients with bipolar disorder.
Considerations and Precautions
While some people have sleep disturbances when first adopting the keto diet, others experienced the opposite. who followed a low-calorie keto diet for a month reported actually sleeping better. Not everyone on the keto diet will experience insomnia.
If you’re considering starting the keto diet, it’s critical to consult your doctor first. Although the diet may promote weight loss and other benefits, it may not be safe for everyone. Those with liver, pancreas, gallbladder, and thyroid conditions should avoid the keto diet.
Individual Variability and Long-Term Effects
Not everyone responds the same way to the keto diet. Research on the long-term effects of the keto diet on sleep is limited. Maintaining proper nutrient balance, including vitamins and minerals, is crucial for overall health, including sleep.
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