Unlock the Truth: How the Keto Diet Can Cause Vitamin Deficiencies and How to Avoid Them!

The ketogenic (keto) diet has gained considerable popularity as a weight-loss strategy. It involves drastically reducing carbohydrate intake and replacing it with fats. This metabolic shift forces the body to burn fat for fuel, producing molecules called ketones, a state known as ketosis. While many have found success with keto for weight loss, it's crucial to understand the potential for nutrient deficiencies and how to address them.

Understanding the Keto Diet

The keto diet, similar to the Atkins diet, restricts carbohydrates to a small percentage of daily calories (around 5%), primarily from non-starchy vegetables and leafy greens. This typically translates to less than 50 grams of carbs per day, excluding carb-rich foods like grains, beans, fruits, and starchy vegetables. The body's primary energy source, glucose, derived from carbohydrates, is limited, compelling it to burn fat instead. While burning fats by eating more of them is enticing, the keto diet has become popular and allows many people to eat the types of high-fat foods that they enjoy, such as red meats, fatty fish, nuts, cheese and butter, while still losing weight.

Potential Benefits of the Keto Diet

The keto diet has demonstrated benefits for specific groups. It can help reduce seizures in children with epilepsy. Endurance athletes and body builders also use it to scrap fat in short timeframes. The keto diet is being studied for reducing symptoms for patients with progressive neurological disorders like Parkinson’s disease.

The Risk of Nutrient Deficiencies on Keto

Despite potential benefits, the keto diet can lead to nutrient deficiencies due to its restrictive nature. Because of the stringent food restrictions, many find the keto diet hard to stick to. “The ketogenic diet can be effective for weight loss when used in a short time period followed by the adoption of healthier eating habits,” says Baljash Singh Cheema, MD, a cardiologist at Northwestern Medicine Bluhm Cardiovascular Institute. “However, we know in studies of these types of diets that once people stop following that diet, they regain at least half of the weight that they lost. Ketosis is difficult to achieve because it’s like a light switch: either on or off. Individuals who consistently track food intake are more likely to remain in ketosis.

When these extremes are employed, the body becomes depleted of an essential nutrient called choline, a nutrient highly concentrated in egg yolks, but also available in liver, meat, poultry, and fish. Choline deficiency is well known to cause fatty liver all by itself. It stands to reason that maintaining healthy choline and methionine levels in our diets or through supplementation is essential in avoiding fatty liver and potential liver damage when we go through a prolonged and extreme keto diet phase.

Common Deficiencies and Their Consequences

Micronutrient Imbalance: Strategizing the types of foods you include in your diet and the supplements you take while on keto can reduce and/or correct the underlying issue, allowing you to lose weight while maintaining micronutrient balance.
Vitamin D: Keto diets and vitamin D deficiency are often linked because a keto diet reduces the intake of vitamin D-rich foods and beverages like milk, orange juice, yogurt and fortified cereal. Some common symptoms of vitamin D deficiency include weak muscles, fatigue, pain, appetite loss, nausea, high blood pressure and even depression.
B Vitamins: B vitamins (thiamin, riboflavin, niacin, pantothenic acid, pyridoxine, folate, cobalamin and more) are essential for the proper functioning of the body. Without them, metabolism will slow down and many chemical reactions involving fats or carbohydrates can be delayed or otherwise impaired, resulting in weight gain.
- Vitamin B12: Your body needs vitamin B12 for energy, and without energy your body may experience anemia, memory loss, anxiety, fatigue, constipation or muscle weakness.
- Thiamin (B1): Since the keto diet includes low carb, high fat foods, keto dieters typically lack Thiamin (B1). The Recommended Dietary Allowance (RDA) of Thiamin for adults is 1.2mg/day for men and 1.1mg/day for women, respectively. Since fatty foods contain little thiamin, this presents a problem. Thiamin deficiency symptoms include fatigue, irritability, memory loss and sleep issues.
- Folate (Vitamin B9): Folate (Vitamin B9) is an important nutrient that helps with red blood cell production and repair body tissue. It is an important mineral during pregnancy when the body is experiencing rapid growth. Folate levels are hard to meet through a natural diet, so supplementation can be necessary.
- Biotin deficiency is usually associated with symptoms such as thinning hair, dry skin, scaly rashes, brittle nails, conjunctivitis, depression, fatigue, numbness and tingling in the arms and legs. However biotin is used up extensively in the processing of fatty acids while on the keto diet. In an animal study, biotin deficiency developed at 7 weeks in mice fed a strict ketogenic diet.
Calcium: Calcium is an important mineral for strong bones and teeth, as well as muscle and nerve communication. High-carb fruits and enriched grains like brown rice and oatmeal contain appropriate calcium levels and are not included in the keto diet plan. Calcium deficiencies are common amongst the keto diet population as dieters tend to have acidic urine, leading to painful kidney stones.
Choline: Choline is an essential nutrient required for your body to regulate memory, mood and muscle function. It’s one of the most important nutrients for brain development as well. A keto diet limits the intake of potatoes and whole grains like rice, whole wheat bread and quinoa, and in turn can create a choline deficiency. Top choline deficiency symptoms include anxiety, restlessness, non-alcoholic fatty liver disease and muscle damage.
Sodium: Keto dieters are prone to sodium deficiency levels (especially keto dieters who are athletes and sweat often). Your body needs sodium to maintain blood pressure and fluid balance. The keto diet plan limits foods rich in sodium like whole grains and low-fat milk products. Sodium deficiency symptoms include fatigue, headaches and poor cognitive and physical performance.
Potassium: Since some high-carb foods like brown rice, bananas and potatoes contain large amounts of this mineral, keto-dieters are at risk for potassium deficiencies. A lack of potassium can lead to low blood pressure, fatigue, digestive problems and muscle cramps and spasms.
Magnesium: Magnesium is a mineral that helps our bodies produce the energy we need and also supports brain function. Magnesium deficiency symptoms include headaches, anxiety and panic attacks, muscle cramps and more.
Selenium: A versatile and critical trace mineral, selenium plays many roles in the body. It acts as an antioxidant neutralizing damaging free radicals. It boosts immunity, ensures normal thyroid function, stimulates blood flow and protects against heart disease among its many other benefits. Although the consequences are not usually severe, selenium deficiency can rarely become life-threatening. This was the case in a 5-year-old who had a normal selenium level before starting a ketogenic diet, but then developed cardiomyopathy (heart disease) and ventricular tachycardia, a fast and potentially life-threatening heart rhythm.
Fiber: A keto diet may be lower in fiber because whole grains are eliminated, so you may experience constipation.

Additional Health Concerns

Heart Health: The high-fat nature of the diet could also have negative impacts on heart health. The American Heart Association recommends limiting saturated fat intake to less than 6%. “In practice, many people eat high amounts of saturated fats, which could increase your risk of heart disease,” says Dr. Cheema. “You may be eating a lot of fatty meat thinking it’s a good thing for you because it's high in fat. This can dramatically alter your lipid profile. While high-fat diets can elevate LDL (“bad”) cholesterol, the type of saturated fat matters. The bottom line is that having more fats in your diet can lead to higher cholesterol. “We know that higher cholesterol tends to increase your chances of heart attacks and strokes,” says Dr. Cheema.
Kidney Problems: The keto diet may not be appropriate for everyone, specifically people with kidney disease. “Although more research is needed in that area, there is some suggestion that it can make kidney disease worse over time,” says Dr. Some people also experience dehydration on the keto diet because they’re eliminating glycogen, which holds water, from the bloodstream.
Blood Pressure and Blood Sugar: The keto diet can cause your blood pressure to drop in the short term due to a reduction in blood volume and changes in your fluid balance. Symptoms of low blood pressure include dizziness, lightheadedness or fainting, especially when standing up quickly. Following a keto diet can also cause your blood sugar to drop, which can be dangerous for people living with diabetes. Common symptoms of low blood sugar include weakness or shaking, sweating, a fast heartbeat and dizziness.
Ketoacidosis: Because a high-fat diet increases ketones, it can also increase the risk of ketoacidosis for those with type-2 diabetes.

Addressing Nutrient Deficiencies on Keto

To mitigate the risk of nutrient deficiencies, careful planning and supplementation are essential.

Nutrient-Dense Foods: Nutritional deficiencies don’t go away unless the new “diet” contains a wide array of nutrient-dense foods, like colorful raw vegetables and organic grass-fed meat, pastured poultry, and wild-caught fish.
Supplementation: Yes, keto diet supplements are crucial to make up for the lack of nutrients your body experiences on the low-carb, high-fat and high-protein diet.
- Multivitamins: Pick a multivitamin that is highly absorbed. There are many great choices out there but we recommend our Liposomal B-Complex with minerals and antioxidants. You will get all eight of the B-vitamins in their “active” forms, such as methylfolate (active B9), methylcobalamin (active B12), P5P (active B6), biotin (B7), a full spectrum of antioxidants (vitamins A, C, E), as well as all of the trace minerals including selenium, molybdenum, manganese, chromium, and iodine. If you’ve never heard the term, “liposomal,” it means that the active ingredients are delivered within liposomes, microscopic spheres made, in this case, of naturally occurring phospholipids (the building blocks of cell membranes) extracted from non-GMO sunflower.
- Folate: If you want to ensure you have enough folate while eliminating most carbs, consider taking an “active” folate supplement-a methylated form of folate that is ready to use by the body. Adding active B-12 (methylcobalamin) usually makes methylation work even better, especially if you carry mutations such as MTRR, which affect your ability to make “active” B-12. Avoid “folic acid” supplementation as folic acid as it needs to be converted to the active methylated folate form and this process can be significantly slowed, especially when dealing with the MTHFR or MTRR mutations (mentioned above).
  - MTHFR Mutation: Ask your doctor to test you and if you have the MTHFR mutation. Quest and LabCorp, the two main laboratories nationwide, have these tests readily available and they are becoming more mainstream. If you’ve done a 23andMe genetic test, you may already have this information (along with hundreds of other genes) available in your account as a .txt data file you can download. Once you have this file, you can upload into an interpretation software like StrateGene (no affiliation).
Dietary Alternatives:
- High quality meats like grass-fed beef, pastured pork, poultry, and eggs will give your body the necessary B vitamins, iron, and phosphorus.
- Dark, leafy greens, broccoli, and avocados are good vitamin B2, B6, B7, calcium, and magnesium sources.
- Full-fat yogurt is a good way to get vitamin B1, calcium, and phosphorus.

Alternatives to Strict Keto

Intermittent Fasting: Intermittent fasting is an approach that allows you to receive the benefits of ketosis while still eating a varied and balanced diet, says Dr. Ring. By cycling between periods of eating and fasting, your body enters “mild ketosis” during the fasting phase. “Unlike the keto diet, which requires strict food restrictions, intermittent fasting lets you enjoy a variety of nutrient-dense foods, such as fruits, vegetables, whole grains and legumes, during eating windows,” Dr. Ring explains.

The Importance of Individualized Approaches

No one diet fits all, and what works for one person may not work for another. Dr. Cheema advocates making small changes based on your health goals. “People tend to burn out on those big goals and challenges, and then they go back into their own habits,” he explains. “Just because you were super fit between the ages of 36 and 38 may not extend your healthy life. But if you make small changes consistently every day from ages 36 to 66, that probably will have a big impact.Monitoring food so closely can lead to psychological distress, such as shame and binge eating.

Long-Term Considerations

For long-term weight loss, Dr. Ring, Dr. Ketogenic diets can help ease a wide range of ailments, like epilepsy and potentially even suppressing cancer. Ketosis is clearly something that our ancestors were exposed to intermittently, but this does not mean that following a ketogenic diet is appropriate for a healthy individual, particularly for an extended period of time. Recent research finds thyroid malfunction in patients receiving a one-year ketogenic diet due to intractable epilepsy, an easily avoidable consequence for a healthy individual.

Read also: Plant-Based K2 Guide

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