Keto Questions and Answers – [Part 2]

Why do my muscles cramp when I eat a ketogenic diet ?


Often when people begin a low-carb, moderate-protein, high-fat, ketogenic diet, they forget to take care of the electrolytes in their body and drink enough water, and an electrolyte imbalance can cause, among other problems, muscle cramps. (I used to get bad charley horses in my calves when I first started eating a low-carb, high-fat diet.)

Especially early on, when you are making the transition from using glucose as your primary fuel source to using ketones, you need to be replenishing your body with salt and fluids. No, this doesn’t mean you have a Gatorade deficiency! (There’s way too much sugar in it anyway.) Instead, there are three very easy strategies you can use to avoid those painful and annoying cramps.

First, you need to get more potassium and magnesium. While you can certainly use supplements for both of these, there are ketosis-friendly foods that are rich sources of both potassium and magnesium. Unfortunately, if you ask most people how to increase the potassium in their diet, they’ll suggest eating bananas.

But bananas are very high in carbohydrates (27 grams) and are not conducive for ketosis. A better option is avocados. One whole avocado contains twice the amount of potassium (975 milligrams) in a large banana (487 milligrams). As for magnesium, raw spinach, Brazil nuts, almonds, fish, and dark chocolate can provide you with this key nutrient.

Second, replenish your body’s salt stores by making a warm cup of broth out of beef or chicken bouillon cubes a few times a day. Unless you have high blood pressure and are salt-sensitive, or you have experienced heart failure, doing this should work well to eliminate cramps. It should even boost your energy enough to prevent the “keto flu” symptoms that can accompany the early days of ketogenic eating. Concerns about salt raising blood pressure levels is a non-issue in those who are not sensitive to salt.

Third, drink, drink, and drink some more. Water is a crucially important factor in preventing cramps, since it helps muscles relax and contract. Staying well-hydrated is especially important if you are exercising regularly. Keep a water bottle with you at all times and take a sip now and then throughout the day. Don’t be surprised if those cramps suddenly disappear. And the longer you do keto, the fewer cramps you’ll experience.

Although it’s unlikely, it is possible to drink too much water, which can deplete sodium and other mineral levels, so keep your water consumption under 800 milliliters per hour. But you’re far more likely to not be getting enough water than to be getting too much.

Can any supplements help me get into ketosis?


You should be able to produce ketones simply by manipulating the macronutrients (carbohydrate, protein, and fat) in your diet to your individual specifications, as we outlined in chapters 5, 6, and 7. That said, there are a few supplements that may help boost your ketone production.


To facilitate beta-hydroxybutyrate (blood ketone) production, we add either MCT oil or coconut oil.

– Dr. David Perlmutter


Medium-chain triglycerides (MCT) oil, found in smaller amounts in coconut oil and sold as a supplement in vitamin and health stores, will raise your ketone levels very quickly over a two- to three-hour period. Be careful using it, though, because it can cause gastric distress, stomachache, and diarrhea if consumed in excess.

Introduce it slowly over a period of time until you’re able to consume higher quantities. Remember, MCT oil should not be a substitute for making the nutritional changes necessary to become ketogenic. But it could give someone who is struggling to produce ketones a much-needed psychological and physiological boost.


The major issue is whether the ketogenic diet provides the micronutrients from vitamins, minerals, essential fats, and antioxidants that are necessary to conduct the biology of life properly.

– Dr. Terry Wahls


In general, a ketogenic diet is incredibly nutritious and should provide you with most of the nutrients you need to be optimally healthy. Taking an iron-free multivitamin (unless you have low iron levels or are a premenopausal woman, in which case an iron supplement may be helpful) can help fill in the gaps here and there. Other supplements to consider include alpha lipoic acid, coenzyme Q10, L-carnitine, vitamin D, vitamin C, potassium bicarbonate, and magnesium. And if you still have strong carb cravings, try 1,000 mg of L-glutamine three times daily, taken on an empty stomach.

Do the ketones produced with MCT oil offer the same benefits as those produced through cutting carbs, moderating protein, and eating more fat ?


Science has not yet settled this question. Many people enjoy using MCT oil because its effect on ketones shows up quickly on a blood ketone meter. But why not induce ketosis nutritionally and naturally by consuming a high level of dietary fat (it doesn’t necessarily have to be from coconut oil or MCT oil), reducing carbohydrates to your personal tolerance level, and moderating protein to your individual threshold?

If you do this, then there’s really no reason why you can’t have all the ketones you’ll need to experience their health benefits. If consuming MCT oil helps you feel good about the changes you are making in your diet, then go for it. But it’s certainly better if you try to induce ketones naturally through diet and the strategic use of spontaneous intermittent fasting.


Don’t forget to include some MCTs from fats like coconut oil—what I like to refer to as the cheater’s way to stay in ketosis! When you do this, it allows you to liberalize your carbohydrate intake without necessarily throwing you out of ketosis.

– Dr. Bill Wilson

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