Keto-Flu and Sufficient Intake of Electrolytes

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People often ask me about potassium deficiency (or any other mineral deficiency) on a low-carb, ketogenic diet. I decided to summarise which minerals you should be aware of and what the adequate intake is...

To pin or bookmark an easy to follow guide to keto-flu remedies, have a look at this post!

What is "Keto-Flu"?

Electrolytes (sodium, magnesium and potassium) are often underestimated on low-carb diets. As low-carb expert and scientific researcher Dr. Volek suggests, mineral and electrolyte management is the key to avoiding side effects typically associated with low carb dieting.

When entering the induction phase of a Ketogenic Diet (50 grams or less of total carbs - about 20-30 grams of net carbs), most people experience "keto-flu”. This often scares them off and they start to think that low-carb is not right for their body. The "flu" is nothing else than a result of starving your body of carbohydrates.

Stay strong! You can easily counteract these effects by replenishing electrolytes. Make sure you include foods rich in electrolytes in your everyday diet and take food supplements (if needed).

Keto-Flu and Sufficient Intake of Electrolytes

Firstly, I would like to share my own experience with electrolyte deficiency. I have been really tired recently. It was actually so bad that I couldn't open my eyes and could barely get up even after 7-9 hours of sleep. Also, my energy levels at gym were very low. I woke up in the middle of the night and experienced heart palpitations (weird feeling that could be described as "heart beating too fast"). I knew what was going on: I was magnesium / potassium deficient.

I have been on a low-carb diet for more than a year and always made sure I include food rich in these minerals in my diet. The truth is, I have been so busy recently that I didn't pay enough attention to my diet. Also, stress may have contributed to all this. Excessive stress usually means you need more vitamins and minerals.

So, I got some supplements - an easy way to boost your electrolyte intake. The one for magnesium was great: 400 mg which is 100% RDA (Recommended Daily Amount) per pill, while the supplement for potassium was not as good: 99 mg per pill (only 5% RDA). I understand that this is due to the risk of excessive potassium intake which may be as dangerous as potassium deficiency. However, I still prefer using lite salt (potassium chloride or potassium sulfate. 1/2 a teaspoon of lite salt (mixed in a litre of water) provides 750 mg of potassium! Now, let's have a look at why electrolytes are so important for us...

Potassium

The most commonly deficient mineral (not just on low-carb diets) is potassium. EDR (Estimated Daily Minimum) for potassium is round 2,000 mg for healthy adults. However, people on a ketogenic diet have special requirements on the top of this, which is round 1,000 mg more. There are a few ways how you can boost your potassium intake.

Keto-Flu and Sufficient Intake of Electrolytes

Eat food rich in potassium or take supplements (if needed). Be careful about potassium supplements, too much of potassium can be toxic and as dangerous as its deficiency. AI (Adequate Intake) of potassium is stated to be 4,700 mg a day. There is no upper limit for healthy individuals and you shouldn't worry about eating too much of potassium, unless you take supplements. Some salt substitutes are very high in potassium while other potassium supplements like this one only contain 5% EMR.

Who should consult supplementation with his doctor: those with kidney disease or take medication for high blood pressure, heart failure or other conditions. Also, salt substitutes may interfere with some medications.

Why is potassium so important for us? Here are signs of potassium deficiency (hypokalemia):

  • hypertension
  • cardiac arrhythmia
  • muscular weakness and muscle cramps, weakness
  • constipation
  • depression and irritability
  • heart palpitations
  • skin problems
  • respiratory depression, heart failure (severe deficiency)

Unfortunately, many potassium-rich foods are not keto-friendly but here is a list of keto-friendly potassium-rich foods:

  • avocados (~ 1,000 mg per average piece)
  • nuts ( ~ 100-300 mg per 30g / 1 oz serving, depending on the type)
  • dark leafy greens (~ 160 mg per cup of raw, 840 mg per cooked)
  • salmon (~ 800 mg per average filet)
  • mushrooms (~ 100-200 mg per cup)

Magnesium

Keto-Flu and Sufficient Intake of Electrolytes

Magnesium is commonly deficient in modern diets, including low-carb diets. You should be aware of your intake, especially if you are an active individual like me. RDA for healthy adults is 400 mg a day. However, if you are suffering from magnesium deficiency, you may experience muscle cramps, dizziness and fatigue. Of course, severe magnesium deficiency can result in more serious problems.

Here is a list of foods rich in magnesium:

  • nuts (~ 75 mg per 1 oz of almonds)
  • cacao powder and dark chocolate (~ 80 mg per 1 tbsp cacao powder)
  • artichokes (~ 75 mg per average piece)
  • fish (~ 60 mg per average fillet of salmon)
  • spinach, cooked (~ 75 mg per 1 cup)
  • blackstrap molasses (~ 50 mg per 1 tbsp)

Who should consult supplementation with his doctor: those with kidney disease or taking diuretics (magnesium citrate has a diuretic effect).

Sodium

Keto-Flu and Sufficient Intake of Electrolytes

Sodium has always been advised against, especially for those trying to lose weight. The truth is that your body needs extra sodium on a low-carb diet. The reason is that insulin, which also has the effect of reducing the rate at which sodium is extracted through kidneys, drops and it can cause sodium levels to drop significantly, too. You should eat 3,000-5,000 mg of additional sodium occurring naturally in food. Keep in mind that sodium in bacon is very high and doesn't count as "naturally occurring in food."

It's quite simple to get sufficient intake of sodium: Unless you have any medical conditions that restrict your sodium intake, don't be afraid to use salt, and even if you feel you need more, drink 1-2 cups of bouillon, stock or broth a day.

You can make your own electrolyte drink in a few easy steps: Beat Keto-Flu with Homemade Electrolyte Drink

Who should consult supplementation with his doctor: those with heart failure or kidney disease.

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Martina Slajerova
Creator of KetoDietApp.com

Martina Slajerova

I changed the way I ate in 2011, when I was diagnosed with Hashimoto’s, an autoimmune disease that affects the thyroid. I had no energy, and I found it more and more difficult to maintain a healthy weight.

That’s when I decided to quit sugar, grains, and processed foods, and to start following a whole-foods-based ketogenic approach to food.

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Please, note that I do not offer personalised advice. For personalised advice you can contact one of our experts.

Comments (151)

I am interested in your keto diet app I’m just starting the diet an really need to lose 40 pounds . I am determined to do this an ready please help.

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Hi Evon, the best way to start: How To Keto

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I got tripped up by the lack of Magnesium and Potassium. You are right it is hard to find foods rich in Potassium and Manganese that is also Keto friendly.

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You need to be VERY careful!!! You are putting people's LIVES in danger! Too much potassium is DEADLY. That's why they won't go above 99 mg. It's not just "as bad" as potassium deficiency. IT WILL KILL YOU. We already get some potassium from our diets. Some people a significant amount. Being ignorant and taking things into your own hands when you know nothing about it is foolish, but you get to make your own decisions. But when you put other people's lives at risk because you think you know better than the experts when you know NOTHING theres a problem. My friend went into the ER one day because he was having heart palpitations and he didn't feel so well. When they took his blood they found that he had too much potassium. They admitted him just to be safe but he seemed fine. The next morning HE WAS GONE. HE DIED. DON'T BE STUPID. And change this harmful article so it doesn't put people's lives in danger!

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Dear Sherri, I'm really sorry for your loss, that is heartbreaking. However, although I can't tell what happened to your friend, I very much doubt it was caused by dietary potassium but more likely by kidney failure/kidney disease. This was already discussed in the comments.
Did you read anything in this post? Have you read what the "deadly" potassium level is? (it's a lot higher than what you imagine)
Not to even mention... Did you read my disclaimer? At what point did I offer medical advice? That's because I didn't. Please, don't call others ignorant, use capital letters or tell others what to do when you don't understand the topic yourself.

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Hi Martina,
A very informative website! Thank you. I have lost 27kg  last year on Keto. I have 10kg to lose but cant seem to win a trick. Seems any carb i eat adds weight and no carbs keeps weight the same!
I walk, use rowing machine at gym too.
Have learnt from here to
*drink more water.
*eat more healthy fats.
*Lessen protein amount.
*Limit calories.
Just wanted to know what Magnesium you find best. Ie oxide or chelate. 😊

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Well done Lisa! This post will help: Complete Guide to Magnesium Supplementation 😊

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I am interested in your Keto-diet app, but I am a vegetarian, are there many recipes in the app for vegetarians? If I am going to pay for something I like to get good value for my money. I know that many of the recipes can be adjusted using vegetarian alternatives i.e. MorningStar Farms, Loma Linda, Worthington, Cedar Lake products, etc. but I would really like to have a choice of recipes that are specifically written for vegetarians. Have you made an alternative list of recipes specifically for vegetarians?
Thank you for all the information you have given on the Keto diet; it is proving to be most informative. I have been on the Keto diet since May 23, 2017, and have lost about 60 lbs. I have been in a stall lately, so I am researching ways to get out of the stall, and how to keep a more accurate food diary. I have been using MFP, but I find I have to look everything up myself to verify that the statistics are accurate. It takes a tremendous amount of time, and my family is complaining! ;(

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Hi Susanne, apologies for the delayed response. Thank you for your kind words!
There are several vegetarian options both in the KetoDiet Meals section and in the KetoDiet Blog section of the app. Please, keep in mind we are still working on new features and one of them will be to add advanced filtering options so you can quickly find any meals based on your preferences.
There are 300 recipes in the KetoDiet Meals section (100 in the starter set and 200 in optional recipe packages). Plus there are over 600 recipes in the KetoDiet blog section and more added almost daily - all of these meals are fully integrated in the app and can be added to the Planner.
I suggest you only buy the KetoDiet app without any additional recipe packages until we add the filtering feature and you know exactly how many vegetarian meals are in each optional package. Until then, you can browse through the 100+600 recipes.
For any questions about our app, please contact me directly via: ketodietapp.com/Blog/contact to ensure I can reply in time.

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I followed the LCHF diet and it almost killed me. You describe well the symptoms that can occur with a mineral deficiency, especially the potassium deficiency. In my case, with an un-discovered mineral deficiency I ended up in hospital with an attack of atrial fibrillation and a minor stroke. So much for the "health effects" of following this diet. And I am in my mid 40s, not overweight, good blood-pressure and so on. In my opinion, the fans of this diet neglect those dangerous outcomes as they might come late (in my case, after 2 years). In my opinion, it cannot be healthy to eat such unnaturally high amounts of fat. Never in the history of mankind, did humans have access to such high amounts of fat as proposed in this diet. It can hardly be marketed as "natural for humans", or "as they did during the palaeolithic times". I think it is a dangerous diet, it almost killed me. Now I have switched to a whole-food plant based diet - which is the reverse of the keto-diet - and I lost 2 kg just in a week. And I am eating as much as I want. I have no heart palpitations any more. Disappeared when I changed my diet. I hope this helps people to look at this critically - this will seriously protect peoples health. Best, John

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Hi John, I'm sorry you had this experience, however, I beg to differ as low-carb diets should not be generalised. A low-carb diet could be processed meat & cheese based (this is how low-carb diets are often perceived and misunderstood), or whole foods based diet with pastured meat, organic eggs, healthy fats, non-starchy vegetables, nuts, full-fat dairy and berries. Both are very different approaches and lead to very different results.
A well formulated low-carb diet is high in micronutrients (there are plenty of resources with more information here: KetoDiet Blog: Diet-Nutrition) - this includes potential mineral deficiencies and how to prevent them.
Low-carb eating is not just about getting pounds of fat into your diet - fat should be eaten to satiety which is different for individuals, depends on their goals and several other factors.
Most dietary changes lead to initial weight loss - what you need focus on is long term results. A plant-based diet will likely lack vital nutrients unless supplemented.

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My Keto diet is very strict. Besides the meat and cheese proteins, it is mandatory to drink 1 gal.water a day, eat 3 cups of vegetables a day and 1 cupbof fruit. I have spoke with my family dr. and a nutritionist and got the okay from both!

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Thankyou for your honesty....I have felt so I'll on this diet and want to change ...whats the diet you are following now?

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John, I realize this is months past your post, however I had the same experience as you. After twelve days on the Keto diet, I found myself in the ER with a full blown atrial fibrillation episode. It took five hours, two IVs, fluids, diltiazem and magnesium drips, plus four potassium pills, and a shot in the belly to prevent a stroke to get my heart back into rhythm. I do have a history of afib, but, with medication, had been episode free for six years. I had checked with my doctor before going on the diet and had an okay. While my cardiologist can't confirm that it was the diet that caused this episode, it's the only thing different that had changed in my life and somehow it doesn't seem like a coincidence. If (and that's a BIG if) I go back on keto I will need to be very careful with getting enough potassium and magnesium. I don't think the importance of electrolytes are stressed enough in keto diet information.

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Love your blog! But I'm confused. Here you say we need 2000 mg potassium or more but under the recommended products, potassium it says 4700 mg.  Please clarify.
Thanks!

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Thank you Natalie! 2000 mg are referring to EMR, while 4700 mg are referring to AI (more explained above)... Ok just noticed your second comment - no problem 😊

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The reason you find potassium supplements in low dosages is because it will erode the stomach and/or intestines if it sits in a pocket or if there is slow motility. Here is a study: www.ncbi.nlm.nih.gov/pubmed/6734038
So take your potassium in liquid form, and from your food sources. A good natural food multivitamin is a great way to ensure you get an adequate supply, and avocadoes should be your daily source. I don't worry about hitting the daily RDA, just slow and steady should do it.
On keto you need to drink alot to help flush the kidneys of all that protein waste, and you lose your electrolytes which help that process, esp. potassium. Stay balanced, drink water, get liquid electrolytes, and keep your kidneys and liver healthy. Damage to them is one of the biggest risk factors of doing keto and everyone needs to know this important info. This is my opinion from my experience only. I am also not describing ketoacidosis here, which is very serious but is only applicable to diabetics. I am adding an addendum to this to do your own research, and understand that each person's adhetence to the diet, supplementation, fluid intake, and body is different and responds differently. Finding a partner (doctor, nutritionist) and awareness of your bodily changes is key.
Here is a forum where it is further discussed. http ://www.marksdailyapple.com/forum/forum/the-primal-blueprint-forum-discussion/primal-blueprint-nutrition/5160-permanent-ketosis-leads-to-kidney-liver-damage
An interesting fact is that an organ meat (like chicken livers) contains the nutrients that will help build or repair that organ in your body. On this forum they talk about Inuit people in the past subsisting off of cooked and raw meats, organs, and a ton of fats (think whale blubber) and not much else (no gardens in the extreme North !), without nutrient supplementation.
Did you know the dogs that run the Iditarod are on keto diet? They have an extreme source of efficient energy from the ketones, and when they are used up, any excess fat on their bodies. They can run this extreme race in the Arctic cold thanks due to the instant source of energy from keto. Enjoy your new-fangled energy!

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Hi Tracey, thank you for your insights!

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Thanks for all your hard work!

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I have been on the diet for only 2 weeks now. I have had 2 episodes of rapid heartbeat and my heart constantly feels it is working hard. Now. I have a congenital cardiac defect, so this is worrisome. I adopted this diet because my doc said, lose the 15 lbs and drop your sugars or you are going to stress out your heart. I'm flabbergasted as to what I am supposed to do. I am taking a magnesium supplement, I drink 2 cups of broth a day plus eat an avocado a day. I am afraid to take a potassium supplement because that can be very toxic (almost lost granddad from a potassium overload).
Believe it or not, outside of the racing heart, I feel amazing. I've dropped 7 lbs in 2 weeks. If I have to stop I'm going to be heartbroken. I know everyone here are not doctors but I'd love to hear your experiences.

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How much magnesium are you taking? If you're having rapid heartbeat I'd up the amount a little bit--I was supplementing with 1250 mg for 2 years and had no negative impacts (except occassional runny stool).
I also highly recommend epsom salt baths while you are adapting to the keto diet--your skin is good at absorbing Mg in the exact amounts you need and where you need it. Good luck!

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Hi Jennifer, I think that when it comes to potassium, you don't need to take supplements as long as you eat avocados and keto foods high in potassium. I find it more challenging to get enough magnesium and I take 200-400 mg per day. Potassium is toxic only in very high doses - I suppose your granddad may have had a health condition? (some medications interfere with potassium supplements). In any case, I suggest you consult your doctor before taking any potassium or magnesium supplements.

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I went on the LCHF diet recently and lost 21 pounds within a month. I was happy that I was losing weight but every day I felt worse. My blood pressure was going up so much that my neck was hurting and I started to get arrhythmia. Scared me to the doctor.
I got nervous and had magnesium water with sodium and felt better and ate normally (with carbs) and felt better the next day. While I had hoped I could continue on this diet- I don't think it was a good choice for me..  Disappointed

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Thank you so much Martina very kind of you to send me this. I am feeling much better and hope that my body will come to terms that sugar and carbs are not entering the system much again. I lost 7 ibs in 7 days (water I assume) but now have gone 5 days no change. Sticking to the diet and hope to get to the next level. Want to lose another 10 to 15 ibs This info you sent is very helpful and I thank you again. Take care Jim

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Thank you so much for this breakdown! I just learned about Keto and I felt confident until I researched further with the Keto flu and learning about essential electrolytes. I still feel not so confidant for when I finally start. Mostly to make sure I am getting what I need.
Do these numbers ever change base on weight and health levels or is this what everyone should base their consumption on? It seems I can reach mag everyday with only 2 cups of spinach and an avocado (400mg). Which confuses me as to why mag is the most common daily supplement.
I downloaded your app too and I can't wait for the upgrades in 2017! I am already familiar with MFP however it will be nice to have a "one stop shop" 😊

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Thank you Anna, it will be out very soon, we just submitted the last beta version before the app goes live with syncing 😊
I think you might have the wrong data for spinach and avocado. 2 cups of cooked spinach (about 310 g/ 11 oz) contain about 235 mg magnesium, and one large avocado (200 g/ 7.1 oz) has 60 mg magnesium. This way you will get to about 300 mg of magnesium per day (ideally you need 300-400 mg). If you have salmon or pork, then you get even more and you should get to 100% RDA. I personally find it difficult to get enough magnesium, even more than getting enough potassium,  so I take supplements (usually Calm).

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Do we continue to keep electrolytes high(6-7g sodium, 3-4g potassium and 400-500mg magnesium) after adapting  or just while adapting to the diet?

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Yes, ideally, you should be getting this much of potassium (minimum 2 g) and magnesium (minimum 3 g) every day. When it comes to sodium, 3-5 g should be enough.

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Just wondering about salmon.  Wild vs. Farmed.   Wild is really low fat and farmed is very oily. So which do we use for potassium etc. Or does it matter?

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When it comes to potassium, it doesn't matter. There is slightly more potassium in wild salmon but the difference is less than 10%. The problem is organic pollutants. If you can, go for wild salmon because farmed salmon may contain PCBs.

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Wow this has clarified so much. I was getting uncontrollable/paralyzing  swelling in my claves, and cramping all over my body - could barely move without cramping somewhere. I had twitches at night, tingling nerve pain, the works! I had been on keto for just under a year and for some reason wanted to amp it up and eat strictly 20g carbs/day.  I was eating mostly bacon (sodium through the roof) and by the look of things no potassium whatsoever...
I went off keto because I was freaking out about my symptoms. And of course the symptoms cleared up (potassium!).
But now I can get back on it and have clear amazing skin again and long lasting energy and less cravings.
So great, thanks.

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So, is potassium sulfate (E-515) safe? Better taken on an empty stomach or with food?
I'm all confused about this potassium conspiracy, and why 99mg is the upper limit for supplements. I already take magnesium (from Doctor's Best), organic sea salt, and sometimes sodium bicarbonate.
I have 1kg of potassium sulfate ("food grade") which I bought as a plant fertilizer some months ago. Would be wise to ingest it in small doses? Thanks!

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Yes, E-515 is safe for consumption and it's better taken with food. I don't think it's easy to get too much potassium - see Wikipedia: toxic dose is 2.5 g/kg (meaning that a lethal dose for 50% of people weighing 75 kg (165 lb) is about 190 g (6.7 ounces): https://en.wikipedia.org/wiki/Potassium_chloride
I don't usually take potassium supplements, I just include foods high in potassium such as avocado, salmon, mushrooms, etc. almost every day.
If you do, only use small amounts like I did in this recipe: Beat Keto-Flu with Homemade Electrolyte Drink

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Ive been in keto for awhile now and only experience lightheadedness in the mornings! Im looking into suppliments and wondered if anyone had any experience with potassium & magnesium aspartate 250??? Was on oxide yea that was a waste lol!!!

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I use ForzaOne BCAAs from Nutrishop (I'm sure many BCAAs on the market are great).  I had headaches last week, some crankiness, and fatigue, but none of the other "flu" symptoms.  This supplement has excellent electrolytes.  This week, I feel much better, and I was able to drop from 30 grams to 20.  
Good luck everyone!

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Reading about the increased salt intake on keto diet makes me wonder if this will be safe for me. I have highblood pressure and I've always been told to keep my sodium intake low. Any advice?

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Hi Samantha, to be safe, you may want to consult this with your doctor before you increase your sodium intake.

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I'm not sure if this is of help to anyone, but I use a zero calorie electrolyte drink called 'high 5 zero'. Not sure if it has all the right balances and it is quite expensive, but easy and convenient effervescent tablets to have with you as and when you need them.
I'm experiencing my first bout of Keto flu, it sucks. I don't have headaches (yet :s), but even though i'm not hungry, I just feel knackered all the time. I feel like this just shows how difficult my body is finding it to use its own fat source for fuel, so I'm hoping this diet is going to undo a lot of metabolic damage over time!

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Is getting all of your potassium from lite salt bad? And exactly how much sodium do you need? I thought it was like 2300mg?

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There is an increased demand for sodium on a keto diet (additional 3000-5000 mg) - if you experience headaches or any symptoms of keto flu, it might be worth adding some foods like bone broth or sauerkraut. Potassium: I'd personally mostly use whole foods like avocados, fatty fish, etc. You are likely getting most of your daily potassium from the foods you are eating but you can supplement your diet with some lite salt.

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Great. Info thank you!

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Hi! I'm staring Keto tomorrow, I'm taking herb tinctures to help balance my hormones
As you may know tinctures have alcohol ,the brand is Herb Pharm , I'm taking 3 diferents herbs
15 drops of each, 3 times at day. Should I cut them now that I'm going Keto????
I don't want to jeopardize my diet. Please help😁
Regards

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Hi Rita, such a small amount of alcohol won't have any impact. I personally use food extracts that are alcohol-based. Small amounts won't make a difference 😊

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thanks so much for this info, ive only been on this WOE for the past 2 weeks, and im feeling so dizzy and furry headed! with pains and heaviness behind my eyes, i was beginning to think i might be allergic to this diet lol! having read this im going to buy some supplements which hopefully will sort me out! i love your app, your blog, your recipes and i love you 😊 x

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Thank you Carroll, I hope you feel better now!! 😊)

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Hi there.
My wife and I have just started our third week on Keto diet and for the last few days we have been having an increased heart rate and heart palpitations.
We got magnesium and potassium supplements, couple of days ago. Magnesium is ok, but potassium is just ridiculous, 99mg per tablet...
So we started taking LiteSalt (66% less sodium, 900mg of potassium per half tsp)
Is it ok to take half tsp twice a day? Just worry that it is too much salt.
Any general advice? My wife is quite concerned about heart rate...
I hope it will get better...
Thank you
Yevgeny

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Hi Yevgeny, if I was you, I'd try to get my potassium from foods like avocado (one avocado a day will give you 50% EMR potassium). I only take magnesium supplements because it's hard to get enough from a regular keto diet. Or you may want to try this instead: Beat Keto-Flu with Homemade Electrolyte Drink

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