Common Side Effects

When you begin a carbohydrate restricted diet, you might encounter certain side effects. They are usually caused by improper implementation of the diet. Below, I will discuss some common issues. If your symptoms persist, become worse or are different than those listed, consult with your healthcare provider.

Most symptoms arise from electrolyte imbalances. It is this electrolyte depletion, that can have serious consequences for people with pre-existing conditions like kidney disease and hypertension, or people taking the medications that treat these conditions. Therefore, it is very important to discuss any changes in your diet with a healthcare professional, before implementation.

• Salt - Carbohydrate restricted diets lower insulin levels and this can act as a diuretic, since insulin retains water. For this reason, you must be extra cautious about your electrolytes and make sure that you are keeping them in balance. Salting your food liberally, to taste, is very important. Adequate salt intake is different for everyone, since we all retain and release sodium differently, so you will have to listen to your body for any symptoms that can suggest dehydration. Headaches, lethargy, dizziness/light headedness upon standing, heart palpitations and weakness can be signs of electrolyte imbalances, that must be addressed by intaking adequate amounts of electrolytes. Do not consume salt in isolation as salt itself causes more dehydration. You need to make sure you are having enough salt and water.
• Water - The release of stored water, from lower insulin levels, can put you at risk for dehydration, but too much water is just as bad as too little. For this reason, there are no specific amounts of water that I can recommend as everyone is different and will require different amounts. What may be too little water for one person, could be too much for another. The important thing is to drink adequate amounts of water. Drink to thirst, but do not go thirsty. Weather and activity levels affect the amount of water you may require. Someone working in an airconditioned office, will require less water than someone doing strenuous physical activity out in the sun. 

As I stated above, listen to your body carefully and keep in mind that dehydration and electrolyte imbalances are a serious issue that needs to be addressed. Most of the side effects that people endure on low carbohydrate diets, some of them quite serious, come from this loss of water. Make sure you are cognizant of your water intake and have the necessary blood work done, through your healthcare professional, for measuring electrolytes and checking dehydration.

Aches and Pains:

The reduction of inflammation and body fat loss can cause a shift in the musculoskeletal system of the body. This can cause pinched and irritated nerves. Inflammation is the body's buffer and when it decreases, underlying issues are exposed, since there is nothing left to mitigate them.

Consult with your doctor for the appropriate testing required to diagnose the cause for your pain. Nerve conduction tests can help identify what could be causing the problem and they are performed by a neurologist.

Amenorrhea (loss of menstruation):

This is a common symptom for women who first start this diet. Some will see a change in their menstrual cycles that can range from irregular to absent.

Insulin regulates sex hormones. When insulin levels lower, estrogen also decreases, and this can cause a temporary hormonal imbalance that can affect menstruation. This effect is strongest with ketogenic diets since they tend to lower insulin levels rapidly.

Another issue that contributes to this is the quick loss of body fat. This sudden loss of adiposity can make the body believe it is starving and it will go into panic mode and shut down certain systems in the body, menstruation being one. Though it sounds like something serious, keep in mind that menstruation is halted for a variety of reasons. Too much exercise, chronic stress, caloric restriction, insufficient protein or any fluctuation in weight, including rapid weight gain, can put a halt or affect the menstrual cycle. This is not something exclusive to carbohydrate restriction.

This effect is transient and hormonal levels will stabilize with time. I lost my menstruation for 4 months, when I started this diet. After that, it resumed normally. Consult with your healthcare provider if you are concerned.

Depression and Anxiety:

When you consume a meal that's heavy in carbohydrates, your body responds by overexpressing insulin in order to lower abnormally high blood glucose. Insulin lowers the concentration of most amino acids. The one amino acid that doesn't decrease, in response to insulin, is tryptophan, which is converted in the brain to serotonin. When insulin lowers the concentrations of other amino acids, tryptophan is able to pass into the brain more readily. The body adapts to this state, especially when this has been happening for decades. Any changes to this hormonal state will result in side effects.

When insulin levels suddenly drop, serotonin levels can be affected, and this can cause multiple side effects like mood changes, sleep disturbances, etc. It can also aggravate pre-existing conditions like depression and anxiety.

Usually these effects, though uncomfortable, are transient and will decrease as the body adapts to its new state, but for others, this can become a serious problem. This is especially true if prescription medications are involved. These symptoms need to be discussed with a healthcare professional if they persist. If you are on prescription medication for the treatment of any psychological condition, you must discuss any diet change with your doctor, prior to implementation.

Digestive Issues:

Every time you change your diet, digestive issues are bound to follow. When switching to a carbohydrate restricted diet, you can experience some digestive issues. Below are the most common.

• Constipation – If nothing goes in one end, nothing comes out of the other. Ketogenic diets and intermittent fasting reduce the amount of food consumed, which affects the frequency of bathroom trips. Grains cause unnecessary stool bulk and since metabolic therapeutic diets do not contain grains, you will not have this extra bulk. Just because you don't have to go, doesn't mean that there is a problem. The body knows when it has to go and when it does not. Humans, unlike cows, do not poop all day. If you have an unusually prolonged period of not going or if you want to go, but can't, you can increase the amount of raw leafy greens, nuts and/or eat a 90% or more, dark chocolate bar. Stay away from seeds like chia, psyllium husk and flax. Although these seeds are often used to relieve constipation, they soak up so much water from the intestine, and oftentimes end up making things worse. You also have to make sure you are not running low on potassium. Constipation is another symptom of electrolyte imbalances.
  
• Bloating, gas, pressure and discomfort – This usually occurs, because of the increase in vegetable consumption. We evolved to eat animal foods. For this reason, we have a hydrochloric digestive system instead of one designed for fermentation. Therefore, herbivores typically have several stomach chambers to properly break down plant matter, but carnivores do not. Our digestive system is closer in design to that of carnivores than herbivores. Plant material needs to ferment to be broken down. Fermentation is caused by bacteria and this bacterium produces excess gas. It will take a while for your stomach to get used to the higher vegetable intake, because vegetables are hard for us to digest. Try drinking apple cider vinegar, lemon juice diluted in water or adding fermented foods when you eat vegetables. This will help introduce more bacteria and increase stomach acid to help break down plant material better and prevent them from sitting longer in the stomach than they should.
  
• Diarrhea – This can happen from the introduction of new foods, especially fat. Because of the low fat diet, the digestive system has not had adequate fat intake in its lifetime and this can cause diarrhea at first.
  
• Acid Reflux – This is one of the most common digestive complaints and it can have several causes. The lowering of insulin and the release of counter regulatory hormones affect the vagus nerve, whose signaling is necessary for proper digestion. Sometimes this effect will cause food to remain in the stomach for longer periods of time, than it’s supposed to, due to slow digestion or gastroparesis. This symptom is also transient and takes time to normalize. Try not to do anything that requires physical exertion until 3 hours or more after eating. This will help reduce this effect. Gargling for a few minutes before meals, can also help stimulate the vagus nerve and the digestive system. Low stomach acid is also a main cause of acid reflux. This causes the esophageal sphincter to not contract properly, so stomach acid rises upwards to the throat. It is most noticeable at night, when the body is in a horizontal position. This is a common problem due to years of grain consumption. Grains are very acidic, and the stomach will tone down the amount of acid it produces to digest. After decades of grain consumption, the stomach has chronically low acid levels. Once the grains are removed, you will notice this low acid production as you try to digest other types of foods (e.g.: real vegetables). This can also occur if antacid medications are taken for a prolonged period of time, like Proton Pump Inhibitors (PPIs). After some time, the stomach might increase its acid production too much, as it tries to find the right levels for your new diet. Again, I recommend apple cider vinegar or lemon juice diluted in water, taken with meals, to restore acidity to the stomach and prevent the stomach from releasing too much acid later. The inability to produce adequate amounts of bile for the digestion of fats can also cause acid reflux. Again, this is caused by years of consuming an unnatural diet, which deregulates the digestive process. If you have been on a diet devoid of fat for most of your life, your bile ducts will not function properly. This is one of the main reasons we see such high numbers of gallbladder disease in modernity. The gallbladder is an organ whose sole purpose is to digest saturated fat. We evolved a special organ, just for this reason. This gives us a glimpse of our past and what foods we were designed to eat - animal foods. Yet the gallbladder is never used in modern diets. People can now live without one. If it’s never been used, it’s most likely not going to function properly, once it is. It will take time for your gallbladder to adapt and properly meet its new demands. Long term use of cholesterol lowering medications and chronic salt restriction, also reduce bile salts which are needed for the digestion of fat.

As you can see, most of these digestive issues are temporary and resolve themselves as the body adjusts to its new diet. If you are experiencing something other than the above ailments or your digestive issues do not go away and/or are severe, then a visit to your healthcare provider is advised. Do not stop taking any prescription medication without consulting your health care provider first.

Hair Loss, Feeling Cold and Fatigue:

Dr. Atkins knew the importance of following a well formulated diet to avoid these types of issues and that's why I continuously remind my readers of this, regardless of whatever "fad" may be going around in the low carbohydrate community.

The most common mistakes people make on carbohydrate restricted diets is the restriction of calories during their meal times, consuming isolated fats, fasting for extended periods of time and/or severely restricting protein. If you eat like this for a prolonged period, you will experience a slew of problems and one of the main ones is thyroid related.

Living in a chronic state of chronically low insulin, high stress hormones and caloric deficiency, will shut down thyroid function. This can slow down metabolism as the thyroid is crucial for its proper regulation. This can cause fatigue, palpitations, hair loss and/or a low body temperature, amongst other symptoms. Many times, thyroid tests will not detect this problem because it's not a problem with the thyroid gland, but with the livers conversion of T4 to T3. Dr. Atkins recommended for his patients to take their core temperature, for three days straight, and if it was below 97.8 degrees, it was surmised that the thyroid was being affected.

If you are having a similar experience, restructure your diet and make sure you are getting enough calories during your meal times and that you are eating whole foods and not any isolated macronutrients. Do not do extended fasts for prolonged periods of time. If you are eating two meals a day and water fasting for the rest, there is no need to restrict protein at meal times. Proper nutrition is extremely important, regardless of the diet being followed. Make sure you haven't lost focus of your micros, while tracking your macros.

Hypoglycemia (Low Blood Glucose):

This section pertains to people who have metabolic syndrome. If you are a diabetic and/or are on diabetes medication, you must consult your healthcare provider for advice.

It’s the dreaded "hypoglycemia" we have all experienced. The symptoms include terrible fatigue, brain fog and headaches that arrive, as expected, two hours after eating the Standard American Diet (SAD). It’s these terrible symptoms that force you to reach out for a "snack", just to make them go away.

Why would this still be occurring with a low carbohydrate diet? Metabolic syndrome is an adaptation towards starvation so in essence it is also an adaptation towards hyperglycemia as the body is trying to keep its blood glucose as high as it can to prevent lows (starvation). This means that any drop in blood glucose, will cause "hypoglycemic symptoms", even when blood glucose does not reach clinical levels of hypoglycemia. 

For some people, their blood glucose does drop significantly enough to be at clinical hypoglycemia. This is dangerous because many of them feel no symptoms at all, due to damage of the central nervous system from chronic blood glucose dysregulation. This phenomenon is much more common in diabetics than in people with metabolic syndrome. You must check your blood glucose with a blood glucose meter in order to determine if you are experiencing pseudo hypoglycemic symptoms, real symptoms or no symptoms at all. Do not guess, use your meter. 

Poor functioning insulin, which is overexpressed, will continue to clear blood glucose into the fasted state and this can drop your blood glucose too low and/or drop it too quickly. These drops in blood glucose reinforce the starvation response, making metabolic syndrome worse and eventually leading to the development of type II diabetes. 

With carbohydrate restriction, no dietary glucose is coming in, while insulin is still overexpressed, so the potential for low blood glucose increases. Unfortunately, this is the only way to stop the condition from progressing as allowing the body to continue driving blood glucose very high, further deteriorates insulin function. Correcting insulin function is vital for the improvement of blood glucose regulation and it cannot be done by coddling the adaptation. It must be broken. 

Hyperglycemia (High Blood Glucose):

This section pertains to people who have metabolic syndrome. If you are a diabetic and/or are on diabetic medication, you must consult your healthcare provider for advice.

Many people who start a carbohydrate restricted diet, will see a significant rise in their blood glucose levels. This is especially noticeable in the early mornings. They wonder how this can be possible if they have restricted carbohydrate intake. The answer is insulin function and its effects on glucoregulatory systems.

When insulin levels drop, stress hormones rise in response. This is particularly exaggerated in people with metabolic syndrome as the body tries to keep blood glucose as high as it can, especially after a night time low. This is often referred to as "Dawn Phenomenon". It's not truly a "phenomenon". It happens to everyone. It is just overexpressed in people with metabolic syndrome due to poor blood glucose regulation and insulin function. Metabolic syndrome makes you adverse to fasting (lowering of blood glucose) and "Dawn Phenomenon" is the symptom of the night time fast. 

Cortisol is one of the stress hormones used to cause a rise in blood glucose. Cortisol is highest in the mornings. Cortisol releases stored glucose from cells and this glucose spills into the bloodstream. Because of poor insulin function, it does not respond quickly enough to this glucose release. This will make your glucose readings higher in the mornings. As insulin levels slowly rise, later in the day or after eating breakfast, glucose will go back down. 

When insulin clears blood glucose, glucagon creates more and vice-versa. These two hormones counterbalance each other to stabilize blood glucose. For the healthy, the goal of stability is to keep blood glucose normal. For people with metabolic syndrome, the goal of stability is to keep blood glucose high. So both of these hormones fight each other in the context of metabolic syndrome, instead of working together. Abnormal insulin to glucagon ratios are most noticeable after eating, causing postprandial blood glucose to rise very high. This is referred to as hyperglucagonemia. But glucagon also responds poorly to the release of glucose when its actually needed so it is overexpressed when it's not needed and under expressed when it is. 

Insulin is the hormone that signals the liver to retain glucose in the form of glycogen. Glucagon is the hormone that signals the liver to release this glycogen as glucose. This glucose then floods into the bloodstream and will cause you to see a significant rise in blood glucose. Again, this is a normal metabolic function that occurs to everyone but is exaggerated and unregulated in people with metabolic syndrome. Not only is the glucose coming out in an unregulated way, but people with these conditions do not have sufficient lean muscle mass to take up this glucose, so they will see it in their blood stream instead. 

As you can see, you will see rises in blood glucose readings, because of the above effects, but you had already been seeing rises in blood glucose readings due to metabolic syndrome itself. Your body is not telling you anything new. You are simply witnessing normal processes that have "gone wild" due to metabolic abnormalities. At least now you are doing something to reverse it, rather than sitting idly by as it progresses. 

In the meantime, there really isn’t anything you can do about the higher glucose readings. If you exercise, it may drop your blood glucose levels, but it might also have the opposite effect and cause blood glucose to rise instead. This is because insulin lowers even more during exercise, to allow the body access to glucose stores for fuel. As long as the body continues having poor blood glucose regulation and insulin function, you will see all of these glucoregulatory systems toggling in abnormal ways. But the more you can control these erratic blood glucose ups and downs, the less they will occur. So the goal is not to simply lower blood glucose but to lessen the disparities in blood glucose, incrementally, until they occur less and less.  

Jitters and Insomnia:

Carbohydrate restricted diets cause for stress hormones to rise as the body desperately tries to keep blood glucose high. These hormones are counter regulatory to insulin (glucagon, epinephrine - also known as adrenaline, cortisol and growth hormone).

When insulin rises, these counter regulatory hormones lower and vice-versa. Because of metabolic syndrome and chronically high insulin, these hormones lose their pulsatile, toggle function and remain much higher than they normally would, as they try to keep blood glucose high. Their toggle function is no longer working. They are overexpressed when not needed and under expressed when they are. This is because their set point and function is determined by insulin but insulin is chronically overexpressed. As insulin lowers, these hormones can now drive blood glucose as high as they want with little mitigation. In some cases, it can take several months for these hormones to catch up to the new, lower insulin levels of the body and this causes side effects.

For some people these effects are mild, but for others, it can become quite uncomfortable. The body does eventually tone down its stress hormone release and returns to homeostasis if the person can sustain blood glucose control. You certainly do not want these symptoms to deter you from the most metabolically helpful diet that exists, so it's best to mitigate these effects in ways that allow you to keep your low carbohydrate diet and fasting protocol intact. Metabolic abnormalities can only be reversed with long term treatments.

• Exercise – Exercising helps burn adrenaline. You cannot "rest" your adrenaline away, the body must use it. Burning it through physical activity is the best way to do this. It will help you sleep better and tone down the "jitters". Take long walks to reduce high adrenaline symptoms and achieve better sleep.
• Remove caffeine – Caffeine will just make things worse, not better. You certainly do not want to have caffeine when stress hormones are already high. Try decaffeinated coffee while your body is adjusting to this new metabolic state. You also want to get rid of any other source of dietary caffeine. This includes teas that might be caffeinated. Make sure you use decaffeinated options for any of these foods. Remember, you cannot properly regulate blood glucose while dosing a stimulant like caffeine. 
• Hidden sugars – Make sure there are no hidden sugars in your food. Sugar is an excitotoxin which only exacerbates the problem. Until sugar has been 100% removed from the diet, the body will continue releasing hormones in erratic ways and will not be able to find balance. Remember, you cannot properly regulate blood glucose while dosing sugar. 
• Breakfast – Having breakfast a short time after waking up, can help reduce morning cortisol levels. So, if you enjoy breakfast, take advantage of this effect.
• Meditate – Taking some quiet time, for yourself, will help you deal with the emotional rollercoaster that these hormones can produce.

Always discuss any side effects you experience with your healthcare provider. These counter regulatory hormones can interfere with certain medications and/or affect pre-existing conditions.