Are you interested in quitting or getting off the keto diet?

There are many valid reasons for doing so, ranging from severe health complications to simply being bored of eating so much bacon.

Should  you get off keto?

So far as my personal opinion of keto goes, I am not a huge fan. I love it for people with certain medical conditions, such as epileptic seizures. Ketone bodies are great for the brain. I like it for people who are very intentional about making  sure they do it healthfully. It can be a great way to improve health and lose weight, especially if you carry significant amounts of weight.

But keto also has its risks and its downsides. It can cause negative health effects such as hormone disruption, skin issues, sleep issues. It can also, as I mentioned above, simply get boring.

In any case, you may wish to transition away from a keto diet. The problem is that keto is not easy to get off of. Throughout this post I’ll explain ab it about why and then provide you with a three-phase set of tips to help you transition away from the diet, should you choose.

Health problems associated with coming off of Keto:

1. Responding to nonpathogenic (physiological) insulin resistance

When you enter a ketogenic state, you actually become a little bit insulin resistant.

Sugar is toxic at a concentration of just a few teaspoons in the blood, so your body has a way of ushering sugar out of the blood asap. This is the job of insulin. Usually, in a healthy body, your body secretes insulin to remove sugar from the bloodstream. The insulin gently escorts sugar to fat cells for storage. Then the insulin levels go back down.

Your body can become insulin resistant, however, which means that it struggles to hear the insulin signals. This results in an increase in insulin secretion and levels in the blood stream.

Insulin resistance is normally a bad thing associated with inflammation and the like – and it is caused by inflammation – but it can be a more neutral thing when you are in ketosis.

Here’s why:

When you eat a very high fat, very low sugar diet, your body will develop some insulin resistance naturally. This is because the body needs more insulin at this point in time to spare blood sugar for the brain (which the brain needs). It wants to be slightly less efficient at getting sugar out of the blood, since you are eating so little of it.

This becomes a problem when you bring carbs back into your diet, however, because you’re body is primed to preserve sugar in your blood. Your blood sugar levels will stay higher than you want, and your insulin levels will be higher than you want.  You may exhibit symptoms of hyperglycemia and hyperinsulinemia (such as headaches, gut problems, circadian disruption, and weight gain) if you take a cheat day or rush to reintroduce carbs after keto.

2. A risk of increases in intestinal permeability coming off keto

When you come off of keto, your blood sugar levels will be abnormally high, because of what I discussed above regarding insulin resistance and the like.

And high blood sugar levels can cause leaky gut.

Having elevated blood sugar levels (hyperglycemia) causes leaky gut in mice. It causes bacteria from the gut to enter the blood of mice – leading toa wide variety of downstream issues (such as autoimmune diseases, presumably).

The mechanism by which this happens is hugely important. It’s not a one off deal, per se. Gene expression gets altered. Hyperglycemia in these mice reprogrammed the way the cells lining the gut worked by changing the expression of more than 1000 genes. 

That’s such a big deal I’ll say it again: having high amounts of sugar in the blood of mice changed the expression of 1000 genes, leading to intestinal permeability. It also caused immune cells to become more myeloid in character, which is a pretty clear indicator of inflammation and the kinds of deterioration associated with aging.

In this study with the mice, humans were also recruited to look for similar signs. They were fed high sugar diets. Their HbA1c – a 3 month average of blood glucose levels – was demonstrated to be elevated in high sugar cases.

Of course, these kinds of problems associated with high sugar diets are part of the reason that keto is so popular in the first place. When you start keto, you can have amazing health benefits associated with lower blood sugar levels and improved gut health. But when you reintroduce foods, either just because you want to or because you’re beginning to see negative health effects on a keto diet, you are very, very likely to accidentally give yourself hyperglycemia.

3. Altered gut biome population

When you go on a keto diet, you ordinarily, pretty significantly, reduce your fiber intake. This results in a reduction of and shift in your gut flora population. Fiber is important for feeding good bacteria and fending off bad. On a keto diet, you should be aware of this and doing what you can to get high quality probiotics (taken as a supplement, but my preferred method is via fermented foods such as kimchi, sauerkraut, or kefir) and prebiotics (these are fibrous foods and especially those containing inulin, a form of fiber that bacteria really like to eat, such as garlic, onions, leeks, chicory, and jerusalem artichokes). But sometimes that’s not enough, and most people don’t do this anyway.

When you add carbs back into your diet, you will simply not have a gut flora population suited to helping you digest and process these carbs.

4. Increases in LipoPolySaccharide (LPS)

LPS is an endotoxin that can lead to low grade systemic inflammation and associated issues.

Just 5 days on a high fat keto diet will increase levels of LPS in your blood.

The way in which this happens is complicated. I’ll put it briefly. There are two main kinds of intestinal permeability: the kind that goes through cells, and the kind that goes between cells. This latter type (called “paracellular”) is what we normally think of when we think “leaky gut,” and there are ways to test for this. But the other type – the type which goes through cells (transcellular) matters too. The gut isn’t leaky – it just lets things through.

LPS increases in the gut and then gets into the bloodstream on a high fat diet, which isn’t necessarily a bad thing in and of itself – on a strict keto diet. Ketones can balance some of the effects of LPS in the blood. The gut bacteria changes that you go through on a keto diet can also help balance out any negative effects of increased LPS in  the gut.

But once you introduce sugar, alcohol, stress, or circadian disruption, you are increasing the possibility that your intestinal permeability will increase – or skyrocket, actually – and release even more of this LPS into your blood.

In sum:

When you embark on a high fat, keto-oriented diet, you shift your gut flora and metabolic hormone levels to a pretty serious degree. This is all right if you stick to this diet (usually), but if you come off of it or have cheat days either because you’re sick of keto or you’re experiencing negative side effects (not uncommon for women, especially those underslept or with stress or with reduced micronutrient intake), you may run into some serious issues. These issues involve systemic inflammation, leaky gut, poor blood sugar and insulin management, and all the possible downstream effects of those big hitter problems, such as weight gain, poor sleep, headaches, low energy, mood swings, autoimmune diseases, hormone dysregulation, infertility, skin issues, and the like.

It’s not pretty.

Fortunately, you can reintroduce carbs. It just takes some time and care. The way to do it is to 1) protect your gut, 2) strengthen your gut, and 3) then introduce carbs slowly.

Here is a three-component re-introduction plan:

PHASE 1. PROTECT YOUR GUT – eliminate stressors

First, DON’T take cheat days – either be keto or not keto, period.

Should you be staying on the keto diet, just don’t ever take cheat days. Small amounts of carbs from time to time, yeah, they’re good. They’re fine. But keep it really minimal, and never splurge. This can be a huge detriment to your gut lining and inflammation status.

Stay away from alcohol

Alcohol can increase intestinal permeability, most notably with abuse, and especially when the gut is already primed to be permeable. So, when you add carbs back into your diet, cut alcohol until you feel comfortable you have successfully reacclimatized to carbs.

Sleep well, reduce stress

Circadian disruption and stress have both been demonstrated to be big factors in causing leaky gut and in making it harder to regulate gut health, inflammation, and blood sugar  and insulin levels. When you sleep well and reduce stress, you make it easier for your body to transition back to processing carbohydrates.

Circadian like a champ

Having  a robust circadian rhythm can be an extraordinary help to managing insulin, inflammation, and glucose levels.

You can do this by going to sleep at the same time every night and waking up at the same time every morning, by getting a boost of cortisol early in the morning/day by exercising (I usually do a couple hundred pushups upon waking, it takes less than 10 minutes), getting blue light during the day and orange light at night, and sleeping in a very dark room.

Another important thing you can do, interestingly, shifting the bulk of your calories to earlier in the day. That is, eat big at breakfast, and eat light at night. I actually don’t do this, but it’s been demonstrated time and time again that for the sake of your weight management, insulin levels, energy, and pretty much everything, it’s best to eat earlier than later.

PHASE 2. STRENGTHEN YOUR GUT – add gut reinforcers

In this phase, you start building gut resilience before adding in carbs. Give it a couple weeks of focusing on these foods (and maybe supplements) before reintroducing, if you can.

Fiber fiber fiber fiber

On keto, you are usually starved of fiber, so the bacteria in your gut start to eat the mucus layer there. This reduces the thickness of the mucus layer. In order to rebuild a health ability to process carbs, you need to restore your mucus layer in part by giving  your bacteria the fiber they need.

Using fiber when you reintroduce will also help keep your insulin levels more in check, so try introducing carbs that are fibrous at first, or couple your more dense carbs with fiber. By this I mean, chop up some apple in a kale salad. Have some kimchi or sauerkraut and add some beets or squash. Have a broccoli, quinoa, and pomegranate salad. There are tons of ways to do this.

The simplest way to think of this is to focus on leafy greens and adding some potato, squash, or berries to the mix. Have a salad and just add a little bit of sweet to it. Of course, you’ll also want to have your normal dose of fat. That will also keep your insulin levels in check. Don’t start skimping on fat just because you’re transitioning off keto!

Probiotics

Get your probiotic foods! Many people of course recommend probiotic supplements, but I’m a much bigger fan of probiotic foods. And of all the probiotic foods, my absolute favourite is kimchi. I am not sure why – and I’m getting very personal and n=1 here with my recommendation, but whenever I have a gut problem, kimchi fixes it. Yogurt doesn’t work, kombucha doesn’t work. Kimchi works. I have a kimchi rec on this page.

Prebiotics

Onions, garlic, leeks, and Jerusalem artichokes are some of the foods highest in inulin, which is a form of fiber good bacteria need to much on. Foods high in inulin are called prebiotics because they contain this compound  that bacteria eat. Probiotics honestly are not all that effective without prebiotics. The prebiotic content of kimchi is perhaps why kimchi is so effective for me as an effective gut intervention – the cabbage in the kimchi is a great prebotic for the bacteria in there that I need to heal my gut.

Try and include these prebiotic, inulin-containing  foods in your meals, especially ones that have carbs in them.

Riboflavin 

Take some riboflavin to help you manage your fat burning. Riboflavin is a powerful fat burning nutrient, but it takes twice as much to burn fat as it does to burn sugar.

Of course, the goal here is to reintroduce carbs, but  you’ll probably be worried about your weight maintenance as you do that. I wouldn’t make weight maintenance in the short term a huge priority – being healthy in the long term is the best way to manage your weight – but some extra riboflavin can help ease your transition.

The best food source of riboflavin is eggs. 

Magnesium

There are tons of nutrients that can help you modulate your insulin levels, but magnesium is my favourite. Natural Calm is a classic and fun way to get a high quality dose of magnesium every night.

PHASE 3. REINTRODUCE CARBS S L O W L Y

Do not, I repeat, do not, just go order an ice cream sundae and call it a win. I mean, you can try this, but I really advise against it. The increases in LPS, shifts in gut flora, and insulin resistance that happen in keto do not go away overnight.

I recommend increasing your daily carb intake first by about 20 grams a day, every other day, for one week.

I mean, add 20 grams of carbs to every other day. 20 grams is about the size of a banana. Spread it out throughout your day if you want – don’t get it all at once. Add it on a Monday. Then wait on Tuesday. Do it again on Wednesday. See how you feel after a week of this.

If you’re fine, then do 20 grams every day. Do this for at least a week. If you’re not fine, go back to the phase where you’re focusing on gut healing.

Then, if you’re still fine, amp it up to 40 grams a day and see how you feel. If you’re okay, eat between 20 and 40 grams of carbs every day for two weeks.

Then, if you’re still fine, amp it up to 60, and so on, and so forth.

Eventually, you can probably eat 200 grams of carbs a day and be fine, and it will be very case dependent in terms of what is good for you. This is why you introduce slowly and assess. Look to your energy levels, your weight management, your  skin health, and most of all, your gut health.

When you reintroduce carbs, perhaps steer away from FODMAPS

FODMAPS are kinds of carbs that can be more challenging for gut flora because they’re just more complex. Fructo-, Oligo – Di – Mono Saccharides, Alcohols, Polyphenols.

(Read about FODMAPs in this blog post by Chris Kresser.)

So I would recommend root vegetables and others that aren’t on the FODMAP list to focus on at first when you reintroduce. You could try FODMAPs; simply, if you find yourself reacting poorly to them, put them last on the list of carbs you reintroduce.


All in all, these recommendations can help you on the road to a more sustainable, physically and mentally healthy diet. I happen to also really love mine and Noelle’s book, which deals with  problems regarding eliminating and reintroducing foods at great length.

If you have experience working with and overcoming the keto diet,  I would love to hear from you! I know that many people in this community think deeply about  and experiment with macros.  Your experience matters and can  help anyone else going through these things! Unfortunately, as much as I’ve read about keto and macros and the gut, I’ve actually never done keto myself. So I can’t weigh in with  personal experience. I’d love to hear what you have to say!

 

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