KETO QUESTIONS

How To Solve The Problem Of Dry Eyes On Keto

After starting a ketogenic diet, your body is going through so many changes. Many of those changes are related to a shift in electrolytes, and as a result, hydration. This may lead people to experience increased sweating, dry lips, and even dry eyes.

A low carb or keto doesn’t directly cause dry eyes. Still, a ketogenic diet may leave people mildly dehydrated or deficient in vitamin A, two possible causes for dry eyes while eating a keto diet. Increasing foods in eye-healthy nutrients and electrolytes may help alleviate these symptoms.

In this article, I’ll go over why a ketogenic diet may cause dry eye, other reasons why you may be experiencing dry eye, and ways to fix or alleviate it.

Does Keto Cause Dry Eye?

A ketogenic doesn’t directly cause dry eyes by any means of being in a state of ketosis. However, many people suffer from mild dehydration or deficiencies in specific vitamins when first transitioning to a ketogenic diet.

Mild dehydration

Many people suffer from mild dehydration due to water loss after transitioning to a ketogenic diet.

When you switched to a ketogenic diet, you may have noticed a substantial drop in the scale. While losing a good amount of weight at the start of a diet is very motivating, a large portion of the weight was water and glycogen (stored carbohydrates).

Don’t get me wrong, some of the weight you lost was fat, but if you happened to notice the need to pee more on keto during the first week, you weren’t imagining. LINK

Once carbohydrates are restricted on a ketogenic diet, water previously-stored is released from the body as glycogen is burned.

Glycogen is just fancy way of saying stored carbohydrates, which is stored in your liver and your muscles.

For every gram of glycogen your body stores, an additional three grams of water is stored with it.

On average, your body will store ~500 grams of carbohydrates, which, if you do the math, equates to ~1,500 grams of water. After carbohydrates are restricted, your body begins to burn through this stored glycogen to fuel your muscles, other bodily functions, and especially your brain.

As a result, your body begins to expel this water anyway it can (breath, urine, sweat, etc.). Along with the water, vital electrolytes, such as sodium and potassium are excreted, and you’re often left mildly dehydrates and with an electrolyte imbalance.

This massive shift in water and electrolytes leads people to experience signs and symptoms of the influenza flu, referred to as the keto flu. If you’re experiencing more side effects than just dry eyes, you may want to pay attention to what I’m about to tell you.

To help combat possible related keto-dry eye, and even keto flu symptoms, make sure you are drinking a sufficient amount of water and replacing lost electrolytes.

You can easily make sure you’re hydrated by making sure you are drinking plenty of water to thirst and salting your foods liberally to taste.

Read: How Much Water To Drink On Keto

A simple way to gauge your level of hydration is by the color and smell of your urine. You want your urine to be a pale yellow and nearly odorless.

Vitamin A deficiency

Maybe bugs bunny, and your mom was right in telling you to eat your carrots. Vitamin A helps promote healthy eyes, and a deficiency in vitamin A may lead to dry eyes and other vision impairments.

In worse cases, deficiency in Vitamin A may lead to permanent eye damage and even blindness.

The good news is, more than 75% of people who eat a standard American diet consume enough Vitamin A. The bad news is, you’re not eating a standard American diet.

If you’re doing lazy keto and not eating whole-unprocessed foods, you may be deficient in this vital nutrient.

Some keto-friendly foods that are rich in vitamin A include:

Darky leafy greens (Spinach, Kale, Swiss chard)
Animal Liver
Seafood (King Mackerel, Salmon, Bluefin Tuna, Trout)
Eggs
Cheeses (Goat, Cheddar, Blue, Feta, Paneer)
Nopales cactus and prickly pear

I should also differentiate, there are two forms of vitamin A, preformed vitamin A, and pro-vitamin A.

Preformed vitamin A is found in animal products and is better absorbed. Pro-vitamin A is found in plant-based foods and must be converted for absorption.

Pro-vitamin A, the form found in plant-based foods, must be converted from carotenoids, the most common one being beta-carotene. However, about 45% of people carry a genetic mutation that reduces their ability to convert pro-vitamin A into usable vitamin A.12

How Keto May Be Good For Your Eyes

While there isn’t any long-term research that looks into how keto impacts eye health, there are some interesting findings. For example, there’s a study that shows a positive impact on glaucoma in mice fed a ketogenic diet.3

Glaucoma is a disease that damages the eye’s optic nerve and leads to progressive vision loss. Glaucoma is also the second leading cause of blindness behind cataracts.

Anecdotally some people experience better vision after starting keto, though no research currently supports this.

Other Causes Of Dry Eye Not Necessary Related To Keto

Here are a few common causes of dry eye not related to keto. Try to see if any of these common causes may apply to you.

Aging

Tear production declines with age, especially if you’re over the age of 50 years old. While this isn’t controllable with any drugs (prescription or over the counter), your best bet is to use artificial tears regularly to provide extra lubrication and relieve the dryness.

Computer or screen use

We live in a modern society filled with screens, especially at work on a computer, or at home watching television or staring at your phone. When we stare at screens, especially at work, we tend to blink less often.

Every time you blink, your eyelids spread oils and mucous across your eye to keep them lubricated. Try to be mindful and make sure you blink periodically or give your eyes a break from the screen every so often.

Allergies and their medications

You may be thinking that allergies don’t give you dry eyes, they do the exact opposite, and you would be correct. However, the oral antihistamines you may be used to treat the allergies can make the symptoms of dry eye worse.

Try looking into antihistamine eye drops if you experience dry eyes from allergies.

Low humidity

If you live or work in an environment with low humidity, or maybe you sleep or work next to an air vent or fan, making sure the air doesn’t blow directly in your eyes may improve symptoms. You may also want to try looking into a humidifier to moisten the air if switching to a different area is out of the question.

Diabetes and other diseases

People with diseases such as diabetes, arthritis, and lupus are also susceptible to inadequate tear production, which may lead to dry eye.

Due to the lower carbohydrate nature of a ketogenic diet, many people with type 2 diabetes give ketogenic diets a shot with great success.

The Takeaway

A ketogenic diet is typically rich in fats, particularly healthy omega-3 fats, which may help prevent dry eyes and possibly cataracts.

When starting a ketogenic diet, you may experience a considerable loss in water, which may leave you mildly dehydrated, and lead to dry eyes. Additionally, making sure you’re eating animal and plant sources rich in vitamin A to help prevent a deficiency can also help.

So does keto cause dry eyes? Not necessarily, but make sure you’re well-hydrated is an excellent place to start.

The Canker Sore Keto Correlation And How To Fix It

On the surface, it may seem like switching to a ketogenic diet should reduce the recurrence of canker sores due to reduced inflammation and carbohydrates. However, certain individuals may notice that they experience a flare-up after starting a ketogenic diet.

Does keto cause canker sores? There is no conclusive evidence as to what causes canker sores, but a ketogenic diet may cause the recurrence of a canker sore due to increased stress from drastically switching diets. Additionally, a ketogenic diet may cause canker sores through the excretion of acetone, a ketone body, from the breath.

In this article, I’ll cover reasons thought to cause canker sores, how adopting a ketogenic diet may cause them, and how to help prevent them in the future.

What Causes A Canker Sore?

A canker sore is an open and often painful mouth ulcer or sore that can make everyday activities such as eating or talking quite uncomfortable. You can tell a canker sore by its white or yellow appearance surrounded by inflamed soft tissue.

While not always the case, you may also experience additional symptoms such as hot flashes, swollen lymph nodes or possibly a fever. Either way, a canker sore is a nuance. The good news is most types of canker sores will heal within about a week or two.

When it comes to what the exact cause of canker sores are, NOBODY knows the exact reason.

Those with a family history of canker sores are more susceptible. Also, canker sores are more common in young adults and females.

Some of the most common causes thought to cause canker sores are:

A vitamin deficiency, especially B-12, zinc, and iron
Stress
Certain foods
An allergy

Why You May Get Canker Sores After Adopting A Keto Diet

Stress

A ketogenic diet is often a significant shift in the way most people eat. You may have gone from a high carbohydrate or even moderate carbohydrate diet to a diet that is very low to no carbs.

This shift in diet and metabolic processes can be stressful on the body. While you are adjusting and adapting to a ketogenic diet, you may fall prey to many of the side effects, such as the keto flu, which causes additional stress.

Stress is often one of the major, if not the biggest, factors though to cause canker sores.

Keto breath

If you’re experiencing a metallic taste in your mouth and notice it smells a bit fruity and almost nail polish-like, you have what's commonly called keto breath. Keto is notorious for causing dry eyes, mouth, and lips in addition to changing how your breath smells during the first few weeks.

The body is inefficient at using ketones for fuel at first, causing ketones to be wasted and excreted.

While your body is adapting to using ketones for fuel, acetone, one of the ketone bodies you produce, is excreted through the urine and breath. This higher than usual excretion in the first few weeks typically results in keto breath, increased urination, and even more sweat production.

While acetone isn’t highly acidic, it is acidic enough, and acidic foods or drinks are thought to be one of the causes of canker sores.

How A Ketogenic Diet Helps Prevent Canker Sores

While you may be experiencing a canker sore after switching to a ketogenic diet, many people believe a low-carb ketogenic diet can help alleviate or prevent canker sores.

A ketogenic diet helps prevent canker sores by:

Reducing inflammation

A ketogenic diet is highly praised for its ability to reduce inflammation in the body. Chronic inflammation has been linked to a variety of diseases that may also be linked to canker sores:4

Diabetes
Cardiovascular disease
Arthritis
Allergies

Not only can a ketogenic diet help you with your canker sores, but it seems to be better overall for dental health as a whole. Keto’s emphasis on cutting down carbohydrates (sugar) may help stop the inflammation that can cause gingivitis and gum disease.

Minimizes sugar intake

Most of us were told as a child to limit or candy intake, or we’d get cavities, and that was for a good cause. Carbohydrates (sugar) is first broken down in the mouth, and bacteria also feed on that very sugar.

Sugar in itself does not cause cavities, but sugar sets off a cascade of events that may lead to them.

Studies have shown that certain bacteria produce acid in your mouth when they come in contact and break down sugar.2 When you minimize carbohydrate intake, you are reducing the number of bacteria in your mouth.

Germs in your mouth eat the sugar and produce acid. As you may now know, acidic foods and drinks are thought to be one of the causes of canker sores in addition to the weakening of tooth enamel and the formation of cavities.

How To Reduce Canker Sores On A Ketogenic Diet

These are some oral hygiene tips that may help the prevention of canker sores.

Vitamin B-12

Another reason thought to cause canker sores is a vitamin deficiency, but most notably vitamin B-12. Eating foods rich in B vitamins, like nutritional yeast, but most notably B-12, may help prevent or reduce the duration of canker sores.

Keto-friendly foods rich in Vitamins B12 include:

Beef, liver, chicken
Fish and shellfish
Cheese
Eggs

Sodium Lauryl Sulfate (SLS) based toothpastes

Sodium lauryl sulfate (SLS) is an ingredient that found in most over the counter toothpaste. The purpose of SLS is to thicken toothpaste and make it lather but does nothing to enhance the effectiveness of the toothpaste.

SLS is similar to that of alcohol in mouthwash. The alcohol itself doesn’t clean your teeth or gums any better, but it makes you “feel” cleaner or that it’s more effective.

Using a toothpaste without SLS may help as it's shown to irritate the mucous membranes of the mouth and cause ulcers.3

Reduce citrus and other acidic foods

Certain foods, such as citrus or acidic fruits and vegetables, should be reduced or avoided.

Some fruits or vegetables that are keto-friendly, but also acidic include:

lemon and limes
blueberries
tomatoes
sauerkraut

Additionally, to help prevent the recurrence of canker sores, you should try and avoid foods that may cause allergy symptoms such as:

Hives
A swollen or tingling tongue
Dry eyes

It may be a particular food or foods that triggered the outbreak. Paying attention to what you may have eaten previous to your last canker sore may give you clue on what exactly to avoid.

The Takeaway

While a ketogenic diet, In theory, should help eliminate the recurrence of canker sores, some may experience flare-ups for one reason or another. These flare-ups may be caused by the stress of drastically switching your way of eating or the high levels of ketone excretion from the breath during the keto-adaptation period.

Other than time, you may try reducing the recurrence of canker sores by:

De-stressing
Consuming more vitamin B-12 rich foods
Cutting foods that may cause allergies
Switching to a non-SLS-containing toothpaste

The Secret Behind Kefir And Ketosis

Kefir is growing in popularity, popping up in almost every grocery store. If you’re not familiar with kefir, it’s a fermented drink that contains a symbiotic culture of yeast and bacteria, similar to how you would make sourdough bread. However, it does contain a fair amount of carbs for those following a low carb or keto diet.

Kefir and water kefir can be consumed on a ketogenic diet within moderation. An average glass (8 oz) of kefir has the same amount of carbs as a glass of milk with 10 grams of net carbohydrates. However, this amount is reduced further through longer fermentation.

In this article, I’ll go over what kefir is and its health benefits, how to reduce the number of carbs, and alternatives that are even more keto-friendly.

Is Kefir Keto Friendly?

Keto-friendly is just another way of saying whether or not a food is generally ok to eat because no food is inherently keto or not keto. Foods aren’t “keto” since keto is a metabolic state achieved by limiting carbohydrates under a certain amount, which is different for everyone.

On average, an 8 oz. serving of kefir from most brands contain ~10 to 13 grams of net carbs. Since most people following a ketogenic diet limit carbohydrates between 20 and 50 grams of net carbs, kefir fits the bill as it falls under that threshold.

The real question is whether using up 10 to 13 grams of your net carbs is worth a glass of kefir. Of course, you can get the health benefits of kefir without drinking a full 8 oz. serving. For example, consuming 4 oz. of kefir only has ~6 grams of net carbs.

While I would suggest getting the majority of your carbohydrates from non-starchy vegetables such as broccoli, cactus, and spinach, you can enjoy treats that aren’t exactly seen as “keto” while staying in ketosis.

I wouldn’t make it a point to try to fit in treats every day, but if it makes you diet more enjoyable and allows you to stick to it, then who am I or anyone to stop you.

You do you.

What Is Kefir

So what exactly is kefir? It’s a cultured, fermented beverage similar to kombucha. Kefir is made similarly to sourdough bread, where a “starter” consisting of yeast and bacteria is used to ferment dairy milk, though other alternative milks may be used.

Kefir is almost like a yogurt drink, it’s not as runny as milk, but it’s not as thick as yogurt. Since kefir is fermented, individuals who may be lactose intolerant don’t seem to have the same reaction with kefir.

If you’ve never seen kefir, you’ll likely find it in the dairy section or lumped in with the yogurts.

Health Benefits of Kefir

Kefir is rich in nutrients, B vitamins, potassium, calcium, and a good source of high-quality protein. However, most people choose to consume kefir for its probiotics.

Other great keto-friendly sources of probiotics include kimchi and sauerkraut.

Probiotics are live organisms consumed through fermented foods or supplements such as kimchi, sauerkraut, and kombucha. Additionally, probiotics are thought to help promote a healthy balance of gut bacteria and linked to a variety of health benefits.

Aside from being rich in nutrients, 5 health benefits of kefir include:

How To Make Kefir More Keto Friendly

By making your kefir, you’ll have full control of making a lower carb version than the ones found on the store shelves.

First, decide which type of dairy or non-dairy base you would like to use. Popular non-dairy alternatives include:

Coconut milk
Goats milk
Rice milk
Almond milk
Macadamia nut milk

Easy ways to make kefir more keto-friendly…

Use coconut milk or another dairy alternative

Make kefir with coconut milk, not to be confused with coconut water, or another non-dairy milk lower in carbohydrates. Using something other than cows milk is an easy way to slash carbs from your kefir.

For example, this recipe from KetoDietApp uses coconut milk and has only ~4 grams of net carbs per 8 oz. serving.

HomemadeCoconutMilkKefir1 — Recipe and image from ketodietapp

Reduce the serving size

Reducing your kefir serving from 8 oz to 4 oz is a way to take in fewer carbohydrates, but still, get the health benefits of kefir and probiotics.

Just because the nutrition label says 8 oz. or 1 cup equals a serving, doesn’t mean that you have to drink that much in one sitting.

Ferment kefir longer than 24-hours

Ferment your kefir longer than 24 hours. Typically, kefir is fermented for 24 hours, but fermenting kefir for 48 to 72 hours will help further reduce the carb count.

Bear in mind, the longer you ferment your kefir, the sourer it becomes, but this is easily remedied by mixing in your favorite zero-calorie sweetener such as stevia or monk fruit.

Or, if you enjoy the sourness, then leave it be.

Drink water kefir

Yepp, that’s not a typo.

You can make kefir from water the same way you can from dairy and other milk. Water kefir is easy to make at home as all you need is water, sugar, and water kefir grains.

The fermentation process is what reduces the sugar content, so using less sugar and increasing the fermentation are perfect ways to reap the benefits of kefir with even less sugar.

Here’s a natural water kefir recipe from Kombucha Kamp.

Image and recipe from Kombucha Kamp

The Takeaway… Is Kefir Keto?

Kefir can most certainly fit into a ketogenic diet as a single serving has ~10 grams of net carbs and a half serving only ~5 grams. However, you’ll get more bang for your buck by making your kefir with non-dairy milk or fermenting dairy for longer than 48 hours.

Kefir is rich in probiotics that have been shown to have a multitude of health benefits, including digestion health and improved bone health, making it worth consideration as part of a healthy diet.

Since kefir is a fermented beverage, the sugar is significantly reduced during the fermentation process. Still, if you ferment it even further, you can reduce the overall net carbs even more.

Swollen Hands And Feet On Keto? Here’s Why.

Transitioning to a ketogenic diet can be quite stressful on the body for some individuals. Often, it's this increased stress along with other changes that may be causing your hands and feet to become swollen.

In fact, during extreme dieting situations, as with my last bodybuilding prep, I was putting my body through long periods of dieting combined with high amounts of physical exertion. This stressful situation led to a period of VERY swollen ankles and feet.

Why your hands and feet are swollen on keto. Swollen hands and feet on keto are usually due one or even a few of the following causes: electrolyte imbalance, too much physical stress (diet and exercise), an injury, or increased temperatures.

Keep reading along, I'll explain the major causes behind swollen hands and feet, how keto may play a role, and a few dietary and physical solutions to fix the swelling.

What Causes Swollen Legs, Ankles, and Fingers?

Electrolyte imbalance

There are two probable causes when it comes to electrolytes, though both are related. One, you're consuming too much salt, the other, you're consuming too much salt, but in proportion to potassium. Meaning, you're not consuming enough potassium.

Sodium and potassium are electrolytes that your body needs to function normally and help maintain fluid balance. When these minerals are out of balance, edema, or fluid retention, may occur in your ankles, fingers, legs, and even around your eyes.

On average, Americans consume too much sodium in relation to potassium.6 According to the World Health Organization, the general guideline for sodium to potassium should be close to 1:1. 2

Physical stress

For a variety of reasons, too much physical stress may lead to swollen hands and feet. 3

When we exercise, blood flow is diverted not only to the working muscles but also to your heart and lungs. Exercise can reduce blood flow to your extremities like your hands and feet, making them cooler. As a result, the blood vessels in your hands or feet may react by opening wider, which is the swelling you're experiencing.

It's not uncommon for runners to experience swollen hands and feet. The constant movement of your arms swinging and feet hitting the ground may contribute to fluid retention. Constant movement increases air across the skin to improve heat exchange with the air to stay cool.

An injury

A common source of swelling in the legs, feet, and hands are from injuries. Injuries include strains, sprains, and even broken bones. While a broken bone may be more visible, sometimes we experience slight injuries or traumas without necessarily experiencing any feedback (i.e., pain). In the case of an injury, blood rushes to the affected areas.

If there is a chance you may have suffered an injury, please seek medical attention.

Increased temperatures

It's quite common for hands to swell in hot weather, referred to as heat edema. Heat causes the blood vessels to expand, sending more blood to the skin in an attempt to help cool you down.

As blood vessels expand, fluids leak into surrounding tissues. With a little help from our friend gravity, fluids can also move and collect in the hands and feet.

If you're going to be in hot temperatures, try to wear breathable clothing and shoes in addition to staying well hydrated.

If exercising outdoors during hot temperatures, try to work out during the colder period of the day if and when possible. Also, tight-fitting jewelry, especially something like a ring, may lead to swelling of the hands and fingers while exercising.

Low protein intake

In rare cases, a deficiency in protein may lead to increased water retention while on a ketogenic diet. Often, people either restrict protein to maintain specific percentages or have heard about protein converting into sugar.

While a deficiency in protein is less common in developed countries, if you're going out of your way to consume LESS protein, you may be doing your body a disservice. Protein attracts water and plays an essential role in helping to maintain water balance.

To figure out your protein intake and other macros, try our keto macro calculator, which will guide you through our recommendations.

How To Fix Water Retention On Keto

Resolving swollen hands and feet on keto will depend on the root cause of water retention.

Stay hydrated and maintain electrolyte balance

Contrary to popular belief, drinking too little water may cause your body to hold onto more water in an attempt to prevent dehydration. Make sure you are drinking plenty of water, preferably to thirst, to stay well hydrated.

Additionally, you must be getting a sufficient amount of electrolytes, especially sodium and potassium. Many people who start a ketogenic diet suffer from the keto flu, which is usually a result of a massive shift in water and electrolytes.

Make sure you're salting your foods liberally and to taste, but also making sure you're getting in enough potassium. Keto-friendly foods rich in potassium include avocados, mushrooms, leafy greens, and even BACON! If you haven't tried Pederson farms bacon, I'd highly recommend it.

Additionally, you can also supplement with an electrolyte drink or supplement, which were specially formulated with the keto and low-carb dieter in mind.

Perfect Keto Electrolytes Capsules (Exclusive 15% off using code AOK on your entire purchase of any keto product)

Supplement vitamin B1

Surprisingly, vitamin B1 deficiency is one of the most common deficiencies. A deficiency in vitamin B1 can lead to fluid retention in your ankles, also known as edema.

Nutritional yeast is a keto-friendly source rich in B1. You may have seen nutritional yeast at your local store like Trader Joes, but it typically comes in the form of little flakes. It's the perfect way to season vegetables or anything of your choosing as it has an almost cheese-like nutty flavor to it, similar to parmesan cheese.

Lower intake of FODMAPs

Sometimes water retention can be a result of inflammation due to food sensitivities. FODMAPs stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols'.

Mainly, certain types of carbohydrates and sugar alcohols may cause digestive stress to specific individuals, especially those who suffer from Irritable Bowel Syndrome (IBS).

Some common keto-friendly foods that are high in FODMAPs include:

Cauliflower
Garlic
Onions
Asparagus
Avocado *gasp*

It may be worth experimenting with the elimination of certain foods from your diet for some time and seeing if the swelling in your hands and feet subside. For a complete list of foods high in FODMAPs, click here.

Compression socks

Compression socks are popular among travelers to help provide pain relief and prevent fluid from collecting in their legs, ankles, and feet. These socks can be a great tool to help alleviate the symptoms if you suffer from swollen ankles and other lower body extremities.

You can find a pair of compression socks at your local drug store, shoe store, or even online on Amazon.

Check prices for compression socks here.

Exercise

In some cases, exercise may be the cause of swollen hands and feet. However, if you're NOT exercising, then doing so may help with swollen hands and feet.

Exercise can help with blood flow in addition to losing weight, which may reduce swelling and will improve your health overall. Sometimes it's sitting down, standing in one place, or being sedentary that can cause your body to retain water and cause swelling.

Additionally, here are seven exercises for leg edema or swelling that you can use.

Increase fiber and probiotic-rich food intake

Many people starting keto try to limit ALL of their carb intake, even fiber. Increasing fiber intake is useful in helping your body digest and balance fluids properly.

Can A Keto Diet Cause Swelling?

There's nothing specific about a ketogenic diet that gives reason to believe that it would cause swollen hands or feet. Chances are you're making changes to your diet and lifestyle, which can be stressful on your body.

Additionally, these changes can affect not only your fluid balance but your electrolyte balance. These changes may have you feeling other side effects such as nausea, increased sweating, and maybe even experiencing a higher heart rate than average.

Once you're able to get a hold of making sure you're well-hydrated, balancing your electrolytes, and getting proper nutrition, you'll be coasting along towards your goals.

Final Thoughts

Swollen hands and feet on keto may be more common than you think. A ketogenic diet is usually a drastic shift from what most people used to eat, which is a stress on your body.

If you find that the pain or swelling in your hands and feet aren't subsiding, you should consult with a doctor as there may be something more serious going on.

Does Keto Cause Heartburn? [9 Tips to Resolve Symptoms]

Suffering from horrible heartburn on a keto diet can be a real drag. Suffering from heartburn period is a real drag regardless of the diet. Maybe you've switched to a low carb or keto diet to help with heartburn or acid reflux, so what gives?

Low-carb and ketogenic diets have shown to be useful for relieving heartburn, or acid indigestion, which is a symptom of acid reflux. Science shows obesity, and high-carbohydrates, mainly sucrose, have a stronger association with an increased risk of GERD, not foods high in fat.

Read further to find out precisely what heartburn is, common causes of heartburn on a keto diet, and ways to manage the symptoms.

What May Be Causing Horrible Heartburn On A Keto Diet?

Heartburn can be caused by not only a variety of foods but different factors, as well. Some common foods that linked to heartburn that you may be eating on a ketogenic diet include:

Fried foods
Chocolate
Coffee and other caffeinated beverages
Acidic foods such as tomatoes
Spicy foods
Garlic and onions
Alcohol

Not a food, but a sudden diet change, such as starting a keto diet, can temporarily make reflux symptoms worse, although not long term.

Non-food related reasons you may be experiencing heartburn on a keto diet are:

Slouching (poor posture)
Certain medications
Eating large meals
Eating too quickly
Eating right before bed
Pregnancy
Diabetes
Ulcers
Hiatal hernia: Hiatal hernia would be an anatomical issue treated through either drugs or surgery.
Stress
Sleep apnea
Obesity
Smoking

What Is Heartburn?

Heartburn is typically a symptom of acid reflux when stomach acid backs up into the esophagus, causing irritation. The esophagus lies just behind the heart, and that's generally where people feel the burning sensation; hence, it's referred to as “heartburn.”

Heartburn is used to describe a feeling of discomfort, usually a burning or painful sensation in the chest. Sometimes you may experience a sour or bitter taste in your throat or mouth, and it typically occurs after a big meal or after laying down post-meal.

If you are experiencing two or more episodes of acid reflux symptoms per week, you may have acid reflux disease, also known as GERD or gastroesophageal reflux disease.

What Causes Acid Reflux Symptoms?

Contrary to popular belief, it's too little stomach acid, not too much that causes acid reflux. Your stomach is supposed to be acidic, very acidic at that.

Both a high fat diet and red meat are often villanized, which makes a keto diet a perfect target for the blame of heartburn and other reflux symptoms.

Between meals, an empty stomach has a pH of one to three. After consuming a meal, pH levels rise to four or five.

For reference, a seven is considered neutral, so anything lower than seven is deemed to be acidic. As another reference, lemon and vinegar have a pH of around two. 2The LOWER the number, the more acidic.

On a ketogenic diet, stomach acid is what will help breakdown the proteins and fats you consume. Unlike carbohydrates, which are first broken down by the enzymes in your saliva, proteins and fats are first broken down in the stomach. Therefore, stomach acid sets the stage for proper digestion, so it needs to be highly acidic.

If too little is produced, food can't be broken down quickly enough. Foods left undigested too long may lead the way to fermentation, and this fermentation can result in the creation of gas.

The creation of gas from food fermented within the stomach may place pressure on the lower esophageal sphincter (LES), which is a small bundle of muscles located between your stomach and your esophagus. Generally, the only way the sphincter opens is for the allowance of food to pass once swallowed.

Most of the time, this is a one-way process , but as you may have experienced, there are rare occasions where it may not be. Better put, food, and beverages are supposed to only go in one direction, from the esophagus into the stomach, not the other way around.

Aside from acid reflux, if you've ever vomited, then you've personally experienced food and liquids going in the wrong direction. During vomiting, the LES opens as a natural response to the body, wanting to rid the body of something toxic.

However, specific individuals have a weakened lower esophageal sphincter, more prone to opening than others. The burning sensation and irritation you experience are a result of foods coming back up or “refluxing,” into the esophagus.

So now that you know that acid reflux symptoms are a result of your stomach not being acidic enough, what may cause it while following a keto diet?

What Causes Reduced Stomach Acid?

As I've alluded to earlier, heartburn can be a result of both food and non-food related causes.

Prescription Antacids

Like many medications, prescription or over the counter, they address the immediate symptoms but do nothing to correct the underlying problem. 3 30 to 40 percent of patients won't even respond to prescription treatment, while up to 60 percent will report residual symptoms. 4

Prescription medications help to alleviate heartburn in the short term by suppressing the secretion of stomach acid, but many individuals with heartburn don't need less; they need more.

Please speak with your doctor before making changes to your medication.

Stress

Not all stress is bad, but stress plays a significant role in how optimally our body can digest the foods we eat. Many people rarely think of stress when it comes to heartburn or any of the other ailments they may suffer from.

The brain is responsible for the biochemical digestion of your food. If you're always stressed, your body secretes less acid for digestion in an attempt to prioritize and handle the incoming stress.

The body needs to be in a parasympathetic state 5Rest and Digest to digest optimally versus a stressed-out sympathetic state 6Fight or Flight.

Additional causes

Surgery: Especially of the stomach, such as gastric bypass, can reduce the production.
Vitamin deficiency: Being deficient in vitamin B or zinc may lead to low levels.
Age: Low stomach acid is more common as you get older, especially over the age of 65 years old.
Smoking 7
High alcohol intake 8
Obesity: Specifically in the abdominal area.

9 Ways To Help Treat Acid Reflux and Heart Burn On A Ketogenic Diet

With low stomach acid being one of the main culprits of acid reflux and heartburn, how to treat it depends on the underlying cause. Here are just a few ways to help alleviate symptoms or to help increase levels, keto diet, or otherwise.

Chew your food

Often overlooked, and simple when you think about it, but chew chew chew your food. Digestion begins in your mouth, sending signals to your body to stimulate your digestive enzymes.

Drink apple cider vinegar (ACV)

Raw ACV introduces more acid into the digestive tract, thus increasing levels artificially. Also, raw ACV has been associated with reducing symptoms of high blood sugar, diabetes, and acid reflux. 9

Stay upright after eating

The conventional wisdom of standing or sitting upright after a meal may serve you well if you suffer from acid reflux and heartburn. Allowing gravity to do its job will help reduce the chances of food traveling back up into the esophagus.

Eat smaller meals

Smaller meals lead to less food to digest. Smaller meals may give your body ample time to breakdown and digest the foods and less likelihood for the creation of gas, causing upward pressure on the LES.

Another tip is to cook with simple keto recipes that have limited ingredients. People may react poorly to certain foods, and finding the culprit or culprits can help alleviate your GERD.

Supplements

Some doctors recommend supplementation of betaine hydrochloride for people who don't regularly produce enough stomach acid.

Check prices of betaine HCl here.

Weight loss

Excess body fat, especially around the abdomen, may result in increased pressure on the LES. While excess body weight isn't always the case, especially since both overweight and lean individuals suffer from acid reflux, it may be a contributor.

Don't eat while stressed

Ideally, we want to eat in a parasympathetic state (rest and digest) versus a sympathetic state (fight or flight). Easier said than done, but try your best to eat in a relaxed environment and a calm state of mind if and when possible.

Eat fermented vegetables

Fermented vegetables such as kimchi and sauerkraut can naturally improve levels. Foods like kimchi and sauerkraut have probiotic effects that can improve digestion, increase gut health, and reduce inflammation.

And yes, you can include these foods while following a low carb diet or ketogenic diet!

Limit liquids with meals

I'm not saying you shouldn't stay hydrated, but it may be wise not to consume a large number of liquids with meals. Large amounts of fluid with your meal can potentially ‘dilute' the stomach acid produced to help break down the meal.

Therefore, keep water intake to a minimum during meals.

Keto Diet And Heartburn Relief

Contrary to conventional advice of avoiding fatty foods, there seems to be no evidence showing a correlation between high-fat intake. Instead, a stronger correlation exists between acid reflux and heartburn with a high carb intake and obesity.

So it would seem a low carbohydrate diet or keto diet, in addition to weight loss, would be ideal in this situation.

A study aimed at measuring dietary carbohydrate intake, more specifically simple carbohydrates, and its association with GERD were conducted. In response to a high-fat low-carbohydrate diet, all GERD symptoms and medication usage after ten weeks of dieting had resolved, in ALL women. 10

Also, this study shows there doesn't seem to be a strong association between dietary fat and GERD. Instead, being overweight, not high dietary fat, was found to increase the risk of GERD. 11

Following a keto diet or other diet low in carbohydrates, which leads to weight loss, only helps reflux and GERD symptoms.

Take Away Message

Acid reflux and heartburn seem to be correlated with the ingestion of carbohydrates, mainly sucrose, and obesity vs. consumption of fatty foods. Both a low carb keto diet and weight loss should help improve GERD long term.

If you're suffering from heartburn while eating a ketogenic diet, try some of the tips outlined above. It may also help to keep your keto recipes simple so you can rule out any possible ingredients that may cause discomfort.

This is when a food log may be of great use.

If you find yourself still suffering from symptoms while following a keto diet, or they are troubling you and possibly unbearable, please consult your local health professionals.