I’ve been doing Keto since July 1 ‘19. I’m down 33 pounds and have been feeling fantastic. I follow this diet to a T and supplement with magnesium, potassium and sodium. I get enough calcium from my food.
Last week I started having back pain that has gotten worse. It is lower back pain on both sides. I’ve been getting periodic headaches too. And I’m tired, like foggy and exhausted even though I sleep great!
I just went to the doctor, they gave me blood and urine tests. It’s not a UTI or dehydration and they confirmed that I had a high amount of ketones present.
I don’t think this is the keto flu because I’m over 2 months in and haven’t slipped out of ketosis once. I even have urine strips I do every morning when I wake up. Has anyone else experienced this? Any idea what it could be and what I can do to alleviate the pain?
I really don’t want to stop doing keto because it’s working and I’m otherwise feeling great!
2.5 months in and experiencing new symptoms
Welcome to the forum. Are you eating enough? What is your diet like? Could it be an injury?
Hmmm, I have no idea. Are you eating enough? That shouldn’t have anything to do with your back pain, but it is the first thing that came to mind when you said you feel tired, foggy and exhausted.
When you say you are following this to a T, what does that mean? If you are keeping to your macros too closely and/or counting calories, I would eat more at my meals (no snacks, however).
Please keep us posted. I hope it resolves or you find out what it is.
Is the doctor going to see you again? What did he tell you?
Thank you. I definitely eat enough. I use my fitness pal and hit my macros everyday, at the very least I always stay under carbs and get as close as I can to the fats. I’m never hungry after a meal. And I don’t think it’s an injury either, I haven’t done anything recently or have a history of that.
When I say follow to a T, I’ve done a lot of research and took the keto macro quiz, and I supplement with magnesium and other keto products if I need to. With the exception of not quite hitting my fats everyday, I’m always under on carbs. I do 70% fat, 25% protein and 5% carbs.
The doctor said everything looks normal. And if it gets worse to go to an ER. I have a fasting bloodwork in the morning to further check kidney function and check my liver. I’m hoping it’s not stones or something. Considering I’ve been pretty lethargic, I was wondering if anyone else has gone through this?
I occasionally have lower back pain, which can get pretty intense (like yesterday) if I am constipated. Could this be an issue?
I have no clue about the back pain, sorry.
Your need for proteins should be based on lean body mass, not a percent of caloric intake. You should compute your macros in grams. If you’re trying to lose weight, you shouldn’t force yourself to eat more fat just to meat meet a macro. You would want stored body fat to be used to satisfy part of your need for fats.
There’s no reason you can’t get the keto flu 2 months in. It’s just more common at the start because all of the water lost early on can flush out electrolytes as well.
Whenever I feel a bit out-of-sorts, I take some additional potassium supplement or have some egg drop soup. I’ve been doing keto for over 2 years and done that a handful of times.
That’s good. But were you hungry before the meal and did you stop when you were no longer hungry? Those are two of my big issues, because of decades of bad eating habits.
I was going to ask this same thing. I too sometimes get back pain when my bowels slow, even if I’m not technically constipated
Headaches could be because of low blood sugars as you transition into keto (takes about 27 weeks/6 months or so) so you might want to eat a little tiny bit of protein but not too much like a half ounce of protein or less at the immediate onset of the headache, it usually clears it up (no more headache?). Usually that becomes less of a problem as you progress in the transitioning process and everything returns to normal metabolically and you become less dependent on exogenous carbohydrates (glucose/sugar).
Some visuals on what that would kind of look like:
These two (below) might help as your transitioning into keto with the lethargy (tiredness & brain fog) especially ubiquinone?
magnesium citrate
Might need more salt sodium and potassium? (check with your Doctor about your salt intake?)
Other Possible Reasons:
Can you develop fibromyalgia even if you’re healthy?
You brought up a lot of good points. I’ll take some extra potassium for sure.
I do have everything I want to hit in grams, I was just using percentages to be simplistic on here. I eat three meals a day and never really considered the whole only eat when you’re hungry and stop when you’re full. I’ll have to re-evaluate how I’m planning out my meals now. Thank you.
No constipation here. I was at first but magnesium supplementation took care of that. Next time I get a bad bout of back pain I’m going to think about the last time I moved my bowels and consider this though. Thank you.
@Blazerific Welcome to the forum. I wish it were under better circumstances for you!
There are lots of reasons for lower back pain and one of them can be caused by kidney issues.
It’s encouraging to hear your doctor said everything looked fine, but am now hoping your bloodwork tomorrow for kidney/liver function comes back clear.
Do you have any history of kidney stones and/or gout?
There’s lots of info on the internet about it - some of it unnecessarily scary, which may not be particularly helpful. Dr. Boz has a good top level balanced description of the topic here or https://youtu.be/mgLoC_dxjPI that might be worth a look just to prepare yourself for the possibility, in case that’s what the bloodwork results lead you to. It’s fairly uncomfortable to pass kidney stones but many people have been through it and - happily- with keto you tend to put it behind you forever more.
Again, check out her coverage of the topic and you’ll likely feel empowered by having the info understood… even if it hopefully turns out kidneys are not at all involved.
Best wishes. Please keep us posted on developments.
Hi Blazerific.
Some questions for you, if I may?
You are hitting your macros. What foods are you eating?
If you rapidly lose body fat, then you will release stored toxins with the stored fat. It depends on your exposures and what you were eating coming into the ketogenic diet.
Since you are following the plan to a ‘T’ and have researched about electrolytes, were you on a ‘healthy’ (main stream) diet before moving into nutritional ketosis? If yes, did you bring some of the keto safe foods across from that way of eating?
The ketogenic diet has the potential to be a little bit toxic for some, depending on the foods chosen. It can also unmask underlying nutritional disorders, if a person starts it in a depleted state.
The doctor says your tests are normal. Were any values in the tests in the upper or lower 30% of the test ranges? You can ask for a print out of your test results.
What was/is your urinary pH? If it is 7, that is quite good. If it is lower, under 6, there are some clues there, and if it is heading toward 8, that end of the scale also provides things to investigate. High or low pH can predispose to different types of urinary crystals.
Lower back pain may not have anything to do with the diet change. It may just be coincident.
Lower back pain has a long list of differential diagnoses to work through. It could be an infection. It could be musculoskeletal: spinal, nerves, muscles. Immune sytem related: previous leaky gut, immune activation, bacterial overgrowth in the gut. Urinary tract, depending how low, kidney soreness, ureteral pain/spasm, or bladder. It could be diverticulosis, large intestinal irritation… Pretty much you need to chase the diagnosis with the help of your doctor.
After blood and urine tests, the next step is imaging - radiographs or CT of the abdomen. The blood and urine tests are just snap shots. Sometimes it takes serial blood and urine tests to discover underlying general pain causes. For example, pain in the urinary tract may be better diagnosed with multiple, serial urine samples over 24 hours.
It is best to work with a medical practitioner on a level field of respect. So keep reading and researching and arm yourself with questions. @atomicspacebunny is quite thorough at providing resources to explore. It’s important not to become too nervous before you gather enough questions.
I’d suggest investigating and ruling out for your own dietary approach along the 2nd video, oxalates, that Bunny provided a couple of posts above. As it covers plenty of things to self correct.
Best wishes in finding out.
Or, if you have extra energy on keto and go out hiking. Unfortunately a few people find they have have Lyme disease when they start investigating their aches and pains.
I just suggested to Emma on her thread to consider Lyme at the exact same time you posted this comment. 
I would have your kidney function tested.
That the pain is in both sides at the same time sure sounds like kidneys…the tired and brain fog could also be kidneys.