Author: Sevi Rutgrink - Keto Coaching

I am sure you will not be surprised to hear I get this question several times per day: ‘Is it okay if I go off plan with non-keto foods every now and then?’. Usually followed by ‘..because, life happens, right?’.

Life happens yes, but I am also pretty sure that piece of bread did not walk into your mouth all by itself. And neither did your co-worker force-feed you that piece of pie. Going off plan, or non-compliance, is a choice. YOUR choice to be precise.

Going off plan implies a conscious decision on your part to eat a certain food or drink a certain beverage knowing it does not comply with your lifestyle. It can be done truly on purpose (the ‘life happens and you only live once’ thinking). Or it can be fuelled by stress or emotions. Either way, going off plan while on a keto lifestyle comes with consequences you may want to avoid, especially if you are dealing with medical issues. So here are the issues that can arise when you cheat:

Going off plan can trigger addiction

While we our species are originally programmed as hunter-gatherers, as a result of our dietary guidelines dating from the ‘70s we are now a society filled with food addicts. We have become hard-wired to crave easy to get, high caloric, high sugar and processed foods. We really seem to forever being led towards these highly processed foods.

A major characteristic of these processed foods is that you need more and more of the same food to feel satisfied and to avoid withdrawal symptoms. In other words: they become addictive. Cutting carbs to 25 gr a day (and in healthy carbs only) and eating healthy whole foods ensures the elimination of this addiction.

The only way to stop this addiction is by going cold-turkey, as one usually does when starting a keto lifestyle. By keeping any of these addictive foods in your life, you are leaving the door open to a possible relapse. And one meal off plan can throw you right back into that addiction. Just like that one cigarette can turn into a packet per day.

It damages your gut

When you are on a keto lifestyle your body has stopped producing the specific enzymes needed to digest complex starches and sugars. Go off plan and it will need to start producing them again. This can take days and during that time, you may experience constipation, bloating and other digestive issues.

LDL cholesterol goes up

Yes that is correct: the exact thing you are trying to remedy gets thrown out of the window. LDL can stay up for 7 or more days after going off plan and doing so repeatedly…well you get my drift.

You put on weight

Your muscles and liver fill up on glycogen again which makes you put back on all of the water weight you lost in your first week of keto. Very discouraging indeed.

Here comes the hunger

Because of the high carb content of an off-plan meal, your insulin will spike more than you are used to. The insulin will block the hormone leptin, which is the appetite control hormone. This means you won’t get the signal that you are full, and you’ll want to carry on eating.

Going off plan can cause cravings

Depending on how many carbs you ate, and for how long, the amount of insulin in your blood could cause abnormal sugar cravings, especially if you go back to eating a low-carb diet as the insulin will have a hard time finding the carbs to convert into glycogen.

It can cause keto-flu…again

Yes, just like when you first started keto, all the symptoms of keto-flu can crop up. These include headaches, muscle cramps, aching joints, irritability, fatigue, constant thirst, and constipation.

It messes with hormones

The body adjusts certain hormones to be able to use of fat as the primary source of fuel. When processed carbs are introduced into the diet again through a cheat meal or day, these hormones can get confused, with really bad effects. For women especially, production of certain hormones like oestrogen can get disturbed. Hormones are very sensitive, so any stress or drastic change to the body can have an impact on them.

Self-loathing

It is possible that you become angry at yourself for going off plan. You feel it is a sign of weakness, a failure and you may find it very hard to forgive yourself. Some people may even resort to self-punishment. They deny themselves food after a cheat, go on a crazy fast or exercise to the extreme. None of these negative feelings or actions serve a positive purpose. In fact, they can lead to binge eating, feeling worthless and even depression. You were non-compliant, it is done, just go straight back to a keto lifestyle and put it out of your mind.

It can disrupt your sleep

Processed foods are known to make people fall asleep quickly. At the same time they can have a bad effect on sleep quality and can cause restless sleep. Disruptions in the gut from cheating only aggravate this. Lack of sleep also increases cravings due to the effect it has on hunger hormones and metabolism, in particular, insulin, cortisol, and leptin.

It delays keto adaptation

If you go off-plan repeatedly it prevents the metabolic adaptations necessary for your body to become keto adapted. Going back and forth from carb-burning to fat-burning can also leave you exhausted and depressed. And the more insulin resistant your are, the more detrimental cheating will be.

If you find yourself repeatedly going off plan you need expert help. Click the button below if you would like to know how keto coaching can help you get back on track.

There is so much miscommunication about keto on the internet. I had to get off the social media keto groups to focus better. Having a very knowledgeable coach helped me understand keto very quickly so I could be successful on my journey to better health. I honestly think many people fail at keto initially because they don’t have someone knowledgeable to ask questions of and guide them. Best decision I made was reaching out to Sevi one day!! I felt like she truly cared about helping you be successul on your keto journey.

I think initially I purchased a one month package. I wanted to practice what I learned during that month. A few months in I found I had more questions/ different questions than I initially had. I liked that I could sign up a few months later after the initial sessions so I could get more support. The flexibility to do that was great!

In terms of particular strengths: her availability to answer any and all questions via scheduled consultative sessions, by email or by simply a message sent; loved that she followed up all conversations with emails so I could refer back to the information at another time. She always provided links to areas for me as well.

If I struggled with something to eat she found options to help me get through the struggle. She opened my eyes to trying new and different things that I still practice today 8 months later. I remember she always Skyped me on time and prepared – even when sometimes I myself wasn’t :-). She remembered little things we spoke about along the way during the sessions too. It made the session always feel very personable. I would absolutely recommend this!

I regularly receive panicked messages from people saying they developed a rash after starting keto. It is very common indeed, although it does not happen to everyone, and it is quite understandable people get into a panic over it. So lets talk about keto rash.

What is keto rash?

Keto rash is a rare inflammatory skin disease of unknown origin but some medical experts refer to it as the known skin condition prurigo pigmentosa, although it has not been officially determined it is in fact the same condition. There seems to be a correlation though between ketone production and the development of prurigo pigmentosa hence the belief the two are the same.

Generally speaking one can assume all keto rashes are also prurigo pigmentosa. But: not all instances of prurigo pigmentosa are associated with ketosis.

What are the symptoms of keto rash?

Keto rash usually shows up as itchy, raised skin lesions. They can be red, brown or light pink in color depending on the stage the rash is in. Although it is not nice to look at and can definitely feel uncomfortable, it is not dangerous in any way. It can resemble eczema and dermatitis and it usually shows on your neck, back, chest, shoulders, torso, and armpit areas. Sometimes it occurs in the face, but this is not as common.

Keto rash can have different stages in terms of how it looks. From slightly raised pinkish skin marks to vividly red lesions that may or may not be filled with fluid. Healing keto rash can look scaly or even more like brown freckles. Another noteworthy fact: it is usually symmetrical on each side of the body.

Like most rashes, the keto rash worsens if exposed to heat, sweat, friction, and other potential skin irritants.

How long does keto rash last?

There is no set time frame for how long your keto rash will last. For some people, the rash will last only for a couple of weeks to a month. Others will struggle with it for several months to non-stop. In fairness, the latter is really quite rare. Most people I have spoken to about keto rash were clear of the rash in just weeks.

What causes keto rash?

Although many studies have found a link between prurigo pigmentosa and ketosis, the exact cause of the rash is unknown.

However, here is a promising theory behind the cause of keto rash: a ketone body called acetone. Here are the facts:

• most of the subjects in research studies done on the subject of prurigo pigmentosa had lifestyles/diets/conditions that promoted ketone production;
• people who are on a keto diet and get the rash usually start to experience itching soon after they get into a state of ketosis; the itching stops within a day or so if they up their carb count and exit ketosis;
• insulin production was found to speed up the healing process of prurigo pigmentosa in one study;
• the rash often gets worse in warmer weather and after exercise due to increased sweating;
• the usual distribution of the rash is typically in the areas where we tend to sweat the most;
• when first entering ketosis, we produce more acetone than usual. Acetone is useless to the body, so it is excreted out with the breath and through sweat;
• when acetone is released through sweat in high concentrations, it can irritate the skin and cause dermatitis-like symptoms.

In short: as a result of producing more ketones for fuel due to your state of ketosis you create more acetone. This acetone most likely will be excreted with your sweat, which in turn exposes your skin to excess acetone and causes an inflammatory reaction, itchiness, and lesions on the skin. This is what we call keto rash.

Possible keto rash triggers

• perivascular inflammation i.e. inflammation around your blood vessels can happen during ketosis and trigger the rash;
• there may be a relationship between fasting and keto rash: stress due to lower blood sugar levels plus a deepened state of ketosis during fasting may be possible triggers;
• being new to a low-carb diet, especially one that causes rapid weight-loss and ketone production, has generally been associated with the occurrence of keto rash;
• an allergic reaction can be triggered in response to various keto-friendly foods previously eaten in smaller quantities or not at all;
• a nutrients deficiency from excluding certain foods, can lead to a rash. For example, vitamin A, niacin, and omega-3 deficiency can all provoke rash-like symptoms if not paid attention to;
• chlorinated pool water, acetone and other potential skin irritants are all associated with prurigo pigmentosa.

Ways to deal with keto rash

Let keto rash heal on its own

Really the simplest way to deal with it is to wait it out. It may very well disappear by itself in a few weeks time. Treat it as part of your body adjusting to the state of ketosis and adapting to using fat for fuel. If you find this does not work, or if you are too uncomfortable, consider the other options below.

Up your carb count

This is certainly not the option I would suggest you go for immediately. But some of you may find the rash just stays around for too long for you to handle and so you may need to increase your insulin levels to help the rash heal (as discussed earlier).

To test if ketone production actually might be the cause of your keto rash, you can:

• try increasing carb intake just enough to fall out of ketosis for a few days and see if the rash starts healing;
• if it does heal, lower carb again and get back into ketosis;
• if the rash then reappears it means you are probably sensitive to ketones and may need to follow a low carb diet that doesn’t provoke consistent ketone production.

To keep your body from going into ketosis you may need to consume 50-100 net carbs daily. This is still considered a low-carb diet! You will eventually be able to find your sweet spot regarding carb intake that helps you improve your overall health while actively reducing the recurrence of the rash.

Eliminate allergens to prevent keto rash

Any dietary change always increases the risk of triggering food allergies. By introducing new foods to your diet or suddenly eating large amounts of certain foods you can trigger a reaction that may be responsible for your keto rash.

The most common keto-friendly foods that trigger allergies are:

• dairy
• fish
• shellfish
• tree nuts
• peanuts (technically not a nut but a legume and as such for strict ketonians NOT part of a keto diet)

To find out which food is the culprit you will need to eliminate suspect foods from your diet:

• remove one of these food groups from your diet every 3-4 weeks;
• check if your rash starts to diminish or disappear;
• if so, then you found a food that is triggering your rash;
• if not, then introduce the food back into your diet and eliminate a new food from the list every 3-4 weeks;
• You may have multiple food triggers, so make sure you try eliminating and reintroducing each one to see how your body reacts.

Supplementation of vitamins, minerals, and other nutrients

To rule out any deficiency related causes, you need to make sure to supplement your diet with vitamins and minerals that you may not be getting enough of. However, I always advise to only do this if a blood panel in fact shows you are deficient in any.

Generally speaking I do always advise to supplement sodium, potassium and magnesium. These minerals are typically excreted in higher quantities while you are transitioning to a ketogenic diet hence the need to supplement. Make sure you are getting enough of each one because they are vital for multiple metabolic functions.

Getting enough Omega-3s helps in reducing inflammation and improve skin health. Also make sure you are drinking enough water. Most people lose a lot of fluid when they first start keto. This can actually increase the concentration of acetone in the sweat and in turn provoke keto rash. Drinking more water may help dilute the acetone so that it doesn’t accumulate on your skin when your sweat. Do not overdo it though: there really also is such a thing as drinking too much water.

Anti-inflammatory foods prevent keto rash

Without an inflammatory response, keto rash would not occur. The itchiness and lesions that characterise the rash are a result of our immune system being activated by what is happening in and around the skin cells.

To help lessen this inflammatory response and reduce the severity of your rash, consider adding these foods to your keto diet:

• glycine, an amino acid, has a variety of protective effects against inflammatory diseases like keto rash. To get more glycine in your diet you should eat more animal skin, collagen, bone broth and/or supplementing with glycine directly;
• wild fatty fish contains a lot of healthy omega-3s so try to eat sardines, salmon and other fatty fish on a regular basis;
• here is one to try: turmeric is a potent anti-inflammatory so try taking it as a supplement for example a curcumin/bioperine supplement;
• virgin olive oil contains high levels of oleocanthal — a phenolic compound that possesses anti-inflammatory properties which help reduce acute and chronic inflammation.

Avoid skin irritants

Skin irritants, like chlorinated pool water or chemicals in laundry detergent or even chemicals found in clothes themselves may trigger the rash or cause them to flare up. So try to avoid:

• any chemicals or products that irritate your skin
• scratching of your skin
• wearing tight clothes, especially around the area where you have the rash
• exfoliants
• scrubbing too hard with a towel
• use of bandages.
• sleeping on the affected area

Avoid excess sweating

Because acetone in sweat is a major rash trigger, it is best to keep yourself from sweating or at least avoid prolonged exposure to sweat.

Take a few days off from the gym or reduce your workout intensity so you can minimise sweating. If you do sweat, make sure to shower directly after to wash off any perspiration but do also avoid using too hot water.

Relax and de-stress to avoid keto rash

Emotional stress has been linked to inflammation on your skin, and can worsen skin disorders including keto rash. If you want to improve your skin health in general but eliminate keto rash specifically, you are best of incorporating activities into your life that help relieve stress.

Try meditation, breathing techniques, taking walks, doing yoga, engaging in a relaxing activity (drawing, painting, reading a book, listening to music), low-intensity exercise, going to therapy, and spending quality time with people you love.

If all else fails: discuss your keto rash with your doctor

All methods described above to help eliminate keto rash are gentle and perfectly fine to try without medical advice. But if they do not work you may find discussing it with your doctor to be more helpful or even necessary. Your doctor can prescribe certain antibiotics for example. Antibiotics can treat the rash in some cases but keep in mind they do not prevent recurrence of the rash. For that reason antibiotics should only be used as a last resort after trying all other options.

Please take note: certain medications have been proven to be ineffective for keto rash. These include: antihistamines, topical steroids and oral steroids.

Can you prevent keto rash?

So suppose you want to start your keto lifestyle today and you are seriously freaked out by all this talk about keto rash: you just want to know if it can be prevented, right? To be blunt, because the exact cause is unknown there is no clear prevention plan. But here are three things you can do:

1. While as a coach I always suggest you lower carbs to below 30 gr net carbs immediately from day 1, if you are really worried about keto rash you will want to lower your carb intake gradually until you can enter and stay in ketosis without any signs of a rash. It may make it a bit tougher for you in terms of withdrawal symptoms from your high carb diet, but perhaps your skins will be helped by it;
2. Increase your carb intake as soon as you see signs of a keto rash to keep it from progressing to more advanced stages. Do not wait till it gets worse, stay on top of it. You can also try using other strategies from the list of potential cures above to help it heal.
3. Immediately start supplementing to avoid deficiencies.
   
   

Keep in mind though: it is NOT a given you will get keto rash, in fact, the odds are on your side and you will most likely not have to deal with it at all.

Do you need help with your keto lifestyle? Contact me to discuss your options.

Good sleep is essential for everyone. But for people doing keto with weight loss as a goal, sleep is crucial. People who are sleep deprived or suffer from a circadian rhythm disorder are more likely to stall in their weight loss journey and even store extra body fat.

Chronic sleep deprivation:

• produces less growth hormone
• impairs glucose metabolism
• decreases leptin, the hormone that signals satiety
• increases ghrelin, the hormone that tells the brain when we are hungry

All the more reason to take a closer look at your sleep habits and see where it can be improved. Here are my eight tips to work on getting good sleep:

Don’t do this if you want to sleep well

• do not exercise vigorously 3-4 hours before bedtime; a nice walk earlier in the evening may help you unwind though
• do not eat a heavy meal right before turning in; digestion may hinder the body’s ability to rest
• do not fall into the trap of thinking shorter sleep during week nights can be remedied by sleeping in during the weekends; you should aim for 7- 9 hours of steady sleep ALL days of the week. Yes that means going to bed at the same time each night, weekends too, as well as getting up at the same time each day
• do NOT forget to balance your electrolytes: adequate levels of magnesium are very important for sleep. (read here about magnesium supplementation)

Control the temperature

The temperature of your body and its surroundings can actually influence the quality of your sleep: our brain needs a natural drop in evening temperature (ideal is between 15 and 19 ºC) as an alert to the brain to release melatonin, the sleep inducing hormone that controls your daily sleep-wake cycles. Central heating can interfere so adjusting the temperature in your bedroom is essential. Sleeping with the right sheets and a good mattress also helps in getting the temperature right, as does leaving a window open for the necessary air circulation inside the room. In really warm weather a small fan helps cool down the room.

Turn all electronics off

This may be an obvious bit of advice but reality is a lot of people tend to use a phone or computer in bed right up to the moment of switching off the lights. Both the blue light from your devices as well as the constant sensory overload caused by endless scrolling through your social media are bound to mess with your ability to fall asleep. Having electronics on in the hour before actually going to sleep may also be responsible for reducing our levels of melatonin by a staggering 50%…ouch!

For some people blue light blockers may be a good option, even during the day if your job entails lots of computer/phone hours, and also keep in mind most phones have a blue light blocker build in so you can actively start using that hours before bedtime. And while you are at it: try to not switch on your devices immediately after waking up. Instead wait one hour: this allows for a much more mindful morning routine and ultimately helps with your sleep too. The world can wait for a bit.

Dim the lights

Where possible, dim the lights in the hours before bed as this is proven to help your body prepare for the sleep to come. Overhead lights especially are not a good idea so try to lower light intensity by keeping those switched off and stick to diffused or indirect light from smaller lamps. Also try to sleep in the darkest environment possible: invest in some good blinds, especially when you live in a city where lights outside may intrude into your bedroom.

Silence helps to get good sleep

Not everyone is blessed with a quiet outside environment, especially when you live in the city. Sudden noises like sirens, the screech of a car braking, neighbours slamming a door: not very helpful when you are trying to fall asleep. But did you know you can actually drown out these annoying sounds by listening to these two other types of sound?

• white noise is a steady ambient sound, like the whirring of a fan or steady rainfall
• pink noise is an alternating steady sound with a mix of high and low frequencies, such as waves hitting the beach

While we obviously can not produce either sound naturally at will there are apps that can. Yes, that would mean leaving a phone on but when put in airplane mode at least the beeping of alerts will not bother you. Check out the Noisli or SimplyNoise apps or you can invest in a sound machine.

Stop worrying

Everyday stress (think work, money, housing, family etc) can keep you up at night. A vicious cycle is usually the result: the more you worry the less you sleep; the less you sleep the more you worry. Here are four tips to try:

• write down the worst unresolved issues and for each one also write down a point of action. It does not function as a to-do list (because most long-term stress also requires a long-term plan of action). But what it does it takes off the immediate pressure, it gives your mind a chance to at least turn away from the worrying long enough to be able to sleep. Try it, I find it very helpful
• calming down the body may help in calming down your mind: lie down in bed and starting at the toes tense and relax the muscles going all the way up the body
• sleep under a weighted blanket. The pressure on your body triggers the brain into upping soothing neurotransmitters
• try meditation techniques: you can do this by taking meditation classes at a zendo but meditation can be taken up anywhere anytime. Again, there are plenty of apps for that too. Headspace or InsightTimer are often used.

Cuddle up for good sleep

It may not be for everyone but cuddling up with someone may help you fall asleep faster. For some being cuddled does the trick, others may find actively cuddling someone else is helpful. If you fall in the last category and you are without a cuddling partner, there are in fact other options. You can hug a pet, a large cushion or the good old-fashioned teddybear. For a more high tech option take a look at the Somnox Sleep Robot, developed in collaboration with Auping.

Implement a bedtime routine for good sleep

Doing the same exact routine every night before bedtime actually helps in letting the brain and body know it is time to get ready for sleep. Exactly what that routine consists of is of course up to you: a skin routine, taking a bath, reading a book, writing in a journal, listening to a podcast, getting your outfit ready for the workday, decluttering your bedroom before actually getting into bed: if done every night and with mindful attention you will in time experience the relaxing effect.

Are you dealing with sleep issues? Book a coach call today and I wil talk you through them.