Drunk Faster, and Not Calling It a Flu
August 2017 — about seven weeks in
I went to Penn State. If you know anything about Penn State you know I'm not new to drinking, and I'm not new to drinking too much. So when the question was "can I drink on keto?", I figured I was qualified to answer, at least on the drinking half. I recorded two short videos the same day, one on alcohol and one on the thing everybody calls keto flu, and both of them came down to the same idea: say what's actually happening to you, and then you can do something about it.
The alcohol part
The short answer I gave was yes, you can drink (video HKPB4359). The way I understood it, your liver puts the alcohol at the front of the line, ketosis pauses while it deals with it, and then ketosis picks back up. The bigger problem is what comes with the alcohol. A light beer runs maybe three or four carbs a can. IPAs and stouts are a different animal, and if you're aiming for 20 or 50 carbs a day you can blow through that in two beers. Most clear liquors don't carry sugar, but the mixers do. Tonic water has sugar in it. A lot of mixers do.
Then I asked the question I think matters more: why are you asking? If you mean a beer at the end of every workday, that's not going to help you, especially if your goal is weight loss or your blood sugar. If you mean a glass of wine at your daughter's wedding, then drink the glass of wine, and I wouldn't even bother counting the carbs or calories that night. A diet is what you eat over a long stretch of time, not one evening. If you're still not eating carbs as a way of life, you'll drift back into ketosis soon enough, probably within the day. The only exception I'd make is if one drink kicks off a backslide for you, or it turns into a regular cheat. Then it's not one evening anymore.
Now the warning, and this is the part that was about me. The distance between buzzed and wasted got a lot shorter. I got drunk faster. It felt like drinking on an empty stomach every single time. The whole scale was compressed. And the hangover didn't wait for the next morning: if I day-drank, I'd feel hungover later that same night. The alcohol breath was sharper too, and I honestly didn't know if that was tied to keto breath or not.
So my advice was to go easier than you think you need to. If you're doing shots or mixed drinks, do a half drink or a half shot, or get twice the mixer. And if you're in week one or two, still adapting, alcohol is mostly a distraction that'll set you back (video HKPB4359).
The "keto flu" part
The other video started with me just saying it: it's not keto flu (live RWQH5170). It's not influenza. It's not contagious. And in my opinion it mostly isn't caused by keto either. What most people feel in the first week or two is withdrawal from sugar and carbs. Calling it keto flu puts the blame on keto and makes the diet sound unhealthy, when the thing you're coming off of is the old way of eating. I said plainly that this part was more my opinion than science.
The other problem with the name is that it lumps a pile of different symptoms under one umbrella. Cramps, headaches, bad sleep, being tired: all "keto flu". But they don't have the same cause, so they don't have the same fix.
- Tired in weeks one and two: your glycogen is gone, there isn't much glucose coming in, and your liver hasn't ramped up enough to run you on fat yet. That's the fat-adaptation gap. It's expected, and it passes.
- Cramps: probably electrolytes. And not "electrolytes" in the vague sports-drink sense. The actual minerals: sodium, potassium, magnesium and calcium. I said vegetables are the safest place to get most of them, and that if you're going to take supplements, talk to your doctor first, because sodium and potassium imbalances can put you in the hospital (live RWQH5170).
Once you name the real cause you can fix it. Tired means you are still fat adapting, and it passes. Cramps mean look at your minerals. A craving is withdrawal from the stuff you quit. "I have keto flu" doesn't point you at any of that.
What I'd tell you now
On alcohol, the drunk-faster thing came from my own body and from stories people told me. It's experience, not a study, and the evidence pages behind this site don't cover alcohol at all. So take it as a warning from one guy: go half-strength until you know how your body takes it. On keto flu, the literature since then fits the timing I described. A 2020 analysis of online posts found people's reported "keto flu" symptoms clustered in the first weeks and were mostly described as passing (Bostock et al., 2020). That study looked at what people wrote online. It didn't test what causes the symptoms, so my withdrawal explanation is still my opinion. If you take medication for diabetes or blood pressure, talk to your doctor before you start cutting carbs, and before you add drinks to that. More in Keto flu: what it is, what causes it, what helps, Can you drink alcohol on keto? and the keto-flu video as it went up on YouTube the next day, It's not keto flu.
Earlier / Later
- Earlier: Five pounds overnight
- Later: An hour of kickboxing, no carbs