Dr. Atkins Advice on Exhaustion and Leg Cramps

If You Don't Feel Well, You Won't Stick to Your Diet
What Can You DO About
Leg Cramps and Exhaustion?

This morning at Low Carb Friends, I ran into someone who really disturbed me.

A patient of Dr. Westman was in the forum asking for help.

She has been on the high-fat low-carb diet known as Nutritional Ketosis for 4 months now. She is still eating at 20 carbs, or less, is losing about 1 to 2 pounds a week, but she feels absolutely horrible.

Despite a high salt intake, she's also having excruciating foot and leg cramps, gets dizzy, and comes near to passing out during gym activities. She says she has zero energy, so her gym routine has dropped from 5 days a week and 1 trainer session, to just the training.

She is taking magnesium and potassium supplements, along with salty chicken broth every day, but nothing is helping. She's exhausted and feels horrible, and yet, the doctor wants her to continue with the regimen she's doing, even though it's not working for her.

This doesn't make any sense to me.

Pinterest Image: Legs with Pink Tennis Shoes

Why Are People Doing Nutritional Ketosis and Not Moving Into Atkins Phase 2? 

A few days ago, I wrote a post about a video that Dr. Phinney had over at You Tube describing Nutritional Ketosis and exactly how that diet is done.

However, most people are not doing it the way it was originally designed.

Although, I've talked about my own experience with a Nutritional Ketosis Diet before and how my results were not good, I now realize I was following the crowd and doing it WRONG.

I take full responsibility for the amount of weight I gained during that time, as I should have read Phinney's book instead of listening to what everyone else was doing.

But I'm really confused about why this girl isn't allowed to move into Phase 2.

I know exactly why this girl doesn't feel good eating low protein and super high fat, especially if she is still eating less than 20 net carbs per day.

Please note:

Dr. Westman is giving her fewer carbs than today's Atkins Diet because he has his patients eating 20 total carbs, for most of their weight loss, rather than net. She is already 4 months into the program and still eating less than 20 total carbs.

Not everyone has the genetics to ramp up enzyme production for fat burning, and staying on an extreme ketogenic diet longer than 3 months won't improve your chances of becoming fat adapted, but most of the low-carb experts today never talk about that point.

Plate of scrambled eggs, bacon, and cheese sticks
Typical Nutritional Ketosis breakfast:
bacon, eggs, and cheese
She is eating an adequate breakfast:
  • 2 eggs
  • 3 slices of bacon
  • coffee with heavy cream and stevia
But she is eating no lunch. She just has a snack in the afternoon 3 times a week of 2 ounces of nuts.

Two eggs and three slices of bacon comes to about 350 calories, plus whatever amount of cream she's geting. This is all of the calories she's getting on most days until dinner.

Three times a week, she does eat 325 calories worth of nuts in the afternoon, but notice that she is eating NO vegetables or salad, and up to this point in the day, her diet is zero carb.

Dinner varies, she said, depending on what she is feeding her family, but the example she gave was:
  • chicken breast breaded with pork rinds
  • broccoli with butter sauce
  • diet soda
  • Carb Smart ice cream bar
This menu comes to 6 to 8 grams of carbohydrates per day, depending on whether she has the nuts.

The only vegetable carbs she's getting is a cup of broccoli with dinner, about 1-1/2 net carbs. There are no carbs in the pork rinds, so her major source of carbohydrate is coming from the ice cream, except for the minute amount in the eggs and heavy cream.

(I am not judging her on the Carb Smart Bar; I eat them myself. What I'm saying is that the doctor has her on a very low-carb diet, which is why she doesn't feel good and her electrolytes are out of whack.)

Atkins Induction was designed to last for 2 weeks. Granted, Dr. Westman has his own way of doing things, his own ketogenic diet that he uses, but not everyone can eat at those extreme carbohydrate levels and function optimally.

IF you're doing good, FEEL good, and are losing weight, you can stay on Induction for a few weeks. However, Dr. Atkins recommendation for those with a huge amount of weight to lose was to move into Phase 2 at 25 grams of carbs per day, and stay there for the larger part of your weight-loss phase.

After the initial 2-week period, you return carbohydrates to the diet in 5-gram implements per day, per week, until you find the highest level of carbohydrate your body can tolerate and still lose about a pound a week.

The average low-carb dieter, at 4 months into the program, eats between 35 and 45 net carbs!

Yet, the doctor still has her eating less than 10.

If You Don't Feel Good You Won't Stick With Low Carb

The sad thing is that there is no way this woman is going to stick to this severe of a diet long term if her energy level and the way she feels doesn't improve.

She might be able to withstand the program long enough to lose the weight (she didn't say how much she needed to lose), but that isn't going to do her any good if she goes back to the way she was eating before, once she reaches goal.

Replies to her plea for help mostly focused on the type of magnesium she was taking, but a couple of folks did ask her about the small amount of food she was eating.

Apparently, Dr. Westman encourages his patients to only eat twice a day, and stresses the need to eat fewer calories in order to drop the weight, so that's what she's doing.

She is following her doctor's advice, as she has interpreted it to be, and says that she is eating to her personal hunger level. It's just the way she feels and the leg cramps that are the problem.

Her reply means that calories are not the issue here. I understand that, since I ate 900 to 950 calories a day and was never hungry, and felt fine, but a lack of carbs has her electrolytes really messed up. Plus, she might be one of those dieters who can't use as much dietary fat as she's eating.

What to Do About Leg Cramps and Exhaustion

Leg cramps comes from unbalanced electrolytes.

Since keto keeps your glycogen storage less than half full, the diet is very dehydrating. Low-carb diets cause the kidneys to dump sodium along with the excess water, so leg cramps are common. Shedding the water the body stores to process glycogen eliminates necessary minerals, which have to be replaced.

Drinking a lot of water, which she is doing, will do exactly the same thing. It sweeps calcium, potassium, and magnesium out of the body.

If you're having cramps, the most important mineral to replace is calcium, but adequate magnesium and potassium are also important:

"When there are leg cramps, extra calcium is in order, and there is often a kind of fatigue for which potassium supplements are the specific." (Dr. Atkins Diet Revolution, page 126.)

Dr. Atkins was really into vitamin and mineral supplements.

He believed in optimum dosages, and not minimum requirements. Minimum daily requirements are only what will keep you alive, not what will produce optimal health and well-being.

However, exhaustion isn't always about potassium. Sometimes, it's about losing more weight than the body can adapt to:

"A weight loss that is too rapid is more than the body can comfortably adapt to. And it isn't necessary to lose rapidly. It is more important to lose easily; and losing easily means feeling well all of the time. I can't emphasize this too much: Quick weight loss is not the primary thing we're after -- what we both want for you is an easy and lasting weight loss." (Dr. Atkins Diet Revolution, page 142.)

His advice for those who feel tired and ill on a low-carb diet is to raise your carb intake to the next level and see if that corrects the problem.

Eating too few carbohydrates is just as stressful on the body as eating too many. It will cause your cortisol levels to rise along with your blood glucose level, so if you're pre-diabetic or diabetic, you'll want to make sure that you eat to your own personal carbohydrate tolerance level.

This isn't a race, so the same could be said for calories. The goal of going keto is permanent weight loss, which means finding an eating style you can live with for the rest of your life.
An eating style that fits your health issues as well as your tastes. The goal isn't to get the weight off in any way you can. That practice usually backfires.

The Atkins Diet is Not Atkins Induction

A lot of people call what they are doing the Atkins Diet, when clearly it is not.

The Atkins Diet is not Atkins Induction.

Atkins Induction is a 2 to 4 week introductory period where you eat from a specific, limited list of foods and try to keep your carbohydrate level to 20 net carbs per day, or less. This introductory period has the goal of getting you into the state of ketosis.

Once you are comfortably in ketosis, you then return carbohydrates to your diet at a slow enough pace that the body continues to burn your body fat for fuel.

Pot of low-carb ham and green bean soup
Low-Carb Ham and Green Bean Soup

If you don't return carbohydrates to your diet to discover your personal carbohydrate sensitivity, then you are not doing Atkins.

You are doing something else.

Doing something else is fine, but calling it Atkins can be confusing to newbies who don't understand what the Atkins Diet actually is.

The Atkins Diet is a progressive diet.

It is not 20 net carbs per day, or less -- unless -- that is the only level that will allow you to lose weight.

However, you won't know that until you try to add additional carbs back in. If you haven't tried to return carbs to your diet, then you don't know if you are resistant to weight loss, or not.

Very low carbs will depress your metabolism and interfere with the way the body converts T4 thyroid hormone into T3, the usable form.

For that reason, many people find that adding carbs back into their diet increases their weight loss! The body won't let go of fat stores if there are other ways to get you the energy you need.

This is why the Atkins Diet is an individual diet fine-tuned to fit your:
  • likes
  • food tastes
  • weight loss
  • and metabolic issues
It is not a cookie-cutter diet where everyone eats from a specific list of foods and keeps to 20 net carbs per day or less for life.

That isn't Atkins.

"OWL allows you much more choice. That means you can now craft a weight loss regimen that is uniquely yours." (Dr. Atkins' New Diet Revolution, page 147)

Dr. Atkins always left the rate at which you lose weight up to you, but he also cautioned patients and readers to be realistic. As long as you are free of cravings, you're satisfied with the food, and you feel good, the rate at which you lose the weight doesn't matter.

What does matter is that you make lifelong, permanent changes in the way you eat and that you feel well while you're creating good food habits.

Dizziness and problems exercising indicates you're having a problem converting fat into energy. If that's true for you, then upping your carbohydrate level and lowering your fat intake a bit might be a better option.


  1. eating only twice a day is ridiculous...little and often is better. You don't want your blood sugar to crash. I've lost 7 stone in a year on Atkins.

    1. Congratulations! That's a lot! Thank you so much for sharing that.


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