BlogHealthy EatingThe Keto Diet and Semaglutide: Is it Okay to Do Both?

The Keto Diet and Semaglutide: Is it Okay to Do Both?

When you’re already limiting carbs and sugar, it’s tempting to adopt a keto diet as well. Slow your roll—and read this first.
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Even though it may seem as if the ketogenic diet has entered our collective consciousness only recently, it’s actually more than 100 years old, says the National Library of Medicine. But it’s certainly experienced a resurgence in the past decade. And if you’re taking semaglutide, you may have wondered whether you can combine that with a keto diet.

First thing to keep in mind: When on this medication, it’s important to consult with your healthcare provider before making any big change to your diet, to make sure you’re getting all the nutrients you need while your eating patterns change. 

And since the keto diet flips a typical carb-heavy diet into a fat-heavy one, there are specific factors to keep in mind. Read on for guidance. 

What is the keto diet?

Modern-day keto tends to focus on weight loss, through limiting carbohydrates. But interestingly, research has shown it may help with other issues, including epilepsy (it was originally developed to help that condition). And one study found that a keto diet may improve cognitive function in people with neurological diseases, including Parkinson’s and Alzheimer’s. 

Because of the low-carb diet’s effect on blood sugar, it may also have some benefit for people with type 2 diabetes. The research isn’t definitive, but some studies have shown promise. One review found people with type 2 diabetes who followed a keto diet lowered their A1C levels—a measure of blood sugar over several months.

People following a keto diet commonly tweak and tailor it a bit, but the “true” ketogenic diet is the following, says Su-Nui Escobar, DCN, RDN, a Miami-based doctor of clinical nutrition and registered dietitian: 

  • 70% to 80% of your daily calories come from fat
  • 10% to 20% from protein
  • 5% to 10% from carbohydrates 

A common misconception about keto is that it’s a high-protein diet, like Atkins. Both are low-carb diets, but keto prioritizes fat more than protein. That’s something to keep in mind when taking semaglutide, since the medication can cause muscle loss. If you decide to try a keto diet, your healthcare provider will likely advise you to eat on the high end of the protein range.

A big downside of keto for many people is that the diet is very hard to sustain long-term  because it’s so restrictive. After all, who doesn’t want a bowl of pasta now and then?

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How does keto work?

The body has two main sources of fuel that it burns for energy and proper cell function, explains Kimberly Gomer, RD, LDN, a dietitian based in Florida. One is glucose, which comes from carbohydrates and fuels our brains, nervous system, muscles, and other cells. Some of what’s left is converted to glycogen, which gets stored in the liver and muscles, says Cleveland Clinic. Other leftover glucose gets stored as the body’s other fuel source: fat. 

When we’re not eating, it’s glycogen that keeps us going. But when we eat, the hormone insulin gets to work, says Cleveland Clinic. Blood sugars go up from the food we consume, and the pancreas secretes insulin to help the body figure out what to do with that glucose. 

Related: The Right Way To Snack When Taking Semaglutide For Diabetes

“Insulin is like the conductor,” Gomer says. “It tells the glucose to either go to your liver, your cells, or your muscles to be used as short-term energy. And then when you’re filled up, it stores it for later use.”

When the body doesn’t produce enough insulin or use insulin efficiently, we can gain weight, according to Cleveland Clinic. Here’s where keto comes in. By increasing fat intake and severely reducing carb intake, the keto diet attempts to switch the body’s main energy source from glucose to fat. 

Instead of squirreling away excess glucose as accumulating fat, the body skips that step and starts burning fat right away (known as ketosis).

Should people taking semaglutide for diabetes try keto?

Keto might sound like a no-brainer for people with diabetes. They’re often already limiting their carb intake to manage blood-sugar levels. But make no mistake: Yes, you can eat carbs when taking semaglutide. Restricting carbs too much could result in blood sugar levels dipping dangerously low if you’re also taking medication to decrease blood sugar, Escobar says. 

Proper nutrition is another concern for those on semaglutide, as the drug suppresses appetite and makes them feel full longer. 

“Overall, they’re going to be eating less,” Escobar says. “And imagine they’re eating less and most of their calories come from fat. Where are all the other nutrients they need to get? It’s going to be more difficult for them to get the nutrition that they need.” 

Both Gomer and Escobar recommend consulting with your doctor or a registered dietitian before starting keto to map out a healthy eating plan.

What are the side effects and risks of keto?

The keto diet shares some similar side effects to semaglutide, Gomer says. Nausea after starting keto is common—typically from switching from eating lots of carbs to eating large quantities of fat. People on keto often don’t get enough fiber, which can lead to constipation. 

Constipation and GI upset are frequent side effects of semaglutide, which is why Gomer doesn’t recommend going keto at the same time or very soon after starting on semaglutide. Allow for an adjustment period to the medication first. 

Keto can also cause brain fog, fatigue, and irritability as the body adjusts to consuming fewer carbs, says Cleveland Clinic

While it’s rare and more common in people with type 1 diabetes, following a keto diet can lead to a potentially life-threatening condition called ketoacidosis, according to the American Diabetes Association

What to eat on keto

Fat is the star of the show on keto, so people trying this diet need to keep a careful eye on their saturated-fat intake. Too much increases the risk of heart disease, stroke, and certain cancers. Only 5% to 6% of your daily calorie intake should come from saturated fat, the American Heart Association recommends.

Animal products, like beef, pork, poultry, eggs and full-fat dairy, are high in saturated fat. So are fried foods, processed meats, and foods made with palm and coconut oils.

Those foods might be officially okay on keto, but it’s smarter to focus on eating healthier unsaturated fats, like these: 

  • Extra-virgin olive oil
  • Avocado and avocado oil
  • Nuts and seeds
  • Olives
  • Oily or fatty fish, like sardines and salmon
  • Tofu
  • Plant-based foods made from nuts, like cashew cheese or butter
  • Plant-based burgers made with avocado oil

Make sure you’re eating enough protein, Gomer says. (Check out our list of on-the-go snacks and mini meals.) The goal is to lose fat, not muscle. Foods that contain both protein and fat pull double duty on the keto diet.

And don’t forget fiber, which can be tough to get enough of when cutting carbs. Try these high-fiber, keto-friendly foods, which are also packed with important vitamins and minerals: 

  • Nuts
  • Seeds
  • Berries
  • Avocado
  • Cauliflower
  • Asparagus
  • Cabbage
  • Mushrooms
  • Leafy greens
  • Brussels sprouts 

If you think a weight loss medication like semaglutide might be right for you, chat with a ReflexMD Wellness Advisor now or take our short quiz to see if you qualify.

Read Next: Taking Semaglutide For Diabetes? 7 Best Foods To Eat

Ketogenic Diet. StatPearls. June 16, 2023.

Wheless JW. History of the Ketogenic Diet. Epilepsia. November 2008.

Grochowska K et al. The Effect of the Ketogenic Diet on the Therapy of Neurodegenerative Diseases and Its Impact on Improving Cognitive Functions. Dementia and Geriatric Cognitive Disorders EXTRA. May 2022.

Dowis K et al. The Potential Health Benefits of the Ketogenic Diet: A Narrative Review. Nutrients. May 2021.

Glycogen. Cleveland Clinic. July 13, 2022.

Insulin. Cleveland Clinic. January 17, 2024.

Insulin Resistance. Cleveland Clinic. December 16, 2021.

Ketosis. Cleveland Clinic. August 15, 2022.

Diabetes and DKA (Ketoacidosis). American Diabetes Association.

Saturated Fat. American Heart Association. November 1, 2021.

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