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Why do my legs hurt on keto?

People on the keto diet may experience leg cramps due to dehydration and electrolyte imbalances. Other causes of leg cramps include sedentary habits and certain medications.

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This article explains why some people may experience leg cramps on keto and offers tips for treating and preventing this uncomfortable side effect. Although this high fat, low carb diet may aid weight loss and even help treat certain medical conditions, it has been associated with a number of side effects — including leg cramps. If you have ever dealt with sudden, severe leg pain on the ketogenic diet, you’re not alone. Cramps are involuntary, localized muscle contractions that are often painful. Leg cramps typically affect the calf muscle, though they can occur in other parts of your leg as well ( 1 ). These contractions commonly occur at night and can last seconds to minutes. Most leg cramps are over in less than a few minutes ( 1 ). Although their exact cause isn’t always clear, multiple factors, including pregnancy, medical treatments, insufficient blood flow, and the use of certain drugs, may increase your risk. The keto diet may make you more susceptible to leg cramps for several reasons ( 2 ).

Too little electrolytes

A potential cause of leg cramps is an electrolyte imbalance.

Electrolytes are minerals that are essential for critical functions in your body, such as cell communication. They include sodium, magnesium, chloride, potassium, calcium, phosphate, and bicarbonates ( 3 ). If your levels become depleted, your nerve cells may become more sensitive. In turn, this leads to pressure on nerve endings, which may cause muscle spasms ( 4 ). When adapting to the keto diet, your body may lose more electrolytes through urination in response to decreased levels of blood sugar and the hormone insulin ( 5 ). This loss is typically greatest during the first 1–4 days of transitioning to keto, so muscle cramps related to electrolyte imbalance may be worse during this period ( 5 ).

Dehydration

People transitioning to the keto diet often urinate more due to factors like reduced insulin levels and increased sodium excretion. In turn, increased urination can lead to dehydration, another potential cause of leg cramps ( 1 , 5 ). Dehydration is one of the most common keto side effects and may thus increase your risk of leg cramps ( 6 , 7 , 8 ). All the same, evidence is mixed and more studies are needed ( 9 ).

Other potential causes

Several other factors may also cause leg cramps.

For example, certain medications, such as diuretics, asthma drugs, and statins, are associated with an increased risk of these pains ( 10 ). Additionally, sedentary habits, old age, strenuous physical activity, and medical conditions like liver and kidney failure are associated with leg cramps ( 11 , 12 ).

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