The Role of Supplementation in Keto: What’s Uniquely Useful

Sources of fat in the diet: avocados, nuts, omega-3 complexYesterday, I explained my rationale for supplementation in a Primal lifestyle. Today, I’m going to get a bit more specific and discuss the role of supplementation on a keto diet. As a diet founded upon the restriction of an entire class of macronutrients, keto seems like the perfect candidate for stringent supplement requirements. And if you go around the web asking other people, you’ll find plenty of opinions, lists, and recommendations for this or that supplement that you absolutely must take or face certain death and disfigurement.

I disagree.

Done well, keto needs no overt supplementation. That said, some supplements can be useful.

Most of yesterday’s post applies to anyone trying to cobble together a healthy diet in the 21st century. Everyone’s access to ancient wild plant foods is limited. Most people spend too much time indoors and need vitamin D to make up for it. We can all benefit from having a reliably healthy, convenient meal replacement on hand, and most people aren’t eating enough collagen. But what are the supplement considerations unique to keto dieting?


For most people, keto seems to slightly compromise top-end glycolytic power—the type of energy you need to push high-volume, high-intensity efforts in the gym and in the world. We simply don’t carry around the same amount of glycogen as your standard carb-loader, and if you’re trying to do the same activities as the carb-loader, you may lose top-end power.

That’s where creatine comes in. By increasing muscle phosphocreatine content, it provides instant energy for intense movements. It doesn’t last long, but we can recycle it with a short rest. The best sources of creatine in the diet are meat and fish, which you’re probably eating. But a little extra creatine monohydrate works well.


Medium chain triglycerides aren’t essential on keto. You can be perfectly ketogenic by burning and converting longer chained fatty acids, both dietary and endogenous. But MCTs are nice to have around because they boost ketone production directly and can really help someone during the transition. Lately, I’ve been whisking some of the powdered MCTs into a little hot whole milk or cream and adding that to my coffee. Placebo or not, I definitely notice an increase in mental alertness and focus.


All the issues preventing people from getting adequate doses of phytonutrients in “regular” diets become compounded on keto diets for two simple reasons:

Some of the richest sources of antioxidants are too high carb for keto dieters to eat on a regular basis. I’m thinking of purple sweet potatoes,

Many keto dieters mistakenly assume that all plant foods are off limits. This eliminates the best sources of antioxidants, like low-sugar berries and non-starchy vegetables.

You can avoid much of this by accepting that unlimited leafy green vegetables and moderate doses of berries like blueberries, blackberries, raspberries, and strawberries are okay on keto, but a dedicated antioxidant supplement providing a broad spectrum of phytonutrients drawn from the entire plant kingdom is a nice buffer. I recommend Primal Master Formula, but then again, I’m biased. Whatever you choose, take on an irregular basis. Much of the benefit we get from these plant compounds is hormetic, and taking it every day can reduce the effectiveness.


Early on in the process of keto adaptation, you’re losing a ton of sodium. You’re losing water as you expend glycogen, which flushes out sodium. Your insulin levels are low, which further reduces sodium retention. As readers of this blog, you’re probably training, which expends even more sodium through sweat. And since you’re not eating any more pre-cooked processed junk food, which tends to contain a lot of salt, you’re probably eating less sodium than before.

The symptoms of low sodium include fatigue, headaches, extreme thirst, and a reduced ability to tolerate physical activity, especially in hot weather.

Salting your food to taste and drinking salty bone broth should be enough for most people, but I sometimes find it helpful to have some sparkling water with lime juice and a generous pinch of sea salt in the morning.


In order to maintain proper sodium-potassium balance, the body responds to declining sodium by shedding potassium. This is critical, because potassium is one of the basic electrolytes our cells need to perform basic functions. I don’t know about you, but I like my cells to function.

Some of the best sources of potassium include bananas, potatoes, and other starchy foods that are off-limits to most keto eaters. You can make up for it with avocados and leafy greens, but in the early days, when sodium is low and potassium drops to balance it, some extra potassium can really help.


Some keto diehards question the relevance of magnesium, seeing as its most famous physiological role is in preserving and maintaining glucose tolerance and reducing insulin resistance. If you’re not eating much glucose, what’s the point of all that magnesium?

Magnesium does a lot more than help you process glucose, though. It’s important for bone health, nerve and muscle function, immunity. It also helps preserve potassium, which many keto dieters can miss out on.

We can get it from plenty of low-carb foods, like almonds and pumpkin seeds, but those come with a hefty dose of omega-6 fatty acids. There’s nothing inherently wrong with eating some whole food omega-6 fat. It’s just that eating pumpkin seeds to hit your magnesium requirements means you’ll go way over your omega-6 limits.


A keto diet is a high-fat diet. Most people who go keto are coming from a decidedly lower-fat diet. Maybe not a low-fat diet, but a lower-fat diet. In order to process all that fat, your liver needs to be equipped with the nutritional tools it requires to function. Choline is first and foremost a powerful regulator of hepatic fat metabolism. In order to manufacture the very low density lipoprotein particles that transport fat from the liver, we need choline. Without it, the liver accumulates fat.

This isn’t just true in “normal” diets deficient in choline. Mice on a strict keto diet deficient in choline manage to lose weight, but gain significant liver fat.  The higher the fat intake, the higher the choline requirements. The more fat you eat in a choline-deficient state, the more fat your liver will store. Saturated fat seems to require more choline than other types of fats, which has particular relevance for the Primal keto dieter.

And another thing: If you’re watching protein intake—as many keto dieters find they must do—you may be eating less methionine, an amino acid found in meat, eggs, and dairy that can offset the choline requirement. Lower protein from meat and other animal foods, lower methionine, higher choline requirements.

The average man, woman, and child already eats too little choline. Keto dieters, whose choline requirements are probably higher than the average person, will need even more.

For liver health, basic choline bitartrate is fine.


Yesterday, I explained why prebiotics are so useful. They feed and support your healthy gut bacteria. Their metabolism by said gut bacteria create beneficial short chain fatty acids that feed your gut cells, improve the health of your gut, and have nice systemic effects like improved glucose tolerance and a lower risk of colon cancer. They can help counter diarrhea and/or constipation, depending on what’s ailing you.

If you don’t know what you’re doing, they can be tough to get on keto. Truly green (unripe) bananas are probably safe sources of resistant starch, a potent prebiotic. Leeks, garlic, and Jerusalem artichokes are great sources of inulin, another potent prebiotic. And all the miscellaneous produce that you eat on keto, from leafy greens to raspberries to broccoli to cabbage, will provide prebiotic fodder for your gut bacteria.

A really quick and easy way to get prebiotics is with raw potato starch (for resistant starch) and inulin powder. There’s also a good amount of inulin in Primal Fuel (along with MCTs from the coconut milk).

And, yes, you don’t need any of these things in supplement form.

  • You can get MCTs from coconut fat, or you can just make your ketones from your own body fat and dietary fat exclusively.
  • You can get antioxidants from non-starchy veggies and low-sugar berries and fruits.
  • You can get creatine from red meat and fish.
  • You can get enough sodium by salting your food to taste, or maybe drinking some salty bone broth.
  • You can get potassium by upping the intake of avocados, leafy greens, and pretty much any other low-carb plant food.
  • You can get magnesium from almonds, seeds, and leafy greens.
  • You can get choline from liver and egg yolks.
  • You can get low-carb prebiotics from green bananas, leeks, and garlic.

It’s just that having some supplements on hand can really help, particularly during the transition as you get the hang of this new way of eating.

That’s what I’ve got. Now I’d like to hear from you.

What supplements do you consider most useful on a keto diet?

Thanks for reading.

Primal Kitchen Buffalo

TAGS:  Keto Recipes

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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32 thoughts on “The Role of Supplementation in Keto: What’s Uniquely Useful”

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  1. Thanks for the recommendations. I’ve been what I like to call “borderline keto” for several years now. Works really well for me and I have definitely reached the metabolic flexibility discussed in The Keto Reset Diet. I consume plenty of non starchy veggies and some berries so I think I’m pretty good in the antioxidant department. The two things on this list that I use pretty regularly are the MCT oil and magnesium. As a high energy person who probably has adult ADD, MCT oil really helps me focus and get stuff done, particularly in the am. And I’ve been taking Natural Calm at night for probably ten years now. It’s just part of my nighttime routine and I do think it helps my sleep, keto or not.

    1. Great Information. Thank you for providing the food supplement options and the breakdown on various supplements. Very useful.

      1. Sorry Ryan, was just leaving a general comment on article.

  2. “Done well, keto needs no overt supplementation.” I would say the same is true of the Paleo/Primal way of eating. It would be easy for you to say, “These supplements are absolutely necessary…and by the way, I just happen to sell them….” Millions of people would believe you and spend a ton of money on products they may not need.

    Thanks for your honesty and integrity, Mark.

    Supplementation isn’t necessarily a bad idea. Some people don’t process or absorb nutrients as well as they should, which can lead to health issues. Over-supplementing, however, can also lead to problems. Megadose isolates can lead to problems because more isn’t always better. Some nutrients can cancel each other out if not balanced. It’s a good idea to find out if one actually has deficiencies instead of simply assuming that’s the case, thereby “treating” something that may not exist.

  3. What’s the difference between MCT oil and coconut oil? Also, does the sourcing of choline matter (e.g. bitartrate vs. taking a precursor like DMAE or Alpha GPC)? Phosphatadylserine (bovine/sunflower/soy-what’s best??)

    1. Coconut oil includes several fatty acids at different chain length. MCT is based on 2 isolated short chain fatty acid (you can get a supplement with the two or just one). Unlike coconut oil, these acids don’t have to be broken down; they bypass the liver and get absorbed immediately as ketons and hence the boosted energy claim. If one is trying to loose weight, he should skip the use of MCT and let his liver convert his body fat to ketons

  4. Water, mct oil to tolerance, a heaping tbsp of cream of tartar, a tsp or so of salt, lime or lemon juice, apple cider vinegar, and sometimes psyllium husk (for obvious reasons) shaken together is a pretty potent potassium and sodium supplementary drink to have either first thing in the morning or mid day before breaking a fast that has no caloric fast breaking impact if you’re in keto. Use it to extend fasts too but stay alert. Plus it hydrates! Drink it then break your fast with a salted avocado and you’ll be topped up with potassium np. You’re welcome ?

  5. Great information as always from Mark. Supplementing potassium is problematic. Adults need 4700 milligrams daily but manufacturers are only allowed to manufacture 99 milligram capsules / tablets because potassium toxicity is dangerous. So, a good idea to monitor your potassium levels which should be 3.5-5.0 mEq/L

    1. When need to I use potassium chloride powder…this way I don’t have to worry about additives. It’s cheep and would last me a long time

    1. Those who “read” the article see that if you are eating variable foods then you don’t need to supplement. That being said, you could make a “possible supplement list” for any diet. In this day and age, it’s possible for someone to want to make sure they are getting all the nutrients they need despite the “diet” they are on.

  6. How much choline do you think is necessary to make a difference? 100mg a day? 300mg a day? 600mg a day? And/or if I’m going to experiment, what symptoms could i look for to see if I need more or less?

  7. Prebiotics are tough to get if you are suffering from SIBO or on a low FODMAP diet. Sometimes you have to wait until you have SIBO under control and then slowly add in prebiotic foods.

  8. Not sure if there is anything to be concerned about, but in addition to salt (for sodium), I added a small pinch of cream of tartar to my morning water, as I learned it’s an excellent source of potassium, has almost no noticeable taste, and is quite cheap to get (find it amongst the seasonings at the grocery store). Mark, any thoughts on this? Is there a better way to get easy potassium?

  9. While I’ve been on a ketogenic diet, I have gotten the antioxidants, minerals, and fiber from root vegetables by fermenting them. Let the beneficial bacteria take care of those carbs for you!

  10. Thank you thank you thank you!! “Lately, I’ve been whisking some of the powdered MCTs into a little hot whole milk or cream and adding that to my coffee. Placebo or not, I definitely notice an increase in mental alertness and focus.”

    I’ve been using the MCT Oil Powder in my coffee for a couple months — I guess I notice an increase in energy and focus, but then I mostly haven’t looked! Life just goes on, happily, for the most part. But I have not seen much noise about the Primal web about it (haven’t looked much — been busy — but wondered if the “powder” was a silly or scammy thing.

    Since I struggled with using actual MCT oil in my coffee (my ‘frother’ broke after just two uses and no way was going to try to use the immersion blender every morning: how many times has it tipped over and spilled whatever I was mixing all over the counter and floor! The powder stirs into my coffee wonderfully (I use a plastic party fork — in pretty turquoise blue — to brighten my morning!) and since I add a TBL cream and a 1/4C almond milk, the MCT oil powder fits right in — no taste, no fuss!

  11. Trying hard not to fall down the rabbit hole of supplements, but since I started keto, almost a year ago now, i got from zero supplements to: D3 + C + MSM + Lysine + Collagen + Gotu Cola + Curcumin + Olive Leaf Extract. Felt fine before, feeling fine now…

  12. Hey Mark, for the potassium/sodium issue when you start Keto I’m using sea salt and Lite salt in my bone broth since the light salt has potassium in it. So far, I haven’t had any flu symptoms.

  13. My wife battles headaches. Which ketone supplement is recommended for immediate relief? I read the Ketone supplements section of the appendix and the various products listed on page 315 of The Keto Reset Diet.

    1. In my experience with headaches and Keto (or not in Keto), I have found that using powdered magnesium (like “Calm”) in a warm drink (even just in warm water) helps a lot and fairly quickly. Dark chocolate is also a good source of Mg, but watch the labels and make sure it’s really dark and very little sugar added.

  14. I see Mark and others recommending choline, particularly in relationship to high fat diets, but I’m frustrated by trying to figure out how much that means. I seem to be getting choline not only from my food, but also also from Betaine HCl, which I take for the HCl part, more so than for the TMG part, as well as other supplements. I’m actually concerned I’m getting too much (since I barely burn 1800 calories on a good day). I would love to see some actual numbers like X mg of choline for Y grams of fat (burned, not eaten, i would assume). I could even live with it if it were expressed in ‘egg yolks per rasher of bacon’.

  15. Is the spray drying process of converting MCT oil into a powder healthy? Is heat used that could turn the fat rancid (I couldn’t find this info online)? Also, I read the oil must be mixed with a starch powder (often corn) before the spraying process and sometimes contains up to 50% starch…if so, wouldn’t the powdered MCT kick you out of ketosis? What MCT powder do you use – does it list what kind of starch it is mixed with?

  16. Hey Mark, for the potassium/sodium issue when you start Keto I’m using sea salt and Lite salt in my bone broth since the light salt has potassium in it. So far, I haven’t had any flu symptoms.