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Strategies that may reduce side effects include: Eating smaller meals Avoiding high-fat or heavy foods Maintaining hydration Following the prescribed titration schedule Serious but Rare Risks Serious side effects are uncommon but may include: Pancreatitis Gallbladder disease Severe dehydration Kidney complications (often related to dehydration) There is also a boxed warning regarding thyroid C-cell tumors observed in animal studies

The use of nutritional supplements to induce ketosis and reduce symptoms associated with keto-induction: a narrative review

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PMID: 24 KleinhansMAlbrechtLJBensonSFuhrerDDissemondJTanS

Those decisions are made based on labs and a clinical consultation, not a general protocol