Lose Weight by Achieving Optimal Ketosis

Do you want to lose weight? Here’s number 14 of my 17 best tips. All of the published tips can be found on the How to Lose Weight page.

Before we get started, here’s a short recap of the tips so far: The first and most crucial piece of advice was to choose a low-carb diet. The next were eating when hungry, eating real food, measuring progress wisely, thinking long-term, avoiding fruit, alcohol and artificial sweeteners, review your medications, stressing less and sleeping more, eating less dairy and nut products, stocking up on vitamins and minerals and finally, exercise.

This is number fourteen:

14. Get into optimal ketosis

Warning: Not recommended for type 1 diabetics, see below.


We’ve now arrived at tip number 14. If you’re still having trouble losing weight, despite following the 13 pieces of advice listed above, it might be a good idea to bring out the heavy artillery: optimal ketosis. Many people stalling at weight plateaus while on a low carb diet have found optimal ketosis helpful. It’s what can melt the fat off once again.

So how does this work? A quick run-through: The first tip was to eat low carb. This is because a low-carb diet lowers your levels of the fat-storing hormone insulin, allowing your fat deposits to shrink and release their stored energy. This tends to cause you to want to consume less calories than you expend – without hunger – and lose weight. Several of the tips mentioned above are about fine-tuning your diet to better this effect.

How do you know you’re getting the maximum hormonal impact from your low-carb diet? You do that by achieving what’s known as “optimal ketosis”. 


Ketosis is a state at which the body has an extremely high fat-burning rate. Even the brain runs on fat, via ketone bodies. These are energy molecules in the blood (like blood sugar) which become fuel for our brains after being converted from fat by the liver.

To encourage ketone production, the amount of insulin in your bloodstream must be low. The lower your insulin, the higher your ketone production. And when you have a well-controlled, sufficiently large amount of ketones in your blood, it’s basically proof that your insulin is very low – and therefore, that you’re enjoying the maximum effect of your low-carbohydrate diet. That’s what’s called optimal ketosis.

Measuring ketones

Today, there are reasonably-priced gadgets available for measuring ketone levels at home. One needle prick of the finger, and in just a few seconds you’ll know your blood ketone level.

Blood ketones are best measured on a fasted stomach in the morning (before breakfast, that is). Here are a few pointers on how to interpret the result:

  • Below 0.5 mmol/L is not considered “ketosis”. At this level, you’re far away from maximum fat-burning.
  • Between 0.5-1.5 mmol/L is light nutritional ketosis. You’ll be getting a good effect on your weight, but not optimal.
  • Around 1.5 – 3 mmol/L is what’s called optimal ketosis and is recommended for maximum weight loss.
  • Values of over 3 mmol/L aren’t neccessary. That is, they will achieve neither better nor worse results than being at the 1.5-3 level. Higher values can also sometimes mean that you’re not getting enough food. For type 1 diabetics, it can be caused by a severe lack of insulin, see below.

Ketones in urine

Ketone levels can also be measured in a more old-fashioned way, with urine test sticks (sold prescription-free in pharmacies or on Amazon). Ketone sticks give less reliable results for several reasons, and the above recommendations can’t be straightforwardly applied to them. They are, however, much cheaper.

My personal experience

Feel free to read my accounts of a two-month personal trial:

  1. Experiment: Optimal ketosis for weight loss and increased performance
  2. Four weeks of strict LCHF and ketone monitoring
  3. Final report: Two months of strict LCHF and ketone monitoring

Although I was quite happy with my weight before these trials, they resulted in a further loss of 4.5kgs (10 pounds) and 7cm (3 inches) around my waist – without additional exercise or even the slightest resemblance of hunger.

How to achieve optimal ketosis

Many who firmly believe they are eating a strict low-carb diet are surprised when they measure their blood ketones. They may be at around only 0.2 or 0.5 – quite far off from the sweet spot! Why?

The trick here is not only to avoid all obvious sourced of carbohydrate (sweets, bread, spaghetti, rice, potatoes), but also to be careful with your protein intake. If you eat large amounts of meat, eggs and the like, the excess protein will converted into glucose in the body. Large amounts of protein can also raise your insulin levels somewhat. This compromises optimal ketosis.

The secret to getting around this is usually to eat your fill with more fat. For example, if you have a bigger helping of herb butter to your steak, you might not feel like having a second steak, and instead feel satisfied after the first one.

A popular trick people use to ingest more fat is “fat coffee” (sometimes called “Magic Bullet Coffee” or MBC). It involves adding one tablespoon of butter and one tablespoon of coconut oil to your (morning) coffee, and requires a food blender for the right texture.

More fat in your food will fill you up more. This will ensure you eat less protein, and even less carbohydrate. Your insulin will drop and, hopefully, you’ll be able to reach optimal ketosis. And that’s when many a stubborn weight plateau is overcome.

If it doesn’t work

Being in optimal ketosis for a prolonged period of time (say, a month) will ensure that you experience the maximal hormonal effect from eating a low-carb diet. If this doesn’t result in noticeable weight loss, you can be certain that too many carbs are NOT part of your weight issue and not the obstacle to your weight loss. There are, in fact, other causes of obesity and being overweight. The next three tips in this series might help you.

Try it

Order a ketone meter online and start measuring. There are a few different models, take a look at this one and this one.


Watch my video interview with the American doctor Peter Attia, on a strictly ketogenic low-carbohydrate diet: Very Low Carb Performance

Read all the tips on the How to Lose Weight page.

A word of warning

If you have type 1 diabetes, you should not follow the above advice on optimal ketosis – it may be risky. If you have ketones in your blood at all, you must be sure that your blood sugar levels are normal. If they are, you’re in normal ketosis – just like the ketosis of healthy people who stick to a strict low carb diet.

High blood sugar levels coupled with high blood ketones, on the other hand, will mean that you have a pathologically low level of insulin – something non-diabetics do not suffer from. This can lead to ketoacidosis – a potentially life-threatening condition. If this happens, you’ll need to inject more insulin; if you’re at all unsure of what to do, contact a medical professional. Coveting really high blood ketones for weight control is not worth the risk for type 1 diabetics.



Top Comment

  1. Ralph, Cleethorpes, UK
    Yes PC (10) that is simplistic. Good luck with that ;-)
    Read more →
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All Comments

  1. Steve
    That is a very good question, Catherine. I'll try to describe it as I understand it. But keep in mind that I am not an expert on the subject.

    The "Net" carbs concept appears to have been invented by the food industry, and does not have a precise definition. However, there is a bit of validity to it so long as you are very careful to understand it; it is very easy to confuse. The time a particular food stays in your body is called the "transit time" of the food. The idea behind the "Net" carb idea is that some of a food's carbs is "bound up in fiber", and does not all hit the body at once. The food industry probably hopes that folks will believe that this means that all of the carbs outside of the "Net" category won't make it into the body in the duration of the transit time.

    And that _might_ be true for a few of the carbs in some rare foods. However, as I have probed into it, it became clear that most of the carbs will eventually make it into the body. Virtually all of them for most of the foods/transit times I have investigated. The only effect that the fiber tends to have is to slow them down, and that does tend to be a good thing by itself.

    However, consider that they will eventually be used by the body. So if you keep adding more foods that have "net carbs" thinking that the non-net part isn't affecting you, you would be making a mistake. Those carbs will (mostly) get there, and be added to by the carbs coming along behind them (if you see what I am saying). So if you eat 300 grams of carbs in a day, banking on the idea that the labels claim that only 30 grams of them are "net carbs", you would probably find that you wouldn't get into ketosis (would be my guess).

    When I said that I went virtually zero carbs (or something like 9 grams per day), I was speaking of total carbs. Most people could probably tolerate more than that. However, it does seem reasonable to try to keep whatever carbs you do consume bound up in fiber as much as possible to spread the impact out over a longer period of time. Perhaps I am wrong, and some of those carbs won't make it out of the fiber in the transit time of the food after all. I don't think there are very many experts putting out good information on that. At least I have not found that information.

    I personally walk for my exercise. One mile at the time 6 times a day. That's another "spread the impact" concept application. The burning of calories though some amount of exercise is a good thing, because it tends to "burn off" the carbohydrate "float", if you understand what I mean. There are not only a little bit of carbs in everything, but also your body makes more from time to time. I highly recommend some form of activity if a person can manage it.

    In the end, someone really serious about knowing what is going on will need a blood ketone meter such as is linked to on this site. The sticks for it are a bit expensive, but it does really tell you what is going on. That reading will be about as close to the "bottom line" as to whether you are accomplishing what you need. If that reading says 0.3, then for whatever reason you are not in ketosis, pure and simple. Make an adjustment that makes sense, be it cutting more carbs, or walking more.

    If it says 4.9 (and yes I did get that reading once)....then you ought to carefully consider if you could use more fiber (which tends to have a few carbs in it that you might then be able to tolerate)....it is best to go by that to answer your own personal question as to "am I getting too many carbs?", or even "are the non-net carbs really affecting me?"

  2. Ahmed
    I have been following on the LCHF diet for the past few months with incredible success. My fasting glucose test has been down from 6.7 to 5.2 consistently (now I did two lots) and my HBA 1C from 8 to 6.1 in the same the period. I do regularly exercises, playing football twice a week or jogging once/twice a week if there is no football.

    My doctor asked me to stop taking any medication for my diabetic type 2 but to continue the same diet as he says I am able to control my diabetic in that way. Any suggestion or advice. Also he said the urine test I had few weeks ago showed small amount protein this may be due to eating a lot diary products: meat and milk. Also my Uric Acid is high 486 (range is 210-420) due to he says again eating vegetables: mushroom and Spinach and meats in particular. Again any advice these are the food that keep my glucose level within the normal level.

    Overall I feel good that my diabetic is under control

    Reply: #205
  3. Teresa
    I would recommend that you drink a lot of water, at least 2.5-3L per day especially considering your high protein intake and exercise levels. Trust me, my husband did not follow that advice and ended up with a very painful kidney stone!
    Reply: #204
  4. Zepp
    If he is a stone builder he can take potasium citrate.

    Its altso used for those whit gout.


    There have been reported that some that get in to ketosis get an acidic urin, that can be one cause for more kidney stones?

  5. Zepp
    Congratulations at first!

    High levels of uric acid in blood is not that much about food as about your kidneys ability to excret it in the urine.

    Protein in urine indicate that your kidney have some problems.. I hope your doctor follow it up.

  6. Ahmed
    As usual than you for the advice. Please review the the result of my blood test on 20/12/2014

    Cholesterol 4.88
    Triglycerides 1.31
    HDL-C 1.23
    LDL 3.06

    Albumin 43
    Calcium 2.39
    Glucose 5.2

    Urea 5.5
    Creatinine 111
    Calcium Corrected 0 .88
    Uric Acid 486
    eGFR >60

    HBA 1C 6.1

    The only problem it indicates is the Uric Acid is high and even though I am a doctor nevertheless I believe it is to do with Diet.

    Please any advice on the way forward

    Reply: #207
  7. Zepp
    4,88/1,23=3,96.. its very good!

    As I told you one dont know why some get high uric acids.. its not directly linked to diet.. more to disturbans of the kidneys ability to filter out the uric acid.

    Fast weightloss is another cause.

    Mayby ketosis have somthing to do whit it too.. one dont know, but ketosis altso interfer whit the kidney.

    Drink a lot of water, take some potasium citrate of you find any, make folow ups.. perticaly that about protein in urine.

  8. Ahmed
    Thank you very much both Zepp and Teresa.

    The lab result for the Urine:
    Albumin/Creatinine 3.4 range is 0-2.5 increase of 36%.
    Albumin Urine 58 range is 0-20.

    I have not taken any glucose control tablets for three months I think as well drinking lots of water I am thinking taking the tablets again to protect my Kidney. Also keep LCHF diet which has responsible for reducing my glucose level to normal. The doctor also prescribed to take "No Uric Allopurinol 100mg" per day to help clear the Uric Acid.

    I hope Zepp you agree with these steps

    Thanks again for the help

  9. Charlotte
    I have a few thoughts about Candida. I've also tried to get rid of it for years. I think I got stuck in Candida-assasination mode and forgot about the most important part - balance. Candida is a normal bowel inhabitant, so the goal can't be to kill it absolutely, just to keep it in check. First of all you want to make sure it doesn't become systemic, like Elaine has clearly suffered. If it does become systemic, it is very likely due to leaky gut.

    What worked for me was taking Hydrochloric acid supplements and enzymes with food (to make sure food went into my intestines sterilised (this drastically reduced fermenting, irritation and even reflux, contrary to what you'd expect my reflux was caused by not enough acid). Correcting small bowel overgrowth took some time. 2hrs after food I would take magensium carbonate, to alkalise and therefore kill any bugs that didn't get suppressed by the acid supplements. I had to eat very carefully to minimise inflammation and help my intestinal walls heal. Getting rid of all grains was a key thing for me, they were causing constant inflammation, letting larger particles through into my blood stream, leading to food allergies and ultimately to autoimmunity. Stabilising blood sugar was also absolutely vital. In the end I bought a glucometer (like diabetics use) and lanced myself all day long until I worked out my own personal tolerance for carbs and sugar. I also tested my blood ketones and kept eating enough fat that they stayed in the zone suggested above.

    I'm not a doctor but I can say, having really suffered with Candida for years, that it's been a hell of a job trying to find balance. I think perhaps for Elaine, looking at addressing any leaky gut issues might help. I also think taking some stress off your immune system could help, then the immune system can take care of the Candida for you. I found among the usual supplements that gymmnemia sylvestre was very useful (apparently it stops yeast from spiralling and migrating as they do when under attack and keeps them as single-celled organisms which can be killed off with anti-funglas), oregano oil, horopito and resveratrol (to actually kill the dastardly things) and molybdenum (for die-off symptoms). I also took a lot of antioxidants, including B12 injections, big vitD does and phase 2 liver support.

    But what it took me a long time to realise is that on top of a great kill protocol, you need a replacement one - leaving the work of keeping Candida in check to friendly bugs is the sweet spot. You need to find the bugs, either some really hardcore probiotics, like prescript assist, or ones tailored to what you need (if you've done a stool sample to see what you are missing, or have in overgrowth). I think you need to eat probiotic foods for life. I make my own kefir and am moving towards fermented foods every day as well, and gut healing foods like bone broth. It really is making a difference. I understand feeling in despair about it. My Dad always used to say you've got nothing, if you haven't got your health. I didn't used to understand what he meant when I was younger. Perhaps full keto is not giving Elaine enough food to nourish her good bacteria??? I hope you find the formula that works for you. My advice is broadly, eat to repair your gut barrier, do a Candida kill program, immediately after go all out replacing with good bacteria. Eat to nourish your good bacteria and they will work hard for you. Very best of luck!!!!

  10. Emma
    Elaine, don't bite me, this is a legitimate question. Have you tried using Epsom salts to get some relief. First in the bath, it's great for various discomfort including aches and itching. It's a topical anti-inflammatory. But also you can gargle it to treat the white stuff on your tongue, just don't swallow it because it's a wicked natural laxative as well.
    Please don't get cranky at me unless you have actually tried it. (not for a cure but for relief of the symptoms). It is relatively cheap so if you haven't tried it yet, at least look into it. There's a lot more info around the web.
  11. Emma
    I forgot specifics. 1 cup of salts per bath. 1tsp of salts per 100ml (hot to dissolve first) cooled water. Best to gargle and spit 20ml at a time til it's all used. 2 or more times a week for both but you can do it every day.
  12. Emma
    And on the real topic, ketosis. I hardly ever measure my ketones but I've lost 13kg since being low carb and I've had a lot of luck with increasing fat on the days I have a few too many carbs to help stay in ketosis. I also go fora 2 kkilometer walk or 5 kilometre bike ride.
    Extra carbs is like when I feel like some sweet potato, pumpkin or gravy. Or strawberries with cream. I just add coconut oil to balance it out a bit. For those who can't eat it off a spoon, whip 2 parts coconut oil with 1 part (no sugar added) peanut butter. Try that instead. It does add slight carbs but only have a tablespoon of it a day and you'll be right. It keeps fine in the fridge and is amazing on celery.
  13. Nicci
    Come to sad conclusion that ketosis is too dangerous for me as Type 1 using an insulin pump. I managed when I wasn't exercising but I need to tone up and get fit as I've just turned 50! Problem is I go hypo each time, often when I'm asleep. What next? Any advice will be much appreciated. Why does my body burn available glucose first????? Very frustrated. How can I get it use ketones for exercise and leave my glycogen alone?? After 26 years I'm now sick to death of being a T1 and bored with constantly trying balance everything!! I've had a few bad scares with ketoacidosis lately when my pump has malfunctioned or the cannula is bent. Oh well.
    Reply: #217
  14. Steve
    I understand what you are saying regarding the danger of ketosis for type 1 diabetics. And I personally have no helpful knowledge regarding that situation. However, if you do speak to medical professionals regarding ketosis (or _near ketosis low carb eating_), and learn something helpful, would you post back and let me and others know?

    I am especially interested if anyone vis-a-vie the medical community knows how ketoacidosis develops, and what causes that in type 1 folks.

    Reply: #215
  15. erdoke
    Glucagon regulates not only blood glucose, but also keton bodies by controlling their synthesis/release in the liver. High glucagon means low blood sugar and high blood ketones. Lack of insulin means no control of glucagon production in the pancreas and no control of its effect on the liver. Very high glucagon tells the liver to produce ketone bodies all the time.
  16. Costas T
    Any suggestions for blood ketone assessment kits?
  17. Zepp
    I have a good meesage to you.. and to others that got type1 diabetes!

    First, dont go for type2 diabetes diet advices, but go low carb anyhow.. it probably looks like the same for moste people that are sugar driven!

    But.. type 1 seldome is insulin resistante.. it means they can use glucose better as fuel.. not that much insulin is needed.. GLUT1 take care of a lot.. whitout help of insulin.. if one only goes low carb!

    You still need the same insulin level in your blood as healty persons, it have other purposes then regulate glucose/fat.

    As more fat/ketones are used for fuel.. less carbs are needed.. and your glucose levels is more stable.

    Its mostly fatoxidation thats importante, and that require low normal stable insulin levels!

    And dont event think that highest keton levels is a better case.. not for type 1, healty persons can try that, becuse insulin/glukagon regulate even keton levels, but then one need a healty pancreas at first!

    Dr Bernstein is the best expert on LCHF and type 1, he is type 1 him self from his youth!



    And as I read swedish forums.. i read that many t1 have to strugle a long time befor they get a grip of it.

    Becuse, first there have some changes in body and hormones, after a wail its a different situation and they have to learn again how there body do react on food and insulin, and again and again!

  18. Linda
    I have been attempting to get into ketosis for about 10 days now my macros would be very close to 5% carbs 25% proteins and 75% Fats. I am drinking 6 to 7 eight oz glasses of water per day. I have shown no weight loss yet. I am 5' and weigh 260 Lbs. I lost my right kidney to Cancer over 5 years ago (no chemo needed) so my remaining Kidney has tested as healthy. No sugars, or processed food. I wonder if I am doing this correctly. Also I had read from someone that if you are already obese (have lots of fat) you do not need the extra fats as indicated for the LCHF way. Can you help me clarify?
    Replies: #219, #221
  19. erdoke
    You can try to limit protein at 60-70 g and/or move to less insulinogenic types. This means reducing red meats and whey protein and eating more eggs and low whey dairy. Increasing fermented, matured foods is also a good idea. Often upping fibers works as well, but be careful of the ratio of water soluble and insoluble fibers, because having too much of the former is the right way to constipation...
    If none of these helps the next step is intermittent fasting to restore insulin sensitivity.
  20. Linda
    Thanks erdoke, I am type II diabetic and I failed to mention that in all of my other info. I have decided to go with intermittent fasting. I am starting out at 12 hours and will go from there. I have a Glucose monitor that also does keto. A week ago I was at .2 today I am at .4 so I am slowly moving into Keto I believe. I appreciate your time.
  21. Zepp
    The HF, high fat part is still high as part of your energy demand!

    And in the best of worlds and if LCHF works like it supose to do, one get very unhungry by eating high fat as part of ones energy demand!

    Its when ones apetite get lower one should folow that signaling and eat fewer meals at first.. twice a day is comon for those adapted to use fat as predominant fuel.

    Protein is essentiall and should be a the same in your diet.. and you keep the carbs as low as you could/can/like, then it is fat that is that you regulate energy intake with!

    Thats what it is about.. but dont do any asumptions befor it happens!

    Its when your body use say 500 Kcal of body fat aday betwen meals, then you dont need to eat them, if you not get extra hungry!

    Thats the way it supose to work. and thats much about mindshift, other eating patterns, listening to ones apetite signaling!

    And on top of that.. it make you an UFO.. some strange person how dont eat what others do and not in the same patterns either!

    Take a breath and think about if it mayby could be that those others eating strange food and in a strange pattern??

    I think this is good advice about how to eat and why?


  22. Manie Ferreira
    "To encourage ketone production, the amount of insulin in your bloodstream must be low. The lower your insulin, the higher your ketone production." Is this true of the insulin that a diabetic injects as well?
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