How to get into optimal ketosis?


How do you get into optimal ketosis? What to do if you’re not losing weight? How long does it take to reverse fatty liver? And why are you not losing body fat, even though your weight is decreasing?

Get the answers to these and other questions in this week’s Q&A with me.

Please note that these answers do not constitute medical advice and no doctor-patient relationship is established. These answers are for general information purposes and you should discuss any changes with your healthcare provider.

How to get into optimal ketosis?

I can’t seem to get into optimal ketosis. Been eating keto for 30 days, under 20 gram total carbs (usually not over 17), 30 to 56 grams protein, and not over 76 grams of fat. I rarely go over 900 calories but that’s because I’m 58 and very sedentary.

According to all my research I should be in optimal ketosis and losing weight like crazy. In 30 days my weight has dropped 4 kg – 9 lbs (I’m in no hurry, but surprised it’s not more) and the highest my ketones have been (by blood) is 1.4 mmol/L (that was after a semi fast) – usually it’s under 1. No where near the magic “3” I hear about. I do IF most of the time, having breakfast around 11 and I try to have dinner between 3 and 5. Any drink that isn’t water I use as a “snack”. I keep count with carb manager and weigh everything. Cutting protein has been hardest. Please tell me what to do to get into optimum ketosis!

Thank you,


Great question. The short answer is there may not be an “optimal” ketosis level when it comes to weight loss and general health. This is a concept that carried over from treating seizures and may apply to specific interventions like for Alzheimer’s, brain cancer or other fascinating areas of research. But when it comes to overall health and weight loss, there is no evidence to suggest higher ketone levels are “better.”

Dr. Bret Scher

I’m not losing weight. What to do?

I have been on keto lifestyle since January 1, have not lost much weight or inches. What can I do to change that so I am losing both weight and inches?


Hi Kim,

This happens often. It can be so frustrating seeing all these amazing success stories and then not seeing the same success in yourself. I get it. For one, check out our realistic expectations guide as we all have our own health journey.

Second, although we usually don’t recommend calorie counting or “macro” counting, knowing your carb grams and total calories can be helpful in the beginning as sometimes our impressions are different from reality.

Also, consider enrolling in our Weight Loss For Good course to help you fine tune your efforts.

Hopefully those suggestions will get you back on your path top success!

Bret Scher

How long does it take for non-alcoholic fatty liver disease to reverse on LCHF?

In general, about how long does it take for non-alcoholic fatty liver disease to reverse itself on LCHF?


Good question. This depends on how you measure it. The lab values for liver function, most notably ALT, should start to get better within weeks, but may not completely normalize for months. Ultrasound evidence of fatty liver is slower to respond and can take months to start to see a response and up to a year or more to see complete resolution. Most of this is based on clinical experience and hopefully we will see better trials coming soon.

All the best!
Bret Scher

Body fat not decreasing, even though weight is going down

My weight is reducing by an average of 3.5 lbs (1.6 kg) a week, but my body fat % remains at 33%.

I started on a low carb diet for a week and now on keto for three weeks and it’s working, but my measured body fat % is not dropping – any ideas?


My first question is, how are you measuring body fat? The gold standard is DEXA but there are many other ways to measure it. Just keep in mind they all have a test-to-test variation. So when changes are small they can be lost in that variability.

But the next question is what are you doing to promote lean muscle mass? The best way to make sure you lose fat and gain muscle, in my opinion, is to eat low carb, get adequate protein, and perform regular resistance training. If you are new to exercise, try our Let’s Get Moving course.
I hope that helps!
Bret Scher

More questions and answers

Many more questions and answers:

Low-carb Q&A


More with low-carb doctors