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, eating only when hungry, measuring progress wisely, being persistent, avoiding fruit, beer and artificial sweeteners, review your medications, stressing less and sleeping more, eating less dairy and nut products, stocking up on vitamins and minerals, using intermittent fasting and finally, exercising smart.
This is number sixteen:
16. Get into optimal ketosis
Warning: Not recommended for type 1 diabetics, see below.
We’ve now arrived at tip number 16. If you’re still having trouble losing weight, despite following the 15 pieces of advice listed above, it might be a good idea to bring out a controversial option: optimal ketosis. Why is it controversial? For most people, “low” or “higher” ketone levels don’t make a difference for health and weight loss, and in general we do not recommend shooting for a specific ketone level. However, for some people stalling at weight plateaus while on a low carb diet, trying to raise ketone levels may be of benefit.
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.1 This tends to cause you to want to consume less calories than you expend – without hunger – and lose weight.2 Several of the tips mentioned above are about fine-tuning your diet to better this effect.
Do you know exactly how to eat a low-carb and high fat diet (LCHF)? This is required for ketosis. If not the easiest way is watching this high quality 11-minute video course on how to eat LCHF, and the most important things to think about.
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Ketosis is a state at which the body has an extremely high fat-burning rate. Even the brain indirectly 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.3
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 likely not in your fat-burning zone.4
- Between 0.5-3.0 mmol/L is nutritional ketosis. This is where you see the beneficial effects on weight and metabolic health. For most people, it won’t matter where in this range you fall
- Around 1.5 – 3 mmol/L is what’s called “optimal ketosis” for some. If you have hit a weight loss stall without a clear reason, one possible intervention is to increase your ketone levels. Although there is no scientific support for this intervention, rare cases may see benefit.
- Values of over 3 mmol/L aren’t necessary. That is, they will achieve neither better nor worse results than being at the 0.5-3 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:
- Experiment: Optimal ketosis for weight loss and increased performance
- Four weeks of strict LCHF and ketone monitoring
- 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 0.4. Why?
The trick here is to avoid all obvious sourced of carbohydrate (sweets, bread, spaghetti, rice, potatoes), consider time restricted eating, and use fat as a lever for taste and satiety.
Sometimes adding MCT oil to your coffee or tea can help increase your ketone levels which may or may not resolve your stall. It may not be “magic” for everyone, but for some it may just do the trick.
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 likely 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.
Also, consider signing up for our Weight loss for good program, free for Diet Doctor members!
Order a ketone meter online and start measuring. There are a few different models, the most popular one is probably the Precision Xtra ketone meter. Unfortunately these meters are all quite expensive to use, as the test strips can cost about $5 per test.
Here’s a complete package with everything you need to check your blood ketone levels.
Learn much more about ketogenic diets here:
Watch my video interview with Dr. Peter Attia, on a strictly ketogenic low-carbohydrate diet: Very Low Carb Performance
Read all the tips on the How to lose weight page.
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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.
The Journal of Nutrition 2015: A lower-carbohydrate, higher-fat diet reduces abdominal and intermuscular fat and increases insulin sensitivity in adults at risk of type 2 diabetes [randomized trial; moderate evidence]
Annals of Internal Medicine 2005: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes [non-controlled study; weak evidence] ↩
Journal of the American Dietetic Association 2005: Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet [randomized trial; moderate evidence] ↩
Some controversy exists for this cut off level as few head-to-head trials exist comparing low levels of ketone production. Some studies have shown benefit of a ketogenic diet with ketone levels as low as 0.3mmol/L. ↩