Lose weight by achieving optimal ketosis

Do you want to lose weight? Here’s number 16 of my 18 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, 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.

confused

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.

Video course

How to Eat LCHF Video Course

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

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

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 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:

  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 0.4. 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!

Try it

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.

More

Learn much more about ketogenic diets here:

A ketogenic diet for beginners

What is ketosis?

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.

443 comments

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. M
    Hi,
    I am on keto diet, I did a ketone blood test and it reads 5.9 is it okay?
    Reply: #452
  2. Kerry Merritt Team Diet Doctor

    Hi,
    I am on keto diet, I did a ketone blood test and it reads 5.9 is it okay?

    As long as you are not diabetic, that should be fine.
    https://www.dietdoctor.com/low-carb/ketosis

  3. trentulmer
    Good morning. I am 9 days into keto and have been struggling to get consistently into ketosis. I tested myself last night before bed after having not eaten anything since about 7:00pm. I tested at 0.7. Then this morning, i woke up and tested again and am sitting at 0.4. I am staying under 20 net carbs per day. Can anyone explain why it's taking me so long to get into consistent ketosis? At 6 days in I finally reached 0.5 and have been as high as 0.9. Any advice would be appreciated. Thanks!
    Reply: #454
  4. Kristin Parker Team Diet Doctor

    Good morning. I am 9 days into keto and have been struggling to get consistently into ketosis. I tested myself last night before bed after having not eaten anything since about 7:00pm. I tested at 0.7. Then this morning, i woke up and tested again and am sitting at 0.4. I am staying under 20 net carbs per day. Can anyone explain why it's taking me so long to get into consistent ketosis? At 6 days in I finally reached 0.5 and have been as high as 0.9. Any advice would be appreciated. Thanks!

    You may find this helpful!
    https://www.dietdoctor.com/why-does-my-ketone-level-fluctuate

  5. Emma from Aus
    Since the ketone sticks are e pensive l first check wirh the ketone urine strip, if its in a zone were it shows ketosis l then use my ketone meter to get an accurate reading. Today tbe urine strip was in the purlesh showing me at 1.5 l tested with meter my ketones were 1.7mmol. Yay me.
  6. Muskaan
    Hi Ana, I think I might just clarify this that our body converts fat into three types of ketones:
    1. Acetone- released through oral cavity.
    2. Acetoacetate- released through urine.
    3. Beta-hydroxybutyrate: released in blood.

    The urine strips measure a different type of ketone than the blood strips hence you get different readings because they’re completely different types. The blood ketone reading is however much accurate. Hope this helps.

    Muskaan

  7. peter
    Hi,
    I've done the keto diet for just a couple months for the last two years. Each time I lost what I needed to: about 15 pounds. I regained after in the winter months due to work cycles, stress, laziness, love of beer, etc.. the yo-yo effect. My GP doesn't like the keto diet (or any diet, he just says learn to be reasonable and eat a variety of foods, right good luck with that!!). But I feel very motivated when on the keto diet, and it's very effective, I find. Some psychological virtuous effect comes into play. It's always in the Spring...
    Advice (from an amateur) for people with no weight loss: keep a log: not just diet, but ketone levels if you're testing, sleep duration and quality, exercise, and other notes. Make a table in a word processing program, and fill it out each day. Use colors to hilight certain key info. Also research carbs for all foods you eat, and in your log, highlight with a color those foods, even if they are really low carb (like say Macadamia nuts). a medium apple is 25g carbs, fennel is, peanuts are, etc.. without going crazy weighing all these foods, you'll see a pattern developing visually in your log (mine in on my computer), and this will really help you 'out' the carbs and get a sense of how to reduce, if needed. Also will help see if your protein is too high. The log is also a ritual which for me helps me stay motivated. While I realize I may want results too fast, I still enjoy the process and am interested in documenting all this at least part of the year.
    I do 30 Km of road cycling some days, and so I can eat an apple (before) I find and still get great ketone levels. Btw, I just measured 2.8, and it's the highest I ever have had. I lost weight in the past on this diet without ever reaching that level. So, I may eat two apples today , or maybe throw a half a carrot in there for fun. Thanks and good luck to all.
  8. Jenny
    Nail meets hammer. For someone who has a brain tumor, keto is perfect. You will starve those cancer cells to death if they try to come back. I recommend you stick with the diet. Your post is right on the money. You ate too much protein and not enough fats. Also you didn't intake the right fats. Mct oil and coconut oil will not help get your ketones high enough. It has to be animal fats. Butter, ghee, tallow etc. Eats those and you will see result. Best of luck to you!
  9. Tania
    That’s interesting because my levels are at 15 with the urine strips so I am wondering if that’s accurate at all ?
    Reply: #460
  10. Crystal Pullen Team Diet Doctor

    That’s interesting because my levels are at 15 with the urine strips so I am wondering if that’s accurate at all ?

    Check out this article on the accuracy of each method of ketone testing. https://www.dietdoctor.com/low-carb/keto/ketone-testing-three-ways

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