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 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.

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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Maximum effect from an LCHF diet

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

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, 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 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.

379 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. Marianne
    I just started my Keto Diet (not even a week in) and I must admit I am really not hungry at all. Of course I have ample stores of fat to fuel my body ;). I probably have around 100 pounds to lose but I am taking in day at a time. Many thanks for all the recipes and great videos on the site I am leaning so much!

    I do have one question though : I have a condition called Hemachromatosis (i.e. too much iron) will all the meat and great green veggies we eat on keto increase my iron? Most real and healthy foods are rich in iron like red meat, broccoli, kale and nuts.

    Thanks

    Reply: #366
  2. Judy F.
    I am on the Keto diet for just over a month now and have lost 20 lbs . My question is about my blood ketones I sit at around 0.3
    How can I raise them my macros are
    18 gr net carbs
    110 Gr fats
    90 gr protein
    I have gone over on my protein a couple of days by a teensy bit ,but not my fats .my carbs I never go over. Any suggestions would be appreciated
    Thanks Judy
    Replies: #353, #371
  3. Peter Biörck Team Diet Doctor
    Hi Judy!

    Increase your fat intake a little bit (you could try a cup of tea with a tablespoon of coconut fat twice a day) and eat little less carbs...and see if your numbers goes up.

    If this doesn't work then try to increase your fat intake even more and eat even fewer carbs.

    If you after that still have problem then you could try to reduce the protein intake.

    Reply: #374
  4. Lori
    I've been on the keto diet for three months I have a monitor I've been in Keto's for majority of the time I have only lost 2 lb I have lost some inches I have been very frustrated to not see my scale not go down I have had A hysterectomy and Mike gallbladder removed I am 58 years old female is this a factor for not losing my weight ?
  5. Bre
    I have been eating keto for 6 days. 20 or less carbs per day. Around 1700 calories. I tested my urine today and it was 4. I was a bit alarmed as I’m reading this is also known as “starvation ketosis”. Should I be increasing my carbs? I’ve been feeling weak and dizzy.
  6. mira
    Scale has been seesawing up and down by a half pound for almost two weeks. (FYI: This is the same weight as I was when I stopped losing weight on every other diet I tried before Keto.) I have been doing intermittent fasting for a week or so. I am usually at a moderate ketone level, but as soon as I eat a meal or have a fat bomb, my ketone level drops down to small or sometimes trace ketones. Why?
  7. Doreen Edmundson
    Re: constipation, if you are drinking regular tea, that contains a lot of tannic acid, which is VERY constipating!
    Try switching to herbal teas. That should make a big difference!
  8. Drag CA
    My Ketone level is over 5. Mostly 8.
    Is that dangerous state, or I can proceed with my diet?

    I am not diabetic!

  9. 1 comment removed
  10. Rachel
    I can’t trust anyone’s advice about what my mitochondrion do or don’t do if they can’t even spell mitochondria. Bro. Really?
  11. Matt
    Your idea of measuring blood ketones as a tool is flawed. Many people are in optimal ketosis at .3-1. It’s not about how many ketones are in your blood as genetics, ketone uptake, fat adaptation etc can result in lower readings. For weight loss it’s about the lipolysis affect, so effectively .0 and 4 are the only readings you need to worry about.
  12. Samantha
    Hi there

    I hope someone can help me.
    I feel at a plateu and I don't Know what to do about it.

    In December 2017 I weighed 185 and started diet doctor January 15th 2 week challenge I lost 8lbs!

    I calculated my macros for my weight to be 108 fat 90 protein 20 carbs. I lost a total of 25lbs. I weighed 160lbs end of April.

    The month of May my weight really fluctuated up and down but I did not lose any more weight. I fluctuate between 160 and 162lbs. I reduced my macros and I'm wondering if this the problem. I got a ketone meter to read my levels and I am 1.3dl which is good but not optimal.

    What can I do?
    I'm not giving up and I'm very happy to lose 25lbs so far and many inches but I don't like this stall/ plateau.

    Please help me!!!

  13. Amy
    Hi i am doing the hcg diet. I did it before and lost 60 lbs in 3 12 months
    Now I am doing it again. In not allowed fats period but I use my oil. I'm only allowed 3 ozs.meat a 2twice a day and 1 leafy veggie 2wice a day and 2 apples or strawberries twice a day. I'm never hungry and my question is how do I get my ketosis to go higher. Is the 2 apples stalling me ?
    Reply: #377
  14. parast
    I am eating 900 cal with 20g carbs 49 gr protein and 76 gram fat! this carb is total carb or net carb?
    Replies: #376, #381
  15. Noel
    My diabetes (2) is totally controlled. Dropped to normal first day. Lost 10kg over six months but very little since. Have no gallbladder, could this be a reason.
    Eat 5-10g carbs p/day. Coffee with cream 2-3 pday. Two eggs. Some cheese. Smallish meat or fish plus veg. Raspberries and cream. Sparkling water with lemon. Stevia sweetener.
    Am trying, digestive enzymes, pre/probiotic combo, magnesium, vit d, multi vit,fish oil
    Just bought a ketone monitor 0.1. (This a.m. Glucose 6.2)
    Any suggestions on how to lose more. Weigh 100 kg, height 5'8". Age 73. Aquaerobics twice weekly, a bit sendentary. Kathy (Noel)
  16. Nicole Moore
    Most likely it will increase your iron stores.
  17. Kelly
    I've been Keto for a month. I have kept my carb intake to 20g/day, don't eat too much protein, and haven't cheated. I'm tracking my Ketones via blood test and I'm ranging 1.7-0.6mmol/L, averaging 1.0mmol/L. Why aren't I achieving optimal levels? I only have one reading within the optimal zone. Please help!
    Reply: #373
  18. marianne
    Hi There ! I realllly need help ...

    I am not sure i am measuring well my blood ketone
    I saw on multiple site that in order to properly measure blood ketone you should :
    take your blood sugar and divide it by your blood ketone
    For instance my blood sugar is 4.7
    Blood ketone level is 0.4
    Then i am at 1.88 so in the range

    Am i right or the only level that matters is the only ketone level which is 0.4?

    Thanks a lot it is a bit confusing when you are a beginner

    Reply: #370
  19. 1 comment removed
  20. Rolando
    you are referring to a GKI (glucose ketone index) which measures the ratio between glucose and ketones
    as a better indicator than ketones alone. The calculation is glucose / Ketones (in mmol/l). According to your numbers this gives you a ratio of around 11.75 , which could be consider OUTSIDE of ketosis

    Here is an article that talk about this..

    https://www.perfectketo.com/track-your-glucose-ketone-index

    Hope this helps..

  21. Don
    Dr Nally suggests a good place to start with protein for women is 45.5 g for the first 5 ft of height and 2.3g for each inch over 5 ft. It's not the end all be all, because it can be different for everyone, but it's a good starting point. Hope this helps :)
  22. Mary Lou
    Ok I have been checking my bld for 4 days. And checking bw 3-6pm and it has been bw 3.1-4.6 the past 4 days. I am not starving myself. My calculator says 115/65/20 and I may go over on my fats but never under and my protein is within 2 everyday. And carbs I never reach it. Just don’t know what I’m doing wrong.
  23. Mark
    Hi Kelly - Are you drinking the BPC (bulletproof coffee or tea) as a part of your diet? Having the coconut oil (or even better MCT oil) will help produce ketones. If you don’t want to drink that to start your day, adding either of these oils elsewhere will help get your ketones up.
  24. Raegan
    I am having the same problem of sticking at 0.4 fairly consistently. I have lost 24 lbs. but can’t seem to get into any deeper ketosis. I have no clue what I am doing wrong. I started fasting from 8 pm to noon and added bullet proof coffee to my morning routine. Suggestions?
    Reply: #375
  25. Peter Biörck Team Diet Doctor
    Hi Raegan!

    Well you seems to do things right if you have lost 24 lbs. :-)

    Never forget that we all are individuals that means one person could have 3.0 and another 0.3 with exactly the same food intake.

    If you really would like to see if you can get higher values then you could try to eat only eggs and bullet proof coffee for a few days and see what happens.... and if your values get higher you could successively add different types of food and measure ketones too see if you eat something that lower your values.

    I am having the same problem of sticking at 0.4 fairly consistently. I have lost 24 lbs. but can’t seem to get into any deeper ketosis. I have no clue what I am doing wrong. I started fasting from 8 pm to noon and added bullet proof coffee to my morning routine. Suggestions?

  26. MPA
    It is your net carbs that you need to be calculating
  27. MPA
    It's very possible because apples contain approximately 12g of net carbs per 100g of apple, and you are eating 2 a day, so that's already 24g of carbs right there. Maybe try switching to berries, they contain about 4-5g of carbs per 100g of fruit. I usually rotate between blackberries, raspberries and strawberries to switch it up a little.
  28. Robert B
    Stop eating the fruit. It is very high in Fructose. Eat more vegies instead.
  29. Anna
    Question: for Type 2 diabetics, what's the ideal ketone level? I am assuming that we wouldn't want it to be too high, but I am not sure what is too high or what to do about it if it is too high?
  30. Terra
    Thank for the tips. For type 1 diabetics the key is to make sure you DO have circulating insulin from an injection. Often after being in ketosis for awhile you might even notice you need a bit more insulin to ha e normal level blood sugars. You can be headed toward dangerous ketone levels with normal level blood sugars so I am not sure why the author didn’t point this out. It really doesn’t have to do with blood sugar levels, it has to to with circulating insulin. I have lived with T1D for 27 years and never had ketones with high blood sugars but have had ketones several times when I have lowered my insulin dosing (normal level blood sugars). Just as ketosis has to do with insulin NOT carbs. Dangerous levels of ketosis for a T1D has to do with circulating insulin NOt blood sugar.
  31. sweetladyk
    Net carb. Carbs - fiber - sugar alcohol
  32. Melissa
    I've been following a strict low-carb diet for a while now, eating just two meals a day (lunch and dinner) or occasionally one meal a day (easily done since I have little appetite).
    I recently started to use a cheap breathalyser (it only cost £5 on ebay uk) after I read on a forum that that the cheap ones don't differentiate between alcohol and the acetone produced in your breath when you're in ketosis.
    It definitely works since I haven't drunk alcohol in over 20 years but whenever I use it, it flashes 'Danger' and usually reads between 0.5 and 1.0 g/L (0.05 to 0.1%BAC).
    I've tested it on the rest of my family, who eat just a moderately low carb diet, and they all read zero on this device.
    I highly recommend using one of these breathalyser as a cheap, easy and non-evasive way to check if you're in ketosis. Just make sure it's one of the cheap ones since the better ones work 'properly' and don't measure acetone from ketosis.

    I just have one question, does anyone know what range of breathalyser readings in either g/L or %BAC would correspond to 'optimal ketosis' as described in this article?

  33. 2 comments removed
  34. Jeff Glainyk
    Ok I’m using the true plus ketone strips should I be in the lighter are which is negative or on the dark side? I’m down 13 lbs so no complaints here, just want to know if I’m on the right path!
  35. Sue Wildey
    I've been on a low carb diet for one month and lost 17lbs. I've just tested for ketones and it's sort of between 4 and 8. I don't eat much fat or dairy, just 1oz of cheese daily. Main foods are meat, fish, eggs, green veggies and mixed salad, lemon juice for the dressing. I drink some alcohol in the evenings with sparkling water. I have felt a bit week and shaky at times but not a lot and can overcome this when excercising. Is my result of 4-8 too much? I'm not diabetic.
  36. Shari Reeves
    I started my keto journey on February 23rd and I have lost 91 lbs. My GKI is 1.2 so I am a high fat burner. My question is why am I not losing weight? I am curious what is going on in my body when the numbers say one thing but my weight has plateaued. I have 70-90 lbs left to lose.
  37. Bonnie Lawrence
    I’m frustrated, I’m actually gaining weight and I’ve been doing it for three weeks, using fat Bomb’s, bullet proof coffeee, lowering, my protein and eating well under 40 grams carbohydrate. What the heck???
    Reply: #389
  38. Andrea
    I'm having the same problem. I started two weeks ago and haven't lost any weight or inches. My ketones are consistently at 2-3.5. I think I will give it a couple more weeks but I'm afraid I'm going to gain weight instead of losing it. Also, my fiance is eating the exact same foods I am and is getting ketones no higher than 1.5. I just don't get it.
  39. Shasta
    I am also having this problem. I did get a Keto blood monitor today so am going to start checking my levels to see if I can figure it out. When is the best time to test? Before I eat or drink anything?
  40. Tanya
    Just want to say THANK YOU to Terra who commented on July 24 about type 1 diabetes, ketoacidosis, and circulating insulin levels. I am T1D and have been struggling with euglycemic DKA (that baffle my docs or they don't pick up or they attribute to stupid things). It happens to me in the first half of my menstrual cycle when I have to drop my dose a lot due to insulin sensitivity. Again, thank you so much for taking the time to comment.
  41. Cindi
    I have been on this for over 7 wks. I use the urine strips and they are always dark. I don't now what I am doing wrong. i have only lost 7 pounds. Can stress slow weight loss I use cmt oil everyday. I watch my net carbs and protein. I eat only 2 meals a day due to fasting mode.
    Reply: #393
  42. Kristin Parker Team Diet Doctor
    Cindi,
    Yes, stress can raise cortisol which can hinder weight loss. If you are not seeing progress, you may want to limit your net carbs to 20 per day, if you have been eating a more liberal low carb diet. Also, a dark result on the strips can indicate dehydration; make sure you are staying well hydrated.

    --Kristin

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