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.


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 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.


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.

Ready to lose the weight for good?

Our new 10-week program helps you lose weight in a healthy and sustainable way.

Sign up now!

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. Lauren
    These are great tips! I have been using the urine strips to measure my ketones. For the past week, I have been in the dark purple range, which is 15mmol. I have read this is a dangerous level, although I do not have any health conditions. I have one question: how can I reduce the amount of ketones closer to the optimal level? You suggest above that you may not be eating enough if your ketone levels are that high. If that is the case and I need to eat more, should I eat more fat or more protein? Thanks!! LD
    Replies: #405, #412, #432
  2. Cwketo
    Did you ever get a response? In the same boat. Curious what came of your situation?
    Replies: #404, #437, #445
  3. Kristin Parker Team Diet Doctor
    You can read our weight loss tips here - you may see something that's inadvertently tripping you up.
  4. Kristin Parker Team Diet Doctor
    How high are your readings? If you have type 1 diabetes or are on any medication, please consult your doctor.
  5. Kristin Parker Team Diet Doctor
    The urine strips are not always accurate. They can expire quickly and a high reading may indicate dehydration.
  6. 1 comment removed
  7. Nicole
    I’ve been on a Keto for a year now. I check my blood and am usually between 1.5 and 3.0

    Although I have lost some inches (not many), I haven’t lost any weight in months. Total weight loss in 1 yr is 35 lbs. I know that’s a step in the right direction but I’m still 60-70 lbs overweight. What am I doing wrong?

    Reply: #408
  8. Kristin Parker Team Diet Doctor
    Here are our top 18 troubleshooting tips that may help pinpoint areas you can tweak.
  9. Mandy
    Definitely the apples! They aren’t keto and have lots of sugar. I did the hcg diet for a 6 months. I did feel like I was starving on that and all my weight came back after. Keto has been a more achievable lifestyle for me.
  10. MrsJudy
    Intermittent Fasting. You should fast every two weeks or when you stall. 16:8 - 16 hour fast, then you have 8 hours to eat all your meals. :)
  11. Kim
    The link for the keto meter is bad.
  12. Anna
    I was the same using the urine strips, i was always in the dark purple 15 mmol/L, so i decided to order the blood ketone meter and it tested that i was only at 0.6 mmol/L so i don't believe the urine strips are accurate at all. If you want the best results its best to have the blood test kit. Was a bit disappointing for me because now i have to adjust my diet all over again to get into optimal Ketosis. :)
    Reply: #414
  13. Tiffany
    I use the Keto Mojo tester and am awaiting a Keyto in the mail. After a week of being at "Lo" today I got 0.2 mmol/L. More work to do but happy I'm getting there. Better than pee strips for sure.
  14. Jenna
    Ugh same!! I thought I was doing great with my ketones and then i got the blood meter and needed to change things up. I was a 1.1 last i checked so s little better than it was. Coconut oil always helps me boost my ketone level.
  15. Cathleen
    Anyone try the keto breathalyzer?
    Reply: #424
  16. Zena Wright
    I have 2 breath meters 1 from Keto Health care & 1 from House of Keto, the one from House of Keto has never worked on me, never measured any ketones at all I contacted them & was told to change the batteries & check the dates on the batteries which I did it made no difference at all. The other registers Ketones much better but, needs new batteries weekly despite me checking the dates on the batteries, the meter once you turn it on counts down from 19 to warm it up, you then blow into it for 10 seconds it then displays your reading however my meter keeps going back to 19 until I remove the batteries & put them in again I have contacted both companies but received no further help so I now rely on a blood meter entirely.
  17. Jackie bourne
    Can you help please l don’t know how to read my blood keto Glu 9.36. MMol/L 17-2 Keto 5.7 could u tell me if this is good or bad
    Jackie bourne
    Reply: #418
  18. Kristin Parker Team Diet Doctor

    Can you help please l don’t know how to read my blood keto Glu 9.36. MMol/L 17-2 Keto 5.7 could u tell me if this is good or bad
    Jackie bourne

    Please contact your doctor to ask for assistance with reviewing test results.

    Reply: #428
  19. John S Thaller
    I was on a "ketosis" diet recommended in conjunction with radiation and chemo treatments following removal of a malignant brain tumor. I ate no more than 20 grams of carbs a day, ate protein (eggs, meat), and fats (bacon, oil on salads). I had my ketones tested weekly, an after the first 2weeks, my ketone level was about .55. after a month or so, though not changing my carb intake, nor protein amount, the ketone level declined to ,3, d then to .25. My dietician said I needed more, and to increase my oil level, she said i was 1000 calories short a day. i did the best i could, but 1000 calories is about 25 tbs of oil, so no way could i increase that much. I did the best I coul, but then started getting skin blemishes, yes pimples, at age 68. I grinded through it anyway, but could not get my ketone level above .25-.3. My only takeaway was I was eating too much protein vs fat. I had 2 eggs daily, and 12 oz meat a day per direction from dietician, Over a 3 month period I lost 17 pounds. I am off the diet now, so, I guess mt takeaway was I was not eating enough fat.
    Reply: #420
  20. Rachel
    Yeah, it sounds to me like your protein was way too high (and you may have been eating hidden carbs/sugar alcohols without knowing it if you were eating more processed things (bacon can sometimes have hidden sugar added, and you may miss it if you're not reading the labels super close). A good way to up your fat without just spooning oil into your mouth is through coffee or tea, adding coconut oil/butter/MCT those sorts of things. There are sneaky ways to get fat into the diet without too much fuss. Also, it would have probably helped you to use a blood meter at home daily (two to three times a day) to help you stay on track. For a therapeutic keto (to fight cancer or repair brain function) it's ideal to have numbers over 3.0, and that's usually created through intermittent fasting and keto in tandem. Hope your health improves quickly!
  21. Amy P
    Hi there. Wondering if its ok to stay in the .5-1.5 range if you dont need to lose anymore weight. Or am I creating any other kind of health risk?
  22. amy p
    I Just read John's comment. Interestingly a few months ago I decided to start incorporating carbs back into my diet (sweet potatos, rice and sourdough only). I might have gained a few pounds but nothing that I didn't need to gain. However, I also started taking a probiotic for gut issues. and then bam - patches of pimples. above age 40. stopped the probiotic. started getting facials and they are slowly starting to go away (but have left scars). I used to have good skin. regardless, i decided to go back to being keto with very careful non-cholesterol inducing fats. I am able to stay under 200 in cholesterol so far. and will still have small doses of rice and or sweet potato and stay within the .5-1.5 range. Ok....so, wondering if there is a link between keto and pimples in our old age? will going back to keto help my skin or hurt it?
    Reply: #423
  23. Kristin Parker Team Diet Doctor
    Most people find that eliminating grains, sugars and starches will result in clearer skin, though there may temporarily be a stage with more breakouts, but that is temporary.
  24. Matt
    I just received my Keyto and started measuring on 3/6/19. I have been between 4 and 7 on their scale. It does not translate to millimolar. Last night my buddy measured his level with the Keto Mojo. He had a reading of 2.4. Then had him use the Keyto and it came back with a reading of 8. Once he gets more strips will be comparing them again. I sent a message to the Keyto folks to see if there is any way to easily convert the numbers or see if millimolar could be an optional setting to choose on the deivce.
  25. Mary0214
    I am extremely overweight and started a strict keto diet. I track all my food and eat and average of less then 12net carbs a day my calorie intake is 1200 calories. The first week I lost 10 pounds the first week. Second and third week I only lost 1 pound. I also purchased a keto mojo and my ketones are 2.7-3.4 range. These last weeks I haven't lost any weight!! Help!!!
    Reply: #426
  26. Kristin Parker Team Diet Doctor

    I am extremely overweight and started a strict keto diet. I track all my food and eat and average of less then 12net carbs a day my calorie intake is 1200 calories. The first week I lost 10 pounds the first week. Second and third week I only lost 1 pound. I also purchased a keto mojo and my ketones are 2.7-3.4 range. These last weeks I haven't lost any weight!! Help!!!

    Eat to hunger. If you are hungry for more food, don't restrict calories. You can read more weight loss troubleshooting tips here - https://www.dietdoctor.com/how-to-lose-weight

  27. Marie-Anne
    Hello, I am wondering if its ok to stay in the .5-1.5 range if the reason for beeing on the Keto diet is not for weight loss.
    Is the fact that I am not losing (trying not to because it is VERY efficient for weight loss!) fat influence my ketosis level?
    Thank you
  28. Linda Wick
    9.36/5.7=1.64 GKI, which is in the optimal ketosis range that KetoMojo posts. Check it online.
  29. Michael
    Hi wanted to add a comment here. I found that when especially on Keto I had to watch my pH urine levels. If I was too acidic it was very hard for me to get into and stay into Ketosis.
    Reply: #443
  30. Bec
    I am 73 hours into an extended fast, I am planning to break fast at 86 hours. I'm feeling really good with good energy levels and concentration. I tested my blood ketones today and got 3.7. I did have a black coffee with a splash of MCT oil today. Wondering if the higher ketones are due to me fasting or the MCT oil?
  31. Kaye
    Hello, I have been doing keto keeping carbs no higher than 20g a day. (with my limited knowledge n experience). I have lymphedema and have swelling all over arms legs and trunk. It is very difficult to decipher weight loss. Since March 28 the scale sales 3bls loss. That said I feel better and look like I've lost more weight than that. Others have pointed out I look like I ve lost weight unprompted. Other than bothersome pimple's and a bit of restless sleeping I feel like it's working but the scale doesn't think so
  32. Paul
    Urine ketones are ketones being removed because you have an excess. you need a blood ketone meter, like precision extra you can get at amazon
  33. Billy
    I test myself with urine strips and a blood meter. I’m having a hard time maintaining a steady level of ketosis. I cut back on my protein a couple days ago. Last night before bed, I was at 1.0. This morning, I woke up to 2.3. Then I went to meetings today and they brought in deli sandwiches. I ate three strips of bacon off a BLT. I also had two cups of black tea with a pat of butter in each cup. I was shocked when I got home this afternoon and was down to 0.2. How did I move -2.1 points in nine hours when all I had was a few strips of bacon and about two tablespoons of butter?
    Reply: #435
  34. 1 comment removed
  35. carly
    Hi Billy, I have a similar question with fluctuating key tones. Generally I have always measured first thing in the am and for the last couple weeks been frustratingly at 0.6, so I stopped reading it and just carried on. For the first time in a while, I tested last pm just before bed and was 1.1 which I though was good considering the weekend I had, I went to bed and I have not eaten or drunken anything since other than water and I tested 0.6 this am......so similarly I have gone down overnight and that is without consuming anything other than water- I don't know the answer to your question, or mine. If you find any clarity or good sites/forums with this discussion on-please do share.
  36. Sub
    Do you have any references about this? Where the evidence for what "optimal ketosis" is please?
  37. Mike
    That's not possible. Use the blood test strips. You will be between 0-5.0
  38. Eileen Molloy
    Can you tell me please if it's OK to do a fast every day? I do an 18/6 fast nearly every day. I'm not hungry, but my Keto breath monitor always put me about .65-.85.
    Reply: #439
  39. Kristin Parker Team Diet Doctor

    Can you tell me please if it's OK to do a fast every day? I do an 18/6 fast nearly every day. I'm not hungry, but my Keto breath monitor always put me about .65-.85.

    That is fine for most people! You can read our full guide on intermittent fasting here - https://www.dietdoctor.com/intermittent-fasting

  40. andrew
    Don't forget what the doctor says.....Eat 36 eggs a day...(or less)!
  41. Eleonora Fois
    Every time I eat protein my blood ketones, the day after, are low, around 1.4. I always extend my fasting to reach the optimal range. Fat intake and fasting help immensely to keep me in the optimal range. Eating OMAD high fat low protein and fasting 48 hours when I eat the more protein is the best option for me to benefit staying in the optimal range of ketosis for at least 24 hours every day.
  42. Clara Walsh
    In reference to pimple breakouts while dieting in any way...sometimes, if your gut flora and fauna are not balanced there may be a die off due to the lack of sugar to feed the bad guys. This die off releases toxins which can affect your overall digestive system. Taking probiotics may help balance the gut and clear the toxins. Also...the use of stored fat in the body can cause an imbalance. I have found that using a mild gut cleans once a week for one month helps clear these toxins and my skin doesnt break out. Eating a high carb sweet diet can cause Candida Overgrowth, these sweet eating bacteria are not good for your body. They can even cause cravings because "they" crave the sugar you are no longer providing. So, use probiotics, cleans and hang in there. Good luck to all my fellow ketoins
  43. Michele B
    Trader Joe’s has an excellent alkaline electrolyte water. I drink at least 1.5L of that per day and supplement with other hydration like regular tap water.
  44. veronica
    all of this was good information. I saw answers to some things I noticed happening in my body, but didn't know it was a result from being in the keto life: like the pimples appearing. But anyway, all of this was great Q/A.
  45. Cath
    When my urine strips are dark purple, I test using my Keto Mojo meter and I am usually around 2.5 mmol/L. From my experience the numbers on the urine strips do not correlate to my blood tester. Also once in ketosis for a while the urine strip results started getting lighter and I had pretty consistent readings with the blood tester. With dark purple results on urine strips, I feel pretty certain I am fine and in optimal ketosis, but everyone is different and you just have to worry if you have type 1 diabetes. Blood meters are $$ but I like being able to test to know for sure sometimes.
  46. ronny de decker
    i was diagnosed : diabetic type II recently and was prescribed : insulin basal injection once a day ( long lasting ) 12 units , I lowered on my own initiative the units to 9 , and in the morning my insuline level is +- 90.
    I decided to do that because insulin injections are counter measuring the ketosis state .
    I also take 2 pills of glucophage a day .

    Should i experiment and lower further my injection dose ,
    Am i correct about the fact that these injections are working against getting into optimal ketosis ( will i ever get there ? )

    Reply: #447
  47. Kristin Parker Team Diet Doctor

    i was diagnosed : diabetic type II recently and was prescribed : insulin basal injection once a day ( long lasting ) 12 units , I lowered on my own initiative the units to 9 , and in the morning my insuline level is +- 90.
    I decided to do that because insulin injections are counter measuring the ketosis state .
    I also take 2 pills of glucophage a day .
    Should i experiment and lower further my injection dose ,
    Am i correct about the fact that these injections are working against getting into optimal ketosis ( will i ever get there ? )

    Please check in with your doctor to adjust your medicine dosage.

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