Suggestions on how to achieve optimal ketosis?


Do you have suggestions on how to achieve optimal ketosis? Can you follow a keto diet without a gallbladder? Effects of alcohol? And, not losing nor gaining weight, what can you do?

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

Why am I not achieving optimum ketosis?

I am being very strict about carb intake (20 grams net carbs, or less). I am using a tracking app – Carb Manager. I have been reading articles here and have realized that I may have been eating too many protein grams, and have endeavored to eat less than 60 protein grams. It’s often hard for me to achieve 121 grams of fat, which my tracking app tells me I should eat given my height, weight, etc. But, I get close.

I bought a ketone meter (Precision). The best I have registered is 0.04 for ketones – most often it registers 0.03. What am I doing wrong? I am female, 68 years old. I feel great, am losing weight (about 22 pounds in three months, with a goal to lose 50 more). I’ve been struggling with weight for 30 years, and only wish I had known about ketogenic eating before this (I had done Weight Watchers, Atkins, and many others before this).

I am totally sugar free and no refined carbs of any kind. I am fortunate to not have had any other health issues, so far. All my lab numbers are normal. I am being very strict! I want to get to 1.5 mmol minimum!? Suggestions?


Hi Jenny!

I’d suggest not worrying about the ketone numbers too much. As long as the diet is successful for you in other ways, all is fine. I also would not recommend eating more fat than you feel you want, that’s just going to slow down your weight loss. Trust your body at least as much as your tracking app, probably more. ;)

Andreas Eenfeldt

Keto without a gallbladder


I am new to this and I had my gallbladder out several years ago. Is there anything I should avoid?



In general, keto seems to work well for most people even without a gallbladder. If you get stomach upset or loose stools you may want to avoid eating larger portions of fat at once.

Andreas Eenfeldt

Alcohol effects

There seems to be much disinformation concerning alcohol. Keto books all state that it is full of calories. Can I suggest that this is totally misleading. Alcohol has a totally different metabolic pathway via acetaldehyde and acetic acid. With the exception of beer and cider (full of carbs), alcoholic drinks have little effect on calories and weight. Just look at Wikipedia on this subject. A vast number of studies, including those on 80,000 and 140,000 subjects say: “The relationship between alcohol and weight is the subject of inconclusive studies. In some, there is a small decrease in weight among women who consume alcohol.” Why are you so naive on this subject, please?

Stephen May

Observational studies can’t really be trusted either way unless the effect is huge. So I’d disregard those.

Alcohol does contain calories and thus it can affect weight, though certainly more so with drinks containing carbs, like beer.

Low-carb alcohol – the best and the worst drinks
Andreas Eenfeldt

Not losing and not gaining

Hi Dr. E ☺️
I am not losing or gaining. I feel well, but am discouraged. I am not very hungry, which is good. I do drink three cups of coffee a day with heavy cream…about 1.5 tablespoons each. I take an antidepressant, cholesterol med, ibuprofen and inhaler for my asthma. I have a stressful job. I am discouraged.


If you’re not hungry when you’re drinking your coffee, I’d definitely recommend drinking it black or with just a little milk. That could help quite a bit with weight loss.

More ideas here.

Andreas Eenfeldt


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