Why can’t I lose weight in ketosis?


Why can’t I lose weight in ketosis? What is the right way to count carbs? And why are you gaining weight on a longer fast?

Get the answers in this week’s Q&A with Dr. Andreas Eenfeldt:

Why can’t I lose weight in ketosis?

I have been eating low carb for two weeks. I have lost 7 lbs (3 kg). I am getting extremely frustrated! I am keeping my carbs at 20 g or less. A basic day for me would be deviled eggs and bacon for breakfast, black coffee. Snack of some cheese, celery, 3 oz. (85 g) of baked chicken (using olive oil), the same for supper. My keto level is moderate. Take anti-inflammatories, anti-depressants, thyroid meds (underactive) and gabapentin at night.


Hi Beth!

You’re getting good results. 7 pounds (3 kg) in two weeks is very normal. Keep it up and you might lose all your excess weight eventually.

To speed weight loss up even more, stop snacking (but eat enough to feel satisfied after your meals).

Here are more tips that you may find useful:

Andreas Eenfeldt

What is the right way to count carbs?

Should we be counting total carbs, or net carbs (total carbs – fiber)? There seem to be a wide variety of opinions on this, and I see on this site to count net carbs which is what I have been doing, but I notice that your new recipe person Kristie (in her Facebook group) says “total carbs only” though her recipes here have net carbs in the nutrition information.

Dr. Westman in the New Atkins for a New You has net carbs, though on his own sites he says total carbs. It is all so very confusing. When I look at your image of 20 grams of carbs in two different ways (whole food vs. bun) that has to be 20 g of net carbs on that plate because it is closer to 35 or 40 g total carbs. Please clear this up!

Thank you,

I think counting net carbs makes more sense. Fiber carbs is not a problem for weight loss or diabetes reversal etc.

That said, aiming for below 20 grams of total carbs is even more strict, difficult and thus also even more effective. But you could get the same result by aiming for let’s say 14 grams of net carbs, which would focus you on the most important thing. Does that make sense?

Andreas Eenfeldt


72-hour fast and gaining weight?

I’ve been doing keto for almost three months. I log my food and believe I’m under 20 grams/carbs. Not losing and start a water fast and started to gain. I do have ketones but my glucose is still in the 80’s mg/dl (4.4 mmol/L). Ketones were approx 0.5. Now that I’m fasting they are 1.6.


Intermittent fasting is great for speeding up weight loss. However, I generally don’t recommend longer fasts than 24 hours or so, unless you really know what you’re doing or have medical supervision. Often you can get almost equally good results with shorter fasts, repeated more often, with less side effects (like loss of lean mass), e.g. 16:8 on most days.

Andreas Eenfeldt


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