Why can’t I lose weight in ketosis?

askdrandreaseenfeld

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.

Beth

 
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:

Best,
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,
Robin

 
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?

Best,
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.

Marsha

 
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.

Best,
Andreas Eenfeldt

More

Keto for beginners

Intermittent fasting for beginners

How to lose weight

More questions and answers

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Low-carb Q&A

Read all earlier questions and answers – and ask your own! – here:

Ask Dr. Andreas Eenfeldt about LCHF, diabetes and weight loss – for members (free trial available).

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21 comments

  1. Tbone
    You didn't gain the weight over night, it's not coming off that way either.
  2. Debbie
    I gained weight while taking gabapentin...a lot..it is one of the side effects.. I quit taking it altogether...it took a while to get it out of my system..but now I am losing weight again.. I do intermittent fasting, keep my carbs low..20 or less. Try to eat 1 time a day but never move than 2. Do better if I eat with in a 4hour window. At least 16 hours between meals. Good luck..
  3. Jackie
    Debbie, I am also on gabapenton and put on 30 lbs and have tried everything. Do I have to stop the medication to take the weight off? Thanks, Jackie
  4. 1 comment removed
  5. Earline Smith
    I'm on 800 mg of Neurontin daily. I've lost 95 lbs.
  6. Kimberly Pugh
    I'm on Risperidone and gained 50 pounds. Do I have to stop to lose weight?
  7. Jill Ridgley
    This is to Kimberly Pugh. Can I ask you what your medication is for. I am also on Gapabention and another medication for Parkinson's disease. Is that what you take it for. Thank you so very much.
  8. Terri Morgan
    I'm very disappointed in your answer about fasting for shorter periods of time and "loss of lean mass". You obviously haven't read anything by Dr. Fung. Why would the body use muscle for fuel when there's plenty of fat available?

    I just lost faith in this website and will no longer recommend it to my friends.

    Reply: #9
  9. Terri,
    I've read pretty much everything that Dr. Fung has written and I'm a huge fan. I agree that loss of lean mass is no issue with fasting up to 24 hours, especially not when you're adapted to burning fat. Even with fasting for a few days losses may be marginal and quickly recovered.

    With longer fasts (several days or even weeks) there will always be *some* loss though. We can argue about how significant of a concern it is, and benefits could be larger, at least in selected cases.

  10. Ember
    Hi, I haven’t seen this question yet but do apologize in advance if it’s a repeat. A little bit about me, I am 5’1” and 117lbs and have a relatively healthy diet of mostly vegetarian dishes so this is quite the change! I just recently (within a week) started the Keto diet, not to loose wait but to get better mental clarity and break horrible habits like drinking soda and adding a ton of sugar to my coffee in the morning along with a weekly pizza ritual. My main concern is the portion sizing. It feels like so much food and I feel full half way through each meal. Is this something my body will get used too or should I cut the portion size and stop when I’m no longer hungry? Thank you for taking the time to read this! I look forward to your reply.
    Thanks again,
    Reply: #11
  11. Peter Biörck Team Diet Doctor
    Hi Ember!

    Read weight-loss tips two and four.

    https://www.dietdoctor.com/how-to-lose-weight

    Hi, I haven’t seen this question yet but do apologize in advance if it’s a repeat. A little bit about me, I am 5’1” and 117lbs and have a relatively healthy diet of mostly vegetarian dishes so this is quite the change! I just recently (within a week) started the Keto diet, not to loose wait but to get better mental clarity and break horrible habits like drinking soda and adding a ton of sugar to my coffee in the morning along with a weekly pizza ritual. My main concern is the portion sizing. It feels like so much food and I feel full half way through each meal. Is this something my body will get used too or should I cut the portion size and stop when I’m no longer hungry? Thank you for taking the time to read this! I look forward to your reply.
    Thanks again,

  12. Rhea
    I have been on the keto (mostly Atkins) diet for a week, and have GAINED weight! Not even 1 lost pound, and I am very strict. Am in ketosis as well (entered very quickly). I have lost weight in the distant past on Atkins, but this time, none of it is working. I never cheat, snack, and keep carbs very low.
    I am beginning to think that the keto diet, as well as Atkins is a total sham.
    Reply: #13
  13. Lynda Rainsford
    Same here.... have you got any answers yet?
    Reply: #14
  14. Peter Biörck Team Diet Doctor
    Hi Lynda!

    We have documented all our weight-loss tips here:
    https://www.dietdoctor.com/how-to-lose-weight

  15. Mary
    Hoping you can help. Been on Keto x 10 weeks. Losing slowly, but surely (about 3 pounds a month), I am 69, BS average 96 and BK 1.8 -2.2 in a.m. upon rising. I have tried to initiate IF the past 2 weeks. I have been getting a headache (wakes me in a.m. about 12 hours after my least evening meal. I have tried to increase NaCl, Magnesium, eating more fat at evening meal. I exercise lightly (total about 350-400 calories) everyday but one.I drink minimum of 2,000 ml/day. Just not sure what to do -
    the headaches are getting me down. My B/P has average out to 126/84. I have not been dx with sleep disorder or sleep apnea. I would like to move to a steady 18/6 IF regime. Any advice? Thanks for listening.
  16. Mary
    PS - forgot 5'5", currently 165, on Metropolol (25 mg bid, Zocor 20 mg...take D3, Vit C and CoQ10 daily)
    I think that about does it. Oh, on average daily macronutrients: 115(fats)-15 (carbs, no net carb count)-73 (protein).
  17. Brenda
    Hi 😊, I would appreciate very much your time for a few minutes
    There are recipes example keto chicken burgers with tomato butter, we do not want that vegetable which is cabbage can we leave out the cabbage and use a salad instead. What would the carbs be for just the meat burgers .There are many recipes that we would rather just have a salad with and I don’t know how to count these particular recipes without all the vegetables that count as carbs we are not interested in . We do not like green or red peppers . Thank you so much for your help and this wonderful website 😍
    Reply: #18
  18. Gentiann
    I'm pretty sure that a green salad has less carbs than the vegetables in any recipe, so go ahead, have the salad and don't worry about the carbs!
    Just be sure the salad dressing has no carb, or you can make your own.
  19. Brenda
    Hi my question is on the visuals you have cheeses as one car but in other places cream cheese has more carbs is this correct or am I miss reading. Is cream cheese just one carb . Thanks
  20. Brenda
    Gentian, thank you I have been looking a little closer at the visuals and found meets have no carbs so that solved my first question. My next question is above about cheeses I see some cheeses only have one car but I do not see cream cheese on the visuals till in another section of visuals has cream cheese has carbs .forgot at the moment what it said but it had I think three carbs am I correct . If so can you please explain why
  21. Brenda
    I’m back ( these comments do not give you the chance to edit after you are done that’s a shame ha ha )I went back to look at the visuals again and found the cream cheese to be for I went back to look at the visuals again and found the cream cheese to be 4 carbs and heavy cream to be 3 carbs . Why is that there now I think it’s clear. Staff we need editing in our comments. Thanks again
  22. Barbara
    I am consistently getting urine ketone levels of 8 -16 mol. I am not diabetic. Is this too high. Why is it likely to be happening. I eat 20 g carbs a day and about 60g of protein. ( my target weight is 60kg) I have been on keto diet for about 5 weeks Thanks.

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