Why you’re not in ketosis

As the COO of Diet Doctor and low-carb enthusiast for years, you would have thought I’d nailed ketosis years ago. I haven’t, and here’s why.

Am I still in ketosis?

To get into ketosis, the most important thing is to eat maximum 20 grams of digestible carbs per day. When I went low carb in 2012, I followed that advice to the letter – replacing all high-carb foods like potatoes, bread, rice, pasta, legumes, fruit, juice, soda, and candy, with eggs, dairy, meat, vegetables, fats and berries – counting every carb I consumed.

I felt great – effortless weight loss, no stomach issues, tons of energy and inspiration.

But over time, something changed – I no longer felt as great as I used to. Until recently, I had no idea why.

The journey to find out started with a simple question: Am I still in ketosis?

The moment of truth

At a Diet Doctor dinner a while ago, our CTO, Johan, gently challenged me. “Bjarte, you’re eating quite a lot of protein. Have you measured your ketones lately?”.

“No”, I said, feeling slightly defensive, “I’ve never measured my ketones. Should I?”.

It was wake-up time.

Johan and I grabbed two blood-ketone meters from a dusty drawer, pricked a finger each, and touched the ketone strips. His results came out first – 3.0 mmol/L – optimal ketosis. He looked happy.

It was my turn. The ketone meter made a weird beeping sound and the screen started blinking – 0.0 mmol/L – no ketosis whatsoever.

What?! I’d been eating strict low carb for years, how could I not be in ketosis? I felt slightly embarrassed, but mainly relieved. Was this the reason I no longer felt great?

Experiment 1: Eating less than 60 grams of protein a day

Several of my colleagues agreed with Johan – I was eating too much protein. To test that hypothesis, I started a 10-day-protein-reduction experiment in April, eating a maximum of 60 grams of protein a day (down from around 80-120). This sucked, as I love eggs, cheese and meat.

What I ate

Here’s an example of what I ate in a day during the experiment:

– Lots of broccoli
– Lots of spinach
– A fair bit of of cream
– A fair bit of butter and olive oil
– About 150 grams of ground beef (27 grams of protein)
– 2 eggs (13 grams of protein)
– A few raspberries
– A few squares of 86% chocolate
– A few brazil nuts
– 2 cups of coffee

Around 40-45 grams of protein, mainly from meat and eggs.

The results

Having eaten strictly low carb AND low protein for ten days, I pricked my middle finger and put my blood on the keto strip.

Beeeeep! The screen was blinking – 0.0 mmol/L. Nothing. No ketosis whatsoever.

My colleagues and I had been wrong – too much protein wasn’t the culprit.

Experiment 2: Eating less than 20 grams of carbs a day

It was time to test my carb intake – was I really eating less than 20 grams a day?

The experiment:
– eat a maximum of 20 grams of carbs a day for a week,
– keep my protein intake at maximum 60 grams a day,
– only make food at home,
– count carbs properly by weighing everything I eat and drink, and calculate my daily digestible-carb intake using Diet Doctor’s visual low-carb guides,
– document everything.

I was ready – the carb-counting could begin.

How many carbs was I eating?

Day one was my calibration day. Eating more or less like I had done lately, how many carbs would that add up to? I was in for a surprise.

What I ate on day one:

– 400 grams of broccoli (16 g carbs)
– 200 grams of cream (6 carbs)
– 150 grams bacon (1.5 g carbs)
– 4 eggs (2 g carbs)
– 150 grams of spinach (1.5 g carbs)
– 5 raspberries (1 g carbs)
– 1 square (1 cm x 1 cm) of 86% chocolate (1 g carb)
– 4 brazil nuts (0.5 g carbs)
– 75 grams of butter (0.5 g carbs)
– 2 cups of coffee (0 g carbs)

30 grams of digestible carbs, 50% more than recommended.

I couldn’t believe my own stupidity. This must be the reason I’m not in ketosis, I thought.

Eating less than 20 grams

For the next three days, I ate less than 20 grams of carbs by reducing my vegetable and cream intake, still keeping my protein intake below 60 grams.

Here’s what I ate on April 21st – the day before I was going to measure my ketones again:

– 100 grams of cream (3 g carbs)
– 60 grams of tomato sauce (2 g carbs)
– 150 grams of butter (1.5 g carbs)
– 2 eggs (1 g carbs)
– 100 grams of spinach (1 g carbs)
– 5 raspberries (1 g carb)
– 1 square (1 cm x 1 cm) of 86% chocolate (1 g carbs)
– 4 brazil nuts (0.5 g carbs)
– 200 grams of ground beef (0 g carbs)
– 2 cups of coffee = 0 g carbs

= 11 grams of digestible carbs.

Game on.

D-Day

On April the 22nd, at 07:52 am, I pricked my finger, touched the ketone strip, and waited. It was now or never.

YES!

For the last two days I’d felt the typical symptoms of getting into ketosis, dry mouth and increased thirst for example. But, getting the confirmation felt great – blood doesn’t lie.

I continued to eat like this for about a week. Every morning, as soon as I woke up, I would measure my ketones, and every morning I would be in ketosis.

It had been the carbs all along.

Count the carbs

I’ve been in ketosis for a few weeks now and it feels great. I’m delighted to be back.

Do you want to stay in ketosis? Then count your carbs – at least every now and then.

The first principle is that you must not fool yourself – and you are the easiest person to fool.

Next

The above is the first of a 3-part blog series. Here’s the next one: How much protein can you eat in ketosis?

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109 comments

Top comments

  1. Peter
    I thought there was no counting on this diet, but it turns out there is - you're just not counting calories but carbs. Frustrating.
    Replies: #24, #55
    Read more →
  2. David
    What was the reason you wanted to be in Ketosis again? Is it a good thing in and of itself? I know of most of the benefits (e.g. helps with weight loss, can reduce fatty liver, gets blood sugar down, can reverse T2D, etc.) but once you reach the point where all of those health markers are back to normal, what's the advantage of actually being in Ketosis vs. just staying healthy and eating a low to moderate carb diet?.
    Replies: #28, #109
    Read more →
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All comments

  1. Melissa
    I am hoping you can help me. I have been doing Keto for several months, Lost about 25 lbs initially, went off a bit over the holidays but have been super careful and following your meal plans exact. When testing my ketones, using urin strips, I am not showing any ketones. I have lost a few pounds since being off plan over Christmas, I am feeling better, however not losing like i did initially and no ketosis. HELP!!!
    Reply: #102
  2. Kristin Parker Team Diet Doctor

    I am hoping you can help me. I have been doing Keto for several months, Lost about 25 lbs initially, went off a bit over the holidays but have been super careful and following your meal plans exact. When testing my ketones, using urin strips, I am not showing any ketones. I have lost a few pounds since being off plan over Christmas, I am feeling better, however not losing like i did initially and no ketosis. HELP!!!

    The urine strips are not very reliable and can expire. As long as you are seeing good progress, you may not need to test for ketones.

  3. Jackie Barrett
    I haven't eaten for 36 hours and am still not in ketosis. Bot sure what else to do.
  4. Joe
    I would say it's not dishonesty but more that they aren't actually sending their dishes through a massspec and are having to estimate while using something like a nutrition textbook, internet or an app like chronometer
  5. Leah
    Would love someone to measure by cups tsp etc.... grams are impossible!
    Reply: #106
  6. Kristin Parker Team Diet Doctor

    Would love someone to measure by cups tsp etc.... grams are impossible!

    All of our recipes have a toggle at the top of the ingredient list where you can switch to American measurements instead of Metric.

  7. T. Lang
    I’m trying to teach Ketosis for 5 days now and I can’t. Probably going myself like you said.
    Thank you for your help!
    I’ll go and count my carbs now...
  8. Cosmic
    You will probably never see this, Hunter, but thank you so much for this amazing teaching.
  9. Melissa Mullins
    Ketosis is when your body begins to utilize fat cells for energy instead of carbohydrates. Weight loss is the best reason to be in ketosis (for me at least).
  10. Andrea
    Wow.

    I would love to know what your daily meals look like. I am new to this and over 50 years old. Lost a few pounds the first week on diet. Bought Ketosis urine sticks and see I’m not in Ketosis. I count carbs and am under 20 grams per day. I am losing weight but not showing I’m in Ketosis. What??? I don’t get it.

  11. Anne
    Same for me, under 20g per day for 5 days now but strip shows no ketones . How much longer will it take I wonder!
  12. Mike Anderson
    I eat < than 20 per day but now ketosis has stopped. My urine strips are new so WTF is going on?
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