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?”.

I heard too much protein could prevent ketosis, but I was skeptical as the science doesn’t seem to support that. It was time to test.

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 – definitely in 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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161 comments

  1. Natasha
    I have a shake every morning with power greens avacado unsweetened coconut almond milk and a keto powder which is 19g of protein and my breakfast is 2 egg omelet with small amount of cheese and zucchini 2 pcs of bacon and 1 pc of ham which is 35g protein and im wondering if i should scale back the protein?
  2. Natasha
    Anyone have any thoughts on my last post? Please im so confused
    Reply: #153
  3. Kristin Parker Team Diet Doctor

    Anyone have any thoughts on my last post? Please im so confused

    Thank you for your questions.

    There is generally more danger from inadequate protein than too much protein. You may find this helpful.
    https://www.dietdoctor.com/food-policy/protein
    https://www.dietdoctor.com/low-carb/protein

  4. Reese
    Can definitely use some help! I’m 2 months postpartum & started keto immediately after I had my baby. I lost 30lbs in the first two weeks & then nothing after. My blood meter says I’m not even in ketosis. I work out everyday, fast 12-15 hours, drink at least 80oz of water, never consume more than 20 net carbs or more than 40 total carbs. My diet consists of healthy fats, meat, veggies and cheese. Not sure what’s happening but I’m feeling extremely discouraged.
    Reply: #155
  5. Charlotte Zwart Team Diet Doctor

    Can definitely use some help! I’m 2 months postpartum & started keto immediately after I had my baby. I lost 30lbs in the first two weeks & then nothing after. My blood meter says I’m not even in ketosis. I work out everyday, fast 12-15 hours, drink at least 80oz of water, never consume more than 20 net carbs or more than 40 total carbs. My diet consists of healthy fats, meat, veggies and cheese. Not sure what’s happening but I’m feeling extremely discouraged.

    We don't recommend eating a ketogenic diet for breastfeeding women. If you are not breastfeeding, the hormonal changes after pregnancy could potentially make it harder to stay in ketosis. Our medical team recommends to have patience as you transition through a physically and emotionally challenging time with a new baby, and to focus more on your health than your weight.

  6. Nicole
    I am in my 12th week of Keto. At week 10 I started using a blood ketosis reader. It read 0.3. I decided to put my carbs at 0 for a 24 hour period, it read 0.7. The next day I added 1.5 carbs it read 0.6. The third day I ate 1.5 regular nutritional carbs and 1.5 net carbs and the meter read 0.5. I am unsure what to do. It looks like I can only eat 3 carbs a day to stay in ketosis. This is not sustainable. Please advise. Thank you.
    Reply: #157
  7. Kristin Parker Team Diet Doctor

    I am in my 12th week of Keto. At week 10 I started using a blood ketosis reader. It read 0.3. I decided to put my carbs at 0 for a 24 hour period, it read 0.7. The next day I added 1.5 carbs it read 0.6. The third day I ate 1.5 regular nutritional carbs and 1.5 net carbs and the meter read 0.5. I am unsure what to do. It looks like I can only eat 3 carbs a day to stay in ketosis. This is not sustainable. Please advise. Thank you.

    Anything over .3 is nutritional ketosis. There is not generally a benefit from being deeper in ketosis. You may find this helpful.
    https://www.dietdoctor.com/low-carb/ketosis#optimal-ketosis

  8. Pamella
    Hi. I've been doing keto for over 2 months. No weight loss. My type 2 diabetes is now norm sugar readins. Around 80. I'm happy with that. My carbs are about 12 to 15 , my fat intake is not high enough. My protein is not high enough. I'm not hungry anymore. I start eating dinner, & I'm full before I'm finished. NO KETOSIS!!! Please help!!
    Reply: #159
  9. Kristin Parker Team Diet Doctor

    Hi. I've been doing keto for over 2 months. No weight loss. My type 2 diabetes is now norm sugar readins. Around 80. I'm happy with that. My carbs are about 12 to 15 , my fat intake is not high enough. My protein is not high enough. I'm not hungry anymore. I start eating dinner, & I'm full before I'm finished. NO KETOSIS!!! Please help!!

    If you are finding that you are never hungry, you may wish to reduce the amount of fat and focus on protein. Fat has a lot more calories per gram and can be very filling. Protein is more satiating per calorie, but has half of the calories as fat!
    https://www.dietdoctor.com/weight-loss/how-to-lose-weight

  10. Dave
    Hunter why don't you have a blog? you clearly know more than the writer of the article Lol
  11. Sufiyo
    Now I am even more confused than before! I used Carb Manager to tally up the macros of the suggested day's eating in the article above which were counted as 11g carbs. Carb Manager says 73g protein, 192g fat!!, 2059 calories!! and 8g carbs.
    I am vegetarian and have been counting everything and not cheating at all but have only experienced ketosis for a few hour twice! I've been rackign my brains as to what I'm doing wrong. Friends say I'm nto eating enough fat but if I eat more I'll exceed the calories by way too much - DO the alories matter at all?? Should I ignore the Carb Manager app??
    I'm vegetarian and have been eating strictly as the app recommeds 5/20/70 with 25% caloric deficit = <1200 calories for weight loss. Calculates I'll lose 1.5kg/month (This feels far too slow! AND I don't have the energy!)
    I am wondering if my active perimenopause (regular hot flushes) could be interfering... (I saw you mention hormones post partum can affect)
    I have been doing this diet strictly for 5 weeks now and have only lost 3-4kg out of a desired 10.
    Can you please tell me what the most important thing to focus on is given I am already eating less than 17-20g net carbs daily. Do the total carbs matter if the net is under 20?
    Thank you so much in advance,
    Sufiyo
    Reply: #162
  12. Sufiyo
    Oh, also I am 47yo and obtain my protein from 2 eggs daily, a protein shake, tofu, occasionally few nuts (so many calories!) and sometimes supplemented with a half or full protein bar (all keeping under 20g carbs). I have tested negative with urine strips but can feel I'm not in ketosis after having experienced it ever so briefly.
  13. Sufiyo
    Argh forgot to say I also intermittent fast, eating betwen 11am and 7pm!! And still no ketosis!!
    Reply: #164
  14. Kristin Parker Team Diet Doctor

    Argh forgot to say I also intermittent fast, eating betwen 11am and 7pm!! And still no ketosis!!

    Here is our guide to keto as a vegetarian. Depending on the ingredients, you may wish to experiment with dropping the protein bar.
    https://www.dietdoctor.com/low-carb/keto/vegetarian

  15. Claudia
    Hei!urmez low carbs de 5 luni,mi se pare ca m-am ingrasat.care ar fii cauza?mulțumesc!!
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