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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135 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 →
1 2 3

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).
    Reply: #128
  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?
  13. Sue Ibrahim
    Try a Ketogenic Diet alongside intermittent fasting 16:8. This should get you into Ketosis.
  14. 1 comment removed
  15. adele
    same for me, i have been under 20g of carbs and 1300 Cals for months, type 2 with hashimoto's thyroiditis scales havent moved for months!!
  16. adele
    and i fast most days - only eating one meal a day!
  17. Mary Colton
    My butter says 0 carbs. My heavy whipping cream says 0 carbs, and eggs, 0 carbs, and yet you are saying that you counted cream, butter and eggs as containing carbs. whats the deal? and, how do you count carbs that aren't listed? How is it even possible to get into ketosis with so much conflicting info?
    Reply: #118
  18. Kristin Parker Team Diet Doctor

    My butter says 0 carbs. My heavy whipping cream says 0 carbs, and eggs, 0 carbs, and yet you are saying that you counted cream, butter and eggs as containing carbs. whats the deal? and, how do you count carbs that aren't listed? How is it even possible to get into ketosis with so much conflicting info?

    The manufacturers can round down on their labels and apps don't always have correct information. You can always follow our meal plans or our completely free two week challenge to help get started!
    https://www.dietdoctor.com/low-carb/get-started

  19. Autumn Pitman
    This is impossible. The amount of food listed that is being eaten is not sustainable long term. And if a person is working out - how is this enough? I feel confused. I have tried so hard to get into ketosis and I am unable to either - but this small amount of food is not enough to sustain and reasonably active person throughout a typical day. 100 grams of spinach - that is 7 tablespoons! Is this cooked or raw? And what is the 2 oz. of tomato sauce being eaten with - the .8 cups of ground beef?! If the calories are going to be kept this massively low, I am not sure the weight loss has anything to do with carbohydrate restriction at all!

    – 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.

  20. Marji
    I have been using the app & putting in every single food Im eating !! For the past four weeks i have kept my carbs under 20 even under 17!!!& my calories under 1500 ,the urine test shows slightly pinker!! I have only lost 1.5 kg which i think is water weight cause comes & goes!!! This diet is very frustrating for me & I am afraid that it has screwed up my metabolism!!
    Reply: #121
  21. Kristin Parker Team Diet Doctor

    I have been using the app & putting in every single food Im eating !! For the past four weeks i have kept my carbs under 20 even under 17!!!& my calories under 1500 ,the urine test shows slightly pinker!! I have only lost 1.5 kg which i think is water weight cause comes & goes!!! This diet is very frustrating for me & I am afraid that it has screwed up my metabolism!!

    The urine strips are not the most reliable method for measuring ketones.
    http://www.tuitnutrition.com/2016/01/dont-be-a-ketard1.html

    Reply: #133
  22. Deb
    This seems to be a trend. I have been doing keto for 4 months and lost 30lbs. I am under 20 g of carbs a day and fo light walking. My keto reading 2 weeks ago was over 2.0 now I am at under 5 for last 2 days and I do fasting. I log everything in my fitness pal. Why am I out of keto and cant seem to get back into keto?
    Reply: #123
  23. Kerry Merritt Team Diet Doctor

    This seems to be a trend. I have been doing keto for 4 months and lost 30lbs. I am under 20 g of carbs a day and fo light walking. My keto reading 2 weeks ago was over 2.0 now I am at under 5 for last 2 days and I do fasting. I log everything in my fitness pal. Why am I out of keto and cant seem to get back into keto?

    It could be a number of things, but I wouldn't be overly concerned. This article may be helpful for you! https://www.dietdoctor.com/suggestions-on-how-to-achieve-optimal-ketosis

  24. Z
    I have to agree that the amount of food listed is quite austere. That’s nearly a starvation diet, and is simply unreasonable to expect almost anyone to follow. If you have to starve yourself, a ketogenic diet is pointless.
  25. Andre
    So it wasn’t because you were eating too much protein? What if you went back to eating a lot of protein, but lower your carbs?
  26. Oleeta
    Hi Everyone!
    I am new and trying to follow the plan, but I am hitting it at 21 or 22 grams of carbs. I know the sticks are not the most reliable, but they are turning a nice shade of light purple. Is this an indicator that I am in Ketosis and do I really need to aim for lower marks?

    Thanks!

    Oleeta

    Reply: #127
  27. Crystal Pullen Team Diet Doctor

    Hi Everyone!
    I am new and trying to follow the plan, but I am hitting it at 21 or 22 grams of carbs. I know the sticks are not the most reliable, but they are turning a nice shade of light purple. Is this an indicator that I am in Ketosis and do I really need to aim for lower marks?
    Thanks!
    Oleeta

    Check out this article for signs that you are in ketosis. https://www.dietdoctor.com/low-carb/ketosis#signs-ketosis

  28. jenny
    The reason for ketosis is primarily fat loss. On other diets where you count calories in vs calories out you lose weight but the loss of made of muscle loss and some fat.
    We want to get fat off of our body and keep muscle. This is why ketosis is necessary.
  29. katrinafrain1
    I’ve been on keto for 3 weeks now. I never seem to get into Ketosis no matter what I do. I’ve even started intermittent fasting. No eating from 8pm to 12 the next day. Still nothing. I stick to the meal plans so I’m presuming the lunch and dinner I choose are good together.. I’m absolutely baffled? I don’t cheat, so I don’t understand what’s going on. It has me thinking that this is maybe not for me. I’m very disheartened, feeling at a loss because I’ve stuck to the Diet Doctor plan. Confused 🤷‍♀️
    Reply: #130
  30. Kerry Merritt Team Diet Doctor

    I’ve been on keto for 3 weeks now. I never seem to get into Ketosis no matter what I do. I’ve even started intermittent fasting. No eating from 8pm to 12 the next day. Still nothing. I stick to the meal plans so I’m presuming the lunch and dinner I choose are good together.. I’m absolutely baffled? I don’t cheat, so I don’t understand what’s going on. It has me thinking that this is maybe not for me. I’m very disheartened, feeling at a loss because I’ve stuck to the Diet Doctor plan. Confused 🤷‍♀️

    It could possibly be too many carbs, but it may actually depend on how you're testing. Not all ways of testing are reliable. These articles may be helpful for you!
    https://www.dietdoctor.com/low-carb/keto/ketone-testing-three-ways
    https://www.dietdoctor.com/low-carb/ketosis#signs-ketosis

  31. Fiona
    I’m also not getting into Ketosis. Carbs are under 20, usually around the 15g mark. Protein under 60. And exercising, I don’t get it.
    Reply: #132
  32. Kristin Parker Team Diet Doctor

    I’m also not getting into Ketosis. Carbs are under 20, usually around the 15g mark. Protein under 60. And exercising, I don’t get it.

    That protein amount sounds very low. You may not be getting adequate protein.
    https://www.dietdoctor.com/low-carb/protein

  33. Nancy
    Hi Kristen I’m having the same problem! I use a keto app and only have 20 grams of carbs a day and I’m not in ketosis or losing weight! Did you get an answer to your question? I’m very frustrated!

    Nancy M

    Reply: #134
  34. Crystal Pullen Team Diet Doctor

    Hi Kristen I’m having the same problem! I use a keto app and only have 20 grams of carbs a day and I’m not in ketosis or losing weight! Did you get an answer to your question? I’m very frustrated!
    Nancy M

    Check out our guide to ketosis with special attention to the How to get into ketosis and How to know you're in ketosis sections. https://www.dietdoctor.com/low-carb/ketosis

  35. Sal
    I’m upset. I’ve been doing strict keto since 4/17/20. I started at 500lbs. On 8/20/20 I was weighed in at 390lbs. I used the keto strips today and tested and it showed a trace of ketones. I’m not going over 20 carbs per day. I’m losing weight but upset i don’t see that I’m in keto sis
    Reply: #136
  36. Crystal Pullen Team Diet Doctor

    I’m upset. I’ve been doing strict keto since 4/17/20. I started at 500lbs. On 8/20/20 I was weighed in at 390lbs. I used the keto strips today and tested and it showed a trace of ketones. I’m not going over 20 carbs per day. I’m losing weight but upset i don’t see that I’m in keto sis

    Urine strips are not always accurate and only measure the ketones you are spilling. If you keep carbs very low, your body will enter a state of ketosis. The progress you are seeing is better evidence of this than the strips. https://www.dietdoctor.com/low-carb/keto/ketone-testing-three-ways

  37. Katie Nilles
    Hi everyone,
    I am struggling to get into ketosis. I am intermittent fasting 16:8 as well as going hard core on keto foods. I haven't slipped once in two weeks and I am still only showing a trace according to the urine strips. I have previously been in ketosis (years ago and 2 kids ago) and got in super fast. This time, I can't seem to figure this out. The only carbs I have been eating are in full fat items and broccoli, asparagus, zucchini, but in very small quantities. Can anyone help? I am getting frustrated!
    Reply: #138
  38. Kristin Parker Team Diet Doctor

    Hi everyone,
    I am struggling to get into ketosis. I am intermittent fasting 16:8 as well as going hard core on keto foods. I haven't slipped once in two weeks and I am still only showing a trace according to the urine strips. I have previously been in ketosis (years ago and 2 kids ago) and got in super fast. This time, I can't seem to figure this out. The only carbs I have been eating are in full fat items and broccoli, asparagus, zucchini, but in very small quantities. Can anyone help? I am getting frustrated!

    The urine strips are not always very accurate. Generally, as long as you keep your carbs very low you will be in ketosis and there's not a need to measure exact numbers of ketones.

  39. Likt
    I’m also returning to keto. I lost weight the first time and gained it back after 2 years off keto. But this time it seems impossible. What gives? Blood test, under 20g carbs, 60-80g protein. Is this because my body realizes that I’m doing keto and not tricked into starvation?
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