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?

More

A keto diet for beginners

Keto video course

Top ketosis videos

66 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?.
    Reply: #28
    Read more →
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All Comments

  1. Dan
    I use "myfitnesspal".
    It's going to cost ya but it's worth it ?.
  2. Robert
    Wow. Thank you for the insight. Looks like I have to go to the grocery store to stock up on low and no carb foods. I've been eating out following Keto guides, but I don't think restaurants are honest in there nutritional information.
  3. Nelia
    I really need help !! I eat on such a system for three weeks, but for some reason I am gaining weight, instead of losing weight .. today I did a test of ketosis, the strip showed 10 ketoses. What I do is not right, I try to lose weight and not die.
  4. Carolyn
    There isn't- if you follow the provided menus.
  5. Dan
    Not certain where all the hate is coming from about this being a restrictive diet. I threw all the foods listed for the "Eating under 20g of carbs" observed day into MyFitnessPal. The totals for the day came out to 1,590 calories, 10-11g of digestible carbs, 64g of protein, and 145g of fat.

    Netting 1600 calories in a day when so much of it is fat hardly feels restrictive. Sure, it's restrictive if you compare it to a supersized double quarter pounder meal with a HFCS soft drink, but it *is* a diet.

    I only wish that there had been some information about whether keeping the carbs under 20g but letting the protein get up to the 80-100g range (about 20% of your daily calories) would also have triggered ketosis.

  6. Hunter
    Another reason you might not be in ketosis(this is for when you are already keto adapted): Fructose especially exceeding 2-3 grams of it (and for sure at 5g/day) will hard stop ketosis for until it's metabolized and used (so you will stay out of ketosis for quite a long time if you have insulin difficulties, which you almost certainly do if over 30 or you desire to be in ketosis in the first place) up by your red blood cells and/or brain, fructose has a preferential use by the body in certain amounts after which it is malabsorbed (in everyone, though for some that threshold is quite low) malabsorbed carbohydrates can enter the blood stream intact and cause vein and artery damage due to how sharp the crystals are, your body will then deposit plaque(fats) to seal the wounds and protect the vein walls from exploding/etc and lead to other problems like cardiovascular issues. This is especially important to take note of on high fat diets, berries while excellent usually contain 0.8-1.5g of fructose or so per handful to cup with the other nutritive sweeteners often described as 'carbs' (really they are organic acids with a much lower calorie count than glucose(carbs), and don't necessarily get metabolized into sugars)) but things like say huckleberries you'd be looking at 13 carbs of which around 7-9 are fructose! Raspberries are deceiving as while they are 3 grams carbs it's almost all fructose which means they have 3x as much SUGAR as strawberries (which are 6-7 carbs per 8 oz but only 0.8-1.7 grams of which are metabolized as sugar/carbs/fructose the rest being things like malice acid, sorbitol, mannitol, xylose, oglisaccrides, etc). A single meal/snack dose of fructose is much riskier to exiting ketosis for awhile than other means.

    Eating too much fructose, glucose, or sucrose will also carb adapt you in just three days, then you will have to spend WEEKS becoming fat adapted again (this is fine if you eat carbs to store up fat only when they would be naturally available to you in the wild, a span of ONLY a few days to weeks in the spring or winter when berries/honey/rose fruit(crab apples, plums, cherries) would be in season naturally. As it's important to carb adapt in the wild quickly as just like becoming keto adapted (through diet, fasting is VERY quick alternative if you have developed the skill to fast for a week or 2 without breaking) there is an immense physiological dysfunction phase when adapting to nonprotien energy sources.

    The TYPE not quantity of protein more directly influences exiting keto than slow digesting or fiberous carbs (also fiber WILL knock you out of ketosis, as nonsoluable fiber does get turned into nonfat compounds by gut yeast and other fungi, celery and sulfurous vegetables are especially risky for this as they contain large amounts of cellulose and certain compounds these organisms can colonize for several weeks in your gut (or years for some 'gums' without digestive 'events/flushing').

    For instance eating certain amino acids more than your body needs THAT PARTICULAR DAY even just a few grams of say phenylalanine or Lucien beyond what you need will behave more like eating sugar and kick you out. This is more risky with noncheese dairy or nonmetal sources of protein.
    Fish, shellfish and red meat (up to 9 ozs of the former and 4 oz of the latter) should not cause problems, but poultry and nonfatty pork and of course most nonseed nonanimal protein sources(except algae) will quickly kick you out that day though won't make you become carb adapted or anything so you just have to wait 2-72 hours(plant to meat) for the protein mass to be digested and expelled. The exception might be raw meat as it is digested even more slowly and up to a certain protein amount (about 1-2lbs of meat weight raw, up to five lbs for people with full wisdom teeth and completely developed haw(very rare outside of hunter/gatherer tribes and Okinawans), however such amounts are done in a feast manner and no or little food is eaten for several days to weeks after as the protein subsists then through long fasting/famine periods taking a week or two before it passes and preventing protein loss from muscles while fasting.

    Alcohol: while alcohol is metabolized into one of the ketones it preoccupies your liver and prevents endogenous ketosis and if it takes long enough will ALSO knock you out (but such binge drinking will usually end up with you fasting for several days due to being unable to eat food anyway) this is great in famine situations as things like beer, ale and mead are loaded with vitamins and mineral sparing substances as well as being protein sparing (with exercise like long walks or climbing trees) to a degree during long periods of time without food or adequete clean fresh spring water (mineral, magnesium, iodine, and silica rich water in particular) provided the alcohol is unfiltered with all the mother from the fungi and bacteria.

    MCTs and omega 3 fats (think eating caviar or fish livers whole/unprocessed, especially cold water cod, or fatty fresh fish like just caught and eaten mackeral, something ONLY a fisherman can do (except in a small town in Japan that has a unique way of keeping them fresh and alive till delivered to certain eateries to be eaten immediately)(though you could also eat meat like snakes or bear as both can be very oily organ meats loaded with it! Insects , worms, and some spiders as well!) directly influence ketogenisis especially in 4:1 diet ratios and can put you DEEP in (4-8 mmol or in my case very quickly 4-16 or more) so must be used very precisely which requires a lot of experimentation and diet balancing (enourmous amount of frankly quite painful to sickening experimentation unless you hit your magic amounts off the bat or just have a good relationship with your enteric nervous system and listen carefully to and follow its feedback (which is actually what all the experimenting teaches you! As your 'needed numbers' change DAILY(or whatever your cycle is if non24).

    As you can see there is lots of variables, however something more important to note.
    The article writer failed to realize their initial anount(not the first day but second day) was likely adequate to renter mild ketosis, BUT IT ALWAYS TAKES SEVERAL DAYS at least to renter ketosis once you exit (baring a few genetic exceptions), always. So testing/experimenting daily with changing the amount DAILY tells them nothing they have to eat the same things in the same amounts FOR THREE DAYS each to actually tell if that amount is correct, with an exception being if you get massive results (i.e. Deep ketosis) 4 hours after a meal (or even immedeatly! You can FEEL it in your, let's say liver, when you switch HARD into ketosis without ketoflu).

    As an amusing anecdote: being in deep ketosis makes you feel similar to being drunk (or rather being drunk makes you feel similar to the immense feelings from prolonged fasting, all due to the acetone/acetotate/acetotetic Acid your brain's gilial cells are feasting on as among other ketones it is the PREFERED energy and one of the most clean energy used by many parts of the brain, some of which can't even function on other exigencies substances! This is a big reason why many animals like fermented food (alcohol is also 7 calories per carb much more efficient than the measily 1.4-4.7 calories per carb the fruit or seed originally had per unit!) as it both generates a state similar to prolonged fasting AND provides a metabolic state great for storing up LOTS of fat for yep you guessed it, prolonged fasting! Of course eating fermented things all the time would be a huge no, short feasty bursts a few days a year only.

    Still it's very fun to feel very very drunk while not actually being drunk at all (none of the physical impairments or detriments but all the other 'fun' effects like increased clarity of mind, in the moment focus, keen ability to rapidly shift focus to what's needed in the moment, etc. less physical pain (from inflammation, etc), decreased symptoms from illness, more 'childlike' state of existence(FYI children(whom don't eat sugar) are constantly in and out of ketosis throughout the day USUALLY regardless of diet(baring the diabeties inducing western sugar/nonnutritivecarbs heavy diets, interestingly diabetes tries to force you into ketogensis anyway due to again insulin difficulties from poor life choices, carbs are again only for VERY brief windows of feasting during such tiny windows in the local environments flora, carbs are extremely rare in the wild for noninsects/birds(hummingbirds, etc))

    Essentially OP was eating a very non ketogenic diet, switched to a correct ketogenic diet the second day, then kept going deeper each day without giving each meal plan it's appropriate amount of time and though their preconception bias was correct when 'results' finally appeared, but failed to realize similar results would have been gained from previous/larger amounts had they just been patient, as entering and reentering ketosis require lengthy time on specific macro ratios, though once you are fully in a ketogenic state you actually have a lot more flexibility, especially with deep ketosis.

    Also as an aside there are some times you don't want to be in ketosis (certain infections where you NEED your inflamitory response to be in overdrive for instance, which keto mildly suppresses, as well as infections where you DONT WANT an energy supply to your body (but you would fast at this time anyway due to how uniquely fasting repairs your immune system, which will put you in a special ketogenic state instead of a nutritional ketogenic state (some very important differences, due to how your liver and digestive system consume resources and filter and combat food vs not having to expend 70% of the bodies resources on combating food and it can focus on repair and eliminating other threats instead) OR WHEN YOU NEED to store up body fat (it's very difficult to store calories from fat as well, fat while in ketosis!) or under certain nutritional deficiency situations where you would have to eat quite a lot of plant matter medicinally.

    Historically humans and non ruminants only ate plants for medicinal purposes, though a special relationship is had with fruit for certain animals (and indeed plants intentionally make their fruits nutritive exclusively/only to the species that help spread their children! This means ONLY certain fruits are beneficial to humans/apes and these are mostly quite sour to slightly sweet citrus fruits and many tropical fruits from the bands humans originated, additionally humans can interestingly most all the same berries that bears can due to eeirly similar biology and digestive anatomy between many humans (Neanderthal and Donovian and 'that other one' in the deep north descended 'humans' so this doesn't apply to African only anscestry that has no genetic admixture from other hominid species) and some bear species. Eveidence of co-evolution from eating lots of animals that ate certain berries and eventually being able to eat those certain berries themselves, or quite possibly the INTENTIONAL shift in nutrient and antinutrients profile of the fruits/ovaries of the plants specifically to accommodate humans, bears, and similar (dogs and wolves and some other canids and some felids too!) creatures, so the plants specifically decided to make their berries edible to humans (of course humans developed cooking and chemistry so we can 'cheat' and disable or extract the compounds that are dangerous or nutritive to us specifically so we CAN eat them, this developed out of curiosity and/or nessecitay to geographical isolation and scarcity/availability). So perhaps if OP had cooked those raspberries in the traditional manner they would have entered ketosis sooner ;)? (Mere conjecture, but given modern humans lack of deep understanding of WHY things done in the old, very very slow ways were done that way, very possibly)

    This seems very wordy, but hopefully it answers every possible question, curiosity, and provided a full intuitive grasp about the real nature of this article as well as the real nature and complexities of ketosis.

    Reply: #66
  7. Lorna-Jean Thompson Anderson
    All that drama just to figure out that you were eating too many carb grams? GEESH!

    BTW-- you don't need to be in ketosis to have success on a low carb plan. I've lost 100 pounds at age 60 with hypothyroidism and no exercise after one year on a low carb plan that includes one or 2 low-glycemic fruits and one slice of Ezekiel toast daily, as well as plenty of greens and seeds as well as an ounce of raw nuts. NEVER had to be in ketosis which is unnecessary and not the healthiest state for seniors with medical issues.

  8. bcjams
    yeah but who thinks and measures in grams...i think in ounces always have
  9. Jen
    Ok, I am scrambling here. I have read this article, I read the article for women over 40 (I am 45), I am using an app to keep a close eye on my macros. For example, yesterday I ate 12g of carbs, 60g of protein and 120g of fat (way more than I thought I had). This has been a typical day for me for weeks and yet when I woke up this morning I was only at .4 mmol/L! WHY? I understand why I wouldn't lose weight with that many grams of fat, but why wouldn't I be in ketosis?!! The most I have been able to get through this whole thing is 1.3mmol/L. I am using a precision Xtra blood ketone tester. I am keeping track of even the most minute possible food ingested. I even put the one piece of xylitol gum on my app yesterday. Why does my body hate ketosis so much? HELP!!
  10. Kaitlin
    Jen - reread later in the day. Mine is always 0.2-0.4 in the morning due to the dawn phenomenon, but then raises to 1.0 or higher at night. By the way any measurement of ketones is ketosis, but it’s considered “barely” ketosis at 0.5 and lower. Many believe the sweet spot or ideal ketones to be around 1.5-3.0
  11. Jenny
    I bought urine test strips to see when I’m in ketosis, but after a few weeks, it was enough. I got really dry mouth and increased thirst. Which is very rare for me, so I guess that’s how I know now. And for some reason, I don’t wake up tired when I’m in ketosis. So I wake up in a great mood. This diet does NOT work for everyone. There are certain ways people’s bodies digest things or react to certain foods, but it works great for me. I love pasta, bread, and rice, so I’m only in ketosis a few days a week. PLUS intermittent fasting: I’m losing weight w out even working out. I’m glad that people are educating themselves on nutrition. Great post!
  12. Raegan Spence
    I have been fairly strict with my carbs and fats but sometimes go over my protein macros. I am losing weight still but not in ketosis according to my blood monitor. Will a diet drink take you out of ketosis? What about a drink sweetened with stevia? Any suggestions to get myself back in ketosis would be appreciated!
  13. Mira
    Every so often I have felt like I had no energy, despite being fat adapted. I assumed I was out of Ketosis even though my carb intake was usually under 10 g each day. I learned that fat wasn't the problem. My lack of energy was caused by carbs, even if I ate Keto rolls or pizza, and my weight loss dropped in half for the week. Even cheddar and mozzarella cheese in the amounts included in Diet Doctor recipes (ex. Keto Tex-Mex Casserole) made me gain weight. Either I avoid Keto starches, reduce cheese in recipes that call for it or tolerate low weight loss if I continue eating Keto starches or recipes with cheese.

    This is a case in point for those wondering why they aren't losing weight or why they've gained weight. The fat contained in Diet Doctor recipes and the starch in Keto pizza and rolls do not work for everyone trying to lose weight, even if they follow the serving amount.

  14. Joelle
    keto diet aside.....I would think just eliminating pasta, bread, flour, and rice alone would be enough to lose weight, especially for a carb junkie like me. I was so disappointed when it didn't work out that way. The scale didn't budge at all in a month. Nor did the scale go up when I was eating those things. I don't get it. My weight stays the same whether I eat carbs or not. Perhaps my body would lose weight only with basic calorie restriction (with all foods).
  15. Jen
    Where did you get so much information???? Wow! Did you copy any of it? How long did it take to type all of that?
  16. Aghork
    Starving himself? The butter, cream, beef and eggs alone are nearly 2000 kilocalories. The rest will have some too, but those are the main energy sources.
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