5 months on keto, but getting more and more tired. Help?


Hello All,

I’ve been on a keto diet since the end of December 2017. Testing shows I’m making ketones (low in the morning, 0.5 – 1.0 or higher as the day progresses) but over the last few weeks I’ve become exhausted all the time, and dizzy and a bit disoriented – sort of removed from myself. I’m finding it hard to function and work. I think maybe my brain is just not getting enough gas somehow – a kind of energy starvation.

I sure would appreciate your suggestions on how to troubleshoot this. Keto is very good for me for several issues (see below) and I sure want to keep up this WOE.

My background:

I’m 48 years old, male, 169cm / 5"7 height, total weight 195lb / 88kg, lean body weight 150lb / 69kg.

My current known issues are:
• Hashimotos, with Thyroid Peroxidase (TPO) at appx. 800 IU/ml. I’m working with a functional medicine guy and now testing various thyroid / adrenal supplements.
• Chronic fatigue for almost a decade
• Anxiety / panic attacks.
• I’m currently not exercising. That petered out 2 years ago as energy levels dropped. If I have a good day, I’ll do a walk.

I transitioned to keto in December 2017.

It was a hernia that pushed me into ketosis. The hernia starting about a year ago and was extremely painful. I had surgery that helped for 6 months, and then failed. I was in severe pain and went back to my surgeon, and he told me there was nothing he could do.

So I figured the one thing that would help would be to lose weight. And the one sure way to do that was fasting.

So I read a bunch of Dr. Fung’s stuff and watched some extended fasters on youtube and did a fast for 37 days:
• 2 weeks of salt + water
• then 2 weeks of bone broth with fat
• then the remainder with slowly increasing protein (meat).

Towards the end of the fast, I started to feel fairly unwell. I think there was an electrolyte imbalance, but I wasn’t able to figure it out, so I came off the fast into a zero carb diet.

That didn’t work well, so after about a week I settled into a keto diet.

My current macros in cronometer: appx. 23% protein, 73% fat, 4% carb.

That’s give or take 110g protein, 20g net carbs, and 160g fat.

I’m also testing higher carb levels to see how I do at 10g intervals, taking each level 3days at a time. E.g. 20g, 30g, 40g etc. Blood testing shows I’m still in ketosis.

Total calories consumed daily is appx 2300kcal.

These number vary from day to day, but I’m strict and not cheating. I’m preparing all my own food, not eating out, and no keto frankenfoods.

Note: Over the past week or two my calories have gone up – sometimes doubled – as I have been trying to find some kind of food that will turn into energy. Most of the extra has been fat, and I have gone as high as 87% calories from fat. I also started carb cycling last weekend – 2days carbs (up to 100g), followed by a fast day, then the rest of the week keto – again, trying to find energy. I also dropped my protein to 1gm/kg lean body weight.

Blood ketone measurements are low in the morning, then rise throughout the day to 0.5 – 1.0 by early evening.

It’s a fairly limited diet – steak / ground beef, beef fat / sheep fat, egg yolks, and a variety of leafy greens, avocado, and low carb veggies. Some cheese, nuts and blueberries. I tried an orange but that seemed to trigger an anxiety attack.

I’m supplementing with vitamin D, C, K2 and I’m taking digestive enzymes – they seem to help me with fat digestion. In the last couple of days, I’ve significantly increased the amount of enzymes I’m taking, again to try to find energy.

So the good news:
• After some refeed weight recovery, I lost 8kg and put my hernia into remission.
• My weight was stable for several months, lately it has started to come back.
• My anxiety is in remission – instead of 3 panic attacks a day, I have had 3 panic attacks in the last 3 months.
• I no longer need starchy carbs – I can get through the day with leafy greens and low carb veggies only.

The bad news:
• 10 days after ending the fast – at the end of Jan 2018 – I got a winter flu. I was sick for months – hacking and coughing up phlegm, poor sleep, and with low energy.
• Near the end of April, I thought it was behind me. I seemed to recover for a couple of weeks – I even had a day where everything was awesome – I got more done in 24h than in the previous 3 months. Then things settled into moderate energy levels.
• And then at the start of May I got sick again – I felt sick for a week, and then that passed, and I have been left with heavy exhaustion and brain fog. So bad it’s been hard to function.

In the last month, I’ve had a three short periods where I felt absolutely amazing – for a day, and twice for half a day. Good energy, good mood, a feeling of wellness.

I hope that is the keto at work, underneath this current exhaustion. But I can’t seem to fully shake the tiredness, and I can’t seem to get to a place where my energy levels and mood are consistent.

As I mentioned, I’m now upping the amount of enzymes, and upping electrolytes as well – drinking salt water and supplementing with a little potassium and some magnesium. Also trying various carb levels, dropping protein to 1gm/kg lean body weight and carb cycling.

So the bottom line is 5 months in ketosis, blood ketone tests show that I’m making ketones, but I am at very low energy – just getting going in the morning is a success at this point.

Any suggestions on how to troubleshoot this exhaustion would be most welcome. Have you heard of something like this? Tweaks to consider? Possible solutions?



(TJ Borden) #2

You mentioned adding salt to water while fasting, but what’s your salt intake been while feeding? Are you getting enough magnesium and potassium?


Hi TJ,
Thanks for getting back to me so quickly. Salt intake while feeding is good, I think. I use a lot. I’m also supplementing by drinking salt water throughout the day. I’m taking 400mg magnesium daily. I’ve only supplemented a little potassium - I’m starting now to add a 100mg/day tablet. I’ve tried the No Salt potassium chloride substitute but it seems to wreck my stomach.

(Bunny) #4
  1. Intermittent fasting when you have Hashimoto’s low thyroid
  1. Hashimoto’s and fatty liver — the culprit is not dietary fat “…If you are not managing? your autoimmune Hashimoto’s hypothyroidism this also may contribute to fatty liver disease. Research suggests a strong link between hypothyroidism and fatty liver disease as proper thyroid function is so vital to fat metabolism and blood sugar regulation. …”
  1. Carbohydrates and Thyroid Health “…A number of small scale studies have shown that after a period of starvation, refeeding with carbohydrates – but not with protein or fats – normalised thyroid hormone levels (8, 9, 10). In one of the studies, researchers evaluated the effects of restricting carbs at various levels (85, 44 and 2% of total energy intake) on thyroid hormones in 6 healthy male participants. …”

Dr. David Jockers explains how to apply a cyclic ketogenic diet and when the best times are to cycle in and out of ketosis. For more information go to:

A. Burn Fat with a Cyclical Ketogenic Diet

B. Using A Ketogenic Diet For Hypothyroid

  1. The Effect of a Keto Diet on Thyroid Function - Dr. Amy Myers
  1. Tired Thyroid Facts That May Surprise You?
  1. Does Fasting Slow Metabolism (effect on thyroid) Thomas Delauer

Dr. Berg talks about Intermittent Fasting and your thyroid. Many people are concerned about intermittent fasting because they think they will lower their calories and damage or slow the already slow thyroid. As long as you keep the calories the same or keep your nutrients the same and eat less frequent meals - you will not slow the thyroid. In fact, intermittent fasting can help convert T4 to T3 improving the thyroid. I do recommend doing a ketogenic diet with intermittent fasting.

Selenium (Nutritional or Brewers Yeast), and iodine is best for the thyroid, and I recommend taking sea kelp. Make sure your sea kelp is organic, is clean. You may want to avoid doing too many cruciferous vegetables as they could slow the thyroid even more. Vitamin A and D are also vital for the thyroid and “Virgin Cod Liver Oil” is the best for that.

So so cold!
Pancreatic Health
(8 year Ketogenic Veteran) #5

Low energy / exhaustion suggests two items to check, fat intake and sodium intake. Sounds like you have tried increasing your energy by adding fat. You gave me some of your stats, however I do not see your height. That would help me understand. It sounds as if you are doing keto and fasting correctly, so to speak. The thyroid may be what is causing your issues. Stress and lack of proper rest can also derail you big time. The take away from me is going to be consistency. Decide on a macro amount and stick with it for several days to judge it’s effects. Also fast a minimum of 2 or 3 days a week (at least an IF or even a 24).


Hi Brenda - thanks for the fast response and your thoughts. I’m 169cm / 5"7. I’ve updated my original post. I’m pretty sure I’ve got the fat intake and other macros dialed in correctly. I think I’m getting proper rest too. What is the thinking behind fasting so much? How can that help energy levels? Based on TJ’s comment, I’ve also upped my electrolytes. That seems to be helping a little, but I’m still pretty drained.

(David) #7

It sounds like you have had a pretty significant illness over the last 6 months.
I wonder if the priority should be making sure you are fully recovered
to establish a keto baseline to work from.
Have you thought about following a pretty simple keto meal plan
for a few weeks and let the weight and energy levels follow their
natural path until the illness is right out of your system?


I would absolutely focus on getting your thyroid function right - most likely with treatment. I am on a synthetic combo. I would prefer NDT but that is not available in France. T4 alone though is rarely good enough so push to get the right treatment for you. That is KEY. You get that sorted and everything else is quite likely to start falling into place. You will most likely get the tests you need as you are working with someone on it but the list to get is…

Free T3 (arguably the most important)
Free T4
Reverse T3

I would recommend supplementing according to need so get tests for D. There are a few things that tie in with thyroid and also fatigue which might be worth checking…
Vitamin A
Vitamin D
Full iron panel inc folate

Calcium and PTH are useful tests while you are daring blood if you have the funds!

Personally, I wouldn’t be playing around with fasting too much beyond IF until you have got your thyroid sorted out. Get good solid meals - again, I would say 2 or 3 meals a day rather than one. Make sure you are getting enough food and not under eating. I would throw the carb-cycling out the window at least for now and just settle into a routine. Getting stability and balance while you sort out your thyroid is key IMO. I would say you might want to increase your protein from 1g per LBM - that feels a bit low to me.

Check out this website if you haven’t already…

You might also find Amy Berger’s articles on thyroid useful…

Just my two cents :smiley:

Hope you get things sorted asap


Thanks, atomicspacebunny. Much appreciated (again). I’ll dig into the links.


Thanks, David.
It’s establishing the baseline that’s been the challenge :slight_smile:
Since I’ve gone keto, I’ve either been sick or low energy.
I am going to go back to where I was at the start of May, with lower carb levels, and see if that has any positive effect.


Hi Daisy – thanks for getting back to me and for the suggestions + links. Yes, I’m working with my functional medicine guy to get my thyroid sorted. I’ve been supplementing with D, but I’ve been off it for a few days, so I’ll pick that up again. A is worth checking as is the iron panel. What do you see as the issue with carb cycling? I basically had a routine that seemed to be working, although I was sick, but then energy dropped out. I’m going to back up to where I was in April – lower carbs, a bit more protein – to see if that makes any difference. The challenge is to find a routine where I have enough energy to function so I can take care of the thyroid and other issues. Oh yeah, and keep my livelihood going :slight_smile:

(Ken) #12

Lot’s of good suggestions here. I’ll consolidate a few of them to try.

Are you eating enough calories? Have you tried more fat? If so, you could also manipulate you macros to 60/35/5% to allow more limited glucose production via gluconeogenesis. This may help with energy balance. It may not, but it’s worth a try.

Salt intake. Coupled with water. Both low salt and dehydration can cause fatigue. Make sure you’re getting plenty of both. Your urine should be white or light green. Any darker indicates possible dehydration.

Iodine. Are you blood type O? Iodine supplementation supports thyroid function. One drop of medicinal iodine iodine in one of your drinks per day could help. Iodized salt helps as well.

Limited Carb intake. Rather than adding a fixed amount of daily carbs, flip your macros for a day, or even two. Use mainly simple carbs like fruit and other sugars, I recommend avoiding starches. It’s kind of a basic CKD, but without the massive load required for glycogen recompensation. If you’re training, total recompensation is an option. If the Carb method is successful, have them periodically rather than daily. After a Carb day you want to have a couple of fat days afterwards to allow glycogen to drop and reestablish lipolysis.

Good luck, solving this issue will require a little experimentation.


It depends really what you are doing when it comes to carb ups. I mean, I don’t have issue with it per se if it works for you. What I would suggest is a good idea though is to get as much as you can stable and remove any possible confounders. Carb cycling by its nature is throwing your system out of whack temporarily. It just makes sense to me to get on a very even keel while you work out your thyroid - hence put as little stress on it as possible. If you feel better with a slightly higher carb count daily then go with that. There are carb ups and carb ups right? Some sweet potato is a different ball game from half a baguette! What you really do need to stay away from is gluten - that is key for Hashis. I have seen my antibodies level improve since being keto.

I would test D to see if you actually need it - you may have already?

I am a very logical person and it just makes sense to me to find a nice steady balance while you get your thyroid sorted. Than start playing around with tweaks her and there - fasting regimes, carb cycling and so on. But that is just my opinion and may not be the best advice for you at all. It just often helps when trying to find the right level of one thing to keep everything else stable.

Are you taking any thyroid meds now? If not, you will see significant improvement when you do. It may be that there is little you can do to really make a difference until that happens.


I think you need a second opinion. This may have nothing to do with keto. It may have something to do with your thyroid or not.

Several health care podcasters I have listened to over the year have say that people tend to praise or blame keto for everything that happens but not everything that happens, good or bad is because of keto. I would get a full check up and full blood panel and see where it leads.

If you are anti doctor, although does not sound like it, I would instead stop keto for a week and see if you feel better. Do not eat twinkies but do more paleo carbs. Eat sweet potatoes, buternut squash, quinoa and fruit and cut back somewhat on fat and see if you feel better. If you do then I would look into Paleo or possibly perfect health diet. Stick to whole 30 type foods, no gluten and no junk (if you have tHasimotos thyroid issues gluten is questionable anyway).

The fact that you say the weight is returning even as you continue to eat keto does make me wonder if there is not hidden sugar in your diet or it needs to be adjusted anyway

(Mary Gillis) #15

KetoKeen - I too have hashimoto’s and am dealing with a Keto/Hashi’s malfunction lol - my initial loss of 15 lbs was seen at a reasonable 1-2 lb loss each week… I felt good! I still feel better now than when eating carbs however the energy levels have reduced significantly and the weight loss has stalled completely… albeit I’ve not gained (except intermittent water weight gain/loss) - I’m 51yrs old, post menopausal but still take estrogen or am tormented with hot flashes.
I was having extreme energy loss by early evening and a visit to my endo resulted in her modifying how/when I took my liothyronine - I still take the same amount but I now take 75% of it early morning (fasted) and the remaining 25% early afternoon (non fasted)… the difference in energy level for the balance of the day is amazing. You may want to discuss this with your HCP (health care professional). Different HCPs will address it differently I’m sure… but the low energy levels are awful - I feel your pain! :frowning:

I got married early May and had an accident on my honeymoon which resulted in a trip to the ER - dermabond to close the wound above my eye… which resulted in an allergic reaction to the dermabond… I began using neosporin (petroleum base) to weaken & remove the dermabond which resulted in an allergic reaction to neosporin UGH!!

The whole experience was awful! And I have now been in a stall ever since (I tried a carb load day hoping that would be the trick… it wasn’t) - my eye is still slightly swollen so I know wonderful Hashi’s inflammation is still hard at work. I take magnesium supplements (vitamin & lotion), Vit D, Turmeric, B12 and selenium.

Please let me know if/when you find some relief -
Frustrated beyond belief! (Not blaming Keto - I know it hashi’s fault)