Advice for my TOFI husband please


Hi Everyone, my hubby has started keto as he wants the energy, mental clarity and hopefully reduction in early osteoarthritis. However he isn’t overweight, if anything he needs to put a little on. So any advice as really want to get him fat adapted asap. He’s 5’11" and weighs 70kg. Thanks!

(Katie the Quiche Scoffing Stick Ninja ) #2

Fat adaption can take anywhere from 6-8 weeks, sometimes longer, especially if the person has a lot of metabolic damage. Typically that’s overweight people who have been dieting for years.

My only suggestion would be to make sure he keeps carbs to 20g, meets his protein goals and eats fat to satiety.
You can’t really rush the fat adaption process, there’s a lot of internal processes at play repairing prior damage.

(Ron) #3

You can help him maybe get through the keto flu period easier if you help him keep his electrolytes in balance. Try this as it will help -


Thanks Ron, I’ve already got him on magnesium, sodium and potassium supplements. I’ve been doing keto myself for the past 19 weeks with great success. However, I’m concerned about him losing weight as he really doesn’t need to. I was thinking to up his fat consumption but wondered if anyone had experience of keeping weight steady whilst the internal body repairs itself?


Thanks Katie, it took me 6 weeks to achieve fat adaption. Will just need to encourage him to tuck into more butter and bacon!

(Alec) #6

No specific experience here, but I think he should go just fine on keto. He needs to make sure he is eating to satiety, and if that results in some unneeded weight loss, he could either try to get more fat in, or alternatively eat a few more healthy carbs.

Does he work out/exercise? Does he need/want to build muscle?

(Ron) #7

I think that weight loss is not the primary focus of the body when one starts keto. Healing metabolic disorders and reducing inflammation takes precedence and weight loss is just a part of the healing process for those that need it. The body has the uncanny ability to establish proper balance for optimum health. Chances are that if he needs to gain weight then the body will control the amount of energy it requires to allow weight loss or growth accordingly. My suggestion would be to continue on as anyone would beginning keto. Set his macro setting on the calculator to maintain or even gain (if you want) and allow him to eat to the macro levels. This will give him a feel for the amounts he should be consuming so by the time he is adapted he has a good understanding of what his TDEE requirements are. After that the counting is a personal preference thing. His weight adjustments will be determined well after adaption so I wouldn’t worry about it, :smile:
Keep us posted how it’s going.


Hi Alec, the only exercise he’s doing currently is walking about 2miles/day. This is due to having been through an extensive flare up of osteoarthritis in the knees and at same time bursitis in both shoulders. He is being treated by an exceptional sports physiotherapist who also practices acupuncture. We intend to take up yoga at his suggestion. Since Xmas he has lost a lot of strength generally and so he will want to build muscle strength but waiting for his physio (private in UK) to advise when.


Thanks Ron, I will. He knows that I’m well read on the whole subject so leaves it to me. However my needs are different to his! I’ve got weight to loose!!! :smile:

(Alec) #10

I think if he can do some exercise he will gain some good benefits from it: he will get hungrier and be able to take in more fat, and he will be building muscle and gaining/maintaining weight.

(Maha) #11

Here is some information from diet doctor for gaining weight on low carb and healthily.

(Bacon is a many-splendoured thing) #12

Nutritional ketosis is not primarily about losing weight, it is about regaining metabolic health. Losing excess fat is part of the return to health. Since your husband has visceral fat, he will lose it as part of his return to metabolic health; you want this to happen, because visceral fat is a warning sign of diabetes, stroke, and heart disease ahead. Whether your husband’s total weight will change is up to his body. If he follows the recommendation to eat fat to satiety, it is likely that he will get most of his calories from his food, while the body burns off the viseral fat, and then gradually he will increase his food intake to compensate for the loss of the excess fat. Given an abundance of energy (i.e., calories), his body may even add lean muscle mass, but that’s hard to predict.


Excellent, thank you Maha!


Thanks Paul for your reply. Greatly appreciated. He has been gradually reducing carbs over last few weeks in preparation for going keto as of last Thursday. He’s already in nutritional ketosis as feels full constantly so all going to plan. Plus now feeling lacking in energy this evening so may be starting with keto flu. He’s doing really well so all good!

(Robert C) #15

If you haven’t already, one thing you might do is see where you really are on the “TOFI” part of the title.
Have him get a DEXA scan - that breaks down the body really well.
It shows the amount of muscle that is really there, how much fat and, more importantly, how much visceral adipose tissue he might have (fat around his internal organs - which can cause real problems).

I believe, if there is a lot of visceral adipose tissue, he would then be motivated to do keto hoping for that number to go down (vs. just weight going down).


Thanks Rob, he’s already motivated to do keto :smile: Will look into the DEXA scan in the UK as not available on NHS unless a medical need. Food for thought though!!!(as long as its KETO of course)

(Robert C) #17

In the US they are only $45. I’ve lived in London and Scotland. Just my opinion but, I would not let NHS limits stop you (unless you are happy with the average outcome of people that use it exclusively).

(Christopher McCollum) #18

Sorry to interrupt, but what does “TOFI” stand for? I’m new here and trying to learn.

(Bacon is a many-splendoured thing) #19

It is a medical term that stands for “Thin on the Outside, Fat on the Inside.” It is a real medical term, believe it or not. (I forget which doctor coined it, however.)

The converse is the term MHO: “Metabolically Healthy Obese.”

These two terms were coined to account for the fact that, while obesity is often equated with metabolic dysfunction and thinness is often equated with health, in reality there are thin people who are metabolically ill, and obese people who are metabolically healthy. We are slowly coming to understand that metabolic health is more about insulin resistance and inflammation than anything else.