I’m primarily making this post to get the advice from the great experts here on a particularly tricky case (me). This is where my thinking is currently headed, and I’m open to anything else that could be a root cause for my current issue beyond one of these three things:
- Any known issues with Crohn’s/ileitis and the keto diet
- Any known issues with PrEP/Truvada for HIV prevention and not being able to obtain ketosis or lose weight
- Hormonal issues or other known indicators that may be undermining ketosis and/or weight loss, due to PrEP/Truvada or something genetic
First, I want to table discussion around the minutia of what I’m eating/drinking; I’ve seen other threads try and tackle the issue of weight gain on keto but those threads seem to inevitably honed in on one very small thing that a person listed must be the cause of the problem. I can say with very high certainty that I have been completely compliant with the keto diet principles around what goes into my body and have heavily researched and planned everything out based on credible keto diet books and guides. This is not my first time on keto; I’m very aware of hidden carbs and hidden sugars in foods; and am in general just very meticulous, at great expense both time-and-money-wise.
In terms of exercise, I have purposely done low-resistance, steady aerobic exercise to avoid putting on muscle mass/increasing the scale, and exercise with moderate intensity three times a week with intermitted walking in between (I take public transit/walk to work). But again, I’d really like the focus to be on my broader questions. All I can say is I don’t believe exercise is the problem here, just like I don’t think food/compliance is the issue.
Next, some context about my experience with keto.
I did the keto diet successfully a year ago, at the 20 gm or less carb level, for about a month-and-a-half. I was testing in at “Moderate” to “Large” on the strips starting after the first week; had the secondary benefits of reduced appetite; and definitely had the keto flu, which is eventually why I stopped doing it. I lost about five to eight lbs. from start to finish.
I was learning during that time and it turns out I was making a few mistakes with some foods I had assumed were safe. Surprisingly, I was still in that “moderate” to “large” phase in the strips.
The only two significant changes between then and now are A) I’m actually even more compliant now on keeping the carb count and calories low, and B) I started taking PrEP/Truvada 9 months ago.
Now, here’s what’s going on right now:
I am male, 6’1”, was about a 34” waist and weighed in at 210 lbs at the doctor five weeks ago. I full-on adopted the keto diet again the next day at the 20 gm carb or less/higher fat/etc. level. Yesterday, five weeks after that weigh-in, I weighed 224 lbs on the same exact weighing machine with roughly the same exactly clothes/shoes, other than my pants are 36” now.
I’ve been using keto strips and started coming out at “trace” on the strip after a few days. Then, after about 10 days, I started coming out as “small,” and peaked at somewhere between “small” and “moderate” at about three weeks in. The past two weeks, I’m hovering very close to “small.”
I noticed there was a problem at about that 10-day mark, when my 34” pants suddenly became very, very tight on me to the point I couldn’t put them on. It’s like suddenly a switch occurred, and whereas I would have expected to begin losing weight at that point, suddenly weight was piling on. I’m completely on 36” pants now (and 14 lbs heavier, apparently).
The past five weeks, I’ve had secondary signs that I am in ketosis despite my readings not indicating I am (though my strips are expired by now):
- My appetite has significantly decreased. Sometimes I’m not even hungry anymore; other times I’m less hungry than I would have been. I’d say my hunger has had a 40-50 percent reduction the past five weeks.
- I’ve had to pee like crazy, at some points I’ve had to pee a lot within just a one-hour time frame and rushed out of a meeting because of it.
- My face has significantly improved in appearance/bloat, with excess fat in my chin appearing to have melted off. Just looking at my face, I’d say I was at about 205 lbs. again. My stomach and love handles have also improved to a lesser degree than my chin/face.
However:
- I’m surprised, though, that I haven’t felt the keto flu. At no point have I felt like “Oh, this is it.” I’d say I’m experiencing about one-forth of the degree of keto flu symptoms when I first did keto last year.
- My pants situation has gone to the extreme, as if my fat distribution went from my chin and abdomen to everything below the waist.
Here’s why I’m trying to investigate complications to the keto diet/situations in which keto could make things worse.
First, I was diagnosed with ileitis, a type of Crohn’s disease, in my teens. Accompanying that are severe sensitivities to gluten, HFCS, alcohol and other foods that are just bad anyway. Crohn’s has caused my weight to fluctuate over time due to the relapse/remission cycle, with my relapses resulting in me obviously not digesting food at all (just goes right through me). Throughout the cycle I seem to gain a few pounds each time as my body exits starvation mode. I began taking Pentasa about two years ago and haven’t had a relapse of ileitis since.
Second, I started taking PrEP/Truvada as I’m a high-risk group and it’s the right thing to do. I don’t have HIV and take it as a preventive measure. I’m finding inconsistent information online about how Truvada affects weight, other than it does, and there are known issues with Truvada and fat distribution.
Here are the medications I’m currently on; the latter of which I started 9 months ago, which is in between the time I first did keto and now.
- Pentasa, 500 mg for Crohn’s/ileitis
- PrEP/Truvada, 200 mg for HIV prevention
Last details:
I’ve asked the doctor I saw yesterday to evaluate me for any blood-related indicators of something else that could be going on to cause my extreme weight gain the past five weeks. He is going to do a thyroid test, and I asked him to do a resting insulin test. It feels like there should be more he should be testing, and after pressing him on it, he basically told me that this issue is beyond his area of expertise and I should find another doctor.
Hopefully someone on here can help me identify what tests I should be doing to potentially catch what could be going on.