Hi, I hope someone in here can help me. I’ve been eating Keto for a few months after recommendation from my doctor due to PCOS. I have always been health conscious and has been eating low carb for the bigger part of the last decade. Now to my issue. I went back to my doctor a week ago because I didn’t seem to be able to get into Ketosis (I have a blood glucose and ketone meter). I showed him my results over the last few months and he was surprised because my blood sugars were excellent. He told me I’m probably not eating enough fat and told me to try eating 80% fat and 20% protein and stay under 10g of carbs per day. He said my ketones should be over 2.0 within a couple of days. It has now been a week and nothing has changed. My ketones vary between 0.3 - 1.0. I struggle to get 80% fat, most days the ratio has been 75/25, but always under 10g of carbs. I have an app where I put in every single gram of food I consume, so I know exactly how much I’m eating. I eat about 1800-2000 calories per day. My blood sugar is stable around 4-4.5 mmol/l.
In addition to this I don’t consume any caffeine, I usually drink alcohol a couple times per month but haven’t had any alcohol during this last week. I sleep eight hours per night, I work out 3-4 times per week plus walk the dog daily. I used to fast as well, ranging from 14/10-20/4 but it didn’t make a difference.
I feel really lethargic and weak. When I’m at the gym I can’t do much because I just feel so weak.
I don’t know what to do, I’m feeling so frustrated. I feel like I’m broken. I have tried to Google but everywhere just says “you probably eat too many carbs” which I know that I’m not doing. I haven’t found anyone with the same problem. Has anyone experienced something similar? Could there be something else that’s wrong? Some hormone problem or something? Or what am I doing wrong?
HELP! Can’t get into Ketosis
Sorry but your doc is giving bad info. The readings you’re getting most certainly do mean you’re in ketosis and very nicely too. It’s the absence of carbs that trigger ketosis, not the amount of fat you eat.
We advise against chasing numbers on the whole, as any reading at all shows you’re in ketosis. Some never get above 0.2 or even 0.1 but are still in ketosis and still get amazing results.
Hi ketopcos, I don’t think you’re doing anything wrong. You’re certainly putting much more effort into your WOE than me, as I just can’t bother measuring or weighing anything, I just keep my carbs to under 10 grams a day and assume I’m in ketosis. Considering the various health benefits I’m enjoying I’m sure I am. No water retention, joint/muscle ache or inflammation for one.
However, the thing to remember is this is all very individual, and affected by several factors such as age, one’s metabolism, hormonal disorders, meds, whether you are insulin sensitive or insulin resistant … And so the result and progress won’t be the same for everyone. For some it might take a bit more time, as the adaption and healing process could take a bit longer. But to me it certainly seems you’re doing everything right. I hope you’ll get lots of valuable input on this, as I’m far from an expert myself. And I wish you best of luck🙂
Sorry, I probably explained that badly. He meant that I’m probably eating too much protein so that the protein turns into glucose (due to my low readings). I was also struggling with not feeling full/satisfied, while at the same time not losing any weight (not a single kilo). So to eat less protein and feel more full, I should eat more fat. If I was feeling good it wouldn’t have been an issue but I’ve been feeling really tired and weak the whole time, so I haven’t gotten any of the benefits that I hear you’re meant to get while in ketosis. That’s why I think he wanted me to get over 2.0.
Thank you, hopefully it’s just a really long adjustment place for me. I want to experience all the positives that everyone is talking about haha
Hi Ketopcos, you may not get all the benefits or you may get different ones, I never got that clarity of mind I was hoping for, as my memory is still rubbish. As to energy, I feel you … I have daily fatigue due to my medication, Tamoxifen, however, I seem to remember the fatigue was even worse at the start of keto, when I switched from a high carb, low fat WOE to the low carb, high fat keto, and to keep it simple cut my carbs first to 20, then below 10, which is where I’ve kept it at. I remember feeling very tired indeed, and I do believe it was my body adapting to the new WOE, like a very low-grade, feverless flue. It did get better, but I can’t really remember when. But I began my ketogenic journey 12 Oct 2022. It’s an ongoing process of healing so really a journey as we discover what works for us. The condition I try to combat with keto or at least treat is secondary lymphedema (bilateral lower leg swelling) and lipoedema, as keto is beneficial for treating lymphatic disorders. But I’ve also suffered from an other illness, so I believe my old WOE was damaging my metabolic health. I believe if your body is in that kind of state, it might be a longer process to heal the body. Given the body’s amazing ability to heal itself, however, given it has the right building blocks, I certainly believe the healing we seek is possible, yet to various degrees and different time limits.
One thing about fat. To me it provides such satiety that I eat less protein on those days. Some days I’ll eat mostly fat, some days mostly protein. If I do find myself hungry, however, I always listen to my body and feed it accordingly, making sure I eat to satiety. It’s whatever feels right for you.
Hello - I think I can help here, because I am about a month ahead of you on a similar path for a health condition (not PCOS).
In general, people here advise against number chasing and explain that ketones over 0.5 are in ketosis - but when it comes to seeking for a high GKI ratio or a low Dr Boz ratio, then you are looking to raise ketones higher.
I can confidently say that your doctor has given you perfect advice, because I was in the same position as you - someone who’s been eating this way long term, and when I tested in a morning, my glucose was around 4.6 and my ketones around 0.8.
Like you, I was eating minimal carbs, having a small eating window etc - and I was quite surprised at the results.
I changed my macros to an 80/20 fat/protein ratio at the start of this year, and now my glucose averages 3.8 and my ketones average 3.2.
It took about 2 weeks of eating 80/20 to see an impact on the glucose/ketone meters.
You may find that you are ravenously hungry when you first start - and that might be contributing to you feeling tired and lethargic. If the theory of being fuelled by glucose-from-protein is correct, then it makes sense that we feel a bit rubbish as we move back to prioritising fat.
For me, this manifested in - no joke - an extra 1000 calories or more a day (I was eating around 2200 a day last year, settling between 1800-2500 depending on what I was doing in the gym. At first, doing this, I was eating around 3300 - now I eat - I double checked here…I do get up to 3300 some days still, but my average overall is 2700 - and I am currently sedentary through illness).
But before you get super scared because I know that calorie figure looks massive, I have lost size over the past month - and as stated, I am sedentary. So if I’m burning through 2700 calories, if you’re going to the gym and living an active life, you will likely be doing the same and/or more.
One of the keys with 80/20 eating seems to be reducing your protein per meal. This has been a huge shift for me and it takes some doing psychologically. I am carnivore, so I was used to sitting down with a steak and eating it. Now, it means having a small portion (maybe 125g) and having fat alongside it (tallow, butter etc) and perhaps something with a higher f/p ratio, e.g. cheese - or even a decaf coffee with dairy in it. (Some in the carnivore space have buttery water, omitting the coffee entirely - I’ve not tried this yet).
This was a huge deal for me because I’d not eaten dairy for 2 years! And suddenly, instead of a massive plate of food that I was accustomed to, I have a tiny side plate with barely anything on it and a big portion of it is dairy.
Eat the fat first. For me, I start by having a couple of fatty decaf coffees and then I eat my first meal maybe an hour or so later - and the fat from the coffee is already starting to satiate me. Then eat the fat from the plate first, if you can, and then eat the protein.
Another thing to watch for is that you do get full but the signal is so delayed. So sometimes you finish a meal, still feel hungry and you contemplate getting something else. Give it half an hour - usually within half an hour, I’ve realised I am full. If I try something else, 90% of the time, I realise too late that I am actually stuffed and any extra makes me feel queasy. If it’s been an hour and you’re still hungry, have some more fat - sometimes I have a bit of whipped cream or a bit of butter or something, and that usually stops the feeling in its tracks.
Also, don’t try to stick to an eating window - especially at first. Eat when you’re hungry. I was eating in a 5 or 6 hour window last year - naturally, not forced. I changed to 80/20 and for a while, I was eating much more often - in more of an 11 hour window. Just go with it and trust your hunger signals.
Sorry this is long but I really feel for you and I recognise myself a month ago. 80/20 is very different, but I feel a lot better doing it. It’s still weird not to just cook a steak and eat the lot, but it has also saved me a fortune on buying meat!
I like the advice you are getting from @Septimius Protein down regulates ketone production ( although surprising so little protein is doing it for you). With enough protein you can zero ketones, with too little you can get ketones over 5.0. In between gets you values between those two extremes which creates and uses the ketones you produce.
That’s Gluconeogenesis, which you’re not doing. Your doc should read more up to date stuff on how all this works. GNG is demand driven, not supply. You’re fine. IF you were to actually pull that off, you’d know it, you ever have the meat sweats? Smell like an ammonia factory? Those are signs it’s actually happening, most people never get there.
Your Ketone levels don’t matter, only that you keep your carbs low enough.
Not really, our TDEE’s vary huge. When you’re bigger, it’s much higher. We used to say that whole “I’m bigger so I need more fuel” thing was something fat people said as a way to rationalize eating more… but it’s TRUE! Bigger person = more fuel to power yourself. That’s why our TDEE’s drop as we lose large amounts of weight. It’s the one time your metabolic rate slowing is actually not a bad thing (unless it’s being forced too low from stupid things like starving yourself).
For most people, eating around 3k cals would have them as wide as they’re tall. People really gotta figure out (their) own TDEE’s and never go by other peoples for that reason. When I was more fat than muscle, and to be fair from a LOT of bad dietary decisions my TDEE was terrible, literally had it checked and it was around the 1700’s! That’s with a physical job and working out 5-6x a week. Now that I’ve flipped that and more muscle than fat, clearly the same height but with my fat at 13% and weighing MORE than I did at the worst, I’m in the low 3000’s cal wise. Body composition matters huge with what you can get away with.
I’m not disagreeing with you in general - but this is a very specific issue. I am sharing my experience that for a period of time - so far, only relatively briefly - hunger levels might change.
There’s no point embarking on a change and artificially restricting calories, which may sabotage your efforts to transition from keto to 80/20 eating. Once the change is complete, then hunger may well then decline.
It is true that TDEE/RMR varies in a significant way between individuals, and I did a lot of work to raise mine after low calorie diets in the past.
However, the point here is that we’re not necessarily discussing weight loss. We’re discussing managing a health condition and I would say that the most important thing is to get into a low GKI ratio and the calories can be resolved later.
I mentioned it because the sudden desire to eat 1000 more calories was something that would understandably freak most people out - but if, through transition, you’re so hungry that it feels painful, you’re not going to stick to 80/20.
Edit: As I’ve said a few times, I’m suffering from an illness. I’m trying to share information to help, but I realise that I might not always write everything perfectly. I think the sentiment of what I was trying to say makes sense.
Welcome to the forums!
This is not as hard as it might seem. Eighty percent of calories versus twenty percent means about 1.78:1.0::fat:protein by weight. Except that it does seem like a lot of fat. Bear in mind, however that fat:protein::1g:1g translates to 69% fat and 31% protein by calories.
That doesn’t sound right. Your ketone level will be whatever your body wants it to be. If you are keeping your carbs under 10 g/day, then you should be fine, as long as you are getting a reasonable amount of protein, along with enough fat to satisfy your hunger. The ketone levels you are reporting are just fine, and in any case, ketone level doesn’t correlate with speed of fat loss or of metabolic healing.
That is a frustrating feeling, but remember that your body has to reactivate it’s fat-burning pathways. You are inevitably going to perform less well in the gym because of that. But it’s only temporary. Your skeletal muscles are busy healing their mitochondria (which were damaged by all those carbs you used to eat) and reactivating pathways that were deactivated from lack of use. Give yourself a couple of months and you’ll find yourself back where you were pre-keto, perhaps better. A word of caution, however: endurance returns first, but explosive power seems to lag a bit. But even that sorts itself out over time.
There is some speculation that a relatively high protein intake doesn’t provide enough energy, so the liver makes glucose to compensate. I don’t know how accurate that is, but it couldn’t hurt to experiment with getting a higher proportion of fat. You’ll quickly know whether it’s helpful or not.
In any case, you probably want your protein intake to be in the range of 1.0-2.0 g of protein per kg of lean body mass a day. Start there, and make adjustments to see what works best for you.
There is some logic to this, but it’s highly individual. Some people need more protein than others, and they need to eat a higher percentage of protein relative to their fat intake. In all cases, however, we should eat to satiety, however that works for us. If your body isn’t getting enough protein, no amount of fat is going to satisfy you. If you’re getting enough, then it is easy to eat to satiety.
Your readings are NOT low.
You’re just adapting to ketosis which takes time.
Make sure you’re getting enough sodium as you’re likely too low.
Hi @Ketopcos, welcome to the forum. You are definitely in ketosis already. Have you researched ketone levels specifically in relation to PCOS? You may not need higher ketone levels to address this condition. Also people are very individual. What one person needs to do to achieve xyz can be quite different from what another person needs.
What symptoms PCOS do you have? Track them. If some are lessening you are on the right path. Keto is a healing way of eating and healing takes time. Keep us posted!
In fact, all it seems to require is lower insulin levels, which comes from lowering carbohydrate. If the person has any ketones at all, that is a sign that insulin is low enough. Elevated insulin messes with the synthesis of sex hormones, which is why one of the signs of insulin-resistance is PCOS in women and erectile dysfunction (which apparently is what we used to call impotence) in men.
Welcome to the forums.
This subforum should have some info for you:
https://www.ketogenicforums.com/c/health/pcos
Daisy’s podcast Keto Woman, lots of discussion about your health issue there.
Also, it sounds to me like you are stressing out about this, maybe cool it on all the logging, after a couple of months, you know what you can eat and what you can’t just do that and see if you notice a change. Also remember you are basically measure what you are not using when using the monitors. You want to use your ketoones, not pass them out in breath, peeing, sweating etc.
This thread might help you understand what good ketones nos. are as well the chart is very helpful::
All the best sorting yourself out.
So to ask a summary question - if you are producing ketone at some level, that is adequate as it indicates ketosis and thus a low enough carb intake. Then regarding protein intake, that appears to be somewhat individual as to what is needed. But again, as long as the carbs are low and there are some ketone, alls good?
Hi @Emcqueen Eve, you may get different answers to your last post. All I can give you is my n=1. I have never registered many ketones, pretty much always 0.2, both when I was keto for 3-4 weeks as well as now I’m eating carnivore. However, my last blood tests (taken 4 months into eating very low to no carb) indicate I am now insulin sensitive/metabolically healthy, and my CRP (an inflammatory marker) is in the normal range for the 1st time. So, for me, extremely low ketone readings aren’t working against me. I am also steadily losing weight (18 kg after 7 months) despite always eating as much as I feel like and whenever I feel like (no eating window).
@MeganNZ’s post just above shows why we generally tell people not to worry overmuch about their ketone levels. The fact that her insulin-sensitivity improved, her CRP normalised, and her fat is being shed all tell us that she is in ketosis. Ketones, while important in themselves, are also a marker that insulin has dropped low enough for metabolic healing and fat-burning. There is no home test for insulin, so we have to make do with measuring ketones and with the kinds of things Megan mentions.