Hi there. I have been following the diet for about 6 weeks now for medical reasons (Narcolepsy). I hit ketosis after about 3 days and have remained there without any issues. To be honest, I didn’t track macros until recently and just made sure to keep my net carbs under 20 g. As I wasn’t carrying too much extra weight I soon found myself hovering in the danger zone. Now I need to gain some weight fast preferably in the form of muscle. I’m pretty active (hot power vinyasa yoga 4-5 times a week and some kettle ball weights a few times a week). I’ve figured out my macros to gain a pound a week. It’s a struggle to eat that much but I can usually hit my fat goals. Hitting both fat and protein is a struggle. Today I’m 30 grams of fat and 80 grams of protein under target. From what I understand I should be eating extra fat to gain weight but what level of ketone reading should I be hitting? I usually am in the “large” ketone category. If I want to gain weight but stay in ketosis, should I be aiming for moderate ketone levels? I’m utterly confused. Any tips?
Thanks!
Help! Newbie to Keto and lost too much weight
You should be eating extra fat in maintenance and to put on weight, yes.
You should not worry about whatever ketone levels to hit, stop chasing numbers, as long as your carbs are <20g a day you can ensure you are in ketosis.
You can absoloutely gain weight whilst staying in ketosis. There are no issues there.
Just increase your protein and eat fat to satiety.
80 grams under your protein macro is not good! What figures (in grams not %) are you aiming for in terms of calories/carbs/protein & fat. Would also help to know your weight/height.
In your position, I’d recommend tracking everything with focus on keeping calories high with fat/protein dense foods and carbs under 20g (not necessarily hitting exact macros).
Out of interest, have you noticed an improvement with your narcolepsy since being in Ketosis?
OK then - deffo on the thin side. As for macros you will definitely struggle to maintain muscle mass if you regularly eat so little protein & consistently undereat calories. Did you use a calculator to set your macros & what numbers did it give you to aim for?
EDIT: If you give us an idea as to what & how much you are actually eating we will be better able to help
Did it resolve your narcolepsy? I do not have it but recently went on a 5 day cheat binge because of some celebrations. I ate a ton of carbs and noticed I could barely stay awake. I was at my parents and was literally going into their bedroom to take a nap after dinner. When on keto I am tired at times but do not have this need to crash as I did
Carbs will do that if you haven’t eaten them for a while or if you are insulin resistant - they can do wonders for short term insomnia!
Interestingly it reminded me of other family dinners where I had this exact reaction when I was not ketogenic over the years
Yep - it’s one of those things people don’t realise is happening until it stops happening 
Ok great. I just equated higher levels with more weight loss, therefore defeating my goal.
So I’m using a low carb app to track macros. Here’s where I’m at today. When filling out the info for weight gain macros it suggested a huge amount of protein that’s not really in line with Keto macros. I’m still trying to get my head around it all!
The last two weeks I have felt better than I ever have. I’m sleeping so much better (and despite what most people think, narcoleptics don’t sleep more than most people. I was averaging 5 hours of unrefreshing sleep a night) and longer. The diet is certainly helping!
Very good to hear about the changes in your sleep pattern. I had insomnia before I started Keto, and it resolved in the 1st couple of weeks doing keto. Now I only have wakefulness if I eat too many carbs. 
This is where I’m totally confused. The calculator told me to set fat at 177g and protein at 150! (Or thereabouts). How can the suggested protein be so close to the fat? Shouldn’t the protein be more around the 45g mark?
That seems like too much fat AND protein. I know you want to gain some weight but that seems a bit much.
Right? This apparently to gain a lb a week! I’ve never been a huge eater so this is a struggle for me. I’m technically not eating a huge amount but adding a LOT of heavy cream to my chia seed pudding or Greek yogurt (usually account for half of my food intake). Add a Bulletproof coffee and I’d be quite happy to be done with food for the day. I do try to eat some meat and veg at dinner time.
Just as it takes those of us who need to LOSE weight time to lose some lbs, it also takes some time to GAIN weight. 3500 cal = 1lb, so you do have to eat several hundred calories/day over and above what your body uses daily for energy.
Gaining a pound a week is probably not going to happen for you (some people maybe) & you certainly won’t be able to gain a pound of muscle a week so my first suggestion would be to perhaps reset your expectations If you can halt your weightloss then you’ll be off to a very good start & can tweak some more from there.
I’m aware you’re trying to manage a neurological condition so it can be trickier to increase protein but I would suggest that you try increasing how much protein you are eating - even if you don’t hit the calculator’s target - & see how that impacts things for you.
Some people have trouble losing weight if they consume dairy, particularly cheese, so you could try increasing dairy which should up both your protein & your fat intake.