Hello! First let me start with some background. I’m 27yo female, I lost 90 lbs a few years back bringing me to my lowest in quite a while to 213 in March 2016. I was maintaining at 230 for almost a year then Gained about 30 lbs back over a year and then in October of 2017 I had my weight jump suddenly overnight up to 270. I do eat bad sometimes but for the most part I ate extremely well. 1200 calories or so most days. Exercise. I am a nurse also and am constantly moving at work. I started seeing a personal trainer after thanksgiving and weighed in at 272 my first day. He put me on a high protein, moderate carb and fat diet. Told me I wasn’t eating enough, still I couldn’t eat more because it didn’t seem right. I saw him 3 times a week, an hour each time. I lost 5 lbs the first week but then gained it back. I didn’t lost another pound after that, but lost a total of 18 inches up to January 12th. On the same date, I started having a lot of swelling in my ankles and calf’s and my forearms and hands. I stopped the trainer, saw my doc and did some labs and everything was fine. Put on lasix, and over three days lost 12 lbs of fluid. Down to 260. I was able to lose another 2 lbs, bringing me to 258. But no luck losing any more, stopped the lasix, continued to work out on my own and still eat only 1200 calories a day. The day I switched to keto, I was back to 261. Now I’m at 257 but have been stuck there since 2/20 which is 3 days after I started. My macros are protein around 100, carbs 13-20 and fat 70 and I’m still around 1200 calories. I’m still having some swelling, but why am I not losing weight? My clothes do feel slightly looser. Do I need to change what I am eating? Has anyone else ever had these issues? I saw multiple doctors including my endo, cardiology, gyno and pcp and no one seems to know why I was retaining so much fluid. Am I never going to be able to lose weight again?
New here and need help!
First, welcome to this message board, and also to the world of keto.
My attempt to summarize your post is as follows;
Facts;
- 27 year old overweight female
- Has lost weight in the past
- Currently eating ~ 1200 cal/day
- Has experienced swelling in ankles, calfs, forearms, and hands
- Nurse as a profession, which keeps her active
- Lab tests show normal measurements
Am I also correct to interpret the above that you started the keto diet on 2/17, and you have currently (on 2/20) lost 4 lbs, and are looking to understand why your weight has remained the same for the next 5 days (to 02/25)?
I believe you can lose weight on the keto diet, and this board is a good place to get info & support. Weight will not drop off instantaneously on the keto diet, and it is normal to occasionally run into weight loss plateaus. Although relatively simple, I believe a learning process is associated with the keto diet, the more you learn the better you can implement the diet.
There was a recent post by @Juke88 on this board that has similarities to your post. It may help you to look up her message threads.
With respect to understanding the keto diet, I found that a good book to read is “The Obesity Code” by Dr. Jason Fung. (Jason Fund also has multiple postings on YouTube that may be helpful.)
A good introduction to the keto diet for “newbies” is the Butter Bob videos on YouTube. This is a series of videos with (what I believe) that gives good practice advice on the keto diet. The series can be found at the following link;
The keto diet is a Low Carb, High Fat (LCHF) diet. Daily macro targets are approximately the following;
5% Carbs
25% to 30% Protein
70% to 80% Fat
Those on a keto diet should target a maximum of 20g of carbs per day. Use of a tool such as the App MyFittnessPal (the free version) is helpful to track dietary caloric intake and automatically calculate macro-nutrients. (Loading the app both on a smartphone, and a computer is helpful.) When I first started keto it took me some time to learn/understand the amount of carbs and location of the “hidden carbs” in the foods I ate, MyFittnessPal helped me with this.
A focus of a keto diet (for weight loss) is to manipulate/lower the hormone insulin within the body. Carbs cause a rise in blood glucose (aka triglycerides) levels. The pancreas produces insulin to regulate/lower blood glucose levels. The insulin promotes the transfer of glucose from the blood into fat cells for storage. When high levels of insulin are present, the cells are resistant to the release of fat (aka triglycerides) from the fat cells back into the blood. Within the keto diet, the focus is keep insulin levels low to promote the release of fat into the blood (for weight loss).
The level of glucose within the blood is most sensitive to carbs. Blood glucose levels are moderately sensitive to protein. Blood glucose levels are insensitive to fat. Therefore, a keto diet high in fat, moderate in protein, and low in carbs results in low blood glucose levels that are not excessive, and low insulin levels. The high fat levels also satisfy the appetite. With a satisfied appetite, people tend to consume less calories and therefore loose weight.
Podcasts such as “2 Keto Dudes” and “The Obesity Code” are also educational/helpful.
Above all, remember the phrase “Keep Calm and Keto On” (KCKO)
Best wishes,
Below is some advise I passed to her;
The following books I found to be helpful not only on understanding the keto diet, the various types of Intermittent Fasting (IF), the science behind the keto diet, and how to apply IFing;
- “The Obesity Code” by Dr. Jason Fung
- “The Complete Guide to Fasting” by Jason Fung & Jimmy Moore
A key aspect to the keto diet is how it controls the hormone insulin. Once you understand this (and what foods impact insulin), keto becomes more of a lifestyle and not a diet.
Thank you. Yes all is correct. I use MFP and have since 2011, so I don’t think there’s any hidden carbs. Do you think my macros are okay? I will look up the info you gave me too
welcome. definitely i agree with the suggestion to read dr jason fung obesity code and complete guide on fasting.
and look up on this site for podcasts . these dudes know their stuff.
also on Dr Fungs site IDDM . https://idmprogram.com/… great info on there until you get the books.
i started 6 months ago with dietdoctor .com. and went from there
i am a nurse as well and 61 years old… great results so far. getting healthy is my first priority as my A1C is now 5.4 and my lipids are all going in the right direction.
And
i got my thyroid rechecked. so on supplements for t3 as well this can only get better.
good luck
I might be completely wrong here, (and please forgive me if I am) but isn’t 1200 calories/day way too low for an active 250lb person?
I’m thinking your body is in starvation mode saving every ounce of energy provided.
Would you mind sharing your height with us Kayla?
Keep things simple in the beginning. Just track carbs (not NET – TOTAL carbs) and keep them below 20 – 
I wholeheartedly agree with this. You’ve been destroying your BMR with years of extreme calorie restriction. The Biggest Loser long term research shows they reduced their BMR by up to 25% through extreme CR and exercise and then never got it back and thus put on most or all of the weight. Exercise makes it worse since you are eating the same and using more so creating a bigger deficit which scares your body into extreme savings mode. 1200 calories is a baseline for starvation experiments and at your size you would expect to eat a lot more.
You need to ignore the whole CICO premise for a while until you can fix your body. I progressed similarly to you. I CICO’d and exercised madly for 9 months and lost 75lbs but when I stopped exercise and ate a ‘normal’ number of calories I would regain weight. I stabilized at 40lbs lost and could not shift it again even with major exercise regimes and more CR. That lasted for 2 years. It was only when I got to keto and ate more calories (but all keto things) that I moved the needle. I ate about 2000-2200 calories for about 5 weeks and once fat adapted my appetite fell away and so did the weight. I’m 47lbs down in 4.5 months.
If you work the keto plan (low carb, moderate protein, fat to satiety) the calories will most likely take care of themselves. A big thing to look out for is this satiety issue. You’ve been starving so long you may no longer have good satiety signals. Listen to the latest 2KD podcast and try to eat more (fat) and don’t worry about exercise for now. A lot of this is about experimentation. What you’ve been doing isn’t working so change it up even if it may seem counterintuitive vs. traditional CICO thinking.
The other thing to consider is that you don’t need as much protein as you calculations suggest though the key thing is to more than double your fat intake. I started higher protein and have since dialed it back and lost faster but it is critical to get fat adapted first and worry about fine tuning as you get stronger in craving control, appetite etc.
The breakdown of macros don’t look too bad. If it were me, I’d lower the protein and raise the fat to targets I’ve previously listed above.
Excessive protein can also raise blood glucose levels (although not as dramatically as carbs)
Sometimes it’s difficult to consume the high amount of fat that is needed on a keto diet. I find this difficult if I eat items such as fish, chicken breasts & low fat beef patties. To achieve higher fat levels, eat fattier cuts of meat (i.e. chicken thighs with skin, rib eye steaks, 70% beef patties, …), or add extra butter and/or oils to the meats and veggies. Use of high fat salad dressing (i.e. blue cheese salad dressing, oil & vinegar, …) also helps. Another method to increase fat in the diet is to eat “fat bombs” and/or drink “bulletproof coffee”.
An oddity that newbies must recognize with a keto diet is a change of perspective of the definition of a “proper” diet. Authorities have for years advertised the “food pyramid”, which recommends a diet with a large amount of carbs. The “keto diet pyramid” almost flips the standard food pyramid upside down.
Note, the above graphic lists the carb level at 20 grams of net carbs (vs. total carbs). There are differing schools of thought whether the carb count should be net or total. I personally count total carbs (not net), others may do differently. I attempt to keep my daily total carb level below 20g (although not always successfully). 
Help on the above acronyms (my guesses);
IDDM = Intensive Dietary Management
BMR = Basil Metabolic Rate
CR = Calorie Restriction
CICO = Calorie In - Calorie Out
2KD = 2 Keto Dudes
KCKO = Keep Calm & Keto On
Hmm, looks like I just attempted to re-invent the wheel here. I was going to post a suggestion to the board to define acronyms, but found the following pre-existing post (click on the “WIKI: Acronyms” hyperlink in the post below for a list of acronyms commonly used on this board);
The Lasix is a huge red flag, that something medical is going on. That’s not a drug that’s given for tuneup, or general weight loss purposes. Have you seen a Dr since then? I’d look for a second opinion/ someone more communicative, you didn’t feel that dr was able to communicate why s/he prescribed lasix.
This
1200cal appears on the low end for intake
I started off w CICO as well, way back
About 1200-1400cal a day
Did I loose weight? Yes
Did I feel good? No. Not at all!! I was weak, tired, got headaches, lack of focus and energy
Just miserable to be around
Fast forward, once going KETO
NOW, I can eat twice as much
Loose and maintain
And I feel awesome !
Any ways, welcome aboard Kayla
Good Luck!
Just a couple of suggestions based on my experiences. If the scale hasn’t budged in 5 days then that tells me you are weighing yourself every day. It will drive you crazy it you let it. Even if you can’t resist the temptation, only pay attention to the weekly numbers… and even then they don’t always reflect fat loss.
You should take measurements as well as weight yourself. Some weeks I would lose pounds but no inches. Some weeks inches, but no pounds. Some weeks both. Some weeks neither. Maddening, I know!
Keep in mind you are in this for the long haul… take the eating advice here on the board of veteran keto’s and you will be fine. Gotta give your body time to adjust.
I decided to try 1400/1500 calories a day and today I got 87g of protein, 22 carbs (not net) and 102g of fat. The first few days my ketostix were about moderate but now they were small yesterday. Haven’t tested today yet.
No but with the swelling my doctor wanted to try it. Still don’t know what the swelling is from? I don’t take it everyday but even when I do I still have some
The initial “Whoosh” of weight loss that many (but not all) get right away is mostly water. Keto is the best diuretic ever. 
Since you’ve been taking something that reduces swelling, you may not lose a lot of water.
The biggest thing I see with new folks is that they want instant results. (who doesn’t). But it takes time to become fat adapted. Your body is still waiting on the glucose to come. I believe that it takes 4 to 6 weeks for (most) people to effectively “run on fat”. It’s an amazing feeling once you’re “there”. You must reduce your insulin levels over a long period of time for your body to fix itself. Keep Calm And Keto On is often stated around here for a good reason.
Welcome, and good luck!