So confused 😐

[Shaz]

Hello everyone and thanks in advance for any help/advice proffered.

I’m going through menopause and up until my GP put me on the oestrogen patch, was sweating so heavily, it was like I’d taken a shower except I hadn’t and it was up to 30 times a day. I became extremely dehydrated. That was nearly 4 weeks ago and my hydration has improved except for when I’m working (nurse so always busy with patients at work and not much time for keep running for a drink).

Last week, I started keto. Yesterday I started getting aches in my hips and thighs which I suspect are due to low sodium so I’m super salting everything I eat (think 1 tsp of salt on each meal). I’m taking a super magnesium supplement which has vit C and D as well as chromium and manganese in, cod liver oil and a mega vit B supplement as well. And yes, I get vitamin B yellow pee lol. I should add that as I’m hypothyroid, I use iodised salt.

Apart from the hips and legs which I think will resolve once I start intaking more salt, I’m confused about keto - specifically about calories. When I started this journey, I read a lot of resources and almost all stated calories count, so watch calorific intake. I want to lose 20 kilos. So far, I’ve lost 2. Well, yesterday I had lost 2.5 but today it’s 2. The scales are a fickle friend, what can I say. I have lost 4 cm off my waist however.

If I cut back my calories to the recommended 1350 per day, I’m so hungry all the time because trying to keep my fat at 70-80% intake means that I’m hardly eating much as fat is high calorie. I do track what I eat and try to ensure that I’m below the calorie count but omg I’m so hungry. Always. Eating only 120 grams of meat twice a day and 2 eggs with some spinach and other green leaf isn’t really cutting it for me p, not gonna lie.

Sometimes I feel like I just need to eat. I’m not even craving carbs or anything. My fluid intake is good for the most part, at least 1.5-2 litres a day which is normal for me. I can’t force myself to drink more otherwise I feel sick.

This is what a typical days food looks like:

Breakfast
20g salted butter
2 extra large eggs
90g spinach

Lunch
100g mixed leafy veg
125g pork & beef mince
Garlic, fish sauce, soy sauce
2 tsp olive oil

Dinner
125g chicken thigh
40g red capsicum
45g green capsicum
100g cauliflower
2 tblsp olive oil

This “typical” menu (which I ate for 4 days) gives me 8% carbs, 70% fat and 22% protein and 1346 calories.

After I ran out of my prepped food (which I was so grateful for), things became a bit more, shall we say, free wheeling and when I had pooped green, I realised there was too much iron in my diet so now I take only 100g daily of the green leafy stuff.

On Tuesday I had some spinach for breakfast, realised it made me feel sick so had 2 boiled eggs instead. I had a gorgeous lunch of 400g of pork with olive oil and a dinner of 125g chicken thigh. My macros were 1% carbs, 72% fat, 27% protein. So far so good right? Then it all fell apart. Wednesday, I was starving and bought a rotisserie chicken and my macros were 1% carb, 67% fat, 32% protein. My calories were 1265.

Yesterday I started worrying that because I was so hungry, I wasn’t eating enough fat, so my calorie intake went shooting up to 2522 calories, broken down as 0 carbs, 74% fat and 26% protein.

But I’m worried I’m eating too much protein and now too much fat and unsurprisingly the scale (oh fickle friend) is up from 82.5 to 83.

My logical nurse brain knows that I’d have to eat a lot more protein for gluconeogenesis to happen as yesterday was 162.83g of protein but it was more protein than previously and apart from breakfast, where I’m now eating bacon and cheese with my eggs (get thee behind me, spinach), I start to feel ravenous after about 5 hours whereas before (keto started) I could go all day without food.

So, should I calorie count? Is 5 hours feeling starving (and my poor little (big) tummy rumbles) normal? My PK (pre keto) habit was to eat breakfast and dinner only but I drank loads (10+) lattes per day which was a lot. Pleased to say too that I haven’t had coffee in over a week. Last time I checked my ketones (at work ) they were 0.3 up from 0.2 the previous day so I think I’m in Ketosis. Although I don’t know if that means I’m fat adapted but hey, I’ve lost cms off my waist and tummy so I’m happy either way!

[islandlight]

I don’t have answers to your questions. Congratulations on how well you’re doing so far!

[OgreZed]

I’m so hungry all the time because trying to keep my fat at 70-80% intake means that I’m hardly eating much as fat is high calorie.

Percentages are irrelevant unless you’re on therapeutic keto of some kind. Your need for proteins should primarily be based on lean body mass, not on caloric intake.

From a “big picture” perspective, I see keto as simply “Minimal carbs. Adequate proteins. Fats as needed (for satiety).”

First, determine your macros, keeping in mind that the proteins macro is a lower limit, while the fats and carbs macros are upper limits.

So, two priorities:

• You need to keep carbs low to stay in ketosis.
• You need to make sure you get enough proteins. Your body needs them. Being significantly low on them over an extended period can cause the body to get it elsewhere. That may mean break-down of muscle tissue. Not good.

After that, ideally, it should be hunger that determines how many fats and additional proteins (and thus calories) that you need to be eating, if only because leaving yourself hungry all the time means keto won’t be sustainable. You don’t need to eat all of the fats macro if you’re not hungry, because the body can make up the difference with stored body fat.

My logical nurse brain knows that I’d have to eat a lot more protein for gluconeogenesis to happen

Too much protein isn’t a practical concern. GNG is a demand-driven process. Not a supply-driven process.

I read a lot of resources and almost all stated calories count, so watch calorific intake.

Yes. How much you eat still matters. Calories may not be a good way to measure though. But if you’re tracking your macros, calories are already being tracked.

[Shinita]

You don’t need to meet some percentage for fat. It’s fine to stay below 70% too, I almost always do that. Some people notice they need to stay lower and higher (maybe they need a specific range in grams) but it’s individual, not a general rule. I let my fat fall where it wants until it causes no problems.

I don’t know your energy need but 1350 kcal is very low for most of us. Anyway, first get used to keto and eat when you are hungry. Okay, even later eat when you are hungry but you will see if you lose fat and if not, you still can tweak something, not necessarily the calories.

Almost no time passed and 0.5 kg is nothing if it’s your bodyweight. It easily fluctuates way, way more. +1 or 2 kg? It means nothing. And if you ate only 2522 (+/- something, we can’t track exactly) kcal for one day, it’s physically impossible to gain enough fat measurable with a personal scale.

Is 5 hours feeling starving (and my poor little (big) tummy rumbles) normal?

I would say so, yeah. Of course, we are individuals and different things are normal. But you have just started, many things are probably temporal. I almost never last for 5 hours if my meal is less than 1500 kcal, even after fat adaptation… And I could be very hungry before fat adaptation, it changed (1300 kcal a day still would feel bad, probably). Many people barely feel hunger on keto right away, that’s normal too.
You could go all day without food before keto… But did you eat this little?

Fat adaptation usually takes months so it’s very unlikely you have that. But as you eat very little carbs, you must be in ketosis.

[amwassil]

Overall, @OgreZed covered the initial basics, which I generally agree with. I would only add the following. Ditch the veggies, you don’t need them and won’t miss them. They only add unnecessary carbs that you could spend better on more nutrient dense fat/protein foods, such as cheeses. If you think you need veggies for micros, I recommend bok choy in any of its varieties. More micros and less carbs than pretty much any other veg. So you could actually eat a couple hundred grams per day and spend fewer carbs doing so. If you think you need fiber/bulk then eat 10-20 grams of milled flax or chia seeds daily. Again, way fewer carbs for the relative benefit derived. There are brands of milled flax seed (TA) that contain zero digestible carbs. Eventually, you’ll realize you don’t need this either. Ditch the olive oil; use butter, ghee, tallow, MCT oil or even lard.

Curious. Why are you eating so much capsicum? Garlic, fish sauce and soy sauce??? I recommend any of innumerable ‘hot sauces’ that contain zero carbs instead.

Chicken is not the best meat. Pork is not much better. Fatty cuts of beef and organ meats (or any other ruminant meats) are way better and have fat with far better fatty acid profiles.

My dad had hyperthoroidism and the ‘treatment’ of the day was to nuke it into a lump of charcoal. Thus, he spent the rest of his life with hypothyroidism, in fact no thyroid. So that may be a challenge for you.

If you want to boost your metabolism you can do a couple easy things. First, eat mostly saturated fats, not MUFAs and especially not PUFAs. Second, spend as much time each day as you can in room temps below 65°F. The first will help you burn more fat by boosting mitochondrial uncoupling and second will help convert some of your fat to BAT (brown adipose tissue) which burns fat rather than stores it.

[Polly1]

I can see that spending time in a low temperature room will be hard for a nurse because hospitals are always (IMHO) horribly overheated. I understand this is for the benefit of the bedbound frail patients but it must be hard on the staff.

[Shortstuff]

Just keep carbs below 20g and eat protein and fat to your appetite.
Nothing confusing.

[Shaz]

Thank you

[Diygurl19]

EXACTLY!
Just count the carbs.

[Shaz]

First, determine your macros, keeping in mind that the proteins macro is a lower limit, while the fats and carbs macros are upper limits.

So the macro calculator said 81g protein but that seems low, so that’s a lower limit and I should eat more and then no more than 100g fat, which is what the calculator spit out for me, but if protein goes up, should fat go up as well? Or keep fat the same or less? Or as long as I get at least 30g of fat I’m okay?

[Shaz]

I probably ate about the same calorie wise but also with the addition of a lot of lattes throughout the day. Which also added up calorie wise to about 800 so yes, there was overall more calories. Probably giving up all those lattes would have done it for a kg or 2 but I really struggle to lose weight as I also have PCOS alongside my hypothyroidism.

[Shaz]

Curious. Why are you eating so much capsicum? Garlic, fish sauce and soy sauce??? I recommend any of innumerable ‘hot sauces’ that contain zero carbs instead.

Well, I was following a free keto meal plan and because I had back to back shifts scheduled it was easier to pre prep 4 days food rather than having to come home late, get up a few hours later, work, come home exhausted and think about what to cook. But I’m glad it’s over! I felt it best to start keto when I was busy in case I started craving carbs and went mad at the local bakery!

Chicken is not the best meat. Pork is not much better. Fatty cuts of beef and organ meats (or any other ruminant meats) are way better and have fat with far better fatty acid profiles.

Where I live, unless you buy offcuts, which is mainly bone and fat (which people usually buy for their dogs), most meat is quite lean. Occasionally you find a steak with more than 3mm of fat on the side but not often. I do like heart and kidney though so have no problem eating them at all.

Second, spend as much time each day as you can in room temps below 65°F. The first will help you burn more fat by boosting mitochondrial uncoupling and second will help convert some of your fat to BAT (brown adipose tissue) which burns fat rather than stores it.

It doesn’t get that cold here in winter. It might do in at around 3am in deepest winter but even the winter we are coming out if, the average daytime temp was above that and we still walk around in tee shirts, with maybe a fleece in early morning because it feels cold compared to summer and then a lighter thin cardigan in the day. To give you an example, today was 78F and I had my light cardigan on as it was a bit cold. Usually it’s above 92/93F so I would have to find a freezer to hang out in

[Shaz]

Yes, even when it’s 100+ outside, the heating is on, although very low and the patients still complain it’s cold

[Shinita]

If protein goes up, fat should go down or maybe stay the same (if we want to eat similar amount of calories every day) but whatever feels right, actually. I can’t even separately move my macros, I do anything (except lowering my carbs), fat usually goes up but with leaner meat, sometimes only protein goes up… Many of us don’t enforce macros. I actually have no fat limit. It does whatever it pleases but I know what fats to avoid if I don’t want it to go too high (or if I want it to go too high on a very active day when I need more fuel or when I had a few lower-calorie days and a high-calorie one is needed - well that’s one reason I don’t have an upper fat limit)…

If you can get away without focusing on macros too much, do that.

[PaulL]

Last week, I started keto. Yesterday I started getting aches in my hips and thighs which I suspect are due to low sodium so I’m super salting everything I eat (think 1 tsp of salt on each meal).

While I am always encouraging people to be sure to get enough salt, too much salt has its effects, as well. According to the PURE study and a couple of others, the healthy range of sodium intake is 4-6 g daily, which translates to 10-15 g daily of sodium chloride (or 2-3 U.S. teaspoons), inclusive of salt already present in food. I get migraine auras and constipation if I don’t get enough salt, and very messy stools if I get too much.

If I cut back my calories to the recommended 1350 per day, I’m so hungry all the time because trying to keep my fat at 70-80% intake means that I’m hardly eating much as fat is high calorie.

Thirteen hundred fifty calories is starvation level. Of course you’re hungry! At that low a food intake, your body is going to think you’re in the middle of a famine, and it will hang on to its fat stores even if you eat a ketogenic diet. You don’t need the app, but if you are going to use it, at least set it to Maintenance, so that you get a better caloric level.

The body reacts differently on a ketogenic diet from how it behaves on lots of carbohydrate, so the rules for keto often seem counter-intuitive. But the lower insulin from not eating so much carbohydrate means that it will no longer be blocking the satiety hormones from registering in your hypothalamus, and your appetite will soon become a good guide to how much to eat. As long as you eat a small enough amount of carbohydrate (we recommend a limit of 20 g/day), your insulin/glucagon ratio will remain low, no matter how much protein and fat you eat. You want a reasonable amount of protein (we recommend the range of 1.0-1.5 g/kg of lean body mass/day) and enough fat to satisfy your hunger. By eating in a way that works with your body, not against it, you don’t have to worry about the caloric intake so much. Without chronically elevated serum insulin to mess you up all the time, your hormones work properly and you can trust your appetite. You may find yourself eating a lot during the first couple of weeks, but this is normal. When the leptin from your adipose starts registering in the hypothalamus again, it can be quite startling how satisfying a meal can be.

My logical nurse brain knows that I’d have to eat a lot more protein for gluconeogenesis to happen

Gluconeogenesis starts as soon as carb intake drops low enough to make it necessary. It and ketogenesis are both stimulated by glucagon, in conditions when the insulin/glucagon ratio is low. You mention getting 163 g of protein, which is probably a bit high. But gluconeogenesis is fairly tightly regulated and is not stimulated simply by an abundance of amino acids. But you can safely eat a bit less protein and a bit more fat.

[Alexaar]

Congrats on getting through your first week!

The advice here already answers most of your questions - it’s common to be hungry at first as it takes a while for your body to learn how to use fat as fuel, and i’d recommend eating at maintenance calories while you adjust mentally and physically over the first few weeks. You might find you settle quickly back into a two-meal a day routine. Once you can access bodyfat for energy you should notice your hunger changes to more of a signal than a demand!

Sounds like you’re often busy with shift work, so you might find the basic meal template I use helpful. It’s basically what you’re doing already but without specific recipes.

For each main meal aim for roughly: 8oz protein (meat/fish/egg) + tbsp fat (lard/tallow/ghee/coconut oil/olive oil) + cup non-starchy veg(optional) + tsp salt

If you’re using lean meat, use 2tbsp fat rather than 1 or add avocado/olives/cheese.

Aim for at least 1 meal to use ruminant meat (beef/lamb).

If you’re hungry outside of meals, try water first and then pick animal-food based snacks (jerky, pork rinds, tinned mackerel, boiled eggs, lump of cheese).

Keto meals can be super simple. Meat + fat + veg.

At a week in, your hormones will still be adjusting which might throw up weird symptoms and changes, particularly with the menopause happening also. It’s most important you stick with it consistently for at least three months to let things settle, so if you can find a level of food that satisfies your hunger you’re giving yourself the best chance of making this a sustainable lifestyle change.

Good luck, you’re doing the right things just give it time and eat a bit more!

[Shaz]

Yes I was super busy on Wednesday as I was at work on an AM shift so tired, cranky and hungry by evening, bought the rotisserie chicken and my protein grams shot up as a consequence. I wouldn’t normally eat half a chicken, although it was tasty

[Shaz]

Thank you for the template and snack ideas. 8 oz is about 200g I think and much better than the 100g (3.5/4 oz) that I saw was suggested. Much more filling. I will start this tomorrow. Thank you again

[Alexaar]

No problem, glad to be of help!

There’s plenty you can tinker with on keto but starting out it’s super easy to get decision paralysis and that’s when it’s easy to end up telling yourself if you’re doing it wrong you may as well eat cake (not advised ha).

I checked out some typical macros for the template (e.g. steak/ghee/asaparagus, chicken thigh/olive oil/broccoli, salmon/ghee/cauliflower) and they’re coming out at 600-700 cals, 50-60g protein, 2-3g net carbs, and 40-50g fat. So if you ate 3 of those meals a day or 2 + snack you’re in the right ballpark. If you can’t manage 3 of these meals that’s totally fine, two is sufficient to keep you chugging along for the day.

Let us know how you get on there’s plenty of nice people who can help you troubleshoot or just keep you motivated during adaptation!

[Janie]

I lost 13 kg tracking carbs only - less than 20 per day. I did not worry about protein or fat macros - just ate whatever protein sounded good to me that day and made sure I ate some saturated fat when I ate. I am 61 and probably not as active as you since you are on your feet so much as a nurse.

My loss was slow and I stalled out at 6 months. But my hunger was gone and I was down 2 jean sizes so was thrilled with keto!

I eventually added in fasting after 6 months to drop the last 5 kg. I was well fat-adapted so was easy for me. No need to think about this until you forget to eat and skip a meal without realizing it - congrats - you are fat adapted!

No need to be hungry - eat more protein and fat to stop the hunger and you will ge fine. This is a long-term process and takes our bodies a while to get used to it.