Q&A: How to Get Into Optimal Ketosis?

How Do You Get into Optimal Ketosis? What to Do If You’re Not Losing Weight? How Long Does It Take to Reverse Fatty Liver? And Why Isn’t Your Body Fat Decreasing Even Though Your Weight Is Dropping?

Get the answers to these and other questions in this week’s Q&A with me.

Please note that these answers do not constitute medical advice and no doctor-patient relationship is established. These answers are for general information purposes and you should discuss any changes with your healthcare provider.

How to Get into Optimal Ketosis?

I can’t seem to get into optimal ketosis. I’ve been eating keto for 30 days, under 20 grams of total carbs (usually not over 17), 30 to 56 grams of protein, and not over 76 grams of fat. I rarely go over 900 calories, but that’s because I’m 58 and very sedentary.

According to all my research, I should be in optimal ketosis and losing weight like crazy. In 30 days, my weight has dropped by 4 kg (9 lbs)—I’m in no hurry, but I’m surprised it’s not more. The highest my ketones have been (by blood) is 1.4 mmol/L (that was after a semi-fast)—usually, it’s under 1.0. Nowhere near the magic “3” I hear about. I do intermittent fasting most of the time, having breakfast around 11 a.m. and trying to have dinner between 3 p.m. and 5 p.m. Any drink that isn’t water, I use as a “snack.” I keep track with Carb Manager and weigh everything. Cutting protein has been the hardest. Please tell me what to do to get into optimal ketosis!

Answer:
That’s a great question. The short answer is that there may not be an “optimal” ketosis level when it comes to weight loss and overall health. This concept was carried over from treating seizures and may apply to specific interventions like Alzheimer’s, brain cancer, or other fascinating areas of research. But when it comes to overall health and weight loss, there is no evidence to suggest that higher ketone levels are “better.”

— Dr. Bret Scher

I’m Not Losing Weight. What Should I Do?

I’ve been on the keto lifestyle since January 1 and haven’t lost much weight or inches. What can I do to change that so I’m losing both weight and inches?

Answer:
This happens often and can be so frustrating when you see all these amazing success stories but don’t see the same results. First, check out our realistic expectations guide, as everyone’s health journey is unique.

Second, although we usually don’t recommend counting calories or “macros,” knowing your carb grams and total calories can be helpful in the beginning, as sometimes our perceptions differ from reality.

Also, consider enrolling in our “Weight Loss For Good” course to help fine-tune your efforts.

Hopefully, these suggestions will get you back on the path to success!

— Bret Scher

How Long Does It Take to Reverse Non-Alcoholic Fatty Liver Disease on LCHF?

In general, how long does it take for non-alcoholic fatty liver disease to reverse itself on LCHF?

Answer:
Good question. This depends on how you measure it. Liver function lab values, especially ALT, should start to improve within weeks but may not normalize completely for months. Ultrasound evidence of fatty liver is slower to respond and can take months to show improvement and up to a year or more for complete resolution. Most of this is based on clinical experience, and hopefully, we will see better trials soon.

— Bret Scher

Body Fat Not Decreasing, Even Though Weight Is Going Down

My weight is decreasing by an average of 3.5 lbs (1.6 kg) per week, but my body fat percentage remains at 33%.

I’ve been on a low-carb diet for a week and now keto for three weeks, and it’s working, but my measured body fat percentage isn’t dropping—any ideas?

Answer:
My first question is, how are you measuring body fat? The gold standard is DEXA, but there are many other methods, and they all have test-to-test variability. So when changes are small, they can be lost in that variability.

But the next question is, what are you doing to promote lean muscle mass? In my opinion, the best way to ensure you lose fat and gain muscle is to eat low carb, get adequate protein, and perform regular resistance training. If you’re new to exercise, try our “Let’s Get Moving” course.

I hope that helps!