Common Ketosis Killers

“I’ve tried your low-carb diet, Dr. Nally, and it didn’t work.”

“Hmm . . . really?”  If your mumbling this to yourself, or you’ve said it to me in my office, then lets have a little talk.

Scale HelpI’ve heard this statement before.  It’s not a new statement, but it’s a statement that tells me we need to address a number of items.  If you’ve failed a low carbohydrate diet, I’d suspect you are pretty severely insulin resistant or hyperinsulinemic.  You probably never really reached true ketosis.   I’d want to have you checked out by your doctor to rule out underlying disease like hypothyroidism, diabetes, other hormone imbalance, etc.

Next, switching to a low-carbohydrate lifestyle is literally a “lifestyle change.”  It requires that you understand a few basic ketosis principles.  And, it takes the average person 3-6 months to really wrap their head around what this lifestyle means . . .  and, some people, up to a year before they are really comfortable with how to eat and function in any situation.

I assume, if you are reading this article, that you’ve already read about ketosis and understand the science behind it.  If not, please start your reading with my article The Principle Based Ketogenic Lifestyle – Part I and Ketogenic Principles – Part II.  If this is the case, then please proceed forward, “full steam ahead!”

There are usually a few areas that are inadvertently inhibiting your body transformation, so let’s get a little personal.

First, this is a low carbohydrate diet.  For weight loss, I usually ask people to lower their carbohydrate intake to less than 2o grams per day. How do you do that?  (A copy of my diet is accessible through my membership site HERE.)  You’ve got to begin by restricting all carbohydrates to less than 20 grams per day.  Any more than 20 to 30 grams per day will cause an insulin release from the pancreas and stimulate fat storage of both carbohydrate and fat for the next 10-12 hours.  Keep a dietary journal to record your progress, your cravings, your successes and failures.  I’m going to want to see it and review it with you if you see me.

No, I don’t believe in “Net Carbs.”  Net Carbs are a sales gimmick to get you to buy “artificial food” that keeps you coming back for “artificial food” and halts your weight loss (you’ll see why shortly).   You’re going to lose the most weight and feel your best when you eat real food. I do allow for the subtraction of real fiber.  Leafy greens are real fiber.  You can subtract them.  In fact, I recommend eating 1-3 cups of leafy greens per day to help bowel function, but, everything else is “carbage.”  Avoid it.

Yes, cottage cheese and yogurt contain carbohydrates.  Be very cautious with them.  No, oatmeal and Cream of Wheat™ are not helpful. See my article on Why Your Oatmeal is Killing Your Libedo.Alcohol

Alcohol also halts your weight loss.  It is not a sugar, the distilling process changes the sugar to alcohol, however, alcohol stimulates an insulin response after the alcohol is metabolized in the liver with a similar response to regular sugar.


Second, this is a low carbohydrate, moderate protein, high fat lifestyle.  N0 . . . it is NOT a high protein diet! That is a misnomer picked up from the “Atkins era” and is false.   Protein is essential for the building and maintaining of muscle, connective tissue and a number of other enzymatic reactions in your body.  However, excess protein intake will be stored by producing an insulin response, being converted to triglyceride (the soft squishy stuff inside the fat cells that make them plump) and stocked away inside your adipose tissue.  Initially, I ask my patients to focus on lowering their carbohydrate intake and I don’t really worry about protein.  (It is often hard enough to figure out what the difference between a carbohydrate and a protein in the first month or two if you’ve never had any nutrition background.)  Most people begin losing weight just by lowering carbohydrates over the first few months.  Once you figure out how to lower your carbohydrates, if your weight loss is not moving and your pants are not getting looser, then you’re probably eating too much protein.  How much protein do you need?  You’ll need to calculate a “ball-park” protein range from your Ideal Body Weight.  It’s pretty easy to calculate and is based on your height and gender.  You can see the calculations in a previous post HERE.

ProteinIf you’re still a little confused about protein, read my article on Why Your Chicken Salad Stops Your Weight Loss.

This also goes for protein powders and protein shakes.  Many of these have 25-40 grams of protein in them per serving, so be careful with their use.

Third, this is a high fat lifestyle.  Yes, I want you to INCREASE your fat intake.  I’m going to repeat that, again, just for clarity, . . . . INCREASE your fat intake.  Increase it to more than 50% of your total calories, . . . 70% of your total calories if you can do it.

“What?! Won’t that cause heart disease and stroke and make my cholesterol worse?!!!”

I know, take a big deep breath . . . (you may even need to breath into a paper bag for a minute if you begin hyperventilating).

No, it will not raise your cholesterol, cause heart disease, or cause a stroke.  If you have lowered your carbohydrate intake to less than 20 grams per day, then there is NO hormonal signal for you to make more bad cholesterol, worsen heart disease, or cause a stroke.  In fact, there is great data showing that increasing your fat and lowering your carbohydrates reverses the blockage in the arteries.  I see this reversal every single day in my clinic through the application of ketogenic diets.


If we remove carbohydrate as your primary fuel, you must replace it with something else.Food Pyramid WrongThat something else should be fat.  Protein must be moderated, as it will also be stored as fat if you eat too much.  So, if the carbohydrates are kept low, fat intake can be increased and the body will pick the fat it wants and essentially throw the rest out without raising cholesterol, causing weight gain or causing heart disease.  This is why we want you to use good natural animal fats like butter, hard cheese, olive oil, coconut oil, avocado, etc.  Look for fats highest in omega-3 fatty acids as these decrease inflammation and improved weight loss.  Look for meats highest in fat like red meat (55% fat) and pork (45% fat).  Take the food pyramid and flip it over.

The fourth culprit in halting your weight loss is usually artificial sweeteners.  There are quite a few of them.  Most of them WILL cause an insulin response (exactly what we don’t want for weight loss) with minimal to no rise in blood sugar.  Raising blood sugar doesn’t matter, if the insulin is being stimulated  . . . “you’re gonna gain weight for the next 10-12 hours.”  I wrote an article for you to print off and hang on your fridge, upload it to your iPhone or carry it with you in your purse to the grocery store. (If you’re a man and you’re carrying a purse, please don’t tell me about it.)  You can find the article here: The Skinny About Sweeteners.  The short list of those sweeteners that are OK to use and cook with, and do not increase insulin response, can be found here in my Amazon Store.

CoffeeCreamersFifth on my list is coffee creamer.  Coffee creamer contains corn syrup solids (another very special name for  . . . SUGAR!!) and/or maltodextrin (SUGAR’s married name!).  If you must put something in your coffee, then use real heavy cream (pure tasty fat) or real butter.   It will taste much better (I’m told – I don’t drink coffee personally) and you won’t get an insulin spike 2-3 hours later and begin craving more coffee and donuts.

Yes, “Half & Half” is half fat and half sugar. . .  avoid it too!!

The sixth culprit in halting weight loss is medications.  Please talk to your doctor before making ANY changes in your medications as suddently stopping them can be hazardous to your health.  Those highest on my list for stopping your weight loss are Glyburide (glipizide), insulin, & steroids like prednisone.  A more complete list of medications that will halt your weight loss can be found on my on my ketogenic diet plan.  If you are on any prescription medications, please talk to your doctor or to a physician board certified in obesity medicine treatment about how to adjust or wean these medications in a way that is safe and appropriate for your individual needs.

The seventh common culprit in halting weight loss is a lack of estrogen in menopausal or post-menopausal women.  About menopause-cartoon-02420% of women that I see in my practice who are over 55 years old, need some degree of estrogen replacement before they are able to lose weight.  Estrogen plays a very large role in regulation of the metabolism and when deficient, causes weight retention or weight gain.  Talk to your doctor about the risks and benefits of estrogen for you individually in this situation.

The eighth reason for shifting out of ketosis is stress.  Acute and chronic stress can be caused by a number of issues. The most common is lack of sleep.  You can read about stress and ways to address it in two of my articles: How Does Stress Cause Weight Gain? and Adrenal Insufficiency, Adrenal Fatigue and PseudoCushing’s Syndrome – Oh My!

For many years, we’ve thought that caffeine was great for weight loss.  However, we are finding, clinically, that too much caffeine can also cause a stress response by raising cortisol, releasing glycogen, thereby stimulating an insulin response and bringing your weight loss to a screeching halt.  How much caffeine? . . . The jury is still out . . . and remains to be determined.  But, I am currently under going an n=1 experiment on myself (as many of you know, I love my Diet Dr. Pepper).  I’ll keep you posted.  . .

Look closely at these eight issues.  Correcting them usually solves most plateaus with weight loss and improves blood pressure, blood sugar and cholesterol control dramatically.

30 Comments on “Common Ketosis Killers

  1. Hi I was wondering if you could recommend a basic book about keto for my mom who is looking to get started. She does not have Internet access.

    • Yes.
      1. KetoClarity by Jimmy Moore
      2. The Art and Science of Low Carbohydrate Living by Stephen Phinney and Jeff Volek
      3. The Ketogenic Cookbook by Jimmy Moore & Maria Emmerich

      • Carol,
        I am not sure about dietitians or physicians in Cape Town, but I’ll check with a few friends and see who they recommend.

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  4. why do you sell/approve TRUVIA on your Amazon link?

    Truvia (Coca-Cola’s branded product) goes through about 40 steps to process the extract from the leaf, relying on chemicals like acetone, methanol, ethanol, acetonitrile, and isopropanol. Some of these chemicals are known carcinogens (substances that cause cancer).

    It is manufactured from a blend of three ingredients, which are:

    Erythritol: a sugar alcohol.

    Rebaudioside A: a sweet compound isolated from the stevia plant, listed as Rebiana on the label (1).

    Natural Flavors: it is unclear exactly what this means.

    • Because Truvia is one of the sweeteners that does not raise insulin and is OK to cook with. I offer it as an affiliate link because I not getting paid for any of the advise I have made available on my website, and I have to have some way to cover the cost of the web services. In all the research I have done, there has been no problem with the use of Truvia on a Ketogenic diet

      • Got a question or more a concern.. the truvia baking blend actually has sugar as an ingredient. Also a cup of it contains 170 where as something like pyure or swerve is zero. I just was a little concerned because my mom has been using truvia and i almost regretted eating a dessert she made as soon as i read the label. I personally use pyure and swerve. What do you think about that? Thanks!

      • That’s why I try to get people to read labels. We use swerve in our home pretty routinely. Companies Chang e formulations all the time. It is important to keep an eye on the labels

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  6. Hi I had not read the ingredients on my soya sauce and it contains corn syrup, I know its bad as I have been told, I will never do it again. It calls for a tablespoon and I was only putting in a tsp for 4 days straight do you feel this will kick me out of ketosis?

    • Bren,
      That really depends on how sensitive you are to sugars. The only way to know if it kicks you out of ketosis is to measure your ketones 1-2 hours after eating it. Each of us has differing sensitivities to starches and based on the degree of insulin resistance you may have you’ll need to reduce carbohydrate intake accordingly.

    • Stephanie,
      Good question. Torani Sugar Free Syrups contain both sucralose and acesulfame potassium. Sucralose in the liquid form does not seem to cause a rise in insulin, however acesulfame potassium has a dramatic insulin stimulus without raising blood sugar.
      Based upon this, I don’t recommend the Torani Sugar Free Syrups, however, the DaVinci Sugar Free Syrups just contain sucralose and should be OK to use with a Ketogenic Diet.

  7. Thank you so much DR Nally. …I really enjoyed listening to and learning from your video talk on Facebook. .

  8. I am a vegetarian eating 2 eggs, almond milk + whey protein shake x 1 , 100G cottage cheese , a stir fry with quorn , some strawberries with truvia and heavy cream each day.
    Totals about 80G protein
    I am quite stressed as I work long and stressful hours. There’s no getting away form this, I had a day off yesterday and worked 15 hours.
    I am 49 and still have intermittent periods
    I move in and out of ketosis, I uses test strips.
    How can I stay in Ketosis to lose weight?

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  10. I am currently following a keto inspired plan (18-20 carbs/day, higher fat, moderate protein) but have stalled at only 6lbs lost in 30 days. My husband is following the same regimen losing 23 lbs in 30 days. I know its easier for men… Major difference is I take 125mg Levothroxine for hypothyroidism daily. Could the medication be impacting my progress?
    I use the test strips to monitor that I’m in ketosis but the scale isnt showing results.

  11. How does one evaluate protein content in a slab of raw meat? If beef is generically 55% fat, some meaningful fraction of the remainder is water and minerals and other “not ” protein components. I’m good with my high fats and low carbs, but I want to get a handle on the protein content of “meats without labels”.

  12. Thank you for this article. We are JUST reading it for the first time and are about 8 weeks in on adjusting to the Ketogenic lifestyle. Things are going well and I feel better than I have in years and have already lost around 15 pounds and am toning up nicely.

    In the final paragraph you are talking about the impacts of caffeine and that you were doing a little experiment on yourself. I actually just gave up my Coke Zero 1. because of artificial sweeteners 2. because of carbonation (I am running once again) and 3. because of caffeine.

    I would be interested to see how your self-experiment worked out and what you now feel about caffeine.

  13. Thank you for this article. We are JUST reading it for the first time and are about 8 weeks in on adjusting to the Ketogenic lifestyle. Things are going well and I feel better than I have in years and have already lost around 15 pounds and am toning up nicely.

    In the final paragraph you are talking about the impacts of caffeine and that you were doing a little experiment on yourself. I actually just gave up Coke Zero, 1. because of artificial sweeteners 2. because of carbonation (I am running once again) and 3. because of caffeine.

    I would be interested to see how your self-experiment worked out and what you now feel about caffeine.

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