The ketogenic, or keto, diet has gained popularity as a low-carb eating approach for weight loss and health improvement. When following a keto diet, carbs are typically reduced to 30 to 50 grams per day, leading to weight loss and potentially improving heart health and blood sugar control. However, to fully benefit from the keto diet, it's important to implement it correctly. Many people find they are not losing weight on the keto diet. There are various reasons for this, including not going into ketosis or not properly counting calories. This article explores common reasons why you might not be seeing the desired results on a keto diet and provides tips to overcome these challenges.
What is the Keto Diet?
The keto diet is all about cutting carbs and eating more fat, similar to the Atkins diet from the 1970s. The ketogenic diet reduces your total carb intake to less than 50 grams a day, which is the equivalent of a cup of white rice. The keto diet excludes carb-rich foods like grains, beans, fruits and starchy vegetables. Roshini G. Merneedi, RD, a dietitian at Northwestern Medicine, explains that your body's primary energy source is glucose, which comes from the breakdown of carbohydrates. The keto diet limits carbohydrates, forcing your body to burn fat for fuel instead. When these stores are full, they are converted into fat. In this state, your body breaks down fats into molecules called ketones. Ketones serve as an alternative fuel source.
Key Principles of the Keto Diet
The premise of the ketogenic diet for weight loss is that if you deprive the body of glucose-the main source of energy for all cells in the body, which is obtained by eating carbohydrate foods-an alternative fuel called ketones is produced from stored fat (thus, the term “keto”-genic). The brain demands the most glucose in a steady supply, about 120 grams daily, because it cannot store glucose. During fasting, or when very little carbohydrate is eaten, the body first pulls stored glucose from the liver and temporarily breaks down muscle to release glucose. If this continues for 3-4 days and stored glucose is fully depleted, blood levels of a hormone called insulin decrease, and the body begins to use fat as its primary fuel. The liver produces ketone bodies from fat, which can be used in the absence of glucose. When ketone bodies accumulate in the blood, this is called ketosis. Healthy individuals naturally experience mild ketosis during periods of fasting (e.g., sleeping overnight) and very strenuous exercise. Proponents of the ketogenic diet state that if the diet is carefully followed, blood levels of ketones should not reach a harmful level (known as “ketoacidosis”) as the brain will use ketones for fuel, and healthy individuals will typically produce enough insulin to prevent excessive ketones from forming.
Common Reasons for Not Losing Weight on Keto
1. Consuming Too Many Carbs
One of the main reasons people don’t lose weight on the ketogenic diet is that they’re consuming too many carbs. The keto diet is a type of diet that significantly restricts carbohydrate intake. To reach the state of ketosis - a metabolic state in which your body burns fat for energy instead of glucose - carbohydrate intake must be drastically reduced. In fact, only around 5% to 10% of your total calories should come from carbs. This is in stark contrast to the standard dietary recommendation that 45-65% of calories come from carbs. It’s normal to have a bit of difficulty cutting out carbs when first adjusting to the ketogenic diet. However, to reach and maintain ketosis, carbs must be decreased to the recommended range.
Solution: To help reach your intake goals, consider tracking your macronutrients through an app like MyFitnessPal. This can help you learn how many servings of carbs you’re allowed to have in a day depending on your calorie needs. Read the nutritional information on anything you're eating. Most of your carbs will be incidental, unavoidable components of foods you'll choose to eat on keto. Understanding net carbs will help you understand your intake.
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2. Relying on Processed Keto Foods
No matter what dietary plan follow, the key to healthy weight loss is to consume nutritious, whole foods. Relying on processed foods can put a dent in your weight loss even if they’re keto-friendly. With more and more keto-specific products in grocery stores, keto cookies and keto granola bars, etc., it's easy to rely on these processed foods. Adding in foods like snack bars, keto desserts and other packaged foods between meals can derail your weight loss efforts with the extra calories they provide. Additionally, eating too many convenience-type foods like hot dogs and fast food when you’re on the run can slow weight loss. These foods are nutrient-poor, meaning they’re high in calories but low in vitamins, minerals and antioxidants.
Solution: To optimize your nutrient intake while losing weight on the keto diet, stick to unprocessed, whole foods. For example, full-fat dairy products, eggs, fish, pastured meats, poultry and healthy fats like avocado and olive oil are all great choices. Be sure to add non-starchy vegetables like greens, broccoli, peppers and mushrooms to dishes to add nutrients and fiber.
3. Eating Too Many Calories
When trying to lose weight, it’s critical to create a calorie deficit. This can be achieved by either reducing the number of calories that you consume or by expending more calories through increased physical activity. If you switch to a keto diet and don’t watch your calorie intake, you’re unlikely to drop pounds. Because many keto-friendly foods, including avocados, olive oil, full-fat dairy and nuts, are high in calories, it’s important not to overdo it. Most people feel more satisfied after eating ketogenic meals and snacks due to the filling effects of fat and protein. However, it’s entirely possible to consume too many calories on a ketogenic diet by eating portions that are too large or by snacking on high-calorie foods throughout the day.
Solution: Paying attention to portion size, increasing physical activity and snacking in moderation between meals can help create the calorie deficit needed to lose weight.
4. Medical Conditions
However, if you’re having a difficult time losing weight even though you’re doing everything right, it’s a good idea to rule out any medical issues that may be preventing weight loss success. Hypothyroidism, polycystic ovarian syndrome (PCOS), Cushing’s syndrome, depression and hyperinsulinemia (high insulin levels) are medical issues that can cause weight gain and make it difficult to lose weight.
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Solution: These conditions can be ruled out by your doctor through a series of tests. If you have one of the conditions listed above, don’t despair. Through proper management, including medication if necessary and lifestyle and dietary modifications, you can achieve and maintain healthy weight loss. A person should contact a doctor if they are unable to lose weight despite adhering to a strict diet and exercise plan. The doctor may carry out tests to determine what is preventing weight loss. Treating the underlying condition may resolve the issue.
5. Unrealistic Expectations
It’s normal to want fast results when following a new diet plan, but it’s important to remember that weight loss can vary from person to person. Although the ketogenic diet can promote weight loss if properly followed, the rate at which you lose may not be rapid - and that’s okay. Small, consistent change is the key to losing and maintaining weight the healthy way. While it may be tempting to aim for lofty weight loss goals, most experts recommend that losing 1-3 pounds or about 0.5-1 kg per week (depending on weight) is best. Not to mention, if you adopt a new workout routine that involves weight lifting, you may gain muscle while losing fat. Though this can lead to slower weight loss, putting on muscle mass and decreasing fat mass benefits health in many ways.
6. Not Achieving Ketosis
Usually, when a person does not lose weight on the keto diet, it is because they have not achieved ketosis. One reason for not achieving ketosis is not cutting back enough on carbs. According to a 2023 overview of previous research. carbohydrates should represent only 5-10% of a person’s calorie intake on the ketogenic diet. Specifically, most keto diets require a person to cut down to between 20 and 50 grams of carbs each day on a 2000-calorie-per-day diet. Sometimes, a person may feel as though they have drastically reduced their carb intake. However, they may still be eating enough carbs for the body to produce energy from glucose, and this may reduce the rate of fat burned in the body. Food is not the only factor that can affect ketosis. Other factors can include sleep quality and hormone levels, such as cortisol. Achieving and maintaining ketosis can be a difficult task for many people.
Solution: Home testing can be a helpful way for people to ensure that they are entering ketosis. A person not losing weight on the keto diet may benefit from purchasing a home testing kit. These kits contain test strips that check for ketones in the urine. A positive result indicates that the body is in ketosis. Another option is to use a small machine called a ketone breath analyzer that detects ketones in the breath. People can use this information to make dietary changes to help them achieve their weight loss goals.
7. Too Much Protein
Many low carb diets allow for a moderate amount of protein. Some people mistakenly think a low carb, high protein diet is a keto diet. However, this type of diet is unlikely to cause ketosis because the body can break down excess proteins into amino acids and convert them to types of sugar. A person on the keto diet will get most of their calories from fat, which should represent about 55-60% of their calorie intake. This fat intake leaves little room for protein. If protein makes up more than 35% of a person’s diet, they may not go into ketosis. The correct proportion of protein in the keto diet is… Instead, increase your fat intake and observe how you feel.
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8. Overconsumption of Keto-Friendly Foods
On the keto diet, several types of carbohydrates are acceptable, including nuts and dairy. These foods are typically high fat, nutrient-dense foods that make a great addition to a keto diet. However, they also contain carbohydrates. Eating too many of these foods will keep a person from achieving and maintaining ketosis. Sugar alcohols are typically a good option for people following the keto diet. They provide sweetness without increasing net carbs in the body. However, not all sugar alcohols are alike. For example, although maltitol is technically a low glycemic index (GI) sugar, it can still affect a person’s blood sugar levels. Consuming too much maltitol may prevent a person from entering ketosis.
9. Continual Snacking
Continual snacking can increase a person’s calorie intake. This can mean a person consumes more calories than they are burning off, resulting in weight gain.
10. Alcohol Consumption
Many alcoholic drinks, such as wine or beer, are high in carbohydrates. Hard alcohols, such as gin and vodka, contain less sugars, meaning they are lower in carbohydrates. However, alcoholic drinks contain many calories. As such, even these options can prevent weight loss. The inherent carbohydrates in beer and wine disqualify them immediately. Most hard liquors are the same.
11. Lack of Exercise
Exercise is an important part of staying healthy. Exercise also stimulates the body’s metabolism and burns calories. Exercise may be especially important on a keto diet, as the high fat foods a person eats contain many calories. Burning calories through exercise can help a person reach their desired weight. Being overly sedentary not only causes you to gain weight but leads to myriad health problems, including heart disease and depression among many others.
12. Stress
A high-stress lifestyle can also stop a person from losing weight on the keto diet. As one 2022 article notes, psychological stress can cause changes in hormone levels, such as cortisol, which can lead to weight gain or difficulty losing weight. It also affects us physically, raising our blood pressure, sapping our energy, preventing sleep, and making the body more prone to illness. Chronic stress may also cause people to crave comfort foods, which can add extra calories to the diet.
General Tips to Help Achieve Weight Loss Goals on Keto
The following tips may help achieve and maintain a healthy BMI on the keto diet:
- Keeping a food journal: By keeping track of what they consume throughout the day, a person can often identify any foods or eating patterns - such as snacking - that may be preventing weight loss.
- Drinking plenty of water: Drinking plenty of water helps fill the stomach, and this may help keep a person from overeating or snacking too much throughout the day.
- Getting plenty of sleep: Sleep helps regulate the body’s normal cycles, and it may also help reduce stress levels.
- Planning meals: A person may benefit from adhering to a keto-friendly meal plan.
Potential Benefits of the Keto Diet
Although people may associate a keto diet with achieving and maintaining a healthy BMI, it may have other benefits. These may include:
- managing acne
- improving heart health
- reducing the risk of certain cancers
- impacting brain health
Potential Risks of the Keto Diet
However, the keto diet can carry some health risks. A person should speak with a doctor or dietician before following a keto diet. Following a very high-fat diet may be challenging to maintain. Some negative side effects of a long-term ketogenic diet have been suggested, including increased risk of kidney stones and osteoporosis, and increased blood levels of uric acid (a risk factor for gout). Possible nutrient deficiencies may arise if a variety of recommended foods on the ketogenic diet are not included. It is important to not solely focus on eating high-fat foods, but to include a daily variety of the allowed meats, fish, vegetables, fruits, nuts, and seeds to ensure adequate intakes of fiber, B vitamins, and minerals (iron, magnesium, zinc)-nutrients typically found in foods like whole grains that are restricted from the diet.
Ketoacidosis
Excessive ketone bodies can produce a dangerously toxic level of acid in the blood, called ketoacidosis. During ketoacidosis, the kidneys begin to excrete ketone bodies along with body water in the urine, causing some fluid-related weight loss. Ketoacidosis most often occurs in individuals with type 1 diabetes because they do not produce insulin, a hormone that prevents the overproduction of ketones. However in a few rare cases, ketoacidosis has been reported to occur in nondiabetic individuals following a prolonged very low carbohydrate diet.
The Importance of Consulting Professionals
Available research on the ketogenic diet for weight loss is still limited. Most of the studies so far have had a small number of participants, were short-term (12 weeks or less), and did not include control groups. A ketogenic diet has been shown to provide short-term benefits in some people including weight loss and improvements in total cholesterol, blood sugar, and blood pressure. However, these effects after one year when compared with the effects of conventional weight loss diets are not significantly different. Eliminating several food groups and the potential for unpleasant symptoms may make compliance difficult. An emphasis on foods high in saturated fat also counters recommendations from the Dietary Guidelines for Americans and the American Heart Association and may have adverse effects on blood LDL cholesterol. The exact ratio of fat, carbohydrate, and protein that is needed to achieve health benefits will vary among individuals due to their genetic makeup and body composition. Therefore, if one chooses to start a ketogenic diet, it is recommended to consult with one’s physician and a dietitian to closely monitor any biochemical changes after starting the regimen, and to create a meal plan that is tailored to one’s existing health conditions and to prevent nutritional deficiencies or other health complications.