Getting into ketosis
The entire aim of LCHF is to get into and remain in ketosis, see why LIHF works. So what does this mean exactly in practice? Quite simply it means that your body starts to run on fat rather than carbohydrates which entails restricting your carbohydrate intake and increasing your fat intake in order to maintain an energy balance. Full “keto-adaption” takes approximately 2-6 weeks, depending on the individual. However, provided you strictly adhere to the rules you should start to see almost immediate results, even within the first week or so of starting LCHF i.e. weight loss.
Note: If you are diabetic, either T1 or T2, you will need to regulate (reduce) your medication in order to avoid any “hypo’s” when going LCHF. Please consult your doctor first..
How much is too much carbs?
This is an excellent question. We are all different and so answering this question definitively for each individual is tricky. Many factors determine your overall carbohydrate tolerance levels, one of the biggest being your age. Carbohydrate tolerance falls with age which means that you are able to tolerate a relatively high carb intake when younger without necessarily putting on too much weight. As you get older, all things being equal and without further carb restrictions, most of us will start putting on weight around mid 30’s, the start of the so called “middle-age spread”. This is further compounded in western societies by an associated increase in affluence i.e. we start to earn and spend more on the “good things” life has to offer. In dietary terms this means eating out & drinking more as well as increased consumption of high-carb foods in general, usually sweet & sugary.
From my own experience and from others that I have read about, I have come up with my own definition of high and low carb in the context of LCHF, namely:
High Carb Intake: anything >100g/day.
I believe it is difficult/almost impossible to attain and maintain ketosis at this level. For most people LCHF will simply not work.
Medium Carb Intake: 50-100g/day.
Probably possible to attain and maintain ketosis for certain individuals e.g. if you are young and very fit. For others LCHF will not work at this level.
Low Carb Intake: 30-50g/day.
Entering and maintaining ketosis should work for almost everyone at this level.
Ultra Low Carb Intake: less than 30-50g/day.
This is for strict LCHF practitioners such as myself and should work for just about everyone. I recommend this level as your starting point for a) getting into ketosis and b) for the entire “weight loss phase”. This will give you the quickest results and confidence that LCHF really is working. You can always add some carbs back later during the “maintenance phase”.
Staying in Ketosis
It is vital that you understand that there is no such thing as partial nutritional ketosis, see below: you are either fat burning or not. Further, if for any reason you drop out of ketosis, it will take you another 2-6 weeks of carbohydrate restriction to get back in!! Hence, in order to get the full benefit from LCHF, your goal should be to enter and remain in ketosis at all times.
How do I know that I am in Ketosis?
The first and most obvious sign that you are in ketosis is weight loss followed by an increase in urination, possible “keto flu” and an “acetone” or nail polish remover smell on the breath. The weight loss is understandable but what about the other symptoms? Why do these occur and are they dangerous in anyway?
Increased Urination: On a carbohydrate restricted diet kidney function changes from storing water to excreting it which means that you start to expel more water “overboard”. This is perfectly normal and all you have to do is drink slightly more salt water, see “keto flu” below.
Acetone “nail polish” breath: As you move into ketosis and start burning fat, acetones are produced as a by-product and are released via the breath and urine. This is perfectly natural. For me it lasted for only a couple of days during the weight loss phase, when ketones were at their highest values. After that, it never occurred again. This a sure sign that you are in nutritional ketosis.
Keto flu: There’s a lot of talk about this, often in a negative way i.e. I hear of people giving up LCHF because of this since they think its something highly abnormal or even dangerous. It is only abnormal if you don’t do something about it and the solution is really simple. Keto flu or a general lethargy associated with ketosis is due do a contraction in blood plasma volume. This in turn is due to the diuretic effects of ketosis, see above, and is easily treatable by taking on more liquid, more specifically salt water. It is not enough to just replace the fluids you pass with “neat” water. As you lose water you also lose minerals, in particular sodium, a key component in blood plasma (that’s why blood tastes salty). So the solution is to simply drink some salt water or bouillon whenever you start to feel light headed or weak, especially during the weight loss phase when water loss is at its greatest. The worst it got for me was just a pleasant mid-afternoon tiredness, as if I had done some hard exercise. Since I was prepared for this I just drank some salt water and the symptoms disappeared almost immediately. As with the acetone smell, this is a passing phase that should not last very long and is certainly nothing to fear.
Cramps: Another common but passing symptom during the weight loss phase and is also associated with low sodium levels, see above. If they become severe then consider supplementing your diet with magnesium tablets as well.
Nutritional Ketosis and whether or not to measure ketones
So called “nutritional ketsosis” is the state you need to be in at all times in order to be a fat burning human. What does this mean in practice? To answer this consider the graph below:
The graph shows optimal fuel flow versus serum ketones in mM. On a high carb diet you produce negligible amounts of ketones but as you restrict the amount of carbs you eat, ketones increase until you reach a value of 0.5 mM, the start of nutritonal ketosis (fat burning). During the weight loss phase this increases even further to anywhere between 1.5 – 3.0 mM, the so-called “optimal zone”. This is where you are achieving the fastest, most efficient weight loss and is associated with a low to ultra low carb intake, see above. If you are getting it right, you can expect ketone values of 1.5 – 3.0 mM or more during the weight loss phase, falling to 0.3 – 0.5 as your weight bottoms out and you move into the maintenance phase.
There are 2 ways of measuring ketones: urine sticks or a blood sugar/ketone measuring kit. The former is cheap and inaccurate, the latter expensive and more accurate. If you are getting it right you should not need to measure ketones. All the signs and symptoms i.e. rapid weight loss, acetones on the breath, keto flu, etc, etc, should tell you all you need to know. Certainly if you follow the advice in these pages to the letter you can save yourself a lot of hassle and money by not having to measure anything at all! I did measure ketones via a blood ketone meter but only because I was struggling to lose weight due to what I later found out to be dairy intolerance. If you do decide to measure ketones then I recommend that you use a blood measuring kit and I also suggest you do it first thing in the morning before breakfast i.e. fasting levels. Without doubt, measuring ketones gives you a great added confidence boost and demonstrates that you are getting everything right during the weight loss phase and beyond!
Note: if you have tried LCHF and failed for any unknown/unidentifiable reason (as happened with me and dairy), despite following the advice on this site, then I suggest you start measuring serum ketones, as well as keeping a strict record of everything that you eat. There will be something in your diet that is inflaming you and hence blocking ketosis. With the help of a ketone measuring kit and a strict dietary record, you can identify and remove the offending substance from your diet.
“THE TEN COMMANDMENTS”
Practical Ketosis: losing weight and keeping it off!
Based on my over 4 yrs of LCHF living, I’ve come up with what I believe to be a definitive ten point plan that will give you a) the greatest chance of success and b) the quickest and safest weight loss. Follow these simple rules TO THE LETTER and I believe you can’t go wrong!
- Ultra Low Carb intake: see above. Drop ALL bread, pasta, rice, potatoes, flour and other starchy foods. With the exception of very dark chocolate (>80% cocoa, pref non-dairy), drop ALL plain sugar, sweets, chewing gum, soft drinks, cakes, ice creams, pastries, high sugar food items, etc.
- Increase “good” fat intake: Incorporate unrestricted amounts of the following saturated fats into your diet: olive oil, ghee, cold pressed coconut oil, coconut cream, coconut milk, home-made mayonnaise (light olive oil), fatty meats e.g. bacon, sausages, etc, fatty fish such as salmon & mackerel, roast chicken and eggs.
- Vegetables: reasonable amounts of above ground veg with each meal, esp avocados.
- With the exception of home made ghee/clarified butter, DROP ALL DAIRY.
- With the exception of a few berries such as strawberries, blue berries, rasberries, etc, DROP ALL FRUIT AND THEIR JUICES. Remove all other sources of fructose from your diet.
- Eat ONLY when hungry, NOT when the clock says and eat to satiation i.e. feeling full.
- SEVERELY restrict alcohol intake, pref NIL during wt loss phase.
- Drink ONLY when thirsty/feeling light headed: salt water/bullion as required to prevent keto flu symptoms.
- Replace dietry sugar with XYLITOL, e.g. hot drinks, baking, etc.
- Exercise ONLY if/when you feel like it (optional).
- the above plan may seem strict and it is meant to be so that you have the maximum chance of weight loss success in the shortest possible time and is based on my own experience and testing. Once all weight has been lost, you start to “bottom out” and move into the weight “maintenance phase”, the above plan may be modified to suit e.g. increased carb intake, re-introduction of some dairy, etc.
- On an LCHF diet there is no need to count any calories or weigh any foods, just restrict your carb intake as above. Otherwise eat as much as you like until you feel full!
Suggested Meal Plan
To get you started, here’s a typical meal plan that I use regularly:
Breakfast: bacon and eggs fried in olive oil, served with cherry tomatoes, cucumber, red pepper, avocado and home made mayonnaise. Fresh filter coffee (Arabica only) with coconut cream, pinch of vanilla powder and xylitol.
Lunch/snack: (usually not reqd) keto coffee
Dinner/evening meal: Oven baked salmon, kale chips, veg, home-made mayo. Dessert: berries with dark chocolate, walnuts and coconut cream. Drink: water with dash of lemon and lime.
16 thoughts on “Getting Started”
2-6 weeks of carbohydrate restriction to get back in? Can You, please say more about it.
This is roughly how long it will take to get back into ketosis if you drop out for any reason.
Yeah, I guess, I understand that. But do You have any reading about that, You may recommend?
This is the only book I ever recommend & the only one you will ever need 😉👊
The Art and Science of Low Carbohydrate Living: https://www.amazon.de/dp/0983490708/ref=cm_sw_r_tw_dp_x_JHfmzb7EWT9CA
It took me first time 3 Days to get into ketosis! I am a vet so I could measure the ketones at my work. I started off brutally with a 600 kcal intake the first day and from then on 2000 kcal, no carbs and 80% fat in a 4-6 hour eating window (12-14 to 18) (I was 104 kg/ 188 cm). So I was doing the intermittent fasting from the start. I started on a tuesday and measured 1,0 mmol/l on friday the same week. It was also by that day I felt the great feeling of euphoria. Until that I had a bad keto flu most of the times and really had no knowledge how to cope with it! I can add that starting so hard without restricting carb successfully is not what I actually would recommend any others.
By the way, I saw a note on coconut milk as good fat in your post. Have you seen this? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582574/
It appears the patient hade problems getting into cause probably because of coconut milk, also highering blood glucose. I was pubmeding ketogenic diet and just ran into that, haven’t really read anywhere that coconut milk could get you out of ketosis, interesting though…
Great blog by the way and good luck in your future journey!
Hi Jari. Thanks for the feedback and article link. Yes, there can be problems with coconut-based products, not so much because of the fats per se, but because people can and do have a straightforward coconut allergy. Anything that inflames, including viruses such as the common cold, will block ketosis in my view, which is probably the reason why this patient failed on coconut milk. Yes, I too experienced that “euphoria” when I started, especially when I drank some “neat” coconut oil! The keto flu will pass so don’t give up. It’s all worth it in the end.
Yeah, I started in february this year so I have learned to cope with the keto flu when and if that happens. Although I thought ketosis was amazing I got out of it from time to time because I wasn’t fully mentally on it. But since july I am 100% devoted and doing “a self study” on the benefits of being fat adapted. The “old” truth says that it is impossible to stick to ketogenic diet and I admit it can be hard if one is not mentally righ there. But truly I would say, since I finally made the decision to be fully committed it is rather really easy to follow that way of Life!
How much total calories in your above “suggested” meal plan? And it’s mean for daily plan?
I have never counted calories. The only thing I’ve counted is carbs. During my LC days, I maintained a strict max 30g/day restriction, which I believe is a critical value for those trying to lose weight in middle age. However, since going ZC at the beginning of this year that is of course no longer an issue. Hope this helps.
Thanks for great advice.
Could you please clarify the point #8 about drinking only when thirsty? Does this consider only salt water drinking or drinking water in general?
Nick – found your site when came across your interview with Ivor Cummins on youtube. I am 75 yo orthopedic surgeon now semi retired. See patients in office but no surgery or call. Have done well on low carb. Lost at least 40 lbs. A1c has gone from 7.2 to 5.7. Feel great. I have seen so many patients over the years who have struggled and suffered with weight. Miserable and usually unsuccessful. Mostly women. I am considering starting a practice trying to help people get on low carb and wondering how to get started. I don’t want to interfere with their own doctors and I don’t need to make money. Just want to educate people and support them doing low carb. Any suggestion on getting started. Thanks for all your information. I practice in Saratoga Springs, NY in USA.
Thanks for the very interesting comments.
Yes, you’re going to be treading on a lot of people’s toes if you go down that route but I guess at your stage in life/ career it doesn’t matter anyway!
If you do do this, you’ll probably end up doing more “real” good for your patients in your retirement than your entire career as a OS. As Dr. Doug McGuff, author of Body by Science, the book on which all of my client training is based often says, he does way more good for his patients in his private gym facility than in the ER department in which he works.
I have a whole wealth of information to give you, too much for this comment. I suggest you email me: email@example.com for more.
I also encourage you to get involved in the forum: https://lihfliving.com/community/ where I tend to answer questions more these days. It’s a more effective [one to many] environment.
Hi! I am wondering if almond milk (sugar free) is ok for coffee? It took me ages to get used to cream in my coffee – truly loved my cappuccinos, and just can’t get used to black coffee. Thank you, I need this to work because I am honestly getting discouraged.
I’m a bit confused about commandment 2, where you advise unrestricted amounts of “saturated fats”, yet name olive oil? As this is actually a mono-unsaturated fat, which are usually rancid in bottles, and to my knowledge are a cause on inflammation? Especially when you fry them (as you also recommend) since they’re unstable compared to actual saturated fats, like ghee, lard, beef dripping. Could you give your rationale for this please? As I am genuinely confused. Many thanks.
Olive and coconut oil are the only 2 vegetable fats I recommend. Yes, they contain MUFA but so do SAT fats, at least to some extent – there is no fat that is pure SAT fat, etc. All contain SAT, MUFA and PUFA; it’s just the proportions that vary. Yes, olive oil will eventually go cloudy but no where near as quickly as industrial seed oils will which in itself is a big clue as to whether or not they are suitable from an oxidative stress point-of-view.
You should try to avoid frying with olive oil and use sat fats as you recommend because of the lower smoke point. Yes, this is potentially toxic to the lungs but only if you’re doing it a lot and standing directly over the pan with no extractor fan.I am not aware that any other toxins are produced in the olive oil itself as a result of frying.