Last week’s post, Troubleshooting Guide Part I, was the first of a two-part guide for solving problems in ketosis.  For those who are new to eating keto, you may find yourself facing a few challenges early in your adaptation.  Part I addresses:

  1. “I have headaches, brain fog and my energy is low.”
  2. “My heart sometimes races or feels funny since I lowered my carbs.”
  3. “I have leg cramps.”
  4. “I salt my food, but I still have terrible headaches and also feel tired, dizzy, and my sinuses are congested.”
  5. “Every time I eat, I have heartburn/indigestion/acid reflux” or “I can’t seem to handle all the fat.”

This week, I will address the next five challenges that face those new to ketosis.

  1. “I’m always cold” or “my hair is thinning” or “I cannot sleep” or “I feel anxious all of the time.” These and related symptoms occur when someone’s thyroid function is beginning to slow. The thyroid is a butterfly shaped gland that sits at the base on the throat.  It is the metabolic control center of the body.  A slow or sluggish metabolism registers a basal body temperature under the average of 98.6 degrees.  This explains why a slow metabolism is often diagnosed by feeling cold. Other signs of a slow metabolism can include constipation, hair thinning or hair loss, inability to sleep, inability to lose weight now matter how hard one diets, etc. (Wentz, 2013).
    Thyroid issues are, sadly, common among those in ketosis.  Does ketosis necessitate a change in thyroid function?  Yes and no.  Ketosis does change how the body metabolizes fuel for energy, but thyroid function should be optimized when humans eat a diet that more closely resembles the diet of our human ancestors.  Before agriculture, we did not have access to carbohydrates in the amounts we do today.  Thus, our ancestors were fueled primarily by proteins and fats which is what ketosis does.  A ketogenic diet, then, more closely mimics the natural human diet that evolved over thousands of years.  For those years, humans were not obese or struggling with sluggish metabolisms.
    So what, then, causes the thyroid to slow down?  There are two arguments about what causes this.  One argument is that eating low carb causes the thyroid to slow down.  The thyroid is one of a few systems in the body that depends upon glucose and cannot be fueled by ketones.  However, the amount of glucose needed by the thyroid is easily provided by eating a minimal amount of carbs (20 grams per day) or by eating enough protein and fat because the body can create glucose from both of these foods via gluconeogenesis (see Why Ketosis for details).  Thus, eating low carb does not cause the thyroid to slow.  The second argument is that thyroid function slows in response to under eating, and this is very true.  People in a hurry to hit their goal weight will often combine severe calorie restriction (dieting) with techniques like going long periods without food (fasting) and overtraining to lose body fat.  However, when the body senses that it is taking in calories at a severe deficit, it eventually slows its use of the calories so that it uses as little (or less) than the body takes in.  For example, if I need 2,000 calories to sustain my body and activities and decide to eat 1,200 calories a day, my body will reduce its energy usage by 800 calories.  What will the body eliminate?  It eliminates or slows down as many processes as it can.  The best way to combat a slowing of your metabolism is to feed the body enough calories so that it maintains thyroid function.  In next week’s post, I will explain how to diet successfully so that you drop body fat without losing other functions or slowing your metabolism.
  1. “I have not lost any weight yet.” It is possible to overeat while in ketosis? Actually, it is. For a short while, I was eating sticks of butter while limiting my protein and vegetables in an attempt to have higher ketone readings.  This did raise my ketone readings, but it did nothing to help my body hit its weight goal.  If you have not lost any weight since becoming ketogenic, then one of two primary factors is likely effecting you:
    a.  You may be eating too many calories, namely slurping down butter or moping up all the bacon grease with a keto biscuit. You do need to eat enough fat because with a ketogenic way of eating, fat is your primary source of fuel.  However, it is easy to eat an extra 500 calories of fat by drinking the popular “Bulletproof Coffee” alongside your meals.  It’s much harder to eat extra calories in the form of nutrient dense foods like fatty proteins and vegetables than to drink or even eat keto treats that are loaded with extra fat.
    b.  You may have elevated insulin levels. Insulin is the storage regulating hormone and it signals the body to grow or reduce it muscle and fat stores. When insulin is high, the body is signaled to store excess calories in your fat cells.  When insulin is low, the body is signaled to burn fat stored in cells.  Once in ketosis, elevated insulin levels will reduce in time if one eats low carb and moderate protein.  Eating too much of either of these will keep insulin elevated and stop the body from accessing its body fat stores effectively.
  2. “I lost weight initially but now my weight is stalled.” Can you also undereat and stop weight loss? Absolutely. The body undergoes many metabolic transformations while mobilizing body fat. Weight loss is not perfectly linear and at times it will raise or hold stable for a while before dropping again.  But if you hit a true stall and your weight remains unchanged for four weeks despite your best efforts, you may be eating too few calories.  Excessive or long term calorie restriction can slow your metabolism and cause your body to feel unsafe releasing its body fat stores (as I explain above).  Just as you do not want to overeat, you do need to eat enough to signal your body that you are not in a famine.  If the body senses that you are in a famine, then its job is to protect you from staring to death.  To this end, it will store all the calories it can.  This may sound dramatic, but ask anyone who has eaten 1,200 calories, hit the gym daily and still gained two pounds.  The stresses created by undereating are very real.

What is most important when it comes to losing body fat is finding “the goldilocks effect” with your diet: not eating too much or too little, but the amount of calories that were just right for you.  If you need some guidance on how to determine this, contact me for information on nutritional coaching.

  1. “No matter how much fat I eat, I am hungry all of the time.” This is the simplest problem to resolve. Eat more protein. There is a premise called the protein leverage hypothesis (Simpson & Raubenheimer, 2005), which stipulates that obesity in humans can be leveraged by protein intake.  The more protein humans eat, the less fat and carbs they want to eat.  If you are eating high amounts of fat in an attempt to satisfy your hunger, consider trading your fat for protein. It is very satiating, to the point that protein is actually difficult to overeat.  When you are satisfied by your diet, then you have found your personal protein need.
  2. “I am never hungry.” This is a normal reaction to being in ketosis. Carbohydrates can create food cravings and unstable hunger, due to their effects on blood sugar levels.  When I eliminated most carbs from my diet, I no longer felt the energy highs and lows that had always determined my hunger in the past.  I was enabled to feel true hunger for the first time, and it took hours longer to feel that hunger.  Because my hypoglycemia was a thing of the past, I went from needing to eat every 3-4 hours to sometimes forgetting to eat a meal.  Nowadays, I eat twice a day and my meals are large enough to carry me for longer periods without eating.  If you are new to ketosis and find you are never hungry, consider that your hunger signals may simply have changed.  Soon enough, the lure of fried chicken, bacon burgers, creamy guacamole and many other foods will certainly reinstate your hunger!  You may find that for the first time, your hunger is naturally in control.  This will enable you to eat the right amount of food to both satisfy your hunger and keep your metabolism fired up.

I hope you found the solution to any problems you are facing while in ketosis in either this guide or in Part I.  If you have any additional questions or struggles with adaptation, please comment below or contact me.  Thanks again.



Simpson, S.J. & Raubenheimer, D. (2005).  Obesity: the protein leverage hypothesis.  Obesity Reviews, 6(2): 133-142.  doi:10.1111/j.1467-789X.2005.00178.x

Wentz, I. & Nowosadzka, M. (2013).  Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause.  Wentz LLC.