Overcoming stumbling blocks on a ketogenic diet: a case study

I had a client contact me for an email consultation this week. She was frustrated as, despite following a ketogenic diet (where carbs are restricted to 30g or below, over 70% of calories should come from fat, and protein is moderated), she was unable to get into ketosis.

I had a look at her food diary and could quite quickly see where I thought she could change things to help enhance her ketogenic approach. With her blessing, she’s allowed me to share this with a wider audience. Like many things, if one person is having challenges finding the right balance in their diet, there are likely many more people doing very similar things and potentially experiencing the same frustrations.  I focused on some of the main issues I saw.

You’ll notice there are foods that don’t align with ketogenic diets OR would be included in any diet for someone wanting to shed fat. We (the client and I) spoke on that in general, as clearly she knows this (i.e. cheesecake). The points I focused on were those that can trip people up that she might not be aware of. I’ve screenshot her food diary, and then my comments are below.

Her diet:


Major points – unable to get into ketosis despite sticking to under 30g carbohydrate per day. This is measured by a blood ketone meter, and she wondered if she needed to add more fat to do this. Her overall goal is weight loss.

The thing with weight loss and the ketogenic diet, if you follow the advice from Phinney and Volek, pioneers of the ketogenic diet space, part of the energy your body needs to consume should come from your own fat stores, and not be provided for by diet. It’s a common misconception, as I see many people embark on a ketogenic diet for fat loss purposes but the opposite occurs – they gain weight. A common strategy at this point is to further reduce carbohydrate intake and bump up the fat. However, this will often further exacerbate weight gain (and frustration around the approach). Worst case scenario here is when the frustration leads to ‘to hell with it’ and that low carb diet is supplemented with all manner of processed refined carb junk food because ‘what’s the point? I can’t do this anyway, I’m useless and it’s not working for me.’ Clearly the end result of this self-punishment is further fat gain, some horrible carb cravings and a bad psychological state. Needless to say, I don’t think adding in more fat is the answer in this instance (and for this client), however I do think that tweaking what she is already doing is going to help.

It’s also good to remember that blood ketones aren’t the be all and end all – these indicate ketones in your bloodstream but sometimes, when these are low, this just means we are using them for energy – which is what you want! This is more likely to be the case in an athlete rather than anyone who is generally just active. In this case example,  I think the diet is the main reason for her not being in ketosis, rather than that the client is using ketones efficiently. However,  it is worth remembering that if you are following a ketogenic diet and are not seeing the expected results on the blood ketone meter.

Finally (and something I mentioned to the client) you don’t need a ketogenic diet to successfully lose weight, and sometimes focusing instead on the pointers I give at the end, regardless of ketosis, will give the same end result. Something like my online menu planner and individualised nutrition coaching. However, I would recommend in that instance to up the protein (double the recommendation I give you) and drop back the fat intake, as people often find that far more satisfying and easier to adhere to – which ultimately is THE most important thing with any dietary approach.

Key issues I picked up:

  • Too much protein in one sitting/in general
  • Processed foods
  • Dairy
  • Unintentional free sugar

1.Milk –  both the sugar in a cup of milk and the protein (whey) will raise insulin levels, thus put you out of ketosis. This is true of skim and standard milk.

2. Protein cookies: the type of sweetener/fibre used to make it a lower carb item can also spike insulin. For some people it is definitely a dose response thing going on – they can eat ½ cookie no problem, but a whole one will kick them out of ketosis. For any items like these, and if you do have blood glucose or blood ketone meters, it can be good to get a reading after a certain dose to see what effect they have for you. At any rate, highly processed goods can still negatively impact on blood sugar and appetite regulation in the absence of them being carb-based.

3. Coconut water – contains 3g sugar per 100ml or thereabouts. Any amount of free sugar in the diet is going to impact pretty quickly on your blood sugar levels if you haven’t just finished exercising, and kick you out of ketosis. The types of carbs you want to be having in your diet are specifically non-starchy carbohydrates -the majority of any carb sources coming from green leafy vegetables, other colour vegetables, perhaps some pumpkin/carrot depending on their effects on your blood sugar.

4. Grapes: any fruit is going to impact on your blood sugar levels, and particularly grapes – even if you stick within your limit of carbohydrate, the sugar from these are going to hit your bloodstream pretty quickly and cause an insulin response, thereby lowering ketones, especially if eaten outside of a meal that contains fat and/or protein (both of which slow down the glucose from hitting the blood stream). Fruit is typically best avoided on a ketogenic diet, aside from lemons, grapefruit, some berries.

5. Protein content of meals: for most, these need to be lower unless an individual is athletic. If struggling with getting into ketosis, it can be good to lower protein consistently to 1g/kg ideal body weight. For this particular client, this is 65g per day. Many days are consistently above this. In addition, the amount of protein in any one meal makes a difference – ideally, not more than 30g protein in any one sitting and, for you, likely 20g in a meal. This is obviously going to differ from person to person – as mentioned, athletes who have a greater energy output can generally get away with more protein (and more carbohdyrate) compared to a person who is sedentary or just lightly active.

6. Timing of food: eating within a restricted window (and not eating later in the evening) can help a ketogenic diet – our liver’s ability to metabolise carbohydrate is dictated in part by a ciracadian rhythm;  we are naturally more carbohydrate sensitive in the AM, less so in the PM, so carbs are likely to spike insulin more in the evening. In addition, fasting naturally upregulates ketone production and can help accelerated ketosis. Further, snacking can (for some) keep them from being out of ketosis, so 3 meals, or 2 meals plus a snack is recommended.

Key recommendations:

1. Drop protein down in each of the meals so you are averaging approximately 20-25g at meals.

2. Time any foods that have a greater amount of carbohydrate in them for after exercise (ie lower sugar fruit, or nuts that have a higher carb count such as cashews). The body doesn’t need to rely on just the action of insulin to deliver carbohydrates to cells in this instance, as we have receptors called GLUT-4 receptors in our muscles and in adipose tissue that can take up carbohydate and are activated post-exercise. Remember, an increase in insulin suppresses the production of free fatty acids, the precursors to ketone bodies.

3. Engage in exercise to help upregulate ketone production – aerobic/weight training.

4. Fasting for 14h at a time to help body produce ketones. Now for women, fasting can be a great tool, but can also backfire (read more about that here). Generally speaking, the fasting approach can be something that is incorporated 1-2 x per week if fat loss is a goal, and on other days, opt for a 12h window between dinner one night and breakfast the next day. The most important thing, though, is to be aware of negative changes to energy, how you feel, mood and sleep patterns – all underlying signs of a stress response that you might not be able to cope with.

5. Focus on diet quality – so the carbs, protein, fats are coming from whole foods and not processed or snack foods – ie protein cookies, fat bombs etc

6. Remove drinks / foods that contain easily digested carbs even if they fall within the carb count for the day. You’ll feel far more satisfied (and it is far more nutritious) to get your carbohydrates from green leafy vegetables which also contains a good amount of fibre.

7. Dairy – stick to hard cheeses and forgo the softer cheese/milk.

These are just some pointers from this client’s diet; another practitioner may pick up others. I will reiterate my point, however, in that a ketogenic diet, when done purely for weight loss, isn’t always the best approach and, for alot of people, unsustainable and too much like hard work. If you’re struggling to get the balance right and not seeing the results, then there are definitely other alternatives out there – one which will fit your lifestyle, eating behaviour, budget and allow you to lose weight with far less effort. It’s adherence that is key. Let me help you with that.

Selection of healthy fat sources

Delicious, nutritious food regardless of your dietary approach.

LCHF…why isn’t it working for me? (Part 1)

It’s about this time of year that I start seeing people come through my doors needing some minor (or major) tweaks to their LCHF eating approach. There are usually one of two scenarios.

Scenario #1: When they embarked on LCHF they saw ALL of the benefits they heard about, effortlessly shedding body fat, boundless energy (in training and afterwards), improvement in skin tone, hair condition, sleep and digestive problems. But lately the opposite is true. Despite seemingly nailing this LCHF lifestyle, they’ve noticed they are lacking energy, gaining weight (especially around the middle), latest blood tests have seen their cholesterol levels have shot up (and perhaps triglycerides), they are unable to sleep… … yet if anything, they’ve instigated (and nailed) the hacks they’ve read to optimise their LCHF eating approach. What gives??

Scenario #2: They’ve given it a good go on their own for the last 5 weeks, following it to the letter and despite this, it’s ‘not working for them.’ Worse, their husband/workmate/training partner has taken to it with ease.

Frustrating, much?

While we are all individual as to what is going to work for us, the LCHF approach is a really good one for most people, most of the time. Despite that, there are small things that can derail your best efforts to improve your diet, so I want to cover off the basic (and more nuanced) reasons people don’t fare well on a LCHF approach, and some tips on how to overcome them. I’ve ended up splitting this post into two parts as it was so long!

  1. Too low carb. The internet is a wonderful and terrible thing – information is everywhere, everyone is an expert and the version of paleo/LCHF/JERF that you’ve adopted based on what others are doing may well be too low carb for you. LCHF is a spectrum, and what is low carb for one person may well be higher carb for someone else – generally speaking, anything up to 200g of carbohydrate/day could be low carb. It all depends on context. I see a lot of people who are trying to stay strictly below 25g of carbohydrate a day – too strict (and unnecessary) for most people. Even Prof Tim Noakes, staunch advocate of a LCHF approach to eating (“banting”) has loosened up on this. The people who really benefit from a diet this low would be those embarking on it for therapeutic reasons: diabetes (both types), epilepsy, cognitive health (Alzheimer’s, for example). That’s not to say that others out there can’t make this level of carbohydrate work for them. But if you’ve noticed fat gain (especially around the middle), irritability, hormone imbalances (such as a missed menstrual period), lack of energy (past the initial phases of the LCHF approach), irregularity of bowel motions, sleeplessness – to name a few symptoms, then you may have gone too low. What to do?
    1. Track your diet for 4-5 days to get an average of the grams of carbohydrate you eat per day. If it’s on the very low end of the scale (less than 50g*, for example), then try adding back in some good quality starch to see if any of your symptoms improve. Don’t be pedantic about vegetables. Really. That includes carrots and tomatoes. To be honest, you don’t have to track your carbs if you’re not a numbers person – but it can be a good way to assess if this really is the problem. Use My Fitness Pal, Cron-o-meter, My Net Diary or Easy Diet Diary as nutritional tracking tools. (If you’re embarking on a lower carb diet, this is a good first step regardless, so you don’t make the jump from 400g a day to 60g a day).
    2. If your carbohydrate intake is in the realm of 80-100g carbohydrate, you may not be too low, it might be more of a timing problem – ensuring you have carbohydrate in the meal after a high intensity (i.e. CrossFit or F45) or long duration exercise session can help improve recovery and alleviate a lot of fatigue/irritability. If you’re struggling with insomnia, then adding in some kumara or potato into your evening meal increases production of precursors to melatonin.
    3. Is it more protein you need? Protein can help keep you fuller for longer, stabilise blood sugars (therefore has implications for focus/energy/concentration), promote recovery and help with sleep. Many people fear protein because of the potential for it to be converted to glucose in the body (via gluconeogenesis). For someone following a LCHF diet this isn’t an issue. Try upping your protein portions by 1/3 – ½ at each meal.
    4. If it’s in the initial phases, then up your intake of sodium – to levels more than you think you need. When we drop the carbohydrate content of the diet, we drop a lot of water stores too (hence a rapid loss on the scales) – this is because for every gram of carbohydrates stored, we store an additional 3g of water. Add salt to your meals, a pinch in your water bottle, make a miso drink or drink bone broth.
  2. Not low carb enough. I see this a lot. People equate carbohydrate to bread, pasta, rice and cereal and don’t think about other foods that are predominantly carbohydrate –fruit, dried fruit, ‘green smoothies’ with a fruit base, bliss balls, natural fruit and nut bars… In addition, many products are promoted as ‘sugar free’ when they contain dried fruit, maple sugar, rice malt syrup or some other type of natural sweetener. This may seem elementary to you, but I know many people are confused by this point. Regardless of what you hear, sugar IS just sugar – that one sugar is lower in fructose doesn’t mean it’s not going to influence your blood sugar levels, it’s likely to affect them more. This has to be my biggest bugbear of the ‘real food’ movement; not that these products contain sugar – but that they are marketed as not. This is no better than being told that Nutrigrain is healthy. We all know that’s not true.
    1. Again, track your numbers (as per above) via a tracking tool. A lower carbohydrate approach is not a fixed number, it’s a spectrum. But if you’re still consuming over 200g a day and not engaging in regular physical activity, then something might need to be tweaked (especially if you’re not seeing the results you’re after).
    2. Get rid of the bliss balls, the dried fruit, the paleo muffin or the smoothie from your favourite juice bar that you thought tasted suspiciously sweet for something ‘green’.
    3. Read the ingredient lists on the packages you buy. Sugar has over 56 different names. You probably don’t need to know them all, but it would be good to have an idea, right?
  3. Too many processed foods or snacks. Even if you’ve found a sweet spot with your macronutrient intake, having too many processed ‘low carb’ snacks can continue to drive your appetite hormones in a way that favours eating more than you need. Leptin is a hormone produced by fat cells that tells the body when we’ve had enough to eat, and is involved in the regulation of calories we burn and body fat that we store. A consequence of being over-fat is high circulating leptin levels in the bloodstream, and the brain stops reading signals sent by leptin that we’ve consumed enough food. Instead, it incorrectly believes that we are starving, thus we feel hungrier. Excess body fat increases Inflammation in the body, and is one of the drivers of leptin resistance, and processed food can drive inflammatory pathways in the body – even low carb processed food. And if you’re not over-fat? Well, vegetable oils and certain additives and preservatives found in these foods can drive inflammatory pathways in the body. In addition, an overabundance of processed flours may cause disruptions to our gut microbiome as they are easily digested, perhaps not even making it to the gut bacteria in our lower digestive tract. This can mean we are starving our good bacteria and instead feeding bacteria that release endotoxins, causing increasing inflammation. This can have a secondary effect of increasing your cholesterol level (see this post here). These foods are created in such a way to send signals to your brain’s pleasure centre and drive your appetite for more food that you just don’t need. One of the benefits of a real food approach (which naturally lowers your carbohydrate intake) is that inflammation reduces, insulin drops, gut bacteria can rebalance and the signalling pathways in the brain that regulate your appetite hormones can begin to normalise.
    1. Get rid of most foods or snacks that come in a package with ingredients you don’t recognise.
    2. Eat real food. Base your snacks around hardboiled eggs, cheese (for the dairy tolerant), vegetables, leftover meat, macadamia nuts, egg muffins.
    3. Drop the nut flours. Just because they’re low carb does not mean it’s a free for all with these processed flours.
    4. Increase foods that help balance out your fatty acid profile: more fatty fish (such as salmon, mackerel, sardines) and (grass fed) meat for omega 3 fats. Consider taking a fish oil or algae omega for those who don’t eat fish – and be picky about the supplement!
    5. Take care of your gut: consider a probiotic for 30-60 days (such as Lifestream Advanced, Inner Health Plus, Syntol or Prescript Assist) to help populate the gut with the good guys, but also keep them fed with fermented foods such as sauerkraut, raw apple cider vinegar, water kefir and an abundance of vegetable fibres.

I’ve got more – quite a bit more actually! – but will post that in Part 2 so as not to risk losing your attention ;-). These are three of the basics that people can get wrong (particularly in the initial phases), and the next post will cover some of the more nuanced reasons, and what you can do to correct them. If you’re not sure whether your LCHF diet is working for you, why not jump on and book a consultation with me? An expert eye can help take the thinking out of it for you and save a lot of stress long term.

*50g still pretty low actually! Again, it’s all context 😉


Are you in the zone? (PC: http://www.tripfitness.com)

So… have you gone all keto?

Yes. But unlike my decision to ‘go paleo’ this was a predetermined, calculated, conscious decision and not ‘by default’, which is how my whole food philosophy came about. And that’s largely because it would be very difficult to just ‘go keto’ without some predetermined, calculated, conscious decision making occurring. Although, with the wisdom that is obviously gained from now 9 days of carbohydrate and protein restriction, and the consumption of vastly increased grams of fat I am pretty sure a lot of people out there who believe they are ketogenic might not be – if the websites devoted to keto foods and recipes are anything to go by. How on earth would they be in ketosis with protein portions that large??

Now why would I bother jumping on the keto bandwagon? A few reasons. A lot of people I know have tried it and I’ve reached a point where I’m curious enough to see if I had the discipline to follow such a strict dietary regime (regime is a rather harsh word, but I feel it’s applicable for this diet). Whilst some people observe what I eat and exclaim how ‘disciplined’ I am (like it’s a virtue), I love what I eat and eat what I want – eating a real food diet isn’t about discipline, it’s about pleasure. The strict limits on not only carbohydrate but protein requires discipline largely reserved for the very analytical and uber intelligent (i.e. Peter Attia over at Eating Academy).

The second reason is self experimentation – a far cry from the days I mocked people for using the term n=1, I now wanted to experience, document and reflect on how it feels to undertake a ketogenic diet. A great way to learn and understand anything is to experience it. My weight and body image issues growing up, for example, have provided me with better insight into the challenges faced by clients who battle with similar problems, despite the fact that, physically, we may look very different. As a number of my clients now have heard of a ketogenic diet and just want to try it, or have legitimate health reasons that warrant a ketogenic approach as a tool to improve metabolic health markers, then to be able to speak from experience is obviously advantageous.

The final reason is because Caryn gave it a go. And therefore, out of those left in our research team at Human Potential Centre who had yet to follow a ketogenic diet, I was the only person left who had yet to try it. Other than Scott. And as he is still drinking energy drinks (albeit he’s switched to the sugar free variety, and swigs water after having it to protect his teeth), it’s fair to say our respective diets are poles apart at this point. However he has recently jumped on the Twitter bandwagon so I’m sure it won’t be too long before he’s swigging bottles of MCT oil and professing the benefits of butter like it’s nobody’s business. However, I am a nutritionist and, as the last one standing I felt not a small amount of FOMO by having not at least tried it. I’m actually in the best position out of my colleagues – as I can learn from their mistakes. Like I did at St Johns. As a cadet in my younger years we had regional competitions that required assessing a medical emergency and stitching or bandaging people up with the one who illustrated the most knowledge walking away with the trophy. As my last name is Williden I was usually last to front up, and my St John’s group would filter information to me so, by the time it was my turn, I was armed with all necessary information to go into the medical situation and assess, inform, and bandage with skills that would make me an indispensable member of McDreamy’s team. This ketogenic diet experiment is not dissimilar, minus the trophy and the badge to stitch on my jersey.

So Day 9… A short time, sure. But I’ve learned a few things already.

  1. It’s hard to stick to the protein limit. Really hard. I got an inkling of that when I read Tim Noakes’ Real Meal Revolution recommendation of keeping animal protein to 80g per meal absolute amounts. But who also knew vegetables contained so much protein?
  2. That it is hard to get the amount of fat necessary for ketosis and overeat. My food volume has dramatically reduced. Obviously, though, if you do eat more fat than you need, this will be reflected in weight gain/gastrointestinal problems etc over the long term.
  3. That I’d wildly underestimated the amount of peanut/almond/coconut butter I actually ate in normal life (like somehow the Gilmours 3kg bags of nuts just disappeared of their own accord). I’ve never tracked my food to this extent (using Easy Diet Diary app for iPhone) and it is a real eye opener.
  4. That not all food apps are created equal. For example, Fitday lists broccoli has having almost as much carbohydrate as pumpkin. It doesn’t.
  5. That for some people to get into ketosis, 50g of carbohydrate (CHO) might be too high, and closer to 30g is better. Is this a female thing? Maybe. This is clearly insight from Caryn who passed this on. While the academic literature often places limits of 20-30g CHO/day,  there are also studies that refer to a low carbohydrate, high protein diet as ‘ketogenic.’ Confusion is clearly not limited to the bloggersphere.
  6. There is a lot of misinformation on the Internet about ketogenic diets. But there are some very smart people writing about this – way smarter and knowledgeable than I am.
  7. People are unnecessarily verbose in recipes and post too many ‘stages’ pictures.
  8. That, despite being my dislike of Thai food and Thai restaurants, I really like my own Thai red curry coconut chicken. (I must be the only person who doesn’t like Thai food. I know. Is it the cheesy American cover songs and proliferation of sweet chilli sauce? Maybe).
  9. That making pastry is way easier than I ever realized.
  10. That if you decide to make pastry to turn that chicken curry into a pie, you should probably check that you own a rolling pin (or a good substitute) first
  11. That I make really good rhubarb crumble and chicken curry pie. These and other recipes are over on my Facebook nutrition page – definitely check them out.

Other thoughts:

  1. Training wise – I’ve felt great. Up until Friday and then it felt like I’d been turned upside down and emptied out. Hardest. Run. Ever. Barely breaking 5.30 k’s (actually that’s an estimate – thankfully Nicky’s evil Garmin wasn’t working and I was too scared to wear mine). Friday and Saturday were complete write offs but today’s run – storming. Seriously. Even after doing weights yesterday I woke up feeling better than I have in a long time.
  2. During normal day: I’ve felt flat. A bit sick on some days too – and particularly on the days when I missed having a coffee with cream, or something similar, which reduces amount of fat I start the day with. But, again, today I feel back to being awesome.
  3. Twice during the week I woke up and couldn’t get back to sleep for an hour. Unusual for me, though not unheard of. Last night I slept right through. This may be due to the diet, might have nothing to do with it.
  4. I miss fruit. And dates. And wine (for now – I’m abstaining for now, given that alcohol is preferentially metabolized in the body – which would largely offset my efforts to turn fat into the go-to fuel tank).
  5. While I, like many people, have my go-to foods, nine days into this and I’ve needed a bit of variety to keep me focused. I typically eat a TON of vegetables, and would feel largely dissatisfied to sit down to a third of that with extra dressing added as a fat source.
  6. It’s a shame that I’m making all these awesome meals and I have yet to meet my future husband. He is seriously missing out on some good eats.

I know. I’m late to the party on this. Just like the paleo/real food/whole food movement, I’m pontificating on something that some of you reading this would have read about, adopted, wrote about, reflected on and then moved on five years ago. If this is you, and you have some wise words then please share! This is a learning curve for me (and clients) so the more I know the better.

So I’m hoping for that ‘keto’ clarity, that ethereal experience people talk about, and that today’s run was indicative of the amazing training that I will experience as I undergo this keto experiment. (It goes without saying that this will of course turn me into an amazing athlete lol) I’m also hoping that my experience will add to the information out there that seems, for the most part, from the male experience. There are a few women writing about it, but it is largely a male dominated space. I will keep you updated, both here and on my Facebook page. Right. Off to make keto hot cross buns. Because nothing says Easter like almond flour buns dressed with a white cross.