As ketogenic diets become more mainstream, research shows what I am seeing in my own practice: Done correctly, they get amazing and fast results for weight loss and so much more.
I’ve had patients lose 20, 30, or more pounds going keto. After that initial transition from burning sugar to fat (I talk more about potential challenges including the keto flu here), they have more energy, feel more mentally focused, and no longer get sidetracked by hunger and cravings that formerly stalled fat loss.
And then suddenly, without warning, they hit a plateau. The scales won’t budge. As a medical doctor who specializes in gut health, nutrition, and functional medicine, almost every patient I see eventually hits a wall. They’re doing everything “correctly,” and still, weight loss comes to a standstill. They feel stuck.
That’s when I shift into detective mode to find underlying obstacles that might hinder weight loss. Sometimes these roadblocks are obvious. Other times, they take some sleuthing.
I see these obstacles occur more often with ketogenic diets compared with other plans. And I became curious to find out why.
These patients initially have success on keto diets but hit a wall at some point and struggle to maintain that plan long term. The clue may be in the need for metabolic flexibility and variety to keep the body guessing.
In my practice, I commonly see these 10 reasons people don’t lose weight on ketogenic diets. When you pinpoint what might create obstacles, you become empowered to change course and minimize their impact. Here are the reasons and how I fix them.
1. You’re not supporting your healthy gut bugs.
As a gut health doctor, this is my biggest pet peeve about keto diets: They sometimes overemphasize foods high in dietary fat like meat and full-fat dairy at the expense of gut-supporting plant foods. Knock your gut flora out of balance and you’re almost sure to hit a plateau since gut health affects weight loss. Even on the strictest keto diet, you can incorporate fermented and cultured foods including sauerkraut, kimchi, and kefir.
2. You’re not food tracking.
Too many “legal” high-calorie foods can sabotage your keto diet. So can lots of other things. One way to pinpoint those potential glitches is through a food journal. One study found people who tracked everything they ate lost twice the amount of weight as those who didn’t track what they ate. A food journal also keeps you honest and compliant with your keto plan.
3. You’re eating too many calories.
On a high-fat ketogenic diet, you can easily eat 3,000 calories or more daily with high-calorie foods like cheese and nuts. Sure, your body will shift into ketosis on a high-fat diet, but eating too many calories means your body will utilize dietary fat instead of body fat. A food journal can help you pinpoint high-calorie foods that might sabotage your weight loss. You don’t need to be on an old Atkins diet plan to lose weight the keto way.
4. You’re eating too often.
Some patients constantly graze on “legal” keto foods that can stall fat loss. Intermittent fasting is the answer here: You naturally reduce your caloric intake and give your gut a break. By not eating, you’re allowing inflammation to quiet down in your body, which helps with blood sugar balance and weight loss. As an example, some plans combine daily fasting with a ketogenic diet. Have a big dinner, close up the kitchen, and push breakfast as far back the next morning as you can. I talk more about this type of keto diet, which I call a Cyclitarian plan, here.
5. You’re not keeping your carb intake low enough.
To maintain ketosis (where you burn fat rather than sugar for energy), you need to keep your carb intake to around 20 to 50 grams daily. Some of my patients have to go to the lower end to get those results. That doesn’t mean you can’t incorporate some carbs: You can fit plenty of green vegetables and low-sugar fruits like berries and avocado into even a 20-gram carb allotment.
Being constantly stressed keeps your sugar-boosting hormone cortisol jacked up, which not only elevates your blood sugar but also short-circuits fat loss. And let’s be honest: When you’re stressed out, you’re more likely to nose-dive into keto-unfriendly foods, like comfort carbs. Find ways to dial down stress levels. I find even five minutes of shutting my eyes and taking deep, diaphragmatic breaths can give me a renewed focus and take stress down a few notches.
7. You’re not eating enough fiber.
Dietary fiber keeps you full longer and contains prebiotic nutrients that support a healthy gut flora, creating a win-win for weight loss. Getting insufficient dietary fiber (yes, I’m talking to you, all-meat carnivore or cave-man diet folks) adversely shifts your healthy gut flora, which will increase inflammation, insulin resistance, fat deposition around the middle, and weight gain. Leafy green and cruciferous vegetables, avocado, coconut, and berries make great fiber-rich, keto-friendly foods.
8. You’re eating foods that you’re sensitive to.
While keto diets minimize sugar and other food sensitivities, they often allow full-fat dairy such as yogurt that, for some people, can stall fat loss. And some packaged keto-friendly foods (yes, there’s a whole industry of keto-friendly cookies, candy, and other junk food!) can contain gluten, artificial sweeteners, and other reactive ingredients. These foods and additives cause dysbiosis (an imbalance between good and bad bugs), leaky gut syndrome, and increase insulin resistance, which raises blood sugar levels—stalling weight loss. Read your labels carefully: Food sensitivities can be sneaky and hide in foods that you would never suspect, like mustard.
9. You’re drinking too much coffee.
Bulletproof Coffee is a hit among many keto followers. I’m not anti-coffee, but for some people, even drinking black, organic coffee can increase insulin resistance, making weight loss difficult. I explain why coffee can stall fat loss (and how to minimize that problem) in this blog.
10. You’re neglecting sleep and other lifestyle factors.
If you’re doing everything else right but missing these elements, you’ll stall your progress. Getting subpar sleep, not moving enough, and environmental toxins are among the factors that can stall weight loss even when you’re vigilantly following a keto diet. What you eat matters, but how you live also dramatically affects weight loss. For many patients, dialing up sleep, reducing environmental and psychological stressors, and incorporating high-intensity burst training can be big needle movers to overcome plateaus.
I’ve found patients almost always overcome plateaus using these 10 strategies on a ketogenic diet. For a few patients, we finally concluded that a keto diet wasn’t right for them. While they initially lost weight on this plan, the very high fat intake didn’t work long term.
That’s fine since no diet is right for everyone. Keto works well for a lot of people, at least in the short term, but what really matters is a plan that you can maintain long term and helps you sustain that weight loss. And that will differ for every person. In the meantime, use these 10 strategies as a first step to bust through your weight loss plateau.