“Why am I more hungry now when I’m only four pounds away from my ideal weight?”

What to do if you still show signs of electrolyte imbalance after supplementing with extra salt and electrolytes? What if you feel tired and lose muscle on keto? How come you feel hungrier when you’re closer to your ideal weight? And why has your weight loss stalled?

Get the answers to these and other questions in this week’s Q&A with me:

Please note that these answers do not constitute medical advice and no doctor-patient relationship is established. These answers are for general information purposes and you should discuss any changes with your healthcare provider.

Heart palpitations and persistent dehydration even after electrolytes and extra salt

Female 52, doing keto for just over a month now, lost 5 kg (11 lbs) mostly from the belly but need to loose another 15 (33 lbs).

In the first few weeks I felt great, not hungry and no cravings at all, however for the last two weeks I have been doing 16 to 24-hour intermittent fasting and have started to suffer extreme episodes of heart palpitations and realize it is probably from dehydration as I need to urinate very often. Eating something seems to help but it keeps happening again within a few hours.

My ketone reading fluctuates between around 3 in the mornings and around 4,7 the rest of they day (except for last night when I took an electrolyte with a bit of glucose (4 g of carbs) because I felt like I was going to pass out it came down to 1.4.

My blood glucose is between 84 to 95 mg/dl (4.6–5.3 mmol/L).

I do tend to have lower blood pressure although after another bad episode yesterday where I was about to call the emergency service I took my blood pressure and it was just slightly lower than normal.

My question is – is this part of the adjustment even though I have been in ketosis for a while now, might it mean that I am fasting too much and eating too little calories, or eating too much fat?

I keep drinking water with lots of salt because of a dry mouth and even take extra electrolytes as well as potassium, magnesium, Vit D3/K2, a multivitamin etc.

Also lots of digestion issues – diarrhoea, rumbling, sometimes cramping after meals.

Do I need to worry about this and will it pass? Just don’t understand why I am so dehydrated all the time?

Elize
 

Hi Elize. While I cannot comment specifically on your case, I can say that mild palpitations are common with intermittent fasting and frequently improve with hydration and electrolyte supplementation. However, I emphasize “mild.” I always tell my patients that it is OK to feel a little hungry or a little low energy with IF, but anything more severe than that may signify that now is not the right time for IF. Especially if they are paying attention to hydration and electrolyte replacement. And certainly if my patients feel faint I ask them to stop doing IF and go back to eating throughout the day, and if they feel faint with palpitations I get them in right away for an ecg or more detailed testing. It is important for us all to learn that just because a technique works for some, doesn’t mean it works for all.

Best,
Bret Scher

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Losing muscle and feeling tired

Hello Doctor!

I am female, 5’4” and I have been eating keto for a month. My original weight was 144 lbs — 65 kg (51 lbs muscle and 51 lbs fat — 23 kg and 23 kg). Now I am 141 lbs — 64 kg (49 lbs muscle and 51 lbs fat — 22 kg and 23 kg). My daily intake is 1,355-1,400 kcal with 5% carbs, 20% protein and 75% fat. I also do intermittent fasting with Bulletproof coffee from Monday to Friday.

Besides not losing fat, I feel drowsy all day, and have low energy and poor concentration. Please help.

Thanks!
Maria
 
Hi Maria. Thanks for your question. While I cannot comment specifically on your case, I can provide some tips I give to my patients. First is understanding that measurements of body fat percentage are not perfect and some techniques have significant variation from test to test. Even DEXA, which is likely the most accurate, has a normal variation. The second bit of advice I give my patients is that protein is important for building and maintaining lean body mass. I think the fear of “too much” protein impairing ketone production has been blown out of proportion and I find people tend to under eat rather than over eat protein (I usually recommend 1.2–1.7g/kg of reference body weight. You can read more in our protein guide.) Last, I advise my patients that to lose fat you need to burn your fat stores, not the fat you eat. So if my patients are consuming extra fat, like in butter coffee, I question if that is slowing down the fat store burning and sometimes ask them to experiment off it.

Best,
Bret Scher

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Why am I more hungry now when I’m only 4 pounds away from my ideal weight?

I’ve very successfully and easily followed a keto diet for six months. I’m very close to my ideal weight now but the food I’m not eating isn’t keeping hunger at bay. I was very successfully eating two meals a day but now I’m finding I’m hungry in the evening when I wasn’t before.

Lorraine
 

Hi Lorraine. One of the things I see over and over again in my patients is that their need for protein and fat change as they progress on their weight loss journey. Initially, they may have ample fat stores to provide enough energy during the day and may not need to eat as much to feel full. As those fat stores dwindle (a successful progression on the diet!), they may need to eat more fat and more protein to remain satiated. Of course there is tremendous individual variation, but that pattern comes up fairly frequently.

Best,
Bret Scher

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Why I can’t lose weight anymore?

I started the keto diet on December and I was 98 kg (216 lbs). And by the middle of March, I reached 80 kg (176 lbs) and I stopped losing weight. I felt upset and I started to return to my old lifestyle and bad eating habits. I want to weigh 68-70 kg (150-154 lbs), but I can’t. Could you please help me to lose weight?

Alla
 

Hi Alla. If there i some thing I have learned from my career as a physician, it is that we are all on our own journey. And for most people, their journey doesn’t look like anyone else’s. I also emphasize the importance of seeing health and weight loss as two separate topics. in fact, we have a guide about this that may be helpful.

Best,
Bret Scher

More

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Intermittent fasting for beginners

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