Dear nutritionist,

I did the keto diet for a little over a month. I lost 10 pounds. I haven’t lost anything else. I need nutritional and exercise tips. I don’t know exactly what to do.

A: “The ketogenic (keto) diet is a high-fat, low-carbohydrate eating plan designed to induce a state of ketosis in the body,” says dietician Claudhia Ashley. “Ketosis occurs when the body switches from using glucose as its primary source of energy to using ketones, which are produced from the breakdown of fats in the liver.”

Ashley said the typical macronutrient breakdown for the keto diet is high fat, where approximately 70-80 per cent of daily calories come from healthy fats such as avocado, nuts, seeds, oils, and fatty fish; low carbohydrate, where carbohydrate intake is limited to around five to 10 per cent of daily calories, typically less than 50 grams per day, a restriction that helps to deplete glycogen stores in the body, forcing it to rely on fat for fuel; and moderate protein, making up about 20-25 per cent of daily calories. Sources of protein on the keto diet include meat, poultry, fish, eggs, and tofu.

“Foods to avoid or limit on the keto diet include sugary foods, grains, starchy vegetables, fruits high in sugar, and most processed foods. Instead, the focus is on whole, nutrient-dense foods that are low in carbohydrates and high in healthy fats,” she said.

Ashley said weight loss can sometimes plateau on the ketogenic diet for several reasons:

1) Calorie intake: “While the keto diet can lead to weight loss initially by reducing calorie intake and inducing ketosis, over time, the body may adjust to the lower calorie intake and metabolic rate may decrease, resulting in a plateau. It’s important to ensure that overall calorie intake is still appropriate for weight loss goals.”

2) Metabolic adaptation: “The body may adapt to the lower calorie intake and increased fat utilisation by becoming more efficient at burning calories. This can slow down weight loss progress.”

3) Muscle loss: “Severely restricting carbohydrates can lead to muscle loss, which can reduce overall metabolic rate and hinder further weight loss.”

4) Hormonal changes: “Prolonged adherence to the ketogenic diet may lead to changes in hormone levels, which can affect metabolism.”

5) Water retention: “In the initial stages of the keto diet, the body sheds excess water weight as glycogen stores are depleted. However, as the body adapts to ketosis, water retention may increase, masking further fat loss on the scale.”

She said to overcome weight loss plateaus on the ketogenic diet, it may be helpful to reassess calorie intake, incorporate intermittent fasting, increase physical activity, ensure adequate protein intake to preserve muscle mass, and periodically cycle in and out of ketosis to prevent metabolic adaptation.

Nutrition tips include choosing sources of healthy fats such as avocados, olive oil, nuts, seeds, and fatty fish.

“These fats provide essential nutrients and help keep you feeling full and satisfied,” Ashley said. “And while protein is important for maintaining muscle mass and overall health, excessive protein intake can interfere with ketosis. Aim for moderate protein intake, focusing on sources like poultry, fish, eggs, and tofu.”

She also said to keep carbohydrate intake low, typically below 50 grams per day, to maintain ketosis. Focus on non-starchy vegetables and low-carb fruits and avoid or limit high-carb foods like grains, legumes, and sugary snacks.

“Drink plenty of water to stay hydrated, especially since the keto diet can have a diuretic effect. Adequate hydration is essential for overall health and can help prevent side effects like constipation and electrolyte imbalances,” she said.