How to Maintain Weight on a Keto Diet

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Many with ME/CFS want to try a ketogenic diet as a possible tool to reduce fatigue, brain fog, and improve overall mitochondrial function. However, the ketogenic diet is highly effective at weight loss. Often weight loss is not the goal in ME/CFS, and in severe patients maintaining body weight is crucial for overall health.

If you’re unfamiliar of how a ketogenic diet can benefit symptoms of ME/CFS, start here.

So how can one benefit from the effects of a ketogenic diet without losing weight?

A Keto Diet Reduces Appetite

A ketogenic diet is known to contribute to weight loss by reducing appetite. During the diet, the intestine are stimulated to release the hormone cholecystokinin, or CCK. This hormone inhibits the motor function of the stomach which can have the effect of reducing portion sizes due to a feeling of early fullness. In addition, ketosis increases the appetite suppressing hormone, ghrelin, which acts in the brain to decrease appetite. Combined, these appetite hormones can reduce food intake and lead to unwanted weight loss, or worse malnutrition.

 

1. Eat More Protein or Supplement

Increasing protein intake is crucial to offset weight loss of a ketogenic diet. Dietary protein is essential to maintain skeletal muscle mass. Choose animal sources of protein first. Don’t shy from fattier cuts of meat. An amino acid supplement with whey protein or pea protein has also been studied to effectively offset any losses of muscle mass in those that are especially thin or severely ill.

2. Adjust Your Macros

The stricter the ketogenic diet, the more prone to adverse effects and dramatic changes in hunger. It is important to maintain adequate calories despite severe carbohydrate restriction. If you’re losing weight, adjust your macros. Aim for a fat to carbohydrate+protein ratio of 3:1, instead of the stricter version of 4:1 which is used to reduce seizures in epileptics. This diet allows for 10% energy from carbohydrates, 15-25% from protein, and around 75% from fat.

3. Eat More Often

If you’re losing weight on a ketogenic diet, consider more frequent meals throughout the day. Snacking is generally no recommended in the context of a standard Western diet that is high in carbohydrate and processed foods. However, a ketogenic diet that relies on healthy fats and protein for snacks will not undo any of the physiological effects of the diet.

Grab nuts, olives, hard boiled eggs, avocados, coconut milk with dark chocolate, or cheeses to boost caloric intake during a ketogenic diet and minimize weight loss.

4. Sneak Extra Fat

At each meal add an extra source of healthy fat to up the caloric content. An extra slice of cheese on your scrambled eggs, a bit of butter blended into your coffee, half an avocado added to your salad, or even a drizzle of unflavored medium chain triglyceride (MCT) oil can increase overall calories to keep the weight on.

If you still have reservations about ill effects or unwanted weight loss on a ketogenic diet, consider working with a nutritionist. This diet has been used for decades in young children with epilepsy without stunting growth and development. Even in elite athletes the diet is used to maintain exercise gains and enhance performance. A well formulated ketogenic diet can be maintained for a long duration without unwanted weight losses that would be counterproductive to those with all severities of ME/CFS.

 

Luat AF, Coyle L, Kamat D. (2016) The Ketogenic Diet: A Practical Guide for Pediatricians. Pediatr Ann. 45(12):e446-e450.

Paoli A, Bosco G, Camporesi EM, Mangar D (2015) Ketosis, ketogenic diet and food intake control: a complex relationship. Front Psychol. 6:27.

Merra G. et al. (2016) Very-low-calorie ketogenic diet with aminoacid supplement versus very low restricted-calorie diet for preserving muscle mass during weight loss: a pilot double-blind study. Eur Rev Med Pharmacol Sci. 20(12):2613-21.