45: Very Low Ketones While Fit, Cold Hands & Feet, Sleep Raising Ketones, Salt, Excessive Calories

45: Very Low Ketones While Fit, Cold Hands & Feet, Sleep Raising Ketones, Salt, Excessive Calories


If you are interested in the low-carb, moderate protein, high-fat, ketogenic diet, then this is the podcast for you. We zero in exclusively on all the questions people have about how being in a state of nutritional ketosis and the effects it has on your health. There are a lot of myths about keto floating around out there and our two amazing cohosts are shooting them down one at a time. Keto Talk is cohosted by 10-year veteran health podcaster and international bestselling author Jimmy Moore from “Livin’ La Vida Low-Carb” and Arizona osteopath and certified bariatric physician Dr. Adam Nally from “Doc Muscles” who thoroughly share from their wealth of experience on the ketogenic lifestyle each and every Thursday. We love hearing from our fabulous Ketonian listeners with new questions–send an email to Jimmy at livinlowcarbman@charter.net. And if you’re not already subscribed to the podcast on iTunes and listened to the past episodes, then you can do that and leave a review HERE. Listen in today as Jimmy and Adam offer of words of wisdom for their Ketonian friends in Episode 45.

**Special THANK YOU to Jane, Sandra, Maria, Erika, Mary, Angela, and Brook**


KEY QUOTE: “A calorie simply is not a calorie. I’m not saying the laws of thermodynamics don’t apply–they do! But they only apply when the hormones are balanced correctly. If the hormones aren’t balanced, the calorie hypothesis isn’t valid.” — Dr. Adam Nally

Here’s what Jimmy and Adam talked about in Episode 45:

– I’m in great shape but my ketones are in the tank. Why?

Hi Jimmy and Adam!

I am a 34-year old male in great shape and have around 12% body fat. I’ve been eating LCHF for about 2 years now and was doing IF for the first 14 months. I decided to try a strictly ketogenic lifestyle about 4 months ago and I am finding it almost impossible to get into nutritional ketosis. The highest reading I’ve tested on my Precision Xtra was 0.7 and I tend to average around 0.2-0.3 daily. I have no idea what I am doing wrong.

I have tried everything from 40 net carbs to 20 total carbs. Slashed my protein to less than 90 grams a day and my meals average around 3-10 total carbs with 55-70 grams of super clean fats. I take MCT 3 times a day and even have a Ketonix breath ketone analyzer. I do not eat any sneaky carbs or sugars—never have and never will. My fasting blood glucose always seems to be in the 70’s and I just can’t figure out what’s up with my ketone levels. I try to consume around 250 grams of fat a day.

I work 7 days a week and am literally on my feet all day. My sleep is around 6.5-7.5 hours a night and I am militant with my regimen. I do take a lot of supplements but nothing from what I’ve read about them should be keeping me out of ketosis. I am beginning to think I have something else gong on. My energy is nonstop from the moment I get up until I go to bed. I do not drink. I feel fine, but I just know that I have never crossed into the 1.0 mmol and can’t for the life of me understand why. Digestion is fine, hydration is fine, electrolytes are good and my recent blood tests were great except for my doctor’s puzzled look at how and why I feel and look so good with a cholesterol of 249 and an LDL-C of 174. I am not worried about those because my HDL/LDL and triglycerides/HDL ratios are well within range. I workout 2-3 times a week. PLEASE HELP ME figure this out.

Thank you and I absolutely love your show!


Eating Lots of Carbs, Sugar May Raise Risk of Cognitive Impairment, Mayo Clinic Study Finds

1. Does being in ketosis lead to cold, clammy hands and feet?

Hey Jimmy and Doc,

I’ve been keto for over a year now and feel great! My energy levels are up, inflammation is down, and I lost a few pounds too. The only negative thing that I have noticed since starting this is my hands and feet are constantly cold and clammy. Is this even related to being ketogenic? If so, what can I do to fix this?

Keep up the great work guys!


2. Does better sleep and exercise suppress hunger due to a rise in ketone levels?

Hi Jimmy and Dr. Nally,

I sometimes wake up in the middle of the night hungry. I’ve heard you guys talk about getting adequate fat at the dinner meal and I try to make sure of that. But this hunger in the middle of the night is annoying. I am usually able to drink some water and go back to sleep without eating anything. Then when I wake up in the morning, I’m no longer hungry. I’ve also noticed that sometimes I’ll wake up in the morning hungry and will go running or lift weights at the gym. Counterintuitively, after the workout I am no longer hungry and can even skip lunch. Is it safe to assume that the reason the hunger goes away in these instances is because I am able to sleep longer and exercise which helps me go deeper into ketosis?  What do you and Doc Nally think?



3. How did our early ancestors get salt in their ketogenic diet?

I have a puzzling question for you guys about Paleo and ketogenic diets. If we are to believe that our early ancestors ate a low-carb, moderate protein, high-fat diet, then what were their sources of sodium? Surely they needed it then just as much as we do in modern times. How dd they get it into their diet? And if they didn’t consume adequate levels of salt while in ketosis much of the time, how did they survive without it? What foods were consumed to provide this key element in their diet? Thanks so much for taking the time to answer this one. I Iove Keto Talk because I learn so much. I only wish I lived in Surprise, Arizona so I could see Doc Muscles on a regular basis since finding a low-carb friendly doctor isn’t that easy.

Thanks again!


KEY QUOTE: “Get your Vitamin F for fat and Vitamin G for greens.” — Jimmy Moore


– Isn’t the problem with weight loss woe on keto too many calories?

Hi Jimmy and The Doc! You guys are the best! I love all the work you do to spread information and support for keto. But I do have a tiny bone to pick with you guys if you wouldn’t mind hearing me out!

I am a certified holistic health coach who has specialized in the ketogenic diet for many years now. I love it with my whole heart because the benefits are outrageous and undeniable! However, I have noticed some do not find weight loss success when attempting keto because of one MAJOR issue in my opinion. I see it time and time again. It’s the calories.

I’m not talking about a person mistakenly eating too many carbs for individual tolerance nor am I talking about accidentally eating too much protein. These are people who are fully keto-adapted with adequate blood ketone readings who are working out and sleeping great, managing stress well, and yet they are not losing weight. Why? It’s because they are eating too many calories to give their body a reason to need to tap into body fat stores.

This is one of the things I have heard you guys repeatedly tell people often on Keto Talk—“calories don’t matter, as long as it’s coming from fat and as long as they are eaten to satiety.” But this doesn’t actually work in real life for most people and it also doesn’t make any logical sense. After all, if it were indeed sound and true, people would not be able to maintain weight in ketosis. Health coaches like me who have been in ketosis for years would just forever keep losing fat until we keeled over. But this isn’t happening because if a person is maintaining ketosis, they are eating enough calories from fat that the body doesn’t have to convert body fat into ketones and homeostasis is achieved.

I hear you guys say it’s hard or darn near impossible to eat too much fat because you get full. But, most people coming into this have leptin resistance, binge eating disorder, and other issues that bypass satiety completely. Without proper coaching and calorie accountability they get totally out of control on keto just like any other plan. Now, I’m not saying health isn’t still improving on keto even with excessive calories. Healing will indeed still happen. But not weight loss for most people. I can confidently say that after years of consulting that this is unfortunately the rule and not the exception.

Most people eat way past satiety after the first month or so of keto. It seems that at first they have such great appetite suppression from ketones and are able to stop before consuming calories in excess. But then that satiety dwindles and they start snacking on fat bombs, macadamia nuts, olives, cheese, and other non-protein or carb containing drinks or shakes with tons of cream. It’s an overload of fat calories. They are still having 1 to 2.5 blood ketone readings but they just keep packing in the calories from fat and stop losing weight. Every now and then even gain a little. It’s not water weight either, it’s body fat.

Then, they totally believe all the myths that keto doesn’t work and you only lose water weight in the beginning and that consuming fat ultimately makes you fat. I HATE those myths. We know ketosis is da bomb diggity and will absolutely shift every metabolic marker in the right direction. And in my opinion weight loss is the least important. But not to my clients! And not to the average person interested in health and wellness. I get clients who have tried various high-fat programs and they end up at me after they get frustrated gaining weight and feeling cruddy.

I wholeheartedly believe this weight gain is completely unnecessary if keto-adaptation happened as a result of using the fat on our bodies preferentially over the fat on our plates. What are your thoughts on this? Thank you so much for addressing my little pet peeve and I hope I didn’t come across as a jerk! I want to see this movement succeed and thrive and this is one topic that we need to get right to communicate the best information to the masses.

You guys are my heroes so thank you for doing what you do!


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Jimmy Moore from “Livin’ La Vida Low-Carb”
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Eating Lots of Carbs, Sugar May Raise Risk of Cognitive Impairment, Mayo Clinic Study Finds

7 responses to “45: Very Low Ketones While Fit, Cold Hands & Feet, Sleep Raising Ketones, Salt, Excessive Calories”

  1. Loretta says:

    What an amazing question/observation from Emily! “… But, most people coming into this have leptin resistance, binge eating disorder, and other issues that bypass satiety completely. Without proper coaching and calorie accountability they get totally out of control on keto just like any other plan.”

    I credit Jimmy with getting me started 8 years ago with low carb, and I’ve gone on to LCHF and Keto since. Lost around 150 lbs so far. I adore Jimmy and the Doc!!

    But… I felt like the main point of Emily’s question had more to do with people who eat for OTHER than physical reasons. For many folks, it’s not just physical hunger as the driving force to eat. She mentioned binge eating, and there are other forms of food issues/disorders that might apply. I can’t tell you how many folks I’ve met over these last 8 yrs who do it all right (right LCHF food plan, sleep, exercise, etc etc) yet unless they use a tool such as calorie counting as a way to LIMIT volume to a normal level, they not only don’t lose, they gain. Me, included. It’s just a tool of regulation, for those whose own “satiety” system doesn’t kick in fast enough. Some of us used food as a “mood alteration” drug. Has nothing to do with physical hunger.

    I’ve looked for years for a local doctor to help me. Zilch. So, I am left with using this volume control tool (calorie counting) as my best way to not eat a zillion calories. I enjoy healthy fats, so no, don’t assume I am just not eating enough “fat to satiety”. There are so many just like me out there, saying YES! to Emily’s comments.

    Maybe it would be fantastic to do a whole show on the OTHER causes of eating. NOT physical ones, but the emotional side of the issue. And I wonder if Doc Nalley might be able to shed light on how Keto/LCHF could even be used as way of helping people like me, to lessen the push to eat emotionally.

    I didn’t get to 460 lbs at my highest by having a little bitty issue with food. I’ve been having to learn a whole NEW dynamic around eating for health. Once I gave up sugar/starches, the physical cravings vanished. BUT the emotional and habitual reasons still tug on me.

    Thank you, Doc Nalley and Jimmy, for all you do. You are my heroes, too!


    • deb says:

      You could also use fasting to limit and it may work better than cal restriction in that more time spent in the fasted state=reduced insulin=fat loss. Try 16:8, 20:4, try a couple of days a week at 23:1 or even 47:1 and it won’t matter how much you eat when you do eat, especially if you keep meals keto. This is my experience anyway. I was HFLC and then keto for a total of 8 years and remained obese. Keto didn’t work, low fat cal restriction didn’t work for me either when I tried it yars ago, but Dr Jason Fung’s videos have revolutionised my life no I understand I must leave time for insulin to drop…. Amount of insulin, how high the insulin spikes when you eat anything and the time needed to allow insulin to fall after eating are ALL higher in obese/T2 people. Eating keto helps, but spending time in the fasted state i the key to fat loss, not cal restriction. Too bad it took me too long to realise this and I spent 8 years HFLC then keto still obese!! Get the word out about insulin and IF and 48hrs fasting for the obese. It works.

      • deb says:

        If you are not obese and active check out Dr Sara Solomon – the result of reducing your eating window and fasted workouts.

      • Loretta says:

        Thanks, Deb. Dr Fung is da bomb! I have both of his books. I usually do a 16:8, or even 18:6 most days. Can’t do longer, due to AFib. But even then, if I let habit reign, I can easily go several hundred extra calories daily, and still not lose. Being aware of calories simply allows me to keep it in check, not binge eat. I don’t do the old constant caloric restriction. Dr Fung has explained the negatives of that well.

        • deb says:

          He is da bomb indeed and so is Ted Naiman…. The thing is what the normal body does in 6hrs after eating (reduce insulin and go to the fasted state and burn fat) the obese and really obese can take days to do. I fasted for 2-7 days between a single keto meal spread over a couple of hours. It worked. I went straight back to fasting after the meal it didn’t really matter. Losing the weight has enabled me to engage with true satiety and I am aware that a lot less food now satisfies. I couldn’t cope being hungry all the time or counting cals (I did that route before and remember crying and collapsing in a heap when on hol a decade ago… I was heading for a ED). When I was fasting for 2-7 days at a time, as an estimate I ate keto 3000-5000cals typically when breaking a 5 day fast for example. It is not binging if you have appetite and eat to satiety. I did not feel ill or bad eating that amount and it did not harm me at all since I was straight back to fasting the next day. The worst stage in fasting is the 20-24hrs mark. If you can get through that with a cup of black tea/black coffee/bone broth then I found I could carry on for up to 7 days with no manic hunger. The fasting resets the hormones somehow? Now I lost 70lbs since Feb I just would not be able to eat 300cals at a meal and also I haven’t found fasting so long so easy, so I do 2-3 day fasts now. Also it seems like a 3 day fast makes me feel like I was doing a 5 day+ fast back when I was obese. Something’s changed for the better. Doc Nally is right, if you are hungry enough to binge on too many cals that would make you gain then you have a hormone problem and it needs addressing. I believe extended fasting can help address it. Thanks my experiences. Best wishes to everyone fighting for their health and taking control of it by whatever means.

          • Loretta says:

            Sounds like you are doing great! Congrats on such terrific progress. I wish I could do longer fasts, too. But with AFib, it’s not recommended. Longer fasts release norepinephrine (per Dr Fung) and he says it can trigger episodes in some with AFib. Which can lead to stroke, etc. So, shorter fasts, done more frequent are what works for me. He is right: one size does not fit all. 🙂

  2. deb says:

    No offence, but this first conversation is ridic. Michael is simply suppressing his ketones by slightly spiking insulin with each snack/supplement/drink/meal. Michael is sound at 12% body fat and does not need to do intermittent fasting, but ANYONE (even thoe most insulin resistant) will see higher ketones with an increase in fasting period.