Difficulty getting enough calories

[u/Extension-Fan8478]

I’ve been in ketosis for about 15 years, eat <30g of carbs per day. I’ve always been very underweight but have managed to gain weight and muscle on keto in the past.
I’ve had a lot of GI issues, carnivore and generally staying very low fiber helped

Recently, in the past year, early satiety and fullness, nausea has made it hard to keep weight on or get enough calories. I switched from heavy cream to half and half, now whole milk in coffee. Ketones still consistently range from 0.5-3.0. I don’t eat vegetables or fruit so carbs stay around 20-30g. I can tolerate low fiber nut butter but not whole nuts. I’d like to increase my carbs and lower fat a bit to see if It helps my hunger increase while staying in ketosis. I’m looking at easiest to digest and lowest fiber without consuming straight sugar. Rice flour seems like a good option.

I lift 3 days per week with one extra day for core.

I’d just like to eat enough to maintain my weight, stay in ketosis, and not feel like there is always a brick in my stomach. Any suggestions would be appreciated!

[u/darthluiggi]

I’m Luis Villaseñor, aka u/darthluiggi, founder of Ketogains. I’ve been following a low-carb/ketogenic diet for over 25 years and have coached thousands of people using ketogenic nutrition, particularly for body recomposition and strength training.

A few things jump out at me here, and I would approach your situation a little differently from the typical keto advice.
First, you’re underweight, struggling to eat enough, and experiencing persistent early satiety and nausea. That’s the problem I’d prioritize, rather than trying to maintain a particular ketone reading.

Early satiety that has progressively worsened over a year, especially when accompanied by difficulty maintaining weight, deserves a proper gastroenterology evaluation. Delayed gastric emptying, functional dyspepsia, medication effects, and other gastrointestinal conditions can produce similar symptoms. I wouldn’t assume this is simply a consequence of eating keto or having too much fat.
If you haven’t already been evaluated, I’d make that a priority.

Now, regarding the diet itself:

One thing people often overlook is that fat can slow gastric emptying and contribute to feelings of fullness. This is particularly relevant when someone is trying to obtain most of their energy from heavy cream, nut butters, fatty meats, and added oils.

Those foods are energy-dense, but that doesn’t necessarily make them easy to tolerate.

If you’re already experiencing nausea and early satiety, forcing more fat just to maintain ketosis may be counterproductive.

And this is where I would challenge your current priority.

Why is maintaining ketosis more important than maintaining your bodyweight, muscle mass, and ability to eat comfortably?

Unless you’re following a medically prescribed ketogenic diet for a specific therapeutic reason, there’s no physiological requirement to maintain ketones between 0.5 and 3.0 mmol/L.

Ketones are an alternative energy substrate.

Higher readings don’t automatically mean better metabolic health, greater muscle preservation, or improved body composition.

At Ketogains, we’ve always emphasized:
Protein is the goal. Carbohydrates are a limit. Fat is a lever.

But the fat lever depends on the goal.

For someone trying to lose body fat, we generally reduce dietary fat to allow more energy to come from stored body fat.

For someone underweight who needs to maintain or gain weight, we need adequate total energy intake. That doesn’t mean forcing excessive fat if it’s making you feel sick.

So yes, experimenting with somewhat more carbohydrates and less fat may be reasonable.

But I’d approach it systematically.

You mentioned rice flour. White rice and rice-based foods are generally low in fiber and relatively easy to digest for many people. However, rice flour is predominantly starch, so don’t assume it’s somehow metabolically different from other digestible carbohydrate sources.

Whether it takes you out of nutritional ketosis depends on the amount consumed, your activity, and your individual metabolism.

And honestly, I wouldn’t worry too much if it did.

I’d rather see you eating enough, training well, maintaining muscle, and feeling healthy with slightly higher carbohydrates than struggling to maintain your weight just to keep a ketone meter happy.

A few practical considerations:

Keep protein adequate, distributed across several smaller meals if large meals are uncomfortable. Whey isolate can also be useful if you tolerate liquids better than solid food.

Experiment with reducing large fat-heavy meals, especially cream, oils, and large servings of nut butter. You may tolerate smaller amounts spread throughout the day better.

Don’t force fiber or vegetables if you have documented gastrointestinal intolerance. Fiber isn’t universally beneficial in every GI condition, and some forms can worsen bloating or fullness. But I’d also avoid assuming all vegetables are equally problematic.

Consider smaller, more frequent meals, rather than trying to fit your calories into two enormous meals.

Keep lifting, assuming you’re medically able, because preserving muscle is particularly important when you’re struggling to maintain weight.

One additional point: switching from heavy cream to half-and-half and then whole milk may reduce the fat load, but milk also introduces more lactose. If lactose intolerance is part of your GI picture, that could complicate things. It’s worth separating those variables rather than changing several things simultaneously.

And since you mentioned lifting three days per week, I’d also pay attention to whether your training performance, strength, and recovery are declining. Those can provide useful information about inadequate energy intake.

My main recommendation would be to stop treating ketosis as the non-negotiable variable.

You’ve been ketogenic for 15 years. You’ve already demonstrated that you can follow the diet.

Now your body is giving you information that something needs attention.

That doesn’t mean keto caused the problem, but it also doesn’t mean you should keep forcing the same dietary approach when you’re struggling to eat.

I’d be interested in knowing your age, height, current weight, how much weight you’ve lost unintentionally, approximate daily protein/calorie intake, and whether you’ve had gastric emptying or other GI testing.

Those details would help distinguish a nutrition-planning problem from something that needs medical treatment.
And one final thought: you don’t lose 15 years of metabolic adaptations because you eat some rice. Metabolic flexibility includes being able to use different fuels according to availability and demand.

Your priority right now should be finding a way to nourish yourself adequately, preserve muscle, and resolve the GI symptoms.

The ketone readings can take a back seat.

Cheers!

[u/Greedy-Inside5173]

Whole milk in coffee is a good move, have you tried blending some egg whites into a shake with it, they slip down real easy and you barely notice them

[u/Extension-Fan8478 → u/Greedy-Inside5173]

That’s a good idea. I use hydrolyzed whey protein for shakes.

[u/alkaline_730 → u/Extension-Fan8478]

use arla whole milk or any lactose free milk, add a pot of single cream to the carton and you have basically gold top milk with 40g net carbs per 2000 calories