Why Keto Might Stop Working and What to Do Next
Reviewed by Eric Westman, MD, MHS (June 2025)
You remember the beginning, don’t you? The first few weeks or months on the ketogenic diet felt like a magic trick. The numbers on the scale were moving down quickly, your energy levels were steady, and that brain fog you’d accepted as normal had miraculously lifted. You were a believer! You told your friends, you bought the MCT oil, and you finally felt in control of your health.
But lately, the magic seems to be fading. The scale has refused to budge for weeks, maybe even months. You might be feeling more tired, the old cravings are whispering at the door, and a frustrating thought has started to creep in: “Maybe keto is not working for me anymore.”
If this sounds familiar, take a deep breath. You’re not alone, and you haven’t failed. Hitting a plateau is one of the most common experiences on any long-term diet, and keto is no exception. It’s not a sign that you should give up, but rather a signal from your body that it’s time for a tune-up. Your body has adapted, and now your approach needs to adapt with it.
This guide will walk you through why your progress might have stalled and provide you with clear, practical steps to figure out what to do next.
1. The Plateau Puzzle: Why Your Body Puts on the Brakes
It’s easy to feel like you’ve done something wrong when your weight loss stalls, but what’s happening is often a natural and predictable biological process.
First, the initial rapid weight loss on keto is largely due to shedding excess water. When you restrict carbohydrates, your body uses up its stored glucose (glycogen). Since every gram of glycogen is stored with 2-3 grams of water, you get a significant “whoosh” on the scale in the first couple of weeks. Once that water is gone, you begin to burn fat, which is a much slower process.
Second, your body is incredibly smart and wired for survival. As you lose weight, your metabolism naturally slows down slightly because a smaller body requires less energy (calories) to function. This is called metabolic adaptation. Your body doesn’t know you’re trying to fit into your favorite jeans; it senses weight loss as a potential famine and tries to become more efficient to conserve energy. This efficiency is what feels like a frustrating plateau. It’s not a failure; it’s your body being good at its job.
2. A Keto Audit: Are Hidden Carbs and Old Habits Creeping In?
When we get comfortable with a routine, it’s easy to let small things slide. What started as strict adherence can slowly morph into “keto-ish.” This is the perfect time for a gentle, no-judgment audit of what you’re actually eating. For just three to five days, consider tracking your intake meticulously. This isn’t about policing yourself; it’s about collecting data.
Here’s what to look for:
- Carb Creep: Are you still reading every label? Hidden sugars and starches are everywhere. That “keto-friendly” protein bar, the extra splash of salad dressing, the handful of nuts (which can add up quickly), or even certain seasonings can push your carb count over the edge and interfere with losing body fat.
- The Fallacy of Unlimited Fat: Have you been following influencers who tell you you need to eat fat to lose fat? That sounds nice, but it’s crucial to remember that calories still count. Fat is used for energy and satiety, but if you’re consuming far more calories than your body is burning—even from healthy fats, like butter and olive oil—you won’t lose weight. As your body gets smaller, your energy needs decrease. You may need to adjust your fat intake accordingly.
- Habit eating: Are you having more meals or snacks in a day than your body needs? Are you eating because “it’s lunchtime” – even if you’re not hungry? Do you ignore your hunger signals and eat when others around you are eating, because you’re afraid of feeling awkward or worried about what others will think? Let your hunger guide when and how often you eat – not a clock, your workplace, or social events.
3. Beyond the Plate: The Lifestyle Factors That Stall Progress
Weight management is never just about food. If your macros are on point and you’re still stuck, it’s time to look at the bigger picture. For women, especially in their 40s and beyond, lifestyle factors and hormonal changes play a big role.
- Stress: Chronic stress is a notorious saboteur of weight loss. When you’re stressed, your body releases cortisol, a hormone that can increase appetite, encourage sugar cravings, and signal your body to store fat, particularly around your midsection. If you’ve been under a lot of pressure lately, it makes sense that looking good in a swimsuit might not be your body’s top priority.
- Sleep: Don’t underestimate the power of a good night’s rest. Poor sleep can disrupt your hunger hormones. It raises ghrelin (the “I’m hungry” hormone) and lowers leptin (the “I’m full” hormone). When you’re sleep-deprived, you’re biologically programmed to feel hungrier and less satisfied, and it’s much harder to stick to your plan when you have to fight hard-wired biology. (To make things worse, you’ll most likely crave sugar when you’re dragging, for a quick pick-me up!)
- Hormonal Shifts: If you’re a woman in your 40s, you may be entering perimenopause. This natural life stage brings shifts in estrogen and progesterone that can affect your metabolism, insulin sensitivity, and how your body stores fat. It can make you more resistant to weight loss using methods that worked easily for you a decade ago. This isn’t a defeat; it’s simply a new set of rules to learn.
- Movement (or Lack Thereof): Your exercise routine matters. If you’re not moving much, your metabolism will be slower. Conversely, doing too much intense, chronic cardio can also increase cortisol and work against you. The sweet spot is often a combination of gentle movement like walking, along with strength training. Building lean muscle is one of the fundamental things you can do to boost your resting metabolic rate. Exercise isn’t required to lose body fat, but it can help!
4. Smart Strategies: How to Tune-Up Your Keto Engine
Once you’ve audited your food and lifestyle, you can start making targeted adjustments to break through the stall.
- Prioritize Whole Foods: Step away from the processed “keto” cookies, bars, and breads. They lack nutrients and typically contain much more carbohydrate than you realize. Focus 90% of your diet on real, single-ingredient foods: meats, fish, eggs, leafy greens and other non-starchy vegetables, and healthy fats.
- Introduce Intermittent Fasting (IF): You don’t need to have any specific “eating window” or go a precise number of hours without food. Intermittent fasting can be as simple as skipping a meal when you’re not hungry. (Pretty radical, right?!) If you’re hungry, eat. Don’t force yourself to ignore what your body is telling you. But IF can help remind you to think about whether or not you are hungry before you reach for a snack or sit down for a meal.
- Check Your Electrolytes: Sometimes feeling sluggish or “off” on keto isn’t a plateau but a simple lack of electrolytes. A low-carb diet flushes out sodium, potassium, and magnesium. Make sure you’re getting enough salt, eating potassium-rich foods like avocado and spinach, and consider a good magnesium supplement – especially if you experience constipation or muscle cramps on keto.
- Explore a Short-Term Elimination Protocol: For particularly stubborn stalls, some people find success with a stricter approach, like the carnivore diet. By focusing exclusively on animal products such as meat, fish, and eggs for a short period, you remove all potential plant-based irritants and hidden carbs that might be causing adverse effects for you. This can act as the ultimate reset to break a plateau before gradually reintroducing well-tolerated keto-friendly plant foods.
5. Defining Your Next Chapter: Evolving Beyond Strict Keto
Perhaps the most important question to ask yourself is this: What was my original goal, and is that still my goal now? Keto is an incredible tool, but that doesn’t mean you have to eat that way for the rest of your life. The long-term goal for many is not to stay in ketosis forever, but to achieve metabolic flexibility – the ability for your body to efficiently switch between burning fats and burning carbs for fuel.
If you’ve used keto to lose weight, fix your metabolism, and get your insulin sensitivity in check, your next step might be a transition to a more flexible plan that feels more sustainable for the long term. This isn’t “quitting keto”; it’s shifting to a slightly different approach because you no longer need keto. You could slowly and intentionally reintroduce small amounts of nutrient-dense carbohydrates from whole foods. Start with berries with full-fat yogurt, or add a small sweet potato to your dinner. Pay close attention to how your body responds. The lessons you learned on keto are invaluable: you now know how to avoid sugar and processed foods, how to prioritize protein and healthy fats, and how to listen to your body’s signals. These principles can form the foundation of your healthy lifestyle, whether you’re in technical ketosis or not.
Your journey is your own. A plateau isn’t a judgment—it’s a fork in the road asking you to pause, look at the map, and choose your next path with intention and self-compassion. You are in the driver’s seat, and you have all the tools you need to keep moving forward.
Reviewer Bio
Eric Westman, MD, MHS, is an Associate Professor of Medicine at Duke University, the Medical Director of Adapt Your Life Academy and the founder of the Duke Keto Medicine Clinic in Durham, North Carolina. He is board-certified in Internal Medicine and Obesity Medicine and has a master’s degree in clinical research. As a past President of the Obesity Medicine Association and a Fellow of the Obesity Society. Dr. Westman was named “Bariatrician of the Year” for his work in advancing the field of obesity medicine. He is a best-selling author of several books relating to ketogenic diets as well as co-author on over 100 peer-reviewed publications related to ketogenic diets, type 2 diabetes, obesity, smoking cessation, and more. He is an internationally recognized expert on the therapeutic use of dietary carbohydrate restriction and has helped thousands of people in his clinic and far beyond, by way of his famous “Page 4” food list.
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