The keto mistake I wish I could undo.

The most difficult question I’ve ever gotten came from my mom.

She was fighting her third battle with cancer. We stood together in the hospital lobby, trying to absorb the news that it was back. She had refused chemotherapy after the devastation the last round caused, and she looked at me and asked, “If it was you, what would you do?”

I told her, “Go home and throw out the carbs.” And I did it right alongside her.

Six weeks later, her cancer was down by 70%, and I had lost 10 pounds.

But we made a ton of mistakes in the beginning. Our resolve to fight back against cancer kept us going through the long stalls, but if I could do it all again, these are the mistakes I wish I hadn’t made.

I was gluttonous about fat, and I stayed that way for too long.

When you transition to a high-fat metabolism, you have to nourish your fat-based hormones. Every one of them starts with cholesterol, which is itself a form of fat. In those first weeks it’s crucial to restore the cholesterol your body keeps in motion, because that cholesterol is the raw material your body uses to build all of those hormones.

This is why the first few weeks of keto feel so good. Your energy climbs, your immune system gets stronger, your metabolism comes alive.

When I started, I was like you. All of those fat-based hormones were locked inside my fat cells. When I changed my chemistry, they replenished. Then they activated. They left my fat cells and moved back into my lean tissue, where they went to work on my immune system and my energy.

I never felt hungry eating so much fat. I loved it. It tasted great and it kept me full.

But on the ketogenic diet, everything stabilizes eventually. To keep getting the benefits, I had to move on and put my metabolism under new stress.

Before keto, my blood sugar told the whole story. Three meals a day, every one of them processed, and my food sent my blood sugar way up.

When I started keto and held myself to 20 total carbs, that blood sugar dropped. At the same time, a wave of ketones rolled in, and that’s the moment I started feeling so well. My whole metabolism changed.

Then my body did what it was supposed to. It adapted. Those ketones settled back down to only the ones I was actually using.

That is when my results stalled, and the clue was right in front of me. I accidentally skipped a meal one day and barely noticed, because the chemistry was carrying me. I was doing great, so I never took the next step. I never dropped down to two meals a day.

This high-fat, three-meal stretch, the gluttony phase, should have lasted four to six weeks. I stayed in it for months.

In my high-carb life, I used food for comfort. On keto, I tried to do the exact same thing, reaching for sugar substitutes and rebuilding the foods I missed without the carbs.

Just don’t.

Stay away from the fat bombs and the keto desserts. It is not a good plan. You would never tell an alcoholic to replace whiskey with wine. Don’t replace dessert with keto dessert. Replace it with community.

If you’re used to something sweet after a meal, build a different ritual in its place. A board game. A card game. Anything that raises your oxytocin and stirs up that loving hormone inside you. That will serve you far better than a fat bomb ever could.

Here is how I mine my own oxytocin. I pray. I write a gratitude list. I play with the dog. I love a good puzzle. When I need a distraction, my husband and I find a show to watch. We play games together. We do whatever it takes to keep our focus off food as we wind down at the end of the day.

This brings me to my biggest mistake of all. Measuring.

Through everything I just described, I wasn’t really testing. I was enjoying my improved metabolism so much that the stall slipped right past me. I had forgotten the most basic rule of all: you are not on the ketogenic diet if you are not circulating ketones.

The urine strips are great. I tell my patients to pee on one first thing every morning, because it’s wonderful affirmation that you’re making ketones and putting them into circulation. But I waited a full year before I pricked my finger to prove I was still circulating them once I was keto-adapted. That is exactly when blood ketones start to fall, and exactly when you need a better measurement to know what is really going on.

Once I finally started measuring, the numbers told me precisely when to move.

Here is what happened when I dropped to two meals a day:

At first it put a real stress on my metabolism, and it produced a fresh wave of ketones. But before long, my circulating ketones fell below 0.5. That was my signal to push my metabolism again.

The best way to do that is to shrink the number of hours you allow yourself to eat. It’s called closing your eating window, or time-restricted eating. I did what most people do. I skipped the morning, ate around noon, and ate again in the evening. It worked fine at first. Then those ketones sank right back down. Even on a morning when I ate nothing, my blood sugar still ran high. It was like half a meal showing up in my bloodstream out of nowhere.

The fix is to move both meals earlier in the day. That gives you a higher wave of ketones that lasts longer. When your first meal overlaps with that natural morning rise in glucose, you cut down the number of times insulin has to surge.

If pricking your finger scares you, here’s a pro tip. Use the side of your finger, and use a spring-loaded lancet. You barely feel it, and if you do, it’s so small it isn’t worth a complaint.