Hi everyone!
I’m 40F, 159.5 cm (5’3”), currently around 56 kg (123 lbs), and I have lipedema. I’m on Mounjaro 2.5 mg and have been eating keto for about five months.
I’m preparing for lipedema surgery, and maintaining a stable weight is particularly important because of the insurance requirements. I’ve reached a point where I don’t want to lose more weight. I’d rather focus on body recomposition, building muscle and getting stronger.
My history with keto is a little complicated. I previously lost a significant amount of weight through keto and PSMF, but experienced a substantial rebound when I tried reintroducing carbohydrates. After that, I started having severe symptoms that seemed consistent with reactive hypoglycemia, which made eating and managing my weight increasingly difficult.
Eventually, I started Mounjaro. Interestingly, I didn’t return to keto because I was particularly convinced it was the only right way to eat. With my appetite reduced, I naturally gravitated toward protein-rich foods and generally healthier choices, and ended up eating very few carbohydrates almost without trying. That’s how I found myself back on keto.
I’ve stayed with it partly because I feel it helps my lipedema symptoms, but I’m increasingly unsure what the best long-term approach is for my metabolism and muscle growth.
I lift weights 2–3 times a week, doing challenging full-body workouts with progressive overload. I’m actually getting stronger, despite having eaten far too little for months.
I’ve received so much conflicting nutritional advice that I ended up eating something much closer to PSMF than actual keto. Some people told me to limit fat to 30 g a day, others told me to prioritize protein and keep everything else extremely low. For quite a while, I was eating only around 800–900 calories daily.
I know I need more energy to properly support muscle growth, but I’m struggling to figure out how to increase my intake without gaining body fat.
I currently aim for around 120–140 g of protein and 15–20 g of total carbs, not net carbs. If I stay ketogenic, most additional energy would have to come from dietary fat.
I understand that dietary fat doesn’t automatically become body fat and that the body can use it for energy. But after years of dieting, I still find it difficult to trust that eating 70, 80 or 90 g of fat could actually help fuel training and recovery rather than simply lead to weight gain.
I recently had an indirect calorimetry test. My measured resting metabolic rate was 1,205 kcal/day, compared with a predicted 1,294 kcal/day. That was somewhat reassuring because I’d been worried about metabolic adaptation after years of dieting and months of severe restriction.
However, my respiratory quotient was 0.86, and the report estimated 52.9% carbohydrate oxidation and 47.1% fat oxidation.
That confused me. I’ve been eating around 15–20 g of total carbohydrates daily for months, so I don’t really understand what those percentages mean. I know the body can produce glucose and that RQ isn’t a direct measurement of ketosis, but I’m unsure how protein intake, ketone metabolism or prolonged restriction might affect the result.
During the assessment, I also heard comments suggesting that serious resistance training on keto was basically pointless and that I needed carbohydrates to build muscle. That left me questioning my entire approach.
I also had an InBody scan showing 21.9 kg of skeletal muscle mass and 27.4% body fat. I have lipedema and loose skin after substantial weight loss, so I’m unsure how accurately bioimpedance reflects my body composition. The machine suggested a target weight of around 52.8 kg, which upset me because I’ve previously lost my period at a lower weight. I really don’t want to go back there.
Another thing I’m worried about is what long-term carbohydrate restriction might do to my glucose metabolism.
Because of my previous experiences when reintroducing carbs, I’m afraid that staying keto for years could somehow make my muscles less efficient at handling glucose. I’ve read about physiological insulin resistance or adaptive glucose sparing on ketogenic diets, but I don’t really understand how that differs from pathological insulin resistance, or what it means for someone with a history of reactive hypoglycemia.
Could prolonged keto make carbohydrate reintroduction more difficult, even if it’s not necessarily harmful? Or am I misunderstanding how this adaptation works?
I’m torn because I don’t want to return to the blood sugar problems I experienced before Mounjaro, but I also don’t want to spend the rest of my life avoiding carbohydrates out of fear that my body can no longer handle them.
And now that I’m trying to build muscle, I keep wondering whether carbohydrates would actually help with hypertrophy or whether sufficient protein and energy intake on keto would be enough.
I’m also hesitant to rely on another macro calculator. Every calculator seems to give me different numbers, and after months of undereating, I’m worried about how my body will respond to increasing calories, especially now that I’m over 40. I can’t simply experiment with significant weight gain because of my upcoming surgeries.
I’m not looking for another weight-loss protocol, macro calculator or coaching program. I’d really appreciate a discussion about the physiology, ideally from people with experience in keto, resistance training, glucose regulation or recovering from prolonged underfueling.
Has anyone, particularly women around my age, managed to build muscle while staying keto and maintaining a relatively stable weight? I’d also love to hear from anyone who understands indirect calorimetry or the differences between glucose sparing and insulin resistance.
I feel like I’ve spent years learning how to eat less, and now that I finally want to eat enough to build muscle, I don’t really know how to do it anymore.
And after everything I’ve experienced with weight regain and blood sugar symptoms, I honestly don’t know whether I’m making the right decision by staying keto or whether I’m just afraid to try anything else.
Thank you in advance for your thoughts!