that seems like a LOT of high intensity exercise every day. Remember that high intensity is glucose-demanding. If you are keeping your dietary sources of glucose down, where is the glucose coming from to support your exercise? a shot of blood sugar from liver glycogen, but where is the glycogen being stored FROM, if you're not eating glucose sources? Perhaps that is causing stress and tiredness.

20g of carbs would not cover the exercise, and 60g of protein does not leave any extra for making glucose. So your only dietary sources would be from fat (the glycerine molecule).

A lot of exercise? An hour walk a day and yoga 3 times a week. Seems not very much to me?
The source of glucose is puzzling me too. I have not had anything but a trace of ketones in urine and the blood ketones also low. Protein not excessive. Where is all this glucose coming from?
Fasting glucose is getting a little higher each day I stay on 20g of carbs. Not sure if I should continue.
I'm waiting for a new box of sticks in case my batch is not accurate

It could be the meter itself, not the sticks, or any of the 30 different impacts on blood sugar readings.
Rather than stress over numbers for which you have no baseline, have a lab test for fasting BG, fasting Insulin, and Hba1c. Take the meter along when the FBG is drawn, and check these baseline numbers first. You are eating well, though you should eat when hungry, you're healthy, and get good exercise...probably no need to be upset about numbers from a tiny drop of blood on a piece of paper.

Do you live in a country where you can go online and request (at your own cost) lab tests? There are commercial sites in the US that have doctors on staff, and they will order the tests that you request, and you then go to the local lab they request, to have the blood drawn.

Not super cheap, but not nearly as expensive as getting it at labs associated with the hospitals in the US.

When you mentioned fatigue and slow/no weight loss my mind goes to hypothyroid. Check out the symptoms online and see if that might be an issue for you.

You also don't have that much excess weight, IMHO, so it is going to be slow and difficult.

I've had thyroid checked, I take a low dose of thyroid replacement and it gets screened regularly. I've been on it 10 years, it doesn't make any real difference.
If I were feeling great I would not be seeking answers, but I am constantly tired, my muscles fatigue out a lot (ie the same hill on the dog walk never gets easier, in fact if I try consecutive days by the 3rd day I just can't get up it) and I have very early arthritis to the extent that I need my 2nd hip replaced and I am only 43 and get alot of joint pain. I only work 3 days a week already, can't reduce that any more as I'm on my own and have to earn. And I am getting heavier despite doing all I can in terms of eating really well, weighing portions etc. Something is not right. I guess I will have to try my doctor for labs....

Try this: find out what your TSH is. AND your free T4, Free and R T3's.

Most GPs don't realize that people who have already been dxed with hypothyroidism need to keep their TSH lower than those who have not--because they've already been demonstrated to have thyroids that have problems making enough hormone.

If you are not going to an endocrinologist for your medical care, then see if you can get a referral to one, based on your symptoms, or, at the least, an internist. Exhaustion and sore muscles and joint pain are NOT normal, as you know. Have you been tested for rheumatoid arthritis?

I don't know what's going on in your body, and it appears that your doctor is uninterested in finding out. But NONE of the symptoms you are listing should be happening, and, although some of them could be attributed to carb flu, you say they've been going on for years.

It's not like you are obese. But eating properly, exercising, and still not being able to lose, while feeling generally crappy on an ongoing basis: something's wrong. You deserve a chance to find out what it is, and if it's fixable, don't you?

Thanks for this - I originally got diagnosed by a maverick consultant who believed in treating the patient not the TSH. I am on natural thyroid. However, when I moved house, my new doctor said she did not approve of him and I had to stop all medicine for 6 months and see the NHS endocrinologist - I had done that before and not got the thyroid diagnosed based on TSH - in fact the consultant told me to try and structure my life and be less lazy. The rebel doctor died 3 years ago. I now get tests done online and buy meds online as the health service will not support me in this. I have varied my dose in the past (with monitoring of pulse, bp etc) without any further improvement in my symptoms. My last TSH was mega low - like 0.01 I think.
I've had loads of tests including Rheumatoid - negative. Had lots of obscure tests as lived in Asia and also lots for zoonotics as work with animals, all negative. This has been going on for a long time. I just sent off some tests for toxic mould from the house and work.
I don't think blood glucose has ever been tested - I've certainly never done a fasting test, so when this came up it seemed worth exploring....

TSH on its own tells you nothing, or, at least, not much. You need to know what your thyroid is doing, not only what the pituitary is telling it to do.

I'd still get the free T4, etc.

And have you been tested for chronic fatigue syndrome?

I get the full thyroid screen. How is CFS tested?

I don't think there is a test for CFS. It is, like lupus and fibromyalgia, many tests for all other known causes of fatigue, then ruling those out; blood sugar problems, etc, first. Then for lack of a diagnosis, a label is placed on a cluster of symptoms.

Since you have been eating Paleo, did you try any of the auto-immune protocols? Dr Terry Wahls, Sarah Ballentyne, http://paleomagazine.com/definitive...e-protocol-aip/

If Rhumatoid arthritis was ruled out, what diagnosis was given to the severe arthritis at such a young age?

Currently CSF is not tested for, its a diagnosis of exclusion. So once your GP has ruled out thyroid issues, anemia, rheumatological conditions, inflammatory bowel conditions. And that you meet the current diagnostic criteria then we can say if you have CSF.

It might soundly clunky, but at least it is now recognized, and not just ignored!

Well, unfortunately, there are still Neanderthal docs who think it's all in the head. But the recognition has become mainstream.

It's the intensity. Your symptoms sound a little bit like overtraining. I know, seems like it's not enough for that. But every system is different. If it's pushing your body hard, but something is wrong with metabolism, it's like running any machine while damaged - just makes things worse.

If you changed your walking to an easy amble instead of heart-pounding brisk, and changed the yoga to a restorative approach instead of intensive burn, I wonder what that would do.

Stored muscle maybe.
It's normal to have fasting glucose in the 100-110 range (US units) when on super low carb like you are on. See Peter at Hyperlipid on this.

Clarification on Fasting Blood Glucose

You have gotten lots of good advice here, but one thing no one asked yet. Are you by any chance taking a statin? Joint aches and muscle pain are a side effect. I have experienced extrememly low energy on a statin as well, though that is not a listed side effect.