Day 7 of 90 Day N=1

Hello again!  Dr. Matt here checking in for the end of week 1.  It’s been a pretty great week far.  Other than on Wednesday, I really didn’t have any problems with cravings, and at no point did I have experience any real hunger.

As far as exercise this week, I didn’t really do too much.  Monday I did a my body weight circuit which consists of the Primal movements outlined in the Primal Blueprint (which I highly recommend picking up the newest version, which you can get here).  That workout looks like this:

Standard Push-ups: 3 sets of 10

Air Squats: 3 sets of 20

Pull-ups: 3 sets of 10

Plank: 4 sets of 30 second holds

Now, my starting at 330 lbs, I had to modify.  I did as many regular push-ups as I could do until I started to fail, and would finish on my knees.  I had no problems with squats, just need to work on my depth.  Pull-ups are being done with resistance bands right now.  Once I get down to 260, I’ll start doing assisted pull-ups.  And plank is being done on my hands, and not my forearms.

That was Monday’s workout.  The rest of the week I tried to get as much walking in as I could over my lunch break, but I didn’t really get another workout in until yesterday (Saturday).  I woke up and did a 30 minute DDPYoga Workout.  That was it for real exercise, but I will tell you that the rest of my Saturday was spent taking stuff out of storage and moving all day.  We cleaned out the back of my dental office getting ready for the remodel that starts tomorrow, and we had to move stuff that looked like it’d been in that building for the last 60 years.  It was kind of cool the old-old school dental equipment (I’m surprised it wasn’t belt driven with a foot pedal), but that stuff was HEAVY to move.  After my team and I finished with that, then I went to help my folks move stuff out of their storage unit.  Which ended up taking 4 truck loads.  So yesterday was a VERY active day.

Alright, so with all that let’s take a look at where I’m at.

Weight:

Boom! Down over 12 lbs in less than a week.  Now let me be clear, a lot of this is water weight.  I want to make sure both you and I are fully aware of this.  The reason why a lot of folks lose a ton of water weight when beginning primal, LCHF, or keto diets is because of two things:  insulin and glycogen.   As noted by the American Journal of Physiology [1], when insulin levels are lowered the kidneys start getting rid of excess sodium from the body.  Lower insulin can also help improve blood pressure as also noted in that study.

Next up is glycogen.  It’s been said that a healthy adult can store around 400 grams of glycogen in the liver, and about 100 grams in the muscle.  This is the conventional wisdom, but I’m having trouble locate the actual scientific sources of this, so take it with a grain of salt.  But let’s say the conventional wisdom is correct.  (Edit:  Busted out my Textbook of Medical Physiology by Guyton & Hall 11th edition, and they state that liver cells can store up to 5-8% of their weight in the form of glycogen and muscle cells can store 1-3%.  Page 832 of this edition if you want to check it out).

So that’s roughly 500 grams of glycogen storage.  And each gram of glycogen caries 3 grams of water [2].  So that means if you deplete you glycogen stores, you can be losing 1.5 kg or 3.3 lbs in water weight.

So of the 13 lbs I lost this week, was it ALL water weight?  Doubtful, but I’m sure it played a part.  What will be interesting is from this point forward.  Do I have that much more excess water weight to lose?  If not, how will it effect the rate at which I lose? Also, I’ll be picking up a blood pressure cuff to use so I can start reporting that as well.

Ketone level:

Getting closer!  Still not quite to a state of nutritional ketosis, but I’m on my way.  A normal person can enter nutritional ketosis relatively quickly, 2-4 days usually.  Here it’s taken me over a week.  That goes to show how insulin resistant I truly am.  It also shows how I need to be super diligent.  If I were to slip up or have a “cheat”, it could take me a whole week to get back into ketosis!  Not worth it.

That’s it for week 1!  Stay tuned as I’ll chime in mid-week for a quick check in.

What is Ketosis? Pt. 3

Welcome back to part 3 of our basic series explaining what ketosis is and how it can be beneficial.

In parts 1 & 2, we reviewed what ketones are, how our body makes them, and how they are used as a fuel source.  Today, we will talk about the $10,000 Question:  Why would a person want to be in ketosis?  This answer is multifactorial, as people have used nutritional ketosis for a myriad of different reasons.  Most people dip their toes into the “Keto Diet” because they want to lose weight.  However, there are numerous other reasons people adapt to a ketogenic lifestyle.  Some use it to help mitigate various symptoms of inflammation such as arthritis or acne.  Some people use it for an advantage in sports performance, namely endurance sports like marathons, cycling, triathlons, etc.  Some people use it to help their mental clarity and mood.  And some folks find better sex drive and fertility (Note: I’ve been working on a post for resources and scientific studies about these very topics.  Feel free to keep an eye out as the list continues to grow).

As I stated in part one, a ketogenic diet (aka “keto”) is a low carbohydrate diet.  However, it differs from other popular low carb diets like Atkins (www.atkins.com) and Protein Power (www.proteinpower.com).  Where those are indeed lower carb compared to the Standard American Diet (SAD), they may not be low enough in carbohydrates to induce ketosis.  The 1st phase of Atkins is very low carb (under 20 net grams) to promote ketosis, however in the actual Atkins guidelines this phase is only meant to be done for 2 weeks.  This differs from a truly ketogenic diet, as this carb restriction is meant to last indefinitely (unless utilizing a modified keto diet like the cyclical or targeted ketogenic diets, which we’ll explain later).

 

When carbohydrates are reduced enough (sometimes 5% or less of calories consumed) and more natural fat is consumed in its stead, your body enters the metabolic state of ketosis.  This state causes your body to become more efficient at using fat as a fuel source (instead of just constantly storing it).  Also, the liver coverts fats into ketones (as we explained in Part 2) that can act as an alternative source of energy for the brain (1,2).  Ketogenic diets have shown to help lower and improve blood sugar and insulin levels.  Also, the increased levels of ketones have shown to have other health benefits as well.  (1,3,4,5)

 

Side Note:  If you want to geek out on science and metabolism of ketones/ketosis, I’m going to recommend you check out Dr. Peter Attia’s blog over at The Eating Academy.  He does a deep dive that I think science enthusiasts will really appreciate.  These two articles are of significant value:

http://eatingacademy.com/nutrition/ketosis-advantaged-or-misunderstood-state-part-i

http://eatingacademy.com/nutrition/ketosis-advantaged-or-misunderstood-state-part-ii

The studies cited above (and more that I haven’t linked to) have shown to be an effective strategy for losing weight and reducing disease risk.  Also, there are numerous studies showing that the ketogenic diet out performs low-fat diets (6, 7, 8, 9).  In fact, a ketogenic diet has shown that it’s possible to lose weight without cumbersome calorie counting or food journaling as shown in a study published by the American Journal of Clinical Nutrition (http://ajcn.nutrition.org/) in 2008 (8).   A 2007 study published in Diabetic Medicine (the journal of the British Diabetic Association; http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1464-5491) showed that those on a low carb, ketogenic diet lost 3 times more weight than those on the Diabetes UK’s recommended diet.  That is pretty darn substantial!

Yet another study showing significant results is a 2003 study published in The Journal of Clinical Endocrinology & Metabolism (http://press.endocrine.org/journal/jcem) (11).  This study showed that participants lost 2.2 times more weight and 2.4 times more body fat than those on the calorie restricted, low-fat diet.  This study also had another interesting finding, as stated in the discussion section:

” Another unexplained, but important, observation was the spontaneous restriction of food intake in the very low carbohydrate diet group to a level equal to that of the control subjects who were following a prescribed restriction of calories. This raises the possibility that the very low carbohydrate diet may have been more satiating”

 

In a nutshell, what this observer is saying is that the participants did not feel the need to eat regular full meals, possibly even refusing to finish what was in front of them, because they didn’t feel the need to continue eating; they were full.  And what they did end up eating during the day counted up to about the same number of calories as the others who were restricting their calorie intake.

 

Ok, its effectiveness in losing weight has been covered.  But HOW do you DO the keto diet?  A buddy of mine and fellow ketonian, Larry Lustig, summed it up well in one sentence:  “Replace the carbohydrates you eat with fat.”   https://www.ketogenicforums.com/t/the-entire-ketogenic-diet-in-one-sentence/497

 

The following is going to be MY recommendation based on what I’ve learned from studying the topic, as well as my personal experience.  Other Keto proponents might disagree with what I say, and that’s perfectly fine.

It’s important to remember that each person is different, so these ratios of fat:protein:carbs needs to be individualized.  The breakdown of a typical keto diet is about 70-75% calories from fat, 20-25% from protein, and 5-10% from carbohydrates.  It can be beneficial to count calories and track your food when you first start, as there can be hidden carbs and sugars in foods that you wouldn’t expect (sugar in cured meats for example).  I for one HATE counting calories, so now that I’ve been doing this long enough, I have a good grasp on the macros of the foods I generally eat.  I don’t count calories or journal; I just go by hunger levels and how I feel.

 

Note that it can take an average of 21 days to become keto adapted!!! Some folks take less time, some can take more.  And it can take a few days to a week of strict carb restriction before you start turning those pee sticks (Ketostix) colors. These are used to monitor ketosis when you first start out. When you do start going into ketosis, you are going to lose retained water and with that you will lose sodium.  It’s important to make sure you are getting enough salt.

 

Example meal plan when I was eating 3 times a day:

Breakfast:  3 eggs, 2 slices of bacon, 1/2 of an avocado

Lunch: BAS (Big Ass Salad) with bleu or feta cheese, whatever full cut meat I wanted (usually what I had for leftovers, just diced up.  Do NOT go for lean meats.  You need the fat.), and a high-quality dressing, like something from Newman’s Own or my new favorite by Primal Kitchen (http://www.primalkitchen.com/shop/)

Dinner:  Grilled Pork Steak and Green Beans or Broccoli cooked in Butter

 

Now that I’m keto/fat-adapted, my hunger is blunted, so I usually only eat lunch (my new Break-Fast) and dinner.  I might have a Keto drink (a shake or coffee with exogenous ketone supplement, another subject for another day) in the morning, but often I’m just not hungry.

 

Common mistakes I see (and have learned from experience):

 

Not enough salt:  When going from fat-burning after being a sugar-burner for so long, you will lose water and sodium.  Some people report a feeling of brain fog and fatigue.  Often this is because they are low on salt.  Feel free to add salt to your meals, and consider a cup of bullion or bone broth once every 1-2 days.

 

Too much protein in relation to your amount of activity and/or level of insulin resistance: This is more likely for highly insulin-resistant folks like myself.  Excess protein cannot be stored, and will be broken down to glucose via gluconeogenesis.  This rise in glucose can kick you out of ketosis.  You might not have that problem with your training, but it’s something I had to learn the hard way. Please note that, IN MY OPINION, excess protein is only a problem if you are SEVERELY insulin resistant (like yours truly).  If you have less than 50 lbs to lose, of if you’re doing a lot of strength or muscle work like bodybuilding, strongman training, or Crossfit, this is unlikely to be the case.  This area of study is still in its infancy, and there seems to be a lot of disagreement in the LCHF camp.  My $0.02:  If you are not morbidly obese and you live a semi-active lifestyle, you’re probably not going to be consuming too much protein.  If you are very insulin resistant and are sedentary, you can skip the 20 oz steaks and protein shakes.

 

Too many carbs:  Carb levels are so individualized that it’s almost moot to talk about.  Some folks can stay in ketosis around 100 grams of carbs a day.  Some folks do better on 50 grams.  I, myself, because of my insulin resistance, must stick between 20-30 or fewer grams. A general guideline is the more weight you need lose, the lower your carb count needs to be.  I’m a rip-the-band-aid-off kind of guy, so I’m all about just dropping down to 20 grams, get adapted, and then play with number of carbs based on YOUR situation.

 

Side Note:  In the low carb community, a constant debate is how to count carbs.  Some people count Net carbs (Total carbs – fiber- sugar alcohols = net).  This is what Dr. Atkins recommended in his protocols.  However, I am in the count total carbs camp.  If you look at some of these “low carb” treats and protein bars, you might see a bar have 23 grams of total carbs, but, after subtracting fiber and sugar alcohols, it might only have a net carb count of 6.  I’ve had trouble with this for a couple reasons.  First, this type of leniency can lead to overindulgence of these foods.  Second, sugar alcohols can still raise the blood sugar of some people and kick them out of ketosis, lead to cravings, or both (which was my personal experience as well).

 

“I feel kinda crappy for the first few days, so it must not be good for me”:  What a ridiculous excuse. Personal note:  I used to smoke, and it sucked quitting.  I was irritable, I’d get headaches, blah blah blah.  Doesn’t mean it was BAD for me, my body was just in transition.  Same thing here.  When you are changing the fuel that your body utilizes (fat burner vs sugar burner), it’s going to take an adaptation process (we talked about how your body needs to get better at creating beta-hydroxybutyrate dehydrogenase in Part 2).

 

So what CAN you eat?   Check this list out for a good breakdown of Low Carb Approved Foods

http://www.ketogenic-diet-resource.com/low-carb-food-list.html

Basically it comes down to plenty of meat (don’t shy away from the fatty cuts), and green leafy or non-starchy vegetables.   Also remember that you want to keep your net carbs (total carbs minus fiber) under 20 grams starting out. And if you’re more insulin resistant (like yours truly),  you may need to keep TOTAL carbs under 20 grams.

 So there you have it:  Why a person can benefit from nutritional ketosis and how to do it.  That was a long post, thanks for hanging in there with me.  I hope that it brought you a lot of value.  In my next post, I will be discussing the effect of ketosis on special situations such a diabetes, cancer, Alzheimer’s disease, heart disease, polycystic ovary syndrome (PCOS), and more.  Also, I’ll be working on a book review for Gary Taubes’s new book, The Case Against Sugar.   Stay tuned!

 

 

1: https://www.ncbi.nlm.nih.gov/pubmed/14525681

2:https://www.ncbi.nlm.nih.gov/pubmed/6865776

3: https://www.ncbi.nlm.nih.gov/pubmed/14769489

4: https://www.ncbi.nlm.nih.gov/pubmed/11122785

5:https://www.ncbi.nlm.nih.gov/pubmed/14769483

 

6: https://www.ncbi.nlm.nih.gov/pubmed/23632752

7: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633336/

8: https://www.ncbi.nlm.nih.gov/pubmed/18175736  (This one shows can lose without Counting Calories or food journaling)

9: https://www.ncbi.nlm.nih.gov/pubmed/15466943

10:  https://www.ncbi.nlm.nih.gov/pubmed/17971178  (lost 3x more weight than Diabetes UK’s recommeneded diet)

11: https://www.ncbi.nlm.nih.gov/pubmed/12679447 (showed keto lost 2.2 times more weight than CR, Low fat; along with improved Tri and HDL levels)

Keto Resources

In this post I will be adding a list of scientific studies, books, blogs, and other resources for easy reference.

Scientific Studies

General

Carbohydrate-restricted diets for obesity and related diseases: an update.  Boling CL, Westman EC, Yancy WS Jr.  Curr Atheroscler Rep. 2009 Nov;11(6):462-9. Review. PMID: 19852888  https://www.ncbi.nlm.nih.gov/pubmed/19852888

Fuel metabolism in starvation.   Cahill GF Jr.Annu Rev Nutr. 2006;26:1-22. Review. PMID: 16848698 https://www.ncbi.nlm.nih.gov/pubmed/16848698

Metabolic syndrome and low-carbohydrate ketogenic diets in the medical school biochemistry curriculum.  Feinman RD, Makowske M.Metab Syndr Relat Disord. 2003 Sep;1(3):189-97. doi: 10.1089/154041903322716660. PMID:18370662 https://www.ncbi.nlm.nih.gov/pubmed/18370662

Medium-chain triglyceride (MCT) ketogenic therapy. Liu YM.Epilepsia. 2008 Nov;49 Suppl 8:33-6. doi: 10.1111/j.1528-1167.2008.01830.x. Review. PMID: 19049583  https://www.ncbi.nlm.nih.gov/pubmed/19049583

Medium-chain triglyceride ketogenic diet, an effective treatment for drug-resistant epilepsy and a comparison with other ketogenic diets.Liu YM, Wang HS.Biomed J. 2013 Jan-Feb;36(1):9-15. doi: 10.4103/2319-4170.107154. Review. PMID: 23515148 https://www.ncbi.nlm.nih.gov/pubmed/23515148

Is a calorie really a calorie? Metabolic advantage of low-carbohydrate diets.Manninen AH.J Int Soc Sports Nutr. 2004 Dec 31;1(2):21-6. doi: 10.1186/1550-2783-1-2-21. PMID: 18500946  https://www.ncbi.nlm.nih.gov/pubmed/18500946

 

What is Ketosis? Pt. 2

In Part 1 we discussed how the basics of what Ketosis is on a very fundamental level.  Today we will talk more in depth about how ketosis works, and the process of how the body makes ketones.

Ketosis is a state in which your liver breaks down body fat for fuel, the byproduct of which is ketones. This is an energy source for your body similar to carbohydrates (such as breads and pastas) which ultimately break down into simpler forms of sugars.  There are 3 types of ketone bodies: acetone, acetoacetate, and beta-hydroxybuterate (BHB)  [1]. When we first go into ketosis, we start “spilling” the ketone acetoacetate, which is found in the urine.  If you’ve heard people checking to see if they’re in ketosis by peeing on test strips (Ketostix), this is the form of ketone that is being tested.   First, a portion gets spontaneously converted into the ketone acetone (the form of ketone found in the breath) and is then turned into beta-hydroxybuterate (the form of ketone found in the blood and the type your body uses most as a fuel source).

A big part of becoming fat adapted is your body becoming better at making an enzyme called beta-hydroxybutyrate dehydrogenase.  This is a pivitol adaptation that your body makes to better use ketones and fat for energy.  This can take a few weeks, so give it time.  Think about it. If you’ve been a sugar burner your whole life, your body has not had to make much of this enzyme before.  So it’s going to take time.  Much like if you have a broken leg that has been in a cast for months.  You can’t just take the cast off and immediately run a marathon.  It’s going to take time for the bones and muscles to strengthen back up.

Believe it or not, most of the cells in your body can use ketones directly for energy as well or even better than they can with glucose [2].  Yes, there are some parts of the body that require glucose like red blood cells and parts of your brain.  However, your body already comes prepared to meet these demands without taking a single bite of carbohydrates.  Your liver is fully able to derive glucose from protein via a process called gluconeogenesis.  Breaking that word down backwards:

Genesis= Create.  Neo=new. Gluco=sugar.  So using spare protein from diet and general body processes, the liver can convert some of this excess protein to sugar.  This is exactly how hunter gatherer tribes were able to survive in harsh winters when vegetables, fruits, and other plant matter was scarce.  Or how tribes like the Inuit in Antarctica were able to thrive without a hint of dietary carbohydrates [3].  It should also be noted that some tissues like the brain can utilize BHB even better than glucose once adapted (we’ll talk about that more in future articles)

 

Ok, so we’ve talked about how your body can use fat for fuel, and why you don’t need to eat carbs to live.  Let’s get the next question… WHY would I want go keto?  You can also lose weight by just eating less and moving more right?  I mean, that’s what has been touted as dietary advice for the last 30 years, nevermind the fact that people are getting fatter and sicker in the process.  So what benefits does a ketogenic lifestyle have over that of a sugar burner?  Great question.  Here is a list of documented health benefits from being in a state of nutritinal ketosis:

 

  • Natural hunger and appetite suppression
  • Much easier weight loss
  • Better sleep
  • Increased Mental Clarity
  • Blood sugar stabilization
  • Decreased insulin resistance
  • Better mood and decreased depression/anxiety
  • Lower blood pressure
  • Increased HDL (aka the “good”) cholesterol
  • Reduced triglycerides and small LDL (the “bad) cholesterol
  • Improved fertility and sex drive
  • Reduction in systemic inflammation
  • Reduction in acne
  • And more….

I will be providing a page for scientific resources in the near future, so if you want to really nerd out on this stuff, feel free.

That’s it for part 2.  Next in part 3 we’ll be tackling some frequently asked questions and debunking some myths you may have heard surrounding the ketogenic diet.

[1]  Berg, Jeremy M., John L. Tymoczko, Lubert Stryer, and Lubert Stryer. Biochemistry. 6th ed. New York: W.H. Freeman, 2006. Print. Pages 630-634

[2] Volek, Jeff, and Stephen D. Phinney. The art and science of low carbohydrate performance: a revolutionary program to extend your physical and mental performance envelope. Lexington, KY: Beyond Obesity, 2012. Print. Pages 29-41

[3] Volek, Jeff, Stephen D. Phinney, Eric Kossoff, Jacqueline A. Eberstein, and Jimmy Moore. The art and science of low carbohydrate living: an expert guide to making the life-saving benefits of carbohydrate restriction sustainable and enjoyable. Lexington, KY: Beyond Obesity, 2011. Print. Pages 14-15

What is Ketosis? Pt 1.

Ketosis (KEY-TOE-SIS) is simply the metabolic state when your body is using ketones (a form of energy from fat) for energy rather than glucose (energy from sugar).

Our bodies are pretty marvelous machines, much like a hybrid car, and are able to utilize multiple fuel sources.  Conventional wisdom tells us that we should be getting our energy from carbs (ie sugar). And it’s understandable why that’s been the prevailing notion for decades.

Our bodies love all kinds of starchy and sugary foods like potatoes, rice, breads, pasta, etc.  Our bodies love this because it’s a quick form of energy. Dr. Stephen Phinney, in the documentary Cereal Killers, compared this to lighter fluid when starting a grill.

However, we can pay a big price for this. If this consumed sugar is not burned, our body will convert and store the excess as fat.

Now let’s flip this coin over and examine the other side: Ketosis.  Ketosis is a natural process where your body utilizes fat, rather than sugar and starches, for its energy demands. This switch is flipped by cutting out starch and sugar out of your diet. In fact for a lot of people, this means only 5% of calories come from carbohydrates.

Once the body is no longer getting energy from cheap and easy carbs, the body then switches gears and starts utilizing its stores of body fat as energy. So instead of getting energy from spaghetti, or breakfast cereal, or that muffin, your body is using the energy already stored in the form of body fat around your waist, hips, thighs, etc.

So that’s the most fundamental concept of nutritional Ketosis. In part 2, we will be explaining in a bit more detail on the mechanisms on how Ketosis works, the benefits of being in a state of Ketosis, and how to get there. Stay tuned!