Older Bolder Life

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Keto (Nutritional Ketosis)

Quick Monday Read: Low Ketone Readings while in Nutritional Ketosis

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Over the weekend a couple of questions popped up from two former clients who have both successfully been enjoying a ketogenic diet for several months now – the questions had to do with seeing progressively lower ketone readings on their surveillance testing (one serum, one breath).

In the midst of an all hands on deck family issue this weekend limiting my ability to expand in detail today, somewhat fortuitously Mark Sisson’s team, over on Mark’s Daily Apple, had reposted an article addressing the issue they’d written several years back – Why Am I Getting Low Ketone Readings on a Ketogenic Diet?

Sisson’s team covered most of the bases quite adequately, and in most cases where this question arises, from where I sit these days, most often what we’re seeing ketone/fat adaptation and/or the free fatty acid adaptation initially described by Volek and Phinney. And the discussion of whether or not physicians may or may not understand the keto phenomenon in the comments is fairly entertaining as well.

Most importantly, it’s imperative to look at the big picture – how does one feel and perform in day to day function and during workouts, are you where you want to be with regard to body composition, are you still dropping body fat if that’s your intent, are you symptomatic at all with anything resembling the “keto flu”, and how are you performing in aerobic level (vs anaerobic) exercise and activities?

Successfully implementing a nutritional ketosis program has very little is anything to do with readings on your serum or breath analyzer at home, don’t fall for anyone telling you otherwise.

My Personal Nutritional Ketosis Report Card 10 January: Through Week 36

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It’s been a few months since I shared my personal perspectives while engaging with a run of nutritional ketosis; my last update was here (15 August 2018), and here’s my post outlining why I wanted to give NK a run.

My Nutritional Ketosis Report Card at Week 36

Once again, for the most part, I’m pleased as punch overall after spending now slightly over eight months in nutritional ketosis, though for at least two weeks (one over the holidays), I’m sure I was drifting in and out of NK during the week.

My schedule is for the most part the same as I outlined in the 15 August post linked above, save for altering my walking routine due to a fairly impressive plantar fasciitis and calcaneal stress fracture (dammit).

A Closer Look at a Few Metrics

As noted in my last personal NK update, I have continued tracking a fairly close estimation of my macronutrients –

Up until starting my NK run, I’d lost 100 pounds without tracking a single calorie consumed over the 15 months window we’d been eating a fairly compliant LC/MP/HF diet around our camp, though of note been in a weight loss stall for several months (Dec-Feb).

I did however, principally at first as a learning tool, and later in part due to my medical training induced affinity for objective data, track a fairly specific diary of my daily carb intake (net carbs), which from the get go were always under 100 per day, and most often under 60 gm/day.

Again, largely as a matter of intellectual curiosity, when starting my NK run, I decided to track, as closely as possible, daily intake of carbs, protein, and fat, and to calculate my total caloric intake and deficit against my estimated BMR (adjusted for activity), as well as the percentages of carb / protein / fat contributions to my total calories.

Please note this point about tracking data: I still don’t recommend that most folks I work with track their intake as obsessively as I have been; it’s simply not necessary to make nutritional ketosis work for most. If you’re a data nut like me, go for it. Over the 36 weeks in NK thus far, the rolling averages of my intake and macronutrient accounting include –

Daily Carb Grams: 22.9 (91.4 calories)
Daily Protein Grams: 81.5 (326 calories)
Daily Fat Grams: 122.9 (1106.1 calories)

Average Total Calories per Day: 1525
Average Calorie Deficit per Day: –1565.7

Average Carbs as Percent of Total Calories per Day: 6.0%
Average Protein as Percent of Total Calories per Day: 21.4%
Average Fat as Percent of Total Calories per Day: 72.5%

Of note, without any conscious effort on my part, the trend of eating less protein and less calories overall continued most weeks, and several weeks I’ve dropped my carb grams to less than 20 g/day just to mix things up a bit, with no change in cognition, energy levels, exercise tolerance, hunger, or satiety.

Weight loss during my 36 week run now totals 59 pounds, fairly consistent with what I noted previously.

My Nutritional Ketosis Week 36 Bottom Line: Let’s Make It a Year

Overall I’ve been extraordinarily pleased with the results of my NK trial, especially in the context of my daily ability to engage with my life tasks, consistently and impressively improve my personal fitness, and chip away at the primary goals I originally outlined.

At this point, barring any unforeseen changes, I plan to ride the keto train to complete a full year in nutritional ketosis. Another report to follow in April.

Keto Thursday: Digging into the History Behind Today’s Nutritional Ketosis

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Over the past few weeks I’ve been spending a portion of my research time digging into the history of nutritional ketosis.

As most nutritional ketosis advocates know, formal discussion of NK in modern medical literature appears to have first been reported by Guelpa and Marie in 1911, two Parisian physicians who noted that fasting had consistent, demonstrably favorable impacts in epilepsy.

Perhaps even more interestingly, fasting is reportedly the only therapeutic measure against epilepsy documented in the Hippocratic collection (disclosure – I haven’t read all the Hippocratic collection), and there’s even a purported reference to fasting for a child with an apparent seizure disorder during Jesus’ time (Mark 9:14-29, KJV).

For those with an interest, I’ve listed below several more current references / links which are fairly easy, if not lengthy, reads. I certainly can’t vouch for the absolute accuracy of the information reported therein, though if you read through all you’ll note the consistencies.

History of the ketogenic diet (Epilepsia, 2008)

History and Origin of the Ketogenic Diet (Chapter two of Epilepsy and the Ketogenic Diet, pp 31-50)

The Origin (and future) of the Ketogenic Diet Part 1, Part 2, and Part 3 (Robb Wolfe’s team)

Do ketogenic diets have a place in human evolution? (Break Nutrition, 2017)

Keto Thursday: Pregame for Your Nutritional Ketosis Run

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By far and away the most common questions I’ve fielded this past summer and early fall have been related to folks wanting to jump on the keto bandwagon, most often in fact some version(s) of how do I get started, what’s the easiest way to get into keto, and do I really have to give up carbs?

My response typically focuses on review of several key points…

First Things First: Why Nutritional Ketosis?

First, I typically query why someone wants to give nutritional ketosis a spin. There are a host of great reasons to give NK a try – pursuit of greater metabolic flexibility, increased cognitive and/or physical performance, particularly in endurance-focused activities, or just overall improving your daily function (and quality of life).

Breaking through a weight loss stall is another worthy, and common, reason, as is dealing with a challenging health or metabolic issue (classically you might think of a seizure disorder here, though keto is commonly brought into the discussion for example when talking about T2DM, pre-dementia states, and even adjunctive treatment for some malignancies).

On the other hand, pursuit of “ketosis” to simply jump on the latest dietary fad bandwagon doesn’t seem to play well over the long haul, at least in my experience.

Pregame for Nutritional Ketosis: Take an Honest Snapshot of Where You Stand Metabolically

Honest self-appraisal, for most of us at least, isn’t the easiest task to accomplish, though this point is pretty straightforward. At the extremes, contrast the 40-year old, overweight, sedentary, desk-bound, over-stressed office worker, languishing on the standard American diet (SAD), crashing and burning multiple times a day, stumbling from one carbohydrate bomb to the next with the 40-year old who’s been eating primally or following a Paleo-ish eating plan, consuming moderate amounts of protein and less than 100 grams of carbs per day, walking 40 minutes 5 days a week, and getting enough sleep to truly rest and repair every day.

While anything is possible, I’d argue simply that the SAD guy above isn’t ready to launch a genuine nutritional ketosis run no matter how strongly he might want to; he could grind it out, but would likely suffer from the ‘keto flu’ (not a big fan of that term by the way) and would be at high risk to fail within the first three weeks. His road would be a danged bumpy one, and could be smoothed significantly with a pre-keto adjustment period (more below).

On the other hand, our guy eating Primally will likely make the transition into NK with relative ease…

Pregame for Nutritional Ketosis: Do a Bit of Housecleaning First

From a post on a similar topic I shared back in June –

Stepping into nutritional ketosis is a relative piece of cake if you’ve done some preliminary diet “housekeeping” to begin with. The most important dietary housekeeping is sorta’ve along the lines of cleaning the most obnoxious things out of your house – one, getting rid of grains and heavily processed carbs, including sugar in all its forms is one, and the second essential dumping the toxic, industrial-processed seed oils that are commonly stocked in pantry and restaurant around the world.

The other bit of housekeeping that I often recommend is to take a thoughtful, honest look at the amount and quality of protein one is eating prior to starting a nutritional ketosis run. Many of us are simply eating too much protein, and too much protein from less-desirable sources (i.e. CAFO beef, pork, and chicken).

Pregame for Nutritional Ketosis: Put on Your Thinking – and Listening – Cap

Two points here. One, be prepared to learn some new concepts. Nutritional ketosis is a fascinating tool (among many) to optimize your health and function, though as with all concepts that are swept to fad stardom, there is a tremendous amount of noise and misinformation in the keto arena these days.

Looking for a great read to kick off the learning process? Consider The Keto Reset Diet by Sisson and Kearns, or Primal Fat Burner by Nora Gedgaugdas to mention a couple. Find a mentor or trusted coach (and yes, we can help you with a customized coaching program here…).

Second, your physiology and metabolism are unique to you alone; your optimal path to and in nutritional ketosis will likely be different than any one you know or read, and will require some thoughtful attention to what your body is telling you. Listen well, and don’t hesitate to make rational, thoughtful adjustments along the way.

Pregame for Nutritional Ketosis: Commit to Give Nutritional Ketosis a Fair Trial

I’ve shared this before –

No matter how you’ve been eating before, truly starting nutritional ketosis will cause your body to make some adjustments as you preprogram your metabolic machinery. I agree wholeheartedly with those who suggest you make at minimum a 6 week commitment to the process, promising yourself you’ll wade through whatever adjustments come your way. And as your body adapts to fat-burning, there are several breakthrough windows that are exciting to watch and feel – though for most that’s territory that occurs in week three and beyond.

Frankly, I’m typically encouraging most of my clients to make a 12 week or more commitment to their NK trial, particularly if they’re over 40 and have been or are ‘metabolically challenged’. And, to be fair, NK doesn’t work for everybody.

There are several other minor points to consider when thinking about an NK run, we’ll come back and revisit on another day.

Nutritional Ketosis Science Thursday: NK and Mitohormesis

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A few weeks ago I posted a link to this article – Nutritional Ketosis and Mitohormesis: Potential Implications for Mitochondrial Function and Human Health – from none other than Jeff Volek (yep, one of the scientific heavy-weights in the ketosis world), VJ Miller, and FA Villamena.

[Citation: Journal of Nutrition and Metabolism. 2018; 2018: 5157645]

IMHO, for those interested in digging a bit deeper into a science behind why nutritional ketosis (NK) provides the hosts of benefits it does, this will go down as one of the landmark articles detailing in particular NK’s impact at the mitochondrial level.

Why does that matter? From the abstract (cited above) –

The free radical theory of aging proposes that reactive oxygen species (ROS)-induced accumulation of damage to cellular macromolecules is a primary driving force of aging and a major determinant of lifespan. Although this theory is one of the most popular explanations for the cause of aging, several experimental rodent models of antioxidant manipulation have failed to affect lifespan. Moreover, antioxidant supplementation clinical trials have been largely disappointing. The mitochondrial theory of aging specifies more particularly that mitochondria are both the primary sources of ROS and the primary targets of ROS damage. In addition to effects on lifespan and aging, mitochondrial ROS have been shown to play a central role in healthspan of many vital organ systems. In this article we review the evidence supporting the role of mitochondrial oxidative stress, mitochondrial damage and dysfunction in aging and healthspan, including cardiac aging, age-dependent cardiovascular diseases, skeletal muscle aging, neurodegenerative diseases, insulin resistance and diabetes as well as age-related cancers…

They go on to discuss the roll that reactive oxygen species (ROS) play in tissue/cellular damage (one of the principal driving forces of aging), the ‘built-in’ systems designed to mitigate ROS damage, and the lackluster results in large scale trials of antioxidants with regards to mortality and morbidity, with a possible exception being Alzheimer’s disease.

They focus a large part of discussion on the mitochondrial free radical theory of aging, which (as complex as it is) is discussed in detail, leading to presentation of the key concept of mitochondrial signaling and mitohormesis –

Apart from generating detrimental oxidative damage, ROS have numerous crucial biological roles in signaling and stress response (reviewed in [33-35]). Emerging evidence suggests that oxidative stress might promote longevity and metabolic health through the concept of mitochondrial hormesis (mitohormesis). The mitohormesis theory hypothesizes that low levels of oxidative stress induced by either caloric restriction, exercise [36], or other stimuli may trigger adaptive responses that improve overall stress resistance, probably through increased endogenous antioxidant defense, which may eventually reduce chronic oxidative damage [37] and subsequently achieve lifespan extension…

The Take Away

While part of the paper details the ongoing search for and testing of pharmacologic agents which induce mitohormesis, the authors clearly reference studies and the science supporting nutritional ketosis, calorie restriction, and exercise (among others) as potential drivers of mitohormesis.

NK’s ability, when properly executed, to induce / encourage these types of adaptive changes at the cellular level is quite impressive, and should lead most to take a more serious look at using NK as an intermittent tool to improve their health.

The paper happens to be extensively referenced, and for those who want to dig deeper into NK, there are several weeks of additional reading and pondering to do…

My Keto Report Card 2 August 2018: Week 15

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Back on the Seventh of June I shared a quick post detailing my personal experience in a fairly diligent nutritional ketosis run; the week before I’d shared a short post explaining why I’d chosen to do the work (in retrospect, it’s been shockingly easy) to give keto a try.

Without rehashing all the why’s I laid out back then, I was interested in pushing through a weight loss stall first and foremost, though wanted to play a bit with seeing if being in NK would really improve mental clarity and my overall reserve of daily energy.

My Nutritional Keto Report Card at Week 15

For the most part, as summarized in the image to the right, overall I’m still pleased as can be with what life looks and feels like in nutritional ketosis.

My schedule hasn’t changed much; I’m still out of the sack between 530 and 6 (after 8 hours of sleep on average), still waking up without an alarm clock with the earliest light of the day. I typically still drink a cold-brewed coffee (still with a bit of cream and 10-11 grams of protein in the form of collagen powder), though due to the scorching heat during this Texas summer, almost every day I head out for a 2-3 mile walk while it’s cool.

Then it’s back to the desk for several hours of fairly intensive cognitive work, typically with very good energy and creative juices flowing, then I’m either doing a HIIT workout 3x/week, walking again or cycling again most days, with a sprint workout thrown in every 7-10 days as well.

Trying hard to eat WHEN (when hunger ensues naturally), typically lunch is somewhere between 1 and 2, with a family dinner then following (after the afternoon’s work) most often around 730 or 8.

We did make a run to Montana (to see a new grand-baby!) a few weeks ago, with a few days on the road challenging my keto compliance; interestingly my weight loss continued, though with a bit less satiety during travel and interestingly the week after.

A Closer Look at a Few Metrics

As noted 8 weeks ago, I have been tracking a fairly close estimation of my macronutrients –

Up until starting my NK run, I’d lost 100 lbs without tracking a single calorie consumed over the 15 months window we’d been eating a fairly compliant LC/MP/HF diet around our camp, though of note been in a weight loss stall for several months (Dec-Feb).

I did however, principally at first as a learning tool, and later in part due to my medical training induced affinity for objective data, track a fairly specific diary of my daily carb intake (net carbs), which from the get go were always under 100 per day, and most often under 60 gm/day.

Again, largely as a matter of intellectual curiosity, when starting my NK run, I decided to track, as closely as possible, daily intake of carbs, protein, and fat, and to calculate my total caloric intake and deficit against my estimated BMR (adjusted for activity), as well as the percentages of carb / protein / fat contributions to my total calories.

I still don’t recommend that most folks I work with track their intake as obsessively as I have been; it’s simply not necessary to make nutritional ketosis work for most. If you’re a data nut like me, go to it. Over the 15 weeks in NK thus far, the rolling averages of my intake and macronutrient accounting include –

Daily Carb Grams: 25.3 (101 calories)
Daily Protein Grams: 88.1 (352.3 calories)
Daily Fat Grams: 121.7 (1093.5 calories)

Average Total Calories per Day: 1552.5
Average Calorie Deficit per Day: –1537.3

Average Carbs as Percent of Total Calories per Day: 6.5%
Average Protein as Percent of Total Calories per Day: 22.6%
Average Fat as Percent of Total Calories per Day: 70.5%

Of note, without any conscious effort on my part, I’ve been gradually eating less per day overall over the 15 weeks (eating WHEN to satiety), with the percentage of carbs dropping over time, and fat increasing. Over the past 4 weeks, I’ve dropped carbs under 20 g/day just to make things interesting…

Weight loss during my 15 week run now totals 30.5 pounds, fairly consistent with what I noted during the first 7 weeks.

My Nutritional Ketosis Week Fifteen Bottom Line: Still Hot Damn!

All in all, I couldn’t be more pleased and feel better than I have since my late 20’s; at this point I’m guessing I might make this a 6-month run. We’ll see in a couple of months when I report again…

Keto Thursday 5 July 2018: Summer Time (or Anytime) Keto Snacks

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As friends, family, and other folks we run into every week notice the results I’m having personally with my nutritional ketosis run (now in week 12), one of the inevitable questions that comes has to do what do I reach for when the urge to snack pops up?

There are really two answers to that question: one, the true urge to snack (much less the actual hangries) frankly rarely happens in my world after starting my NK run, given my current level of fat-adaption (which has basically erased the need to  snack between meals). And two, on the rare occasional when I do get hungry and for whatever reason it’s not time for a sit-down meal, a little advance planning makes a huge difference, and here’s what’s been on the ‘reach for’ list of late.

The Lowly Radish

Perhaps related to the lowly radish being the first vegetable I ever grew in a Texas Panhandle childhood garden, when in season (much of the year) we keep a small container of trimmed radishes in water in the fridge. They offer a number of health benefits, including a healthy dose of vitamin C and a number of other micronutrients, are packed with fiber and detoxifying agents called indoles, and carry almost no soluble carbs in their tidy red and white packages. And in their quirky, crunchy,  savory way, just taste good with a healthy sprinkle of pink salt.

Boiled Eggs with a Twist

The mighty egg is clearly one of nature’s most perfect foods, and we often keep a few boiled eggs in the fridge for snacking or a quick lunch. They’re great sliced into a big lunch or dinner salad, make a quick egg salad or deviled egg platter, and we’re particularly fond of marinated eggs – try this recipe from Serious Eats.

A Tablespoon of Coconut Butter

Like many of you, we keep a jar of Artisana Coconut Butter in the pantry for all sorts of things, but sometimes just a tablespoon right out of the jar (high fat, very low carb) just tastes great and hits the spot without any kitchen prep or cook time at all.

Butter Pecan Fat Bombs

There are probably hundreds of recipes out there for various iterations of “fat bombs”; I tend to favor an uber-simple recipe of 1/3 cup coconut butter, 1/3 cup coconut oil, 1 T good butter, and 1/4 cup toasted, chopped pecans. Molded in a mini-muffin tin they’re perfectly bite-sized and easy to store in the fridge.

Feta and Olives

My lovely wife and I have long been fans of great Greek cuisine, and try to keep a nice block of Feta cheese in the fridge (in brine); try an ounce topped with a drizzle of very good olive oil (and maybe a sprinkle of oregano – try fresh), along with 5-7 Greek (or your fave) olives. Wow, isn’t that good?

Crudite and Quick Guacamole

We’re of the mind that guacamole with anything is pretty danged tasty, and love this Quick Columbian Guacamole or this Tomatillo Avocado Salsa for dipping crudite into when the impulse strikes (we often end up making that a dinner, maybe with a little bit of cold, leftover protein from the day before…).

Almond Butter and Dark Chocolate

This combination is kinda’ve a no-brainer to include on a snack list; you don’t need much, even a half tablespoon on a few squares of good dark chocolate can hit the spot.

Thursday Keto Corner 21 June : My Day in the Nutritional Ketosis Zone

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Over the past several months I’ve been asked nearly every day by friends, family, and coaching clients how life has worked for me while in nutritional ketosis, even though I’m just in my 10th week of NK currently.

Everyone who queries gets more or less the same quick story (maybe it’s not so quick), which includes a brief touch on the following main points.

My day typically starts at about 6 when I awaken naturally without setting an alarm; that’s about the time of late that the eastern sky lightens in our neck of the woods this time of year. We’ve also been working hard around our to camp to improve our approach to restful sleep, and typically I’ll have slept 8 hours +/- 30 minutes by that 6 AM start.

Almost every early morning I pour a big glass of cold-brewed coffee, with either a bit of cream or full-fat coconut milk to soften it just a tad, along with one scoop (10 gm protein) of collagen powder. Otherwise, for months now I’ve been implementing the WHEN principle when it comes to eating, not consuming anything else until When Hunger Ensues Naturally, very easily (and initially unintentionally) accomplishing another goal of ‘painless’ intermittent fasting.

I then work in my home office for several hours, typically stopping mid to late morning for a workout (fairly high intensity resistance 2-3 days per week, sprinting one day, and walking or hiking 5 to 6 days per week). It’s then back to the desk for another 1-2 hours of work until somewhere between 1 and 2 when I feel the first real urges of the day to eat.

Lunch for me, the first food intake of the day, is most often cold, leftover grilled or roasted chicken, pork, steak, occasionally a hamburger patty or a high quality salami; often a few olives or quick dill pickles are included, though I personally often don’t consume any more than just a handful (or less) carb grams at lunch. If the day’s planned menu is lean on fats, I might have a spoon of coconut butter or a fat bomb with lunch as well.

It’s then either back to the desk or out for errands, finishing up work and communication tasks, taking several stretch and quick walk intervals; the protein and fat rich lunch provides all the fuel I need to remain sharp and productive, with no post-workout or post-meal crash at all.

Given my wife’s work schedule (area manager for large national retail chain) we most often consume our largest meal of the day in the early evening – typically a grilled protein (steaks, pork chops, tenderloin, or pork shoulder, coldwater fish in the spring, summer and fall) with one of the many coleslaws or salads we enjoy (including several cauliflower and broccoli-based), or another grilled, roasted, or raw vegetable.

We then relax with a short walk, reading or writing (that novel is taking forever), or chase little bass with a fly rod on several local ponds, and are usually crashed in bed by 10, getting ready to get sleep well, and get another day started.