Nutritional Ketosis Day 4

Friday August 2nd was the fourth day of my journey documenting how to achieve nutritional ketosis. So far my dietary intake of net carbs have been 10 gms, 17.6 gms, and 22.5 gms. Yesterday, I had 17.2 gms of net carbs. I’m averaging 16.8 gms of net carbs per day. Not bad, I think.

Breakfast was three eggs, bacon, sausage and cheese with black coffee. Lunch was beef brisket, an avocado, and a tomato with a spoonful of Purely Pecans sea salt pecan butter with unsweet tea. This stuff is very good and is often what I eat with apple slices. At 1.5 net carbs per tablespoon and 12 gms of fat it’s a great low sugar, whole food snack. Breakfast was 5 gms of net carbs and lunch was only 7 gms of net carbs.

I also need to give a shout out to one of my awesome patients who brought me some of the best tomatoes I’ve ever tasted. He came in this week for a routine follow up and we celebrated a reduction of his fasting blood sugar back to normal and a reduction of his fasting insulin by over 50%! Truly unbelievably good work. I’m so proud of you and happy birthday today!

Dinner was a naked hamburger patty topped with cheddar cheese, sauteed mushrooms, diced tomatoes on a bed of baby spinach leaves. Adding another spoonful of pecan butter made the total meal only 5 net carbs.

Again, my glucose readings remained pretty flat all day. This produced a ketone reading of 0.9 mmol/L this morning after fasting overnight. (I forgot to snap a picture of it before leaving the house this morning, whoops).

I’m pleased with this progress. I’ve been able to eat well and feel satisfied while producing a mild nutritional ketosis. My energy level is good and sleep is too. Both are things that I find deepen in their quality when I eat really well.

You may have noticed the dip in my blood glucose around 4-5 am noted in red on the graph above. I don’t have a definitive explanation of that. It could be associated to changes to cortisol and growth hormone levels that usually happen around that time each morning.

I remember that night as being a particularly dream filled night too. While we sleep our metabolic rate isn’t very much lower than when we are awake and REM sleep, where dreams happen, produces brainwave activity similar to doing those same actions while being awake. The brain consumes a large amount of the body’s energy needs at around 16% so it’s possible that my particularly intense dream consumed more glucose than a typical night. It’s also possible that my night time mental activity had nothing to do with my glucose as REM sleep is always dream filled, we just don’t usually remember it as such. Regardless, the dip, I believe, is inconsequential to my overall progress and health. The CGMs don’t measure lows as well as they measure highs and I always take numbers less than 60 gm/dL with a grain of salt.

Nutritional Ketosis, CGM Day 2

Wednesday was day two of documenting my journey into a nutritionally ketotic state of metabolism. As I mentioned yesterday, the body stores glucose which must be utilized prior to becoming fat adapted. Certain cellular machinery must be upregulated to mobilize fat from storage and allow it to enter the energy generating chemical pathways more efficiently. This process often takes about 72 hours on a low carb or ketogenic diet and can be accelerated by adding more glucose utilizing exercise along the way or starting from a low carb state of health. Full fat adaption takes nearly 6 to 12 weeks in my experience with patients when they first attempt to transition to a low carb lifestyle. Interestingly, I’ve never had a patient tell me they didn’t feel better having done so. Sure, some revert back to high carb diets for reasons similar to why it so hard to quit tobacco, alcohol, and recreational drugs; they’re addicting. No one goes back to a high carb diet once they truly experience a low carb diet because they felt better in their old way of life and enjoyed being 20 lbs heavier.

My dietary log for Wednesday started with the Kisner Omelette at Nick and J’s Cafe along with black coffee. That’s a hidden menu item created by one of my friends but unfortunately not named for him. It is a three egg omelette with onions, mushrooms, green peppers, tomatoes, cheese, diced ham, and sausage. It is amazingly good. I tend to have mine without the cheese and the carb content is about 11 gms net mostly due to the onions and mushrooms.

Lunch was a simple plate of pulled chicken breast from Archers with a little of their Moonshine Vinegar BBQ sauce and unsweetened tea. BBQ sauces are common culprits for added sugars especially in this area where tomato based sauces are preferred. The mustard based sauces are probably lower in carb content but the vinegar based sauces of North Carolina are likely the lowest. Each sauce can be pretty individualized so check out the labels if you get a chance or ask the cook for their opinion. Lunch was 0 gms of carbs.

When dinner time rolled around I was pretty excited to dig into my dry rub BBQ beef brisket that I was making at home. Over the last year, I have developed a recipe cooking brisket Sous Vide style for 36 hours that allows me to cook a large whole brisket separated into smaller 5-7 lb bags. Once cooked, I freeze what I’m not going to use right away. These can be thawed in the fridge for a day or two then finished in a 225 F convection oven for two hours. It has become one of my favorite meals and at $3.79/lb I can’t beat that price. It doesn’t hurt that my son loves this recipe and asks for it. It can be hard to feed a picky teenager and every little bit helps.

Prior to getting to eat my brisket I felt hungry, or rather, unsatisfied. I took that to indicate that I needed more fat intake. I think this relates to the Rabbit Starvation I mentioned yesterday. With 30-45 minutes left for my brisket to finish in the oven, I ate a cup of Fage whole fat (5%) Greek yogurt. This was 7 gms of carbs but 11 gms of fat and very satisfying. The 10 oz of brisket I ate later was 0 gms of carbs. It’s a moderately fatty portion of the brisket too.

For the day I had about 17 gms of net carbs with the majority of that being from the yogurt and the onions in the omelette. I’ve told my patients for years that once you get to about 20 gms of carbs or less per day that’s about as low as one can go. Even an egg as 0.7 gms of carbs and although many nutritional counters log meats like chicken and brisket at 0 gms of carbs per ounce that’s probably not true. When one eats 16-20 ounces of meat per day there is going to be some accumulation from these small amounts. However, the point isn’t to keep the carbs as low as possible or document every single quarter gram of carbs. The point is to keep the carbs low enough to keep my blood glucose stable and in the normal range.

The net effect of this day of Keto food was a pretty stable glucose reading. I call this a win. The lows, in this scenario, are inconsequential. I’ll talk more about them in another post.

So what was the result the following morning after a night of fasting? My serum ketone level, beta-hydroxybutarate to be precise, was 0.5 millimolar/L. That’s a 0.2 mmol/L increase from the prior morning. Remember that 0.5 mmol/L is the lowest end of the ketosis scale. My goal will be too get in the 1.5-2 mmol/L range.

Nutritional Ketosis CGM Experiment Day 1

During the last series on using a Freestyle Libre continuous glucose monitor (CGM) I documented the effects of a typical Western high carbohydrate diet on my blood sugars. Many of the meals I ate were obvious treats containing a lot of sugar, but many were just traditional foods, like toast, which still had a significant impact.

In this series I’m going to show the progression into nutritional ketosis (NK), that is, the process by which my body adapts to using ketones from fat breakdown as a major fuel source. The definition of nutritional ketosis is somewhat in flux but it’s generally accepted that NK begins around 0.5 millimolar of ketones as measured in the serum or blood. I will be using my KetoMojo ketone meter every day to show you the results I’m obtaining.

To start off this experiment, I was not particularly careful on my diet over the weekend. I ate quality food, mostly, but not very low carb.

Starting Tuesday, July 30th, I began to follow a ketogenic diet and will continue to strive to keep my carb intake 20 gms per day or less with a maximum of 50-60gms per day for the two week duration. These are recommendations I often give patients with type 2 diabetes and they are very successful in reversing that disease process. My default carb goal is about 75-100 gms per day. I’ve learned over the years that this is the level at which I feel really well and energetic. I focus on my carbs from whole foods such as fruit and sweet potatoes and allow variation from day to day depending on my activity level and taste buds. So a day of hiking might allow for more carbs after returning home while a day of office work I’d try to be more strict.

My diet log for yesterday is pretty simple. I ate three eggs fried in ghee and two pieces of Swaggerty sausage for breakfast along with my multiple cups of black coffee (3 gms of carbs). Lunch was with a friend at Archers BBQ consisting of 1/2 lb of pulled pork and unsweetened tea (0 gms of carbs). I know unsweet tea is sacrilege in the South but there’s a reason diabetes is so prevalent here too. Dinner was two roasted chicken thighs with sauteed onions and mushrooms (5 gms of carbs). My daughter and I then went to work out at VitalSigns which was 40 minutes on the elliptical and 25 minutes of resistance training with machines and body weight exercises. Trying to keep up with a cross country running Freshman during her workouts has left me sore many times this summer. After our work out, I made a protein powder shake about an hour before heading to bed (2 gms of carbs). That’s actually eating later in the night than I really want to, but I felt like the shake was a good idea. Part of the whole purpose of these meters is to allow someone to become more self-aware and be able to respond to their body’s needs instead of just following an regimented program that can’t adapt.

Nutritional profile for the day.
Note: carb count rounded in write up

The nutritional content of my day was very low at about 11 gms of carbs for the whole day. Protein was pretty close to my max goal. From prior personal experience, I don’t feel great when my protein intake gets too far above 160 gms for too long, but that can be dependent on my fat intake. This has been called rabbit starvation by Arctic explores like Vilhjalmur Stefansson due to eating the lean protein of rabbits without enough accompanying fat. However, I don’t want anyone to think that’s a prescriptive level, just my experience with my own diet.

So what was my result after one day of a ketogenic diet, a moderate intensity exercise for about an hour and fasting for 8-9 hours while asleep? Unsurprisingly, it was pretty normal. My ketones were still pretty low.

The human liver makes glucose continuously and can supply all the needs that the body has. Additionally, it stores about 2500 kcals of glucose as glycogen. That would take about 2-3 days of minimal activity to burn through or about 2-3 hours of intense activity. My one day of low carb intake and modest calorie expenditure is not enough to move me into nutritional ketosis. We’ll see what tomorrow holds.

Fueling Up for the School Year

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It’s that time of year again, when the combination of trying to get kids out the door for school and keeping nutrition in check seems a bit overwhelming. While prepackaged, convenient and prep-free food options may seem enticing, they provide little to no nutrients. Your child’s nutrition is a huge determining factor of how well he or she stays focused and alert throughout the school day. Below, are my top five recommendations on how to ensure your child is properly fueled and ready to learn this school year. 

1. Choose whole-foods for breakfast.
This doesn’t necessarily mean make a huge breakfast meal every morning. Rather, have easy grab-and-go pre-prepped items on hand, like egg cups, hard-boiled eggs, almond flour sausage balls, or even as simple as a cheese stick and berries. These protein and healthy fat-packed options provide much more brain fuel than the traditional (convenient, but not nutritious) frozen waffle, granola bar, or Pop-Tart.

2. Pack healthy snack options.
Once again, keeping it whole-foods based is key. Snacks that are highly processed or high in carbohydrates can negatively affect energy, spiking the blood sugar and causing an energy dip soon after. Snacks like celery with natural peanut butter, cottage cheese, turkey and cheese roll up, salted nuts and seeds, or a variety of veggies and hummus are great options.

3. Pack lunches.
Compared to most cafeteria lunches, home-packed lunches can be much more nutrient-dense. Whether it’s leftovers from dinner or a homemade version of a lunchable, you can keep it simple and easy as well as wholesome and healthy. When preparing lunches, aim to make half of the lunch a variety of non-starchy vegetables to load up on vitamins and minerals. Add in some lower sugar fruit, a good protein and healthy fat source and you’re good to go. Minimizing processed foods and high carbohydrate foods in lunches keeps the mind sharp and helps prevent any after-lunch fatigue.

4. Stay hydrated.
Hydration is vital to physical and mental well-being. Staying hydrated keeps the body energized and functioning properly. Poor hydration can result in a lack focus and learning. As you pick out school supplies, make it fun and have your child pick out his or her own water bottle to carry at school.

5. Cut out night time snacking.
Late night snacking or after dinner treats can negatively affect quality of sleep. Close the kitchen two to three hours before bedtime. This gives time for digestion and starts the process of preparing the body for a restful night sleep.

CGM Experiment: What I learned as a non-diabetic from wearing a continuous glucose monitor – Lily Nichols RDN

Here is a great blog post from Lily Nichols, RDN author of Real Food for Pregnancy and Real Food for Gestational Diabetes and presenter at this years Low Carb Denver. Her presentation on low carb nutrition during pregnancy was a solidly scientific and engaging talk.

This post chronicles her time wearing the Freestyle Libre continuous glucose monitor and a good discussion on what ‘normal’ blood sugars should be for the non-diabetic.

I think there is a lot of good information here to consider for those of us who don’t have diabetes but want to understand the stress our body undergoes when we eat certain food.

I’ll be placing a new sensor on next week and blogging about my journey into nutritional ketosis and possibly the effects of fasting on my blood sugars. Stay tuned for that series although, sadly, there will be less cake involved compared to the first series.

Special thanks to my patient who found this article and shared it with me. One of the reasons I love my DPC job is I get to work with incredible people like you all. Patients who are engaged in their own health journey and challenge me too grow, learn, and apply are simply amazing.

Many non diabetics are wearing CGMs to better understand their blood sugar patterns. Here’s what I learned from wearing a continuous glucose monitor.
— Read on lilynicholsrdn.com/cgm-experiment-non-diabetic-continuous-glucose-monitor/

IDM: Women and Fasting: Top Tips for Women Going Through Menopause Part 2

I’ve seen this same observation time and time again. Since using a CGM with most of my patients I’ve begun noticing how often artificial sweeteners cause a reactionary drop in glucose. Presumably this is from the body producing insulin assuming that the sweet taste represents a usable sugar. Since there is no increase in blood stream sugars the net effect is a lowering. So where do sugars go when they leave the blood stream in that manner? They aren’t leaving the body. They aren’t being used as fuel during exercise. They get stored in a cell. It’s hard to lose weight when the body keeps storing glucose in the cells.

Women and Fasting: Top Tips for Women Going Through Menopause Part 2 – Intensive Dietary Management (IDM)
— Read on idmprogram.com/women-and-fasting-top-tips-for-women-going-through-menopause-part-2/

The Truth Behind What Intermittent Fasting Does to Your Body | Inverse

Studies show intermittent fasting can lead to weight loss, stabilized blood sugar, reduced inflammation, improvements in memory and stress resistance, slowed aging, longer lifespan, and blood sugar stabilization — all promising health benefits in return for considerable lifestyle changes.
— Read on www.inverse.com/article/57625-what-intermittent-fasting-actually-does-to-your-body

Decent article on fasting if you ignore the unsupported semi-vegan dietary recommendation. It’s amazing how one can write an entire article on lowering insulin production through fasting and then ignore that very concept when choosing food to eat. Plants are part of a good dietary plan but most plants are mostly carbohydrates. To lower insulin levels all the time, not just when not eating, you have to lower the carb intake. You can’t build your diet on a non-essential macronutrient and expect to stay healthy.

Maybe saturated fat doesn’t cause heart disease

Several recently published meta-analyses of observational studies and randomised controlled trials (RCTs) have found that total saturated fat is not associated with non-communicable diseases including coronary heart disease, cardiovascular disease, and all cause mortality

https://www.bmj.com/content/366/bmj.l4137

A recent report published in the British Medical Journal calls into question the validity of associating saturated fat intake with cardiovascular disease. Maybe the tide is changing.

bmj.l4137.full-1.pdf

CGM Day 9 & 10: Minor detour for ice cream

Did great yesterday until the end of the day when I succumbed to the siren call of ice cream after a very long day. The breakfast spike was due to my infatuation with blueberries.

Today was a new day though. I had my typical Wednesday breakfast at Nick and J’s Cafe of three eggs over well with bacon and black coffee. Then I met a friend for lunch at Dickies for 1/2lb of brisket. We celebrated his amazing success on his low carb/fasting journey which I hope he’ll share on this blog sometime soon.

This afternoon there was a handful of green grapes running out the door to go do yard work at the office.

Glory be to God, tomorrow is always a new day.

CGM Day 8: It takes one day

After last week’s daily deluge of carbs this week I plan to be much more moderate in my intake.

Today, breakfast was just a few scrambled eggs which had no impact. Lunch was a protein shake I like to make from About Time Protein powder with added MCT oil. Again there was no impact.

Dinner was the only meal that showed any increase in my blood sugar. It consisted of roasted chicken, fresh corn on the cob, steamed carrots, and some Colbyjack cheese. The elevation wasn’t enough to push me over 100mg/dL however.

So the lesson I’d like to impart here is that it only takes one day of change to see an impact on your health. Studies show that by the third meal of a low carb nutrition plan there is measurable improvement in someone’s insulin resistance. The time to change is right now.

I heard a proverb one time that said the best time to plant a tree is 20 years ago. The second best time is right now. Make your next meal the first meal of a new way of life. If you need help, call my office. That’s what I do.