Nutritional Ketosis, Day 5

Saturday was day 5 of my journey journaling nutritional ketosis for my patients. It was a pretty busy day where I staffed Trinity’s walk-in clinic and then had lots of home chores to get to before school starts next week for the kids.

Breakfast was three eggs fried in ghee and a half dozen chicken sausages from Jones Farms that I’ve been meaning to try. I found these breakfast sausages at Costco a while ago and they looked like a pretty good option for a fast low carb breakfast. They tasted fair but not outstanding, too herby for me. So, they’ll probably stay on the grocery list for when I need something quick to get out the door but, despite the name, I won’t be jonesing for them. Breakfast yielded a net carb of 1.1gms.

During medical school and residency after a long night of call in the hospital, some of the best attendings would show up at morning rounds with a nice treat like bagels or donuts. In that tradition, I’m very appreciative of the team at Trinity and the exceptional fellow clinicians with whom I work that do most of the heavy lifting during our Saturday clinics. As such, I bring fruit, yogurt, and lower carb granola as a treat for everyone. While working I ate a Fage 2% plain yogurt and a 1/4 cup of blueberries. I’ve shown before that too many blueberries, which I love, can elevate my glucose so I had to resist the temptation to eat all of them. This time around there wasn’t much of a bump in my readings. The net carbs for the yogurt and berries was about 9 gms. Again, that’s if the carbs in plain, unsweetened yogurt need to be fully counted. The process of making yogurt uses up some of the sugars in milk.

I didn’t finish up work until mid afternoon so didn’t get to eat lunch until after 3pm. My ketone levels were solid at 0.9 mmol/L though. Same as post overnight fasting. That’s a really good mid day number for me.

For lunch I finished off the brisket along with an avocado and 2 oz of macadamia nuts. Net carbs were 7 gms. After lunch I went to work out at VitalSigns with my daughter. Interestingly, after an hour of cardio and strength work, my ketones actually went down a little to 0.7 mmol/L.

Dinner was a ribeye. Seriously, just 8 ounces of a deliciously marinaded ribeye. Net carbs were under 1 gm. It was a very satisfying meal.

The day’s total net carbs were right at 20 gms with a robust amount of fat and protein too. My glucose readings for the day were static under 100 mg/dL the whole time. This day produced an overnight fasted ketone level of 0.7 mmol/L.Tomorrow, when I write the entry about today’s journey (how timey-wimey), I’ll share with you what caused my glucose to bump over 100mg/dL and why I’m not worried about it.

Nutritional Ketosis, CGM Day 3: Now we are getting somewhere

As this blog series has rolled along, I’ve talked several times that it takes a few days to get into nutritional ketosis as you must first use up your excess stored glycogen. Yesterday, I started to see my numbers move a little more in the direction I’m wanting to go.

Here’s a quick rundown on my food for yesterday August 1st….

More fat is more satisfying

I incorporated more fats into my diet than I had been and more fiber as well. The total carbs are up quite a bit from prior days but the net carbs are still under 20 gms by a few points. My CGM for the day was super stable hovering around 70-80

Steady as she goes captain

Breakfast was another three egg omelette with sausage, ham, cheese, green peppers, onions, and mushrooms with three pieces of bacon. That was the majority of my carbs for the day at 13 net carbs.

Lunch was two roasted chicken thighs (4.5 ounces) and one serving of Avocado Mash from Good Foods. I really like this stuff. I get it at Costco and it offers me a way to eat avocados without trying to find the 3 1/2 minutes that they are actually ripe but not overripe and bruised. I added 2 ounces of macadamia nuts a little bit after lunch too for more fat. Net carbs for lunch was 5 gms. The nuts however added nearly 50 gms of fat. That was hugely satisfying.

Post work out ketosis

After lunch I worked out on the elliptical for about 45 minutes. It wasn’t a very hard work out but every little bit can help. Exercise can be a great way to reduce stress levels and build peace which as we all know by now is the fourth pillar of good health. Even though the workout wasn’t challenging, my post work out ketone level was up at 1.0 mmol/L

Brisket, avocado, and tomato.

Dinner was left over brisket, which when sauteed with ghee can be better than fresh out of the oven, an avocado and about 1/4 of a fresh tomato. A generous serving of Himalayan salt and this meal is hard to surpass in my opinion. Net carbs were 4.5 gms after subtracting out the 13.5 grams of fiber.

Moving on up after three days of keto nutrition

After my overnight fast of about 12 hours this morning’s ketone level remained as positive progress reaching 0.9 mmol/L. Not quite to the goal I’m aiming for but getting better.

I offer a couple take away points after three days of keto. First, eat more fat. It is very satisfying. Go read about Rabbit Starvation. Many times when patients tell me they are still hungry on a ketogenic or low carb diet they aren’t adding enough fats. They forget that it is a low carb, high fat diet not a low carb, high protein diet. Avocados, nuts, and olives are great sources for quality fat. Second, add more salt if you want it. Generally speaking, this diet reduces the amount of salt you retain and you diuresis more water. This helps reduce blood pressure for those wanting to come of medication. (Don’t do that without talking to your doctor first!) Imagine your food fixing your health more than your pills. Amazing! Lastly, don’t stress over exercise goals during the initiation phase of low carb. You probably won’t feel as energetic as normal and certain won’t feel as energetic as you will later on once you fat adapt.

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.