Nutritional Ketosis and Intermittent Fasting

Over the last week I’ve documented my progress into nutritional ketosis through a ketogenic diet. Yesterday, I added intermittent fasting to that process. Here are the results.

As most of you know, I have advocated for low carb high fat nutrition to reverse metabolic disease since I began practicing it myself in 1999. My understanding of this powerful tool has grown both with my personal experience of it and with the growing body of literature helping to explain the nuances we should all understand. Over the last three years intermittent fasting (IF) has come into it’s own in large part due to the influence of Jason Fung, MD author of The Obesity Code and The Diabetes Code, both books I highly recommend to my patients. I have adopted IF as a personal routine over the last year and have found it extraordinarily powerful at improving my health and well-being.

There are many different ways to undertake fasting ranging from time restricted eating (TRE) to prolonged fasts. TRE is simply not eating for about 12 hours in every 24 hour cycle such as not eating after dinner until breakfast the next day roughly 12 hours apart (8pm to 8am). Most studies don’t consider this true fasting as many of the genes and benefits of fasting are not measurable until one reaches 14-16 hours of fasting.

Intermittent fasting therefore is usually anything lasting 16 hours or longer with the remaining hours used as an opportunity to feed. A 16:8 protocol is nothing after dinner at 8pm until noon the next day. A 20:4 protocol is nothing between 8pm and 4pm the next day. I recommend many of my patients undertake a 24 hour fast weekly or every fourth day depending on the goal. Again, I stress, please don’t undertake this without talking to me first as many times patients need their medications reduced or altered to avoid being over treated during the fasted state.

Yesterday I undertook a 24 hour fast which ended up lasting 27 hours due to the timing of my dinner meals on Monday and Tuesday. Monday night I ate a quick meal of roasted chicken, blueberries, and macadamia nuts then went to exercise around 5:30pm. I didn’t eat again until Tuesday night at 8:30pm. Tuesday’s dinner of 1/2 of chicken, an avocado, and cheese was 5 net carbs.

Throughout the day I followed my glucose levels on my Libre and my blood ketone levels on my KetoMojo meter. As you can see from the Libre readings below, my glucose levels were exceedingly stable and slowly declined throughout the day to a nadir of about 69 mg/dL right before dinner. My meal didn’t budge that number at all.

The ketone readings steadily climbed to some very nice levels throughout the day and have stayed higher than last week even after I’ve eaten several times today. Starting out the day at 1.0 mmol/L they climbed to 1.7 mmol/L by lunch time, 2.7 mmol/L by the end of work, and 3.1 mmol/L by the time I broke the fast at dinner.

Beneficial ketone zones after an overnight fast should be around 0.5 mmol/L or higher. They are are optimal around 1.5-2 mmol/L while eating a long term ketogenic diet. After a prolonged fast they can be around 3-5 mmol/L.

When I fast I tend to feel better and better as the day progresses. The initial hours can be challenging but as the ketones develop the desire for food all but fades to zero and hunger is non-existent. I really enjoy that freedom. The clarity of thought and presence of mind that comes in this state is one of the main benefits I desire from fasting. It brings me back to it again and again and I find myself looking forward to the next day of fasting.

If you’re interested in learning how to use nutritional ketosis, intermittent fasting, or a continuous glucose monitor for its health benefits give me a call. We’ll walk through the process together to ensure your success and safety.

Trump’s New Executive Order: Unleashing HSAs For Direct Primary Care

You might have missed this big news because the media .08/04/2019 8:11:46AM EST.
— Read on townhall.com/columnists/chadsavage/2019/08/03/trumps-new-executive-order-unleashing-hsas-for-direct-primary-care-n2551034

They Want It to Be Secret: How a Common Blood Test Can Cost $11 or Almost $1,000 – The New York Times

I offer this test for free to our Trinity DPC patients four times a year. It’s so inexpensive for me to purchase wholesale that it’s not worth the hassle to bill for it.

Huge price discrepancies like that are unimaginable in other industries. Also unusual: not knowing the fee ahead of time.
— Read on www.nytimes.com/2019/04/30/upshot/health-care-huge-price-discrepancies.html

Imagine if We Paid for Food like We Do Healthcare

Dr Ryan Neuhofel, a fellow DPC physician, writes this intriguing look at applying our current medical industry regulations to food. I know I would never pay for a $37 burrito twice.

A thought experiment showing just how dysfunctional and distorting our health insurance system is.
— Read on www.libertarianism.org/building-tomorrow/imagine-we-paid-food-we-do-healthcare

Just gimme the facts — DPC Alliance

Just gimme the facts — DPC Alliance
— Read on www.dpcalliance.org/blog/2018/9/11/recent-fact-stats

This data represents about 1/3 of the known DPC practices in the United States. Trinity DPC is glad to be one of the 5 DPC practices in Tennessee.

I believe DPC allows physicians to provide the care they feel a patient needs. It offers us the opportunity to lower the cost of healthcare delivery and offer charity care when appropriate. In this survey 85% of DPC practices routinely offer charity care.

On a side note, with only 4.2% of DPC physicians double boarded in Internal Medicine and Pediatrics like I am, I’m still somewhat of an oddball. No surprise for anyone that knows me.

-Dr McColl

Senator Alexander Advocates for DPC

Tennessee Senator Lamar Alexander discusses on the Senate floor his findings from recent testimony by Dr. Lee Gross, a DPC physician from Florida.

The full hearing for “Reducing Health Care Costs: Improving Affordability Through Innovation” can be viewed here.  Dr. Gross’s testimony can be read here.

Make HRAs and HSAs DPC-compatible

The IRS has an opportunity to clarify HRA and HSA use for Direct Primary Care.  Please take a moment to respond to their request for feedback.

IRS Regulations Comment Section

Ask Your Doctor These Four Questions About Any Treatment

Please, please, please ask questions. Our goal at Trinity DPC is to help you make good decisions not to make decisions for you. We want to provide sound advice and counsel so you can obtain the health goals important to you. We take a minimum of 30 minutes with each patient, are available by phone and email, and have no cost office visits to guarantee you have a chance to get your questions answered.

Your doctor recommends a thing, and you do it. That’s the simplest version of how the doctor-patient relationship might go, but it’s not always the best one. You may find out later that there were other options for treatment that you never knew about, or that the drug you took has risks that may outweigh its benefits. To get the full picture, ask these four questions.
— Read on vitals.lifehacker.com/ask-your-doctor-these-four-questions-about-any-treatmen-1830830788

Buying Health Insurance? The Outlook Is Brighter

As you navigate new low-cost choices, weigh the risks.
— Read on www.kiplinger.com/article/insurance/T027-C000-S002-buying-health-insurance-the-outlook-is-brighter.html

Millennials moving away from primary care doctors | Fox News

Alternatives to the traditional fee for service primary care are on the rise. Direct Primary Care programs are part of the shift away from spending your day in a waiting room for a 10 minute visit. Fellow DPC physician, Jeffrey Gold, MD, is featured in this article as an example of simple, affordable care that focuses on the patient and not their insurance requirements.

Many young Americans are opting to get their healthcare from urgent care centers and retail health clinics.
— Read on www.foxnews.com/health/millennials-moving-away-from-primary-care-doctors.amp