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.

Nutritional Ketosis, Days 5 & 6

I didn’t get a chance to update the daily posts yesterday as the start of school, high school sports practice, and school supply shopping made for a long day. Regardless, the data hasn’t changed much. I had about 29 net carbs Sunday and 22 net carbs Monday.

This produced very stable blood sugar results as shown below.

The spike on August 4th around noon was due to some heavy outdoor work I was cutting down another storm blown tree. The following trend down into the red zone (again not dangerous) was a recovery period. To a degree this is repeated on August 5th at 6pm where I worked out hiking the Hardin Valley hill. During exercise my glucose climbed and then right afterwards it dipped again. That’s an interesting phenomenon that I’m going to have to study more. It happens more often with outdoor exercise than indoor exercise. Maybe the body heat, sweat, and evaporation have something to do with it. This is a good reminder that not all causes of glucose elevation are to be avoided or are harmful. As the body works it wants to fuel the cells and will send glucose out to do that.

My last meal of the day was at 5:30pm yesterday which was some roasted chicken, blueberries, and macadamia nuts. Then I started my 24 hour fast. I’ve tried to incorporate a 24 hour fast into my weekly routine starting Monday after dinner until Tuesday dinner. For various reasons this is the day I’m least likely to eat with my family so giving up a meal doesn’t usually impact our time together. As I write this I just finished up today’s only meal so the fast ended up lasting about 27 hours. I have to say I feel focused and calm more than normal and I have the ketones to prove it. I’ll tell you more about that tomorrow.

So after one week of ketogenic nutrition with daily net carb intake averaging 19.6 gms per day this morning’s ketone level was a solid 1.0 mmol/L. I hope that one week journey into nutritional ketosis show just how straightforward it can be and how it can be implemented in a very busy life.

Tomorrow I’ll share with you my ketone levels throughout a day of fasting. Stay tuned.

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.

How to Make Ghee

I make ghee regularly to have on hand at home. It’s got a great flavor and a high heat point so is perfect for cooking eggs or sautéing brussel sprouts for LCHF and keto. Since it removes the milk protein, ghee is Whole30 approved.

Here’s my latest batch.

Another advantage is that it is stable at room temperature for several weeks or longer, especially in these small mason jars which seal as they cool. This makes it great for camp cooking in the RV.

I’ve also started making flavored ghee. Here are my recent creations of garlic-basil and turmeric-curry. They have a great through and through flavor. Notice that the ghee solidifies and becomes opaque when it is stored in the refrigerator.

Ghee is very easy to make. Below is an article to walk you through the steps.

I’ve started using a thick bottomed tea kettle to boil the ghee. It keeps the bottom for scorching as easily and, if you’re careful, allows for you to pour off the ghee directly into the containers without straining it.

Finally, I have two bits of advice. First, don’t turn up the heat too high or the solids at the bottom can create a strong scorched nutty flavor. Second, leave it alone until it froths up a second time. It won’t be ready until then.

Hope you enjoy it as much as I do!

Learn how to make ghee (aka liquid gold), how long homemade ghee lasts, and what its health benefits are.
— Read on www.realsimple.com/food-recipes/recipe-collections-favorites/popular-ingredients/how-to-make-ghee

Eat real food.

Anyone that’s looked at my Wellness Prescription handout knows that the first step of good nutrition is to eat real food. After that, we need to engineer a low enough carbohydrate diet to achieve our health goals. Typically, I recommend newbies start at 100gms per day, but I always individualize that level with each patient at their office visit and adjust it as they grow in experience and success.

With all the reaction to the new ‘low carb is killing you’ study, I liked what cardiologist Aseem Malhotra, MD had to say about it during a recent interview. Essentially, eating fake food is always not good for you even if you are generally low carb. However, real food that is low carb is the best of all. If you don’t know what that is or how to implement it in your life, come see us at Trinity DPC. We talk about this stuff all the time.

We have two upcoming ‘Food as Medicine’ discussions that are free for members and $20 a person for non-members.  Carly Slagle, RD and Dr. Hone are hosting a meeting in Maryville on August 23rd from 12 to 1pm.  In Hardin Valley, Carly and I will be hosting a discussion on September 4th from 1 to 2pm.  Call our office you have any questions.