Mealtime patterns

Posted below are two reports generated from the Freestyle Libre LibreView website. They show the average relative change in my blood glucose with each meal of the day. The first report was during the high carb, standard American diet experiment in July. The second report is from the nutritional ketosis diet I just blogged about and am still following. I think it is readily apparent the differences. In the high carb diet I would jump 20-30 mg/dL every time I ate and I averaged 30-80 gms of carbs per meal at least. With nutritional ketosis the glucose changed less than 10 mg/dL with each meal and I only averaged 6gms of carbs per meal.

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 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 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.

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/

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.