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 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.

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.

CGM Day 3: double spikes all day

Here on my 3rd day of wearing my Freestyle Libre, I moderated my food intake a little and didn’t go overboard on anything in particular.

Cracker Barrel Double Meat with Biscuits, Jelly, Gravy, and Grits

For breakfast, I ate at Cracker Barrel with my Bible study group and I ordered the Double Meat. Typically I skip the biscuits and gravy before heading to work but have been known to partake on other occasions. This time I chose to eat both biscuits with butter and one strawberry jelly. This was about 70 gms of carbs as calculated through LoseIt.com. Remember that the toast and jam I had on Day 1 was 72 gms. Interesting that I ate more carbs at home than at Cracker Barrel. I admit, I didn’t see that coming.

CGM Day 3

Breakfast developed a double peak glucose spike again. Pizza showed a similar response last night but you can see that it continued to cause spikes well into the night. It caused 5 spikes all together and then still displayed lots of variability in the normal range until I got up only to disturb it again with breakfast. All told, having eaten the pizza at about 6pm last night my glucose wasn’t stable until about 6am this morning.

After breakfast, my numbers leveled out until lunchtime when I ate a low carb meal of eggs and cheese with a medium sized apple listed at 22 gms of net carbs. It barely got my glucose over 100 mg/dL and then it leveled again.

When I got home from work I ate a small snack of 7 dates at 28 gms of net carbs. They are often one of my whole food snacks when carb count isn’t as critical. As you can see, their effect is not very high and is a smoother curve than breakfast breads have been. Foods in their whole form often are much slower in digestion and absorption than you might expect for the amount of carbs in them. This will show up as lower peaks and a more rounded shape on the monitor.

After eating, I headed outside to keep working on cutting up the fallen and hung up trees from last week’s windstorm. It was strenuous work especially given the heat and humidity. Exercise can mobilize glucose for immediate use which I believe accounts for the second spike after that from the dates.

Lessons learned from today, I think, are real food is better than fake food, the effects of poor choices can last a long time, and more than food can cause glucose to rise and you can’t always control those factors.

Tomorrow I’ll have a couple opportunities at my family’s get together to really test my glucose response. Rumor has it there will be cake!

Pizza’s sucker punch

Tonight I enjoyed my favorite pizza, Little Joe’s ham and mushroom. Having grown up with the owners, I spent many a Saturday night there with my family. The breadsticks are fantastic.

As you can see pizza has a hidden surprise. It’s not just one peak of glucose dumping into the blood stream, it’s two. This delayed phase can be especially tricky for diabetics who live by insulin (type 1).

I decided to follow it up with two mashmallowless S’mores. I calculated the pizza at about 102 grams of carbs and the S’mores at 72gms. That’s a huge sugar load right here before I go to bed. Wonder how I’ll sleep and how long it will take me to recover once I get back to eating well.

Tomorrow I have my weekly Bible study breakfast meeting. Our usual place is closed so we’re headed over to Cracker Barrel. I’m going to see what a couple biscuits and jelly do relative to my toast experiment from earlier this week.

I’m honestly anxious to finish up this process. The data makes it so clear what I should eat and it’s hard not to clean it up. I know that anytime by blood sugar is much above the green area my body is being injured. I can feel my brain not working well. Things are dull and I know I’m slower than I should be. But the experiment must continue.

All in the name of science!

Day 2 of CGM

Here’s the majority of today’s readings.

You can see small impact of breakfast which was the same 3 eggs and 1/2 cup blueberries as yesterday but no toast or jam. What a difference that made. Note too the dip in my glucose right before awakening and the rise as I got up. The normal stress of standing upright and waking in the morning will raise your glucose some. Notice the good glucose control overnight when the body isn’t trying to metabolize a Star Crunch but is essentially fasted? Powerful.

Lunch was a 1/2 pound of delicious beef brisket. There was no impact or elevation on my glucose. Dry rub BBQ is one of the best options to limit sugar intake as almost all BBQ sauces have added sugar.

The blue arrow indicates an elevated glucose associated with a stressful situation. We should be cognizant that our body responds to stress with elevated glucose. This is why the fourth pillar of good health is peace, or stress management.

Tonight’s dinner is going to be one of my all time favorite meals, Little Joe’s pizza and breadsticks. There’s no doubt what’s going to happen but it will be interesting to see the impact it has. Stay tuned for a full report later on.

Star Crunch and skyrocketing insulin

My CGM experiment started last night when I placed the Free Style Libre CGM at about 7pm. It takes an hour to ‘warm up’ before showing any readings.

As I previously wrote, I’ll be eating foods that I call ‘celebration’ foods during the first week. Generally these are foods I reserve for treats and times of celebration. They are foods that have a clearly powerful impact on hyperinsulinemia (think jet fuel on a bonfire). Being mostly simple sugar and nearly nothing else they drive the blood sugar up extremely fast which drives the insulin up. As insulin goes up all the things you don’t want to happen do.

Star Crunch, Little Debbie’s best treat

So for the prequel to my one week celebration food experiment I decided to document the effect of one of my all time favorite packaged treats, Little Debbie’s Star Crunch. Perhaps, it’s more of an emotional attachment for me as I used to have this food as my 2am reward when I was on call at LeBonheur Children’s Hospital in Memphis. When you’re 20 hours into a 36 hour shift and it’s a struggle to fight off fatigue to answer your pager one more time, sometimes you need little rewards to encourage you through. Ironically for me, but great for the kids, LeBonheur decided they needed to offer healthier food in their cafeteria for the kids and removed all the Little Debbie snacks about halfway through my last rotation there.

Back to my prequel experiment…I had spent the weekend camping with my family and some friends and, perhaps, had started my ‘celebration’ food experiment a few days early without my CGM. However, after returning home Sunday afternoon, I spent a considerable time working outside in the yard including chainsawing some trees that were toppled in Friday’s isolated freak windstorm. I had worked hard. It was time for my reward.

I decided to eat the Star Crunch about 30 minutes prior to going to bed. Studies show that most American’s eat about 15 hours a day consuming something within the hour prior to getting into bed. I thought it would be interesting to see just how bad this habit would be for me.

Here’s the nutritional information for a Star Crunch.

Star Crunch Nutritional Data

The carb calculation for a Star Crunch is 42gms of net carbs. Forty-three grams of total carbs minus 1 gram of fiber. So what was the effect on my blood sugar?

This is disturbing.

As you can see, the Star Crunch eaten before bed caused my body to be hyperglycemic all night. My morning glucose was 103 mg/dL. Incidentally, I didn’t feel well either when I got up. I felt like I hadn’t rested well.

So what’s the take away? Did I learn that a Star Crunch is not healthy? Was I surprised that it made my blood glucose go up? Not at all, I already knew those things. What I learned was to associate the feeling of being unwell with the knowledge of why I felt unwell. Honestly, it made it hard to eat breakfast. I’ve come to enjoy fasting as a corrective measure so much that I naturally wanted to skip breakfast to correct this issue. Yet, I soldiered on and ate anyway. I’ll document that in a post later today. Stay tuned.