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.

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 5: Recovery may be boring but boring may be good.

Recovery can be boring but good for you.

Yesterday was day 5 of my CGM experiment with my FreeStyle Libre. It was pretty boring which was a little by design and a little by accident. Interestingly, this blog series has prompted about a dozen of my patients to contact me and acquire a CGM for themselves. I have heard feed back that the lowest price seems to be about $35 per sensor using a GoodRx coupon. Several folks have found that price at Wal-Mart and Walgreens.

I started out the morning still feeling very full and, as you can see from the graph, my glucose numbers were still bouncing around until about 3 am from all the food on July 4th. So, I fasted for breakfast to try and recover. I had planned to have a very low carb lunch of left over plain hamburgers but walked out of the house with them still sitting on the counter. Doh!

I wasn’t able to leave the office at lunch so only ate a small snack and a protein powder shake. In total, it was about 20gms of carbs. That accounts for the small spike and quick recovery. I didn’t end up getting home until 9pm and decided to have leftovers from the July 4th party. That was a pretty high carb meal. As I’ve come to expect, I spiked and dropped after going to sleep. The roller coaster of numbers continued until this morning. One lesson I’m learning is just how detrimental late night eating is. Next week I’m going to eat some moderate to large size dinners of very low carb food and see how much effect that has while I’m asleep. I’m also going to focus on skipping more late night dinner meals if they aren’t a sit down meal with my family.

Overall, the first part of the day was a recovery period which went well. If I had stuck with that process, you can see how a day of appropriate celebration can be accommodated better when surrounded with a few days of self-control and proper eating. We are built for cycles of fasting and feeding. Celebration with rich food can be very appropriate. We just need to limit our celebrations to those days which are in fact a celebration.

CGM Day 4: Did I say cake? I meant cakes.

Celebrating Independence Day, like almost every other American holiday, involves lots of food. Yesterday’s rumor of cake was not unfounded and today was a day marked not by one big meal but by multiple opportunities to eat richly.

Breakfast began with my first cake, four of them to be exact. Paleo Pancakes found at Costco are a lower carb (but not low carb) grain free version of traditional pancakes. They are surprisingly filling for their size and generally you don’t want very many.

Interestingly, these pancakes produced in me a phenomenon I see in many other people and regularly talk about. It’s a clear sign of insulin hypersecretion and dysregulation of the body’s glucose balance mechanism. I developed reactive hypoglycemia after my breakfast meal of four 3 inch diameter pancakes with honey and butter, two fried eggs, and blueberries.

When my CGM read low I double checked it with a finger stick. You can see they correlate well. As my glucose rose, so did my insulin level. It effectively moved my blood stream glucose into the cells of the body and brought the level back down to normal. However, when it hit normal, about 85 mg/dL, the body’s compensatory hormones that help balance the effect of insulin likely failed to appropriately be released. Glucagon is the chief counter-regulatory hormone and signals the body to release its stored glucose from the liver. This slow dripping stream of glucose raises the blood glucose levels just as insulin lowers them. The delicate balance between the two allows for a stable number. Failure of glucagon to release allows insulin to work unchecked thereby continuing to move glucose into body cells and lowering the blood level. Many people feel this occur and Snickers has based an entire ad campaign on this phenomenon. “You’re not yourself when your hungry.” Anyone ever been called h-angry?

Many people try to correct these symptoms by having a carb rich snack or drink. If you must, have a small amount of complex carbs possibly with some protein or fat to slow digestion. Something like a couple ounces of nuts or half an apple and avocado. Ultimately the best fix for this scenario is retrain your body to release hormones appropriately by converting to a low carb, moderate protein, quality fat diet as we’ve been discussing. When done correctly this always corrects the issue as a thoroughly fat adapted individual cannot suffer hypoglycemia.

Of note, I think my hemoglobin and hematocrit are low as a result of the retained fluid from my excessive carb intake this week. Hyperinsulinemia results in retained salt and water which dilutes a stable red blood cell mass. I suspect my blood pressure is running higher than normal too although I haven’t checked it. I have noticed more lower leg and ankle swelling at the end of each day.

After breakfast we began getting ready for our family to come over to cook out. As I started the fire and prepared the outdoor space, my wife made an All-American Angel Food Cake. Her offer of the mostly empty frosting bowl and a spoon was not refused and that promptly spiked my glucose around noon.

Lunch was burgers and hot dogs cooked over the open fire using this awesome campfire grill set up from Wimpy’s. Burgers cooked over a real wood fire really are the best you’ll ever have. They were so good I had the leftovers for dinner. Both lunch and dinner were finished with a piece of cake. You’ll note a small peak between those two meals on the CGM graph. I honestly don’t know what to attribute that to. I don’t think it was food related.

Lastly, what’s Independence Day without a little bowl of ice cream? I think I remember from history class that General Washington celebrated each victory with vanilla bean, or maybe that was Captain America. Either way, it’s definitely American.

So like many holidays, at the end of the day I’d swear I’ll never need to eat again but without fail I do. I think this is a challenge for many of us. Our celebrations are defined by food. We celebrate holidays and get togethers and times with friends and families. I’ve celebrated many an afternoon just making it through the work day. We celebrate Saturday mornings and Sunday lunches. We should celebrate all of these times as life is a celebration of God’s grace and love to us. However, we don’t always have to celebrate with massive meals of carb rich food. Remember the 1/2 lb of brisket I ate the other day? It was delicious and never moved by glucose. I truly believe we can celebrate wonderfully without developing insulin resistance or diabetes. Just think of all the extra celebrations we could have if we lived this out well. Too many lives are cut short by diseases resulting from high insulin levels. We can be a generation that adopts a new normal and changes our own destiny.

I don’t know what tomorrow’s going to be like. It’ll be hard to top today but I’m sure there will be something I can try.

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 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.

Article: Cancer cells’ use of sugar holds the key to their destruction

A well constructed low carbohydrate diet has been shown to improve health in many ways including the treatment of some cancers. Purposeful fasting also has some proven benefits. While much remains to be discovered in this field I believe good nutrition is key to good health. I would welcome the chance to help you in your nutrition journey.

-Dr McColl

10 Paleo Thanksgiving Recipes to Delight the Pickiest Eaters | MyDomaine

Instead of crossing your fingers for at least one edible dish this Thanksgiving, ask your host if you can prepare one of these paleo Thanksgiving recipes.
— Read on