Category Archives: ketones

optimal meals and foods for fat loss and muscle building

Ever wondered what foods and meals are optimal for fat loss and muscle building?

Ketogains’ Luis Villasenor recently put a call out for recipes for their upcoming Ketogains Boot Camp, so I thought it would be interesting to see what the Nutrient Optimiser had to say about optimal foods and meals that align with the Ketogains approach.

luis villasenor

The essence of the Ketogains approach is to:

  1. consume adequate protein,
  2. limit carbohydrates, and
  3. use ‘fat as a lever’.[1]

This article unpacks each aspect of the Ketogains system.

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Protein as a goal

The Ketogains macro calculator recommends a minimum protein intake of 0.8g per pound of lean body mass (LBM) (i.e. 1.8g/kg LBM), increasing to 1.0g/lb LBM (or 2.2g/kg LBM) on lifting days.

This protein intake level is more than would be recommended in a therapeutic ketogenic approach or even the average protein intake for the general population.[2] [3] It does, however, align with Steve Phinney’s recommended protein intake level for athletes and performance and represents a more optimal protein intake for active people.[4] [5] [6]

From a sports nutrition standpoint, more than 2.2 gram per kilogram of total body weight is regarded as “high protein”.[7]  This could be as high as 3.0g/kg LBM when fat mass is taken into account.  So, while the Ketogains protein recommendations might be considered high in therapeutic keto and vegan circles, the Ketogains recommendations would be ‘moderate’ in a sports nutrition and bodybuilding circles.[8]

This chart above (from Lemon, 1998[9]) shows that, for a strength athlete, muscle protein synthesis is maximised when they consume at least 1.8g/kg BW of protein.

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Protein intake even more important when you are trying to lose weight.  The higher the energy deficit, the greater is our need for protein to prevent loss of lean muscle mass.  If we are active and/or doing resistance training, then our requirement for protein is even higher again.  As shown in the chart below from a recent review paper by Stuart Phillips, muscle mass is best preserved best when we have higher levels of protein, particularly if you are targeting an aggressive deficit.[10] [11]  If you are targetting a moderate energy deficit (e.g. 10%) then a protein intake of around 1.5g/kg BW is appropriate.  However, if we are targetting a very aggressive energy deficit then higher levels, up to 2.6g/kg BW will be beneficial to prevent loss of lean muscle mass.  If we are active then we will also need more (dashed line) while we need less if we are sedentary (dotted line).

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While it’s actually difficult to consume such high levels of protein due to the satiety effect, more protein won’t turn to chocolate cake.  [12]

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Protein contributes to your energy intake.  So if your goal is fat loss, then you want to target the minimum effective dose of macronutrients and micronutrients.

As a general rule, a higher protein intake tends to lead to a better nutritional profile[13] and increased satiety.[14] [15]  Very high protein diets (i.e. above than 80% energy from protein) will likely rely on supplements and may minimise other foods that provide more vitamins and minerals.  As you can see on the far left of this chart, actively targeting a low protein intake can lead to a poor nutritional outcome.[16]

protein (%) vs nutrient density score [click to enlarge]
[note: If your goal is therapeutic ketosis for the management of epilepsy, dementia, cancer, Parkinson’s or Alzheimer’s you will need to pay particular attention to ensure you get your share of micronutrients.]

Carbs as a limit

As you can see in the chart below,[17] you can get a reasonable level of nutrition if you consume anywhere between 0 and 60% of your energy from non-fibre carbs.[18]  However, with an exploding diabetes epidemic,[19] [20] [21] it’s probably fair to say that the majority of people would do better if they reduced their consumption of refined grains and sugars.

carbohydrates (%) vs nutrient density score [click to enlarge]
If you have already developed insulin resistance or diabetes, then reducing your carbohydrate intake to the point you achieve normal blood glucose levels is a good idea,[22] both in terms of overall health and controlling appetite that can be driven by excessive blood sugar swings.

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The fact that much of the population is already insulin resistant is likely part of the reason the Ketogains approach, with its limit on carbs, has been so successful.

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Low carbers are fond of saying “there is no such thing as an essential carbohydrate”.  However, unless you are focusing on getting lots of organ meat, shellfish, or fresh meat, you may benefit from consuming some non-starchy veggies to get your essential vitamins and minerals.

Twenty or thirty grams of non-fibre carbs doesn’t sound like much in the context of grains or sugars, but it can feel like a LOT of food to consume if it’s from non-starchy veggies.[23]

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Fat as a lever

So to recap before we get into discussing fat:

  1. Adequate protein is critical to support muscle growth and repair.
  2. Non-starchy veggies (which contain a small amount of non-fibre carbohydrates) provide vitamins and minerals (unless of course, you are eating heaps of shellfish, organ meat or drinking blood like the Maasai).

Recently, many people are swinging back from their fear of fat to embrace dietary fat again.  Carbohydrate is a more explosive fuel source for emergencies, while fat is a slower burning and more efficient fuel source.

While there are essential fats, we don’t require much to meet our minimum requirements of essential fats.[24]  Beyond this, where you get your energy doesn’t matter that much.

Many people do fine on a diet that obtains a lot of the energy from carbs while other do well on a diet that get the majority of energy from fat.  However, where things seem to go wrong is when people consume diet that is high in energy dense nutrient poor fat and carbs with minimal amounts of protein.

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As you can see from the chart below, we can achieve a respectable nutritional outcome with a fat intake of between 10 and 65%.   More fat is not necessarily better, but very low-fat levels are not great either as they tend to have minimal amounts of protein and other essential nutrients.

fat (%) vs nutrient density score [click to enlarge]
If you are trying to reduce body fat, then maximising the nutrient density and reducing the energy density of your food is a worthy goal.  A protein sparing modified fast, an extreme version of this, provides adequate protein while limiting both fat and carbohydrates.

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If you are looking to gain weight, add muscle or perform extended feats of endurance exercise on a regular basis, it may be beneficial to load up on more energy dense foods.  However, conversely, if are not an endurance athlete but trying to use your body fat for fuel (like most of us these days living in a sedentary environment full of hyperpalatable food), you may want to wind your dietary fat intake back.

Micronutrients

Once you’ve worked out your macros using the Ketogains calculator and got the hang of using fat as a lever to manage energy intake, the next step is to ensure you are getting your share of micronutrients.

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Focusing purely on macros (e.g. Flexible Dieting, IIFYM, etc.) is short-sighted because it fails to consider micronutrients.  Chronic energy restriction without attention to micronutrients can lead to chronic nutrient deficiencies,[25] a lack of energy, increased hunger,[26] rebound bingeing due to cravings and even death.[27]

You’re likely aware that the branched-chain amino acids (BCAAs) trigger muscle protein synthesis and ensure you use the rest of the amino acids to build and repair your muscles.[28]  However, recent research has found that the amino acids arginine and lysine trigger satiety and hence we find foods that contain these amino acids more filling.[29] [30]

The chart below shows what your micronutrient profile would look like if you focused on branched chain amino acids (valine, isoleucine, and leucine) and the satiety-related amino acids (lysine and arginine) while also keeping carbohydrates low.

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While we get plenty of protein with this approach, we would not obtain the recommended minimum levels of a large number of the essential vitamins, minerals, and essential fatty acids.

As much as we like to focus on macronutrients (i.e. fat, protein, carbohydrates, fibre, ketones), micronutrients are arguably a more useful to assist us in our nutritional decision making.

Getting adequate minerals is especially important for:

  • avoiding the symptoms of the keto flu,[31]
  • reversing insulin resistance and minimising the amount of basal insulin circulating in your body,[32] [33] [34] and
  • maximising athletic performance.[35]

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The chart below shows what happens to our micronutrient profile when, in addition to BCAAs, we also prioritise foods that contain the harder to find micronutrients.  The purple bars represent the nutrients contained in the average of all foods in the USDA foods database while the blue bars represent the nutrients contained in the shortlist of foods.

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Optimal foods

In case you were wondering which foods will give you the most micronutrients while also having a lower energy density and fewer carbs, I have listed them below.

vegetables

  • endive
  • alfalfa
  • chicory greens
  • escarole
  • coriander
  • pumpkin leaves
  • asparagus
  • spinach
  • Chinese cabbage
  • lettuce
  • parsley
  • okra
  • zucchini
  • beet greens
  • watercress
  • arugula
  • portabella mushrooms
  • chives
  • chard
  • white mushroom
  • turnip greens
  • cauliflower
  • mustard greens
  • banana pepper
  • cucumber
  • pickles
  • sauerkraut
  • yeast extract spread
  • summer squash
  • radishes
  • broccoli
  • collards
  • shiitake mushroom
  • celery
  • artichokes
  • eggplant
  • cabbage
  • snap beans
  • turnips
  • red peppers

spices

  • basil
  • dill (fresh)
  • sage
  • marjoram
  • curry powder
  • thyme
  • caraway seed
  • mustard seed
  • dill seed
  • cloves

fruit

  • blackberries
  • avocado
  • raspberries
  • olives

seafood

  • salmon
  • sturgeon
  • halibut
  • fish roe
  • anchovy
  • crab
  • trout
  • caviar
  • crayfish
  • flounder
  • mackerel
  • sardine
  • oysters
  • mussel
  • rockfish
  • pollock
  • lobster
  • herring
  • haddock
  • perch
  • whiting
  • tuna
  • shrimp
  • white fish
  • cod
  • octopus

offal

  • liver
  • kidney
  • heart
  • brains
  • headcheese
  • brains

animal products

  • pork chops
  • pork shoulder
  • lamb
  • roast pork
  • pork loin
  • ground pork
  • pork ribs
  • roast ham
  • leg ham
  • sirloin steak
  • ground beef
  • chicken drumstick
  • chicken breast
  • veal
  • bratwurst
  • chuck steak
  • roast beef
  • ham
  • ground turkey
  • turkey
  • beef roast
  • lamb
  • ribeye fillet
  • bison
  • beef loin
  • ground beef

dairy & egg

  • whole egg
  • egg yolk
  • whey protein powder

You should ideally focus on the foods closer to the top of these lists.  But once you’ve eaten as much endive, alfalfa, liver and caviar as you can, feel free to move down the list to more energy dense foods or ones that you might enjoy eating more.

Supplements

If you can’t get enough nutrient-dense foods, it may be beneficial to use supplements.[36]  Keep in mind though, the nutrients from whole foods are likely to be better absorbed.

Too many minerals at once will ‘give you a dose of the salts’ and all your expensive supplements will end up in the toilet.  Whole foods are also more likely to contain other beneficial non-essential nutrients that come along with nutrient-dense foods.

What to track

“What gets measured gets managed”.[37]

But we can only manage a handful of things at a time.

“If everything is a priority, nothing is a priority.”

Rather than trying to track everything all at once you need to identify a few things to track to ensure you are moving towards your goals.

In the context of losing fat and gaining muscle the best things to track appear to be:

  1. weight/body fat,
  2. macros/calories, and
  3. performance (e.g. weight on the bar).

weight / body fat

Most people want to have more energy and look good naked.  While it’s much easier to track body weight, this ultiamte goal really about losing body fat.

There are a ton of different ways to measure body fat (e.g. DEXA, comparison photos, bioimpedance scales, Skulpt, the Navy Method, etc.).  They are all inaccurate to some degree.

You can do your head in focusing on the fluctuations on the scale or body fat from day to day.  But, you want to see your overall weight and body fat reducing toward your target levels.  People who successfully lose weight and keep it off manage their food intake, measure their weight regularly and are active![38] [39]

If you’re a fitness model you might want to measure yourself daily.  If you’re just starting to focus on eating well and lifting, then you might just want to weigh yourself weekly or monthly.[40]

If you are not moving towards your goals over the long term, something needs to change.

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But first, you need to set some realistic goals.  Take the time to determine your current and target body weight, fat (in kg and %) and lean body mass (LBM).

  current target
body weight (kg)
body fat (%)
body fat (kg)
LBM (kg)

If you are disciplined, it is possible to lose 1% of your mass per week, but 0.5% is a more realistic and less aggressive target.  If you are already lean, then it will be harder to lose fat without losing muscle so you may need a less aggressive deficit.[41]

It’s not all about the weight on the scale.  You can be losing fat and gaining muscle, the weight on the scale probably is the most reliable indicator that you’ve got your inputs right.  If you’re getting enough protein and working out, incrased muscle mass should be looking after itself, and any loss should be mainly fat.[42]

Keep in mind that body weight is a lagging measurement that tells you whether you’re on the right track.  Tracking inputs (e.g. food intake and exercise) will be much more useful.

macros / calories

Personally, I don’t enjoy tracking my food, so I’ve designed a range of food lists and meals that will help most people improve from where they currently are.  It will be pretty hard to get/stay morbidly obese if you eat only the foods and meals listed above.

But eating to satiety won’t guarantee you will lose weight.  If you want to look like a fitness model, or you are not getting your desired results from ‘eating ad libitum’ you will likely need to track your food to overcome your inbuilt impulse to maintain a higher body weight and prepare for a possible famine ahead.

Tracking your food in an app like Cronometer can be a useful educational experience.

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The Ketogains calculator will give you a starting point in terms of calorie intake based on your current weight and activity levels.  If, after a few weeks, you are not seeing the progress you were hoping for you will need to adjust your inputs.

Performance/weight on the bar

Building muscle or achieving a performance goal is probably more important than weight loss, particularly if you are not trying to get down to a very low level of body fat.

The great thing about using a performance goal is that it is both a leading and lagging measure.  By going harder, faster and heavier you are providing a greater stimulus for growth.  And by measuring your performance outputs, you are ensuring that you are getting fitter/faster/healthier.

While being strong doesn’t guarantee weight loss, being stronger will improve your metabolic health, insulin sensitivity and ability to burn fat more effectively than nearly anything else.

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Having more lean muscle mass will ensure you burn both glucose and fat more efficiently.  Lean muscle mass is a key predictor of longevity.[43]

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The Ketogains boot camp uses a 5×5 strength progression.  The Stronglifts 5×5 or Starting Strength uses a similar progressive overload approach.  These programs involve compound lifts (squat, deadlift, bench press, overhead press, row etc.) and progressive overload meaning that you add weight to the bar each time and continue to get stronger.   By doing this, you train your body to produce energy more efficiently.

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Don’t be surprised if your appetite ramps up during the first few months of intensive lifting as your body goes into anabolic overdrive to recover and build new muscle.  This should settle down though after a while, and you can then focus on dialling your diet in if you want to gain strength as well as lose body fat.[44]  You have a unique window of ‘newb gains’ during initial whne you can get stronger at in a way that you may never achieve again.  You can focus on getting to single digit body fat later.

Other stuff that you could track

There are other things that you might like to track, but they will be less useful than the things mentioned above.  Most people have limited time and don’t really want to live a completely quantified life.  Unless this is your only hobby or you are a professional athlete or fitness model, you may quickly hit ‘analysis paralysis’ and give up.

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There is no guarantee that technology will help you reach your goals.  In fact, it seems that you are more likely to gain weight if you use wearables like a Fitbit.[45]  It’s hard to know whether this is due to the EMF or perhaps the wearer is always allowing themselves to consume the extra calories that their technology told them that they just burned with exercise.

So, coming from a biohacker nerd….  don’t try to track too many things at once!  OK?

Heart Rate Variability

Heart Rate Variability (HRV) is a measure of the variability between your heart beats.  If you are stressed and/or exhausted your heart will be more rhythmically as well as more rapidly.   If you are relaxed and well rested your heart will be more to stresses and quickly return to rest.

HRV.png

Measuring your Heart Rate Variability (HRV) can tell you if you’re pushing too hard and need to rest recover or you’re not pushing hard enough and should be working harder to maximise your progress.  Training when you are burning out can be counterproductive and lead to injury or under recovery.

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HRV tells you whether your sympathetic and parasympathetic nervous system is balanced.

  • If you are “parasympathetic nervous system dominant” you might be overstressed from too much activity, not enough sleep, too much caffeine or work stress.
  • If you are “sympathetic nervous system dominant”, then it probably means your body wants to rest. You’ll probably do better if you listen to it and let it recover.
  • If your overall HRV is dropping, it means you are burning out and should consider slowing down.

After 1.5 years of measuring my HRV each morning, it’s uncanny how many times I will see my HRV fall a few days before you get the flu or hit the wall.  I don’t like to stay still long enough to meditate, so tracking each day with Elite HRV is part of my relaxation, breathing and focus at the start of each day.

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Blood sugar

Your blood sugar and glucose control is a powerful indicator of metabolic health.  But blood sugar readings can vary depending, not just due to the food you eat or your metabolic health, but also exercise and stress.

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If you have diabetes, then refining your food choices to normalise your blood sugars is critical. However, regular blood sugar tracking is likely a waste of time and money for most people who are following a Ketogains style approach (i.e. tracking their food to ensure they are moving towards an optimal weight, getting adequate protein and lifting regularly) is unnecessary.

Blood ketones

Unless you require therapeutic ketosis to help manage epilepsy, cancer, Alzheimer’s or Parkinson’s measuring your blood ketones is also largely an irrelevant distraction.

Lots of people get caught up chasing ‘optimal ketosis’ by eating more dietary fat and less protein.  However, this is exactly the opposite of what you need to gain strength and lose body fat.

Blood ketones do increase when we don’t eat. But high ketone levels don’t mean you are burning your own body fat.  It could just be the three Bulletproof coffees and exogenous ketones you just had to get that are driving your high ketone levels.

Some people, especially those who are physically fit and/or have been practising a low carb diet for a long time, seem to have lower blood ketone levels, even if they are eating a ‘ketogenic’ diet.  It’s hard to know whether this is due to the more efficient use of ketones or the fact they are burning more fat through non-ketogenic pathways.

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Ketones are just one of a number of ways that we burn fat (chart from Dave Feldman)

Someone who is not so metabolically healthy can load up on exogenous ketones, butter and MCT oil and get a high blood ketone reading on their meter.  But this may just mean that they have eaten a lot of fat that they are not burning (because of their lack of activity and/or poor metabolic health) and the fat is backing up in their bloodstream.

A healthy metabolism seems to keep the total energy circulating in the bloodstream fairly low (i.e. from glucose, ketones or free fatty acids).  If you are metabolically healthy, you can easily access your fat stores so you don’t need to build up high energy stores in the blood.  By contrast, someone with a less healthy metabolism seems to maintain higher energy stores in the blood (i.e. glucose, ketones, free fatty acids) as well as on their body.[46]

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This chart shows more than 3000 data points of blood glucose and ketones together from a range of people following a low carb and ketogenic diet.  Having high blood ketones and high blood sugar at the same time is not good!  Healthy people tend to have lower blood sugar and moderate level ketones.

Most people don’t need to worry about their blood glucose and ketone levels consciously.  If you focus on nutrient dense food to optimise your mitochondrial function and strength building to keep pushing your mitochondria to produce energy at peak efficiency, then your body will probably look after the rest.

[At the risk of getting too technical, it’s worth pointing out that blood ketones rise because there is a lack of Oxaloacetate (from protein and carbs) available to burn Acetyl CoA from fat in the Krebs cycle, so the body defaults to a starvation protocol to produce ketones (AcetoAcetate). 

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Figure from Amy Berger showing how fat can be burned in the Krebs cycle or via ketosis when there is not enough Oxaloacetate from protein and carbs turn the Krebs cycle.

If your NAD+ is low, AcetoAcetate will not be converted to Acetone so there will be lots of beta-hydroxybutyrate left in the blood to be measured on your meter.  So, other than fasting and/or exercising to deplete your liver glycogen levels, one ‘hack’ to achieve high blood ketone is to avoid protein and eat a nutrient-poor diet low in niacin and other B vitamins (which produce NAD+).  But don’t try this at home.  It’s not a recipe for optimal health, just high blood ketone levels.]  

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Ketogains’ Tyler Cartwright has lost nearly three hundred pounds without exceeding 0.4mmol/L blood ketones on his ketone metre (other than that time he ate nothing but lard for two weeks as an experiment and got to 0.5mmol/L).[47]

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Breath ketones

Breath ketones are an interesting indication of your metabolic health.  But again, they’re not necessary if you are already focusing on a nutrient-dense diet without too much energy and plenty of activity.

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Waist measurement

BMI is often used to assess whether or not someone is at a healthy weight.

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However, BMI is notoriously problematic for people with more muscle.

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Waist to height ratio is a much better predictor of the years of life that you will lose due to your poor health.[48]

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Micronutrients and nutrient score

Focusing on the nutrient-dense whole foods above and the meals below will get you most of the way to optimal nutrition.  However, you can also track your macronutrients in Cronometer to help you identify the nutrients you are not getting from your diet.

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But then, once you’ve tracked your food in Cronometer, you are left wondering what foods and meals you should eat.  and if need to supplement, how much of each supplement do you require and how much?

The Nutrient Score is a measure of the micronutrient quality of your diet.  If you were able to get two times the recommended daily intake of all the essential micronutrients, you would get a perfect score of 100%.

To demonstrate what this looks like in practice, Ted Naiman’s diet got a very respectable nutrient score of 70%.

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Luis’ got 72%.

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Nutrition nerd Alex Leaf (and regular reviewer of my blog posts… thanks so much Alex!!!!) scored an impressive 74%.

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Mike Berta also scored 74%.

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Brianna Theroux’s scored a very healthy 79%.

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And sitting at the top of the leaderboard is Dr Rhonda Patrick with a score of 82%.

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But the coolest competition is against yourself.  Andy Mant managed to seriously up his nutritional game…

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… by eating a LOT of nutrient-dense seafood…

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… in preparation for his Paris wedding.

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By following the recommendations of the Nutrient Optimiser analysis, Robin was able to improve her nutrient score to 32% (junk food diet) to 68% over a number of iterations (see report 1, report 2 and report 3).

In the process, she was able to significantly improve her blood glucose levels, dropping her HBA1c from 10.6% to 6.4%.  Robin was also able to progress from taking hundreds of units of insulin per day to only needing occasional correcting doses to fine tune her blood sugars.  She also managed to lose 2.6lbs per week!

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And after a couple of rounds of following the Nutrient Optimiser recommendations and a couple of Ketogains boot camps the Matt Standridge (aka The Ketodontist) has stepped up from a nutrient score of 48% to 73%.  He says he is feeling great and continues to gain muscle and lose fat.

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The Nutrient Optimiser

While there are common themes, each person’s micronutrient fingerprint is unique.  The optimal foods and meals that will balance your micronutrient profile are unique to you.  The Nutrient Optimiser is the only tool that will tell you what foods are ideal to balance your diet while also aligning with your goals.

Currently, the Nutrient Optimiser is a manual report that will help you optimise your nutrition from the micronutrients based on your food log in Cronometer.  We’re working hard to develop an automated system that will use your goals and whatever data you have to help you refine your nutrition to achieve your goals.

If you don’t want to track your food, the system will tell you what meals and foods will align with your goals.  But if you want to step up your game and provide other data we can work with that to further refine your nutritional prescription to fill in your micronutrient gaps.  The system will also adapt with you to improve your nutrition, ideally from diabetic to weight loss to achieving your performance goals.

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It might just be your secret weapon to help you blitz #transormationtuesday.

Summary

  • The Ketogains protocol involves getting adequate protein (to support muscle growth and recovery) and adequate carbs to get essential vitamins and minerals. Fat is used as a level to manipulate energy intake to suit your goals.
  • If you are limiting your energy intake, maximising your nutrient : energy ratio is critical!
  • The Nutrient Optimiser can help you identify foods and meals that align with your goals and fill in your micronutrient deficiencies.
  • Chose what you track wisely. Trying to manage too many things can lead to ‘analysis paralysis’.  If you manage the most important inputs, results should naturally follow.

 

 

Meals

I’ve been building a database of to help identify the meals that provide you with the nutrients you need more of and align with your goals.

If you are tracking in Cronometer, you can sign up for a Nutrient Optimiser analysis and report here to find out which foods and meals will help you move forward.  I’ve also been working with Alex from Nutrient Hero for the past few months building a massive database of recipes we can use to optimise your nutrition.

It feels like it’s been a long time coming, but it won’t be too long before it’s all automated and online.  If you want to be the first to trial the beta version then make sure you enter your email in the pop on this page or head over to NutrientOptimiser.com now to learn more.

The recipes below are some of the highest ranking when we prioritise some of the harder to find vitamins and minerals (potassium, magnesium, calcium, zinc, vitamin D, thiamine and choline) as well as higher protein and a lower energy density.

I have included the link to the Cronometer entry as well as the nutritional profile and a list of foods that will help you balance the nutritional profile of the recipe.

Bootcamp omelette

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Gayle Louise created this simple omelette recipe for her Ketogains boot camp workout days.   Nutritional yeast has a fantastic nutritional profile and adds a cheesy taste without the calories, minimising fat and maximising nutrient density.

ingredients

method

  • cook the spinach first with ghee or butter.
  • whisk 4 eggs with salt and pepper and add too cooked spinach
  • sprinkle with nutritional yeast, cover and cook until firm.

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Cronometer analysis

https://nutrienthero.com/recipe-analysis/boot-camp-omelette

 

Potassium salted caramel coffee

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Everyone loves coffee, and most people find potassium harder to get in their diet than sodium.  So why not potassium coffee?!?!  The milk and caramel syrup are not essential, but they give you that indulgent salted caramel taste.

Getting adequate minerals is critical to ensuring insulin sensitivity, nutrient partitioning, muscle building and recover and avoiding diabetes.

While most people don’t need to worry about getting too much salt, having a potassium : sodium ratio greater than two is hard to achieve for most people, even if they do eat a lot of greens.

My friend Raymund Edwards of Optimal Ketogenic Living has been doing a LOT of research into the wide-ranging benefits of alkalising electrolytes, in particular, potassium.  This recipe was inspired by Raymund after hearing that he was adding potassium to his coffee.

Raymund said, “A potassium enriched coffee in the morning really wakes the muscles.  It’s better than any warm up.  Loose and alive we can feel the difference as they soak up actively the potassium especially after the night fast (where muscles have been releasing potassium).  And  the coffee in my view tastes so much better too.”

It’s hard to get a significant amount of potassium from tablets as they are limited to 99 mg which is only a fraction of the 3,800 mg of potassium that we need each day (you would need to take forty tablets to get the DRI for potassium!).

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You can also add the potassium citrate powder to your drinking water, coffee or pre-workout mix.  You would need more than 10g of the citrate powder to get your recommended daily intake of potassium, but, like all things, start slowly. However, in time, it might just make you feel amazing!

ingredients

method

  • Pour coffee shot from fresh grounds
  • Add potassium citrate powder
  • Add caramel syrup (optional)
  • Add a dash of full cream milk to taste (optimal)
  • Add hot water to taste (depending on how you like your coffee)

Cronometer analysis

nutritional analysis

 

Greens + eggs + seafood

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Dom D’Agostino infamously told Tim Ferriss in his sound check that his breakfast was sardines, oysters, eggs and broccoli.  It might sound bizarre, but it packs a nutritional punch.

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Most days my breakfast is some variant on frozen greens (spinach, broccoli, kale) + eggs + seafood (sardines, mackerel, oysters, mussels, anchovies) + nutritional yeast.

If you’re not focusing on losing body fat you can add cheese or peanuts for some extra indulgent taste, but leaving these out will help you increase your protein : energy and nutrient : energy ratio which is ideal if you are trying to lose body fat (and will make Ted Naiman and Luis Villasenor proud).

You could take more time to fry these ingredients up and plate them up nicely, but most of the time breakfast only needs to be time efficient and doesn’t need to look good.  If you can start the day with a high protein nutrient dense breakfast, you’ll be less likely to succumb to other cravings later in the day.

ingredients:

  • 250g frozen veggies. Spinach is always best, but broccoli or kale work too.
  • Three eggs. Consider removing the yolks if you are focussed on lower fat higher protein fat loss phase, though this will decrease the overall nutrient profile.  The yolk is where all the vitamins and minerals are!
  • 1 can of seafood (e.g. mackerel, sardines, oysters, mussels or anchovies).
  • 1 teaspoon of nutritional yeast
  • Peanuts (optional, only if not looking to lean out)
  • 1 oz mozzarella cheese (optional, only if not looking to lean out)
  • Salt (No Salt, Celtic Sea or Redmond Real Salt) & pepper to taste.

method

  • Defrost greens in bowl for five minutes in the microwave.
  • Add eggs and cook for a further minute or until done. (I often find that the eggs need a bit more cooking but stir everything in at around three minutes and then cook for another two minutes).
  • Add other ingredients
  • Salt liberally to taste.

Nutritional analysis

Cronometer entry

Photos of other variants (hey, they ain’t pretty, but they work).

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Bacon, egg, spinach and mushroom

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This is a variant on the common bacon and eggs recipe. The spinach mushroom and tomato round out the nutritional profile of the stock standard bacon and eggs.

The spinach provides a wide range of vitamins and minerals, particularly vitamin K and vitamin A.  Most people think kale is the ultimate nutrient-dense green vegetable.  However, kale just has a lot of Vitamin K1 and not so as much of everything else.  Spinach has a much better nutritional profile across the board.

If you are focusing on reducing body fat and maximising nutrient density, consider eliminating the cream, draining the bacon fat and keeping the butter to a minimum for cooking.  If your goal is bulking and recover, then you can be more liberal with the cream and cheese to taste.  Remember, fat is a lever.

ingredients:

  • 3 large eggs
  • 200g fresh spinach
  • 2 mushrooms
  • 30g cream (optional)
  • 30g mozzarella cheese (optional)
  • butter
  • Salt (No Salt, Celtic Sea or Redmond Real Salt) & pepper to taste.

method

  • Fry bacon separately. If your priority is reducing body fat then you can let the bacon rest on a paper towel to drain the fat.  Alternatively, bacon grease can be used to fry the spinach, mushroom and eggs.
  • Fry eggs separately.
  • Add cream and cheese if not looking to lean out.
  • Salt to taste.

Nutritional analysis

Cronometer entry

 

Steak, egg, tomato, avo spinach and lettuce

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This is a fairly standard Sunday night family dinner at our place.  A solid piece of steak on the BBQ with salad.

ingredients:

method

  • Grill BBQ steak
  • Cook spinach with some butter or coconut on BBQ plate when grilling the steak.
  • Serve with boiled egg (or fried on the BBQ) along with salad (avocado, tomato and lettuce shown here).
  • Salt (No Salt, Celtic Sea or REdmond Real Salt) & pepper to taste.

Facebook

Nutritional profile

Cronometer

 

Be sure to check out the more than 300 meals on the Nutrient Optimiser Facebook Group.  You might even want to add some of your own.

 

 

 

references

[1] https://ketogains.com/2017/06/energy-balance-macros-nutrient-density/

[2] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm

[3] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/abstract

[4] http://www.artandscienceoflowcarb.com/the-art-and-science-of-low-carbohydrate-performance/

[5] https://www.amazon.com/Art-Science-Low-Carbohydrate-Performance/dp/0983490716

[6] https://www.youtube.com/watch?v=GkQYZ6FbsmI

[7] https://optimisingnutrition.com/2017/10/15/high-protein-vs-low-protein/

[8] https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0201-z

[9] https://www.ncbi.nlm.nih.gov/pubmed/9841962

[10] https://www.ncbi.nlm.nih.gov/pubmed/29182451/

[11] https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.dropbox.com%2Fs%2F1if7n957u66htiy%2F10.1123%2540ijsnem.2017-0273.pdf%3Fdl%3D0&h=ATNppfskJJ6fMuIVoJrC0rX_8H9KCT2SeryF0MeRrAnJz6X9p_3FPhPYUK3RGSOE-kDTeOLxKdw26vel3zBWDbOlaCQzxkxpDU8CjFs9Moo51fC9NByHYvs83uU7PvjFolOxvqx3Pw

[12] https://optimisingnutrition.com/2017/06/03/why-do-my-blood-sugars-rise-after-a-high-protein-meal/

[13] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[14] https://www.ncbi.nlm.nih.gov/pubmed/15836464

[15] https://www.ncbi.nlm.nih.gov/pubmed/24588967

[16] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[17] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[18] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[19] https://www.reuters.com/article/us-health-diabetes/cost-of-diabetes-epidemic-reaches-850-billion-a-year-idUSKBN1DD2SW

[20] http://www.diabetesincontrol.com/the-true-cost-of-diabetes-and-preventing-it/

[21] http://www.diabetes.co.uk/cost-of-diabetes.html

[22] https://optimisingnutrition.com/tag/insulin-load/

[23] https://www.dietdoctor.com/low-carb/20-50-how-much

[24] https://www.nrv.gov.au/nutrients/fats-total-fat-fatty-acids

[25] https://www.ncbi.nlm.nih.gov/pubmed/17593855

[26] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

[27] https://optimisingnutrition.com/2017/06/17/psmf/

[28] https://metabolicnutrition.com/branched-chain-amino-acids-bcaas-benefits-for-muscle-growth/

[29] https://www.sciencedaily.com/releases/2017/09/170927093254.htm

[30] http://suppversity.blogspot.com.au/2013/09/the-satiating-secret-of-arginine-lysine.html

[31] https://ketogains.com/2017/06/keto-flu-electrolyte-imbalances/

[32] https://www.ncbi.nlm.nih.gov/m/pubmed/21036373/

[33] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC301822/

[34] https://diabetesmealplans.com/6285/magnesium-and-diabetes-type-2/

[35] https://www.ncbi.nlm.nih.gov/pubmed/22150427

[36] https://ketogains.com/2016/08/ketogains-seven-must-supplements/

[37] https://athinkingperson.com/2012/12/02/who-said-what-gets-measured-gets-managed/

[38] https://www.ncbi.nlm.nih.gov/pubmed/24355667

[39] https://en.wikipedia.org/wiki/National_Weight_Control_Registry

[40] http://www.nourishbalancethrive.com/podcasts/nourish-balance-thrive/keto-masterclass-robb-wolf/

[41] https://www.ncbi.nlm.nih.gov/pubmed/15615615

[42] https://www.bodyrecomposition.com/muscle-gain/calorie-partitioning-part-1.html/

[43] https://optimisingnutrition.com/2016/03/21/wanna-live-forever/

[44] https://startingstrength.com/articles/clarification_rippetoe.pdf

[45] https://jamanetwork.com/journals/jama/fullarticle/2553448

[46] https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

[47] https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwjpo5y5qu_XAhWHFpQKHV8VAXgQFggvMAE&url=http%3A%2F%2Fketogeek.libsyn.com%2F14-tyler-cartright&usg=AOvVaw04xLzYxE3tS8oa8LWvLkZk

[48] http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0103483

the complete guide to fasting (review)

Considering the massive amount of research and interest in the idea of fasting, not a lot has been written for the general population on the topic.

Brad Pilon’s 2009 e-book Eat Stop Eat was a great, though fairly concise, resource on the mechanisms and benefits of fasting.

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Martin Berkhan’s LeanGains blog had a cult following for a while in the bodybuilding community.

image17Michael Mosley’s 2012 documentary Eat, Fast and Live Longer documentary piqued the public interest and was followed by the popular 5:2 Diet book.

Then in 2013, Jason Fung emerged onto the low carb scene with his epic six part Aetiology of Obesity YouTube Series in which he detailed a wide range of theories relating to obesity and diabetes.

Essentially, Jason’s key points are that:

  • simply treating Type 2 diabetes with more insulin to suppress blood glucose levels while continuing to eat the diet that caused the diabetes is futile,
  • people with Type 2 diabetes are already secreting plenty of insulin, and
  • insulin resistance is the real problem that needs to be addressed.

Jason’s Intensive Dietary Management blog has explored a lot of concepts that made their way into his March 2016 book, The Obesity Code.  However surprisingly, given that Jason is the fasting guy, the book didn’t talk much about fasting.

my experience with fasting

I have benefited personally from implementing an intermittent fasting routine after getting my head around Jason’s work.  I like the way I look and perform, both mentally and physically, after a few days of not eating.  I also like the way my belt feels looser and my clothes fit better.

Complete abstinence is easier than perfect moderation.

St Augustine

I recently did a seven day fast and since then I’ve done a series of four day fasts, testing my glucose and blood and breath ketones with a range of different supplements (e.g. alkaline mineral mix, exogenous ketones, bulletproof coffee/fat fast and Nicotinamide Riboside) to see if they made any difference to how I feel and perform, both mentally and physically.

Fasting does become easier with practice as your body gets used to accessing fat for fuel.

I love the mental clarity!   My workout performance and capacity even seem to be better when I’ve fasted for a few days.

My key fasting takeaways are:

  1. Fasting is not that hard. Give it a try.
  2. You can build up slowly.
  3. If you don’t feel good. Eat!

The more I learn about health and nutrition, the more I realise how critical it is to be able to burn fat and conserve glucose for occasional use.  We get into all sorts of trouble when we get stuck burning glucose.

Our body is like a hybrid car with a slow burning fat motor (with a big fuel tank) and high octane glucose motor (with a small fuel tank).  If you’re always filling the small high octane fuel tank to overflowing, you’ll always be stuck burning glucose and your fat burning engine will start to seize up (i.e. insulin resistance and diabetes).

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Reducing the processed carbs in our diet enables us to lower our insulin levels and retrain our body to burn fat again.  But nothing lowers insulin as aggressively and effectively as not eating.

Even though lots of Jason’s thoughts on fasting seem self-evident, his blog elucidating them has been very popular, perhaps because the concept of fasting is novel in the context of our current nutritional education.

We’ve been trained, or at least given permission, to eat as often as we want by the people that are selling food or sponsored by them.[1]

context

Jason’s angle on obesity and diabetes comes from his background as a nephrologist (kidney specialist) who deals with chronically ill people who are a long way down the wrong track before they come to his office.  Jason also talks about how he had tried to educate his patients about reducing their carbs, however, after eating the same thing for 70 years, this is just too hard for many people to change.

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Desperate times call for desperate measures!

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Many of these patients come to him jamming in hundreds of units a day of insulin to suppress blood glucose levels, even though their own pancreas is still likely secreting more than enough insulin.

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Rather than continuing to hammer more insulin to suppress the symptom (high blood glucose), the solution, according to Jason, is to attack the ultimate cause (insulin resistance) directly.

Jimmy Moore is well known to most people that have an interest in low carb or ketogenic diets.  Whether you agree with his approach, it’s safe to say that low carb and keto would not be as popular today without his role.

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Meanwhile, Jason talks about trying to educate people about reducing the processed carbs from their diet not working, not because of the science but more due to people not being able to change their eating habits after 70 years.

the Complete Guide to Fasting

You’ve probably heard by now that Jason has teamed up with Jimmy to write The Complete  Guide to Fasting which captures Jason’s extensive thoughts on fasting from the blog along with Jimmy’s n=1 experiences and wraps them up in a cohesive comprehensive manual with a colourful bow.

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Jason and Jimmy both sent me a copy of their new 304-page book, The Complete Guide to Fasting, to review (thanks guys).   So here goes…

Similar to The Obesity Code, TCGTF is a compilation of ideas that Jason has developed on his Intensive Dietary Management blog.  Blogging is a great way to get the ideas together and thrash them out in a public forum.   Some people love to read the latest blog posts and debate the minutiae, however, most people would rather spend the $9 and sit down with a comprehensive book and get the full story.

Unlike The Obesity Code, TCGTF is a bright, ffull-colourproduction with great graphics that will make it worth buying the hard copy to have and to hold.

TCGTF did originally have the working title Fasting Clarity as a follow on from Jimmy’s previous Cholesterol Clarity and Keto Clarity.   However, other than Jimmy’s discussion of his n=1 fasting experiences, TCGTF is predominantly written in Jason’s voice building from his blog, so it wouldn’t be appropriate for it to have become the third in Jimmy’s Clarity series.

What is similar to Jimmy’s clarity series is that it’s easy to read and accessible for people who are looking for an entry level resource.  This book will be great for people who are interested in the idea of fasting.  It is indeed the complete guide to fasting and is full of references to studies, however, it doesn’t go into so much depth as to lose the average reader with scientific detail and jargon.

The book covers:

  • Jimmy’s n=1 experience with fasting,
  • Dr George Cahill’s seminal work on the effects of fasting on metabolism, glucose, ghrelin, insulin, and electrolytes,
  • the history of fasting over the centuries,
  • myth busting about fasting,
  • fasting in weight loss,
  • fasting and diabetes, physical health, and mental clarity,
  • managing hunger during a fast,
  • when not to fast, and
  • when fasting can go wrong.

The book is complete with a section on fasting fluids (water, coffee, tea, broth) and a range of different protocols that you can use depending on what suits you.  What did seem out of place are the recipes for proper meals.  Apparently, the publisher insisted they include these to widen the appeal (If you don’t like the fasting bit you’ve still got some new recipes?)

Overall, the book will be an obvious addition to the library (or Kindle) of people who are already fans of Jason and / or Jimmy and want a polished, consolidated presentation of all their previous work with a bunch of new material added.

TCGTF will also be a great read for someone who is interested learning more about fasting and wants to start at the beginning.   TCGTF is the most comprehensive book on the topic of fasting that I’m aware of.

my additional 2c…

Jason doesn’t mind weighing into a controversial argument, using some hyperbole or dropping the occasional F-bomb for effect and Jimmy’s no stranger to controversy either, so I thought I’d take this opportunity to give you my 2c on some of the topical issues at the fringe that aren’t specifically unpacked in the book.  We learn more as we thrash out the controversial issues at the fringes.   Many arguments come down to context.

target glucose levels

Jason has come under attack for using the word ‘cured’ in relation to HbAc1 values that most diabetes associations would consider non-diabetic,[2] though are not yet optimal.[3]

In the book Jason does discuss relaxing target blood glucose levels during fasting.  This makes sense for someone taking a slew of diabetic medications.   They’re probably not going to continue the journey if they end up in a hypoglycaemic coma on day one.

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The chart below shows the real life blood glucose variability for someone with Type 1 Diabetes on a standard diet.  With such massive fluctuations in glucose levels, it’s impossible to target ideal blood glucose levels (e.g. Dr Bernstein’s magic target blood glucose number of 4.6 mmol/L or 83 mg/dL).

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If your glucose levels are swinging wildly due to a poor diet coupled with lots of medication, your glucose levels are simply going to tank when you stop eating.  Hence, a safe approach is to back off the medication, at least initially, until your glucose levels have normalized.

Being married to someone with Type 1 Diabetes, I have learned the practical realities of getting blood glucose levels as low as possible while still avoiding dangerous lows.[4]  My wife Monica doesn’t feel well when her blood glucose levels are too low, but neither does she feel good with high blood glucose levels.  Balancing insulin and food to get blood glucose levels as low as possible without experiencing lows requires constant monitoring.

The chart below shows how scattered blood glucose levels can be even if you’re fairly well controlled.   Ideally you want the average blood glucose level to be as low as possible while minimising the number of hypoglycaemic episodes (i.e. below the red line).  If you can’t reduce the variability you just can’t bring the average blood glucose level down.  The last thing you want is to be eating to raise your blood glucose levels because you had too much blood glucose lowering medication.

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Pretty much everyone agrees that it’s dumb to be eating crap food and dosing with industrial levels of insulin to manage blood glucose levels.   High levels of exogenous insulin just drive the sugar that is not being used to be stored as fat in your belly, then your organs, and then in the more fragile places like your eyes and the brain.

Jason’s perspective is that people who are chronically insulin resistant and morbidly obese are likely producing more than enough insulin.  The last thing they need is exogenous insulin which will keep the fat locked up in their belly and vital organs.  Dropping insulin levels as low as possible using a low insulin load diet and fasting coupled with reducing medications will let the fat flow out.

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fasting to optimise blood glucose levels

In the long run, neither high insulin nor high glucose levels are optimal.

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Once you’ve broken the back of your insulin resistance with fasting, you can continue to drive your blood glucose levels down towards optimal levels.

One of the most popular articles on the Optimising Nutrition blog is how to use your glucose meter as a fuel gauge which details how you can time your fasting based on your blood glucose levels to ensure they continue to reduce.

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Your blood glucose levels can help calibrate your hunger and help you to understand if you really need to eat.  I think this is a great approach for people whose main issue is high blood glucose levels and who aren’t ready to launch into longer multi day fasts.

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In a similar way, a disciplined fasting routine can help optimise blood glucose levels in the long term.  The chart below shows a plot of Rebecca Latham’s blood glucose levels over three months where she used her fasting blood glucose numbers AND body weight to decide if she would eat on any given day.

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While there is some scatter in the blood glucose levels, you can see that regular fasting does help to reduce blood glucose levels over the long term.

Once you’ve lost your weight , broken the back of your insulin resistance and stopped eating crap food, you may find that you still need some exogenous insulin or other diabetic medication to optimise blood glucose levels if you have burned out your pancreas.

fasting frequency

The TGTF book covers off on several fasting regimens such as intermittent fasting, 24 hours, 36 hours, 42 hours and 7 to 14 days.  One concept that I’m intrigued by, similar to the idea of using your glucose meter as a fuel gauge, is using your bathroom scale as a fuel gauge.

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The reality, at least in my experience, is that we can overcompensate for our fasting during our feasting and end up not moving forward toward our goal.

If your goal is to lose weight I like the idea of tracking your weight and not eating on days that your weight is above your goal weight for that day.

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Again, Rebecca Latham has done a great job building an online community around the concept of using weight as a signal to fast through her Facebook group  My Low Carb Road – Fasting Support.

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The chart below shows Rebecca’s weight loss journey through 2016 where she initially targeted a weight loss of 0.2 pounds AND a reduction of 0.25 mg/dL in blood glucose per day.   After three months, she stabilized for a period (during a period when she had a number of major family issues to look after).  She is now using a less aggressive weight loss goal as she heads for her long-term target weight at the end of the year.

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The chart below shows the fasting frequency required to achieve her goals during 2016.  Tracking her weight against her target rate of weight loss has required her to fast a little more than one day in three to stay on track.

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Eating quality food is part of the battle, but managing how often you eat is also an important consideration.  After you’ve fasted for a few days, you can easily excuse yourself for eating more when you feast again.  And maybe it’s OK to enjoy your food when you do eat rather than tracking every calorie and trying to consciously limit them.

The obvious caveat is that there are a lot of other things that influence your scale weight such as muscle gain, water, GI tract contents etc, but this is another way to keep yourself accountable over the long term.

FAST WELL, FEED WELL

Fasting is a key component of the metabolic healing process, but it’s only one part of the story.

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Fasting is like ripping out your kitchen to put in a new one.   You have to demolish and remove the old stovetop to put the new shiny one back in.  You don’t sticky tape the new marble bench top over the crappy old Laminex.  You have to clean out the old junk before you implement the new, latest, and greatest model.

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In fasting, the demolition process is called autophagy, where the body ‘self eats’ the old proteins and aging body parts.   The great thing about minimising all food intake is that you get a deeper cleanse than other options such as fat fast, 500 calories per day or a protein sparing modified fast (PSMF).

But keep in mind that it’s the feast after the fast that builds up the shiny, new body parts that will help you live a longer, healthier, and happier life.

“Fasting without proper refeeding is called anorexia.” 

Mike Julian

Even fasting guru Valter Longo is now talking about the importance of feast / fast cycles rather than chronic restriction.  In the end you need to find the right balance of feasting / fasting, insulin / glucagon, mTOR / AMPK that is right for you.

In TCGTF, Jason and Jimmy talk about prioritising nutrient dense, natural, unprocessed,  low carb, moderate protein foods after the fast.  I’d like to reiterate that principle and emphasise that nutrient density becomes even more important if you are fasting regularly or for longer periods.

In the long term, I think your body will drive you to seek out more food if you’re not giving it the nutrients it needs to thrive.  Conversely, I think if you are providing your body with the nutrients it needs with the minimum of calories I think you will have a better chance of accessing your own body fat and reaching your fat loss goals.

optimising insulin levels AND nutrient density

It’s been great to see the concept of the food insulin index and insulin load being used by so many people!  In theory, when people reduce the insulin load of their diet they more easily access their own body fat and thus normalizes appetite.

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Some people who are very insulin resistant do well, at least initially, on a very high fat diet.  However, as glycogen levels are depleted and blood glucose levels start to normalise, I think it is prudent to transition to the most nutrient dense foods possible while still maintaining good (though maybe not yet optimal) blood glucose levels.

The problem with doubling down on reducing insulin by fasting combined with eating only ultra-low insulinogenic foods is that you end up “refeeding” with refined fat after your fast.

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While lowering carbs and improving food quality is the first step, I think that, as soon as possible you should start focusing on building up your metabolic machinery (i.e.  muscles and mitochondria).   A low carb nutrient dense diet is part of the story, but I don’t see many people with amazing insulin sensitivity that don’t also have a good amount of lean muscle mass which is critical to ‘glucose disposal’, good blood sugar levels and metabolic health.

This recent IHMC video from Doug McGuff provides a stark reminder of why we should all be focusing on maximising strength and lean muscle mass to slow aging.

The chart below shows a comparison of the nutrient density of the various dietary approaches.  Unfortunately, a super high fat diet is not necessarily going to be as nutrient dense and thus support muscle growth, weight loss, or optimal mitochondrial function as well as other options.

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The chart below (click to enlarge) shows a comparison of the various essential nutrients provided by a high fat therapeutic ketogenic dietary approach versus a nutrient dense approach that would suit someone who is insulin sensitive.

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I developed a range of lists of optimal foods that will help people in different situations with different goals to maximise the nutrient density that should be delivered in the feast after the fast.   The table below contains links to separate blog posts and printable .pdfs.  The table is sorted from highest to lowest nutrient density.   In time, you may be able to progress to a more nutrient dense set of foods as your insulin resistance improves.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

protein

Jason had  a “robust discussion” with Steve Phinney over the topic of ideal protein levels recently during the Q&A session at the recent Low Carb Vail Conference.

To give some context again, Phinney is used to dealing with athletes who require optimal performance and are looking to optimise strength.  Meanwhile Jason’s patient population is typically morbidly obese people who are on kidney dialysis and probably have some excess protein, as well as a lot of fat that they could donate to the cause of losing weight.

I also know that Jimmy is a fan of Ron Rosedale’s approach of minimising protein to minimise stimulation of mTOR.  Jimmy and Ron are currently working on another book (mTOR Clarity?).  Protein also stimulates mTOR which regulates growth which is great when you’re young but perhaps is not so great when you’ve grown more than enough.

The typical concern that people have with protein in a ketogenic context is that it raises blood insulin in people who are insulin resistant.  ‘Excess protein’ can be converted to blood glucose via gluconeogenesis in people who are insulin resistant and can’t metabolise fat very well.

Managing insulin dosing for someone with Type 1 Diabetes like my wife Monica is a real issue, though she doesn’t actively avoid protein.  She just needs to dose with adequate insulin for the protein being eaten to manage the glucose rise.

The chart below shows the difference in glucose and insulin response to protein in people who have Type 2 Diabetes (yellow lines) versus insulin sensitive (white lines) showing that someone who is insulin resistant will need more insulin to deal with the protein.

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As well as insulin resistance, these people are also “anabolic resistant” meaning that some of the protein that they eat is turned into glucose rather than muscle leaving them with muscles that are wasting away.

People who are insulin resistant are leaching protein into their bloodstream as glucose because they can’t mobilise their fat stores for fuel.  They are dependent on glucose and they’ll even catabolise their own muscle to get the glucose they need if they stop eating glucose.

While it’s nice to minimise insulin levels, I wonder whether people who are in this situation may actually need more protein to make up for the protein that is being lost by the conversion to glucose to enable them to maintain lean muscle mass.  Perhaps it’s actually the people who are insulin sensitive that can get away with lower levels of protein?

As well as improving diet quality which will reduce insulin and thus improve insulin resistance, in the long term it’s also very important to maintain and build muscle to be able to dispose of glucose efficiently and also improve insulin resistance.

In TCGTF Jason talks about the fact that the rate of the use of protein for fuel is reduced during a fast and someone becomes more insulin sensitive.  He goes to great lengths to point out that concern over muscle loss shouldn’t stop you trying out fasting (which is a valid point).

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A big part of the magic of fasting is that you clean out some of your oldest and dodgiest proteins in your body and set the stage for rebuilding back new high quality parts.   But the reality is that you will lose some protein from your body during a fast (though this is not altogether a bad thing).[5] [6]

Bodybuilders often talk about the “anabolic window” after a workout where they can maximise muscle growth after a workout.  Similarly, one of the awesome things about fasting is that you reduce your insulin resistance and anabolic resistance meaning that when at the end of your fast your body is primed to allocate the high quality nutrients you eat in the right place (i.e. your muscles not your belly or blood stream).

In the end, I think optimal protein intake has to be guided to some extent by appetite.  You’ll want more if you need it, and less if you don’t.

I think if we focus on eating from a shortlist of nutrient dense unprocessed foods we won’t have to worry too much about whether we should be eating 0.8 or 2.2 g/kg of lean body mass.

However, avoiding nutrient dense, protein-containing foods and instead “feasting” on processed fat when you break your fast will be counter-productive if your goal is weight loss and waste a golden opportunity to build new muscle.

are you really insulin resistant?

Insulin resistance and obesity is a continuum.

Not everyone who is obese is necessarily insulin resistant.

If you are really insulin resistant, then fasting, reducing carbs, and maybe increasing the fat content of your diet will enable you to improve your insulin resistance.  This will then help with appetite regulation because your ketones will kick in when your blood glucose levels drop.

However, if you continue to overdo your energy intake (e.g. by chasing high ketones with a super high fat, low protein diet), then chances are, just like your body is primed to store protein as muscle, you will be very effective at storing that dietary fat as body fat.

image05

I fear there are a lot of people who are obese but actually insulin sensitive who are pursuing a therapeutic ketogenic dietary approach in the belief that it will lead to weight loss.  If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help you identify your optimal dietary approach.

image19

optimal ketone levels

Measuring ketones is really fascinating but confusing as well.

“Don’t be a purple peetone chaser.”

Carrie Brown, The Ketovangelist Podcast Ep 78

Urine ketones strips have limited use and will disappear as you start to actually use the ketones for energy.

In a similar way blood ketones can be fleeting.  Some is better than none, but more is not necessarily better.  As shown in the chart of my seven day fast below I have had amazing ketones and felt really buzzed at that point but since then I haven’t been able to repeat this.  I think sometimes as your body adapts to burning fat for fuel the ketones may be really high but then as it becomes efficient it will stabilise and run at lower ketone levels even when fasting.

image27

If your ketone levels are high when fasting then that’s great.  Keep it up.  They might stay high.  They might decrease.  But don’t chase super high ketones in the fed state unless you are about to race the Tour de France or if you want your body to pump out some extra insulin to bring them back down and store them as fat.

image20

The chart below shows the sum of 1200 data points of ketones and blood glucose levels from about 30 people living a ketogenic lifestyle.  Some of the time they have really high blood ketone levels but I think the real magic of fasting happens when the energy in our bloodstream decreases and we force our body to rely on our own body fat stores.

the root cause of insulin resistance is…

So we’ve worked out that large amounts of processed carbs drive high blood glucose and insulin levels which is bad.

We’ve also worked out that insulin resistance drives insulin levels higher, which is bad.

But what is the root cause of insulin resistance?

I think Jason has touched on a key component in that, as with many things, resistance is caused by excess.  If we can normalise insulin levels, then our sensitivity to insulin will return, similar to our exposure to caffeine or alcohol.

However, at the same time, I think insulin resistance is potentially more fundamentally caused by our sluggish mitochondria that don’t have enough capacity (number or strength) to process the energy we are throwing at them, regardless of whether they come from protein, carbs, or fat.

image13

A low carb diet lowers the bar to enable us to normalise our blood glucose levels.  However, the other end of the spectrum is focusing on training our body and our mitochondria to be able to jump higher.  In the long term this is achieved through, among other things, maximising nutrient dense foods and building lean body mass through resistance exercise.

image23

summary

  1. The Complete Guide to Fasting is, as per the title, the complete guide to fasting. It’s the most comprehensive guide to the nuances of fasting out there and there’s a good balance between the technical detail, while still being accessible for the general public.
  2. Fasting can help optimise blood glucose and weight in the long term, with a disciplined regimen.
  3. Fasting makes the body more insulin sensitive and primes it for growth. When you feast after you fast, it is ideal to make sure you maximise nutrient density of the food you eat as much as possible while maintaining reasonable blood glucose levels.
  4. Understanding your current degree of insulin resistance can help you decide which nutritional approach is right for you. As you implement a fasting routine and transition from insulin resistance to insulin sensitivity you will likely benefit from transitioning from a low insulin load approach to a more nutrient dense approach.

references

[1] https://intensivedietarymanagement.com/of-traitors-and-truths/

[2] https://www.diabetes.org.uk/About_us/What-we-say/Diagnosis-ongoing-management-monitoring/New_diagnostic_criteria_for_diabetes/

[3] https://optimisingnutrition.com/2015/03/22/diabetes-102/

[4] https://optimisingnutrition.com/2015/08/17/balancing-diet-and-diabetes-medications/

[5] https://www.dropbox.com/s/h3pi53njcfu4czl/Physiological%20adaptation%20to%20prolonged%20starvation%20-%20Deranged%20Physiology.pdf?dl=0

[6] https://www.facebook.com/groups/optimisingnutrition/permalink/1602953576672351/?comment_id=1603210273313348&comment_tracking=%7B%22tn%22%3A%22R9%22%7D

are exogenous ketones right for you?

I’ve spent a lot of time lately analysing three thousand ketone vs. glucose data points trying to determine the optimal ketone and blood sugar levels for weight loss, diabetes management, athletic performance and longevity.

In this article, I share my insights and learnings on the benefits, side effects and risks of endogenous and endogenous ketosis.

Exogenous vs. endogenous ketosis

But first, I think it’s important to understand the difference between exogenous and endogenous ketosis:

  • Endogenous ketosis occurs when we go without food for a significant period. Our insulin levels drop, and we transition to burning body fat and ketones in our blood rise.
  • Exogenous ketosis occurs when we drink exogenous ketones or consume a ketogenic diet.

Ketones vs glucose

Ketones are important.  As blood glucose decreases, the ketones in your blood increase to keep our energy levels stable.

The chart below shows three thousand blood glucose vs ketone values measured at the same time from a range of people following a low carbohydrate or ketogenic diet.

BHB ketones vs blood glucose

While there is generally a linear relationship between glucose and ketones, each person has a unique relationship between their blood glucose and ketone values that provide a unique insight into a particular person’s metabolic health.

image02

Some people produce more ketones than others.  Some people have higher blood glucose levels.

What our ketone and glucose values tell us about our metabolic health

Hyperinsulinemia has been called as the “unifying theory of chronic disease” [1] [2] [3] [4] [5].  It’s beneficial to understand where you stand on the spectrum of metabolic health and insulin sensitivity.

The chart below shows the typical relationship between blood glucose and blood ketone for a range of different degrees of insulin resistance/sensitivity.

2017-04-17 (11)

If your blood glucose levels are consistently high it’s likely you are not metabolising carbohydrate well.   When you go without food, endogenous ketones are slow to kick in because your insulin levels are also high.  You feel tired and hungry, and you are likely to eat again sooner and not stop until you feel good.

By contrast, if you are insulin sensitive you may be able to go longer between meals naturally and you will not feel as compelled to eat as much or as often.  If someone is insulin resistant, a lower insulin load dietary approach will help with satiety and carb cravings while keeping blood glucose levels and insulin under control.

hyperinsulinemia and metabolic disorders

Exciting research is coming out underway looking at the use of EXOGENOUS ketones as an adjunct treatment for cancer or to provide energy directly to the mitochondria for people with epilepsy, dementia, Alzheimer’s and the like.[6]  [7]  

EXOGENOUS ketones may help to relieve the debilitating symptoms and side effects of acute hyperinsulinemia, Alzheimer’s, dementia, epilepsy or other conditions where glucose is not used well.

exogenous ketones and the low carb flu

Patrick Arnold, who worked with Dr Dominic D’Agostino to develop the first ketone esters and ketone salts, has noted that exogenous ketones may help alleviate the symptoms of the ‘keto flu’ during the transition from a high carb to a low carb dietary approach.


However, once you have successfully transitioned to a lower carb eating style it may be wise to reduce or eliminate the exogenous ketones to enable your body to fully up-regulate lipolysis (fat burning), maximise ENDOGENOUS ketone production and access your body fat stores.

As discussed in the article Are ketones insulinogenic and does it matter? it exogenous ketones require about half as much insulin as carbohydrate to metabolise (or about the same amount as protein).  Hence the continual use of exogenous ketones will limit how much our insulin levels are able to decrease.

Someone with diabetes who follows with a nutrient dense low insulin load dietary approach may be able to successfully normalise their blood glucose and insulin levels. When this happens, your liver will be able to more easily produce ENDOGENOUS ketones which will help improve satiety between meals and decrease appetite which will, in turn, lead to weight loss.

Exercising to train your body to do more with less is also helpful.

image20

my experience with exogenous ketones

The light blue “mild insulin resistance” line is based on my ketone and glucose tests when I started trying to wrap my head around low carb/keto.

image

I enthusiastically started adding generous amounts of fat from all the yummy stuff (cheese, butter, cream, peanut butter, BPC etc) in the hope of achieving higher ketone levels and therefore weight loss, but I just got fatter and more inflamed as you can see in the photo on the left.

image05

My blood tests suggested I was developing fatty liver in my mid-30s!  And I thought I was doing it right with lots of bacon and BPC?!?!?

image5

The photo on the right is after I worked out how to decrease the insulin load of my diet and learning about intermittent fasting.  I realised that ENDOGENOUS ketosis and weight loss is caused by a lower dietary insulin load, not more EXOGENOUS fat on your plate or in your coffee cup.

I recently had my HbA1c tested at 4.9%.  It’s getting there.  But knowing what I know now about the importance of glucose control,  I would love to lose a bit more weight and see my HbA1c even lower.

I initially purchased a couple of bottles of KetoCaNa after hearing a number of podcast interviews with Dominic D’Agostino and Patrick Arnold.[8] [9]

Part of the reasons shelling out the money for the exogenous ketones was to see if it would provide a fuel source that didn’t need insulin for my wife Monica who has Type 1 Diabetes.

This metabolic jet fuel is definitely fascinating stuff!  My experience is that it gave me a buzz like a BPC but also has an acute diuretic effect.

I had hoped it would have a weight loss effect like some people seemed to be saying it would.

2016-08-10

I did find it had an amazing impact on my appetite.  While it was in my system I didn’t care as much about food.  However, once the ketones were used up my appetite came flooding back.

image17

Unfortunately, my hunger and subsequent binge eating seemed to more than offset the short term appetite suppression that had occurred while the exogenous ketones were in my system.  And it was not going to be financially viable for me to maintain a constant level of artificially elevated ketone levels which return to normal levels after a couple of hours.

do exogenous ketones help with weight loss?

I asked around to see if anyone had come across studies demonstrating long term weight loss effects of exogenous ketones.[11]   It was a VERY enlightening discussion if you want to check it out here.

image30

The Pruvit FAQ says that one of the benefits of Keto//OS is weight loss.  However, no reference to the research studies was provided to prove his claim.

AVPageView 11082016 13036 PM.bmp.jpg

Also, the studies that were referenced in the Pruvit FAQ all appeared to relate to the benefits of ENDOGENOUS or nutritional ketosis rather than EXOGENOUS ketone supplementation.

Princess_Bride_That_Word

According to Dominic D’Agostino in a Pruvit teleseminar, the EXOGENOUS ketone salts were not designed to be a weight loss product and hence have not been studied for weight loss after all!

The only studies that we could find that mentioned EXOGENOUS ketone supplementation and weight loss were on rats and they found that there was no long term effect on weight loss.[12]   

So in spite of my hopeful $250 outlay, it seems that exogenous ketones ARE just a fuel source after all.

image06

Even the experts don’t seem to think exogenous ketones help with fat loss.

image25

image28

image16 [13]

Confused?

I don’t blame you.

Metabolically healthy

The “metabolically healthy” line in the chart above is based on RD Dikeman’s ketone and glucose data when he fasted for 21 days.

image32

Due to his hard-earned metabolic health and improved insulin resistance RD has developed the ability to fairly easily release ketones when he doesn’t eat for a while.  RD still doesn’t find going without food effortless, but it is easier than when his insulin levels were much higher which prevented his body from accessing his body fat stores.

2016-08-10 (2).png

Through a disciplined diet and exercise habits RD has achieved a spectacular HbA1c of 4.4%.

image04

Perhaps a two or three day water only fast testing blood glucose and ketones with no exercise would be a useful test of your insulin status?  You could use RD’s glucose : ketone gradient as the gold standard.

RD also told me that when he is not fasting and is eating his regular nutrient dense higher protein meals his ketone levels are not particularly high. While RD fairly easily produces ketones when fasting, it seems they are also quickly metabolised so they do not build up in his bloodstream.

I know Luis Villasenor from Ketogains finds the same thing.

image10

total energy = ketones + glucose

Where this gets even more interesting is when we look at the glucose and ketone data in terms of TOTAL ENERGY.  That is, the energy coming from both glucose and ketones.

The average TOTAL ENERGY of the three thousand data points from these healthy people working hard to achieve nutritional ketosis is around 6.0mmol/L. It seems the body works to maintain homoeostasis around this level.

optimal fasting ketone and blood sugar levels in ketosis

When the TOTAL ENERGY in our bloodstream increases outside of the normal range it the body raises insulin to store the excess energy.  That is, unless you have untreated type 1 diabetes, in which case you end up in diabetic ketoacidosis with high blood glucose and high ketones due to the lack of insulin available to keep your energy in storage.

Regardless of whether your energy takes the form of glucose, ketones or free fatty acids, they all contribute to acetyl-coA which is oxidised to produce energy.  Forcing excess unused energy to build up in the bloodstream is typically desirable and can lead to long term issues (e.g. glycation, oxidised LDL etc).

I’m not sure if ketones can be converted to glucose or body fat, but it makes sense that excess glucose would be converted to body fat via de novo lipogenesis to decrease the TOTAL ENERGY in the blood stream to normal levels.

A number of studies seem to support this view including Roger Unger’s 1964 paper the Hypoglycemic Action of Ketones.  Evidence for a Stimulatory Feedback of Ketones on the Pancreatic Beta Cells.[14]

Ketone bodies have effects on insulin and glucagon secretions that potentially contribute to the control of the rate of their own formation because of antilipolytic and lipolytic hormones, respectively.  Ketones also have a direct inhibitory effect on lipolysis in adipose tissue.[15]

image26[16] [17] [18]

Looking at the glucose and ketones together in terms of TOTAL ENERGY was a bit of an ‘ah ha’ moment for me.  It helped me to understand why people like Thomas Seyfried and Dominic D’Agostino always talk about the therapeutic benefits and the insulin lowering effects of a calorie restricted ketogenic diet. [19] [20] [21] [22]

Dealing with high ketones and high glucose is typically not a concern because it doesn’t happen in nature or when eating whole foods.  But now we have refined grains, HFCS, processed fats and exogenous ketones to ‘bio hack’ our metabolism and send it into overdrive.

While fat doesn’t normally trigger an insulin response, it seems that excess unused energy, regardless of the source, will trigger an increase in insulin to reduce the TOTAL ENERGY in the blood stream.

I am concerned that if people continue to enthusiastically zealously focus on pursuing higher blood ketones “through whatever means you can[24] in an effort to amplify fat loss they will promote excess energy in the bloodstream which will lead to insulin resistance and hyperinsulinemia.

Using multi-level marketing tactics to distribute therapeutic supplements to the uneducated masses who are desperate to lose weight with a ‘more is better’ approach also troubles me deeply.

My heart sank when I saw this video.

MORE investigation required?

There are anecdotal reports that exogenous ketones provide mental clarity, enhanced focus and athletic performance benefits.  At the same time, there are also people who have been taking these products for a while that don’t appear to be doing so well.

A July 2016 study Ketone Bodies and Exercise Performance: The Next Magic Bullet or Merely Hype? didn’t find that EXOGENOUS ketones to be very exciting.

Recently, ketone body supplements (ketone salts and esters) have emerged and may be used to rapidly increase ketone body availability, without the need to first adapt to a ketogenic diet. However, the extent to which ketone bodies regulate skeletal muscle bioenergetics and substrate metabolism during prolonged endurance-type exercise of varying intensity and duration remains unknown. Therefore, at present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes’ performance under conditions where evidence-based nutritional strategies are applied appropriately.

However, another study by Veech et al (who is trying to bring his own ketone ester to market) from August 2016 Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes found in favour of ketones.

Ketosis decreased muscle glycolysis and plasma lactate concentrations, while providing an alternative substrate for oxidative phosphorylation. Ketosis increased intramuscular triacylglycerol oxidation during exercise, even in the presence of normal muscle glycogen, co-ingested carbohydrate and elevated insulin. These findings may hold clues to greater human potential and a better understanding of fuel metabolism in health and disease.

I can understand how exogenous ketones could be beneficial for someone who is metabolically healthy and consuming a disciplined hypo-caloric nutrient dense diet. They would likely be able to auto regulate their appetite to easily offset the energy from the EXOGENOUS ketones with less food intake.

While it seems that EXOGENOUS ketones assist in relieving the symptoms of metabolic disorders I’m yet to be convinced that a someone who is obese and / or has Type 2 Diabetes would do as well in the long term, especially if they were hammering both more fat and exogenous ketones (along with maybe some sneaky processed carbs on the side) in an effort to get their blood ketones as higher in the hope of losing body fat.

Some questions that I couldn’t find addressed in the Pruvit FAQ that I think would be interesting to answer through a controlled study in the future are:

  1. What is the safe dose limit of EXOGENOUS ketones for a young child?  How would you adjust their maximum intake based on age and weight?
  2. IF EXOGENOUS ketones do have a long term weight loss effect what is the upper limit of intake of EXOGENOUS ketones to avoid stunting a child’s growth?
  3. Is there a difference in the way EXOGENOUS ketones are processed in someone is metabolically healthy versus someone who is very insulin resistant?
  4. Does the effect on appetite continue beyond the point that the ketones are out of your system?
  5. Do you need to take EXOGENOUS ketones continuously to maintain appetite suppression?  Does the effect of ENDOGENOUS wear off as your own ENDOGENOUS ketone production down regulates?  Do you need to keep taking more and more EXOGENOUS ketones to maintain healthy appetite control?
  6. How should someone with Type 2 Diabetes adjust their medication and insulin dose based on their dose of EXOGENOUS ketones?  Should they be under medical supervision during this period?
  7. Is there a difference in health outcome if you are taking EXOGENOUS ketones in the context of a hypocaloric ketogenic diet versus a hypercaloric ketogenic diet?  What about a diet high in processed carbs?
  8. Is there a minimum effective dose to achieve optimal long term benefits to your metabolic health or is MORE better?
  9. Are the long term health benefits of EXOGENOUS ketones equivalent to a calorie restricted ketogenic diet?

Unfortunately, I think we will find the answers to these questions sooner rather than later with the large scale experiment that now seems to be well underway.

Perhaps the burden of proof is actually on Pruvit to prove it rather getting their Pruvers to demonstrate that within 59 minutes they are successfully peeing out the product they’ve just paid some serious money for!

The lower the better?

Alessandro Ferretti recently made the observation that metabolically healthy people tend to have lower TOTAL ENERGY levels at rest (and hence have a lower HbA1c), but are able to quickly mobilize glycogen and fat easily when required (e.g. when fasting or a sprint).

Metabolically healthy people are both metabolically flexible[25] and metabolically efficient.[26]   These people would have been able to both conserve energy during a famine and run away from a tiger and live to become our ancestors, while the ones who couldn’t didn’t.

image29

Similar to RD Dikeman, John Halloran is an interesting case.  He has been putting a lot of effort into eating nutrient dense foods, intermittent fasting and high-intensity exercise.

image13

He is also committed to improving his metabolic fitness to be more competitive in ice hockey.  His resting heart rate is now a spectacular 45 bpm!

image08

And he’s been able to lose 10kg (22lb) in one month!

image12

At 5.2mmol/L (i.e. glucose of 4.0mmol/L plus ketones of 1.2mmol/L) John’s TOTAL ENERGY is well below the average of the 26 people shown in the glucose + ketone chart above.  It seems excellent metabolic health is actually characterised by lower TOTAL ENERGY.

MORE is not necessarily BETTER when it comes to health.

Fast well, feed well

To clean up the data a little I removed the ketones vs glucose data points for a couple of people who I thought might be suffering from pancreatic beta cell burnout and one person that was taking exogenous ketones during their fast that had a higher TOTAL ENERGY.  I also removed the top 30% of points that I thought were likely high due to measuring after high-fat meals or coffee.

So now the chart below represents the glucose and ketone values for a group of reasonably metabolically healthy people following a strict ketogenic dietary approach, excluding for the effect of high-fat meals, BPC, fat bombs and the like.

image22

The average ketone value for this group of healthy people trying to live a ketogenic lifestyle is 0.7mmol/L. Their average glucose is 4.8mmol/L (or 87mg/dL).  The average TOTAL ENERGY is 5.5mmol/L or 99mg/dL.

ketones (mmol/L)

blood glucose (mmol/L)

total energy (mmol/L)

average

0.7

4.8

5.5

30th percentile

0.4

4.6

5.2

70th percentile

0.9

5.1

5.8

The table below shows this in US units (mg/dL).

ketones
(mmol/L)

blood
glucose (mg/dL)

total
energy (mg/dL)

average

0.7

86

99

30th percentile

0.4

83

94

70th percentile

0.9

92

104

It seems we may not necessarily see really high ketone levels in our blood even if we follow a strict ketogenic diet, particularly if we are metabolically healthy and our body is using to ketones efficiently.

the real magic of ketones

When we deplete glucose we train our body to produce ketones.

This is where autophagy, increased NAD+ and SIRT1 kicks in to trigger mitochondrial biogenesis and ENDOGENOUS ketone production (i.e. the free ones).[27]   The REAL magic of ketosis happens when all these things happen and ketones are released as a byproduct.

I do not believe that simply adding EXOGENOUS ketones will have nearly as much benefit to your mitochondria, metabolism and insulin resistance as training your body to produce ENDOGENOUS ketones in a low energy state.

Everything improves when we train our bodies to do more with less (e.g. fasting, high-intensity exercise, or even better fasted HIIT).  Resistance to insulin will improve as your insulin receptors are no longer flooded with insulin caused by high TOTAL ENERGY building up in your bloodstream (i.e. from glucose, ketones and even free fatty acids).

image01

Driving up ketones artificially through EXOGENOUS inputs (treating the symptom) does NOT lead to increased metabolic health or mitochondrial biogenesis (cure) particularly if you are driving them higher than normal levels and not using them up with activity.

You may be able to artificially mimic the buzz that you would get when the body produces ketones ENDOGENOUSLY, however, it seems you may just be driving insulin resistance and hyperinsulinemia if you follow a “MORE is better” approach.

Simply managing symptoms with patented products for profit without addressing the underlying cause often doesn’t end well.

Perhaps as more exogenous products come to market without the marketing hype that that comes with multi level marketing (e.g. Julian Baker’s Insta Ketone which are a sixth of the price of the Pruvit products) people will get to see if they really do anything useful.

Just like having low blood glucose is not necessarily good if it is primarily caused by high levels of EXOGENOUS insulin coupled with a poor diet or having lower cholesterol due to statins, having high blood ketone values is not necessarily a good thing if it is achieved it by driving up the TOTAL ENERGY in your blood stream with high levels of purified fat and/or EXOGENOUS ketones.

nutrient density

When we feed our body with quality nutrients we maximise ATP production which will make us feel energised and satisfied.  Nutrient dense foods will nourish our mitochondria and reduce our drive to keep on seeking out nutrients from more food.

Greater metabolic efficiency will lead to higher satiety, which leads to less food intake, which leads to a lower TOTAL ENERGY, increased mitochondrial biogenesis, improved insulin sensitivity and lower blood glucose levels.

Prioritising nutrient dense real food is even more important in a ketogenic context.[28]  While we can always take supplements, separating nutrients from our energy source is never a great idea, whether it be soda, processed grains, sugar, glucose gels, HFCS, protein powders, processed oils or exogenous ketones.

the best exogenous ketone supplement

If your goal is metabolic health, weight loss and improving your ability to produce ENDOGENOUS ketones, then developing a practice of FEASTING and FASTING is important.

To start out, experiment by extending your fasting periods until your TOTAL ENERGY is decreasing over time.  This will cause your circulating insulin levels to decrease which will force your body to produce ENDOGENOUS ketones from your ENDOGENOUS fat stores.

best exogenous ketone supplement

Check out the how to use your glucose meter as a fuel gauge article or how to use your bathroom scale as a fuel gauge for some more ideas on how to get started with fasting.

If you want to measure something, see how low you can get your glucose levels before your next meal.  Then when you do eat, make sure you choose the most nutrient dense foods you possibly can to build your metabolic machinery and give your mitochondria the best chance of supporting a vibrant, active and happy life.

As my wise friend Raymund Edwards keeps reminding me, FAST WELL, FEED WELL.

 

 

references

[1] http://www.thefatemperor.com/blog/2015/5/6/the-incredible-dr-joseph-kraft-his-work-on-type-2-diabetes-insulin-reigns-disease

[2] http://www.thefatemperor.com/blog/2015/5/10/lchf-the-genius-of-dr-joseph-r-kraft-exposing-the-true-extent-of-diabetes

[3] https://profgrant.com/2013/08/16/joseph-kraft-why-hyperinsulinemia-matters/

[4] https://www.amazon.com/Diabetes-Epidemic-You-Joseph-Kraft/dp/1425168094

[5] https://www.youtube.com/watch?v=193BP6aORwY

[6] http://fourhourworkweek.com/2016/07/06/dom-dagostino-part-2/

[7] http://www.thelivinlowcarbshow.com/shownotes/10568/848-dr-dominic-dagostino-keto-clarity-expert-interview/

[8] http://superhumanradio.com/579-shr-exclusive-patrick-arnold-back-in-the-supplement-business.html

[9] http://superhumanradio.com/shr-1330-best-practices-for-using-ketone-salts-for-dieting-performance-and-therapeutic-purposes.html

[10] http://docmuscles.shopketo.com/

[11] https://www.facebook.com/groups/optimisingnutrition/permalink/1574631349504574/

[12] https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-016-0069-y

[13] https://www.facebook.com/groups/optimisingnutrition/permalink/1574631349504574/

[14] https://www.dropbox.com/s/287bftreipfpf29/jcinvest00459-0078.pdf?dl=0

[15] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129159/

[16] https://www.facebook.com/BurnFatNotSugar/

[17] http://www.dietdoctor.com/obesity-caused-much-insulin

[18] http://www.lowcarbcruiseinfo.com/2016/2016-presentations/Hyperinsulinemia.pptx

[19] http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0115147

[20] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/

[21] http://healthimpactnews.com/2013/ketogenic-diet-in-combination-with-calorie-restriction-and-hyperbaric-treatment-offer-new-hope-in-quest-for-non-toxic-cancer-treatment/

[22] https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjK8Jvku7DOAhUJspQKHS5-DkwQFggbMAA&url=http%3A%2F%2Fwww.rsg1foundation.com%2Fdocs%2Fpatient-resources%2FThe%2520Restricted%2520Ketogenic%2520Diet%2520An%2520Alternative.pdf&usg=AFQjCNFuTA7xmWX1pFr6wBTV_hsS7C5j_w&sig2=pcBN_f_kCLSgFKYUy–uug&bvm=bv.129391328,d.dGo

[23] https://www.facebook.com/DocMuscles/videos/10210426555960535/?comment_id=10210431467003308&comment_tracking=%7B%22tn%22%3A%22R9%22%7D&pnref=story&hc_location=ufi

[24] https://www.facebook.com/DocMuscles/videos/10210426555960535/?comment_id=10210431467003308&comment_tracking=%7B%22tn%22%3A%22R4%22%7D&hc_location=ufi

[25] http://guruperformance.com/episode-3-metabolic-flexibility-with-mike-t-nelson-phd/

[26] http://guruperformance.com/tag/metabolic-efficiency/

[27] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852209/

[28] http://ketotalk.com/2016/06/23-responding-to-the-paleo-mom-dr-sarah-ballantynes-claims-against-the-ketogenic-diet/

 

post last updated: July 2017

REVERSION Y REMISION DE LA DIABETES TIPO 2 CASO DE ANTONIO C. MARTINEZ II

¿Puede el ayuno intermitente optimizar los niveles de glucosa en la sangre y reducir la necesidad de medicamentos para la diabetes? Antonio Martínez estaba ansioso por descubrirlo, por lo que se propuso realizar un experimento con él mismo.

[for the English version of this post click here]

El Dr. Antonio C. Martinez II., es un Abogado reconocido de nivel distinguido por Martindale Hubbard, y de la Red Legal de los Mejores Abogados (Top Lawyers) en Nueva York y un hombre de negocios que trabajó para el ya fenecido Dr. Robert C. Atkins MD en relaciones gubernamentales y apareció en su programa de radio en los años 90. Fue uno de los principales cabilderos que logró la aprobación de la Ley de Educación y Salud de los Suplementos Dietéticos de 1994 (DSHEA). Ha participado activamente en cuestiones de salud en las leyes y políticas a lo largo de su carrera. En los años 90 Antonio adoptó un enfoque bajo en carbohidratos para bajar de peso durante un tiempo, pero luego retomó una dieta moderada en carbohidratos. No fue hasta que Antonio comenzó a tener sus propios problemas de salud, como la diabetes tipo 2 y un ataque cardíaco, que se dio cuenta que necesitaba intensificar sus esfuerzos para elevar la calidad de su nivel de vida con respecto a su salud.

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DIAGNOSTICO: DIABETES TIPO 2

Antonio tiene antecedentes familiares de diabetes tipo 2, ya que ambos padres sufren de la enfermedad, así que es diagnosticado con diabetes tipo 2 en 2002, por lo que los médicos le indicaron inicialmente empezar a tomar Metformina y a partir del 2008 utilizar Janumet. Con la ayuda de éstos Antonio mantenía un HbA1c (HbA1c se refiere a la hemoglobina glucosilada ( A1c ), que identifica la concentración promedio de glucosa en plasma)  en los 6s y fue elogiado por sus médicos por su gran control de la glucosa en sangre, sin embargo, a pesar de que los mantuvo por debajo de los recomendados por la Asociación Americana de Diabetes (un máximo de HbA1c del 7%) ,  Antonio en realidad estaba en el rango de alto riesgo para la enfermedad cardiovascular, como se muestra en la siguiente tabla. Durante este tiempo él siempre fue informado por sus médicos de que su A1c estaba entre 6 y 7 se encontraba dentro de las directrices médicas.

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Si bien los medicamentos antidiabéticos ayudan a disminuir los niveles de glucosa en la sangre (es decir, el de los síntomas) estos datos que se muestran a continuación muestran que los medicamentos no reducen necesariamente el riesgo de enfermedades o permiten que la grasa de sus órganos puedan ser lanzados para restaurar la sensibilidad a la insulina (es decir, la solución).

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Como se muestra en la tabla a continuación, la insulina es una hormona anabólica que permite que el cuerpo construya reservas de energía en el cuerpo. Sin embargo, si su problema es la hiperinsulina, la diabetes tipo 2 o hígado graso, entonces su objetivo debe ser reducir el nivel de glucosa en la sangre y los niveles de insulina para permitir que la grasa almacenada se metabolice a energía. Parece que simplemente tomando medicamentos para reducir el alto nivel de glucosa en la sangre sin cambios en la dieta va a conducir la energía de nuevo en el almacenamiento en forma de grasa, incluso dentro el corazón, el hígado y el páncreas.

El siguiente diagrama del Dr. Ted Naiman ayuda a explicar cómo la resistencia a la insulina, los niveles altos de insulina (hiperinsulina) y azúcar en la sangre (hiperglucemia) están interelacionados y ambas cosas son malas noticias.

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ATAQUE CARDIACO

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Lamentablemente el 28 de marzo de 2014 Antonio sufrió un ataque al corazón, razón por la cual le colocaron un stent en una arteria. A su ingreso en el hospital pesaba 158 libras y tenía una HbA1c del 7%. Después de su ataque cardíaco, Antonio se le indicó tomar aspirina, medicamentos para la presión arterial, una estatina, un anticoagulante y un bloqueador beta. En poco tiempo comenzó a sentir los efectos secundarios de las medicaciones múltiples. Frustrado, volvió a leer una serie de materiales de salud y medicina y dijo a sus médicos que no estaría tomando medicamentos para el resto de su vida. También vio el documental “Cereal Killers – Asesinos del Cereales”, que fue como una luz en su camino para seguir dando los pasos necesarios en los cambios de sus hábitos para su restablecimiento.

Ver este video a continuación:

https://www.youtube.com/watch?v=dON-fPp5Hy0

DIETA BAJA EN CARBOHIDRATOS

En julio de 2014 Antonio dijo a su médico de cabecera y a su cardiólogo que iba hacer una dieta baja en carbohidratos y rica en grasas. Mientras que sus médicos no le aconsejaron nada en contra de ella, eran escépticos y le advirtieron que tendría que hacerse un análisis hecho con frecuencia para controlar el impacto de la dieta. A continuación, para septiembre de 2014 Antonio recibió una llamada de su médico quien le dijo: “¡felicidades, lo que sea que está haciendo, sígalo haciendo, tiene usted un HbA1c normal!, por lo que le recomendaron dejar de tomar el medicamento Janumet y como forma de control que siguiera tomando el Metformin”. Como se muestra a continuación, el HbA1c de Antonio había bajado del 6,6% al 4,9% con el enfoque de la dieta baja en carbohidratos, también había rebajado trece libras, por lo que se encontraba ahora con 145 libras, mientras que su presión arterial se había normalizado, su HDL aumentó en 20 puntos y sus triglicéridos habían disminuido por debajo de 100 mg / dl.

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ELIMINANDO EL FENOMENO DEL ALBA EN LA DIABETES TIPO II

A pesar de comer sólo dos comidas bajas en carbohidratos por día, Antonio observó que a finales del 2015 sus niveles de azúcar en sangre comenzaban a dispararse hacia arriba en horas de la mañana.

El fenómeno del amanecer es el proceso en el que el cuerpo segrega una serie de hormonas y la glucosa en el torrente sanguíneo, en preparación para el día, sin embargo, si usted es resistente a la insulina entonces la respuesta de la insulina puede no ser adecuada para mantener los niveles normales de glucosa en la sangre, por lo que Antonio después de haber sufrido un ataque al corazón se tomó esto en serio y estaba dispuesto a hacer lo que fuese necesario para revertir esta situación, así que para poner en marcha el nuevo año, Antonio adoptó un régimen regular de ayuno intermitente que involucró a ir a la cama sin cenar el domingo por la noche y luego no comer hasta el martes por la noche, ofreciéndole esto una ventana de ayuno de 44 a 48 horas cada semana. La siguiente tabla muestra los números de glucosa en la sangre de Antonio hasta diciembre antes del protocolo de ayuno y luego a través de enero y febrero con el protocolo de ayuno en su lugar.

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La vida real de los números de la glucosa en la sangre siempre van a rebotar, sin embargo, se puede ver que los valores promedio de glucosa en sangre de Antonio han mejorado mucho. Sus números de glucosa en sangre por la mañana se muestran a continuación. “Estoy consiguiendo los mejores números que he tenido y sin fenómeno del amanecer”, dice Antonio.

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Mientras que los ayunos más largos están trabajando bien para Antonio, también puede utilizar períodos de ayuno más cortos regulares para mantener su glucosa en la sangre hacia abajo. Echa un vistazo a la sección: usando el medidor de glucosa en su artículo como un indicador de combustible para que obtengan algunas ideas sobre cómo puede asegurarse de que su glucosa en sangre promedio sea una tendencia en la dirección correcta.

Una forma de ver los niveles de glucosa en la sangre y el fenómeno del amanecer es la manera del cuerpo de liberar el exceso de energía almacenada en el torrente sanguíneo para ser utilizado. Si usted es resistente a la insulina del cuerpo va a utilizar un proceso llamado gluconeogénesis para convertir el exceso de proteínas, grasas e incluso hasta cierto punto, en glucosa. Una vez que el exceso de grasa de las personas disminuye, la frecuencia será más sensible a la insulina y el cuerpo detendrá el bombeo de este exceso de glucosa en el torrente sanguíneo.

HBA1C

Comenzando con una HbA1c de 5,1% se notaba que Antonio ya había realizado buenas modificaciones con los cambios en su dieta debido a su baja ingesta en carbohidratos bajo un enfoque disciplinado. Sin embargo, la adición del protocolo de ayuno le ayudó a fundar sobre una buena base y a hacer posible que sus niveles de glucosa en la sangre disminuyeran aún más que los niveles óptimos y en base a esto sus valores de glucosa en sangre ahora tienen un HbA1c de alrededor del 4,6%.

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CETONAS

Las cetonas de Antonio son estables, pero en realidad con tendencia a la baja después de la introducción del régimen de ayuno. El hecho de que Antonio tiene valores más bajos de cetonas no es realmente una preocupación dado que él está probablemente utilizando sus cetonas de manera más eficaz de la energía en lugar de dejar que se acumulen en la sangre como podría ser el caso con una dieta alta en grasa y sin ayuno.

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Creo que muchas personas se meten en problemas persiguiendo a altos valores de cetona, añadiendo más grasa dietética sin mejorar su metabolismo y la sensibilidad a la insulina, hasta el punto en que realmente puede utilizar las cetonas. El ayuno da fuerzas al cuerpo para aprender a usar cetonas como combustible.

GLUCOSA: INDICE DE CETONA

La relación entre la glucosa y las cetonas (GKI) pueden ser una medida más útil cuando los niveles de glucosa en la sangre se están reduciendo. Un GKI reductor es una indicación de que los niveles de insulina están disminuyendo y su salud metabólica está mejorando. Podemos ver en el gráfico a continuación la glucosa de Antonio: relación de cetona (GKI) que mejora cada vez que ayuna y que está en una baja tendencia con el tiempo. Estos valores bajos GKI indican que él está logrando una excelente salud metabólica.

Thomas Seyfried GKI es una herramienta útil para el seguimiento de su salud metabólica una vez que sus valores de glucosa en sangre están acercando a los niveles óptimos. Seyfried apunta a sus pacientes de cáncer para tienen una GKI de 1,0, aunque un GKI debajo de 10 se considera que es un estado de insulina bastante bajo y que en menos de tres es excelente para la salud metabólica de alguien que no esté persiguiendo una cetosis terapéutica.

¿NO HAY VUELTA A ATRÁS?

Antonio sigue disfrutando de los ayunos semanales durante el cual se centra en beber grandes cantidades de té, café y un poco de caldo de hueso, ingiere también varios suplementos dietéticos y una aspirina diaria. Su peso ahora se ha reducido a 141 libras y ha vuelto a usar la misma talla de ropa que solía llevar durante estuvo en la universidad.

Cuando sus amigos le preguntan cómo ha logrado revertir su diabetes tipo 2 y cómo ha logrado perder peso, él responde: “lo he logrado al comer una dieta baja en carbohidratos y rica en grasas en base a comer comida de verdad. Yo trabajo para mantener la mayor cantidad de mis alimentos en el rango del 70% de grasa, 20% por ciento de proteínas y un10% de carbohidratos como mis objetivos ideales. Yo miro mi ingesta de proteínas, porque el exceso convertirá a través de la gluconeogénesis. “Yo me propongo mantener este enfoque para el resto de mi vida, pues amo los resultados que esta dieta ha proporcionado a mi nuevo estilo de vida! ”

Antonio dice: Otra manera de mirar la resistencia a la insulina es su cuerpo, ya que éste le dice que usted está comiendo en exceso, ya sean demasiadas cosas inadecuadas o simplemente comer demasiado a menudo. Nuestros antepasados ​​eran cazadores recolectores cuyos hábitos de alimentación eran más como escasez y abundancia, no de tres comidas con bocadillos. Conozca y respete la insulina, ya que ésta le dirá cómo puedo hacerlo y si no atiende a sus señales le podrá causar estragos en su salud metabólica.

También puede pensar en su medidor de glucosa en sangre como indicador de combustible. Si sus niveles de glucosa en la sangre son altos, entonces podría ser el momento de dejar de llenar el depósito de combustible por un tiempo. El ayuno intermitente es como ir a un gimnasio metabólico y de trabajo. El cuerpo obtiene la oportunidad de reparar, recuperar y regenerarse si se utiliza de forma inteligente lo que hará la diferencia para su salud y para los sensibilizadores a la insulina.

Estoy decepcionado en el establecimiento médico, ya que deben saber mejor que yo lo que hay que hacer y no lo hacen. ¿Por qué no es la educación en nutrición clínica y terapéutica obligatoria en la escuela de medicina y no es enseñado con el mismo énfasis que la farmacología?

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Con el ex líder de la mayoría del Senado EE.UU, Tom Daschle (SD) en Washington DC, febrero  2016.

¿CURADO?

¿Antonio está curado de su diabetes tipo 2? La respuesta depende de su definición de “curado”.

¿Antonio va a ser capaz de comer comida chatarra y alimentos procesados ​​cinco veces al día? Probablemente, no, sin embargo, si Antonio mantiene este protocolo en ayunas junto con su enfoque bajo en carbohidratos entonces él podría ser capaz de mantener los niveles óptimos de glucosa en sangre sin temor a otro ataque al corazón. Si ese es su definición de “curado”, la respuesta podría ser sí.

Felicidades Antonio y mantener el gran trabajo!

Referencias:

[1] http://www.thelivinlowcarbshow.com/shownotes/12960/997-attorney-Antonio-martinez-pushing-lchf-through-public-policy-and-the-law/

[2] http://www.cardiab.com/content/12/1/164

[3] http://www.fitnessunderoath.com/the-44-hour-diet/

[4] http://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

Contacto:

Si usted está atravesando por una experiencia similar a la de Antonio, a él le encanta oír de usted a través de su correo email acmartinezlaw@gmail.com o su página web en www.acmartinez2.com

Agradecimientos:  A la Ing. Julia Angelica Mariñez por la traducción del ingles al español.

 

what is a ‘well formulated ketogenic diet’?

While everyone uses fat for fuel to some degree, a ketogenic diet aims to reduce insulin levels to a point where ketone levels are high enough to be measured in the blood, breath or urine. [1]

In starvation, insulin levels plummet with glucose levels coming down and ketone levels increase progressively.

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According to Dr Steve Phinney’s chart below, a “well formulated ketogenic diet” contains between 3 and 20% carbohydrates and between 10 and 30% protein.

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Other dietary templates such as the Mediterranean or Paleo diets typically contain more carbohydrates and less fat.

The concern typically expressed about restricted carbohydrate diets is that they will not provide adequate nutrition (i.e. vitamins, minerals and amino acids).

Diabetics, along with the general population, are advised to eat in line with the USDA Food Pyramid / My Plate guidelines which emphasise “healthy whole grains” while discouraging saturated fat and cholesterol.

Diabetics are told that they should not deprive themselves of any foods or not to risk getting inadequate nutrition, but rather to “cover” any carbohydrates they eat with insulin (or treat with medications such as Metformin for type 2 diabetics).

Even in health circles ketosis is sometimes considered to be extreme and not worth the effort for most people, but is it really that hard to achieve?

When we look at the relationship between ketones, blood sugar and HbA1c we see that someone with excellent blood glucose levels will have a moderate amount of blood ketones.

The chart and table below are based on my tracking of blood sugars and ketone values.  Optimal blood (i.e. 4.6mmol/L) glucose corresponds to a ketone value of about 1.3mmol/L.

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HbA1c average blood sugar ketones
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 2.1
optimal 4.5 4.6 83 1.3
excellent < 5.0 < 5.4 < 97 > 0.4
good < 5.4 < 6.0 < 108 < 0.3
danger > 6.5 > 7.8 > 140 < 0.3

In view of this it’s hard to see why ketosis is extreme.  It’s just what happens when someone has reduced their dietary insulin load to a point where they are achieving excellent blood sugars!

Ketosis is a sliding scale.  Some people will want to push their ketone levels to therapeutic levels though fasting and a higher fat diet, but this may not be necessary for general health.

Most people would benefit from reducing their dietary insulin load to a point where their blood sugars are close to excellent.

See Diabetes 102 for more info on what your blood sugars should be and the Goldilocks Glucose Zone for more thoughts on how to manipulate your diet to get excellent blood glucose levels.

I am a big fan of Steve Phinney (I attended a masterclass with him when he was in Brisbane last year), but I think he potentially alienates people when he starts off talking about the Inuit and Steffanson living off all meat diets.

I also understand why the people generally might baulk at the idea of mainlining butter and MCT oil to drive up ketones.  “How can eating all that extra fat really be healthy?” they ask.

I propose an alternative sales pitch for ketosis:

  1. ketosis occurs when your blood sugars are close to optimal,
  2. blood sugars can be optimised by reducing the insulin load of your diet, and
  3. once you optimise your blood sugars you will reduce your hunger, access your body fat for fuel and a whole host of other health markers will improve.

What’s not to like?

What do you think?

[this post is part of the insulin index series]

[Like what you’re reading?  Skip to the full story here.]

[1] http://www.dietdoctor.com/lose-weight-by-achieving-optimal-ketosis

[2] https://www.youtube.com/watch?v=2KYYnEAYCGk