The Effects of a Year in Ketosis

My journey began at Thanksgiving of 2012 with a question of my sister. This is my family, that’s my sister next to me right at the back. And I had spent a decade running a biotech company that was acquired, and I joined a venture capital group of a crop protection company, and my sister said to me, "You know, some of that corn that you’re growing goes into high-fructose corn syrup and why is that a good thing?"

And this got me reading more about corn syrup. And while I found that it’s no worse than sugar, the more I learned about the health effects of sugar, the more concerned that I became.

The 150 pounds of sugar that the average American consumes annually, as well as starch converted into sugar, isn’t just empty calories, it has a negative effect. I used to eat toast, jelly, and a banana for breakfast. That’s 75 grams of carbs that spiked my blood sugar, which spiked my insulin, which crashed my blood sugar and made me hungry again. It also blocked using energy from body fat, since insulin stops fat mobilization.

And as I looked at this more and become increasingly convinced that this carbohydrate overloading is behind many of the diseases of civilization, as this cartoon says, "that high carb diet that I put you on 20 years ago gave you diabetes, high blood pressure, and heart disease, oops."

So in 2013, I began reducing my carbs and tracking along the way. Last year I went further, adopting nutritional ketosis where most of my calories come from fat, and that’s the story I’ll share today.

So let’s focus on ketones, which are one of the things that I track. Ketone bodies are natural metabolites that we all have in our blood, usually at low levels. They derive from fat metabolism, and rise went fat is the primary fuel, either from food or from body fat. Then they have turned into glucose, and when you’re fasting, they’ll they actually provide 60% of the brains energy. They are also a clean burning fuel that reduces oxidative stress. And there are well-documented benefits to ketosis. Clinical trials show that blood pressure drops, blood triglycerides decline, HDL rises which are all good things. And hunger also diminishes from fat loss.

And so what I’ll take you through now are some of the challenges, and as well as the benefits that I’ve seen with restriction of carbohydrates and entering ketosis. I’ve driven my insulin levels down by restricting carbohydrates. So rather than getting 350 grams a day from carbohydrates, I’m getting about 20 grams a day.

I avoid sweets, grains, and fruit and I moderate my protein intake to about 120 grams a day, because too much protein can cause a rise in glucose by gluconeogenesis. I log my meals, and I’ll show you some examples.

And one of the things that I have learned from this is that there is too much protein in these examples, as you will see. So in the upper left, that 8 ounce filet mignon has 60 g of protein. Add eggs, cheese, and nuts and that’s enough to block ketosis for the day.

So the solution to this is to find sources of fat that doesn’t, along with protein. Things like coconut oil, butter, and olive oil. But unfortunately, we’ve been told for generations that these fats are dangerous. But recent analysis shows that there is no association between saturated fat and disease.

What I do to measure whether I am in ketosis is that twice a day, I use a drop of blood from a finger prick and I measure Beta-hydroxybutyrate. Typically, people see not .1 mmol or less if you’re having a fairly high carbohydrate diet. But I am about tenfold of that level, so I see 1 mmol at night in red, and 2 mmol in the morning in blue.

And find that this immediate daily feedback is very helpful, because it’s often hard to know the nutrient content of a meal. So let’s go through some of the benefits of ketosis that I’ve seen.

I’m 25 pounds than at my heaviest. I’ve lost half my body fat, I’m at 12% by DEXA. I no longer get tired or hungry after meals, and I can sustain long stretches of concentration. The athletics stamina that sustains intense workouts are extraordinary. So for instance, a trail run that I did, I was limited not by my cardiovascular, but by the footing on the trail. I’ve also seen decreases in inflammation, and ketogenic diets are known to be anti-inflammatory. So that joint pain has gone, and I verify this with a low level of C-reactive protein.

One of the best benefits I’ve seen is in my blood pressure is way down. So prior to limiting carbs, it was high as 136 over 90. My average of recent physicals has been 112 over 72, and I’ve also been measuring this for two months with a Scanadu, and I’m at 113 over 71. And lastly, as expected my triglycerides have dropped substantially, and my HDL cholesterol, the so-called good cholesterol has risen.

So let’s move onto some of the challenges. My LDL-cholesterol has risen, but while LDL is called bad cholesterol, these carriers are actually not one class, but a range from large buoyant and benign to iatrogenic small dense particles, and can’t restriction shifts LDL from small dense to large buoyant, and this is what I see in my NMR lipoprofile, my LDL particles are benign large buoyant.

So other challenges have been muscle cramps, slow workout warm-ups and cold sensitivity. I knew that cramps could be an issue, because insulin signals the kidneys to retain salt. When insulin levels drop, the kidneys release salt and water follows.

I’ve been using cramping as an indicator of this electrolyte imbalance. I would get a calf cramp and I would have a bouillon cube. But what I eventually realized is that these cramps are actually a great indicator, and for me cold sensitivity and soreness early in a workout are more sensitive symptoms.

So there’s a scene in the movie, the Avenges, the recent Avengers movie where the AI program, Jarvis is under attack from Ultron. As Stark and Barnett watch, Ultron, the fluid blue hologram attacks Jarvis and Gold piercing its core. And this is how I felt this spring swimming. The waters freezing and I know what’s coming. The cold will begin in my fingers and creep towards my core. But this time I feel warm like I’m wearing a wetsuit, and the reason is simple; it’s the salt that I had took before the workout.

Getting enough sodium, 5 g a day or so has been the solution to the remaining issues that I’ve had with ketosis. But is this much salt safe? The recommended daily allowance for sodium is only 2.3 g. However, a 2014 study found that the lowest cardiovascular risk actually occurs with much higher 4 to 6 g of sodium a day, which is right where I’m aiming.

So in conclusion, I’ve learnt that the benefits of ketosis for me are substantial, and they make me want to continue. Getting rid of sugar was the easy part. More challenging has been moderating protein and getting enough fat and salt. And that requires contradicting conventional wisdom about nutrition.

Lastly, it’s been a fun challenge and this is a work in progress.