Deeper ketosis without protein restriction

In my last update, I had talked about the trouble I was having staying at the β-hydroxybutyrate level I wanted while eating to satiety. Not only was eating to hunger driving my ketone levels down, but higher ketone levels were correlating with irritability. Hunger and irritability are not my style. Besides, I have the intuition that something as healthy as ketosis should not entail health compromises. That's one reason I think the calorie restricted approach to ketogenic dieting, even in cancer, is likely to be wrong. More on that another day.

I am delighted to report that for a couple of weeks now I have consistently been in the 1.5 — 3.5 mmol/L range without restricting the quantity of my food, or even trying to be careful about not passing the satiety mark. Though I do, as always, emphasize fat in my foods, I am not limiting or even measuring my protein intake. My body's signals are clear and accurate and I don't agonize over whether this bite would be the line between enough and too much. There is no longer any correlation, as far as I've noticed, between irritability and higher ketone readings.

The trick seems to be exercise.

A few weeks ago, I made a few lifestyle changes at once. (I don't always have time for controls!)

• I started getting up at 5:30 (amended to 5:00 several days later).
• I gave up all but two small cups of coffee a day.
• I started going to a weightlifting class at the local gym twice a week for an hour. I enjoy the 15 minute walk home.
• I started running around the block once or twice a day in order to keep up with the 3-year-old riding his strider bike. That usually involves a little sprinting as we go the downhill direction, and walking or lightly jogging for the rest of the way. Some days I've also done a longer distance walk or bike ride.

There could be some effect of lower carbohydrate contribution from cream, or from something disruptive in the coffee itself. However, I feel fairly confident that the driving factor is the exercise.

Lyle McDonald: Effects of exercise on ketosis

Way back in 2002, I got my hands on a copy of Lyle McDonald's The Ketogenic Diet. It was out of print at the time, and was acquired for me magically by Zooko, in honour of our second anniversary. (Thank you, Sweetheart!) Back then, it was one of the few resources available for studying ketogenic physiology. Lyle McDonald's purpose in writing his book was to promote Cyclic Ketogenic Dieting for bodybuilding, and dispel myths associated with it. It is fairly technical, and well-referenced, but it does not presuppose detailed knowledge about specific biochemical pathways, so it's also accessible.

In it he shows that high intensity exercise (weight training or interval training) is a quick route to establishing ketosis, because it uses up glycogen stores. In the short term, however, high intensity exercise can decrease ketosis by inhibiting free fatty acid (FFA) release into the bloodstream. He also emphasizes the utility of low-intensity aerobic exercise, both for lowering glycogen and for increasing FFA for the liver to make ketones with. Low intensity aerobic exercise is very effective in establishing ketosis, but it takes a long time to deplete glycogen that way.

His bottom line recommendation, then, for establishing ketosis quickly, is to do a high intensity workout to deplete glycogen, followed by 10-15 minutes of low intensity aerobics.

This is precisely what I've been doing every day! Lifting and then walking home, sprinting and then a fast walk around the block, or a long distance, low intensity walk or ride, all qualify as efficient ketosis enhancement.

This is working for me without recourse to hunger-inducing protein restriction.

Fat loss without muscle gain necessarily implies a caloric deficit even though caloric deficit does not necessarily result in fat loss. Analogously, inducing ketosis through exercise and carbohydrate restriction may well be resulting in a naturally lower protein intake for me. I don't really care that much. I'm eating as much as feels good to me of foods that make me well, and it is no longer interfering with my health goal of being in ketosis.

Whether and to what degree this affects my body composition is not yet clear. My clothes are fitting better. I guess I ought to buy a scale.

On lard (from Gary Taubes)

I recently misremembered these figures when talking to friend, so I'm setting the record straight.

"Take lard, for example, which has long been considered the archetypal example of a killer fat. It was lard that bakeries and fast-food restaurants used in large quantities before they were pressured to replace it with the artificial trans fat that nutritionists have now decided might be a cause of heart disease after all. You can find the fat composition of lard easily enough, as you can for most foods, by going to a U.S. Department of Agriculture website called the National Nutrient Database for Standard Reference. You'll find that nearly half the fat in lard (47 percent) is monounsaturated, which is almost universally considered a "good" fat. Monounsaturated fat raises HDL cholesterol and lowers LDL cholesterol (both good things, according to our doctors). Ninety percent of that monounsaturated fat is the same oleic acid that's in the olive oil so highly touted by champions of the Mediterranean diet. Slightly more than 40 percent of the fat in lard is indeed saturated, but a third of that is the same stearic acid that's in chocolate and is now also considered a "good fat", because it will raise our HDL levels but have no effect on LDL (a good thing and a neutral thing). The remaining fat (about 12 percent of the total) is polyunsaturated, which actually lowers LDL cholesterol but has no effect on HDL (also a good thing and a neutral thing).

"In total, more than 70 percent of the fat in lard will improve your cholesterol profile compared with what would happen if you replaced that lard with carbohydrates. The remaining 30 percent will raise LDL cholesterol (bad) but also raise HDL (good). In other words, and hard as this may be to believe, if you replace the carbohydrates in your diet with an equal quantity of lard, it will actually reduce your risk of having a heart attack. It will make you healthier. The same is true for red meat, bacon and eggs, and virtually any other animal product we might choose to eat instead of the carbohydrates that make us fat. (Butter is a slight exception, because only half the fat will definitely improve your cholesterol profile; the other half will raise LDL but also raise HDL.)"

From Gary Taubes in Why We Get Fat: And What to Do About It (emphasis mine).

Update on Ketosis and Weightlifting

Well, that was a really long month. In seriousness, writing frequently is hard for me, not because I'm not constantly brimming with things to say — trust me, I am — but because I have so many other things going on. In, particular, it turns out that raising three children is a lot of work, even when you are well. I also released some software as part of the effort to finish my long-stalled Master's degree. My hobby site, The Ketogenic Diet for Health, which we started as a way to make progress on writing a book about ketogenic therapies, gets almost no love at all.

So, let me briefly tell you what I learned from actively deepening ketosis, and reintroducing myself to weightlifting.

Deeper Ketosis

I had decided not to measure some things that could be informative, such as protein or calorie intake, and just to focus on eating only when hungry. I started making a lot of fatty broths, and drinking that if I felt what I perceived to be a habitual desire to eat, rather than hunger. I took smaller portions to make my clean-the-plate tendencies less detrimental.

This was effective for increasing blood ketones, and as those went up, I lost weight and fat, at least according to my Tanita scale. I lost about 6 pounds over the course of 2 months. That doesn't sound like a lot, but I don't have a lot of weight to lose, and I wasn't in deep ketosis all the time.

Then I ran out of measuring strips, and soon after that I found my scale in a mysteriously broken state.

Odd things

Here are some particular things I noticed during the process:

• Even though I am already keto-adapted to some degree, I found it hard to stay in the zone I was aiming for (1.5 - 2.5 mmol/L) consistently, because some days eating to hunger meant eating a lot of protein, which drove the ketones down. In other words, staying in deep ketosis for long periods was effortful.

This is strange to me, because theoretically, living off my ample fat stores should allow me to feel satiated indefinitely. As long as I am getting enough protein for body maintenance and blood sugar, why would I ever feel hungry? But I do get hungry, and I do get symptoms like brain fog if I go too long without eating, even when I've been in deep ketosis for days.

This brings me to a second point,

• The reason I don't like to go higher than about 2.5 mmol/L is that I start to get irritable when ketosis gets too high. I figure this must be a blood sugar effect. I haven't measured blood sugar and ketosis together consistently enough to be sure of a pattern, but other people have reported an inverse relationship, and we found scientific support which we reported here.

Dr. Ede also reported great discomfort in very deep ketosis, although I notice that her blood sugar is not nearly as low as mine gets at similar ketone levels. When my ketosis is above 3mmol/L, my blood sugar gets close to 65mg/dL.

It's possible that I am simply not sufficiently keto-adapted, but I have suspicions that there is more going on. I'll get to that in my next post. With any luck that will be sooner than 4 months from now.

Weightlifting

My first idea was to do short sessions every day, rotating parts so that major muscles would get worked a couple of times per week. There were two reasons for this. First, it was very hard for me to get more than 10 minutes of uninterruted time in a day while looking after a 3 year old. Second, sometimes it seems easier to make a habit stick if it is a daily one. Relatedly, missing a day was not devastating.

This worked only okay. I could feel strength gains, but not tremendous ones. I'm not sure why.

Then my schedule changed. Morning preschool sessions started up again after a long winter break, and I found a wonderful person to care for my son on some afternoons, too. I started working out my whole body twice a week, and this seemed to be much more effective. I don't have a good way of measuring the results. I don't even have a scale, though scales don't show recomposition well. Nonetheless, I was feeling stronger, and Zooko seemed to think he could see a difference.

Unfortunately, a couple of weeks ago, as has happened to me many times in the past, a few of life urgencies resulted in missed sessions, and then I lost the habit.

A new scheduling plan

While reading a post by Cal Newport, my favourite productivity blogger, I realized that trying to make every day or even every week the same for the sake of habit building is not necessarily helpful, and in cases like this, it seems harmful.

So my new plan is to take one week at a time. At the beginning of the week I'll schedule the things I want to get done around all the perpetual idiosyncrasies that make up my life. In other words, instead of planning to work out every Monday and Thursday afternoon, and then falling off the wagon because this week I had to meet the principal on Thursday afternoon, I'm going to be more adaptive.

Ultimately, I need to find ways of operating that promote consistency over a chaotic, ever-changing life situation. I have too much going on to benefit from "bikini bootcamp" style interventions that require me to focus on nothing but getting slim for 10 weeks. This probably means that it will take me more than 10 weeks to reach my goal, though.

Bottom Lines

Although I could see the beginnings of progress in fat loss from deepening ketosis (which for me amounts to eating less), there were serious sustainability issues that I didn't anticipate and don't understand. Some ideas to follow.

Similarly, weightlifting seemed to be having a positive effect, but I need to figure out how to make it happen consistently in the face of constant uncertainty and chaos. This is no different from the struggles I am facing in other arenas of my life, including graduate studies, book writing, and blogging.