Week 4: Scientific Facts About Ketosis

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1 Week 4: Scientific Facts About Ketosis What is Ketosis? A healthy and normal condition that is a result of a low carbohydrate diet. The body uses ketones/fat as primary fuel instead of glucose. Ketones are produced in the liver from fat. Insulin shuts off burning fat as a fuel and production of ketones. Getting a moderate levels of ketones is an indicator that your insulin levels have remained low enough for long enough that insulin is no longer blocking the use of fat as a primary fuel (lipolysis). Ketones can be used for some functions as an alternative fuel to glucose. In fact, ketones are the only fuel that the brain can use aside from glucose. Excerpt From Art and Science of Low Carbohydrate Living there is a fundamental shift in your body s fuel homeostasis (i.e., energy regulation) away from glucose as a primary fuel. This shift is the adaptation of the body s hormonal set and interorgan fuel exchange to allow most of your daily energy needs to be met by fat, either directly as fatty acids or indirectly by ketone bodies made from fat the primary serum ketone (betahydroxybutyrate, or B-OHB), rises At this ketone level the brain begins to derive a substantial portion of its energy needs from B-OHB Nutritional ketosis is different from ketoacidosis! Excerpt From Diabetic Ketoacidosis vs. Dietary Ketosis (Manninen, 2004) in severely uncontrolled diabetes, if the ketone bodies are produced in massive supranormal quantities, they are associated with ketoacidosis [a] life-threatening complication of diabetes mellitus However, during very low carbohydrate intake, the regulated and controlled production of ketone bodies causes a harmless physiological state known as dietary ketosis. In ketosis, the blood ph remains buffered within normal limits mild ketosis may offer therapeutic potential in a variety of different common and rare disease states.

2 Week 4: Scientific Facts About Ketosis About initial water weight loss Depletion of liver and muscle glycogen, a carbohydrate store, converts to glucose when energy is needed. When you deplete glycogen in ketosis, there are three times as much loss of water. Intense water weight loss is a good first indicator that the diet is working! (Thanks to Eric Westman) What is a low-carbohydrate, ketogenic diet? (excerpted and adapted from The Ketogenic Diet by Kristen Mancinelli, a registered dietician). The low carbohydrate, ketogenic diet sends a message to your cells that says, Please use fat instead of carbs. Once this message is received, after a few days of keeping your carb intake below g ( calories) at most, you enter a new metabolic state called ketosis; now your body is fueling the majority of its energy needs with fat! You keep the fat-burning metabolism turned on by keeping your carb intake low. When you eat very few carbohydrates, your body changes the way it metabolizes nutrients. The ketogenic diet shifts the body entirely to an alternate state of metabolism, so that you don t swing back to using carbs for energy. Your body burns fat and more fat. It burns fat when you re eating and not eating; it burns fat when you re sleeping, sitting, standing, reading, and exercising. As long as you avoid carbohydrates, your body continuously burns fat. Also, most people feel less hungry on the ketogenic diet, so you may eat less as a side effect which is a nice bonus for anyone with a busy life who d rather not waste time looking for meals morning, noon and night. In general, you may eat as much as you want of the low-carb foods. However, keep in mind that the more calories you take in from food, the less your body will need to take out of fat stores. So while there is no restriction on how much fat you can have, it is a good idea to eat until you are 80 percent full. Fat takes a few hours to fully digest, and you will not feel hungry for a long while after a keto meal. Metabolically speaking, you will not stop ketosis by eating too much fat. However, you may slow your weight loss if you overindulge.

3 Week 4: Quality of Fats Fat Types to Eat (from The Art and Science of Low Carbohydrate Performance) Current evidence shows no association between dietary saturated fat intake and cardiovascular disease (CVD). There is, however, a consistent pattern of increased risk for CVD and diabetes associated with increased amounts of saturated fat circulating in the blood. It is a common mistake for people to assume that your intake of saturates is what determines your blood level of this much maligned nutrient, but this is incorrect. Particularly in the keto-adapted state, fat is being burned at a much higher rate, and this is particularly true for saturated fat. In two recently published studies we showed that a low carbohydrate, high fat diet significantly decreased circulating levels of saturated fat. It s hard to imagine how dietary saturated fat can be problematic when it is promptly burned to carbon dioxide and water. From a recent meta-analysis: Dietary recommendations were introduced in the USA (1977) reduce overall fat consumption to 30% of total energy intake and (ii) reduce saturated fat consumption to 10% of total energy intake. Randomised controlled trial (RCT) evidence currently available does not support the current recommendations to restrict dietary fat. The lack of generalisability of current evidence prevails. This study finds that only one primary prevention RCT, including men and women, is available to inform public health advisors and that this was without statistical significance. Public health advice on dietary fat has prevailed since 1977/1983 in the absence of supporting evidence from RCTs. The US 2015 draft dietary guidelines exclude recommendations for total fat for the first time, but maintain the advice to restrict saturated fat. The current evidence does not support this recommendation. Harcombe, Z., Baker, J. S., DiNicolantonio, J. J., Grace, F., & Davies, B. (2016). Evidence from randomised controlled trials does not support current dietary fat guidelines: a systematic review and meta-analysis. Open Heart, 3(2), e000409

4 Week 4: Possible Side Effects of Ketosis Some people experience side effects when starting a low carbohydrate diet. If anything serious or concerning arises, please let us know. Feeling faint, light headed, dizzy, or having headaches? You re not getting enough salt. Your body functions differently when you are eating a low carb diet. Your kidneys switch from retaining salt to rapidly excreting it, along with stored water. This explains the sudden weight loss that can occur at the beginning of starting a low carbohydrate diet. This change can also bring with it exhaustion, headaches, faintness, body aches, difficulty concentrating, or other flu-like symptoms. These are usually mild and pass quickly. But, to treat these symptoms, it s recommended that you have 1-2 cups of moderately salted broth a day OR liberally salt your food. Have about 2-3 grams of sodium a day. Try having normal (not reduced) sodium broth 1-2 times a day. To prepare, add a cube of bouillon into a cup of hot water. Or, make your own drink (4 cups water, 1 tsp salt, ¼ tsp Lo Salt, and a sugar-free beverage like Kool-Aid, Crystal Light, or True Lemon Lemonade: each cup has about 600 milligrams of sodium and 100 grams of potassium). Exercising or planning to be out in hot weather that makes you sweat? Have some salt (a liberal sprinkling of salt, salty food, a serving of broth, etc.) in the hour before you go exercise or exert yourself in the heat. On days that you exercise, take one dose of broth or extra salt in the hour before you start. From the Art and Science of Low Carbohydrate Living: When the human body adapts to a low carb diet, the kidneys fundamentally change how they handle sodium. Removing most carbs from the diet causes your kidneys to aggressively secrete sodium (and along with it, extra fluid) a continuous moderate intake of sodium is necessary to keep your circulation adequate to handle heat stresses like hot weather, endurance activity, or even a hot shower. At a minimum, we suggest sprinkling your food with a bit more salt and making sure you're well hydrated... and then see how you feel. Make sure to get your salt and water over the course of the day, rather than all at once. Bad Breath? Make sure you are drinking enough water Take care of your mouth: go to a dentist, brush your teeth and tongue twice a day, and floss daily Try sugar-free gum (but watch out for the possible bloating from the sugar alcohols)

5 Week 4: Possible Side Effects of Ketosis Constipation? Once a day, in a cup of cold water, a sugar-free drink or a yogurt, add a heaping teaspoon of a sugar-free fiber product such as: o Original KONSYL made with psyllium husks ( Mix-Formula-Psyllium-Powder/dp/B001HSMOEE) o Sugar-free Metamucil made with Inulin Fiber ( Servings/dp/B001EP3IEA/). Try sugar-free milk of magnesia as directed on the bottle. ( Ounces/dp/B00068Y9US/) Have 1-2, 200mg tablet of magnesium citrate daily ( Foods-Magnesium-Citrate-Tablets/dp/B000BV1O26/) Make sure you are eating enough salt and drinking enough water Diarrhea? Are you having watery diarrhea several times a day for several days? If so, please page the study doctors. Are you having mild diarrhea every few days, please try the following: o Are you eating sugar-free candies or other foods with sugar alcohols? This can cause diarrhea. Discontinue and see how you feel. o Look for foods that give you a problem. This type of stomach upset can be caused by foods like dairy, caffeine, nuts, wheat, corn, soy, and shellfish. Keep track of which foods seem to be a problem. Stop eating them for a few days and see if you start to feel better. Gas or bloating? Cauliflower, broccoli, cabbage, Brussels sprouts and other cruciferous vegetables can cause gas and bloating if you eat too much ( Are you eating more of those than you used to? For some people coconut oil can cause bloating. Are you having that? For some, eating refined coconut oil solves the problem. FODMAPs can sometimes lead to gas and bloating ( Another thing that commonly gives people gas and bloating are sugar alcohols. Check anything that you've been eating with those ( like malitol or xylitol. Cut them out completely and see how you feel. Consider adding probiotics, in the form of supplements ( or yogurt, to see if that helps. For some people, probiotics can get rid of chronic indigestion and bloating.

6 Week 4: Possible Side Effects of Ketosis Muscle Cramps? It turns out that people with type 2 diabetes are often low on magnesium. Muscle cramps are one sign that you re low on magnesium; some others are numbness in your feet and fingertips, feeling anxious, poor sleep, and constipation. So, the first thing to try if you are having muscle cramps is taking about 200 mg of magnesium a day for 20 days. For example: Citrate-Tablets/dp/B000BV1O26/ If your calf is cramping, try a standing stretch (see image to right). Also, try getting more potassium. Foods with high levels of potassium include: One-half of a medium avocado (450) Three ounces of baked or broiled salmon (319) One cup of fresh or cooked asparagus (288) Three ounces of roasted turkey, dark meat (259) One-half cup of cooked mushrooms (277) One-fourth cup of sunflower seeds (241) Three ounces of cooked lean beef (224) Two tablespoons of peanut butter (214) One-half cup of fresh green beans (187) One-half cup of cooked zucchini (173) One-half cup of fresh cauliflower (151) One-half cup of fresh broccoli (143)

7 Week 4: Low-Carb Mistakes Low-Carb Mistakes and How Nutritional Ketosis Rescued Me From Them (Paraphrased/Edited from original material by Jimmy Moore) Due to the influence of a fantastic new book by low-carbohydrate diet researchers Dr. Jeff Volek and Dr. Stephen Phinney called The Art and Science of Low Carbohydrate Performance, I ve been doing my own n=1 experiment of nutritional ketosis. Today I want to share some mistakes I was making in my own low-carb plan that prevented me from reaching the needed level of nutritional ketosis. Correcting these mistakes has helped me effortlessly shed 50 pounds (and counting!) in less than five months. 1. Consuming too much protein. A well-formulated low-carb diet is actually high in FAT, not protein. I bet you never thought that protein could hinder your weight loss but it can. Why? Here s the word: GLUCONEOGENESIS! When you consume excess protein, your liver transforms it into glucose (sugar). If you are eating a bunch of lean meats, you might be defeating the purpose of your low carb lifestyle. Try choosing fattier cuts of meat and controlling the absolute amount of protein you are eating I aim for 12% of my total calorie intake to see how that impacts your blood ketone levels. 2. Not eating enough dietary fat. One of the major keys to my success with nutritional ketosis has been a very deliberate increase in fat consumption. One of the lingering effects of the lowfat propaganda machine over the past 3+ decades is the idea that dietary fat is harmful, that it will clog your arteries and make you fat. So it s probably not surprising to hear that many who begin a low carb diet simultaneously cut their fat intake. They erroneously think that if low-carb is good, low-fat and low carb is perfect. That s a fatal error in your attempts get into nutritional ketosis, staving off hunger and cravings. Even if you think you re eating pretty high-fat you may need to ramp it up a bit. I m eating around 85% of my calories from dietary fat during my n=1 experiment. Get creative and don t fear the fat. Avocados 82.5% fat. An avocado is cooling when you re eating spicy foods, and offers a smooth texture change. I eat a whole avocado almost everyday with my eggs and wouldn t imagine doing nutritional ketosis without it! Coconut oil 100% fat. My favorite brand is Nutiva Organic Virgin Coconut Oil; it imparts a pleasantly sweet smell with a very mild flavor of coconuts. I especially enjoy cooking my eggs in coconut oil along with sea salt and parsley; it gives them a nice buttery flavor. If you are trying to increase your level of blood ketones, then there s probably no better way than to start adding coconut oil to your daily menus. Coconut 88% fat. The best part about coconut is that its fatty goodness jacks up those blood ketone levels amazingly. Mix some coconut into a smoothie in the morning and it will keep your hunger satisfied for hours on end. It s time to get cuckoo for coconuts! Whole eggs 61% fat Bacon 69.5% fat. At the 2012 Ancestral Health Symposium, Harvard organic chemist Mat Lalonde extolled the virtues of consuming bacon. He noted that the fatty acid profile of this much-vilified food is actually pretty darn close to ideal.

8 Week 4: Low-Carb Mistakes Butter 100% fat. My favorite brand of butter is Kerrygold grass-fed. Once you get a taste of this bright gold goodness you ll never go back to anything else! I usually fry up 2-3 eggs in 2-3 tablespoons of butter it s an incredibly tasty way to start the day. Cream cheese 88.5% fat Sour cream 88.5% fat. If you are able to tolerate dairy, I can t imagine why you wouldn t want to add sour cream to just about everything you eat. It s such a rich source of fat while providing amazing flavor and luxurious texture to anything you eat. Full-fat cheddar cheese 74% fat. Like cheddar, Monterey Jack, and Swiss. 70% Ground beef 59.5% fat. Look for 70% ground beef, and choose locally farmed grass-fed beef whenever possible. EatWild.com can help you find a local source of grass-fed beef. The great thing about a burger is you can cook it in butter, add some cheese (see below), and spread some sour cream on it for a mouthwatering low-carb, high-fat meal that will put you well on your way to reaching nutritional ketosis. WOO HOO! (Editor s Note: What, no avocado on your burger?!) Dark chocolate 65% fat. Nope, I m not kidding. I have fallen head over heels for a brand of chocolate that is far superior to anything I ve ever put in my mouth before Taza 80% Stone Ground Dark Chocolate. This stuff contains little chunks of real cacao and even has real sugar in it (GASP!). But I eat a half and sometimes a whole bar of this daily with no negative impact on my blood sugar or blood ketone levels. It s got to be the cocoa butter that make it such a perfect addition to my nutritional ketosis plan. Are you eating high carb fruits? These carbs can sneak in without us realizing. *(Carbohydrate counts from the Atkins Foundation)

9 Week 4: Goal Don't try to do a low carb diet that is also low fat. Focus on whole foods and good quality fats - avocados, coconut/coconut oil, butter, etc. - with adequate protein, and nutritionally-dense vegetables. I was very 'carb-addicted when I first started this diet, so it was difficult for me to give up breads, sweet desserts, and highcarb fruits I finally gave up worrying about the fat and, to a certain extent, the calories. And I continually lost weight. I also realized that one cannot flip back and forth between a low-carb diet that is higher in fat and a low-fat diet that s higher in carbs; you cannot have the higher fat one day and have higher carbs the next or you do not lose weight (because you do not stay in a relatively ketotic state over time). - Someone on a ketogenic diet I was diagnosed T2 at 24. I was incredibly depressed... The doctor who diagnosed me sent me to a class to teach diabetics how to eat. The American Diabetes Association recommends a diet rich in carbohydrates After 3 months of the diet given to me, my A1c went from 12.7 to Better, but still terrible. I was crushed by the number, and started searching. I found this low carb diet, and figured I had nothing to lose. I ate low carb for 3 months, I didn't watch calories, if it was not a starch or sugar, I ate it. After 3 months of non scientific low carb eating, my A1c went from 11.2 to 7.1. When my doctor saw that number he was ecstatic. He said what ever I was doing to keep it up, diabetes is a marathon, not a 40 yard dash. With the new results, I got scientific. I measured and balanced everything. I planned entire weeks worth of meals. Nine months after being diagnosed with an A1c of 12.7, my new blood results were 4.6, and my cholesterol was perfect. My doctor almost couldn't believe my results, and told me I was the most successful diabetic patient he had. He said most patients give up and spiral out of control when they get diagnosed. Oh and a side effect of eating low carb to fight my diabetes was me losing 80 lbs. I also only take 500 mg of metformin now. Hoping to be completely off all medication by the end of this year. Low carb life style saved me. I went from boohooing about how unfair life was, to feeling better than I had ever felt in my life. - Diabetic, Low Carber

10 Week 4: Goal Bonus: Chewing Gum & Mints Many common types of breath mints have 0 net carbs: Altoids Smalls Mints, Peppermint Altoids Mints, Sugar-Free, Cinnamon Ice Breakers Mints, Sugar Free, with Flavor Crystals, Coolmint Ice Breakers Mints, Sugar Free, Fruit + Cool, Raspberry Altoids Mints, Sugar-Free, Wintergreen Most chewing gum brands have sugar free versions available. Be careful, though.. these aren t all created equal! The following are some of the best types of gum, with 1 net carb: Orbit Gum, Sugarfree, Bubblemint Trident Gum, Sugar Free with Xylitol, Bubblegum Trident Gum, Sugar Free with Xylitol, Minty Sweet Twist 5 Chewing Gum, Cobalt Sugarfree Orbit chewing gum, Strawberry Remix Sugarfree There are more! Visit for a longer list

11 Week 4: Goal Goals for Week 4 Start tracking your ketone levels. Check at least 3 times/week before dinner (i.e. in the late afternoon or early evening, before eating). Record your results in your logbook. Keep writing in your favorite foods diary. Use it for inspiration.