I'm about to take you down a deep rabbit hole, on a path that will challenge what you believe about nutrition and health. This is a journey of experimentation, and I encourage you to keep a very open mind, and in fact, I hope you decide to experiment with these themes yourself. I'm not a nutritionist or doctor, but I am very passionate about finding ways to optimize my body and health (especially as I age), which is why I've been doing intermittent fasting for the past five months -- and that experience has been life changing. I've gone from XL to medium sized shirts, from a 38 to 32 waist, and most importantly, from 34.7% body fat to 24.5% (and my goal is to get under 20%). Intermittent Fasting has put me in control of my body for the first time in my life.
And just when I felt that I was really starting to figure it all out, this rabbit hole opened up. And it's called ketosis.
In addition to intermittent fasting, I'm experimenting with ketosis through the end of 2015, which is triggered by eating a ketogenic diet comprised of 75% fat, 20% protein and 5% carbs. Yes, that's right -- in order to lose fat and become healthier, I'm going to eat mostly fat. The mind blowing counter-intuitiveness of that statement is why I'm writing this blog.
But before we can talk about this ketogenic approach to nutrition and health, we have to understand how the body uses two energy sources -- glucose and ketones -- and why, with your diet, you are probably only ever tapping into glucose (and how that may be making you unhealthier, especially as you age).
See an enlarged version of this picture here. The illustrations come from a video for a ketone supplement called Keto-OS -- see my comment below.
Glucose is the "lighter fluid" energy source that your body uses to create energy for its cells, whereas ketones are the "charcoal" -- harder to ignite, but can power your body for longer when used because ketones burn fat and are a more efficient metabolic energy source. Why does the human body have the ability to burn two entirely different types of energy? The theory is that as humans evolved, we went through periods of feast or famine and had to be able to make use of energy when available, as well be able to as stash away longer-term energy, which was stored on our bodies as fat, and then convert it to energy (via the creation of ketones by the liver) when the glucose was depleted.
But in our modern society, sugar and carbs are all around us, all the time. We never starve for 2 days between meals. This means our bodies dutifully store away excess glucose as fat, but we never tap into those reserves to actually use them -- we don't need to; our bodies can be powered 100% of the time with glucose thanks to plentiful access to calories all around us.
What this meant for me was that six months ago, I was on the verge of having Metabolic Syndrome, and I didn't even know it. Metabolic Syndrome (a proxy for insulin resistance) put me at an elevated risk for getting many types of Cancer, Alzheimers, Obesity, Diabetes, Stroke, and Coronary Heart Disease. One is defined as having it if one has three of the following five indicators:
- Expanding waistline (above 40"; mine was 38")
- High Triglycerides (above 150 mg/dL; mine were at 141)
- Low HDL (below 40 mg/dL; mine was at 38)
- High blood pressure (systolic BP > 130 or diastolic BP >85 mm Hg)
- High blood glucose (above 100 mg/dL; mine was at 98)
Astonishingly, the prevalence of Metabolic Syndrome is estimated to be 34% of the US adult population, and if you've got it, you have a 2x increase in risk for heart attack. Dr. Peter Attia has an excellent hour-long talk about the ketogenic diet and Metabolic Syndrome, which I highly recommend to anyone who's flirting with these numbers, as I was. Here's a screenshot from his talk showing his numbers (and I've overlaid mine):
I'm going to get my blood re-tested next month to see how (or if!) intermittent fasting has helped bring my markers down from these at-risk numbers, but I know that at the very least my waist has gone from a 38 to a 32, which is encouraging.
The big take-away: When you eat sugar and carbs, your body burns what it can and converts the rest into fat as storage. But when you don't eat sugar or carbs your body switches to a fat burning mode called ketosis, and it becomes "keto-adapted" which means it gets good at burning fat directly, and your body doesn't care if the fat it's burning is fat you're ingesting, or fat it has stored away. This is why, counter-intuitively, when you almost completely remove carbs from your diet and replace those calories with fat, your body becomes more adept at burning fat instead of storing it. The ideal caloric intake ratio is 75% fat, 20% protein and 5% carbs.
The big caveat here is that you can't have a diet that's high in fat and high in carbs, because whenever you ingest carbs, your body switches to burning them and you fall out of ketosis, which also means you start storing the fat. So if you're inclined to cheat on diets, and you just can't resist eating those carbs, then this approach will backfire on you. And I happen to be one of those people. I just hate having the cognitive overhead of having to think about whether I should be eating something or not (that's why fasting has been so good for me -- either I'm eating that day, or I'm not. Very binary). So why would someone like me who absolutely hates "diets" try the ketogenic diet for a month? It's because, just like with fasting, recent medical research is starting to show that staying in ketosis is very good for one's body, including:
- Being in ketosis makes your body more efficient, which makes you less hungry. (Many people also experience a clarity of mind when their bodies switch to ketosis, myself included)
- Ketosis helps get rid of abdominal fat, which is an especially harmful type of fat
- Being in ketosis tends to lower triglycerides dramatically
- Being in ketosis is known to raise HDL
- Being in ketosis dramatically lowers blood sugar and insulin levels (In one study in type 2 diabetics, 95.2% had managed to reduce or eliminate their glucose-lowering medication within 6 months)
- Blood pressure tends to go down in ketosis
- Removing carbs from one's diet leads to lower inflammation
- And most importantly for me: Low-carb diets are the most effective treatment known against Metabolic Syndrome
Eating on a ketogenic diet is interesting -- you can have in abundance the kinds of foods you usually restrict, so long as you don't let yourself go near sugar or carbs. Here are some examples:
A very ketogenic dinner: Pork belly (perfect ratio of fat to protein) and lots of veggies. The glass of wine contributes about 4 grams of carbs (my daily limit is 50 grams).
Dumplings made from cabbage instead of flour... and delicious!
Salami, with some special gluten free, grain free, very low carb "keto crackers" that my wife Sue baked.
For a snack, I have nuts or sardines, an incredibly healthy way to get protein and other nutrients.
If you'd like to go down this rabbit hole with me, I'd love your company. I don't know if I'll keep eating ketogenic past the end of 2015, but I am enjoying the experiment so far. If you want to dive in head first, I highly recommend the following resources:
Tim Ferriss interviews Dr. Dom D'Agostino:
This three hour-long podcast is incredibly medically dense but also incredibly good. If you're skeptical about what I've written above, I highly recommend you give it a listen. This is the single best resource I've found to date about this topic.
Dr. Stephen Phinney - 'Optimising Weight and Health with an LCHF Diet' - Part 1
This is a three-part series of videos (I've only linked to the first video), each about an hour long, and they're spectacular.
Dr Peter Attia on How he changed to burning fat instead of burning sugar
This is the video I linked to earlier in the post.
Peter Attia: What if we're wrong about diabetes?
This is a TEDx talk about re-examining the relationship between Type II diabetes and obesity
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Here's a great study on the impact of high dairy consumption:
"The observational evidence does not support the hypothesis that dairy fat or high-fat dairy foods contribute to obesity or cardiometabolic risk, and suggests that high-fat dairy consumption within typical dietary patterns is inversely associated with obesity risk."
I found this great NIH paper which outlines the benefits of a low carbohydrate diet on inflammation:
and this blog post is also very well referenced.
Here's a followup on the relationship between fasting and ketosis aimed at people that are trying to decide how to jump into all of it, and in what order:
- As described in this blog, ketosis is the natural process you body undergoes when it converts from burning glucose for energy, to creating ketones, which allow your body to burn fat for energy (whether it's stored fat on your body, or fat you ingest as a part of your diet). Therefore, when you fast, since you're not consuming any energy, your body will naturally switch over to ketosis after some period of time.
- When you fast, there's a period where you run out of glucose (since you're not eating) but before you really start effectively burning fat in ketosis. This is the hardest part of fasting for most people, because you can become irritable, have low energy, etc. But as your body becomes more "keto adapted" it gets better at switching over to using ketones for energy, which makes fasting feel less arduous when you do it.
- When you start eating again post-fast, you fall out of ketosis because your body again has glucose to burn from the food you're ingesting.
- The caveats to points to 2 & 3 above are this: When you consume calories on non-fast days, you might choose to artificially stay in ketosis by modifying your diet via not ingesting glucose. That's the experiment I'm doing through the end of 2015: Eating a diet that's 70% fat, 20% protein and 5% carbs. What that should mean is that my body is in ketosis 100% of the time, whether I'm fasting or eating. The reason that's intriguing to me is multi-fold: A) There's evidence that the human body burns energy more efficiently while in ketosis. AKA you perform better physically. B) There's evidence that being in a keto-adapted state can help stave off some types of glucose-dependent cancers. C) If you're always in ketosis, you body doesn't care if it's burning stored fat or ingested fat, which means that I should be able to lower my body fat percentage by being in ketosis because my body will more readily burn the fat it's already stored when it needs energy. (Interestingly, many people in ketosis report not being as hungry, and I can definitely say that's been true for me. I find myself eating fewer meals when in ketosis, like 2 per day, bkfst and dinner, on some days).
So all of that sounds great, right? Just jump into fasting and ketosis at the same time, right?
Actually, I don't recommend that. Here's why:
I've always been terrible at diets. I know I'm supposed to do one thing and then I go and do something else and just feel terrible about it. And that danger is magnified with trying ketosis, because specifically, the only way a ketogenic works is by having 5% carbs or less. If you ingest more than 50g to 100g of carbs per day (depending on your body size) while you're ingesting 70% fat in your diet, your body will start burning the glucose instead of the fat. And guess what happens to the fat? Your body stores it. Along with all your other fat. The fat you were trying so hard to get rid of.
In this way, a ketogenic diet is really dangerous for people like me that suck at diets. That's also a reason why I'm only trying it for 6 weeks through the end of 2015, despite all the amazing benefits of it. I'm just not sure that I can do it long-term, and I really want to ensure that the things I do are things I can keep doing for life (or at least keep doing until I learn more about how to do them better, or differently).
If you have not yet started fasting nor a ketogenic lifestyle, I highly, highly, highly recommend you start just with fasting, and that you do it for long enough (at least 3 months) to really start seeing some benefits from it. By changing just one variable in your life, you'll be able to directly attribute the benefits you're seeing to it. You'll understand what it's doing for you. Then, once you've gotten good at fasting, you can experiment with using a keto-friendly diet to stay in ketosis on your eating days, and you can see what that does for you.
And for my keto report 3 weeks in to my six week test: Not much body change delta vs. what I was getting just by fasting. Although I am enjoying eating keto, so it's not been too difficult so far (and I generally like the idea of staying away from sugar, regardless).
So, start with fasting first. Here are my tips on how to get started. Get good at it. Then layer in other experiments like ketosis. And good luck!
I read it all . Comments too. Can vegans do this? He long do I need to go carb free and sugar free to get into ketosis? 12-24 hr? Can I do it with smoothies? Also isn't this just Atkins? And doesn't it make your breathe stink like a dead skunk? Keep it up. Engage my Doctor Uncle. He could be your personally free consultant.
Looks to me like vegans can do it; you'd just have to find non-animal fat sources. Here's a quote from here:
Vegetable and Non-Animal Fat
Getting significant amounts of fat in the diet from vegetables is challenging. Turning towards “pseudo” vegetables, fruits, and nuts makes it easier.
Avocados, which are actually a fruit, provide a healthy amount of monounsaturated fat, a plethora of vitamins and nutrients, and most of the carbohydrate content is fiber, which feeds your bowel bacteria and will not affect ketone levels like non-fiber carbohydrates.
Coconuts, coconut oil, and coconut manna (the pulp of the coconut which contains some fiber) provide significant saturated fat and medium-chain triglycerides, which are easily turned into ketones.
Macadamia nuts provide the best bang for your buck in terms of fat-to-carbohydrate ratios with 21 grams of fat per ounce serving and only four grams of carbs (two grams are fiber).
Almonds are also good sources of fat and vitamins but can often lead to issues, as their fat content per ounce serving drops to 14 grams and the carbohydrates rise to six grams.
Here I got more for you. Here is an interview with Dr Richard Veech from the NIH (info on him here: http://irp.nih.gov/pi/richard-veech) after reading your blog post.
Wow this is AWESOME Frank. So interesting about KetoForce being harmful vs. helpful (just actually bought some KetoForce so very timely!) Also interesting re: racemic mixtures. Thanks for this amazing video, I have about 1,000 more questions for Dr. Richard Veech. I also found some great research papers by Dr. Veech:
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d-β-Hydroxybutyrate protects neurons in models of Alzheimer's and Parkinson's disease
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Super interesting paper by Geoge Cahill about fuel metabolism in starvation that mentions Dr Veech's work, specifically this quote (emphasis mine): β-HYDROXYBUTYRATE: THE MOST EFFICIENT FUEL: Veech and colleagues discovered that administering β-hydroxybutyrate to the perfused rat heart in place of glucose increased work output but decreased oxygen consumption." and also "The data demonstrated that the increased efficiency was the result of the widening mitochondrial substrate ratio of NADH and NAD+ between complex 1 and complex 2. The net effect is a greater potential for ATP production.
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And in this article, 'Ketosis and the Possible Benefits of Ketogenic Nutrition': "Your heart can take up to a few weeks to adapt to using ketones for energy, but once it is adapted, it may run much more efficiently compared to when it runs on glucose. Veech and colleagues have done studies and reached this conclusion."
Here is the answer to your other questions by Dr. Kieran Clarke from Oxford.
This is mindblowing.
Really interesting what Dr. Clarke saying about PET scan — a PET scan is just someone drinking a sugary drink w/ a dye in it, and the reason it works is that the cancer gulps up the sugary glucose drink in the body (and the dye) and then they can see where the cancer is in the PET scan. So what Dr. Clarke was saying is that if a PET scan shows the cancer, that means it’s likely glucose dependent, so a ketogenic diet would help starve it. HOW IS THIS NOT COMMON KNOWLEDGE?!!!
Here's a video of what I had for lunch at the office today (and the choices I made to try to achieve the 70% fat, 20% protein and 5% carbs split)
Here's the Keto-OS video I linked to in the blog post above. The thing I really like about it is that it clearly explains the relationship between glucose and ketone creation, which surprisingly no other simple video does (I looked literally for hours). The only other place where it's explained is in the more technical, and long, videos from the medical researchers like the ones I linked to above. But if you just want to gain a quick understanding of ketosis, this video does a good job.
The reason I didn't embed it directly in the blog post above is that it makes ketosis sound easy -- like you just have to take their supplement, and you'll be a superhero. But it's not that simple. Here are some of the caveats you should be aware of as you watch this video:
- Supplements like Keto-OS are called "exogenic ketones," which means they provide you with external ketones that you ingest, vs. the ones your body makes naturally when it doesn't have access to glucose. This can help put you into ketosis quickly (within an hour vs. 12-24 hours naturally). The benefit of ingesting exogenic ketones is that you skip the period of stress your body goes through when it switches from glucose to ketones for energy. However, some researchers believe that having your body go through that period of stress is a good thing -- for example, in that transition period your body may flush out pre-cancerous cells that have damaged mitochondria.*
- They claim that exogenic ketones have been used on navy seals and NASA astronauts. That's true. Dr. Dom D'Agostino started his research in 2008 trying to help navy seal divers avert seizures when using rebreathers at depth. The divers would start having seizures within 15 minutes because of the oxygen rebreathing. But when in ketosis, the divers could stay down for more than an hour, pointing to how the body utilizes energy more efficiently when in ketosis.
*A note about pre-cancerous cells that have damaged mitochondria: Cancer cells need glucose to survive. They cannot use ketones for energy, even though your normal cells can (there's copious research on this, like this NIH study). The reason for this is that they have damaged mitochondria, and the mitochondria is what converts the ketones to usable energy at the cellular level in normal cells. Therefore, by restricting glucose intake, you are arguably giving cancerous or pre-cancerous cells less fuel to use as energy. Now, like I said, I'm not a doctor, I've just been doing a ton of research on all of this. If you want to go deep down the rabbit hole around the potential cancer benefits (which I didn't really touch on in the blog post above), I highly recommend Dr. Dom D'Agostino's Tedx talk below on "Starving Cancer" as a quick primmer, and then that you listen to the 3 hour Tim Ferriss podcast with Dom D'Agostino to go way deeper. I'd also love to hear from you if you think these claims are just plain crazy -- a lot of this research seems to be very new (within the last 5 years) and I can't quite tell how mainstream it is yet.
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Fasting Update: Three Months In
On DROdioIt’s been 13 weeks since I wrote the in-depth post on my fasting experiment (read that first if you haven't already), which I originally only expected to try for 8 weeks. But the results have been so life changing that I’ve decided to continue doing it through at least the end of the year, and possibly indefinitely. Here’s what I’ve learned and experienced over the past couple of months, along with the pro-tips I recommend for others interested in trying it themselves, and answers to the questions I get most often.
The main thing I’ve learned in the past couple of months is that fasting is deeply misunderstood by people, including the reasons for doing it, the science and nutrition behind it, the actual experience of fasting, how it makes you feel, and how best to be supportive of someone in your life who’s giving it a try. Fasting just isn’t mainstream enough to make sense to people, and they often immediately respond with “I could never do that” (which is how I used to also feel before really diving into it).
From my fasting experience I’ve also become convinced that the obesity epidemic in America can be solved by integrating fasting elements into our culture. I don’t know if fasting will ever reach that level of cultural prominance, but I do now know with certainty that there’s a solution out there that works, and although fasting is a very individual thing, I’m convinced that it could be codified into an approach that could work for anyone. This also means that if you are unhappy with your current level of health, fasting is something you can do to fix it. It may not be the only thing you can do, but from experience I can tell you that it is absolutely an approach that will work. If you’re serious about trying to become healthy, fasting will work.
Why The Slow Carb Diet Simply Can’t Fail
On Imported BlogIn a society of greedy CEOs and persuasive marketing, how does one fully trust the messages being displayed to them?
This is not a problem if you’re simply looking for a new pair of running shoes but when your health is the issue at hand, you need answers. Let’s be honest, those who profit from many of today’s popular diets and nutritional supplements are in no rush to let you know whether or not their product works.
It is situations like this when one must see through the bells, whistles, and celebrity endorsements and take a more critical look at things. Where better to get an unbiased, reliable opinion than your old Biology text book. If you were to review any of the fundamentals of how the human body works, I`m confident you`ll quickly see why the Slow Carb Diet can work for you.
The Diet:
The Slow Carb Diet utilizes the knowledge of the Glycemic Index which is a scale to measure how quickly and sharply a food with raise blood sugar levels. With the Slow Carb Diet, you avoid foods (including some which you may have initially perceived as beneficial in your weight loss journey) which rank high on the Glycemic Index. It promotes the consumption of lean proteins, vegetables, legumes and healthy oils.