Friday, August 08, 2008

Eight Tips for Living with Ketosis


As of August first, I have been ketogenic with my diet. I'm going to try to go 30 days with less than 20 grams of carbs a day -- it's almost impossible to be zero-carb -- there are incidental carbs in things like nuts, cheese, and other staples of the ketogenic diet.

I'm not really trying to lose weight, just trying to drop some bodyfat without losing muscle or strength. Usually it takes me three months to drop fat on a low-carb diet, so I'm experimenting to see if I can get the same benefit in 30 days.

So, for the last several days, once my glycogen stores were depleted, I have been in ketosis. Here is a brief explanation of the biology of the ketogenic diet from Wikipedia:

The diet mimics aspects of starvation by forcing the body to burn fat rather than carbohydrate. Normally, the carbohydrates in food are converted into glucose, which is then transported around the body and is particularly important in fuelling the brain. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. When the body produces ketone bodies, a state known as ketosis, this has an anticonvulsant effect.[1]

The diet has just enough protein for body growth and repair, and sufficient calories to maintain the correct weight for age and height. The "classic" ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by eliminating foods high in carbohydrates (starchy fruits and vegetables, bread, pasta, grains and sugar) while increasing the consumption of foods high in fat (cream and butter).[1]

Most dietary fat contains long chain triglycerides (LCT), but a form of coconut oil can be manufactured that contains only medium-chain triglycerides (MCT), which are much more ketogenic.[1] A variant of the diet known as the MCT ketogenic diet uses MCT oil to provide between 30 and 60% of the calories. Carbohydrates and protein can be increased a little, which allows for greater freedom in planning meals.[2]

First and foremost, ketosis is not unhealthy. Of the four macronutrients (carbohydrates, proteins, fats, and water), only carbs are non-essential to our lives. Glucose may be the preferred source of energy, but ketones are perfectly capable of fueling the body, but until you adapt to it, it might feel like hell.

Luckily for me, I function best on a low-carb diet anyway, so ketosis doesn't really make me moody or depressed. In fact, I feel better physically than I have in a while (and I usually feel pretty good). One of the cool things about ketosis is that hunger goes away, which makes the diet easier to stick to if you can deal with the first 5-10 days (where most people struggle with adapting to the diet).

I'm doing a slightly different version of the diet than described above, which was designed from treating epilepsy in children (and has been used successfully with other disorders, including autism and ADHD). I'm getting about 300 grams of protein a day, and about 80 grams of fat a day. So I am in calorie deficit as well as forcing my body to burn stored fat for energy anyway.

Some tips for surviving ketosis

1) Psyllium husk and ground flax seed. The hardest part of being ketogenic is the lack of fiber, if you know what I mean. I mix ground psyllium husk and ground flax seed in a large container and use about 4-5 heaping tablespoons a day. We're talking zero carbs with this, and a little healthy fat with the flax seed. I use it mixed in cottage cheese and in whey protein shakes.

2) Don't expect great workouts. The first thing you'll notice when you lift is the lack of a pump. No carbs = no pump. You'll also notice the lack of endurance. The focus during a ketogenic diet should be low reps and heavy weights. I'm as strong as ever, but a ten rep set of squats feels like running a 100 meter sprint. So I'm staying around 4-6 reps per set and doing more sets.

3) Don't do the old-school version of this diet. In the old days, heavy cream, bacon, sausage and lots of red meat were a part of this diet when body-builders used it to drop fat (the high cholesterol boosts hormone levels). You'll still see people advocating that approach. I favor lean meats (chicken, tuna), eggs (free range), cheeses (feta, mozzarella, Monteray Jack), nuts (peanut butter, walnuts, almonds), low-fat cottage cheese, fish oil (about 20 grams a day), and protein drinks (with olive oil or flax oil, but don't combine oils and fiber in the drinks -- the fiber will suck the fat right through your body). I'm still planning to do some red meat, mostly for the extra calories from fat.

4) Use Cinnamon and alpha lipoic acid. In the absence of glucose, these supplements should be useless for energy stabilization, yet they seem to help me quite a bit. Go figure.

5) If you are lacking all energy on this diet, use MCT oil. MCT oil is composed of medium-chain triglycerides (from coconut oil), which are much more easily burned for energy than long-chain fats. I suffer the gastrointestinal "side effects" mentioned below, mostly cramping, so I leave these to others. This is from Wikipedia:
The ketogenic diet's severe carbohydrate restrictions made it difficult for parents to produce palatable meals and few could maintain it for long. However, in the 1960s it was discovered that medium-chain triglycerides (MCTs) are much more ketogenic than normal dietary fats (which are mostly long-chain triglycerides). This is because MCTs are absorbed rapidly and contain many calories. In 1971, Peter Huttenlocher devised a diet with sufficient MCT oil to induce ketonuria and tested it on a dozen children and adolescents with intractable seizures. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. About 60% of the diet's calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. Most children improved in both seizure control and alertness: results that were similar to the classic ketogenic diet. Gastrointestinal side effects were a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children.[12] The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.[5]
So if you can't do the full-on version of the diet, the MCT version still gets the job done and you'll likely feel better in terms of energy and mood.

6) Take your vitamins. Because this diet is limited in what you can eat, you need to be sure to take a good multi-vitamin, beta carotene, vitamins B, C, D, E, calcium, magnesium, and zinc.

7) Caffeine. I highly recommend coffee and green tea (or a green tea supplement) while on the ketogenic diet. Hell, I like caffeine in general, but on the diet its necessary and useful. The energy boost is the best part, but caffeine also forces the body to mobilize fatty acids to burn as energy, which helps make the diet more effective (paraxanthine is one of the major metabolites, at about 84%, which increases lipolysis, meaning that fat is released for energy).

8) Buy some breath mints. Any ketones not used by the body for energy are excreted in the the urine and the breath, resulting in what some have termed "sweet breath." While not horribly offensive, it's also not pleasant, so buy some Altoids.

Benefits of the Ketogenic Diet

This list is from a good article at BodyBuilding.com -- you can go there to read the science supporting these claims.
Establishing this metabolic state of ketosis even for a short period of time has many outstanding benefits.

1. The main benefit being that it increases the body's ability to utilize fats for fuel, which gets very lazy on a high carbohydrate diet. When on high carbohydrate diets the body can usually expect an energy source to keep entering the body. But in the state of ketosis the body has to become efficient at mobilizing fats as energy.

2. Another nifty thing about being in a state of ketosis is that if the body has no further use for ketones they can simply be excreted through urine as a waste product. This means that at times your body will be peeing out body fat! This is a novel theme because you body is very efficient at storing energy substrates for later use.

3. Ketosis has a protein sparing effect, assuming that you are consuming adequate quantities of protein and calories in the first place. Once in ketosis the body actually prefers ketones to glucose. Since the body has copious quanities of fat this means that there is no need to oxidize protein to generate glucose through gluconeogenesis.

4. Another benefit has to do with the low levels of insulin in the body, which causes greater lipolysis and free glycerol release compared to a normal diet when insulin is around 80-120. Insulin has a lipolysis blocking effect, which can inhibit the use of fatty acids as energy. Also when insulin is brought to low levels many beneficial hormones are released in the body such as growth hormone and other powerful growth factors.

5. Another small but very important benefit about the ketogenic diet is that when in the state of ketosis, ketones seem to blunt hunger in many people. I mean honestly, what is not better than being on a low calorie diet and not being hungry all the time like you usually are such as on a high carbohydrate diet. Since on the ketogenic diet you have to consume a lot of fat, which hold 9 calories, you are not getting much food volume. This makes not being hungry a very good thing when on the diet. When you add such thermogenics like the ECA stack and prescription appetite suppressants you won't even think about your next meal. It's kind of funny that when the Atkins' diet first came out one of the early criticisms was that the diet blunted hunger too much! What, is it mandatory to be hungry on a reduced calorie diet?

6. The last benefit has to do with the fact that a ketone body is an inefficient fuel source due to the fact that when the fatty acid is converted to a KB it contains 7 calories. This means that the normal pound of fat has less than 3500 calories.
So there you go. After a week, I'm feeling pretty good and thinking that 30 days will be a piece of cake.


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