Reflections on a Ketogenic Diet

So I went “hard-core” keto for two months.?This really means three things….a diligent attempt to minimize my daily net carbs and sugars, logging and tracking all the food I ate and the macronutrients it contained, and testing multiple times a day to see if I was actually in a state of nutritional ketosis.?It was a fun experiment…mostly.?And I’ve got some thoughts. ?

1. The ketogenic diet was devised 100 years ago as a therapeutic intervention for diabetes.?Then it was found to have some likely benefits for a whole spectrum of additional chronic physical and mental diseases.?But you may know it as a weight loss diet.?A common side effect of eliminating certain foods, like carbs, and converting to a fat burning metabolism is shedding pounds.?Part of this has to do with how the body retains water, but it also has to do with your cells scavenging off a new fuel source in the absence of glucose…fat.?Now I don’t have extra weight to lose…so to just maintain weight at my current levels of exercise I was trying to target 3200 calories a day.?Turns out when 70% of those calories need to come from fat, 25% from protein, and my window of eating is from 7 AM to 6 PM, it’s really hard.?10 lbs fell off me in less than a month before I figured out how to flatten the tailspin. ?
2. Achieving and sustaining a nutritional state of ketosis is really hard.?Twice a day I would test my blood with a glucose / ketone monitor…the results would be calibrated into a Glucose Ketone Index (GKI)…at 9 or below you’d be in a state of ketosis.?This is the point at which blood glucose is low enough, and excess ketones in the blood are abundant enough, that you can confirm your body is producing and using ketones as a primary fuel.?I found that I needed to have definitely less than 50 net carbs/day, but closer to 30 net carbs before I’d even be in a low grade ketosis.?Then there’s all kinds of other factors that can spike blood glucose, like physical and emotional stress, sleep, medications, time of day, excess protein….any one of these things can knock you clean out of ketosis.
3. I was able to achieve high therapeutic ketosis with a GKI of 2 or less when I was fasting.?On day 2 of a 3 day water fast, I’d be in full blown ketosis.?And I actually felt pretty energetic.?I was pairing these intermittent fasts with my chemo infusions and I found that when I received steroids as part of the cocktail, this would severely blunt the quality of my ketosis…by more than half.?On rounds when I passed on a chemo drug and the accompanying steroid, my ketosis was off the charts.?But then as soon as I started eating again….even introducing no to minimal net carbs, my ketosis would dilute down to a low grade state of 6-9 in the following days. ?
4. Net carbs and sugars are sneaky little bastards.?Start paying close attention to food labels and you’ll see that almost everything has net carbs (total carbs - dietary fiber) and sugar, either natural or additive.?So in an effort to minimize my daily total, I’d review the nutrition data for everything I ate.?But the REAL sneaky part is something that seems low net carb would be based on some silly small serving size.?“Oh!, this only has 2 net carbs…but the serving size is a tablespoon, and I just ate 2 cups…which just put me at half my entire daily quota….dammit”.?It’s almost impossible to maintain ketosis without tracking all your ingredients and serving sizes…which makes eating out challenging.?Sauces, serving sizes, sources of food, ingredients in complex meals, are virtually impossible for a customer to know, and often the purveyor doesn’t even know.?Assume that salad dressing is loaded with sugar and that chicken is not organic free range. ?
5. I was really conflicted by having to eliminate some foods that I love and know are good for me, but contain natural sugars or net carbs, like blueberries.?I fucking love blueberries, but went without for two months and it made me sad.?But even a handful of them would shut down my body’s production of ketones.?Popcorn, warm sourdough bread with brie, a slice of homemade strawberry rhubarb pie…there’s just not a keto friendly version of these things.?And that’s missing out on a delicious slice of life.
6. But amazingly, there are keto adapted variations of most things.?Waffles made with coconut flour, cream cheese lemon cheesecakes, erythritol as a sugar subsitute, cauliflower rice, zucchini noodles, lettuce wrapped burgers…and there’s some convenient and processed foods available catering to the keto craze…crunchy cheese bites, no sugar BBQ sauce, keto ice cream, zero carb tortilla wraps, even Papa Murphy’s has a “keto pizza”.?Google just about any recipe and add “keto” to the search, and there will be something that comes up. ?
7. The staple of a ketogenic diet is saturated and unsaturated fat.?For me, trying to pack in 2,240 calories of fat a day proved challenging.?I feasted on macadamia nuts, avocados, butter, cheese, olives, MCT oil, eggs, heavy cream, olive oil, king salmon, and chicken thighs.?But it often left me feeling bloated and overfed.?Constipation set in so I scavenged on vegetables with high dietary fiber, and supplemented with stool softeners and ground flax seed.?Coffee was definitely required.?And without just straight guzzling olive oil, I often wasn’t able to hit my targets.?Hence the weight loss. ?
8. A great question to ask at this point would be, “So, what did all that keto do for you?”?My honest answer is I’m not really sure.?Presumably as a therapeutic intervention for cancer, it would starve cancer cells of their primary food, glucose, while the rest of the body happily feasts on fats and ketones.?It’s not as black and white as that as the biochemistry of our body is infinitely complex, but it’s not a stretch to hypothesize that reducing sources of glucose in the body could have an impact on cancer progression.?I have seen my cancer markers decline pretty dramatically in the past several months but this could also be due to at least 10 other factors.?You could also ask, “how long or intense does the ketosis have to be in order to make a difference?”.?Also an excellent question without a clear answer.?I will say that converting my metabolism to a ketogenic engine did seem to come with an overall boost in energy, sharpness, stamina, and mood.?And my overall diet improved to include whole, organic, simple ingredients that I knew where they came from.?That alone could trigger a cascade of healthy outcomes rippling forward. ?
9. My ketogenic final exam happened a week ago as I set out to jog the 30 mile Wildwood Trail in Forest Park.?I rated this as extremely challenging for me given my?modest training, ongoing chemo treatments, and a distance I’d never attempted to run…ever.?My goal was to crank out 15 minute miles.?Early that morning my GKI was a 6…moderate nutritional ketosis.?I loaded up on protein shakes, MCT oil, fat bombs, baby bell cheese, nuts, 90% dark chocolate, and smoked salmon.?No sugar or carbs before, during, or after.?How would my body perform in an endurance activity on only fats, proteins, and ketones??At about 4 hours I was right on pace, but I could feel the tank running low.?As I approached 20 miles I could tell that I would soon cross the threshold of the pain cave…I could keep going, but shit was gonna start falling apart.?I pulled the parachute and called for an extraction.?5 hrs and 8 min.?I wanted to see what I was capable of, but not hurt myself.?At home, I measured a stout GKI of 2…high nutritional ketosis, and I was still walking.?I considered the test a success. ?
10. I’m going to transition into a “low carb” diet….there’s been a number of foods that have been pretty easy to let go of that for me just don’t have any redeeming nutritional value…breads, rice, potatoes, chips and cereals, legumes, added sugars, foods with wheat flour or breaded, sugary fruits like bananas and pineapple.?But reducing net carbs to the extent that induces sustained nutritional ketosis is a cancer intervention I’m going to let go of.?Because…blueberries.?