“ Let food be thy medicine, and let medicine be thy food.” – Hippocrates
Over quoted maybe, but insightful and timely.
To this day the ketogenic diet is still not widely recognized or commonly recommended as a safe and effective treatment for type 2 diabetics. You are more likely to have your doctor recommend you take metformin or another antiglycemic medication before they prescribe you a ketogenic diet regimen. But time and time again it has been shown to decrease patients HbA1c (marker for regular carbohydrate intake), fasting blood sugar, insulin resistance, fasting triglycerides, weight and need for medications better than a diet higher in carbohydrate.
When I decided to commit to the diet, I knew I needed to devote time to it. You can get into ketosis in under a week, but that doesn’t mean you’re reaping all the benefits. The juice comes from the squeeze. I took the recommendation from The Art and Science of Low Carbohydrate Living that I mentioned in my last post, and blocked the next 8 weeks on my calendar. Dr.’s Phinney & Volek believe a person must sustain nutritional ketosis for a minimum of 6 weeks to elicit the true benefits of metabolic adaptation in all the various organs and tissues that are learning to use the new fuel sources. No pizza nights, no beers or donuts. No fun? No worries. I was excited.
First step was to calculate my macronutrients. Using a basic TDEE (total daily energy expenditure) calculator online, I adjusted for a slight deficit with a goal of weight loss, and arrived at a recommended 2,500 calories a day. Start weight 223 pounds. A healthy person may decide to begin their diet with anywhere from 65-85% of their calories coming from fat. I wanted to eat 1 gram of protein per pound of lean body mass, which I estimated to be 185lbs. Net carbohydrates were to be kept under 50 grams per day. With 185 grams of protein, 50 grams of carbs, both coming in at 4 calories / gram, I had a total of 940 calories. 2,500 – 940 = 1,560 calories of fat, which equates to 63% fat. 1,590 / 9 calories per gram = 173.3 grams of fat a day. This was BY FAR more fat than I had ever eaten at once. 2,500 calories: 185 Protein / 50 Carb / 173 Fat.
Delicious routine meals were easier to prepare than expected. With an abundance of fat to include in each meal, everything tasted good. I found myself grooving to the tune of an egg based breakfast and a cast iron pan meal for dinner. Breakfast was most commonly a slice of a breakfast frittata my roommate and I made every Sunday. It held well, could be frozen, and was a hefty dose of protein and fat. Other mornings I would fry up some eggs and veggies, or take some hard boiled on the road with some carrots and celery.
Food that I often traveled with were beef jerky, turkey jerky, almonds, walnuts, carrots, hard cheeses, hard boiled eggs and avocados. If I was having lunch at the house, it was often a high fat salad. Loads of mixed greens, cucumbers, tomatoes, shredded cabbage and carrots, broccoli slaw, walnuts, avocado, feta cheese, any lean protein I had, and a high fat dressing.
The cast iron became my best friend. Every evening started with olive or coconut oil in the pan. First some fresh garlic or chopped bacon. Then a generous amount of leafy greens. Once they’d wilt down, some veggies. Lastly, some protein and whatever cheese was fitting. Mix it around and serve when the protein is heated to your liking. Simple, and endless possibilities. Especially when mixing in new herbs and spices.
Dessert was an area I navigated before the widespread sale of ketogenic friendly ice cream. A common choice of mine was a small carton of sour cream with a tbsp of cocoa, some monk fruit sweetener, and a few frozen blueberries. My roommates thought I was losing my mind, but honestly, I loved it.
Staples in my pantry at the time: beef jerky, canned tunafish, canned salmon, pork rinds, almonds, walnuts, macadamia nuts, avocado mayonnaise, chicken bone broth, riced cauliflower.
In Volek & Phinney’s book, they discuss a study they published called the FASTER study (fat adapted super trained endurance runners). They were investigating fat metabolism and fuel efficiency in fat adapted ultra runners vs runners consuming a high carbohydrate diet. What the study ultimately showed was that the diet was not superior, it did not significantly improve performance, but it did show a massive advantage in fuel availability during these ultra long events. The fat adapted runners didn’t have the need to consume gel-packs and glucose supplements every hour like the carbohydrate consuming runner. Although these athletes have little body fat, it is still a massively larger available fuel source than their muscle and liver glycogen stores. The fat adapted athletes pull from their fat depots all race, while the carbohydrate consuming runners need to continue to refuel before they “bonk” or deplete their glycogen supplies.
I was so intrigued that I decided to sign up for a 10 mile race. I had been in ketosis for a month, but had never run more than a 5K. My training style had changed, and I was primarily doing fasted CrossFit workouts in the morning. I found myself to be in more control of my mental game when training fasted, so I ran the ten miler on an 18 hour fast. I would pass each mile marker and realize I felt better than I expected to. It made me go faster. My pace sped up the last 3 miles. In my CrossFit training, my strength was diminishing slightly, but my aerobic and anaerobic abilities were increasing. I felt fitter, but not stronger. This was the goal of the experiment. At the end of the eight weeks, I weighed 198.3. The first time I had been under 200 pounds since middle school.
I had reached my goal, and had to reevaluate. I decided it was time to bring carbs back into the fold, and work on my strength again. I could have gladly kept going with the diet, but I didn’t feel the need or want to at that time. I came away from it with a new tool in my toolbox. For me, I will try and have a 6-8 week ketogenic stretch each year. Following the experiment, I noticed my baseline shifted to a lower carbohydrate intake. I wasn’t consuming carbs with meals that I normally would have. Carbs were now a tool for me. My system was resensitized to them, and I began to actually feel the increased energy in workouts when I would consume them prior. I’ll be doing a ketogenic diet this summer, and will share some of the experiments on here (measuring glucose and ketone changes to marketed keto-friendly foods). People will bash you for wanting to try it, says it’s unsustainable, not good long term, blah blah blah. As with all things, don’t knock it until you try it. And if you’re going to try it, commit and do your research. But first, get your doctor’s approval.
Seyfried et al., Cancer as a metabolic disease: implications for novel therapeutics
Weber et al., Ketogenic diet in the treatment of cancer – Where do we stand?
McDonald and Cervenka, The Expanding Role of Ketogenic Diet’s in Adult Neurological Disorders
Beneficial mechanisms of a ketogenic diet for adult TBI patients
Sourbron et al., Ketogenic Diet for the treatment of pediatric epilepsy: review and meta-analysis
The Charlie Foundation has a plethora of resources and information on the diet for pediatric epilepsy.
Virta Health is a relatively new company using the accessability of telemedicine to implement a ketogenic diet for type 2 diabetics. They published a one year follow up study showing their intervention’s efficacy in reversing type 2 diabetes.
Metabolic characteristics of keto-adapted ultra-endurance runners, Volek et al.