Ketosis and Blood Ketones

Nutritional ketosis is the state in which ketone bodies are produced to fuel nearly every type of cell in the human body.  This energy state occurs when humans ingest typically less than fifty grams of carbohydrate per day.  It could be surmised that if you randomly sample a single human on Earth, they will not be in ketosis, due to the high amount of processed and inexpensive food conveniently available.  In third-world populations, this is especially true due to limited food availability, poor economy, war and climate-related issues.  It is this type of food which contains high carbohydrate concentration and prevents ketosis from ever becoming a remote possibility.

Glycolysis is the human body's state where glucose, derived from any carbohydrate ingestion, is used to create energy.  This can occur from ingestion of sucrose, lactose, dextrose, galactose, or any other "ose" (simply speaking - sugar).  Generally an individual will be in glycolysis if they ingest over 50 grams of carbohydrate per day, though this may be higher or lower for some individuals.

As stated in countless articles, studies and texts, the peptide hormone insulin is kicked into action when blood-glucose levels are heightened after ingesting a meal with carbohydrate.  One of insulin's main functions is to lower blood-glucose.  It does this due to the fact that prolonged and continuously high levels of glucose in the body is toxic and can lead to future debilitating disease, coupled with cellular-insulin resistance.  Insulin also does its job of storing fat away for fuel, whether you need it or not.

Individuals who gain weight that was not a direct result of sex hormone (i.e. puberty) or genetic issue are beginning to see the result of a lifelong state of glycolysis.  Scientists, organizations and nutritionists alike will explain this is simply a result of aging and "slowing metabolism".  Fortunately, we have data that a lot of people who ate differently - some not too long ago - had very different health outcomes.  It was not until Western Diet (like that mentioned earlier) was introduced that Western Diseases were concurrently introduced to previously isolated cultures.

This "slowing metabolism" is the degrading of the body's adipose tissue's ability to properly regulate fat flow.  This tissue prefers to hold onto fat for those in glycolysis.  In ketosis, stored fat (triglyceride) actually breaks down into component fatty acids which are released into the bloodstream for fuel.  After a meal, if you compare triglyceride levels in someone in glycolysis vs. someone in ketosis - you will see the latter has a much higher level of triglyceride.  However, the body regulates this soon after the meal - while the former individual maintains a high level of triglyceride long after the meal.  This result can be seen comparing fasting lipid profiles of each individual.  Triglycerides are predictably low in KD patients, while low-fat and high carbohydrate adopters possess very high levels.  

Little known is the fact that ingestion of carbohydrate leads to lipogenesis, or the creation of fat.  Many firmly believe that eating "low fat" foods is healthy, as it equates to less fat in their bodies.  However, when you remove fat, you typically insert more carbohydrate (perhaps some protein) - which invariably leads to a much higher output of fats through lipogenesis.

Many people have found they can lose weight quite easily by simply reducing their refined carbohydrate intake, not needing to push their bodies into a state of ketosis.  Yet, dependent upon the specific goals of the individual, keto-adapting may be an individual's best bet for losing the most weight and having a much better rate of diet retention.  Most of the cause for this higher success rate has been shown to be:  greater satiety; no calorie limit; no hunger pangs and speedy weight loss.

When the body is in a state of ketosis, triglycerides are broken down into their component fatty acids for fuel.  The liver is busy churning out ketone bodies. 

Previously, one could check whether they were in a state of ketosis via the guidance of ketostix, as mentioned in my July post.  However, this tests urinary ketone levels.  This is not a very effective way to check for ketosis for a few reasons.  The main strike against it is that some individuals may never pass ketones in the urine.  Others may pass them only at certain times...or in limited amounts.  This type of information can mislead an individual to believe they are not in ketosis. 

Using a ketone meter to instantly check blood ketone levels is currently the best method for testing whether one is in ketosis.  As the aforementioned post also stated, there are a specific range of blood ketone levels associated with nutritional ketosis.  Naturally, people begin to wonder - what 'level' they are at currently.  Furthermore, what does it matter?

Tom Naughton, of Fat Head fame, claimed on his blog that regarding Jimmy Moore's plight to start losing weight again, it was not until his blood ketone levels went from 0.1 to 2.0 that he began to lose weight.  He also mentions that some individuals are "...hyper-responders to insulin-producing foods, staying in ketosis may be the key."

Dr. Andreas Eenfeldt AKA "The Diet Doctor" has a recent blog post claiming he's performing a N=1 experiment on fat loss by testing blood ketones.  It seems like a lot of us have these new toys.  But, the word is still out on whether a higher level of ketone bodies equates to an increased efficiency in fat burning. 




Gary Taubes has been nice enough to take the time to answer some of my deepest, darkest questions recently.  Gary stated that he was not aware of any correlation between blood ketone levels and fat loss, though he thinks there would be.  Of course, he like I would prefer to have the facts.  Hopefully he'll get some as the NuSI was just launched yesterday!

A recent "Ask the Experts" Jimmy Moore podcast hosted Dr. Stephen Phinney.  I was lucky enough to have him answer one of my questions:

"Do higher levels of ketosis mean you will experience more rapid weight loss? I’ve been measuring my blood ketones and wondered if readings over 2.0 millimolar meant that I was in the ideal range for optimal fat loss."


His responses (around 1:06) "...being in ketosis doesn't guarantee weight loss...being in ketosis facilitates fuel flow."  He goes on to say how nutrient ratio is more key to the reduction of fat.

(around 1:08)  "There is nothing about having a specific blood ketone level that guarantees weight loss.  What that does guarantee you is excellent fuel flow.  So if you can then use that fuel flow by either cutting back modestly on total amount of calories eaten or as in my case upping amount of calories expended....[you will then begin to see the change]"  He goes on to say he and Dr. Jeff Volek are looking into ketone variance between individuals - the variance is significant.  Should know more on that within a year.

As far as scientific data, it looks like the question is definitely still out there on blood ketone levels and their affects on many health aspects.  Hopefully we'll get some solid information from the aforementioned doctors and initiatives.

Low-Carb Gravitation

If you asked someone to play the word association game with the phrase "Low-Carbohydrate", what do you think the first word would be?  I surmise most players would state "weight".  If someone who does not know much about LC, they may know it is a method to lose weight, but not much more. 

This was the level of knowledge I had attained back when I had originally started the Atkins Diet plan so long ago I don't remember.  Don't blame my memory - I was in a glucose-induced fog back then. 

I had started the Atkins diet, alongside my wife in an effort to lose weight, plain and simple.  The regiment of cutting carbohydrates significantly was simple enough after we learned via carb-counters what foods actually contained carbohydrate.  We both saw great success in limiting our carbohydrates - and at the time, Atkins was experiencing a big BOOM in popularity.  Restaurants such as TGIF were appealing to us, offering "low-carbohydrate" menu items.  LC grocery items were appearing in supermarkets...I had never seen so many flavors of pork rinds in my life!

We knew that staying LC was a life commitment in order to keep the weight off, however we did not care so much for the science behind it.  We read one of Dr. Atkins' books, but perhaps the "why" of it all had never sunk in.  

We decided to stop LC while we were trying to and after my wife became pregnant.  Only later did we find out that insulin resistance begins in utero - from the food that the mother ingests.

Regardless, we stopped and both promptly began to gain back the weight we had so triumphantly lost.  There were a few stints I made later on where I would resolve for New Years to lose weight.  I had a very easy time of doing it.  I would cut out all candy, soda, chips and dessert.  That was enough for me to lose what I desired.  I remember not linking this to cutting refined carbohydrates - but this is exactly what I was doing.

A couple of years after our last son was born, my wife mentioned one night "We should go back on low-carb".  I had thought about it a lot since the last time we'd done it - and was eager to begin again.  During the course of reading about LC again online, we heard about this book called "Why We Get Fat" by Gary Taubes.  My wife was most interested in reading it.  Me, not so much as I have been trying to read some of the same books for years.

While my wife was making dinner one night, she was talking about the book.  At one point she said "The author states that eating this way can avoid cancer".  At this point, I was like, bullshit, give me a break.  However, I sucked it up and read the book with an open mind.  Like many reviewers of the book have stated on Amazon, Goodreads etc, the book is a mind-blowing experience.  I often equate reading it to taking the red pill from the movie The Matrix.

Why?  Reading the book and its obliteration of prior dietary hypotheses completely reverses everything I ever thought I knew about nutrition.  Everything.  I grew up believing that dietary fat was bad and should be limited, sugar could be ingested (including candy) because it was "fat-free", people grew up and got diabetes, heart attacks and cancer as a result of aging.  This was the "common knowledge".  This is what my parents told me.  I never questioned the source - I believed this was what everyone knew.  My parents wouldn't lie to me, right?

They were not lying.  They were passing on what their parents had likely told them - information they had picked up from Senate Committees, the USDA and organizations such as the American Heart Association. 

I am currently listening to the book Why We Get Fat's predecessor, Good Calories Bad Calories, by the same author, which is a more detailed account of everything from diabetes to blood pressure.  Every new chapter, there is an expansion of knowledge on nutrition, based on real science.  I have a difficult time not smacking myself repeatedly in the forehead for how ignorant I was - never questioning the source of my "knowledge". 

I used to believe that LCHF lifestyle was good for weight loss.  I honestly believe now, weight loss is one of the most minor aspects in the way it improves your overall health.  If you have not yet read the aforementioned book, I implore you to do it now. 

American Diabetes Association - The Great Deception

I thought it was important to reach out to the American Diabetes Association and see what their "Stop Diabetes" program is all about.  A representative informed me that on November 2, 2009 the program began in an effort to educate people on the many levels diabetes impacts individuals.  It was also created to ignite a sense of urgency and inspire individuals to get involved in "the fight".

The representative, Harold Young of the Center for Information and Community Support states that "Scientists do not know the exact cause of type 2 diabetes."  This exact sentiment is echoed in other pages around the blogosphere, including The Real Food Revivalist. 

Also, in the correspondence with Mr. Young, he explains that while there is no known cause of type II diabetes, it is associated with several risk factors including genetics.  He strongly affirms that most individuals do not realize type II diabetes is a true disease.

That it is a disease has been well documented in population studies.  In the book, Good Calories, Bad Calories by Gary Taubes, he details many different cultures across the globe who were directly observed by doctors on site for periods of several years to decades.  These were isolated groups - eating their normal diet which mainly consisted of meat - and were completely cut off from current Western staple foods (i.e. white flour, sugar, rice and their various combinations).  Within this book, also documented were the Native Americans of the United States - in which over a hundred thousand individuals' health status were documented by doctors.

In all these cases where Western foods were concerned, there were no virtually no cases of diabetes or appendicitis - not to mention extremely low incidence of malignant cancer.  It was only after the introduction of Western foods, which essentially was refined carbohydrate - that these same previously isolated groups began to experience the epidemic of Western diseases.

These same groups of individuals consisted for the most part on animals, as often as possible ingesting the fattiest meat.

Despite these facts the ADA's "Stop Diabetes" program supports high carbohydrate, low-fat meals.  I suggested to Mr. Young that low-carbohydrate diets, which are high in fat sounded like the ideal diet for an individual attempting to keep their blood-glucose levels in check.  He responded:

"There isn't a one-size fits all diabetic diet.  Everything is individualized so you can have more flexibility in planning meals to fit your schedule, lifestyle and food preferences.  If a person with diabetes chooses to eat a low carbohydrate diet and has the approval of their health care team to do so, then they can.  If a certain diet works well for you does not mean that it will work well for all people with diabetes."

Essentially, Mr. Young is stating that even if eating a certain way were to be beneficial, we don't want to be pushy about it.  It may not complement someone's lifestyle.  If the ADA is so concerned about patient outcomes and the progression of diabetes, why are they not more aggressive on diet?

I explicitly asked if he realized there was a cure for type II diabetes, which I have seen first-hand.  His response:

"There are some people who are able to manage their blood glucose, through a healthy diet and regular exercise. This does not mean they no longer have diabetes. They need careful ongoing assessments of blood glucose control conducted by their health care provider, as those with normal blood glucose levels are at risk for a return of hyperglycemia."

Note the word "manage".  This seems to be the key factor in the ADA and other diabetes campaigns across the country.  This infers there is no cure for this disease.  


Mr. Young claims there is no scientific proof for the cause of type II diabetes, yet we know how to diagnose it - continuous high blood-glucose levels and marked insulin resistance.  What causes insulin resistance?  Continuously high levels of glucose in one's blood.  What causes continuously high levels of glucose in one's blood?  Something we ingest or come in contact with that converts to glucose in our blood.


The test of this theory has been well established.  Someone with type II decides to commit to a low-carbohydrate lifestyle.  They eventually ween themselves from the need for insulin.  They continue to have normalized blood glucose levels.  Is this not curing the disease when you have no symptoms?  

If you cannot diagnose the disease when someone comes in for a test, then it does not exist.  Or am I completely missing a point?

 

 Mr. Young clearly states that it is not curable, yet this runs counter to the National Diabetes Information Clearing House (NDIC), although much of what the NDIC is counter to actual science.

 They state that insulin resistance and prediabetes can be reversed and is completely preventable.  However, they state that it requires both dietary and physical activity.  The mention that individuals must be "...making wise food choices..."  For information on their wise food choices, see below:

In their "Points to Remember" section :

Individuals can prevent or delay onset of type II diabetes by eating a diet low in fat. 

Some quick pointers about the consensus from the worldwide diabetes conglomeration:

1)Type II diabetes has associated risk factors, but no known reason for contraction
2)Eating a low fat diet and exercising may ward off this disease, or at least delay the onset
3)Type II diabetes, once contracted can only be managed as there is no known cure
4)Genetics seem to play a strong role in development
 

The saddest part about this entire situation is that many individuals who are diagnosed with type II diabetes trust in the doctors and organizations.  They trust they are researching cures, looking out for them and giving them good information.  I personally feel terrible this is happening.  The Great Deception.

I Have Diabetes - Help!

You'd think the above glucose meters were iPod shuffles, right?  Diabetes has become such a common occurrence, they're designing flashy meters to meet the rising inclusion of teens into the group.  Nearly 1/4 of the current population of the United States - 100 million - have either full blown type II diabetes or are pre-diabetic.

So you have type II diabetes?  Here is all you need to do to get your life back and stay off the meds:

1)Don't listen to your doctor.  Type II diabetes is completely preventable AND reversible.  You did not inherit it from your mom or dad. 

2)Go to the bookstore, Amazon.com or wherever and read up on some literature.  A good list (diabetes-related toward the bottom) can be found here:

http://www.fathead-movie.com/index.php/recommended-reading/

You need to read up on:  a)How you became Type II
                                       b)How to reverse it
                                       c)How to keep it from coming back

3)Begin a low-carbohydrate lifestyle on day 1.

Type II diabetes is a metabolic disorder, much like obesity.  And in tandem with obesity (which it is often cited as having correlation to), simplistically speaking it is caused by continuously high levels of blood-glucose - leading to eventual "insulin resistance".  Insulin resistance is when all but fat cells resist insulin's main job of storing fatty acids/offloading glucose from your blood.  This is why many type II's are also overweight or obese - comes from the same cause.  However, the subcutaneous fat may not be present until later after diagnosis unless blood-glucose is controlled.

Doctors, nurses, dieticians, and major organizations (i.e. American Diabetes Association) all push diabetes management, rather than the proven cure aforedescribed.  Even the ADA's "Stop Diabetes" site promotes "healthy eating" changes.  See here:  http://www.diabetes.org/mfa-recipes/meal-plans/

For their July meal, here is a nutrient breakdown:

205 GRAMS OF CARBS!

There is the standard USDA-Approved low-fat (especially saturated fat), high carbohydrate meal.  I suppose it is lower than the 350grams of recommended carbohydrates.  Assuming normal non-diabetic individuals can process around 9g of carbohydrate an hour, I would say this is a mealtime disaster.  This is case in point on why you cannot listen to most doctors, organizations and advice.  They are so ingrained with completely false unscientific information, they don't know any better.  

Let me know if you have any questions, I'll be glad to help.

Am I In Ketosis?

Is your body in a state of Ketosis?  If you eat some form of low-carbohydrate plan, this is a question that commonly comes up, especially early on in the process.  The amount of carbohydrate restriction required to enter a state of Ketosis varies from person-to-person.  A general rule of thumb is below 50 grams/day, though some individuals propose as long as you keep your hourly carbohydrates as much under 9 grams, it is sufficient.  

For most people, after a week or so of eating low-carbohydrate their bodies will be keto-adapt - their bodies will begin to shift from using glucose as a primary fuel source - and start using fat as the main fuel.  One product of this process of fat breakdown in the body via ketogenesis is the production of ketones.  These compounds fuel the brain, and have been shown to be the preferred brain fuel - giving many on low-carbohydrate eating lifestyles "clearer thinking".  I personally have experienced this and it has made my graduate career much easier.  I'm maintaining my 4.0!

The older way of testing whether or not you are in ketosis is by purchasing urine test strips.  Generally, it tells you whether or not you are passing ketones.  This is unreliable as the information you are receiving is hours old.  The newer method, as mentioned in the Fat Head Blog is to test your ketone levels by electronic meter.  The advantages of testing by meter is that you can accurately obtain your blood ketone level, it takes a matter of seconds and you can do it anywhere - no trip to the bathroom necessary.

Let's say you obtain a meter - how do you even read the results?  Most meters will not check ketone levels, they are made for individuals concerned about blood-glucose concentrations (i.e. diabetics).  If you are interested in obtaining a meter which checks ketone levels (free of charge), let me know in the comments.

  

As Tom Naughton on the aforementioned blog explains, "Drs. Jeff Volek and Stephen Phinney call nutritional ketosis: a blood ketone level of between 0.5 and 3.0 mM.".  So anywhere in between means you are in a good place.  Jacqueline A. Eberstein, R.N., who began working with Dr. Robert Atkins in 1974, gives some great information on ketone levels:

Blood levels of ketones:

Fed state---0.1mmol/L

Overnight fast---0.3mmol/L.

On low carb---1 to 2 mmol/L

More than 20 days fasting---10mmol/L

Diabetic ketoacidosis---more than 25mmol/L

Having a meter with a glucose blood test is also nice as it gives confirmation that you are on the right path.  A quick glucose blood test calculator/analyzer is here:  http://www.medindia.net/patients/calculators/bloodsugar_chart.asp

Keep in mind, I have never been pre-diabetic, diabetic or otherwise.  I obtained a meter recently out of curiosity and for n=1 purposes.  I took my first ever self-administered separate ketone and glucose tests:

Ketones = 1.5 mmol/L

Glucose = 85 mg/dl

This was after 2 large cups of coffee, which included about 6 tablespoons heavy whipping cream and around 1 tablespoon of coconut oil.

Rita's Supports the Fight Against Cancer?

Here is Rita's continued support of Alex's Lemonade Stand.  Obviously, it is a great cause - fighting cancer.  No one disputes this.  However, the method whereby the money is made - essentially ingesting large quantities of sugar is dare I say counter-intuitive? 

As many of us are fully aware, high quantities of sugar ingestion raise blood-glucose levels and may lead to eventual metabolic disorders, fatty livers and organs.  These disorders cause an out of whack glucose regulation in your body.  Where does all of this glucose go?

            Cancer's Food = Glucose.  It requires it.



There's no way I'm saying that the Foundation for Childhood Cancer has some backhanded motive.  They are just going about fundraising in the worst way possible.  For instance, from 2001-2004, check out the Usual Intake of Added Sugars on the National Cancer Institute site:

http://riskfactor.cancer.gov/diet/usualintakes/pop/added_sugars.html







It is important to note that these Added Sugars include:

"...white, brown and raw sugar, syrup, honey, and molasses that were eaten separately or used as ingredients in processed or prepared foods such as *breads, cakes, soft drinks, jams, and ice cream."

 *Don't forget, healthywholegrains are breads too - and included as added sugar.

 While some readers may take offense to me suggesting that having a Rita's now and then doesn't hurt, take a look at the facts.  Some children...even infants ingest way too much added sugar in their diet.  I'm sure most kids, after a certain age don't want the kid size either.



Your body is not in a toxic state if you have less than a teaspoon of sugar/glucose throughout your system.

Kids portion:  11.4 teaspoons of sugar.

Regular portion:  18.3 teaspoons of sugar.

Back to the lemonade - how many cups of sugar are they putting in 1 pitcher nowadays?

Another Study Dissuades Ingestion of Too Much Red Meat

From CNN/Health.com, we get the following information skimmed from a study published in the Archives of Internal Medicine:  too much red meat increases risks of dying, weight gain and more.

The source of the information is:  "Using data from two long-running studies of health professionals, researchers tracked the diets of more than 121,000 middle-aged men and women for up to 28 years..." so for anyone who is informed, this was not a clinical trial but an observational study.  Due to this fact, one can conclude from the data that was accessed - only correlation or link - not causal information.  However, we see the "AP" version on CNN/Health.com state things like:  "If everyone in the study had slashed their average red-meat intake to less than half a serving per day, the researchers say, 9% of deaths among men and 8% of deaths among women could have been prevented."  Really?

Other great excepts include:  "Why is red meat, and especially processed red meat, potentially harmful? In addition to the high saturated fat content, which can contribute to heart disease, charring red meat at high temperatures can produce carcinogens on the surface, Pan says. And processed meats contain certain additives that in high quantities are believed to promote cancer as well." 

I thought we were all aware saturated fat has never clinically been proven to be harmful - and is in fact beneficial to health.  Yet, it is continually blasted in observational / meta-analysis studies.  And here we have scientists explaining why meat is also bad - the carcinogens produced.  What part of the study was that in?  I call it grasping at straws.

There is a small voice of reason toward of the CNN article in which Staffan Lindeberg, M.D. from Sweden questions the validity of the study.  He states that the real threats to health is sugar and starch-heavy Western diets.  Lindeberg advocates an offshoot of the Paleo lifestyle.  

It is nauseating to read that "Sure enough, Pan and his colleagues found that the men and women in the study who ate the most red meat also tended to be heavier, less physically active, and more likely to smoke and drink alcohol than their peers.". 

Perhaps a more viable study would be to review the diets of those who mainly ate red meat - there are plenty of individuals available!  Don't worry about the study's validity however, they took into account those who were less active, smokers and drank alcohol.  Must have been a simple formula for the thousands of participants.

Newest Non-Fasting Lipid Panel

Due to a recent minor surgery (endoscopic sinus) my primary doctor had a full blood panel done.  I was surprised (as was my ENT when they saw I had one done prior to surgery) but went along with it.  Too bad I didn't fast though, as I had a full lunch (whole avocado and lots of other fats) just a couple of hours prior to the test.  Whoops.  I discovered that the result is an extremely high level of triglycerides in the blood.  This is entirely normal for those on low-carbohydrate.  Your triglyceride count may actually be higher than your high or moderately high carbohydrate eaters.  The main difference being, a few hours after your triglycerides will be kicked in their place if you subscribe to LC.

Without further ado, here are some interesting results from my non-fasting full blood panel:
(All mg/dL unless noted)

Total Cholesterol:  207
Triglycerides: 143 (YOWZA!)
HDL:  57
Chol/HDL Ratio:  3.6 ratio
LDL (Direct):  126

Other interesting readings:

Glucose:  90
Bun: 19
Creatinine: 0.8
Sodium: 140mmol/L
Potassium:  4.6mmol/L
Chloride:  98mmol/L
Calcium:  9.8
Uric Acid:  5.4

(For those that state low-carbers have low calcium and high uric acid - eat those results!)

Note:  The test results state again:  Your lipid profile is abnormal.  Please continue to work on a low fat diet, exercise and weight management.  Please return in 3 months.  OK for surgery.

To borrow from Tom Naughton (http://www.fathead-movie.com) 

It appears there was a good increase of HDL.  From the clinical trials and studies I read up shortly after receiving this test, triglycerides are the most affected by not fasting before the test - and eating fatty foods will only compound the figure.  The other reading may also be total cholesterol.  But we all should know by now that cholesterol counts (even in the "High" range) are not cause for concern.  We need it.

And for comparison, my last fasting lipid panel (which didn't have a full spectrum of other cool stats):

Total Cholesterol: 189
Triglycerides: 50
HDL: 51
Chol/HDL Ratio: 3.7
LDL (Direct): 117