I’ve been following a Primal / Paleo diet for a few years and hit a plateau with my fitness, body composition, and nutritional goals. So, I thought I would mix the diet up and investigate ketogenic dieting to drive my body composition a little leaner and see if I can retain my power / strength while staying in Ketosis. See this prior post. Ultimately, I’d like to find an optimal nutritional lifestyle that keeps me lean, strong, powerful, and healthy without having to cycle through various traditional training programs of mass-gain / lean phase / etc. Nothing lofty, just the holy grail of nutrition and training objectives *smile*.

I’ve been in ketosis for approximately 10 weeks now. Here is my experience.

Disclaimer:  You should consult with your doctor or medical practitioner before embarking on any significant change to your diet.

First, what is ketosis.

Ketosis is when your body enters an alternative energy state by converting fat into ketone bodies for fuel rather than glucose from carbohydrates. When glucose is present and your body is not ketogenic adapted (used to burning ketone bodies) your body will leverage glucose as a primary fuel source for your cells, however, everyone has the capability of generating a secondary fuel source known as ketones. You enter ketosis by flushing your body of excess carbs and glucose, and your liver starts to turn fat to ketones bodies as a fuel source. The main ketone bodies generated by the liver are acetoacetate, and beta-hydroxybutyrate.

A lot of research has been done and is being done on ketosis as pertaining to health. Studies show that ketosis can be an effective treatment for many conditions and improve health at a cellular level. Doctors are beginning to use ketogenic diets to treat conditions such as epilepsy, autism, alzheimers, diabetes, and other conditions for increased cellular energy and mitochondrial health.

I am very interested in the health benefits ketosis provides in improving brain energy pathways and shedding excess fat without sacrificing muscle loss.

Here is a great resource for more information on Ketosis and Ketogenic Diets

Going into Ketosis – The first 10 days

First 10 days of entering ketosis I felt pretty drained, low energy, and mild persistent headache. I read this is pretty normal as your body adjusts from burning glucose to Ketones for fuel. Training was a real challenge while dropping into Keto because I just couldn’t push through like normal, I would hit the wall much earlier in my training than pre-keto. During this time I was testing my urine with Keto Strips every morning and evening and also tracking my nutrition macros with MyFitnessPal. I’ll talk a bit more about measurement and nutrition a bit later. I finally hit moderate to heavy ketosis about on or around the 11th day.

My Nutrition Specifics

I am averaging about 73% fat, 20-23% protein, and 3-5% Carbs on 2000-2300 calories per day. You could say this is a bit more of a modified ketogenic diet and not clinical keto, as clinical keto diets are closer to 90% fat. I’ve read a number of studies that point to athletes or those that put in a lot physical activity better preserve and gain muscle with the macros I noted above. My food intake mostly consists of; Eggs, bacon, butter, coconut oil, MCTs, avocados, high fat nuts, fatty fish, higher fat beef, green vegetables, and occasionally some daily like heavy cream and cheeses.

Here is a typical day of food:

Wake up
Coffee with butter, coconut oil, and some heavy cream

Breakfast
Eggs and bacon or sausage

Lunch
Chicken, Beef, or Fish
Leafy green salad with olive oil
Avocado

Dinner
Beef or Fish
Avocado
Mixed Veggies or leafy green salad with olive oil

Snacks throughout the day
Macadamia nuts or mixed nuts
Nut butters
Fish oil
Epic bacon or beef bars

I typically use snacks throughout the day to adjust for hitting my macros. It was also critical that I logged for food for the first few weeks so I had a good idea of how my macros were panning out per meal and for the day. Certain foods were higher in carbs than I originally realized until I was tracking the intake. For example, mixed nuts had a lot more carbs than I thought so I moved most of my nut consumption to macadamia nuts as they seem to have the highest fat low carb ratio.

It took a few weeks to get used to so much fat consumption and finding the right foods per meal that gave me the macros I was aiming for, but once I got used to it I found it was quite easy to stick to the diet. Even when traveling and eating out I could usually find foods that fit within my macros.

Ketosis Measurement

I find it really valuable to measure my level of ketosis day by day or after particular meals. I started off by using Keto strips that you can pick up at any Walgreens or CVS, these measure the level of acetoacetate in your urine. The darker the stick the more acetoacetate and hence higher level of ketosis. After about 10 days of measurement with the strips it was measuring pretty consistent as moderate to heavy ketosis, and I felt like I needed further measurement to understand my ketosis state better than some general color matching.

I bought two devices to test concurrently; A Precision Xtra blood ketone monitor, and a Ketonix breath analyzer.

The Ketonix device measures the levels of acetone in your breath. Acetone is produced by the breakdown of acetoacetate in the blood, and the resulting acetone can be measured in your breath. It’s often said that those in ketosis have bad breath which is the result of increased levels of acetone.

The Precision Xtra blood glucose / ketone monitor measures the levels of Beta-Hydroxybutyrate in the blood. Beta-Hydroxybutyrate is measured in mmol/l, whereas Ketonix measures acetone in parts per million. BHB is supposed to be a more accurate measurement for ketosis, but also more invasive requiring a finger prick for blood and more expensive as the testing strips are around $3-4 per test.

For nutritional ketosis you want the urine strips to show moderate to heavy, breath to show >50ppm, and blood between 1-4 mmol/l.

ketosis

When I would measure the breath and blood I would see the consistent measurement between the two. For example; 1.0 mmol/l BHB would register as 46ppm Acetone and 3.0 mmol/l BHB would register as 58ppm Acetone.

The most important thing is getting accurate consistent results. Moving forward I will likely reserve the blood testing for specific times or special testing while the Ketonix will turn into the daily test.

Blood Workup

The only way to real know how a diet change will impact your health is to get your blood checked. Prior to embarking on my ketosis journey I got a full blood workup to get a baseline for a number of markers, such as:

Lipids otherwise known as Cholesterol
Lipid particle size
Inflammation
Metabolic
Glycemic
Insulin Resistance
Liver Function
Hormones (Thyroid, Testosterone, Estrogen, DHEA)
Omegas

After 10 weeks in ketosis I then got the same full blood workup to compare the results. The results were interesting, some I expected others I was a bit surprised by.

Total cholesterol and LDL went up a couple of points and my HDL stayed about the same, not significant. My cholesterol tends to run a bit on the high end due to my genetics, but my doctor and I haven’t been too concerned because my HDL (good cholesterol) is super high and my Lipid particle size markers are in decent ranges. The most interesting thing about my lipid profile is that my triglycerides dropped in half, from an already pretty low number. This seems to corroborate the studies that show improved triglyceride and lipid particle size metrics.

The most concerning aspect about my blood work is that my inflammation markers went up significantly. hs-CRP, Lp-PLA numbers all almost doubled from average ranges to high ranges and Myeloperoxidase went up from good to moderate ranges.

hs-CRP is High Sensitivity C-Reactive Protein. CRP is a protein produced in response to inflammation and excessive deposits of cholesterol and fats in the liver and other tissues.

Lp-PLA is Lipoprotein-Associated Phospholipase A2 an enzyme made by white blood cells that causes inflammation in the artery walls.

Myeloperoxidase (MPO) is an enzyme made by white blood cells in the artery wall. Elevated levels may indicate unstable plaque.

By reading general literature the claims are that Ketogenic diets are supposed to be anti-inflammatory with people reporting decreased pain from inflammation. I haven’t been experiencing any additional pain in joints, or other indicators of pain oriented inflammation but my blood markers are clearly showing some increased level of inflammation. Interestly, I’ve run across a few studies that show ketogenic diets increase CRP inflammation which is what I seemed to experienced, however, the study isn’t clear whether why this is the case. After I discussed these numbers with my doctor I’ll be making a few modifications to my diet and supplementation; decrease dairy a bit as I might have a slight allergy to dairy products, increase my antioxidant supplementation such as CoQ10 and Resveratrol, and increase my vitamin supplementation. One final note on inflammation, my doctor indicated that my CBC blood markers were a bit high so I might have been fighting off an infection of some sort that might be raising my inflammation. I’ll make some adjustments and we’ll see the results in 8-10 weeks. On to some other markers.

My metabolic markers all improved slightly from good to better specifically cortisol improved better than slightly, glycemic control markers stayed the same at optimal levels, insulin resistance markers also stayed the same at optimal levels. Liver function improved moderately, and my Omega ratios improved quite a bit. Lastly, hormone markers like DHEA improved while testosterone and IGF1 decreased slightly but not in a significant manner.

All in all blood results show some increased cholesterol and inflammation, some generally improved numbers, but overall unremarkable.

Training

I was also very interested to see how my training performance would be impacted by a ketogenic diet. I went in based on my research expecting that my top end performance might decrease slightly for a few months, and that is exactly what I have experienced.

My general strength numbers are still good and consistent, but my top end PRs are off in a few categories. The biggest hit has been to my cardio. I hit the wall far sooner in a high intensity workout than I did before ketosis, I’ve tested this many times with the same result.

I’ve also been experimenting with exogenous ketones (BHB ketone salt supplementation) to aid energy production during training sessions. I’ve been happy with the products from Ketosports as they seem to be the most cost effective well researched product designed and manufactured by a well known and respected performance supplementation chemist Patrick Arnold (great podcast on the Tim Ferriss Show). They seem give me a little boost, but the jury is still out to whether they are helping or not. I’ve been playing with some pre-workout formulations to include exogenous ketones with some decent results. More to come on that topic.

I’ve read that it could take up to 6 months for my body to become fully keto adapted for high intensity training, so I’ll keep measuring my performance over the next few months and see.

Body Composition

10 weeks ago I weighed 168 lbs and was hovering around 14% body fat as measured with a Withings Scale and a Skulpt Body Monitor, I’ve been extremely happy with the Skulpt measurement device being the most accurate and easy body composition analyzer I have used.

Over the course of 10 weeks I have lost 9 lbs and am now around 9-10% body fat. This tells me that I haven’t materially lost muscle and most of my weight loss has been fat. Thats good.

This weight and composition feels good and right. I don’t feel like I need to lose any more body fat, but will play around with gaining a little muscle and see if I can keep body fat percentages low.

General Observations

There are also a number of anecdotal observations I have had while in ketosis:
1. I seem to sleep a little better, but nothing that significantly shows up in my sleep metrics. I just feel a bit more rested in the morning with the same amount of sleep and wake up without needing much snooze time.

2. Energy throughout the day is strong and consistent. I used to occasionally get the afternoon crashes and need some caffeine to pick me up, but I haven’t experienced any of those crashes and don’t need any supplementation to aid my energy levels throughout the day.

3. Overall, I just feel good. Better than my paleo-ish diet prior to keto.
Next steps

I’m going to continue the ketogenic diet while I do some fine tuning on my cholesterol and inflammation markers, and continue to measure my training performance with some additional tweaking of my pre-workout supplementation. I’ll post some of my additional learnings as I continue this journey.

I hope you found my experience useful as you consider if ketogenic dieting is right for you. Please feel free to leave some comments if you have any questions.

 

UPDATE

 

For those of you that have been following my blog or other social media updates, you probably recall seeing that I have been experimenting with a Ketogenic Diet.

I originally got interested in Ketosis for the supposed health benefits of leveraging Ketones for energy rather than glucose. Specially, the brain health and anti-inflammatory aspects of the diet. So, thought I would give it a whirl.

Under the supervision of my doctor I got a full blood work up done prior to Keto and another blood work up done around 10 weeks into the diet. From a blood perspective the results were unremarkable, a few bad markers were up like cholesterol and inflammation, and a number of good markers improved like decreased triglycerides and improved liver function. But all in all not a significant positive or negative benefit was reflected in my blood. I did however anecdotally feel a bit better; seemed to be getting a bit more sleep, and consistent energy throughout the day. The most bothersome aspect to me about Ketosis was the drop in my performance in the gym. Strength numbers were slightly down from PRs, and cardio efforts were significantly off.

My doctor said that if I want to continue with the diet it’s up to me, but she wasn’t seeing any real positive benefits. I figured I would continue to stay on the diet and see if I could do some tweaks to improve my gym performance while in ketosis.

Fast forward 3 weeks.

I wake up on a Monday with a cramp in my left calf that was swollen and noticeably larger than my right calf. I couldn’t quite figure out why it was cramped as I didn’t recall any particular training effort or injury that would explain it. So I did as any other relatively healthy individual would do; I figured it would just go away. But it didn’t. Still hurt Tuesday, so I regularly iced it. Still hurt Wednesday, so I put some compression on. Thursday comes around and I notice something different. My ankle was starting to swell and my leg had redness isolated in certain areas. I couldn’t make a connection between why my calf and ankle would be swollen at the same time with no memorable injury. It was time to get it looked at.

The ER is never fun. I figured this time would be extra fun because I knew I could to be there for hours as I was not a high risk patient. Triage for an hour. Various blood and urine tests with hours of waiting in between each one. No diagnosis. The doctor then wants to run an ultrasound of my leg looking for clots just to be safe. He wasn’t too confident that he would find anything because I didn’t fit the bill of a normal blood clot patient; didn’t smoke, regularly exercised, wasn’t overweight, and relatively young.

Screen Shot 2016-06-06 at 6.56.31 PM
Another hour after the ultrasound the doctor comes in and says, “Well, we found what we didn’t want to. You have a Deep Vein Thrombosis (DVT), which is blood clots deep in the leg arteries.” He was a pretty cool doctor because he then said, “Medically, I don’t give a shit about the clots in your leg we now need to know if they have moved to your lungs. We need to do a CT of your chest.” He then proceeded to explain how a DVT can turn into a serious pulmonary embolism (PE – clot in the lung) if not discovered and dealt with early. It wasn’t 60 seconds after he explained what a DVT and PE was that an army of people descended on the room with EKG monitoring, IV, blood draws and then whisked me off for CT scan. It was then that I knew my risk as a patient was elevated significantly and the ER snapped into action and does what it does best, save lives.

The doctor came back in after the CT results were analyzed and said, “The bad news is that you have a PE in both lungs, the good news is the clots are small and not much of a risk. We caught it early.” He then explained that I was to be put on blood thinners right away and kept in the hospital overnight for observation to make sure a large clot doesn’t break loose and find its way into my lungs. I was released from the hospital the next day with a 3 month supply of blood thinners in hand and some instructions to follow up with my primary doctor on next steps. Throughout my experience in the ER almost every nurse and doctor that I talked to seemed surprised that someone who doesn’t fit the standard blood clot patient profile actually had a DVT.

Over the next few days talking with and emailing my doctor we attempted to drill into why I experienced blood clotting and narrowed it down to two recent changes in my lifestyle that could have potential high risk blood clotting factors; Increased air travel and the Ketogenic Diet.

Air travel increases the risk for blood clots due to sitting in a stationary position for long periods of time without moving, this immobility decreases the circulation in the legs which can result in blood clots. But since I am a pretty active person this didn’t seem like it would be a key contributor.

Which now brings me to the Ketogenic Diet. There doesn’t seem to be a concern with Ketosis itself or Low-Carb dieting as there isn’t any known link between Ketosis and blood clotting, the concern is with the high amount of saturated fats I was consuming over a 3 month period. Some would say the jury is still out whether saturated fats contribute to heart disease and high cholesterol or not. But the fact is there are many studies that point to saturated fats as a contributor to blood platelet “sticky-ness” and potentially increasing the risk of blood clots.

This all being said, a true “smoking gun” hasn’t yet been found. I still am undergoing some tests for genetic markers relating to blood clotting and researching other contributory factors such as hydration, stress, dietary changes, or other links between sport specific athletes and blood clotting. I’m not bashing the Ketogenic Diet as I was pretty happy on it, but the increased saturated fat link for blood clotting is the closest answer I’ve got for why I may have developed a DVT. This may change as I learn more. It’s entirely possible that a number of various increased risk factors have come together to trigger the DVT, not just increased saturated fat intake./

So in the meantime…Doctors orders: Moving off the Ketogenic Diet and better balancing out my macro nutrients while limiting saturated fats is probably a good idea until we get some further information.

As I learn more I’ll update this blog post with the latest.