Typically I eat what I consider a healthy diet which is based on five years of personal research and trial and error through my medical practice. Last year I simplified my diet by switching to a paleo-type plan with some dairy included. I dubbed this lacto-paleo. Simplification is key for sticking with a diet and as long as I stayed within the parameters set forth by this eating style, I was fine. However, this past fall, I put aside my diet, for reasons I can only assume were not at the conscious level and indulged in a plethora of sugar and wheat-based holiday dessert items which were dropped off at my house by numerous well-wishing friends and relatives. I had fallen into the false "I can treat myself this one-time" mentality which snowballed into treating myself almost every day!
January 2, 2018 rolled around and I jumped out of bed, refreshed from my brief but much needed holiday break from work. I went about my morning ritual but when I tried to cinch up my scrub bottoms I noticed they weren't fitting like they normally do. I had to pull the drawstring extra tight to gather up enough to tie a knot. Throughout the day, my normally comfortable, pajama-like work attire felt tight and uncomfortable. I like to encourage my patients to measure fat loss success by the fit of their clothes and I was now experiencing how well that strategy worked. In a moment of curiosity, I decided to get on the scale to see the damage. Ooof! I had gained eighteen pounds in about three months by my best estimation! My first thought was, "Why the hell didn't anyone tell me I was getting tubby!?" And then quickly shifted to, "I better take this weight off or I'm going to follow the path of my father and grandfather and wind up a cardiac patient or worse, dead! (If you're reading this and have a loved one who is packing on the weight, here is a tip - let them know! Making the necessary lifestyle changes sooner rather than later, maybe save their life.) I had to make some changes before I settled into this heavier version of myself. I was already paleo and that apparently wasn't restrictive enough. I had to consider that I had an "allergy" to excess carbohydrate that manifests itself as excess fat. It was time to implement a strategy I use on many of my patients struggling with weight management: the ketogenic diet.
If you haven't heard about the ketogenic diet by now then I would like to personally welcome you back to Earth. How was your trip to Mars? What was it like to be completely out of touch with the rest of the society? Okay, enough about you Mr. Astroman... let's get on with my article!
What exactly is "ketosis?
Ketosis is a metabolic state of for which metabolically active ketone bodies (derived from fats) are utilized for energy instead of human's primary energy source, glucose. Ketones are produced by the liver when the body breaks down fat for energy. This typically occurs when an individual is in a fasted state or in instances of starvation but can also occur when carbohydrate intake is so low that glucose becomes unavailable to meet daily metabolic needs. Humans get our glucose primarily from carbohydrate consumption and then from protein consumption if needed. When there isn’t a sufficient level of available glucose and insufficient glucose stored in the body in the form of glycogen, blood sugar and insulin are lowered and the body looks for an alternative source of fuel. And when the body begins breaking down stored-fats for energy, a process called beta-oxidation, ketones are formed and become the primary fuel for the body and brain. This is known as being in a state of ketosis.
Great! So there is a complicated physiological process which allows the human body to switch primary fuel sources from glucose to fat. Who cares? And more importantly, why should you go through the hassle of triggering this process? For one, the benefits of being in a state of ketosis include less reliance on carbohydrates for energy. This means a virtual elimination of sugar crashes many people experience between carb-rich meals. When a person who is fully adapted to a ketogenic state their body simply alternates between utilizing glucose and fat as its primary energy source. This results in reduced cravings for high carb foods as the body doesn't panic when glucose stores deplete because it has the metabolic hardware to use fat as a back-up and in some cases as it's main fuel source. A common theme among folks who try keto is hunger becomes more of a manageable afterthought rather than a pressing issue. I can attest to this (more on that in a bit)
Could the Ketogenic Diet KILL ME?!?!
Wait... hunger control, fat loss, blood sugar control, anti-inflammatory, mental clarity, increased energy?! If any of this was true, it could be a panacea to the modern epidemic of metabolic syndrome, a combination of poor cholesterol levels, obesity, high blood pressure and pre-diabetes. When I think of the countless medications on the market that claim the above effects but come with a boatload of side effects (some severe), it makes me wonder why this diet isn't recommended by practitioners to more of their patients. I think the most obvious reason is that when you increase your fat intake, you will undoubtedly increase your LDL or as some call it, "bad cholesterol." But simply looking at a total cholesterol number doesn't tell the whole story. In order to tell the whole cholesterol story, we need to look at your diet to determine what foods are driving up your LDL and then examine your triglyceride and HDL levels. By looking at the various ratios of these blood lipids, we get a complete picture of your heart health. There is a TON I have to say about understanding lipid profiles (your cholesterol numbers) and that will have to wait for another article. But for time's sake - yes, a ketogenic diet raises your cholesterol. However, this may not actually be a bad thing! But everyone is different and in order to truly know, you should get a full cardiac lab workup before you venture into ketosis. (WellnessFX.com has a plethora of labs you can buy on your own). I took some simple labs in my own clinic and here is how my numbers looked prior to ketosis:
- Total Cholesterol: 210
- LDL: 120; HDL: 33
- Triglycerides: 145
- VLDL: 29
- HgA1C: 5.2
- Waist to height ratio: .60
- Body Mass Index: 29
- Blood Pressure: 138/88
None of those values are exceptionally good. In fact, medical markers such as my triglyceride to HDL ratio (4.4) and waist to height ratio (.60) were telling me that I was skirting the edge of metabolic syndrome and on my way towards heart disease! PANIC! It was definitely time to make a change! As a practitioner, I dove deeply into the medical implications of ketogenic diet and certainly didn't want to add to my risk of heart disease and stroke. I knew, through my medical knowledge and experience that cutting my carb intake below 25 grams per day would slash my average blood sugars and thus my insulin levels - both precursors to obesity and diabetes when elevated. This was good. However, approximately 20-25% of your cholesterol is dietary and I was a bit concerned about those levels jumping up a bit. I simply had to trust the research. It has been proven, time and time again, that increasing healthy and natural dietary fats (really any unprocessed fats including animal fats) would help my body reduce dangerous triglyceride levels, increase helpful HDL levels, and make my LDL cholesterol fluffy, buoyant, and harmless. It's hard to go against 50 years of erroneous medical advice to avoid fats and cholesterol. We have brainwashed to believe cholesterol is the enemy and it turns out, that's just not true. "Trust the science" became my mantra and I was ready to begin!