Week 1: How to Keto
Where did I hear about the ketogenic diet?
The first time I heard about the "ketogenic diet" outside of medicine was a few years back while perusing YouTube, I came upon a video where a guy was describing his technique for entering ketosis. This piqued my interest as I have been studying the effects of nutrition on health since I started practicing medicine 5 years ago and this was the first time I heard of anyone altering their diet to purposefully put themselves into this metabolic state. He explained how he would begin by fasting for 48-72 hours consuming only water and electrolytes in the form of bone broth. He would then periodically check his blood ketone levels to ensure they reached 0.06-3.0 mmol/dL which was consistent with being in "nutritional ketosis" (btw - since ketosis is based on strictly regulating carbohydrates and increasing fat intake, all ketosis is nutritional). After he entered ketosis, he would continue to monitor his blood ketones several times a day and strictly adhere to preset macro-nutrient ratios composing approximately of he daily calories consisting of 70-90% fat; 5- 20% protein; and 0-10% carbohydrate.
Wow... going keto seemed like it would be a total pain in the ass! And if you are jumping right in without research and preparation, it will be a pain in the ass! I have to disclose a few things that were working in my favor as I began this journey. Last year I implemented various types of intermittent fasting (IF) into my life. IF is an entire topic in and of itself and I could write a book about the many benefits of getting in a regular fast here and there but we are trying to stick to the keto topic today. In short, IF will teach your body to tap into its fat stores for energy after it depletes its glycogen stores, which is essentially stored glucose. Initially, your body may try and break down protein into glucose to get this energy (this is bad) but our bodies have had millions of years to adapt to intermittent feeding periods and after a few attempts at IF your body will activate genes that allow it to burn stored fat as energy and spare muscle mass. This, in essence, is a type of "intermittent keto" as the process is basically the same. So with a little IF prep work (as little as 30 days worth), your body should have the machinery in place to begin burning fat a lot quicker than if you cut out all the carbs cold turkey. Does this mean I had no carbohydrate cravings? Nope! I fell face first into a pile of chocolate covered Oreos left over from Christmas on day 2 and to start all over. But luckily, that was my only hiccup. The next day I got rid of all chocolate and sweets in the house (except for Alter Eco Dark Chocolate, I could eat 2-3 squares of that a day and it only had 2-4 grams of carbohydrate) because after I saw those first ketones register on the meter, I didn't want to ruin all my hard work.
Weeks 1 & 2
Before I started, I bought a blood ketone meter. I have mixed feelings about this and for most people, you really don't need one. For one, it is a great way to measure your state of ketosis. It will give you an accurate measuring of your body's ability to create ketones in the absence of glucose. However, this can be a nuisance as well. Our bodies will go into ketosis despite whether you check the levels or not. I guess a ketone meter plays a role in experimenting on which foods you can safely eat and which will drive your levels down. Also, if you're like me, I like to see measurable results and checking my ketones daily was a way for me to record my progress and give me something for which to strive. It was difficult to reach 1.5 mmol of ketones and I sure as shit wasn't going to ruin it with another chocolate covered Oreo! On the other hand, if you check it too often, you're going to drive yourself crazy <- Trust me!!! So my recommendation is to check your ketone levels, initially, every day at the same time. I did this every morning and watched the levels slowly creep up (0.0, 0.1, 0.2, 0.4).
My ketones levels were undetectable in the first 3 days and then fluctuated widely as my body learned to operate without glucose. Then I had to pee! I mean A LOT! I woke up 2-3 times a night to hit the toilet and forget about holding out till 9 or 10 am to drop off my first few cups of coffee. I was literally peeing every 30 minutes during the first few days. When your body burns through its glycogen stores, you lose a TON of water. You store about 3 grams of water for every gram of stored carbohydrate. So if you go from eating 300-500 grams of carbohydrate per day to 25-50 grams - you're going to lose a lot of water my friends.
It is important to know that as you lose your water, you lose your electrolytes as well. I initially knew that I was in ketosis when I was woken at 3 am with a muscle cramp in the instep of my foot. It was quite painful but I was expecting it nonetheless as I had done plenty of research and knew that getting your electrolytes in check was a critical step in feeling good throughout the process. At first, I remedied this with a ZMA supplement at night and a teaspoon of salt in 8 ounces of water every morning. But then I found an all in one electrolyte supplement called LYTEshow that came with a nifty travel dropper bottle. I just tossed it in my bag and poured a dose in my water 4-5 times a day. Once I got my lytes in check - I was truly good to go!
The Dreaded Keto "Flu"
I never felt sick entering ketosis. Most folks I've found will complain about feeling fatigued, sluggish, and generally "foggy" at first which is dubbed "The Keto Flu" and from what I heard, the symptoms can be quite severe. I experienced none of this. Except for the occasional muscle cramp, I suffered no ill effects. In fact, the muscle cramps actually served as a reminder that A. I was indeed still in ketosis and B. I needed to up my electrolytes.
The biggest change I encountered was a significant drop in athletic performance. This can be a HUGE issue for folks may be the deciding factor when it comes to trying their own self-experimentation with keto and this is understandable. I don't compete in jiujitsu anymore nor run 5-10k races, so I really wasn't concerned about a temporary drop in performance. I do enjoy high-intensity exercise with my body-weight, kettlebells, dumbbells, and sandbags. However, without sufficient glycogen storage, my muscles would bonk out rather quickly (bonk is used by athletes to describe the state in which there is absolutely no fuel left in the gas tank). For example, instead of being able to hammer out 20-30 burpees in a minute, I would run out of gas at 15 and need a good 3-5 minute break in-between sets. This was a weird feeling and took some getting used to. I no longer participate in long-distance endurance sports, so I have no personal experiences with how keto affects those activities. From what I would imagine is that long distance aerobic activities would improve after becoming keto-adapted - improved ability to metabolize fat as efficiently as we metabolize glucose. Why? If we are glucose dependent and not keto-adapted then after we burn through our glucose stores at various rates and when we hit "empty" we experience the dreaded bonk. I experienced this phenomenon out in the Nevada desert during a particularly grueling 100+ mile bike ride back in 2010 (before I was aware ketosis was even a thing). I literally rode till my legs quit. I had no more energy in reserve to keep going so what I had to do was slosh down sweet glucose filled jelly supplements and gooey syrups in order to power myself to the finish line. How would ketosis have helped me back then? It's hard to say but I imagine my body would have been able to easily switch fuels from glucose to fats and left me with a virtually unlimited supply of energy to keep me going without having to suck down sugar every 15 minutes. So athletic performance may be a concern in the short term but if you're a weekend warrior who wants to up his game, ketosis may work for you. A period of metabolic adaptation can take anywhere from 1-6 months for most folks forgo this process. You need to ask yourself, what do athletics mean to me? If you're covering an NFL wide receiver or hitting home runs for a living - maybe not for you. Do you enjoy the occasional community 5-10k or even marathons... it may fit you perfectly.
So that covers my first few weeks of the ketogenic diet. Stay tuned next week for weeks 3-8. Topics include sleep, weight loss, muscle gain and much more!
Part I - Part II