Unless you live under a rock like a true caveman, most of you have probably heard about the ketogenic diet (often shortened to ‘keto’), the very low-carb and high-fat diet that I like to call “primal eating on steroids”.

There is a bit of a celebrity cult following surrounding keto of late, with celebrities and athletes like Gwyneth Paltrow, Kim Kardashian, Tim McGraw, Halle Berry, and LeBron James publicly touting its health benefits. Don’t let the fact that Gwyneth and Kim are fans of ketogenic eating turn you off (particularly Gwyneth, with her dangerous health and wellness advice involving extreme cleanses, jade eggs and herbal steaming of delicate body parts). Similarly, don’t get sucked by the negative opinions of so-called nutritional experts who decry it as a unnatural and unhealthy ‘bacon and butter’ diet.

The current notoriety and popularity of the ketogenic diet aside, use of this dietary approach clinically has been around for nearly 100 years; it was developed in the 1920s as a treatment for severe epilepsy in children, with great success. It has also been the main way that mankind has eaten since we first arose as a distinct primary species. In fact, it has only been in the past few centuries that carbohydrates rather than fat became the main source of calories in the human diet. That trend started with the agricultural revolution but really gained steam recently following the ‘Green Revolution’ and the simultaneous industrialization of food production after the end of World War 2.

Numerous studies have now demonstrated its many health benefits, including weight loss, increased insulin sensitivity in type 2 diabetes and metabolic syndrome, improved cholesterol levels, lower blood pressure, delayed onset and progression of neurodegenerative diseases like Alzheimer’s and Parkinson’s (of particular importance to me), reduced incidence and severity of seizures in epileptic children, and even accelerated recovery from traumatic brain injuries.

By severely restricting the consumption of carbohydrates, the ketogenic diet mimics starvation. When carbohydrates are ingested, they are rapidly broken down into glucose and used as energy or stored as glycogen in the liver and muscle. Our bodies preferentially use glucose as the primary source of energy, particularly our energy-greedy brains. When levels of glucose in the blood fall and the glycogen stores in our liver become depleted, we reluctantly shift into using other sources of energy.

A low-carbohydrate, high-fat diet forces the body to derive the energy it needs from fatty acids consumed or previously stored as body fat. The liver converts these fatty acids to chemicals called ketones – such as beta-hydroxybutyrate (BHB), acetoacetate and acetone – which are used by our cells, tissues, and organs for energy instead of glucose (excess ketones are excreted in the urine and exhaled from the lungs, giving those who follow this diet characteristically sweet “ketone breath”). Interestingly, although the body prefers to burn glucose first, the use of ketones like beta-hydroxybutyrate may be even more efficient in terms of energy production and may also yield fewer of the oxygen free-radicals that are believed to contribute to aging, to cognitive decline, and to inflammatory-related diseases. Thus, following a ketogenic diet may not only help people to lose weight but also to look better longer, and protect their brains from the inevitable ravages of age-related cognitive decline.

There are several versions of the ketogenic diet, including:

Screen Shot 2018-04-19 at 2.15.59 PM

Standard ketogenic diet, where 75% of daily calories come from fat, 20% from protein and only 5% from carbs.

Cyclical ketogenic diet, where 5 days on a standard ketogenic diet are followed by 2 higher-carb days.

Targeted ketogenic diet, in which carbohydrate intake is increased before workouts.

High-protein ketogenic diet, which is similar to a standard ketogenic diet but includes more protein. Daily caloric intake comes 60% from fat, 35% from protein, and 5% from carbs.

Over the past year, once I was cleared to return to the gym following my abdominal surgery, I’ve been following a pretty rigorous exercise routine. When not traveling for work, I work out 5 to 6 days a week at the gym, including weekly one-on-one sessions with a personal trainer. I try to lift heavy weights or do resistance training at least 4 times a week, for an hour each time. I also include 1 to 2 so-called “sprint” or “cardio” sessions that are thirty minutes in duration (e.g. the half-hour mixed-martial arts [MMA] class I take on Saturdays), and at least one dynamic stretching or yoga class.

This training routine has allowed me to regain most of the muscle mass that I lost with my 17 days in the hospital and my four months of forced inactivity, but I still struggle with getting my overall body fat percentage down. Like most middle-aged men, I have a small roll of fat around my belly that simply won’t go away. In fact, I’ve plateaued in this regard. Despite mixing up my routine on a regular basis, I’m not longer seeing significant improvements in body composition (i.e. lean muscle mass versus body fat) or in my strength and stamina.

To try to change this, for the past 30 days I’ve been following a high-protein ketogenic diet and recording my experience. My daily dietary target has been to consume 2,000 calories on the days I exercise and 1,800 on the days I do not. Of those 2,000 calories, only 100 of them come from carbohydrates (25 g) while 700 come from protein (175 g) and 1200 from fat (about 135 g). I also incorporated intermittent fasting into this approach, restricting my calorie consumption to after 12:00 PM; although I wake up most mornings by 5:30 AM and usually hit the gym around 7:00 AM, the only calories I consume before lunch come in the form of a cup of “Bulletproof” coffee (i.e. a cup of high-quality black coffee supplemented with a tablespoon of Kerrygold butter and a tablespoon of MCT oil).

I generally felt full and satiated during the day, even with the intermittent fasting. In fact, I only slipped once during this 30-day period, when my sister was visiting us. We went out with friends to dinner while she was here, and I had a bun-less burger with fries (washed down with a beer) that pushed me over my daily carb limit. Other subjective observations included better sleep (although that might have been a result of the overlapping and continuing experiment of avoiding blue light), a generally happier mood, and improved energy and mental acuity in the morning.

Below are some of the before and after data from my first 30 days.

I weighed myself weekly at the same time under the same conditions (i.e. Thursday mornings after I woke up and had urinated, but before having any coffee). Total weight and overall body fat, lean mass, and bone mass percentages were calculated using a commercial-grade Tanita Body Composition Analyzer using bioelectrical impedance for body mass analysis.

March 15, 2018:

Total Body Weight = 189.5 lbs.

Percent Body Fat = 18.4% (34.9 lbs.)

Percent Lean Mass = 77.3% (146.4 lbs.)

Percent Bone Mass = 4.3% (8.2 lbs.)

March 22, 2018:

Total Body Weight = 186.5 lbs.

Percent Body Fat = 17.2% (32.1 lbs.)

Percent Lean Mass = 78.5% (146.4 lbs.)

Percent Bone Mass = 4.3% (8.0 lbs.)

March 29, 2018: 

Total Body Weight = 183.9 lbs.

Percent Body Fat = 16.8% (30.9 lbs.)

Percent Lean Mass = 78.6% (144.5 lbs.)

Percent Bone Mass = 4.6% (8.5 lbs.)

April 5, 2018:

Total Body Weight = 180.8 lbs.

Percent Body Fat = 14.4% (26.1 lbs.)

Percent Lean Mass = 81.3% (147.0 lbs.)

Percent Bone Mass =  4.3% (7.8 lbs.)

April 12, 2018:         

Total Body Weight = 179.8 lbs.

Percent Body Fat = 13.3% (23.9 lbs.)

Percent Lean Mass = 82.2% (147.8 lbs.)

Percent Bone Mass = 4.5% (8.1 lbs.)

 

I lost a total of 9.7 pounds over the month. That’s almost two-and-a-half pounds per week, which is a little higher than the recommended one to one-and-a-half pounds that most fitness coaches recommend, but I was training particularly hard as my heart rate monitor and other workout metrics suggested. Surprisingly, I actually gained some lean muscle mass so my total body fat loss was even higher (11 pounds total). Admittedly the Tanita scale I used is not as accurate as other methods of body composition analysis, but the effects of the ketogenic diet were pretty startling in this regard.

I also monitored my ketone production daily, using professional grade ketone test strips for urinalysis. Admittedly this gives only a crude measure of excess ketone production and is not as accurate as breath analysis or blood testing, but I wasn’t willing to spend $240 on a breathalyzer or stick my finger every morning for a relatively minor data point. It took me about five days of consuming less than 25 g of carbohydrates daily to detect ketones in my urine, but once they were there I continued to excrete relatively large but declining amounts of excess ketones (usually 4.0 – 8.0 mmol/L in the first couple of weeks, dropping over time to a constant 1.5 mmol/L towards the end of the 30 days). There was also one day, immediately following the cheat day mentioned above, when my total output was less than 0.5 mmol/L but it bounced back within 24 hours.

Given some of the concerns raised publicly about the ketogenic diet – particularly the effect of a diet high in saturated fat on serum cholesterol and other clinical markers – I also had a full fasting blood panel run before and after this experiment. Serendipitously, I had my annual physical in late February, so only had to have an additional blood draw done. The relevant laboratory and clinical results from prior to and after starting a ketogenic diet are here:

 

1 March 2018

15 April 2018

Reference

Weight

191.1 lbs.

179.2 lbs.

Body Mass Index

25.9

24.3

18.5 – 24.9

Glucose, Serum

86 mg/dL

89 mg/dL

65 – 99

BUN

14 mg/dL

14 mg/dL

6 – 24

Creatine, Serum

1.14 mg/dL

0.91 mg/dL

0.76 – 1.27

eGFR

76 mL/min/1.73

101 mL/min/1.73

>59

BUN/Creatine Ratio

12

15

9 – 20

Sodium, Serum

142 mmol/L

138 mmol/L

134 – 144

Potassium, Serum

4.8 mmol/L

4.4 mmol/L

3.5 – 5.2

Chloride, Serum

101 mmol/L

98 mmol/L

96 – 106

Carbon Dioxide, Total

21 mmol/L

23 mmol/L

18 – 29

Calcium, Serum

9.7 mg/dL

9.6 mg/dL

8.7 – 10.2

Total Protein, Serum

7.3 g/dL

6.8 g/dL

6.0 – 8.5

Albumin, Serum

5.1 g/dL

4.8 g/dL

3.5 – 5.5

Globulin, Total

2.2 g/dL

2.0 g/dL

1.5 – 4.5

A/G Ratio

2.3

2.4

1.2 – 2.2

Bilirubin, Total

1.4 mg/dL

1.3 mg/dL

0.0 – 1.2

Alkaline Phosphatase

55 IJ/L

49 IJ/L

39 – 117

AST

33 IJ/L

25 IJ/L

0 – 40

ALT

22 IJ/L

34 IJ/L

0 – 44

Total Cholesterol

182 mg/dL

134 mg/dL

100 – 199

Triglycerides

71 mg/dL

52 mg/dL

0 – 149

HDL

78 mg/dL

57 mg/dL

>39

VLDL

14 mg/dL

10 mg/dL

5 – 40

LDL

90 mg/dL

67 mg/dL

0 – 99

TSH

1.660 uIU/mL

1.720 uIU/mL

0.450 – 4.500

Vitamin D

33.6 ng/mL

35.5 ng/mL

30.0 – 100.0

Although it has been reported that some people will have a spike in their cholesterol levels when first starting a ketogenic diet, I would the exact opposite in my case. My overall cholesterol levels dropped. My HDL:total cholesterol reading stayed around 0.39 or so, with a value over 0.24 considered ideal. I also kept a high HDL:LDL ratio and a low triglycerides:HDL ratio, which put me in the lowest risk category for heart disease.

In fact, with the exception of an abnormally bilirubin count (caused by Gilbert’s syndrome, a largely asymptomatic condition in the liver does not properly process bilirubin), my blood work remained the same or improved on a ketogenic diet. Given that my overall body composition and other subjective indicators of health and wellness also improved, coupled with studies that suggest it may be protective against Alzheimer’s, I will likely stick with the ketogenic diet for the time being.

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