Biohacking Thursday: Nutritional Ketogenesis

Can you lose weight and gain muscle on the ‘bacon and butter’ diet?

POSTED ON APRIL 19, 2018

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:

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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Staying Healthy While Traveling

Tips for eating well and working out while on the road.

POSTED ON APRIL 10, 2018

I travel quite a lot for work, both domestically and internationally. In the past six months, for example, I have been to Atlanta, Kansas City, New York City (four times), China, Grenada, and Mexico. Over the next few months, I will again return to New York City, Grenada, and Mexico for business, staying in each place for a week or more. I will also be spending four days in Miami, although for a much needed mini-vacation rather than work.

It can be particularly challenging to stick to a workout schedule or to maintain healthy eating habits when on the road. Between the jet lag, the unfamiliar locations, the uncertain quality of most hotel fitness rooms, and the limited food choices in airports and room service menus, I sometime have to deviate from my normal routine.

Since five extra pounds and an overly tight waistband are not the kind of souvenirs that I like to take home, I’ve developed a number of tips and tricks to help me stay health and fit even when away from home for weeks at a time.

1. I choose my hotels based on their gym and other fitness facilities.

I usually make my own travel arrangements, usually using online booking services like Travelocity, Hotels.com, and Kayak. I use those sites, combined with information gleaned from the hotel website or review sites like TripAdvisor, to choose a hotel that has a decent fitness room. Specifically, I look for fitness facilities that have a combination of weight machines and free weights like dumbbells, a decent array of cardio equipment, and space for stretching and mobility exercises.

Alternatively, I research what gyms and other recreational facilities are nearby. Most places will allow you to purchase a day pass (or multi-day pass), while others may have relationships with local hotels to allow guests to use the gym at a discount (or sometimes for free). Your home gym might also have reciprocity arrangements with other fitness centers around the country. The larger chains like Planet Fitness or the YMCA have packages that allow you to use any similarly branded facility, while smaller companies might belong to consortia like MyIClub that give you access to gyms in other cities.

Finally, you can always choose a hotel that is on or near the beach or a bike path and at least get a couple of sprint or cardio workouts in.

2. I bring the gym with me.

I hate checking my bag at the airport, so always travel as light as possible. Thanks to years of practice, I can now travel for two weeks or more with a roll aboard suitcase and a messenger bag. Despite this, I always find the room to pack a set of resistance bands or some lightweight suspension straps. These allow me to turn my hotel room into an impromptu gym. While I won’t be able to do any really heavy lifting or strength training, I can still work up a good sweat through a combination of calisthenics, body weight exercises, resistance work, and yoga.

3. I walk a lot.

Walking is always a good low-intensity exercise and can give you a great workout regardless of your fitness level. In the mornings, during lunch or breaks, or after I am done working for the day I try to get out and about. It also offers me a chance to really get to see the cities and towns I am visiting, to meet the local people, and to experience the daily life and special events of those around me. I have made some great friends, found some outstanding local restaurants, and discovered amazing off-the-beaten-track gems on these daily walks. Just make sure to ask your hotel’s concierge for a map and recommendations (of things to see but also of unsafe places to avoid) before setting out.

4. I eat like a local.

Best-selling author Scott Westerfield once wrote that, “the best way to know a city is to eat it.” Food is universal, but our cultural cuisines are as diverse and as varied as the 7 billion people that populate this world. Being adventurous and trying the local delicacies is not only an important (and fun) part of traveling but can also be a good way to eat healthy when away from home. While there is the off-chance that you might get sick (easily avoided if you avoid sketchy looking restaurants, stay away from ice, and avoid salads or fruits that you cannot peel), eating like a local allows you to eat food that are fresh and locally grown. Try to choose foods that are heavy in seasonal vegetables, and you’ll not only experience unique tastes and flavors that you can’t find at home, but you’ll also naturally avoid foods that are overly processed, have lots of empty calories, or are full of preservatives and chemicals.

5. I bring healthy snacks.

You never know when you’ll miss a flight and get stuck in the airport for a while. The resulting boredom and lack of restaurant choices make it harder to avoid scarfing down a slice of Sbarro pizza or a triple-mocha latte from Starbucks. That’s why I always make sure to pack several healthy snacks in my carryon bag, like dried fruits, nuts, jerky, or protein bars. These can also double as my meal on a long-haul flight, rather than be at the mercy of whatever carb-laden entrée the flight attendants serve up.

6. I stay hydrated and avoid alcohol and caffeine.

Drinking plenty of water is particularly important while traveling, as the dry and rarefied air on planes can dehydrate you rather quickly. As I often travel to places a lot warmer than upstate New York (such as the American South, Mexico and the Caribbean), I make sure to drink extra water throughout to help my body adjust to the change in climate and to stave off jet lag. I do this by packing a steel water bottle for my trip, filling it at an airport drinking fountain after passing through security (this is also a good trick for saving money, as water from the drinking fountain is free while airport stores may charge $3 or more for a single bottle). I also set a timer on my phone to remind me to drink regularly throughout the day, both while traveling and while visiting my destination. Finally, I avoid alcohol and caffeinated beverages while traveling as these contribute to dehydration, fatigue, and jet lag (not to mention are often full of empty calories.

7. I fast.

Popular in the primal and ketogenic communities, intermittent fasting involves limiting caloric intake for sixteen hours or more as a way of stimulating fat metabolism. Many people who practice intermittent fasting skip breakfast, for example, or limit themselves to a single cup of Bulletproof coffee (i.e. coffee with a dose of butter, ghee, or MCT oil) until late in the day. They then restrict their actual meals to a short window of time in the late afternoon or early evening, albeit still sticking to a pattern of healthy eating with dishes that are rich in fresh vegetables, high-quality protein, and good fats. I tend to use intermittent fasting routinely as a way of improving my body composition or my athletic performance (there will be a biohacking post on this soon), so I am comfortable doing so. I can easily go without food for 24 hours or more without feeling hungry, making intermittent fasting a way to avoid unhealthy food while in airports or trapped on planes. That said, not everyone is able to fast. Moreover, you shouldn’t try to fast while unless you’ve got your diet ‘locked in’ and have engaged in intermittent fasting before. Intermittent fasting isn’t about skipping meals willy-nilly but about doing so in a metabolically-adapted and structured way. If you don’t employ a carefully thought out and strategic way to skip meals, you risk having a blood sugar crash.

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Why Rest Days are Important

It’s okay to skip a workout. In fact, you should.

POSTED ON APRIL 1, 2018

… And he rested on the seventh day from all his work which he had made (Genesis 2:2)

Today is a fairly significant holiday in the US and many other predominantly Judeo-Christian countries. It is Easter Sunday (as well as the second day of Passover), which means that many businesses are closed or open only limited hours today. That is true of my gym, which opened at 7AM but closed at 2PM.

But while many might bemoan that fact that the gym closed early – as well as the fact that most of the training classes normally offered on Sunday were cancelled – it doesn’t really matter to me. That is because for me most Sundays are active rest days. This is not for any religious reason, but rather because taking rest days isincredibly important to any health and wellness program.

In my case, I work out an average of six to seven times a week. I usually split those workouts up between four hour-long strength-training sessions, two shorter sprint or cardio sessions, and one yoga or stretching session of varying length. But I always make sure to take one day off from the gym every week. Sometimes I even take two, should I find my energy or motivation to exercise is lacking.

So why is it so important to rest?

1. Rest is essential for recovery.

Quite simply, rest days are physically necessary so allow our muscles to repair, rebuild and strengthen themselves.

When we workout, we cause microscopic tears in our muscle tissue. It is your body’s attempt to repair this damage that leads to muscle growth and improvements in strength and stamina; the body is slowly remodeling the damaged muscles into larger and stronger versions that are better able to handle the stresses and strains of future workouts.

This process of recovery and remodeling takes time. In fact, after a particularly tough and targeted workout (such as a chest day when you hit a new personal record on the bench press), most exercise physiologists recommend giving that muscle group at least two to three days to properly recover.

Without giving your body enough time repair and replenish itself, overtraining syndrome – characterized by fatigue, muscle weakness, and decreased performance – is likely to result.

2. Rest helps prevent injury.

Taking rest days is also proven to reduce the likelihood of an exercise-related injury. This is not just because of the microscopic physical trauma to your muscle, tendons, and joints that exercise causes, but also because of the impact that over-frequent workouts can have psychologically.

When you don’t allow your body to recover from high-intensity exercise, mental fatigue can set in. Brain fog and mood shifts are just one more frequent symptom of overtraining, causing professional, amateur, and causal athletes to lose motivation and focus. This can lead to sloppy form while lifting weights, or lack of attention while engaging in cardio activities like running or martial arts, all of which is a recipe for disaster.

Without sufficient time to allow both your body and your mind to recover, the likelihood of injury skyrockets. Taking a day off will not only help your body heal and help you regain mental focus, but will also make you more enthusiastic and excited to return to your regular workout routine.

3. Rest prevents illness.

A healthy amount of exercise provides boost to your immune system, helping you fight off the myriad of disease-causing bacteria, viruses, parasites, mold that you encounter on a daily basis.

Overtraining, however, actually reduces immune function and makes you more susceptible to getting sick. This is because exercise cause significant changes in two key hormones: norepinephrine and cortisol.

When you workout, your body produces higher levels of these two so-called ‘stress hormones.’ That is usually a good thing; these hormones are part of the “fight-or-flight” response that gives you the energy and the strength to lift that barbell for one more rep, to row that extra kilometer on the NordicTrack, or outrun that hungry bear that you accidentally disturbed while hiking.

These same hormones also suppress your immune system. Normally, that exercise-associated dip in immune function is transitory. However, overtraining can cause the total number of functional immune cells in your body to decline over time. This might explain why studies have found that elite athletes are three times as likely as recreational athletes to acquire respiratory infections like the common cold or the flu during the winter. It may also explain why, when elite athletes do get sick, their symptoms tend to last longer and be more severe.

Rest is essential for avoiding illness and, when it happens, for bouncing back quickly.

These are just three of the many reasons why rest days are so important. But it is also essential to remember that rest days are not an excuse to sit on the couch binging watching Game of Thrones while scarfing down a pint of ice cream.

Depending on your current level of fitness, try for an “active” rest day. Take the dogs an extra long walk, go for a hike with your husband, go for a bike ride with your kids, or play some touch football with your kids at the park.

Get out and do something, just keep it light and keep it fun.

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Finding the Time to Live a Healthy Lifestyle

With only 24 hours in a day, sometimes you can’t have it all.

POSTED ON MARCH 27, 2018

In addition to running ReEvolution Health – a seemingly never ending task given the various clients I counsel, talks that I give, paperwork that I juggle, and blog posts and webpages that I write – I also direct a Masters program and teach classes at a local university, consult for various companies and organizations, travel for work and pleasure, shop for and cook lunch and dinner for my family, run a variety of personal errands, and try to keep up on the numerous chores and home maintenance tasks that come with owning a 200-year-old historical townhome that is slowly being renovated.

Not only do I struggle with getting all of this work done with a mere twenty-four hours in a day, I must also find time to spend with my friends and family. That should be a priority in my life but all too-often becomes secondary to my professional demands.

Squeezing in my workouts can thus be a challenge. I try to get in at least 4-5 strength training sessions weekly, along with 1-2 sprint or cardio sessions (such as the 30-minute MMA-style class that my gym offers throughout the week, which not only gives me a good aerobic workout but also helps me release a lot of stress by allowing me to hit things very hard without getting arrested for assault).

I’ve often wondered how successful health and wellness coaches and entrepreneurs like Mark Sisson and Dave Asprey do it. Do they drink seventeen cups of coffee a day? Do they rely on a professional and personal staff of twenty? Do they even sleep? Are they even human?

It was nice to learn that we all have faced the same problems.

Yesterday, in a soul wrenching Instagram post, founder of the Whole30 program Melissa Hartwig admitted that she too has often struggled with time management, writing:

A few years ago, my 24-hours looked like me working my ass off just trying not to fall apart, as my marriage was crumbling, my business was up in the air, and I was single-parenting my young son. Those 24 hours look NOTHING like the 24 hours I have now.

Her post is worth reading, as are the tens of thousands of comments thanking her for honesty.

Despite what the various fitness gurus and time-management experts say during those 5-minute televised spots on such pop-culture mainstays as the Today Show or Dr. Oz, sometimes we simply do not have enough time to get to the gym or plan and cook a healthy meal for our kids.

And that’s okay.

Living a healthy lifestyle is about more than religiously working out or eating right.

Sometimes the most important thing we can do – what we need to prioritize with the limited time that we have – is maintain our mental health, our emotional health, and the health of our personal relationships with our loved ones. It’s about figure out what is most important for you and making time for that.

So sleep in that extra hour with your husband, spend the afternoon playing with your kids, and order that Chinese takeout if you are just too harried or tired to cook. There’s no guilt or shame in doing that, and it’s as important to your health and wellbeing as getting to your Zumba class. After all, the gym will still be there tomorrow.