A Tale of Two Keto Dieters

My sister Jo and I were on one of our long-distance hikes a few months ago, discussing, as we frequently do, our health and this time drifted into the ketogenic diet we both are trying to follow. “I guarantee you’re not reaching ketosis,” she said. She said I couldn’t be, judging by how difficult it was for her to reach that state and knowing my typical diet. I was a little surprised, but after she described how much she was struggling, I figured she must be right.

A person following a purely ketogenic diet consumes roughly 70 percent of his or her calories from fat, 20 percent from protein and 10 percent from carbs. In our carb-addicted, fat phobic society, this almost seems ludicrous – even deadly. But believe it or not, eating a high-healthy-fat diet is one of the best things, if not the best thing, you can do for your health, especially cognitive health. The human body will always burn for energy any available glucose (sugar converted in the body from all forms of carbs) first and foremost. Eat a high-carb diet and your body will never burn fat – it will keep burning the carbs, and any excess that doesn’t get burned will be stored as fat (not to mention wreak havoc on the body through insulin resistance, glycation and oxidation/chronic inflammation) Flip that diet on its head, however, and limit carbs to only low-glycemic fruit and non-starchy vegetables and start adding healthy fats to anything and everything, your body transitions into ketosis and becomes a fat-burning machine.

Ketosis is a state in which the body no longer has glucose to burn and so begins burning fat. In this state the liver produces ketones, a type of fat that serves as another energy source for the body. David Perlmutter, M.D., author of “Grain Brain” says our bodies have been equipped to burn ketones since we first started roaming the Earth, and it reverses every negative effect produced by eating a high-carb diet. Achieving a mild state of ketosis – not an extreme state – on a regular basis is ideal.

“Both the heart and the brain run more efficiently on ketones than on blood sugar, by as much as 25 percent,” he writes in “Grain Brain.” “Healthy, normal brain cells thrive when fueled by ketones. Certain brain tumor cells, however, can only use glucose as fuel.”

So doesn’t it make sense to feed your brain the energy source it prefers and starve any cancer cells of their needed fuel? Perlmutter goes on to say achieving ketosis is a brain protector and enhances the growth of new neurons.

“This is why the so-called ketogenic diet has been a treatment for epilepsy since the early 1920s and is now being reevaluated as a very powerful therapeutic option in the treatment of Parkinson’s disease, Alzheimer’s disease, ALS, and even autism,” he writes. “Specifically, consuming ketogenic fats (i.e., medium chain triglycerides, or MCT oil [such as coconut oil]) has been shown to impart significant improvement in cognitive function in Alzheimer’s patients. … A ketogenic diet has also been shown to reduce amyloid in the brain, and it increases glutathione, the body’s natural brain-protective antioxidant, in the hippocampus [the part of the brain responsible for memory formation]. What’s more, it stimulates the growth of mitrochondria and thus increases metabolic efficiency.”

Mark Sisson in “The New Primal Blueprint” says glucose in the body burns “dirty,” creating “considerable metabolic waste products, inflammation, and oxidative damage.” Fat and ketones, on the other hand, burn “clean,” optimizing mitochondrial function and protecting against free-radical damage/oxidative stress.

I had begun my own health transformation quite a while before reading either of these books. In 2015, I had never heard of ketones or a ketogenic diet. I simply created a health/diet plan based on my own intuition and what my body was telling me – or perhaps more accurately, screaming at me – to do. I knew sugar and grain were destroying my body, and I had to do something about it. I was quite successful, dropping 35 pounds in that first year and another 25 pounds in the proceeding years, clearing my many health issues. So by the time I read these books, I thought heck, I’m basically already doing this keto diet! I’ll bet I’m achieving ketosis. I don’t need to buy one of those meters. Then Jo had to go and burst my bubble.

Jo in August of this year decided to buy a ketone meter to better track her success with the diet. The meter tests how many ketones are in the blood and therefore whether or not a person is in ketosis. As mentioned above, the body produces ketones when it runs out of glucose to burn for energy. Unlike glucose, which is stored as fat when not burned, ketones cannot be stored in fat cells. Instead they stay in the blood stream until some part of the body needs them and picks them up, Sisson writes in “The new Primal Blue Print.” Ketosis occurs when enough ketones are produced to have excess detected in the blood stream. Jo said she had given up gluten a few years prior and considerably reduced the grains she consumed and just before beginning the keto diet had limited her added-sugar intake to no more than 5 grams per day – just like me. So, also just like me, she didn’t think transitioning to the keto diet would be that difficult having already mostly adopted it. This is her story she shared with me:

“After a month of being very diligent, my twice-daily ketone test continued to show little or no ketones in my blood (ideally, readings should be between 0.5 and 4.0 mmol). I lost 2 pounds in that month – not much, but at least something. My nutritionist believed that, despite my efforts, I was still not eating enough fat. So during month 2, I focused on increasing my healthy fat intake. The first half of the month, I still never reached ketosis. Then I got the flu and didn’t eat for 2 days. This fast pushed me into ketosis, but it quickly reversed when I started eating again.”

Perlmutter, Sisson and “The End of Alzheimer’s” author Dr. Dale Bredesen tout the benefits of fasting as a healthy part of a keto diet and brain health, and in my experience, it’s a very important key to the diet’s success. Perlmutter recommends trying one-, two- or three-day fasts up to four times a year. Sisson and Bredesen, however, both recommend intermittent fasting, in which you wait at least 12 hours between finishing dinner and eating breakfast the next morning every day, and both recommend trying to stretch that fast to 14-16 hours. For more details on this subject, visit my post on fasting. Jo said she discovered that daily intermittent fasting, along with exercising on an empty stomach before breaking her fast in the morning, were important steps to achieving ketosis. And while I haven’t been tracking my progress with a ketone meter as she has, I have definitely noticed these two things have tremendously helped my overall feeling of well-being and spurred some further weight loss.

Jo’s journey, however, was still only just beginning. After her initial fast from sickness, she soldiered on, strictly following the diet and finally began yo-yo-ing in and out of Ketosis. She decided to keep a food journal to learn which foods were helping her achieve ketosis and which ones would throw her out of it. She said she learned she could eat the exact same things two days in a row and be in ketosis one day and not the next. She got so frustrated she wanted to quit. I asked her one day how her diet was going and she said, “On days when I’m in ketosis, I love it, but when I’m not I want to throw the ketone meter out the window.”

When beginning a keto diet, it’s hard to imagine just how much fat you need to consume to make it 70 percent of your diet. It becomes something you have to consciously add to pretty much everything you eat. Having vegetables? Douse them in butter. Preparing eggs or other dishes? Cook them in coconut oil, butter or avocado oil and don’t be stingy. Having chicken for dinner? Opt for the thigh and not the breast. It’s not easy when you’re coming from a fat-phobic/carb-addicted belief system.

Jo said she was still determined to succeed with her diet and followed her nutritionist’s advice to increase her fat intake. She finally found recipes for “Fat Bombs,” which became her saving grace. These bite-sized snacks can be made with endless flavor combinations, but Jo said she usually sticks with the chocolate recipes to satisfy her sweet tooth and her love of chocolate.

“These felt like such a treat and were very filling,” she said. “But the best part was on days that I had a few Fat Bombs as an afternoon snack, I had great ketosis readings. At the end of month 2, I was finally consistently in ketosis, and I had lost an additional 4 pounds (6 total). The weight loss wasn’t exactly Earth-shattering, but I was motivated to continue with this plan.”

Learning Jo’s story made me step back and reevaluate my own food intake to make sure I was eating enough fat and not going overboard on protein. (If you eat more than your daily recommended value of protein – 1 gram for every kilogram you weigh – every gram of excess is metabolized as sugar in the body.) I now make a point of adding butter or olive, coconut or avocado oil to everything I eat for the sake of optimal brain (and the rest of my body) health. But I also remind myself that everything I’ve done over the past four years has worked wonderfully well for me, and I’m the healthiest I’ve ever been, regardless of whether I’ve ever achieved ketosis or not. Visiting Jo one day this past December, she let me use her ketone meter. I wasn’t expecting the results to show ketosis because I had just eaten my afternoon snack of a hard-boiled egg with some bell pepper, avocado and kimchi (an Asian fermented cabbage, a great source of probiotics) all drizzled in olive oil. Turns out my reading showed an ideal state of mild ketosis. This was enough to prove I’m succeeding in at least sometimes, if not frequently, achieving ketosis. This was all I needed to know. No need to make any major changes. What I’ve been doing is just right for me.

Jo and I have very different methods when it comes to this keto diet. She has approached it very analytically, tracking and measuring to make sure she’s doing everything exactly right. I, however, am more comfortable just taking things a day at a time and seeing what happens while listening to what my body is telling me. Is one way better than the other? Nope. It all depends on the person. For me, taking a more scientific approach by measuring and counting only means adding more work and, as a result, more stress, which is never helpful when improving one’s health. For an analytically minded person, however, following the data isn’t work but instead provides a source of comfort knowing exactly where you stand.

Most recently, Jo and I have turned our attention to vegetables. It’s easy to let vegetables fall by the wayside when you’re so focused on increasing fat and limiting carbs as much as possible. Vegetables are after all a carbohydrate, and a high-fat diet is very filling. How do we find the right balance to make sure we’re reaching our ever important vegetable quota? Stay tuned.

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