[To read what happened from day 1 to day 3, click HERE].
Day 4 (2/3/13)–fourth day of fasting
- Plain water/plain seltzer and a little salt…until 2 pm…
- Morning blood glucose: 73
- Morning blood ketones: 1.9
- Morning urine ketones: large (20)
Notes: Only slept from 2 am to 5:30 am. Big jump in ketones this morning, but hungrier. Numerous unhappy symptoms: difficulty concentrating, tired but couldn’t sleep, mild headache, low energy, a little cold, heartbeat a little stronger than usual, dark circles under eyes (proof that not all dark circles under the eyes are due to food sensitivities–impossible in this case), stomach growly, and slight tinnitus (ringing in the ears). I was at this point already considering breaking the fast, but then something happened that convinced me it was time to eat.
My cell phone rang at about 2 pm [my ringtone is a harp playing a lovely arpeggio; you may be familiar with it]. Anyway, I answered the call, spoke for a few minutes, and then hung up. But the harp kept playing, very faintly and mysteriously, in the distance, nowhere near where my phone was located…over and over again. Uh-oh. It occurred to me that I must be having a mild auditory hallucination–certainly something I had never experienced before in my whole life, and, while absolutely fascinating to me on one level, it was a clear indication that my brain was not getting the nutrients it needed to function properly, so quite concerning on another level. This hauntingly beautiful harp call was either a sign that my ascension was drawing nigh, or it was time to have some lunch. I chose lunch:)
What does this mean for people with cancer who may have been considering using a 3 to 5 day fast to rapidly establish ketone levels of 4.0 mM? It may mean nothing. It may be my own unique response to fasting. Perhaps some people tolerate it beautifully. However, at least for me, fasting for longer than 3 days was not tolerable, and to have continued the fast would have been unwise. It made my brain unhappy. Now, if I had continued another day or two until my ketones had risen to 4.0 mM, would all of the side effects have gone away? I don’t know. If I had already been keto-adapted (at lower ketone levels), would I have tolerated the fast better? Maybe, I don’t know. But since the point of the fast is to begin with a regular diet and rapidly establish ketosis, people who try this plan aren’t expected to be keto-adapted already. In most cases, I think it may be wiser to try Dr. Seyfried’s alternative initiation plan instead of fasting (details in article 3).
I certainly could never have accomplished his recommendation of an annual 7-day fast, so my cells will not have the opportunity to cannibalize each other after all. I am just going to have to hope that my healthy diet naturally reduces my risk for developing pre-cancerous cells in the first place:)
So, what’s next?
I will now attempt to continue trying to reach Seyfried’s “zone of metabolic management” while eating a carefully measured, mostly meat diet. First, I need to calculate my protein requirements.
- Dr. Seyfried recommends I eat between 62 and 92 grams of protein per day.
- Phinney and Volek recommend I eat between 75 and 156 grams of protein per day.
- Dr. Rosedale recommends I eat 77 grams of protein per day based on my body measurements, but 47 grams of protein per day based on my body fat percentage (I have a Tanita scale at home that estimates body fat).
Hmmmm… I understand that protein requirements are difficult to estimate (see my protein page for more details) and that there is probably no one perfect recommendation, so I’m just going to start with 75 g of protein per day, and if I need to adjust it along the way, I will.
If I were trying to treat an active cancer, Dr. Seyfried would want me to reduce my calorie intake significantly below my daily requirements (resting/basal metabolic rate). My estimated BMR is 1400 cals/day. While I am lucky to be able to say I don’t have cancer, I would like to lose a little weight, so I will try to eat less than 1400 cals per day most days.
Day 4, continued:
- Calories: 913
- Protein: 75 g
- Fat: 65 g
- Carbohydrate: 3.5 g
- Protein:Fat (cal) ratio = 1:3
- Evening blood glucose: 100 (whoa…)
- Evening urine ketones: mod (20)
- Foods: Roasted chicken w skin, duckfat, cucumber, unsweetened/caffeine-free mint tea, fish oil
Notes: I felt much better about an hour after eating some food. It was especially wonderful to regain my powers of concentration. And surprisingly, despite having not eaten a thing for nearly 4 days, my appetite once I started eating was actually fairly low, and so my calories for the day were pretty low. Was this the effect of high ketone levels/low insulin levels?
Sleep–very good; 7.5 hours.
Day 5 (2/4/13)
- Morning blood glucose: 108 (hmmm…)
- Morning blood ketones: 1.1
- Morning urine ketones: moderate
- Weight loss past 24 hours: 0
- Total weight loss: 3.8 lb
- Evening blood glucose: 89
- Evening urine ketones: mod
- Calories: 1092
- Protein: 77 g
- Fat: 85 g
- Carbohydrate: 7 g
- Protein to Fat (cal) ratio= 1: 2.5
- Foods: Tuna, salmon, turkey, chicken broth, omega-3′s, duckfat, cucumber, vinaigrette, caffeine-free mint tea
Day 6 (2/5/13)
- Morning blood glucose: 83
- Morning blood ketones: 1.3
- Morning urine ketones: mod (80)
- Weight change past 24 hours: -0.2 lb
- Total weight change: -4.0 lb
- Evening blood glucose: 98
- Evening urine ketones: max (160)
- Calories: 1493
- Protein: 75
- Fat: 127
- Carbohydrate: 18
- Protein:Fat = 1 : 3.8
- Foods: Bacon, chicken, duckfat, chicken liver, cucumber, fish oil, olives
Day 7 (2/6/13)
- Morning blood glucose: 92
- Morning blood ketones: 1.5
- Morning urine ketones: mod
- Weight change past 24 hrs: - 0.4 lb
- Total weight change: -4.4 lb
- Evening blood glucose: 90
- Evening urine ketones: sm
- Calories: 800
- Protein: 77 g
- Fat: 60 g
- Carbohydrate: 25 g
- Protein: Fat = 1:1.75
- Foods: Duck breast, Olives, Chicken, Duckfat, Fish oil, Cucumber, Hearts of Palm
Reflections on Week 1
- Fasting certainly does jump-start ketosis, but fasting for more than 24-48 hours may not be safe for everyone, and was no fun.
- Appetite is generally much lower as ketones rise.
- Hunger feels different in ketosis–mild headache, stomach growls, calm thoughts of food, can still go hours without eating and function fine. Zero emotional component. Compare this to hunger on a standard diet, which (for me) = irritability, anxiety, distractibility, emotional longing for food, sense of urgency, carbohydrate cravings, and wish to stop whatever I’m doing and find something to eat right away.
- My blood sugar is still pretty high despite high ketones, but I think all bets are off during first few weeks, as “keto-adaptation” can take 3 weeks or more. [Keto-adaptation refers to the body's ability to efficiently use ketones for fuel instead of carbohydrate.]
- Do I need to eat more fat to get higher ketones, or is it just a matter of time? If I were to eat more fat, that would mean more calories–would my weight loss slow down or stop?
- I am hesitant to do any experiments within my experiment until after a month of this plan, so for now I’m going to stick with: 75 g protein, 1400 cals max, carbs less than 30 g/day, mostly meat, no dairy, no caffeine, no artificial anything.
Me and My &^#$@! Metabolism
My metabolic/diet background may be useful in interpreting my n=1 experiment going forward. Obesity runs strongly in family, and I was overweight even as a young child. I have struggled with my weight all my life. In my childhood, teens and twenties, I used low-cal/low-fat diets + exercise off and on to try to control my weight. Frustrating, only temporarily effective, constantly hungry, repeatedly regained weight. Utterly demoralizing.
In my 30′s I discovered the South Beach Diet and used a combination of low-fat, low glycemic index diets and exercise to control my weight. This worked better–I naturally ate less because I was less hungry, so it was easier to keep my calories down. But I still had to exercise a lot to maintain a reasonable weight.
At around the age of 40, this plan stopped working, so I adopted a very low-carbohydrate, low-fat diet. This was helpful until I started developing a myriad of mysterious health problems in my early 40′s (fibromyalgia, IBS, chronic fatigue, migraines, etc.). Using trial and error and a food/symptom journal, I was able to reverse all of these problems within several months by eating only meats, fruits, and a few specific vegetables [this is the experience that inspired me to study the connection between food and health]. I couldn’t eat much fruit without gaining weight and getting hungry, so eventually I began eating a mostly-meat diet–meat plus small amounts of low-glycemic fruits, and small amounts of the few vegetables I can tolerate.
A mostly-meat diet (let’s call it an MM diet for short) changed my life. With MM, my weight and appetite naturally stabilized, and I felt better than I had ever felt before, even when I was young. I still had to exercise to look and feel my best, but, for the first time in my life, I didn’t have to count calories or exercise to maintain a reasonable weight. If I exercised less, I did not gain weight. This was nothing short of miraculous for me, and worked for a couple of years. Mind you, by “reasonable weight”, I mean a BMI of about 26; not my ideal weight, but compared to my natural tendency to rise into the 30-31 range if I’m not extremely careful–pretty good, if you ask me–especially for a woman in her late 40′s with a strong family history of obesity. While most of my friends (even my naturally slender friends) continued to slowly gain weight each year after 40, I was at least maintaining.
However, (sigh), last year my weight started creeping up again, so I began paying more attention to calories again, which helped. I am a big fan of Gary Taubes’ work, and his book Good Calories Bad Calories was nothing short of a revelation to me. However, while I am absolutely convinced that carbs, especially refined and high glycemic index carbs, are the single most important driving factors in obesity, it’s clearly not all about the carbs. I am also a big fan of Dr. Andreas Eenfeldt’s work, but he also believes that carbs are king and that nobody should need to count calories if they eat a low-carb, high-fat Paleo+dairy diet. At least in my own personal experience, calories, protein, and maybe even fat, seem to matter, too. Perhaps these other factors matter more for women than for men. Or maybe they are more important more for those of us with damaged or disordered metabolism which has been affecting us since childhood. Oddly, most diet gurus are men without a serious history of weight problems…
Anyway, I had to try a new approach, so, as an experiment, last summer I ate a strict all-meat diet for 90 days. I lost 15 pounds, and felt better than ever. It seemed I needed to keep my calories between 1100 and 1400 per day and exercise at least 5 times per week in order to bring my BMI into the normal range (24). This was the first time my BMI had been below 25 in over a decade. My mood, energy, productivity, stamina–everything was wonderful. It was a very boring diet, and it was hard to stick to.
New Guru for a New You?
Then I attended the Ancestral Health Symposium in August 2012 and heard Dr. Ron Rosedale speak about ketogenic diets. His talk left a big impression on me. I spoke with him after his lecture and later bought his book, The Rosedale Diet. I wondered if one of the reasons my calorie-controlled all-meat diet had worked so well was that perhaps it had been ketogenic (I hadn’t been measuring blood sugar or ketones at that point). I purchased all three of Phinney and Volek’s books about ketogenic diets, and listened to Dr. Phinney’s interview on Jimmy Moore’s terrific podcast “Ask the Low-Carb Experts”. I became inspired to try a ketogenic diet and ordered all the necessary supplies, which arrived in November 2012. [By the way, from September to late November, I had stopped my calorie-restricted all-meat diet and gone back to my MM diet, so I was starting to gain weight again.]
In November and December I attempted a mostly-meat, ketogenic diet, but was not very successful. I limited protein to 50-80 g per day, carbs to 0 to 30 g per day, and the rest of my diet consisted of fat. I was hoping I wouldn’t need to limit calories, so my caloric intake varied widely. Most days calories naturally ranged from about 1100 to 1600 per day, but on certain days it would be out of control–up to about 2700 on a few occasions. The highest blood ketone level I achieved was 1.4, and only on a few occasions. I did not lose an ounce of weight. My appetite was sometimes very high. My downfall seemed to be the fat:protein ratio issue. I found it psychologically challenging to limit protein, which I’d never had to do before in my life. I found it logistically challenging to eat an 80% fat diet, especially given the fact that I don’t tolerate beef, pork, or avocado very well, can’t eat coconut oil or nuts of any kind, can’t eat eggs or shellfish, and most dairy products do not agree with me.
It was hard for me to eat a high-fat diet without eating dairy, which was why I added heavy cream to the menu from time to time. I only attempted this diet for 25 days (weighing, measuring, and tracking every morsel along the way), but it seemed that dairy may have been increasing my appetite (driving high calorie intake a few times) and interfering with my ability to achieve and maintain ketosis, but I honestly wasn’t sure. I became confused and frustrated, so I took a break from my ketogenic diet experiment in early January, intending to try it again in the future without dairy.
It was during the month of January that I happened to be reading Dr. Seyfried’s book, Cancer as Metabolic Disease. Dr. Seyfried’s talk at the Ancestral Health Symposium had also left a huge impression on me. So, I suppose it is natural that I would have wanted to combine what I had learned from ketogenic diet experts such as Rosedale and Phinney/Volek, with what I had learned from Dr. Seyfried, and apply it to my own situation, hence, my unusual dietary experiment of this past week was born.
Why try a ketogenic diet?
It is clear to me that, now that I’m in my late 40′s, none of my other dietary strategies work anymore. So, if I want to stay healthy and maintain a healthy weight, this approach may be my best hope. And the only one with the power to keep my appetite low enough to be able to control how much I eat.
Ketogenic diets clearly have magical healing properties. Ketogenic diets appear to have the ability to manage and/or reverse a wide variety of brain disorders, obesity, and even cancer. Does this mean that they have the power to prevent these conditions as well? I don’t know, but it seems plausible.
A ketogenic diet may be the ideal diet for the brain. As a psychiatrist, every patient in my practice comes in with brain complaints–difficulty concentrating, moodiness, fatigue, racing thoughts, insomnia, etc. If I am going to suggest that people try this diet in my practice, I feel I should try it myself to obtain a real world understanding of what is involved, and therefore be able to provide better guidance to my patients.
So my plan now is to try to achieve deep ketosis using a MM diet. If I find I eventually need to go to all-meat, then I will. I do feel my best when I eat an all-meat diet, but it is hard for me to sustain. In the beginning, I will post weekly about my progress, and then, once I achieve stable ketosis, I will post monthly about it. There are so many other food and health issues that I love studying and writing about that I don’t want this experiment to overshadow or interfere with those. Also, there are many others out there who write about ketogenic diets (especially for weight loss), and who know a lot more about them than I do. I am posting about my ketogenic diet in case the real-world details are useful to any of you who may be considering it. I have been inspired by Jimmy Moore’s own amazing n=1 nutritional ketosis experiment, which he has been living and writing about for nearly 9 months now. I hope that my own data will be a useful addition to his, particularly for women and for those with food sensitivities.
To read about days 7 through 14 and see how I got my ketones way way up, click HERE.
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