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Starting the Ketogenic Diet: A How-To Guide For Beginners

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The beginning of the keto diet depends on where you’re starting the ketogenic diet. Most of my patients eat an enormous amount of carbohydrates. They usually consume over 300 carbohydrates in their Standard American Diet.  Slamming their carbohydrate intake down to the recommended 20 carbs a day will undoubtedly cause side effects. Side effects lead to failure of starting on the ketogenic diet.

For That Reason I Recommend The Following Weekly Plan For Starting the Ketogenic Diet:

Week 1 –  Start by consuming no calories in your drinks

That means that your liquids should be limited to tea, black coffee, or water for the first week. No soda pops. No juice. No milk. No protein shakes. With this simple rule, the daily intake carbohydrates drop as dramatically as 70 to 150 carbs per day. This one rule will step you closer to the goal of 20 carbohydrates per day. But will do it in a way where your body adjusts without serious side effects.

Week 2 –  Remove All Starches  

Think “white foods.”  In general, these are the carbohydrates that are easy for patients to pick out. They include potatoes, rice, pasta, bread, pastries, and cereals. Step one removes calories that you drink. Step two removes the white, starchy foods.  This approach has successfully transition hundreds of patients. The average blood sugar of most patient is higher than they think. Their blood sugar quickly drops when they slam their daily carbohydrates to 20 per day. It “hurts” if their usual intake is over 200 carbohydrates per day.  The adjustment is drastic and causes a significant chemistry shift within their system. SLOW DOWN. The faster you make a change.  The faster it goes away. 

starting the ketogenic diet

Patients interested in how to start on the ketogenic diet usually are chasing the weight loss.  That‘s great, but the keto diet is so much more. Slow down. Make changes that will stick. This 2-step process gradually shifts their blood chemistry and allows for their system to adapt. Give the body a week to adjust before stepping into the next level of change. Changes that happen suddenly fail suddenly.

Those who suffer the most when transitioning into starting the ketogenic diet are those with blood sugars that are above 100 in the mornings.  That means nothing to most of you, but if you have tried to go keto and felt awful, I’d wager a bet that your morning fasting blood sugar is above 100.  Unbeknownst, these high blood sugars hold onto lots of extra water. Drop your carbohydrates too quickly, and a tidal wave of change happens in your kidneys and blood vessels.  

These high blood sugars will quickly correct when you improve your eating.  Step through these two critical transitions and avoid the keto flu. If you don’t succeed at seven consecutive days of calorie-free-drink, keep going until you get seven days in a row.  Some patients take up to a month to find their groove. Once you graduate with seven days of calorie-free drinks, move to WEEK 2. Remove starches. This transition is meant to last a lifetime.  If you eat a lot of starches, this could be tough. I encourage patients to start with breakfast.  No cereal. No toasts. No oatmeal (that is cereal, folks.) No pastries. Try out the no-calorie-drink rule at home, then at church, then at the restaurants.  After proving to yourself that you can hold that change, make the next move. 

Remove All Temptations When Starting The Ketogenic Diet 

If you’ve ever helped an alcoholic throw away their hidden stash of alcohol, you might grasp how unsettling it was for us to dispose of all sorts of food. Grandma Rose’s pantry looked like every other farmer’s wife in the county: stuffed with enough processed carbohydrates to survive a famine of biblical proportions. Floor to ceiling, her shelves were filled with ketosis-killing food.  We quickly filled trash bags with cans of corn, peas, green beans, black beans, and lots of canned fruit. We tossed Bisquick, crackers, cornmeal, oatmeal, and rice. Out went wheat flour, white flour, rice flour, brown sugar, powdered sugar, white sugar and farm-grown honey.  We purged her fridge of carbohydrates hiding in ketchup, mayo, BBQ sauce, peanut butter and low-fat milk. All the low-fat stuff like salad dressings, coffee creamers, and low-fat cheese got chucked as well.

Next, we removed all baking goods like chocolate chips, evaporated milk, sweetened condensed milk, and cornstarch. Gone. All of it. When we were done, we had three boxes of canned goods for the local charity and four trash bags full of food that no human should eat. The pantry and storage shelves in the basement went from overflowing to barren. What was left? Beef bouillon, pecans, and macadamia nuts. Pickles made the cut. So did green olives in oil. We filled her shelves with coconut oil, cans of sardines, olive salad in a jar (my favorite is Muffuletta), almond butter, and liverwurst. Grandma Rose bought the biggest carton of heavy whipping cream she could find, five dozen eggs, sour cream, cream cheese, and butter. We also grabbed ketone urine strips from a pharmacy as we headed back to the farmhouse.

Build a Tribe: Start with ONE Person

When starting the ketogenic diet and getting ketosis to work, my parents needed to change so many habits. My folks had over seventy years of food patterns to unwind. “Do or Die.” 

I knew Grandma Rose would fail without a wingman for support. We recruited Dad into this high-fat-frenzy with a can of sardines. Apparently, years of mom denying him sardines was enough. “If you are telling me I can eat sardines AND liverwurst-and you say this is healthy; I am not going to argue with that you.” I set their daily carbohydrate goal at 20 grams of carbs per day. Every morning, they peed on their ketone stick and compared results.

By the end of the week, both Grandma Rose and my dad crossed the ketosis threshold. Like kids, they called me to share their excitement. Seeing the positive results on their ketone strips strangely empowered them both. We were all pumped up by their initial success. So far, so good.

Learn more about the ketogenic diet by checking out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.

Keep up with our blog at Bozmd.com!

Diet

Quick and Easy Rules of the Keto Diet

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rules of keto diet

Rules are important when it comes to tricking your body into altering it’s chemistry. The rules of the keto diet are not complicated but I can assure as weird as some of these guidelines sound they will help you.

Step 1: No sugar. No starch. High fat.

The best summary of this diet is “no sugar, no starch, high fat.” Say those words out loud. Again. No sugar. No starch. High fat.

Step 2: Remember the Number 2

It is critical as I will explain later. For now, commit this number to memory:

Step 3: Buy Urine Ketone Strips

rules of keto dietI hate even to have to say this, but I recommend you buy something. Yes, as a physician who has been subjected to more multi-level marketing pitches than I care to admit, typing this recommendation makes me uncomfortable. But it is necessary.

To succeed at switching your fuel source from sugar to fat, you need to know if you are producing ketones. Spend some money. Ketone strips typically cost about $15.

Buy the smallest quantity you can. I buy bottles of 50 strips. I have put them in every single bathroom at my clinic and my house. I have even been known to leave a bottle at a friend’s house because she always complained that she could not lose weight.  

It is super important because the keto diet is measurable! Here is my favorite part.

I have coached patients for decades that come in and say “Doctor, doctor, my diet is just not working for me.” And they’re right. The scale didn’t move.

These changes seem strange to most everyone I advise. Keto strips allow me to measure patients’ compliance. More importantly, the strips allow patients themselves to monitor their progress.

In the first two weeks, I want you peeing ketones as quickly as possible. Burning fat for fuel is the basis of this diet. Getting to the other side has proven to be unique to each patient. You will need the feedback that what you’re doing in YOUR SPECIFIC situation is the right thing for you.  

Some patients, usually men, stumble into ketosis. They pee ketones within 24 hours of changing habits. They may not always stay there, but they can pee a ketone mighty quickly.  Other patients may take several weeks to burn through their stored sugar and struggle with their body chemistry due to insulin resistance.  

Sometimes this is because they don’t know what they’re doing. But more often than not, the bodies were merely locked into using only sugar for fuel for years-if, not decades.

Some have been living with chronically high insulin levels for years. It can take weeks to burn up all the extra stored glucose in the body and finally see their insulin fall back to normal range. Remember, you can’t produce ketones until both your blood sugar and your insulin comes down.

How resistant is your body to insulin?  

There is a blood test you can take to get the answer. I offer this to my patients when I see them in the clinic, but I don’t routinely recommend it. The test is expensive and coupled with the cost of a doctor’s visit. It won’t tell you anything you don’t already know you are addicted to sugar and have been for a long time. You have gained weight and can’t seem to lose it because of your body’s insulin cycle.

You will have a rotten time giving up carbs initially. Most people don’t need a blood test to tell them that. Spend your efforts and money measuring something that does matter: The time it took for you to start producing ketones. Start using those urine sticks! If they turn pink, this means you made ketones. Pat yourself on the back, jot down how long it took you to pee that first ketone-and keep going!

Step 3.5:  Buy MCT C8: C10

We will get into how to use this powdered fat supplement later. For now, click on BUY and get it shipped to your home. Local stores are not likely to have this on hand, so I recommend searching the internet for direct delivery. Search these words: MCT C8: C10

Step 4: Empty Your Cupboards  

It is a challenging step. Empty out your cupboards.

One of the hardest changes you will have to make when adjusting to a high fat, low-carb diet is dealing with temptations. You need to put a lot of distance between yourself and the high carb foods you previously loved to eat. Do yourself a big favor and rid your home entirely of these distractions and temptations. Cleanse the places you control.

rules of keto diet

When walking addicts through a recovery plan, we start with asking a friend to help them cleanse their environments. It means throwing away all the signals that tempt you to go back to your old habits.

For an alcoholic, this means booze bottles stashed in the silliest places. For a drug addict, it involves needles, spoons, and lighters. For a carb addict, your enemy is processed food. The more food has been prepared, the quicker it ends up in your mouth. Moments later, your system is crammed with glucose molecules ruining your ketosis.

Even when you have cleansed the areas you control, be prepared for temptation. The devil has placed carbohydrates everywhere-from gas stations to coffee shops to your workplace. Protect the sanctuary of your home. Keep carbs out.  

How do you know which food items to throw away when rifling through your cupboard?

Look at each item’s label. Any item with a high level of carbohydrates or sugars needs to go. When trying to decide to keep or throw something, another rule-of-thumb centers around processing.

If the food is highly processed, lose it. In our family, we took a box and everything that was made with flour, rice, corn or had sugar in it, we simply put in the box and took to the community food pantry.

This was therapeutic for my household. My kids helped with this. If they considered keeping it, I had them count how many ingredients were in the product. If it had more than 8 ingredients, we tossed it. Keto can be very stressful. Do this with a friend and make sure you don’t quit until it’s done.

Here are just a few things that ended up in the box that we took to the food pantry:

  • Hamburger Helper
  • Bags of pasta
  • Bags of rice
  • Flour
  • Sugar
  • Refried beans
  • Cans of corn
  • Cans of pears and other fruits (remember, fruit is evil)
  • Ketchup   

Step 5: PAUSE

After the cupboards are bare, STOP.  PAUSE. Do not rush the next steps. Grocery shopping will still be there tomorrow. Just pause long enough to understand these following few steps.

Step 6: Remember That Number?

What was that number you were supposed to remember?  Yep: Twenty.  20. To start on your path to ketosis, you are allowed 20 grams of carbohydrates per day. The only thing I want you counting in a day is carbohydrates. Not calories. Not grams of fiber or fat or protein. Not pounds or inches. I only wish you focused on carbohydrate grams.

Forget about net carbs. Forget about dietary fiber. Don’t distract yourself with ‘sugars.’ Just remember 20 and start counting carbohydrates! Restrict yourself to only 20 carbohydrate grams per day.

Transitioning people’s behaviors starts with clear instructions and something measurable.

The clear instructions?

  • 20 grams of carbohydrates per day.  

The measurable factor?  

  • Peeing ketones.

Here’s an objection I usually get when I discuss this step with my patients:

“Doc, calories matter. Why aren’t you telling us to count calories?”

For the last four decades, the medical establishment in the US has been preaching that calories matter. The truth? They don’t matter when insulin is ruling your body. We can talk about calorie balance after you’re keto-adapted. But the first thing you need to focus on is reducing your bloodstream insulin level, and that means HIGH FATS, LOW CARBS. Your mission right now is to get rid of those carbohydrates!

Step 7: Eat Enough Fat to Feel Full

It is what sets this diet apart-there is no starvation! There is no want for food. I’m not exaggerating. With this approach, there’s enough fat feeding your body that you don’t feel hunger. Your brain receives a powerful chemical message of fullness from your system. This process begins when you eat fat after cutting out sugar or carbs.

rules of keto diet

Don’t believe me? You have my permission to begin your day tomorrow by eating a stick of butter. Yep. You read that correctly. After not eating anything for several hours (because you were asleep) you can have a stick of butter for breakfast. Add salt for added taste if you like. Pair it with water or black coffee. Still, the only ‘food’ you should eat is butter. Don’t imagine this story. Do it. Listen carefully to what your body is saying. Notice the sensation your brain sends to your body? Your brain detects the signal that you are full when fat fills your stomach.

No wonder, so many of my patients boast about how sustainable and satisfying the ketogenic diet is.

Step 8: Eat Only When You Are Hungry

Do not sabotage your system’s chemical transition from sugar to fat by snacking unnecessarily.

Your habits may seem so automatic that you hardly become aware that you’re snacking until the bag is empty. Recognize these habits. Bring the habit out of your subconscious by keeping a food log.   

My downfall was morning breakfast. For so long I told myself that breakfast was the most important meal of the day, that I did not stop to ask myself if I was starving or just eating breakfast out of habit. After two months of keto eating, I challenged myself: No calories until I felt hungry. When hunger hit, I would take in my favorite foods first: coffee with heavy whipping cream. Before long I stopped eating breakfast, sipped on my favorite coffee with cream until well into the afternoon.

If you’re suffering from anxiety or stress, make sure you only eat when you’re hungry instead of eating for comfort. If you do choose to snack, reach for fat instead of carbs!

Step 9: Restrict Protein

Nearly every person I have coached at some point overate protein. They are confusing boosting fats by loading up on protein. Perfectly understandable. The notion of a high protein diet as a healthy option has been around for a long time. Bodybuilders and health food promoters all have a protein supplement to help you remain healthy. In our minds, it all seems natural that protein is healthy. Those same people think high-fat diets are unnatural. According to this ‘conventional wisdom,’ it is safe to eat lots of protein, and it is unhealthy to load up on fat.   

rules of keto diet

What’s going on here? Lipophobia: the fear of fat. The media won this game. They successfully frightened us from enjoying fat.

I correct this thinking by educating patients that we are solving a human biochemistry puzzle. Our body’s chemistry controls weight loss. The most crucial piece of the puzzle is insulin. Keep insulin down, and weight loss happens.  

In the absence of carbohydrates, fat does not spike your insulin. Fat also sends a robust hormonal message to your brain to stop eating. This chemical shift is what makes the keto diet so powerful and effective. Fat does not spike insulin. Carbs spike insulin. Excess protein spikes insulin, too. For me, the most challenging pantry item to throw away was the protein powder.

On a ketogenic diet, how much protein does it take to spike your insulin?

Here’s the formula I teach my patients: write down your ideal body weight-the weight you want to be. I’m 5’3” and would love to be 125 lbs again. Divide 125 (your ideal body weight in pounds) by 2.2. This is the number of protein grams per day that you should eat. In my case that is about 56 grams of protein per day. If I stay under that goal for the day, my insulin does not surge. The first month when I failed and failed and failed to produce my first ketone, I was adding a scoop of protein powder to heavy whipping cream. That one scoop had 50 grams of protein and blocked my insulin from falling. No ketosis.  

The number 20 was the only number you need to insist remember-I you stick to that for now. This protein number only surfaces when patients are having trouble. If you are in week 2 and you still haven’t peed ketones, you have a problem. The culprit? You’re probably eating a high protein diet instead of a high-fat one. This is the most common mistake I see.  

Eat too many proteins, and your body will start to squirt out insulin. Insulin is the enemy of ketones. For more information on the benefits of a ketogenic diet, check out the book ANYWAY YOU CAN written and recorded by Dr. Bosworth.

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Ketogenic Diet and Intermittent Fasting

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ketogenic diet and intermittent fasting

Ketogenic Diet and Intermittent Fasting : NOT A LOW-CALORIE DIET. Please, do not confuse my support of intermittent fasting with support for starving. Let me be clear: NO STARVING ALLOWED!  

Reduced calorie diets are a no-no. Intermittent Fasting (IF) knocks the socks off of a Low Calorie or Reduced Calorie diet. Indeed, I would say they are the OPPOSITE of each other. Intermittent fasting shifts your chemistry in the opposite direction of the low-calorie diets.

ketogenic diet and intermittent fasting

A calorie-reduced diet would be more accurately called a torture diet. No matter its name, it triggers your chemistry to store fat. This low-calorie setting takes your food and squirrels it away into cells designated to save energy. If you want body chemistry that locks your energy efficiently into your fat cells, go on a reduced calorie diet. Every study regarding reduced calorie diets has proven this over and over again.

Notice that I have not mentioned carbohydrates or fat. When scouring through every reduced calorie diet, notice that the instructors of these diets select food with the fewest calories. Fats add the most calories per bite, therefore are chosen sparingly for these diets. When the dietician adds fat to the list of foods, suddenly their low-calorie diet is no longer low in calories.

Look at the diet comparison graph showing calories along the bottom and the carbohydrates along with the left side.

For example, one very low-calorie diet recommends a total daily intake of 800 kilocalories (kcal) in the form of liquids or protein bar supplements. The results? After several weeks, people on this diet might see significant weight loss. However, their bodies are in crisis.

Their system is stressed, and you can measure their stress hormones to prove it. They don’t sleep well. They feel tired, crabby, and a countdown to the day they can start eating again. Sadly, their metabolism suffered the most damage. During the eight weeks of their diet ordeal, their body remains in the ‘store all that you can find’ mode. When they resume eating, watch out. BOOOM! The calories will be sucked into storage never to be re-released.  

Why Does the Body React This Way to the Ketogenic Diet and Intermittent Fasting?

The body registered a trickle of incoming fuel and those limited resources transmitted a message that you are ‘about to face starvation.’ The key word is ‘about.’ Never do they enter a time of absent calories. Evolution has taught each of your cells that when food gets this scarce, they need to store calories away because there’s a famine coming. People on starvation or reduced calorie diets are only a few hundred calories away from a biochemical state where their cells say the opposite message.

 

Take away those final calories, and the message changes to ‘We are in a famine, release calories from storage. We need to survive by using all resources from within our body.’

ketogenic diet and intermittent fasting

By consuming low calories instead of zero calories, your body chemistry never entirely shifts to fasting mode. You miss out on the advantages of fasting.

A low-calorie diet gradually slows down your metabolism. Your body prepares for what is to come by conserving every possible calorie. Your cells’ internal furnace also helps by reducing the energy burned in the mitochondria throughout the body.  Translation: you’re tired.

This ‘pre-fasting’ state sabotages even the most diligent people. In this biochemical state, you torture your body with a grumbling hunger, nervous irritability, as well as an unsettled feeling of impending stress. How does your body do this? In a word, it’s your chemistry.

Low-calorie diets provide the ideal chemistry to keep fat inside your fat cells. The longer you stick to your torture-based-diet, the greater the damage to your metabolic motor. Put simply; you’re caught in a race to the bottom!

Eventually, you will eat normally again. I’ve had patients stay on these low-calorie diets for months, even years and their metabolism plummeted to as little as 600 calories a day! At that level, it’s so easy for them to gain weight. Every tiny bit of food they eat after the first 600 calories goes right into their fat storage. It stays there forever! Locked! The body compensates for all the lost time spent begging for more calories by storing anything extra. That chemical signal remains active for weeks after they start eating again. It’s as if their body does not trust that the food will remain available. In my clinic, it takes 6-12 weeks to fix that broken metabolism.  

To sum up, if you go on a calorie-reduced diet :

  •    Your metabolism slows down.
  •    You are hungry all the time.
  •    You reverse any weight loss process because you are fighting against your hormones.

Now you might ask…

“How the heck is a reduced calorie diet different from fasting?”

Strangely, the difference when measured by calorie intake is only a few hundred calories apart, but the divergent biochemical effects could not be more pronounced.

Fasting chemistry is an extension of ketogenic chemistry. Both fasting-based chemistry and ketosis-based chemistry produce the opposite effects of a low-calorie-setting. Completely halting your intake of calories switches ON your body’s ketone production system.

I explain it to my patients this way: In a low-calorie-chemical state, those few calories tell your body that you’re going to respond to the hunger and eat. Your body receives the signal that there’s food around-just not very much. Your body gets the command to hold on to any calories it comes across, and even sends some irritable, aggressive signals to your brain to grab food! Your body then stores many of those calories for the perceived impending famine.

When you’re fasting, your body gets a clear message that there is no food. You are on your own to survive until food becomes available again.

The chemistry and hormones hear ONE MESSAGE: No food.  The chemical message is: ‘Don’t die between now and the next meal. Use your stored energy.’ This signal is clear and effective. Within 12 hours, your body chemistry begins to shift. This biochemical signal is loudest and clearest after 72 hours of fasting. Chemical signals surge throughout your body instructing cells to burn calories from your energy reserves-your stored fat!

Ketogenic Diet and Intermittent Fasting are on the same spectrum of body chemistry. Of course, fasting features a more intense chemical setting compared to ketosis.   

Intermittent fasting sends a clear and distinct chemical message to your body to shift and adapt to no calories for the next 12, 24, or 36 hours-however long you remain fasting.

When you eat, do not wreck that chemical shift with carbohydrates or excess protein. Instead, adopt a high-fat ketosis diet. Doing so keeps your insulin levels low and allows your cells access to your body’s stored calories-your fat deposits if needed.

Studies indicate that calorie-reduction body chemistry leads to a disastrous metabolic mess. This happens Every. Single. Time. A host of studies have shown when you reduce calories; the body slips into slower metabolism. Also, your body instinctively stores calories in preparation for starvation. It stores all that energy and awaits the ‘drought’ of calories that are coming soon. When we restrict, instead of stopping calorie intake, we get stuck in that pre-starving (pre-fasting) chemistry.   

 ketogenic diet and intermittent fasting

Look carefully at this chart documenting the progress of a person losing fifty pounds of fat. Before switching to ketosis, she had whittled her metabolism down to 800 calories per day. She needed 800 measly calories to keep her alive. If she ate precisely 800 per day, her system would use those 800 calories to stay alive and signal every mitochondrian to slow down. ‘Use less energy.’

Tomorrow her body would need only 799 calories to stay alive. If she ate 130 carbohydrates through her low calorie/ low-fat diet but accidentally ate one extra bite pushing her total to 820 calories, all 20 of those extra calories would go into storage. She would get fatter. Her body followed the rules by putting every extra calorie into her fat cells. In our example, anything over 800 calories is extra because she is in ‘pre-starvation’ mode. Her body protected her by storing all extra calories above her body’s energy expenditure, or the base amount of energy to keep her alive.

In the chart, she switches to a ketogenic diet which sparked a chemistry shift that flushed out her extra water and began the slow rehabilitation of her broken metabolism. The first twenty pounds she lost came from getting rid of all that excess water.

Twenty-five days after she started, her body fully adapted to using fat as her fuel. Notice her ‘Expenditure’ row. This refers to how much energy it takes to fuel her body each day.

Think back to your cellular furnaces.

In the 800 calorie setting, her furnaces were all but shut down. Any remaining furnaces all burned her carb-based fuel- those ‘pine needles’ that burn hot and fast. Initially, she argued with me saying, “But Doc, I am on a high protein diet.” She failed to grasp that she forced most of those proteins into carb-fuel because of her pre-starvation chemistry.

The difference between an 800 calorie energy expenditure and a 2800 calorie expenditure sparked a lightning bolt throughout her body. Her 800 calorie-fueled-system made her look and feel wilted-complete with thin hair, dull skin and a brain that limps from one task to the next. During my first visit with her, I noticed her muffled and slurred speech-symptoms of a swollen, toxic, sugar-fed brain.  

The 2800-calorie-eating took two weeks to awaken her lifeless mitochondria and lit a fire-cracker to her metabolism. How did I know her metabolism was so high? It didn’t take a medical degree to figure that out. Everyone saw it. Her energy was contagious.  

She lost 70 pounds over that year. It is worth noting that the chart shows her first 50 pounds. The final 20 pounds came when she lowered her carbs back to about 30 grams per day. Her history of ‘energy-storing chemistry’ was very sensitive to carbohydrates. The slightest increase in carbs and her system slipped into making insulin and locking her fat cells closed.

“Wait. Why was she eating 30 carbs per day?  Doesn’t this violate the 20-gram rule?”

She simply measured her blood ketones and glucose. She studied herself. When she ate more than 50 carbs per day, her blood ketones were rarely in ketosis (any reading greater than 0.5mM.)  When she stayed at 20 carbs per day, she was always in ketosis but found herself giving in to temptations. She gradually increased her carb intake to 30 grams per day where she was still in ketosis, yet able to eat enough carbs to say no to the foods she should not eat.  

This diet is a measurable chemistry equation. Measure your chemistry to prove to yourself what is happening with your system. Fit your food intake into the equation to get the desired effect.

By the end of that year, she had radiant skin tone, healthy new hair growth, and abundant energy. The best victory in her ketogenic diet and intermittent fasting mission  is that this woman now has the metabolism that will enable her to fall off the keto wagon every once in awhile. If she overeats and stops producing ketones, she still has a built-in motor to reverse any imbalance before her cheating has a chance to produce much weight gain.  

When asked what the key to her success was she replied, “Testing my ketones every day. I had to be honest with myself. I became the ketone pee stick lady at work. I had to keep proving to myself that I was eating right. Lots of friends and family thought I was nuts for eating so much fat. Ketone sticks helped me to know I was doing this correctly and scientifically. Every day, I peed on a stick. That made all the difference.”

CLINCHER:

Calorie reduction increases your hunger and decreases your metabolism.  

Intermittent fasting does the opposite. It decreases your appetite while stimulating your metabolism-all while burning your stored fat.

If you want to learn more about the ketogenic diet and intermittent fasting, check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.

 

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Autophagy and Fasting: The Mystery Behind It.

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Autophagy. The literal translation of this word: ‘to eat thyself.’

Autophagy is a hot topic. Yoshinori Ohsumi’s 2016 Nobel Prize for Physiology and Medicine converted the medical world’s previous whispers and murmurings about Autophagy and fasting into a full-blown conversation. Ohsumi discovered how our body degrades and recycles its cellular components. Autophagy for short. 

Why should you care? Isn’t this a keto-focused site?

Well, it turns out ketones and autophagy are linked.  

Baby Boomers: please pay attention.

You endured the most abuse from the medical establishment over the last 40 years. Before it’s too late, we in the medical establishment might have a few years to redeem some of the atrocious recommendations that your generation lived were given. The science of how your body eats itself is something you should pay attention to and master.

It may sound weird, but this process of autophagy might be the saving grace to medical advice for your era. The science of autophagy surfaced in the nick of time for Boomers.

Autophagy removes debris found inside your body’s cells. All those years of poorly fed brain cells, sleep deprived hearts, smoking in your early years, and becoming fatter than any generation before has left you with lots of crusty cells. The debris within your tissue has been there for years. If you are overweight, this debris has been around for as long as those extra pounds have insulated you. PLUS ten years.  Brain autopsies tell the tale.

Proteins build up in a damaged brain. This damaged brain leads to Parkinson’s, Alzheimer’s disease and dementia. The beginning of these problems don’t start with your genetics; they begin with inflammation.

After ten years of constant inflammation, your gray matter’s genetics can trigger all sorts of brain diseases. The chemistry produced by the combination of fasting and high ketones reverses the inflammatory grime afflicting most Baby Boomers’ brains. In fact, this chemistry decreases the swelling of the brain. Fasting and high ketones trigger your cells to start eating the ‘junk’ that has been messing up your brain’s electrical signals and activity for years.  

Brains destined for dementia have been squirreling away extra proteins for years before you experience your first memory glitch. If you could take a virtual tour around your brain the year before your memory starts to go, you would see lots of these crusty, extra proteins also known as plaques or neurofibril tangles.

Are you already experiencing memory problems? Start eating up plaque! Stimulate autophagy by adopting a keto lifestyle with intermittent fasting.

Hopefully, I have your attention! That strange word with a comical definition should interest every Baby Boomer.

How do you switch on your autophagy processes? Thankfully, Nobel laureate Ohsumi’s research sheds light on this science. Autophagy is a very regulated process where your cells break down components and then use those parts as nutrition.

Our cells are programmed to die. When will your cells die?

That depends on how well you’ve taken care of them.

Apoptosis (pre-programmed death) is triggered when cells become old and worn down. Different cells in the body live longer than others, but they all have an end date – a predestined date that they will die. That date comes quicker if they are poorly built or inflamed continuously.

A similar process happens on the subcellular level. Instead of throwing out the whole cell via apoptosis, autophagy replaces just a section of the cell. This process doesn’t kill the entire cell.  

  • APOPTOSIS says, “This cell is crap. Time is up. Throw it all away.”
  • AUTOPHAGY says, “This section of the cell is crap. Let’s break it down and use it as fuel for the rest of the cell.”

Autophagy describes your cells’ internal housekeeping processes. Your cells vacuum up debris and recycle these parts as fuel. Cells clean up the old worn out or defective proteins inside them and toss them into the furnace, the mitochondria. Thankfully, those burning flames of the mitochondria are right there inside the cell too.

Why should you care? Answers: Flabby skin after weight loss.

It is embarrassing to share how many Boomer patients have said these words to me, “Doc, I don’t want to lose that weight. It will leave me with too many wrinkles.”  

I’ve got some great news for you. If you lose weight while stimulating autophagy, your body will ‘eat’ those deformed skin cells that caused your wrinkles. You will ‘eat’ those extra blood vessels, fat cells, and connecting cells as you lose weight. Without that left-over, unneeded tissue, your skin connects tightly to the overlying tissue. It results in tight, toned skin. No batty arm wings for you!

Take a trip through history. Lookup Holocaust victims in World War II concentration camps. The photos of these people show tight skin and no flabby or wavy folds of skin.

Some were overweight when they entered those camps. Sadly, they lost lots of weight during their months or even years of imprisonment. These individuals were in a state of ketosis with intermittent fasting for most, if not all, of their confinement.

A Tale of Two People who Lost 100 Pounds:

One loses 100 pounds while stimulating autophagy. The other woman used a low-calorie (a.k.a.torture) diet to lose the same amount of weight. No autophagy involved.

The autophagy patient’s body successfully absorbed all of her flabby skin cells and used the cellular parts as fuel. Additionally, there is no extra flesh in her arms, butt, or abdomen. Her body used that protein- and fat-filled tissue to feed her system during her fasting period. She saved herself the pain and expense of having to go under a plastic surgeon’s knife just to cut those ‘wings’ of flab off.  

In the medical field, these leftover tissues are collectively called a ‘curtain of skin.’ Removing all this excess tissue by way of surgery carries a massive risk of blood loss. Until I saw this with my own eyes, I underestimated how many blood vessels remained in that tissue after tremendous weight loss.

The restricted-calorie patient also lost weight and got skinnier. No doubt about that. But her weight loss program left behind thousands of blood vessels, connective tissue cells, skin cells, fat cells and more.

Patients who choose to cut that curtain of skin off after their weight loss suffer from large rope-like scars where the surgeon connected the remaining skin back together. They are not soft and flexible scars-they are keloid roadmaps.

Why?

One word: INFLAMMATION.  

Nothing says inflammation like blood when it is outside of your blood vessels. Thousands and thousands of little threads of blood vessels remain in that curtain of skin. Without the help of autophagy, there is no process to remove the leftover blood vessels and tissues that used to hold, feed and support those layers of fat. Regardless of how skilled your plastic surgeon may be, shutting down every tiny blood vessel before stitching the edges of the skin closed leaves some gnarly-looking scars.

The imagery unsettles my patients and me as I tell them of their options. However, it is inspiring to see folks lose 100 pounds and NOT have this ‘flabby arm-wings’ problem. People do manage to lose weight and avoid flabby skin-only if they trigger the process called autophagy. By activating the recycling process of the energy found in the leftover flabby skin, your body can eat itself into a tighter, firmer, and better-looking form.

How do you trigger autophagy?  

This answer involves complicated biochemistry. Thankfully, the cliff notes can be summed up in one word: FASTING.

As previously mentioned, your body chemistry during times of no eating is an enhanced version of the same chemistry you have during ketone production. By achieving ketosis before you fast, you set the stage for faster autophagy activation. Your ketone-burning cells can start ‘recycling’ their crusty parts in as little as 12 hours from the start of your fast. On the other hand, if carbs are your cells’ primary fuel source, autophagy kicks in several days after you stop eating.

Good news: When patients are keto-adapted you don’t have to fast as long as Grandma Rose did. She fasted for over forty days.  You don’t even have to fast 24 hours. By establishing a ‘fasting window’ of 12 hours every day (this includes 8 hours while you sleep), you benefit from your body’s recycling system. In fact, fasting can change the way you age.

Fasting’s anti-aging benefits come directly from the autophagy triggered when people stop eating for longer blocks of time. Fasting triggers two reactions. First, your body finds nutrition although you haven’t consumed any calories. Where? Your body converts old junky proteins from within your cells into energy. Second, your cells experience a burst in growth hormone production. Human growth hormone promotes muscle and bone growth. This compound also pushes your body to empty its fat cells.

As I write this post, I am on my fifth day of fasting. My average blood sugars hover in the 50-80s and my ketones have steadily risen to the 4.0-5.5 range. Because this fast occurred after months of ketosis, the transition was not difficult. In fact, I would agree with the literature that the first two days are the hardest. After that, each day seems to produce a higher level of energy and clearer thinking. Two of my patients in their 80s have recently fasted for seven days.

 IN THEIR 80s! They attend my weekly keto-support-group and shared their experience with all of us. They choose to fast this long after reading and learning about autophagy. For several months prior they had been in ketosis with pockets of intermittent fasting. Most of their fasts lasted 24 to 48 hours. A few times they did 72 hours. This week-long fast pushed them to a new level. I don’t recommend this long of a for most people … especially in their 80s.

However, these folks were very good at monitoring their biometrics of blood pressure and blood sugars and blood ketones.  They also had quick access to me if anything went awry. But it didn’t. They reached their goal of seven days with only salt, water, and tea. This fast certainly boosted their growth hormone, sparked their metabolism, and ignited autophagy deep inside their cells.

How do you stop autophagy?

Just start eating again. When your body gets glucose from your food, insulin production is triggered. Insulin slams the brakes on autophagy. Even the smallest amount of insulin can stop ‘energy recycling’ in its tracks. Autophagy is only possible through fasting. A ketogenic diet allows you to slide back into a fasting state much more comfortable and faster compared to multiple days needed with a carb-heavy diet.

BOOMERS: EAT YOURSELF!

If you want to learn more about the ketogenic diet, check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.

RESOURCES:

  1. Nobel Prize Honors Autophagy Discovery.” Cancer Discovery, vol. 6, no. 12, 2016, pp. 1298–1299., doi:10.1158/2159-8290.cd-nb2016-127
  2. Ogawa, Chikako, et al. “Autopsy Findings of a Patient with Acute Encephalitis and Refractory, Repetitive Partial Seizures.” Seizure, vol. 35, 2016, pp. 80–82., doi:10.1016/j.seizure.2016.01.005.
  3. Kerndt, Peter R., et al. “Fasting: The History, Pathophysiology and Complications.” THE WESTERN JOURNAL OF MEDICINE, vol. 137, no. 5, Nov. 1982, pp. 379–399. https://www.ncbi.nlm.nih.gov/pubmed/6758355
  4. Fung, Jason. “Blog.” Intensive Dietary Management (IDM), idmprogram.com/blog/

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