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Diet

What About the Keto Diet and Exercise?

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Let start off with listing a few athletes that use the keto diet and exercise to compete at the professional level: Lebron James, Dwayne “The Rock” Johnson, several argue that Tom Brady’s diet teeters in and out of ketosis. With the best advice money can buy, why are they using a keto diet and exercise?

ANSWER: Keto Diet And Exercise Provides A Distinct Advantage

Before I reveal that distinct advantage using the keto diet and exercise, let’s look closer at endurance athletes. Endurance athletes pay lots of attention to their deliverance of energy while they compete. If they run out of usable energy at the end of their race, bad things happen.

keto diet and exercise

The next time your community is hosting a marathon, volunteer to hand out water or guard an intersection in the last mile of the race. Watch what happens to some of the ill-prepared athletes as they push themselves at the end of the race.

It is not uncommon to find athletes losing control of bowels and behaving strangely– as if their thinking is not quite right.  I am not talking about the crazy notion of running 26.2 miles. I am referring to the way they can’t connect the right words or thoughts or actions to the current setting in front of them. This is called “bonking.”

‘Bonking’ is the term for running out of fuel during an endurance race. Specifically, the fuel for their brain is missing. Traditional athletes fuel their bodies with carbs. Their glucose fuel source must be replenished again and again throughout the race. They burn through their fast, carb-based energy like the “pine-needles” in a campfire. The burning rate of that energy becomes wickedly fast at the end of a long race.

All of their energy stored in the liver and muscles has been depleted. Glycogen storages are tapped. Empty. To finish the race, they must carefully calculate this delicate situation. They must throw the proper amount of ‘pine needles’ into their furnaces to keep racing. Too much glucose too fast and the gut will struggle to absorb it in this intense situation. This results in the squirts and the wrong time.  

If they run out of glucose, they ‘bonk.’ Their brain shuts down. Without enough sugar, their brain starts taking functions “offline.” With a totally glucose-dependent body, the only fuel their cells know how to use is glucose. They are stuck.

Just imagine for a moment who we are talking about. These are very lean athletes. Many keep their body fat close to 15%. As a comparison, non-athletes are closer to 25%.  If you are overweight that percent sores to over 30% body fat. How much energy could these skinny athletes possibly deliver if their body-chemistry had adapted to ketosis?  In short: A LOT.

Even a lean athlete with under 15% body fat can carry more than 50,000 kilocalories in their fat. These calories are useless to them because their system is not adapted to burning fat for fuel.  Their chemistry has been practicing and perfecting the use of carbs. Not fat.

keto diet and exercise

The last mile of a 100-mile race is not the time to be asking your body to figure out ketosis. After several hours of intense exercise, an athlete running out of available glucose will describe their ‘bonk’ as,  “a strange experience where a dramatic loss in performance, a profound sudden depression, and intense food cravings coincide.” Observers may notice the athlete shake and quiver with chills. They lose control of their bowels or bladder. They stumble as if drunk while their brain scrambles to find any morsel of glucose lingering around.

The bonking athlete is much like a diesel-powered truck that runs out of fuel while hauling a tank filled with gasoline. There is gasoline fuel in his tank, but diesel engines are not equipped to use gasoline.

On the other hand, fat-fueled athletes, have the advantage. They have a choice between fuel sources.  The flexibility to choose between fat and glucose in the last 2 miles of the race only happens if they’ve properly prepared their mitochondria. If their mitochondria never saw more than a morsel of glucose over the past three months, their cells boast the perfect condition to flip between either fuel. Their body has “turned on” the mitochondria parts that burn fat. This burnable fat is called a ketone.

keto diet and exercise

This gives them a distinct advantage. Their brain cells can use either fuel. So can their muscle cells. So can their heart cells. Their body adapted to efficiently use either fuel.

If their body gets low on fuel, they can add some glucose and use it. But if they run out of glucose, their keto-adapted cells quickly activate their furnaces to burn fat instead of carbs.

This transition happens in a flash if they are keto-adapted. They don’t poop their pants. They don’t ‘bonk.’

keto diet and exercise

Becoming fat adapted through a life of ketosis does not erase your body’s ability to use glucose. You will always use the glucose in your blood before you use ketones.

Evolution has guaranteed that the glucose always gets used first. However, if your body only sees glucose as fuel and never sees ketones, the mechanism to burn a ketones all but disappears.  To keep the parts of the cell actively ready to use ketones, your body must burn ketones for the better part of your life.  I can’t skip over 

another teachable moment that I’ve learned from the athletes under my ketogenic-care. They universally remark about how much better they think. It takes only one glimpse at the research of endurance athletes by Dr. James O’Keefe, a cardiologist from the Mid America Heart Institute at St. Luke’s Hospital, to appreciate the multitude of health risks found in the population of endurance athletes.

Their bragging rights linked to the elite 26.2 club deserve respect. However, what we have known for some time that their bragging aught to stop after the first or second marathon. The list of ailments found in the hearts other body parts of endurance athletes in their second decade of a racing compares to patients pushing 80 in my medical clinic.

When I pair the striking improvement my keto-adapted athletes report in their sleep, tissue-repair time, and mental stamina, my mind jumps to the word INFLAMMATION.  The link between the vast problems that reverse on a ketogenic diet consistently point towards the near-removal of inflammation when in a ketogenic state. Maybe these endurance athletes will have fewer troubles linked to chronic inflammation if they spend most of their time in ketosis.

The jury is still out on that. Fat-fueled, low-carb endurance athletes aren’t just running races, they are winning at record-breaking times. Nothing grabs the attention of competitive endurance athletes, like titles.

keto diet and exerciseketo diet and exercise These athletes are tossing out the carb-dense foods and chewing on fat for their fuel. Just think how much time gets shaved off a race if they don’t have to pause for a bathroom break ten times in the race’s last stretch.

But what does this all mean for the “normal” athlete that wants to try the keto diet and exercise?

Use carbs to fuel your body before a peak performance. ABSOLUTELY.  You will feel the rush of carb energy surge into your system and kick you into high gear. However, give yourself the advantage by training in a ketogenic state.

 Keep your mitochondria burning ketones outside of those peak performances. Ketosis promotes the fastest healing times, in part, due to its anti-inflammatory state.

From head injuries to torn muscles to micro-tears in a tendon – a bath of ketones coursing through your veins ensures the chemistry of lowest inflammation.

Finally, ketosis strengthens your mental performance. Any athletes wet behind the ears knows that games are won in your mind. Clear thinking, restful sleep, and protection for an irritable mood all lead to the best performance possible.

For more information on the keto diet and exercise, check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.

keto diet and exercise

RESOURCES:

  1. Volek, Jeff, and Stephen D. Phinney. The Art and Science of Low Carbohydrate Living: an Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable. Beyond Obesity, 2011
  2. Volek, Jeff S., et al. “Effects of Dietary Carbohydrate Restriction versus Low-Fat Diet on Flow-Mediated Dilation.” Metabolism, vol. 58, no. 12, 2009, pp. 1769–1777., doi:10.1016/j.metabol.2009.06.005.
  3. Volek, Jeff S, et al. “Low-Carbohydrate Diets Promote a More Favorable Body Composition Than Low-Fat Diets.” Strength and Conditioning Journal, vol. 32, no. 1, 2010, pp. 42–47., doi:10.1519/ssc.0b013e3181c16c41

Diet

The Hard Math Behind Your Metabolic Health

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Losing weight starts with changing your body chemistry. Once you become 20 or 30 pounds overweight, your body’s chemistry gets locked. To reverse this, stop triggering insulin.

You burn what you eat.

If you want to burn fat, you must turn on the fat-burning mechanism inside your mitochondria. If you want to lose fat, eat fat. Don’t add carbs. Focus on WHAT you eat, not how much you eat.

Read this equation reflecting how we lose weight:

Fat Gained/Lost = Calories In – Calories Out

This formula is the gospel according to Metabolism Math. According to this equation, to calculate the fat you want to lose, you must know how many calories you put into your body and subtract the calories used by your body. That is all you need to know.

That’s it. If you eat 1000 calories in a day and you want to lose weight, you must use more than the 1000 calories you consumed.

Clear enough, right? Unfortunately, it’s wrong.

Weight loss doesn’t work this way.  

For over two decades, I told many patients, “Eat less. Exercise more. That’s how you lose weight.” My advice was wrong. This equation is flat out wrong.  

Shocking, right? After all, going against that equation goes against the First Law of Thermodynamics, let alone common sense and conventional wisdom. But the equation is wrong.

Hear me out. Mammals are much more complicated.

Let’s break this equation down.

Fat Gained or Lost = Calories In – Calories Out

Two parts of this equation are undoubtedly measurable: ‘Fat Gained/Lost’ and ‘Calories In.’ These two sections of the equation are easy to understand and measure.

FAT GAINED OR LOST

We can measure exactly how much body fat you have today. We can repeat that measurement several weeks from now and precisely know if you have gained or lost body fat. The best way to measure body fat is using a DEXA scan. DEXA (Dual-Energy X-ray Absorptiometry) Scan is X-ray technology used to size up lean tissue, bone density, and fat across regions of the body with incredible accuracy. Other techniques that don’t use radiation include underwater weighing, whole body plethysmography, skin-fold measurements, and several other options.  

My point: FAT GAINED or LOST is measurable.  

CALORIES IN

We can measure ‘Calories In.’ Each unit of drink or food consumed has a measurement of energy. Add up all that passes your lips in twenty-four hours, and you have this number. CALORIES IN is also measurable.

Fat gained = Calories In – Calories Out

CALORIES OUT

With two of the three variables measurable, we can do the math and calculate Calories Out.  Right?

To double check our answer, can we measure the ‘Calories Out’ part of the equation? Don’t nod your head so quickly.

What is the ‘Calories Out’ portion of the equation?  

Calories Out are the total energy it takes to run your system for twenty-four hours. It represents the calories your body uses in one day to stay alive. Measuring calories out is not straightforward.    

 

Calories Out include the following five components:

For you science geeks out there – the formula looks like this:

TEE = BMR + TEF + NEAT + EPOC + Exercise

 

In plain English:

 

Energy used to run your body =  Metabolism + Energy to Process Food + Activities of the Day + Repair from Exercise  + Exercise

The energy needed to run your body is much more than exercise. Let’s break down each of these sections to get an understanding of our daily energy needs.

METABOLISM or BASAL METABOLIC RATE (BMR):

The term metabolism refers to the ‘purr of your motor.’ How much energy does it take to fuel the furnaces inside each of your cells? How lively are you? Would your friends describe you as a sloth or a busy bee?

Metabolism includes your breathing, maintaining your body temperature, pumping your heart, fueling your thinking, powering your cleansing team, i.e., your liver and kidneys. The list goes on for pages. Metabolism is a blanket term for a wide range of complex operations happening in your body. Also, it is not stable. It fluctuates along with your lifestyle, needs, and activities. If you think more today than you did yesterday, the equation is different. If your body had extra toxins to remove, you need a different amount of fuel.

Metabolism depends on many factors, including

  •    Genetics
  •    Gender (Men > Women),
  •    Age (Young > Old),
  •    Weight (More muscle > Less muscles),
  •    Height (Tall > Short),
  •    Diet (Underfeeding slows down metabolism. Pulse feeding, every 24- 36 hours, boosts metabolism),
  •    Body temperature (fever>normal>low body temp)
  •    External temperature (Hanging out in the cold requires heating the body and takes more energy than cooling it.)
  •    Organ functions  
  •    New Protein Production: Replacing cells in your organs.
  •    New Bone Production
  •    New Muscle Production
  •    Lymph System: Replacing antibodies. Fighting new invaders.
  •    Diseases: Is your body fighting off infection? Do you have an autoimmune disease? It takes energy to fight that.
  •    Brain Cognition: How much did you think today?
  •    Heart: How many beats pound through your heart every minute?
  •    Heart: How hard does your heart squeeze each beat?
  •    Liver: Detoxing your blood.
  •    Liver: Making energy. Storing energy.
  •    Kidney: Cleaning your blood. Making urine.
  •    Pancreas: Producing enzymes.
  •    Bowels: Moving and processing your food.
  •    Breathing: Lots of breaths per minute or not so much. Think of the energy needed to breath if you are suffering with asthma, or emphysema.
  •    Bowel Excretion: The ‘slime’ produced to flush, clean, and lubricate costs you energy.  
  •    Fat Production: Storing extra calories you did not use today takes energy.
  •    Cancer: Cancer growing inside your system drains energy.

FOOD EFFECT or THERMIC EFFECT OF FOOD (TEF)

TEF refers to the energy used in digestion and absorption of food. Your body processes and absorbs various foods differently. For example, fats are quickly absorbed and take very little energy to metabolize. Proteins are harder to process and use up more of your resources. Foods high in fiber require the most effort to transform.

Food’s effect on metabolism also varies according to how much and how often you eat. Multiple small meals in a day take more energy than one large meal. The ratio of fat vs. protein vs. carbs in your meals also influences TEF.

LEVEL OF DAILY ACTIVITY or NON-EXERCISE ACTIVITY THERMOGENESIS (NEAT)

NEAT measures the energy used as you live out your day-without factoring in exercise. Sitting at this desk typing this blog for several hours today creates a much different demand when compared to hustling around a busy medical clinic.

Did you sit for most of your day? Did you go for a walk during a break? Did you cook a couple of meals? Did you go shopping? Other than exercise, how sedentary were you?

EXERCISE

Most people get this one. In fact, usually, this is the ONLY one most people think of when calculating their metabolism.   

AFTER-BURN or Energy Post Oxygen Consumption (EPOC)

EPOC is the energy used to repair your body and replenish the glycogen storage that you used up during your workout or other activities. During your daily hustle, your body reached for the quick and fast energy stored in your liver. This fuel, called glycogen, is in short supply after your workout. Once your storage is used up, your body starts replenishing it. This process requires fuel.  

How much energy did it take for your body to repair from your workout today? It depends on your activities as well as intensity. Did you lift weights today? Maybe it was higher than your usual weight. Did you pull or damage your muscles during today’s workout? Maybe you went for a run for the first time in years? Or did you do a two-mile slow walk for your exercise?  

The body does not need much energy to repair from the strolling walk. However, those muscle cells that you tore during the last back squat will need mending. That takes a lot of energy.

Imagine this. As you walk into your office, there is a sign inviting you and your coworkers to a pushup challenge. You have not done a pushup in years. The muscles needed to push your body up from the floor have been resting quietly with most of their furnaces (mitochondria) all but shut down. You decide to take the challenge and start with day one doing one pushup. Not much repair is needed.

Each day you meet the daily challenge by adding a pushup to the number you did yesterday. By the end of the second week, your sore arms remind you of your new routine. Somewhere around your 14th pushup, your muscle cells said, “If this is the plan, we need to recruit some sleeping mitochondria to help out.” It takes energy!

Accordingly, resistance training workouts burn more energy than cardio workouts. Check your treadmill’s LED display for how many calories you burned with your twenty-minute fast walk. It will give you a nice number. Don’t be fooled. Do pushups for one minute, then one minute of rest. Back and forth between these intervals for 20 minutes. The twenty minutes of resistance training outperforms your treadmill workout every time.  

Why? It is because the energy your muscles use to repair from those pushups is much more significant. The advantage lies within the after-burn. Your after-burn counts!  

When trainers say “the burn the next day is not your enemy,” they are correct. Your body is using up extra calories to recover.  

‘Calories out’ is not just exercise. All the processes below require energy to keep you alive for the day. The calories burned for the day is more than just the total loss from exercise.

The number in this equation that changes the most is your metabolism, the BMR.  

Eat 700 calories a day for three weeks and you will cut metabolism (BMR) by almost half. Then increase your calories from 700 to 1800, and it will increase by 50%.

Get cancer, and you can triple your metabolism in weeks of cancer growth.

Exercise accounts for only 5 percent of the game!

Exercise never produces as much weight loss as we calculate. It is a fact proven again and again.

Why?  It is because the human body is NOT a stable formula. We can only calculate the equation for today. But in a week, it will change.

Living Means adapting.

We survive changes in our world because we keep up. Mammals are magnificent at this! Our bodies work to keep things stable. If something in your energy formula changes, another area will shift to compensate. It is called homeostasis. Our system as a whole strives to remain stable.

Not surprisingly, if we increase our daily exercise, we eat more. All the discipline in the world won’t stop us from consuming more calories. Period. Several studies have proven and validate this repeatedly.

If our daily activities rise, we exercise less. It’s not my opinion. Studies repeatedly show this. Exercise is essential for many excellent reasons, but it will not produce significant weight loss.

It’s a minor player. Emphasizing activity detracts from the real issue of dietary problems. When one thing changes, something else in the system counters that change. We compensate. We adapt.

If you want your energy to rise, change your fuel.

The easiest way to boost your metabolism is to switch fuels. Fuel your body on sugar and your furnaces put out two units of energy for every glucose molecule burned.

Burn fat and 32 units of energy are produced for every single ketone. This is not just a math equation for losing weight. The increased production from ketones raises your metabolism along with your thinking, focus, energy and the rate your body repairs.

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.

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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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Diet

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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