Resist the Dark Side and Easily Shift Into Ketosis09.03.2016
by Greenfield - Ben
Four years ago, I realized that I'd been duped. I'd been lied to about carbohydrates.
Despite obtaining a graduate degree with advanced courses in human nutrition, biochemistry, microbiology, and exercise physiology, a sports nutritionist certification, and plenty of time with my face stuffed in dietary research journals, I was simply doing things completely back-asswards when it came to fueling my body.
See, my physical performance on my "gold-standard" 50-60% carbohydrate intake was just fine. Performance wasn't an issue. I was quite competitive and very fast in my triathlons, runs, swims, bike rides, and workouts.
But I also had bloating. Gas. Fermentation. Wildly fluctuating energy levels. Extra bits of fat around my belly and hips. Inflammation. All the warning signs of high blood glucose. All the signs that I was sacrificing health and longevity for performance…all the issues I talk about in gory detail in my book Beyond Training.
So I simply gave a finger to dyed-in-the-wool, orthodox sports nutrition advice that trickles down from companies like Gatorade, Powerbar, and the US Government's Food Pyramid. I took a deep, deep dive into a more ancestral, natural form of eating. I started eating more greens. More vegetables. More nutrient-dense plants.
And I combined those plants with oodles of healthy, natural fats like avocadoes, olive oil, coconut milk, seeds, nuts, fatty fish, grass-fed meats, and yes, even "weird" foods like bone broth, liver, sardines and many of these unorthodox meals and pantry foods.
I began eating the "cyclic" low-carbohydrate diet that I outline in my book on low carbohydrate eating for athletes, meaning that I would save the majority of my carbohydrate intake for the very end of the day, and even then, I ate the clean stuff, like white rice, sweet potatoes, yams, quinoa, red wine and dark chocolate.
I even began to experiment with "ketosis," a style of eating in which I incorporated strategies such as intermittent fasting, high amounts of coconut oil, complete avoidance of frequent snacking and grazing, and an even lower carbohydrate intake of less than 10% carbohydrates.
What is ketosis?
Skip the next two paragraphs if you already know, but if not, give them a quick read.
Ketosis is a metabolic state where most of the body's energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis where blood glucose provides most of the energy. Ketosis is characterized by serum blood concentrations of ketone bodies over 0.5 millimolar with low and stable levels of insulin and blood glucose. However, with ketone supplementation (as you'll learn about later in this article) ketosis can actually be induced even when there are high levels of blood glucose.
Keto-adaptation, AKA "becoming a fat burning machine", occurs when you have shifted your metabolism to relying on fat-based sources, instead of glucose (sugar) sources, as your primary source of fuel. Your body increases fat oxidation and breaks down fats into ketones to be used as the primary energy source. Depending on your current level of carbohydrate intake (takes longer if you're pretty sugar addicted), this process can take two weeks to six months to fully train your body, but once done, it's done, and you have achieved fat-burning status that can stick with you for life.
Frankly, the results of my foray into ketosis and eventually keto-adaptation were astounding. I had the best Ironman triathlon season of my life and shocking levels of mental focus and physical ease, especially for races and workouts that lasted longer than two hours. Without experiencing muscle loss, hunger pangs, or brain fog, I found I could go the entire day without eating, which was enormously helpful for business and personal productivity. My gas, bloating, fermentation and GI "issues" disappeared. My blood levels of inflammatory markers like HS-CRP and cytokines dropped to rock-bottom, while my levels of good cholesterol, vitamin D, and anti-inflammatory fatty acids skyrocketed.
At the end of this entire transition, I had spent nearly three years eating a high-fat, low-carbohydrate diet of 50-60% fat, 20-30% protein, 10-30% carbohydrate, and a final fourth year devoted to a full-blown "ketosis" approach of 70-90% fat, 20-30% protein, 5-10% carbohydrate.
And it all culminated with me stepping into Dr. Jeff Volek's world famous laboratory at University of Connecticut to subject myself to extensive blood testing, chunks of muscle removed from my legs, fat sucked out of my butt-cheeks, urine, stool and gut microbiome testing, oxygen and carbon dioxide testing, and countless hours of treadmill running to discover what a full twelve months of eating a ketogenic diet had actually done to my body.
You can check out the full study, which was just released a few weeks ago in the Journal of Metabolism at "Metabolic characteristics of keto-adapted ultra-endurance runners". Here's just a teaser from the abstract:
Many successful ultra-endurance athletes have switched from a high-carbohydrate to a low-carbohydrate diet, but they have not previously been studied to determine the extent of metabolic adaptations.
Twenty elite ultra-marathoners and ironman distance triathletes performed a maximal graded exercise test and a 180 min submaximal run at 64% VO2max on a treadmill to determine metabolic responses. One group habitually consumed a traditional high-carbohydrate (HC: n = 10, %carbohydrate:protein:fat = 59:14:25) diet, and the other a low-carbohydrate (LC; n = 10, 10:19:70) diet for an average of 20 months (range 9 to 36 months).
Peak fat oxidation was 2.3-fold higher in the LC group (1.54 ± 0.18 vs 0.67 ± 0.14 g/min; P = 0.000) and it occurred at a higher percentage of VO2max (70.3 ± 6.3 vs 54.9 ± 7.8%; P = 0.000). Mean fat oxidation during submaximal exercise was 59% higher in the LC group (1.21 ± 0.02 vs 0.76 ± 0.11 g/min; P = 0.000) corresponding to a greater relative contribution of fat (88 ± 2 vs 56 ± 8%; P = 0.000). Despite these marked differences in fuel use between LC and HC athletes, there were no significant differences in resting muscle glycogen and the level of depletion after 180 min of running (-64% from pre-exercise) and 120 min of recovery (-36% from pre-exercise).
Compared to highly trained ultra-endurance athletes consuming an HC diet, long-term keto-adaptation results in extraordinarily high rates of fat oxidation, whereas muscle glycogen utilization and repletion patterns during and after a 3 hour run are similar.
OK, so that's all good. But wait.
What if you're not an endurance athlete?
What if you have zero desire to run on a treadmill for an ungodly number of hours, or to do an Ironman, or a marathon, or – hell – even a 10K?
My brother Zach become absolutely shredded on a diet very similar to mine, it turns out that this whole idea of ketosis isn't just for endurance.
What are some other benefits of ketosis? The list is pretty exhaustive. Currently, research support the use of ketones for the following benefits:
- Weight loss
- Blood sugar balance and enhanced insulin sensitivity
- Increase satiety, and decreased food cravings
- Improved energy levels, oxygen capacity, motor performance & athletic performance
- Enhanced blood flow through vasodilation
- Migraine treatment
- Neuroprotective benefits in seizure disorders; ADHD; Alzheimer 's disease, memory and cognitive function; Parkinson's Disease and Multiple Sclerosis
- Autism and improved behavior and social impacts
- Mood stabilization in bipolar disorder (type II)
- Stroke prevention; cardiovascular disease; metabolic syndrome management; improved cholesterol levels
- Inflammation management
- Endurance enhancement
But ketosis is not all rainbows and unicorns. There is definitely a dark side to ketosis. For example, consider the following…
Dark Side To Ketosis #1: Triglycerides
Let's say you decide you're going to get into ketosis by eating boatloads of grass-fed butter, peanut butter, almond butter, animal meats, and oils, and you aren't very selective in the quality of those fats.
That's a definite shortcut to throwing your triglycerides through the roof.
And not only are high levels of circulating triglycerides a good way to get fat fast, but studies have consistently linked high triglyceride levels with heart disease, heart attacks and stroke. Fructose is one quick way to elevate triglycerides, but this really doesn't seem to be an issue with high-fat, low-carbers.
However, vegetable oils and butter and animal fats and nuts and seeds can also significantly raise triglycerides. One big issue here is that if these oils and fats have been exposed to high amounts of temperature and processing, triglycerides are getting dumped into your body chock full of free radicals.
So if your high-fat diet includes a high amount of roasted seeds or roasted nuts, nut butters, heated oils such as heated coconut oil or heated extra virgin olive oil, barbecued meats or meats cooked at very high temperatures, then your triglyceride count is going to go up. You should have triglycerides that are less than 150mg/dL, and a triglyceride to HDL ratio that is no more than 4:1, and in most of the healthiest people I've worked with, triglycerides are under 100 and the triglyceride to HDL ratio is less than 2:1. If your ratio is whacked, your ketogenic diet isn't doing you any favors.
Dark Side To Ketosis #2: Inflammation
If you have high levels of cholesterol, which you probably do if you're eating a high-fat, low-carb diet, then you need to be worried if your HS-CRP levels (a primary marker of inflammation) are above 1.0 mg/dL – even if you're a hard charging athlete.
I like to see most people under 0.5 for CRP levels, and here's why: a high amount of inflammation in your body is going to make the cholesterol circulating in your bloodstream more likely to become oxidized, generating a high amount of heart and connective tissue-damaging free radicals.
As a matter of fact, it's more dangerous to have high levels of cholesterol and high levels of CRP than low levels of cholesterol and high levels of CRP – even if your high levels of cholesterol are "healthy", big fluffy LDL particles, and not small, dense vLDL particles. In other words, no matter how many healthy fats you're eating, these fats may actually come back to bite you if you're creating high inflammation from too much exercise, not enough sleep, exposure to toxins and pollutants, or a high-stress lifestyle.
Dark Side To Ketosis #3: Cholesterol Damage
Free-ranging glucose molecules in your bloodstream can adhere to cholesterol particles and cause those particles to remain in the bloodstream for long periods of time, since your liver can't properly process cholesterol when it has a glucose molecule attached to it.
The longer cholesterol circulates in your bloodstream, the higher the likelihood that it will dig its way into an endothelial wall and potentially contribute to atherosclerosis or plaque formation. This is why it's so dangerous to eat a high-fat diet, but to also have your nightly dark chocolate bar, overdo it on the red wine, or have weekly "cheat days" with pizza, pasta, or sugar-laden ice cream.
So if you're going to eat a high fat diet, then you need to ensure your fasted blood glucose levels are staying at around 70-90mg/dL, and your hemoglobin A1C (a 3 month "snapshot" of your glucose) is staying below 5.5. If not, your high fat diet could actually be significantly hurting you.
Dark Side To Ketosis #4: Thyroid Issues
Carbohydrates are necessary for the conversion of inactive thyroid hormone to active thyroid hormone, and if you're on an extremely strict low carbohydrate diet, then you may actually be limiting this conversion. Your TSH is what tells your thyroid gland to "release more hormone," so your TSH rises when your thyroid gland is underactive, or conversion of inactive to active thyroid hormone is inadequate. A high TSH means that the pituitary gland is releasing its hormone to try to get the thyroid to respond and produce more thyroid hormone. Because of inadequate carbohydrates, TSH will often elevate in a high-fat, low-carber – indicating potential for long-term thyroid and metabolic damage.
If I see a TSH above 2.0 or a trend towards higher values in someone who is testing repeatedly, I get worried – and prefer to see TSH at 0.5-2.0. Of course, this doesn't mean that you begin to shove carbohydrates indiscriminately down the hatch. However, it means that your high-fat, low-carb diet should include thyroid supporting foods rich in iodine and selenium, such as sea vegetables and brazil nuts, and should also include carbohydrates timed properly, such as before, during or after workouts, when the carbohydrate is more likely to be utilized for energy and less likely to spike blood glucose levels.
It also means that if you're a very active athlete or exercise enthusiast and you're following "trickle-down" advice from the sedentary or less active ketosis experts to eat less than 40g of carbs per day, you're making a big mistake when it comes to your hormonal balance, and you need to up your carbohydrate intake to 100-200g of carbs per day. You'd be surprised at how easy it is (if you're a very active person) to stay in ketosis on this level of carbohydrate intake. Go ahead. Do breath testing to prove me wrong. You can eat boatloads of carbohydrates at night and be back in ketosis within just two to three hours. When you combine that with the cutting-edge tricks you're about to learn, you'll find that you can toss hormonal issues out the window, get into ketosis, have your cake, and eat it too. Literally.
Dark Side To Ketosis #5: Social "Limitations"
Let's face it: if you're eating 70-90% fats, it can be very, very difficult to hang out with your friends at an Italian restaurant. Or to walk past a bakery. Or to find yourself surviving and having fun at a holiday party with fresh baked cookies, wine, chocolates, and cocktails.
In other words, I personally found that while following "strict ketosis", things became eerily similar to the days in college when I was a competitive bodybuilder pursuing sub-3% body fat percentages. I simply wasn't the most fun guy to hang out with in social situations due to my extreme dietary restrictions, the intense self-control became nearly exhausting, and when I traveled, I missed out on many culinary experiences, such as homemade ravioli in Rome, freshly baked crostinis in the Basque regions of Spain, and Korean rice bowls in Seoul.
As a matter of fact, what you've just read about is exactly why, after the study at University of Connecticut, I personally quit messing around with ketosis and returned to what I considered to be a more sane macronutrient intake of 50-60% fat, 20-30% protein, 10-30% carbohydrate.
OK, now don't stop reading and walk away from this article because you don't want to screw your triglyceride levels, jack up inflammation, oxidize your cholesterol, de-balance your hormones and be a complete bore at parties.
But surprisingly, every single one of the issues you just read about it can become a complete non-issue if you implement what you're about to learn. And that's exactly why I've returned to ketosis as my main diet.
That's right: it turns out that if I could go back and do my year of strict ketosis again, I would do everything you've going to discover below. If I had done that, I would have avoided all the uncomfortable, unhealthy issues I experienced when I was eating a high-fat diet, and I would have gotten all the benefits with none of the harm. As a matter of fact, in the past 30 days, as I've begun a new journey into ketosis, I am now implementing the exact four methods you're about to discover.
But first, before we delve into the latest and greatest biohacks to help you painlessly get into ketosis and stay in ketosis…what exactly got me back into being interested in ketosis in the first place?
In a word: freediving.
See, two years ago I released two podcasts that got me very enthralled with the concept of using both ketosis and freediving to become a better athlete, with a stronger nervous system and enhanced stress resilience:
- An interview with University of Florida researcher and scientist Dominic D' Agostino. In that episode, Dominic highlights his research into the use of ketones to enhance breathhold time and reduce the brain's requirements for oxygen.
- An interview with James Nestor about why Olympians are now turning to freediving as a way to enhance performance, consciously lower their heart rate and deactivate their "fight-and-flight" nervous system response.
Apparently, Dominic's research seems to be suggesting the fact that diet-induced ketosis from a high-fat, low-carb intake, especially when combined with the use of nutrition supplements such as powdered ketones or MCT oil, can vastly reduce the need for the brain to use oxygen to burn glucose. This is because the brain can use up to around 75% of its fuel from ketones. So a ketone-fed or a fat-adapted brain can be better equipped to withstand low oxygen availability and potentially support longer breath-hold times. Dominic's research also shows that in the presence of ketosis, the brain and body are able to resist the potential cell damage of long periods of time with low oxygen, also known as "hypoperfusion."
As I learned in a University of Connecticut lab experiment I mentioned earlier, a high-fat, low-carb diet can teach and allow the muscles to tap into more fat for fuel, making your body crave less use of oxygen in the large muscles of the legs, arms or other areas that you've learned oxygen gets shunted away from when deep underwater.
A diet low in sugar and starch is also less acidic. This lowers carbon dioxide levels in the body, which could theoretically also increase breath hold time. This is because breath holding is normally terminated due to an urge to breathe that is mostly caused by increasing carbon dioxide levels.
Interestingly, most of the animals that regularly rely upon the mammalian diving reflex are marine mammals. Marine mammals, for the most part, live on almost exclusively fat and protein (e.g. fish) and yet are able to maintain a largely aerobic, (oxygen-based, metabolism – even while holding their breath.
Based on all this, along with advice from Dominic and information from previous podcast I've done with Dr. Peter Attia, the week prior to the epic freediving excursion, I began experimenting with all the strategies I'm about to outline below, and I was absolutely shocked.
What was I so shocked about?
I was shocked at how easy it was (using the new supplements and methods outlined below that have been developed since my initial foray into ketosis) to get into ketosis without extreme carbohydrate restriction, without excessive, diarrhea and "diaper-moment" inducing amounts of MCT and coconut oil, and without the inflammation, triglyceride and hormonal issues, or social discomfort I outline above. I was also able to achieve a much more immediate and deeper level of ketosis than I ever achieved in previous experiments sans these newer strategies you're going to learn about.
Hooray for science.
OK, hang with me here. We're almost to the point where I reveal the new method I recommend to get you into ketosis fast.
But first, I want to explain exactly why you've been lied to about carbs. After all, you may still be wondering why you can't just slam an energy gel, bar, or sports drink and go do your workout or race.
After all, if you open any textbook on human performance, read any magazine article on workout nutrition, or review any research produced by the world's leading exercise and diet science institutes, you'll see the same two pieces of standard advice churned out with robotic-like repetition:
Standard Piece of Advice #1: Before any big workout days, eat seven to ten grams of carbohydrate per kilogram of body weight daily for optimal performance. On any other days, eat five to seven grams of carbohydrate per kilogram of body weight.
So how many carbs is that? Let's do the math. 7-10 g/kg of carbohydrates is about 3-4.5 g/lb. So in the 24 hours before a heavy workout day, a 150 pound male would be advised to eat roughly 450-675g of carbs. And that's 1800-2700 calories of carbs per day – the equivalent of 38-56 slices of bread. Or 17-25 bowls of cereal. Pick your poison.
And on any average day, even a non-workout day, you'd be advised to eat around 2-3 g/lb, or 300-450g of carbs. That's 1200-1800 calories of carbs per day. So if you were eating a relatively typical 2500 calorie per day intake, you'd be looking at about 50-75% carbohydrate based diet.
Don't believe me? Does 50-75% seem like too much to you? Sadly, this level of carbohydrate intake is status quo for the gold standard in athletes and exercise enthusiasts.
The Gatorade Sports Science Institute (GSSI) is widely considered one of the world's top go-to resources for cutting-edge exercise and nutrition science advice – which is probably why Gatorade vending machines dot the campus here, and the majority of the kids seem to be walking around campus with a never-ending big gulp-sized cup full of sports drink.
Anyways, here's an excerpt on recommend carb intake from GSSI's Sport Science Exchange Journal. Note that they actually go as high as TWELVE grams in this particular article:
"Adequate dietary carbohydrate is critical to raise muscle glycogen to high levels in preparation for the next day's endurance competition or hard training session. Accordingly, during the 24 h prior to a hard training session or endurance competition, athletes should consume 7-12 g of carbohydrate per kilogram of body weight. However, during the 24 h prior to a moderate or easy day of training, athletes need to consume only 5-7 g of carbohydrate per kilogram of body weight."
Here's another excerpt from a different GSSI article:
"Soccer players' diets, especially in the days before hard training or competition, should include 8-10 grams of carbohydrate per kilogram of body weight (3.5-4.5 g/lb). Cereals, fruits, vegetables, breads, and pastas are good sources of carbohydrates."
Incidentally, a serving of Gatorade has about 25-35g of carbohydrates. Just sayin'.
OK, let's move on to Standard Piece of Advice #2…
Standard Piece of Advice #2: Ensure that during exercise, you keep your blood glucose levels evaluated by consuming the majority of those carbohydrates are from fast-burning carb sources such as sugary drinks, gels, and bars during both prolonged activity (like a long run) and also intense activity (like weight training).
For example, from this GSSI article:
"The advice for prolonged endurance events (2.5 h or longer) is an intake of 90 g of multiple transportable carbohydrates per hour. This advice is not expressed relative to body mass because body size/mass appears to play no major role in exogenous carbohydrate oxidation."
So what the heck does "multiple transportable carbohydrates" mean? In most cases, this refers to the standard two primary ingredients you'll see featured in just about every sport drink and energy gel on the face of the planet: a mix of fructose and maltodextrin sugars.
From another GSSI article:
"Given that there is no known detriment to consumption of a high-carbohydrate diet (other than body weight gain due to water retention) and some research reports a benefit, it is recommended that all athletes consume a high-carbohydrate training diet, i.e., at least 60-70% of energy as carbohydrate (7-10 g/kg), and increase this to 65-85% for the few days before competition. Use of a carbohydrate supplement before and during exercise will likely improve performance of intermittent, high-intensity sprints."
The "no known detriment to consumption of a high-carbohydrate diet" part of that statement above is very damn disturbing. You'll learn why in just a moment.
However, at the risk of appearing to be on a completely biased anti-Gatorade rant, and to drive home the point that a relatively enormous intake of carbohydrates is recommended for performance, I'll also point out this anecdote from the "Nutrition And Athletic Performance" position statement from the American College of Sports Medicine:
"For events longer than 60 minutes, consuming 0.7 g carbohydrates·kg-1 body weight·h-1 (approximately 30-60 g·h-1) has been shown unequivocally to extend endurance performance. Consuming carbohydrates during exercise is even more important in situations when athletes have not carbohydrate-loaded, not consumed pre-exercise meals, or restricted energy intake for weight loss. Carbohydrate intake should begin shortly after the onset of activity; [and continue] at 15- to 20-min intervals throughout the activity."
And from the International Olympic Committee's "Consensus Statement on Sports Nutrition" for longer exercise efforts:
"To achieve the relatively high rates of intake (up to 90 grams/hour) needed to optimize results in events lasting longer than three hours, athletes should practice consuming carbohydrates during training to develop an individual strategy, and should make use of sport foods and drinks containing carbohydrate combinations that will maximize absorption from the gut and minimize gastrointestinal disturbances."
Are you getting the feeling that the Holy Grail of nutrition for athletes seems to be to protect carbohydrate stores at all times?
You'd be right with that feeling.
The general argument for carbohydrate consumption goes something like this:
Physical or mental fatigue during workouts (or while you're sitting at your office) is caused by the low blood glucose that occurs as your carbohydrate fuel tank approaches empty. Because it is generally (and sadly) accepted as orthodox knowledge that the human body can't burn fat as a reliable fuel source – especially when you're exercising for long periods of time or at high intensities – nearly every shred of nutrition science is simply looking for ways to somehow increase the size of your carbohydrate fuel tank and hack the body to allow it to store more carbs or absorb carbs more quickly.
Ironically, these efforts to encourage sky-high levels of carbohydrate intake are continued despite the fact that even the leanest of people naturally have tens of thousands of calories of readily accessible stored fat.
In fact, most folks have enough stored body fat to fuel aerobic activity for days and days without running out of energy. For example, a 150 pound dude at a hot, sexy and ripped at 8% body fat still carries 12 pounds of storage fat – which at 3500 calories per pound of fat can easily liberate 42,000 calories of useable fuel for exercise. You've got those same thousands of calories sitting around your waist, abs, hip, butt and thighs – just sitting there, waiting to be burnt.
Yet, it's still standard advice to eat Wheaties for breakfast, guzzle Gatorade during a hard workout and to down a sugary Jamba Juice as you walk out of the gym. And this is the message being preached worldwide to kids and adults by exercise nutritionists and scientific bastions of diet research. We accept this as status quo.
Just think about it: when was the last time you ate a Powerbar before a workout? Had a big smoothie before you hit the gym? Finished up a workout and dumped some kind of powder into your blender (check the label and you'll probably see maltodextrin and/or fructose as primary ingredients)?
Now, there is absolutely no arguing with the fact that high carbohydrate intake before, during, and after a workout can certainly improve performance. So sure – there is at least some logic to the standard recommendation that you should consume a diet which provides high carbohydrate availability before and during exercise.
But while carbohydrates can help you have a better workout, go faster, or go longer, this only applies to acute, in-the-moment performance. Once you take a look (which you're about to do) at the long-term effects of chronic high blood sugar levels, things change drastically. If the damage that you're about to discover is worth it to you, then you are either mildly masochistic or you value performance much more than health.
Perhaps you fall into the category of Olympic athletes who would dope with damaging drugs, even if they knew it would kill them. However, if you desire a long, high-quality life, you don't want to be a washed up ex-exerciser with diabetes, or if you don't want to experience joint, nerve and brain inflammation, damage, and degradation, you may need to adjust your lens.
This all depends on the lens through which you view your body and value your health and your own personal philosophy on performance vs. health.
So what is your lens? Are you chasing performance and a better body at all costs, or are you willing to entertain the idea of thinking outside the box and defying standard practice if it means that you can achieve the same or superior levels of performance and a better body but with superior long-term health implications?
Before we discover the answer to that question, let's delve in and find out what happens if you actually listen to the standard advice to fuel your workouts with massive amounts of "healthy" carbohydrates.
The bullet points below will help you understand the risks of consuming carbohydrate levels like "7-10g/kg" (if you want more details and studies behind some of these points, read this excellent article from the Life Extension Foundation).
Numerous studies have found that the risk for cancer increases with high blood sugar, which makes sense, since cancer cells feed primarily on glucose. This includes cancers of the endometrium, pancreas, and colon and colorectal tumors. Tim Ferriss recently hosted a fantastic article by Peter Attia about this very issue, and how ketosis may indeed be a potential cancer cure.
High blood sugar has been shown to increase the risk for cardiovascular events, cardiovascular disease, and cardiovascular mortality—while lower glucose levels result in lower cardiovascular risk. Coronary artery disease risk has been shown to be twice as high in patients with impaired glucose tolerance, compared with patients with more normal glucose tolerance. The risk for stroke increases as fasting glucose levels rise above 83 mg/dL. In fact, every 18 mg/dL increase beyond 83 results in a 27 percent greater risk of dying from stroke. Incidentally, glucose can "stick" to cholesterol particles and render these particles extremely dangerous from a heart health standpoint, which is why it's all the more important to control blood sugar levels if you're eating a "high-fat diet."
High blood sugar results in cognitive impairment and dementia.
Surges in blood sugar drive the production of fibrous kidney tissue and vascular complications in the kidneys, which can cause chronic kidney disease. There is a direct increase in chronic kidney disease as levels of hemoglobin A1c (a three-month "snapshot" of glucose control) rise.
The beta cells in the pancreas that produce the insulin to help control blood sugar become dysfunctional with high blood glucose, raising the risk for type 2 diabetes. Researchers have discovered that beta cell issues are detectable in people whose glucose levels spike two hours after eating, despite those levels staying within the range considered normal and safe by the medical establishment.
Diabetic retinopathy is damage to the retina that can lead to blindness—and it is highly aggravated by high blood sugar.
Nervous System Damage:
It's been shown that patients with neuropathy whose after-meal glucose readings were above the diabetic threshold sustained damage to their large nerve fibers. Even neuropathy patients whose glucose readings remained well within the normal range showed damage to their small nerve fibers. Studies have shown that within any blood sugar range, the higher the glucose, the greater the damage to nerve fibers.
I don't know about you, but I find these risks pretty damn concerning. The fact is that I want to be around to play with my grandkids, and considering that my genetic testing with 23andMe has revealed that I have a higher-than-normal risk for type 2 diabetes, I doubt that shoving more gooey gels and sugary sports drinks into my pie hole is going to do my health any favors. So if I can achieve similar levels of performance and body composition with carbohydrate restriction, I'm all in.
But let's say you have a hard time thinking 20 years ahead to your future health prospects.
Perhaps diabetes and joint degradation seem like a long way off to you, and it's tough to get motivated by those vague concepts. You just want to rock your workouts, feel like a million bucks and look good naked – right now. In that case, there still a multitude of benefits to controlling blood sugar and lowering carbohydrate intake.
For example, a key component of safe and lasting fat loss is your capability to tap into your body's own storage fat for energy. This access to fat cannot happen if your body is constantly drawing on carbohydrate reserves and blood glucose for energy. In the type of moderate- to high-carbohydrate diets you've learned are widely recommended by prevailing nutrition science, not only does the utilization of fat for energy become far less crucial (since you're constantly dumping readily available sugar sources into your body), but your metabolism never becomes efficient at using fat. There is a growing body of evidence proving that a high-fat, low-carbohydrate diet results in faster and more permanent weight loss than a low-fat diet. Furthermore, appetite satiety and dietary satisfaction significantly improve with a high-fat, low-carbohydrate diet that includes moderate protein.
A study in the Journal of Applied Physiology showed that people who do twice-a-day workouts, but defy standard nutrition recommendations by not eating for two hours after the first session (thus depleting carbohydrate stores with the first session) experienced a better ability to burn fat (with no loss in performance) compared with a group that trained only once a day and ate carbohydrates afterward.
Another study, described in detail a high fat diets for cyclists, deprived participants of carbohydrates then subjected them to high-intensity interval training on a bicycle – and showed better fat burning and an increase in the enzymes responsible for fat metabolism, again with no loss of performance.
And biochemistry research shows that when carbohydrate stores are depleted by almost 50 percent (e.g. by doing a workout without eating carbohydrates), there is increased stimulus for enhanced enzyme activity in skeletal muscle – which is a good thing, since it means that you can more efficiently produce ATP energy from fat calories.
But the benefits of going low carb don't stop at fat loss.
For example, in trained people and athletes who eat a low-carbohydrate, high-fat diet (not to be confused with a low-carbohydrate, high-protein diet), a large amount of fat burning can take place at intensities well above 80 percent maximum oxygen utilization (VO2 max) – allowing for very-high-intensity or long efforts with low calorie intake and also allowing for use of fat fuel stores during long steady-state exercise, even at a relatively fast pace (so much for the "fat burning zone" giving you the best bang for your buck). With high-fat, low-carb intake, you can go hard and still burn tons of fat. In addition, this means that more carbohydrate stores will be available when you really need them, such as for an all-out, 100%, maximum effort.
You also get incredible gains in metabolic efficiency when you use fat as a primary source of fuel – especially when doing high-intensity interval training – with this one-two combo causing potent 3–5 percent decreases in the oxygen cost of exercise, which is extremely significant. Translated into real- world numbers, this increased fat utilization from carbohydrate restriction and high-intensity interval training would allow you to pedal a bicycle at a threshold of 315 watts, whereas a high-carbohydrate, aerobic-only program (the way most people train) would allow for only 300 watts. Talk to any cyclist and you'll find out that an 15 extra watts of power is huge in a sport like cycling, and something most cyclists train years and years to achieve.
A high-fat diet also trains your body to burn even more fat during exercise, even at high intensities. Fat is released faster and in greater amounts from your storage adipose tissue and transported more quickly into your muscles and mitochondria. Your muscles also store more energy as fat and use this fat-based fuel more efficiently and quickly. Even more interestingly, a high-fat diet can cause a shift in the gene expression that codes for specific proteins that increase fat metabolism – and create very similar adaptations to exercise itself. So the mere act of shifting primary fuel intake from carbohydrates to fat begins to make you more "fit", even if you're not exercising.
And guess what else?
This benefit surprised me when I first discovered it, but eating fewer carbohydrates during a workout can actually help you recover from workouts faster. The repair and recovery of skeletal muscle tissue is dependent on the "transcription" of certain components of your RNA. And a bout of endurance exercise combined with low muscle-carbohydrate stores can result in greater activation of this transcription. In other words, by training in a low-carbohydrate state, you train your body to recover faster.
But sadly, whether due to government subsidy of high carb foods like corn and grain, funding from big companies like Gatorade and Powerbar, our sugar-addicted Western palates, or the constant (unfounded) fear mongering about saturated fats and heart disease, the type of research that shows these fat-burning and performance benefits of carbohydrate restriction simply get shoved under the rug.
In addition, most studies that compare carbohydrate utilization with fat utilization fail to take into account the fact that full "fat adaptation" that allows you to gain all the benefits of using fat as a fuel actually takes time – often more than four weeks – and up to a couple years. But since most studies that compare fat and carbohydrate burning are short-term, you rarely see the benefits of this kind of fat adaptation actually fleshed out in research. Instead, the average research participant begins the study in a non-fat adapted state, gets either a high fat or high carb diet, then launches into exercise. But in an ideal study, that person would have followed either a high-fat or high-carb diet for many months before getting their fat burning capability investigated.
So the textbooks and the nutrition science recommendations stick to the standard two pieces of advice you learned about earlier, and continue to preach that to be a good exerciser, to get maximum performance and to optimize your workouts, you need to be a complete carbaholic.
But what if this wasn't true?
What if we could prove that eating a low-carb, high-fat diet for a long time, becoming fat-adapted and even avoiding carbohydrates during the one time when we're most encouraged to consume carbohydrates (during exercise)…
…could actually turn you into a fat-burning machine without losing a shred of performance capability or causing any metabolic damage?
Well, as you've learned, that has just been proven this year, and you can read all the details in the study that was just released a few weeks ago in the Journal of Metabolism at "Metabolic characteristics of keto-adapted ultra-endurance runners".
So, let's summarize what you've learned so far:
- I used to eat lots of carbohydrates. Then, for health reasons, I quit and shifted to a high-fat diet.
- Eventually, I began utilizing ketosis, and got even better results.
- But I experienced some significant logistical and health issues with ketosis, so I shifted back into a "non-ketotic" but still relatively low-carb diet, while continuing to avoid high carb intake due to the host of health issues you just learned about.
- Then recently, in my recent foray into freediving, I re-explored the newer, more cutting-edge ways to get into ketosis.
- Which brings us, drumroll please, into a new cutting-edge ways to easily shift your body into fat burning and ketosis.
Let's do this.
Powdered MCT's + Exogenous Ketones In The Form Of "BHB Salts"
Supplementing with exogenous ketones allows you to experience deep ketosis and elevated blood ketone levels, without having to eat copious amounts of fats, follow an excessively carbohydrate restrictive ketogenic diet, or do a ton of fasting which, as you learned earlier, is often difficult or even damaging to adhere to.
To understand exogenous ketones, you should know that there are three types of ketones: beta-hydroxybutyrate (BHB), acetoacetate (ACA), and acetone, and all three are the normal by-products of fat breakdown by your body. In much the same way as glucose, ketones can be used by your tissues, especially your brain, diaphragm, and heart and are actually a far more efficient fuel source than glucose.
BHB is the primary ketone your body can most efficiently use as fuel during exercise and at rest (especially when you're keto-adapted), it is the most stable of the ketones, and it is actually found in nature in many foods including eggs and milk. A "BHB salt" is simply a compound that consists of sodium (Na+), potassium (K+), and the ketone body beta-hydroxybutyrate.
Before you consume a BHB salt, these individual components are held together by ionic bonds. However, when you consume a supplement containing a BHB salt, it is absorbed into the blood where it dissociates into free sodium (Na+), potassium (K+), and finally, the actual ketone. This means that consuming a product containing a BHB directly and immediately puts ketones into your blood, without the need for you to eat tons of fats or engage in carbohydrate restriction or fasting to generate the ketones.
Yes, that means that normally your body would only generate BHB after it metabolizes fats or is in a deep state of fasting or carbohydrate restriction, but you can bypass that entire process by simply ingesting a BHB salt and thus get yourself into a deep state of ketosis in as little as ten minutes flat.
Then there are medium chain triglycerides (MCT's). Most dietary fat has to be converted into water soluble molecules that then need to enter the liver via your lymph system. Your liver then converts these molecules to fatty acids and ketone bodies. But unlike most other forms of dietary fats, MCT's can enter your liver directly without having to go through your lymph system. This means that consuming MCT's gives your body an opportunity to quickly produce ketone bodies.
The addition of MCT powder to ketones serves the purpose of maintaining endogenous production of ketone bodies by stimulating fatty acid oxidation in the liver, which to the production more ketone bodies. In this transcript from a podcast with Dr. Dom D'Agostino it is mentioned that MCT's cross the blood-brain barrier straight to the brain. So not only are the ketones being used by the brain as an alternative fuel but so are MCT's.
In this study by Dr. Dominic D'Agostino, it is also mentioned that your blood brain barrier (BBB) "is relatively impermeable to most hydrophilic substances, such as ketone bodies. Therefore, the transport of ketones across the BBB is highly dependent on specific carrier-mediated facilitated transport by a family of proton-linked monocarboxylic acid transporters". Basically, what this means is that MCT powder may act as a carrier to shuttle the ketone bodies across the BBB.
So…just imagine if you could inject your body with a one-two combo of BHB salts and MCT's.
It can now be done. Enter a product called KETO//os (Ketone Operating System) made by a company called Prüvit. KETO//os is a ketone salt formula that has been researched, tested, and physician approved to provide elevated blood ketone levels to the body.
KETO//os contains a specifically engineered ratio of ketone mineral salts blended with a high fiber based medium chain triglyceride (MCT) formulation, so you get a potent delivery of both exogenous ketones and medium chain triglycerides. It is simply a powder that you mix with 12-16 oz of water. Within 15-30 minutes it puts your body into a full and deep state of ketosis.
Here's what the nutrition label of this stuff looks like:
As you can see, it's very clean – primarily BHB salts, MCT powder, and natural flavors along with stevia, in a caffeine-free or caffeinated version.
Now, there a few things you should know before you begin using KETO//os. First, ketones naturally act as a diuretic, so you lose salt, potassium, calcium, and magnesium, and it is generally encouraged to increase sodium intake with ketones. That's why there is extra sodium added to KETO//os. The combination of BHB with sodium also acts as a bit of a buffer to natural ketone acidity.
Next, you should know that supplementing with KETO//os (or following a ketogenic diet) can cause a slightly diuretic, water-losing effect, and can deplete your natural magnesium, potassium and sodium stores. This can be rectified by supplementing with a good electrolyte or increasing the sodium in your diet. This is another reason KETO//os adds additional sodium to the formulation to counteract this sodium depletion.
Next, you need to ease yourself into this stuff. As I mentioned earlier, KETO//os is blended with MCT's, which can cause digestive distress if you're not used to consuming them. This is due to the fact that your body has not yet adapted to the increased fats in your diet, and is less efficient at utilizing ketones as its fuel source. Once your body has adapted to MCT in the diet, the digestive distress will resolve. But I recommend you start slowly with just about a half a serving a day, and over two weeks, build up to a full serving twice a day.
You can actually do more than two servings per day if you want, and you can experiment to see how many servings your body should handle. You should know that it would be very difficult to overdose on ketones. They are water soluble, so any excess ketones will be eliminated mainly via the urine.
I know that was a freaking boatload of information.
So bookmark this article and use it as a reference for your training, your daily productivity, and your competitions. Save it to your phone, your e-reader, your computer, or wherever else you need to access it as a quick reference.
And, should your head still be spinning from the knowledge dump, here's the summary of how to use this new cutting-edge ways to easily shift your body into fat burning mode and ketosis.
Simply use up to two servings of KETO//os as a pre- or during-workout fuel for workouts, or for a snack throughout the day to keep you in ketosis. And yes, it can be mixed into smoothies or other drinks. You may find that you can work yourself up to higher dosages than that and if so, great!
That's it. You keep this option in your cupboard and you'll have the perfect weapon you need for easy fat-burning and ketosis, and each of these options will allow you to sustain high levels of blood ketones while still eating enough carbohydrates to avoid the metabolic damage that can occur from extreme carbohydrate restriction.
Our bodies were meant to burn ketones. We have a parallel system within us designed to use ketones as an energy source. Ketones are faster and more efficient than the way our bodies use glucose. Ketones give you 38% more energy than you can get from glucose. We as a society are following a deceptive food pyramid.
We're operating in a high carb world where food is abundant and it is destroying our brains and bodies.
And that's dumb.
So now you know how you've been lied to about carbohydrates and how to fix it.
And in the meantime, if you have any questions click here to Ask A Specialist.
A Final Smattering of Research For You
In case your brain isn't full yet, here are a few additional studies and resources you may enjoy:
The Charlie Foundation for Ketogenic Therapies website:
Ellen Davis' Ketogenic Diet Resource website:
The Effects of Beta-Hydroxybutyrate on Cognition
Dietary ketosis enhances memory in mild cognitive impairment
Increased plasma ketone bodies resulted in a corresponding reduction in cerebral
metabolic rates of glucose:
Under conditions of ketosis, glucose consumption is decreased in the cortex
Brain, Livin' On Ketones – A Molecular Neuroscience Look At The Ketogenic
Neuroprotective and disease-modifying effects of the ketogenic diet
Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes
in Military Personnel (2011)
Clinical review: Ketones and brain injury
No impaired endurance performance when in ketosis:
Treatment of diabetes and diabetic complications with a ketogenic diet
Insulin Sensitivity and Glucose Tolerance Are Altered by Maintenance on a Ketogenic
Long-term ketogenic diet reduces blood glucose:
Ketogenic Diet Could Delay the Effects of Aging
Scientists see a Ketogenic Diet for Aging and Longevity
Ketosis cleans our cells
Long-term ketogenic diet significantly reduced the body weight and body mass
index of the patients:
Cancer Cells Can't Live Using Ketones As A Fuel
Ketogenic Diet for Cancer – ClinicalTrial
Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric
oncology patients: two case reports.