The Great Ketogenic Diet Experiment
Recently I completed a 6 week dietary experiment with a nutritional approach that was new to me. It is called the ketogenic diet, and I originally expected this to be a private experiment, something I wouldn’t make public beyond mentioning to a few friends and family members, mainly because I expected it to not hold interest for most people. But the implications for me are life changing, and surely someone else out there will also benefit. This is what motivates me to make my experience public.
The experiment emerged unexpectedly just after Halloween. My young boys had had a successful trick-or-treat experience, obtaining a large volume of chocolate. As a good, responsible parent, I had regulated their consumption to 1 piece per day. I, on the other hand, had all but snorted about 5 pieces per day. Maybe 10. Apart from that, a family celebration and other undisciplined dietary actions had led to a slight gain in weight. My pants were tight, slowly strangling my hope, and when combined with work stress and the mental fogginess that accompanies eating too much sugar, I felt irritated, out of control and ready to do something drastic.
With all of this in my mind, I happened to listen to Tim Ferriss’ podcast of November 3, 2015 that interviewed Dom D’Agostino in depth about the ketogenic diet. Dr. D’Agostino is a PhD researcher of metabolic therapies with a particular interest in nutritional ketosis. All at once inspiration struck that this could solve the malaise I had inflicted on myself. I went from not ever hearing the word ketogenic in my life, and not contemplating any significant dietary change, to committing to experiment with it overnight.
The part of the interview that tipped the scales was D’Agostino’s explanation that brain function changes as a result of the ketogenic diet, specifically represented by two stories:
In the 1920s, it was discovered that children with epilepsy stopped having seizures altogether when on the diet. The treatment persists as a valid alternative up to the present time. Mysteriously, despite advances in science in the century since the discovery, no one can definitively account for why the diet eliminates seizures.
Much more recently, Navy SEALs experimented with a rebreather and the ketogenic diet. A rebreather is a scuba diving device that keeps all air in a closed system, not allowing the air you exhale to escape to the surface. You can easily imagine that if you are trying to avoid detection, leaving a bubble trail visible on the water’s surface could be a life ending event. A rebreather starts with 100% oxygen, and the longer the SEAL remains under water, the higher the proportion of carbon dioxide becomes as a result of the exhaled air staying within the closed system. After the amount of available oxygen diminishes to a certain point, insufficient oxygen exists to support brain function, and the SEAL will have a seizure. But SEALs on a ketogenic diet can function longer, with less oxygen than a SEAL on a standard diet.
The Ketogenic Diet Surpassed Expectations: great weight loss, but even bigger therapeutic benefits
I do not perform covert, underwater operations. Nor have I ever had a seizure. But I do have a sufficiently varied amount of tasks going on in my life for which I would like to experience enhanced mental acuity. Could the ketogenic diet improve the performance of a white collar professional in cubical warfare?
I generally felt unfocused, irritated at the barrage of information coming at me, not clear on what to do next. Could a dietary change impact that?
The results of my experiment went far beyond my expectations. Let's compare results to original expectations:
Did increased focus happen? I felt like a well oiled mental machine. Check
Did I lose weight? I had to punch a new hole in my belt. Check
Neither of those outcomes carry life changing implications. In fact, I just validated the diet. But something extraordinary happened as well, a potential outcome not referenced in the podcast. I have osteoarthritis in both knees, a condition which has plagued me since - I think - my teenage years. And after several weeks of the ketogenic diet, the inflammation and pain disappeared. I didn't anticipate this and it shocked me.
The ketogenic diet has multiple benefits. In this post I discuss how I designed my experiment, what I did, what the results were and next steps (click the links if you need to jump ahead).
What is a Ketogenic Diet?
Before we dive in, you might be wondering what the heck a ketogenic diet is. There is nothing faddish about it, so you haven’t encountered people at the office with boxes of Ketogenic Diet frozen entrees, or seen plans advertised on tv. Its under the radar status is part of the allure for me. I don’t consider myself old (I’m forty - your opinion may vary), but I have been around long enough to see diets come and go. The ketogenic diet has been around, as I mentioned above, since the 20s.
The essence of a ketogenic diet builds upon a caloric ratio of 80% fat, 15% protein and 5% carbohydrate. The name of the diet derives from ketone, a substance produced by your liver that converts fat into fuel for your body. In a conventional Western modern diet, the carbohydrates and starches we eat are converted by the body into glucose, which is used as fuel. So amazing a machine is your body that it recognizes the presence of fat and runs through a simple "if/then" scenario that goes something like this:
"I see that there is fat in my stomach - is there also carbohydrates/starch? If yes, then I will store the fat for later, in case the supply of carbohydrate runs out. If no, then I will direct the liver to produce ketones for my body to use as fuel."
The body's mechanism for dealing with carbohydrates is insulin, which converts carbohydrate to glucose and simultaneously causes fat to be stored instead of utilized or excreted. If your body is running on ketones, there are low levels of insulin and your body is burning fat as fuel since no glucose is available.
And this presents the coolest part of the diet to me. You can measure the amount of ketones in your blood to determine if you are running on ketones instead of glucose. A blood ketone level of 1-3 mmol/L is how you know. It is simple to quantify. When your blood levels of ketone are in that range, you are in a state of ketosis. It is in that state that you lose body fat, see your cardiovascular risk factors improve and experience cognitive gains.
You can read much more about the bio chemistry of how the ketogenic diet works by going here, here and here.
You’ve probably gotten the idea by now that the ketogenic diet is a low carb diet, and you are probably relating it to other low carb diets you have heard of. Good call! If you are familiar with the Atkins Diet, Paleo, or even the South Beach Diet (the first two-week phase of it), then you are in the same ballpark. The differences from those vary, but I like to think of the ketogenic diet as: eat whatever gets your body into a state of ketosis without elevating cardio risk as evidenced by blood tests that profile conventional markers like lipids.
The blood chemistry question is one of the most intriguing to me. Growing up in the 70s and 80s when the gospel of the low fat diet descended upon all the land, I developed an almost instinctive point of view that fat was bad. Meatless pasta was low fat, so eat all you want. Sugar free Cool Whip was good. Placing freshly fried bacon on paper towels and carefully patting the grease off of it was as necessary as washing your hands after going to the bathroom - it was gross if you didn't do it.
Beyond diet, we learned that consuming high fat diets and lots of cholesterol caused blood cholesterols to go up, which meant death. So to reduce the risk of death required reducing fat, especially cholesterol.
In light of that Brave New World that I grew up in, reading that eating as many calories as I wanted, as long as I made sure 80% of them were from fat, sounds crazy. But, 4 years ago, after my wife gave birth and I came to realize that I had added 15-20 pounds of sympathy weight over the previous 9 months, I stumbled upon the South Beach Diet, which didn't highlight for me that high fat was good, but put me on a low carb, restricted calorie diet, which resulted in weight loss. It was something of a gateway drug for me, because in the course of achieving success, I also learned that I actually felt physically better. Not just from being lighter, but more mentally focused and alert. A friend I shared this with told me about Paleo, which I learned about from an interview with Arthur De Vany. Over that year I went on to lose 30 pounds and one of the distinctive memories of that time is how much better I felt mentally. I may not have been in ketosis, but I was in the vicinity. With that experience under my belt, I knew this would be a worthwhile experiment.
Experiment Design
I mentioned earlier that I committed to this quickly. I felt that the longer I waited, the more likely my inspiration was to be extinguished like a candle in the swirling wind of life, and felt urgency to act while the podcast was ringing in my ears. So I did little in the way of preparation, and sketched out a simple design:
The duration of the diet will be 6 weeks. I knew this would give me about a month of being in ketosis, and I heard D’Agostino make a reference to people alternating in a 6 week cycle on a ketogenic diet and 3 weeks off. From that I inferred that 6 weeks of ketosis was long enough for good things to happen.
At the conclusion of the diet I would get a blood test done to evaluate my cardiac risk.
I would weigh myself daily.
At the end, I would fast. Ferriss and D’Agostino had a fascinating conversation about cancer as a metabolic disease, in which D’Agostino explained how cancer cells die in the absence of glucose, and fasting is likely an excellent preventative tool. They did not mention a recommended duration for fasting, so I picked 48 hours. This number came out of the air. I had done a 24 hour fast once before. I figured I could go longer than that, and 72 hours sounded daunting.
During my fast, I would have blood drawn to take a snapshot of my cardiovascular risk.
I would have follow up blood tests done at some point after the conclusion of the experiment to understand how my blood changes after being on my “regular” diet again.
You will note that I did not take baseline labs. I was in too big a hurry, and as I mentioned before, I did not intend to publish this, so it wasn’t that important. I now know that you can order lab tests and get them done in a day, which I will get to later on, and I wish I had appreciated that as it would have been an interesting comparison point.
Implementation of the Ketogenic Diet
Getting to a place where your diet is carb free takes work. Your body shows displeasure at giving up a ready supply of glucose through sugar, carbohydrates and starches. I've heard this referred to as the "Keto Flu." You feel grumpy, sluggish, and hungry until your body adjusts. I had experienced this twice before: once when doing South Beach, and once when going Paleo. And my poor wife was the first victim, downstream from my cutting comments, irritability and general disagreeableness to be around. Over the following years, I've voiced the periodic aspiration to go low carb occasionally, which has always been received, I think, with great apprehension. I can't help but think it comes across a little threateningly. She will have to endure a dark cloud in the house. When I listened to the podcast, she was about to depart for a 5 day girls trip, which would coincide with most of the transition through carb withdrawal. Sparing her from most of the carb withdrawal was another reason to act immediately.
I jumped into it on a Thursday. The symptoms quickly followed. I felt grouchy, irritable, (more) impatient and hungrier. Eating enough fat is key. I found it helpful to focus on what I could eat rather than what I could not. And, it was exotic to consume so much fat that had always felt “naughty” before.
In the podcast, Ferriss had asked D’Agostino what he ate, and I used that as a general template, starting with his breakfast, because:
He's been in ketosis for a long time,
If he were doing it, I know it is the right nutrition and
It sounded exotic.
His breakfast was eggs accompanied with sardines in olive oil. He said he eats 4 eggs, but he lifts weights. I don't and have a sedentary lifestyle, so I ate two eggs cooked in a tablespoon of coconut oil and a tablespoon of grass fed butter, along with the sardines. I was stuffed, uncomfortably so, all the way through lunch, where I felt run down and like I should eat, but also full and uninterested in food.
It took about a week for the fatigue and irritability to go away. But after that, increased focus came, which was a great lift. Imagine sitting in a stuffy room and then someone opens two windows on opposing sides of it, allowing a stream of air to blow in. The view is the same, the contents of the room is the same, but suddenly there is fresh, cool air all around you. It is a total change, and a cause for excitement. That is what it is like to go into ketosis. You feel more ready, you are eager to act, you are more focused and more productive. I could spend longer time on tasks without feeling distracted, I could see the volume of work increase. It was fabulous.
The key to staying there is to eat enough so that when you are in a compromising situation, you don't fall to temptation. For me, that meant eating enough. I continued to experiment with breakfast, and ultimately settled on the following staple:
Bulletproof Coffee - which is a large cup of coffee with a tablespoon of coconut oil and a tablespoon of grass fed butter.
2 Fried eggs in a tablespoon of grass fed butter.
Sauteed collards, or fresh lettuce, drizzled with 1 tablespoon of olive oil.
Nutrition?
Total calories = 529
Fat = 55g
Protein = 14g
Carbs = 3g
That's 77% fat, 15% protein, and a sliver of carbs.
On that, I felt great, and could skip lunch without issue. Although I found that it takes a while to optimize the diet. Towards the end I discovered that if I pushed up the breakfast calories to 850 by adding bacon, lunch wasn't even a question, saving time: I could swim laps instead of using the time to have lunch, and then eat a large dinner.
Routine was largely helpful here. I followed that standard breakfast approach throughout the 6 weeks. When I ate lunch, I made it a salad, and as I often had to eat at restaurants for lunch due to networking for business, salad presented a reliable option. On a couple of occasions, I noticed that the salad I ordered contained corn - a carb - but I don't think it was enough to kick me out of ketosis.
Dinners were made easy, largely by the support of my wife. It was a sincerely loving act for her to accommodate my experiment. She was not party to the agreement and the diet is highly restrictive. She prepares most of our dinners, but she made sure that there were enough carb free options to keep me on track. We typically had chicken or pork, and a combination of broccoli, salad, cauliflower, and she often added a carb like potatoes or rice for the kids and her. I always skipped the carbs, and once in ketosis, did not feel a craving for it. I discovered a few menus items that I chose to eat repeatedly. The website ibreatheimhungry.com had some good options, especially feta and sundried tomato meatballs, creamed cauliflower, and cauliflower pepperoni. Another standard option was cauliflower rice.
Many times, a consequence of the dinner was that it was fairly low fat. Fat is absolutely essential to success with the ketogenic diet, which put me in the unusual position of seeking out more fat whenever possible. Another tip from D'Agostino helped me here. He described a dessert he often ate of coconut cream mixed with cocoa powder and stevia. I did this for myself, using Trader Joe’s coconut cream which tasted like a delicious chocolate pudding. I ate it almost every night for the duration of the experiment. A serving added about the following to the nutrition, and provided excellent satiety at the end of the day:
Fat 16g
Protein 2g
Carbs 4g
Socially, this was a challenging experience. Restaurants were difficult, and my wife and I enjoyed a terrific date night at a local Nashville restaurant, one of those places that prides itself on a carefully crafted menu by an intentional chef. It was not one of those places where you ask for subsitutions and the prospect of doing so reminded me of the time I was an ignorant 16 year old at a nice steak restaurant and I asked for steak sauce to accompany the steak. I will never forget the look on the waiter's face. It was awkward selecting a course that worked, which ultimately resulted in requesting a lamb loin prepared in phillo pastry to have the pastry served on the side. As a major foodie, I don't enjoy showing up as a picky eater.
My diet crossed Thanksgiving as well. What a carb centric holiday. I made sure there was cauliflower and salad to accompany the turkey, and my mother kindly made a diabetic recipe for sugar free, grain free pumpkin pie. I got through it ok.
Physiological Results after 6 Weeks on the Ketogenic Diet
The cost of a ketogenic diet is socially high and physically strenuous, but the results are clear. The first result to notice is weight loss. It began on day 2 and continued throughout the experiment:
Weight
I started the project at 180.2 pounds, and finished it at 162.2. That's a BMI of 25.5 at the start, which is borderline healthy weight/overweight, and 22.9 at the end, quite solidly healthy weight. It should be noted that BMI is a deeply flawed metric, but, given the data available to me - I didn't perform a body fat test at the beginning and only knew that pants that used to fit quite comfortably now fit tightly - BMI is a good proxy as a comparative measure.
Weight Loss During Ketogenic Diet
18 pounds in 6 weeks - 3 lbs a week, is a lot. I think it should be adjusted slightly. Your body stores water differently on a low carb diet, and I estimate that about 5 pounds of weight came entirely from water. That takes us down to 13 pounds, which is right around 2 pounds per week, a healthy weight loss pattern for a ketogenic diet with some calorie restriction.
You will note above that there are occasional upticks in weight. They happen to occur about weekly. The reason for that is I tend to have alcohol on weekends. Alcohol always caused my weight to increase.
When I was two weeks from the finished line, I resolved to give up alcohol for the remainder of the experiment. This was my best, most focused weight loss opportunity in a long time, and I wanted to maximize it. The result was just as expected, I saw no uptakes in weight until my last day of eating prior to my fast. This should be expected, and indeed, weight fluctuation separated from alcohol should be expected.
Mentally, I don't know how to measure it, only to say that I felt calmer, more alert, and more focused. One area that D'Agostino discussed in the podcast that highly intrigued me was sleep. I am an 8 hour a night guy, which is very time consuming! But, I don't argue with it and just accept that optimal performance flows from adequate sleep. He mentioned that he only needs 6 hours of sleep, and although he hastened to add that although there is no evidence linking sleep and ketosis yet, I was hopeful that I would experience the same thing. I did not. When I got less sleep due to a particularly busy day, or my kids rising extra early on a weekend after I had stayed up late, I felt as diminished as always when having less sleep.
The Shocker: ketogenic diet as arthritis "cure"
Thinking back to my original goals: lose some weight, feel better, position myself to fast for cancer risk mitigation and see what happens that might be interesting, I have to say that the absolute biggest shocker was what happened to my arthritic knees: The pain and inflammation mostly resolved, and by mostly, I mean 90%.
If you don't suffer from arthritis, that might read as mildly interesting and as a footnote. Let me attempt to impact you differently.
At the age of 15, I joined my high school football team. Little league football had been promising for me. I performed well, especially on defense, and it was a source of joy. My freshman year of football, I was outmatched, and didn't do well. I resolved to change that with tremendous effort in the weight room. I took the recommended training program seriously, and worked hard. I recall one of the seniors on the team describing me to his peers as the hardest working guy in the weight room, a huge compliment to a young freshman with no credibility. But during the off season as I worked away, my knees started to hurt. I noticed it first when doing squats, and then when running.
Something was wrong, so I went to my family practitioner. He told me that weight lifting was bad for your joints and he recommended against doing it any way, and in my case in particular, the clear solution was not to lift weights. This meant quitting the team and never gaining strength, which meant probably never going on a date with a girl or having a girlfriend or getting married or having children or being happy. This struck me as a prison sentence.
25 years later, I don't consider it the "life ending" recommendation I did at the time, but I do consider it bad advice. Weight lifting is great for your health. There is risk if you use bad form, and many people do, but the solution is not to avoid it, but to do it with good form. This was the first in a series of disappointing encounters with doctors.
Later in the year, I made an appointment with an orthopedist, a man with prestige - he was the team orthopedist for the New Orleans Saints, and in those early days of astroturf, he must have been pretty busy in the OR, but I digress. I felt like I was going to see a wizard when the appointment came. I was honored. He looked at me briefly, examined the mild swelling in my knees, and then had my lie down and he raised my leg and pushed it back. He found that my hamstrings were very tight. He diagnosed me as requiring stretching, and sent me to a physical therapist for stretching exercises, and said I shouldn't play football. Thus ended my football career. I was disappointed to say the least, and unsatisfied with his answer, although there was nothing more I could do.
I continued to jog and to play football in yards with my friends, and swelling of my knees continued to flare up from these activities. Stretching helped, and I did it regularly. Multiple attempts to lift weights through high school and college always resulted in intense soreness and swelling, and ultimately I abandoned it while in college for good.
At the age of 25, I took up jogging again, wanting to lose some weight and build endurance. Swelling became so onerous that I visited another orthopedist. He took X-rays and did an examination. He came into the room with a long, sad expression, asked me repeatedly about whether I'd had an injury (I hadn't). Finally, he pronounced what sounded like a death sentence: I had osteoarthritis in both knees. I had the knees of a 50 year old man. I should not run or do any high impact activity. He would drain my knees of fluid, give me a shot or cortisone and a prescription of naproxin, and told me I would need to come in every few months for a shot of cortisone and that I'd be taking naproxin for the rest of my life. It felt hopeless.
I told my mother of this, who was a personal trainer. She told me that naproxin every day indefinitely was not good for me, that routine cortisone injections were not good for me, and that I would get a lot of benefit from stretching, an activity the physician had not mentioned. I felt nagged and annoyed: what does a personal trainer know that a doctor doesn't? So I decided to call him just to make sure I didn't have to face her questions. And when I did and asked him, he said, "yeah! Stretching is great - it increases the surface area where the muscle connects to the cartilage, reducing discomfort." Now I was pissed. He was going to medicate me the rest of my life, and just because I happened to have a mother passionate about wellness I was able to ask a probing question of him. [good place for link to Econtalk podcast]. I decided to not trust doctors any more that day.
But I don’t want to get to heavy handed with doctors. I really like what comedian Jim Gaffigan said on this topic:
I’m not anti doctor. I think there is way too much pressure on doctors these days to be God-like saviors, and as a result there is much arrogance in the medical community. Doctors always have the attitude of “Look, we are scientists-we’ve figured out the human body. Trust us.” Yet whenever I go for a checkup, they are always like, “It’s either a freckle, or we have to amputate your head. That will be five thousand dollars.”
The point is, doctors are just people, trying their best, improving lives for many people, but making mistakes that can misguide people in some situations. My mistake was not that I sought counsel from a doctor. My mistake was letting the doctor be the last word.
At the time that I was diagnosed with arthritis, I resolved to live as active a lifestyle as possible, accepting certain activities as off limits. I walked regularly for exercise, I took up lap swimming, taking lessons at the local YMCA. It became my favorite exercise, and, 15 years later, its still is. I also committed to stretching regularly.
About 10 years later, I stumbled across Kelly Starrett and this exercise. Before it, I had focused all stretching only on my hamstrings. Starrett preached a gospel of thinking upstream and downstream of the problem area. Adding hips and calves to my stretching routine was even more of a game changer. Walking had never caused prohibitive discomfort, but it always caused some. Now with these new stretches, it caused significantly less. I took up spin classes, thinking that the swelling would stay away. It didn't. I had found that the limitations were still high.
With all of this background, I went into this experiment. I lived an active life, with routine walking, swimming, and lots of stretching. It was how the world worked.
So imagine my shock when, after three weeks, I noticed that my knees felt better than I could remember. I flew up and down stairs. I never felt stiff after sitting for extended periods. My knees didn't swell. They didn't hurt. What was going on?
Thinking that perhaps I had simply been more sedentary than usual, causing my knees to be extra rested from impact, I decided to run. My hopes were rising and I didn't want them to be dashed. So I ran a quarter mile, an activity guaranteed to cause intense soreness, stiffness and significant swelling. It never came.
No swelling. No stiffness. No soreness. I couldn't believe it.
Talk about opening a world a possibility! Now the sky was the limit. I could take up biking, or snow skiing, or karate. Even more, I could participate in social activities like football or ultimate frisbee with friends. Turning down those invitations, always out of a bizarre, unfounded place of shame, resulted in nothing but increased loneliness in the past. Now I could participate. And I saw a future where I could run and play with my young sons, something I had already resolved to do no matter what, not without a physical price.
Somehow the ketogenic diet had resolved the osteoarthritis in my knees.
What was it?
I turned to Google, and found multiple references that I had never seen before. Some pointed to gluten. Others to sugar. One article described one person's experience of removing gluten, grain, sugar and nightshades to resolve arthritis. This was daunting. As restrictive as the ketogenic diet is, I hoped to not have to live on it permanently to resolve my condition.
Even so, I felt elated to know that there is a way to eliminate arthritis.
Lab Results after 6 Weeks on the Ketogenic Diet
A really interesting area is what happens to cardiac risk factors in the blood while on the diet. In another Tim Ferriss podcast, Dr Attia recommended several lab tests, some of which were genetic, but some of which were cardiac. I incorporated his advice and got the following lab tests done:
Cardiac Risk Lab Tests
Lipid NMR. The “standard” lipid profile, including LDL, HDL, Total cholesterol and triglycerides, but also, importantly, LDL Particle, HDL Particle, VLDL Particle, Small LDL Particle, LDL size and HDL Size, and Lp(a). Be sure to check out Dr Attia’s thorough treatmentof cholesterol, which covers these lipid measures.
My results were not great.
Test
Result
Recommended Range
LDL-P
1184
<1000
LDL-C
155
0-99
HDL-C
57
>39
Triglycerides
149
0-149
HDL-P
28.9
>=30.5
Small LDL-P
474
<=527
LDL Size
20.8
>20.5
Large VLDL-P
3.4
<=2.7
Large HDL-P
6.4
>=4.8
VLDL Size
39.9
<=46.6
LDL Size
20.8
>=20.5
HDL Size
9
>=9.2
LP-IR Score
43
<=45
Unfortunately, due to no baseline, a critical question goes unanswered: did my results improve compared to what they were on the beginning of the diet? I haven’t had my blood work done in several years, but I can say that I’ve never in my life seen cholesterol levels that high. Two things come to mind:
In the D’Agostino podcast, he referenced dialing back dairy as a result of increased cardiac risk. After eating 2 tablespoons of butter a day, I think reducing that may have an impact.
I was shedding fat continuously on this diet. Dr. William Davis, author of Wheat Belly, states that when in such a state our cholesterol levels can go haywire. He recommends allowing our weight to plateau for 6 weeks before taking a true measure of cardiac risk. Another angle to try.
Inflammation Tests
There are not blood tests that I am aware of that reflect inflammation due to osteoarthritis. However, my layman’s logic postulates that:
If diet influences joint inflammation, that inflammation will be reflected somehow via blood.
If diet changes and thereby reduces joint inflammation, the change will be shown.
The question that follows then, is what blood tests will show it? I concluded that CRP and ESR were likely candidates.
My C Reactive Protein (CRP) was .34 mg/L, which I understand to be a minimal value.
Sedimentation Rate-Westergren (ESR) was2 mm/hr, which I understand to also be a minimal value.
I expected to gain no insight from the initial test, but to see a difference for the next test when I get a second test after being back on my standard diet.
Ketone Blood Levels
Because I didn’t expect to publish any results and because I expected this to be a single, one time experience, I originally intended not to measure blood ketone levels. However, with a week left in my diet, I realized this experiment would become a baseline, and future experiments were likely. Also, because I knew that I would publish my results, I knew that I would want to become more quantitative. As a result, I ordered a blood meter, the Precision Xtra by Abbott Labs, and conducted tests for the last 5 days of the diet. As I mentioned earlier, optimal ketosis occurs between 1-3 mmol/L. Higher values result from fasting. On the last 2 days of the diet I was fasting, which you can easily see below. Also, I tested twice a day during my fast to see what was happening during the day.
Blood Ketone Levels During Ketogenic Diet
Interestingly, my first test occurred right before dinner on the first day. I did not have lunch that day and the result reflects slightly elevated ketone levels, a sign that my body was in a fasting state after only 10 hours without food.
The fast was fairly painless. I worked out (30 minutes of lab swimming) towards the end of the day and felt great doing it. I crashed afterwards, however. I felt extremely fatigued and short-tempered. I went to bed an hour earlier than normal that evening. The next day, I felt solid with good energy and a positive mood. In retrospect, I probably could have done 72 hours without much of an issue.
What the Ketogenic Diet Taught Me
I learned a ton from this experiment:
Osteoarthritis has a nutritional component. I don’t yet know exactly what it is, but carbohydrates in some way significantly impact my arthritis.
Many (most?) doctors are not trained or prepared to evaluate the nutritional impact on arthritis, and by extension (and speculation!) probably not many other conditions. Independently researching and evaluating your condition is important. In my case, I unduly suffered for 25 years.
Lab testing is much easier to arrange than I thought. I figured I had to go to a doctor and get him to write a script. I am amazed that on short notice, I an order essentially any lab test I want.
Lab results don’t always give you a definitive picture that you expect, even when you think you know the limitations. I thought the absence of a T1, T2 comparative result was the extent of the limitation. Having observed high cardiovascular risk (according to the result), I know that additional experimentation is required to fully understand the impact.
A low carb diet absolutely improves mental acuity and is definitely achievable. If one can acquire the discipline for the ketogenic diet over 6 weeks, you can do less restrictive low carb longer term, especially in light of comparable health benefits.
The extreme restrictiveness of the ketogenic diet makes it unappealing except for in the case of severe medical problems. If it turns out that my arthritis can only be controlled by a ketogenic diet, the restrictiveness of chronically swollen knees is much worse than giving up carbs.
The most important takeaway from labs are that periodic tests and an intentional diet make a ton of sense in general. Irrespective of what nutritional strategy you follow, there is immense value to pegging your cholesterol values to it.
The second most important takeaway is that when undertaking a nutritional experiment, in modern America it is possible to test your own blood without having to coordinate with a middleman (doctor) to get tests done. Simply go on line and order the tests. So, when motivation strikes, take action and order labs immediately. You can get the blood draw the same day. As you can easily tell from reading this, there would be more answers if a baseline had been established.
The Next Chapter
The promise of more physical activities from reduced arthritis pain and inflammation, the appeal of playing football with my boys in the yard, taking up cycling, working out in the gym and doing deadlifts and squats, means that optimizing my diet around foods that don’t cause inflammation in my joints is essential.
The first question I want to answer is: do I have celiac disease? I have experienced other symptoms such as fatigue and digestive discomfort that seem unexplained, and I want to definitively rule this out. I will attempt to settle the question with a blood test. Apparently, I need to be eating gluten for about 3 months for the blood test to show results. At the conclusion of that time period, I will have that test as well as the others that I did a few weeks ago.
The next priority is to ensure that my cardiac risks are controlled. It is likely that I will do another period of a ketogenic diet at that time, irrespective of the celiac disease question, simply because I’d like to know the true impact of the ketogenic diet on my risk profile. At that point, I will augment my training regimen to include weight lifting that involves the use of my knees.
But! I am open to suggestions. If you were me, how would you approach the elevated cardiac risk factors? What would be your next step on managing arthritis? Do you know of any research linking nutrition to osteoarthritis? Let me know in the comments. Also, if you’d like to receive updates along the way about the experiment, please subscribe below. It would be an honor to have you as a part of this journey.