#13 Ketogenic Diet Update (July-October 2014)

Below are our latest observations about our ketogenic diet. If you need to backtrack, our previous experiences with the diet are mentioned in our 2014 travel log "#12 Doing the Dolomites Differently," and in "Beyond Gluten," and "Beyond Gluten:  A Plan" which are pieces under "In More Detail" .

1. It’s Amazing
We love it! We continue to be stunned by the many wonderful changes in our sense of well being and in our athletic performance while using the nutritional ketosis strategy. It requires careful analysis of the net carbohydrate content (total carbs-fiber=net) of every bite of food until you get the hang of it; it is a very limited diet; and it requires truck-loads of discipline but we are both absolutely convinced that it is the right dietary strategy for each of us.

Dark leafy green entree salads are a mainstay of the ketogenic diet folks - even for those traveling by bike.
2. Weight Loss Is Easy
It's easy to see why the diet is used for weight loss: I had no desire to lose weight (13.5 % body fat in June 2014) and in July I was struggling to keep weight on. I didn't know how much I had lost while overseas but if it weren't for my elasticized belt, I couldn’t have kept my pants on. One pair was new before the trip, another pair of hipsters I managed to keep wearing by drawing up to my waist, but  6 weeks on both pair were hopelessly baggy.

The keto diet is a high fat diet and so 'eating to satiety' is the rule or 'eat until you are no longer hungry.' Hunger is no longer intense, so it is easy to postpone eating until it is convenient and hence the body fat slides off. And combining this low carb diet with our low FODMAP (fermentable sugars) meant that handy snack foods were hard to come by so we didn’t snack much. 

I already was eating 4-5 oz of cheese a day, so nibbling on more cheese wasn't appealing. I love nuts but I ate my maximum allowed per day on both diets with breakfast, so they were off the list for snacking. Another avocado would make a dent in my calorie deficient, but they weren't always available, ripe, or convenient to eat. I'd been reduced to swigging olive oil in a pinch, but that is only tolerable straight in small quantities.

Many days I would end up waiting until the next meal to eat even though I was hungry, which resulted in me being a little calorie short many days. It would be easier to eat more varied food when we were back in the US but my experience underscored how effortlessly weight loss can be achieved on this diet.

A late afternoon snack: ice cream for many; a "brie cone" for the keto-crowd.
3. Athletic Performance
We're certain that our performance on our loaded touring bikes when in Europe this summer improved after about 10 weeks on the keto diet. We were undoubtedly a little stronger this year than last because of training for the Italian mountain run in July but we were also clear that the diet was having a separate effect on our power. 

On the bikes, we especially felt the effect of the diet when doing 15-20% grades. Those have always been at my breaking point but this summer we both could both keep pushing: we could dig deeper and push those pedals harder and I could press on past my previous “give-up” point. Our guess was that since the muscles were fueled by plentiful fatty acids instead relatively scarce glucose/glycogen that we had greater power and endurance. And of course, pushing longer at our edge made us a little stronger for the next challenge that came along.

In addition to feeling like there was more fuel available in my legs to stick with a demanding climb, my recovery time was much better this summer as well. On one nasty stretch on an Austrian bike route, I rode until I was exhausted and hopped off my bike on the slope. I pushed to a flat spot, rested 1-2 minutes, and then was able to successfully crest a shorter stretch that peaked at 20%. In the past, I wouldn't have gotten enough recovery from such a short rest to succeed on a track that steep. And it wasn't just my opinion: Bill was already on his way back to me to help me push my bike because he knew from experience that I wouldn't be able to pedal to the top of the last climb.

Unfortunately for us, there were numerous opportunities in the Alps for us to scrutinize our performance. We still had to dismount and push up several pitches, especially on rocky surfaces, but we were also convinced that we had substantially better endurance on steep grades than ever before, even with non-existence conditioning for climbing with our 100 lb bikes over the winter.  

4. Hunger When Idle
We were baffled this summer by an urgent need to eat when we were relatively idle to stave off feeling ill but rarely needing to eat when we were very active. We presumed that once our bodies adapted to ketosis (efficiently burning fat) that our need to eat would be blunted regardless of our level of activity, but that wasn't the case 3 months into the diet. We were either just plain wrong with that assumption or we needed the activity to restart the mechanism for cannibalizing our body fat when we'd gotten behind on our daily caloric intake. But the result was that sometimes when we were in a low output mode that we'd tank and have to eat immediately to recover. 

Perhaps our bodies were slow learners: after 5 - 6 months in ketosis, this phenomena disappeared and we rarely had sense-of-wellbeing crashes that required eating to be reversed. We would however still get appropriate signals that it was meal time.

5. Cravings
We learned that those who had gone before us were right: it’s time to eat if you start craving carbs. When fast food sounded appealing or I started craving Mexican food, I learned that I needed to eat. Clearly the carb craving was an imprecise message because eating from my ultra-low carb menu completely blunted the impulse.

6. “Where Has All the Fiber Gone?”
We both were challenged by getting enough fiber on the keto diet to have what doctor's politely refer to as “patient satisfaction with bowel functioning". Whacking almost all fruits, eliminating grains, and severely limiting our vegetable intake to be both low carb and low FODMAP occasionally triggered constipation. 

We each had pretty well found the perfect balance on the diet in the late spring, then we flew to Europe and some of our high fiber/low FODMAP foods suddenly weren't readily available, like chia seeds, coconut, and ground flax seed.

I read online that many keto fans rely on psyllium seed husk to treat constipation but even a single, small, starter dose made me feel terrible and had me running to the toilet at odd times for about 5 days. I threw it out. Getting enough fiber was a challenge but we were confident it was a solvable problem that we anticipated being able to fix. And indeed, once back home, we again found our equilibrium.

7. Good-Bye Jet Lag
We both have suffered miserably with jet lag twice a year for the last 14 years. Our bodies are suppose to fully adapt to the 9 time zone change of 9 hours in 9 days. The first 4-5 days usually are horrible and I know from experience that my cognitive functioning isn't 100% until almost 3 weeks after the flight.

Our experiences with jet lag this year after flying to Europe in June and returning in September were dramatically less traumatic, with September's adjustment being amazingly inconsequential. We are sure it is because of the ketogenic diet and the ongoing improvement in our brain inflammation triggered by carbohydrate intolerance.

We arrived home from Europe in the early afternoon after a 10 hour flight and didn't struggle to stay awake until our bedtime of about 9 pm. We easily got out of bed at our regular wake-up time of 5:30 am after a reasonable, though imperfect, night's sleep. Bill aided his sleep as usual with a Lunesta pill, which doesn't always deliver a full night's sleep; I managed with only melatonin. Each night it was the same: we had no trouble staying up until bedtime and were more than ready for sleep at the appointed hour. Immediately returning to our normal schedule was shocking.

Our sleep that first week wasn't equal to our new best on the diet, but we were getting enough sleep each night to feel energetic and efficient during the day. We’d still awaken multiple times in the night but had no difficulty going back to sleep. We couldn't believe how much we were accomplishing and how resilient we were when several appointments were cancelled at the last minute one day. For the first time, I could understand why some people dismiss jet lag with "It doesn't bother me.”

"Stunned" is an overused word when it comes to us talking about the keto diet benefits but this experience with jet lag confirmed that even 4+ months into our "keto lifestyle" that we weren't through with cashing-in on further benefits. 

8. CRP--An Inflammatory Marker
Seeing a new primary care physician in 2010 after mine retired brought with it new lab tests, including CRP (C Reactive Protein).  At 2.5mg/L, my CRP was high in 2010 and 2 years later it peaked at 5mg/L. Below 1.0 mg/L is normal; 3.0  mg/L sets off alarm bells as a predictor of diminished cardiac health. 

My lipid panels were still stellar but my persistently elevated CRP's were worrisome. I had long ago made the lifestyle changes in diet and exercise that should have kept my CRP's low and my internist shrugged his shoulders with an "Oh, well” when another set of bad results came back.

Zoom forward to May 2014 and my CRP of 4.1 mg/L was still disturbingly elevated but in September it crashed to less than 0.4 mg/L. I was ecstatic. A year+ being gluten free hadn't brought it down; 3 months of eating low carb hadn't budged it; but it plummeted after almost 5 months in ketosis. Of course, there could be other variables, but my CRP had been persistently elevated for almost 4 years. 

Bill's CRP's have always been low, so of course he didn't see any change. CRP's are only 1 measure of inflammation but the only routinely available one so we believe it matters and I’m relieved to finally get a “Normal” result. 

9. Carb Brain
Stephen Phinney, MD, my guru for this ketogenic diet, refers to carbohydrates as "carbage" and carbs do seem to be garage for our brains, though not everyone's. Reducing carbs as recommend by  Dr. Perlmutter of the "Grain Brain" fame did improve our cognitive functioning, but like with bringing down my elevated CRP levels, it took drastically reducing my carb intake to really feel and see big differences.

We were blown away by the dramatic mental performance improvement when preparing for our fall 2014 road trip and felt confident it was the diet. The slightly lazy, half-hearted attitude with which we approached our chores was gone. Instead, we both felt enough more energetic to bump-up our attention to detail, to increase the completeness of our follow-through, and to be more consistent when it came to the 'get it done now and do it right' attitude. 

We felt the shift in effectiveness before we arrived home from Europe but the results were undeniable when we hit the ground running once back home. Even with less than 3 weeks to turn-it-around between our European and state-side travels, we were doing so well that we were simultaneously shopping and organizing for our return to Europe in June of 2015 while preparing for heading to the SW for the winter.

What a delight. We finally felt like we were out in front of the parade instead of struggling to bring up the rear. Being decisive about pitching outmoded belongings when we encountered them was easier as was taking a few extra minutes to re-organize a shelf or drawer needing attention. More was getting done every time we turned around.

Because of issues with having our truck and camper in our apartment building parking lot, we generally have about 24 hours to load and organize the camper. The 3 prior years, we left the grounds around dinner time after resorting to heaving the last of our belongings in, making a terrible mess we cleaned up over the next several days. This fall however, we departed a little after lunch; had time for a 2 hour walk in the Columbia Gorge; and swiftly organized most of our supplies in time for bed a little after 9pm with no stress. The next day we got in a brisker 2 hour hike before lunch, put in our requisite few hours of driving in our bid to get to Yellowstone National Park, and  finished the last of the "put-away" project with good humor.  Ordinary for some, but the efficiency and ease with which we  made the transition into our little camper was exemplary for us.

10. Altitude Tolerance 
I doubt that the ketogenic diet speeds the series of physiological changes needed for altitude acclimation but our performance at moderate altitude was stunningly better after 5 months on the diet than ever before. Bill has always struggled mightily with altitude discomfort and was even worked-up in 2012 for a heart attack when he actually had acute mountain sickness. 

We amazed ourselves during the last minutes of a 12 mile hike at Bryce Canyon National Park. It was near sundown and we were pooped but as we approached the parking lot trailhead at 8,300' I said "Let's sprint to the asphalt." We both effortlessly poured on the gas and bounded up the rustic stairs. We were hardly out of breath from the effort that should have dropped us to our knees. 

“Wow!” Other people were struggling to slowly walk the same distance that we effortlessly ran wearing day packs. That little sprint confirmed what we’d suspected: that our altitude tolerance had bumped up on the diet. 

11. Magnesium Supplements
Author Dr Phinney, our keto guy, is right-on about a magnesium product called “Slow Mag.” I’ve taken magnesium citrate supplements for years to help my sleep and quiet my tremor and have been satisfied. But when muscle cramping set in on the keto diet, I started taking “64 Mag”, a cheaper product equivalent to Slow Mag. Phinney stated that one’s need for magnesium increases on a keto diet and Slow Mag or its generics would fix the cramping problem.

He was right: after being on the 64 Mag for 2 weeks I began noticing improvement in my muscle cramps that were mainly triggered when stretching. I fiddled with lower doses of 64 Mag and substituting my magnesium citrate for some of the 64 Mag and my muscle cramps and tremor returned. I’m experimenting with other formulations because the 64 Mag has more calcium than I want to ingest in the form of a supplement but I’m thrilled to have a new standard by which to measure magnesium products. Having my tremor completely knocked down was yet another unexpected, though indirect, benefit of this entire ketogenic diet journey.

Another Keto Update??
It’s hard to imagine that after all of the dramatic changes we’ve experienced in 6 months of being ketogenic that there could be more good things to come. We do however assume that as our bodies continue to recover from presumed inflammation due to carbohydrate intolerance that there will be more positive shifts but that they will be small and subtle. Perhaps in hindsight a year or 2 from now we’ll say “Oh yeah, that used to be an issue for me but isn’t any more.” 

We each have some secret hopes that particular health challenges that we have will melt away with time and yet know that that is too much to hope for. But, at the outset, this whole notion of carb intolerance and brain inflammation seemed preposterous and we were wrong, wrong, wrong. We’ll hope we are wrong again and that additional dramatic improvements lie ahead. If so, you’ll have a chance to read about them in another Keto Update.