Adventures in Ketosis (long)

Yes, the biggest thing I get from reading is that a calcium score really isn't all that useful. One big study showed that nearly half of the sudden cardiac deaths they looked at were in people with zero scores.
That article linked indicated a score might be useful in the 7.5% to 10% estimated CVD risk category, and I would probably be inclined under those circumstances.

Plenty of people have heart attacks with low cholesterol too. I think the number was also nearly half.

So if you have a blockage issue, it will pick it up. If you don’t have a blockage issue - no guarantee that you won’t still get a heart attack. But atherosclerosis didn’t contribute? Who knows.
 
... my PCP at my last telemedicine checkup was not happy with my LDL number which went higher with my keto diet and has mostly stayed there. A higher fat diet does that in many folks.

Yeah, this is the biggest issue with keto, and there's just not enough data yet to know if it's really worth worrying about.

But high LDL is an independent risk factor for CVD, regardless of how good your other markers look. I.e., lowering LDL always seems to lower risk. And this has been demonstrated by multiple lowering mechanisms (statins just being one example).

So the other side of the keto-coin is: why not statins? If you tolerate them, they seem to work with relatively few side effects.
 
My cholesterol numbers were down a bit, and doctor didn’t even express any concerns this time, but noted that my HDL, trigs and blood glucose all looked excellent. Considering my 10 year risk of ASCVD estimate is low (2.6%) that seemed appropriate.

My triglycerides were the lowest ever for me - 65, my HDL was higher, 68. So I broke through the 1.0 mark on the Triglycerides/HDL ratio which is kind of cool!

Pretty much if you look at my numbers, I am totally far away from any metabolic disease which is the real scourge IMO.

I am also normal weight and routinely have systolic blood pressure below 110. And I exercise daily - a variety including rowing, cycling, strength training and quite a bit of yoga.
 
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Pretty much if you look at my numbers, I am totally far away from any metabolic disease which is the real scourge IMO.


I agree with this. There are numerous studies out now that point toward insulin resistance as the real culprit behind quite a few chronic diseases, including cardiovascular disease. One study from a few years ago concluded that only about 12% of the U.S. population is "metabolically healthy". That is why I always ask my doctor to include things like fasting glucose, HbA1C, and fasting insulin in my annual bloodwork, just to provide more info. on how I am doing. The triglyceride/HDL ratio, which you also mentioned, is another good indicator as to one's metabolic health. If your ratio is 1.0 or below, and your blood pressure and weight are good, your metabolic health is probably excellent.
 
I agree with this. There are numerous studies out now that point toward insulin resistance as the real culprit behind quite a few chronic diseases, including cardiovascular disease. One study from a few years ago concluded that only about 12% of the U.S. population is "metabolically healthy". That is why I always ask my doctor to include things like fasting glucose, HbA1C, and fasting insulin in my annual bloodwork, just to provide more info. on how I am doing. The triglyceride/HDL ratio, which you also mentioned, is another good indicator as to one's metabolic health. If your ratio is 1.0 or below, and your blood pressure and weight are good, your metabolic health is probably excellent.
My other doctor routinely does HbA1C and fasting insulin, and those numbers are also good.
 
An update:

I've been in ketosis for over 2 years now (I occasionally use a blood meter to measure it). I no longer count carbs - haven't for the past 1 and 1/2 years. I simply don't eat grains or white potatoes, no sweeteners, and limit some other starchy vegetables and most fruit. I've been eating very clean and almost exclusively home cooked "just real" food. I have a very small amount of extreme dark chocolate almost every day. It has to be top quality dark chocolate, so there is always a little sugar added. I find my ketogenic "diet" effortless. It's been super easy to maintain and we eat really, really well.

Recent blood test results were my best ever for HbA1C and fasting glucose. HbA1C was 4.6% and fasting insulin was 4.8 uIU/mL. Triglycerides remain very low, HDL high, and triglycerides to HDL ratio persists around 1.

Getting lots of daily exercise, including a lot of yoga. I am getting stronger and fitter.

Started doing some time restricted eating as well, 14:10, with only water drinking during the fast. Time restricted eating has been somewhat of a challenge for me because getting a schedule worked out that accommodates my meals, exercise schedule and sleep schedule has been a bit challenging. I had to switch to delayed or skipped breakfast to make it work. If I stop eating too early before going to sleep it easily interferes with my sleep quality, and I have had challenges getting enough sleep anyway.

My general focus has shifted from clean metabolic health to the more elusive benefits of reducing risks of chronic aging diseases such as dementia, cancer, etc. Some would throw longevity in there but to me longevity is not particularly important, quality of life as I age is very important. As such intermittent fasting and exercise and adequate sleep are as important to me now as maintaining ketosis. And I've been doing a great deal of reading on the topics of diseases of aging.

FWIW I'm currently 61.
 
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Very impressive, Audrey. You are obviously very motivated and dedicated to maintaining good health.....certainly more than most people.

My health goals are similar to yours - specifically trying to maintain health and fitness as I age, while reducing my risk for chronic diseases like cancer. I have been eating a paleo-type diet for about 11 years now. I tried keto briefly, but I lose too much weight on a keto diet, so I discontinued it. I'm already at the same weight I was while in college (148 lbs, at 5'10"), so I do not want to lose any weight (I am 66 years old). So I do eat some potatoes (and sweet potatoes), a small quantity of white rice, some wild rice, and some corn/cornmeal. Most of my meals, however, are centered around fresh vegetables, meat/fish, and healthy fats. Most of the meat we eat is either grass-fed (beef, lamb), or venison from deer that we harvest ourselves. I grow a large vegetable garden, and we eat fresh veggies from it daily for about 6 months of the year. We also use fresh herbs from the garden in most of our cooking, and we make our own salad dressing using high-quality olive oil. I don't eat much fruit, except for blackberries and blueberries that we harvest around here every year. I eat a few nuts and seeds now and then, like pecans and pumpkin seeds (which are high in zinc). I also enjoy a piece or two of dark chocolate on occasion........usually at least 85% cocoa content. I do drink a glass or two of red wine each day with my dinner (some of which we make ourselves, from fruits harvested around our yard).

For exercise, I do a set or two of bodyweight exercises each day, and take at least a couple of 30-40 minute fast-paced walks around the neighborhood. I also mow a big lawn with a pushmower and work in the garden on most days, which keeps me pretty active. I also do a lot of kayaking and fishing.

My HbA1C was around 5.4 recently, so pretty good, though not quite as good as yours. My trig/HDL ratio is about 0.75, which is good. My other blood work is all good, though there is always room for a little improvement.

I found out some years ago that my body tends to accumulate too much iron, causing problems, so now I donate blood 3X each year to keep my iron level in check. It's also interesting that people who donate blood on a regular basis tend to live longer than those who don't. Not sure if that is related to iron levels or not, but it could be.

I do take several supplements that are somewhat difficult to get from food or water these days, such as magnesium, kelp (for iodine), Vitamin D3/K2, curcumin. I live in a northern climate, so it's hard for me to get enough Vitamin D without taking a supplement.

I also take a daily IP6/Inositol capsule, the first thing in the morning. IP6/Inositol is basically a component of rice bran, so very safe to take, and there are numerous studies supporting its ability to reduce the risk of many types of cancers. I am not taking any prescription meds at this time.
 
Congrats, Audrey. We eat low carb meals but I wish we had a more satisfying, low effort and low carb snack repertoire. Any favorites?
 
We eat a very wide variety of dishes/foods.

My trusty smoker provides a lot of great dishes. I also do some stews in the instant pot. Oven-roasted fish too. Boiled shrimp, grilled foods, etc.

We eat a lot of seafood as well as poultry and meat.

We eat a lot of eggs.

Meals are pretty much protein and one or more veggies. We eat a very wide variety of vegetables.

We eat a lot salads, avocados, olive oil….

We eat a lot of nuts - DH is very good at roasting nuts.

We still eat a lot of old faves, just removing or replacing the starch. We still eat fave (homemade) Thai dishes and pasta sauce/ragú. We now use sautéed sliced cabbage instead rice of noodles. That works very well.

We try to limit snacking, but nuts and “tapas” - cheese, celery and dip, charcuterie, pickles, olives, roasted veggies, baba ganoush, hummus, etc. Works for snacks or a very light meal.

We still enjoy wine in more moderate portions.
 
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We try to limit snacking, but nuts and “tapas” - cheese, celery and dip, charcuterie, pickles, olives, roasted veggies, baba ganoush, hummus, etc. Works for snacks or a very light meal..


Yeah, we have charcuterie-type lunches a lot. They vary depending what we have on hand, but a typical one lately would have things like: sardines and/or pickled or smoked fish; cheese; sliced tomatoes or perhaps an avocado; maybe some nuts, like pecans or cashews; maybe a soft-boiled egg; and a couple of rice crackers. You could skip the crackers if you want to go very low carb. It makes for a nice light lunch, using mostly nutrient-dense foods.
 
I’ve been making my own bacon. And I occasionally smoke salmon or trout for us.

We bought an entire Jamon Ibérico from Costco last February and carved it up, vacuum-packing and freezing portions. We’re still enjoying that delicious treat.
 
time restricted eating as well, 14:10, with only water drinking during the fast.

What's the point if you are in ketosis 24/7 ?

Proponents claim that the fasting phase triggers "garbage cleanup" but never explain the biochemistry. You are already low sugar, low insulin, so what triggers this cleanup?

Cannot be starvation since your liver provides a continous supply of lipids.
 
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One of the most common criticisms and even dismissals of the ketogenic diet is the declaration that it’s simply not sustainable. I never see references for that assertion either.*

It doesn’t make any sense to me.

Some of the researchers/doctors have been doing it for decades.

*would they also say the “just eat real food” diet is unsustainable as well? I expect that for some people it is.
 
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One of the most common criticisms and even dismissals of the ketogenic diet is the declaration that it’s simply not sustainable. I never see references for that assertion either.*

It doesn’t make any sense to me.

Some of the researchers/doctors have been doing it for decades.

*would they also say the “just eat real food” diet is unsustainable as well? I expect that for some people it is.

The ketogenic diet is probably sustainable for a majority of people. For me, though, I can't stay on it without losing weight (and this is from experience). My body needs a few more carbs than would be permitted under keto to maintain itself. I'm not saying that I need to eat refined grains (I don't), but I do need to eat things like starchy vegetables and other "whole food" carb sources in order to maintain my weight. It probably has something to do with my metabolism. So......I do eat a mostly whole food diet, but for me that does include some whole foods that are relatively high in carbs.
 
There may be a suggested carb limit for keto, but I don’t count carbs anymore. I simply avoid high-carb dense foods and avoid highly processed foods, and it’s easy for me.

So I suppose that I could be eating as much as 100gr of carbs a day. I don’t know. I call my diet a ketogenic diet because I remain in ketosis. Maybe for some folks their carb threshold is much lower.

Maybe it’s the careful carb counting that people consider unsustainable. Could have a point there but I think it’s more what you are eating that they think is unsustainable. Some people believe that a high fat diet is unsustainable, even if it’s mostly the supposedly “good” fats.
 
I'm starting keto again after a few years. I did a structured plan with provided shakes and lost a lot of weight fast, then converted over to my own low calorie diet back in 2017. It was very good, and I did well until a bad fall and two rotator cuff surgeries in one year. That took me out of exercising and I Yo-yo-ed back up.
Thank you for a great read and inspiriation.
 
I started keto 7/1. Great for kick starting weight loss, but doesn't give me enough carbs to sustain running and vigorous yard work. So I added a little carbs to keep energy level up the last few days.
 
Dr. William Davis (the "Wheat Belly" author) has written about the ketogenic diet. His feeling is that it is fine to use for relatively short periods (for weight loss and improving metabolic health), but that staying on it long-term could lead to some potential health issues.

Basically, he believes that ketosis is an acute stress response by the body to some danger or threat, and can therefore be very beneficial in the short-term - but that we are not designed to be in ketosis for very long periods of time.

Similar to Ronstar, if I am in ketosis for even a relatively short period of time, I start losing weight and am also noticeably lacking in energy. And my body definitely starts craving higher-carb foods, like a baked potato, or something similar. I have come to the conclusion that my metabolism is just not suited for staying in ketosis for long periods of time.

I am not saying I agree with Davis 100%, but his points are worth considering.

https://www.wheatbellyblog.com/2019/03/is-the-ketogenic-diet-dangerous/
 
I simply don’t have any trouble with energy and endurance.

Long term researcher Phinney and many others don’t see a problem maintaining ketosis long term. In fact Dale Bredesen “End of Alzheimer’s” recommends maintaining a “slightly ketogenic” diet long term to avoid dementia.

I started keto 7/1. Great for kick starting weight loss, but doesn't give me enough carbs to sustain running and vigorous yard work. So I added a little carbs to keep energy level up the last few days.
Ronstar - it takes several weeks to fully adapt to fat burning. The first couple of weeks most people experience “keto flu” which includes low energy as their body adapts.

Plenty of endurance athletes perform well on keto. Sami Inkinen is a great story.
 
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If you are in ketosis, your glycogen refill rate is lower. That is the process of getting glycogen back into muscle tissues after maximum efforts. Most people, myself included, have no issues at normal exercise levels. Push really hard and then try to do it again soon and you tend to notice the differences. It is completely worth it to me to get into and stay in ketosis.
you don't have to add very many carbs to kick yourself back out.
 
I simply don’t have any trouble with energy and endurance.

Long term researcher Phinney and many others don’t see a problem maintaining ketosis long term. In fact Dale Bredesen “End of Alzheimer’s” recommends maintaining a “slightly ketogenic” diet long term to avoid dementia.


Ronstar - it takes several weeks to fully adapt to fat burning. The first couple of weeks most people experience “keto flu” which includes low energy as their body adapts.

Plenty of endurance athletes perform well on keto. Sami Inkinen is a great story.

Never heard of Sami - thanks for the info! I realize that the keto diet diet will take longer than 2 weeks to take full effect. But I think that I will end up being semi-keto with an occasional carb influx for the foreseeable future. I'm going for my annual wellness exam next month. I'll tell my doc about my lack of energy and see what he comes up with.
 
If you are in ketosis, your glycogen refill rate is lower. That is the process of getting glycogen back into muscle tissues after maximum efforts. Most people, myself included, have no issues at normal exercise levels. Push really hard and then try to do it again soon and you tend to notice the differences. It is completely worth it to me to get into and stay in ketosis.
you don't have to add very many carbs to kick yourself back out.

Once adapted to fat burning you don’t need glycogen stores for endurance. In fact in ketosis we don’t have glycogen stores! The initial rapid loss on keto is the glycogen stores depleting and the huge amount of water stored with it. Low insulin means the kidneys retain much less water, and blood pressure drops. The kidneys excrete sodium more readily too.

If you want to learn about the physiology of ketosis including physical performance I recommend “The Art and Science of Low Carbohydrate Living” by Volek and Phinney.
 
Never heard of Sami - thanks for the info! I realize that the keto diet diet will take longer than 2 weeks to take full effect. But I think that I will end up being semi-keto with an occasional carb influx for the foreseeable future. I'm going for my annual wellness exam next month. I'll tell my doc about my lack of energy and see what he comes up with.

My point is that 2 weeks into keto you should expect some lack of energy. That is typical. And temporary.
 
I found this thread yesterday and have read through all 15 pages. My question is why keto instead of South Beach type diet, where the latter emphasizes low carb and low saturated fats?

I grew up very thin but I started gaining a bit more weight after 30 and my BMI has since been between 21 to 22. I am 58 yo and I am trying to get back to 19 to 20.

As long as I keep total carb to under 100g per day, I do not put on weight. I am very active, golf 4 to 5 days a week and on golf days, I allow myself to get up to 120g carb. Genetically I am predispositioned to be diabetic, mother and siblings diabetic, but I have managed to remain in healthy, below 5.6 A1C even when I was allowing myself to have 150g carb per day. I am currently on the below 100g carb a day diet, limiting calories in the meantime to try to lose 10 lbs.

My cholesterol is also great, very low LDL (61), high HDL (67) and normal triglycerides (130) and I am working on getting triglycerides down closer to 1:1 ratio triglycerides to HDL by going low carb. I had the LDL breakdown test and confirmed that my LDL is particle type A, the large fluffy type.
 
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