Keto diet question

[twaddle]

Except that kcal math ignores appetite, which is huge component. As mentioned, go out of ketosis and the sweet tooth (appetite) surges. People are not machines and if you think you are in control, read "The Righteous Mind"; we humans have an amazing ability to do illogical things and then make perfectly logical reasons for why we did what we did. I think it applies well to dieting.

No argument from me. Appetite (and craving) suppression is the secret sauce of keto for sure.

But the OP complained about his rate of loss, and that is a function of calorie deficit (by whatever path you take to get there).

FWIW, 4 m&m's won't knock you out of ketosis, and ketosis isn't required to break a sweet-craving habit (or to lose weight), but everybody can find what works for them.

 

[Chuckanut]

FWIW, 4 m&m's won't knock you out of ketosis, and ketosis isn't required to break a sweet-craving habit (or to lose weight), but everybody can find what works for them.

+1

I doubt if I spent or currently spend much time in Ketosis. The goal is reasonable weight loss that can be sustained while enjoying life and keeping healthy. I find that a lower-carb/slow-carb diet does that for me. YMMV.

 

[Bongleur]

1. Gluconeogenesis. I have found conflicting information exactly how much protein it takes to start converting it into carbs. One source says more than 12 hamburgers; it won't happen until the liver is so overloaded with protein that the normal process is swamped.

2. How long does it take to get back into ketosis after one insulin pulse? If it takes "days" as claimed in the Keto Dieting books, then Intermittant Fasting cannot work, because you only have at most 18 hours of fasting.

Which is telling a lie - the keto diet books or the intermittant fasting books?

3. How do you really know when you are in ketosis or insulin metabolism? Can you have a positive-for-ketosis ketosis number (from a breathalyzer, using acetone as a proxy for Beta-HydroxyButyrate) for some period of time even after an insulin pulse?

If you are willing to prick your finger to quantify insulin -- exactly what is the number that turns off ketosis? How fast does the switchover happen - minutes, or the by the end of the ~3 hour length of an insulin pulse?

Nothing I have read indicates that you can be in a blended state where your cells are taking in both sugar and lipids at the same time. And your liver is converting/releasing both at the same time. But the intake paths ARE different at the cellular level...

If the liver is an either/or switch, then sugar might compete with fat for entry into cells until the lipids in the blood are exhausted; I don't know if cells have a preference - I have not found any info about that. It would have to do with the metabolic cost of transporting each. If you have excess sugar + fat above in your blood above your metabolic needs, would insulin have fat cells
convert both to fat for the duration of the pulse? Therefore, exercise immediately after eating until the insulin pulse fades

I just blew a 7.9 on my KetoScan breathalyzer, and we are having chili for dinner, which has a good amount of carbs (no sugar added to the beans). I'll do it again afterwards a couple of times. But I'm kind of hungry now, so I'll snack on a few ounces of Heavy Whipping Cream. A quart has 65g carbs.

4. People talk about being in "deep" ketosis, which means a high number. I don't see the relevence; if you are burning calories because you are exercising the number should rise, and when sedentary fall. Nobody talks about learning your "resting" keto number; why not?

5. I'd like to see a scale converting a keto breathalyzer number into calories/minute being burned. Would need to factor in your lean weight... Surely that is done by the lab/medical treadmill test machines?

6. I have read that the urine strips for keto are not useful once you are "in" keto, because they measure a waste product produced during the transition and not so much when in steady-state. Or something like that.

7. Getting to 70-80% fat is mathematically difficult. Meat and hard cheese don't seem to have more that 55%, maybe 60% fat, and you need to eat all the bacon grease from the pan to get there*. A tablespoon of MCT oil in your coffee is not nearly enough to make up that remaining 20-25% fat.

At 1600 Kcal, you get 800 fat + 800 protein in your meat/cheese, then add 400 pure fat; its only 60% fat total (12/20). At 55% fat, it adds up to 64% fat. And I need lots of roughage (not soluble) to keep fat in my gut long enough to be absorbed and not expelled (GERD issue).

* Which is hard to do without bread. The fake bread is not very absorbent, and most taste & have a mouth feel like cardboard.

 

[audreyh1]

I use a blood meter to measure ketones on occasion. Every time I’ve measured in the last two years I’ve been in ketosis, so I think I can conclude that I’ve been in ketosis pretty much whole time.

I used to measure far more often with urine strips and they said the same thing.

Even though I’ve been on a ketogenic diet for 2 years I still measure ketones in my urine. That didn’t really seem to change. If it dropped it wasn’t much.

No, a meal does not knock me out of ketosis. Generally what kicks you out of ketosis is eating too many carbs in a given day. The recommended daily carb limits were established to help you maintain ketosis. Ultimately this is very individual and some people can stay in ketosis with higher daily carbs and others not.

Gluconeogenesis occurs naturally when the liver anticipates that your body needs more blood glucose for the brain, particularly at night and a lot first thing in the morning, and has nothing to do with how much protein you eat. Otherwise once you are “fat adapted” organs happily burn available ketones, and the brain can burn ketones too.

Personally I’m fine with blood ketone (beta-hydroxybutyrate) range of 1.5 to 3. Initially it was quite a bit higher - 3.5 to almost 5. I was doing a lot of exercise and I think that was pushing it up more but perhaps also very strict carb counting initially, and probably my body going through a big adaptation.

For the first six months I was using a carb counting app (Carb Manager), and I easily met or exceeded 70% fat most days. I did not find that hard at all. Fats from avocados, nuts, oils such as olive oil, olives, some dairy, eggs, moderate protein, etc. With low carbs the fat % easily went way up.

It’s all about insulin. You don’t make ketone bodies if insulin is high. It has nothing to do with fat in the blood. Eating carbs is what increases blood insulin, and protein has a more muted insulin response than carbs. Fat has no insulin response at all.

I guess there are a lot of crazy keto myths running around.

You might be better off reading some books or watching video presentations by Dr. Phinney and Dr. Volek if you are trying to understand the physiology of ketosis.

I did lose some weight, but my main goal was to bring my triglycerides way way down and maintain low blood insulin for good metabolic health and reverse any incipient insulin resistance. I pretty much achieved that goal in a few months and my recent triglyceride reading was 65, the lowest ever, which was even lower than my HDL at 68.

I’m quite comfortable eating this way so I kept with it. I no longer count carbs. I’m sure I eat more carbs, but I don’t eat any grains or regular potatoes at all, and only occasionally eat starchier vegetables like winter squash or field peas. I don’t worry about carbs in many others vegetables such as onions, tomatoes, carrots or leeks and have then regularly. My diet is obviously low carb enough for me as I am still in ketosis.

 

[Bongleur]

So about 50 minutes after starting to eat, my reading is 10 ppm.
Might have gone up because of that cream I drank an hour before dinner.
After 2 hours, same at 10 ppm.

There seem to be a handful of blood meter brands that will test both glucose & ketones, but I think they all require you to use a different strip for each (same finger stick, I suppose). Finding the meter is easier than finding the price of the strips. One is under $20 but the strips are said to be expensive.

A microbiologist told me that under 100mg/dl glucose there is no insulin secretion.

The rule that you can eat 50-100g carbs a day seems to presume they are spread out evenly; so people doing one or two meals a day might not be able to eat so much. Dunno.

https://bodyketosis.com/ketone-breath-analyzer/
Breath acetone ketosis levels

Breath acetone can range in concentration from 1 ppm in healthy non-dieting people to 1,250 ppm in diabetic ketoacidosis. In healthy individuals, breath acetone levels can be affected by multiple factors, like dietary macronutrient composition, caloric restriction, exercise, and some other more minor factors.

When testing your acetone levels with a breath meter, you will get back a number in PPM (parts per million). The breath value ranges for nutritional ketosis are 4-30 PPM, so you’d want your number to fall somewhere within this range. If you are at 0, you are not in ketosis at all, if you are at 1, 2, or 3, you are in a light state of ketosis, but you would want to try and increase it, so it fits the range.

Most of the breath meters nowadays use the PPM metric system, but if yours happens to be in nM (molar basis), the conversion is 1 ppm = 39.7 nM.

 

[audreyh1]

I haven’t used a breath meter.

I did measure my blood glucose a couple of times about an hour after a meal and both times it was under 100 mg/dl. I measured it out of curiosity because I was feeling the after meal fogginess I occasionally get, but it obviously wasn’t due to high blood sugar!

 

[EastWest Gal]

I understand the relationship between carbs and sugar, especially how blood sugar affects the body's metabolism.

I do pretty well eating LCHF (or Keto or Paleo), but sometimes, I do have a very small sweet. I am talking about 2 or 3 peanut M&Ms! Or sometimes, a small piece of 70% dark chocolate. I may do this 4 times during the week (I love a small sweet with coffee).

And most days, I do not exceed 1500 calories. I also walk 4 miles about 3 days per week.

My question is: is my minimal sweet tooth able to pretty much cancel out my LC diet? It seems to! I have not lost more than 5 lbs in at least 3 months.

Maybe try more protein? Diet Doctor recently had a podcast and article about it. I'm in the same boat, so if anyone has any suggestions let us know.

 

[chris2008]

Maybe you just do not eat enough, so that your metabolism is in constant hunger mode?

 

[saydiver]

There are some chocolate bars on the market that don't raise blood sugar/insulin levels in most people, but you really need a meter to see results. One brand is Lily's Chocolate.

To calculate net carbs not only do you subtract the fiber, but also the sugar alcohols.

 

[Highbeam]

To calculate net carbs not only do you subtract the fiber, but also the sugar alcohols.

Uh oh, not so fast, not all sugar alcohols are the same. A common ingredient in current sugar free candy is maltitol. Whoa, that stuff causes a huge insulin response and you are only allowed to subtract a portion of it from the total carb count.

Staying under 20 grams of carbs per day essentially guarantees ketosis so there is no need to measure. In fact, modern keto theory is that measuring is a waste of time and money. Just stay below 20 carbs per day. In addition, who cares if you are in full ketosis? Only those doing this for a medical reason such as epilepsy really need to be in full ketosis. Being fat adapted is far more useful.

Always hit your protein macro or slightly more, don't exceed your carb limit or less, and I have found that fat is takes care of itself. If you're worried, it's easy to add fat with butter or coconut oil but I prefer to let my body eat body fat.

I'm trying to add back carbs now after a 6 month stint on keto since hitting my goal weight. It's easy to lose weight, easy to gain weight, but holding steady is tough.

Oh and my LDL numbers are through the roof. Needed to go on a statin!

 

[saydiver]

Uh oh, not so fast, not all sugar alcohols are the same. A common ingredient in current sugar free candy is maltitol. Whoa, that stuff causes a huge insulin response and you are only allowed to subtract a portion of it from the total carb count.

I agree not all sugar alcohols are the same. I only consume the sugar alcohols that have a minimal response on my blood sugar level like stevia, monkfruit and a few others. That may not be the case for everyone.

 

[audreyh1]

I don’t count carbs anymore, so I measure my blood ketones every few weeks to track ketosis. I don’t eat any grains and or white potatoes and easily stay in ketosis. I guess I stay in ketosis because it’s easy for me to stay there given my eating patterns. Over 2 years now.

I found even sweeteners that aren’t supposed to cause any insulin response can make me hungry/trigger cravings and want snacks, so I’ve had to learn to drink unsweetened coffee. That was a recent change. Supposedly just the sweet taste can be a trigger to the brain.

I do eat some very dark chocolate (85-88%) and that doesn’t seem to cause problems in very small amounts. I just couldn’t stand the artificially sweetened ones when there is plenty of very high quality very dark chocolate out there.

 

[chassis]

Thanks to all. I have NOT tried to count carbs, only total calories. I am trying to not have to be too obsessive about counting anything. I would like to lose another 10 lbs, so I am not grossly overweight but it seems like I am "maintaining" and not losing, hence my question about whether sugar, independent from carbs or calories, could be preventing my losing.

Total calories in must be less than total calories out (burned) in order to lose weight. That's all.

Ignore all diets with names. Keto, Paleo, Atkins, vegan, etc etc

Eat a balance of all food groups. Including confectionary if you like. All calories must be counted without exception.

What is your age, height and weight? 1500 calories per day is quite low.

 

[audreyh1]

Total calories in must be less than total calories out (burned) in order to lose weight. That's all.

Ignore all diets with names. Keto, Paleo, Atkins, vegan, etc etc

Eat a balance of all food groups. Including confectionary if you like. All calories must be counted without exception.

What is your age, height and weight? 1500 calories per day is quite low.

No that’s not true, your metabolism gets in the way and interferes with a simple energy balance equation. This has been demonstrated several times. Those poor Biggest Losers totally screwed up (way lowered) their metabolic rate by prolonged extreme under-calorie over-exercise scenarios and weren’t able to recover.

CICO probably works fine for someone with a healthy metabolism, but if your metabolism is messed up due to chronic metabolic disease, what you eat and when you eat absolutely matters. You have to treat the underlying conditions like hyperinsulinemia and fatty liver to heal the metabolism and let all those powerful hormones that control hunger and fat storage normalize. Mostly through diet (type of food) although intermittent fasting can also help.

 

[chassis]

No that’s not true, your metabolism gets in the way and interferes with a simple energy balance equation. This has been demonstrated several times. Those poor Biggest Losers totally screwed up (way lowered) their metabolic rate by prolonged extreme under-calorie over-exercise scenarios and weren’t able to recover.

CICO probably works fine for someone with a healthy metabolism, but if your metabolism is messed up due to chronic metabolic disease, what you eat and when you eat absolutely matters. You have to treat the underlying conditions like hyperinsulinemia and fatty liver to heal the metabolism and let all those powerful hormones that control hunger and fat storage normalize. Mostly through diet (type of food) although intermittent fasting can also help.

@audreyh1 you are saying that a chronic disease invalidates the calories in-calories out relationship?

 

[harley]

@audreyh1 you are saying that a chronic disease invalidates the calories in-calories out relationship?

I'm not Audreyh1, but I'll step in and say that the calories in-calories out relationship is not valid, as in there are many other factors that affect weight and health. As a diet it can work for some, but not everyone. We're not multiplication tables, we're quantum physics.

 

[chassis]

@harley OK. What is an example, or two, of calories in-calories out being invalid?

 

[audreyh1]

@audreyh1 you are saying that a chronic disease invalidates the calories in-calories out relationship?

Among other things, CICO ignores a third major factor, the metabolism, which can reduce significantly and make it very difficult to lose weight long term.
https://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html

 

[mpeirce]

Among other things, CICO ignores a third major factor, the metabolism, which can reduce significantly and make it very difficult to lose weight long term.
https://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html

We’re built to survive famines. Our bodies have a variety of mechanisms to keep us alive as food inputs vary. And they always varied.

 

[chassis]

@audreyh1 Do you have a link to something I can read that comes from an educational institution, or a government agency, that explains under what conditions calories in-calories out is invalid?

A link with .edu or .gov would be wonderful. For example a medical school or the US NIH. Thank you!

 

[Aerides]

@audreyh1 Do you have a link to something I can read that comes from an educational institution, or a government agency, that explains under what conditions calories in-calories out is invalid?

A link with .edu or .gov would be wonderful. For example a medical school or the US NIH. Thank you!

I think you know, as most of us do, it's not that simple. And that for one person, the way they do "calories out" is not the same as another. For example, the calorie-per-hour stuff on cardio machines? Hahaha...totally average and not real.

One might run and burn 500 calories an hour, on a 5'7" 165lb somewhat muscular body.
But if someone else runs for an hour, and they are 5'10" and 150 and very lean, or 5'10', @225 and very muscular, how they burn is very different.

Add in their diet, time of day, if their body is healthy or under nourished...someone eating a tremendous deficit (say under 1k calories per day) is not going to burn the same way. Or an athlete who is very very active who needs to eat 4k calories per day because they are more efficient at getting the C's Out...

CICO is a simplified starting point, but far from the end of the science.

 

[Mark1]

I don't have a dog in this fight, but I had to laugh when I saw the thread. I'm just getting done reading a book by Robert Lustig entitled Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine where among other things he goes on a rampage that "a calorie in is not a calorie out".

 

[audreyh1]

@audreyh1 Do you have a link to something I can read that comes from an educational institution, or a government agency, that explains under what conditions calories in-calories out is invalid?

A link with .edu or .gov would be wonderful. For example a medical school or the US NIH. Thank you!

So showing that a person’s metabolism can drastically slow in response to a large calorie deficit and even become long lasting damage is not good enough?

No, I don’t have such a thing. But I have work from respected doctors in the field. Dr. Robert Lustig has done a lot of work in this area and published a lot. He’s a well respected pediatric endocrinologist and has done careful work in this area and demonstrated that “a calorie is not a calorie” - that is, calories are not interchangeable because the body metabolizes different foods differently. He in particular goes after added sucrose (table sugar) and HFCS and fruit juices because the high fructose loads result in fatty liver in children. His work argues directly against the food industry which claims that it doesn’t matter where your calories come from. He has online video presentations and does a lot of interviews on this topic.

The point is, that if you take the strict CICO approach, you are barking up the wrong tree. Someone who needs to lose a lot of weight probably has a metabolism disorder, likely hyperinsulinemia, and needs to treat the metabolic disorder in order to lose weight. Simply “eat less exercise more” usually won’t work. Measuring hormones such as insulin, triglycerides and blood sugar to determine the situation and then bringing that insulin down can make it much easier for someone to deplete their fat stores without feeling hungry. Interestingly, there is no drug for this. You manage it by what you eat and when you eat it. Nephrologist Dr. Jason Fung has great online video lectures in this area.

An interesting video that demonstrates how someone gained weight while eating about the same number of calories and maintaining the same exercise regimen is That Sugar Film. He switched from a moderate diet that had no added sugar to a supposedly healthy low fat diet that had 40 teaspoons daily of added sugar - matching the sugar intake of the typical western diet. And this is with absolutely no junk or sodas or sweets. He gained weight and started developing fatty liver within a month, and much worse after two.
https://watchdocumentaries.com/that-sugar-film/

 

[chassis]

Thanks @audreyh1. Are you, or were you, engaged or employed in the healthcare field? Or was a close member of your family engaged or employed in healthcare? Your knowledge seems to exceed that of the average person.

I remain in search of a peer reviewed published piece of writing on this topic, from an .edu or .gov source, preferably a medical school or the NIH.

Where does lifestyle choice come into this - gluttony and sloth? Said in terms the modern culture might understand better - eating too much and exercising too little?

Disorders and diseases are part of life. Yes, I get it. I acknowledge this fully. Where in the pareto chart do diseases and disorders fall, relative to lifestyle choices to each too much and exercise too little?

 

[audreyh1]

We have heard “Eat less exercise more” for decades starting with the fitness craze in the 70s, yet a fat lot of good it’s done our population which has since developed increasingly widespread chronic metabolic disease, including in children. It’s going to bankrupt our health care.

Yes, I’ve watched a lot and read a lot on the topic over the years. There are plenty of papers published on various aspects of this topic. Unfortunately standard of care in Western medicine is way way behind.

You can do your own. I’ve given you some references.