My experiment with Serum Ketones (Nutritional Ketosis)
 

I read Jimmy Moore's blog http://livinlavidalowcarb.com/blog/...-day-1-30/14409 and something that I thought I had learned, finally sank in. I knew I was in ketosis, but not really what that meant. I listened to Dr. Phinney and was reminded of what I had read in the following book, and decided to do this experiment.
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The Art and Science of Low Carbohydrate Living
by Jeff S. Volek, PhD, RD and Stephen D. Phinney, MD, PhD

<This is wonderful book that provides the science behind Low Carb High Fat eating, in an understandable way, along with menus and recipes. I have typed some excerpts to help explain what I am doing.>

Taken from Chapter 1
Defining 'Nutritional Ketosis'

The second way to define "low carbohydrate" is physiologic – specifically that level below which there is a fundamental shift in your body's fuel homeostasis (i.e., energy regulation) away form glucose as a primary fuel. This shift is the adaptation of the body's hormonal set and inter- organ fuel exchange to allow most of your daily needs to be met by fat, either directly as fatty acids, or indirectly by ketone bodies made from fat. This process, …, begins for most adults when total carbohydrate is restricted to less than 60 grams per day along with a moderate intake of protein. After a few weeks at this level, the primary serum 'ketone' (beta-hydroxybutyrate or B_OHB) rises above 0.5 millimolar (mM). At this ketone level, which is ten-fold higher than that in someone with a daily intake of 300 grams of carbohydrate, their brain begins to derive a substantial portion of its energy needs from B-OHB, resulting in a commensurate reduced need for glucose.

With further restriction of carbohydrate below 50 grams per day, the serum B-OHB rises in response to reduced insulin secretion. However, because dietary protein prompts some insulin release, and serum B-OHB itself stimulated insulin release by the pancreas, (albeit subtly), adults eating 20 grams of carbohydrate and 75-150 grams per day of protein rarely run serum above 3 mM. …

This 10-fold range of serum ketones, from 0.5 to 5 mM, is your body's normal physiological response to varying degrees of dietary carbohydrate and protein restriction. This response rate is called 'nutritional ketosis', and is associated with metabolic adaptations allowing your body to maintain a stable stare of inter-organ homeostasis. This process is dependent on an adequate, albeit minimal, ability of the pancreas to produce insulin in response to dietary protein and serum ketones, thus maintaining serum B-OHB in the range where it replaces much of your body's (and your brain's) need for glucose without distorting whole-body acid-base balance.

Taken from Chapter 13
Ketones-To Measure or Not

As noted in Chapter 1, nutritional ketosis is defined by serum ketones ranging from 0.5 up to 5 mM, depending on the amounts of dietary carbohydrate and protein consumed. In most people, the combined intake of 100 grams of carbohydrate and 100 grams of protein with drive serum well below 0.5 mM. While there is nothing magical about having circulating ketones above this threshold level, it does have the practical value of providing he brain with a virtually limitless, fat-derived fuel source. This alternative fuel is eminently more sustainable, particularly in the insulin resistant or carbohydrate intolerant individual.

Within a few days of starting on our carbohydrate restriction, most people begin excreting ketones in their urine. This occurs before serum have risen to their stable adaptive level….

Meanwhile, the body is undergoing a complex set of adaptations in ketone metabolism. ….

… Over time the urine ketone excretion drops off, ….

These temporal changes in how the kidneys handle ketones make urine testing a rather uncertain if not undependable way of monitoring dietary response/adherence. Testing serum for beta-hydroxybutyrate is much more accurate but requires drawing blood, and it is expensive because it is not a routine tests doctors normally order.
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… the key question is why do it? Many people are able to initiate and follow a low carbohydrate diet just fine without ever measuring ketones. Others, however, find an objective measure of nutritional ketosis to be reassuring. …

Taken from inset in Chapter 16
Human Protein Tolerance
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As a result of these observations, plus our studies of muscle retention and function during carbohydrate restriction, we recommend daily protein intakes between 1.5 and 2.5 gram per day per kg of reference weight. For a person on weight maintaining low carbohydrate diet, this typically translates to somewhere between 15% and 25% of your daily energy coming from protein.



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Here is Doctor Phinney's interview by Andreas Eenfeldt
http://www.dietdoctor.com/low-carb-living

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There is so much more interesting, science and fact based information in this book, I highly recommend reading it for yourself.

Now, to why I am doing this experiment?
I am insulin resistant. I was on my way to total replacement of my insulin before eating low carbohydrate. I want to know how much protein will cause me to go out of nutritional ketosis. I also want to know how long it takes me to go into nutritional ketosis.

Dr. Phinney told us in his lecture that it can take up to two weeks in the beginning AND if we eat over the recommended amount of carbs and/or protein for a day or two we get kicked out of it and have to restart. I would like to know if that means I stop losing weight or feel different if I am out of serum tested nutritional ketosis.

Atkins dieters know that when we start dieting, we lose a large amount of water then the loss slows. It also sometimes stalls. Is it because we are eating too much protein and not enough fat? I have eaten a high fat low carb menu for about six months now, and when I recommend it to others I am asked about eating fat and trying to lose fat. How can that be the way to do it?

This is one way to show, not just tell.

I was traveling for about 19 days. I admit it, I tried to eat in the plan but it is hard to do while traveling. I also ate nuts, too many nuts….. And on the plane home, I had bread and ice cream covered in chocolate sauce. Yes, I cheated and gained a few pounds. However, I did not even think about the consequences of my ketone homeostasis. I am not sure if I had, that I would have skipped the ice cream, but probably would have skipped the bread.

I started back tracking on a strict low carb way of eating two days ago. Yesterday and today, I started fully tracking what I ate. I have had, what I call, the symptoms of low carb eating, icky tasting mouth that is always dry, dry eyes, and I can smell it in my urine. I have never tracked my urine ketones, but I imagined I would turn the sticks purple.

I had ordered the meter and the strips started testing today. The strips are expensive (!!!) so, I bought 20 and am only going to test every other day.
Goals
1. Am I in nutritional ketosis defined by my serum testing?

2. How long did it take to reach it, if I am not?

3. How easy is it to knock myself out of it?
3a. Looking at protein intake
3b. Looking at carb intake.

4. If I knock myself out, how long will it take to get back in?

5. How do I feel during the phases?

6. How much fat will it take to bring my calories up to maintenance level when I decide to stop?

Conclusions, how much of certain things can I eat? What are my goals with this way of eating?


I weighed 153.3 pounds today. So far, on low carb, I lost 50 pounds. I would like to weigh about 140 and lose the roll left around my middle. I have been eating LC for two days and have lost water.

According to the book, I need a daily protein intake between 1.5 and 2.5 gram per day per kg of reference weight. I am going to use my reference weight as 140 lbs.

Here, http://lowcarbdiets.about.com/od/nu...n/a/protein.htm I am told I need to eat at least 52 grams of protein a day.

So --140 lbs is 63.5029 kgs
I can eat 95 to 159 grams of protein a day and I plan on eating around or less than 30 net carbs a day to get into nutritional ketosis. At that level of carbs and even the highest level of protein, I should get into nutritional ketosis if I am not already.

And so I start. I will try to stay on my every second day testing schedule, and try my best to stay on target with my food. I really want to see what is ahead…..


Monday, July 16, 2012
1592 Calories
36 g carbs ( 18g net)
79g protein
132g fat
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Tuesday, July 17, 2012
Weight 153.3
Fasting glucose 92
Fasting ketones .2 (!!!! I thought I was there! I need a .5 or above to be in nutritional ketosis)

1730 calories
45 g carbs (21 net g)
66 g protein
150 g fat
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Added Second installment of Jimmy Moore's blog http://livinlavidalowcarb.com/blog/...day-31-60/14669

I'm new here, this is my first post, but I'm intrigued by this concept and your very scientific approach to it! :) I'm tempted to try it too, as I love all things data collection. I look forward to following your thread. :) And sheesh, I wish those strips weren't so expensive too, or I'd be on Amazon ordering them right now. I have a trip coming up next week, but maybe when I get back I'll embark on the same experiment and just deal with the cost of the strips. :) Good luck in your testing. :)

Thank you McJess and Welcome!

Cool, Arlene, this looks like an enlightening experiment that'll teach you a lot about your body.

I want to join, but will have to wait until August 4th or later, and will also have to think about the cost of those darn strips!

HI LaZigeuner, Yes, the strip cost is prohibitive. I hope the alternate testing will show me what I want to know.

DAY 3 Weds July 18
Weight 153.3 (same as yesterday)
1818 Calories
38 g carbs ( 25g net)
84g protein
154g fat


I AM EATING BASICALLY INDUCTION, NO FRUIT BUT YES NUTS.

I test tomorrow.

Arlene, do I understand correctly that you have a meter that measures the ketones in your blood serum? What did that cost you and how about the strips or whatever you have to measure on? Even the urine testing strips are costly enough but at least they are easily available.

I look forward to following this experiment. I find Jimmy's experiment really inconclusive because, as usual when he does these n=1 things, he is changing more than one factor. Yes, he's limiting carbs and protein and upping fat but he is also really drastically reducing calories. Although he isn't posting his menus, he says that he eats 1-2 meals a day and at one point talked about going 29 hours without food. This is similar to experiments in the past (meat/eggs) when he did post menus which showed low calories plus a ton of exercise. I have no doubt that he will lose weight as long as he can keep this up. Even if he is eating the same number of calories, eating less often will reduce his insulin response and allow fatty acids into the bloodstream to be used for fuel.

What is less clear is whether one would lose weight eating their usual 3 meals (or whatever) and calories with just reducing protein and carbs and upping fat. I have my doubts that this would be as effective. I hope you prove me wrong!

Very good observation. I was just thinking about that this morning. From what Jimmy said, he is reducing the number of meals he eats, but also says he is not looking at the calorie count. From my experience, eating two meals a day, I have 1- 2 ozs of HWCream in my coffee and 1Tbs coconut oil in AM, You can still have a high number of calories. Fat itself is a high density food and packs in calories. I decided to stay at the calorie level I was using for maintenance, about 1850 or so and id I eat more or less, not to worry so much about it. In my opinion, the fat calories are metablized differently and so if they are the majority of calories I should lose until I stop or if I stall. If I stall I will reassess..... We shall see!

Thank you for this very informative post. I look forward to reading your updates.

95g of protein doesn't seem like it is really less than I was eating before when I was doing VLC.

What's their position on fiber? Count it as carb?

Thanks for sharing Arlene. However, you demonstrate why -- for me -- I was thinking that LC wouldn't be a good fit, despite my liking of the LC science.

I travel for a living, and really can't see myself doing what you are doing. I had THOUGHT, that if one weren't in Ketosis, then LC didn't work...the whole "eat carbs, get kicked out".

That may be true, but that's not the same thing as saying there is no benefit to LCHF unless one is in ketosis. At least I hope it's true. I've been losing by counting my calories, and then starting to "Make the Better Choice" to choose LCHF foods more often. But I'm not anywhere near low enough for ketosis.

I am losing, though.

Don't worry leebase. While I am very interested self-research, no one can realistically argue that weight loss, whether by limiting carbs or not -- can only be accomplished in ketosis. There are many ways to lose. And then comes Part 2 -- maintaining -- which is a whole different challenge.

I would encourage you to stick with it and not worry too much about the science and whether it gibes with your experience as your experience is what's more important. I've lost weight despite rarely or ever being in ketosis, I suspect. And there are people here who have been stalled for a long while while eating low carb who then have success on JUDDD (Johnson's Up Day Down Day Diet) which would seem to defy the idea of ketosis being necessary as their "up day" may or may not even be low carb.

Which is not to say that figuring out what's needed for ketosis wouldn't be useful.

I am just not so sure in general that permanent weight loss isn't still a conundrum that science really hasn't cracked yet.

I so agree. This journey is for me and if you learn something from it then so much the better. Jimmy Moore is making his own journey and I am already different than he is on this. Remember, I really want to keep my insulin down, if what you are doing works, then hurrah!! and keep it up!

ARGH scariest month I had was when I decided that I was going to maintain and then actually had to do it. I am still learning about myself on this journey....... LOL