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Old Wed, Jul-18-12, 12:50
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Aradasky Aradasky is offline
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Plan: Atkins
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Location: Southern California
Default 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.

… 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

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
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