Lifelong ketosis considerations?

[cflegal]

I have been in mild ketosis for about a year. I hope to live many more years. I currently plan to be in ketosis for the rest of my life. Are there any issues, concerns, questions, medical consequences for lifelong ketosis? Does anyone have years of ketosis experience to share? What routine medical checkups are called for?

Kudos on all of your improvements on ketosis, cflegal! I'm especially impressed with the cessation of your tremor. That feels very profound. I assume that you're also experiencing an improvement in cognition? I certainly did when I switched to a ketogenic approach. That said, are you achieving ketosis through MCT supplementation only or are you also practicing a long daily fast, exercising, and cutting out starchy and refined carbs? I ask as those strategies concurrently optimize metabolic health, endogenously create ketones, and will ultimately make the need for a ketone supplement unnecessary.

Tests that should be performed to monitor health would include fasting glucose, insulin and hbA1c, as well as an advanced lipid test like an NMR Lipoprofile test as well as an oxidized LDL test. If those show anything concerning, you may want to consider a low radiation coronary CT scan to check your coronary calcium.

I've been using ketones as my primary source of fuel since 2013. I initially relied on dietary fat to get there and now rely much more heavily on a long daily fast (over 20 hours) and exercise to get there. I've never felt better or cognitively sharper. I plan to maintain this lifestyle in indefinitely.

"I am new to ketosis (less than a year). I adopted the keto-MIND diet using caprylic acid (and sometimes C8/C10 and even a mixture with coconut oil). My wife and I have been on a relatively low fat diet like DASH or Mediterranean for 25 years. We both exercise daily and get regular restful sleep. We got a new puppy six months ago and life was pretty chaotic. I had brain fog and interrupted sleep. That is when I started caprylic acid and noticed immediate improvement. I looked on Amazon for user comments for a few different brands and many people were reporting nearly identical results. I have a strong medical team and have been visiting them all in the last 12 months. Also the aducanumab study kept tabs and notes on my underlying health."

[Julie G]

"I am new to ketosis (less than a year). I adopted the keto-MIND diet using caprylic acid (and sometimes C8/C10 and even a mixture with coconut oil). My wife and I have been on a relatively low fat diet like DASH or Mediterranean for 25 years. We both exercise daily and get regular restful sleep. We got a new puppy six months ago and life was pretty chaotic. I had brain fog and interrupted sleep. That is when I started caprylic acid and noticed immediate improvement. I looked on Amazon for user comments for a few different brands and many people were reporting nearly identical results. I have a strong medical team and have been visiting them all in the last 12 months. Also the aducanumab study kept tabs and notes on my underlying health."

I'm really happy that you're getting so much benefit! As I recall, you're an E4 carrier, so I'd encourage you to keep a close eye on your advanced lipids. Some people experience dramatically elevated LDL-P with MCT. It's also really important to track your glycemic markers. The MCT helps because it's overriding your reduced cerebral glucose utilization, but it's just a band-aid, and I would imagine difficult to keep up the constant dosing. Only by addressing any underlying insulin resistance will you begin to heal the primary issue. If you concurrently slowly adopt a long daily fast, with exercise, and cut out refined and processed carbohydrates, you'll begin making your own endogenous ketones. One of our members, Amy Berger Tuit Nutrition described MCT use without healing insulin resistance, as being akin to bailing water out of a sinking boat without first plugging the hole. So while you're receiving benefit now, you may not be able to sustain it indefinitely without doing the underlying work.

You were in the aducanumab study? Wow! Deep bow. Thank you for your service. Were you ever told if you were receiving a placebo or the actual Pharma? You're pretty impressive, my friend. Keep up the great work and share your progress along the way.

[mike]

I am very weight stable with a BMI of 19 and look forward to my daily feast. My ketones come from burning my own body fat.

I guess I'm missing something - how can you be weight stable when you are burning your own body fat?

[Julie G]

I guess I'm missing something - how can you be weight stable when you are burning your own body fat?

Because I'm eating enough calories to maintain my weight. By only eating once daily, by body is forced to burn my body fat as fuel for much of the day.

[TheresaB]

I guess I'm missing something - how can you be weight stable when you are burning your own body fat?

A keto adapted, aka fat adapted, person isn’t constantly losing weight but burning fat (vs glucose) as the body’s primary fuel source, note the subtlety.

Even a lean man has fat cells and stores of fat. Fat cells flux up and down, that’s what they’re supposed to do - act as a flexible fuel storage. As long as a person eats adequate calories, i.e. nutritional ketosis, weight stability maintains.

Once a person has become good at burning fat, there are epigenetic changes that up regulate your fat burning pathways and you'll stay good at burning fat for a while, a sort of metabolic inertia. When you run on fat, you’re level loading your electron transport chain (a good thing), and the body (mitochondria) lives happily off stored body fat (and keeping our mitochondria happy is very important for ApoE ε4s).

Nutritional ketosis reduces blood sugar, improves insulin sensitivity, and reduces inflammation, all good lifelong considerations for ApoE ε4s.

[mike]

Even a lean man has fat cells and stores of fat. Fat cells flux up and down, that’s what they’re supposed to do - act as a flexible fuel storage.

Okay, this makes more sense - I had always considered body fat to be more of a longer term storage, more seasonal. You are saying that there is a constant in and out of adipose tissue of fats, so excess energy from a single meal is being stored and then the fat is being released throughout the rest of the day?

[TheresaB]

You are saying that there is a constant in and out of adipose tissue of fats, so excess energy from a single meal is being stored and then the fat is being released throughout the rest of the day?

Exactly! There is a seasonal component to fat flux, but there's also a daily component. Your fat cells are supposed to expand during the day when you're eating, shrink at night when you're fasting.

[mike]

I was always under the assumption that glycogen was performing the day to day balancing of energy needs... A new subject to research!

[Josiah]

This has been an extremely informative thread, particularly Tincup's description of his regimen. I am certainly sold on the benefits of a life in ketosis. I have now been in ketosis for going on three months and while never having had any unpleasant experiences, I have seen next to no improvement in the important glucose related metrics and I have seen no improvement in my energy level (which sorely needs improvement) and I've also experienced (subjectively not metrics) a decline in cognitive functioning. Peter Attia reminds us that not a trivial percentage of people who want to succeed with ketosis and comply with the regimen still fail to prosper following this regimen. In the world of the internet low carb health you hear a lot about successes but very little about failures. And I'm beginning to wonder if I might be a ketosis failure.

[slacker]

I have now been in ketosis for going on three months and while never having had any unpleasant experiences, I have seen next to no improvement in the important glucose related metrics and I have seen no improvement in my energy level (which sorely needs improvement) and I've also experienced (subjectively not metrics) a decline in cognitive functioning.

Sorry to hear this Josiah. I apologize if you've mentioned this in another post: are you testing your ketones? If so, what method and what are the results? Are you getting enough to eat, or do you get "hangry" or have a sudden drop in energy that improves slowly after eating? Have you lost weight (and did you want to lose weight)?