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?

[Tincup]

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?

I've been "keto adapted" for 9.5 years. Followed Dr. Gundry's advice for E4's since mid-2014 and became a patient in the first part of 2015. Posted labs and transcripts of consults here. We've had 8 consults but have only gotten around to posting 7. Will post the most recent one when we have time.

Our diet is ovo-pegan (eggs, white fish, shell fish, no grains, legumes, nightshades, seeded veggies or fruits except avocados, but lots of leaves, tree nuts and other veggies & resistive starches). When I did a two week diet tracking experiment with a gram scale two years ago, my carbs/day were ~88, 123, 180 (min, average, max). Of that 50-60g/day were fiber. Per Dr. Terry Wahls, I try to eat around 9 cups of veggies/day with 1/3 greens, 1/3 from sulphur containing veggies & 1/3 from veggies colored all the way through with at least 3 different colors. I eat in a 2 hour window once a day. My fats are mostly monos from olive oil, avocados & nuts and comprise 70-75% of my daily 2100 calories. About 60g are protein. If I test BHB, I'm usually between 1 & 2 mmol/L in the morning. If I do a multi-day fast, by the morning of the 3rd day, my glucose is in the 50's (mg/dL - 3's in mmol/L) and ketones > 4 mmol/L.

I consider myself a "dual fuel machine." All activity is fasted by 14-20 hours. Sometimes I will do material exercise on day 5 to 7 of a water fast. This is OK for working out in the gym, less so for skiing the steeps off piste in deep heavy snow (I've done it).

Travel days are always fast days.

Don't know what tests to suggest. Gundry runs a huge swath (linked above) from 5 different laboratories on us. We do well on almost all the metrics. Our tests of inflammation run very low (various cytokines).

We pulse our intake of starches (green plaintains, sweet potatos, yuca & etc). We never un adapt from ketosis. We do focus on nutrient density and variety.

I forsee maintaining my diet till I'm done on the planet.

[Creekside]

@Tincup - What does "pulse our intake of starches" mean?

And, thank you so much for the transcripts and data you have provided us. They really helped me start to build a better picture of some core ways Dr. Gundry approaches the issues for you and your wife. (Especially nice to see the differences as well as the commonalities.)

[cflegal]

One thing that I have not mentioned in previous posts is "intentional tremor" in my right hand. Since I began taking caprylic acid and being in permanent ketosis my tremor has diminished. There is some literature examining ketosis and caprylic acid in specific suggesting that this is an expected effect and is being studied as a recommended therapy. I love this side effect.

[Tincup]

@Tincup - What does "pulse our intake of starches" mean?

And, thank you so much for the transcripts and data you have provided us. They really helped me start to build a better picture of some core ways Dr. Gundry approaches the issues for you and your wife. (Especially nice to see the differences as well as the commonalities.)

My original goal for keto adaptation 9.5 years ago was to maintain low insulin levels. Higher levels of insulin will inhibit ketone production. As ketones (blood, urine, breath) can be measured at home and insulin can't, it seemed like a way to accomplish this. Our diet is not what is commonly construed as "keto." The common one is <20 or so g carbs a day, a piece of meat with a veggie, maybe with a bunch of cream. Ours is higher carb and significantly plant based. If someone is not metabolically compromised or using ketosis to treat a specific illness, such as cancer or epilepsy, then the thought is that continual deep ketosis, without any breaks may be suboptimal. Hence periodic carb spikes may be in order. So every few days we tend to have a meal that is carbier, generally using a carby resistive starch for this purpose. This could be sweet potato, jerusalem artichokes, yuca. I've talked Dr. Joe Mercola about this and he does this on days he works out at the gym. That being said, I still tend to be in mild ketosis (0.5 mmol/L or more) if I sample the morning after (I don't sample frequently because the results aren't variable and don't provide information). I'm not too intentional about this - meaning I don't say "I'm going to carb up every X days." It just happens usually one or more times a week. I should also note we are both very metabolically healthy at this point. If someone was working on getting rid of the NAFLD, then fasting/strict keto would be in order.

I have a family member with a glioblastoma brain cancer who eats a strict keto diet. I would not suggest that he have increased carb days.

[aphorist]

Hey George. Quick Q for you -- do you drink any coffee or tea? Caffeine? Thanks in advance and for all your contributions to this forum. It is quite valuable to others.

Best

aph

[Tincup]

Hey George. Quick Q for you -- do you drink any coffee or tea? Caffeine? Thanks in advance and for all your contributions to this forum. It is quite valuable to others.

I'm genetically a slow caffeine metabolizer so no coffee. Gundry, in our most recent consult (not yet posted transcript) and in his most recent book said that one way that Metformin works for metabolism (when I asked his opinion of metformin for longevity - he said he doesn't take it) is to increase of akkermansia muciniphila as gut bacteria. He says he consumes Pu'er or Pu-er tea from China which is supposed to do the same thing. Hence I may try this, but will have to drink it very early in the day so as to not disrupt sleep. My 4/4 retired Navy wife does drink about 40oz of coffee each morning. I do eat about 12g of 90% dark chocolate most days. I can't eat more or I can't get to sleep. Of course chocolate has theobromine, and theophylline in addition to caffeine. I have an Oura ring (which I keep in airplane mode). I've noticed that my heart rate drops significantly early in the morning if I fall back to sleep during meditation. I'm wondering if this is from a) eating my daily meal later in the day and/or b) the chocolate. I know that from a circadian rhythm perspective, not eating after noon would be ideal. It doesn't work too well for us socially, but I may experiment. Here is a Pu-er post from Gundry. A mice study.

[Julie G]

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 Lipioprofile 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.

[mike]

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.

Julie, are you saying that you are no longer following a high-fat diet? Endogenous ketones have to come from somewhere - either from something that you are eating, or from existing body tissue. Are you maintaining body weight?

[Julie G]

Julie, are you saying that you are no longer following a high-fat diet? Endogenous ketones have to come from somewhere - either from something that you are eating, or from existing body tissue. Are you maintaining body weight?

It's certainly not low fat, but I eat primarily non-starchy vegetables for carbs. Most days I enjoy a liberal serving of EVOO and other high fat foods like avocado, nuts, olives because I like them. 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.