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keto, weight loss, hunger

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JD2020
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keto, weight loss, hunger

Postby JD2020 » Wed Jun 17, 2020 11:13 am

I am a patient of a doc who is fully committed to Dr. Bredesen's protocol. I have a family member with cognitive issues and am embarking on this journey as a hopefully preventive measure.

My diet is healthy, "Eat food, not too much, mostly plants," organic, good quality food. My normal reading on Keto Mojo before any adjustments is .5 - 1.0.

The doc said that there is benefit to be had in reaching the higher level of ketosis. If I were in a disease state, I would transition to keto fully. Since I am not, I decided I would try to do this two days a week so that I might realize some of the benefits and enjoy food with the family the rest of the week. The other issue is that I previously tried keto full time, lost weight fast, and it took me a couple of months to regain.

Here is my question: what can I eat that doesn't have carbs, will fill me up, and will allow me to maintain weight?

I will use this week as an example of what I have done. I woke up this morning to 2.1 on Keto Mojo. For Monday and Tuesday, I ate veggies at every meal, eggs with breakfast, chicken with lunch and dinner, an avocado each day, lots of olive oil with everything. I also had several chunks of cheese (not my doc's favorite, but honestly, I need something that doesn't just float in my stomach) and lots of walnuts and almonds.

I need more. I can't fit any more veggies in. A nice bowl of rice or pasta would be helpful, but I know that that is not ok on keto. I woke up in the middle of the night hungry, this morning starving. Dinner was over at 6:00 (bed at 9:00). I lost 3 pounds, and based upon prior weeks, it will take me the rest of the week to regain that.

Thanks for any suggestions.

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Julie G
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Re: keto, weight loss, hunger

Postby Julie G » Thu Jun 18, 2020 8:04 am

I need more. I can't fit any more veggies in. A nice bowl of rice or pasta would be helpful, but I know that that is not ok on keto. I woke up in the middle of the night hungry, this morning starving. Dinner was over at 6:00 (bed at 9:00). I lost 3 pounds, and based upon prior weeks, it will take me the rest of the week to regain that.

Your current plan certainly isn't sustainable. Waking up with ketone reading of 0.5-1.0 is terrific. As someone who is insulin sensitive (do you know fasting insulin & bhA1c?) and using this approach for prevention, I question your doc's push for higher ketones. My guess is that you're already getting them later in the day. You clearly need more calories. Feel free to increase dietary fat with more EVOO, nuts (macadamias), etc. Also, experiment with small amounts of resistant starches like colored tubers, legumes, small amounts of rice, etc. Eating them cooked and cooled may both increase RS content and reduce glycemic impact. Be sure to finish with lots of EVOO to blunt a potential glucose spike. You could also do 1 & 2 hour post prandial glucose checks to see how your body is responding. As you already know, excessive weight loss can become counterproductive.

JD2020
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Re: keto, weight loss, hunger

Postby JD2020 » Thu Jun 18, 2020 12:55 pm

Thanks for the reply, and thanks for the reinforcing feedback that what I have worked out so far is not sustainable. I will start working on implementing your suggestions.

Just to clarify - the .5 - 1.0 readings have all been later in the day. I will do a reading on a "normal eating" day first thing in the morning to get a baseline.

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Re: keto, weight loss, hunger

Postby floramaria » Sat Jun 20, 2020 5:02 pm

JD2020 wrote:Thanks for the reply, and thanks for the reinforcing feedback that what I have worked out so far is not sustainable. I will start working on implementing your suggestions.

Just to clarify - the .5 - 1.0 readings have all been later in the day. I will do a reading on a "normal eating" day first thing in the morning to get a baseline.

Hi JD2020, I second Julie G in questioning your need to be in higher level of ketosis for prevention. And also in supporting you in your assessment that what you are doing is not sustainable. You don't want to wake or starving or be losing weight that you don't want or need to lose.
One thing that was helpful for me when I was new to a ketogenic diet was tracking my food intake on Cron-o-meter while I was adjusting to my new way of eating. (It is free) Though I was eating alot, my caloric intake was often far below my basal metabolic rate even for someone who was inactive, and I have never been inactive. My own solution was to add a lot more fats. I drenched my salads, my vegetables, and even my omelettes in EVOO,
and if my caloric intake was still low towards the end of the eating period, I'd have a Tablespoon or two of almond butter for a quick hundred + calories.
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JD2020
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Re: keto, weight loss, hunger

Postby JD2020 » Sun Jun 21, 2020 11:02 am

Good morning!

Thank you for the reply. I am feeling the need to defend the doc....

I think I last saw her in Feb. At that point, I said I could not do keto - way too complicated and way too much weight loss. I had been tracking everything in Excel and felt like I was obsessing over something that I used to enjoy (eating healthy food). She simplified it for me with this: 75% above ground vegetables, fill the rest with healthy fats (evoo, avocados) and protein. That seemed doable.

I asked her if there was benefit to achieving higher levels of ketosis if my natural diet got me to the low levels. She said that she does not know for sure as this is all relatively new, but she thought that there were benefits to be achieved by reaching higher levels.

I had a big work deadline, so I didn't start working on this until late April. Going hard for 2 days per week was my idea.

Floramaria - I love the idea of almond butter. Thanks for the suggestion. Almond + butter = what's not to love? Also, you make a point about basic math. This isn't going to feel good if I'm not getting enough calories, which clearly I am not. My natural diet is 3 - 4 cups of veggies a day, and I was trying to achieve the roughly 10 cups described in the ketoflex handout that I received. This goes hand in hand with tracking everything in Excel, right? Obviously suddenly increasing veggies by 2 1/2+ times doesn't leave a lot of room for food with calories. It also doesn't feel very good.

Julie - you and my doc know each other well. She does this work full-time, and she is devoted and brilliant. I feel lucky to have found her.

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Re: keto, weight loss, hunger

Postby Julie G » Sun Jun 21, 2020 3:24 pm

Julie - you and my doc know each other well. She does this work full-time, and she is devoted and brilliant. I feel lucky to have found her.

Hi JD2020! I'm blessed to know many devoted and brilliant docs so I will just have to guess as to her identify. :D I also appreciate the additional detail. Depending upon your age and how many copies of our "lucky" gene you carry, I may actually agree with your doc about the need for a higher level of ketosis. I mistakenly thought your BHB readings were fasting. If they are later in the day, you may need more.
She simplified it for me with this: 75% above ground vegetables, fill the rest with healthy fats (evoo, avocados) and protein. That seemed doable.

I also agree with your doc's description of what your plate should look like, but in terms of calories, the breakdown will be very different, only because fats are more calorically dense than carbs and protein. The actual macronutrient breakdown will be more like: fats: 70%, carbs 15% and protein 15%, with lots of room for individualization based upon your gender and basal metabolic rate with activity level. For me, this breaks down to 4-5 tbsp EVOO, a few handfuls of nuts and a small avocado for fat. I suspect you may need more, my friend. Please share your fasting glucose and BHB when you get a chance. Also, I'm curious about the length of your daily fast. FWIW, right before I break my fast, I typically reach my highest BHB level for the day.

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Re: keto, weight loss, hunger

Postby JD2020 » Mon Jun 29, 2020 11:07 am

Good morning!

To answer your questions:

I am 57, apoe 3 /4

BHB readings…not sure what this means, but I’m guessing that it is my morning Keto-Mojo readings. From this morning:

Ketones .5
From the glucose strip:
90 mg/dl
HCT 41%
13.9 Hb g/dL

Fasting glucose….I must have this. We did $$$$ worth of tests, but I do not see it.

I am trying this keto thing again today and tomorrow. I am going to dial down the veggies to make more room for food with calories. For exercise after all the gyms closed, I started walking up a nearby fire trail. I do this 2 – 4 times a week. It is a beautiful walk with a challenging hill. But on the one Wednesday morning that I tried to make it up the hill, I couldn’t do it. I was exhausted and freezing cold. Since then, I have not even tried after 2 days of keto. This time I will make sure I get more calories, and hopefully I will feel better. Thanks for all the help.

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Re: keto, weight loss, hunger

Postby Tincup » Mon Jun 29, 2020 7:41 pm

JD2020 wrote:BHB readings…not sure what this means, but I’m guessing that it is my morning Keto-Mojo readings. From this morning:

BHB = betahydroxybuterate = ketones from your KetoMojo
Ketones .5

Fasting glucose….I must have this. We did $$$$ worth of tests, but I do not see it.


From the glucose strip:
90 mg/dl

I am trying this keto thing again today and tomorrow. I am going to dial down the veggies to make more room for food with calories. For exercise after all the gyms closed, I started walking up a nearby fire trail. I do this 2 – 4 times a week. It is a beautiful walk with a challenging hill. But on the one Wednesday morning that I tried to make it up the hill, I couldn’t do it. I was exhausted and freezing cold. Since then, I have not even tried after 2 days of keto. This time I will make sure I get more calories, and hopefully I will feel better. Thanks for all the help.


You are making some ketones, but not sure how keto-adapted you are. This can take a while to fully adapt. Once you are, shouldn't have an energy issue.

The ketones will make your brain less hungry, but at the same time, your body will get more used to using fat for fuel. When this happens, your body's need for carbs for energy will decline.

When I keto adapted in Oct 2009, the only way I knew to do it was full stop <20 grams carbs/day. It was a shock to my body. I recall rock climbing and my bicep didn't want to contract as I'd run out of muscle glycogen. Once I was fully adapted, which took a while, this was no longer an issue. Now, I can water fast for 5 or 7 days and still go out and be pretty active without issue. I can't go quite as hard as I could in a fed state, but still not bad.

I'm also not sure you have to push the ketones to the max right away. My experience, and that of many others, suggest that full adaptation can take months, if not years. As you get more adapted, you can push the limits.

Being consistent with a ketotic diet will help your body adapt. Once you are fully adapted, going in and out is less of an issue. However initially switching back and forth could hinder adaptation.
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Re: keto, weight loss, hunger

Postby JD2020 » Tue Jun 30, 2020 10:37 am

Thanks for the reply and the reality check. What I am hearing is that if I don't eat keto consistently for a while, I am going to have issues every time I do this two day sprint. Food for thought.

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Re: keto, weight loss, hunger

Postby Tincup » Tue Jun 30, 2020 12:56 pm

JD2020 wrote:Thanks for the reply and the reality check. What I am hearing is that if I don't eat keto consistently for a while, I am going to have issues every time I do this two day sprint. Food for thought.


From my understanding, there are enzymes and other components that have to be upregulated for the ketone/fat system to work well. In many of us who've been eating a carb centric diet without long fasting components, this system could be considered in "mothballs." Nominally, there is generally a two week acute adaptation phase, (usually after this the "suck" ends). After that, adaptation can continue for months or years, but at a slower rate. After the acute adaptation phase is over, most people feel pretty good.

"Consider an analogy. Imagine that our bodies are fuel tankers. We drive these large tankers around, but only have a limited amount of gas in the gas tank. After the gas tank runs out, we are stuck on the side of the road calling for help. But wait, you might say. That’s ironic. You are carrying an entire tank of gas, but ran out of gas. How is that so? Well, that gas is not accessible.

In the same manner, we carry around huge stores of energy as fat (even very lean people). But our muscles are trained to run on sugar, and they run out of energy, so we need to continually refuel despite the large tank of fuel stored as fat." Source
Image

Even after acute adaptation, your muscle glycogen stores may not be refilling. Hence activity that requires Type IIX fibers, such as sprinting or very heavy weight lifting may suffer lower performance. Steve Phinney MD PhD did a bicycle racer study around 1980 and writes about it here.

Personally, this is not an issue for me and many others who are adapted longer term. For most it isn't a huge deal after the acute adaptation phase, unless they are competitive athletes. I'm 65, I can ski the steeps off piste all day without any rest keeping up with my very fit friend who is 30 years my junior. I can rock climb all day. I can jump rope, do bodyweight exercise, TRX suspension trainer with their military programming, weight lifting and so on. I can do all of this multiday (2-7 days) fasted.

Also, my system now makes ketones almost no matter what my carb intake. In 2017, I did a two week study where I weighed everything that went into my mouth on a gram scale and recorded it in the Cronometer.com database. My carb intake ranged from ~80 to 180g/day with a mean of 123, of which ~50 were fiber. I was still testing 0.9 mmol/L ketones in the morning. If I do a multiday fast, I experience no "keto-flu." My glucose just drops, usually into the 50's (mg/dL) after a couple of days and ketones rise to between 4 and 8 mmol/L, depending on length of fast.

The keto-flu link has suggestions on how to minimize these impacts. Primarily electrolyte intake. I was not well educated on this in 2009, so I just powered through.
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