Note: for those of you that didn’t read part 1, read part 1 – ‘k?

Sorry for the cliffhanger. I’m nearing 10 weeks in ketosis and have written 84 pages journaling my experience. Dumping that on you would be a bit much – but trying to summarize has been a bear. This is my second shot at it.

I’ve been doing (at least trying) to do a low carb / keto diet since 2003. In this go-round I have done a number of things radically different than in the past.

I made health – not weight loss – my goal. I have spent 15 years reading and researching this diet. I truly believe it to be the best diet for me. As I am focused on the health aspects, the moving of the scale is a nice perk – not the main goal. If the scale doesn’t move it might frustrate me – but it is not a failure. Eating off-plan is the failure.

I immersed myself in everything I could about the ketogenic diet. There are way more books, audiobooks, and podcasts with new information. Keto has become a ‘craze’ again and there’s a lot of new and interesting information and many people in Facebook groups discussing it. I personally don’t completely agree with *any* of the approaches I have seen, but have borrowed things from many of the approaches to forge my own version. I did a lot of experimenting and learning – and while I have been in ketosis for nearly 10 weeks now, how I stayed there has radically changed from the way I did it in 2003 – and the way I did it in April 2018.

I have started taking supplements again. When I looked I back to 2003 and asked myself what was different from when I first lost 80 pounds and now,  one big difference was I didn’t take supplements anymore. Back in the day I had taken a plastic film canister’s worth each day. I became disillusioned with vitamins (read ‘Do You Believe in Magic?‘ like I did to understand why) and had cut back to just a multivitamin – and only a few days a week. I began taking it every day and began to try to figure out what other supplements might improve health and am building up a ‘stack’ of supplements to see what impact it might have. I’m still experimenting here but will discuss this further below.

I fast 16 hours per day. I do what’s called a 16:8 intermittent fast daily. I skip breakfast – only having black coffee. This used to bother my stomach but I’ve apparently healed whatever the reason was for that and now it’s not a problem. I then have my lunch around 1pm and my dinner between 8-9pm. I don’t have hunger issues nor do I have food fantasies. Being in ketosis this long simply removes constant hunger from the equation.

I don’t snack. Here’s a really interesting notion I am experimenting with. While removing carbs reduces blood glucose, it’s not really blood glucose that is at the heart of the problem – it’s insulin resistance. Insulin is an energy storage hormone. When you eat carbs, your pancreas squirts out insulin to get the excess glucose out of your system, driving it into your fat stores mostly. After decades of abusing this system, your cells no longer respond to insulin and your pancreas has to squirt out more and more to get the same effect. So you can check your blood glucose levels and everything looks fine – but your insulin is through the roof.

So you give up carbs and your blood glucose goes down. That’s great, but you still have this insulin floating around. Know why? Because protein also stimulates an insulin response, you are STILL promoting insulin resistance.

So here’s an idea that seems to make sense: what if you were able to give your body an ‘insulin holiday’ – would being able to allow your body to not have insulin constantly in your bloodstream give your cells a rest and allow them to increase their insulin sensitivity?

Some people think it does, so I’ve decided to experiment with this. I’ve read that an insulin response can last up to 8 hours after a meal. This would mean that doing a 16 hour fast – with no calories coming in – gives me at least 8 hours per day where there is no insulin in my system.

The notion of snacking means you NEVER stop producing insulin. So the notion of a ‘snack’ is not part of my life.

There’s a second part to this which I will go into next.

I make sure my meals contain enough protein. What I read was that a particular amino acid – leucene – in adequate amounts – produces ‘Muscle Protein Synthesis’ or MPS. From what I read you need at least 3 grams of leucene in a meal to produce this effect – and leucene is approximately 10% of the amino acids in a piece of meat. From what I’ve read this will prevent muscle loss during weight loss even is you sit on your ass. A 16:8 fasting schedule provides me with 2 doses of this effect per day and maximizes the efficiency of the protein I take in per day. Remember that a properly formulated ketogenic diet is supposed to be an ‘adequate protein’ diet. If I have between 40-50 grams per meal I am well within the ‘adequate range’ but making every ounce of protein count.

I don’t add fat to my food. What kind of screwed up keto diet is it where you don’t add fat? Here the idea is that if you want your body to burn fat, you want it to burn your CURRENT BODY FAT – not the fat you ingest. I calculated my macros (carbs, protein, and fat using one of the many ‘keto calculators’ out there. This one at https://www.ruled.me/keto-calculator is adequate – and instead of aiming for an exact target I came up with my own ranges – these are mine:

Calories:     1200 – 1892
Carbs:        20
Protein:    94-124 (104 is ideal)
Fat:        77-155

This give me a wide latitude to play in and not have to worry about being so damned exact about things. I typically meet my minimums at lunch and have a larger meal in the evening. I tend to be at the low-end on fat – which comes from the meat. I very rarely add fats to my cooking – maybe olive oil to a salad though I don’t eat salad as often as maybe I should. And this leads to another interconnected point.

I have a very limited and simple diet. OK – this is where you stop reading. I get it. But if you are interested in how my relationship to food has changed, keep reading.

If you join the keto groups on Facebook, you will frequently be exposed to keto food porn on some of them. The inventiveness in these groups is boundless and you can find bread recipes, pizza, ‘fat bombs’, all sorts of snacks, and could happily avoid most carbs and still have your favorite indulgent foods. The problem is two-fold for me: these recipes take a lot of time to prep, and sometimes the calories are through the roof.

I don’t do this. I’ve stopped frequenting these groups that post the food porn. Instead, I’ve chosen to follow a very simple diet dominated by the following foods:

• Chicken thighs
• Chicken breasts
• Grass-fed beef
• Hot Italian sausages
• Grass-fed, nitrate-free hot dogs
• Nitrate-free bacon
• Broccoli
• Lettuce
• Kimchi (Korean fermented cabbage)
• Avocados
• Arugula
• Olive oil
• Ghee (also called ‘clarified butter’)
• Less than 4 oz. of cheese per day.
• Salt
• Trader Joe’s 21 Seasoning Salute

I’ve certainly had other keto-friendly foods (pickles, tomatoes, eggs, cauliflower, a little pasta sauce, salsa, among others), but the above list predominates.

You might be thinking: what a restrictive diet!

that is exactly what I thought as well – until I tried it.

I find it LIBERATING.

Nearly everything I cook is baked. I cook enough meat and veggies for 2-3 days. I measure out my portions into sandwich bags on a scale for lunch, then weigh out my dinner. Since I don’t snack, I have what I would call a natural and normal hunger response when I do eat – and I enjoy my food. I even find my portions to be almost too large at times – though my total calories for the day can sometimes be as low as 1200 calories. While you might think this is a rather bland set of flavors, my response to flavor has changed since I removed what I some call ‘hedonic’ foods with complex layering of flavors. I thought I never could wean myself off of my Orange-Tangerine artificial sweetener, but after a few miserable days, I didn’t miss it anymore. My palate has adjusted, I love my meals, shopping is a breeze, cooking is a breeze, lunch is a breeze – and now I know what it feels like to ‘eat to live’ rather than ‘live to eat’.

“I don’t eat that.” I’ve given up a lot of things – all grains, nuts (portion control problem), sweeteners, a lot of dairy (portion control problem), and so many other things I can’t count. I don’t have willpower nor do I believe in willpower as something that can be sustained over a lifetime against something as primal as hunger – and there is a bit of a mind trick I use to deal with this.

I have a lot of respect for ethical Vegans. They have made a decision that eating animal products is wrong and they do not eat them. They simply say: “I don’t eat that.”

there’s no negotiation here. Ethical Vegans don’t have a ‘cheat day’. It is black and white for them. I’ve decided to do this on my diet. I have foods I eat – and a very long list of foods I don’t. If offered, I say: “I don’t eat that for health reasons – and I can’t even have a taste.” If a further explanation is needed, I am eating this way to avoid getting full-blown diabetes and the best way for me to do that is not having the smallest cheat. As soon as you open the door to a small cheat, a larger one can easily creep in, and BAM! There goes all your hard work. This has happened to me too many times to count.

Like Vegans, people will think you’re odd – even odder than Vegans because their way of eating is better known. My diet is for health reasons first. I have my reasons for eating this particular way that most people won’t care about – and I won’t bore them.

I can easily sit and watch people eat all this stuff in front of me and I don’t care. My older daughter tried tempting me with bread at the steakhouse but my reaction to the bread was like a rabbit reacting to a slab of beef: utter indifference – because I don’t eat that. If I allowed cheats I would exhaust myself with the ‘how much can I have’? then having even a little taste will turn on cravings in the brain I don’t have anymore for 72 hours after the cheat, according to one doctor. So even one bite will at least make me miserable for 3 days – and at the worst, completely derail 10 weeks of hard work.

If I eat the way I do now, I don’t have diabetes. If I eat like a normie – I do.

I watch my salt, magnesium, and potassium. When you start a low carb / keto diet you lose a lot of water weight quickly as the carbs in your system bind to water molecules. No carbs and you lose that extra water – good – but as you lose the extra water you begin to mess with electrical pathways in your body and have the potential for problems if you don’t watch your electrolytes. This is how you get the ‘Atkins Flu’ as it was called years ago, or the ‘keto flu’. You get a headache, you get shaky, you get a head rush. This is your body’s electrolytes going screwy.

With salt, I make sure to salt all my food. Then I will have a glass of salted water if I feel weird – or just because I haven’t eaten in a while. I also take a magnesium supplement daily.

From what I’ve read, I am leery of taking potassium supplements. People on these keto Facebook groups usually use a product called ‘No-Salt’ – a salt substitute, but what these online groups don’t tell you is that some people – like me – are on ‘potassium – sparing’ blood pressure medications where is says on the damn label not to use this stuff. So I don’t. Potassium also seems to be the one that can also fuck you up the most – causing your heart to beat wrong. That’s something that can kill you and I am not going through all this trouble to die! I usually get my potassium through foods – an avocado is a great source.

Being this deep in ketosis also means heavy exercise or being out in high heat can mess you up way faster than normies walking around with excess water weight and electrolytes. I’ve heard people say they steal salt packets from restaurants and make sure they have a couple on hand – and some water – in case they feel weird during activities like these. This electrolyte issue also calls into question the bogus medical advice of drinking 8 glasses of water a day. For regular folk – so what – it gives them something to do other than eat, makes them feel full, and makes them feel good about themselves. Folk in heavy keto lose extra electrolytes like this. I will frequently drink a liter of seltzer on ice in the evening, or water during the day – but I really don’t count and do it because I’m thirsty.

I take ‘weight loss’ naps. Sleep is real important. I know a lot of people struggle with sleep – I don’t usually have a problem. One less thing for me to worry about as poor sleep can prevent weight loss – and is certainly not good for your health.

But here’s something I noticed in me by accident. Occasionally, on a weekend, I find the opportunity to take a nap. Lazy shit that I am – I take it. What I have found more often than not is if I weigh myself after the nap, I’ve lost a pound or two. It’s the damnedest thing. I’ve seen no one else mention this, but it does happen to me.

I measure my meals using Cronometer. None of the diet tracking apps are just right. Some can’t count net carbs. Some have nutrient values that are not based in reality. Some are just not designed very well. I’ve recently started using Cronometer and while the free version has annoying advertisements that can make you wait a few seconds before entering your values on certain screens, it is my current fave. I particularly like how you can set your own macros, clearly show net carbs, and view your micronutrient counts. There’s some things I don’t like – and some things that don’t work as expected, but here’s the thing: because I eat pretty simple, it’s pretty simple to enter my macros in a minute or two. Another app called Carb Manager is also good – I just prefer Cronometer.

I mess up at pretty much all of the above. Think of all of the above as the bullseye on a target for me. I aim for that center. Sometimes I don’t hit it – but that’s what I keep aiming for. Example: after a very good meal where I had two martinis (which I should not have had!), when putting away the food I ended up having some of my kid’s leftover mashed potatoes. While this didn’t cause me to go out of ketosis, it *did* cause my blood glucose to spike – my morning fasted glucose the next morning was 138. the day after it was 40 points lower.

Lesson learned: The way I eat determines if I am a diabetic. This one cheat helps reinforce the reason I have a ‘no cheat’ rule. I still drink from time to time. Usually red wine. It does not knock me out of ketosis and doesn’t raise my blood glucose – but it does increase insulin resistance and does slow weight loss – and does make me feel crappier the next day. I’m still working to minimize, if not eliminate this.

I feel better, but think I could feel better still. I still have a lot to learn not only about a long-term ketogenic diet as so much new research and thinking has been done in the past few years, but I have to learn about Me – my personal physical and emotional makeup at the present time in the context of a ketogenic diet.

Let’s face it: I’m 55. I’m probably late to the game of optimizing health – and there is certainly no shortage of people who want to tell me the right way to do this. Dr. Jason Fung, in the book ‘The Obesity Code‘ wants me to go on extended fasts lasting days.

I don’t know about that. I’ve read that there can be positive benefits – autophagy is one example – which is a recycling and cleaning of your body’s cells when you fast. (Here’s a link to some online doc I just found that discusses why it’s good for you.) Sounds good, but I’m not sure that I can’t get some of that same benefit with my 16 hour fasts – or occasionally eating once a day (which I can pull off with little effort). Or Dr. William Davis’ book and website ‘Undoctored‘ where he suggests you add raw potato as a prebiotic to a smoothie. Not too sure about *that* one, Doc – though I *did* take his advice to NEVER take calcium supplements with vitamin D because adding calcium to the diet has never been shown to help reduce bone loss – but there’s some evidence that this calcium ends up on you artery walls. I’ve got more to learn here, though to fully understand what he is saying.

I recommend both books. Dr. Fung’s makes a strong case that the focus on health for most of us fat folk leads to minimizing insulin resistance. Dr. Davis has a grander goal and proposes an entirely new medical model where patients educate themselves to treat the underlying causes of disease, be smart enough to know when to involve a doctor, and to establish a doctor-patient relationship where they are partners in decisions because the patient might just know more about their disease state – and physicians stop acting like they know it all when the hours they work and the volume of information makes that impossible.

Right now my goal is to have my next blood work 6 months (October, 2018) from the start of my diet. It can take that long for numbers that can go out-of-whack as you begin the diet to normalize. During that time I will hopefully be able to lose more weight – which should help those numbers. I’d like to further explore supplements. Some I’m taking now I could not give you a clear explanation as to why I am taking them. For example: I’m taking 6000IU of vitamin D3 per day. Why? Because my Retinologist – a ketogenic nutrition nerd like myself except way smarter – told me that’s what he takes since he read the book ‘The Vitamin D Solution‘. I have the book, but haven’t read it yet. I am going to supplement with a small amount of iodine – 300mcg – because from what I’ve been reading from multiple sources, I have some symptoms of a sluggish thyroid – and most clinicians do not run the proper tests to determine this – and even the test they do run they misinterpret. But too much can also be bad and actually *cause* hypothyroidism. I have a lot of researching to do here. I want to study this area more closely and understand why I need a TSH test, a Free T3 test, a Free T4 test, a Reverse T3 test, a TPO antibodies test, and a TgAb test. *I* also need to understand the current thinking on how to interpret the results because docs won’t order test they can’t interpret.

I also need to understand a great deal more about why a standard lipid panel is not adequate for someone living a keto lifestyle. I know the short answer: the LDL-C. The ‘C’ in the name means ‘calculated’. It’s not an actual count but a calculation that isn’t particularly accurate for people on a keto diet. The NMR test actually counts the different LDL subfractions and provides a lot more precision as there are only a few of the LDL subfrations that are dangerous. I have to be able to convince my doctor so when *he* gets second-guessed by the health plan as to why he is ordering a more expensive test, he doesn’t have to hear them bitch about it.  Or I have to convince him to write me a prescription for it and then pay for it out-of-pocket – and it doesn’t even appear that I am legally allowed to order my own blood test in New Jersey – I’ll have to drive to PA to be allowed to get a blood work I will pay for myself as New Jersey thinks it is too dangerous to allow me to make these decisions for myself?

There’s also potential dangers to the diet – depending on who you listen to. Of course, a normal diet will most assuredly give me a case of Diabetes with complications of kidney disease, blindness, dementia, and amputations being some of the wonderful complications I can expect from that. But still – if not done right – keto can potentially cause pancreatitis, gallstones, kidney stones, and dangerous heart rhythms. All this leads to the my last point.

Don’t follow me – I’m lost. Ever see the bumper sticker that says that? It’s probably the best advice – the wisest advice I can give you. Don’t go on a ketogenic diet. Don’t do this. Don’t try this at home. Most people just want to be told what to do – they don’t want to do all this ‘thinking’. Ketogenic diets are poorly understood – or even considered dangerous (often for the wrong reasons) by most doctors.

There are people who learned about the keto diet 2 years ago, lost weight, set themselves up as an expert, and run blogs and Facebook groups signing people up for expensive courses on how to lose weight. They sure *act* like they got it all figured out…but I’m not sure.

I see one group contradict another. how do you calculate your protein intake? One group says calculate it using your current body weight – the other say by your *ideal* body weight. Some say saturated fat is great – others say it’s OK, but any added oil should be monounsaturated olive oil. Some think seed oils like corn oil and soybean oil are OK – I avoid them like the plague. I don’t see much discussion about the Omega-6 to Omega-3 ratio. This is important. I see some people recommend taking a ton of fish oil – but don’t mention that it is a natural blood thinner and could be dangerous to people already on blood thinners.

I could go on…is your head spinning yet? My wife just asked me “What do you do all the time on the computer?” I explain that I spend most of my waking hours reading and researching nutrition and ketogenic diets. I don’t think she believes me – or if she does she thinks I am crazy.

I spend all this time – it’s my hobby/obsession – but the more I learn the more I know I don’t know squat. That is why a long time ago I got out of the advice business. Please read my disclaimer if you even remotely even consider applying anything here to your own life.

I could go on but I’m sure you’ve had enough.