My Keto (measuring) Journey
Some of you may know that my "Keto Journey" began about 8-9 years ago. Battling infertility and looking for help and answers everywhere, out of desperation really, I put myself on a very strict "detox" for just over a month in the hopes that it would somehow "miraculously" help me get pregnant. I wasn't overweight, but I had gained a significant amount of weight in a very short time, and it all seemed to coincide with my menstrual irregularity, hair loss and inability to get pregnant. At the time, I didn't call this diet "keto" not even Low-Carb. I was not in "that world" at that time. I lived in Mozambique and even though my practice focused almost exclusively on helping people with "Metabolic Syndrome" (Obesity, Diabetes and the like), I had very little training in the Nutrition field. I helped people eat "healthier" by substituting refined flours with "whole grains" and eating more fruits and vegetables. I was really on the fence about "fat" in general, I just knew that "margarine" was definitely bad for you and olive oil was not! The "Base Diet" I used to give my patients, if I had to categorize it now, I would call it a "Paleo-like Diet", a Moderate Low-Carb Diet (I had never heard of Paleo btw), and the "Detox" I had them do about once per month, I would today call it a "Keto-like Diet", a strict Low-Carb Diet. Wanting to get pregnant and intuitively knowing that some of my patients got pregnant "miraculously" after losing some weight, I went "all-out"! "Detox" for me, all month long, every day! Wouldn't you know it, the very next month, I obviously ovulated...and got pregnant. Thank you very much, dusted my hands off, that's all I needed, no more diet for me.
Fast-Forward a few years, after Pregnancy #1 and #2, complications after complications, medications and medications, weight gain after more weight gain, very unsuccessful attempts at following a "healthy" diet, I decided to follow a Keto diet, at least for a while. I, like many other people, did not want to follow a strict low carb diet, nor did I believe it to be healthy or necessary, LONG TERM. So, instead, I started trying to do a more Moderate "Paleo" Low Carb Diet. I liked the idea of it. It went along with my ideals of a "healthy" diet, it included root vegetables and fruit, and 5-6 meals per day. But for "whatever reason", this did not work for me (insert shocked face here). "Paleo" was very well known and talked about at the time, and I knew many people that did very well on it. I wanted to do very well on it, too. It made total sense to me. At the insistence of my husband, who had dabbled with MANY (successful) attempts at Low Carb eating in the past, we decided to try the "Keto Diet". It did seem a bit crazy to me. LOTS of fat, very little carb, no root vegetables or fruit?!? This was a welcomed change for my husband because even though he had done a lot of Low Carb Diets in the past, they were not necessarily high in Fat, probably higher in Protein. My initial attempt at Low Carb (TTC with baby #1) wasn't necessarily higher in fat either, although I wasn't really monitoring that or calories at the time.
I thought, let's give a try and see how it goes. This is how it went: Weight shed off, quickly. All baby weight gone (#1 and #2). One day, while walking in the middle of a drugstore, I noticed I was VERY dizzy, so decided to check my BP (Blood Pressure) right there. VERY LOW. Got off all BP meds that same day. Energy levels, VERY HIGH. Mood, significantly improved, probably the most significant (reported by husband). Cravings (another biggie for me) not present at all. No snacking, no hunger, no "reactive hypoglycemia" (a lifelong struggle). Hum, so now what? This was within a few months of following this Keto Diet (maybe 2 months?). I did not "Macro Count" and I never checked ketones, really because I didn't want to, didn't know too much about it, and it was working just fine for me. This is called following a "Lazy Keto" approach. I really like "lazy" (just ask my mother"). At this point, I became a MAJOR keto advocate. I was completely immersed in it. I would read everything I could get my hands on, I would post and repost stuff. I watched every video out there, researched where all the conferences were at. I was just about to start practicing again after my Mat Leave, and I decided from that day forward, I would never advise any other "diet" to anyone, every again (until IF came into my life).
My "lazy keto" day looked like this: I followed Keto recipes initially, and then started making my own. I started eating 3 meals/day and probably some snacks (? can't remember), but eventually I moved to eating 2 large meals, until satiety. I really don't think this was on purpose. It's just what happened, naturally. Eventually I discovered that most people on a Keto diet followed a "natural" 16/8 "fast". Intermittent Fasting came into my life! This is when I discovered Dr. Jason Fung and Megan Ramos. As fate would have it, a few months later I met Dr. Fung at a conference and he invited me to work for IDM (of course like many other millions of people, I had already contacted him in the past...).
My professional journey into the Low-Carb world started approximately 15 years ago I guess, when I had to put something into my practice. My personal journey started when I was trying to get pregnant 8-9 years ago with my first child. My true venture into keto started close to 5 years ago. Initially very "lazy" (as mentioned above), then as my interest grew in learning about how insulin reacts in response to different foods, I started checking macros and eventually ketones. I would like it to be noted that I am not a "keto dictator" or even a "keto fanatic" as I have heard people describe keto advocates. I actually "don't care" how many grams of carbs or fat people consume, as long as it works for you. But if you are wanting guidance, particularly if your diet is NOT working for you, tweaking might be a good idea.
The very first time I checked blood ketones was 3 weeks ago (seriously). Yup. I have checked urine ketones and breath ketones in the past, not regularly, and always out of curiosity more than anything because I was one of those lucky ones that "lazy keto" always worked really well. I decided to start checking blood ketones for a few reasons:
1) My program Director, Megan Ramos, got me a Keto Mojo (so it was "free", lol)
2) I started to feel "unwell" and my BP (Blood Pressure) had measured high at a recent doctor's visit and I was curious to know what was going on "inside"
3) Once I started checking, I realized that these numbers gave me a lot of confirmation and validation of what I had learned over the years through my own experiences and those of my patients
4) I wanted to share these numbers and this guide with people, so that others too may get an insight at what might be going on inside when they eat certain things (since I am not an alien, I figure that my insulin responses may be very similar to those of other humans), so maybe not necessarily n=1
Important questions before you start reading this journal:
1) What are Ketones?
2) How does Insulin affect ketone production?
3) What is Nutritional Ketosis?
4) How does Nutritional Ketosis differ from (dangerous) Ketoacidosis?
Right. Well, none of the above are addressed here. For those questions, I suggest a bit more research. But...if you know the answers to the above questions, let's move on.
I figure some of you may still need a "legend":
Some of you may recognize this image from Volek and Phinney's book "The Art and Science of Low Carbohydrate Performance". I am referencing it here because I believe this image illustrates exactly what my blood ketones have taught me, or at least confirmed what I already believed. When people switch to a Low Carb Diet, they normally start to produce some ketones. Carbohydrate restriction lowers insulin production, lower insulin will trigger the body to burn fat for fuel (producing a by-product called ketones). Great. Will you lose weight right away? Well, if we understand the functions of insulin, it will make sense that as your insulin levels start to drop, not only do ketone levels rise, but there's also a "release" that expresses itself as "increased urination". There's some obvious weight-loss that accompanies this physiological process.
Most of us want to achieve the "Optimal Ketone Zone" illustrated above. Why? This is the low insulin, low blood sugars, high energy, FAT BURNING zone. In blood ketone measures, this looks like 1.5-3 mmol (millimolar), the dark green area above. I call the 1.0-1.5 mmol the "being on the fence zone" (light green area). I personally don't like it, it doesn't feel good, and doesn't seem to look good on the scale either (not everyone cares about weight though, I get it). The astute LC/IF follower will recognize the yellow zone above, "Starvation Ketosis", the 3-6 mmol range, as the AWESOME level some of you may have reached during EF, Extended Fasts, often reached after 3d+ (72h).
MY KETO (measuring) JOURNEY:
I started measuring in the beginning of June, 2018, and I wrote a journal for my IDM patients.
Wednesday, June 6 at 8:41 PM
I’m feeling very accomplished right now. Just measured 1.5 (mmol) on my Keto Mojo. On a Wednesday (I haven’t been getting to that level until Friday and then I kick myself off...you guys have heard this story...). My goal is to see at least a 1.5 (mmol) on a Monday morning...and that’s what I’m going for. I needed a good kick in the butt and I got it! 1. Blood pressure went up (but that wasn’t enough)... 2. PCOS acne returned (that still wasn’t enough...) 3. Saturday morning after having toast and mango (I blame my mom...) my BG was 163 (mg/dl) 😱 that’s a 9 (mmol/L) for my Canadian buddies...
Sunday I went to a party but I fasted! And this week I’ve been doing the 8am/2pm (meals) and ADF (Alternate Day Fasting) for 24h. Next week I’m prepping to do a 3-5 day fast. I feel better than I have in a long time!
Friday, June 8 at 4:01 PM
I’m doing this cause I’m going out to dinner and the weekend is starting. My commitment to myself is that I want to be in this ketone range come Monday and Tuesday. You all know how very honest I am with myself and you! So bring the weekend on!!!
Monday, June 11 at 9:07 PM
About 28h into my fast (planning on doing 72h+/-) and look at these numbers?!? I could not have done this WITHOUT YOU. Being part of this community is so important for my health and commitment. Being honest and true to you guys, I was able to stay Keto for 2 weeks, prep for this fast and hydrate properly! And I still went out Friday and Saturday with my family. I ❤️YOU GUYS"
Tuesday, June 12 at 8:50 PM
I didn’t have my phone nearby, but my EF (Extended Fast) continues, BG (Blood Glucose) at 70 mg/dL and ketones at 3.3 mmol/L. I’m going on till tomorrow and then I’ll decide. Might have 2 meals tomorrow (72h) or have a meal in the evening, or might even go on till Thursday. I find that even in the past I had a hard time going beyond 72h because of lack of “motivation”, in my mind I always think it’s “enough” for me because I am very good at Keto and IF...that’s my “sweet spot” (when things are good!)
Wednesday, June 13 at 9:54 PM
Some more info on my tracking journey...not great! So after about a 76h fast (Pictures 7 an 8), I decided to eat the meal below (Mexican cauli rice and berry heaven, Pictures 5 and 6). Both recipes sent earlier (on my site). I didn’t put cheddar cheese on the cauli rice but it did have sour cream. The berry Heaven (whipped cream) was “unexpected” but I was hungry enough to eat it and enjoy it, which is great, but my numbers don’t look great! Post meal (about 1 hour later) are pictures 1 and 2. Pictures 3 and 4 are about 3-4 hours post meal (ketones still going down, mostly because it’s getting later in the evening and insulin rises slightly). Remember ketones and insulin work on a twitter totter (even though blood sugars much better). I blame TOO MUCH DAIRY. Even for me. It’s a great learning experience. I’ll be doing 2 meals tomorrow and probably one on Friday. I’ll keep checking and reporting in. After a 3.9 blood ketone (Picture 7) this is a HUGE DROP (Picture 1)!
Thursday, June 14 at 8:28 AM
JOURNEY CONTINUES: this morning my BG was 74 and my ketones went back up to 3.4 woohoo!!! IN THE MORNING (remember yesterday it went down to 1.6 after a meal too high in dairy!)
___________________________________________________________________________________________Thursday, June 14 at 1:04 PM
Hey beautiful people. So I will NOT be checking my bloods this often for the rest of my life, but I’m currently trying to make a journal. So here goes. AGAIN my BG not bad after meal but ketones DROPPED immensely after another Dairy-laden meal (no berries this time, so can’t blame the carbs in there). Check the picture comments for details, if you want.
Picture 1 BG 1 hour after meal
Picture 2 Blood ketones 1 hour after meal (dropped from 3.4 😲)
Picture 3 90-second bread recipe
Picture 4 Bacon-wrapped avocado fried with “magic dip” (sour cream and spices)
Picture 5 Fasting (morning ketones)
Picture 6 Fasting (morning) blood sugars
Thursday, June 14 at 5:57 PM
My journal continues: pre-meal numbers (Pictures 1 and 2) (remember how low my ketones went today after my dairy-laden meal-1.2) I can only assume I’m fat-adapted at this point to have numbers go this high at 5 pm (Picture 1). I will check my numbers later (post meal) but this meal also has DAIRY (Picture 3).
Thursday, June 14 at 8:57 PM
KETO JOURNEY: drumroll ... 😂 bloods after meal (2 hour post-meal) 2.4 ketones (Picture 1) and 91 blood sugars (Picture 2). Not bad, you’re thinking right?? Especially considering a meal with dairy (Picture 3), right? Well, actually, look at my pre-meal numbers...blood ketones were 4.1 (Picture 4), so the drop is still HUGE...meaning having a dollop of sour cream with my butter chicken (Picture 3), not to mention cream, in the curry. So the important question is, what does this mean? Can I, or SHOULD I, not have dairy? EVER? Here’s my interpretation. If I drank cream (or G-forbid, milk) in my coffee in between meals, my ketones would be low and insulin would be high all the time (insulin causes retention, among other things). Would insulin go down this quickly and ketones go back up this quickly in a person who was not FAT-ADAPTED? Probably not. So will I continue to have dairy? A bit. A very little bit. And not all the time. I was actually ready to let dairy go when I saw the first huge drop, but then realized how very quickly my ketones went back up. I’m planning on writing a full blog/journal about this journey so I can explain ketones/insulin, checking blood sugars, ketones etc, for those interested.
___________________________________________________________________________________________ Friday, June 15 at 2:03 PM
Pretty cool KETO JOURNEY I’ve been on. First of all, note that this meal had NO DAIRY (Picture 3 and 4). So blood ketone drop not so huge (2.8-1.7). Significantly less drop than after dairy (less of an insulin response). Even though all animal protein (meat) creates a moderate insulin response. Blood sugars look a little higher post-meal than the previous days (these are assumptions here, “educated guesses” at best) and likely because I had less of an insulin spike (insulin removes sugar from the blood), so they will drop slower (I used to have “rebound hypoglycaemia” I think from having huge insulin spikes and then lower than desired blood sugar drop).
Picture 1 Blood ketones 1.5 h post meal (no dairy)
Picture 2 Blood sugar 1.5 h post-meal (no dairy)
Picture 3 Steak and eggs
Picture 4 Asparagus with Hollandaise sauce
Picture 5 Blood ketones pre-meal (12 pm)
Picture 6 Blood sugar pre-meal (12 pm)
Friday, June 15 at 9:03 PM
KETO JOURNEY: Post-dinner blood ketones (Picture 2) and blood sugars (Picture 1). I didn’t have a chance to measure pre-dinner. Note that ketones are low (lowest all week) and blood sugars a bit higher. My dinner was at a restaurant, I had chicken, some grains (corn), veggies, avocado, olives, sour cream, and cheese. Tomorrow I’ll check my numbers again and report back.
Saturday, June 16 at 2:25 PM
KETO JOURNEY continues: morning numbers (Picture 1 and 2) pretty good considering that I had grains last night (fat-adapted?). 2-hour post-meal bloods (Picture 5 and 6), after brunch (eggs benny and French toast) (Picture 3 and 4) not impressive. I’ll be very cautious today and check evening numbers. My summary so far is that my numbers (ketones) always go down post-meal. Particularly when I have dairy (more so than even grains, interesting...), but as long as I stay on track with correct meal-timing (i.e. no snacking and late night eating), I go easily into >1.5 mmol fat-burning mode (even if only after the long overnight fasting period). Pretty good info, I think.
Saturday, June 16 at 8:36 PM
The very HONEST KETO JOURNEY continues. So today, the experiment, continues. I did have some grains (potato) with my steak dinner, but I also had FRUCTOSE (an iced Margarida!). For the first time in the last couple of weeks, my ketones did not register (Picture 1). BAD....because it is very unlikely that they will register tomorrow, or above 1.5 in the next 3-5 days. Which sucks, but this is the reality of things. I wanted to see if it just went down like grains, but NO. FRUCTOSE IS SIGNIFICANTLY DIFFERENT. So fructose very likely not only kicks you out of ketosis COMPLETELY, it very well stops FAT ADAPTION. I will continue the journey and challenge, and post. Lastly, notice the “rebound hypoglycaemia” (Picture 2). I suffered with this my entire life (because I produced too much insulin in response to FRUCTOSE). Insulin in turn does its job. It removes blood glucose from the blood (and stores it as glycogen). In a bit, I’ll be shaky, no doubt, and craving sugar... The take-home message here: how many people believe they have “low blood sugar” because they “need more sugar”? When my ketones are high and my insulin response is lower, I don’t experience rebound hypoglycaemia. My blood sugars do not drop this low. So right now I have no ketones, high insulin and LOW blood sugars.
Sunday, June 17 at 9:39 PM
HAPPY FATHER’S DAY to all the lovely dads in this group. So my KETO JOURNEY continues... we had a lovely lunch (and lovely guests) as such I started the day with low ketones (0.4-remember I had a Margarita yesterday and measured low). By 2 pm (lunch time) my ketones were up to 0.8, and then...I had steak, pork belly and short rib, black beans with bacon and grilled pineapple. Results speak for themselves. Take home message here: you don’t stay FAT ADAPTED if you eat carbs 3 days in a row. My plan: I will now fast as long as it takes to get to >1.5 ketones. That might be 1 day, 2 days, 3 days...
Picture 1 Blood sugars (9pm)
Picture 2 Blood ketones (9pm)
Picture 3 Blood sugars pre-meal (2 pm)
Picture 4 Blood ketones pre-meal (2pm)
Picture 5 Blood sugars fasting am
Picture 6 Blood ketones fasting am
June 18 at 9:02 PM
What a very exciting KETO JOURNEY this has been. So yesterday night as you may recall, my ketones were “undetectable” and I decided I would check my numbers to decide how long to fast. Recall that I had both glucose and fructose throughout the weekend and I registered my ketones throughout (look back if you are interested in the results). This morning as expected my ketones were still undetected (Picture 1), by 2 pm still at 0.2 (Picture 3) (so no eating) but by 6 pm they were already up to 1.0 (Picture 4). My thought was: this would be a great time to test a FF ("Fat Feast")meal. And so I did. I had Bacon Rapini with sardines (extra EVOO and spices) (Picture 6), and low and behold.... ketones just 1.5 hours after the meal were...0.9 (Picture 7)!!! Recall that your insulin ALWAYS rises when you eat, but after a FF this was as insignificant a rise as you will ever see (0.1 drop in ketones). Recall that when I had a Keto meal with dairy I had drops larger than 1.5 and after fructose completely out of ketosis! This is huge confirmation of what we already knew!!!
Tuesday, June 19 at 7:25 PM
KETO JOURNEY: things are going “downhill” for me today. After yesterday’s FF, woke up with great ketones (Picture 1), but when I checked before lunch they had actually gotten LOWER (Picture 3). Strange except I could feel I was coming down with a little “bug” and it got worse throughout the day. I haven’t even measure before and after my dinner. Depending on how I feel tomorrow I may check and let you guys know. (Remember, when the body is under stress, insulin goes up).
Saturday, June 23 at 12:10 PM
AND HERE WE GO AGAIN...the Keto journey (re)continues. I’ve been quiet most of the week. Earlier this week (Tuesday) I told you things were going “downhill” for me (as I had come down with a little “bug”). The next day I had “minor surgery” booked (TMI ends there lol). And to be honest (always) the lower blood ketones led to “poor” food choices for the rest of the week (excuses, excuses). Thursday I took my kids to the movies, and Friday we went out for dinner at the Irish Pub I worked at during University (nostalgia). This morning I woke up with undetectable ketones (obviously) and I’m fasting on until dinner tonight. At 12 pm, my ketones started to rise (Picture 1), and as I said, my lifelong journey continues. I know what to do. I got this, and so do you!
What I've learned (or confirmed):
1) Carbs lower your ketones (i.e. raise your insulin) duh
2) Fructose (sugar found in fruit, juices, sod and sweets) lowers ketone production the most
3) Dairy (whey protein) lowers ketones (almost) as much as carbs
"Insulin is released when eating carbohydrates, but also when eating protein, especially in type 2 diabetic patients. Certain animal proteins, such as the whey in dairy, generate almost as much of an insulin response as carbohydrates. Insulin signals the cell to start synthesizing proteins." Some of you know I am writing a book with Dr. Fung. This is what he wrote on one of the chapters he sent me today. We talked a lot about DAIRY this week in my groups...
4) Fiber and Fat (FF "Fat Feast") create an insignificant insulin response
5) Other things, besides food, lower ketones (i.e. raise insulin)
i) stress (cortisol)
ii) illness (infection, inflammation, etc)
iii) poor sleep
iv) certain medications (see i))
v) eating later in the evening
vi) eating more often (snacking, grazing)