Ketogenic Diets

[mdpfirrman]

That's an interesting perspective Shawn. I have heard of many low carbers taking it to the extreme like you have. As someone that is certainly not a doc, I've changed my views drastically toward the mainstream too out of necessity (for my wife's health). I really respect you as a doc taking an approach that's not mainstream and seen by some as radical. It takes a very open mind to do that. If it's working for you why not?

I think Lefty stated well what I believe. It's an individual thing. My wife gets sick from too much meat (physically it throws her fibromyalgia into a tailspin). If she has dairy, she gets really sick. For her (and most fibro patients), eliminating grains (or making sure they are organic) while limiting meat consumption works.

I chose (for price / cost) and ethical reasons (should say personal beliefs, not really ethics), to eat mostly a plant based LCHF diet and it's seemed to work well for me. Though I'll never be the athlete Shawn is, I think that has to do more with commitment and genetics more than diet.

[mdpfirrman]

Greg,

What's the reason that you're looking into a ketogenic diet?

I think you'll find that the research fairly conclusively shows that you're better off sticking with a "normal" diet (whatever that means) with plenty of carbohydrate intake, especially if you're an athlete who trains regularly. This is not to say ketogenic diets don't "work," but rather that I'm not sure the cons outweigh the benefits.

As you yourself pointed out, if you judge it by the studies that have been done, the evidence points in one direction, while you'll get a totally different answer when posting the question to the public where you're going to get mostly responses from people who are proponents of the diet and you're going to run into a self-selection and anecdotal evidence issue.

Anyway, just curious why you're considering this type of diet when you're already a very successful athlete as it is.

One reason I posted the review of studies was because I have seen a lot of anecdotal evidence from different places about people doing well with these diets, and I wanted to see if they saw gaps in the studies that I didn't. I thought Shawn's feedback about inflammation and the length of the studies was interesting.

As for why I might consider this type of diet. I used to be much heavier, and it is a struggle to keep my weight down. In fact, I really should be 20 pounds lighter. If I eat very clean, and constantly count calories on a standard diet, I can lose weight, but it is a pretty miserable existence.

I am embarking on an 8 month project to train for a longer open water race, the Blackburn Challenge. It's a little over 20 miles of offshore rowing and can take between 3 and 5 hours to complete, depending on weather conditions. Obviously, training for this is going to be focused on base aerobic / fat matabolism kind of stuff. It seemed like it ketogenic diets might work as well or better than conventional diets with this type of training plan.

I probably won't do it. My life includes a fairly large amount of social and business dining. I don't want to be "that guy", who is a pain to go out to an Italian restaurant with. I think I will get back to counting calories though. I don't want to drag extra weight in this race.

Greg,

I think you'd find that just making your ability to burn fat better a great strategy. I used to use (and still do on occasion if I want to track macros) Loseit. You can also use Mypitnesspal too. Either way, both are cheap and you can start to analyze your ratios of carbs to protein to fat. What I've found is that you don't have to go to extremes (though I do envy a guy with Shawn's commitment) to achieve what you're trying to achieve - better fat burning and less reliance on carbs for your energy.

A few ideas that could help you:

Intermittent fasting - been shown to promote more efficient fat burning. I don't know if you work out in the AM, lunch or in the evening but if you work out in the AM or lunch, you could fast all morning and then do SS work with nothing in your stomach. It's like a double dose of fat burning. The intermittent fasting helps you burn fat better and not eating carbs before a workout also helps you to learn to utilize fat better for energy. On interval days (or lifting days), eat only a small amount of carbs before and after workout (and still shouldn't throw off your fat burning ability).

Shoot for a 50% or higher fat ratio on your macros. Not that hard and very doable even with dining situations, business lunches, etc. Meat, vegetables and salad (assuming the salad is made with oil / vinegar). Just eliminate unnecessary carbs / starches and eat more avocados, nuts, olive and coconut oil (and meat, eggs and cheese if you tolerate that OK).

That would be fairly easy to implement and live with according to your lifestyle. To be more a much more efficient fat burner, it doesn't have to be all or none. Here's an article by Peter Attia, a pretty well known low carb "guru". I think he covers a lot of your question in this article pretty well. How you can still eat carbs and remain in Ketosis. Also, look into Caprylic Acid too (derived from coconut) - it's the secret stuff that they overprice and label as Brain Octane in "Bulletproof Coffee". Those that take Caprylic Acid claim they can be a little more liberal in their carbs and still stay in ketosis.

http://eatingacademy.com/sports-and-nut ... n-co-exist

[Bob S.]

Also, look into Caprylic Acid too (derived from coconut) - it's the secret stuff that they overprice and label as Brain Octane in "Bulletproof Coffee". Those that take Caprylic Acid claim they can be a little more liberal in their carbs and still stay in ketosis.

Why not just have some goat cheese once in a while. It is a good source of caprylic acid (as an ester of course), as well as caproic and capric.

[mdpfirrman]

Also, look into Caprylic Acid too (derived from coconut) - it's the secret stuff that they overprice and label as Brain Octane in "Bulletproof Coffee". Those that take Caprylic Acid claim they can be a little more liberal in their carbs and still stay in ketosis.

Why not just have some goat cheese once in a while. It is a good source of caprylic acid (as an ester of course), as well as caproic and capric.

No reason why not Bob. I just actually forget it's in goat cheese (in the fat). My wife has a dairy allergy so we just don't eat that much cheese. In supplement form, it's 100% caprylic acid. The nice thing about Caprylic Acid is it can immediately be broken down for energy in a fat form.

[Bob S.]

In supplement form, it's 100% caprylic acid. The nice thing about Caprylic Acid is it can immediately be broken down for energy in a fat form.

This sort of thing always puzzles me. I am leery of any use of break down products of foods like caprylic acid in free form. The same with threonine and other amino acids used as supplements. These compounds are not available in free form in foods. In fats, the fatty acids are not free acids, but glycerol esters of these acids. I am just a straight organic chemist, with only a smattering knowledge of biochemistry, but it is my strong impression that things like fatty acids and amino acids are never "free" in the process of metabolism, but are tied up as other types of compounds with some kind of coenzyme. The similar example of this to me is acetic acid, the active ingredient of vinegar. As acetylCoA, i.e. the acetate ester of a coenzyme, it is the main energy unit from either triglycerides or carbohydrates. But is seems highly unlikely that ingesting vinegar would supply the fuel we need. It can only be oxidized to produce energy in the form of acetylCoA. I have never looked into the biochemical mechanisms of the metabolism of fats to the individual fatty acids, but I am convinced that it involves some sort of trans-esterification of the glycerine-fatty acid esters to esters of those acids with various coenzymes - a form that the body can use - never the free acids.

Bob S.

[left coaster]

I found this article interesting, https://www.sciencedaily.com/releases/2 ... 115923.htm

Light years from conclusive or immediately applicable to humans, but interesting from a theoretical perspective. I remain uncertain re the long term implications of ketogenic diets...

[gregsmith01748]

This just came out and since it is about race walkers, I guess it is closer to being a human based study.

https://www.ncbi.nlm.nih.gov/pubmed/28012184

In short the study showed that the folks on a LCHF diet improved their ability to metabolize fat, and showed that they were keto-adapted, but had significantly worse training results than the control groups on a more conventional diet.



The main issue that I have with the study is that many people advocate a "Train Low, Race High Strategy", which provides additional carbohydrates for competitive events, but restricts them during training. The study did not examine that approach.

[mdpfirrman]

https://www.ncbi.nlm.nih.gov/pubmed/27528626

This article just came out too (yesterday actually). You can bet that some cycling teams and perhaps certain Olympic organizations might already be looking into these special ketone esters mentioned in this study...

[GJS]

As I think you suspect, Mike, the cycling teams with deeper pockets have been using them for a number of years already:

http://www.cyclingweekly.co.uk/news/lat ... ing-151877

[jag]

I find nothing appealing about the ketogenic diet. First of all, it is an extreme diet that forces you to dramatically change what you eat - you will probably be unable to eat any meal that you currently eat. Second, you need to stop eating most foods that are considered healthy (you can't eat any fruit of any kind, you can eat only very few vegetables in limited amounts, you can eat absolutely no whole grains, and no milk products except hard cheese, and the list goes on). Finally, you also need to limit the amount of protein that you eat and eat a very precise amount every day - because when your body doesn't get enough carbohydrate (i.e. when you are in ketosis), it metabolizes protein to make glucose out of it to keep your brain alive. If you don't eat enough protein every day then your body muscle will be broken down (losing muscle mass is a common side-effect of eating ketogenic and not exactly a good thing if you are trying to maintain or enhance your athletic ability). But if you eat too much protein, then your body will metabolize that into glucose and you will no longer be in ketosis - i.e. you will no longer be eating a ketogenic diet.

Finally, I would point out that although the ketogenic diet is often talked about as a weight loss diet, I haven't actually observed that to be the case. If you look at the people on any forum who talk the most about the wonders of the ketogenic diet, they are often overweight or obese. Which begs the question that if the diet is so great for weight loss, then why aren't they losing weight?

Personally, I believe in the well-tested truth of calories-in, calories-out. If you want to lose weight, then eat less and/or exercise more. The best tested means to do this that I've seen: Get rid of all the snacks in your house - meaning anything that you eat that isn't part of a meal. Chips, cookies, nuts, candy - get rid of them because you don't need them and they just add extra calories. Certainly don't drink any sweetened drinks (soda, juice, sweet tea or coffee) and minimize beer intake. And eat smaller meals - this is the hardest part, but it is certainly possible. As far as the meals you eat - that is really up to you, and there is no obvious reason that you need to exclude anything from your meals as long as the calories contained in them are under control. Hopefully you'll consume a lot of fruits and vegetables since those are both filling and good for you, but you don't need to eat ONLY fruits and vegetables - eat what you like.

[Shawn Baker]

JAG- your statement that calories in versus calories out being the only reason for body composition is then immediately contradicted by your prescription of what foods you should and should not eat- why not just eat twinkies, ice cream and pizza restrict calories and take a multivitamin then?

4 days before my 50th birthday on a current diet of fatty meat and eggs (around 70% of calories via fat) and at this point, years of being very often in ketosis- obviously muscle is wasted and my athletic performance is greatly diminished

You don't happen to have a current photo showing off your "athletic prowess and well muscled physique on your"balanced diet by chance?

[left coaster]

Shawn, I think we all know that with a balanced, calorie controlled, diet (healthy of course, not what you describe) and the type of exercise routine you adhere to it is possible to have a similar body.

It's amusing that you have gone from talking about your diet choices as an experiment to coming across as a bit narcissistic about the whole thing. Some carbs may help you feel a bit more friendly towards the world -- you know, bump up the serotonin a bit

I respect your choices Shawn, but there are "many roads to Rome" and yours is not the only one.

[mdpfirrman]

I'm not as extreme as Shawn but I disagree with JAG too. I've seen many people have weight loss success using a ketogenic diet, even drastic weight loss. I was obese four years ago and joined Loseit (like myfitnesspal). There are literally 100s of people I've seen that tried everything else and CICO (calories in, calories out) wasn't the whole picture for them. For me, for instance, fat / protein / carbs didn't matter as long as I watched calories. For my wife, though, she tracked calories for nearly a year before she dropped gluten and dairy and quickly dropped 25 lbs on the same amount of calories. Actually studies prove that if you up your percentage of fat, you burn more or change the "calories out" side of the equation. It's pretty conclusive actually.

[Bob S.]

I respect your choices Shawn, but there are "many roads to Rome" and yours is not the only one.

Nor have I ever seen anything in his posts that indicated that he claims it is. I believe that you and others who read this thread regularly are aware of that as well. JAG seems to have jumped to the conclusion that Shawn is pushing others to take it up. That conclusion was out of line in my opinion.

Bob S.

[Shawn Baker]

Just to clarify (as apparently I need to)- indeed there are many ways to achieve desired health outcome. However, again the statement that calories are the sole determinant of body weight is unfortunately in my view not correct. I have amputated feet, toes, legs and fingers, as well as treated uncountable problems related to poor dietary choices and advice and thus beyond my own personal goals I have a lot of interest in the study of nutrition- above all WHAT we eat is far more important than any other aspect of nutrition- calories, appetite, meal frequency, timing etc.. are all ultimately determined by the type of food we eat. For someone to trash a system of eating that I and many, many utilize to greatly improve their health and in many cases improve athletic performance is not helpful to those that may have an interest. We have a society overrun with disease and obesity (almost all of them have tried and usually failed in the long term using the, incorrect calorie in versus calorie out model)- I put up a photo to show JAGs comments regarding the unsuitably of a low carb or ketogenic diet for getting lean and athletic are very misleading. My dietary choices are driven by results not dogma. If I felt and performed the best eating a vegetarian diet or a DASH diet or anything else it then that is what I would do. I spent most of my life believing the calorie model and encouraged patients for years to lose weight (with almost no success) using the same principles espoused by JAG and countless others- my challenge for him to post a photo is a tongue in cheek way to say "put your money where your mouth is"- the sad truth is most guys in their 40s, 50s etc.. are flabby and low on muscle (despite eating whole grains, fruits, low fat etc....) I was in the same boat more or less about 5 years ago, despite an exercise volume that very few could have handled and a diet similar to that espoused by JAG (maybe I just didn't try hard enough)- I was developing HTN, sleep apnea was always tired, frequently snacking and likely pre-diabetic. That was enough to send me digging for MY solution and I have been fortunate enough to see many successes in others as a consequence. If you are completely happy with your health and weight and your current regime works then by all means stick to it, but if not feel free to experiment (to include a carb restricted diet, you can very easily have a great deal of variety but you might need to learn how to cook!)