In this blog post, I outline a strategy for my attempt to transition to becoming adapted to nutritional ketosis adopting a primarily vegetarian ketogenic diet with no more than 30% saturated fats to achieve this. Ketosis is a metabolic state where most of the body’s energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis where blood glucose provides most of the energy. It is characterised by serum concentrations of ketone bodies over 0.5 millimolar with low and stable levels of insulin and blood glucose – which can be achieved by eating a ketogenic diet – low in carbohydrate, moderate in protein, high in fat (as shown in this pie chart).
Why Do This?
Our interest in becoming ‘keto-adapted’ is that there is growing evidence that it substantially reduces risk for major cardiovascular diseases (heart and stroke), resulting in better health biomarker levels (e.g. blood triglycerides, LDLs, insulin sensitivity, and so on). It may also help stabilize moods, clarify and enhance cognition, and result in performance gains in sports and other practices. Dr. Peter Attia provides an excellent introduction to nutritional ketosis in this video:
- Week 1: Measure biomarkers and ‘psimarkers’ (psychological tests) and current diet (macros/nutrients). Formulate transition plan.
- Weeks 2-4:Transition diet to better approximate the right macros and nutrient balance, while staying clear of nutritional ketosis.
- Week 5: Dropping into nutritional ketosis, preferably with others. Measuring ketones during this period.
- Weeks 5-7: Continuing with strict keto-diet, introducing heavier exercise.
- Week 8: Follow up with measures of biomarkers and psimarkers and sharing experiences.
Week 1: Measures & Plan
Measure your daily calories, macro-nutrient percentages, and other nutritional statistics (e.g. percentage of saturated fats) using e.g. the MyFitnessPal app.
I have been doing intermittent fasting which gives me a calorie intake like this (there’s a 2 day gap here where I didn’t record what I was eating):
My macro proportions (and I assume they are similar to Annie’s) have recently been:
- 50% carbohydrates
- 35% fats
- 15% protein
I was quite surprised about the amount of fat in our diet!
Also the breakdown of fats was: [listdot]
- Saturated: 44%
- Polyunsaturated: 15%
- Monounsaturated: 41%
Measures of key metabolic biomarkers:
- Weight (78kg)
- BMI (22.9)
- Body fat / lean body weight (using this calculator, and these calipers)
- Blood glucose
- Total cholesterol
- Ratio of total cholesterol to HDL (140)
- Blood pressure (112/72 – occasionally measures at 120-130 systolic)
- Resting pulse (72)
- QRISK 2-2014 10 Year Risk: 2.4% (risk of having a heart attack or stroke within the next 10 years)
The doctor has my blood glucose, HDL and LDL and I’ll get this data when I go for the post-keto adaptation follow up test.
Annie’s biomarkers were:
- Weight (56kg)
- BMI (21.3)
- Blood glucose (5.6)
- Total cholesterol (4.04)
- Ratio of total cholesterol to HDL (1.9)
- Blood pressure (112/ 71)
- Resting pulse (60s)
- QRISK 2-2014 10 year risk: 0.6%.
Interesting how much greater risk men have relative to women, just looking at typical scores – close to double. Even so, Annie is super healthy. It will be interesting to see if her stats get even better.
For ‘psimarkers’ (psychological tests) we could use these. I haven’t them all them all. Just set up Yonni Donner’s the useful Quantified Mind ‘experiment’.
- The Daytime Insomnia Symptom Scale (DISS) (page 1, page 2) a good measure of resilience. I got an overall score of 3.18.
- Optional – 6 minute general test of cognitive functioning. Sign up to Quantified Mind using Google Chrome (install here), and then select ‘Ketosis Experiment’ and take the first test battery by clicking ‘Take Test’. Take the test when you are feeling rested, alert and motivated.
- Optional – IQ test. (You later take a post-keto adapted IQ test after ketogenic adaptation.) These tests take 30-40 minutes. Take the IQ test when you feel alert and motivated.
For athletic performance or general fitness:
- VO2Max. This can be calculated using a Garmin runners watch, or using the activity-based measures here.
- Recovery Rate. One method for calculating this is explained here.
- Maximum reps for e.g. pushups or pull-ups.
- Maximum power.
- Use a urine sample stick, or ideally a blood test kit. I ordered these Ketostix and these. My value last test gave me: 0.5 mmol/L
Weeks 2-4: Keto-Preparation
Some sources recommend a gradual transition, others recommend a binary transition – from e.g. 60% carbs one day to 6% carbs the next.
“Some very credible people advocate easing into carbohydrate restriction slowly by cutting back one food category at a time (e.g. first sugars and juices, then refined carbs, then starchy vegetables, etc). Other’s take the ‘Nike approach’ – as in ‘just do it’. To date, no one has done a study with a large group of subjects to see which strategy yields a higher proportion making an effective transition into nutritional ketosis….a concern with easing into a low carb diet is that once you are eating less than the 150 grams of carb needed to feed your brain with glucose but still more than the 50 gram threshold below which ketosis is dependably operating, your brain’s fuel supply becomes pretty tenuous. If there is not enough glucose to meet the brain’s 600 Calorie daily energy habit, and blood ketones remain below the 0.5 millimolar threshold where they can begin to pitch in, your body’s only two options are:1. Burn up protein.2. Bing on carbs.In our clinical experience, the ‘Nike approach’ is better. Particularly if you use broth/buoillon to get enough sodium and eat plenty of low carb vegetables to get enough potassium.”
- This allows for a ‘psychological adaptation period’ in getting used to a very different kind of diet.
- It gives us a period to develop nutrition habits, learning how to count calories and macros and get creative and intuitive with meal plans that match the constraints. A rapid switch from one type of diet to the other with no transition doesn’t allow much time for habit and understanding enough time to change in syc with this..
- If fat intake is increased during the transition period and carbohydrates much reduced, and at the same time strategies are employed to stimulate fatty acid / ketone metabolism (see below), this is likely to here is likely to be ‘enzyme -reconstitution’ over the weeks as you adapt to your changing diet, which should help with transitioning to full ketosis.
During this period fat burning practices can be encouraged – e.g.
- Consuming MCTs (e.g. coconut oil, or MCT oil)
- Low intensity exercise (50-65% VO2 Max)
- Drinking coffee just before exercise.
We are STARTING with 35% fat, 50% carbs and 15% protein (left). There would be different programs depending on the starting point. We want to end up at percentages on the right by the end of week 3. Carbs could be around 10% and fat 65%.The extra protein is to allow for conversion to glucose if it is needed with the drastic drop in carbohydrates.
With this kind of macro ratios, we should maintain glucose levels for the brain without a problem.
Then in Week 4, we’ll switch to a full nutritional ketosis, by dropping protein intake and increasing fat. (Below). More on this below.
- Week 1: 35% veg, 25%fruit, 40% starch/grain —- 40% carbs
- Week 2: 55% veg, 25% fruit, 20% starch/grain —- 25% carbs
- Week 3: 80% veg, 20%fruit; 0% starch/grain —- 15% carbs
- Week 1: 40%
- Week 2: 50%
- Week 3: 60%
- Week 1: 20%
- Week 2: 25%
- Week 3: 25%
In terms of the percentages of different fats:-
We’re starting around here:
- 20% saturated fat
- 60% monounsaturated fat
- 20% polyunsaturated fat (with a balance of Omega 3 to Omega 6)
We want to end up here (and it looks like we’re pretty close already). This is the “approximate fatty acid composition of subcutaneous adipose tissue”. MUFAs and SFAs are the fats that we burn for fuel in ketosis, so we need to keep those stocked up.
Since we’re already close to this, we can transition to this approximate ratio immediately.
On a vegetarian diet is critical to maintain a balanced ratio of Omega 3 to Omega 6, using supplements if needed. On a non-vegetarian diet this can come from cold water fish.
During the transition weeks we’ll do lower-intensity (fat burning) type exercise (staying at lower than 70% of VO2Max if possible). And SOME interval training, but no more than e.g. the 7 minute workout.
After a couple of weeks of keto-adaptation we can start experimenting with more intense exercise.
Water & Minerals
Ketogenic diets result in loss of sodium and water by the kidneys. It’s normal for people to lose 4-5 pounds (about 2kg). The loss of water and sodium can reduce plasma volume and make you feel sluggish. Also low sodium can upset potassium metabolism, affecting your CNS functioning. So ensure that you’re drinking enough water – and sodium.
- Daily water: 3-4 litres?
- Daily sodium: 2 teaspoons?
- Potassium and Magnesium supplements if needed.
During this period occasional checks on weight, blood pressure and ketones are advised, with one check of ketones before the workshop.
Week 5: Nutritional Ketosis
Important during this period to measure ketones regularly.
Here the carb intake drops to below 50grams. Ketone measures should be 1-3 millimolar.
The macros should look like this.
During the first three days of this period – where there may be ‘ketosis flu’ we will be doing a lot of meditation, breathing exercises, with only light exercise.
Symptoms of ketosis flu include:
- Upset stomach
- Lack of mental clarity (brain fog)
After 2-3 days of this, the expectation is to wake up feeling clear headed and refreshed one morning – in full ketosis:)
Weeks 5-7: Continuing Adaptation to Nutritional Ketosis
During this period continually measure ketone levels.
In the second half of this period experiment with:
- More intense exercise bouts.
- Fasting regimes – e.g. 12 pm to 7 pm fasting window, 2 times per week, and then extending this, to e.g. 12-5pm fasting window. Or try the alternate day or 5:2 restricted diet (5-600 Cal) regime.
Measure the biomarkers and psimarkers again, to see how things have (or have not) changed!
It’s challenging to do a vegetarian keto diet, since protein sources (e.g. beans) are often high in carbohydrates.