A very interesting week! I discovered the pivotal relationship between protein and ketosis, and finally saw a reduction in my appetite.
Note: this post was originally published on Aug 1, 2013. It was edited to streamline content and improve graphics, then re-posted in June 2016, therefore some older comments may pertain to content that was removed during revision.
This post is part of a series describing my attempt to follow Dr. Seyfried’s dietary recommendations for cancer. To start at the beginning, please go to the first post: Seyfried’s Ketogenic Cancer Diet: My Fasting Jump-Start to Ketosis.
Traveling on a Ketogenic Diet
Being in Salt Lake City from Day 7 to Day 11 was challenging. I had no car, no grocery store, no microwave…I was completely at the mercy of hotel, conference, and restaurant food. Luckily I had a great pocket-sized travel scale (made by Salter) to help me out, but most of the meats I ate while away were not my usual fare. I did my best!
Day 8 (2/7/13)
Notes: Very hungry with mild headache first thing in the morning and again at midday, but no appetite at dinnertime.
Day 9 (2/8/14)
Notes: Very hungry with mild headache in the morning. Forgot my scale today while out and about, so overshot my protein grams.
Day 10 (2/9/13)
Notes: This was the first morning that I wasn’t extremely hungry with a headache first thing in the morning—I felt fine. Overshot protein again. Appetite much lower all day. After snowshoeing, when everyone else felt hungry, food did not even interest me. Easily sat in an ice cream/chocolate cafe with other people without any temptation whatsoever.
Now that my appetite has come down and I’ve completed seven full days on my original plan of ~75 g protein (yet continue to see high blood glucose levels and only modest blood ketones), it’s time to adjust the plan.
NEW PLAN: Continue max carbs 30 but reduce protein to see if I can get ketones up to at least 4.0 mM and blood glucose down into the 60’s (Seyfried’s “zone of metabolic management”).
Day 11 (2/10/13)
Notes: Mild headache in the morning but appetite low today. Flew back to Boston from Utah. Finally home where I have total control over food choices.
Day 12 (2/11/13)
Notes: Sleep light, eyes feel dry (this always happens when I eat olives). Hungry mid-day and at 8 pm, but not ravenous. Very sleepy from 12:30 to 1:30. Queasy early evening. I don’t know if it was the extra fat intake and/or the guacamole itself which caused the sleepiness and queasiness.
Ketones and blood sugar clearly seem to care most about protein grams (as some of you had commented), and it is interesting to see how rapidly the ketones responded to the reduction in protein intake. This gives me hope that If I lower protein even more, the ketones and blood sugar will fall into range quickly.
Day 13 (2/12/13)
Notes: Sleep light, eyes dry, mild tinnitus (ringing in ears), but felt better within an hour of waking. I got hungry at lunchtime, so I eyed the 2 little lamb chops in my fridge. I thought to myself: “there is no way that those 2 wee lamb chops are going to do the trick.” Even worse, when I calculated how much protein I could have for lunch, I realized I should only eat ONE of these mini-meats. I cooked only one of them, and stared at its teeny tiny-ness, feeling like I could have easily eaten TEN of them. But I ate just the one, and within 10 minutes I was not hungry any more. Wow. Sleepy late afternoon and took a nap.
I was aiming for 50 g protein today to see if I could get ketones up to 4.0. I didn’t realize that the avocado contained protein, so overshot by 4 grams.
Day 14 (2/13/13)
Notes: Mild headache and dry eyes in the morning (I should really get rid of the olives…but they are so helpful—they have no protein, and are very low-carb and very high fat).
Reflections on Week 2
Protein and Ketosis
While it’s still early in this experiment, it seems that protein grams are an important driver of ketone levels—not calories, not fat grams, not protein to fat ratios. I am happy to see that I don’t need to eat MCT oil (which I’ve heard can cause gastrointestinal side effects in some people), palm fruit oil (which I know I don’t like or tolerate well), or increase fat grams any more to achieve high ketone levels. Some of you very smart people who are experienced with ketogenic diets were begging me to lower my protein intake sooner, and you were clearly right, but I was in no hurry with this experiment and wanted to wait at least a whole week to observe my own patterns. I also wanted to stick with the protein intake recommended by the “experts” in the field for a full week to see if it would work for me, but clearly my ideal protein intake is lower than that recommended by some experts. I was also too hungry during Week 1 to even think about eating less protein…
Appetite and Ketosis
Appetite level was very unstable during Week 1 but really came down during Week 2. On the final day of Week 2, I was perfectly satisfied eating less than 1000 calories. I wasn’t even trying to limit my calories that day, I just happened not to want any more food.
With appetite so much lower, I’m hoping I can cut back on the salads, because I feel better when I eat mostly meat.
Calories and Ketosis
I suspect that if I were to raise my calories by raising my fat intake, I would stop losing weight, but some of you have said that this isn’t true and that I should eat a lot more fat. At least right now, I have no desire to eat any more than I’m eating, and my ketone levels are nice and high, so I feel no need to raise my fat intake. My logic tells me that if I eat more fat, my body will burn more of that fat and therefore burn less excess body fat, which is the goal.
However, I would like to experiment with this once I’m fully keto-adapted. After I’ve been in ketosis for a full month, maybe I will try adding in more fat calories just to see what happens. Or, if I get hungry, I will add more fat, of course. I have no desire to be hungry on this plan—after all, one of the benefits of a ketogenic diet is supposed to be excellent appetite control.
What this experiment means for cancer patients?
Of course this is just my own personal experience, and yours may be very different. I am hopeful that cancer patients may be able to rapidly achieve Seyfried’s “zone of metabolic management” by strict protein and carbohydrate limitation rather than fasting. It does not appear as if calorie restriction is necessary, as he suggests (based on his mouse experiments). My ketones rose nicely regardless of how many calories I ate.
Dairy and Ketosis
Keep in mind that I’m not eating dairy products, which can raise insulin levels (see my dairy page), and therefore interfere with deep ketosis. So, if you limit your protein and carbs but are eating a lot of cheese, heavy cream, sour cream, etc. and you find your ketones are not rising enough, you may want to eliminate dairy for a few days to see if that helps.
Goals for the coming week
- To further explore the relationship between fat grams, calories, and ketosis
- To eliminate olives and the new vinaigrette to see if energy, sleep quality, bloating, and mild morning headaches improve.
- To try to maintain blood ketones at 4.0 or higher
- To bring morning and evening blood sugars into the 55 to 65 mg/dL range and keep them there. What will I need to do to achieve this? I don’t think I should lower protein or calories any further…Will I need to increase exercise? Get rid of all plant foods? [Plant foods = carbs]. I have always felt best when I eat no plants at all, but while adjusting to the ketogenic diet I was pretty hungry and had to eat something….
To see if I was able to reach any of these goals, please see the next post in this series: Ketosis for Cancer: Week 3—Being Sick on a Ketogenic Diet.