Nutritional Ketosis Week 3 (plus Anne’s lab tests!)

Billiard 3 licensedThis week was even better…I think I’m getting the hang of this…

Day 15 (Thurs Apr 4)

Morning notes:  mild tinnitus (ringing in ears), creasey skin.

  • Weight:  153.2 lbs
  • Body Fat:  35.5% (home Tanita scale)
  • Morning glucose:  84
  • Morning blood ketones:  0.9
  • Morning urine ketones:  high
  • Morning blood pressure:  94/63
  • Morning heart rate:  59
  • Evening glucose:  82
  • Evening urine ketones:  mod
  • Evening blood ketones:  1.2
  • Protein:  86
  • Fat:  84
  • Carbohydrate:  37
  • Calories:  1224
  • Exercise:  none

Foods:  Chicken sausage, artichoke dip, tuna sashimi, ketchup, avocado, zucchini, black tea, green tea, fresh cheese (1 oz)

Evening notes:  Slept 6.5 hours

Day 16 (Friday Apr 5)

Morning notes:  Fine.

  • Morning glucose:  79
  • Morning blood ketones:  1.4
  • Morning urine ketones:  small
  • Morning blood pressure:  91/60
  • Morning heart rate:  60
  • Afternoon blood pressure using cuff at work:  121/82
  • Evening glucose:  77
  • Evening urine ketones:  small
  • Evening blood ketones:  1.1
  • Protein:  81 g
  • Fat:  88 g
  • Carbohydrate:  24 g
  • Calories:  1384
  • Exercise:  walk 50 min

Foods:  Chicken, duck fat, tuna sashimi, Emergen-C (1 packet orange), iceberg lettuce (1/2 head), green tea w 1 tsp xylitol, 1 Hershey’s kiss, 1 oz fresh cheese (don’t ask me why).

Evening notes:  Slept 6.5 hours, but broken into two phases.

Day 17 (Saturday Apr 6)

Morning notes:  mild migraine headache (most likely due to cheese), creasey.

  • Morning glucose:  82
  • Morning blood ketones:  0.4
  • Morning urine ketones:  trace
  • Morning blood pressure:  95/65
  • Morning heart rate:  59
  • Morning axillary temp:  95.1 F  (by request from a reader)
  • Evening glucose:  84
  • Evening urine ketones:  high
  • Evening blood ketones:  0.9
  • Protein:  77 g
  • Fat:  88 g
  • Carbohydrate:  0
  • Calories:  1195
  • Exercise:  15 min resistance (arm weights)

Foods:  Fresh cheese 2 oz (I threw it away after this…), chicken, duck fat, unsweetened black tea

Evening notes:  Cloudy-headed sensation all day. Slept 6.5 hours.

Day 18 (Sunday Apr 7)

Morning notes:  Unremarkable

  • Morning glucose:  72
  • Morning blood ketones:  0.8
  • Morning urine ketones:  small
  • Morning blood pressure:  100/68
  • Morning heart rate:  58
  • Morning axillary temp:  forgot
  • Evening glucose:  83
  • Evening urine ketones:  high
  • Evening blood ketones:  0.7
  • Protein:  93
  • Fat:  58
  • Carbohydrate:  20 g
  • Calories:  1122
  • Exercise:  none

Foods:  Chicken, duck fat, mint green tea, chicken liver, Emergen-C (1 pkt orange), swordfish, blackberries (1/2 pint)

Evening notes:  In mid-afternoon would get a headache whenever I stood up. Caffeine did not take it away.  It went away after dinner, and I experienced excellent energy, excellent motivation and found myself thinking about organizing and cleaning.  Nice clarity. Optimistic.  Great mood. Slept 8 hours but broken into two phases.

Day 19 (Monday Apr 8)

Morning notes:  Head feels fine.  Good energy from first thing in the morning.

  • Morning glucose:  75
  • Morning blood ketones:  0.8
  • Morning urine ketones:  mod
  • Morning blood pressure:  96/67
  • Morning heart rate: 67
  • Morning axillary temp: forgot (it’s a new thing–I’ll get it down…)
  • Evening glucose:  84
  • Evening urine ketones:  mod
  • Evening blood ketones:  0.8
  • Protein:  94
  • Fat:  69
  • Carbohydrate: 9
  • Calories:  1102
  • Exercise:  none

Foods:  Chicken, duck fat, swordfish, black tea, turkey, zucchini (1 cup), Emergen-C (1 pkt orange), 1 TBSP mozzarella cheese.  That’s it…no more cheese!

Evening notes:  Good energy right up until bedtime.   Very subtle rash–probably the cheese?  Slept 7 hours.

Day 20 (Tuesday Apr 9)

Morning notes:  Feel good this morning.

  • Morning glucose:  78
  • Morning blood ketones:  1.2
  • Morning urine ketones:  mod
  • Morning blood pressure:  90/61
  • Morning heart rate:  71
  • Morning axillary temp:  96.3 F
  • Evening glucose:  92 (taken less than an hour after dinner; I usually test at least 2 hours after dinner)
  • Evening urine ketones:  mod
  • Evening blood ketones:  1.4
  • Protein:  92
  • Fat:  76
  • Carbohydrate:  24
  • Calories:  1287
  • Exercise:  jog 2.25 miles

Foods:  Chicken, duck fat, Emergen-C (1 pkt orange), black tea, blueberries (1 cup), 1 milk chocolate square.

Evening notes:  Good energy, very productive. Legs felt heavy during run. Slept 8.5 hours.

Day 21 (Wednesday Apr 10)

Morning notes:  Feel fine this morning.  Mildly creasey skin and body feels a bit heavy, but clothes fit better than last week.  No more rash.

  • Weight:  152.8 lbs  (down 0.4 lbs this past week)
  • Body Fat Percentage:  35% (down 0.5%)
  • Measurements:  I forgot to take these.
  • Morning glucose:  82
  • Morning blood ketones:  0.8
  • Morning urine ketones:  mod
  • Morning blood pressure:  100/61
  • Morning heart rate:  71
  • Morning axillary temp:  95.7
  • Evening glucose:  78
  • Evening urine ketones:  max
  • Evening blood ketones:  1.1
  • Protein:  121 g (wow)
  • Fat:  55
  • Carbohydrate:  9
  • Calories:  1048
  • Exercise:  none

Foods:  Duck breast w skin, turkey, chicken, green tea, zucchini (1 cup), Taza dark chocolate (6 g carb).  No more Emergen-C.  No potassium or magnesium today.

Evening notes:  Got pretty hungry by late afternoon and ate a lot more protein than usual. Is this because I jogged yesterday?  Slept 8 hours.

Reflections on Week 3

Ketones  Interesting how the urine ketones and blood ketones are not particularly well-matched this week. I know that the relationship between the two can be complicated, particularly in the early weeks of ketogenic diets, so I’ll just keep tracking them to see what unfolds. 

Blood Sugar  Blood sugar stability is truly remarkable on this diet.  Imagine someone with diabetes having this much control over daily blood sugars.  Think how much less insulin or medication would be required when blood sugars are this well-regulated.  

Weight Loss  No significant weight loss in the past 2 weeks.  I am not unhappy about this–my primary goal is to achieve stable ketosis and to hopefully adapt to burning ketones for fuel.  This can take 3-6 weeks, as I understand it.  If I don’t start losing weight after week 6, I will consider making changes to the plan, but it’s too early for me now to worry about this. 

Energy improved dramatically during the second half of this week, as did focus and productivity.  I don’t know how much of this was due to possible keto-adaptation, cleaner diet, and/or improved sleep.

Sleep also improved a lot during the second half of the week.  I attribute this mainly to food choices.  

Lab results:  Delayed by a technical error at the lab

Goals for Week 4

To increase exercise, completely avoid all devilish dairy products, and keep my diet as free of plant foods and “old”, processed, cured, canned, and aged foods as possible without getting hungry.

Update from Real Woman Anne!

Anne tells me she has continued to lose weight, and is now at 118 lbs, which is 8 pounds lighter than she was able to achieve with Weight Watchers plus exercise 2 years ago.  She has surpassed her original goal of 120 lbs and has set her sights on 115. Go Anne! She hasn’t been able to exercise much during this ketogenic diet due to hip pain, which has interfered with her ability to enjoy her favorite activities–tennis and dancing. She had an MRI of her hip last week that showed a torn labrum and is about to receive cortisone injections for that (anyone want to try to convince her to go Paleo?)

She had labs drawn in March of 2011 (while eating a standard diet, not during her Weight Watchers diet) and again in March of 2013, while on a ketogenic diet.  I have excluded electrolytes, blood count, kidney and liver function tests because they were normal and unchanged. 2011 results are posted below in orange, and the 2013 results are in blue and labeled “KD”:

  • Fasting Blood Glucose:  105     KD89
  • Anion Gap:  9     KD13
  • TSH:  1.44 (not tested in 2013)
  • Free T4:  1.13  (not tested in 2013)
  • Vitamin D:  18.9     KD15.3
  • Hemoglobin A1C:  (not tested in 2011)   KD4.8
  • Total cholesterol:        238       KD302  
  • LDL:    153        KD223   
  • HDL:    77         KD59  
  • Triglycerides:    42       KD101  

Reflections on Anne’s results:

Anne’s fasting blood sugar is much better on a ketogenic diet, but her lipid profile has “worsened”.  Anne is eating a standard ketogenic diet–high fat, moderate protein, low carb, and not exercising much.  She includes dairy and some processed foods in her diet, as the vast majority of people who eat a ketogenic diet do.  Her triglycerides, while still in the normal range, have increased significantly, and her HDL has fallen.  I will not venture to form a conclusion about these results except to say that they may or may not be due to a) the high fat content of a ketogenic diet, b) the process of fat burning, c) the presence of dairy, d) low activity levels (HDL in particular).  

My own (much more extreme) version of a ketogenic diet earlier this year, with little/no dairy or processed foods, and almost no exercise, produced the following lipid profile:

  • Total cholesterol 260
  • LDL 170
  • HDL 70
  • Triglycerides 99

[For my complete lab results, click HERE.]

What do you think of Anne’s lab test results?  Her primary care doctor was very concerned about the trend in her lipid profile.  She recommended she reduce her saturated fat intake, and start taking red rice yeast daily.

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  • http://www.facebook.com/charles.grashow Charles Grashow

    Anne should get a NMR test to see what her LDL-P and small LDL-P counts are. Her Vit D levels are EXTREMELY low. She should also test her ApoB levels.

    The fact that her trigs are going up and her HDL is going dow is cause for concern as well

    More info is needed -ESPECIALLY the LDL-P and small LDL-P numbers

    • F Jeff

      I agree on the Vit D level and on NMR testing, but the changes in the profile are not so much of a concern because she is actively losing weight, so the lipid numbers will be “off” until she plateaus and the weight stabilizes.

  • Trina

    Paul Jaminet has written about high LDL on a low carb/paleo diet http://perfecthealthdiet.com/2011/09/high-ldl-on-paleo-revisited-low-carb-the-thyroid/.

  • Rari

    Orange Juice, milk chocolate, hershey’s kisses – where excactly is this a LCHF / ketogen Diet?

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Rari

      If you notice my carb intake per day is extremely low, and I am generating ketones, so this is a low-carb, ketogenic diet. Is it perfect and pristine? No-but it’s a lot more pristine than most, I’d reckon. I know it would be best not to eat any chocolate whatsoever, but most days I’m eating a maximum of 6 grams of carbs from chocolate–that is a single triangle of Taza dark chocolate, which is the size of the top half of my thumb. And you know how small a Hershey’s kiss is. I got rid of the Emergen-C packets (6 grams carbs per day) the other day. I was using it to mix in with my potassium solution to cut the bitterness and saltiness, but I am not going to use that anymore. I may also decide to get rid of the chocolate bits entirely, but psychologically they are somehow helpful in an otherwise very strict diet. If I don’t lose any weight with 6 grams of sugar per day, I’ll get rid of it completely to see what happens. As I’ve said, I am cleaning my diet up along the way as I adjust to it.

    • TooSteep

      123g of carbs over 7 days is indeed a very LC diet! That’s less than 18g of carbs a day. I would categorize it as a low carb, moderate fat, high protein diet. My own experience is that I need to keep the protein level much lower in order to keep the ketones in the 1.5 – 3.0 range. And I am closer to 200g/day of fat. It would be interesting to get a lipid profile, as I have stable weight throughout.

      • http://diagnosisdiet.com/ Dr. Ede

        Hi TS

        I agree that my protein is higher than some would recommend, and I may need to lower it at some point, but my experience with 50 g per day was terrible, so I wanted to go at it more gradually this time. Given my food sensitivities it’s pretty challenging to find ways to increase my fat any more–I tried all kinds of experiments with this last time around without success. This week I’m trying to increase fat by sauteeing zucchini in duck fat–we’ll see how it goes. And I did decide to ditch the few grams of sugar entirely after pondering Rari’s comment below. I know it’s not healthy and it may be throwing things off.

        • MAD Gal

          I was just wondering if you have thought about adding cream cheese to your diet? Or are you sensitive to all cheeses? Cream cheese is very versatile and can be used as dessert (cheesecake balls w/ non-sweetened choco and artificial sweetener) or as snacks (cheese balls rolled in coconut or other LC topping). Lots of yummy fat there. :)

          • http://diagnosisdiet.com/ Dr. Ede

            Hi MAD Gal
            Thanks for the thoughtful suggestion. Those desserts sound delicious! Unfortunately I’m sensitive to all dairy products :(

  • http://www.facebook.com/jeff.puhek Jeff Puhek

    Her primary care doc needs to update. First off, NMR profile is better; more modern. The standard lipid profile will always be out of whack when active weight loss is “under way” – this is well documented by Dr. Davis in his “Track Your Plaque” book (2nd ed) and on his blogs http://www.trackyourplaque.com and wheatbellyblog.com. Even NMR will be “off” until weight stabilizes. The rise in total is definitely from the fat-burning processes, making the LDL calculation WAY off – fictitious! HDL could be an effect of particle size increase, but without NMR, we’ll never know.

  • Elizabeth Bowler, MD

    Thank you for another interesting post. I would not be at all concerned about Anne’s lipid profile at this point. NMR would be helpful but she might wait until her weight has stabilized. She needs to increase her Vit D immediately though.

    Re your results this week, it sounds like the second half was quite good and your pulse rate even improved although your basal temp remained low. The temp is helpful information although I prefer oral (per the temp protocol of Wilson’s Temperature Syndrome).

    Chris Masterjohn just posted a review of the red meat/TMAO article on the WAPF site – v

  • evinx

    It is a bit pre-mature, I suspect, to be concerned about Anne’s lipids.

    Here is what Volek & Phinney state in their book, “The Art and Science of Low Carbohydrate Living.”(Chapter 13).

    “There is one anomaly in clinical testing that physicians and
    patients should be award of: a transient rise in serum total and LDL
    cholesterol that can occur with major weight loss. We reported this in
    1991 [101], and our research revealed the cause. It turns out that along
    with the triglyceride stored in adipose tissue, our fat cell also
    contains a small amount of dissolved cholesterol. After about 30 pounds
    of weight loss, the shrinkage of these cellular fat droplets proceeds to
    the point that some of this cholesterol has to be released into the
    serum. The amount of cholesterol involved is 100-200 mg per day in
    someone losing 2 pounds of adipose tissue per week. Interestingly,
    although this represents ‘reverse transport’ back to the liver, this
    cholesterol rise appears in the LDL fraction. But once a person’s weight
    loss ceases, this expulsion of cholesterol stored in adipose tissue
    stops and serum LDL cholestrol returns to its new post-weight-loss
    baseline.

    So if you or your patient experience a rise in serum LDL cholestrol
    as the scale passes 30 or more pounds of weight loss, don’t panic. This
    is a sign that your body is dumping previously accumulated cholesterol.
    Since this situation typically lasts only a month or two,whereas it
    takes decades of elevated LDL cholesterol to cause blood vessel damage,
    the probability of any clinical risk is very small.”

    By the way, Red Yeast Rice is really a low dose statin – and likely an inconsistent dose as the standards are different for supplements vs pharmaceutical grade. She should check it out carefully before agreeing to take it.

  • ddick

    Do you cook with the duck fat or just eat it plain? Is duck fat better than beef fat or coconut oil?

    • http://diagnosisdiet.com/ Dr. Ede

      I usually don’t eat it plain–I cook with it or I heat it, add salt to it and use it as a dipping sauce of sorts for dry meats such as chicken breast. Unfortunately I can’t tolerate coconut oil or beef fat (see my original ketosis posts from the Seyfried experiment if you are curious to see all the details, but that’s the bottom line).

  • Laura James

    Does it shock you at all to have such a low temperature? It did me. I don’t have all or any answers really, but when you get your thyroid panel, maybe the temps will mean something. I need to save up to get the full thyroid panel myself.

    My temps are up though from lows (2 months ago) in the mid 95′s to a steady 97.7-98.6. The good news is that temps throughout the day usually go up. It’s the nighttime and morning ones that can get super low. I started out by just adding easy carbs like fruit, and veg and a few grains like oatmeal and rice. I know this is anathema to the LC/VLC but I was afraid of the low temps and what might be happening with my metabolism.

    I am now in the moderate carb, lower protein, moderate fat camp (if there is one) at about 20/40/40 Again I don’t have answers for anyone else and my reasons for focusing on thyroid are individual.(cancer prevention and estrogen dominance) I do go by how I feel and I am sleeping well, going through menopause easily, have great energy and stabilizing my weight (not losing tho:( )

    I hope this protocol will show in future labs as a working thyroid and a liver able to process estrogen well. I’m looking forward to more of your experiment.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Laura
      I don’t have any answers either, so we are in the same boat:) I am interested in getting to the bottom of these thyroid questions and once I have some sort of handle on it I will write a post about it. It sounds as if you have thought a lot about it and found a diet that works well for you, which is what it’s all about! If a ketogenic diet does not suit me well, I will certainly be exploring other options myself.

  • bjjcaveman

    Interesting to see that she has high LDL cholesterol too despite benefiting from fantastic glucose control and weight loss from being in ketosis.

    There are a few theories out there as to why people on low carb can have higher cholesterol, and I’m currently in the process of trying to figure this out for my self.

    http://bjjcaveman.com/2013/04/06/the-effect-of-a-ketogenic-diet-on-cholesterol-part-3/

    Here is my most recent post on it, as I’d be interested to hear your thoughts.

  • Rich

    Lipid profiles in women are not a reliable indicator of heart disease at all. In fact lipid profiles are not a very good indicator of heart disease in light of the most recent research into the subject. Having 3 or more of the 5 indicators of metaboloic syndrome is what i would worry about. Keep going on the diet.