KCP008 – Show Notes
Type 2 Diabetes – Type 2 diabetes is a chronic disease that occurs when your blood has a high concentration of circulating glucose. High levels of circulating glucose can lead to many chronic conditions including diabetic nerve damage (neuropathy), damage your optic nerve causing blindness (diabetic retinopathy). It can lead to chronic ulcers of the legs and feet and it is the leading cause of toe, foot, and leg amputations.
Metabolic Syndrome – Is a combination of conditions that increase your risk for cardiovascular disease, diabetes, stroke, and sudden death. According to the American Heart Association These conditions include:
- Waist size > 40 inches (men), > 35 inches (women)
- Diabetes (Hgb A1c > 6.5 or fasting glucose > 100+ mg/dL)
- Hypertension (SBP > 130, DBP > 80)
- HDL < 40mg/dL (men), < 50mg/dL (women) or triglycerides > 150mg/dL.
Having one of these conditions is not necessarily a problem, but if you have three or more your risk increases dramatically. BTW, many type 2 diabetics have all of these conditions.
Ketones and Ketone Bodies – Ketones, are the byproducts of the metabolic process known as ketosis. In the absence of starches and sugar, the liver begins to breakdown your stored fat into ketones also know as ‘ketone bodies’ that it will use for fuel in place of glucose. Instead of burning sugar for energy, your body burns ketones for energy. Your body creates these ketones by burning it’s own body fat, a process known as ‘nutritional ketosis’.
Free Radicals – Free radicals or reactive oxygen species (ROS) are a byproduct of oxidative cellular metabolism created by our mitochondria due to high levels of inflammation. These free radicals damage the body’s cells, leading to a wide range of chronic diseases. As we age, our bodies lose their ability to fight the effects of free radicals. This results in more free radical production, and more cellular damage. Which leads to, or increases the symptoms of chronic diseases such as diabetes, metabolic syndrome, and kidney disease.
Free radicals are also a contributing factor in increasing insulin resistance (p82). It work like this…Dietary carbohydrates raise serum insulin levels.
Insulin promotes inflammation. Inflammation increases free radical generation. Free radicals attack and damage or destroy the polyunsaturated fat membranes in muscle tissue. Because polyunsaturated fat membranes are an important determinant of insulin sensitivity. If the muscles cannot store glucose, then more is left in the blood stream. Damaging or destroying these muscle membranes interferes with insulin sensitivity which increases insulin resistance.
The major contributing factor to inflammation, and the trigger for free radical production is…you guessed it dietary carbohydrates.
Why Eat A Ketogenic Diet (13:18)
- Dietary carbohydrates are a direct source of blood glucose especially in rapidly digested forms. (p186) Carbohydrate restriction leads to fewer fluctuations in blood sugars and insulin levels. Ketogenic diets show better glucose control and increased insulin sensitivity than any other diet especially in people with metabolic syndrome and type 2 diabetes. (p187)
- The restriction of carbohydrates leads to fewer fluctuations in blood glucose, and decreases the more than 16 markers of chronic inflammation. (p84, 186)
- Ketogenic diets perform better than low fat diets. Including improvement in triglycerdies, HDL & LDL particle size, glucose control and insulin sensitivity. (p188)
- Carbohydrates cause acute hyperglycemia which activate a number of inflammatory and free radial pathways in the body. (p186)
- Research has shown that the markers for inflammation are elevated in chronic diseases such as diabetes and heart disease.
- Inflammation of the artery walls increases the formation of plaque which is a major risk factor for stoke and myocardial infarction.
- Inflammation cases the mitchondria in our cells to increase the production of molecules known as free radicals.
- A Ketogenic diet can reverse the damage caused by free radicals. (p83)
Carbohydrate Restriction (17:00)
If you have not figured it out so far, let me make it perfectly clear….The only way you can get into nutritional ketosis is by restricting dietary carbohydrates (sugar and starches). The only way, short of gastric by-pass, that you can reverse your type 2 diabetes is again through carbohydrate restriction.
For the purpose of this and further podcasts,when I speak of carbohydrate restriction, I am referring to net carbohydrates.
Total carbs – fiber – ½ sugar alcohols = Net carbs
One of the most common questions I get asked when people hear I am on a ketogenic diet is: How many carbs do you eat?
- Carbohydrate restrictions vary per individual (p200,201)
- A few lucky individuals can get into ketosis eating <100 grams of net carbohydrates per day.
- Many people can get into ketosis when eating < 50 grams of net carbs per day.
- Almost everyone can get into ketosis when eating < 40 grams of net carbs per day. (p199, 209)
- Everyone will get into ketosis when eating < 20 grams of net carbs per day.
- If you are not diabetic, or suffering from metabolic syndrome, then you can probably eat 30 to 50 grams of net carbs and easily get into ketosis.
- People with DM & MS should eat < 20 grams of carbs per day.
What About Protein? (19:00)
Protein recommendations vary depending on the source. The USDA recommends that a person needs to eat 0.8 grams of protein per kg of total body weight. Dr.s Phinney and Volek recommend 1.5 – 2 grams protein per kilogram, or 0.7 – 0.9 grams per pound of reference body weight (RBW). (p44)
- Reference body weight (RBW) is the midpoint in the “healthy” weight range according to the USDA.
- For a 5’9” male, the ideal body weight (IBW) range is 144 – 176lbs, the mean reference body weight is 160lbs, or 73kg .
- For a 160lb male, Phinney & Volek’s recommended daily protein intake would be 112 – 144 grams, or 448 – 576 calories per day.
- For a 73kg male, the recommended amount of protein would be 110 – 146 grams, or 440 – 584 calories per day.
The Diet Doctor website recommends 1 gram of protein for each kg of body weight for optimal weight loss. The m aximum protein level should be no greater than 25% of total calories eaten per day when following their ketogenic diet (about the same as Phinney & Volek). But they set no specific daily caloric target.
The USDA dietary recommendations (25% protein).
- 1800 calories = 450 calories or 113 grams of protein.
- 2000 calories = 500 calories or 125 grams of protein.
- 2200 calories = 550 calories or 138 grams of protein.
- 2400 calories = 600 calories or 150 grams of protein.
Keep in mind 25% is the maximum amount of recommended protein. Even vigorous athletes on low carb diets do well when just 15% of their energy needs come from protein. (209)
How Much Fat Should You Eat? (23:03)
The simple answer to how much fat you should eat is to “let satiety rule”. (p163) But what does that mean? If carbs account for only 3 – 5% of energy needs, and protein 25%, then the remaining 70 – 72% of energy must come from fat. Therefore, the majority of calories consumed on a ketogenic diet come fro healthy fats.
- Sources of healthy Fats include: butter, bacon grease, olive oil, coconut oil, avocado oil, MCT oil, lard, tallow, HWC, cheese, fatty meats, fish, seafood and nuts.
- Fats that you want to try and avoid include: just about any vegetable or seed oil such as corn oil, soy oil, safflower oil, sunflower oil, cottonseed oil, vegetable oil.
- One gram of fat provide 9kcal of energy, twice the amount of protein or carbohydrates.
- If dietary fat is < 30 grams per day during rapid weight loss, cholesterol can build up in the gallbladder and increase the risk for gallstones. (p168)
- While protein does have a satiating effect, fat costs less and is more satiating. (p209)
Counting Calories (25:25)
Keto does not promote the counting of calories, the amount of carbs consumed daily is the key, not total calories. Dietary research continues to show that participants on a low carbohydrate diet eaten to satiety lose more weight than those on a low-fat calorie restricted diet. (p163) Because of the high satiation power of fat, many people will actually reduce their total caloric intake on a LCHF diet simply because they are not hungry. So while you may eat less calories, keep in mind your body is furnishing those additional calories that you are not eating by burning it’s own fat.
Everybody wants to know how much they should eat…
Sample 2,200 Calorie Ketogenic Diet
Because everyone wants to know exactly how much they should eat, let’s look at a basic 2,200 calorie keto diet. A diet that supplies it’s energy from 3.6% carbs, 25% protein, and 71% fat, would look something like this:
- Net Carbohydrates – 20 grams or 80 calories ( 3 – 5%).
All carbs should come from green leafy vegetables.
- Protein – 138 grams or 552 calories (25% maximum).
Red meat, pork, fish & seafood, wild game, cheese, etc…
- Fat – 174 grams or 1,566 calories (72%+), either from your plate or from your own fat stores.
Butter, ghee, olive oil, macadamia oil, avocado oil, coconut oil, bacon grease, fatty cuts of meat, fatty fish (salmon, herring, tuna) dairy (cheese, HWC, cream cheese).
Testing For Ketones (30:08)
Most people who have been on a ketogenic diet for a few days or weeks, really want to check and see if they are in ketosis.The two most common ways to test for ketones are by using either a blood ketone monitor or urine test strips. The serum blood monitor I use is from Keto Mojo, and no I am not getting paid by them, I just like their monitor.
Urine Test Strips:
- Urine test strips are inexpensive, but have limitations.
- Developed to test for diabetic ketoacidosis
- Only test for the ketone acetoacetate.
- Are ineffective once you become fully keto adapted, as betahydroxybutyrate is the primary ketone in your bloodstream, and fewer ketones are excreted by the kidneys.
Blood Keytone Monitors:
- Serum blood ketone monitors are the most accurate.
- Test for betahydroxybutyrate.
- Blood test strips are expensive, about $1.00 each.
You do not need to test your blood or urine for ketones. I was keto for 18 months before I bought a monitor. I only test for blood ketones when I am fasting for my own research purposes. To prove my point about urine test strips, these are my ketones after a 48 hour water only fast.
- Serum blood ketones were 3.2mMol/dL.
- Urine test strip(s) were negative for ketones.
Again, you do not need to test for ketones, but if you wish to, my advice is to get a good blood ketone monitor. They are expensive, but accurate. Urine test strips cheap, but once you become fully fat adapted are eventually useless.
Cheat Days (32:32)
- Are not recommended.
- When a fat adapted person eats transient and or modest amounts of refined carbohydrates. They can be kicked out of ketosis in a matter of hours, and remain so for 3 – 7 days. (p203)
- Eating one high carb meal a week could potentially keep you out of ketosis more than 50% of the time.
- Bottom line, for continued success, no carbohydrate related cheat meals should be eaten.
- If you have a bad day and fall off the wagon, that’s ok. It happens to all of us, just dust yourself off and get back to it. However, scheduled breaks in the diet should be avoided.
- Cycling in and out of nutritional ketosis and the ketogenic flu (carbohydrate addiction) sucks!
Key Points To Remember (35:28)
Some key things to remember from today’s episode:
- In order to go from what we call a “sugar burner” to someone who fuels there body from ketones which are made from your own fat stores. You have to restrict the amount of carbohydrates you eat each day until your body begins to produce ketones as an alternative fuel source. A low carbohydrate, moderate protein, high fat diet is the only diet that will put you in a state of nutritional ketosis.
- A ketogenic diet reduces the dietary carbohydrate trigger that causes free radical production which can increase insulin resistance.
- Type 2 diabetes can be reversed with a ketogenic diet, despite the fact that many physicians continue to tell their patients that their diabetes will only get worse.
- You do not have to count calories. Eat to satiety.
- You do not have to test for ketones. Remember, once you are fat adapted urine strips are ineffective.
- Cheat days are not allowed.
- Everybody has a bad day and falls off the keto wagon, even me. When it happens, write it off and start over. Don’t beat yourself up your only human. Sometimes life throws you a curve ball or two, the important thing is that you keep swinging, even if you strike out.
You’ve Got Mail (38:45)
Chris writes, “Hi, I’ve been doing keto for a week now. I just did a test strip and it gave me a much lower number than I expected between .5 and 1.5 which says trace or small amount. Is this normal or weird? I’ve only been eating vegetables, meat, cheese, eggs, unsweetened Greek yogurt and occasionally peanuts and almonds. I feel good when I am not hungry but when I get hungry I feel really bad..”
Chris thanks for your question, first we need to examine a few things that I think might help you:
According to the book “The Art and Science of Low carbohydrate Living”, if your serum ketones measure 0.5 to 5.0mMol/dL you are considered to be in ketosis. So yes, you are in ketosis, great job! Not knowing exactly how many grams of carbohydrates you are eating daily makes it a little more difficult to answer your question, but a few things concern me.
- While vegetables can be good for you some contain a lot of carbohydrates in the form of natural sugars. So you have to be careful, to make sure that the majority of vegetables you eat are the green leafy kind.
- You have to be careful with yogurt, ½ cup of unsweetened Greek yogurt contains 5 grams of carbs.
- While nuts are generally acceptable on a ketogenic diet, peanuts are really legumes (bean family). A ¼ cup of dry roasted peanuts also contains 5 grams of carbs.
- Eating just 1 serving each of yogurt and peanuts puts your net carb total at 10 grams for the day. If your goal is 20 grams or less, then you have already ate half your carbs in snacks.
I am not sure what you mean when you state “I feel good when I am not hungry but when I get hungry I feel really bad..” It is possible that when you start to feel hungry your blood sugar may be low. You did not mention that you are a diabetic, if so then hypoglycemia is the likely cause of your “feeling bad”. However the terms good and bad are subjective and are not easy to identify.
Some dietary suggestions I think that might help you with your ketogenic journey:
- Eliminate the yogurt from your eating plan, or at least minimize it to a couple of times a week.
- If you feel like you need a snack find a better nut choice. Almonds contain 3 grams of net carbs, pecans contain only 1 net gram of carbohydrates.
Just in case you have never heard of them before “fat bombs” is a term used for a small amount of coconut oil that have been melted and shaped into a single serving that you can pop into your mouth to increase your daily fat intake. You can of course use any of the other healthy fats such as butter, ghee, cacao butter, almond butter etc., to make your fat bombs as long as the type of fat you use will solidify at room temperature. Personally, we prefer coconut oil as it tends to be the best value for the money as is easy to work with. Therefore all the fat bombs in this article will be made with organic refined coconut oil (has no coconut flavor). If you use another type of fat, then your nutritional values will of course be different.
You can use any number of extracts, powders or combination of both to add flavors to your fat bombs. While fat bombs can be either sweet or savory, we tend to only make sweet fat bombs which we use as a sweet treat.
Peanut Butter Fat Bombs w/Peanunt Butter (Yield 24)
Peanut Butter Bombs w/Peanut Butter (Yield: 24)
1 cup coconut oil
½ cup peanut butter
10 -15 drops liquid sucralose
Calories – 2920, 292 grams fat, 32 grams protein, 32 grams net carbohydrates
Calories – 121.6, 12.6 grams fat, 1.3 grams protein, 1.3 grams net carbohydrates
Peanut Butter Bombs w/PBfit Peanut Butter Powder (Yield: 24)
1 cup coconut oil
4 tablespoons PBfit peanut butter powder
10-15 drops liquid sucralose
Calories – 2180, 223 grams fat, 12 grams protein, 4 grams net carbohydrates
Calories – 90, 9.26 grams fat, 0.5 grams protein, 0.16 grams net carbohydrates
Place the coconut oil in a bowl and heat for 90 seconds in your microwave or until the coconut oil has melted. Then add the liquid sucralose or sweetener of your choice and the remaining ingredients and mix thoroughly with a whisk.
Grab your ice cube trays or molds and fill each with 1 tablespoon of the coconut oil mixture. Place the trays in the refrigerator or freezer and allow to cool. Once they have solidified simple pop them out of the trays and keep them in the fridge until ready to eat.
Chef’s Note: I get my ice cube trays from Dollar Tree, you get two trays for $1.00, so the cost is quite minimal and they are easy to use. As you may have seen in the picture we also have some silicon molds that are pumpkin shaped. To be honest I think the ice cube trays are easier to work with.