30 days of healthy living: Day 20

Phew! 3+ days of a migraine and I still have the remnants of it. UGH! My sincerest apologies for not getting back here sooner 🙁

Tonight I want to discuss ketosis. Most of you have probably heard of someone doing a “keto” diet. Maybe you looked into it and thought no way or maybe you didn’t and just rolled your eyes over the latest fad. I’m here to say there is some validity to this way of eating but I think that people often have some misconceptions about the difference between the process of ketosis and the “keto” diet. I’d like to try to clear up the confusion.

First. KETOSIS is the process by which your body breaks down fat for fuel. Your body can use carbohydrates, fat or protein for fuel and there is a hierarchy for this process. Carbohydrates are the preferred fuel source. Your body is designed to use carbs for energy and the design is efficient. It is much easier for your body to use carbs for fuel and generally there is plenty to go around in the Standard American Diet (SAD-the abbreviation is kind of perfect…). If there are no carbohydrates to use, the next best and easiest to use fuel is fat. If you restrict calories or carbohydrates enough you will use fat as fuel. This can also occur after exercising for an extensive period of time (sorry but a 45 minute aerobics class isn’t likely enough. 60 minutes minimum is needed and maybe longer depending on intensity). Using fat as fuel produces a metabolic product called ketones. Getting into the state of ketosis these, burns fat, helps you lose weight, increases energy and helps maintain muscle mass.

However. There is always a however. Once you reach a state of ketosis, as soon as you consume carbohydrates the process will come to a halt and your body will default to bring carbs again. This is where the “keto” diets come in. By restricting the amount of carbohydrates consumed daily to 50 grams or less, you can maintain ketosis for an extended period of time. It generally takes 3-4 days on a 50gram of carbs or less diet to produce sustained ketosis. During this time many people experience what is called a “keto flu” which includes headache symptoms, fatigue, aches, etc, kind of like “flu” symptoms (without the pneumonia, fever and death parts). Headaches and fatigue are the most common as you body adjusts it’s fuel source.

Where does protein fit in here? You don’t want to burn protein for fuel. This is very bad. You can also kick yourself out of ketosis by eating too much protein so most keto diets consist of 70-75% fat, 20% protein and 5-10% carbs. Total grams of carbs should be less than 50. A healthy body should be able to handle the amount of ketones generated with this diet and you can help your body by drinking LOTS of fluids to flush everything out. Your kidneys will excrete the extra ketones for you as long as you do. In fact, there are test strips you can use to test ketones in your urine although it is not a direct correlation between your urine ketones and your serum (blood) ketones.

Diabetics beware! Diabetics are at risk of ketosis due to lack of insulin which prevents your body from using carbohydrates as fuel. For diabetics this is bad and can lead to ketoacidosis which is a build up of ketones in the blood. Ketoacidosis can cause coma and death. If you are diabetic, please use extreme caution and work with your medical provider to lose weight and change your diet safely!

So, yo put it in a nutshell: The keto diet is an eating pattern which is low in carbohydrates, high is fat and moderate in protein that helps put you into and keep you in a state of ketosis or fat burning. Ketosis can also be achieved by fasting, calorie restriction, intense or extended exercise or, in diabetics, a lack of insulin (this last one is VERY VERY BAD). Eating carbohydrates stops the process of ketosis. In general this process is helpful for weight loss and remaining in ketosis for extended periods will likely result in faster weight loss, more energy and preserved muscle mass while losing weight. A transition period is usually 3-4 days if adherent and most commonly causes a mild headache for a few days. People with diabetes need to use caution because ketosis can lead to ketoacidosis, or an extreme build up of ketones, and cause coma or death. Diabetics should not attempt extreme diet changes unless monitored closely.

My take on this is that anyone on a true keto diet should be monitored by their medical provider. That is true for anyone who needs to lose an extensive amount of weight. Nutritional deficiencies are common on restricted diets and typically require blood work to monitor. Taking crazy amounts of supplements can cause overdosing of vitamins and minerals and there isn’t much evidence to suggest that taking multivitamins is helpful. There are potential side effects of extreme diet changes and the safety of hit pattern of eating for the long term is unknown. I think it is a good short term weight loss strategy for otherwise healthy people who are diligent about eating healthy foods in general. I think its a not great idea for anyone who thinks it gives them a license to live on bacon and cheese and expect to be healthy in the long term.

We will continue to discuss insulin resistance, metabolic syndrome and diet in the next couple of posts.

you can read about the keto diet here and here, here and here.

Until then,

Have a happy healthy week!

Liz

30 days to healthy living: Day 3

What to eat when. That’s the topic for today and what a loaded topic this is!!
Quiz time: What do YOU think is the best way to fuel your body through out the day?
a. one meal per day
b. 2 meals per day
c. 3 meals per day
d. snacks
e. no snacks
f. limit the number of hours you can eat during
g. no eating after 7 pm
h. something else
Well, if you look on the internet you will find someone telling you any and all of the above is the “right” way to eat. (And I’m going to kind of do that too…) So what’s the evidence? Short answer: it’s conflicting.
The governments My Plate recommendation is vague. It gives total recommendations for the day and approximate amounts you should put on your plate via an infographic. You can find calculators on the website that will help you determine your caloric needs for weight loss and maintenance based on your activity but I feel like the numbers were on the high side. Basically it looks like 75% vegetables/fruits/carbs and 25% protein with a little dish of dairy on the side. No fat recommendation on the infographic itself and I did a lot of clicking but didn’t find much that was more specific than that. At the bottom of the infographic it tells you what a serving of each food group is and how many per day you should eat based on your calories for the day. So some good, very basic information but I think it leaves too much room for error. If you are ambitious, you can read the entire 2015-2020 dietary guidelines for Americans here. Good luck!
Paleo: meh. I think we need some good whole grains in our lives. I don’t live in a cave and don’t forage for my food. I do find a lot of good recipes here when I need a gluten free version of something. Just don’t be afraid to add a little brown rice or other whole grain. It will stretch your recipe, give you more fiber and sustain you a bit better.
Keto: So a true “keto” diet should only be undertaken under medical supervision, especially if it is for something like controlling epilepsy. There is research supporting it’s use but again, with supervision. Your blood is supposed to be a fairly neutral/slightly alkaline pH. Mess with that and you are courting a coma. In fact, that’s what happens to diabetics when their diabetes is not well controlled. I like fat and I think we should include healthy fats in our diets everyday but 70-80% fat? I am not a huge fan. Plus, if your blood is acidic it will pull calcium from your bones in order to balance it. This in turn will cause osteoporosis over time.
Alkaline: As I just noted above, your body needs just a slightly alkaline blood pH of 7.4 . Acidosis is defined as a pH of 7.35 or lower and alkalosis as 7.45 or higher. Not a lot of wiggle room there. Getting your blood MORE basic isn’t any better for you than getting it slightly acidic and it may actually be worse. Thankfully your body has natural mechanisms during digestion and absorption to balance your blood pH all on its own. When your blood pH is out of whack, you are in trouble. Blood pH isn’t something to try to change on your own. And so I will go on the record and say that although I am an Arbonne Independent Consultant and use their products for weight loss and maintenance including their healthy living materials and 30 day program, I do not support attempts at “alkalizing” your blood. Its why I also don’t agree with having to avoid coffee and vinegar. There are a lot of health benefits to be had from a couple cups of coffee per day and when you consume vinegar, which is an acid, your body turns it into an alkaline substance. Its the same with lemons. There IS an article from the Journal of Environmental and Public health discussing the alkaline diet and it”s potential benefits but mainly that’s because it is mostly plant based and eliminates processed foods. Bottom line, you can’t and shouldn’t significantly change your blood pH. You SHOULD include more vegetables and fruits and less processed foods and meat in your diet.
Detox: Do you have a liver and kidneys that work? Then you have all the “detox” you need. So while I actually love Arbonne’s Detox Tea, I really dislike the name. There are so many “detox” plans out there and really nothing can clean your blood for you any better than your liver and kidneys can (well dialysis can but we are trying to avoid that with a healthy diet, ok?). Want to “detox” for real? Drink lots of water and eat fiber. “Detox” seems to be a euphemism for pooping. Yep I said it. Pooping. You should do this at least once a day. In fact, probably after every meal since it should ideally take 24 hours for your meal to pass then entire length of your gut end to end. Our guts are generally messed up though and medications interfere with our gut function. So water + fiber= poop= “detox”  ps: the funny thing about the Detox tea? It doesn’t make you, uh, “go” but it does have some great herbs in it that support the liver’s function. So maybe the name isn’t as bad as it sounds…
Intermittant fasting (Time Restricted Feeding): Ok, if anything is going to get a gold star it’s going to be this. There is actual research showing promising results in mice(and other animals) that limiting the number of hours you consume food during the day is helpful in preventing weight gain, stabilizing blood sugar, preventing fatty liver disease, extends lifespan and supports weight loss. This is purely anecdotal but I have a friend who has been using intermittant fasting and has lost weight and has been able to get off of her diabetes medication with her medical provider’s blessing and support. (As with anything else, do not stop any medications without involving your provider!) I read the mice study this summer. Basically the best results were seen in mice who followed schedule of eating during an 8-10 hour time frame and ate a healthy diet although there was benefit even when eating a higher fat diet. Cool stuff and more research is needed.
Last, I’d be remiss if I didn’t mention the Blue Zones diet. This is a common denominator diet found to be followed generally by the “blue zones” or places where there is the highest concentration of people living to 100 and beyond. It’s mostly plant based, 90-95%. Yes, there will always be that George Burns type who seems to live forever on cigars and whiskey but the vast majority of those who live to be centenarians follow a much healthier lifestyle. This style of eating certainly can’t hurt!
There are other diets out there as well but these are the most popular right now that I am aware of.  I personally have to follow a gluten free diet no matter what other eating pattern I choose to follow because of celiac disease. I recently read an article about the potential benefit of a low gluten diet helping with GI symptoms but it seemed to be related more to an increase in amount and type of fiber for those who had GI symptoms but not celiac disease. If you don’t have celiac, maybe try more fiber first. Gluten free dieting without medical need is not recommended.
My recommendation:
1. eliminate processed foods, soda, sweeteners and temporarily starchy vegetables like potatoes and corn as well as alcohol.
2. Make sure you are truly fasting overnight. This means at least 12 hours. Set a cut off time if you need to. I generally have black coffee until about 10 am then a protein shake to break my fast.
3. Eat 2 “lean and green” meals per day. This is 3-5 oz lean protein, 3 cups leafy greens or 1.5 cups other vegetables along with a small serving of whole grain such as 1/4-1/2 cup brown rice, 1-2tsp healthy fat such as olive oil, herbs to season and some vinegar if you are making a salad.
4. Space your meals about 4-5 hours apart if you aren’t using a really short (8 hours) time restricted eating pattern. I try to keep all eating within a 10 hour window.
5. Have a snack only if you are truly hungry and limit it to 100-150 calories. I love having a green apple and a tbsp of almond butter. 15 almonds also works. Hot tea, especially green tea, can help with cravings and is an excellent accompaniment to snacks.
6. Calculate your basic caloric needs and subtract 500 calories. This is your maximum for the day.
7. Try meal replacements. I use Arbonne protein shakes and add almond milk, fiber and sometimes peanut powder or cacao powder and a banana. There are loads of recipes on Pinterest for Shakes using Arbonne protein powder! I have one for breakfast every day and I have 2 a day when I am trying to lose weight.
8. write down what you eat. That journal you started on day 1 is for recording your daily intake. Use it! And write EVERYTHING down. what you ate, where you ate it, how you felt before and after and what was going on that day. This is helpful for identifying eating patterns and any potential food intolerances.
9. Drink 64 oz water daily at minimum. Hydration hydration hydration. Tired? drink water. Hungry? drink water. Bored? drink water. We are all walking around like shrinky dinks because we don’t drink enough. Hint: your urine should be CLEAR!
10. Be cautious with alcohol. Alcohol lowers your inhibition and this includes your ability to follow your diet. Drink too much and next thing you know you’ve eaten 2 dozen hot wings and half a pizza. When losing weight its best to avoid altogether or save it for a special occasion or the weekends and then only have 1 serving per day for women and up to 2 per day for men. (Not fair I know. Blame biology)
That’s it in a nutshell. Or a really long wandering article depending on how you look at it 😉
Questions? Leave them in the comments and I’ll be happy to help!
Happy day 3!!
Liz
PS: I am here as your coach. I am not acting as your medical provider. I cannot give you medical advice. What I am suggesting is what has worked for me and is largely based on programs I have used than I know get good results. I also check for evidence based dietary recommendations and read actual medical research studies on diet. Before you change your diet or start to exercise, discuss it with your medical provider. If you are on medications changes in your diet can affect how your medication works. Weight loss can affect birth control methods. Leafy greens can interfere with “blood thinners.” Your provider is also a good person to help you set goals. Don’t put your health in jeopardy trying to get healthy (ironic I know)  talk to your medical provider first!!