June 18, 2013

Nutritional biochemistry

My Quantified Self, Part I

My 2013 presentation at the Institute for Human and Machine Cognition (IHMC): An Advantaged Metabolic State: Human Performance, Resilience & Health.

Read Time 2 minutes

In 2013 I gave a presentation at the Institute for Human and Machine Cognition (IHMC) in Pensacola, Florida. Ken Ford, the CEO and Founder of IHMC, is a remarkable person and I could not wait to meet his team and see their research.  IHMC does cutting edge work, primarily for the Department of Defense (DoD). I had an exhilarating day which culminated with a presentation I gave to the team and also the public.

The talk I gave was a first timer.  (Usually the first two or three times I give a talk it’s not very good, as I need to work out some kinks.)  However, since the talk was recorded I’ll set my perfectionist tendencies aside and share it, below.   The talk is about an hour, and the Q&A session was also recorded.

A month or so before the talk, I asked Ken what he wanted me to talk about and he suggested I speak about human performance and resilience – both topics of importance for the DoD.  I don’t consider myself an expert in either of these topics, but I certainly appreciate the need to maximize, or least optimize, both.  Rather than give a highly technical talk, I chose to give a slightly technical talk that focused more on my own journey in this space and some of the experiments I’ve done on myself, specifically those around energy utilization.  This talk does not present all of the data on my self-experiments, of course, but hopefully it gives you a sense of what kind of data can be gathered for studying energy utilization.  In subsequent posts I’ll likely delve further into the data that support these findings and expand on a few of the tangents not fully explored here.  For “regular” readers of this blog, the first half of this presentation is pretty basic, but the second half should offer novel info.  For new readers, hopefully the entire talk will be informative.

For those reading via email, here is the presentation:

http://www.youtube.com/watch?v=NqwvcrA7oe8

Photo by Siyan Ren on Unsplash

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.

303 Comments

  1. I noticed a couple of questions in previous posts – one on coconut oil, and another two from Amanda and Pierre Le Grande re. effects of artificial sweeteners on ketosis which prompted an “N-1” type experiment today which I found interesting and maybe relevant.In the past, despte a pretty strict, mostly no-carb diet, my ketone levels at best have struggled to get over about 1.2 mmol/l and only rarely over 2. This last week I have started taking coconut oil in my coffee and have found my ketone levels have started to come up.
    This morning I did my experiment on artificial sweeteners. Had my usual breakfast of eggs and bacon, cream and berry smoothie and coffee with cream and coconut oil. Did a 10km run 1 hour after breakfast and started to measure my ketones and blood sugars after the run
    Ketones and sugars immediately after the run were 1.3 and 5.4 respectively ( remeasured 5 minutes later to confirm stability).
    Then held 1 teaspsoon of Stevia in my mouth for 5 minutes and then spat it out and mouth wash.
    5 minutes later – ketone/sugar was 1.8 and 2.4
    15 minutes later- levels were 2.4 and 4.9
    So – no effect from sensation of sweetness in mouth. Rather, ketones continued to rise and glucose levels stable so no effect from sweet taste in mouth.
    1/2 hour later swallowed 1 teaspoon of stevia (really gross)
    5 minutes later levels were 3.11 and 4.7
    30 mintes later – 2.9 and 3.9
    1 hour later ketones had gone to 3.6 ( at this point I was high as a kite – see previous post)
    Over the aftermnoon my ketones dropped to 1.5 with sugar stable at about 4.4
    To test the effect of coconut oil I then drank 1 cup of decaffeinated coffee with cream and 1 tablespoon of coconut oil.
    10 minutes later, my ketone level was back up to 2.6.
    10 minutes after my evening meal (contained a small amount of carb and sugar), ketone was down to 1.3 and blood sugar up to 6.1.
    Conclusions from experiment:
    1. Stevia has no effect on either ketones or blood sugars so presumably no effect on insulin, for me at least
    2. Coconut oil is awesome at getting me into Ketosis with much higher levels than previously achieved with a quite strict LC diet.
    These experiments are quite easy to do with a home-testing meter.

    • Andrew, thanks so much for doing this! I think you know this, but I want to be sure other readers do, also. Some may wonder why B-OHB went from 1.3 to 1.8 to 2.4 mM in a period of 15 min with Stevia in your mouth. I would guess the Stevia had minimal, if any, effect, and the rise was merely your net accumulation of ketones which were still being pumped out of your liver at the same rate they were when you were running, though your body is no longer consuming them.

    • Is there a proper way to add cocunut oil? Is it necessary to use an immersion blender or is it fine to add it in with a spoon? My jar liquified in my cabinet; is it still good? Thanks!

    • MaryAnn: immersion blender is not necessary, been using a spoon for months, also coconut oil does liquefy at room temperature, no worries as it’s a stable saturated fat.

    • Maryann,

      -You need to blend your coffee after adding the coconut oil to make a proper emulsion, else it will just float on top because it’s lighter than water.

      -An alternative you could look into is a simple handheld milk frother for this purpose. I have one by the brand “Aerolatte” that works very well and requires practically no clean-up.

      -If you don’t mind to have a small amount of carbs and protein, you could also consider to instead add coconut milk into your coffee. Unlike the coconut oil I assume that it wouldn’t require blending although haven’t tested it myself.

      -If you specifically want your coconut oil to remain solid, store it in the fridge. It’s good either way.

    • Thank you so very much for taking the time to answer my question Devra and Jacob, I really appreciate it! Maryann

  2. I viewed your TedMed talk online yesterday and had several ah-hah moments. My daughter who was the most skinny and frail child (we were worried that she would never break 50 pounds in her young life) has had a weight problem now for two years … some of that was medication induced because she is on antidepressants. She also, recently becomes ill after eating (she likes a lot of sugar). We are in the Dallas-Fort Worth area and I’d like to find a physician that ascribes to your hypothesis to have her evaluated. Something about your hypothesis seems to fit here …. and her cravings for starches and sugars magnify no matter what we do. Thank, you Dr Attia for your response. You may message me at my email about Dr.’s in our area.

    • Lou, sorry to hear about your daughter’s struggles. Jimmy Moore’s website has a list of doctors around the country who understand how to work with carb-reduced diets. Hopefully, there will be someone you can find.

  3. I just put a tablespoon of coconut oil into the coffee and stir it until melted then add cream and stir it again. I find I drink it pretty quickly because the oil tends to float to the top and looks odd. Taste-wise, I like the taste with the added oil, but like fat and oil anyway. Using a blender seems excessively complicated and the coffee will get cooler while it is being blended. I think something that might work is to warm cream to just above the melting point of coconut oil, add melted oil and blend briefly without causing the cream to thicken. If it worked you could make up enough to last a day or so – ?fat heaven.. an experiment to try!

  4. Here is an alternative way of eating coconut oil: heat up a spoonful over an oven. I use a big metal spoon. Then just pour it into a yoghurt stirring while doing so. The oil will form small drops in the yoghurt. You could add some berries. It tastes quite good!

    • If you like a bit of salty chicken broth while on a ketogenic diet, you might just add some coconut oil to that. It certainly is good added to a cup of the homemade broth that has become a staple around here over the past year and a half.

  5. There may not be one single diet that works for everyone. But, there is a general direction in which optimal diets are pointed: fat burning. Mathematically, variational principles tells us this. For a given set of boundary conditions, you can’t have optimal solutions that are orthogonal. I think it was Ron Rosedale that said health is conferred by the amount of fat one burns.

    Exogenous ketones will probably cause similar unintended consequences as exogenous sources of other things that the body makes, like hormones. Can’t decouple a coupled system. We need to stop trying to out smart nature.

  6. I have just watched your TED talk and wanted to thank you for voicing this issue. I am a PhD student in epidemiology but also did a graduate work in cancer immunology and public health. I personally believe the current obesity epidemic in the world is associated with the food industry’s practices and it is not the volume of eating, but what goes into that volume and the epigenetic factors effecting the insulin metabolism. Our bodies were not designed to consume all this highly processed food material, simple carbohydrates, food coloring, hormones and corn syrup, stevia, etc. Physiologically none of this makes sense.
    By personal experience, I have seen such incredible changes in people’s body shapes after changing their diet simply from highly processed to vegetables, protein and complex carbohydrates. I am not an overweight person but as I got older, I started gaining weight around my waist area. In 2007, I lived in Spain for 7 months. Within couple of months, the weight around my waist disappeared. After returning back to US, I redistributed my weight again. Then I started paying attention to what I put into my mouth and eliminated simple carbohydrates and all the additives. The result was drastic. When I became a student again, I stopped paying attention to what i was eating and got right back to where I was. As an epidemiologist, I can tell several of Bradford Hill’s suggestions were fulfilled by my own experiment of n=1. 🙂 It is also important to note what kinds of population are mostly devastated by this unhealthy eating practice: youth, students and poor.
    Anyways, instead of putting all our efforts into educating people to eat less and exercise more (which are good goals, but not the right intervention for intended result), we should educate people what to eat and make that affordable by getting the food industry to buy into it. The industry responds to consumer demands, so it is important to make people aware what they are putting into their mouths.

    Thanks again for getting attention to this important topic.

    • Ayse, thanks very much for sharing your experience. I do think a series of well-conducted and well-controlled experiments could elucidate these issues with greater clarity than we have today.

  7. Peter….I’m a new fan of yours. I found you on ted talks and have loved what I’ve been learning from you. Thank you. Really… thank you.
    I have a question, I have one kidney (I recently donated one to a stranger) they told me I should never have a high protein diet because of ketosis/ketones is hard on my one remaining kidney. But… I’m skeptical from this advice. I am insulin resistance and when I eat, as I should for being insulin resistance I feel pretty darn good. When I eat, the Food guide Pyramid way….I feel lousy and like I have a hangover in the am. I know this is from the carbs.

    I don’t want to jeapordize my only kidney but what are your thoughts about staying in a nutritional ketosis?

    Thank you
    Teresa

    • Teresa, wow, what an amazing story. Having done a number of kidney transplants (on one particularly difficult stretch in residency, along the attending, we did 13 in 60 hours…zero sleep…very tough, but all the patients did great), I can tell you how much I appreciate your altruism. You’ve saved a life.
      To your question, ketosis is not a high protein diet. In fact, it’s actually a low- to normal-protein diet. In ketosis I consume about 60% of the protein I used to, in my case about 120 gm/day down from an average of about 200 gm/day.

  8. Peter,

    You did 13 transplants in 60 hours!!!!! WOW….. I bet that was hard… I am so amazed at doctors stamina when it comes to surgical practices.

    Anyways…..I was so hoping you would give me the advice you did. I am so on the same page with you. You are a breathe of fresh air Peter. I hope more and more people can hear your powerful testimony and amazing scientific studies!

    Thanks.
    Teresa
    p.s. I will be allowed to meet my recipient in a couple of weeks. What a cool story – I just can’t believe I’m in the middle of it.

  9. Hi Peter,
    I’ve been low carbing for a year but have only lost 18 lbs. I just measured my fasting glucose and it’s 112 mg/dl.
    which concerns me.I had previously measured it to be 84 using a glucose meter. I read about other people
    experiencing the same issue. My fasting glucose went up to 114 when I started experimenting with intermittent
    fasting.

    Is ketosis making me more insulin resistant? Having fasting glucose this high in the morning can’t be good
    in the long term, right?

    Thanks for having such an informative website.

  10. I thought some more about the effects of ketosis on mood and cognition as a result of an experience I had while operating this week. I must sadly confess that I have often had a tendency for my mind to wander while operating (usually microsurgery) which is annoying to say the least. This week I was definitely in ketosis when operating and the difference in my perceived mental state was quite profound – far more focussed and mentally quiet. I would probably not have noticed this doing an activity requiring less attention. Really cool! This was at a ketone level of around 1.2 – no euphoria fortunately. This prompted me to do a google search on “mood & ketosis”. It’s pretty overwhelming – bad science I know – but so many posters who have tried ketosis for weight loss or body building comment on the marked effect in stabilising and improving mood and cognitive function. This somehow got me into the effects of ketosis on mitochondria – this is where it gets really awesome! So many of the potential benefits of ketosis on a whole range of neurological disorders, mitochondrial diseases, cancers and so on seem to be tied to the effects of ketosis on mitochondrial function. A ketotic diet appears to be able to increase mitochondrial numbers and protect mitochondria from damage from such things as reactive oxygen species. This results in increased energy available to cells – this may explain the anti-epileptic effect of ketosis, and possibly the effects on mood and cognition. The best part for me is the potential for preventing or controlling cancer – as a result of my genes I have a 50% chance of developing a particular cancer. I have just started reading Thomas Seyfried’s book “Cancer as a metabolic disease”. He makes a compelling case that almost all types of cancer have the common state of dysfunctional mitochondria that are not able to metabolise glucose using oxidative phosphorylation or metabolise ketones at all. He actually goes further than that and believes most cancers are caused by defective mitochondria and the resulting defective energy metabolism in the cell is what causes the genetic chaos found in cancers. He cites a large amount of experimental data showing that a ketogenic diet which lowers glucose levels significantly and raises ketones can selectively kill off cancer cells which are not able to metabolise ketones and become energy depleted due to the low glucose availability. Most of his work is on aggressive brain tumours but he also cites a lot of work on other cancers. He has found that a ketotic diet (at least in animals) can normalise metabolism in cancer cells and even normalise abnormal gene expression in tumors.
    Go ketosis – what’s not to like. It makes you happy and focussed, helps you lose weight, and boosts your midichlorians!

    • Andrew, I would like to explore the evidence of this more in subsequent posts. There is certainly much N=1 suggestion of improved focus, etc. As far as seizure control, it seems there are several possible mechanisms, which may explain part of the efficacy proposed in Alzheimer’s disease.

    • Looks like we are living in interesting times, carbos are being debunked, perhaps most of the cancers are up for debunking next. I started my strict ketogenic diet for that very reason, cancer prevention. Thanks for the book suggestion.

    • Andrew and Peter,

      Do you have any insight into how statin drugs fit into this story about ketosis and mitochondria?

      Thanks.

  11. Thanks Peter for sharing this with us, I finally got around to listening to it. It was great to hear the other new stuff and I quite like your four scenarios at the end, it is quite useful for explaining to people that we don’t all need to be in ketosis and why. Interesting to hear you allude to epigenetics and to hear you say the words about cancer that I think we all suspect already. Loved the TedMed talk too. All the best.

  12. Does any of the butyrate produced by GI bacteria breaking down prebiotic dietary fiber get absorbed and utilized by us systemically as hydroxybutyrate?

  13. Hi Peter, Awesome post. All that testing and analyzing helped me a lot to optimize my diet, you are definitely a hero. I do pretty much 0-carb + 85-100% chocolate most of the time as well, being super liberal on green veggies.
    I didnt get the minerals right initally, now I use just a little bit more salt and supplement potassium, magnesium e calcium, which seems to work excellent.

    Quick questions:
    1) That state of mind you describe – do you have any idea from what level of Beta-Ketones that starts? Whenever I had it and measured I got more than 2.5 mmol, which is pretty high and most probably dont achieve

    2) My wife likes baking and hence once in a while I get to eat a piece of low-carb cake (we use a lot of butter, chia seeds, brown coconut flour, erythritol, coconut oil … all the good stuff) with a lot of unsweetened cream.
    – You say that Carbos and Ketones are inversely related, the impact probably depending on your glycogen stores.
    – In some of your charts we see that ketones go actually up after a meal

    Well, a few days ago I had a piece of thatlow-carb cake with a lot of heavy cream … and my beta-ketones skyrocketed to 2.8 mmol, which was the highest value I ever measured in my blood. I immediately measured urine ketones as well, which were also very high. I dont measure a lot but normally I am around 0.8-1.5 mmol, so I would really like to know where this spike came from. That day I didnt work out as well, so I must have been the cake.
    The only other thing that I ate was a chilli con carne (w/o beans) with a lot of cream as well 5h before that.

    Any theories?

    Some random other feedback
    3) From my own n=1 10 day experiment I can confirm that at least dry red wine does not shut down your ketones. I drank a lot of wine for 10d, but stayed on very low carb and I never had ketones below 0.8 – however I definitely gained weight, even though I worked out quite some.
    Alcohol really seems to work similar to fructose.

    4) I definitely breathe less nowadayw when working out ie running, hence confirming the respiratory quotient.

    • Andre, sounds like you’re well on your way to tweaking your own diet. I don’t know exactly where the effect you describe kicks in, though B-OHB levels north of 2-3 mM are sufficient to provide at least half of the brain’s energy requirements. For some (not all) dairy, especially heavy cream, has a similar effect to MCT, which results in high levels of B-OHB.

  14. Wonderful talk. Are you planning to use these experimental techniques at NuSI? Your sample size for this experiment was one. How large of a sample size do you think is needed to get consensus?

  15. Hi! I watched your talk and was very interested in what you have to say. I was diagnosed with type 2 diabetes 2 years ago and I am wondering if the Doctors made the right diagnoses since non of the pills that they give me seem to help. Metformin doesn’t even break down in my stomach…takes about 20 minutes and the pills are in the toilet! My Doctor insists that I keep taking them…to what purpose? lol….my sugars are usually 130 at the lowest and if they go lower then that I don’t feel right…and they want them at 80! I have gallstones also and they won’t take out my gallbladder even though the attacks are worse every time (10 years of fighting to have it removed!) because my sugars are out of control…I’ve seen 5 different doctors with the same results!!! So I’m going to try what you suggest and see if things improve (I’ve lost almost 100 pounds in the last 2 years also)…Do you have any suggestions on the best way to start? and should I involve the doctors that insist on me taking pills that don’t work? Thanks and keep up the good work!!!!

    • Denise, I can’t really comment, but I wonder if changing your diet, perhaps in parallel with the medical recs of your doctors, could eventually decrease or eliminate your need for the medication?

  16. Hi Peter. My (short) story is similar to yours. I had most, if not “all”, of the metabolic syndrome conditions a couple of years ago, including a father that had his first heart attack at age 48. At age 50, I started becoming more concerned with my well-being as I started, what I thought at the time, rapidly deteriorating health-wise. Hypertension (w/ medication), for the prior 15 years or so was @40 lbs overweight (considered obese at 30 BMI), 38-40 in. waist, avid runner running 25 miles a week, I’m fairly certain that my BG was constantly running high (never checked back then, but do now!), triglycerides constantly above 150 and cholesterol NEVER below 230 in my life, even when I was thinner (w/ low ratios)…

    In any event, I started the fasting lifestyle, fasting @20 hrs a day, cut carbs to <100 grams/day on average and I lost 35 pounds in about 8 months, and more importantly have kept it off! Waist: 33 in., cholesterol now at 193 (3.4 ratio), triglycerides down to 47, BP averages 125/70 (off meds!) and now only run about 10 miles a week just to stay active and I've never felt/looked better in my life and I have people like you, Gary Taubes and a few others to thank as you are all great inspirations! Thank you for your personal hard work and devotion to these endeavors and I wish you good luck in the future.

    I am one of your statistics… please feel proud, Doctor… you're changing lives!!

  17. Hello Peter,
    I’ve been reading your blog since I found it a few weeks back and I really appreciate the technical explanations you give in your blog posts. My own personal experiments with a sample size of one (me) bear out much of what you say.
    I ran across a newsarticle in ScienceNews 18 May 2013 discussing a study by Robert A Koeth et. al., “Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis” Nature Medicine 19, 576-585 (2013). (http://www.nature.com/nm/journal/v19/n5/full/nm.3145.html)
    Thy found that intestinal bacterial used the L-carnitine found in red meat to produce a byproduct called trimethylamine N-oxide (TMAO). They then found a link between high blood levels of TMAO to risk of impending heart attack and stroke.
    As a person with a high family risk of heart attack, this article has me worried.
    What are the chances that in the future you could add this article or subject to your queue and help explain what it really means or why the study is flawed for those of us more technically challenged.
    Thank you for your time.

  18. Thanks Peter for your work and sharing it with us on the internets…

    Question about an n=1 experiment I just did. During a recent IF (skipped breakfast and lunch), I checked my Blood Glucose every 2 hours. Background – obese with prediabetes, low carbing. The readings were always between 102 and 113 (average 106). Checking my log for all my BG readings, about a 25% are under 100.

    During my fast, there was plenty of time for insulin to bring down my BG to a lower range (80-95). This would suggest that something is keeping my BG at a higher setpoint that a normal person. Right?

    Could it be that my body wants to keep my blood sugar higher so that there is more glucose available for my brain? Low carb helps keeping my postprandial BG lower, but what can I do to keep my preprandial/fasting BG as low as possible?
    Thanks!

Leave a Reply

Facebook icon Twitter icon Instagram icon Pinterest icon Google+ icon YouTube icon LinkedIn icon Contact icon