March 7, 2012

Ketosis

The interplay of exercise and ketosis – Part I

Read Time 7 minutes

I embarked on a self-experiment last weekend to see if I could better understand the interplay between the different types of exercise I do and ketone production (beta-hydroxybutyrate, or B-OHB, to be specific).  To be clear, nothing I do with a sample size of one “proves” anything, but sometimes self-experiments can help you formulate hypotheses and, if nothing else, understand how your body works.  Consider the parable of the black sheep.  If you see even a single black sheep in the field, depending on your field of training, you can draw conclusions:

Three scientists were on a train and had just crossed the border into Scotland. A black sheep was grazing on a hillside. The biologist peered out of the window and said, “Look! Scottish sheep are black!” The chemist said, “No, no. Some Scottish sheep are black.” The physicist, with an irritated tone in his voice, said, “My friends, there is at least one field, containing at least one sheep, of which at least one side is black some of the time.”

My point is, even a self-experiment of one can be good for something.

To test the relationship between exercise and ketosis I decided to examine my blood levels of glucose, B-OHB, and lactate immediately before and after three different types of workouts on three successive days.  This interplay is complex and no one knows “everything” about it, including the world’s experts (which I am not pretending to be).  I’m going to try to balance a fine line in this post – I want to be rigorous enough to explore the ideas with substance but not too detailed to put you to sleep.  I hope I am able to balance these forces adequately.

If any of you are not familiar with the work of Jeff Volek and Steve Phinney, but you are interested in the biochemistry of nutritional ketosis, I recommend getting familiar with their work.  The list of people who know more about nutritional ketosis is short.

Let’s take a look at the three parameters I measured in a bit more detail.  To give you a sense of what is “normal” here are some guidelines:

 

Glucose

A normal fasting glucose is generally considered to be between 75 and 100 mg/dL.  My mean over the past year has been about 90, but I need to mention two very important caveats:

  1. On the four occasions I have calibrated my hand-held device with an actual laboratory test, my device seems to run high by about 11 mg/dL, so a measurement of 95 mg/dL on my device is probably closer to 84 mg/dL in reality.
  2. I carry a genetic trait for a disease called beta-thalassemia.  The clinical manifestation of this is that I have much smaller red blood cells than normal (about 65% of normal size).  There is some evidence in the literature that this condition prevents some accurate testing of any assay that can interfere with hemoglobin.  For example, a test measuring glycosylated hemoglobin suggests I have much more glucose in my blood than is actually measured. In fact, the Glycomark test for mean post-meal glucose level suggested I have an average post-meal glucose level of 190 mg/dL which is obviously not true.  In other words, something about my beta-thalassemia seems to interfere with, at the very least, measuring glucose linked to hemoglobin, and possibly measuring glucose in general.

I mention these 2 features to say my glucose levels (unlike B-OHB and lactate which I’ve documented to be very accurate) may be artificially elevated. Here’s the important part, though: the discrepancy seems to be constant, so the increases or decreases seem to be good measurements.

Beta-Hydroxybutyrate (B-OHB)

A normal fasting B-OHB level for a “normal” (i.e., non-ketotic) person is zero.  Within a day of fasting, you might expect this number to reach 0.2 to 0.4 mM, and about 1.0 mM within 48 to 72 hours of complete fasting, though this is highly variable among subjects.

If you’ll recall from my discussion of keto-adaptation, the threshold for nutritional ketosis is about 0.5 mM.  My normal morning fasting level of B-OHB is usually between 1.0 and 2.0 mM with an arithmetic mean of about 1.4 mM.

Both insulin and glucose (probably by causing the secretion of insulin) suppress ketones. This is why, for example, consuming more than about 50 gm of carbohydrates per day and/or more than about 120-150 gm of protein per day makes it difficult to be in nutritional ketosis – too much insulin secretion.

 

Lactate

Lactate (or lactic acid) is a byproduct of anaerobic exercise.  A normal level is considered to be below 2.2 mM.  Basically (I’m oversimplifying a bit), when you exercise in a predominately aerobic capacity, while you do generate lactate your liver is able to match muscle production with clearance via a process called the Cori Cycle (a process in which the liver turns lactate back into glucose).

If you’ve ever done a very intense exercise – like run an all-out mile – and felt like your body is completely seizing up and you are unable to move, you’ve experienced a high lactate.  Technically, the lactate is not causing this.  Lactate gets a pretty bad rap, and it’s actually a good thing as it allows us to generate energy even when we demand it in an environment where sufficient cellular oxygen is absent.  The real “bad guy” is the hydrogen ion that accompanies lactate and interferes with the ability of our muscles to contract and relax properly.  However, we use lactate as a proxy for the hydrogen that is actually causing the pain and difficulty in muscle contraction.

For me (personally, though this is probably true for most people) the highest lactate I generate tends to be in all-out activities lasting about 2 minutes which use all muscles in my body (the more muscles you use, the more lactate you generate).  Hence, the 200 individual medley (IM) race generates the most lactate in my body: It’s 2-plus minutes of maximum exertion sending pain into every muscle in my body (this event requires a swim, in order, of 50 yards each of all-out butterfly, then backstroke, then breaststroke, then freestyle). A runner would probably concur that the 800 meter (half-mile) run is one of the most painful races in that sport.

The highest lactate I have ever measured in myself, following a 200 IM race, was about 16 mM.  I have measured higher levels in several Olympic swimmers, including 20.2 mM in one (as he was vomiting all over the pool deck – for reasons I’ll try to remember to explain in a subsequent post). On my bike, where I’m mostly using my legs, obviously, I think my highest recorded lactate measurement was about 12 or 13 mM following a set of ten 2-minute all-out hill repeats.

I measure my lactate levels using a different hand-held device from the one that measures glucose and B-OHB.

[Another parable, this time about marriage: 2 years ago my father asked me what my wife and I wanted for Christmas.  I said “we” wanted a lactate meter with about 200 test strips (I think it was about $900 for everything).  He looked at me funny, but figured I knew what I was talking about.  When Christmas rolled around and “we” got “our” lactate meter I had to spend a few minutes explaining to my wife why this was a perfect gift for “us” as it allowed “us” to spend lots of time together while she pricked my finger for blood during my workouts.  She didn’t really agree with me.  I clearly don’t understand women very well – I really thought she would find this device “cool.” Which is why this is a blog about health, not marriage.]

 

Results from my experiment

 

Day 1: Saturday (hard swim workout, race pace)

This was a one hour, 45 minute swim with warm-up and cool down.  The “main set” was mostly freestyle and butterfly at all-out race pace for distances of 25, 50, 75, and 100 yard intervals with long rest (1:2 – 2 times more rest than swim time) for the all-out 100 yard swims, and modest rest (2:1 – half the rest time of each swim).  The single most demanding aspect of this workout took place with about 25 minutes remaining and, though I didn’t measure peak lactate, I suspect it was around 12-14 mM, based on the discomfort I experienced. I was surprised that my lactate level was still as high as it was (see below) 25 minutes later, though I suspect I didn’t cool down as gingerly as I should have, to optimize for maximum lactate clearance.

During this workout I consumed nothing and prior to the workout I consumed my usual 40 mL of medium chain triglyceride (MCT) oil.

At 7:29 am, just before beginning the workout, my glucose was 86 mg/dL, B-OHB was 0.7 mM (which is low for my fasting level), and lactate was 1.9 mM.

Immediately post-workout, at 9:14 am, my glucose was 118 mg/dL, B-OHB was 1.0 mM, and lactate was 7.2 mM.

 

Day 2: Sunday (long ride, 80% of race pace)

This was a tempo ride covering 104 miles (167 km) with 5,600 feet of climbing.  Average pace was 17 mph (about 28 km/hr) with lots of headwind.  My average HR over this 6 hour ride was 141 and average power output was between 190 and 200 watts.   There were many sections of the ride, particularly on the climbs, where my HR was sustained in the 160’s for 30 minute stretches and power output was above 275 watts (which, for me, means my muscles generate lactate faster than my liver can clear it).

During this workout I consumed the following:

  1. Two single-serving packets (1 oz) of cream cheese (14 gm fat; 2 gm carb; 2 gm protein)
  2. 50 gm of super starch, by Generation UCAN mixed in my water bottles (50 gm super starch which, technically, is a carb but does not behave like one with respect to insulin secretion and ketone suppression – I will write a dedicated post on super starch in the future, but if you must try it now, use this code to get a discount: “UCANPA”)
  3. 2.5 oz of mixed nuts (25% of each almonds, cashews, walnuts, peanuts – 36 gm fat; 14 gm protein; 15 gm carb)

Total intake during 6 hour ride, therefore, was: 50 gm fat; 16 gm protein; 67 gm carb (of which 50 gm was super-starch), for a total of about 750 calories.

About 90 minutes prior to the ride I consumed 4 eggs fluffed with heavy cream, cream cheese, coffee with heavy cream, and my usual 40 mL of MCT oil.

At 7:56 am, my glucose was 88 mg/dL, B-OHB was 1.3 mM, and lactate was 1.7 mM.

Immediately post-ride, at 2:39 pm, my glucose was 74 mg/dL, B-OHB was 4.4 mM, and lactate was 2.2 mM.

 

Day 3: Monday (dry-land, high intensity training)

On this particular day, it was raining (one of 3 days a year this happens in San Diego), so I did not do the outdoor stuff (including tire flips).

Prior to the workout I consumed nothing other than my usual 40 mL of MCT oil and during the workout I consumed about 4 gm of branched chain amino acids (BCAA) and 10 gm of super starch mixed in my water bottle – so essentially just water.

Immediately prior to the workout, at 6:43 am, my glucose was 77 mg/dL, B-OHB was 3.5 mM*, and lactate was 1.6 mM.

At 7:52 am glucose was 132 mg/dL, B-OHB was 2.2 mM, and lactate was 5.4 mM.

*If you’re wondering why my fasting B-OHB level was so high (recall, I’m usually between 1.0 and 2.0), I suspect it’s at least a partial result of 2 things:

  1. Residual fat breakdown from the previous day’s long ride and caloric deficit, and
  2. On Sunday night I ate (no exaggeration) about half a gallon of my wife’s famous zero sugar, high fat coffee ice cream, which must be the closest thing I’ve ever experienced to heroin in terms of addiction potential.

 

Summary

The figure below summarizes the data from the mini-self-experiment I just described.

 

Exercise summary data

What can we learn about the interaction between glucose, B-OHB, and lactate?

How does super starch impact my ketosis?

Is ketosis helping me or hurting me?

Stay tuned for next week, when I will try to interpret these results…

Photo by James Thomas on Unsplash

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327 Comments

  1. Looks like Swimming and High Intensity had a similar response with respect to Glucose and Lactate. You’ll probably need to separate your testing days with a day of rest in between so you have a better starting baseline, especially with respect to the B-OHB results. Have you posted the recipe for the high fat ice cream? I don’t like coffee but I’m sure I could add another flavor.

    • Dave, to be super rigorous, I would need to make a few changes, and your idea is a good one, especially if you believe I have not been able to fully replenish whatever hepatic glycogen stores I have.

  2. Dr Peter.
    Some light observations.
    1. Seriously, what’s up with your wife? (Christmas gift)
    2. No man understands woman
    3. After swimming for 1 hour 45 minutes and then riding for 104 miles with 5600 feet of elevation, it was rain that stopped your work out?
    Seriously, you are a machine. I would have worked out in the rain and bypassed the bike & swim.
    I will have to wait for the interpretation next week.
    Any chance you can post your wifes famous no sugar ice cream recipie?

    • Anthony, in order:
      1. I *really* thought she would think it was cool and it would ensure we spent good quality time together when working out. I thought she’d want me to test her lactate levels, too.
      2. I think I might agree
      3. If there is any moisture on the tire it is impossible to grip, so you can’t flip it.
      4. Recipe is up in response to a previous question. Enjoy!

      • “I *really* thought she would think it was cool and it would ensure we spent good quality time together when working out. I thought she’d want me to test her lactate levels, too.”

        . . .Pitiful

        “Noted…But on the good side, whatever you do the next year looks infinitely better, right?”

        Do you seriously believe that?! My my my. . . Until I read that, Dr. Attia, you had fooled me into believing you were an empiricist.

        “No man understands woman”
        “I think I might agree”

        You might be right. (sigh) In lieu of actual understanding (which I cannot provide you with) I offer you a few simple rules of thumb. While not perfect, this is a good place to start…

        1. SILK, simple design, soft color, thin straps. No gift certificates (make the effort) Get a gift receipt (in the likely event that you have no taste).
        2. Whatever gift you ask your father to provide for the TWO of you should serve as a setting for (or compliment to) said clothing article.
        3. Above all: Quality time between husband and wife should NOT involve drawing blood.

        I mean honestly gentlemen. I dare not imagine what your thinking is like when you are not in ketosis.
        Give my best to your beautiful and long suffering wife.

        PS. And tell her that if she brings the almond milk to a brief light simmer, and then cools it in a Bain-marie over ice and water before mixing it with the cream, it will make for fewer ice crystals in the finished product, should she ever have the opportunity to get some of it into the freezer.

        PPS. Fantastic website!

  3. I’m interested to hear your interpretation. I’m a little concerned as to how ketosis will affect my endurance activities. I’ve been in ketosis for 9 months now, but I’ve only done two long (which I’m defining as 2+ hours), high intensity endurance workouts in that time. Both have been excruciating and resulted in severe light headedness and nausea and long recovery. After the first one I thought it was due to excessive sweating (it was a very hot day and a grueling hike climbing 3,000 ft in 2.5 miles). even though I drank a lot, I thought maybe I lost too much sodium or something. The 2nd workout last weekend I took some Phinney/Volek advice and had a gram of sodium prior to the workout and tried to drink as much water as I could while riding my bike in 30 mph winds (gotta love Colorado). The extra sodium didn’t seem to have much of an effect, and I was a disaster after I got home.

    For reference, back when I ate carbs, I would routinely do multiple hour, high intensity hikes and bike rides. Other than feeling hungry and sore, I didn’t feel “off” like I do now. Now, I know my sample size is only 2, but I am a little concerned because I have big plans for this summer.

    Also, give me this ice cream recipe immediately.

    • Mike, I’m supplementing an extra 2 gm of sodium every single day, at a minimum. On the days I ride long, I do 2 gm before I ride, and another 2 gm later that day. In other words, I consume 5 to 8 gm of sodium in total every day.

      If readers remember only one thing: WHEN YOU ARE VERY LOW CARB OR KETOTIC, YOU MUST SUPPLEMENT SODIUM EVERY SINGLE DAY, WHETHER YOU FEEL LIKE IT OR NOT. Some days more than others, but for me 2 gm of bouillon is the minimum. If I miss a day, I might feel ok, if I miss 2 days, I’m hosed.

      Second, warm up is everything. I’m I’m going to ride with a group (i.e., ride at the pace of others) I need to EITHER get a few miles in before on my own, or try like crazy to keep up for the first 30 minutes. It just seems to take a bit longer to warm up when you predominantly rely on beta-oxidation.

      Don’t give up on it yet. Recipe is up in response to another question…

      • I would add that people on a ketotic regimen should also remember to eat foods with or supplement with potassium and magnesium as well. All those minerals get excreted and can effect muscle performance.

        • Correct, especially the magnesium — I supplement with 400 mg/day. If your sodium and Mg are in check, potassium is less necessary. I’m currently experimenting with zero supplemental potassium.

        • How do you supplement with sodium? These come in pills? I have seen some people put a certain type in water for like long runs, is that what I would drink before a workout or long run?

          • I MUCH prefer bouillon over sodium tablets. Somehow it just works better me on many levels, including bowel regularity. It’s probably worth figuring out what works best individually, though.

        • You don’t think it’s possible to get enough from food and generosity with the salt shaker? Do you only need supplementation if you sweat a lot? There have been such mixed benefits/detriments reported as a result of taking vitamins and supplements that it’s always seemed more beneficial just to eat nutritious foods, like fish, nuts, and green veggies, which contain all these minerals.

          • It is, but for me it’s more efficient and “routine” to just know I’m getting my extra 2 gm from the daily dose of bouillon. Intake of sodium (i.e., requirement) does vary by activity and perspiration, of course.

        • Peter,

          To clarify: 2g of sodium, as found in about 4g of salt?

          Or do you and Phinney/Volek mean 2g of sodium chloride?

          Patrick

        • Peter,

          My apologies. I was lazy, assuming that salt is about 50% sodium. It’s more like 30%.

          My earlier question draws attention to the distinction between salt and sodium (an ingredient in salt).

          I don’t care to buy bouillon cubes–I make stock and consume it daily. Much tastier!

          I’d like to be sure that I’m consuming the appropriate (minimum) quantity of salt. So I’m eye-balling a carefully weighed 6g of salt, to learn the approximate amount.

          Fellow readers: note “carefully weighed”. Depending on the label you read, 6g of salt is either 6 tsp (some Korean sea salt in my cupboard) or 1 tsp (table salt, according to the food nutrition site you link to). You can get wildly different results from volumetric measures. Pinching, however, can be quite reliable (one of my pinches is about a gram).

          Since Phinney and Volek recommend a range of 2-3g daily, I think this cook’s technique should be fine, especially when combined with the normal human body’s excellent salt-regulation mechanisms (i.e. any excess is easily pissed away, given enough water intake, which a normal sense of thirst will also regulate).

          Cheers!

          Patrick

          • Also, keep in mind how much this is more art than science, at least when it comes to dosing. You don’t need a micrometer to measure the length of a car. Agree that homemade bouillon is infinitely better, if you have the time to make it and the room to store it.

      • Could you explain a bit more about how you supplement with sodium? Do you just drink bouillon? Is it homemade or from a store? I understand theoretically that I should be eating more sodium when I am ketotic but still a bit puzzled about how to do it, since obviously I can’t be adding more salt than needed to food — and I am already very generous with salt.

      • If readers remember only one thing: WHEN YOU ARE VERY LOW CARB OR KETOTIC, YOU MUST SUPPLEMENT SODIUM EVERY SINGLE DAY, WHETHER YOU FEEL LIKE IT OR NOT. Some days more than others, but for me 2 gm of bouillon is the minimum. If I miss a day, I might feel ok, if I miss 2 days, I’m hosed.

        I read somewhere on your site that you would do an entry on supplements, but would you mind telling us quickly, or give us a link, on why we should have sodium supplements (I guess eating more salt) when going low carb ? How about Magnesium ?

        While I am at it, may I put gentle pressure to write about ketosis and alcohol sooner than later.

        I love you blog, Thank you for your good work.

        • I have not got to it yet…if you need to know soon, read the book by Phinney and Volek on my books & tools section. Basically, when low carb the kidneys excrete more sodium. Failure to increase sodium intake leads to low sodium (obviously), which has a bunch of problems. See previous comments for more details.

    • My guess in regards to the bouillon helping with your bowel is the wheat. I would encourage you to use something like better than bouillon to make a gluten free broth. Another thought is simply that a warm beverage is known to effect the bowel.
      As a celiac though I have to actively avoid most bouillon due to a base with wheat. Soy sauce and many dressings are the same way. Much like sugar, wheat is everywhere.

  4. Forget the interpretation, could we please just get the recipe to your wife’s famous coffee ice cream that is as addictive as heroin?

    OK, I do want the recipe, but I have to say that I have enjoyed your blog very much. You are able to put things in a way that I can understand these technical issues. In other articles I just gloss over them, but on your blog, I actually try to understand. Thanks for communicating with us non-medical people in a way we can actually find out what the science under the covers is all about.

  5. One last thing, I can’t imagine the dog house I would be in if I got a blood monitoring device for Christmas as a gift for my wife and I. Don’t make that mistake again.

  6. I for one would like to hear more about this famous zero sugar ice cream. I’m sincerely hoping that her recipe isn’t a secret!

  7. Looking forward to the interpretation. Regarding glycosylated hemoglobin, wondering if there’s anything in the idea that there is more turnover in red blood cells in a diabetic compared to a non-diabetic, and the logic may be extended where someone who keeps blood sugar in check, it will last longer, and can therefore accumulate more sugar, and confound HbA1c readings?

    • Chris Kresser stated exactly this on his website: http://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker.

      The pertinent part is: The main problem is that there is actually a wide variation in how long red blood cells survive in different people. This study, for example, shows that red blood cells live longer than average at normal blood sugars. Researchers found that the lifetime of hemoglobin cells of diabetics turned over in as few as 81 days, while they lived as long as 146 days in non-diabetics.

      I have great blood sugar values and a mysteriously high A1c (5.8). Kresser’s article was very reassuring for me.

  8. Thank you so much for the great work you are doing for nutritional science and the low-carb blogosphere, but when are we getting the recipe for your wife’s no-sugar, high-fat coffee ice cream?!

  9. “… my wife’s famous zero sugar, high fat coffee ice cream, which must be the closest thing I’ve ever experienced to heroin in terms of addiction potential.”

    You are going to give us the recipe, aren’t you?

  10. Peter, thanks for the great write up again. However, did I miss what you ate AFTER your workout? Are you stating you ate nothing, just measured?

    • That’s correct. I just measured. About an hour after the swim workout I had bacon and eggs. About an hour after the ride, I had cheese and salami. About half an hour after the lift I had my high fat shake. Measurements were immediately post workout.

      • Thanks Peter. So going on with what you responded with last week on a comment of mine…you don’t “replenish” at all with any type of carbs after “hard” workouts? High Fat shake recipe I can find somewhere on your site, right?

        • Right, I don’t have an active plan to replenish glycogen at once. Because I’m so low carb, whenever I consume substrate for gluconeogensis, it’s going there (i.e., to muscle or liver for glycogen replacement). Recipe for my shake is on my “what I eat” post.

  11. Doc, can you address this issue if possible: weight loss scenario: a eucaloric 1000 cal/day regimen with an average carb intake of 16/day; if I change up the protein/fat ratios, it effects weight loss. If fat intake gets higher than 45% percent of total calories, weight loss slows down. How does the body choose to burn internal fat over dietary fat, when calories taken in are less than expenditure?

    • It probably varies significantly by person, timing, activity, and type of fat. No doubt there are set points within the body that are under constant adjustment. Some fats (e.g., saturated fats between 6 and 12 carbons, for example, which are very high in coconut and palm), can’t be stored, so they immediately promote their own oxidation. Tough question to really answer without knowing a lot of the details, and even then, it might not be entirely “knowable.”

      • Peter,
        I have read in several comments throughout different posts that “dietary fat is/can be burned before body fat”. This confuses me and I’m trying to figure it out on my own but without a science and medical background, I’m stuck. For me it always seemed like a “no-brainer” to up fat intake and decrease protein intake and, generally, eliminate an insulin response.

        I just got Volek and Phinney’s book. Will I find answers there or have you addressed this somewhere else on the blog???

        I apologize if you have to repeat yourself. I’m just a bit frustrated. Thanks so much.

        • You will definitely find the answers in that book. The sort answer is that it depends on which fats you’re consuming. Some fats we eat can’t actually be stored and must be immediately expended (e.g., via activity, themogenesis, waste).

        • Thank you for the short answer and I will continue looking in the book.

          So, the general goal for those wishing to lose weight should thus be to eat the right ratio of fat/protein/carbohydrate until weightloss has occured and then to increase fat intake on which to subsist and remain in ketosis? This is my deduction based on your experience/writing with the specific example that you have increased your MCT oil consumption…

          This deduction of mine will also perhaps be confirmed in the book…

          • Not really. My experiment with increasing MCT consumption is more subtle. Remember, not one “formula” for everyone. Important to really figure out where you’re starting from and what you’re optimizing for.

        • Peter,
          Yes, you are right “not one formula for everyone”. I went back and re-read “Revisiting the causality of obesity” as well as “What I Actually Eat” to, so-to-speak, re-focus on the point behind all this info (info from your posts, people’s valuable comments, et cetera).

          Because this issue is so complex I guess I was trying to come up with the perfect elevator speech for when I talk to people who are interested…kind of like your cool four-corner with goals vs. genetics. I was even thinking of putting together a PowerPoint presentation for my family (am in consulting too).

          Anyway, I’ll keep at it. Thanks for faithfully answering again and I promise not to ask either about the ice cream recipe nor the boullion…

    • Hi Peter,

      I have that presentation I mentioned (Post March 9). Where do I send it if you would like a look at it?

      Please keep in mind…I’m just an amateur here trying to open the eyes of my aging diabetic father…

    • I’d certainly be interested in that elevator speech! I just finished writing a reply to the article in my local paper (the one that recommended margarine and more grains) and it was a struggle to keep it from going all over the place…

    • …I have mailed the presentation (9 slides including title page, so not really an elevator speech) to Peter.

      If Peter mentions that it adds value and sends the correct message, then I would be willing to share it.

    • Thanks very much. I would like to tackle the effect of carb intolerance on cholesterol next. When I have it, I’ll post a link like I did here. Maybe eventually we can come up with a type of “Carbs for Dummies” (in the sense of the “Dummies” book-series I mean).

    • Peter, I probably would not come up with as scientific and explanation as you but if there is any way I can help/contribute and save you some time then give me a shout or point me to the info I need to summarize…

  12. my wife’s famous zero sugar, high fat coffee ice cream

    Is that something you’re willing to share? The recipe, I mean.

    • Greg, I’m not sure it’s ethical, or even LEGAL, to share something with such addictive potential…
      We’re still working on the nuances, but the current version is composed of 3.5 cups whole fat (35% fat) cream, 1 cup of zero sugar almond milk, 1 tbsp vanilla extract, 2 tbsp almond extract, 3 tbsp ground espresso powder, and 2 tbsp xylitol. This makes enough to feed about 8 normal people, or me in one sitting.
      You’ll need an ice cream maker, obviously, to mix at at freezing temperatures.

      • Ehhh, ethics schmethics…given the people what they want! And I want coffee ice cream, my favorite, which I’ve only indulged in a couple times since embarking on my low-carb adventure…so I’m so excited about making some!

      • I too had already copied the text

        “my wife’s famous zero sugar, high fat coffee ice cream, which must be the closest thing I’ve ever experienced to heroin in terms of addiction potential” to paste and ask about but as I suspected, someone beat me to it! Thanks for sharing the recipe – sounds amazing!

      • Hi Peter,

        What kind of cream are you using? I was using generic heavy cream, or heavy whipping cream. I have since discovered that those typically have thickeners and other additives. So I switched to the stuff that Peet’s Coffee (up here in the Bay Area) uses: Berkeley Farms “Manufacturing Cream”. It has 40% fat content and is pure cream, nothing else. It is usually available only for restaurants / food service, so I have been buying it at Smart & Final.

        • I use a brand from Costo (only place I can afford it! — $6 for a gallon versus $4 for pint at Whole Foods). I do like the brand you mention. I just make sure I’m consuming a variant that does not add dextrose, as some do. As you note, pure is better.

      • I’m wondering what “ground espresso powder is.” Is that the espresso powder that you can reconstitute with water, like instant coffee, or is it actual beans that have been ground into a powder? If it’s the first, do you measure before grinding?

        Have you thought about adding some vegetable gums like guar gum and xanthan gum to the ice cream? They improve the mouth feel, but be careful about using too much. I prefer xanthan gum, though some people claim that a combination of the two works best. They can be hard to add without clumping, but if you can pour them into the vortex of something in the blender or at least add them to something high in fat like the cream rather than the almond milk, they seem to work fine. They are 100% fiber, I believe, and should not affect blood sugar in any negative way. They give a nice silky texture to things like ice cream.

        • I think you could use either, but we use the stuff one can mix with water for sub-stellar espresso. For me, personally, the “feel” and texture are perfect now, but I think your ideas would great for folks who want a different feel.

    • That’s funny – this was the first question that came to my mind. Looking forward to next week’s analysis too though.

      • I wondered about this too. I really wonder about the texture of it once it’s been in the freezer for a day or two. My experience with home made ice creams led me to believe that the sugar played an important role in the “mouth feel” of the frozen delight (these days I just don’t eat ice cream). But it was much less of an issue straight out of the maker. Perhaps this stuff is so good it doesn’t even get into the freezer for storage?

    • I made some of the Attia family’s coffee ice cream recipe last weekend. Everybody loved it. I think I like stronger coffee taste and have more of a sweet tooth than Peter, so I ended up with a little more espresso power, xylitol, and a little bit of stevia too. While I was making a mess, I came up with a chocolate recipe myself that is just as easy. A little espresso powder added to the cocoa powder really brings out a darker chocolate flavor. The two gallons I made (1 coffee and 1 chocolate) did not last 36 hours at my house. Anyway… thanks as always for all your efforts.

  13. Have you recently increased your MCT dosage? In your “What I actually eat” post you mention 30mL of MCT but looks like you are now at 40mL.

  14. Peter, in a blog I did on A1c (http://www.healthcentral.com/diabetes/c/5068/64028/a1c-accuracy) I mentioned thalassemia.

    “People with unusual hemoglobin types, for example those with sickle cell anemia or thalassemia, or those who keep producing fetal hemoglobin even as adults, may have A1c results that don’t jibe with their meter readings. This is because these less common hemoglobin variants, as well as other rarer variants, although they work to transport oxygen in the blood, produce slightly different varieties of glycated hemoglobin that react differently in the A1c tests.”

    It shouldn’t affect regular blood glucose testing. The A1c test separates out hemoglobins according to their charge or immunologic properties, and the glycated unusual hemoglobins don’t run with the A1c fraction.

    • Yes, it may be completely unrelated. The most compelling reason for why I think the meter runs a bit high is that I’ve tested it side-by-side 4 times. Delta’s seem to be fine, and fortunately, the other measurements seem spot on.

  15. Peter,

    I have really been enjoying your posts. I, too, do a lot of n=1 experiments. In terms of your glycomark testing, dietary restriction can effect levels as well. Myself as well as several of my low carb/hi fat dieting patients all have low glycomark tests (10-12). It puzzled me initially and i went as fair as wearing a CGMS for a week and it did not correlate with my glycomark of 11.7. Fat has lower levels of 1,5-AG, so that could also be a reason your glycomark was low. I have not been able to find (nor do the makers of glycomark) have any data on thresholds of intake.

    I also find it interesting in a lot my low carb patients that HbA1C hangs around 5.4-5.5. The only thing i can attribute to could be increases in BG after HIIT type activities (ie crossfit) depending on frequency during the week as not in some of your excursions post exercise

    • Same here. I’ve been training and racing at the elite level on a mountain bike in ketosis for two years now. My A1c is 5.2, fasting glucose 90, insulin 2.1, c-peptide 1.0, MCV 94. GlycoMark 6.0. There’s a chance my BG gets up to 180 during the cyclocross races I compete in at the moment but it seems a bit of stretch.

  16. Hi Peter,

    Keep up your postings–I really enjoy the data… P.S., I was a USA swimmer–100/200M Breaststroke + 200IM. If I only knew back then what I know now…

    All my Best,

    Stella Metsovas B.S., CCN

  17. Intriguing results. Thank you for sharing them. It is very helpful to have a rough/nominal/about number for carbohydrates per day to help generate ketones. Since the brain can operate on ketones, I’m thinking that vigorous swimming exercise may be especially helpful to those with dementia who are also physically fit.

    • There is almost daily increasing amount of data suggesting that ketones are particularly brain-healthy can play a huge role in preventing and reversing dementia. I do plan to get to this in time…so much to write about.

      • I’m very interested in this topic. My mother has Alzheimer’s, her brother and father died from it, as well as *all* of her father’s siblings. I feel so targeted I can feel the laser dot on my forehead.

        I first saw mention of the connection in Taube’s GCBC, and then here: http://www.medscape.com/viewarticle/749616
        which I interpret as an attempt to boost the brain’s glucose metabolism in insulin-insensitive brains.

        Now I’m reading more and more about using ketosis instead: http://www.ncbi.nlm.nih.gov/pubmed/18625458 and http://www.nutritionjrnl.com/article/S0899-9007%2810%2900280-7/abstract

        There are sketchy web sites out there promoting coconut oil and such, but they reek of homeopathy and snake oil. I’d like to find out who is doing the research and who can I trust.

        • Mike, I appreciate your concern. Perhaps to a lesser degree I feel that way about heart disease. Presumably you’ve been tested for ApoE genotyping?
          I do plan to write about this, though I don’t know I’ll have all of the answers. Quick response: I have a lot of reasons to believe that ketosis can be protective, at least delay onset.

    • I haven’t done genetic testing yet. It seems like they are finding more and more markers, and I’m hoping the price will come down and these commercial tests will include these new markers. Besides, even people with two APOE ?4 alleles don’t always get Alzheimer’s.

      All I can do for the time being (whether I know if I have the APOE ?4 alleles or not) is eat low-carb, but it would be nice to know if I just need to eat low-carb and keep my insulin levels low and prevent my brain (and body) from becoming insulin insensitive, or if I need to be all the way into ketosis to get protective benefit (if any exists). I’m 53 and the difference between just a low carb lifestyle or trying to stay in ketosis for 30 years requires a big difference in motivation for me.

  18. Hello Peter
    I enjoy your humour. Our lactate meter was a carpenters’ dust collection system for DH’s shop. Not for me…but really, in the big scheme of things, as official house duster, I suspect it was.
    A quick note to thank you for sharing this work. I am new to all this (picked up Protein Power Feb 2) 54 yr female recreational runner, yoga & TRX practioner, who banged on 15 pounds in about 8 months and said WHAT the heck is going on? I wish I had a buck for every person who told me I was ‘building muscle’ with the TRX. What I was building was a big fat gut. My doc said ‘menopause’ and recommended watching the carbs & getting enough protein. My adult son who was diagnosed 2 years ago with type 1 (at age 25 – likely an autoimmune attack) has been telling me for a year now he doesn’t count fat…just carbs. And he doesn’t use low fat anything. I finally ‘heard’ him. What an education I am getting! I am even playing with ketostix and often light up those shades of violet! Very interesting stuff.
    At risk of this quick note turning into a speech, I will attempt to finish by saying I feel more energetic than I have in probably 3 years, and it’s only been 5 weeks! Lost my top end run speed, but as a recreational runner….it doesn’t exactly take me off the podium anyway. ? I suffered with the menopause sleep interruption that so many women do. I now sleep and if I do wake up, I can now go right back to sleep. Besides the 11 pounds I have lost, the proper sleep is a huge gift. And my brain is getting a good workout too in reading your posts, and others; trying to wrap my head around the science. On low fat, I was always looking for the next thing to eat. Now I’m feeling a bit devilish making blue cheese dip for my salt n’ pepper wings. Who knew?
    To close, I am keeping as detailed a log as the layman can…food consumption, blood pressure, bodily ‘functions’, exercise, sleep etc., and hoping when I return to my doctor at April end, she is willing to play along. I am due to have my ‘numbers’ checked anyways, so excited for that result.
    It’s pretty funny to experience a cravings switch from bread/popcorn for say….a bowl of strawberries (with fresh cream, of course) I really could go on and on….I cannot believe how great I feel!

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