I recently decided that I was tired of feeling sick after eating breakfast. Breakfast was a low G.I. (glycaemic index, for those of you not down with the lingo) fruit free, wheat free, nutty muesli. It was delicious. It was also topped with low fat vanilla yoghurt.
For most people, these would probably be reasonably healthy options. Not so for the Kate. For someone who is not technically insulin resistant (numbers leaned that way, last time they were tested, but weren’t over the line) or diabetic, I have a ridiculous response to sugar.
My breakfast choices have become more and more lean. First, no fructose. Okay, well, that cuts out wheat and a lot of grains, and anything with dried fruits… Then, low G.I. Well, that cuts out a lot of sugary cereal… anything with honey (also a fructose issue)… uhm…
And I stayed on my nutty muesli for a while before I started to feel sick again.
It’s what happens when, after waking up in the morning, ravenously hungry and tanking on low blood sugar, I feed myself a whackload of carbohydrates, and then I get an insulin spike and an eventual sugar crash. The definition of “whackload” is, of course, relative, but it turns out that for me, it’s a pretty low number relative to what a lot of people experience.
And I just cracked. The blood sugar fluctuations, the insulin spikes, all of it; I don’t eat much wheat, I focus on low G.I. carbohydrates where I can (for the most part. The occasional pizza binge was just a fact of life), and still there’s the blood sugar tanking anxiety, frustration as I struggle to find something I can eat that’s not full of wheat or some other source of fructose, something that won’t set off my weird sensory triggers (some textures and smells; notably salad) and make me panic and/or throw up.
That’s it. I was tired of feeling ill after eating.
So I have gone low carb, or more specifically, low carb-high fat (LCHF), the ketogenic diet wherein you go through a potentially upsetting induction process as you train your body to metabolise fats by denying it carbs. I did extensive research and reading on the subject (my god, I know more about nutrition and metabolic biochemistry than I ever have in my entire life, what nutrients different organs absorb and in what different forms they absorb them, and I am now reasonably convinced that livers are basically wizards), and I eased in, at first.
I started cutting a few things here and there. Dropped to about 100g carbs/day. Realised that it wasn’t actually that hard, so I dropped a little further, and now I’m below 50g, which is the mark at which my body should start swapping to ketosis (the production of fat-containing ketone bodies to power the brain and muscles as opposed to using sugars), and have been for about two weeks. A lot of people recommend going below 20g/day for induction, just to fast track the process, but I don’t feel the need to fast-track it. It will happen as it happens, and below 50g/day should be plenty low enough to get the ball rolling.
I’ve been lucky. Prior to this, I wasn’t eating a hugely sugary diet overall (in spite of the occasional cake or pizza, which is now sadly off the menu lest it interrupt the induction of ketosis), and most of my carb sources were relatively slow-release, which means that I haven’t suffered through the dread “keto-flu”, where people feel really quite sick for a few days as they adjust and as various gut flora die off to be replaced by different gut flora.
I’ve been a little tired. Had some headaches. It was recommended I increase my electrolytes (insulin tells your kidneys to hang on to sodium and various salts, and when the insulin levels in your body fall, you flush out a bunch of salts, so you want to stay on top of sodium, potassium and magnesium in particular), and I did, and bam, headache gone, in under 20 minutes.
That’s it. That is really all that happened in my initial keto transition (usually keto-flu is the first 3-4 days). I’m now just hanging in for full keto-adaptation as my body upregulates the production of ketosis-related enzymes and downregulates all my carb-digesting enzymes.
Now, as far as the insulin/sugar issues go: this has worked a fucking treat. It has been amazing. I am not ravenous in the morning. I do not feel sick after eating. My energy lasts longer.
But wait, there’s more.
I sleep better. This is apparently a mixed bag; apparently a lot of people sleep worse when they start keto. I’m wondering if they were big bread or pasta eaters prior to this, and the disruption to their usual metabolic process is the problem and hopefully it will settle. But a lot of other people report sleep improvements, and so far, I sleep like a goddamn log. Even when Amos wakes me up with his insistent barking demands to be allowed outside to eat possums and secure the perimeter, I wake up, tell him to settle, and then after a few minutes I conk out again.
(side note because I can’t let it alone: you don’t yell at a dog for barking, by the way. It’s not because I think it’s “mean”, it’s not because I’m being “soft”, it’s just because it simply doesn’t work. They just think you’re barking back and you can have a lovely conversation. A loud conversation.)
I have more energy. It’s true that this only lasts until I put a certain amount of stress on my body (more on that below), but I am more alert and clear headed than I have been in a long time. I feel awake rather than constantly fuzzy and foggy and frustrated.
I am more calm. Things that previously would have upset me… just don’t. It’s not that things don’t bother me, they do, I just don’t get excessively anxious or panicky or furious about it. I can be angry in a calm way if I need to, which is great, because excessive emotion in a non-calm way has, historically speaking, made me feel sick (probably adrenaline related, and losing all my blood sugar). Things that frustrate me are merely frustrating, not the end of the world. I am not giving myself nearly so many “chill out and get some perspective” pep talks.
My digestion is significantly improved, concerning which I shall not go into any more detail and we can all be very thankful.
We (as a household) are cooking more, because preparing food without carbs means less restaurant visits and take away (for the most part. Tapas works well!), and as a consequence I am actually eating more vegetables, believe it or not. I am seeing kitchen time as a problem solving exercise (i.e., how can I get nutrients x, y and z without eating carbs or anything I really don’t like), instead of opening the box of triggery food anxieties.
I no longer feel bloated.
Low carb high fat means exactly that, so while I am not eating sugar, or bread, or pasta, or rice, or cake, or biscuits – I am eating lots of very fatty foods. Energy’s got to come from somewhere, and you can’t get it all from protein (excess protein is converted into glucose anyway, so it defeats the purpose, really). So: butter, cream, bacon, cheese, eggs, macadamia oil, nuts…
Best. Diet. Ever.
And just in case anyone is not up with the fact that fat does not in and of itself make you fat, I am in fact losing weight. And still gaining muscle.
There are downsides!
While I’m adapting – i.e., still upregulating all the various chemical bits and bobs necessary to induce and sustain a high level of ketosis – I don’t have as much ready access to energy as I did when my bloodstream was flooded with carbs. Entirely to my surprise, I managed to put my weights up at gym, but I cannot run. I really can’t. I just finished Couch to 5K, and have been used to running continuously for 25-30 minutes – now I can manage about a minute.
You can sustain high level athletic performance if you are fully keto-adapted, but only if you’re very consistent about it, and only if you get enough salt (see below).
But Kate, isn’t fat really bad for you?
Look, if you’re eating a diet that has bucketloads of carbs and fats, then yes, fat is going to get shunted into storage (what I prefer to think of as insulation; your mileage may vary), but that seems to be about it (although there is more nuance to be found on what fat cells actually do and what hormones they secrete).
This is because of the insulin spike associated with carbohydrate/sugar consumption (just in case anyone is not aware: sugars are carbs. They are simple carbs, and perhaps what all other carbs aspire to be. Carbs get broken down into sugars in your body). Insulin is there to tell your body to absorb all the blood sugar, to try and keep it all in normal range rather than sitting way up high, because consistently high blood sugar is genuinely toxic. This is more important than absorbing fats and converting those to energy, so insulin shuts down that process. You have to use up the excess blood glucose first, then you can start burning fat (except that if your body is not adapted to using fats, this is not an efficient process).
Simple summary: if insulin is high, fats will not be mobilised for energy.
The mobilisation of fats for energy by the liver results in the formation of ketone bodies (basically a useful way of repackaging fat so that it is easier for organs and muscles – particularly the brain – to use). If you have enough of these hanging out in your bloodstream for easy use, you will have plenty of energy to function, and above a certain level you will be able to maintain all sorts of athletic pursuits just as if you had carbs hanging about in there instead.
But in order to keep ketone levels high enough, you can’t interrupt the process by eating carbs – if you do, up comes the insulin, the ketosis screeches to a halt, and you have to (1) consume the energy provided by the carbs and (2) wait for the insulin to subside before ketosis kicks in again (although if you are fully adapted this is a lot quicker than it is at the start).
But I thought ketones were poisonous! Isn’t ketosis, you know, that bad thing?
No, that’s ketoacidosis. Not the same thing. That’s when your ketones get insanely high (nutritional ketosis should get you to a maximum of about 5 mM in your blood, although individual maxima will vary; ketoacidosis has you at about 20mM). It’s a risk for people with type I diabetes. Keto might not be for them, or at least, it needs to be more carefully managed.
You absolutely cannot do exercise without carbs or sugar.
You absolutely can, but there are important caveats. I’m reading a couple of books on these issues at the moment, and so I will soon know more (I like knowing things!). At this point the caveats are primarily:
- do not interrupt ketosis. You need your ketone levels to be high enough for your body to have ready access to energy if you’re going to do marvellous things like cycle long distances or lift heavy weights.
- Eat a moderate amount of protein. You want enough to maintain lean muscle mass, but not so much that your liver starts using it to make glucose (and it will), because – see above – that will interrupt ketosis.
What do you mean, salt?
I mean salt. Specifically, sodium (although the magnesium and potassium are very important as well). Most people are all about getting less sodium in their diet, and that makes good sense for the most part – unless you are restricting carbohydrates. If you are restricting carbohydrates, you are probably eating more whole foods and less processed things (for the most part) and this means you are consuming less salt. You’ll need about 3-5 grams per day, but only if you are restricting carbs.
This is because, among its many other magical talents, insulin changes the way your kidneys process water and salts. You flush salts a lot faster on a ketogenic diet, and believe it or not, your muscles need sufficient sodium to function. Without sufficient electrolytes, you will experience the fatigue and the cramping and the headaches and discomfort that a lot of people experience on the ketogenic diet – and which is the main reason for many people, including more physically active people, abandoning it. Depending on how you manage your diet, you should be getting enough magnesium and potassium from elsewhere, but it’s worth chugging some extra of those as well (don’t overdo it) if you’re not sure.
I only recently came to this realisation, and since I have started ramping up the sodium intake, I am feeling miles better. The most common suggestion for getting enough sodium does involve drinking broth.
This would be fine if I actually had any inclination to make broth. The backup plan for people like me is to drink “boullion”, a.k.a., “stock”.
This means that I actually heat up a mug of chicken stock in the microwave and drink it.
Isn’t that gross?
Actually, yes. I’m waiting on a better solution that doesn’t involve just pouring sodium chloride on my hand and licking it, because that is even more gross. Vegetable stock is actually undrinkable (I tried, thinking it might be better, because I prefer it when I used to make risotto). I have actually done shots of salt water. This is stupendously gross but at least it’s quick, and then I can just drink a gallon of water to get over it. My concern is that saltwater can be quite caustic and I’m not sure if this will damage my throat.
All the same, it has definitely led to improvements in how my body functions on a keto diet.
Edit: I recently made the discovery that some stock is more drinkable than others. I was trying to drink Campbell’s “Real” Stock, and it was pretty gross, even though that’s the brand I prefer to actually cook with. Then I swapped to Continental, and it basically tastes like Cup-a-Soup, and if you add cream, it tastes like Cup-a-Soup Cream of Chicken, so… basically like my childhood. This is much, much better.
But you need carbs. For, like, life.
Nooooo, I don’t. Admittedly, most people don’t recommend you go zero carb. Not only is it extremely difficult to maintain for some people (i.e., me. Most of the things I eat on a low carb diet have a negligible carb content, but they would add up if my budget for the day was zero!), but it’s good to have a little bit of a buffer there.
To be fair: while your muscles and organs are not very picky about what sort of energy they use, your brain is limited to two sources: glucose, and ketones, and it still needs to get at least a little bit of its energy from glucose even if you are getting happy results on your ketone-o-meter. Fortunately, your liver to the rescue: your liver is perfectly capable of making glucose from protein via gluconeogenesis, and this will be plenty to supply half the brain’s energy needs.
(this is one reason that I think livers are basically wizards that live under your ribcage. They do magic)
I still think this is a bad idea. People have been telling me I need lots of healthy whole grains my whole life.
And the fact is, for a lot of people, the “healthy whole grains” model is probably okay. It may be stressing your body out a little bit more, but if you are reasonably sensitive to insulin and thus able to tolerate carbohydrates well, then I very much doubt even the most enthusiastic low-carb dietitian would tell you to change what is working for you. This is not something I am likely to get evangelical about; it’s only something I’d even suggest if someone is worried about their blood sugar cycle and energy levels relating to that, and even then only if they actually want to talk about it (food discussions can be a bit triggery, I am no different).
However, a lot of people don’t have a good response to insulin; there seem to be a lot of people who, like me, feel sick after breakfast, and who spend their day chasing their own tails as their blood sugar cycles up – and down – and up – and down, decades before it gets bad enough to cause Type II diabetes (which it will often do); and for those people, restricting carbs, ditching the “healthy whole grains”, and ramping up the fats instead, is a much better idea, especially if you either supplement fibre, or eat fibrous low-starch veggies (there are lots of veggies on a keto diet when done properly).
Look at it this way: low-carb and ketogenic diets are extremely – and increasingly – popular, in spite of the fact that it’s a very difficult transition to make at first.
Most people feel quite sick at the start, and they have lowered energy following that for at least two weeks (I’m in the latter part of this period); they can’t eat a lot of the things they have been used to eating their whole lives, and I’m not just talking about cakes and biscuits and popcorn. No bread, no pasta, no rice; no healthsome muesli; no pastry, sweet or savoury; no sugar in the coffee; a dramatic reduction in milk (contains sugars in the form of galactose); no chickpea batter (my Indian meal selections have been drastically reduced); no lentils; and some things are surprisingly high in carbohydrate content that you might not expect (always check the nutritional information on the packet).
That is a very high barrier to entry for most people; so why are so many people picking it up?
Well, for starters, it does lead to very rapid weight loss (and no, it’s not all water weight, that’s just the first week, and as long as you are getting enough salt and protein you shouldn’t lose muscle mass either), and that’s compelling for a lot of people – but there are other actual health benefits worth mentioning (other than not feeling sick after eating which, as we’ve seen, is my primary motivation).
Their serum triglycerides usually go down.
Their body fat percentage almost always goes way down.
Their low density level cholesterol (LDL) usually goes down. It is worth mentioning, though, that a minority of people experience a temporary increase in LDL – this is usually linked to weight loss, but if not, it is readily repaired by swapping out some of the saturated fats for monounsaturated fats (i.e., out with the butter – noooo! – in with the macadamia oil – om nom).
Their HDL – the “good” high density cholesterol level – goes up (see all the links above).
They stop craving food in cycles (the onset of hunger, I’ve noticed, is a lot softer on keto than on a regular diet).
Fasting insulin and blood glucose obviously go down (see all the links above, I got sick of Google Scholar, but there are heaps of others if you have a look).
People maintain keto because, once they are fully adapted, they feel better. Quality of life on sustained keto is pretty good. I’ve only been doing this for two weeks and my track record on diet alteration is not good and I am still vowing I will never go back, just because it is so nice to not feel slightly ill all the time.
It’s not for everyone. If nothing else, a lot of people will balk at the amount of salt and fat they have to work into their diets after decades of being told those things are bad for them, and as I said, there are people who are very insulin sensitive (that’s a good thing) who will not see any need or reason to try it out. There are also people for whom the social pressure to eat grains will be too much – I am trying to get my head around the fact that going to the movies is no longer inextricably linked with popcorn (I love popcorn, I’m not even kidding), and on an emotional level that has been surprisingly difficult!
And yet I don’t think I can trade this clear headedness, this sense of satiety, this extraordinary get-up-and-go that I have – I can’t trade it in for a bucket of popcorn, or a really good pizza. It’s not worth it.
So I’ll be sticking to it for a while. Watch this space.