No shortage of lessons this week in my little Ketogenic Klassroom. Viruses, hormones, hunger, red meat, and a long-awaited dairy experiment! I wasn't the happiest of campers this week and had difficulty figuring out what more I could eat to stave off hunger without falling out of ketosis. While I'm hopeful that keto-adaptation will occur if I stick with it and remain patient, this experiment is becoming more challenging with time, which is precisely the opposite of what I'd expected.
Note: this post was originally published on Aug 1, 2013. It was edited to streamline content and improve graphics in June 2016; therefore some older comments may pertain to content that was removed during revision.
This post is part of a series describing my attempt to follow Dr. Seyfried's dietary recommendations for cancer. To start at the beginning, please go to the first post: "Seyfried’s Ketogenic Cancer Diet: My Fasting Jump-Start to Ketosis."
Day 22 (2/21/13)
Notes: Woke up feeling fine other than minor residual cold symptoms. Wasn't hungry.
Day 23 (2/22/13)
Notes: Eyes dry and vision slightly blurry for about a half hour after waking; then fine after eating. Lethargic, heavy, slow, drained today but mentally clear, focused, and productive. Appetite was fine until evening, when it became very strong. I wasn't exactly sure how to count values for the roasted chicken skin, so I may have under-eaten today. Stomach growly, cold, tired, heart poundy. Slept from 9:30 pm to 1:30 am and woke up extremely hungry, so I tested my blood ketones and blood sugar:
So I ate more chicken skin and some tuna fish + olive oil, which helped. Because it was the middle of the night, I added the chicken skin and 1/2 of the tuna values to Fri and the other half of the tuna values to Saturday. Went back to sleep from 4:30 am to 6:15 am (poor quality, light sleep). The roasted chicken skin weighed 50 g but I was unable to locate any nutrition data for roasted chicken skin by weight on the internet. (The day's food stats don't include the chicken skin.)
Day 24 (2/23/13)
Notes: Woke feeling unrefreshed, very hungry, slightly lightheaded, lethargic, heartbeat strong. I ate my entire protein allotment for the day by 10 am because I was so hungry. It helped a lot. I'm clearly not getting enough of something lately—not enough calories? Not enough protein? Not enough fat? Who knows . . . I'm starting by adding more fat calories, but if that doesn't do the trick, I'll need to increase protein.
Afternoon/evening appetite was low, but I ate some beef fat anyway as an experiment to raise my calories. It made me feel a little queasy and gave me a mild headache, but it took away the heart pounding sensation I've had for the past 3 weeks . . . interesting . . . and took my appetite down to zero. My energy improved a bit, as well, but my sleep quality was poor.
Day 25 (2/24/13)
Morning notes: Woke feeling unrested. No ravenous hunger or pounding heart, but somewhat hungry with low energy. My cold symptoms are almost entirely gone.
Mid-morning notes: Two hours after eating a breakfast of chicken and duckfat (21 grams of protein + 29 grams of fat for a total of 374 calories), I still felt a bit lightheaded and cold and fuzzy-headed, so I purchased some beef fat from the local butcher. Before eating it, I checked my values:
In honor of Pippin (from The Fellowship of the Ring), and my time living in Germany, I decided to have a "second breakfast" (or "zweites Frühstück"). This consisted of tunafish and duck fat (13 g protein and 227 g fat). Then I checked my values after two more hours:
Now for brunch I'm going to have the rest of my protein grams (chicken) and the same amount of fat grams as in the first two breakfasts, but in the form of heavy cream. I've wanted to do a dairy experiment for a long time, but wanted to wait until I was firmly in ketosis first. I have long suspected that dairy can throw some people out of ketosis but have never tested this idea before. I waited two more hours and re-tested everything:
The cream caused a bit of upper respiratory irritation, making me feel like coughing whenever I took a deep breath. It also gave me a very mild headache and I felt warm. Those are the highest blood sugar and lowest ketone readings in a while. Was it the cream? We can't be sure yet, because, as you know, I haven't been testing my values throughout the day like this, so this may be a normal trend, but a few more experiments will give us better clues.
I will eat the rest of my fat calories as heavy cream today, and we'll see if my values continue to go down. It will be especially interesting to see what my values are tomorrow morning, since I have lots of previous data for morning values. I won't go any higher on my fat grams today than yesterday, so that we can do the cleanest experiment possible.
Evening notes: In the afternoon and evening, I was distracted by thoughts of food—dancing through my head were images of chocolate cupcakes, giant balls of fresh mozzarella cheese, grilled burgers, and all kinds of yummy things. I told myself that if I don't eat dairy tomorrow, I should be free of these intrusive, delectable daydreams. Productivity and mental energy was pretty good today.
Day 26 (2/25/13)
Notes: I did not have hunger signals this morning—no lightheadedness, lethargy, or pounding heart. Also no food cravings. While I can't be 100% sure that it was the cream that caused my food cravings yesterday, it seemed to spike my blood sugar a bit, and dropped my ketones this morning. I have no other explanation—especially for the ketones.
Day 27 (2/26/13)
Notes: Felt a bit lightheaded mid-morning so ate some more food.
I've been trying to use roasted beef fat for extra fat/calories but if I eat more than a little bit, my stomach feels quite queasy and I get a mild headache.
I had eaten all my protein and fat calories by 1 pm, felt lousy for a few hours, napped briefly a couple of times midday. Then my mind felt more awake and I was not lightheaded anymore.
Day 28 (2/27/13)
Morning notes: Heart pounding, mild tinnitus (ear ringing), and sl bloated/heavy feeling. I am attributing these effects to beef products, which I usually avoid, but I'm having a hard time finding fat that is appealing to eat on its own. I am envious of those of you who can eat cheese, cream, coconut oil, nuts, and eggs. Any ONE of those things would make this diet much easier.
Evening notes: I was fairly hungry by early evening but was still able to concentrate and function very well at work. Dry cough, dry eyes, poor sleep.
Keto-adaptation and reflections on week 4
This current plan is not sustainable for me and is clearly not healthy. Perhaps if I'd been able to comfortably eat more fat, it would have worked. I would have been willing to tolerate some fatigue and some hunger, which some people experience during the first two to three weeks of ketoadaptation, but it's been more than three weeks and these have not been the only worrisome signs, so time to increase protein intake.
Food sensitivities and ketosis
My original goal for this week was to eat the same things every day to make for a cleaner experiment, but when I was eating only chicken, turkey, tuna, and duck fat, I felt I wasn't getting enough nutrition, so I wanted to add some red meat. Beef seems to bother me, so I added lamb. Unfortunately, one can't buy lamb fat, and I needed to add fat to manage hunger.
Energy and ketosis
I may not have been in ketosis long enough (it's been 25 days) to be fully adapted—for some it can take up to five weeks. I hope that this is why my physical energy is generally low. It may be that, despite the fact that I'm generating plenty o' ketones, my cells are not yet good at burning them for fuel. I had originally intended to add some exercise this week, but I didn't feel like I could do that yet.
My cold virus lingers. Although symptoms are very mild, they are not completely gone.
Hormones and ketosis
I was not expecting to have a practically nonexistent cycle this month. I have never experienced that before. When I looked into it online, it turns out to be a well-known side effect of ketogenic diets for women, yet there is not a single word about this potential issue in either Dr. Rosedale's book nor in Phinney and Volek's books. However, these experts don't ask people to aim for ketones of 4+ mM, either. According to Dr. Rosedale, when one loses weight on his diet, the body naturally focuses on maintenance and repair, not on reproduction. That all makes sense, but I am not interested in extreme dieting to the detriment of normal body function.
My blood sugar occasionally flirts with 65 mg/dL (the upper end of Dr. Seyfried's "zone of metabolic management" for cancer patients), but it only goes that low when I haven't been eating enough. I may need to abandon this goal, since the only way I can think of to reduce my blood sugar even further would be to reduce protein even further, and I can't do that.
Can ketones be too high?
When ketones are in the 5+ range, it feels more like starvation (based on my experiences with fasting on days 1 through 4) than dieting, and doesn't feel healthy. I feel cold, sluggish, and can't sleep.
For people without cancer or seizures, who are just using this diet to lose weight, improve function/performance, manage mood swings, or manage appetite, does the degree of ketosis matter? Most people seem to report good weight loss and energy with ketone levels in Phinney & Volek's recommended range of 0.5 to 3.0 mM.
Sleep and ketosis
My sleep could have been affected by my red meat experiments this week (beef, lamb) and/or by the diet itself, which does cause insomnia for some people. Given that I've had some good nights of sleep on this diet when I avoid foods that tend to bother me and my ketones are under 5, I'm inclined to think the majority of the blame for this week's lousy sleep belongs to red meat.
Dairy and ketosis
I found the dairy experiment very interesting. The carbohydrate cravings were strong, and dairy did seem to lower ketones and raise blood sugar. However, a single days' experiment is not much to go on, so I may need to repeat this experiment from time to time.
Timing of meals and ketosis
My tendency was to want to eat most or all of my food in the morning. Dr. Rosedale recommends dividing meals throughout day, but I was too hungry in the morning to be able to do that. In an interview on Jimmy Moore's podcast, Ask the Low-Carb Experts, Dr. Phinney said it is unknown whether dividing meals or to eating once a day is better.
Protein vs. fat vs. calories
I've tried increasing fat and calories to increase my energy, blood pressure, and ketones and reduce the hunger I've had this past week, but I haven't been very successful. I am very concerned that I'm not getting enough protein—as evidenced by nearly nonexistent hormonal cycle, low energy, and poor/slow recovery from cold virus.
What does this mean for cancer patients?
I wish I were a better guinea pig for those of you considering ketogenic diets for cancer treatment, but it appears as if my food sensitivities may be affecting my keto-adaptation course and therefore make it difficult for you to use my experiences to tell you what this kind of diet would be like for you. However, if you can tolerate fats like coconut oil, butter, cheese, sour cream, mayonnaise, etc., you may be able to achieve Seyfried's target zone without raising your protein intake.
Goals for week 5
- Increase protein to see if I can improve my blood pressure and energy.
- No red meat—to see if my sleep will normalize without it.
To see whether I reached either of these goals, go to the next post "Keto for Cancer: Week 5—Ketogenic Diet Blood Tests." If you are interested in starting a ketogenic diet yourself, see my online guide: "Ketogenic Diets 101."