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September 05, 2016

Monday Moron Medical Monitoring Recap

A reader asked what plan we were all following (or at least I and a couple dozen people were following) and I told him I'd put up a thread reviewing it all.

I'm following Jason Fung's advice and doing two different things at once (plus a great deal more exercise than I had been doing). Jason Fung's book, The Obesity Code, is an easy read and you can knock it out in two or three nights.

But if you want an easy teaser, here's a video where he talks about the medical community's fundamental mistake as to the mechanism of weight gain (and weight loss).

To cut the chase: Fung recommends two lifestyle changes done in tandem. First, shifting your diet to be High Fat, Moderate Protein, Low Carb. (Usually this is called HFLC, for high fat low carb; protein is neither a particular hero nor villain, and so is left out of the acronym).

Second, he recommends intermittent fasting, which is a really misleading name, and we really need a different one. Intermittent fasting isn't really "fasting;" it's just extending the period each day when you're not eating. If you're on a 16/8 plan, that means you're not eating for sixteen hours straight -- which isn't as bad as it sounds, because, of course, you'll be asleep for 6-8 of those hours -- and then you eat your meals during an 8 hour window. The window opens, you start eating, it shuts, you stop eating. No late-night snacks, nothing. Window's closed.

I personally do something like 19/5 every day, where I start eating at 2 or 3 pm and stop at 7 or 8 pm, but it doesn't matter which part of the day you don't eat during, except that it should of course include your sleeping period. If you love breakfast, then start eating 6 am... but then you have a late lunch at 1:30 pm and you're done eating until the next morning.

Note, importantly, you don't have to do both IF (intermittent fasting) and HFLC (high fat low carb) at the same time. You could just choose to do one, or the other. (Though my doctor tells me the HFLC plan has a lot more punch than IF itself.)

Together, the two plans' benefits stack, but either one could be done without doing the other.

That's the basics. I'll talk a little bit more about the plan below.

One big Caution: You shouldn't do either of these if you're diabetic except under the monitoring of a doctor. Jason Fung is a diabetologist and in fact recommends this plan to diabetic patients, BUT this plan poses special and serious risks for diabetics which have to be closely guarded against.

And when I say "serious" risks, I mean a diabetic runs the risk of death if he pushes himself into a dangerous state called ketoacidosis. So, if you're diabetic, definitely talk to a doctor about maybe trying this, but expect to have to check your blood sugar and stuff a lot more carefully than usual.

Your body has several methods of generating energy to circulate in your bloodstream: It can break down sugar and other carbs into glucose (glucose being a main part of carbs).

If it can't find carbs to turn into sugar, it can turn protein into glucose in a process called gluconeogenesis.

If it's forced to, due to lack of food or low levels of carbs, it will send signals to your fat cells to release fatty acids, which are then converted into molecules called "ketones," in a process called ketogenesis or ketosis.

Most organs can run on either ketones or glucose. Some run better one on than others. (Many claim the brain runs better on ketones.)

You don't really have to worry about running out of glucose, even on zero carb diet, because your body will manufacture glucose out of protein if it needs it.

Of the three macronutrients, protein, fat, and carbs, carbs are the only one that is completely unnecessary. Fat is absolutely needed for a variety of things (I think cell walls must be made of fat, which can't be synthesized). Muscle can only be made of protein, and an enormous number of cell structures are made of amino acids (the components of protein).

Carbs' main function is to provide sugar energy for the blood, but again, this can be synthesized from protein as well, as needed.

The glucose in your blood is regulated by the hypothalamus, which sends signals to flood the body with insulin if glucose gets too high -- and it often gets too high, as the blood can only hold something like 5-10 grams of glucose in it at any time, and a carb rich meal will put maybe 60 or even 100 grams of glucose in the blood.

Insulin sweeps glucose out of the blood and sends it to either muscles, if the glucose is needed to fuel them during periods of exercise, or to fat cells, at all other times.

People like me --prone to weight gain -- have a condition called hyperinsulimia where our bodies just produce too damn much insulin in response to a meal, and keep insulin levels elevated for far too long. So when my body is provoked into an insulin response, it pushes *too much* glucose out of the blood and into fat -- leaving me feeling fatigued. (This is the spike-and-crash phenomenon.)

This is why fat people are actually hungry even after they've eaten -- a hyperactive insulin response has swept the glucose out of their blood, making their body send the signal it needs more energy, it needs more carbs. The glucose they ate barely had time in the blood to actually serve as an energy-carrying molecule; it got pushed too fat too quickly.

See this video starting at around 8:40 to 10:40 to see how profound an insulin response a fat person has compared to a thin person. The whole video is worth watching, but you can cut to the graph at 10:05.

But even people without an overweight problem will experience this on a milder level, when they've overeaten, or had a big dessert, or whatever.

Both IF and the HFLC diet seek to reduce this counterproductive insulin over-response by reducing carbs (which is the macronutrient that has the highest capacity to provoke insulin response).

Protein has a mild capacity to provoke insulin. Ingested (dietary) fat, oddly enough, does not provoke insulin at all.

That's how HFLC targets the insulin response. But IF helps too.

The idea of IF is to increase the period of not eating so that all food eaten at the last meal has been digested and gone on to its final state (burned for fuel, or stored as fat), so the body really has no other choice but to start telling the fat cells to release fatty acids to convert to ketosis in order to fuel the body.

This is a common thing, and usually happens, to a mild extent, while you sleep. As you're obviously not eating for at least six or eight hours.

IF just extends this period. If you're already not eating the eight hours that you sleep, IF would suggest you stop eating four hours before going to bed, and delay eating until at least four hours after you wake up, so that you're going 16 hours without eating.

11-14 hours after you have last eaten, your body has depleted most of the glucose in the blood and starts burning fatty acids as ketones. The longer you stay in this state -- the fasted state, it's called -- the more fatty acids you turn into ketones. After 10 or 11 hours or so, you start making ketones; after 14 hours, the ketone production zooms up (way up), and the longer you can stay in this elevated ketone production level, the more ketones you'll have in your blood (and the more body fat you'll burn).

This is why people delay eating for longer than 15 hours. Sometimes I go 20, 22, or even 24 hours without eating, because I'm now in the Ketone Bonus Round for hours and hours.

But that's not necessary, especially starting out. 16 hours is generally considered enough to burn fat and start converting the body into relying more on ketones than glucose for energy.

You don't have to start at the 16 hour fasting state. Some people find they're just too conditioned to eating breakfast and find this transition too tough. If you do, just try sneaking up towards the 16 hour mark little by little. You can stop eating a little earlier, then delay breakfast a little (maybe say bring something to eat to work, but only eat it at 10:30).

Once you get used to going 13 hours without food, 14 hours won't seem so bad, and once you're used to that, 15 isn't tough.

Then you can do 16.

Once you get used to 16 hours without food, after say a couple of weeks, then going 20 or 24 hours is not so hard. And it's not so hard because your body is now accustomed to burning fat for its energy needs, so you don't have those pangs of hunger caused by low blood energy -- your blood is being fed fairly constantly with ketones, so no signals go out saying "I must eat."

Again, you don't have to do 20 or 24 hours. However, it just starts happening, pretty much by accident, because your body is no longer telling you "I'm low on blood energy, eat something." You'll have blood energy, so there's no urgency about eating.

Obviously, if you go 24 hours without eating, you are going to start feeling pretty hungry though. I think that might be the body telling you "Okay, fine, we have blood energy, but we need fat and protein too, you know."

As I mentioned, it takes a little bit to spur your body, long accustomed to deriving glucose to carbs, to start revving up its largely-unused ketone-producing machinery. Some people find that in between reducing glucose and kicking on their ketone machinery, they'll get very fatigued.

But this is a temporary thing. Your ketone burning machinery will turn on; it has to. It's how humans survived in the old days when it might be two or three days between meals.

The claimed -- but very plausible and increasingly proven -- benefits of ketosis are pretty big, ranging from increased longevity, reduced risk of cancer and Alzheimer's, reduced blood pressure, etc. Basically the problem is that the human body was just never designed to handle the huge, energy-dense carbohydrates we eat now. Old time bread had lots of fiber (useless for metabolism) mixed in with the carbs; modern milling strips all this filler fiber out, leaving you with bread that is much more energy dense than your biology can easily process.

Well we're getting into the low-carb high-fat thing now, but IF, by at least reducing the periods where your body is pushing out insulin, is helpful for all this.

Another interesting thing is that a process called autophagy only happens when your digestion isn't engaged. Autophagy is the process of finding and eating damaged cells and proteins, detoxing yourself of broken and damaged cells. But it doesn't happen when your metabolic processes are being utilized for digestion; when you're going hours and hours without eating, autophagy occurs, cleaning you of damaged proteins and DNA.

One more thing: depending on whether your do low-carb high fat AND IF, or just IF, you might get something called "the keto flu." Basically what happens is that once ketosis kicks on, you'll feel a lot more bodily energy (it's like an amphetamine). But then after two or three days of that, you'll crash and feel fatigued.

What happens is that carb-rich diets cause the body to retain excess water, and when you go ketogenic, your body releases that unneeded water. However, sometimes it goes too far, or at least your body isn't quite ready to drop five pounds of excess water, and you feel fatigued due to dehydration.

The trick to avoiding this is to drink a lot of water and get plenty of elecrolytes (your body won't hold water without enough electrolytes). The best source of these is something natural like a bone broth (loads of recipes online; LauraW might give us a primer in the comments, if we're lucky).

Bone broth has lots of electrolytes (leached out of the bones you cook), so that should help avoid that dehydration.

Also, when people start eating healthier, they sort of inadvertently cut down on salt consumption (crap food has a lot of salt). So when people eat healthier, they suddenly don't get the salt (electrolytes) they're used to.

Bone broth should take care of that, but in a pinch, just making sure you're adding some salt to food here and there should help.

Getting back to the low-carb thing:

After about two months of being in ketosis, your body gets "keto-adapted," which means it has accepted ketosis as its usual method of generating energy as opposed to it just being a temporary/emergency fix. At this point, you can slip up and have carbs, and that will put you out of ketosis, BUT your body will go back into ketosis in 2-3 days. Before you're keto-adapted, having carbs will knock you out of ketosis for like 8 or ten days.

Some people find they have greater focus when they're keto-adapted. As I mentioned, they say the brain actually runs better on ketones than glucose.

I personally don't find that, but I do have lots of energy, and i just generally look for things to do now. Previously I just wanted to do nothing, to conserve the very limited amount of energy I had. Now that I have plenty of it, I'm out of energy-saving mode and into energy-spending mode.

One last bit about coffee:

People doing IF drink "bulletproof coffee," but you can obviously have bulletproof green tea or bulletproof cappuchino if you like.

It's just coffee (or tea) plus 1 tablespoon grass-fed unsalted butter (Kerrygold is a good brand) and 1 tablespoon of either coconut oil, or "MCT oil" (medium chain triglycerides).

You can also add some heavy whipping cream if you like (high fat, almost zero carb, low protein).

That fat will not provoke insulin, but will be used by the body to make ketones. thus, it's a small breakfast that starts making ketones.

Basically the point of drinking this fat-laden coffee is to cheat a bit and break the fast without breaking it in the way that counts (i.e.. spiking insulin).

There is an expensive form of this called Bulletproof Octane Oil. The various medium-chain triglycerides come in different sizes, according to their length in carbon molecules; they can be 6, 8, 10, or 12 carbon molecules long.

Most stuff sold as "MCT oil" has mostly 12 chain carbons, which are kind of garbage and can't be used for ketosis very easily. The easiest sort to use for ketosis and to fuel your brain are, supposedly, the 8-carbon-long ones, which is what Bulletproof Octane has (or it has like 90% of those, or something).

One thing I'm not sure about is whether BCAA's and other essential amino acids would break the fast. I keep wondering if I can take BCAA's at night, or in the morning.

I've heard that amino acids themselves won't break the fast (though enough protein would), but I don't really know.




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posted by Ace at 04:24 PM

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