By T.J. Murphy
Ketogenic Diet #2 | Second in a series. Read the intro article here.
My personal experiment with well-formulated nutritional ketosis began a week ago, when I began restricting my carb intake to 30 grams per day, shooting for a window of protein intake of 100g to 110g per day, and eating healthy fats to the tune of whatever satiated my hunger.
On Feb 3, 2017, I woke up in the morning and measure my blood ketone levels with a Nova Max meter. The number was .8 millilmoles per liter, a low-level of nutritional ketosis. Considering that the books I’ve read on the subject, like the Art and Science of Low Carb Performance suggest that it’s going to take about two weeks, maybe three or four, to attain nutritional ketosis, I was surprised to see that I was on my way. Per what you’ll read below, I’m considering the standard to meet is 1.0mM/liter, but as of Feb 3 I was surely heading in the right direction. I plan on testing again this coming Wednesday.
Has it been hard? From my reading and listening to podcasts with experts like Dr. Ken Ford, Dr. Peter Attia,MD, Jeff Volek, PhD., Robb Wolf(author of a new book coming out, “Wired to Eat,” ) and Dr. Kirk Parsley, MD, there’s a great deal of individual variation when it comes to trying a ketogenic diet. Both in the adaptation phase—for some folks it can be a rough ride—and even in the overall efficacy. Both Attia and Parsley have talked about how the ketogenic diet definitely works for some but not everyone. For others, it can be (in Parsley’s words) “a real shit show.”
It’s become clear to me over the past few years that I’m most likely in the camp that will benefit from a ketogenic diet. I’m clearly predisposed to insulin resistance and Type 2 diabetes.  I spent my 20s and 30s doing some damage on this, because I ate an off-the-charts high-carb diet. In the past few months, I’ve learned how I’m also predisposed to craving carbs. I haven’t looked into the research on carb cravings and addiction to carbs and all that, but if I spend a couple of days allowing, for example, Christmas cookies and good beer, I have stepped onto a Six Flags-style monster roller coaster in terms carb cravings, energy levels, mood and more. Just one week of low-carb and my energy is overall higher, more sturdy, and the carb cravings have gone away. I am able to walk through our kitchen without wanting to raid the cupboards for any cookie-like foods that might have survived previous raids.
I’ll be doing some further blood testing to see how my overall health is responding to a well-formulated ketogenic diet. But a question for the endurance athlete: If you go to a Dave Scott camp (and Dave is a fan of the ketogenic diet) and decide to try it, does that mean carbs will not be a part of your training?
Having just broken free of the grasp of carb cravings, I personally think I might have to just label myself carb intolerant and deal with it. But as demonstrated in a personal experiment conducted by Dr. Attia, an engineer and high-regarded clinical doctor and human longevity expert (I should also mention that six-time Hawaii Ironman champ/super-coach Dave Scott channels a lot of his thinking and insight on the ketogenic diet from Attia’s blogeatingacademy.com) a hard-training triathlete, runner, etc can definitely eat more carbs than the ketogenic diet dictates and stay in ketosis.
(Being in nutritional ketosis has the following sorts of benefits for at least some people: greater efficiency and in fact reliance on burning fats, improved cognition and apparently with a host of cell signaling benefits that are good for a range of health and performance matters).
The context of one of Peter Attia’s experiments that he wrote about in detail on his blog: Two hard, long bike rides on two consecutive days. 110 miles each ride, 6000 feet of climbing per day, harsh winds. Gathered metrics on the second ride: Average normalized power output of 225 watts; arithmetic average power output 184 watts. From this Attia calculated a ride burn of 5000 calories, estimating that for the 24-hour day that included this ride his caloric expenditure was 6800 calories total.
So what did I eat that day?
1 Breakfast (pre-ride): 5 scrambled eggs, 2 sausage links, 3 pieces of bacon, coffee with cream.
2 In ride nutrition (I spread this out over 6 hours): 14 oz (not a typo) of salted cashews, 2 Quest bars, 1 peach, 1 apple, 6 bottles of Biosteel High Performance Sports Drink, water. (Since I know someone will ask, I did not consume super starch this day since I was craving cashews as my carbohydrate source and was craving more sodium, given the 90+ degree temperature.)
3 Late lunch/early dinner (post-ride): 2 oz ham, 3 oz pulled pork, large salad with oil and vinegar dressing, 2 slices of cheddar cheese, 6 mini hamburger patties, 2 tomatoes.
Attia tabulated all of this in terms of grams of macronutrients, with the resulting macronutrient ratio:
Hence, on this day I consumed about 5,400 kcal in total at the following ratio:
• Fat – 58%
• Protein – 18%
• Carbohydrate – 24% (equaling more than 300g of carbs)
If you’ve read your Jeff Volek/Steven Phinney books and articles, you’ll know that the above ratio does not correlate with a “well-formulated ketogenic diet,” as Volek might put it, one that restricts carbohydrate intake to less than 50 grams per day, moderate protein intake and plenty of fat, represented by something more like 80-85% of caloric intake.
“Context matters!” Attia says in his post, explaining that if he ate the 5400 calories with 320+ carbs on a less strenuous day, he would have been smacked out of nutritional ketosis. But because of the extreme exercise effort, he woke up the next day performed a blood ketone test. His betahydroxybuterate level (the ketone body that blood ketone tests measure, considered the most accurate way to derive whether or not you’re in ketosis) at 2.2 mM/L, well into ketosis. Nutritional ketosis is typically defined as reading at least higher than .5 mM/L (Attia’s personal standard is higher: 1.0 mM/L).
Last week I did two tough bike rides on consecutive days.  Each day we rode 110 miles under challenging conditions.  Over 6,000 feet of climbing each day and very strong winds, which were either headwinds or cross-winds.  On top of this, we rode pretty fast. For the purpose of illustration I recorded everything I did and ate on the second day, which I rode a bit easier than the first day.
• Fat – 58%
• Protein – 18%
• Carbohydrate – 24%
I encourage you to read Attia’s entire post on this and bop around his website to get a full and accurate portrait of Dr. Attia’s thought and work in the arena of nutritional ketosis. This was his basic conclusion:
Context matters!  If I ate even one-quarter of that amount of carbohydrate and two-thirds of that protein on a normal day – say, 2.5 hours of riding or 1.5 hour of riding followed by 1 hour of swimming, or a day of travel with no exercise – I would have been out of ketosis for two days or more. (Of course, my appetite on those days would not have allowed me to eat 5,400 kcal without feeling sick, but I won’t get into that until a later post.) But on this day, with these glycogen demands, I was able to maintain the perks of ketosis AND glycolysis simultaneously.