The Keto Challenge, Part II

How much bacon can one man eat?

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About four years ago, in mid-2013, I was a younger middle-aged man. JC and I had one child (the advantage was still ours). I was active and apparently healthy, lifting weights 3-4 times per-week, doing some sort of cardio another 2 days a week, eating a generally clean diet, but splurging when I wanted to. Except there was one problem. I was getting heavier. And less healthy. My cholesterol numbers in particular were headed the wrong direction. I had resisted taking drugs (statins) that my doctors had recommended for the last 5 years. Eighteen months before this point I finally gave in and started taking the statins, and though my cholesterol numbers started to lower, I was not well. My energy levels were in the tank. And my testosterone levels were tanking, despite a vigorous exercise routine and a low fat, multi-grain, lean protein dominant diet.

I was desperate, to be frank. I felt like my youth was escaping me and I had no idea what I could do to reverse this train that seemed to be leaving the “Health” station and heading on to “Fat, Sick, and Slowly Dying” town.

And then, I came across an article from a blog I had been reading for the past 6 years, The Art of Manliness. This particular post was written about increasing testosterone without drugs-a big selling point for me as I wasn’t wild about the idea of taking more pills to fix problems that I had a sense of having deeper causes. Within this post there was a link to another blog post (see Internet rabbit hole: enter here) titled “The Straight Dope on Cholesterol”. This 2-part series that took me less than 2 hours to read, and in that time taught me more about the role of cholesterol in human health than I had learned in 4 years of undergraduate studies as a science major, and 3 years of graduate work in the field of medicine. The author of this series, Dr. Peter Attia, wrote a larger, multi-part series on the nuts and bolts of cholesterol metabolism and it’s relation to human health and longevity on his own blog, The Eating Academy.

Armed with more information than my primary care doctor could explain or put into context, I immediately decided to do two things:

  1. Fire my primary care physician.
  2. Eat a ketogenic diet.

Brief primer: ketogenic diet= 60-80% of calories derived from fat, 10-15% from protein, 10% or less from carbohydrates. I know, it’s crazy. Hang in there, I’ll explain.

Point #2 is what brings us to the reason for this blog post today. When I switched to a ketogenic diet a funny thing happened, I had to buy new pants. Smaller pants. Like 2 inches smaller. In 3 weeks. I was 18 pounds lighter. And all the weight I lost was around my stomach and waist.

Before you run off and start eating keto to fit in those pants you haven’t worn since high school, let me finish the story.

Six months later, I was cruising along not missing bread, pasta, rice, or any other carbohydrates, as I stuffed my face with bacon, eggs, cheese, heavy cream, full-fat milk, and meat, meat, meat. I was nearly 20 lbs lighter than I was a half-year earlier, I hadn’t lost any of my strength or stamina in the gym, and my mind was razor sharp from the time I got up until the time I went to bed. I could go 16 hours without eating, then go lift heavy weights for an hour, and slam down a “Fat Shake” (8 oz. heavy cream, 8 oz. half & half, scoop of protein powder), and be good to go for another 16 hours without feeling one pang of hunger.

Yet beneath this dramatic change, was a lingering concern. My libido had left town and hadn’t left a forwarding address. I didn’t get it. I was living each day like my hair was on fire but felt flat emotionally. Depression set in. Deep, anxiety-inducing depression. The kind that people can’t talk you out of, cheer you up from.

It was time to stop playing doctor and ask for some help. To turn the ship around, I turned to the good folks at the University of Kansas Integrative Medicine Department. And I learned a few valuable lessons.

First, no matter what you think you know about yourself or how to take care of yourself, you need an objective 3rd party to help you sort through your health concerns. I say it to my patients and clients all the time: we all need a coach. You’re not objective enough or smart enough to handle everything on your own.

Second, test, test, test, and test. And then re-test. You have to have some objective data to make important decisions about your health and figure out if you’re headed the right direction. As it relates to diet, it is extremely helpful to have advanced cardiovascular, micro-nutrient, and genetic testing done to figure out exactly what the proper air/fuel mixture is to help your body perform its best. For me, when I got those tests done we found out a few key things:

  1. Wheat, gluten, and dairy don’t agree with me (goodbye, Fat Shake) in such a way that they actually were the cause of my tanked testosterone levels.
  2. I don’t metabolize certain vitamins and minerals efficiently, and in some cases, at all. Supplementing to help support my crappy genetics was actually one of the big keys to helping me feel my best.
  3. My risk of dementia and cardiovascular disease is somewhere between 10 to 20 times higher than a person who doesn’t have my specific genetic characteristics (in this case, I am a member of the rare ApoE 4/4 allele) .

Which brings us to our conclusion. After all the testing I switched from a true ketogenic diet to a low-carbohydrate cousin of it. And for the better part of two years, I’ve motored along pretty well. But as of late, I’ve been a little less than my best, mentally and physically speaking. I can’t tell you exactly what is off, except to tell you I’m just not as sharp as I previously have been.

And so, I’m back in ketosis. But this time, we’re being a little smarter about it. No dairy fat. More mono-unsaturated oils. More non-starchy veggies. Paying more attention to the lifestyle details: good sleep hygiene, dedicated stress-relief work every day, and (gasp!) no alcohol.

You may ask me, “Won’t you miss the fruit, the sweets, the booze?”.

And I will tell you this:

Compared to living long enough to walk my daughter down the aisle at her wedding, teaching my boys to be real men, and growing old with the love of my life, no food or drink holds a candle to them.


Post-Script

If you’re curious to hear more about this story, please feel free to e-mail me directly at restorethrive@gmail.com and I’ll fill in the gaps and give you the road map I followed. And if you want to learn more about yourself before you start making dietary changes on a whim because some yahoo with a blog told you about how you could fit into your high school jeans, please get some help. I’ve said it before and I’ll say it again, my colleague and friend Robyn Johnson is one of the premiere integrative dietitians in the country. Click on the link, get the help you need.


COMMENT RULES: If you are a real person, leave your real name. We are not a clearing house for solicitors so don’t do it here. Criticism and questioning is fine, that’s how we all learn and grow. Personal attacks, name calling, and the like ARE NOT COOL-if we catch you doing it you’re gone. Other than that, have at it folks! We love hearing from followers and newcomers alike and will try to reply to as many comments and questions as we can!

Treating Concussions

Current treatment approaches for treating Post-Concussion Syndrome.

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This probably doesn’t sound like the post you’ve been waiting for. This is, however, a post I’ve been meaning to write for quite some time. As the only PT at my clinic who treats patients suffering from Post-Concussion Syndrome (PCS) I want to write about this topic for a few important reasons:

  1. The CDC (Centers for Disease Control) estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities every year. You probably know someone (or are someone) who has sustained a concussion.
  2. We spend, directly and indirectly, over $60 billion per-year treating concussions in the U.S. on a yearly basis.
  3. Many folks who sustain a concussion don’t seek immediate medical advice or treatment.

It’s that third point that I intend to address now. Reducing concussions is, to a certain extent, a fool’s errand. Accidents happen. People are going to play sports, run around and have fun, and occasionally slip/fall/run into something leading with their heads. The most important component in a traumatic brain injury situation is that the victim of the injury receives immediate treatment. Sitting in a dark room and waiting to feel better is a recipe for disaster. Seeking professional help and restoring your normal day to day functional abilities should be priority number one.

Let’s talk briefly, and as plainly as possible, about what happens when you sustain a concussion in terms of physiology. I’ll start with a diagramConcussion Pathophysiology

This is your brain when it becomes concussed. For those non-science majors, note point #3 in the diagram “Calcium in the cell impairs ATP production in the mitochondria, worsening energy crisis”. Put more simply, your brain is running out of energy to perform it’s normal functions. ATP, the energy produced by your body for everything from sprinting performance to recalling your daily chore list in your brain, isn’t produced at adequate levels when you have sustained a concussion.

To the left of the diagram you see a description of the depolarization and neurotransmitter release. Hang in there with me. In a nutshell, this means your brain gets really incompetent at using glucose (sugar) for energy.

And here’s where we start with our current methods for treating PCS. Lifestyle modification is key. If you are suffering from a concussion, start with these modifications:

  1. Avoid any screens with blue light (that means computers, tablets, TV’s, cell phones, and the like). Blue light heightens brain activity (read: energy consumption), something an injured brain can’t spare.
  2. Sleep in a pitch black room. We’ve discussed the ins and outs of the importance of sleep here. It’s doubly important when you’re trying to set the stage for your brain to heal that you optimize your sleep hygiene.
  3. Modify your diet. Reduce your carbohydrate intake. Carbohydrates are not the friend of an injured brain (carbohydrates are broken down into simple sugar in your body, and simple sugar are broken down into glucose-the fuel your brain can’t use when you’re concussed).
  4. There is considerable research demonstrating that an alternative fuel source can fuel the brain for all of the functions it requires energy for. That fuel source? Ketone bodies. Ketones are produced in the liver during bouts of intense exercise (not recommended if you are concussed), low carbohydrate intake, low calorie intake, or untreated Type 1 diabetes. Initially I recommended that my PCS patients consider a ketogenic (low carbohydrate, moderate protein, high fat) diet to supply the necessary fuel substrates (ketones) needed for their brains to heal. I still support that recommendation. Within the last year, though, there have been several companies that have started making exogenous (synthetic) ketones that you can mix as a drink to derive the same cognitive benefits that previously only came about when following a strict ketogenic diet. There are a host of brands if you do a simple search on Amazon, but I would recommend one of the following three brands in particular: Keto O/S, Kegenix, or KetoCaNa. These supplements are not cheap, but they are a small price to pay compared to the lost earnings from missed work time and myriad of medical expenses you will incur after a concussion if you decided not to take personal responsibility for optimizing the healing environment for your brain. (Side Note #1: Please contact my favorite dietician, Robyn Johnson, here, if you need help sorting out the nutrition component)

After you accounted for your light exposure, sleep, and nutrition, it’s time to get to work in restoring the normal function of your brain. This can be a multi-disciplinary process. I have been trained to administer vestibular rehab (restoring the normal function of reflexes that occur between the eyes, the brain, and the 5 canals in each of your ears that gives you sense of your body’s position in space). Sometimes vestibular rehab isn’t enough. If a concussed patient has a particular vision deficit, I refer them out to a neuro-optometrist to address the visual changes they have sustained. (Side Note #2: If you live in the Kansas City area, I highly recommend Dr. John C. Metzger at Kansas City Vision Performance Center if you have any visual deficits after a concussion).

Each concussion patient has a different experience. Though an estimated 80-90% of cases “resolve” in two weeks, if you’re part of the 10-20% of cases that don’t get better, you need to seek treatment ASAP. Even if you’re “recovered”, if you haven’t had a thorough vetibular-ocular exam, it is entirely possible, if not altogether likely, that you still have some deficits that are effecting your physical and mental capabilities.

Don’t wait to get the help you need. Find a qualified professional to help point you in the right direction to recovery.

One last side note (#3, for the record): if you have sustained a concussion, or even if you haven’t sustained a concussion and participate in a contact sport such as American football or ice hockey, you should seriously consider avoid the consumption or administration by injection of non-steroidal anti-inflammatory drugs (NDAIDS). This class of drugs has been shown to increase blood-brain barrier permeability. If you’re already concussed, receiving one of these drugs (Aleve and Toradol are two common forms) you’re making the problem worse. If you’re not yet concussed but taking these drugs, you’re opening the door for a more severe traumatic brain injury should you become concussed. Think long and hard about how much you enjoy your current mental capabilities before heading down the pharmaceutical pathway.


COMMENT RULES: If you are a real person, leave your real name. We are not a clearing house for solicitors so don’t do it here. Criticism and questioning is fine, that’s how we all learn and grow. Personal attacks, name calling, and the like ARE NOT COOL-if we catch you doing it you’re gone. Other than that, have at it folks! We love hearing from followers and newcomers alike and will try to reply to as many comments and questions as we can!