Two Years in Ketosis: My Health Update

I've been doing a longer experiment with ketosis for about two years now. I started naturally slipping into ketosis when I started intermittent fasting and found that I really loved the way it felt.

Most people have very little knowledge of what ketosis is and how it works -- if they've ever even heard the term at all. If you fall into that camp and would like a quick primer, this Reddit "Keto in a Nutshell" is a great place to start.

Here's an update on what I've learned after experimenting with putting my body into a regular state of low-grade (~1 to 1.5 millimolar) ketosis for the past two years:

This is what I looked like back in 2010. I weighed 250 lbs, a 38" waist and I was on the verge of metabolic syndrome -- and I didn't even know what that meant until 2015. If you're not sure either, but your numbers are like mine, this would be a very good time to read up about it, because those with metabolic syndrome are at a 5x higher risk of developing Type 2 diabetes, and 2x the risk of cardiovascular disease.

It's really hard for me to post that photo -- and in fact, that's one of very few photos of me shirtless, because I hated being that guy in those pics. I don't even recognize myself in that picture. My mental image of myself was never being that out of shape. But I had gone from being really in shape in my 20s to really out of shape in my 30s.

I've spent the last two years crawling out of the hole I dug for myself, through a combination of intermittent fasting, exercise, and ketosis. Here's a picture of me trying new clothes on in 2017. And let me tell you, it felt amazing to go shopping for new clothes after donating my old wardrobe of XL shirts and 38" waist pants that was now too big for me.

All of that sounds like a personal success, right? Well, not so fast -- what about my blood work results while on ketosis for the past two years? Here are the results of seven blood tests I've taken in the past seven years:

Although my triglycerides went down to 70 from 202 and my HDL (the good cholesterol) went up to 65 from 38, my LDL (the bad cholesterol) also went up, from 135 to as high as 201. Must be all the saturated fat that comes from eating bacon and other high-fat foods while on ketosis, right? And we all know that saturated fat is really horrible for our bodies, yes? The funny thing is that I no longer believe that's true. In his book "Eat Fat, Get Thin," Dr. Hyman, the director of Cleveland Clinic’s Center for Functional Medicine, references large reviews of randomized trials, observational research and blood-level data that show no link between saturated fat and heart disease. He now believes saturated fats actually provide a net benefit to health so long as they're not ingested alongside a high carbohydrate diet (this NY Times interview provides a good summary):

When my higher LDL came back, I also ran an LDL-P test to test for the small LDL particles that are belived to be really bad. These small LDL particles are the ones that form plaque in arteries. My LDL-P numbers were off the charts, in a really bad way, scoring 2,155.

My primary care physician was concerned enough that she ordered a CT scan to find out if I had any plaque build-up in my arteries after doing ketosis for two years. And I literally just got the results back today:

Zero plaque, thankfully.

So what have I learned, and where am I going from here?

I'll break what I've learned into what I know to be true, and what I think to be true:

What I know to be true:

• Intermittent fasting has helped me regain control of my body
• Being in Ketosis provides me a smoother energy curve than glucose (which I find to be spikey, like crashing after lunch), with fewer hunger pangs

What I think to be true:

• Saturated fat isn't bad, so long as it's not consumed with a high carb load
• I'm honing in on the ideal diet [1] for me, which is probably something like a "pegan" to "pescatarian keto" diet (details below).
• Controlling chronic inflammation is what really matters for heart (and general) health, and so the Tri:HDL ratio is a very important one to track & minimize. I've got a lot more thoughts on chronic inflammation that I'll write up in more detail at some point.
• - While high LDL is universally considered bad by all doctors I talk to, my personal finding is that it's something to keep tracking and experiment with finding ways of lowering, but it hasn't casued any plaque build-up in my arteries (at least, not yet) so I'm not as worried about it as I was, so long as my Tri:HDL ratio stays strong.
• - I also think that it's very possible -- even probable -- that things I think to be true, actually aren't true. So it goes with health and medicine, so take all of this with the appropriate caveats.

Here's what I'm trying next:

I've started experimenting in three-month tranches, with blood panels in-between. These are the experiments I currently have queued up:

Just started: Instead of keeping myself in an always-on state of ketosis through diet, for the next three months, I'm going to experiment with more of a "pegan diet" to see if that can lower my LDL while maintaining my other numbers.

Up next: I really want to try a "pescatarian keto" diet, where I keep my body in ketosis, but get my fats from fatty fish vs. other meats.

I'm also continuing to fast two days per week and exercise regularly through the experiments above.

And there's one last experiment I'm intrigued to try: A friend from college, Frank, is commercializing a ketone ester into a product called KetoneAid . I tried it for the first time this week and I'm pretty excited about it. Dr. Richard Veech is Frank's wife's godfather, and Dr. Veech has been studying ketones for the past 40 years at the NIH. Dr. Veeh states "A true ketone ester is a salt free and non racemic (D-bhb) drink that replicates the secondary fuel that the body produces during times of starvation," and this is what Frank is working on bringing to market. The cost to develop this kind of pure ketone ester has traditionally been $1,000 per gram. Frank is working to bring that down to $1 per gram.

I tried an early sample of KetoneAid and it was amazing. We tested my ketone levels, and they shot up to 3.4 millimolars within 15 minutes. Several hours later they were still above 2 millimolars. This won't mean much to people who don't track their ketone levels, but it would normally require a five day fast to get up to that level of ketosis. Here's a bit more about what this means:

When you're in ketosis, you don't get hungry as quickly because your body is in a mode where it's burning the fat stored in your body for energy. Drinking KetoneAid catapults your body into ketosis in 15 minutes, which means:

• You get the benefits of being in ketosis without having to adhere to the strict keto diet protocol. For example, I could potentially eat a pegan diet (allowing for some carbs which I consider healthier, like oatmeal, sweet potato, lima/butter beans, peas, legumes and lentils) while still being able to get into ketosis.
• It serves as a really powerful appetite suppressant. For example, here's what happened to me: Have you ever had an experience where you pick up to-go food, and you have to drive it somewhere before digging into it? So you've basically been cooped up in a car, ravenous, smelling your to-go food that you can't eat because you're not at your destination yet? That's exactly the situation I was in, except when I arrived at our destination, Frank met up with me and said "drink this," which I did (video below), and I amazingly then skipped lunch entirely and didn't eat again until 8 hours later. For someone like me that has a "food beast" inside that I have to work really hard to control through intermittent fasting, exercise, and diet, the ability to drink something and boost my ketone levels to run off that fuel for 8 hours is beyond description. Frank's just starting to ramp up production [2] so I'm hoping to get enough KetoneAid to do a proper longer term test of it.

Here's my experience trying KetoneAid for the first time:

Here was the followup 50 minutes later:

Here's a picture of the bottle (front & back):

Here's a picture of my ketone levels after 50 minutes:

[1] Re: Ideal diet: The word "diet" gets pretty twisted in our society. When I refer to "ideal diet" I'm talking about a long-term way of eating vs. a temporary diet.

[2] Re: Frank's just starting to ramp up production of KetoneAid: He's going to do a kickstarter once he gets ramped up; you can register to learn more on his website, www.KetoneAid.com. It's really, really, really hard to produce a quality ketone ester. I'll ask Frank to post some follow-up comments explaining why.