Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (15 page)

– Dr. Ron Rosedale

I spoke with Marylou Van Hintum, a bariatric nurse based in Manassas, Virginia, about this, and she noted that she has seen so many frustrated patients counting “net carbs” and wondering why they are not seeing results.

“When sugars are present in foods, even with comparable amounts of fiber, [it] can trigger a sugar response in many people,” she explained. “After eating something like a ‘low-carb tortilla,’ you may find yourself craving either more of the tortilla or even things that have more carbohydrates than you have been eating, including fruits.”

Unfortunately, as she noted, these foods are not conducive to producing adequate ketones to stave off hunger and cravings and make positive changes in your health. Far too many people fall for the “net carb” marketing gimmick or purchase products whose packaging advertises “no sugar added,” “gluten-free,” or “great for low-carb diets.” Van Hintum says you need to be aware of how these food choices are impacting you if you want to be in ketosis.

“Learn to listen to your body if you are eating a low-carb, high-fat, ketogenic diet,” she said. “And if you happen to find yourself suddenly craving foods, especially carbohydrates, that’s your cue to reassess what you are eating to make sure [that] there aren’t any hidden sugars in your diet [and that] you haven’t consumed too many carbohydrates for your personal tolerance.”

Van Hintum’s best advice for ketogenic dieters: “Steer clear of sugars in any form (including starchy carbohydrates) because they can be disruptive to the way you process and metabolize foods.”

When it comes to carbohydrates and simple sugars, follow my simple rule—when in doubt, throw it out! Carbohydrates should come mainly from non-starchy vegetables rather than starchy and refined carbohydrates. For people with any degree of insulin resistance (and that would be just about everyone these days), it will be a challenge to achieve and maintain ketosis if you consume more than 50 grams of carbohydrates per day. Those without insulin resistance can probably consume more carbohydrates and still maintain a state of ketosis.

– Dr. Bill Wilson

After two weeks, if you are producing ketones (we’ll share how you can measure them in chapter 8), try slowly adding 5 to 10 grams of daily carbohydrates for one week, to see what that does to your ketone production. If ketones remain at the appropriate level of nutritional ketosis, then you’re able to tolerate a little more carbohydrate in your diet. Keep repeating this weekly until ketone production begins to decline, then return to the level of carbohydrates that allows you to continue producing adequate ketones.

If you’re not producing ketones after two weeks of consuming 20 grams of total carbohydrates daily, consider going down to 10 to 15 grams daily and restricting your protein consumption (a topic we’ll explore more in the next chapter). Don’t lose hope; it is possible to get into ketosis even if you are especially carbohydrate sensitive. Believe me, I understand this completely. I cannot consume more than about 30 grams of carbohydrates daily or I get out of ketosis. You have to remain committed and purposeful in your pursuit of this. It won’t just happen by chance.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Carbohydrate tolerance is an individual thing. In general, you can eat more carbs if you are younger and more active. But postmenopausal women tend to have to keep their carb consumption really low.

2. Test your triglyceride levels.

You’re probably thinking,
Hey, I thought this book was about ketosis. Why in the world are we talking about a part of the cholesterol panel?
It’s a good question. If you read our previous book,
Cholesterol Clarity
, then you already know that one of the best ways to lower your triglycerides (a key measurement of fat in the blood) is by slashing your carbohydrate intake. If your triglycerides are over 100, then you are most likely eating too many carbs for your personal tolerance level. The blood chemistry doesn’t lie.

Heart disease is not caused during the fasting state; it is caused during the hours after eating. After a meal, there is a flood of digestive by-products of the meal that generally lasts six to eight hours. While fats make a modest contribution to after-meal lipoproteins, carbohydrates cause a much larger, though delayed, after-meal surge in lipoproteins. This delay occurs because the liver must convert sugars from carbohydrates to triglycerides . . . . Remove carbohydrates and the after-meal surge in lipoproteins is substantially diminished, thereby further reducing heart disease risk.

– Dr. William Davis

Let’s say you got your triglycerides tested and they came back at 137. While that’s not super-high and would fall within what your doctor thinks is “normal,” it does indicate you are very likely eating a few more carbohydrates than your body can properly manage. Cut out all sugar, grains, and starchy foods for thirty days and then get tested again. What you’ll probably discover is that your triglycerides drop like a rock below 100, and most likely even below the optimal goal of 70. This is a simple yet highly accurate way to figure out how many carbs are right for you.

After thirty days of cutting out all sugar, grains, and starches, you can slowly reintroduce small amounts of these foods one at a time to see what happens. The
New York Times
bestselling book
It Starts with Food,
by Dallas and Melissa Hartwig, is a great resource for exploring this kind of an elimination diet.

3. Get a glucometer and test your blood sugar levels.

It is helpful to measure fasting blood glucose and fasting beta-hydroxybutyrate levels and monitor progress by keeping a journal. Testing can be done with glucose and ketone monitors and test strips that can easily be purchased over the counter.

– Dr. Mary Newport

One of the best ways to determine just how sensitive you are to carbohydrates is to get a blood glucose meter—also known as a
glucometer
—from your local pharmacy or drugstore. Test your blood sugar in a fasted state when you first wake up and then at thirty-minute intervals for at least two hours after consuming a specific food. This will show you exactly how your body is responding to that food. Ideally you will see your blood sugar rise only slightly one hour after eating and then return to baseline within two hours of your meal.

For example, let’s say your blood sugar when you first wake up is 88 and it only rises to 105 an hour after eating a breakfast of bacon and eggs. Two hours after eating, it comes back down to 89. That’s a perfect response. But let’s say your fasting blood glucose is 88 and you eat a whole-wheat bagel with fat-free cream cheese or oatmeal topped with margarine. Don’t be surprised if you see your blood sugar soar to 160 and not even come close to returning to baseline within two hours. (This is an extreme example, of course, because you’re probably not eating grains and fat-free foods—or at least you shouldn’t be after you read this book!)

Cutting carbs to the level of ketosis has numerous health benefits in addition to normalizing weight. Not only does a ketogenic diet tap into the excessive fat stores people are carrying around, but this level of carb restriction also improves blood sugar and insulin balance, making one less likely to develop type 2 diabetes. If one has diabetes, it allows for better blood sugar control with less or even no medication.

– Jackie Eberstein

Getting into ketosis is harder for some than others. Dr. William Wilson explains that people with type 2 diabetes or severe insulin resistance will very likely have trouble getting their blood sugar levels low enough. He suggests two shortcuts for circumventing this issue to help you produce ketones: first, have your doctor write a prescription for a medication called
metformin
, and second, get an over-the-counter supplement called CinSulin, a concentrated form of cinnamon. There is also a supplement called Glycosolve, made with berberine and banaba leaf, that helps to normalize blood sugar levels naturally.

Dr. Wilson says that these “work by improving insulin sensitivity and reducing glucose production, resulting in more stable blood glucose.” If you need an additional boost in controlling your blood sugar, Dr. Wilson says 200 to 800 mcg daily of chromium picolinate (also available from any vitamin store) will “help push you into ketosis if you have insulin resistance.” He describes these supplements to his patients as “mommy’s little cheaters” for getting into ketosis!

I started measuring serum insulin nearly twenty years ago, when there was only one laboratory in the country doing it, and found out quite quickly that as a person’s diabetes was rapidly improving, as indicated by lower, more stable glucose measurements, their serum insulin numbers would also greatly decrease. What was happening was that they were becoming more insulin sensitive. Their cells were able to listen to insulin much better; their ability to “hear” insulin was being much improved. They were getting much more bang for their insulin buck.