1 Week of Maintenance

I’ve done decently well at sticking to my maintenance macros this first week. My original goals were to keep the macros in the range:

  • Protein: 165-175 g
  • Fat: 160-170g (updated later to 145-155g)
  • Carbs: 25g (max)
  • Calories: 2120-2250

Here’s the daily average of my last 7 days.

Looks like I hit the top end of my calories range (gross, but net was way under due to over-exercising this past week). Protein was over by 10 grams a day (pretty close). Carbs were very close. Fat was still a bit lower than the range I set at the start but I had adjusted the fat number down to accommodate the nominal 20 g of carb.

These numbers are 32.5%, 4.4%, 63% of calories from Protein, Carbs, and Fat.

Weight

So what happened with weight? My goal was to stay in the 165-175 lbs range and I’ve done that so far.  I had a pop up a couple of days ago when I deliberately loaded a bunch of salt to prepare for a long bike ride the next day.

Across 2 weeks my weight has gone up and down a few lbs but looks pretty stable.

I am committed to sticking to these macros for the rest of the month.

 

 

Day 4 of New Maintenance Numbers

Today is the end of day 4 of my maintenance numbers.

My target ranges are:

  • Protein: 165-175g
  • Carbs: 20g
  • Fat: 145-155g

I did pretty good yesterday and today with my maintenance numbers. Here’s my macros and food log for yesterday. I went a bit over on fat but considering I did a 25 mile bike ride that’s not going to be a problem.

Tady I hit the numbers except the carbs. I had a lot of broccoli and some Kimchi (a great probiotic).

Here’s my macros and food log from today.

I’ve been asked what I eat so I am publishing my food logs. Hopefully this will encourage others to do the same. Any critiques are welcomed. Don’t bother to tell me I need more carbs. Ain’t going there.

Weight Chart

Dropped a bit again today. I could not predict yesterday if I would drop today or not given the intensity of my 25 mile bike ride yesterday.

Day 3 of New Maintenance Numbers

I am a mission to maintain my weight and stay Low Carb.

Here’s my macros from yesterday:

I tweeked my macros for a goal weight of 165-175 to:

  • Protein: 165-175g
  • Carbs: 20g
  • Fat: 145-155g

So, yesterday I hit my range. How’s my weight doing?

So far my maintenance numbers are not stabilizing my weight. Today I did a long bike ride and my legs are on fire. That could add some water weight tomorrow. Burned 800+ calories in the three hour 20 mile ride.

My food yesterday was:

My ketones on the Ketonix are:

10.2 PPM is about 1mM:

Blood sugar

  • 77 after bike ride
  • 87 when I got up this AM

So all signs are good.

 

Low Carb Maintenance Plans

It seems like there are [at least] three basic ideas of how to implement maintenance on Low Carb. I picked representatives of each of three and look at their methodology for maintenance. Each of these three has their merits and downsides.

Dr Atkins – Titrate Carbs

Sometimes the first idea is the right idea and Dr Atkins sure did suffer a lot of slings and arrows in his day. He was tormented even in death by his opponents. I did his diet back in the 1990s and did well for over a year on it. I tapped out due to heart rhythm issues which seem to be recurring now (PVCs in particular). I think they are likely electrolyte imbalances. (Later note: See this post for my current strategy which seems to be working].

The Atkins diet starts with a 2 week induction period at 20g of carbs a day and then increases. At maintenance, the person is supposed to work up to their personal carb limit and remain at that level with an occasional adjustment if they go too far off the rails.

This approach might work well for some. It worked OK for me and at least taught me to avoid really stupid amounts of carbs but I never went below about 228 lbs before I transitioned over to maintenance carbs.

Later on, my Insulin pump data showed my average was 200 grams of carbs a day before I got off Insulin which is less than SAD and proof that I did learn something about carbs back when I was on Atkins. But, clearly 200 g of carbs was above my personal threshold. And there’s good evidence that 100 g is probably too much, too.

Carbs have a way of sneaking back in and this method is a way to get back on the blood sugar roller coaster for some. Above some point the benefits of the keto diet get lost because carb cravings get stoked. Plus it is difficult to add carbs and keep them clean carbs. It’s really easy to add back in junk carbs.

Dr Berstein – Titrate Protein

Dr Bernstein is a Diabetic Type 1 medical doctor who is also a pioneer. Bernstein recognizes the problems with titrating down carbs in his patients. Here is Bernstein’s own words (from 2015):

Bernstein – “When we want to halt weight loss we increase protein“.

I think Bernstein nicely addresses the problems with bringing back in carbs but I don’t think his method works for me. I’ve essentially done it when I did carnivore and I kept losing weight in spite of eating a lot more protein. It might work for others. My normal diet gives me enough substrate for GNG (which is demand driven) plus substrate for Muscle Protein Synthesis. Beyond some point Protein just gets eliminated via urea.

The reason this is ineffective may be that increasing protein over my normal diet significantly has a very marginal effect on FQ. Holding carbs constant (22.8g) and fat constant (191g) and taking my Protein from 179 to 300 only takes my FQ from 0.740 to 0.749 at the expense of a whole lot more protein.

Dr Ted Naiman – Balance Energy (P:NPE)

Dr Ted takes a unique approach which seeks to take into account the strengths of both of the previous methods. His method is to balance the energy from protein with the non-protein energy (in terms of grams of each not in terms of calories). His formula is essentially 30% of calories from Protein and 70% from fat and carbs. His method keeps ketogenic levels of carbs (20 or 30 or less a day) from good sources and avoids carb cravings that come with higher carb levels (no blood sugar roller coaster).

I Picked Dr. Ted

I am currently trying Dr Ted’s method. His method sets the Protein grams to body weight in lbs. I am currently 169 lbs, so if I want to stay in the 165-175 lbs range (nominal 170 lbs) I need to eat 170g of protein a day. That would be matched with 20 grams of carbs and 150g of fat a day. That is a FQ of 0.744-0.745. That is slightly more than my current 0.740 from last week.

P:NPE Balanced
FQ g cals portion cals Numer. Denom.
Carbs 20 80 0.032 0.0071 0.0071
Fat 145-155 1305-1395 0.52-.56 0.0817 0.1161
Protein 165-175 660-700 0.26-.28 0.0562 0.0708
Total 2045-2175 0.1450 0.1940
FQ 0.744-0.745

I am interested to see how this works out since that’s a lower total calorie count than I have been eating (and I was still losing weight). I was at an average of 2526 calories a day last week and my starting/ending weights were the same.

Dr. Ted’s method doesn’t adjust up or down for physical activity. I will do this for a month and see how it works out. If I drop below 165 lbs for any extended period I will evaluate whether I need to increase calories or not.

 

Day 1 of New Maintenance Numbers

Earlier I found my maintenance macros.

I ate to the macros today and did OK I think.

My targets are listed there (minimum targets). I didn’t get in quite enough protein and I got in a bit more fat. I did CrossFit earlier today and enough yard work that my watch detected it but I didn’t include that explicitly (it’s there in calories net). My goals were:

Ketonix?

I am back to feeling like I am in ketosis (taste in mouth) so I broke out my ketonix and I got this:

7.6 PPM corresponds to somewhere around 1 mM on the conversion chart.

That’s in nutritional ketosis range. So far, so good.

I don’t feel full or hungry. Here’s my food log for the day:

Not bad food choices.

 

Maintenance Macros – Dr Ted Naiman

I’ve been struggling to figure out how to stop losing weight on keto.

Dr Ted Naiman (who I greatly respect in the Low Carb world) may have the answer to my ketogenic macros for maintenance questions.

Dr Ted says for ketogenic maintenance to eat grams of fat and protein the same and set both to the body weight. That is an approximately 70:30 split (calories from fat:protein).

There is a calculator on Dr Ted’s site. Adjusting for carbs as energy gives me.

Protein to Energy Ratio

This makes a lot of sense because of the protein to energy ratio. If you overeat protein then the ratio drops. This is pretty close to what I’ve been doing this past week, but at a higher caloric level. I look forward to scaling back the calories and seeing how well I maintain weight.

I will give these new macros a try for a month and see how they play out for me. I want to keep the macros in the range:

  • Protein: 165-175 g
  • Fat: 160-170g
  • Carbs: 25g (max)
  • Calories: 2120-2250

I feel like I have a plan I can move forward on. Dr Ted does not adjust calories on workout days. I will do the same and not adjust on workout days.

IIFYM Keto Style

Keto isn’t necessarily contrary to IIFYM. It’s really just a different set of macros. If you are switching from IIFYM you can track the same way. You just get to have a low carb number and a higher fat number. Plus, you lose your cravings for sweets (after a few days).

I have a macros calculator. It is here. Let’s plug in my current numbers.

Macro Levels to Maintain Current Weight

Protein: 112 grams, 448 calories, 19.9% of calories (minimum)
Net Carbs: 20 grams, 80 calories, 3.6% of calories (maximum)
Fat: 191 grams, 1719 calories, 76.5% of calories (maximum, less if you exceed protein)

There’s no pizza, tacos, ice cream or gummy bears on this diet. But you will get used to eating real food. It might take a while but the desire for junk goes away with the cravings. This is pretty much all that there is to it.

 

You can safely go under on carbs. You can safely go over on protein. If you go over on protein just ease up on your fats.

If you want to lose weight, you just need to eat less fat. If you want to gain weight, you eat more fat.

Objections to the Keto Diet – Part 4 – Long Term Consequences Are Unknown

One of the frequently repeated criticisms by dietitians of the ketogenic diet is the claim that long term consequences of the diet are unknown. This claim needs to be compared against other diets. The other question is what sort of consequences are being compared against. Also, how long is “long-term”?

Studies on the Long Term Consequences

It is difficult and expensive to do randomized control trials of diets on a long term basis. This gets particularly difficult to do this in a metabolic ward. What other diet has passed this hurdle?

The truth is there have been long term studies of captive populations under controlled conditions.

This 2004 study was a 24-week study which showed favorable results for the ketogenic diet (Exp Clin Cardiol. 2004 Fall; 9(3): 200–205. Long-term effects of a ketogenic diet in obese patients. Hussein M Dashti, MD PhD FICS FACS, Thazhumpal C Mathew, MSc PhD FRCPath, Talib Hussein, MB ChB, Sami K Asfar, MB ChB MD FRCSEd FACS, Abdulla Behbahani, MB ChB FRCS FACSI PhD FICS FACS, Mousa A Khoursheed, MB ChB FRCS FICS, Hilal M Al-Sayer, MD PhD FICS FACS, Yousef Y Bo-Abbas, MD FRCPC, and Naji S Al-Zaid, BSc PhD). From the results:

The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients. Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol. Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.

There could be some currently unknown test that the ketogenic diet might be demonstrated to be negative but no study has shown a negative effect.

Another [small] patient population (n=3) has been studied for five years. This population has aglucose transporter 1 deficiency syndrome (GLUT-1 DS) that is only treatable with a ketogenic diet.  That study which focused on bone density and body composition is described in this study (Nutrition, 2014, 30(6), 726-728. Long-term effects of a ketogenic diet on body composition and bone mineralization in GLUT-1 deficiency syndrome: a case series. Bertoli, S., Trentani, C., Ferraris, C., De Giorgis, V., Veggiotti, P., & Tagliabue, A.). From the results:

Our data suggest that maintaining a Ketogenic Diet for more than 5 years does not pose any major negative effects on body composition, bone mineral content, and bone mineral density in adults with GLUT-1 DS…

Let’s take this up a notch. Where’s the proof that any other diet has similar safety? The low fat switch was made with zero evidence and all of the evidence in the meanwhile has shown low-fat was a bad choice.

A recent, longer study of the same sort of patients (GLUT-1 deficient patients) was done (Clin Nutr. 2017 Nov 11. 10 patients, 10 years – Long term follow-up of cardiovascular risk factors in Glut1 deficiency treated with ketogenic diet therapies: A prospective, multicenter case series. Heussinger N, Della Marina A, Beyerlein A, Leiendecker B, Hermann-Alves S, Dalla Pozza R, Klepper J.). From the results:

Baseline and 10 year follow-up investigations were available for 10 individuals with Glut1D on KDT. After two years on KDT BMI increased significantly, while total cholesterol, HDL-cholesterol, and LDL-cholesterol decreased. Within 3-5 years on KDT these differences disappeared, and after 10 years blood lipid parameters reflected the situation at initiation of KDT. Prior to KDT one child had dyslipidaemia, but no child after 10 years on KDT. No significant differences were observed with respect to BMI SDS (p = 0.26), CIMT (p = 0.63) or systolic and diastolic blood pressure (SDS p = 0.11 and p = 0.37, respectively) in Glut1D children treated with KDT for at least 10 years compared to healthy controls.

Children with seizures have been treated with the ketogenic diet since the 1920’s.

This is a very interesting study with a shorter term but surprisingly good results for the ketogenic diet (Nutr Metab (Lond). 2018; 15: 18. Resting metabolic rate of obese patients under very low calorie ketogenic diet.
Diego Gomez-Arbelaez, Ana B. Crujeiras, Ana I. Castro, Miguel A. Martinez-Olmos, Ana Canton, Lucia Ordoñez-Mayan, Ignacio Sajoux, Cristobal Galban, Diego Bellido, and Felipe F. Casanueva). The study results were:

The rapid and sustained weight and Fat Mass loss induced by VLCK-diet in obese subjects did not induce the expected reduction in Resting Metabolic Rate, probably due to the preservation of lean mass.

Over 250 medical centers worldwide offer ketogenic diets to children with epilepsy. This study looked at five years (Epilepsy Behav. 2016 May;58:61-8. Establishing an Adult Epilepsy Diet Center: Experience, efficacy and challenges. Cervenka MC, Henry BJ, Felton EA, Patton K, Kossoff EH.)

This study, the largest series of adults with epilepsy treated with ketogenic diet therapies to date, provides evidence that ketogenic diets may be feasible, effective, and safe long-term in adults…