On February 24, 2013, I weighed in for the beginning of a little experiment. About four months after learning I have a grade two brain tumour, I’d finally marshalled my mental resources and done some reading. I also made use of the expertise of a few valued coworkers and friends who are cancer and metabolic health researchers. I basically tasked a couple of these fellows with doing some reading for me, and telling me the stuff I needed to know, but nothing negative that was not actionable. I found I needed that small degree of shielding from the internet.
I learned that there is a lot of good research out there that builds on foundational work done in the 1920’s by Nobel laureate Otto Heinrich Warburg, now referred to as the Warburg Hypothesis. Essentially, Warburg observed that a key difference in cancer cells compared to normal cells is that the way they generate energy for growth and reproduction is altered, replacing the way normal cells use oxygen, with fermentation of sugar. Although Warburg won a Nobel prize, much of his work was set aside as not causal of cancers, but perhaps just a side-effect. Also, in the 80’s and 90’s, we saw the rise of genomics and the Human Genome Project, which held a sexy promise of curing disease through the unravelling of the secrets of the genetic code of life.
In recent years, interest in Warburg’s work has been renewed, including research on cancer as a metabolic disease. I’ve referred before on this blog to the work of Dr. Thomas Seyfried of Boston College, which is really the key information I found online that pointed me in the direction of the ketogenic diet. It was this presentation from Dr. Seyfried that set me feverishly to work trying to understand the ketogenic diet and whether it was something I could reasonably incorporate into my lifestyle.
In my initial research, I meandered through information and cookbooks about Paleo and Neolithic diets and Atkins diets. These are all variations on the low carbohydrate theme. What I had learned from my research, however, is that what I wanted, in a nutshell, was a diet high enough in fat and low enough in sugar that my body would be forced to adapt and use fat for energy. It is worth noting that I did not do this in cooperation with a dietician or doctor. I do have a background in biology and health research, and a lifelong interest in fitness and diet, so after doing my research, I felt the changes I was prepared to make were not extreme enough to require actual medical supervision. Judge that as you may.
The ketogenic diet has been used successfully as a medical intervention in children with refractory seizure disorders that do not respond to medication. That means a lot of the information found online deals with epilepsy. This is what I focused on, as opposed to diet plans that were more clearly designed for weight loss exclusively, for example. The goal is to obtain about 65% of daily calories from fats (including the saturated fats that we’ve all been taught to fear), 30% of daily calories from protein, and only about 5% from carbohydrate sources. You’ll find different breakdowns, but that’s generally in the ballpark across sources I’ve seen. Another piece of advice I encountered and took to heart was that you should try to eat no more than 50 to 100 grams of carbohydrate per day, and then make up all the food you need for the day from fat and protein sources, with a focus on the fats.
Why, you ask? The idea is that on a regular North American diet (think traditional food pyramid, with breads and starchy carbs as the base), glucose is a major energy source in your body, and is transported in your blood to fuel your brain. If you eat no sugar, but high fat, the fat you consume is not stored. Rather, your liver converts it into something called ketone bodies, which can be used by cells in your body for energy instead, and can pass into the brain and be used as an energy source for brain cells as well. It turns out that brain cells love using ketones for energy; some of the leading proponents of this diet as a lifestyle claim improved mental function, even higher IQ, on a ketogenic diet. The underlying idea as it pertains to cancer, particularly brain tumours, is that cancer cells are somewhat primitive from a metabolic perspective, and they love to use sugar for energy. When sugar is unavailable, other brain cells can convert to use ketones, but cancer cells aren’t this agile, so the idea is that they start to “starve” for energy, slowing growth.
This brings me to February 24, 2013. On that date, I started a ketogenic diet, and started collecting my own data. For the past year, I’ve weighed in using a home body fat scale on a weekly basis, and measured my blood ketones using a ketone meter. Hey, I’m a bit of a data nerd, okay? My initial concern, having been inculcated into the low fat way of thinking over most of my adult life, was that I would, quite simply, get fat. This diet is high fat, adequate protein, low (or no) carb. I viewed low carb diets as fads that I’d encountered in fitness circles for years, and I am extremely skeptical of any diet fad. Even ones that last for decades, like Atkins. But what it came down to, is that I figured eating a diet high in saturated fats for a few months was probably not as risky as a burgeoning brain tumour, so I felt pretty relaxed about it. This is info for another day, but I also started to tune into information like Gary Taubes’ excellent New York Times piece entitled “What if It’s All Been a Big Fat Lie?”, which made me rethink my perspective on dietary fats altogether.
I ate eggs, bacon, and a dollop of full fat sour cream for breakfast. I got weird looks at Starbucks or my local neighbourhood espresso bar when I ordered my sugar free latte prepared with heavy cream. I ate my own weight in avocadoes and was pleased to find that with the explosion in popularity of the Paleo diet, my local Costco carried giant tubs of coconut oil. With gluten-free diets becoming more prominent, I discovered that Bulk Barn was teeming with nut flours and other ingredients I’d never had cause to seek out.
The results, so far: in the past year, I lost 13.4 lbs. Percentage-wise, my body fat decreased by 5.3%, and my muscle mass increased by 1.7%. This translates into 8.5 lbs of body fat lost, and 3.3 lbs of muscle lost. I started out at 118.2 lbs, 22.1% body fat, and 37.8% muscle mass. So I didn’t have much weight to lose, of course. And this was not a weight loss experiment. But I have been continually surprised that with this kind of diet, I was not gaining weight at all. In fact, I was getting leaner. As someone with a life long interest in health and diet, and a fitness instructor, I also find it of note that I did not take any measures to preserve muscle mass. I do yoga once a week and go for some walks, if I’m honest. I’m not on any regular workout program right now. So I was not working along the way to increase or maintain muscle mass. And yet, although 3 of the 13 lbs I lost are muscle mass, in terms of percentage body composition, my muscle mass now comprises a larger portion of my weight. This is referred to as “lean mass” and is considered in fitness circles to be a good thing. I will say that these measurements were taken with a home scale; these are well known for not necessarily being absolutely accurate, quantitatively. This means that if a professional measured by body fat percentage, it might not come out to the same exact number as on the scale. But they are accepted to be pretty accurate at measuring change. So if I saw a 5% decrease in body fat, this is likely to be fairly accurate.
I did measure blood ketones, using a finger prick method and an Accuchek meter. I used guidelines found broadly in ketogenic resources, with the target being 0.5 to 3 mmol/L. It took me about four weeks to get into that range; my normal diet had my ketones sitting around 0.1 most mornings. I took these measurements on an empty stomach every morning. After the first three weeks, I saw regular measurements around 1.5 to 2 mmol/L fasted in the morning like that, which I felt was the target. I also noticed around that time that my energy was up and brain fog was clearing, both problems I’d read would occur during the first weeks of adjustment until my body got used to using ketones for fuel. I continued to measure my blood ketones while I played with the diet a bit, to fine tune things, but found that getting up to 2.5 mmol/L in the morning was rare, and I seemed to settle in at around 1.9 or 2 always after a couple of months, after which I stopped pricking my finger every day.
What have I learned? Well, I didn’t get fat because I ate fat. I don’t miss carbs as much as I thought I would, and I was a carb-aholic, no joke. I’ve always been lucky to not struggle with weight, so I’ve never had to stick strictly to a diet, and I learned that I can. I don’t even feel tempted to cheat, for the most part. I just think of my brain tumour, growing fat and happy on pasta and croissants, and I find it easy to pass them by. For what it’s worth, anecdotally, I haven’t been down with sniffles or a virus in a year, I think my immune system is stronger. I can see ribs and abs that I didn’t before. My husband says he thinks I’m healthier than I was a year ago, hands-down. I’ve never really considered myself a “cook” or “baker” but now I do both (bitter irony). My last MRI in October, six months into the diet, showed no change in my tumour. While I was a little sad it wasn’t shrivelled up altogether, I’ll take this as a “no news is good news” scenario.
They say a good diet is one that you can be on for the rest of your life. I think this fits the bill for me.
Some tips, if you’re interested in doing your own research, which I encourage:
- There are a lot of low carb diets out there, don’t be overwhelmed by the variety. Look for “ketogenic” or “low carb/high fat” or #LCHF.
- The current prominence, in particular, of Paleo diets is an advantage, because it makes so many recipes and ingredients more available; just know the difference. Watch out for the Paleo friendly carbs such as sweet potatoes, which can add to your daily carb count in a hurry.
- I’ve linked to some resources in the body of the blog, some sites I’ve found useful include Diet Doctor, Bulletproof Executive, keto diet in a nutshell, and for an app and great blog see Keto Diet App.
- I know navigating the idea of eating high fat is difficult to understand, or it was for me. The Keto Diet App blog linked above just posted this fabulous guide to dietary fats.
- I have just become aware of this website, Ketogenic Diet Resource, which is very well written and very comprehensive, and includes sections by health concern (added 13 March 2014).
Obligatory disclaimer – these have just been my experiences, I am not a doctor, I am still a learner, I am not a promoter of any of these products, books, or blogs and am not receiving anything in return for listing them here.