Getting and staying in Ketosis, eating enough protein to build muscle

[rdpchef]

HI,

I have trouble getting into ketosis and staying there all day. I am Apoe4. My macros are 75% fat, 15% carbohydrates and 10% protein. I have osteoporosis and in order to build bone, I need to both consume adequate protein and work out as safely as possible while weight training as heavy as I can with 3-5 reps.

I understand that if I eat too much protein it can convert to Carbs. Just not sure I can build muscle with only 10% protein.

So, what to do? Does anyone here have experience with this?

I'm a career chef so I know food very well and I'm currently half way through a certified functional medicine health coach program at FMCA.

Thank you,
Patty

[TCHC]

Hi Patty

It's great to "meet" a fellow FMCAer. I certified in March last year, so I'm not much ahead of you! I did the Re:CODE training at the same time - the benefits of being a bit under-employed in covid!!

I'm guessing you're testing your ketones throughout the day then? And that you arrived at 10% protein via something like the Apollo calculator?

So firstly, have you noticed what kicks you out of ketosis?

Are you getting back into ketosis pretty easily?... you say you're not in ketosis all day..

Have you tested out eating a little more protein and testing ketones to find your best level?

Lindsey

[rdpchef]

HI Lindsey, I plan to do the RECODE training also but i'm maxed out right now with school and FT work.

Yes, I test throughout the day but not all day every day. Those strips are expensive and I eat pretty much the same, salads, veggies, nuts, some protein. Yes, i'm 10% protein, 75% fats and 15% carbs. It's sometimes hard to get the carbs so i'm testing adding in quinoa, lentils, beans, some fruit after I eat fats, etc.

Honestly I'm so busy all of the time, tracking everything every day just adds to stress. And I'm really working on stress.

If you were to pick two times a day to test, when would that be?
I even wore a CGMonitor for the past 14 days. The reading from it and ketomojo were different. I don't know that I learned much but part of that could be that I don't understand it. I do log food in cronometer daily. Sometimes I take breaks for a few day but I'm back to logging regularly.

What are you doing with your coaching? Would love to talk one day about that.

Any thoughts?
Patty

[TCHC]

Hi Patty

The Re:CODE training is amazing. Tough, but so interesting. I'd recommend it!
I personally only test now if I think I'm noticing I'm out of ketosis (eg if I feel hungry!)
But why don't you cut it down to just testing about 2 hours after a meal where you've tried a new food? Then again the next day to check you're back in?
It's really easy to get a bit overly focused on testing and tracking, and I don't know if that makes you anxious or stressed, but if so, it's definitely not worth it! This is a long-haul not a sprint, and the long term aim is metabolic flexibility... and stress relief!

Lindsey

[rdpchef]

Yes, still trying to figure it all out and i've been with this doctor for one year and another year before that with a previous doctor..
It is a process. I even decided to get a health coach to help me work it out. step by step.

[Tincup]

I have trouble getting into ketosis and staying there all day. I am Apoe4. My macros are 75% fat, 15% carbohydrates and 10% protein. I have osteoporosis and in order to build bone, I need to both consume adequate protein and work out as safely as possible while weight training as heavy as I can with 3-5 reps.

Hi Patty,

Here are some thoughts from the peanut gallery.

Per protein researcher, Don Layman, protein should not be thought of as a % of your calories. It is really requirements of x grams for certain amino acids, just like vitamins. For elderly folks, need protein in 30 gram boluses at the first and last meals of the day. This assumes protein from animal (fish, eggs, poultry & etc), veg protein would be more because of the different amino acid concentration. The 30 g is to get enough leucine to stimulate muscle protein synthesis. From memory, I think this is around 2.5 g, but don't quote me.

One way to accomplish is is with essential amino acid supplements. I do take some and I think 10g of the EAAs is equivalent to 50g protein. I use this product, but there are a number of similar.

As to your strength training, in Doug McGuff MD's book, Body by Science and its Q&A companion book, they talk about a study that co-author, John Little, did at his facility with a Bod Pod (a device measuring body composition). This is really about recovery. Their training method is "super slow to failure" on a few (3-5) exercises done once a week. In John's study they found that the subjects that did fewer exercises gained more muscle and lost more fat. This is a very high intensity protocol. In any case they suggest keeping very careful records. In your case, probably number of reps and time under load. If you don't improve on one of these metrics, then add more time between workouts. This is not what most trainers do.

On protein, according to this, "f you’re fairly insulin sensitive, any glucose response to a high-protein meal is dealt with accordingly. GNG also occurs slowly, and it’s unlikely you’d experience high blood sugar in response to a single high protein meal. And, GNG doesn’t happen because it can—it’s not a supply driven process. Rather, GNG happens only when it needs to—it’s demand driven."

Marty Kendall is an Australian Engineer with a T1 diabetic wife. He has her on an "artificial pancreas" where the continuous glucose monitor and the insulin pump are tied together with an app controlling the pump. As Marty sees all this data, he learns a lot. One thing is that most in the keto world give fat a free pass from insulin stimulation. While this is true from an acute perspective, it is not true from an area under the curve for the day perspective. He has an article on this topic here. I've seen this personally. If I reduce fat on a day, my fasting blood sugar will be lower by 15 to 20 mg/dL. I'm 68 and 14% body fat, weighing what I did in grade 10 and leaner than then, too. I've been keto adapted since 2009, so have a lot of experience. Protein really doesn't impact my glucose much. Fat moreso. In my case, I don't worry much about high levels of ketones. For one thing, the longer you are in ketosis, the more efficient your body gets at using them (what you measure is really excess). While I always test positive for ketones on a morning fingerstick, I don't have any specific target. I also tend to eat a lot more carbs than most on a keto diet (up to 200g/day). On a normal day, I fast 16 or so hours. However if I start a multi-day fast, my ketones can quickly get north of 4 mmol/L (I've run them as high as 8) and blood sugar drops into the 50's (mg/dL). So, in your situation, staying equicaloric, I'd likely reduce fat and increase protein and see what happens. I assume you've been doing this for a little bit, so you are keto adapted?

[Julie G]

I have trouble getting into ketosis and staying there all day. I am Apoe4. My macros are 75% fat, 15% carbohydrates and 10% protein. I have osteoporosis and in order to build bone, I need to both consume adequate protein and work out as safely as possible while weight training as heavy as I can with 3-5 reps.

Hi Patty! So cool that you're doing FMCA training and are a career chef. Do you also have a background in nutrition? If you're trying to follow Dr. Bredesen's advice, remember that the goal is not to stay in a constant state of ketosis (unless necessary for cognition) but rather to create metabolic flexibility — the ability of the brain to use both glucose and fat as fuel. We like to suggest that folks reach a state of endogenous mild ketosis (a minimum of 1.0mM or 10 ACEs) at least once daily. Ideally this is done by combining a long fast + exercise + using the KetoFLEX 12/3 plan. By the time I break my fast (which is the best time of the day to check ketones), I'm always between 1-2.0+ mM and I'm not consuming gobs of fat.

We do suggests macros similar to yours for those trying to re-train their bodies to get into an endogenous state of ketosis. Very often those eating a diet with sugars and processed food have burned glucose exclusively for years and sometime it is difficult to make that transition, but no one is suggesting that much dietary fat on an ongoing basis. Out of curiosity, how long are you fasting now? Are you doing any other exercise besides the strength training?

Per protein researcher, Don Layman, protein should not be thought of as a % of your calories. It is really requirements of x grams for certain amino acids, just like vitamins. For elderly folks, need protein in 30 gram boluses at the first and last meals of the day. This assumes protein from animal (fish, eggs, poultry & etc), veg protein would be more because of the different amino acid concentration. The 30 g is to get enough leucine to stimulate muscle protein synthesis. From memory, I think this is around 2.5 g, but don't quote me.

Wouldn't you love to see a conversation between Valter Longo and Don Layman? FWIW, I always get nervous with these blanket recommendations without taking someone's age, activity level, gut health, etc. into account. Very often older people need more protein simply because their gut health has eroded. It becomes really important (especially as we age) to focus on gut health optimization so that we can properly absorb the protein from our food. Taking Betaine HCI or even a shot of unfiltered apple cider vinegar before meals can be super helpful.

[rdpchef]

HI Julie,
I'm not a nutritionist. I've been a chef for decades and have am a Certified Research Chef which means I have a decent knowledge of food science.
After graduating, Feb 2024 from FMCA coaching program, I'll take the Apollo course then hopefully the board exam for coaches. Even though I'm 60 years old, I still want to work my brain as much as possible and if I'm going to coach, I want to help Alzheimer's patients and their families.

I don't quite understand everything you wrote in your email. I go to Dr. Sandison and I believe you know who she is. She said to be in Ketosis 1 month out of every quarter but I have no idea what I'm supposed to eat the other two months. I've asked and it doesn't seem to ever get answered.

If I was only dealing with apoe4 then fine but I'm dealing with osteoporosis and hypothyroidism as well. The osteoporosis really concerns me because diet it a big part of that. SO is exercise.

I do 20 min of cardio, after weights, the four days I do weight training. then on Saturdays I fast walk about 4-5 miles and on Sunday usually swim, or walk, or bike while its summer.

I do take Betaine HCI. I'm waiting to talk with Dr. S about my last stool results. I'm trying to eradicate H Pylori and I wasn't digesting fats. I'm 5'9" and only weigh 125 lbs. Here I am eating 155 grams of fat a day and not gaining any weight.

I'm not sure if you'd be willing to speak with me on the phone but if so, I'd appreciate that just to clear some of the ketosis things up. I'd like to do the Bredesen protocol as well as seeing Dr. Sandison but I just can't afford anything else. My out of pocket medical costs, tests and supplements are crazy. The supplements alone are over 500.00 per month.

I did look at the latest stool results and I only have a very low level of H Pylori remaining but now I have high levels of Streptococcus spp. 2.46e3 High ↑. I'm doing such an amazing job of eating well and moving every day that it's hard to deal with every step backwards.

Regards,
Patty

[JD2020]

For elderly folks, need protein in 30 gram boluses at the first and last meals of the day. This assumes protein from animal (fish, eggs, poultry & etc), veg protein would be more because of the different amino acid concentration.

Does the protein in milk count as animal protein? Of course, it is from an animal, but I never see it listed as an acceptable protein source.

[Tincup]

Does the protein in milk count as animal protein? Of course, it is from an animal, but I never see it listed as an acceptable protein source.

I went into Cronometer.com and, using the NCCDB data source (they have amino acid values) put in a cup of whole milk and 1.1 egg so they'd each have 7.7 g of protein. Then made an image of each of their amino acid profiles. Visually they look comparable to me.

Egg

Screen Shot 2023-08-16 at 2.59.21 PM.png

Whole milk

Screen Shot 2023-08-16 at 2.59.49 PM.png