Very-Low-Carbohydrate Diet Studies

This will be a growing list of Very-Low-Carbohydrate Diet Studies (and related subjects).


The Name “ketogenic diet”

There’s a problem with the name “ketogenic diet.” The problem lays in the origin of the term and the appropriation of the term as a weight-loss diet term. Much of the earlier scientific use of the term in medical literature refers to the origin of the term. More specifically, originally the “ketogenic diet” referred to

…a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children (Wikipedia)

The ketogenic diet was widely used to treat seizures until the advent of anti-seizure medications. For a large number of patients the medications removed the symptoms and they were able to return to the Standard American Diet. But for some portion (maybe 20-30%) the medications didn’t work and the diet was the only thing which provided relief.

The medical uses of the ketogenic diet had been high fat and included just enough protein to spare muscle mass. This was done in the medical ketogenic use to minimize blood sugar increases from protein (there’s some blood sugar rises from dietary protein although much less than from dietary carbohydrates). This was probably appropriate and necessary for seizure patients who needed to fuel as much of the brain as possible using ketones as the fuel source. Also, the main patients were children who needed a higher fat diet for growth.

There were many medicals studies done of the effects of the ketogenic diet in the seizure community and the diet was generally well tolerated and effective. It also had the side effect of dropping body weight in those who had the diet.

Along came Dr Atkins who popularized the Banting Diet (from earlier years). The major emphasis there was low carbohydrate levels. Aktins started people at 20g of carbs for a couple of weeks (called induction) and later allowed for some increases in carbohydrate levels.

Since there are only three macronutrients reducing carbohydrates meant that protein and/or fat would need to be increased. The medical community used ketogenic (low levels of protein) and higher levels of fat. The Low Carb community (Atkins and such) had higher levels of protein and lower levels of fat.

That set us up for the current state of affairs. The term ketogenic has been taken in two different directions. For some, chasing ketones has become the goal. For others, fat loss is the goal.

I don’t care what my ketone levels are.
I do care about what percent body fat I have.

My proposal is to give back the term ketogenic to the medical community for use with seizure patients. Stick with Low Carb or some other term. Come to some agreement about what macros are allowed and not toss people out of Low Carb groups for having higher protein or lower fat.

Protein Sparing Modified Fast Calculator

I put together the previous formulas into one single webpage, the Protein Sparing Modified Fast Calculator. I’ve put my own current numbers into the calculator. Just hit the “Calculate” button to see my numbers. Feel free to try it out with your own numbers and see if it helps you figure out any of this. I don’t see the numbers you enter nor are they stored in any database. All of the calculations are done on your phone web browser or Internet browser (Firefox and Chrome works but Internet Explorer doesn’t).

If you find any errors, please let me know. I tried it with my own numbers and they make sense but I didn’t have a woman’s secret numbers to check.

Here’s a decent introduction to the Protein Sparing Modified Fast (PSMF). I only take exception to one point which is the question of how long you can do a PSMF. They say you can’t do it for an extended period of time. If you continually re-calculate your numbers you should be able to fine tune for maintenance levels. This calculator makes that re-calculation relatively easy. Here’s the results I got for my numbers.

Your Scale and Metabolism Numbers

Current Weight: 199.8 lbs
Goal Weight: 171.3 lbs
Lbs from Goal Weight at start: 28.5 lbs
Body Fat at start: 25.4%, 50.8 lbs
Lean Body Mass (LBM): 149.0 lbs
Basal Metabolic Rate (BMR): 1818.0 cal/day
Initial Total Daily Energy Expenditure (TDEE): 2500 cal/day
Initial Maximum Fat Loss on Protein Sparing Modified Fast: 0.45 lbs of body fat per day


Protein Sparing Modified Fast (PSMF) Dietary Macros (per day)

It is very important on the PSMF that you eat at least the macros listed here. If you go below these numbers you risk lowering your metabolism and you actually can’t lose body fat any faster. Attempting to be just above the numbers is OK.

Protein: 119.2 g (476.8 cals)
Carbs: 20 g (80 cals)
Fat: 40.9 g (367.7 cals)
Your total Dietary Calories are 924.4 cals for maximum fat loss.

If you consume 216 g (1943 calories) of fat you will stay at your current weight.At your goal weight you will be able to consume 119.2 grams of Protein, 20 grams of Carbs, and 176.3 grams of Fat.


Can You Fast?

One important question to ask when considering extended fasting is whether or not you have sufficient body fat to fast.

You currently use 2500 cal/day. You have 1575 calories per day available from your body fat for maintenance. You have less calories available from body fat than your daily requirements and may not be able to fast. If you fast, your body may drop your base metabolism, energy expenditures or may consume protein stores. You will be -924 calories short per day

The thermic effect of food contributes somewhere from 5-20% of your current TDEE number so if you are fasting that can reduce your TDEE. Reducing your TDEE by 10% would result in you using 2250 calories per day. Calculating in a 10% Thermic Effect of food still leaves you in a caloric deficit during fasting. The Protein Sparing Modified fast solves this issue by providing the calories needed for the deficit.

How Much Muscle Can You Gain?

The Maximum Lean Body Mass that you can carry on your frame is 186.5 lbs at your goal of: 15.0% Body Fat. That would be a weight of 214.5 lbs.


Use this information at your own risk and with the advice of your medical professional. We are not doctors nor do we pretend to be one on the Internet. We do not take responsibility for errors in these calculations. We do not guarantee that these numbers will work for people at the extremes of the ranges. If you discover an error in calculation, please let us know through email: keto at land-boards dot com.

Biochemical Stages of Short and Long Fasts

Here’s a great paper on what happens during a short and a long fast.

The paper covers the daily feast/fast cycle of the regular American diet. It also covers what happens over a longer fast. One of the interesting charts relates to a longer fast:

The chart on the left is the Glucose level over a longer fast and the chart on the right is the Ketone Bodies chart. Per the charts the Blood Glucose falls faster than the Ketone Bodies can kick in. That could the reason that the third day of an extended fast is considered to be the toughest. This also explains why it is much easier to enter a fast being already in Ketosis because your Ketone levels are higher.


Extended Fast – Tapped Out at 25 Days

I made it 25 days on my Water Only Fast. Ended yesterday. I miss fasting already. Felt better while fasting than I do on food. Ended with Chia Seeds and a pickle. The Chia Seeds act like a slowly moving cork through the system which is good after a long fast.

Thinking about doing Chia Seeds once a day on my next fast. Won’t technically be a water fast, but I like the idea of keeping some fiber moving through my system. I am just a few lbs over my goal weight so I am not in all that much of a hurry.

Weight loss was 24 lbs. Should hang onto a lot of it since I really kept up on salt. [2017-12-07 Update: Only held onto about 6 lbs long term].

Can’t wait to do my next Extended Fast. Maybe after the Keto meetup this weekend. [2017-12-07 Update: Not enough body fat to do this again.]

Tomorrow is my third intro class to CrossFit then I can join the regular people in torturing myself. I know that this will be much harder than Keto and Intermittent Fasting. And I will definitely keep up the Intermittent Fasting and Keto. Never going to give up the gains I have made with Keto + IF.

Thought about Longer Extended Fasting

I’ve put together some thoughts on Extended Fasting. In particular, I am interested in the subject related to Angus Barbieri. Here are my thoughts:

  1. Support helps. Angus’ doctors originally intended for his fast to be a relatively short one but when Angus decided he wanted to fast longer they agreed to monitor his fast. Since few modern doctors would support such a fast there are other supports such as Facebook groups on Fasting.
  2. Fasting until you reach your goal weight was a much more accepted practice back then. They didn’t feel that shorter fasts had as much long term effectivity as fasting until goal weight. That mindset allowed the doctors to support Angus’ fast.
  3. Fasting is easier than even LCHF. No obsessing about macros, too much protein, etc. It is absolutely free. It requires no meal preparation or planning. There is no shopping time.
  4. Sometimes we self limit in Extended Fasting. We could go longer but we set our minds to fasting for a particular time length.
  5. Having a realistic goal weight is important. Angus stopped at 180 lbs which is the chart value for the upper end of normal weight range. This can guard against judging by the mirror and the charge of anorexia (although that is a totally different issue of body image dysphoria).
  6. It helps a lot if you are already fat adapted. The transition to fasted state can be tough but it’s easier the more times you have fasted. Day three seems to be the hardest day for many people.
  7. Social engagements are a major reason for ending fasts early. We often have an event to go to with friends or family which gets in the way of an Extended Fast. A helpful white lie is “No, thanks. I already ate.” It is true though. If you are fasting you are consuming your own body fat so you are actually eating really well. Saying no to children, parents and friends only invites questions so be prepared ahead of time for what you are going to say. Or cancel the engagement altogether.
  8. Fear of refeeding syndrome can derail a longer fast. Picture the German concentration camps after WW II. The American soldiers came in and fed the starving people and many died from overeating. But there are many significant differences between us and those poor souls. They had no body fat left. They were truly starving. Their organs were in very bad shape. One of the prisoners who was liberated by the Russian troops said that they were better off being freed by the Russians than by the Allied troops since the Russians didn’t feed them.
  9. Another thing which derails us is we feel ill at some point and the standard fasting advise is to stop when your body tells you to stop. But how do we differentiate our body telling us to stop and dehydration? Eating a lot of salt can help with that. I put Morton’s Lite Salt in my coffee because it is half Sodium and half Potassium. Angus was given Potassium and Sodium supplements at different times in his medically supervised fast.
  10. Another common reason is the advise that people give to cover their own backsides of “Make sure you do this fast under medical supervision.” Judge for yourself the soundness of this advice. I followed their advice and ended up on 100 units of Insulin a day. Medical doctors know very little about this subject. Research for yourself by visiting You can search for anything there. Angus’ own story is up there in a scientific paper.
  11. Daily life, cooking for others can derail. TV has constant commercials for food. People eat food at work at their desks and you are assaulted by the smells. I have a friend who is on keto and his food really bothers me because it is so attractive. They buy a cake at work to celebrate a good goal being met. You can’t have that reward. I especially feel sympathy for moms and dads who cook for their kids all the time.
  12. High expectations of rapid losses. You hear stories of how people lose 25 lbs with 10 days of fasting. How long have they been at this? Angus lost 3/4 of a lb on average a day and he started at over 450 lbs so much of his weight was when he was heavier. Expect to lose anywhere between a quarter pound a day and a half lb a day. The longer you fast the less the drop will be. There might be days that the scale doesn’t show any loss or maybe even a gain. I put on 6 lbs after I drank a half jar of leftover juice from olives.
  13. Looking at the Blood Glucose meter can instill fear. I saw a blood sugar number in the 50’s. Angus had blood sugar as low as 17 at least one day with no symptoms of hypoglycemia. The brain switches over to be fueled by ketones. Angus was mostly in the 30’s. That would put any diabetic in the hospital. If you are ketone fired this is no issue but if your regular blood sugar is high then going low may make you feel ill. That makes me think that many people who try fasting are not yet fat adapted and the blood sugar drop is a problem for them. If you don’t have one, blood sugar meters are cheap. This is probably one of the things that surprised Angus’ doctors the most. They had not experienced patients with such low Blood Sugar numbers before who were functioning fine.
  14. Stopping because of the clock. Having an open ended fast may produce a longer fast. I knew that because when I got to ten days the last four fasts I didn’t want to stop but I only wanted to fast to ten days.
  15. You will get acidosis. That is what my own MD told me. Yes, your body becomes more acidic when fueled by ketones. Dr Berg says that’s the problem – we are too alkaline. That’s why Apple Cider Vinegar is effective it lowers your pH value. Ti answer the object, Ketoacidosis is when your ketones are high and your blood sugar is high. That is not the problem during long fasts where your blood sugar is very low. If you are concerned monitor your blood sugar. Ketoacidosis can be an issue when refeeding after fasting if you eat a lot of carbs.
  16. I will be fuzzy headed. I don’t have that experience in general. There are moments where I feel that. The research also indicates that ketones don’t mess up mental functioning.
  17. But, Angus was only 52 when he died. Well he died 24 years after the fast so it’s pretty unlikely that the fast killed him. We don’t yet have a death certificate for Angus and we don’t know what his diet was like after the fast. We also don’t know what damage was done to his body for the years he was heavy. His whole family was heavy per his friend. Angus did marry and had two children so obviously he had a quality of life.
  18. Competition can be a motivator. Fasting with someone else can be great but expect them to wash out early if they are not experienced fasters. Or they may go much longer if they are more experienced.
  19. The first rule of fasting is don’t tell anyone about your fast. Same as Fight Club. Others will discourage you and try to scare you. I had a VP come and talk to me after one of his people told him I was fasting. I don’t tell too many people what I am doing.

Two Ten Day Fasts Last Month

Last month (March ’17) I did two extended fasts. I separated the two fasts by four days. The fasts were both ten days.

I tracked a bunch of numbers during the last fast including my Blood Ketone levels. I bought a Precision Xtra meter to measure Blood Ketones. The meter cost $25 on Ebay.

The meter comes with no strips. The strips are really expensive, at about $3 a strip. They are more accurate than any other home method of measuring Blood Ketones.

Blood Ketone numbers greater 0.5 indicate that you are in Ketosis. I saw numbers as high as 6.8 while doing extended fasting. Most non-fasting days I get values around 2.0.



Ketonix Notes

The Ketonix 2017 model that I recently purchased has been disappointing. Previous year models seemed to work better for others.

Seems that the reason they were better was that the previous models used a different unit of measure and produced a wider range of “normal” Ketogenic readings.

The new scale is in PPM which is a lower scale than the previous model used. From the article: Measuring breath acetone for monitoring fat loss: Review

In normal healthy individuals, BrAce can range from 0.5 to 2.0 ppm. Adults on ketogenic diets (e.g., high fat with low carbohydrate) can have elevated levels of up to ∼40 ppm.

The article includes a graph which has the same data:

This actually correlates to what I measured with my Ketonix. I got numbers from 4 (in Ketosis) to 22 (when fasted 10 days).

That correlates to the scale above which shows a Ketogenic Diet in an adult to go from 2 to about 40.

The problem is that the middle of this Ketogenic Diet scale is 10. It took me several days of fasting to get to this level. So for normal Ketogenic dieting there’s not enough scale to blink the colored LEDs on the unit. If you look at the fasting scale you can see I never reached the higher levels I should have been seeing at 10 days into a fast.

Seems like the unit sort of works and sort of doesn’t work. If it is accurate for PPM then I would never see a number above 50% if I was at the very top of the Ketogenic diet scale – which is not realistic.


Ketosis Data

From (Ketone body metabolism and cardiovascular disease):

Ketone body oxidation becomes a significant contributor to overall energy metabolism within extrahepatic tissues in numerous physiological states, including the neonatal period, starvation, postexercise, and adherence to low-carbohydrate diets, when circulating ketone body concentrations increase from ∼50 μM in the normal fed state to up to 7 mM. Circulating ketone body concentrations rise to ∼1 mM after 16–20 h of fasting in healthy adult humans but can accumulate to as high as 20 mM in pathological states like diabetic ketoacidosis

Therefore, the metabolism of ketone bodies may influence numerous human disease states relevant to cardiovascular disease, including obesity, diabetes, atherosclerosis, and heart failure.