Sunday, July 15, 2012

The Nutrition Debate #59: What I Eat and Why: The Very Low Carb Ketogenic Diet (VLCKD)

I eat a Very Low Carbohydrate Ketogenic Diet (VLCKD) because I want to lose weight, and do it in a healthy way, and because I want it to be easy (of course) and not involve hunger. I also want to eat in a way that achieves good blood glucose control (I’ve been a Type 2 diabetic for 26 years), and I want to continue to maintain the incredible improvement in my blood lipids (cholesterol), and regain the blood pressure improvement I had when I was at my lowest weight.
I didn’t know it when I started to eat Very Low Carb, but I had a medical condition that has come to be known as the Metabolic Syndrome, with all five indications: central obesity, T2DM (or pre-diabetes), hypertension, elevated triglycerides and low HDL. When I kept to the VLCKD, all five of these indications were mediated by this diet.
I know I have sufficiently restricted my carbohydrate intake to be in ketosis by testing my blood glucose in a fasting state (before eating breakfast). Since I am a Type 2 diabetic with impaired glucose tolerance and insulin resistance, if I have glucose stores available for energy (in the form of glycogen in the liver or muscle cells), or amino acids stored in the liver (from  eating too much protein) from which the liver will make glucose (through a process called gluconeogenesis), my fasting blood sugars will be above ‘normal’ for me (average 126, range 114 to 137). When I return to dietary ketosis, my fasting blood glucose drops to the 80s and 90s (average 93). That’s me. Your Mileage May Differ. We are all different.
My pancreatic function and other aspects of my metabolism are broken and have been for many years. I, like many Type 2s and even pre-diabetics (diagnosed and undiagnosed!), cannot tolerate more than very small amounts of carbs (low GI or otherwise). I must accept that I will never be able to do so without “excursions” (dangerously elevated levels) of “sugar” (blood glucose) circulating in my system. Inevitably, that will lead either to diabetic complications (eye, nerve or kidney disease), or one of the Diseases of Civilization that are strongly associated with Type 2 diabetes, such as cardiovascular disease, hypertension, and various cancers . So, what do I need to eat to remain in a mild state of ketosis?
Breakfast and lunch are easy for me because, as Richard K. Bernstein, MD, recommends in his book The Diabetes Solution, I eat the same thing every day. Breakfast is two fried eggs, two strips of bacon and 12 oz of coffee with 2oz of half and half and two packets of Splenda. K:G ratio = 1.88:1. It would be better if I could forego the artificial sweetener.
For lunch, (when I remember to eat it – I’m really not hungry, so I’m not “reminded”), I eat a can of King Oscar brand Mediterranean style Brisling sardines in olive oil. I drink the oil in the can too (about 1 Tbs). Lunch K:G ratio = 2.93:1.        I sometimes wash it down with diet ice tea (again, with artificial sweetener). Of course, water would be a better choice.
For dinner, we eat a medium portion of protein (with skin and/or fat on) and a portion of vegetables with melted butter or olive oil. Sometimes, with salmon for example, we use a sauce made with crème fraiche. We like roasted meats, including chicken, spare ribs, lamb chops, short ribs or a petite filet (with the leftover slices for breakfast instead of bacon). We also like to rub our cuts of meat with herbs and olive oil before roasting. We sometimes roast the vegetables too, after tossing them in olive oil and sea salt. Cauliflower, Brussels sprouts and asparagus are especially good this way.
We avoid the sugary vegetables (carrots, peas, beets and corn) and of course all the starchy root vegetables. As a general rule we also try not to eat vegetable oils (high in n6s). Instead of store bought mayonnaise (made with soy bean or canola oil), we make our own using equal parts coconut oil, olive oil and MCT (medium chain triglyceride) oil , with a little flax seed oil to “up” the Omega 3s. Coconut oil is also a medium chain triglyceride that makes more ketones than long chain dietary fats. It is also metabolized directly and thus is easily “burned” and less likely to be stored as body fat.
This menu usually adds up to about 1,200 calories a day, which is at least 1,000 less than I probably use. That negative calorie balance adds up to at least 7,000 a week, which is 2 pounds, the amount I would like to lose each week. The balance of energy comes from my fat stores, as long as I am in dietary ketosis and my blood insulin level is low. That only occurs because my carbohydrate intake is very low, and protein moderate, allowing my dietary and body fat to break down for fuel. This diet is about 5% carb, 25% protein and 70% fat. The K:G ratio of most meals is >1.5. This is a VLCKD.                  
© Dan Brown 7/15/12


  1. As a pre-diabetic your"The Nutrition Debate #59: What I Eat and Why: The Very Low Carb Ketogenic Diet (VLCKD)" and statement: "This diet is about 5% carb, 25% protein and 70% fat. The K:G ratio of most meals is >1.5. This is a VLCKD"

    Resounds with me. The direct, simple breakdown of what it takes to heal and maintain what is/was a deranged metabolism is something a young person might not grasp speaking (as a 60yo observer). Grasping what is happening to our physiology when those ratio(s) are so distorted and acknowledging the addictions to the myriad, processed additives to 90% of the food supply that feed our derangement is not really mysterious--except for the naysayers.

    Having followed your scientific, peer reviewed synopses of nutrition data for months has encouraged me to fight the ever-present nemesis of the toxic food that threatens our health day to day.

    Thank you Dan.

  2. Thank you very much! Your comment makes my day and encourages me to write more. I want, and we (as a culture) need, more "followers" of a more sensible Way of Eating.

    I just had my "can of sardines lunch" and now will sit down to write #60. Thanks for being a regular reader. Why not sign up as a "follower" too?