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Closer Still #keto

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This is a continuation of the keto journey. Previous articles:

It's been roughly a month, so that means another update!

Diet progress update:

Diet progress

Diet progress

First things first, I have not been so successful in keeping my calorie intake low - in fact on average it went up a bit. As I will discuss in a bit, I have been eating too much keto chocolate. I really need to keep on top of this if I want to meet my Christmas goal of 90kg.

Despite this... The other day I got my weight checked by the GP, it was 111.6kg on the 14th. I adjusted by predicted burn rate accordingly to 0.3kg loss per day. Later on the 21st I had an appointment with the Dietician in which we measured my weight again, and it perfectly tracked to 109.5kg as predicted.

This is some of the largest rate of weight loss I've had on the entire diet, including the water loss at the beginning. The question is, why? I have a few theories about this:

  1. Exercise - I have been running, and am generally more active in any case. I've been walking a hell of a lot during these days.
  2. Measurement - I have less "free pour" items, even though I am having an intake that is supposedly higher, everything that I do have is measured very accurately. I can say with high confidence that my daily intake must be below 1200kcal - it cannot be higher.
  3. Hydration - Due to the use of Aeroplane Jelly, a jelly that basically has nothing in it, I have been taking on at least an extra litre of water a day. Why is that important? Well, your body needs water in order to burn fuel and during initial fat reduction, the body fills the fat cells with water temporarily. I have heard it said that it does this as a "just encase you need it again shortly" measure, but I believe it might actually be part of a process to push the fat out of the cell as water and fat do not mix.
  4. Vitamins - During these days I am taking awful amount of vitamins, including "Keto Diet" mixes, collagen and glucosamine. I believe that generally these have allows me to be more active and have helped in raising my metabolic rate.

These of course all could be wrong, but generally I feel that they are the best guesses regarding why I would suddenly be seeing a consistent increase in weight loss. In any case I will not complain and will generally try to keep doing what I'm doing.

If this rate of loss can be maintained, at 0.3kg per day, the calculation is simple 109.5900.3=65 days - so before December 1st! This will give me enough time to begin the process of re-introducing some carbohydrates and returning to a more long-term sustainable diet (whatever that will look like).

Recap

And now I ponder upon some previously made points:

Social

And now for the #keto posts over on dead social:

This is when I found out I had actually done some serious damage to my knees - when I failed to even get a lap out of myself despite showing I am capable of doing 8 miles. As I stated before, this turned out to be a little more serious.

Aeroplane Jelly turned out to be a massive success, helping to increase hydration and generally pushing back hunger. The first wasn't so successful, but it turned out that four hours wasn't nearly enough, and the jelly needs at least six hours. It's now much easier to make if I am patient.

I am really dismayed by this anti-meat movement that appears to be gaining traction. I am not sure if I could have achieved the 70-80kg loss so far without the help of animal protein (steak) and animal produce (cheese, eggs, gelatine, etc). Eating meat is the one thing I won't give up after this diet (although as I will discuss, it has not been without issue).

I am not sure if it is helping, but I have increased my weight-loss rate. I have zero idea if MCT is helping or not. It certainly hasn't helped with hunger as it claims!

Not so many for this update, but that's not to say there hasn't been more going on!

Running Injury

Running was going well, although I felt my knees were under a lot of stress. I always left a few days of recovery and it seemed like they were returning to normal. After the 8 mile run my knees did not return to normal, specifically the right knee.

It turns out that I had been running the same way around the block every time during lockdown level 4, the pavement was at an incline and this in turn likely caused an ITB injury:

The problem is friction where the IT band crosses over your knee. A fluid-filled sac called a bursa normally helps the IT band glide smoothly over your knee as you bend and straighten your leg.

But if your IT band is too tight, bending your knee creates friction. Your IT band and the bursa can both start to swell, which leads to the pain of IT band syndrome.

So it appears that is can be relatively easy to fix, I need to make the band more flexible, increase supporting muscles and use a better running method. Coming down in weight should also massively help with this effort.

I of course went to visit the GP and they confirmed it was screwed. On the plus side, my blood pressure is down and my weight is continuing to decrease!

The next step is to get some physiotherapy in order to repair/strengthen the related areas and relax the ITB. At the same time I will continue losing weight and all of these factors should work together in order to support recovery.

Dietician

I have also been to see the Dietician again, for what will now be the last time this year.

High LDL

One thing I discussed with the Dietician was my high LDL... We discussed whether I had previous data on this, but at the time none of these systems were properly connected.

My earliest health check I have results for prior to starting the diet unfortunately doesn't have results available for lipids, but I do have some information regarding my BMI from 25/09/2020:

Results: BMI

Results: BMI

If I remember correctly, the lady making the measurement accidentally recorded it as at least 20kg less than my weight actually is as the scale looped and I believe she was too polite to check, so just added 100kg instead. My weight at the time was closed to 178kg. Sadly, for the next month and a half I continued to put on weight, and I could have been as high as 190kg at one point.

In a previous medical update and resulting article on 19/06/2021, it was shown that my LDL is quite high:

Results: Lipids Master Panel

Results: Lipids Master Panel

And then a following check-up and resulting article on 29/07/2021:

Fasting status:Not stated

Cholesterol:4.7 mmol/L HH

Triglyceride:1.0 mmol/L

HDL Cholesterol:1.37 mmol/L

LDL cholesterol:2.9 mmol/L HH

Chol/HDL Ratio:3.4

We discussed that LDL is 'bad' cholesterol and that it should ideally be kept below 1.8 mmol/L, whereas my latest results show 2.9 mmol/L. When I asked what this means, I was given the following information sheets:

Dietician advice page 1

Dietician advice page 1

So apparently an excess of LDL can mean that it gets built up on my arteries, ouch.

Dietician advice page 2

Dietician advice page 2

Apparently the types of fats that can increase LDL levels is animal fats and cheese - which is basically my main source of fats. We generally agreed that the benefits of the keto diet far outweigh the negatives.

Looking online, apparently high LDL is a known problem on a ketogenic diet:

With a well-formulated ketogenic diet, we see a shift away from the small dangerous LDL even when the total LDL goes up, so most of this increase is in the ‘good’ or ‘buoyant’ LDL fraction (Hallberg, 2018).

So even though I may have more LDL, apparently it is more likely to be the good kind of LDL.

Another factor to be taken into account is that during rapid weight loss, cholesterol that you had stored in your adipose tissue (ie, body fat) is mobilized as the fat cells shrink (Phinney 1990). This will artificially raise serum LDL as long as the weight loss continues, but it then comes back down once weight loss stops.

Which again, is exactly where I fall into. In fact, the weight loss could explain entirely my excess LDL.

To avoid being misled by this, the best strategy is to hold off checking blood lipids until a couple of months after weight loss ceases.

This looks like something I should address again after Christmas and see where I'm at, perhaps in February 2022. I would suspect all of my values to fall back well within range, especially as then I should be able to start hitting some proper exercise with the use of carbohydrates.

Come Off

One thing we discussed again is the process of coming down from the diet. It really won't be easy and for keto they have absolutely not clue (as they don't train about it and never suggest anybody to do it). That said, they still maintain that my progress has been some of the best they have ever seen - so something must be working.

According to one source, there appears to be a few tips:

  1. Take it slow with carbs.

So essentially I run the risk of my body not being able to control its blood sugar effectively - and this can have all kinds of crazy side effects. I need to reintroduce carbohydrates slowly and carefully.

  1. Choose high-fiber foods.

I generally agree with the article on whole grains, beans and vegetables - but not fruits. I want to avoid fructose and generally anything at all high in sugar, particularly refined sugar.

  1. Watch your portions.

My intention as I come out of the diet is to up vegetables as the main source of carbohydrates, as these are high in fibre are and generally more bulky. I can also keep protein raised whilst I slowly transition in the other foods.

  1. Don’t forget to exercise.

As I mentioned to many people now, my intention is to run a marathon next year.

  1. Practice self-care.

Essentially this last point is a bit of a nothing-burger, but could be interpreted as "don't repeat your previous bad habits" - which is a great point. My intention is to form healthy habits from the start.

One thing I wanted to discuss with the Dietician but wasn't able to was difficult to was giving up the control. One thing you learn to love is the highly detailed control you have over your diet, it's addictive. Last time I did a diet even remotely comparable I almost couldn't give up control. This is something I will definitely have to battle with when the time comes.

Christmas

One thing we discussed (almost annoyingly) is what I will have when I come off. My goal is to reach 90kg and I will keep going until this is achieved. I said that one thing keto people struggle with is bread, and then we ended up discussing bread for some time. It's a good job I was not hungry in that moment and even better that there was no option for fresh bread available.

When I reach this goal, my intention is to have scrambled egg on wholegrain toast on Christmas day. Bread is the one thing I really miss, although it will have to be researched and measured.

I am looking forward to being able to stop tracking all the macros and to just be able to eyeball foods. It's depressing to even be offered something keto but not be able to try it as I have no way to accurately logging it.

Next Steps

The next parts are my goals:

Until next time!