This month, I bit the bullet and got a third blood test. Nervous about abjectly failing and having to write about it, I was relieved when my rather astonished internist in Chicago, Paul Szyperski, called and said, “What have you been doing?” My LDL was down 33% to an acceptable 114, well below our original goal of 130. Total cholesterol was 200, exactly the dividing line between acceptable and “borderline high.” (Levels of two newer blood markers linked to coronary disease, C-reactive protein and homocysteine, were also low; the C-reactive protein fell from the earlier test.) Since my protective cholesterol, HDL, was up to 75, the total number looks relatively better.

Ketone strips are not mandatory on a ketogenic diet, but you may find that having them on hand keeps you motivated and holds you accountable. On the other hand, you may find that testing your ketone levels is an added burden and prefer a more laidback approach. At the end of the day, it is a personal decision and comes down to what works best for helping you achieve your health goals. If you are meeting your goals of weight loss, decreased body fat, improved energy and focus, and/or better sleep, then a number on a meter or a color on a test strip is moot.


Here is the situation: I am 46 yo female with Crohn’s and migraines. I went gluten free in Aug 2012 and Paleo (still do lactose free dairy) Jan 2013. My Crohn’s which was mild, has completely subsided and my migraines nearly disappeared. I went from 167 lbs (I am 5’5″) to 145. I feel great and have started running again because I have so much energy. I rarely “cheat” and if so it is always gluten free. I recently decided to try the Fat Fast (Ketogenic) diet to see if I could lose the extra 10 (135 has been my goal…) since I have essentially stalled at 145-148 lbs. I started the fat fast 4 days ago and already lost 4 pounds (although that might be due to running 6 miles yesterday!). Ironically, I also had a physical planned for yesterday and had fasting blood work done. Breakdown was: TC 341, LDL 248, HDL 74, TG 98 Chol/HDL 4.6. My doctor called immediately and wants me to go on statins. I think not. I told her I was doing Paleo and now the Fat Fast for a few days and she does not get it (I didn’t expect her to, as I have gone thru the SAD, messed up medical school myself and have a PhD in Biochemistry, (again ironically) in Cholesterol Metabolism!) I’m embarrassed to say that my entire thesis was based on the “Lipid Hypothesis” and can be completely discarded at this point. Thankfully, it is not what you study, but learning to think while studying it that matters. Regardless – Can you tell me – what are your thoughts on this? I believe that it is entirely possible that my numbers were out of wack because I was ketogenic and fat wasting. And all that fat was probably hanging out in my blood! It makes biochemical sense. Have you seen/heard any concrete evidence of this yourself? My plan is to stop the fast (although it was pretty easy…and I was not hungry, AT ALL) as I am content losing a few lbs and that is good. And I will ask to have my blood work repeated in a few weeks/month. Any comments very much appreciated.
Consider adding some resistance exercises to your workout routine to build more lean muscle tissue. Remember, muscle burns more energy than fat—about three times more, experts estimate. So the more of it that you have, the faster your metabolic rate will be. Don’t worry about trying to transform into a bodybuilder. Aiming for two strength training sessions per week is a great place to start .
A few years ago, for example, a 55-year-old woman arrived at the Pritikin Longevity Center weighing 218 pounds. Her resting metabolic rate was tested. (Resting metabolic rate, or RMR, is the number of calories your body just naturally burns each day, without exercise.) This woman’s was 1440. Four years later, eating and exercising Pritikin-style, she returned to Pritikin. The scale had fallen to 198, her body composition (ratio of muscle to fat) had significantly improved, and her RMR had risen to 1640.
The reason these gasses matter for metabolism is simple, Chen said. We get fuel in the form of calories — from carbohydrates, fat, and protein. But to unlock those calories, the body needs oxygen. When we breathe in, oxygen interacts with the food we’ve consumed, breaking down (or oxidizing) chemical bonds where the calories are stored and releasing them for use by our cells. The product of the process is CO2.
There are several predictors of how fast or slow a person’s metabolic rate will be. These include the amount of lean muscle and fat tissue in the body, age, and genetics. Women tend to burn fewer calories than men. Having a higher metabolic rate means your body uses food for fuel (instead of storing it as fat) more quickly. But you can still gain weight if you consume more calories than your body needs. Counterintuitively, heavier people generally have higher metabolic rates than skinny folks to meet the fuel demands of their larger bodies.
I asked Hall if there were any other potential explanations for why I felt I gained weight so easily. He told me NIH does other studies that could answer that. If he had tracked my metabolism before I had lost weight earlier in life, he’d be able to detect any slowdown in response to slimming. Or if I participated in an “overfeeding study” — where I was deliberately fed more calories than my body required — he might detect no change in my metabolic rate. There are some people whose metabolic rate speeds up when they overeat, using the extra calories as fuel instead of storing them as fat, and it’s possible I’m not one of them.
I love fruit. I’m getting better at eating veggies (thanks to my local CSA!). But in order to satisfy my sweet tooth, I turned to fruit. I noticed I was feeling so much fuller due to the fiber content (something I often write about, but it’s always nice to be validated firsthand). Organic cashews (unsalted, roasted) became my staple snack. High in fat, yes, but filling, tasty, and easy to munch on.

It’s hard to say. Achieving a natural state of ketosis (as in, by eating a ketogenic diet) is thought to be beneficial in the short-term. But experts don’t know the long-term effects, Palumbo says. And some suspect that it could lead to problems like kidney damage or an increased risk for heart disease (and day-to-day keto diet side effects are, at this point, well-documented). Assuming that ketone supplements do work identically to natural ketones, taking them long-term could have similar health effects.


My case was a quandary: I already exercised diligently, running about four miles most days. I had long ago given up red meat and most cheese. Yet my bad cholesterol last October was 169, way above my recommended high of 130 and an optimal 100. (People’s LDL goals depend on their number of risk factors such as smoking, diabetes or high blood pressure.)
Fasting blood samples were collected prior to all interventions. Following consumption of study drinks (details below), blood, expired gas and urine samples were collected at regular intervals for 4 h. Water was freely permitted and participants remained sedentary at the test facility throughout the visit. A subset of participants returned for samples 8 and 24 h after the ketone drinks (Study 1).
One type of sugar isn't necessarily better than another, but there's definitely a difference in the foods containing natural or added sugars, says Fear. Case in point: A sugary banana comes with a lot more good-for-you nutrients—and less calories, saturated fat, and trans fat—than a glazed donut. And guess what? One banana actually packs more grams of sugar than that donut. Go figure. What’s more, foods that contain natural sugars usually have other nutrients, such as fiber (as is true with bananas), protein, and healthy fats, she says. Keep reading to find out why this is so important—and instead of focusing on the sugar content of those sweet foods, think about the food’s overall nutritional value, says Fear.
The amount of weight you can expect to lose when cutting out starch and sugar depends on a number of factors. If your diet is currently heavily based around sugary and starchy foods and you switch to eating mainly lean proteins and green vegetables, you can expect to lose up to 5 or 6 pounds from water weight, plus another 3 to 4 from fat loss. If you already eat a relatively low-carb diet, cut starches and sugars but increase your consumption of fat and protein, you may not lose any weight, or could even gain weight.
I noticed around 2 weeks into my challenge I looked more defined, not bad for someone who hadn’t been to the gym yet in January. Which makes me wonder what kind of fat is lost when sugar is removed from the diet. Around the same time I realized I was on a high-fat, moderate-carb and protein diet – nuts, cheese, avocados, and peanut butter became regular snacks. Main meals were made up of carbs or veg, along with fish or meat. Which likely made me more fat-adapted, someone who burns fat for energy instead of sugar or readily available glucose.
Consistent exercise needs to be part of any weight loss strategy. It needs to be maintained following weight loss to ensure that your body stabilizes while you make new and more metabolically fit fat cells over time (and your old unfit ones die off). Exercise turns on genes that enhance metabolic function that simply will not turn on if you aren't active. It is more important to be consistent than intense. No matter what your current level of fitness, find activities you can do consistently, and gradually increase your intensity. Sooner or later you will get to a level of fitness that tilts fat burning in your favor, not to mention improving liver and cardiovascular health.
Human's ability to produce and oxidize ketone bodies arguably evolved to enhance survival during starvation by providing an energy source for the brain and slowing the breakdown of carbohydrate and protein stores (Owen et al., 1967; Sato et al., 1995; Marshall, 2010). The brain is normally reliant on carbohydrate as a substrate, being less able to metabolize lipids, despite adipose tissue representing a far larger energy store than muscle and liver glycogen. Therefore, during starvation, lipids are used for hepatic ketogenesis and, via ketone bodies, lipids sustain the brain. Endogenous production of the ketone bodies, d-β-hydroxybutyrate (βHB) and acetoacetate (AcAc), increases slowly, driven by interactions between macronutrient availability (i.e., low glucose and high free fatty acids) and hormonal signaling (i.e., low insulin, high glucagon and cortisol). Produced continuously under physiological conditions, blood ketone concentrations increase during starvation (Cahill, 1970), when consuming a “ketogenic” (low carbohydrate, high-fat) diet (Gilbert et al., 2000) or following prolonged exercise (Koeslag et al., 1980).
Some studies have shown as few as 3% of people with NASH developing cirrhosis, while others have shown as many as 26% doing so. There's no test or risk factor that predicts who will develop cirrhosis and who won't, although one study did find that people who are older or whose initial liver biopsies showed more inflammation were at greater risk. It's clear, though, that the prognosis for NASH is far better than it is for steatohepatitis that's the result of heavy alcohol consumption. Perhaps as many as half of all those with alcoholic steatohepatitis (which lacks a handy acronym) go on to develop cirrhosis.
Obesity is also recognised as an independent risk factor for the progression of fibrosis in other chronic liver diseases.6 A number of studies have now demonstrated an association between increased BMI or visceral adiposity and hepatic steatosis7 and fibrosis8 in patients infected with hepatitis C virus (HCV). In overweight patients with chronic HCV, we recently demonstrated an association between increasing insulin levels and increasing hepatic fibrosis, suggesting that host metabolic factors also contribute to disease progression.9 Similarly, in patients with alcoholic liver disease, elevated BMI and fasting blood glucose were independent risk factors for hepatic fibrosis.10
The sugar in your diet affects the amount of sugar in your bloodstream—and studies suggest that high blood sugar levels set up a molecular domino effect called glycation. Say what? That's just a fancy term for a process that can hinder the repair of your skin's collagen, the protein that keeps it looking plump. A diet full of treats can also lead to reduced elasticity and premature wrinkles. Thankfully, research suggests that slashing your sugar intake can help lessen sagging and other visible signs of aging.

One human study that includes raspberry ketones and other ingredients for weight loss shows promising results. The Journal of the International Society of Sports Nutrition published a randomized, placebo-controlled, double-blind study that evaluated 70 obese but otherwise healthy women who participated in an eight-week weight-loss program. The women were given a multi-ingredient supplement containing primarily raspberry ketone, caffeine, capsaicin, garlic, ginger and citrus aurantium.
In summary, in men with the metabolic syndrome, short-term weight loss with a low-fat diet increases the catabolism of LDL apoB-100 and decreases the catabolism of HDL apoA-I. The full benefit on HDL metabolism is offset, however, by reduced secretion of HDL apoA-I. Further studies should be conducted to explore the mechanism and effect of weight loss with different diets and lifestyle modifications on apoB-100 and apoA-I kinetics in a wider group of subjects and the incremental benefits of selected pharmacotherapies, as well as the effect of more extended periods of weight loss.
What we know to be true is much simpler: "Sugar calories promote fat storage and hunger," the write. "Fat calories induce fullness or satiation." For every additional 150 calories in sugar (i.e., a can of soda) a person consumes per day, the risk for diabetes rises 11-fold, regardless of how much or little we exercise. The single most effective thing people can do for their weight, they write, is to restrict calories – and even more, restrict carbohydrates.
All wine has sugar. This fact was researched in-depth on day seven, when I was having a rough day and desperately wanted to go home to a glass of red. I did learn that while hard alcohols-gin, vodka, whiskey, and rum-don't have added sugar, mixers are loaded with the sweet stuff. I always thought gin and tonics were a healthy option, but it turns out, 12 ounces of tonic water could have 32 grams of sugar-more than the daily recommended amount for adults. I did drink during the challenge, but opted for liquor on the rocks or mixed with club soda (which is sugar-free). I'll admit, gin and club soda isn't as good as a gin and tonic, so I'm making the switch back. The occasional glass of wine, cupcake, or piece of chocolate is worth the added sugar to me. However, I will keep my consumption to a minimum-I'll just savor it that much more now. (Can You Drink Alcohol and Still Lose Weight?)
There are many studies showing just how different sugar and fat calories are. Most scientists still hold on to the dogma that fat makes you fat, that fat causes high cholesterol and that low fat is the way to go to live a long healthy life. Plenty of evidence proves otherwise. What if the fact that this conventional wisdom is completely wrong is what has actually caused our obesity epidemic?
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A growing number of people are giving it a try, thanks to exogenous ketone supplements that claim to launch your body into a state of ketosis within two and a half days—even if you’ve been living on pasta and cookies instead of following a low-carb diet. How can that be, though? And can that kind of rapid transformation actually be safe? Here’s what you should know.
In the context of weight loss, metabolism is considered how fast and how many calories you burn daily, therefore theoretically, metabolism should dictate how quickly or easy it would be for someone to lose, gain or control their weight. Unfortunately, fast and slow resting metabolisms are more of a myth than reality. Although two people of the same weight, height and body composition may burn calories at a slightly different rate, the difference is so small it’s virtually insignificant in the big picture. And no matter who you are, the heavier the body, the more calories it burns in all activities. Contrary to what most people believe, we do have control over our metabolism and how fast we lose weight. As an example, simply standing up instead of sitting burns more calories, so minimizing time spent sitting will boost your overall metabolism. If you start walking or doing any activity on a regular basis, your metabolism will increase significantly.

Eating more often can help you lose weight. When you eat large meals with many hours in between, your metabolism slows down between meals. Having a small meal or snack every 3 to 4 hours keeps your metabolism cranking, so you burn more calories over the course of a day. Several studies have also shown that people who snack regularly eat less at mealtime.
Given that blood βHB after identical ketone drinks can be affected by factors such as food or exercise (Cox et al., 2016), the accuracy of tools for non-invasive monitoring of ketosis should be investigated. Breath acetone and urinary ketone measurements provide methods to approximate blood ketosis without repeated blood sampling (Martin and Wick, 1943; Taboulet et al., 2007). However, breath acetone did not change as rapidly as blood βHB following KE and KS drinks. Acetone is a fat-soluble molecule, so may have been sequestered into lipids before being slowly released, resulting in the differences observed here. Similarly, significant differences in blood d-βHB between study conditions were not reflected in the urinary d-βHB elimination. As the amount of d-βHB excreted in the urine (≈0.1–0.5 g) represented ~1.5% of the total consumed (≈23.7 g), it appears that the major fate of exogenous d-βHB was oxidation in peripheral tissues. These results suggest that neither breath acetone nor urinary ketone measurements accurately reflect the rapid changes in blood ketone concentrations after ketone drinks, and that blood measurement should be the preferred method to quantitatively describe ketosis. That said, it should be noted that although commercial handheld monitors are the most practical and widely available tool for measuring blood ketones, they can overestimate blood D-βHB compared to laboratory measures (Guimont et al., 2015) and these monitors do not measure L-βHB and so may not provide accurate total blood ketone concentrations, especially if a racemic ketone salt has been consumed.
This is a fairly common observation around these parts: “I eliminated wheat from my diet and have limited my consumption of junk carbohydrates like corn and sugars. I lost 38 pounds over three months and I feel great. I initially lost weight rapidly, but have more recently slowed to about 1-2 pounds per week. But my doctor checked some lab values and he flipped! He said that my HDL dropped, my triglycerides went up, and my blood sugar went up 20 points! He wants me to take a statin drug and metformin for my high blood sugar. What gives?”

What if everything you ever learned about weight loss was wrong? What if losing weight has nothing to do with calories—counting them or cutting them out by sheer willpower? What if, in fact, most health professionals (including doctors and dietitians), our own government and especially the food industry are giving us weight loss advice guaranteed to make us fat?
But, Bustillo cautions against hanging too much hope on this: “Many companies that sell the ‘after burn’ or ‘metabolic workouts’ are just utilizing a marketing strategy with [a grain of science behind it],” he says. “They're not technically lying, because training can increase BMR [in the 24 hours post-workout], but it's not by more than 200-300 calories on average.”
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Your body needs water to process calories. If you are even mildly dehydrated, your metabolism may slow down. In one study, adults who drank eight or more glasses of water a day burned more calories than those who drank four. To stay hydrated, drink a glass of water or other unsweetened beverage before every meal and snack. Also, snack on fresh fruits and vegetables, which naturally contain water, rather than pretzels or chips.
A few years ago, for example, a 55-year-old woman arrived at the Pritikin Longevity Center weighing 218 pounds. Her resting metabolic rate was tested. (Resting metabolic rate, or RMR, is the number of calories your body just naturally burns each day, without exercise.) This woman’s was 1440. Four years later, eating and exercising Pritikin-style, she returned to Pritikin. The scale had fallen to 198, her body composition (ratio of muscle to fat) had significantly improved, and her RMR had risen to 1640.
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