If there is one area of our bodies that is debated to extremes, with literally hundreds of differing strong opinions on it, it’s nutrition. For many, beliefs about nutrition and diet are tribal. We put ourselves in different camps and we war agains the other camps. Whether it be paleo, low fat, low carb, Atkins, high fat, low protein, vegan, raw vegan and so on.
It’s exactly this sort of area where I see data as essential. Without data we have no hope of cutting through the maze of opinions to get to what really works.
Part of the problem with nutrition and diets is that we tend to think that one diet should be good for everyone. But increasingly, research and N=1 experiments, are showing that that isn’t the case. And this is exactly why you should pay attention to today’s show.
Today, we’re looking at what has relatively recently become the fastest growing nutrition or diet trend. The high fat diet. Also known in different guises as the ketogenic diet, or the low carb diet. And specifically how this can affect our different individual biochemistries, how we can measure “Ketosis” and other biomarkers to understand how our specific biology is reacting to it… and allowing us to troubleshoot and course correct when it isn’t getting the desired results we’re looking for from it.
Today’s guest is Jimmy Moore. In 2004, Jimmy, at 32 years, weighed 410 pounds. Since then he has transformed his own biology, shedding all that additional weight with low carb and ketogenic diets. He has also interviewed nearly 900 people on his “living the Vida low carb show” podcast, discussing every aspect and detail of ketogenic diets you could think up.
Most recently he pulled together the best information, in collaboration with the top experts he has found in the field, into a book “Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet“. It’s extremely detailed, and I’d recommend that anyone on or interested in high fat, ketogenic or low carb diets read it. You’ll definitely learn more no matter your existing knowledge.
The show notes, biomarkers, and links to the apps and devices and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!
- The benefits of getting your body into the state of ketosis.
- The wide range of biomarkers a high fat, low carbohydrate and low protein diet can impact positively.
- Why we can’t just assume we are getting into ketosis and staying there as was originally thought and assumed with low carb diets such as Atkins and other ketogenic diets.
- How cholesterol markers typically said to be predictive of cardiovascular health have been superseded by more accurate lipoprotein particle biomarkers.
- How to interpret your blood glucose numbers and why it’s the most important marker of your metabolic health.
- When protein is not a healthy macronutrient and how to use ketone measurements to understand your protein tolerance.
- How to measure ketones in blood (beta hydroxy butyrate), in urine (acetoacetate) and in breath (acetone) and the differing accuracy, cost and convenience of each approach.
- How to measure ketones with The Ketonix while avoiding some of the confounders that can affect its accuracy.
- Jimmy Moore’s suggested ketone body testing strategy to minimize costs and maximize convenience and accuracy.
- What Jimmy Moore routinely tracks for his own body and who he recommends to learn more about the subject of ketosis from.
- Using the hs-CRP to monitor body inflammation from diet and being aware of big confounders to its reading such as exercise, injuries and illness.
Lipids and Cardiovascular Risk Markers
- Cholesterol Panel: The cholesterol panel covers a number of markers related to lipoproteins in the blood. There are standard markers that all doctors and labs will run, and some newer specialist labs that are more specific and accurate.
- Triglycerides: Below 100, optimally under 70. Jimmy’s are at around the 40 mg/dl mark now.
- HDL: The traditional measure of ‘good cholesterol’ used by doctors and healthcare. Jimmy mentioned that on a true ketogenic diet people can measure up to 80 mg/dL which is very high. Levels are consider protective of cardiovascular disease over 60 mg/dL. Damien’s levels were 72 mg/dL at last test.
- LDL (Low Density Lipoprotein): The traditional measure of ‘bad cholesterol’ that many doctors still use, but that research has now determined not to be the best predictor of cardiovascular risk.
- LDL-P: Measures the density of your LDL particles. Research shows that small LDL particles are the ones that play a role in cardiovascular disease. This test is not yet routine.
- hs-CRP (high sensitivity C-Reactive Protein: The inflammation marker that is used to track amongst other things cardiovascular risk. Below 1, you do not have a cardiovascular disease risk. As examples, Jimmy’s is at 0.55 mg/dL when he last checked and Damien’s hovers between 0.1 and 0.2 mg/dL.
Blood Sugar Regulation
- Fasting Blood Sugar: Typically taken first thing in the morning after an 8 hour fasting period. Should be in the 80s, and definitely below 92 mg/dL.
- Post-Meal Blood Sugar: You can test your blood sugar response after meals with a standard glucometer available in pharmacies. 1 hour after a meal your blood sugar should be below 140 mg/dL and after 2 hours it should be back to your baseline (in the 80s ideally).
- HbA1c (Hemoglobin A1c): This is a proxy biomarker for your average blood glucose level over the lifetime of red blood cells. Doctor’s tend to use a reference range where anything below 6% is fine, however this already represents blood sugar disregulation. You should be aiming for less than 5.3%. Jimmy noted that his is now around 4.3%.
Ketones and Ketosis
- Beta-Hydroxybutyrate / β-hydroxybutyrate (Ketones in Blood): Blood ketones are the gold standard for measuring your state of ketosis. Jimmy finds that over 1.0 on your blood ketone monitor gives you the good benefits, and there is no need to go over 2.0. Stephen Phinney and Jeff Volek (from the Art and Science of Low Carb) recommend between 0.5 and 3.0.
- Acetoacetate (Ketones in Urine): Measuring urine ketones is the easiest way to get started, however for some people this measure will not reflect blood ketone levels once they have become fat adapted, start to mobilize ketones routinely in their blood.
- Acetone (Ketones in Breath): Measuring breath ketones is the latest method for monitoring ketone levels. Research studies show that there is good correlation between breath acetone levels and blood ketone levels (β-hydroxybutyrate).
Devices and Lab Tests
- Precision Xtra NFR Blood Glucose Monitoring System: The Precision Xtra does both ketone and blood glucose monitoring via ‘finger prick’ approach. You need to buy Precision Xtra Blood Ketone Test Strips to use it which can work out expensive.
- The Ketonix: The Ketonix is the breath analysis device that estimates your blood ketone levels based on acetone in the breath.
- Ketostix: The test strips to use with urine to assess whether or not you are in a state of ketosis.
- NMR Lipoprofile Test: This lab test is currently the gold standard of cardiovascular risk assessment which it does by looking at the LDL particle number and size.
- The VAP Cholesterol Test: Another lab test option that measures LDL particle number and size.
- Ketogenic Diets: The main tool discussed in this episode were low carb-high fat diets that put your metabolism in a state of ketosis. Jimmy outlined how easily your body switches to making ketones depends on the state of your metabolism with factors such as your weight and diet history and your genetics. Jimmy is releasing a book with recipes for ketogenic diets in 2015: The Ketogenic Cook Book.
- The Atkins Diet: The popular Dr. Atkins’ diet is a low carb, high fat and high protein diet. We discussed in this episode how it’s not well designed to put you in a state of ketosis, however it may work for some people – results depend on your metabolism. For Jimmy limiting protein is a requirement to put his metabolism in a state of ketosis.
Jimmy Moore & Livin La Vida Low Carb
- Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet: Jimmy Moore’s recent book covering the ketogenic diet and its health impacts and measuring approaches in detail.
- Connecting with Jimmy Moore: You can connect with Jimmy at his website LivinLaVidaLowCarb.com (company site) and also on twitter @LivinLowCarbMan and facebook facebook.com/LLVLC.
Other People, Resources and Books
- Stephen Phinney and Jeff Volek were mentioned by Jimmy for their work on low carbohydrate diets and athletic performance. Their work is covered in their book The Art and Science of Low Carbohydrate Performance.
- Dr. Eric Westman was the co-author with Jimmy on Keto Clarity. You can connect with and learn more about him here and see his research on pubmed here.
- Bulletproof Coffee was mentioned with regards to fasting and its impact on ketosis.
- Lebron James’ use of a Ketogenic Diet for athletic performance
- Dr. Atkins and his original diet: Dr Robert Atkins popularized the ketogenic and high fat or low carb diet. His approach is covered in his original book “Dr. Atkins” New Diet Revolution“.
Full Interview Transcript
[Damien Blenkinsopp]: Hey Jimmy, thank you very much for making time to come on the podcast today.
[Jimmy Moore]: Hey man, what’s going on, Damien?
[Damien Blenkinsopp]: It is going good. So I have been wanting to get you on because you have spoken to a lot of people about one specific topic. How long have you been working in the area of ketosis?
[Jimmy Moore]: Well, ketosis and low-carb diets – I have been doing this for about the past decade since I lost pretty famously 180 pounds on Atkins diet back in 2004. But really hot and heavy looking into ketosis and what we call nutritional ketosis in my new book probably since 2012.
[Damien Blenkinsopp]: Great, so you got into this and it was more focused on the low-carb approach and you weren’t really considering getting into ketosis and all of these aspects.
[Jimmy Moore]: Well, I assumed that being low-carb was ketosis when I first started this because a lot of Dr. Atkins’ teaching talked about ketogenic diets and getting into a state of ketosis. At the time i thought it was all predicated just on limiting your carbohydrates but I have since learned in my own testing on myself and then interviewing literally all the experts in the world on this topic that is just one element that it takes to get into a state of nutritional ketosis. There is really a whole lot more involved with it, which is why we wrote Keto Clarity.
[Damien Blenkinsopp]: Great, and I understand it is a very individual kind of thing that people weren’t expecting, especially ten years ago when you got started and so everyone is kind of saying if everyone will just follow the same diet plan it is all going to be fine and the same.
[Jimmy Moore]: How is that working for you? Not very well.
[Damien Blenkinsopp]: I find the same, that you kind of have to test yourself. This podcast is all about testing or making sure that you are doing whatever is right for your body so it is fantastic to have you on to talk about this topic. So how many people, just as a quick background, how many people have you interviewed on this topic over the years?
[Jimmy Moore]: On the specific topic of ketosis? Is that what you are asking?
[Damien Blenkinsopp]: Yeah, if you know a rough idea.
[Jimmy Moore]: We hit on ketosis here and there with different people. I would say at least a couple hundred of the almost 1,000 interviews that I have done, and at least a couple of hundred have shared some pretty good nuggets of truth that didn’t end up in my vernacular in thinking when it came to wanting to write a book about this. But yeah, I have interviewed literally 1,000 people on all kinds of topics over the years, not just ketosis. But obviously ketogenic diets are a huge passion of mine.
[Damien Blenkinsopp]: Yeah, so what are the benefits people are looking for? This is a very quick broadstroke, if one of the listeners at home hasn’t gotten into ketosis and why to do it, on one hand what are the benefits people are looking for when they are trying to get into the state of ketosis?
[Jimmy Moore]: Oh man, do you have all day? That is the great thing about this, Damien, is there is a lot of great science that we have, both solid, good, and emerging science that we have put in the back 16, 17, and 18 chapters that talk about all of the great health issues that can be improved with a ketogenic diet. But just for people that are wanting to maybe make their day-to-day quality of life better, check out this list of things that you have to look forward to if you get into a state of ketosis.
How about this? Natural hunger and appetite control, effortless weight loss and maintenance, mental clarity like you have never had before because your brain just loves ketone bodies, sounder sleep, normalized metabolism, your blood sugar gets stabilized, your insulin sensitivity is restored, inflammation levels, which we know is the real cause of heart disease as one of the themes that we talked about in my last book, Cholesterol Clarity. It is not high cholesterol that is causing heart disease, it really is inflammation and this diet lowers it. A feeling of happiness and general well-being.
Your blood pressure comes down, your HDL (good) cholesterol goes up, your triglycerides come down, you have less of those small, dense LDL particles. You can fast spontaneously between meals upwards of 12 to 24 hours because you just aren’t hungry. You use your stored body fat as fuel, you have energy beyond belief. I am in a ketogenic state and have lots of energy. Heartburn goes down, you improve your fertility and sex drive, it helps with traumatic brain injury, your immune system is improved – I could go on and on and on. But there are so many great benefits, even if you don’t have some dastardly disease just these day-to-day quality of life improvements that happen from a ketogenic diet make it all worth it.
[Damien Blenkinsopp]: Great, and you rattled out a whole bunch of markers when you were talking about this too so these are things people can then track. What are the main things, when you have been talking to either interviewers or you have been seeing with people you are consulting with, their numbers. What are the main things that you have kind of rattled out there that change quickly and maybe change over the long term in terms of markers?
[Jimmy Moore]: Yeah, oh my gosh – immediately when you start reducing carbohydrates and replacing those carbs with more fat and getting into a state of ketosis, let’s go to your cholesterol panel since I wrote a whole book about that one last year. Here are the things that are almost instantly going to happen within a couple of weeks to a couple of months. Your triglycerides will fall like a rock. You will see those go down below 100 and optimally under 70 and my personal level right now is in the 40s. Then your HDL cholesterol will respond very well to the increase in saturated and mono and saturated fats that you consume and those are the raw materials that help you make HDL cholesterol and it will go way up. Mine is currently around 80-something.
[Damien Blenkinsopp]: Wow.
[Jimmy Moore]: And then the small LDL particles, and these are the truly atherogenic particles of your LDL that will penetrate the arterial wall – a lot of people will be like, ‘What do you mean, LDL particles?’ Yeah, there is more than one LDL. LDL is not just one number, it is actually two major numbers. One is large, fluffy LDL particles which really are not atherogeneic and are benign when it comes to heart disease but it is those small, dense LDL particles that are the real problem and how do you get small, dense LDL particles?
It is two things. You have too many carbohydrates in your diet and that shifts your LDL to the small kind and you are consuming vegetable oils which pretty much leaves your body devoid of all of the large, fluffy – that’s why vegetable oils are promoted, because it does reduce your LDL cholesterol but it reduces all the good ones and leaves you will all the bad ones and then does this nice little thing called oxidation to those LDL particles, which makes them inflammatory, which we just said is the real cause in heart disease. So those are some blood markers that we see change immediately. Now, you might see your total cholesterol go up and you might see your LDL-C number go up, but those aren’t a big deal in the context of all these other numbers getting better.
Now, we mentioned inflammation. There is a great marker and if you haven’t had it run before this is one I love having run, because especially all these people that think my high cholesterol is going to kill me, I point to the HSCRP number, that is the C-reactive protein and is the key inflammatory marker in the body. If that number is below 1.0 you have nothing to worry about when it comes to inflammation and without that inflammation you can’t have heart disease. So i think my level when I last checked it was 0.55, which is really, really good.
Another one at home I think people could have run, and this is one when I did a whole year and I did an online experiment that I talked about in Keto Clarity of this nutritional ketosis. What i did was i quantifiably measured weight just because people think that’s interesting. I don’t but people do. Blood sugar levels and then blood ketone levels. So let’s go to blood sugar. Blood sugar is a huge marker of where you stand in your metabolic health. If you have got fasting blood glucose levels that are in the triple digits you need to get that under control and a ketogenic diet does that for in spades. Now, it doesn’t do it immediately in a lot of people. Some people say, ‘I have been eating low-carb, high-fat for a week. I have got great ketone levels but my blood sugar is still elevated.’ I am like, ‘Come on, you have got to give it a little bit of time but over time as blood ketone levels go up your blood sugar levels will come down.’ And they will even come down to levels that some might say are too low and we can talk about this in a minute if you want to, but when you have higher levels of blood ketones they step in the place of the blood sugars so you could have a lower blood sugar that would look like hypoglycemia to most medical doctors and yet you’re completely fine. And again, we can get into that in a second.
Then the last thing I wanted to mention was the blood ketones and this is kind of technology that has been out there. I had never heard of it before 2012 when I read the art and science of low carbohydrate performance by Dr. Stephen Phinney and Dr. Jeff Volek and he talked about measuring blood ketones. And I am like, ‘What’s that?’ The ketones are what you pee on a stick and you see a urine test and those are great and all for when you first start but when you want to see how you are doing in nutritional ketosis once you become keto-adapted and started using that fat for fuel. Then you need to be testing for blood ketones. I did that for a whole year and it is exactly like a glucometer. It takes a little bit more blood than a glucometer, and yes I prick my finger every morning and night. That is probably no strange thing for your listeners to do that, and sometimes I did it every hour on the hour all day long.
[Damien Blenkinsopp]: There are a couple of things you mentioned in there that I just wanted to clarify. First of all, you were talking about the LDL and the particle size. Is that the LDL-A test? Could you specify because I know that most people are going to walk into their doctors or most labs and get a straightforward LDL test and what you are given even when you ask for it, you have to really know what you are asking for in these cases because you are going to get the standard, which isn’t what we are looking for here.
[Jimmy Moore]: Yeah, the test that you mentioned, I am not familiar with it. Is there a name for that test or is it just called the LDL-A test?
[Damien Blenkinsopp]: Well I know on my one that [inaudible 00:13:28] chart, they have LDL bracket A.
[Jimmy Moore]: Oh, Wellness FX. That is what I was getting at. Where are you running that, dude? No, where are you located?
[Damien Blenkinsopp]: I am in Spain right now.
[Jimmy Moore]: So in America you can actually run a test that will test for the particles and you can actually go to your doctor and ask for the particle size test – even Dr. Oz did a big show on this asking patients to go to their doctor and asking for the particle size tests. But there are so major ones that are out there that measure for the particle size. There is one I am not a big fan of but I know people love because it does show you the breakdown of the particles. It is called the VAP test. But there is another one that I am a big fan of because it shows you the number of particles that you have in your LDL and then it gives you the breakdown and it specifically gives you a number of the small, dense LDL particles. That test is called the NMR lipoprofile test and it is run in Raleigh, NC. And they are basically the only lab in the whole world that does this specific test. And again they will spit out the total number of LDL particles that you have and then the small ones. And again the way you get more small is you eat more carbohydrates and you consume vegetable oils.
If you do those two things you are going to have a lot more small. So that is why a low-carb, high-fat of saturated and monounsaturated fats, a ketogenic diet helps with that because it helps to eliminate and greatly bring down the number of small LDL particles but the way you test for it – I am not sure how you can do it overseas but in America you have got the VAP test, you have got the NMR profile test and there is one other that is kind of coming on in the recent years called the HDL labs test, which also shows you your particle size breakdown.
[Damien Blenkinsopp]: Great. So with those people can get a much clearer idea and they can order that test from any doctor, like the ones that you were talking about with One Lab.
[Jimmy Moore]: Yeah, literally any doctor in America that uses Lab Corp, which is what every doctor uses, they can run it. They can run this test but they may give you pushback. That is kind of the frustrating part about all of this, patients are trying to do the right thing to get the tests run and to see where they stand, see how they are doing in their health. And yet doctors are like, ‘Whoa, that is unnecessary because you don’t have a family history of heart disease and that is only for the people with the greatest risk.’ But then they will turn right around and say, ‘Oh, you’re total cholesterol is 230 so that is way too high and we need to put you on a statin drug.’ And that is when I would push back as a patient and say, ‘Wait, I want to have this run because this will tell me whether my LDL cholesterol is really the bad kind or if I am okay despite having a higher level of total cholesterol.’
[Damien Blenkinsopp]: The other test I wanted to just touch on that you mentioned was the glucometer, your blood sugar. You didn’t talk about the context and I know this can vary a lot. So are you talking about fasting blood sugar there?
[Jimmy Moore]: When you do a blood sugar reading it almost always needs to be in a fasted state – and we can talk about postprandial state, but when we are talking about where you are in your blood sugar, when you wake up in the morning after an overnight fast and you haven’t eaten all night, your morning blood sugar reading should be pretty steady in the 80s. That is a normal reading, definitely below 92 and you’re going to be okay.
Now, we can talk about post-prandial and how it should be after you eat something, but you test it fasting and then you can test for a couple of hours every 30 minutes after you eat – at the one-hour mark you definitely should not be over 140 and after the two-hour mark you should be back to baseline. So if you started at 85, two hours later you should be pretty darn close to 85. If you’re not, guess what? You probably ate too many carbohydrates or maybe just a tad too much protein in that meal with just keeping your blood sugar elevated. Fat is benign when it comes to your blood sugar and it will not raise your blood sugar unless you are gorging yourselff on it. Then that gorging will extend the gut and make your insulin and blood sugar go crazy. But if you are eating normal amounts of those things it should not impact it at all.
[Damien Blenkinsopp]: Great, and the other one I don’t think you mentioned is HBA1C – is that something you look at too?
[Jimmy Moore]: Yeah, I did not mention that one but that is an ancillary one to the blood sugar one we were just talking about, absolutely that is a great marker. Most medical doctors say, ‘Well, get it below 6.’ And I am going, ‘5.9 is still severe insulin resistance.’ Why don’t we aim for a much better one of how about below 5.0? I had mine measured in the midst of my nutritional ketosis experiment and i came in at 4.3, which is really good.
[Damien Blenkinsopp]: Yeah that is really. My understanding is that some of these tests can have confounders because when you change to a low-carb diet, like some of them will change. I think HBA1C is one of them where your red blood cells will start living longer so the values don’t kind of matchup. Some of these tests have confounders. Are there a lot of these tests that have confounders that you have to watch for and maybe it takes longer – like you were saying there is a longer period that you need to look at it. Or is it just a few of them?
[Jimmy Moore]: I think it is just smart to remember all of these tests are simply tools. don’t rely on them as gospel truth. I get well over 500 emails a day and people write to me and say, ‘Oh I just went to my doctor and I got this one test and it said this. And so now the doctors want to put me on some medication or have some surgery,’ and I am going, ‘One test, really? How about you ask for a few more months and run that same darn test again.’ Why are we making treatment based on one test that could be flawed?
[Damien Blenkinsopp]: In terms of flawed to you mean not accurate, a bad reading?
[Jimmy Moore]: It could be a very bad reason and yet they want to make changes. I will give you a hard example of this. My wife, Christine went to see her general practitioner in November last year and her total cholesterol came in at 240, which they think is high – anything over 200 is high. The doctor said, well – and he knows better than to bring up the statin drug thing to me. So i was sitting in there and he said, ‘Christine, I think you need to cut your saturated fat.’ Because he thought that was what it was going to take to improve her numbers and she said, ‘No, I am going to keep eating saturated fat.
That is what helped me to get these numbers to begin with.’ She had great HDL, incredibly triglycerides numbers, and lower inflammation than she would if she was eating a standard American diet. so she said no. And he had read my book Cholesterol Clarity and he said, ‘Well, maybe Jimmy can fix your numbers.’ Challenge accepted.
So I go home and guess what we do, Damien? I don’t cut her saturated fat. We doubled her saturated fat. So whatever she was eating before, I had her eat twice as much saturated fat and we went back for the six-month checkup, her total cholesterol? 200. It had gone down by 40 points and it was all in the LDL. So what she did was she shifted the small, dense LDL particles over to more of the large, fluffy LDL particles and her HDL stayed the same, her triglycerides stayed the same, and don’t you know he didn’t say a damn thing about it.
[Damien Blenkinsopp]: Yeah, that’s amazing. there are tons of stories. And you made some important points about the tests here. Now, you have just given us a whole slew of tests and I am sure for some people that is a real maze. How do you typically suggest – when someone is coming and saying they are thinking of doing a low-carb or ketogenic diet, what is the obvious place to test in order to understand if it –
[Jimmy Moore]: If it is working?
[Damien Blenkinsopp]: So that they know they are getting the benefits they want. Are there the main areas like – my concern is diabetes, my concern is – I don’t know, the top three concerns and there are a couple of tests for each one that they should focus on or something like that?
[Jimmy Moore]: I think what everybody should pay attention to, probably more than anything else, is that blood sugar level. If your blood sugar is elevated, regardless of what you think your current state of health is, you should know your blood sugar level and it is not just for people with diabetes. This is one that frustrates me, Damien, and maybe our next book will be Blood Sugar Clarity, because I think people are confused about what do you mean, I have to test my blood sugar? I am not diabetic.
People think it is all about diabetes but it is not. Having a normalized blood sugar level is a sign of great metabolic health. So getting that blood sugar level down and by extension your insulin levels down, unfortunately you can’t test your insulin at home but you can test your blood sugar all day, every day. Test, test, test and see where you stand in that blood sugar.
That is a great marker to know where you stand in your metabolic health. So that is one that absolutely everybody should go down to their pharmacy, pick up a glucometer and start testing your blood sugar to see where you are. If it is in that 80s range when you wake up in the morning, great. If not then you need to start making some tweaks to your diet and supplementation and there are things that we have talked about actually in Keto Clarity that can help with that because that is a biggie.
[Damien Blenkinsopp]: So is it between 70 and 90, is that what they are kind of aiming for?
[Jimmy Moore]: Yeah, 70 to 90 is probably pretty good but in the context of Keto, which I was alluding to earlier, sometimes it might even go lower than 70 and it doesn’t mean that you are outside the range within context if you have higher levels of blood ketones, you could have lower levels of blood sugar because the ketones kind of step into the place of where that blood sugar would be. So I wouldn’t even put it in that low range of 70 to 90 because it could be below 70 and still be normal.
[Damien Blenkinsopp]: So you really need to focus on not having over 90 and that is more the emphasis?
[Jimmy Moore]: Yeah, that is probably a good thing to shoot for. Now, postprandial, after you have eaten something it will go up somewhat. I will have a breakfast of eggs cooked in some butter and some sausage and my blood sugar will be 85 before and then after an hour it might have gone up to like 95. Then by the end of two hours it is back to 85 or 86. That’s perfect.
[Damien Blenkinsopp]: Great. So, you have been doing this for a long time. Now, take someone who has still been eating donuts and stuff – because I guess you never eat donuts these days.
[Jimmy Moore]: No, not unless they are made of bacon.
[Damien Blenkinsopp]: Do you know what would happen to your numbers if you had a donut. You gave us an example where it shoots up really high still, or obviously maybe you don’t know but do you have an idea of what would happen now? Would it be the same as it was 10 years ago?
[Jimmy Moore]: I have no idea. That might be a fun N=1 experiment although I wouldn’t look forward to eating a donut. My wife might like that. But to be honest I have no idea. I would assume that because I had this problem before where that would spike my blood sugar that it would still act the same way now. I don’t want the way I would feel after eating that. Forget what happens to blood sugar, I don’t want to feel like crap and I definitely would eating that, just based on past experience.
[Damien Blenkinsopp]: Great, so if everyone focused on the blood sugar that is a pretty good area to focus on no matter where you are coming from for this ketogenic diet?
[Jimmy Moore]: Yes, correct. And I think that one we mentioned earlier about the CRP level, that HSCRP. Everybody needs to know your level of inflammation. If you are above 2.0 on that, you probably need to do something to bring down the inflammation in your life and for a lot of people it is those processed and refined carbohydrates that are primarily doing that and even the so-called healthy whole grains are also causing that inflammation to go up, and the vegetable oils. Eliminating those from your diet, your inflammation should come way down and you can see that in your HSCRP.
Now, there is more that impacts that inflammation than just those two food items. If you are highly stressed that is also going to show up on your HSCRP so run that number. Optimally you want it under 1.0 and definitely under 2.0 and anything above that shows that you have problems. And that is an easy test to run too. I think it is like 60 bucks if you run it on your own or your doctor can run it for you.
[Damien Blenkinsopp]: Right, I am glad you brought up that test because that is the test I have been running for the longest, probably about since 2004 or something, when I first learned about it. And it is has been interesting to see how mine has changed over time. I think mine is 0.1 these days and sometimes it is 0.0 or something. It depends on the lab because I don’t think all the labs actually have the high sensitivity to the actual [inaudible 00:26:21] like less than 0.1.
[Jimmy Moore]: Yeah, you definitely need to have the HSCRP.
[Damien Blenkinsopp]: Yeah, and that is the point I wanted to make because there are a lot of the CRP tests still out there and maybe not so much in the US. I haven’t had so many problems when I test in the US, but when I test abroad they will sometimes give the C-reactive protein, which only measures down to 1 so you don’t have any idea of how good you are or if you are doing well. You can just say, ‘Oh, I am doing bad because I am over 1,’ which isn’t that helpful.
[Jimmy Moore]: Now, you mentioned you wanted a third test. And the third one I think besides blood sugar and CRP is absolutely your triglycerides. If your triglycerides are over 100 and we mentioned this in Keto Clarity, if your triglycerides are over 100, that means you are eating too many carbohydrates in your diet. So that is one way you can figure out how sensitive you are to carbohydrates, by looking at that triglycerides number. Get it below 100 and you’re in nirvana.
That’s where you want to be, optimally under 70 but definitely under 100. Your doctor might say, ‘Well, 140, oh that’s normal,’ and he won’t even bat an eye. But 140 is, again, showing signs of insulin resistance. So you have got to get that number down, down, down and the way you do that is cut the carbs. So that is a great trifecta of tests where if you wanted to kind of track your progress to see how you are doing in your whole health, those three are probably the standard bearers.
[Damien Blenkinsopp]: Great, thank you for clearing that up. That makes it a lot simpler to follow. So we’re trying to get into ketosis. And the people will say that you are becoming a fat burner and I think that can be a little bit confusing for some people. They say a sugar burner, a fat burner, and this is some of the terminology that is used. Is that what is actually happening in your body? How do you look at the mechanism for this when you start eating less carbs and you start increasing the fat? What is going on in your body here, the main metabolic change? What is happening here?
[Jimmy Moore]: Yeah, I think it is a great imagery for people to realize that the body can be fueled by fat. That is going to be a new concept to a lot of people because if you ask people what is it that fuels the body most people are going to say that you drink Gatorade and that replenishes your body with electrolytes and gives you energy, blah, blah, blah, and that is when you are a sugar burner. So I think it is easy for people to understand that a lot of people are sugar burners. But when we start talking ketosis we want to change the terminology to make people realize sugar is not the only way you can fuel your body. So saying that you’re a fat burner kind of gives it – and yes it is very layman’s terms and that is kind of my style of writing and my style of educating, to make it a little simpler.
But here is what happens – you are shifting your body from using glucose as the primary fuel source over t using fat as the primary fuel source. So when you cut off the carbohydrate content of your diet and limit that so that you are not raising your blood glucose levels and then you are limiting your protein and we can talk about why you do that here in a minute. But you limit your protein also so that you are limiting the glucose effect and then you are eating more fat and the body has to do something. It has to switch from being a sugar burner to one that burns fat and then the resulting ketone bodies that come from that as fuel. So yeah, I think it is a great way for people to understand that sugar is not the only way to feed your body and fuel your body, you actually can make that switch over to being mostly a fat burner.
[Damien Blenkinsopp]: So are you saying that any fat we eat will turn into ketones that we are going to burn? Or is it a bit more complicated, like you are saying?
[Jimmy Moore]: Certainly you want to try to find the best quality fats and you can certainly drink vegetable oils and produce ketones. I wouldn’t recommend that, by the way, if you want to keep your inflammation levels down. So yeah, I mean, they are the raw materials by which ketones are made. So cutting your carbs is definitely a huge must and we talked about this at the very beginning. I used to think just because I cut my carbs on my Atkins diet that it was producing ketones.
Well, that is only one thing that you do. You cut carbs to your personal tolerance level, you moderate down the proteins to your individualized protein threshold and we can talk about that if you want. And then you eat fat to satiety, the saturated and monounsaturated fats that are primarily what we are talking about. Of course, the omega-3 fats are in there as well. And when you do that those things are the raw materials that make switch over from sugar burner to fat burner and it is that burning of fat that results in the production of ketones.
[Damien Blenkinsopp]: Okay, and then you can test for ketone levels to see if you are actually in the fat-burning mode or not. Is that the idea?
[Jimmy Moore]: Absolutely. And currently there are three different ways that you could measure for ketone levels – one that I really hate, one that is the gold standard, and one that is the future of testing. So do you want to talk about that?
[Damien Blenkinsopp]: Yeah. First of all, you kept on bringing up the confounder of the proteins so I would like to kind of get that out of the way before we jump into that.
[Jimmy Moore]: There is so much to say.
[Damien Blenkinsopp]: Right, there are a lot of confounders, basically. It is not easy stuff. So if I am eating a ton of protein every day what is happening? Why is that not going to put me in ketosis?
[Jimmy Moore]: Yeah, this is the big confounder and this is probably arguably the biggest mistake people have been making in their low-carb diet when they say, ‘Well, I have tried that low-carb thing and my blood sugar never came down and I gained weight and I could never get my hunger under control and blah, blah, blah.’ This is why. When you consume protein in excess there is this real long G-word that we talk about in Keto Clarity called gluconeogenesis. Now, don’t let that long word scare you. All it means is when you consume more protein than your body can use the liver has to convert that protein into sugar. SO while that is not a one-for-one thing like you would be eating carbohydrates and raising your blood sugar, it is still producing sugar in the body and when there is glucose present, sugar present in the blood, guess what that does to ketone levels? It kills them.
They are gone. And so that is why moderating down on the protein is so critical. Don’t fall for the media headlines that say that low-carb, high-protein diet – now. It is a low-carb, moderated protein to your individualized threshold level, high-fat diet and that is what will get you into ketosis. People eat chicken breasts every day, Damien, and they are like, ‘It’s low-carb.’ Yeah, it is low-carb but it is loaded with a lot of protein and that is not a health food. Even if you drench it in butter in the pan it is still giving you a huge, big bolus of protein. Moderate down the protein and either use less of it or choose the fattiest cuts of it.
[Damien Blenkinsopp]: That’s great, so that is one mechanism. Is that very individual, like the carbs? Do people have different protein tolerances as well?
[Jimmy Moore]: Absolutely. And think about it this way. If you are really sensitive to carbohydrates like I am – I used to weight 400-plus pounds, so I have a little bit of a problem with carbohydrates. I have often joked that I have already eaten all the carbs that I am allowed to have my entire life in the first 32 years of my life so I have to keep them low the rest of my life. That is probably not true, but anyway – yeah, if you are sensitive to carbohydrates you are going to be sensitive to the protein as well because of that gluconeogenesis.
When you have a low sensitivity to carbs it means your body very quickly starts making this glucose and wants to become a sugar burner again. So that will happen with the protein if you start eating it in excess and having a chicken breast, blah, blah. Then that is going to convert to sugar and very quickly your body will be like, ooh, you are giving us glucose. Let’s use that for energy and it will get away from being a fat burner, which is counterproductive for what you are trying to do with being in a state of ketosis.
[Damien Blenkinsopp]: Great, so the other mechanism I just wanted to look at before we look at how you measure ketosis and know that you are actually getting into this state. People talk about also taking fats to push you into ketosis, so actually consuming more. People talk about this in the context of taking some MCT oil or some other specific fats. Could you talk a little bit about how that works? If I am eating some regular diet in the morning and then maybe I test and I am not in ketosis and I have some fats, how does that work?
[Jimmy Moore]: There are definitely supplements out there that you can take that will temporarily boost your ketone levels. So you mentioned one of them, MCT oil, Medium Chain Triglycerides. These are readily made into ketone bodies. So if you take some of this, and be careful not to take too much of it because it will give you a stomach upset in excess but if you take some MCT oil within like 30 minutes you can test your blood ketones and you are going to have really high levels of ketones. You might think, wow, this is easy, why am I cutting my carbs? The only problem with that is it temporarily raises blood ketone levels. It is just a transient thing. So it could be helpful for people that are using it for – I know some athletes that get into ketosis and like to be fat burners and use ketones for fuel.
This is a great thing for an athlete to use maybe before an athletic performance. It is great to do that. Or if they are doing it for therapeutic purposes, let’s say you are an Alzheimer’s patient and you are trying to get more ketones in there for the therapeutic effects from that I think MCT oil is a perfect thing for people like that. But for the average, everyday person that is probably listening to your podcast right now it is best to do it nutritionally by getting your carbs to that personal tolerance level, moderating down that protein like we just talked about, and eating more real food-based fats like butter, coconut oil, lard, full-fat meats and cheeses, cream, and that kind of thing. That is going to give you the therapeutic effects fo real nutritional ketosis without artificially raising them with these supplements.
[Damien Blenkinsopp]: And the idea behind that is that you are saying it is temporary and it is not going to last very long whereas –
[Jimmy Moore]: Very transient, yeah. It doesn’t give you a true, accurate picture.
[Damien Blenkinsopp]: Are you aiming to stay in ketosis the most amount of time or are you aiming for the highest levels? Or is it a combination of both. Maybe this hasn’t been discovered yet but what is the ideal that we should be aiming for?
[Jimmy Moore]: There really aren’t any studies that have been done on a long term of doing this. I try to stay in it all the time because I feel best when I am in a state of nutritional ketosis pretty much as much as I can. It is very easy because of my tolerance levels being so low. It is easy for me to be out of it so I don’t want to be out of it. So I have to work really hard to make sure that I am in it. Now, you asked about trying to get levels higher and higher. Your goal is not necessarily super, duper high. Optimally what you are trying to do is get over 1.0 on that blood ketone monitor and if you’re over 1.0 that is the level that I feel the most benefit starting to really kick in.
Now, Volek and Phinny in their book talked about between 0.5 and 3.0 kind of being the range, but I found anything over 1.0 probably is going to give you the most therapeutic bang for your buck and I didn’t really see any reason to go too much over 2.0. Now, you can go over 2.0 and I have – in fact, the highest reading I ever had was 6.7 on the blood ketone monitor. My blood sugar at the time was 62 and I felt completely fine. But the goal is not necessarily higher or being better, just steady within a good range of somewhere between 1 to 3.
[Damien Blenkinsopp]: Right. As with most things it is probably some kind of U-curve where you get benefits in a certain area but if you are going to push it to crazy heights something else could go wrong that we don’t understand yet.
[Jimmy Moore]: And there is no need to do that if you don’t have to. The only thing I can think of is if you get your levels to higher amounts like that it gives you a little more wiggle room to maybe have a few more carbohydrates or a few more grains of protein than you otherwise would because it is going to knock it down a little bit and that may not be a bad thing.
[Damien Blenkinsopp]: Right, so it is literally like a ratio in your blood when there is more ketones it is hard for the blood sugar to get raised.
[Jimmy Moore]: Correct.
[Damien Blenkinsopp]: I guess this is what people are sometimes are using the MCT as well to help them along, great.
[Jimmy Moore]: Yeah, and unfortunately the MCT oil doesn’t necessarily bring down the blood sugar though because people are like, ‘Well, my ketones are 4.5 and yet my blood sugar is 105.’ And I am like, ‘Well, did you take MCT oil?’ They are like, ‘Of course.’ And I am like, ‘Well, of course your body hasn’t really adapted to using those ketones and making those ketones, and you just basically infused ketones into your body. That doesn’t mean that your blood sugar levels are going to just automatically come down.’ That is why I believe doing it nutritionally is going to give you the best benefits because you will eventually see that blood sugar go down as you nutritionally raise your blood ketones.
[Damien Blenkinsopp]: Right, so what you are saying is you have to get the blood sugar down because that is causing damage and that is a negative. And until you get rid of the negative you are not going to get all of these benefits, although you might feel a bit better if you have got more ketones running in terms of energy.
[Jimmy Moore]: And I think it takes time in a lot of people. When I first started doing this I had been low-carb for a while but not purposely ketogenic so during my experiment, that year that I did the experiment, it took probably three to four months before my blood sugar came to a level where it was naturally in the 80s range in the fasted state. It took some time to be able to get that under control and that is okay. I think that is part of the healing process.
[Damien Blenkinsopp]: Yeah, nothing is going to be achieved in one day, especially if you have been going for 20 years.
[Jimmy Moore]: Exactly.
[Damien Blenkinsopp]: Okay great, so I understand that it is a little bit complicated and there are a few different measures with different accuracy and that is one of the things you go through in Keto Clarity trying to get to the bottom of it. First of all it would be great to have a bit of background on what you achieved now – like, do you know how much time you spend in ketosis? Do you see that as the most important – 90% of the time when you test are you in ketosis? And when you slip out what is the kind of standard after you been on a ketogenic diet for like a year, or I think it is three months, is it relatively easy to be in that zone for 90% of the time?
[Jimmy Moore]: Yeah, people ask that question all the time – oh my gosh, if i have one carb-based meal is it going to knock me out of ketosis and I have to go through this all over again? One thing I have found, Damien, is that once you are in ketosis and then you have some indiscretion that knocks you out of it you can get back into it really quick. So I know that sometimes I will be in a situation where maybe I have a little more protein than I typically do and that will completely kill the ketones. Well, it takes about two to three days and I am right back into ketosis again.
So no, it doesn’t take long. I think that initial period where people try to get adapted is going to depend on their carb intake before starting. So when I started this I was already pretty low-carb, having been low-carb for a long time and just not ketogenic. So all I did was up the fat more and moderate the protein and within four days I was in nutritional ketosis. For somebody like the old Jimmy MOore who used to eat 16 cans of Coca-Cola a day and two boxes of Little Debbie snack cakes a day and was a carbohydrate-addicted mess, that man might take two or three months before he got into a state of ketosis because his body would have to deal with all that first. So yeah, I think it is going to depend very highly on the individual.
[Damien Blenkinsopp]: All right, great. So why should we test for ketosis? We just spoke about the important thing as reducing the blood sugar to make sure that is in line. Why do you see it as important also to test for ketosis?
[Jimmy Moore]: You are flying blind if you don’t. You will have assumed, like Jimmy Moore did in 2012, where I thought I was being ketogenic simply because my carbs were low. You can’t assume anything. You have to test to know where you stand so when I tested that first time, Damien, and I pricked my finger and got the blood reading that said 0.3 and Volek and Phinney said it needed to be between 0.5 and 3.0, I went, ‘Ah, crap.’ Now I see why I am having some issues going on here so without testing you are just simply guessing whether you are actually in ketosis or not. Now, you can be super, duper strict in your carbohydrates and get your protein down to some arbitrary number and eating more fat and probably most people that would make them ketogenic but unless you are testing, you have no earthly idea.
And when you first start there is probably – the easiest way when you first start, only for the first couple of weeks – I think if you want to see where you are in your ketosis go buy those urine strips. They are called keto sticks and they are about $15 for a little thing of 50 of them and you can actually test to see how you’re doing spilling a ketone body that is known as acetoacetate. So you measure for that acetoacetate and it will turn pink to purple on the pee stick and if you show any color change then you are producing ketones. So that is a great kind of reinforcement for a lot of people when they first get started. Unfortunately, they don’t always stay in the urine.
So that acetoacetate actually gets converted over into the blood ketone body and that one is called – that ketone is called beta hydroxybutyrate. And so that is the one that is free flowing in the body and when we say your body is running on ketones that is the one we are talking about, beta hydroxybutyrate. So measuring directly for that with the ketone meter – one that I love that I think is just the best one in the whole world is called precision extra. Now, the strips are extremely expensive and we talk about this in the book, how you can get them on the cheap and where to get them, but man oh man, that gives you great information.
[Damien Blenkinsopp]: What kind of price are we talking, just to give people a rough –
[Jimmy Moore]: The meter itself is about $15 to $20 but the strips in the States can cost as much as $3 to $5 apiece.
[Damien Blenkinsopp]: And how many do you use? You said before you were testing every morning and every evening.
[Jimmy Moore]: Yeah, during my experiment I tested morning and evening and sometimes every hour on the hour. So yes, it got quite expensive and I will tell you about a cheaper alternative that may be pretty good here in a second. But you can go to Google and type in ‘Canadian Pharmacy.’ And some of those Canadian pharmacies have the strips for about $2 apiece. I did see down in Australia they sell them very cheaply but there is no online place for people to buy them. I think they are like $0.70 apiece there.
[Damien Blenkinsopp]: And just to be clear you use one strip every time. So you are saying it is $2 a piece, that is pretty expensive and it is going to add up quickly.
[Jimmy Moore]: But if you are a quantified selfer and you want to see where you are going with this, that is worth it. And keep in mind you are not doing this forever. I think if you did it for a morning and night for two to three weeks just to see what it takes I think after a while you kind of know and you can kind of feel okay, I am in a state of ketosis or not.
[Damien Blenkinsopp]: That is an interesting point. Are you able now to associate with the way you are feeling or certain aspects of your being now that you have been measuring for a while?
[Jimmy Moore]: Yeah, let me answer the ketone story and then I will answer that one. So that is blood and I think blood is probably still the very best way that you can test. The third ketone body, though, this is the one that is coming in the future and it is called acetone. It is the one in the breath and that is the ketone body in the breath. They are actually coming out with these things that you can blow into so people are a little squeamish about pricking their finger and you can just blow into these devices and it will give you your ketone reading of acetone.
Now, acetone unlike acetoacetate which gets converted over to beta hydroxybutyrate and some people lose acetone on the urine, breath ketones actually correlate pretty darn well and a couple of good studies with the beta hydroxybutyrate levels in the blood. So if you are testing for breath it is not a one-for-one thing because all these ketone bodies have different mechanisms and different times that they are operating in the body but it is pretty close and people that don’t like the prick, it is good, and it is less expensive. Right now there is one meter on the market called Ketonix – this guy with epilepsy in Sweden that developed this and it is pretty darn close.
I actually tested it side by side with blood ketones and urine ketones for about six or eight months. And I found for about 80% of the time the Ketonix was spot on. Now, I did find that it was much more accurate in the morning after an overnight fast. Don’t eat or drink anything within four hours of blowing into it because apparently drinking and eating washes out some of the breath ketones out of the mouth. So you want to make sure that you are not skewing the results by eating or drinking but that is technology that is definitely developing and there are a lot more companies that are working on meters.
[Damien Blenkinsopp]: Are there slips with that? Are there variable costs involved or is it the one-off meter cost and you can use that indefinitely.
[Jimmy Moore]: The Ketonix one is a little device that you just blow into and yeah, you can blow into it thousands of times so it is not a one-off. Some of the ones that I know are in development are disposable but they are a lot more accurate apparently. We will know when they come out.
[Damien Blenkinsopp]: Yeah, are these coming out really quickly? Are you expecting over the next year a lot of different ones to come out?
[Jimmy Moore]: Well, so the one that I am aware of in Arizona is a company called InVoid Technologies and they are actually going through the FDA approval process right now and as soon as the FDA gives them the go ahead they will be ready to roll. They are hoping by this fall and I know Japanese researchers are working on an iPhone app that would be this apparatus that you plug into your iPhone and then you blow into it and it gives you a reading on your iPhone. So I don’t know when that one will be developed but I know in the next couple of years we are going to be seeing a lot more acetone readers come on the market.
[Damien Blenkinsopp]: That’s great news because a lot of people don’t like the finger pricking all the time and the pretty high cost. I don’t the glucometer all that much because of that. One thing I wanted to clear up for the audience is that you have got the ketones coming out of your breath and out of your urine – is this your body throwing these away? So we are using the proxies of something that is throwing away and it is why it is not working over time in the urine? What is the mechanism here? Ideally we definitely want to know what the blood level is because that’s the end result.
[Jimmy Moore]: Right, and so when you are using ketones in your body yeah, absolutely that is a great point. I am really glad you brought that up. When you are spilling them over into your urine, that is what the body is kind of saying okay, we don’t need these, and it is getting rid of them. So it is very transient and that is why that acetoacetate is getting converted into beta hydroxybutyrate after a while you don’t see the acetoacetate anymore because the ketones have made that shift.
You have gone from sugar burner to fat burner. When you are still making that transition the body is like, ‘Oh, it is giving me what I want to be able to convert these ketones in the urine and acetoacetate over to beta hydroxybutyrate in the blood.’ So yeah, absolutely they are a waste product but it is a transitionary type of thing.
[Damien Blenkinsopp]: So that sounds like a positive thing. If your urine stops producing these it actually means that you have adapted metabolically to burning ketones properly?
[Jimmy Moore]: That is exactly right and that is why testing blood is so critical because you could pee on a urine stick and see no ketones. That can mean one of two things – one very bad thing or one very good thing. The very bad thing is you are still not in ketosis and you are not making ketones in the blood or you are in great ketosis and you have become fully keto-adapted and you have now shifted all of your acetoacetate over into beta hydroxybutyrate and that is a very good thing.
Now, the problem with this Damien is it only happens in some people. Others, myself included, show ketones on the pee sticks basically all the time. I don’t ever not show it. So I am one of those people who shows both acetoacetate in the urine and blood ketones and that is okay too. I think it is more important to know what your level of ketones are in the blood because that is the one that actually matters.
[Damien Blenkinsopp]: Is that exactly the same measure? Like, you gave us the 1.0 reference there. Do they give you the correlated or do they give you another measure that you then have to kind of map?
[Jimmy Moore]: Unfortunately it doesn’t work that way because it is not the same ketone body. There is just a correlation there so when they have done the studies they showed that when your level of blood ketones are at a certain level the acetoacetate is also at a corresponding level. Unfortunately those levels aren’t spot on perfect but they are pretty darn close and from a cost-effectiveness I would rather blow into this device that costs $100 a be kind of close 80% of the time than to necessarily break the bank testing blood. But if you can afford it definitely do the blood more than anything.
[Damien Blenkinsopp]: Yeah, so it sounds like the testing strategy would be like as soon as you want to do this for the first month you can probably do the urine one without any concern or do some people adapt quickly?
[Jimmy Moore]: My strategy would be yeah, use the urine test for the first week and see if you are even producing ketones and if you start to see color change on there then go grab you a blood ketone monitor. Then if you want to do it on the cheap you can use 8 total strips within a month and here is how you do it. Sometime during the week measure in the morning, so when you wake up in the morning before you drink or eat or do anything – well, you can go to the bathroom but before you do anything that you would ingest, prick your finger and see what your blood ketone level is. It is probably going to be lowest in the morning, highest in the evening, but test that one time in the morning and sometime during the week. So let’s say you choose Tuesday morning to test, so test it and write that down.
Then some other time during the week test at night. So let’s say you choose Saturday night, so you do a test on Saturday night at night at least four hours after eating or drinking anything and test and see it again and that number should be higher at night than it was in the morning. It is not always true with everybody but that is the general correlation. And then do the same thing again the next week, the next week, and the next week. So over a month period you get to see the trend of how you are doing in the morning, how you are doing in the evening, and over time you will be able to see how you are doing in your state of nutritional ketosis. That is 8 strips and even if you paid $4 a piece for those that is still about $32, not as bad as pricking your finger every single day morning and night and breaking the bank.
[Damien Blenkinsopp]: Great, thank you so much for that. It is very valuable. Then would you move over to –
[Jimmy Moore]: Acetone in the breath, yeah, as a maintenance strategy once you kind of get going with this blood ketone thing for a while and you are like me and you can kind of sense where you are, I can almost within a few tenths of a [inaudible 00:53:35] pretty much tell you what my level of ketosis is on a blood ketone meter now, just by how I feel.
[Damien Blenkinsopp]: In terms of that feeling, what is it? Is it like an energy feeling? Or is it something else?
[Jimmy Moore]: Well the energy you are going to have being in a state of ketosis. That definitely is a big one, the mental clarity, the hunger control. That is a big one. But I am talking about just kind of intangible type of feelings like in my mouth. When I wake up in the morning I can almost tell just by – it is not really a film or anything but just kind of the feeling on my tongue and I can just feel that I have got a lot of ketones going on. And it is a beautiful thing and I have been doing this a while, Damien. It is kind of cool that I really have to prick, but then I do prick my finger and it is 1.4, and I am going wow, okay yeah. I felt it right.
[Damien Blenkinsopp]: I was interested if you have looked into fasting and intermittent fasting and any kind of impacts that has on ketosis?
[Jimmy Moore]: Yeah, we did a whole chapter on just this topic in Keto Clarity because it is the other F-word because people don’t like the word fasting and yet this is one thing that I have found doesn’t have to be forced. In fact when I first started doing my testing my wife Christine looked over at me one day and she said, ‘When is the last time you ate?’ So I looked up at the clock and I noticed it had been 24 hours since my last meal. And I went, ‘Oh, it was yesterday. I guess I could eat something.’ You totally forget to eat because is it is so satisfying and the hunger is under control.
So I have never been a fan of intermittent fasting before I started doing this nutritional ketosis thing but what I found is if you allow your body to do it naturally in response to your satiety signals, being under control, not having hunger to me, Damien, is a great sign of metabolic health. I think if you are doing it naturally, don’t starve yourself. People say, ‘I could never do intermittent fasting because I don’t like being hungry.’ It’s not about being hungry. It’s about allowing your body to kind of basically use your fat for fuel. So you do that by allowing your body to eat the fat that is on your body and the way you do that is not giving it more energy to deal with in the interim. So that is why intermittent fasting is so incredibly important.
[Damien Blenkinsopp]: Have you seen anything interesting from the measurements of the ketosis when you were fasting? Is there any difference that you see or in typical scenarios of fasting which compares to when you are eating fats on a typical diet?
[Jimmy Moore]: Yeah, one thing you will see is that is a great way to raise your ketone levels. The reason why is people are eating so often because they are just eating by the clock. So it is 7 o’clock in the morning, oh, it is breakfast time, so they eat. And then noon comes around and oh it is noon, so it is lunch time. So then they eat. And then supper comes at 5:30 or 6 o’clock and it is supper time, so they eat.
So they are constantly eating and they are never allowing their body to really tap into those energy stores that are on their body – even if you are eating low-carb, high-fat, you need to give your body some of those times between the meals to be able to make the ketones and utilize the ketones and one thing to remember is if you are getting hungry that quick after eating, so like you ate at 7 and the you have to eat again at noon, five hours later, you didn’t eat enough fat or enough fat in that earlier meal. So try bumping up the fat and making sure the carbs and protein are where they need to be but try bumping up the fat earlier in that meal or earlier in that day and then maybe skip that lean meal and then eat again at 6 o’clock. Now that is a great sign of metabolic health.
[Damien Blenkinsopp]: Right, so would you say most people could eat twice per day and that would be –
[Jimmy Moore]: Once or twice a day is about the pattern that I fall into most days.
[Damien Blenkinsopp]: Once per day?
[Jimmy Moore]: Once or twice per day.
[Damien Blenkinsopp]: That is great to hear. I know I have been doing this for a while too and I forget to eat a lot and I find that I get a lot of work done.
[Jimmy Moore]: Yeah, absolutely. You become more productive and me, that’s money. Time is money they say but that really does make you much more productive in your day if you don’t have to sit there and constantly think about food. Think about all these people, Damien, when they go eat. What is the thing they talk about when they are done eating? Gee, I wonder what I am going to have for lunch after they had breakfast. Gee, I wonder what I am going to have for dinner when they are just done with lunch – so people are always thinking about food, let’s get away from thinking about food and go into more important things.
[Damien Blenkinsopp]: For sure, it is very distracting. So when you fast and you take fat – some people talk about you are fasting and then you have some fat while you are in that fast and they kind of count that still within the fast. Is that how you look at it?
[Jimmy Moore]: No, because technically a fast is going without food. So if you are giving your body nutrition – I assume you are referring to bulletproof coffee for example. Some people actually write to me and in fact I just got an email from a lady, ‘So if I still in a fast if I am having bulletproof coffee?’ And technically a fast is no nutrition at all, no food or anything, so no, but I don’t think you will necessarily lose your ketones doing that because like we said earlier carbohydrates will raise blood glucose which would kill your ketones and protein in excess will raise your glucose, which will kill your ketones, but fat is pretty much benign on blood glucose levels and so you should not lose your ketones.
So it is a good strategy, especially if you think you are going to feel a little bit peckish and need to eat a little something – definitely have that and I am personally no fan, Damien, of coffee in general. So I don’t do that and I would much rather have the butter straight up.
[Damien Blenkinsopp]: Yeah, that is good to hear. Butter has a bit of protein in it. Do you make the difference between like [gui 00:59:25] and other pure sources of fat versus the one that has a little bit of protein in it? Is this something you think about when you are eating or would advise certain people, maybe those with more difficulty that others, who should think about that sort of thing?
[Jimmy Moore]: If people are sensitive to dairy in general I think they should be very careful with that. That is where foods like [gui 00:59:43] and coconut oil step in to help those people. But if you don’t have a sensitivity to dairy certainly butter is okay. I have never thought about the protein content of butter because it is so overwhelmingly high in fat, especially saturated fat, which is what I want.
[Damien Blenkinsopp]: Great. I am just wanting to look at some very typical scenarios of when people are doing this and what kind of challenges they have come across. You have kind of gone for the typical one where it is pretty straightforward to getting ketosis, but what are the common troubleshooting that might come up where they are not getting into ketosis based on the measurements we have just been talking about. What are the biggest things that they should be looking for that might be getting in the way?
[Jimmy Moore]: They are doing it all wrong and we kind of touched on this already that one of the big ones that we talked about in the book that I think bears repeating over and over and over again is that protein thing. Don’t overdo it on the protein. And some people are like, ‘Well, I am only eating 150 grams of protein and I heard that one gram per kilogram of body weight or 1 gram per pound or whatever the different calculations they have,’ and that is a big one. Maybe you are using too much protein in your diet and that is going challenge you and you are going to be like, ‘Well, dang, I can’t get into ketosis because it is always low.’ It is probably that protein.
[Damien Blenkinsopp]: So that is the biggest one? That is the number one?
[Jimmy Moore]: That is the biggest one. I think if people, whatever amount of protein they are having, and they are not seeing ketones, obviously make sure your carbs are dialed in because that is an obvious choice and obvious thing to look at, but the protein and dialing it in, that has helped so many people.
I have already gotten this book that has been out a couple of weeks and I have gotten more emails from people that said, ‘Thank you, thank you, thank you for telling me about the protein moderation. I have been stuck for 2.5 years, I have been stuck forever.’ This was kind of a cool one – ‘My fasting blood sugar was between 98 and 105. All I did was moderate down my protein by about 15 to 20 grams from what I was eating and now it is 85.’ It made all the difference in the world. So don’t neglect that one.
Then we also talked about how people are using urine ketones to test and we have already explained why that is a bad thing and you might want to take another look at the blood ketones. Saturated fat and monounsaturated fat I think we have become so fat-phobic in our culture that even people that know those things aren’t harmful to their health, maybe in the back of their mind they go, ‘Well, if low carb is good maybe I should back up a little bit on my fats.’ No, you need to probably eat more fat than you have ever eaten in your entire life.
[Damien Blenkinsopp]: Could you give us an example just to make it kind of concrete, like five sticks of butter or to put it into terms so people can get it because I know that not eating enough fat is one of the issues, which I think is what you are pointing out.
[Jimmy Moore]: Well, and again it is going to go back to the individual. So for me I have to keep my carbs very low, so that is around 30 grams a day, and I have to keep my protein moderated at a pretty low level of around 80 grams a day. So everything else in my diet has to be comprised of fat and depending on how many times I eat in a day, if I am eating twice in a day obviously it is not going to be as much in that one meal as it would be in two meals so one meal a day – you need to get all of your calories in that one meal.
And I think when you skimp on the fat you do several things and you don’t give your body enough of the materials that would keep you satiated so you don’t have to eat again and then you are not able to produce the ketones that you would want to produce as well and then you get into a hypocaloric state, which brings on some of the negative side effects that people say about ketosis – that it damages your thyroid and all this other nonsense that is put out there.
All that is is you are not eating enough calories and that goes back to the fat thing. So for me if I am making a meal, let’s go back to that egg meal I was talking about earlier. I would cook say, four eggs cooked in butter. I would put cheese on top of that and then I would have an avocado on the side of that. I would have sour cream and maybe some sausage. Now, that is a whole lot of fat.
[Damien Blenkinsopp]: That is mostly fat right there.
[Jimmy Moore]: And it is a moderated amount of protein and very few carbohydrates. Most of the carbs are from the avocado but that is what I know I need to do in order to produce the ketones to feel satisfied and have all those benefits that we talked about in the beginning of the podcast and all those benefits come because I eat that kind of a meal.
[Damien Blenkinsopp]: Great, I think that is eye-opening for a lot of people who haven’t been doing this for a while. You have a lot that you have to get through. Have you ever seen any negatives from consuming this much fat? Like people’s measurements or biomarkers or anything that goes wrong in some areas? Is there anything to look out for on the negative side?
[Jimmy Moore]: Well the doctor will think it is wrong but your LDL will probably go up, the LDL-C number we were talking about earlier and your total cholesterol will also possibly go up, not in everybody but definitely in a certain segment of the population and keep in mind that when you are still losing weight, don’t be doing any testing because your body is in a transient position at that point. You will have some levels of cholesterol and different other markers that may, in that interim while you are losing weight, while fat is being mobilized in the body – it may show up on these tests as a false negative.
So if you are losing weight get weight stable for a few months and then go get tested and you will have a much more accurate picture so yeah, your doctor may see some funky things on your panel and say, ‘Oh, you have a statin drug deficiency. Let’s give you Lipitor for that high cholesterol.’ No, that is not necessarily true. Definitely read my book, Cholesterol Clarity, if you want to know the whole story about that. but yeah, that is definitely a very good point, thank you for bringing this up.
[Damien Blenkinsopp]: Thank you, I just wanted to make sure we covered any of those downsides. I had very high LDL and I got told the same story by a doctor. So I think it is not uncommon. I think a lot of people have walked into doctors with high LDL and they start eating differently like this. So they expect it, basically. I just want to ask you a few rounding off questions now and thank you for the review of all the ins and outs. Who would you look at besides yourself to talk about these types of topics or other health-related topics in terms of who have good data vision on it? Are there people that you have learned from or that you respect or that you look at?
[Jimmy Moore]: I am going to turn to my co-author first because I think he is one of the leading voices on behalf of ketogenic diets, his name is Dr. Eric Westman. he is a researcher at Duke University in Durham, North Carolina and has been using this in research and practically with patients for over a decade and a half now. He has been doing some really great work over the years and I am very honored that he decided to join little ol me in writing books about these subjects but he is a great one that I think more people should know about.
But he is not alone and I mentioned earlier that there were two other researchers that had written some books as well, the art and science of low carbohydrate living, low carbohydrate performance and they also co-wrote the book with my co-author, Dr. Eric Westman and the New Atkins for a New You. They are the low-carb researchers, Dr. Steve Phinney and Dr. Jeff Volek doing some really fantastic work. Keep an eye on them in the coming years because they are doing a lot of work with ketogenic diets and athletic performance. You might have heard about Labron James cutting his carbs and getting in better shape since the end of the NBA season and that’s huge. Guess how he did it? A ketogenic diet.
So we are seeing more and more of these things happening in our mainstream culture and it is the influence of these researchers like this now. Besides the United States you can go around the world. In Sweden you have got Dr. Annika Dahlqvist, Dr. Andreas Eenfeldt down in South Africa. You have got professor Tim Noakes who is doing some really good work. Over in the UK you have got Dr. John Briffa and Zoey Harcombe, all kinds of people literally around the world who are using this approach to help improve the health of their patients and of their clients and it really is catching on like fire and I am really privileged to kind of be on the forefront of this ketogenic diet movement.
[Damien Blenkinsopp]: Great, thanks for that. That is a great list and we will make sure to have all of those in the show notes. What would be your number one recommendation of one piece of data someone should track in this area if they want to keep an eye on it?
[Jimmy Moore]: Blood sugar. You knew that was what I was going to say. Blood sugar.
[Damien Blenkinsopp]: Well it is good for reinforcement.
[Jimmy Moore]: Absolutely, I can’t emphasize blood sugar enough. I think everybody right here right now listening to your podcast, if you do not own a glucometer go to the store and get one. Measure your blood sugar. Do it when you wake up in the morning and if it is over that 90, 92 level you probably need to make a few changes to something and definitely a ketogenic diet will help you get it lower and into that better range.
[Damien Blenkinsopp]: Great, thanks very much. So are there any other data metrics that you track? What do you track currently, routinely? Once a month? Once a week? Once every day? What is your ongoing measurement cycle?
[Jimmy Moore]: Because I did that test for a whole year I don’t really like to test too often unless I am actively doing an experiment. I know I do test blood sugar pretty often and I also test ketones with that breath meter I was telling you about. I do that every single day now. I do step on the scale – not because I think there is any inherent good or bad that comes from seeing what your weight is, but I think it is a good marker to keep an eye on.
So I do this very easily where we step on the scale and you can see where you stand. I don’t let it mess with me psychologically. If it is up, okay, whatever, and if it is down okay, whatever. It doesn’t really mean anything but it does kind of let you know okay, something is going on in the body that might be making weight fluctuate. And then when I do blood tests I do like to run that CRP to know where I sand. I do like to run triglycerides, like we mentioned earlier.
But I am one of those people where I have done so much testing I almost know where I stand and I don’t get so obsessive about it that I feel like I have to do it all the time. I think if you do a once or twice a year whole body analysis that is probably going to be enough for most people.
[Damien Blenkinsopp]: Right, that is great. It sounds like mostly the blood tests, right, and you are doing them once every six months?
[Jimmy Moore]: Yeah, like thyroid, cholesterol.
[Damien Blenkinsopp]: LIke you said, the things like CRP and these other things, you don’t see them vary that much if you have been living the same kind of lifestyle and it shouldn’t really be jumping around or doing anything anyway.
[Jimmy Moore]: But it could be a precursor of something happening so that is why it is important to run it and to kind of see if anything is off the charts. Now, that doesn’t mean one reading should make you upset but that one reading if something is off then okay, get that same reading within six months and let’s see how you’re doing.
[Damien Blenkinsopp]: Yeah, and I just remembered a confounder we didn’t talk about, and this happened to me. I fell on my ass and broke my coccyx and then unfortunately one of my first CRP tests was pretty soon after that. It was high because I had a lot of information going on in my body because of broken bones rather than anything else going on. So then obviously it covers all sorts of information from beyond this and broken parts of the body. And also overtraining is I think an obvious one, like a lot of crossfitters would have that a bit higher than me or other people.
Well, Jimmy, this has been great and there are tons of metrics. This has been such a full episode and thank you very much for your time and going through the ketosis topic so comprehensively. It is a great map.
[Jimmy Moore]: Thank you man and I really appreciate that podcasts are out there because I think this whole quantified self movement and trying to make yourself into a great, quantified body – this is the future of medicine so you are really leading the charge with this podcast and I just wish you well as you continue on.
[Damien Blenkinsopp]: Thank you so much. I am really happy that you are doing your work as well because we can learn from you.
[Jimmy Moore]: I have done a couple.