Does HIIT take a hit on a ketogenic diet?

Much of the research points to the utility of a keto diet for increasing fat oxidation for longer, slower training. After a period of adaptation, athletes are then able to tap into an alternative fuel source which affords them an extensive supply of fuel at a steady rate, unlike carbohydrate (glycogen) stores which are limited and easily depleted in a moderate-long training session. Thus, it stands to reason athletes are able to go for longer than if they are straight carb-burning athletes in an endurance event – something that Maunder and colleagues discuss in this most recent paper outlining the practical application of a low carbohydrate diet for athletes of varying abilities. However many of the recent randomized trials (such as this one here) have found that performance, particularly at the top-end of the spectrum, is compromised when athletes switch to a lower carbohydrate approach. Further, the relative effort at a given heart rate is increased. You go slower, but it feels harder. Ouch. This understandably makes an athlete’s coache a little nervous to recommend their athletes go on a lower carbohydrate diet.

Interesting though, this is not the experience of many people I work with who transition to a lower carb diet. If anything, performance improves for the athlete (something I’ve written a lot about over the last few years, including this blog here). Given enough time, any reduction in power that occurs early in the transition phase appears to be reversed and the athlete comes out leaner, stronger and fitter in their endurance training. Reducing reliance on carbohydrate as a training fuel reduces the oxidative damage that occurs during training, thus inflammation is reduced. They aren’t placing their body under as much oxidative stress and therefore the athlete can train more consistently during the season with less risk of stress-related injury and illness. This may also be due to a higher presence of beta hydroxybutyrate in the bloodstream, which act as signalling molecules and increase the transcription of enzymes that encode antioxidant genes superoxide dismutase, catalase 2 and glutathione peroxidase. This helps scavenge free radicals created through training and protects the athlete from tissue damage. This may be one of the reasons why they are seeing better results with their key races.

Two of my mates felt similarly, and experienced similar benefits of adhering to a low carbohydrate diet, experiencing no detriment to high intensity training, despite what the research deemed. So they decided to test the hypothesis.

They took 18 male endurance athletes who were habitually eating a standard western diet, and randomised them to consume either their normal diet (control group), or a very low carbohydrate ketogenic diet, consisting of no more than 50g carbs per day for four weeks, and performed graded exercise tests before and after the experiment, and a HIIT session (5x3min, work/rest 2:1, passive recovery, total time 34min) before, and after 2 and 4 weeks.

The researchers found that (as expected) fat oxidation levels increased in the experimental group throughout the tests, and total time to exhaustion, performance in the HIIT session and rate of perceived exertion was no different between the groups. Ergo, the ketogenic diet did not impact the athlete’s ability to undergo high intensity training (nor make it seem harder for them). Interestingly, the level of protein in the diet was around 29%, higher than the 17% used in other studies – this could account for the level of ketones present in the blood stream that were lower at the end of the study (0.4 mmol/L), just out of the ‘nutritional ketosis’ range. The difference this may have made to the athletes’ performance, however, we don’t really know.

Many of the studies conducted that have found performance is reduced are likely too short to allow the athletes to adapt to a ketogenic diet, which is thought to take several weeks to months. Hopefully this new research makes you think twice about taking the results of a study like such as the one here, as a reason to dismiss the low carbohydrate diet for athletes.

To recap, then, of what we know is possible for athletes following a lower carbohydrate approach:

As a side note, lots of peeps look at the elite athlete who chows down on carbohydrate in racing and during everyday life and thinks to themselves that, if they can perform to that standard eating a higher carb approach, then why can’t I? A couple of points to note:

  • The elite athlete may train from 20-30 hours per week – by default they spend a lot of time in a depleted state, meaning they are likely training low glycogen as it is impossible to replenish carbohydrate at the rate they are burning it. This is going to afford them the same capacity to train in the lower carb state that provides enhanced training adaptations. The average age grouper may have time to train 12-18h a week maximum, and don’t have the volume available to get into the low glycogen state.
  • They are elite for a reason. They are able to go harder and faster than most people –psychologically they are able to hurt more and potentially go longer before they bonk – we age-groupers have more of a preservation mindset. They may also be able to train harder when in an inflamed state for this reason. I’m not saying this is ideal (far from it). I’m just putting it out there as a reason why there are professionals who are able to see results where others don’t.
  • Even at the top of the field the elite athlete can suffer, and far more than an age-grouper. Years of a nutrient-poor, carbohydrate rich diet and overreaching to the point of overtraining will leave an athlete burnt out and unable to continue on at the level they previously enjoyed. It might appear that elite athletes are bullet proof but I’m sure as you’re reading this you’re thinking of someone who falls into this category. Things aren’t always as they appear, and the golden glow of success can be pretty fleeting.
  • Of course, there are others who are just awesome and continue to turn up and take it out year after year, regardless of diet, training methods, lifestyle etc. Like the people who drink every day, smoke like a chimney and don’t eat vegetables, yet live to 102 years.
  • Re: racing high carbohydrate – that Maunder paper again – worth a read.

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Keto diet update: week 2.

I wasn’t going to post again about my ketogenic experiment. Well, not immediately. However after getting 28 more followers of my blog in the last week, I figured that perhaps this was something people were interested in hearing more about. It makes sense. A ketogenic diet is the extreme version of a low carbohydrate diet. And when you combine the words ‘diet’ and ‘extreme’ in reference to an eating pattern, then that’s bound to spark some interest. Think ‘magic bullet’ It’s like Beyonce endorsing the lemon detox diet. Except she likely received a hefty payout for the pleasure of losing 9 kg in 7 days (to then gain it all back… but who’s counting?) I’m still waiting on my cheque. Not sure who to contact, however. Within the last week I have delved further into the information I have around what constitutes a ketogenic diet. How much of what we read on the internet is in fact ‘ketogenic’ and how much is someone’s misinterpretation of it?

For example, there are a few websites that provide information on the ratio of carbohydrate (CHO) and protein to fat that you should aim for when adopting a ketogenic diet. This keto calculator here gives a good overview of the information that should potentially be taken into account when providing structure to the diet. I used this as a starting point with regards to CHO and protein, and adjusted the fat grams per day so the end result wasn’t a hefty calorie deficit leading to unwanted weight loss. However, as that is the end goal for a good number of people, it will provide some idea of the macronutrient totals. On that note, there is a misconception that you can eat fat ‘ad lib’ and you will lose weight or – at the very least – not gain it. That’s just not the case. I know many people who have dabbled in ketosis and have not been successful with their desire to lose weight, whereas others have found the weight has literally dropped off. Of course, as ketogenic diets are the extreme end of a low carbohydrate, high fat (LCHF) diet, there are many people who have lost weight just by opting to include more real food in their diet and have spontaneously eaten less due to the higher satiety factor, without the need to meticulously count macronutrient grams, weigh food portions or think twice before eating out.  This can be a source of frustration for others who have committed to doing all of the aforementioned but have not had the same experience. I did wondered if part of this is to do with the macronutrient ratios – that their protein and/or CHO grams are too high to truly get into ketosis and enable the body to adapt to burning fat. I emailed Stephen Phinney – one of the world’s experts in the ketogenic diet and co-founder of the Art and Science of Low Carb – a website where you can find information on the research he has conducted and the books he has authored with Jeff Volek and Eric Westman. His response?

The simple answer is that if your ketones are above 0.5 mM and after a meal you are satiated (while keeping protein in the area of 1.5 g/kg), then you have got your diet right.  Rather than trying to prescribe fat intake in grams or ratios, it works best to eat fat to satiety.  In this regard, it is important to recognize and manage ‘fat hunger’ by having high fat items available so that one is not tempted to over-eat protein.

And that makes sense -so potentially it has less to do with the ratios as a rule, however they are the starting point for some people and could help if they are having trouble regulating their protein intake. For some, however, merely recommending they eat fat to ‘satiety’ is too difficult for them to put into practice successfully and still lose weight. It is entirely possible to get into ketosis and have blood ketones above the 0.5 mM that illustrates they are being used as the predominant fuel source. However, the amount of fat consumed is in excess of what they need, and the fat that is used for energy is provided by the diet, therefore there is no physiological requirement for burning body fat. Frustratingly, despite meticulously counting macronutrient ratios, watching protein portions and being mindful of situations that could blow them out of ketosis, those jeans are not getting any looser.

While managing fat hunger is the key, it’s really difficult for some to recognise their fat hunger – as this is relying more on the physiological signals sent by the body in response to the food eaten. For many people, the hormones responsible (insulin and leptin being the predominant ones) are either disrupted due to poor metabolic health and/or being overridden in the context of the food environment they have been exposed to for most of their life. The food choices that have been part of a ‘healthy, balanced diet’ have constituents that drive appetite and feed into our food/reward system in the brain that extend far beyond our physiological needs. Couple that with ingrained behaviour whereby we must eat what is in front of us, it is rude to decline a piece of home made cake, and those around us comment on what we choose to eat or not to eat, it is no wonder many people have lost touch with their true appetite.

As with any change in diet, it’s such a good time to assess the effects of those environmental cues on your own appetite and adjust where necessary. Serving smaller portions is a great start when following a ketogenic diet, as fat is naturally more satiating. Chewing food properly and finishing a mouthful is also key. For some, putting their knife and fork down in between bites is a good way to do this. Eating without distractions is often recommended, though some can read/browse the internet while still being mindful of their food intake – so use your honest judgement here.

I’m also learning a lot about my own dietary habits and how a change in eating has affected other things. In no particular order, these include:

1. For the first time in memory I’ve been consistently sleeping through the night. I mentioned this last week but in the last seven days I’ve slept through the night on all but one occasion. I put this down to a reduction in vegetables that I’ve been eating. Don’t go thinking I’m vegetable free – at ALL! I’d easily meet the 5-a-day recommendation for me, you and that person who sitting over there on a normal day. Now I’d probably just meet mine and yours. This reduction in water means I’m no longer getting up in the middle of the night and despite the fact that humans likely didn’t sleep throughout the night back in paleolithic times, I’m loving the uninterrupted sleep I’m getting.

2. While I was meticulously weighing my food portions in the first 10 days, I’ve reached a point where it’s easy for me to eyeball amounts. I have eaten out a few times over the holiday period, stayed at a friend’s house for three nights and maintained my ketone levels between 0.7 mM and 3.9 mM.

3. Training hasn’t been that bad, aside from an almost repeat of last Friday’s run. This time it was on trails and I knew within two minutes it was going to be a long 90 minutes. I believe this was down to dehydration actually – my heart rate shot up immediately, then settled, though was still a hard run. There has been a slight decrease in strength for my weight training also. However I’m a bit slack on that front so there are obviously confounding variables (as with all of this…) These have been offset by some awesome sessions too.

4. Throughout the day my energy levels drop off markedly – more than usual I believe. I think this will change as I adapt. I understand, according to Steve Phinney, that it can take up to 12 weeks for that to occur. Perhaps this is longer than a four week experiment.

5. Peter Attia, The Eating Acadamy, is a WEALTH of information – the posts are just the start of it. He is amazing with his responses in the comments sections and I’m learning a lot there. Go over and check it out if at all interested.

6. It took about a 10 day period to get my head around the smaller portions and that they would be filling enough. The reason why I ate so many vegetables is down to being a calorie-counter for over half of my life. As vegetables are low energy, nutrient dense, I relied on them to fill me up. This clearly goes hand in hand with the ingrained dietary fat phobia for the same time period and my tertiary education in nutrition. If you think it’s hard to get your head around a high fat diet, try having the nutrition qualification at the same time. THAT is a challenge ;). Whilst I’ve made massive dietary shifts over the last 18 months, this experiment has been as much about what I’d experience psychologically as it has been physically. I have read the science that clearly shows fat doesn’t make you fat. I tell people on a daily basis that fat doesn’t make them fat. I have had clients and friends who have upped their fat intake (within and outside of the ketogenic diet) and have seen them improve or maintain an already good body composition throughout. Perhaps for some, seeing that with their own eyes would be convincing enough. It wasn’t for me. However, after 13 days on a ketogenic diet, one kilogram down from when I started,

7. Fat – from between 130g – 200g per day depending on the day, in the form of cream, nuts, low carb desserts, olive oil, coconut oil, butter, cheese, coconut cream – is not making me fat.

So… have you gone all keto?

Yes. But unlike my decision to ‘go paleo’ this was a predetermined, calculated, conscious decision and not ‘by default’, which is how my whole food philosophy came about. And that’s largely because it would be very difficult to just ‘go keto’ without some predetermined, calculated, conscious decision making occurring. Although, with the wisdom that is obviously gained from now 9 days of carbohydrate and protein restriction, and the consumption of vastly increased grams of fat I am pretty sure a lot of people out there who believe they are ketogenic might not be – if the websites devoted to keto foods and recipes are anything to go by. How on earth would they be in ketosis with protein portions that large??

Now why would I bother jumping on the keto bandwagon? A few reasons. A lot of people I know have tried it and I’ve reached a point where I’m curious enough to see if I had the discipline to follow such a strict dietary regime (regime is a rather harsh word, but I feel it’s applicable for this diet). Whilst some people observe what I eat and exclaim how ‘disciplined’ I am (like it’s a virtue), I love what I eat and eat what I want – eating a real food diet isn’t about discipline, it’s about pleasure. The strict limits on not only carbohydrate but protein requires discipline largely reserved for the very analytical and uber intelligent (i.e. Peter Attia over at Eating Academy).

The second reason is self experimentation – a far cry from the days I mocked people for using the term n=1, I now wanted to experience, document and reflect on how it feels to undertake a ketogenic diet. A great way to learn and understand anything is to experience it. My weight and body image issues growing up, for example, have provided me with better insight into the challenges faced by clients who battle with similar problems, despite the fact that, physically, we may look very different. As a number of my clients now have heard of a ketogenic diet and just want to try it, or have legitimate health reasons that warrant a ketogenic approach as a tool to improve metabolic health markers, then to be able to speak from experience is obviously advantageous.

The final reason is because Caryn gave it a go. And therefore, out of those left in our research team at Human Potential Centre who had yet to follow a ketogenic diet, I was the only person left who had yet to try it. Other than Scott. And as he is still drinking energy drinks (albeit he’s switched to the sugar free variety, and swigs water after having it to protect his teeth), it’s fair to say our respective diets are poles apart at this point. However he has recently jumped on the Twitter bandwagon so I’m sure it won’t be too long before he’s swigging bottles of MCT oil and professing the benefits of butter like it’s nobody’s business. However, I am a nutritionist and, as the last one standing I felt not a small amount of FOMO by having not at least tried it. I’m actually in the best position out of my colleagues – as I can learn from their mistakes. Like I did at St Johns. As a cadet in my younger years we had regional competitions that required assessing a medical emergency and stitching or bandaging people up with the one who illustrated the most knowledge walking away with the trophy. As my last name is Williden I was usually last to front up, and my St John’s group would filter information to me so, by the time it was my turn, I was armed with all necessary information to go into the medical situation and assess, inform, and bandage with skills that would make me an indispensable member of McDreamy’s team. This ketogenic diet experiment is not dissimilar, minus the trophy and the badge to stitch on my jersey.

So Day 9… A short time, sure. But I’ve learned a few things already.

  1. It’s hard to stick to the protein limit. Really hard. I got an inkling of that when I read Tim Noakes’ Real Meal Revolution recommendation of keeping animal protein to 80g per meal absolute amounts. But who also knew vegetables contained so much protein?
  2. That it is hard to get the amount of fat necessary for ketosis and overeat. My food volume has dramatically reduced. Obviously, though, if you do eat more fat than you need, this will be reflected in weight gain/gastrointestinal problems etc over the long term.
  3. That I’d wildly underestimated the amount of peanut/almond/coconut butter I actually ate in normal life (like somehow the Gilmours 3kg bags of nuts just disappeared of their own accord). I’ve never tracked my food to this extent (using Easy Diet Diary app for iPhone) and it is a real eye opener.
  4. That not all food apps are created equal. For example, Fitday lists broccoli has having almost as much carbohydrate as pumpkin. It doesn’t.
  5. That for some people to get into ketosis, 50g of carbohydrate (CHO) might be too high, and closer to 30g is better. Is this a female thing? Maybe. This is clearly insight from Caryn who passed this on. While the academic literature often places limits of 20-30g CHO/day,  there are also studies that refer to a low carbohydrate, high protein diet as ‘ketogenic.’ Confusion is clearly not limited to the bloggersphere.
  6. There is a lot of misinformation on the Internet about ketogenic diets. But there are some very smart people writing about this – way smarter and knowledgeable than I am.
  7. People are unnecessarily verbose in recipes and post too many ‘stages’ pictures.
  8. That, despite being my dislike of Thai food and Thai restaurants, I really like my own Thai red curry coconut chicken. (I must be the only person who doesn’t like Thai food. I know. Is it the cheesy American cover songs and proliferation of sweet chilli sauce? Maybe).
  9. That making pastry is way easier than I ever realized.
  10. That if you decide to make pastry to turn that chicken curry into a pie, you should probably check that you own a rolling pin (or a good substitute) first
  11. That I make really good rhubarb crumble and chicken curry pie. These and other recipes are over on my Facebook nutrition page – definitely check them out.

Other thoughts:

  1. Training wise – I’ve felt great. Up until Friday and then it felt like I’d been turned upside down and emptied out. Hardest. Run. Ever. Barely breaking 5.30 k’s (actually that’s an estimate – thankfully Nicky’s evil Garmin wasn’t working and I was too scared to wear mine). Friday and Saturday were complete write offs but today’s run – storming. Seriously. Even after doing weights yesterday I woke up feeling better than I have in a long time.
  2. During normal day: I’ve felt flat. A bit sick on some days too – and particularly on the days when I missed having a coffee with cream, or something similar, which reduces amount of fat I start the day with. But, again, today I feel back to being awesome.
  3. Twice during the week I woke up and couldn’t get back to sleep for an hour. Unusual for me, though not unheard of. Last night I slept right through. This may be due to the diet, might have nothing to do with it.
  4. I miss fruit. And dates. And wine (for now – I’m abstaining for now, given that alcohol is preferentially metabolized in the body – which would largely offset my efforts to turn fat into the go-to fuel tank).
  5. While I, like many people, have my go-to foods, nine days into this and I’ve needed a bit of variety to keep me focused. I typically eat a TON of vegetables, and would feel largely dissatisfied to sit down to a third of that with extra dressing added as a fat source.
  6. It’s a shame that I’m making all these awesome meals and I have yet to meet my future husband. He is seriously missing out on some good eats.

I know. I’m late to the party on this. Just like the paleo/real food/whole food movement, I’m pontificating on something that some of you reading this would have read about, adopted, wrote about, reflected on and then moved on five years ago. If this is you, and you have some wise words then please share! This is a learning curve for me (and clients) so the more I know the better.

So I’m hoping for that ‘keto’ clarity, that ethereal experience people talk about, and that today’s run was indicative of the amazing training that I will experience as I undergo this keto experiment. (It goes without saying that this will of course turn me into an amazing athlete lol) I’m also hoping that my experience will add to the information out there that seems, for the most part, from the male experience. There are a few women writing about it, but it is largely a male dominated space. I will keep you updated, both here and on my Facebook page. Right. Off to make keto hot cross buns. Because nothing says Easter like almond flour buns dressed with a white cross.