Increase in Cancer Among Obese Young Adults and the Poor

Obesity among young adults is on the rise. This cases may start as early as from childhood, teenage years or even at the onset of young adulthood.

Cancer related diseases such as those that affect the pancreas and colon are likewise on the rise due to much deposition of body fat than it’s expected. When this happens at this early stage of life, it sets the ground for long term exposure to the risk of development of cancer and other conditions like metabolic syndrome, diabetes, hypertension and other non-communicable diseases.

In a study done by American Cancer Society, it was shown that there was a high increase of cancer among people aged 25-45 years as compared to people above 50 years old.

The study involved young adults and older adults of both genders who were obese. Cancers of the pancreas, gallbladder, kidney, uterine, multiple myeloma and colorectal cancer were among of those which were shown to have risen in the aforementioned age group.



Obesity in Low Income Households

obese women

Obesity has been a headache to our health. Women usually comprise the largest cases of obesity however child and teen obesity is on the rise with the highest percentages being observed in developed nations.

Previously, obesity was also more commonly observed in individuals from the middle and high class background however that’s no longer case as it is becoming prevalent among low income households.

The main cause for this rise in this demographic is the change in lifestyle and food. Currently most of the food that is available and affordable is processed. This food is typically refined, has added sugars and contains less fibre making it ideal for weight gain.

This is further exacerbated by the fact that most low income families have moved to urban areas having left behind farming to venture into formal employment, informal work or business. Once here, they experience a largely sedentary lifestyle unlike in the countryside where activities such as farming and herding necessitate higher physical activity levels.

However as we saw on a previous article, obesity cases are similarly on the rise in rural and peri-urban areas, with the proliferation of supermarkets in these areas being cited as contributing factor.

The cause for this is that with less farming taking place courtesy of the migration of young adults, the remaining population that comprise mostly of the elderly will more readily engage in cash crop farming rather than subsistence farming.

This in turn causes them to rely on packaged foods for their sustenance unlike in the past where subsistence farming would provide them with an inexpensive source of healthier indigenous foods.

With fewer people also taking up farming as a means of livelihood, the result is that either lesser land is put to farming or the more likely scenario that the few that engage in farming switch to cash crops and intensive farming practices.

This leaves little room for the farming of indigenous foods which is precisely the impetus behind the rise in organic farming and this turn of events where some indigenous foods cost more than their packaged counterparts. Despite this, the notion that indigenous foods are a poor man foods still persists.

The control and management of obesity and cancers thus calls for a radical change not only in the lifestyle of individuals but also in policies that govern agriculture, rural development and the employment opportunities for young people.

Without addressing these secondary factors it’s clear that the battle against these two plagues is only going to get tougher by the day and it's the poor that will pay the higher price.

Why You Shouldn’t Wait Too Long to Drink Your Fruit Juices

Eating fruits is very essential to our bodies. They along vegetables are the main providers of vitamins and minerals.

Consuming a variety of fruits supplies the body with a variety of these micronutrients as their availability and quantity varies across different fruits. Accordingly, the WHO recommends a consumption of more than five servings of fruits across most days of the week.

Fruits can be consumed in different ways, the most common being eating the whole fruit. However, an increasingly popular method nowadays is to juice fruits. The fruits juices are extracted from the one fruit or mixed with those from other fruits.

Often at times, the fruit juices are also mixed with vegetable juices for purposes of enriching or simply as a means of improving flavour. Such juices however seem to be mostly consumed for purposes of “detoxing”.

Nevertheless, not all fruits are “juiceable” making this method only suitable for certain fruits. For those that can be juiced however, it’s important to consider the perishability of their juices, especially with regards to their nutrients.


How Exposure to Air Causes Loss of Nutrients in Fruits

Fruit Juices

Fruits are very perishable especially when the flesh is exposed to air. This explains the swift colour change witnessed after peeling fruits like bananas or apple.

This discolouration is as a result of a process called oxidation that happens on the fruit’s surface. What happen is that oxygen in the air reacts with phenolic compounds in the fruit to form substance called quinones with the help of some fruit enzymes.

Quinones later react with amino acids in the fruit causing loss of nutrients and discoloration. The same reaction happens in the fruit juices.

Juices however spoil faster than whole fruits as there is much larger surface exposed to the air hence a big surface area for reaction.

Therefore, to ensure you get the most out of your fruit juices, it’s advisable to have them within 20 minutes to 48 hours after preparation. This time frame is however not absolute as its further affected by the method used to extract the juice.


How the Lifespan of Juices is affected by method of Extraction

There are two main ways of extracting juice from fruits:
  • by centrifuge, or
  • by mastication

In the centrifuge method the juice is extracted by a machine rotating at a high speed (e.g. a blender) while in mastication the extraction is through cold-pressing.

The centrifuge method of juice extraction has a higher rate of spoilage than the mastication one. This is because the rotation introduces more oxygen in the process causing it to react well with the juice. In addition to this, there’s generation of heat which further degrades the quality of the juice.

Juices extracted this are thus ideally supposed to be drunk within 20 minutes because the rate of spoilage is quite high.

In the mastication process, there is less reaction with oxygen as compared to the centrifuge method and heat generation is minimal or not present. Juice extracted this way can for up to 48 hours.

To be on the safe side however, drink the juice immediately after preparation when the enzymes and vitamins are still active or refrigerate after preparation for at most 4 days.

Other factors that can increase rate of spoiling of juices and that you should consider when juicing include:
  • Light – this increases rate of spoilage
  • Storage – it's good to store the juice in clean opaque containers that are well covered to minimize air from getting in
  • The type of fruit – some fruits spoils faster than others
  • Heat – the higher the heat, the higher the rate of spoilage (hence refrigeration)

How to Add Cross Training to Your Workouts

Dedicated training is something to be admired. Many athletes strive for the ability to get up and get out every single day whether it’s for a specific race or event or even, simply driven by a goal.

Often that can mean adhering to a training plan based on both repetition and incrementally increased difficulty – monotony and overuse be damned.

But you may get hurt. Or plateau. Or experience a disruption in your training schedule. These can all be detrimental to accomplishing a goal. Then there’s also that inevitable boredom of doing the same training day in and day out. You swear that footprint on the trail was yours from yesterday.

Enter cross-training, an exercise program usually employed outside of these intense training blocks to add some variance (physically and mentally) to workouts.

It keeps the body guessing, and has many athletes reap the benefits for their main sport: decreased injury potential, and added strength to the most-used muscles.

Here, we’ll detail the science behind cross-training, how to work it into your schedule, and some new exercises to try. Your main sport will thank us.


This is Your Body on Cross Training

benefits of cross training

Simply put, cross training is training in another discipline in improving your main sport.

The options are almost limitless – runners can strength train, swimmers can paddle board, cyclists can do yoga. The goal is to supplement your main sport with training that’s beneficial for certain muscles, movements, or even, your brain and mood.

For most athletes, the inclusion of cross training into a workout plan is triggered by an injury sidelining them from regular training. I was no different – hours of basketball and running led to knee pain (from patellar tendonitis, known as “runner’s knee” or “jumper’s knee”). But I was stubborn.

When I should have stopped the joint-pounding activities, I continued to beat them like a drum. It got to a point where the pain wasn’t worth the workout, but I couldn’t give up working out all together. So I started swimming and incorporating yoga into my routine, which delivered positive and painless results.

Turns out, I’m not alone. Up to 56% of recreational runners experience injuries, with most of those relating to the knee.1 Supplements can help (like glucosamine, which promotes the development of cartilage), but up to 75% of those are overuse injuries.1

Since a majority of injuries happen due to time dedicated to a single sport, cross training can help prevent injuries for the simple fact that it forces athletes to spend less time training singularly. Cross training doesn’t just maintain activity by reducing the risk for injury – it also can increase performance.

A study of 27 male runners were assigned one of three different resistance training regimens (in addition to their normal endurance training): heavy resistance, explosive resistance or muscle endurance training.

In all three groups, running endurance performance increased.2 The heavy-lifting group, in particular, saw improvements to high-intensity running characteristics, like sprinting at the end of the race.2

The benefits of cross training aren’t just physical; there’s also a potential mental benefit of switching it up.

Mental fatigue can impact physical workouts – you may be less likely to workout knowing that you’re facing the exact same exercise every day. Especially if an athlete is in-season or training for a specific event, cross-training can provide an exciting challenge.

It’s easy to be training heads-down; cross-training can help you see the forest between the trees.


Implementing Cross Training

Divorce yourself from the idea that cross training takes away from your regular training schedule. While you’ll inevitably be spending time away from your sweetheart sport, absence makes the muscles grow stronger.

There are three main groups of cross training for endurance athletes: strength training, aerobic low-impact work, and aerobic impact work, and each can be part of a cross-training program.
types of cross training


1. Strength Training

Touching upon all major muscle groups is important for effective strength training.

Incorporating strength training into an endurance regimen can enhance physical fitness, as it did in this meta-analysis of distance runners.3 Even just 30 minutes per week, once or twice a week, can suffice. And it doesn’t necessarily have to be done in a gym; you can take the at-home approach to incorporate plyometrics or things like push-ups.

Regardless of where you strength train, a full body workout will maximize the time you spend training. Consider hitting all the major muscle groups such as arms, chest, shoulders, back, core and legs (more on this later).


2. Aerobic Low-Impact Work

Probably the reason many athletes experiment with cross-training: take stress off those weary joints and reduce injury risk. Low-impact activities or no-impact workouts can be done two or three times a week.

It’s easily implemented, as it can replace an active recovery day or even a harder workout day depending on the exercise; so for those who think they’re losing gains because of cross-training, you may actually find yourself enjoying the cross training more than your main exercise.

Cycling, swimming, and rowing are some of the most popular low-impact workouts. For flexibility and core exercises, yoga and pilates are go-tos. And you may even be able to work out longer and more frequently using these types of workouts due to the lack of stress they cause the body (swimmers can work out every day, and they’re hitting all the major muscle groups).

For example, if you planned on running 45 minutes, you could easily spend 70 minutes cycling.


3. Aerobic Impact Work

Maybe the reason you’re reading this article is because of too much aerobic impact work.

If you’re training, the amount of aerobic impact work will likely be higher (and maybe your only focus during that training block). But in the off-season, or times when you’d like to give your body a break, aerobic impact work should be done once or twice a week.

As a general rule, cross-training is meant to limit the impact on the body.

Typically, cross training is meant to offer your body a break from the impact it faces during regular training. You can play team games, train runs, circuit train or do CrossFit as a cross-training method, as the impact is likely different from your normal routine. But be mindful: any impact work still puts a strain on the body.


The Importance of Rest

Before getting into the specific exercises to try, remember the need for rest. Your muscles are asking for it.

The goal of every training session is to break down muscle and without recovery, a portion of that work might be wasted. During recovery, the body begins the process of rebuilding what has been broken down.

Muscle protein synthesis can increase by as much as 50% in the hours after a workout, helping encourage muscle growth.4 Concurrently, muscle fibers are rebuilt. These processes are a normal part of the exercise, and recovery allows the muscles to become stronger.

Fluid restoration is also key, as it helps deliver nutrients to organs and muscles through the bloodstream. And acids (via that hydrogen proton associated with lactate) accumulate during workouts – so recovery provides time for the body to restore intramuscular pH and blood flow for oxygen delivery.

Even though cross training is meant to give the body a break from regular training, it’s still is a source of stress and requires recovery time (or you might burnout). For most athletes, it’s difficult to slow down. Many of us are goal-oriented, hardworking and ultimately – a bit stubborn.

Budgeting recovery time is essential, as is providing your body with the necessary fuel to recover properly.

Supplementing recovery may help expedite that process and get you back in the saddle faster. HVMN Ketone has been shown to improve recovery by decreasing the breakdown of intramuscular glycogen and protein during exercise (when compared to carbs alone).5

It also expedited the resynthesis of glycogen by 60% and protein by 2x when added to a normal post-workout carb or protein nutrition.6,5

Doing the same exercise can be mentally exhausting, leading to mental fatigue that wears down on your desire to even do the workout. Research has shown that the mind is usually a good gauge of the body,7 with a mental strain reported by a questionnaire being closely related to stress signals in the hormones of the body.

By switching it up with cross-training, and also ensuring rest days, the mind will get a chance to recharge too.


Cross Training Exercises

Now is the time to incorporate cross-training workouts. The exercises below touch on several different areas of exercise, from strength training to both low-impact and impact aerobic activities.

You can begin by folding in some additional exercises to your existing workouts. Runners may try hills or cyclists may try 30-second sprints – this isn’t cross-training exactly, it’s just extra training.

The benefits of cross training come with learning something new and focusing on different areas of the body that regular training can neglect.

Try working some of these exercises into your routine. It’s important to pick which is best for your personal needs.


1. Swimming

swimming

Benefits: Aerobic and cardio workout without the joint or muscle impact
Concerns: Technical ability can limit the quality of training
How to try it: Ensure you have the proper equipment (goggles, swim cap, fins, etc.), check lane times at your local pool, familiarize yourself with technique

A great whole body workout, swimming is one of the low-impact exercises most often used for recovery or cross training. Interestingly, reports show many people enjoy water-based exercise more than land-based exercise.8

Swimming works the whole body; it increases heart rate without the joint-pounding stress of running, it builds endurance and can also build and tone muscle.

Because of these benefits, it’s a great option for recovery – a study showed that patients with osteoarthritis showed reduced stiffness, joint pain, and overall less physical limitation.9

It also torches calories. Swimming has shown improved body weight and body fat distribution when compared to walking.10

An average person can burn almost 450 calories when swimming at a low or moderate pace for one hour. At an increased pace, that could go north of 700 calories. For comparison, running for one hour at a leisurely pace burns about 400 calories.

Outside of the aerobic benefits, swimming (and water training, like deep-water running) has shown to improve cardiovascular health and lung capacity.11,12,13

To incorporate swimming into your cross-training routine, first find a place to swim. Then gather the necessary tools (like goggles, swim cap, fins, etc.), and brush up on the form before jumping in the pool. Try it one to three times a week for 30 minutes to start.


2. Cycling

cycling

Benefits: Low impact, aerobic, and strength building
Concerns: Risk of injury and cost of equipment
How to try it: For outdoor cycling, get a bike properly fitted and map your cycling route. Or find a bike / spin class at your local gym. For beginners, try cycling 45 minutes to an hour

Another low impact workout, cycling is a great way to reduce stress on those joint while still clocking in the aerobic hours.

Similar to swimming, cycling burns calories at an impressive clip, anywhere from 400 - 1,000 per hour depending on the intensity of the ride. And since cycling is also a resistance exercise, it’s not just burning fat – it also builds muscle.

A systematic review analyzed the benefits of cycling, showcasing a myriad of results. There was a positive relationship between cycling and cardiorespiratory fitness, cardiovascular fitness, and general fitness.14

Whether on the road, the track, or in the gym on a stationary bike, the benefits of cycling as a cross-training mechanism stem from the fact it’s a low impact, muscle building, aerobic workout. It can help athletes train if they have experienced an injury.

There are several ways to train on a bicycle. You can ride hills to build muscle and strength, or do shorter sprints to build speed. There’s also an option for endurance, with riders cycling hundreds or thousands of miles over the course of a long session.

For beginners, get a feel for the workout on a stationary bike. As you advance, visit a local bike shop to get your bike properly fitted.


3. Strength Training

strength training

Benefits: Increased muscle strength, bone density, injury prevention, mental health
Concerns: Improper form and too much weight can lead to injury
How to try it: Find a gym with the proper equipment and build a training plan, picking exercises that target both the upper and lower body.

Many endurance athletes don’t consider strength training as part of their workout routine, but it can help prevent injury while improving strength for your main sport.

For runners, maybe that’s improved core strength for economy. For cyclists, maybe the outcome is a higher power output. Regardless of your sport, strength training is imperative to improving endurance for runners15 and cyclists.

In a study of postmenopausal women, high-intensity strength training exercises showed preserved bone density while improving muscle mass, strength and balance.16 It can also help prevent injury. In a study of soccer players who strength trained in the offseason, hamstring strains were lower (and that group also saw increases in strength and speed).17

The mental benefits of resistance training have also been documented; studies have shown it improves anxiety and depression.18,19

A good strength training regimen will focus separately on different muscle groups. There are several options for lifters of all different levels, but starting with some simple bodyweight exercises (like push-ups or pull-ups) can allow you to build toward free weight training, weight machines, or rubber tubing.

A meta-analysis of periodized training – varying your strength training workouts – has shown results for greater changes in strength, motor performance and lean body mass.20 So don’t get stuck doing the same routine over and over again. A good way to push yourself is to incorporate overload training into some of that strength work.

If you’re strapped for time, a full-body workout once or twice a week (with dedicated recovery time) should suffice. Make sure to also spend some time nailing down form in the weight room, as improper form and too much weight can lead to injury.


4. Yoga

yoga

Benefits: Increased strength, mobility, flexibility, and mood
Concerns: Improper form can lead to injury
How to try it: Find a studio and pick a class level that’s appropriate for your skill level.

An ancient practice designed to create a union between the body and mind, many athletes seek out yoga for its ability to increase strength and flexibility while also promoting mental health benefits.

Yoga can improve performance by targeting specific aspects of flexibility and balance – one study, which took place over the course of 10 weeks in male collegiate athletes, saw improvements in both balance and flexibility.21 In older adults, studies have shown improved balance and mobility.22

Strength is also a target of many yoga programs, especially in the core. Even a study in which a specific pose (sun salutation) was used six days per week for 24 weeks, participants saw increased upper body strength, weight loss and endurance.23

But with yoga, the body is only half the game. It has been shown to decrease cortisol levels (the stress hormone),24 along with the ability to lower levels of depression, stress, and anxiety.25 There have even been studies which showed overall quality of life improvements in seniors.26

Maybe part of these mental benefits are linked to better sleep quality. One study illustrated that a group participating in yoga fell asleep faster, slept longer and felt more well-rested in the morning.27

Yoga isn’t an aerobic workout, but it stretches muscles, builds strength and has been shown to improve mood. Because it’s low-impact, yoga can be done every day. Typically gyms or studios have beginner classes, and they will typically last between 60 and 90 minutes.

Athletes can use yoga as recovery days, so between one and three sessions per week would be perfect.

Remember: listen to your body. Athletes always want to push the limit, and many may scoff that yoga is difficult (compared, say, to running). But extending a stretch too far, or practicing yoga without learning form, can lead to injury.


5. Other Exercises

There are different activities that may be considered cross training, outside of the usual suspects we detailed above.

Hiking, for example, is a great way to build strength and get outside during a recovery day. Same goes with exercises like kayaking or stand-up paddle boarding28 – these can help build upper body strength while encouraging an athlete to get out of their comfort zone (literally, and figuratively).

We wouldn’t recommend team sports because there’s a risk of injury.

But tennis might be an exception. While there are of course injury concerns with every sport and exercise, tennis has shown to improve aerobic fitness, lower body fat percentage, reduce risk for developing cardiovascular disease and improve bone health.29

For more passive cross training, think about everyday things you can do to improve strength and balance. Even investing in a standing desk, or sitting on a medicine ball at work can encourage better posture and more movement overall.


Cross Training for Athletes

During peak training season, athletes feel the grind. You’re putting in the hours with a race or event or goal in mind, laboring over the same path, the same laps, the same routine, with little variance.

Cross training is meant to serve as a break, but one that’s productive. It can be a break from your normal routine, both physically and mentally. But it can also invigorate the mind, providing it with a new task to learn, a new challenge to face. And of course, the physical benefits of testing the body in new ways are evident.

To incorporate cross training, try one or more of these exercises a couple times a week. See how you feel. You’ll likely find one you enjoy more than others, one that maybe provides better results than the rest. It’ll take some time to find a balance.

What’s your cross training routine? Let us know in the comments and share your experience.

Originally published on HVMN by Nate Martins.


SHOW/HIDE REFERENCES
1. Van mechelen W. Running injuries. A review of the epidemiological literature. Sports Med. 1992;14(5):320-35.
2. Mikkola J, Vesterinen V, Taipale R, Capostagno B, Häkkinen K, Nummela A. Effect of resistance training regimens on treadmill running and neuromuscular performance in recreational endurance runners. J Sports Sci. 2011;29(13):1359-71.
3. Yamamoto, Linda M; Lopez, Rebecca M; Klau, Jennifer F; Casa, Douglas J; Kraemer, William J; Maresh, Carl M. The Effects of Resistance Training on Endurance Distance Running Performance Among Highly Trained Runners: A Systematic Review. Journal of Strength and Conditioning Research: November 2008 - Volume 22 - Issue 6 - p 2036-2044 doi: 10.1519/JSC.0b013e318185f2f0.
4. MacDougall JD, Gibala MJ, Tarnopolsky MA, MacDonald JR, Interisano SA, Yarasheski KE. The time course for elevated muscle protein synthesis following heavy resistance exercise. Can J Appl Physiol. 1995 Dec;20(4):480-6.
Holdsworth, D.A., Cox, P.J., Kirk, T., Stradling, H., Impey, S.G., and Clarke, K. (2017). A Ketone Ester Drink Increases Postexercise Muscle Glycogen Synthesis in Humans. Med Sci Sports Exerc.
6. Vandoorne, T., De Smet, S., Ramaekers, M., Van Thienen, R., De Bock, K., Clarke, K., and Hespel, P. (2017). Intake of a Ketone Ester Drink during Recovery from Exercise Promotes mTORC1 Signaling but Not Glycogen Resynthesis in Human Muscle. Front. Physiol. 8, 310.
7. Steinacker JM, Lormes W, Kellmann M, et al. Thaining of junior rowers before world championships. Effects on performance, mood state and selected hormonal and metabolic responses. J SPORTS MED PHYS FTTNESS 2000;40:327-35.
8. Lotshaw AM, Thompson M, Sadowsky HS, Hart MK, Millard MW. Quality of life and physical performance in land- and water-based pulmonary rehabilitation. J Cardiopulm Rehabil Prev. 2007;27(4):247-51.
9. Alkatan M, Baker JR, Machin DR, et al. Improved Function and Reduced Pain after Swimming and Cycling Training in Patients with Osteoarthritis. J Rheumatol. 2016;43(3):666-72.
10. Cox KL, Burke V, Beilin LJ, Puddey IB. A comparison of the effects of swimming and walking on body weight, fat distribution, lipids, glucose, and insulin in older women--the Sedentary Women Exercise Adherence Trial 2. Metab Clin Exp. 2010;59(11):1562-73.
11. Broman G, Quintana M, Engardt M, Gullstrand L, Jansson E, Kaijser L. Older women's cardiovascular responses to deep-water running. J Aging Phys Act. 2006;14(1):29-40.
12. Cider A, Sveälv BG, Täng MS, Schaufelberger M, Andersson B. Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure. Eur J Heart Fail. 2006;8(3):308-13.
13. Sable M, Vaidya SM, Sable SS. Comparative study of lung functions in swimmers and runners. Indian J Physiol Pharmacol. 2012;56(1):100-4.
14. Oja P, Titze S, Bauman A, et al. Health benefits of cycling: a systematic review. Scand J Med Sci Sports. 2011;21(4):496-509.
15. Hoff J. Maximal Strength Training Enhances Running Economy and Aerobic Endurance Performance. Medicine & Science in Sports & Exercise: May 2001; Volume 33 ,Issue 5, p S270
16. Miriam E. Nelson, PhD; Maria A. Fiatarone, MD; Christina M. Morganti, MD; et al. JAMA Otolaryngol Head Neck Surg. 2015;141(5):428.
17. Askling C, Karlsson J, Thorstensson A. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scandinavian Journal of Medicine & Science in Sports. 2003; 13(4);244-250
18. Gordon BR, Mcdowell CP, Hallgren M, Meyer JD, Lyons M, Herring MP. Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials. JAMA Psychiatry. 2018;75(6):566-576.
19. Gordon, B.R., McDowell, C.P., Lyons, M. et al. Sports Med (2017) 47: 2521. https://doi.org/10.1007/s40279-017-0769-0
20. Fleck SJ. Periodized Strength Training: A Critical Review. Journal of Strength and Conditioning Research. 1999l;13(1).
21. M Jay Polsgrove, Brandon M Eggleston, and Roch J Lockyer. Impact of 10-weeks of yoga practice on flexibility and balance of college athletes. Int J Yoga. 2016 Jan-Jun; 9(1): 27–34. doi: 10.4103/0973-6131.171710
22. Tiedemann A, O'rourke S, Sesto R, Sherrington C. A 12-week Iyengar yoga program improved balance and mobility in older community-dwelling people: a pilot randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2013;68(9):1068-75.
23. Bhutkar MV, Bhutkar PM, Taware GB, Surdi AD. How effective is sun salutation in improving muscle strength, general body endurance and body composition?. Asian J Sports Med. 2011;2(4):259-66.
24. Katuri KK, Dasari AB, Kurapati S, Vinnakota NR, Bollepalli AC, Dhulipalla R. Association of yoga practice and serum cortisol levels in chronic periodontitis patients with stress-related anxiety and depression. J Int Soc Prev Community Dent. 2016;6(1):7-14.
25. Michalsen A, Grossman P, Acil A, et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit. 2005;11(12):CR555-561.
26. Oken BS, Zajdel D, Kishiyama S, et al. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Altern Ther Health Med. 2006;12(1):40-7.
27. Manjunath NK, Telles S. Influence of Yoga and Ayurveda on self-rated sleep in a geriatric population. Indian J Med Res. 2005;121(5):683-90.
28. Schram B, Hing W, Climstein M. The physiological, musculoskeletal and psychological effects of stand up paddle boarding. BMC Sports Sci Med Rehabil. 2016;8:32.
29. Pluim BM, Staal JB, Marks BL, Miller S, Miley D. Health benefits of tennis. Br J Sports Med. 2007;41(11):760-8.

Top 3 Ways To Test For Ketosis

Measuring one's ketone levels is an excellent biomarker for tracking the effectiveness of fasting, ketogenic dieting, and exogenous ketones. But there’s more than one way to test for ketosis.


Why should you care about how high your ketone levels are?

Understanding blood ketone levels offers insight into where you might feel best, or help optimize diet to achieve personal goals.

Many people monitor blood ketone levels while on the keto diet or taking exogenous ketones like HVMN Ketone to verify that they’re actually in ketosis.
blood ketone levels
Blood Ketone Levels

Setting a baseline while on the keto diet is helpful, especially if you’re using the keto diet for weight loss and other health benefits like controlling metabolic syndrome.

For those on the low-carb, high-fat keto diet trying to lose weight, moderate ketone levels could be an indicator measurement of your dietary needs to reach those weight loss goals.

When on the keto diet, fat stores are broken down and fatty acid concentrations increase in the bloodstream. Those fatty acids are turned into ketones in the liver. When ketone levels exceed 0.5mM, that’s considered to be a state of  "ketosis".

Nutritional ketosis is defined as blood ketone levels ranging from 0.5 - 3.0mM by pioneering ketone scientists Jeff Volek and Stephen Phinney in "The Art and Science of Low-Carbohydrate Living".

There are three methods to measure ketone levels; with this data, you’ll have the power to optimize your biohacking protocol.


1. Blood Testing

Blood Ketone Meter

Pros
  • Most accurate way to measure ketosis in mmol/L (mM)
  • Measures BHB, the predominant ketone in the body, rather than acetoacetate or acetone
Cons
  • You need a handheld device (i.e., Precision Xtra or Keto Mojo) and test strips, which can be expensive relative to other techniques
  • You have to take a finger prick blood sample which can be bothersome and invasive at first until you get used to it

When testing blood using a BHB/glucose meter, you’re getting the most accurate measurement available. The meters measure glucose or ketone levels depending on which test strips are inserted.

Those with diabetes commonly use the same procedure and the same blood meters to measure their blood glucose levels. It's critical for people with diabetes to control blood sugar levels and also to avoid dangerously high levels ( > 20mM) of ketones, known as ketoacidosis.

Using a blood ketone meter device is simple. You’ll need the device itself, compatible test strip, a lancet device (to pick the finger), lancets (needs to prick the finger) and an alcohol swab for sanitation.

To take a reading, follow these steps:
  • Remove the cap from the lancing device and insert the lancet into the device
  • Rotate the tip of the cap of the lancing device and set it to the desired depth of puncture
  • Arm the lancing device by sliding the control button until you hear a click
  • Insert a strip into the reader
  • Swab the tip of your left index finger with a sterile wipe
  • Place the lancing device firmly on your left index fingertip
  • Press the button on the lancing device to puncture your fingertip
  • Gently squeeze your fingertip to extract a large drop of blood
  • Hold the reader and touch the bottom of the strip to the blood sample
  • Hold the reader in place and allow the strip to absorb the blood sample

Wait a few seconds for the reader to analyze the sample

All things considered, using a blood meter might seem like the obvious choice to measure ketone levels. But the finger prick and cost may lead you to explore other avenues for testing. Here are a couple more options.


2. Urine Testing

urine testing
Urine Ketone Testing

Pros
  • Relatively inexpensive
  • Widely available in pharmacies
  • Non-invasive

Cons
  • Less accurate than blood
  • Over time the body adapts to excrete fewer ketones in the urine

Urine testing was designed to measure acetoacetate – one of three ketone bodies. But it doesn’t account for BHB, so urine testing may not be the most accurate measure of ketosis.

Since urine is a waste product, what’s displayed on the ketone urine strips is what the body is excreting.

By nature, that may not be the best indication of how well the body is utilizing ketones as fuel. As you become more keto-adapted, you’ll excrete fewer ketone bodies through urine.  

Hydration status can also affect these ketone readings, and leads to inconsistent results as relative hydration level can dilute the concentration of ketones in urine.

It comes down to this: urine ketone stirps are a cheap and easy way to get an understanding of early ketone levels, but for long-term use, they’re not the most accurate option.


3. Breath Testing

Breath Ketone Meter

Pros
  • After purchasing the device, it’s free each time you test

Cons
  • You need a handheld device (e.g. Ketonix)
  • Less accurate than blood meter
Breath ketone meters are relatively new to the market for testing ketone levels. They specifically measure the amount of acetone excreted in breath, providing readings that relate well to blood ketone levels at low concentrations.

But the research is limited. There haven’t been enough studies done to confirm the accuracy of breath acetone meters at higher levels, such as the level achieved after drinking HVMN Ketone. Acetone is the simplest and smallest of the three ketone bodies.


Choosing the Right Ketone Meter for You

In general, we recommend testing ketone levels if you’re trying to achieve nutritional ketosis or using exogenous ketones like HVMN Ketone. Blood ketone levels after using HVMN Ketone can reach 6mM making it one of the most advanced ketone products on the market.

Fat burning mode via the ketogenic diet is tough to maintain, so it’s helpful to monitor ketone levels to make sure your efforts are worthwhile.

While ketone readings don’t paint the whole picture of ketosis, they’re a large piece of the puzzle. You’ll have more transparency into what’s happening inside the body, developing an understanding of how fast and the level of ketosis you’re able to achieve.

Over time, some people develop intuition around what diet or routines lead to a given ketone level, but it’s helpful to establish a periodic basis for using an accurate ketone measurement device to get reliable objective data.

Originally published on HVMN by Justin Liau, Michael Brandt and Nate Martins

How Long Should Cooked Food be Refrigerated?

Food spoils occurs fastest when food is cooked. This is because the nutrients are exposed to more of the spoilage bacteria in this state.

The rate of food spoilage is however not the same in all foods and is instead affected by different factors such as the type of food, environment, mode of cooking and preparation and duration since preparation.

To minimize the rate of spoilage, we often rely on various storage methods depending on the duration we intend to preserve the food.

For food that we don't intend to preserve for long (a couple of hours or so), we can prevent food spoilage in the short-term by:
  • covering the food properly after cooking to prevent it from contamination
  • using clean utensils for storing and serving the food
  • storing utensils to be used in clean dry places

While not a storage method, cooking food amounts that will be finished at a specified meal time goes a long way in preventing spoilage and the wastage that comes with it.

On the other hand, we often have to rely on the refrigerator for food that has to be stored for a couple of days or weeks.

However, we often forget that food in the fridge is not entirely safe from spoilage and thus we end up storing it for longer than it should.



Duration that Food is Supposed to Stay in the Fridge

fridge

The refrigerator provides a low temperature environment below the room temperature. This however does not kill the food spoilage bacteria but merely slows the rate at which they grow.

The colder it is the better at curbing this growth explaining why the freezer preserves the food for longer than the lower compartment. This lengthened duration may however come at the price of  affecting the quality of the food.

Food is likely to go bad if its stored in the fridge for more than four days. Some shorten this down to two days in the case of leftover foods.

The problem however is that many of us are not able to tell whether the food has spoiled. The assumption is that, if it looks good and doesn't smell, then it’s safe to be consumed.

This explains why sometimes we observe the leftover food is spoiled only after warming or putting the food in a room temperature for a short while.

Therefore, consider disposing leftovers if they have been refrigerated for longer than four days. Fresh foods that haven't been cooked can stay for longer.

Disposing seems like too drastic a measure, however it’s necessary if one is to avoid the potential food poisoning or food intoxication.

The difference between these two is that, food poisoning occurs when we eat food with the bacteria while intoxications occurs when the food has toxins released by the bacteria.

Their effects however vary across individuals and will ultimately depend on factors such as one's immunity, age and the bacterial load (extent of contaminated food consumed).

With that said, the duration of storage is just one of many factors that contribute to food spoilage in the fridge. Other things to consider are:
  • keep your fridge hygienic by cleaning it regularly
  • store food in clean containers that are well covered
  • don't re-refrigerate/refreeze reheated food (i.e. reheat foods only once)

Keto Diet Fundamentals

You’ve probably heard of the keto diet, a low-carbohydrate, high-fat diet people are adopting for reasons like performance and weight loss.

The goal of the keto diet is to get the body producing ketones– a fundamentally different energy source than the carbohydrates and fats your cells typically use for energy. It can take several days of ketogenic eating before the body starts to produce ketones. And the time it takes to get into ketosis varies between individuals.

“Keto” comes from the word “ketogenic.” This is a nuanced term meaning that the body is producing ketones from fat.1 When blood ketone levels exceed 0.5mM, the body has achieved "ketosis."

So ketosis can be achieved either through diet or fasting (meaning the body is producing its own ketones to be ketogenic), or also by consuming products that raise blood ketone levels (like HVMN Ketone or ketone salts or MCT oils).

Limiting carb intake and protein intake encourages the body to burn fat and thus produce ketones. Importantly, restricting proteins as well as carbohydrates limits the amount of substrate available for gluconeogenesis. This is the process of making glucose from non-glucose molecules such as lactate, glycerol, or protein.

Because the ketogenic diet is low-carbohydrate, it often gets confused with other low-carb diets out there. Just because a diet is low carb doesn’t mean it’s keto. It’s the subtle differences in the macronutrients provided in the diet that determine if a diet is ‘ketogenic.’

A macronutrient is something humans consume in large quantities to provide the bulk of energy to the body. The primary macronutrients are carbohydrates, fats, and proteins. For a diet to be ketogenic, it must be high in fat, low-moderate in protein, and very low in carbohydrates.


Low Carbohydrate Diets

low carb diets
Low Carb Diets

Here are some helpful definitions of diets with an element of reduced carbohydrate intake:

Ketogenic Diet
  • The aim is to trigger the production of ketones in the body
  • High fat, low/moderate protein, and low carbohydrate

Low-Calorie Ketogenic Diet
  • The aim is to severely restrict calories to a level below the basic metabolic needs (i.e., <800 kCal)
  • Even if this diet is relatively high in carbohydrates, the calorie deficit created can still lead to a state of ketosis
  • Not sustainable in the long-term

Low-Carbohydrate Diet
  • Defined in medical literature as a diet with < 30% energy from carbohydrates 2
  • May not lead to ketosis as the carbohydrate and protein intake could be too high

Atkins Diet
  • This diet has several phases
  • Initially, the aim is to restrict the carbohydrate intake to less than 20g per day. This degree of restriction is likely to lead to ketosis, although this is not an explicit aim
  • Subsequently, the diet reintroduces carbohydrates to a level “the body can tolerate” 3
  • Less restriction on protein compared to a ‘true ketogenic diet – high fat, moderate protein, low carbohydrate

Paleo Diet
  • The aim is to limit the diet to foods that would have been available to Paleolithic man 4
  • Wide variability in interpretations
  • Foods allowed include vegetables, fruits, nuts, roots, and meat
  • Foods excluded include dairy, grains, sugar, legumes, processed oils, alcohol, and coffee
  • No structured macronutrient target; however, following a Paleo diet results in higher protein and fat consumption than an average diet

Now you have a grasp of what makes the ketogenic diet unique but where did it all start?


The History of the Ketogenic Diet

Fasting and Early Pioneers of the Ketogenic Diet

The concept of fasting (taking in zero calories) predates the ketogenic diet as we now understand it. Many of the benefits of fasting are likely due to the presence of ketones in the body.

Since the earliest days of man, fasting has been used as a tool to physically and spiritually cleansing.

The Bible describes fasting as a treatment for convulsions. The ancient Greek philosopher Hippocrates said, “To eat when you are sick is to fuel your sickness.”

Early advocates of fasting were obviously unaware of ketosis as a crucial factor in the anticonvulsant effect of fasting. In the early 1900s, physicians at the Mayo Clinic observed a link between a low-carb diet and fasting.

They discovered that severely restricting dietary carbohydrates and increasing fat intake could decrease seizures in the same way as fasting.5 It was not until the mid-1900s, when scientists could measure ketones, that we understood fasting led to the presence of ketones in the body.

Epilepsy was not the only disease historically treated with a low-carbohydrate, high-fat diet. Low-carbohydrate diets were also advocated for patients with diabetes and obesity. Before the discovery of insulin in 1921, diabetes was managed through carbohydrate restriction.

William Banting, an obese British mortician, popularized the weight loss benefits of a diet “stripped of starchy foods” in a pamphlet called “Letter on Corpulence, Addressed to the Public.”


The Dark Ages for the Ketogenic Diet

To many, a low-carbohydrate and high-fat diet is a counter-intuitive approach to support health. There is a widespread fear dietary fat is linked to obesity, high blood pressure, high cholesterol levels and other associated health complications.

In 1953 Ancel Keys, an American biochemist published an epidemiological study that introduced the “diet-heart” hypothesis. The study claimed dietary fat was a key risk factor in developing heart disease.

The “diet-heart” hypothesis proposed blood LDL and cholesterol derived from dietary fat accelerates the development of atherosclerotic plaques.6

His work came at the time that US President Dwight Eisenhower, suffered a heart attack.
Following the advice of his physician, Eisenhower publicly cut back his fat intake. Nutrition was in the spotlight and Keys was able to further his hypothesis.

This led to radical changes in global food policy and public practice.

In 1977, the USDA Dietary Goals for Americans recommended a decrease in dietary fat intake, and a diet based on grains and cereals.7

At the time, there was still no clinical evidence supporting Keys’ “diet-heart” hypothesis. Subsequent large trials, including the Framingham Study and Women’s Health Initiative Randomized Controlled Dietary Modification Trial, failed to illustrate decreasing dietary fat lowered the risk of heart disease.8,9

Obesity rose following the adoption of the USDA guidelines. Some investigators hypothesized that increased dietary carbohydrates were responsible for the developing health crisis.

John Yudkin, a British physiologist and nutritionist, described this phenomenon in his book “Pure, White and Deadly”10 – the widespread fear of dietary fats caused scientists and nutritionists to overlook the role of sugar and starch.


Resurgence of ‘Low-Carbohydrate’ Diets

‘Low-fat’ dieting was widespread in the late 1900s. During this time, Dr. Robert Atkins became an infamous spokesperson for the keto diet.

Dr. Atkins brought his version of the ketogenic diet to the masses in his 1972 book "Dr. Atkins' Diet Revolution." In his 40 years of practice, he treated an estimated 60,000 patients for obesity and related conditions.

At that time, there were no clinical studies to validate the benefits of the diet. Many patients reported side effects while starting the diet, including fatigue, weakness, dizziness, headache, and nausea. This uncomfortable induction phase was labeled the ‘Atkins Flu.’

After Atkins’ death in 2003, others started to promote the ketogenic diet for health. The Atkins Foundation recently funded a group of scientists to study the effects of the Atkins diet formally. This group of scientists includes Jeff Volek, Stephen Phinney, and Dr. Eric Westman.

These scientists discovered that the Atkins diet outperformed a diet based on the 1977 USDA guidelines with respect to measured coronary risk factors, including decreased low-density lipoprotein-cholesterol and total blood saturated FFA alongside increased high-density lipoprotein cholesterol.11

This outcome may be due to the decrease in carbohydrate and concomitant changes in the hormonal milieu, or due to effects of ketone bodies on substrate metabolism.

The pendulum of public perception begun to swing in favor of diets higher in fat, thanks to the emergence of influential writers and speakers such as Gary Taubes, Robert Lustig, and Nina Teicholtz, and clinicians and scientists such as Professor Tim Noakes, Dr. Jason Fung, and Professor Thomas Seyfried. The work of these individuals exposed flaws in the ‘diet-heart hypothesis.’

These influencers helped expose corruption in the political decisions that resulted in the last decades of vilification of dietary fat. Evidence illustrating the role of high dietary carbohydrate intake in the development of obesity and diabetes has started to grow.

Much of the recent research suggests that low-fat diets may be harmful to health. This culminated with a recent meta-analysis of data from 18 countries, which linked increases in carbohydrate intake with increases in mortality.12

The fear of fat has continued to reverse. Over the last few years, the ketogenic diet has grown in popularity. Popular culture is starting to recognize and adopt the keto diet, and online searches have grown.

More and more doctors now encourage and prescribe the ketogenic diet to treat metabolic disorders and obesity. Large online communities bring thousands of people together to discuss research, share keto diet before and after photos, and encourage each other.


Keto Diet for Weight Loss

The ketogenic diet can be used to help with weight loss and also to treat some diseases. Recently, the number of positive keto diet reviews has increased. The rising popularity of the diet has led to a demand for further randomized control trials to study its long-term efficacy.

A key reason why the ketogenic diet helps weight loss is that it decreases hunger. This makes it easier to maintain a calorie deficit. It is important to stress that the overconsumption of calories will prevent weight loss, regardless of the macronutrient composition.


Macronutrient Composition of a Keto Diet

Macronutrients are food groups that humans consume in large quantities. They provide the bulk of the energy to the body. The primary macronutrients are carbohydrates, fats, and proteins.

The macronutrient composition of a diet can be described using the mass of each macronutrient, the ratio of macronutrients in the diet, or the percentage of each macronutrient in the diet. The variety of descriptions can make things a little confusing!

For example:
  • A ketogenic diet contains about 5% of energy as carbohydrates.
  • A ketogenic diet has a ratio of 2-4g of fat to every 1g of carbohydrates plus proteins.
  • A classical ketogenic diet contains 20-30g of carbohydrate per day

When starting off on the ketogenic diet, these are good target macronutrient ratios:
Macronutrient Ratios
Example of a Keto Diet Macronutrient Ratios

Examples of food rich in:
  • Carbohydrates: bread, pasta, potatoes, cereals, sugary food (sweets).
  • Fat: oils (olive oil, coconut oil), butter, fatty cuts of meat, brazil nuts, macadamia nuts, avocado.
  • Protein: beef, chicken, pork, fish, milk, cheese, yogurt, eggs.


Carbohydrates

carbs role
Role of Carbs in Keto Diet

The main function of dietary carbohydrates (‘carbs’) is to be a source of energy. Some say that dietary carbohydrates are not ‘essential’ as they can be made from dietary protein and fat.13

Carbohydrates are biological molecules that contain carbon, hydrogen, and oxygen, usually with a 2:1 ratio of hydrogen:oxygen. Carbohydrates occur as a collection of single units (monosaccharides, e.g. glucose), two molecules joined (disaccharides, e.g. sucrose), and chains of molecules (oligosaccharides and polysaccharides).

When following a ketogenic diet, the carbohydrate intake should be very low. This contrasts with the modern western diet, where most dietary calories come from carbohydrates.

Consuming carbohydrates causes insulin release which inhibits ketone production in the liver and thus ketosis. Therefore, monitoring and modulating your carbohydrate intake is an important part of following the ketogenic diet.

Dietary carbohydrates replenish the stores in muscle and liver (glycogen). It also maintains blood glucose concentrations to provide fuel for the whole body, but most importantly for the brain.

Blood glucose is easy to measure using a handheld blood glucose monitor. Normal blood glucose levels fluctuate throughout the day and vary between individuals. Therefore, it is useful to track over the long term and in response to different ‘challenges,’ such as a meal or exercise.

Ranges of Blood Glucose levels for clinical diagnosis are as follows:14
  • Fasting: healthy = 4-6 mM / 70-110 mgDl
  • Fasting: diabetic = ~ 7 mM / 125 mgDl
  • 90 minutes post-meal: healthy = < 8 mM / 140 mgDl
  • 90 minutes post-meal: diabetics = > 11 mM/ 200 mgDl

When you’re following the ketogenic diet, key concepts are the total amount of carbohydrates, the ‘net’ amount of carbohydrates (accounting for the accompanying fiber), and the speed with which carbohydrates raise blood glucose (glycemic index).

With a standard ketogenic diet, it’s recommended to keep the total amount of carbohydrates limited to less than 5% of energy intake.15 See the table above for a calculation of the advised carbohydrate intake grams for a 2000 kCal per day 4:1 ketogenic diet.


Dietary Fiber

Dietary fiber is carbohydrate-based material from plants that is not entirely broken down by the small intestine. Instead, it passes to the large intestine, and either undergoes fermentation (which supports the growth of beneficial bacteria) 16 or excretion.

Fiber is a significant part of a well-formulated ketogenic diet. It helps to maintain gut health, and also increases food bulk and helps with the feeling of ‘fullness.’ Green and cruciferous vegetables are rich in fiber and are helpful to include in a ketogenic diet.

Depending on how ‘complex’ the source of fiber is, it has different assumed caloric values. One approach is to treat fiber as having the same amount of calories per gram as carbohydrates: 4 kCal/gram.

However, as a proportion of fiber is not digested, other approaches use a lower value of 2 kCal/g. Digestion-resistant fiber does not contribute to calorie intake, as it is not broken down.

Net carbs refer to the mass of total carbohydrates, minus the total fiber, which could be a better metric to judge carbohydrate intake because:
  • Fiber is mostly digestion-resistant and so should not increase blood glucose.16
  • Studies have shown an increase in fiber does not affect blood ketone levels.17


Glycemic Index

The ‘glycemic index’ is a scale that ranges between 1 and 100, and it indicates how quickly food raises blood glucose after consumption. Pure glucose is the reference and is set at 100 (i.e. raises blood glucose quickly).

Other foods have a comparatively lower value as they raise blood glucose more slowly. Example values for the glycemic index of food are white potato: ~80, white bread: ~75, apple: ~35, peanuts: ~15.

Glycemic load’ accounts for both the speed of carbohydrate release and the TOTAL amount of carbohydrates in food.
Glycemic load = (total carbohydrates (g) x glycemic index) / 1000.

A food can have a relatively high glycemic index (eg. carrot = 47) but because the total carbohydrate amount is low (carrot = 5g per serving), the glycemic load of one serving is very low.


Proteins

Proteins are large molecules composed of chains of amino acids. The functions of dietary protein are:
  • Building structural and functional components of cells
  • Conversion to glucose via gluconeogenesis
  • Top up intermediates in other metabolic pathways, such as the Krebs Cycle
Role of Protein in Keto Diet

While it is possible for a protein to be used as a fuel, this isn’t its primary function.

When following a ketogenic diet, there must be a balance of sufficient protein to maintain muscle mass. If dietary protein exceeds 20-25% of calories, gluconeogenesis from protein can stop the ketone production.

Initially, target a protein intake of 0.8-1.2g per kilogram of body weight. This target balances the need for protein against the chance of excess gluconeogenesis.18

Some individuals (such as strength or endurance athletes) may have higher protein requirements. They might require a modified ketogenic macronutrient ratio of 2:1 fat:non-fat (where 65% of energy is fat, 30% is protein, and 5% carbohydrate) and can still be effective for therapeutic ketosis.


Fats

fat role
Role of Fat in Keto Deit

Fat gets a bad rap. In nutrition, fat is the dietary macronutrient made up of triglyceride molecules. The main functions of fats in the diet are to provide increased energy levels and makeup key functional and structural parts of the human system.

But we often misuse the word “fat.” There’s a difference between fat in cells and different types of fat molecules.
  • Adipose tissue: the tissue that stores energy as fats/lipid droplets inside adipocytes (fat cells). This is body fat.
  • Adipocytes: individual cells that store fats/lipids.
  • Lipids: the most general term for insoluble and polar biological fat molecules. The lipid class of molecules includes mono-, di- and triglycerols, cholesterols, and phospholipids.
  • Triglycerides: a lipid molecule made up of glycerol (that acts as a backbone) joined to three fatty acid molecules
  • Fatty acids: a molecule composed of a chain of carbon atoms bonded to one another with a carboxylic acid at one end.

To be specific, our diet includes many sources of lipids.

Lipids are digested and travel in the blood as triglycerides and fatty acids before being used as a fuel, or stored by adipocytes in adipose tissue.

Dietary lipids undergo many tightly regulated metabolic steps before storage in adipose tissue. Dietary fat does not equal stored body fat.

Triglycerides are the most important source of energy in a ketogenic diet. They account for >70% of dietary calories. For those following a ketogenic diet, it’s helpful to understand how the lipid source in the diet is processed in the body.


Types of Fats in Foods

Fatty acids can be saturated (no double bonds between carbons), or unsaturated (one or more double bonds between carbons).

Saturated fats are relatively stable and tend to be solid at room temperature (i.e. lard, butter, coconut oil). Historical guidelines recommended limited the intake of dietary saturated fats because fat consumption was thought to be associated with heart disease and high blood pressure.

However, emerging research has shown saturated fat can have beneficial effects on blood biomarkers (i.e. increase ‘healthy’ HDL levels).12

Unsaturated fatty acids can be further divided into monounsaturated fats (only one double bond between carbons) and polyunsaturated fats (multiple double bonds between carbons). The number of double bonds is important as it determines how the fatty acid behaves both inside and outside of the body.

They tend to be liquid at room temperature (i.e. vegetable-based fats such as olive oil). Unsaturated fats are thought of as healthier than saturated fats (also known as “healthy fats”).

Increased consumption of mono and polyunsaturated fats have been linked to improved blood biomarkers (i.e. lower blood triglycerides).19 Eating enough unsaturated fats is important when following a ketogenic diet.

Increased fat consumption is not associated with cardiovascular disease.20

Eating a moderate amount of saturated fat is unlikely to be as harmful as previously believed, and saturated fat consumption as part of a ketogenic diet is unlikely to increase the risk of cardiovascular disease.

Trans-fats are produced artificially when hydrogen is added to unsaturated fatty acids in order to solidify it and make it last longer. Because of associations with poor health outcomes, these artificial fats had their generally regarded as safe (GRAS) status removed in 2015 by the FDA. 21

Avoid high levels of trans-fat consumption by eating a diet based around whole foods.

Essential fatty acids are important to include in the diet because the body cannot naturally produce them. This group includes polyunsaturated omega 3, omega 6, and omega 9 fatty acids.

It’s believed the anti-inflammatory effects of essential fatty acids may have broad benefits for health and performance. Oily fish, such as sardines and mackerel, and seeds (i.e. flax) are good dietary sources of essential fatty acids.


Fat Metabolism

The number of carbons in the fatty acid chain also has an important effect on its metabolism. The carbon chain of fatty acids can be up to 28 carbons atoms long. If there are >13 carbons in the fatty acid, it is called a long-chain fatty acid, between 8-12 is a medium-chain fatty acid, and under 5 carbons is a short-chain fatty acid.

The body metabolizes fats differently according to chain length. Long-chain fatty acids are absorbed and go from the gut into the lymphatic drainage system and from there are released directly into the blood.

By comparison, medium and short-chain fatty acids do not go into the lymphatic system. They travel in the blood from the gut directly to the liver.22

If a large amount of these short and medium-chain fats are delivered to the liver at once, this can trigger the liver to convert them into ketones, even without dietary carbohydrate restriction.

Medium-chain fatty acids are highly ketogenic. They can be found in natural sources such as coconut oil or in an artificially purified form. However, for many people, consuming a high amount of medium-chain fatty acids can cause an upset stomach. This limits their use to raise ketones artificially.

When integrating these concepts into a ketogenic diet: target the majority of dietary calories as fat.
Aim to include a variety of fats from different animal and plant sources (i.e. red meat, poultry, fish, dairy, olive oil, coconut oil, nuts, and avocados).

Conversely, micronutrients must be obtained in the diet in small quantities, but are essential to health. Vitamins and minerals are examples of micronutrients.


Micronutrients in a Ketogenic Diet

micronutrients
Key Mirconutrients in Keto Diet

When following a ketogenic diet, it is important to be mindful of micronutrient intake because:
  • Reducing carbohydrate intake can lower consumption of micronutrient-rich foods (i.e. fruits and vegetables)
  • In the initial 28 days of following a ketogenic diet, the balance of some micronutrients (such as sodium, potassium, magnesium, and calcium) can become disturbed due to an increase in their excretion.23 The body resolves this issue naturally after adapting to the diet
Sodium is the principal cation in extracellular fluid. Its functions are related to blood volume maintenance, water balance, and cell membrane potential. Sodium is also essential for acid-base balance and nerve conduction.

The level of sodium can fall at the start of a ketogenic diet. Adding extra sodium to meals (like adding salt or consuming bouillon/ bone broth) can reduce the chances of feeling the common side effects associated with low sodium (like cramps).

Potassium is the principal cation in the intracellular fluid. Its primary functions are related to maintaining cell membrane potential and electrical activity in cells such as neurons and cardiomyocytes.

As with sodium, levels of potassium fall at the initiation of a ketogenic diet due to increased excretion. When starting a ketogenic diet, include sources of potassium like nuts, dark green vegetables, and avocados.

Magnesium is an essential element in biological systems, especially for nerve, muscle, and immune function. Levels of magnesium also fall at the initiation of a ketogenic diet due to increased excretion. When starting a ketogenic diet, include sources of magnesium like oily fish, dark green vegetables, and seeds.

Calcium has a role in muscle contraction and is important for cardiovascular and bone health. Calcium deficiency is less common during a ketogenic diet, as staples of the diet such as fish, cheese, and leafy greens are rich sources of the mineral.

Now that an understanding of the biology of the ketogenic diet has been reached, we’ve arrived at the fun part: how to start the keto diet.


How to Start a Ketogenic Diet

start keto diet
Starting a Keto Diet

Don’t try to start the diet gradually. If carbohydrate intake is moderately-low, blood sugar levels may not be enough to fuel the brain, and the presence of carbohydrate in the diet might still be enough to stop the body from making ketones.

The main objectives when starting the ketogenic diet are to:
  • Restrict carbohydrates to 20 digestible grams per day or less – a strict low-carb diet
  • Consume plenty of fiber
  • Restrict protein to moderate levels. If possible, stay at or below 0.45 grams of protein per day, per lb of body weight (1g/kg). So about 70 grams of protein per day if you weigh ~155 lbs (~70kg). If your goal is to lose weight, aim for 1 gram of protein per kg of your target weight
  • Consume fat until you are satiated


Tips for Starting the Ketogenic Diet

  • Make a keto diet menu. It’s a good idea to keto meal plan before starting the diet. Make a shopping trip to stock up on a range of foods that are low in carbohydrates and high in fat
  • Use an app to track macronutrient intake. Apps such as MyFitnessPal are great to get an idea of the macronutrients in common foods. There is also a range of special online keto diet calculators.
  • Search for a few keto recipes to adapt cooking methods. Due to the high-fat consumption required to get into ketosis, it may be beneficial to change daily staples or cooking methods. Keep an eye out for coconut oil, heavy cream, and lots of cheese.
  • Make an approved list of keto foods and eliminate carbohydrate-rich foods. It will be easier to follow the diet by throwing out any foods to avoid. It’s recommended to check the labels for hidden added sugars.
  • Consider starting the ketogenic diet within a short period (16-36 hours) of fasting (consuming zero calories). Fasting depletes carbohydrate stores and can accelerate ketone production. Click here to read more about fasting protocols.
  • Gentle cardio exercise (~30 minutes) or some short high-intensity intervals (10-second sprints) can deplete carbohydrate stores and speed up ketone production.


Cyclical Ketogenic Dieting and ‘Cheating’

At the moment, there is not a clear answer as to whether the benefits of the ketogenic diet can be achieved by cycling on and off the diet. It’s best to stick to the diet for 1-2 months minimum to see benefits. It can take several days to get into ketosis1 and 3-6 weeks to become “fat adapted.”18

Some research indicates ~40 days on the ketogenic diet interspersed with periods of healthy eating with more carbohydrates (Mediterranean diet) could maintain weight loss.24

“Cheating,” and consuming high-carbohydrate food, quickly stops ketone production by the liver. It can then take a considerable amount of time for the body to get back into ketosis.

Time taken to get back into ketosis will depend on many factors. These include the amount of carbohydrates consumed, how adapted the body is to produce ketones, activity level, etc.

However, cyclical ketogenic diets are a promising area of scientific investigation. Recently, scientists studied the effect of long-term cycling of the ketogenic diet (one week on, one week off the diet) compared to a normal diet in mice. Cyclical keto dieting reduced mid-life mortality and increased healthspan.25


Optimal Range of Ketosis

As with all processes in metabolism, the state of ketosis is a spectrum. Past a threshold (which varies from person to person), even a small increase in dietary carbohydrate intake can trigger enough insulin release to take the body out of ketosis.

Guidelines for target levels for blood ketones are:
  • No ketosis: under 0.5 mM BHB in blood
  • Low ketosis: 0.5 - 1.5 mM BHB in blood
  • Moderate ketosis: 1.5 - 3 mM BHB in blood
  • High ketosis: over 3 mM BHB in blood
  • Pathological ketosis: over 15 mM BHB in blood

ketone levels
Blood Ketone Levels

The level of ketosis required for different physiological benefits is unknown. For endurance sports, a higher level of ketosis (~4 mM) appears to be superior to lower levels.26,27

This is possible because ketones fuel athletes.

However, some other benefits of ketosis, such as reduced appetite may be seen at much lower levels (0.5 mM).28

The best way to know if you are in ketosis is to measure the levels of ketones (BHB) in your blood. You can also estimate blood levels by measuring ketones in your breath or urine.


Physiological Ketosis

The typical methods used to generate physiological levels of ketosis are fasting, the ketogenic diet, and consuming exogenous ketones like HVMN Ketone.

After an overnight fast, a low amount of ketones (0.1-0.2 mM) can often be detected in the blood. As the time spent fasting increases, blood ketone levels slowly rise until a plateau at 8-10 mM of BHB has been reached after many days. Scientist Hans Krebs described this plateau as "physiological ketosis."29

Fasting long-term is unsustainable, so following a strict ketogenic diet can be used to maintain a low level of continuous ketosis. Research suggests blood BHB levels between 0.4-1mM can be achieved while following a ketogenic diet.18 Anecdotal evidence suggests it’s sometimes possible to reach higher levels.

Using exogenous ketones can raise blood ketones to a physiological level without the ketogenic diet or fasting. The level of ketosis reached depends on the exogenous ketone supplement used.

Reported levels range from 0.6 mM with a ketone salt or a medium-chain triglyceride supplement (26, 30) and up to 6 mM with HVMN Ketone.27


Pathological Ketosis

Sometimes, the body starts producing ketones as a result of a disease (pathology). This can lead to dangerous levels of ketones in the body, though these high levels are very uncommon in healthy people following the ketogenic diet.

Alcoholic ketoacidosis (AKA) is a result of chronic alcohol consumption usually accompanied by malnutrition.

AKA is characterized by increased ketone production (levels > 15 mM) via liver alcohol metabolism, in conjunction with a mild elevation in blood glucose levels. Symptoms include nausea and vomiting, fatigue, altered breathing, and abdominal pain.31

Diabetic ketoacidosis (DKA) occurs most frequently in patients with type 1 diabetes.

DKA is the simultaneous occurrence of high blood ketones (> 20 mM), high blood glucose, and acidification of the blood.31 It develops when insulin is absent, or insulin signaling is no longer functional.

This means the physiological state of starvation is triggered, even in the presence of high blood glucose. As during starvation, lipolysis (fat release) increases. This causes the liver to produce a high amount of ketones and blood pH to fall (as ketones are an organic acid).

As glucose levels are very high, the excess is excreted in the urine. This draws water and electrolytes out of the body, causing dangerous dehydration.

Symptoms of DKA include nausea, vomiting, altered breathing, abdominal pain, and unconsciousness. The rapid onset and alarming nature of DKA is a reason why ketosis has a bad stigma in the medical community.


Who Should Avoid a Ketogenic Diet?

Following a ketogenic diet may not be suggested for people with the following medical considerations:
  • Pregnancy
  • Kidney failure
  • Impaired liver function
  • Impaired fat digestion (gallbladder disease, gastric bypass, pancreatitis)
  • Genetic defects in metabolism (CPTI/II deficiency, beta-oxidation defects, fatty acyl dehydrogenase deficiency)


Potential Side Effects of the Ketogenic Diet

When starting a ketogenic diet there can be a period of 2-3 days where blood glucose levels are low, but ketone production has not reached a sufficient rate to provide enough fuel for the brain.

This can result in a series of symptoms, known as the keto flu, which include:
  • Headache
  • Muscle cramps
  • Fatigue
  • Nausea
  • Dizziness

Exogenous ketone supplements, such as HVMN Ketone, and medium-chain triglycerides can be used to reduce symptoms of keto flu. They provide the brain with a source of energy without carbohydrate consumption.

These supplements increase the levels of ketones in the blood artificially. Exogenous ketones do not increase the body’s ketone production (called endogenous ketones) and can inhibit the release of fatty acids from adipocytes. 32

It can be initially tricky to adjust food intake to ensure adequate nutrition when following a ketogenic diet. Also, some people find the diet isn’t sustainable due to individual differences in metabolic state or lifestyle.

If the diet does not provide the correct balance of macro and micronutrients, some individuals develop other symptoms beyond the keto flu after the adaptation period. These include:
  • Constipation
  • Bad breath
  • Difficulty in maintaining physical performance
  • Hair loss
  • Gallstones
  • Elevated blood triglycerides or cholesterol

To treat these symptoms, ensure the diet provides enough calories and micronutrients. Many people reduce fruit and vegetable consumption on a ketogenic diet (due to carbohydrate content). This means it is easy to become deficient in vitamins and to under-consume fiber.

The ketogenic diet can alter the way that the kidneys excrete electrolytes (such as sodium), so electrolyte supplementation can reduce the side effects of an electrolyte imbalance.


Possible Clinical Applications of the Ketogenic Diet and Ketosis

Some of the earliest reports of the ketogenic diet describe its use in a clinical setting.

In the early 20th century, ketogenic diets helped treat drug-resistant epilepsy. Doctors also prescribed ketogenic diets to treat type 1 diabetes before the invention of insulin.

As analytical techniques progressed, scientists learned that ketones themselves might be a crucial part of the success of the ketogenic diet to treat disease. From this finding stemmed a field of research to examine the potential benefits of ketosis in a range of disease states:
  • Weight loss
  • Diabetes and metabolic syndrome
  • Neurological disease: epilepsy, Alzheimer’s disease, Parkinson’s disease, migraine, concussive disease, and traumatic brain injury
  • Cancer
  • Inflammatory diseases

While the ketogenic diet is not yet a first-line treatment recommended by doctors for any of these diseases, it’s a relatively easy and tolerable step that patients with these conditions can take to improve their health.

Emerging research suggests there may be beneficial effects of ketosis for some people, and further studies are required to confirm how best to use the diet in these clinical settings.

Originally published on HVMN by Dr. Brianna Stubbs and Nate Martins.


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