Olli Sovijärvi & Teemu Arina BIOHACKER’S GUIDE TO KETOSIS BIOHACKER’S HANDBOOK: SPECIAL ISSUE 1 Biohacker’s Guide to Ketosis Biohacker’s Handbook: Special Issue Version: 1.0 Publisher: Biohacker Center BHC Inc. PO Box 955 FI-00101 Helsinki, Finland www.biohackingbook.com © Olli Sovijärvi and Teemu Arina 2019 Visual design, layout and illustrations: Lotta Viitaniemi Advisor and studio critic: Dr. Sam Inkinen English translation: Salla Williams Proofreading: Anne Belott No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of the publisher. This guide is based on the personal experiences of its authors, and the advice it contains is based on a combination of experience and scientific research. This guide and the viewpoints that it expresses should not be treated as medical advice. Consult with your doctor before using any methods presented in this book or ordering and using any of the herbs or supplements mentioned in this guide. 2 BIOHACKER’S GUIDE TO KETOSIS 3 HISTORY of protein per kilogram of body weight, 10–15 grams of carbohydrates, and acquiring the rest of the daily calorie 3 The modern history of the ketogenic diet goes back as needs from fat. In terms of macronutrient distribution, this far as a hundred years—it was used in the 1920s to treat is practically identical to the ketogenic diet in medical use 4 epilepsy patients, with very promising results. The very first in 2019. Western medicine trials using the ketogenic diet to treat epilepsy were carried out in 1911 when two French doctors The ketogenic diet was used successfully for two decades (Gulep & Marie) treated 20 epileptic children and adults after its invention until the treatment of epilepsy was with the so-called starvation technique (fasting). The John revolutionized by medication. Treatment through diet was Hopkins Hospital was the first clinic to treat pediatric largely forgotten. In the past 20 years, the ketogenic diet epilepsy in particular with the ketogenic diet. However, has again become popular. Many clinics for example spe- fasting and ketosis are known to have been a popular cialize in strict dietary treatment of epilepsy. The effects treatment method even in Ancient Greece approximately of the ketogenic diet on many other illnesses have been 2500 years ago. Documentation on the matter can be widely studied. It is increasingly being applied in the treat- found, for example, in the writings of Hippocrates.1 ment of neurological illnesses as well as various metabolic illnesses. In 1921, a scientist by the name of Woodyatt discovered that fasting or eating a low-carbohydrate diet caused the However, the main indication and secret of the ketogenic body to produce acetone and beta-hydroxybutyrate.2 That diet lies in the very effective weight management and the same year, Dr. Wilder from the Mayo Clinic defined the activation of lipid metabolism it offers. Because of this, the term “ketogenic diet” based on this mechanism. This early popularity of the ketogenic diet has increased exponen- version of the ketogenic diet involved eating one gram tially within the past few years (see image on next page). 4 THE POPULARITY OF “KETOGENIC DIET” INTERNATIONALLY, ACCORDING TO GOOGLE TRENDS THE POPULARITY OF “KETOSIS” INTERNATIONALLY, ACCORDING TO GOOGLE TRENDS 5 KETOSIS everyday lives have caused us to develop in the wrong direction: the sensation of hunger and fasting have Ketosis refers to the metabolic state in which ketone become rarer and there are more obese people now bodies (and not glucose) form the body’s primary energy than ever before. source. Ketosis takes place when the consumption of carbohydrates has been repeatedly restricted to less than Ketosis is induced incrementally after 3–4 days of low 50 grams per day, or the overall energy consumed is less calorie intake, fasting or limited carbohydrate intake than 800 kcal per day (very low calorie diet, VLCD).5 6 once the body’s glucose stores (mainly glycogen in the Assuming that the metabolism is functioning normally, liver and some glycogen in the muscles) are depleted. the body enters a mild state of ketosis after a night’s sleep The activation of ketosis is a normal bodily reaction to (8 hours). The slow onset of ketosis after fasting is also secure the energy supply of the central nervous system 8 9 directly proportional to abdominal obesity. The more and the brain when no glucose is available. obese the individual, the slower the onset of ketosis.7 The so-called keto flu is a common condition resembling Ketosis is very natural for the body and part of normal the common cold, caused by the homeostasis of energy metabolism. In other words, our bodies are “designed” metabolism shifting from burning glucose to burning to burn fat for energy and to store excess energy in the mainly fat. The fatigue, headache and irritability associated adipose tissue. The process is highly functional, particu- with the keto flu, as well as any muscle cramps, are usually larly when there is insufficient energy available from food. caused by the loss of fluids, electrolytes, and glycogen. Throughout evolution, ketosis and the activity of lipid These symptoms are also signs that the body is not yet metabolism have played a key role in human survival. utilizing fats efficiently nor using the resulting ketone 10 11 On the other hand, ketosis has not always been the bodies effectively as an energy source. The insulin default metabolic state in humans. The development production in the body is also significantly diminished of agriculture, the constant availability of food, food with the lower carbohydrate intake, causing increased 12 advertising, and simply the presence of food in our sodium excretion into the urine. 6 THE ABSORPTION AND DELIVERY OF FATTY ACIDS IN THE BODY The keto flu can be prevented by consuming plenty of electrolytes (particularly sodium, potassium AcylCoA and magnesium) and salt (such as sea salt) during the initial phase LCFA of ketosis. If you feel faint, drink plenty of fluids and electrolytes MCT LCT Chylomicron (including salt). The keto flu is MCFA typically less severe or non-existent Lumen when the ketosis follows a relatively MCT low-carbohydrate diet (less than Intestinal mucosa 150-200 g/day). Avoid heavy exercise during the first few days. The intake of diuretics (such as Fatty acids LCFA coffee) should also be limited. Lipids CO2 The onset of ketosis may be Liver Peripheral tissues accelerated by consuming medium-chain fatty acids (MCT Note greater efficiency in absorption MCTs versus LCTs. oil).13 Compared to long-chain fatty acids, MCT fatty acids are Source: Ward, D. & English, J. (2013). Medium chain triglycerides (MCTs). Beneficial effects on energy, atherosclerosis and aging. Nutrition Review. <https://nutritionreview.org/2013/04/medium-chain-triglycerides-mcts/> very rapidly used for energy due to being readily absorbed (see image). MCT fatty acids also move quickly into the be activated after intense and prolonged exercise, mitochondria and (unlike long-chain fatty acids) they particularly if only a small amount of carbohydrates was do not require carnitine to oxidize fats. Ketosis may also consumed before such exercise.14 7 THE FASTEST WAY TO ACHIEVE KETOSIS: 1. Before starting a ketogenic diet, slowly begin to 4. Drink plenty of fluids and add high-quality salt to limit your intake of carbohydrates. For example, both food and drinks; electrolyte sachets may cut out all cereal products and replace them with prevent keto flu symptoms almost entirely. vegetables, berries, and fruits. 5. Walking activates lipid metabolism and helps the 2. After 2–3 weeks, limit the intake of carbohydrates body switch from burning sugar to burning fat. to less than 50 grams per day (you will achieve even better results and a faster ketosis if limiting 6. Intermittent fasting significantly accelerates the them to less than 20 grams) – the term “carbo- onset of ketosis (see the section on intermittent hydrates” here refers to the carbohydrates that fasting). impact the blood sugar levels (net carbs), not fiber. 7. Limiting energy intake accelerates the onset of 3. Increase the intake of high-quality fat (for example ketosis; however, extreme calorie restriction/ olive oil, avocado, butter, coconut oil and hemp extremely low-energy diets are not necessary or oil, as well as the fat occurring naturally in animal recommended. products) whilst reducing the intake of carbo- hydrates; however, note that the energy content 8. The fastest way to ketosis is a 3–4 day liquid fast of one gram of carbohydrates (4 kcal) is equivalent after which the body is in a deep state of ketosis; to roughly half a gram of fat (1 gram of fat = however, this requires more willpower and approximately 9 kcal). perseverance than other methods. 8 Fasting or restricting the consumption of THE BIOCHEMICAL REGULATION OF KETOSIS carbohydrates decreases insulin levels in the circulation whilst increasing the levels 15 of glucagon and adrenaline. This leads to Triglyceride the release of free fatty acids and glycerol Glucose Hormone sensitive lipase (beta-oxidation) into the circulatory system. NEFA + glycerol Oxidized fatty acids and glycerol form into Phosphoenolpyruvate acetyl-coenzyme A, which in turn enters the Fatty acyl-CoA citric acid cycle in the mitochondria (see Pyruvate section “Metabolism—the Cornerstone of Acetyl-CoA Energetic Life” in the Biohacker’s Handbook Exercise chapter for more information). x Citrate TCA 2 Acetyl-CoA The production of ketone bodies is activated cycle by the excessive production of acetyl-coen- Oxaloacetate Acetoacetyl-CoA zyme A. The process is activated when all the malate has been has been used for Acetoacetate gluconeogenesis and there is insufficient amount of oxalo-acetate available for the Acetone Beta-hydroxybutyrate normal citric acid cycle (compared to a situa- tion in which carbohydrates are continuously During high rates of fatty acid oxidation, primarily in the liver, large amounts of available).