Thursday, August 26, 2021

Am I coming back on track?

After all the sinning and breaking rules since June, my ketone level reading was really low. Low that I wonder if I was still in ketosis. Plus there were just so many keto goodies I had. OMG! I have a bad weakness for desserts and sweets. 

Perhaps I was able to keep track coz I ran out of goodies and chocolates, which is also about time as I topped up and am expecting my chocolates soon and ketojunkie's goodies came in today. 

Had a splitting headache yesterday (25th) and something tells me to get the blood test kit out. My ketone read 0.7mmol/L and glucose went down to 4.2mmol/L. Based on GKI calculation I'm 6, which means I'm in low level ofketosis. Initially wanted to eat the chocolate chip cookie that Aruna (@ketojunkie) gave, I decided against it. I'm finally seeing some positive signs so I do not want to jinx it. 

Slept at 11pm. It was the time I slept when I started keto. But sometime in June, I began sleeping late at 2am. So does sleep affects keto results? Yes, apparently it does.

26th Aug (Thu)

My weight had been stagnant at 69kg for some time, inevitable since I was on high level of intoxicating myself with all the goodies. So this morning's 68kg gave me some positive vibes. *wink wink*

Went for Fight Do class and after sending the girls to Tampines and I returned home, I had headache again but I was also very hungry. By then it was already 3+pm, it was my late lunch. 

Took the test kit out again. My ketone reading read 0.6mmol/L and glucose went even southwards to 3.6mmol/L.  GKI Index is 6, which means I'm in low level of ketosis. 

Bought KFC for dinner. should i eat it? My ChocZero haul arrived. Oh no! 

I had only one piece of chicken breast and that's it coz I'll hit my carbs intake if I were to eat two. Told myself not to eat the chocs but ..... I took one hazelnut choc. Argh! I have very weak will power. So I guess the best thing is not to have those things at home. I won't think of them if I don't see them right? I really need to be more disciplined. 5months into this diet and only 10kg lost (my weight was stagnant after 3mths coz nottie girl lor...), I would have lost more if I had been more strict with myself.  

Monday, August 23, 2021

Re-organizing

Have the craziest idea of re-organizing stuffs in the fridge - pour all sauces into uniformed sauce containers

Get another set of airtight containers, maybe a different colour or design (if there is) of OXO to put the keto baking stuffs inside. Abit siao. So can differentiate between the normal baking and keto friendly baking ingredients. But I don't have a big pantry!! 

Flower pot stands. Find a double level so I can put more pots. Get more rectangular pot to make everything look uniformed. Perhaps re-pot my adenium so pot will look similar. If too large space, then get one more adenium and put 2 in one rectangular pot? 

I think I'm crazy. I have so many things I need to do, why am I thinking about some other things. 

Saturday, August 21, 2021

Qo Broadcast from Ms CXXX, the school Principal

This serves as a recollection of the events that happened in 2021 August when lil' one and 3 classes were given QO. 

I copied the messages and saved them in the camera roll as a "souvenir" for lil' one too.  

Ms CXXX, the Principal started a chatgroup for the parents of the affected children. She did very well as a leader of the school, she chose to keep us updated which means she'll be kept busy day and night. Thank you very much Ms CXXX     

QO BROADCAST - MS CXXX

9th Aug @ 3.12pm


Dear parent, the school will create a broadcast Whatsapp group for parents of affected students from the S3 classes to provide updates where possible. In order to receive these broadcast messages, please add this number to your phone contacts list now. Thank you. ~school name~.


@ 4.41pm


Dear Parents and Guardian


Good afternoon.  This is XXX, Principal/ ~school name~. Thank you for accepting this into your phone address book so that you can receive any broadcast message from me. I understand that MOH has followed up/ will be following up with you very shortly to serve the Quarantine Order.  


To have your daughter undergo the quarantine process may be an anxiety-ridden one and we recognise that.  I am setting this broadcast chat as a support platform for parents with the aim to 

1) provide general information MOE HQ and MOH may provide to the school

2) provide an overview of school support to the girls' learning and socio-emotional development

3) share school announcements, if any


Should there be queries on any MOH-related process, we will try our best to assist.  However, I appeal for your understanding that the school may not have all MOH-related information.  


Amongst us, I am aware that there are some girls who have to undergo this QO experience for the second time… I am grateful that many of these parents who calm when the Form Teachers (FT) broke the news to you. We are in extraordinary times, it is a trying period for the school – students and staff. We do our best to support and weather this as a KC family, we will emerge _stronger together_.


If you wish to get in touch with us, pls call us at ~telephone number~ to reach my Vice-Principals Mrs XXX/ Ms XXX or me.  You can also email us at our respective email addresses here: ~email addresses~ 


For any reason if you do not wish to continue to be on this broadcast list, pls send me a text.


@ 4.42pm


Over the next few days, your girl's FTs and I will do our best to assist you in the QO process. In order that I continue to support you during this period of their’ QO, I will raise some pointers here so that I can manage expectations 


Some admin pointers here:

1. We will broadcast to parents whose numbers are in the school records as the first number for data integrity, and to parents whose students are on QO.

2. I am the _only_ person manning this line, a channel I avail to whenever our girls are on QO. For now, as you are aware I do have to juggle amongst a few groups in this WA line, my response may not be immediate. I ask for your understanding and patience on this! 🙏


@ 6.19pm


*Update 1*


I understand many have received their Quarantine Order (QO).   Some may serve their QO at home (if there is ensuite facilities), some may serve their QO at a Government Quarantine Facility (GQF). I learnt that, for GQF allocation, Certis may not be allocating all students to the same hotel due to supply issues. We have had parents accompanying their child in the QO.  For students between 13 to 19, parents may sign letter to allow the minor to stay alone. 


This is what I have found out from MOH website on QO:

https://www.moh.gov.sg/covid-19/faqs/faqs---leave-of-absence-(loa)-stay-home-notice-(shn)-and-quarantine-order-(qo)


For packing list, beyond all her personal daily necessities, do remember to pack in their learning materials, medication, learning/mobile devices and chargers. Not forgetting, their favourite soft toys/ snacks or books/ games to engage them during their down time.  


MOH protocols I am aware of:

1) There are two swabs needed for the QO process:  Entry and Exit Swabs 

2) Entry Swabs may be conducted after the girls enter into Government Quarantine Facility (GQF), swabs may be conducted onsite at GQF.  Or in past instance, MOH will send a driver to pick them from the GQF to the swab site. But increasingly I am hearing from our past cases, that swab is now done onsite at the GQF.

3) Exit Swab is conducted at the end of their QO.

4) Girls will have to upload their temperatures 3X daily through the Homer app

5) Sometimes MOH officers will make video calls to them to check that they are in their rightful quarantined settings

6) Parental consent may be needed for the swab tests (pls check with CISCO or MOH)


I beg the indulgence of some parents who may find this info familiar. I will continue to customise where I can on the specific situation of this group of QO girls..


@ 6.20am


*Update #2*


Also, I think this is a good link to go to. It gives a good handy list of FAQs:


How is a COVID-19 quarantine order different from a stay-home notice? And what happens if you are staying with family? 


Here's a handy list of FAQs: https://cna.asia/3A80xpg


@ 6.22am


*Update #3*


A parent from an earlier case has shared the following info with me which I am in turn providing to parents here who are preparing to be conveyed to GQF.  Just need to bear in mind that different hotels may have different services:


1) fridge, hairdryer and ironing board available in the room 

2) Laundry service available. FOC for up to 4 pieces per person. Towels change every 3 days, bed linen, 7 days 

3) Special meal choices available 

4) Food delivery service ok. Family members can send home cook food but should be packed in disposal ware. Otherwise, she will have to keep the containers with her and take them home only upon “check out”


Further suggestions to add on to packing list : 

5) Thermometer. Students have to record their temperature 3 times a day. Caregiver should bring one too.

6) Extension cord for the multiple gadgets the kids and caregiver might have

7) Face masks. Needed whenever we open the room door to collect / dispose food, rubbish or laundry. 

8) Room spray or Lysol disinfectant spray may be useful (for toilet runs!)


Hotels may provide but they might also be overwhelmed.


May I request that you *let the FTs know* if your girl is serving QO at home or at a GQF once you have confirmation from Certis pls. And also which Hotel when she is eventually conveyed.


That’s all I have for today. I will update here should here be noteworthy information which will be useful for the QO process. Thank you and keep well.


10th Aug

@ 5.17pm


*Update #4*


Good afternoon.  I am happy to share that most of the girls’ entry swabs have been done. And for those done, all negative! For girls who have not been contacted for entry swabs, pls let their FTs know and I will follow up with MOH.


It appears that many of our girls have been conveyed to the GQF already, with just a handful awaiting for their transport.  Currently, it looks that the spread of the GQF is within our school vicinity and in city areas.  I understand some girls are serving their GQF alone.  Do remind them to *secure their doors at all times* and a little reminder that they are not to visit each other if they happen to be at the same GQF! QO is a legal order!


In our previous QO experiences with our staff and students, some of them are tagged (a little wrist tag) for the QO. This is basically a tracker, as I understand it.


Do let us know if your girl have any difficulty uploading her temperature through the Homer App. I understand that it will have to be the _number which MOH has first contacted you_ to be registered in the Homer App.


Back in school, we have also just completed our Mandatory Swab Test smoothly. The first batch of results (comprising largely the staff’s) has also been received, with happy news!


That’s all I have for today now. Take Care and Keep Well.


@ 5.46am

*Update #4a*


Some parents have texted me that their daughters are still awaiting or not received the calls to be conveyed to a GQF _yet_ despite the decision from MOH that it is a GQF.  May I ask that you alert their FTs. I will request the *FTs to collate* so that I can send a chaser to MOH.  Just to prepare parents, in our previous case, a handful of girls were conveyed to GQF a few days later in spite of the (day and night chasers!). FT collation will be a lot easier for me😅 Thank you for your understanding


12th Aug

@ 6.28pm


*Update #5*


Thank you for your patience and understanding!  By now, save for 3, all who were supposed to be conveyed to a QGF have all been conveyed.  The outstanding 3, pls be assured that I have been on MOH's heels!  The FTs or I will reach out to you personally.


Regarding swabs results, a parent shared with me that you can also access _Health Hub_ for your girl’s PCR result, lest you are waiting in vain for a text message.  It is a similar experience for us at ~abbreviated school name~ on the day of our swabs op too - staff in ~abbreviated school name~ received their Negative results – some from SMS and some from their Health Hub.  It continues to confound us on the difference and it didn’t matter! What matters is that we are Negative! 🙏


It’s been a trying period for us, but I know it is also the same for you parents as well.  So if you haven’t video called your girl, or given her a virtual hug or send her favourite food over, do take this time to bond with your girl.  I would like to end with this message from a parent, “The darker the night, the nearer the dawn”.  Powerful imagery and message for us here in ~abbreviated school name~! And we continue to trust and have the faith that we will weather together as a ~abbreviated school name~ family. Your kind words and support meant a lot to us.


13th Aug

@ 10.14pm


*Update #6*


Good evening.  I am happy to report that all who are to be conveyed to GQF have finally done so!  For majority of our girls, this would have been their third/ fourth day being quarantined. Perhaps some of them might feel a little homesick, I hope this coming weekend would be kind to you and avail some time for you to connect with your girl. 


I am excited to share this clip which my staff had sent me. This was aired over Symphony 92.4 over the evening drive earlier.  I encourage you to share this with your daughter and let them know that the teachers are trying innovatively to let them know they are on our minds!


Since it is late and I do try to pace out my updates, I will broadcast the QO exit process tomorrow instead and the info is still in good time for you.


Have a good night!


** 2 videos on radio dedication **


14th Aug

@ 6.45pm


*Update #7*


With the girls exiting their QO on *Thursday 19 August*, I would like to share some important information here:


_Transport back from GQF_

Conveyance is only provided from home to the GQF in view of the health risk measures. However, once exited from GQF, no transport, as I understand it, is provided. Accompanying parent and child are to make their own way home on their own. Parents with child staying alone at GQF, pls note this.


_Exit Swabs_

The all clear to exit QO is given only upon negative exit swab. 

Here is the process in the lead-up to the successful transition out of the QO which I am sharing here for your advance info.  Your girls (through your mobile line which MOH uses to contact you) must

1. receive their notification for exit swab,

2. receive exit swab and also

3. exit swab results.

For most of them, this would be

notified on 17 Aug,

swabbed on 18 Aug and

received negative result/exit on 19 Aug

Essentially, it is [Exit Day -2 ] for notification of exit swab.


So, let’s monitor 17 Aug closely.  The FTs will collate the responses from the girls. As and when they have received *1* and *2*, pls get her to inform both FTs. We plan to collate at end of day (17 Aug) so that we can escalate asap to MOH if she has not received 1 and 2.


It’s been an eventful week for many of us.  I hope you have been able to rest a bit this weekend.

We must remember to care for ourselves, centre ourselves so that we can in turn, care for our children. 

Sharing our Founder, Blessed Nicolas Barre’s words as the day winds down:

_Whatever happens, remain always in peace and trust in God_


17th Aug

@ 10.47am


*Update #8*


By now, most of your girls would have received one e-care pack from the ~abbreviated school name~ Family through their FTs.  It is a e-voucher of sweet treats which the girls can request delivery to their GQF or homes. This is to be redeemed online and delivered to Home/GQF.  In our previous QO cases, we had the luxury of student leaders coming together to pack the physical care packs and teachers to double up as delivery folks. In this round, with the intermittent HBL we have been on and a third of our staff on quarantine, it will have further taxed our manpower to repeat what we did.  Our teachers have innovatively explored this alternative (see image below👇) and I am glad to be able to bring to the students. For students exiting QO soon, it is advisable that the sweet treats be delivered to their homes, instead of the GQF. I hope the carepack will brighten their day.  Pls tell our girls we love them and they do themselves proud to get through this period positively!


With love,  The ~abbreviated school name~ Family.


@ 10.48am






@ 11.13am


*Update #9*


Further to our plan shared with you in _Update 7_, we will be alerting MOH based on our collation as of *5pm* this evening for all who have not received the notification for exit swab.  I also hear that for those who are in the GQF, the notification may be on the same day of the swab. I’d be grateful for your girls to contact her FTs as we begin collation at 5pm later for us to submit the names to MOH (for those not contacted yet)


If you happen to have received the notification _after 5pm_, pls also just inform their FTs anyway, so that we can help monitor this list, for and with MOH on the go!


Currently it looks that the girls have progressively received their exit swab notification and swabs too. I think the exit process is making good progress! In the event, for any reason it is not the case for your girl, pls reach out the FT who are collating. Regardless, let’s continue to still keep the spirits up for her and with her, in spite of our own anxieties (and frustrations). We are on our final stretch! 


I will provide the next broadcast tomorrow regarding the physical exit out of GQF. Until then, keep well!


18th Aug

@ 12.09pm


*Update #10*


*Exit Swabs*

Almost all girls have been swabbed and they are progressively receiving their negative results! Notification is through SMS or Health Hub (so, pls check Health Hub App). Results should be posted today.


*Impt Info for Exiting out of QO*


_Those on Home QO_ - Person Under Quarantine (PUQ) who have -ve result for exit swab, they will receive a notification on the Homer App, where they will automatically exit at 12noon on day of QO expiry. 


You can find out more info in this link:

https://www.moh.gov.sg/covid-19/general/faqs/faqs---for-persons-under-quarantine-(puq)-on-home-quarantine-order-(hqo)-who-are-fully-vaccinated


_Those at GQF_ - PUQ with  -ve exit swab result, please wait for hotel to get update from MOH on day of QO expiry. PUQ can inform front desk that they are ready to check out and hotel will also chase MOH if no word from MOH.  Hence stay in the room till call from front desk! Unlike those on HQO, exit may or may not happen at noon, pls check in with the front desk.  Also, pls ask front office or get your girls to ask the staff escorting them out, where you should pick her up (hotel driveway, for instance?). Different hotels have different exit points, as I understand. 


I will have a final broadcast tomorrow, to ensure all have exited safely. We are on a home stretch and let us pray that it will be smooth. Thank you.


19th Aug 

@ 1.10pm


*Final Update*


This is the final update of our QO journey with our girls. Many are either progressively checking out and have already checked out. Parents, pls give them a good embrace for us when they are home. For our HQO girls, no hugs are too many for you too at home! 


We look forward to seeing them back in school *tomorrow (20 Aug)* ! I will cease broadcast after this.  If you need to get in touch with the school leaders, you can email us or call us at the school number (details in my Update 1). You can also reach out to the FTs as well. I will be turning off the phone _after_ today and _after_ deleting your numbers.  


Thank you, parents, for all your patience and cooperation.  I am grateful to have journeyed with you.  In spite of the context, I see the silver lining of this experience... that perhaps, we have grown closer to our girls, have enabled them to see that we are here for them, or perhaps, they have discovered something invaluable about themselves they didn't know they have. 


As we move into an endemic state and with the revision of the QO policy (which takes effect 19 August today – PG notification to all parents yesterday), I hope for the beacon of light to come for many of us.  Covid-19 has caused much disruption to lives and livelihoods. These are tough times, and as the significant adults for our children, we want to continue to help them (and help ourselves) to distill from this experience and appreciate that we have all grown from this experience.  Anxieties aside and SMM notwithstanding, we want to help our children grow up as normally as we can, be connected to one another, we remain hopeful that as a nation, we are together in battling this, playing our respective roles as our nation implements our Covid-19 endemic road map. And then, I look to years later, when they can recall this chapter of their lives, and say that we have been for them, and that the experience has shaped them for the better. 


Nicolas Barré says, _a little love makes everything easy._We want to remember the front liners (our Certis folks, the swab teams, the MOH folks) who have been confronting this for the past 18 months… May we all connect with each other with patience and love.


We look forward to giving our girls a welcome Milo drink at Uncle Jeffrey’s stall during their recess tomorrow. Code name is *Dinosaur QO* (_pls share code name with them, only they get it! And only on _20 August!_) ☺️


God bless all of us, and ~abbreviated school name~ _~school motto~ _



****************************************

Link to this topic : 

10th Aug - Somebody Striked Toto

Monday, August 16, 2021

Optimal ketone and blood sugar levels for ketosis

Optimal ketone and blood sugar levels for ketosis
extracted from : https://onketosis.com/optimal-ketone-and-blood-sugar-levels-for-ketosis/

optimal fasting ketone and blood sugar levels in ketosis
  • A low carb helps reduce blood sugars and insulin levels and helps improve common metabolic diseases (e.g. diabetes, heart disease, stroke, cancer, Parkinson’s and Alzheimer’s).
  • We become insulin resistant when our adipose tissue becomes full and can’t store any more energy. Excess energy is then stored in the liver, pancreas, heart, brain and other organs that are more insulin sensitive.
  • Endogenous ketosis occurs when we don’t eat, and we burn our own body fat (e.g. fasting). While insulin and blood sugar levels are low, we may have lower blood ketones flowing from our fat stores.
  • Exogenous ketosis occurs when we eat lots of and/or take exogenous ketones. Our blood ketones may be higher, but our insulin levels will also rise because we have an excess of energy coming from our diet.
  • Most of the good things associated with ketosis occur due to endogenous ketosis.
  • Most people following a ketogenic diet have lower blood ketone values than Phinney’s ‘optimal ketosis’ chart, especially once they become fat adapted and are not trying to drive high blood ketones through the consumption of excess energy from refined fat.
  • If your goal is blood sugar control, longevity or weight loss then endogenous ketosis with lower blood sugars and lower ketones is likely a better place to be than chasing higher blood ketones via lots of added dietary fat.

  • I have seen a lot of interest and confusion recently from people following a ketogenic about ideal ketone and blood sugar levels.
    This article reviews blood ketone (BHB), breath ketone (acetone) and blood sugar data from a large number of people who are following a low carb or ketogenic diet to understand what “normal” and “optimal” really look like.

    This understanding, based on real-life data from people following a ketogenic dietary approach, will help us fine tune our diet and lifestyle to suit our goals whether they be:

    Many people initiate a low carb diet to manage their blood glucose levels, insulin resistance or diabetes.

    As shown in the chart below, foods with less carbohydrate do in fact have a smaller impact on our blood sugar.[1] [2] [3]

    image

    While not typically recommended by dieticians and diabetes associations, it it appears that, if you are insulin resistant, have prediabetes, or full-blown diabetes (Type 1 or Type 2) it makes sense to reduce the carbohydrates in your diet to the point where you can achieve the blood glucose levels of a metabolically healthy person.

    According to mainstream medical definitions:

    • “normal” blood sugar regulation is defined as having a HbA1c of less than 6.0%,
    • Prediabetes is diagnosed when you have an HbA1c between 6.0 and 6.4%, and
    • Type 2 diabetes is diagnosed when you have an HbA1c of greater than 6.4%.

    However, as you can see from the charts below, this definition of “normal” is far from optimal.

    image
    image
    image

    By the time you have “pre-diabetes” (with an HbA1c of greater than 6.0%), you are at risk of many of the most common western diseases of ageing and causes of death (i.e. heart disease, stroke, Parkinson’s, Alzheimer’s and cancer).[4] [5]

    image

    If you’re interested in optimal rather than that what currently passes for “normal” health, the table below shows some suggested HbA1c and average blood sugar targets for optimal health and longevity.

    risk level

    HbA1c

    average blood sugar

    (%)

    (mmol/L)

    (mg/dL)

    optimal

    4.5

    4.6

    83

    excellent

    < 5.0

    < 5.4

    < 97

    good

    < 5.4

    < 6.0

    < 108

    danger

    > 6.5

    > 7.8

    > 140

    While high glucose levels are bad news in and of themselves (glucose toxicity and excessive glycation), high blood sugars typically go hand in hand with high insulin levels which are also bad news.[6] [7] [8]

    A metabolically healthy person will store excess energy in their fat cells, ready for easy access when required later. But if we continue to fill our fat cells with the excess energy they get to the point where they cannot continue to expand to accept more energy. It is at this point that our adipose tissue becomes insulin resistantTed Naiman does an excellent job explaining this.

    The good news is that insulin resistance will slow the expansion of our fat cells (the excess energy can’t get in as easily). The bad news, however, is that once our fat cells become insulin resistant the excess energy will be re-directed to the parts of our body that are more insulin sensitive such as our liver, pancreas, heart, brain and other vital organs.

    Our pancreas will work overtime secreting more insulin to try to keep the energy in the liver as well as put it back into storage.

    High insulin levels mean that we will find it harder to release energy from our fat stores when we go without food.[9] Without easy access to our body fat stores, we will be driven by our appetite to eat again sooner.

    Someone who is insulin resistant is more likely to become obese because their chronically elevated insulin levels will drive them to eat more often because, without easy access to their fat stores, they feel bad without a constant flow of glucose for energy.

    image7.jpg

    Fasting insulin levels in healthy populations range between 2 to 6 mIU/L.[10] [11] [12] The average insulin levels in western populations are 8.6 mIU/L. Meanwhile, the official reference range for “normal” fasting insulin is less than 25 mIU/L.[13] [14] Given that the western world is going through a crisis of metabolic health, it is safe to say that, similar to the “normal” blood glucose levels, this cut off for ‘normal’ insulin levels is also far from optimal.

    image

    To help optimise your insulin levels and blood sugar you can tailor the insulin load of your diet to suit your current level of insulin resistance. As shown in the chart below, our insulin response to the food we eat is proportional the net carbs in our diet plus about half the protein it contains.

    image

    Reducing the insulin load of your diet can help to reduce your insulin and blood sugar levels to the point where your pancreas (and any insulin resistance you may have) can keep up.

    When our insulin levels are low, we can access our body fat for fuel, either from our body or our food. We then see the ketone levels in our blood rise. At this point, we are deemed to be “in ketosis”.

    A person with type 1 diabetes (like my wife Monica) is not able to produce enough insulin from their own pancreas. Without exogenous insulin injections, they will see both their blood glucose and blood ketones rise to very high levels. This is called ketoacidosis which is a dangerous and requires exogenous insulin as soon as possible to prevent their body from falling apart.

    Without insulin, people with type 1 diabetes are unable to metabolise glucose and turn to their muscles for energy. As shown in the image below of JL, one of the first children with type 1 diabetes to receive insulin, they quickly regain weight.

    image

    Rather than minimising insulin, it’s important to find the optimal balance of insulin. We want to have the blood sugars and insulin levels of a metabolically healthy period. Lowish blood ketones with healthy blood glucose levels is a normal healthy state where your body fat can more easily be accessed for fuel.

    People who switch to a low carb diet often find that their blood glucose and insulin levels plummet and they are not hungry because energy can more easily flow out of storage (a little bit like someone with uncontrolled type 1 diabetes).

    However, the problem with a very low insulin load dietary approach (e.g. very high fat therapeutic ketogenic diet), is that it may not contain enough of the vitamins and minerals that you need for optimal function and avoid nutrient cravings in the long term.

    2017-05-28 (7)

    High-fat foods also have a high energy density which can make it hard for some people to control portion sizes. This can be problematic if their goal is weight loss. Very high-fat foods also tend to be less nutrient dense.

    2017-05-28 (2)

    When we go without food, our blood glucose levels will decrease as the glucose in our bloodstream and liver (glycogen) are used up. The body then turns to our fat stores and our liver converts them into ketones for use. This is termed “endogenous ketosis” (endogenous = originating from within an organism).

    As explained by Dr David Sinclair in this video, there are a tonne of beneficial things that occur during endogenous ketosis such as autophagy, mitogenesis, mitophagy, upregulation of SIRT1 and increase of NAD+).

    The chart below shows my blood sugar and blood ketone (BHB) during a recent seven day fast. As glucose levels decrease, ketone levels rise.

    image

    You can see that the sum of glucose and ketones continues to increase during fasting. I have termed the sum of glucose and ketones as “total energy” (i.e. glucose + ketones).

    Often in fasting, it seems that the body will let the total energy in the blood go quite high. This enables you to be in a state of very high alert ready to find food to survive. It feels great. I typically feel at my sharpest after not eating for a few days.

    I think it’s important to understand the difference between exogenous ketosis and endogenous ketosis.

    • Endogenous ketosis is when we eat less than the body needs to maintain energy balance and we are forced to use some of our body fat to make up the difference.
    • Exogenous ketosis occurs when we eat lots of fat (or take exogenous ketones), and we see blood ketones (beta-hydroxybutyrate) build up in the blood.

    Ketones in the blood occur when you are eating more fat than you are burning. Lower blood ketones are not a cause for concern as long as your blood glucose levels are also low (i.e. low total energy).

    The reality is that we will all be somewhere on the spectrum between exogenous and endogenous ketosis. We need enough energy to get through the day and not fade away.

    But keep in mind that most of the good things we attribute to ketosis and the ketogenic diet occurs due to endogenous ketosis when fat is coming from our body.

    We may not have high blood ketone levels when we are in endogenous ketosis, but that’s OK because that’s where the good stuff.

    The ketogenic diet is still evolving and fertile area of research. Even Keto Clarity co-author Eric Westman recently admitted that there is still a lack of clarity around what constitutes ideal ketone levels.[15]

    image

    The chart below shows the ‘optimal ketone zone’ from Volek and Phinney’s Art and Science of Low Carb Living which is typically referred to as the ultimate guide to optimal ketone values.

    image

    The problem, however, is that it’s hard for most people to achieve “optimal ketone levels” (i.e. 1.5 to 3.0mmol/L) without fasting for days or eating a lot of additional dietary fat (which may be counterproductive if you are trying to lose weight).

    Recently, I had the privilege of having Steve Phinney (pictured below in our kitchen making his famous blue cheese dressing) stay at our place for a night when he spoke at a Low Carb Down Under event in Brisbane.

    image

    I quizzed Steve about the background to this optimal ketosis chart. He said it was based on the blood ketone levels of participants in two studies. One was with cyclists who had adapted to ketosis over a period of six weeks and another ketogenic weight loss study. In both cases these ‘optimal ketone levels’ (i.e. between 1.5 to 3.0mmol/L) were observed in people who had recently transitioned into a state of nutritional ketosis.

    Since the publication of this chart in the Art and Science books, Phinney has noted that well-trained athletes who are long-term fat adapted (e.g. the athletes in the FASTER study) actually show lower levels of ketones than might be expected.

    Over time, many people, particularly metabolically healthy athletes, move beyond the ‘keto adoption’ phase and are able to utilise fat as fuel even more efficiently and their ketone levels reduce further.

    image

    Urine ketone strips are often considered to be of limited usefulness because the body stops excreting ketones as it learns to use them. Could it be a similar situation with blood ketones (BHB), albeit over a longer period of time?

    image30.jpg

    As our blood glucose levels decrease, our ketones increase to balance out the fuel deficit. When we have less glucose available our insulin levels go down, more fat is burned, and blood ketone levels rise.

    The chart below shows the sum of the blood glucose and ketones (i.e. total energy) from nearly three thousand data points from a broad range of people following a low carb or ketogenic dietary approach.

    image24.png

    [In late 2015 I pooled a range of data from myself and a number of people on the Optimal Ketogenic Living (OKL) Facebook group. After sharing this data initially, a number of other people sent me their data. Later, Michel Lundell from Ketonix agreed to share an extensive set of anonymised data for me to analyse.]

    On the left-hand side of the chart, we have a low energy situation where insulin levels are also low. The body will be drawing on stored body fat for fuel to meet the shortfall and weight loss will occur.

    On the right-hand end of the chart, we have a high energy situation from both glucose and ketones. This high energy situation causes the pancreas to secrete insulin to hold the glycogen back in the liver and stop lipolysis (i.e. the release of fat from storage) because there is more than enough energy floating around in the blood.

    It’s a slight oversimplification to say that the left-hand side of the chart is endogenous ketosis (which is good) and the right is exogenous ketosis (which is bad).

    We may or may not see high blood ketone levels when we go without food for an extended period. However, replicating high ketone levels with high levels of exogenous ketones or an oversupply of dietary fat is not the same as endogenous ketosis, even though both situations are called “ketosis”.

    Based on this data it seems the body tries to maintain a blood glucose level of around 4.9mmol/L and a blood ketone level (BHB) of around 1.5mmol/L. The table below shows this data in terms of average as well as the 25th percentile and 75th percentile points (i.e. 50% of the values fit between the 25th and 75th percentiles).

    ketones (mmol/L)

    BG (mmol/L)

    BG (mg/dL)

    HbA1c

    GKI

    BrAc

    total energy (mmol/L)

    25th

    0.6

    4.2

    76

    4.3

    1.8

    46

    3.4

    average

    1.5

    4.9

    89

    4.7

    7.3

    56

    6.4

    75th

    2.1

    5.6

    101

    5.1

    14

    66

    12.9

    Some people come to low carb or keto for therapeutic purposes (i.e. to manage chronic conditions such as cancer, epilepsy, traumatic brain injury or dementia). These people will benefit from high ketone levels to feed the brain when glucose cannot be processed due to high levels of insulin resistance.

    Most people, however, do not require this degree of therapeutic ketosis, particularly if managing insulin resistance or obesity is the priority. People using low carb to manage diabetes or weight loss goals may end up driving excess energy consumption and a lower than necessary nutrient density, both of which may be counterproductive.

    image2.png

    People following a therapeutic ketogenic diet may be fuelling up with MCT oils to achieve high ketone levels and low glucose:ketone index values (GKI) value for therapeutic purposes. Others will target high levels of ketones for brain performance. Others will load up on exogenous ketones and glucose to ‘dual fuel’ the system for athletic performance.

    One of the benefits of a low carb or keto diet is that it tends to eliminate a lot of hyper-palatable processed foods, and lowers insulin levels which help many people normalise their appetite and eat less.

    The danger, however, with trying to drive exogenous ketosis is that it will lead to an energy excess situation which will drive insulin to remove excess energy from your bloodstream, which can worsen insulin resistance.

    Even though we are getting most of our energy from fat rather than carbs, the body will still work to bring the total energy back towards optimal levels using insulin, and stop the release of stored glycogen and body fat until you have used up the energy in your blood from your food. This is why Thomas Seyfried and Dominic D’Agostino talk about the benefits of a calorie restricted ketogenic diet. [16] [17] [18]

    image

    Many people embark on a ketogenic dietary approach to manage their diabetes and achieve long-term weight loss. They want lower insulin levels to enable them to burn more body fat for long-term insulin sensitivity and health.

    image8.png

    On the left-hand side of the total energy chart below, we have a situation where we are generating endogenous ketosis, meaning that our own body fat is being burned for fuel. With a lower total energy level in our blood, our body needs to pull fat from our body fat stores as well as use excess stored fat and old proteins in our liver, pancreas, brain and other vital organs (i.e. autophagy).

    image

    To understand what all this means I have divided the three thousand data points into five quintiles, from lowest to highest total energy. For each quintile, I have calculated the average, 25th percentile and 75th percentile blood ketone (BHB) value. Half of the ketone values will fit between the 25th and 75th percentile values.

    optimal ketosis

    The key takeaway from this analysis is that, as detailed in the chart below, the lowest blood sugar levels are associated with lower ketone levels and a lower total energy.

    quintile

    average BG (mmol/L)

    BG (mg/dL)

    ketones (mmol/L)

    total energy (mmol/L)

    25th

    average

    75th

    1

    4.5

    80

    0.3

    0.6

    0.7

    5.0

    2

    4.9

    88

    0.4

    0.8

    1.1

    5.7

    3

    5.1

    92

    0.6

    1.1

    1.5

    6.2

    4

    5.1

    92

    1.2

    1.8

    2.3

    6.9

    5

    5.1

    922.2

    3.2

    4.0

    8.3

    In the discussion above we see that the lowest risk of the modern diseases of ageing and metabolic health occurs when we have a HbA1c of less than 5%. Dr Richard Bernstein recommends a blood glucose of 83 mg/dL or 4.6 mmol/L as optimal. It seems that as a general rule (maybe other than when we are fasting or aiming for therapeutic ketosis) being somewhere to the left of this chart is optimal.

    You may not always be able to live at a very low total energy level, but as you fast or increase the spacing between your meals your total energy levels will decrease, and you will get all the positive benefits of fasting. (See How to Use Your Blood Sugar Meter as a Fuel Gauge and How to Use Your Bathroom Scale as a Fuel Gauge for objective measures to refine your balance between feasting and fasting to achieve your goals).

    You don’t achieve optimal ketone levels by adding fat with super high ketone levels, but rather by managing your energy balance, carbohydrate intake, and meal timing so you can dip into endogenous ketosis on a regular basis.

    When you do eat, you should try to maximise nutrient density to ensure you get the nutrients you need. Your blood ketone levels will decrease when you are using insulin to build and repair your muscles. When you stop eating for a while, you will see them rise again as fat flows out of storage.

    image14.png

    Anecdotally it seems that people who are very physically fit may find they have lower blood ketone levels. Lower blood ketone levels (say greater than or equal to 0.2mmol/L) with low blood glucose levels seems to be a healthy place to be.

    image21.png

    In fact, you could even save your money on testing ketones and just focus on making sure your blood sugars are closer to optimal. One of the simplest and most accurate blood glucose machines is the Abbott FreeStyle Lite.

    If you want to test your ketone levels and blood glucose levels, then the Abbot Optium Neo is the one to go for.

    If you don’t have health cover for diabetes, the test strips can get expensive if you want to check regularly. However, you can quickly get a feel for whether you are insulin resistant and which nutritional approach you need to follow.

    A smart friend of mine, Robert Miller, has been challenging my thinking recently around ketones. Robert’s theory is that the benefits that people attribute to ketones are actually largely due to an increase in nicotinamide adenine dinucleotide (NAD+).[19] [20]

    Adequate levels of NAD are critical to moving energy around our body, from our food to our mitochondria.[21]

    image

    NAD+ declines with age, increases in fasting, during a ketogenic diet or in response to exercise. When NAD+ rises, SIRT1 helps our body to repair and improve our insulin resistance.[22]

    Our NAD+/NADH balance is critical to controlling our appetite and telling the body whether we need more fuel, or if it’s time to tap into our body fat stores.

    image

    We can increase our circulating levels of NAD+ by eating a nutrient dense diet, particularly with adequate niacin (vitamin B3).[23] There are a range of NAD+ supplements that seem to have positive benefits.

    Nicotinamide Riboside is a close precursor to NAD+ which can be helpful for people who struggle to make NAD+ directly from food.

    Image result for niacel

    However, Nicotinic Acid (i.e. full flush niacin) is a much cheaper supplement that will work just as well for most people.

    NAD+ metabolism is a fascinating rabbit hole if you want to do some research, but for now, let’s say that it’s important to have adequate NAD+ to enable your mitochondria to convert the food you eat to energy rather than having it back up in your body.

    You will likely be aware that three separate types of ketone bodies:

    1. acetone (breath ketones),
    2. acetoacetic acid, and
    3. beta-hydroxybutyric acid (BHB in the blood).
    image

    Fatty acids come to the liver either from our food or lipolysis (mobilisation of fat from our body) and converted to acetoacetate. Unfortunately, we have no way to directly measure acetoacetate, only BHB in the blood and acetone in the breath.

    image

    The Ketonix is a device that you blow into that measures the acetone which is akin to exhaust that is released when you burn acetoacetate. [Special thanks to Michel Lundell from Ketonix for sharing the data and Alessandro Ferretti and Weikko Jaross for help with number crunching.]

    image27

    Blood ketones (BHB) are the most well-known form of ketone bodies. There is some relationship blood ketones and breath ketones, but it is not direct. The chart below is Measuring Breath Acetone for Monitoring Fat Loss: Review (Anderson, 2015)[24] which states

    “ENDOGENOUS ACETONE PRODUCTION IS A BY-PRODUCT OF THE FAT METABOLISM PROCESS… BREATH ACETONE CONCENTRATION (BRAC) HAS BEEN SHOWN TO CORRELATE WITH THE RATE OF FAT LOSS IN HEALTHY INDIVIDUALS… A STRONG CORRELATION EXISTS BETWEEN INCREASED BRACE AND THE RATE OF FAT LOSS.”

    image

    The Ketonix data shows a similar relationship but with a lot of scatter!

    image

    Most people at this point throw in the towel and go back to blood ketones (BHB) which appear to be more reliable. However, it’s important to note that breath acetone is a stronger marker of burning ketones for fuel, not just buffering energy in the blood.

    What I’m trying to illustrate with the dodgy clip art in the chart above is that having high blood ketones and low levels of breath acetone appear to be a sign that you are not burning the fat you’re eating.

    By contrast, a high level of breath acetone with a low level of blood ketones (BHB) and low blood glucose may be a sign that you are very efficiently burning the fat you eat.

    If you had a choice, I think it’s better to have high breath acetone (BrAce) and lower blood ketones (BHB) (which would indicate that you were efficient at burning fat) than high BHB and low BrAc (which would indicate that you were good at eating fat but not necessarily burning fat).

    The figure below shows BHB vs BrAce for the different purposes that people nominate for using the Ketonix. What we see is that people with diabetes (red trend line) have both higher blood glucose and higher blood ketone (BHB) levels (i.e. higher total energy). Fuelling the mitochondria with the right nutrients that increase NAD+ will both help to burn off the excess energy and manage appetite through the NAD+/NADH ratio.

    image

    The second law of thermodynamics states that the total entropy (chaos) of an isolated system can only increase over time. The total energy concept is novel, but it seems that an organism that is ageing will decay and not be able it’s energy packed in storage, but rather we will see increasing levels of energy floating around in the bloodstream.

    image
    • Metabolic related diseases such as heart disease, cancer, stroke, diabetes, Alzheimer’s disease, kidney disease are the leading causes of death.
    • People with the best metabolic health (i.e. low HbA1c, insulin and blood sugar levels) have the lowest risk of dying from these common western diseases of ageing.
    • Keeping your processed and starchy carbohydrates low will help to keep your blood glucose and insulin levels and reduce your risk of obesity.
    • When we fast, our glucose levels decrease, and ketones increase to maintain our energy levels.
    • People who are metabolically healthy and insulin sensitive typically have a lower level of total energy (i.e. glucose + ketones) in their bloodstream.
    • We can mimic the rise in ketones with added fats or exogenous ketones that we see in fasting. However, the real benefits occur when the body is forced to draw on its own stored energy, and we experience autophagy, upregulation of SIRT1, and a rise in NAD+.
    • The benefits that we often attribute to ketones may also be due to increased NAD+ levels which occur in fasting and/or with a nutrient-dense diet.
    • We can only measure beta-hydroxybutyrate (in the blood) and acetone (in the breath). We can think the BHB as a buffer ready for use, and acetone as the exhaust showing that the ketones have been burned for fuel. Higher levels of fat burning with a lower need for buffering is a better place to be than a large buffer in the blood and minimal fat burning.

    [2] https://www.researchgate.net/profile/Peter_Petocz/publication/13872119_Holt_SHA_Brand_Miller_JC_Petocz_P_An_insulin_index_of_foods_the_insulin_demand_generated_by_1000-kJ_portions_of_common_foods_Am_J_Clin_Nutr_66_1264-1276/links/00b495189da41714fa000000.pdf/download?version=vs

    [4] http://www.cardiab.com/content/12/1/164

    [10] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

    [13] http://emedicine.medscape.com/article/2089224-overview

    [15] https://www.facebook.com/AdaptYourLife/videos/vb.1608140252761871/1899686180273942/?type=2&theater

    [25] https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0009-2

    [26] http://care.diabetesjournals.org/content/24/2/362

    post last updated October 2017

    optimising your diet for normal blood sugar and insulin levels:

    OnKeto.com is a news aggregation service that brings you best of world articles to you for your consumption.

    Author: Marty Kendall
    Author URL: https://optimisingnutrition.com/author/martykendall/
    Original Article Location: https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/