Dr. Stephen Phinney's take on a well formulated ketogenic diet

#1

Hi everyone. Today, after my lovely morning walk, I’ve been gorging on articles regarding nutrition (my old hobby horse), and today I looked into Dr. Stephen Phinney and came across this article which I thought to share, it is quite possible it’s already been shared in the forum before.

I’ll just copy a small extract here: Defining Characteristic #2: A WFKD has to provide adequate macronutrients to preserve lean body mass and function.

  • Effective protein intakes can range from 1.2 to 2.0 g/kg-d reference weight, where reference weight is based upon sex-based standard values for height⁷,⁸. See protein recommendations.

  • In this protein dose range, the addition of dietary carbohydrate is not necessary to maintain lean body mass⁷,⁹.

  • The combination of both carbohydrate and protein intakes at the upper ends of an individual’s tolerance range typically drives ketones down out of the NK range, particularly for those with underlying insulin resistance. For this reason, the best practice of a WFKD typically requires holding protein in moderation and adding just enough dietary carbohydrate to allow dietary variety and provide valuable micro-nutrients and minerals from vegetables, nuts/seeds, and berry fruit.

~

So it appears Dr. Stephen Phinney does believe consuming too much protein could drive ketones down, potentially kicking one out of ketosis? Any thoughts on this? Though intuitively, this is how I’ve been eating, I’ve eaten fats and proteins to pleasant satiety, for example I like having a snack plate of three dollops of KerryGold butter which I think taste delicious on its own. Since I could never do OMAD and eat that much food in one sitting, I eat 2-3 meals a day, which usually involves cuts from different animals, sometimes fish too and eggs.

Dr. Stephen Phinney does believe one can obtain valuable micronutrients and minerals from vegetables, nuts/seeds, and berry fruit. His take on a well formulated ketogenic diet appears to be based more on dietary variety whilst still reaping the benefits of remaining in ketosis. Any thoughts?

I will continue to look into his work, but as with everything, there is always the trap of becoming biased. {Meaning, one tends to find information that agrees with one’s viewpoint.} Anyway, I’m off to boil my pasture eggs, which I will enjoy with my KerryGold, and a glass of raw milk🙂

(Ohio ) #2

My thoughts are; you are diving into the unthrottled protein intake, confirmation bias belief, common in the keto world.

Pure Carnivore is the simplest way to keto, so you’ll find yourself stuck in that echo chamber. My perception is ketosis turbocharges the benefits of the vegan diet :v::peace_symbol:

#3

Hi Hippie, thanks for your reply and your thoughts. I could never do the vegan diet. Just the thought of it makes me ill, and in fact, when I did try it many years ago, it did make me ill. And I was just miserable without meat. I dreamed of eating it, lol. It’s the only time in my life I ever had intense cravings, except for when I was pregnant.

Yes, the trap of bias is ever present. My WOE is still animal based, with the inclusion of a quarter teaspoon raw local honey and a glass or two of raw milk daily. I am thriving on this WOE, I could absolutely never be a vegetarian or a vegan, both WOEs would make me ill, yet my SIL is vegan, and my MIL are vegetarians, and they’re quite happy on their WOEs which I can never wrap my head around. But it just goes to show how different we all are, and how unique our bodies’ needs, preferences and desires. My body desires this: to eat animal based, to drink my raw milk, enjoy my pasture eggs, butter, tiny bit of raw honey, and eat fresh berries and fruits only when in season (summer, autumn) sourced locally hereabouts. To me that is the most luxurious WOE I can think of, but we are all different.

As to macros, fat/protein ratio, I never think about such things. If I am fortunate enough to have my favourite fatty cuts of pork in possession, I’ll happily gorge. If I have my least favourite cuts (because less expensive) I’ll eat to satiety, but I wouldn’t go overboard, some days I eat less, some days I eat more. I’m pretty sure my body is in ketosis as I am still experiencing those same benefits, lack of inflammation, no sharp hunger, no water retention. Our limits are highly individual.

(Bob M) #4

It depends on what you think is ketosis, and how long you’ve been keto. I tried to test whether ketones go down on a high protein diet, but they don’t go to zero. They do go below 0.5 mmol/l, but every morning I’m below that, unless I’m fasting multiple days. And it doesn’t matter what I eat.

For instance, I’ve been eating a very high fat animal diet to test the theory that it’s mass that matters (animal fat has less mass theoretically). My ketones this morning? 0.2 mmol/l. Now, that was after 50 minutes of body weight training, so ketones MIGHT have been higher before then.

Keto since 1/1/14, so I think my body has gotten used to lower ketones and using FFAs.

(Bacon is a many-splendoured thing) #5

With all respect to Dr. Phinney, some people think that “too much” protein is never a problem. They may or may not be right. What is clear is that at some point the uric acid pathway gets overwhelmed and ammonia toxicity becomes a problem. I believe that @richard calculated it at 3.1 g/kg, but you should go look for the thread in the Science forum where he posted his calculations, for the correct figure. However, I believe that it’s very hard to eat that much protein in the form of real food, though protein supplements might make it easier.

Dr. Phinney is not an advocate of a carnivore diet, despite the fact that one of his heroes, Vilhjalmur Stefansson, was a carnivore for the last five decades of his life. Given that the human race appears from radioisotopic analyses to have eaten meat almost exclusively for much of the two million years of modern human evolution, it is hard to argue that meat can’t provide all the necessary nutrients. On the other hand, people are used to eating plant foods, so if they can handle them, why shouldn’t they continue eating them, so long as the quantities remain low enough to permit ketogenesis?

Dr. Phinney and Prof. Volek are some of the most prominent researchers into the ketogenic diet and its effects. They are the people who coined the term “nutritional ketosis.” Other researchers you might want to check out are David Ludwig, Richard Feinman, George Mann, Mary Enig, Robert Lustig, Alfred Pennington, Chris Palmer, and others of the people mentioned in the books by Nina Teicholz and Gary Taubes (they surveyed the scientific literature and interviewed practically everyone in the field who was still alive).

#6

Hi Bob, I’ve been on a ketogenic WOE for a much shorter time than you, only since 12 October 2022. How I think of ketosis is that state I first entered when I started keto to treat my lymphedema and lipoedema, and I experienced all the lipoedema pain and tenderness went away. That felt like a miracle. But other aches went away too, and I understood it to be the absence of inflammation. It was such a blessing. The other noticeable benefit was lack of water retention. How incredibly that’s helped my lymphatics. Well, those benefits are all still present, and that is why I still believe myself to be in ketosis, or possibly that my body is fat-adapted. Ketosis only matter to me in the benefits it can give me such as absence of inflammation, water retention=improved lymphatics. We all have different goals. But since giving up all conventional dairy and replacing it with raw grassfed milk, I no longer have issues with constipation, I no longer take my magnesium citrate, I take no supplements, and my goal is to get everything I require from my food. The quarter teaspoon raw honey I have in the morning may be too little to provide benefits, but it’s a nice way to wake up, it acts both as a neuro stimulant, like coffee, and also an appetite suppressant, I don’t eat breakfast usually, but lunch, dinner and sometimes supper as well.

#8

Hi MattWisti, thanks for your reply and your thoughts. Your post provides food for thought. I personally tend to prefer fatty meat to lean, and also tend to eat more fat than protein, intuitively. It doesn’t appear to be a problem that I’ve incorporated raw milk, I drink about 2 small glasses of it daily. I also don’t think it should be a problem that I’ve incorporated raw honey (quarter of a teaspoon daily) with regards to remaining in ketosis. Ketosis allows my body to remain inflammation-free so it’s important to me. It also provides better mental clarity. So when you talk about adding carbs and it being a potential barrier to ketosis, are you talking above keto levels, or above carnivore/ketowore levels? I still think it would be OK to bring myself out of ketosis during the summer and autumn, if eating one cup of fresh berries a day or a small farm apple/pear/plum would do that, and then remaining in ketosis the rest of the year. My WOE consists of minimally processed and non processed, mostly 1-ingredient foods. Among the non processed 1-ingredient foods are: my locally sourced grassfed raw milk, my locally sourced raw honey, all my meats except my Aberdeen Angus burgers which have been added salt and pepper to, my pasture eggs. Among my minimally processed foods: my Aberdeen Angus burgers, which are a staple in my house, and my KerryGold grassfed butter. Not that this of course impacts whether or not one stays in ketosis, but it’s a WOE that feels very luxurious and that my body is very happy with.

The only thing I’m not sure provides any benefits on my WOE is coffee, but I like the taste of it, I have 1-2 cups a day with some of the raw milk in (this to my mind sounds very wasteful, but it’s in addition to the couple glasses of raw milk I drink daily) Coffee is my vice.

(Bob M) #9

This is one of the charts I made up. Started the diet 1/1/14. You can see pretty high levels of ketones even two years after that. Then they slowly go down.

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And I had another table where I showed ketones during a 4.5 day fast. Such a fast in 2016/2017 would elicit ketones over 4 on the last day; one in 2020 would only get up to about 2.

#10

Hi Paul, thanks for your reply and your thoughts. I will look into those researchers. Although Dr. Stephen Phinney’s idea of a well formulated diet sounds perfectly fine and logical and reasonable, my body likes it closer to carnivore/ketowore with the exception of raw milk and raw honey. But I can see many people thriving on plant based WOEs, my SIL and MIL certainly do, but I never could. I love meat too much, which is why, even with my raw milk and raw honey foods, I still relate most to a carnivore though technically I suppose I am ketowore, the labels can get confusing. When I think all I really did was replace a couple tubs of heavy whipping cream daily with a couple glasses milk daily instead. Anyway, I do love learning, and I think it’s important to amass knowledge so we can make well-informed choices for ourselves, but still let our wonderful bodies’ votes have the last say.:slightly_smiling_face:Much food for thought today, but my biggest indicator the WOE is working wonderfully (after giving up conventional dairy, that was the glitch) is how good my body is now feeling, even whilst taking a medication that used to have noticeable side-effects.

(LS Conway) #11

Hi Matt,

Among those of us who have been in continuous ketosis for long periods of time, generally a year to several years or more is a common experience that overall measurable ketone levels seem to drop

This is a question that I have wanted to ask and this seems to be the correct time. You say”continuous ketosis”. There are days that I wake up and the breath ketone reader shows zero.

I eat VERY few carbs. I don’t understand how all these people that post these dessert recipes and higher carb recipes do it. I am not losing like I was and seems not at all. (I don’t weigh and only go by my clothes.)

Just don’t know how to be in continuous ketosis. I would think from my diet that I would be.

Thanks

#12

Hi Lsconway, from what I understand it depends on whether you are insulin resistant or insulin sensitive or where you fall between those two. Also, if you eat processed foods, it would be easy to misread or not notice ingredients, and then you might get what people here often refer to as carb creep. I only eat non-processed 1-ingredient foods, apart from my Aberdeen Angus burgers which have 2 ingredients, salt and pepper, and my KerryGold butter which has salt added to it. Anyway, I’m not suggesting you stick to only 1-ingredient foods, that’s just what I like to do and we’re all different, all individuals. Do you keep a carb count at all? Any idea what your current carb allowance is? I don’t personally keep track if such things, but it can be beneficial for some.

#13

Hi Bob. No idea as to the answer, but MattWisti posted an interesting theory which you might want to check out. Could it also be the body’s ability to adapt to any situation, and possibly in the absence of carbs and glucose, it may respond by producing carbs and glucose? I don’t know. But it is something I wonder about. So much more research is needed, and we are ever learning more, discovering new ways to think about nutrition, the importance of the biome, the ketogenic WOE and the nutritional state of ketosis. It’s a never ending learning curve.

(KM) #14

If your body is using its ketones for energy, then a reading of zero is just fine. It doesn’t mean you aren’t in ketosis. It could mean that, but it all it definitely means is you aren’t producing more ketones than you need. Ketones in breath or urine are the excess the body’s casting off. If you truly want to know whether you’re producing ketones you have to intercept them in the blood, before they’re utilized by the body.

(LS Conway) #15

Hi Never2late,

That is what I was talking about. All these people that eat crazy foods.
I did make some chicken with egg, pork rinds and some almond flour yesterday. I woke up at a 6 ketone level. Maybe cause of more protein. The only processed foods I eat is sometimes when I make taco meat with Rigel. But… I use a lot of meat so as not to get many carbs. No I don’t count cause I eat little to nothing as far as carbs. Some asparagus maybe sometimes… anyway… I don’t know. Just want to lose weight.
Thanks

(LS Conway) #16

Hi Kin1,

Maybe so, but I just don’t know why I am not losing like others.

Thanks

(Bacon is a many-splendoured thing) #17

I would certainly expect you to be in ketosis, given that you are eating very little carbohydrate and are still breathing in and out. Presumably, anyway—you’re not a zombie with a keyboard, are you? :grin::grin:

But don’t confuse “in ketosis” with “measurable serum β-hydroxybutyrate.” Firstly, there are three ketone bodies that the liver produces (the other two are acetoacetate and acetone), and we typically measure only the one, even though all three are found in our blood, breath, and urine. Levels of ketones circulating in the blood are the gap between the rate of production and and the rate of consumption, which are impossible to measure. Skeletal muscles prefer to use fatty acids instead of ketones (which is analogous to preferring to burn wood over charcoal). It is the brain that needs ketones, since fats are too large to pass the blood-brain barrier. If you are not going into hypoglycaemic shock, then presumably your brain is getting enough fuel.

One consideration, however, which Amber O’Hearn raised in a recent article, is whether people who’ve been keto for a while are getting enough fat in their diet. She speculates that if we don’t eat enough fat to make ketones out of, then the liver might step up the production of glucose as an alternative fuel. You might try increasing your fat intake, to see what that does to your serum glucose and your serum β-hydroxybutyrate.

(LS Conway) #18

Hey Paul

Thank you! I do eat a little cheese and hwc in coffee. Not much because I am afraid of too many carbs/dairy/fat. Many get back to my pork Belly I was eating before. Lol

#20

Hi MattWisti, thanks for your information. My carb allowance was like yours, or less, prior to incorporating my two small glasses of raw milk, and my quarter teaspoon honey. As to my macros, I don’t pay any attention to them but my body prefers fat over protein though I eat both, and I go for fatty cuts of meat, and have a daily snack plate of about 3 or 4 lumps of my KerryGold butter, which I think is delicious.

I’d be quite surprised at myself a week ago to hear me say, I choose my raw milk and raw honey over ketosis. My message to ketosis is, if you’ll play nice with my new buddies raw milk and raw honey, then I’ll be delighted to have you all in my arsenal. But like someone once said about coffee, you can take my raw milk from my dead, cold hands. After raw milk, I am slimming/streamlining even more. My SO comments I am thin, but look healthy, not emaciated. My stomach is consistantly flat (no bloat) and firming up, the skin on my hands is smooth, the skin on my legs noticeably better because of well-functioning lymphatics. And I have no aches. My SO came down with a really bad cold, but I flew over it. My raw milk is to me like a treasure I’ve found, and it must take the place of ketosis, if need be. But I don’t actually think I’m out of ketosis, for all that. I still experience all the same benefits, no hangry moments or sharp hunger, no blood sugar spikes or crashes, no water retention, no aches and no inflammation.

I’ve read a lot about Amber O’Hearn and read some of her book and her blog posts. Most fascinating woman. I’ve also read about Siobhan Huggins, and her research into the lipids. I’m always happy to learn, but I will always let my body have the last say. Drinking a glass of raw milk as I type this🙂

(Bacon is a many-splendoured thing) #21

I’ll have to look around and see. Will post it, once I find it. Although a forum search might turn something up.

#23

Hi MattWisti, I’m Norwegian and my ancestors would have had a lot of dairy in their WOE, but raw, straight from cow, sheep or goat. So the fact I am doing so well with raw milk, but do poorly with pasteurised products tells me the problem isn’t lactose or casein, but something that happens during pasteurisation, which my body doesn’t agree with. But I seem to be chugging down raw milk, and it not affecting ketosis. Also my raw honey seems fine. I am thinking of experimenting with fruit to test my insulin response/sensitivity, but this thought is not born out of a craving, or a desire for something sweet. When I think of food I think first and foremost of benefit, vitamins, minerals and micronutrients, and I research nutrition which I feel passionate about. But as to fruit, I would only eat 1 fruit a day, of some choice, I have never found eating fruit causes me to crave more of it. I’ve always been lucky that way, the only time I ever craved anything (and I craved it intensely) was when I went vegan and I was craving meat. But people I know have cravings, and want certain things to eat, I tend to first research the food, then make a list of the foods, and then purchase them to eat. But it was a great surprise when I started a ketogenic WOE the benefits I experienced from ketosis. I still want to experience those benefits, and will be using my body as a barometer to whether or not a certain food inclusion makes me fall out of ketosis, and whether, more importantly, that does away with those benefits.

I thank my ancestors too🙂