I bounce in and out of ketosis. Some prosper in perpetual ketosis, like Dominic P. D’Agostino and newborn babies (though if you know Dom, it is rather difficult to have him in the same sentence as newborn babies). Some adamantly refuse ever purposefully going into ketosis (many, many, many, old school nutritionists and physicians who, for years, have confused it with ketoacidosis). This article is not what is best for you. The following is my Periodic Ketogenic Diet Protocol.
I seem to perform best when I periodically enter into nutritional ketosis. I have been in ketosis for 6 months, a year, you name it. I have tried everything in terms of timing, and brief periods of ketosis are optimal for me. Over the years, I have gradually come up with my own protocol to get into ketosis quickly and maintain it for around 5 days.
Periodic Ketogenic Diet Protocol
After 12 years of reading study after study, I have created my personal periodic ketogenic diet protocol. I am in no way saying this protocol is good, bad, or even appropriate for you. In fact, I am not even inferring that this protocol is safe for you, as I have no clue if you have any medical conditions.
This is what I do. This is what keeps me lean, metabolically healthy, and hopefully provides my body with the tools to fight cancer now and for the rest of my life. Maybe it will work. Maybe it won’t. But my review of the data tells me this is my best bet. So this is what I do.
In the middle of July, in a small city of champions known as Pittsburgh, I was due for some ketosis. I decided to write down everything I did, from meals to workouts. The following is a step-by-step description of the five days following my personal protocol. I get many questions from my readers and patients asking what I do, so I hope this answers most of them. I try to key in on some aspects that have caused me issues in the past and common issues/misconceptions that exist regarding the ketogenic diet, which I will refer to as KD for the rest of the article.
Five Days of the Periodic Ketogenic Diet Protocol
Periodic Ketogenic Diet Protocol Day One – Diving in:
Switching from high fat, moderate protein, and low carb to very high fat, low protein and very low carb.
Coffee with heavy cream and MCT oil while reading on the front porch.
One mile walk with my dog, interrupted at nearly 100 feet intervals as it stops to smell every spot of other dog pee.
For breakfast I have one of my last big meals for the day (sometimes I minimize this or cut it out). Breakfast is the most flexible of my meals at all times, but more so during my protocol.
I cook 3 eggs from pastured chickens, 2 eggs from pastured turkeys, ¼ cup of raw, organic cheese from grass-fed/finished cows, and 2 cups of spinach. I cook the spinach first and then add the eggs whole, eventually stirring them once they are decently cooked.
While cooking my breakfast, we also cooked up 4 ounces of cod in butter from grass-fed cows with liberal salt, pepper, garlic, lemon, and a big handful of kale for lunch.
After lunch I add 2 tablespoons of MCT milk (Betaquick from Vitaflow) to a cup of moringa green tea. I usually do this with regular green tea, but a patient’s family member brought me moringa as a gift and it works better. I walk 1 mile.
Old school German volumetric training, old school rap, one-legged squats, box jumps, and then walk dog 1.5 miles.
1 scoop of super-secret specially made keto whey protein mixture, 2 tablespoons (realistically a huge gulp) of MCT milk, 5 g BCAA, 1 g Lysine
3 ounces ground beef mixed with 3 ounces ground liver and my special Indian spice powder (Sambhu’s Spice), raw manchego cheese, 2 cups Brussels sprouts, glass of Turkish wine, and 1 episode of Rick and Morty.
At this point, my ketones are at trace on ketone urine strips and less than nutritional ketosis if I was doing finger sticks (for all intents and purposes we are defining this as 1mmol/L or greater). I know my levels are not over 1, so I do not waste a ketone strip since they are like Lamborghinis in price these days. While my carbs are clearly low enough, I likely had too much protein for the day.
Take note – this is the most common problem that I see in the clinic. As the days progress (usually 3-5 total), I tend to eat less protein and if using supplements, I rely on BCAAs to get more metabolic bang for my buck without stunting my ketone production.
As a side note, you’ll notice that I list Scivation BCAAs. Any high-quality BCAAs will do, but I prefer Scivation because they are good quality and I also have no qualms promoting them because they are an awesome company and one of the few nutritional/supplement companies that donates a substantial amount of money to cancer research.
BCAAs are important for many reasons, like muscle preservation and metabolic support, but are also important on a ketogenic diet as you’ll read below.
Periodic Ketogenic Diet Protocol Day 2 – Keto-Tweener Day:
Day 2 is started with a keto fast. This is not necessarily a fast, but more of a fast “hack.” I consume coffee with MCT milk. While I am not officially fasting, I am maximizing ketone production while reducing insulin and promoting some anticancer pathways (i.e. proapoptotic and antioncogenic molecular pathways) while still consuming food.
This “hack” will hopefully one day synergize with cancer treatment to work much like fasting, yet also provide a population at risk for weight loss – remember we are talking about cancer patients here – with helpful fuel during treatment.
Of note, fasting during cancer treatment has been done and may even be helpful,1 but is certainly concerning for the cancer patient at high risk for weight loss and cachexia. A “hack” that mimics fasting while still providing fuel and calories has obvious advantages. This is not the case with all cancers, as many patients with breast, prostate, and some other cancers would greatly benefit from weight loss.2
Coffee, heavy cream, and MCT oil consumed during my mile walk.
Afterwards, I mix some BCAA, potassium citrate powder, and magnesium in water and throw it down the hatch along with 2g of Lysine. I also have a bite of pure, grass-fed butter that I cut from a block. It is about the size of Andre the Giant’s pinkie finger.
A Brief Side Note on Leucine and Amino Acids:
You’ll notice I supplement with L-lysine. I initially tried this during a ketogenic diet in an attempt to help fight viruses during the winter. The goal was to reduce any viral loads in my body; we all have lots of viruses in us and are exposed to many viruses all the time, a ketogenic diet may help suppress viruses, and lysine may also help suppress them. My thought was to add them together to provide me with my own Howitzer against the flu and other attacking viruses. (Note: I have no data to support this, but merely thought it made sense). This is the kind I use.
The interesting part of this all is that, along with leucine, lysine is a purely ketogenic amino acid. In other words, it is directly broken down to acetyl-CoA – the precursor of ketone bodies – as both carbons enter the citric acid cycle and end up as carbon dioxide. Other amino acids can be converted to glucose – i.e. glucogenic amino acids – and we want to minimize that to a degree during the keto protocol. Other researches have similar thoughts with increasing BCAAs while on a ketogenic diet.3
Leucine also happens to be a BCAA, along with isoleucine and valine. Five amino acids are both ketogenic and glucognic:
The other 13 amino acids are glucogenic, which is one of several issues with consuming excessive protein while on a ketogenic diet. See the picture below that I hijacked from Wikimedia Commons (thanks Mikael Häggström):
You’ll notice that of the three BCAAs, one is exclusively ketogenic (leucine) and one is partly ketogenic (isoleucine). This is what I mean by getting more bang for your buck with these amino acids. I get more muscle preservation with less glucose production from other amino acids. Lysine was originally coincidentally ketogenic, but I now use it routinely for more of that benefit (and maybe some immune system virus-fighting benefit as well, though again, I have no data on that).
In total, there are nine essential amino acids that must be consumed. They are histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. All three BCAAs are included here as is lysine (all bolded). Again, more bang for your buck.
Three grass-fed beef and ground liver “meatballs” with grass-fed bufala mozzarella in the center, homemade tomato sauce, a large serving of Brussels sprouts, all covered in a massive amount of olive oil. I also had a cup of moringa green tea with MCT milk. This mixture is quite delicious. I take a 1 mile walk afterwards.
I had an after-work work event. I was fine not eating anything, but did not want to be rude after rejecting food offers five times. I ended up having two pieces of cheese and a slice of prosciutto, washed down with an hour of boring small talk.
German volumetric training (triceps and back) followed by BCAAs, Lysine, and MCT milk mixed together.
Unfortunately, my dinner was a difficult one. My beautiful “chef” cooked up my favorite – some Korean spareribs. This is a very important issue to keep in mind – if a friend, significant other, family member etc. has planned to make dinner for you, you may want to revolve your keto days around this or they may end up ticked off, unless of course they are doing it with you (the preferred course). We had our friend over as well. He is often out of town, so I had no choice but to cooperate.
I had 3 spareribs (very fatty), kimchi, broccolini doused in olive oil, a fistful of grass-fed, raw, stinky cheese, and a glass of French red. As expected, following this my friend made me drink some bourbon with him. I had a small glass on the rocks. I also took another lysine and some magnesium and potassium pills afterwards with some salty broth (I increase my salt intake significantly to offset salt loss through the urine).
A Side Note on Wine:
I love wine. One glass is fine for me during a ketogenic period or not. In fact, even more wine was included in the “Spanish Ketogenic Diet,” which is easily one of the greatest studies ever conducted in world history. It was basically studying the ketogenic diet in participants that were supplied wine. To reiterate, by agreeing to participate in this study, you were basically forced to drink free Spanish wine daily. I wrote about it before, and if you want to read more click here.
One glass of wine does not interfere with my ketone production. Two glasses start to drop them. When I am in a ketosis cycle, I (mostly) always avoid anything over a glass of red.
Periodic Ketogenic Diet Protocol Day 3: Full Ketosis
I am in nutritional ketosis. I can feel it. I have that “clarity” that people refer to when they are running on ketones. I feel like I’m in the zone back when I played basketball and scored the first 21 points against MRC in eighth grade or caught an alley-oop in high school, dunked it, hung and the rim, and got a technical foul (with a college recruiter watching in the crowd). Yes, I’m living in the past, but I’m in ketosis so it’s all good.
I confirm it for the sake of this article, but know my body enough at this point to accurately predict when I enter the “keto zone” (said out loud in Archer voice as he tells Lana to call Kenny Rogers because he’s in the Daaaanja Zoooone).
Sure enough when checking, I am pushing out values in the 2mmol/L all day and steady rockin all night long.
At this point I start supplementing with salt, potassium, and magnesium as follows:
- Sodium – high sodium broths 1-3 times per day and liberal salt usage with food
- Potassium – 500mg supplement taken twice a day
- Magnesium – 300-400 mg tablet daily (take at night as it can have a relaxing effect).
I do not take magnesium on an empty stomach, as I have learned the hard way that is can cause some discomfort.
I start the day with a typical 1 mile walk then down some coffee with heavy cream, MCT oil, a small amount of butter. I also add BCAAs to the coffee, which actually works well. I am not sure if they are sensitive to the heat of the coffee, but it doesn’t matter – I’m in ketosis. I also take 2g lysine.
I sip on MCT milk (Beta Quick from vitaflow) all morning.
I really enjoyed my lunch yesterday, so I repeated the same thing. I also had a cup of moringa green tea with MCT milk. This mixture is quite delicious. I take a 1 mile walk afterwards.
I usually do not do three days of intense heavy lifting in a row, but I am feeling awesome so I roll with it. German volume training and old school hip hop. I hit it pretty hard again.
I love broccolini and made a bunch the night before, so I have some more of this in olive oil with sea salt and black pepper. I have a couple shrimp cooked in grass-fed butter with Sambhu Spice. I also eat the remainder of the grass-fed, raw, stinky cheese with a glass of Aglianico.
The best part of this day is that it’s National Junk Food Day. Nothing feels better than eating absolutely no junk food on National Junk Food Day. I tweeted that I was going keto for National Junk Food Day and then throwing all the junk food away in my hospital. I got some funny responses, but the following was the best by far:
Periodic Ketogenic Diet Protocol Day 4: Running on Ketones
My ketone levels are oscillating between upper 2’s and 3’s. I sip on small amounts of MCT milk all day.
Coffee, heavy cream, and MCT milk. I drink it during my 1.5 mile walk with the dog. I sip on MCT milk periodically throughout the day.
Grass-fed ground lamb wrapped around feta with coriander, cumin, mustard powder, salt, and pepper and raw spinach. I enjoy another cup of moringa green tea with MCT milk. 1.5 mile walk today in anticipation that I am skipping any workout tonight.
It’s Friday and I worked out the last three days, so I am taking a break. I plan on being up early and outside to avoid the heat. I still manage 5 miles for the day.
While dinner is cooking I eat a giant slice of grass-fed butter – this time as big as Andre the Giant’s thumb. Dinner consists of a small grass-fed/finished ribeye, a plate of bacon, orange peppers, and though we have cauliflower, I am really digging the broccolini and eat it yet again. I could eat it every day of the week and be happy. I also have some grass-fed bufala mozzarella and a glass of Aglianico.
Periodic Ketogenic Diet Protocol Day 5: The Final Countdown
Today will be the final day of the “protocol.” I end with my typical Saturday morning fast; I ate dinner Friday night at 5:30 during the early bird special. I don’t eat again until noon on Saturday for an 18+ hour fast. I do this most weekends and on Sunday morning as well.
While this often means no food and only water, I want to end this keto protocol with a bang so I have some coffee at 7am with MCT milk and heavy cream, followed by some more coffee at 9:30am with coconut oil (always unrefined and in a glass jar), heavy cream, BCAA, and 3 grams of Lysine.
After reading for an hour, I take the dog for a 1.5 mile walk and then go to the farmer’s market to pick up my chicken heart, chicken liver, beef liver, grass-fed spareribs, beets, peppers, and broccoli. I also pick up some turkey and chicken eggs. They are out of kale and my oxtail is backordered so I am ticked off – but it’s OK, I’m in ketosis.
I round off one of my last keto meals with a lunch fit for a king. This meal is higher in protein than would be ideal for a ketogenic diet, but at this point I do not worry about that as I am coming out of it regardless later today. The breakfast is cooked for two, though I eat the majority of it. For good measure I check my ketones about 30 minutes later – 4.5 mmol/L. My ketone production remains strong. I check my glucose (which I rarely do anymore) for good measure and it is 72. Unlike many people, my glucose drops significantly when I am in ketosis and even reaches down to the 50’s in the morning.
I cook a half pound of organic spinach in lard, adding Maldon salt (my favorite) and pepper. I then mix 4 pastured turkey eggs, 4 pastured (pastured is not the same as pasteurized) chicken eggs, about a half pound of bacon, and about a half cup of raw, organic, grass-fed cheese.
I eat nearly the same “brunch” every Saturday after a fast, with little derivation. It’s one of my favorite meals of the week and I often have a smaller version during the week. People – the same people who eat the same bowl of cereal seven mornings a week – tell me that this is monotonous. They also eat the same two pieces of disgusting wheat bread with some form of processed, but low-fat meat/tuna fish between it for lunch daily, and have never even eaten over 90% of the foods I get from the farmer’s market each week, but I digress. The important point here is to ignore the naysayers and haters when you are on this diet. People are often threatened by those who have a deep commitment to their health. This is always why I surround myself with positive people both during my keto periods and at all times.
At this point, I am less concerned if I am in nutritional ketosis or not, as I am planning on breaking the keto period with some delicious sweet potatoes during my dinner. I headed over to my 95 yo grandmother’s house to sit at the pool. She asks me why I am not married yet (in front of my girlfriend, no less). I eat a couple handful of some mixed nuts. My liver was determined and continued to keep me in ketosis. I even downed two glasses of wine at the pool (Aglianico of course) and my liver simply laughed as it persevered and continued to pump out ketones. My ketones oscillate around 2 mmol/L.
At dinner I eat a massive grass-fed porterhouse with sweet potatoes and wine from Calabria. I actually continue to pump out ketones just below 1mmol/L.
The following day I wake up in ketosis and eventually knock myself out after some post-workout white rice. The Periodic Ketogenic Diet Protocol is over.
Periodic Ketogenic Diet Protocol Final Thoughts:
While I hate to ever solely rely on powders and supplements, well-made supplements do make the protocol much easier. Since it is only a couple days, I do not have as much issue with this. For those on a permanent or long-term ketogenic diet, I would keep the real food consumption to a maximum. I kept it to mostly real food when I was on a ketogenic diet for a year and then for six month periods with several of my patients. The patients in my first published study describing the ketogenic diet (in those receiving chemoradiation for glioblastoma multiforme) relied primarily on food.4 It worked out just fine. These even consumed more protein than many recommend these days. However, it is certainly easier with the help of supplements and likely more efficacious with the usage of BCAAs and MCT oil/powder and if I could do it all over again, I would have used them more often.
I usually come out of ketosis with sweet potatoes (which did not work this time around) or some Paul Jaminet-esque white rice. If you want to get out by eating ice cream or other sugar-laden foods, prepare to feel pretty terrible afterwards when your sugar comes back down the roller-coaster hill.
So there you have it. This is my Periodic Ketogenic Diet Protocol Day. I hope you find is useful.
PLEASE NOTE: This article is not describing a therapeutic ketogenic diet for seizure control or a cancer treatment protocol (hopefully on a clinical trial). They are certainly stricter. That being said, it is unclear how important it is to be in all out nutritional ketosis versus simply pumping out higher than normal levels of ketones. Nobody knows the answer to this, not even Neil deGrasse Tyson. Check out an excellent and timely podcast on this topic by Chris Masterjohn for more information. This is my protocol for my personal periodic ketogenic diet cycle. When doing your own protocol that works for you, always run it by your doctor. If you don’t have a doctor that you feel you could discuss this with, find a new doctor.
- Safdie FM, Dorff T, Quinn D, et al. Fasting and cancer treatment in humans: A case series report. Aging (Albany NY). 2009;1(12):988-1007.
- Champ CE, Volek JS, Siglin J, Jin L, Simone NL. Weight Gain, Metabolic Syndrome, and Breast Cancer Recurrence: Are Dietary Recommendations Supported by the Data? Int J Breast Cancer. 2012;2012:9. doi:10.1155/2012/506868.
- Evangeliou A, Spilioti M, Doulioglou V, et al. Branched chain amino acids as adjunctive therapy to ketogenic diet in epilepsy: pilot study and hypothesis. J Child Neurol. 2009;24(10):1268-1272. doi:10.1177/0883073809336295.
- Champ CE, Palmer JD, Volek JS, et al. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. J Neurooncol. 2014;117(1):125-131. doi:10.1007/s11060-014-1362-0.
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