Written by DR. GEORGE TOULIATOS, MD

30 June 2020

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Dr. Testosterone
By George Touliatos, MD

KETOSIS

In order to enter ketosis, carbohydrate depletion is needed for three to four days, depending on glycogen stores and physical activity. During this time the organism struggles to switch from carbohydrates into fat burning as fuel. After those 72-96 hours, when liver and muscle glycogen stores are empty, the liver starts to release ketosomes for an energy source.

Breath smells like a rotten apple and ketosomes appear in urine, and in blood too. Under ketosis blood and urine pH drops, since ketosomes are acidic. As a compensatory mechanism lungs will hyperventilate, in order to counterbalance this metabolic acidosis, by respiratory alkalosis, toward hypocapnia (low CO2).

We have to know that classic keto diet relies firstly on fat (70%) and then on protein. After all, the body adapts to the kind of fuel you are providing to it. However in bodybuilding, protein is the main macronutrient and must be at least 3gr/kg of bodyweight.

In order to give an anabolic kick and escape from ketosis for a while, we can follow the CKD and boost carb intake during the weekend. In this way, insulin will ensure anabolic drive and provide energy to thirsty muscles that are deprived of glycogen stores. The day after this, training will be of higher intensity, while mental focus will be much better after a short break after a low-carb week.

In the absence of carbs, insulin gets low and glucagon and growth hormone are high, favoring fat burning. However, this project works and is effective under caloric deficit. The weight reduction is remarkable in the first days, due to water loss from the absence of glycogen stores and water. Later, fat is burned as ketosomes are produced from liver. Fat is burned in a slow pace and 1 kilogram of adipose tissue requires 9,200 calories for its oxidation.

KDs had pros and cons, as there is a flip side to every coin. KD was sort of monophagy of fats and proteins, avoiding carbs, while fiber and greens were allowed. However, the saturated fats increase the hepatic synthesis of cholesterol, while cardiology is skeptical about their consumption, since it is still believed to be blamed for atherogenesis and to be inflammatory in the absence of carbs, and the body loses water and dehydrates, while B complex vitamins and certain minerals are lacking. Protein elevation under dehydration can strain renal function and elevate creatinine, urea and lower glomerular filtration rate (GFR).

Another thing about low-carb diets is the absence of immediate energy release, since carbs and muscle glycogen eclipse. Slow-pace cardio is favored, while explosive, anaerobic physical activity is going downhill.

During this time, athletes usually use either medium-chain triglycerides (MCTs) or exogenous ketosomes that can provide an immediate energy source, resembling simple carbs.

Another disadvantage of KD is that brain metabolism requires 100gr of sugar on a daily basis. Therefore, ketosomes are an alternative fuel, giving the feeling of mental fatigue and being sluggish. We have to understand that mood is bad in the absence of carbs, because carbs promote the release of serotonin, the joy hormone that calms the CNS. So during KD we may feel edgy and grumpy as well, especially in those individuals who are of lower brain serotonin (predisposed to depression).

The benefit of KD is the improvement in insulin sensitivity, in the absence of carbs and the weight reduction coming from fat loss.

Advantages of high carb-low fat diets:

1. Increase in muscle glycogen stores, enhancing explosive anaerobic physical activity (weightlifting, sprinting, lifts, jumps, throws).

2. Improved mood (anti-depressive effect) by elevating blood sugar and neurotransmitter serotonin (the joy hormone).

3. Promote anabolism through insulin and IGF-1 release from pancreas and liver, while carbs are muscle sparing.

Disadvantages of high carb-low fat diets:

1. Insulin can lead to fat storage, while the organism adjusts not to burn fat, but muscle glycogen instead.

2. Lethargy from insulin spikes.

3. If poor quality of carbs (refined) is included, then insulin resistance can appear (A1C>5.5%), along with elevated triglycerides and LDL.

Advantages of low carb-high fat diets:

1. Improved insulin sensitivity and reduction in insulin resistance.

2. Increased fat burning, through low insulin, high glucagon and high growth hormone. Basically, the system adjusts and adopts in the fuel you provide.

3. Ketosomes are known to be muscle sparing.

Disadvantages of low carb-high fat diets:

1. Mental focus and sharpness becomes sluggish, since ketosomes are alternative fuels and glucose is the primary fuel for optimal brain metabolism.

2. If SFAs/trans fats are consumed, then we risk for dyslipidemia and possible atherogenesis that may establish cardiovascular disease.

3. Explosive anaerobic physical activity is impaired, because glucose and muscle glycogen, the main fuels for strenuous exercise, are lacking.

Moreover insulin and IGF-1 are low, meaning there is no anabolism

George Touliatos, MD is an author, lecturer, champion competitive bodybuilder and expert in medical prevention regarding PED use in sports. Dr. Touliatos specializes in medical biopathology and is the medical associate of Orthobiotiki.gr and Medihall.gr, Age Management and Preventive Clinics in Athens, Greece. Heis the author of four Greek books on bodybuilding, has extensively developed articles for www.anabolic.org and is the medical associate for the book Anabolics, 11th Edition (2017). Dr. Touliatos has been a columnist for the Greek editions of MuscleMag and Muscular Development magazines, and has participated in several seminars across Greece and Cyprus, making numerous TV and radio appearances, doing interviews in print and online. His personal website is https://gtoul.com/

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