Ketogenic Diet Update 3

Ok in the middle of my third week.  I have a few observations to report

  1.  My strength has diminished by approximately 10%.  This may be related to just not getting enough calories in during the day
  2. My leg recovery is very slow.  I have a hard time with squatting more than a few reps without a “burn”.  I suspect my thigh muscle glycogen level is at a minimum.  I must investigate if big muscle groups like the thighs can adjust well to using ketones for energy production
  3. I have not lost much weight, maybe 3-5 pounds max
  4. I am sleeping extremely well, unless I wake up hungry like last night
  5. Splitting cardio into 2 sessions really makes sense and is easier to do with 20 minutes in the am and 30 min in the pm
  6. Probably need to up my calories



Cute Baby Picture

Total aside from what I usually write about, but I had to post this picture of one of our employees new baby boy and me, holding him.  Its so strange to think that until I had my own kids, I was such a hard charging individual.  Once I had children, I really began to mellow out, and I just love babies!



Ketogenic Diet Diary Part II

OK just completed my second week of keto diet, and I really must say that it does seem to be “tightening things up” although my weight is basically unchanged at 170 pounds. My pants are looser (waist size 32).  I have not checked my labs i about 3 months so I will probable check my blood work to make sure my triglycerides and cholesterol levels as well as the cholesterol fractions are good.  Going to take another picture to document the progression.

I have been reading a lot about the various diets.  I guess diet is really a misnomer since I don’t really limit limit the amount I eat, unlike the traditional diets.  I just change the composition of what I eat as well as the times.  I am going to put a table together of the popular diets, and compare the different philosophies behind them.  The ones I am going to concentrate on are the Bullet Proof Diet, the Paleo Diet, The Atkins Diet, and the Ketogenic Diet.  After 6 weeks, i will post my results with the ketogenic diet.  I will say that it has not been hard to keep the ketogenic diet.  I also am sliding away from heavy weight training and more towards calisthenics for strength and fitness

Ketogenic Diet Diary

So far, so good.  Up to 3 teaspoons of MCT oil daily, without any side effects.  Some observations so far:

  1.  Once you get into it, you tend to pay attention more to what you are eating, and I find myself not eating that cookie with my coffee, or snacking on the cupcakes that the drug rep brought over that I would never have thought about before
  2. Combining high quality protein with a salad is truly delicious
  3. I really like kale, which surprised the hell out of me
  4. I think I am sleeping better, although that may because of the cardio I added
  5. My overall attitude about everything is better
  6. I do not get the usual fatigue after lunch like I used to even with a reasonable carb lunch
  7. I have lost maybe about 4-5 pounds, and maybe a little strength, but overall it has been a positive experience
  8. I plan on doing this experiment for 6 weeks total, combining the diet with 20 minutes of elliptical in the am and 30 minutes of some type of cardio in the pm as well as 45 minutes of weight training in the pm
  9. Be interested in anyone else who has tried the ketogenic diet giving me their thoughts and experience

Ketogenic Diet

So I started on a ketogenic diet about a week ago, in order to reduce my body fat and get into better shape.  Not that I am in horrible shape, but I wanted to experiment to see how it made me feel.  Like most people, I get the fatigue symptoms after lunch, and generally have lost some of the high intensity energy I used to have.  I guess part of that lack of energy could be from being 55 years old, and 8 year of college and medical school, 8 years of general and vascular surgery residency, and 24 years of clinical vascular surgery practice can do that to you!  I have already learned a few things and some observations

  1.  MCT oil is palatable in coffee, but do not start of with a tablespoon of oil.  It will most likely lead to diarrhea, and you won’t take it again!  Start of at just a teaspoon, and slowly increase it over a week or two.  I am now up to 3 teaspoons a day, and no problems
  2. Take high quality proteins that are low in fat such as skinless chicken breast and salmon or tuna.  I eat less red meat, mostly because its sometimes hard getting a lean cut of meat, and animal fat tends to be more saturated fats which is what I am trying to avoid
  3. I am loving using more olive oil in cooking and salads
  4. I really enjoy eating a handful of nuts daily, including almonds and peanuts
  5. I dont feel guilty about snacking on a tablespoon natural peanut butter when I am hungry
  6. Not sure about the bulletproof coffee concept will have to research that further but it seems like a large calorie dump from butter
  7. I can definitely feel a difference within one week in terms of decreasing my body fat.  I am going to keep a picture diary weekly to make sure that it is not an illusion
  8. I also added a 20 minute cardio session in the morning.  It is well known that splitting cardio into 2 sessions increases your metabolism over a 24 hour period better than doing all the cardio in one session.  It also makes is easier time wise to split it up, and less strain on my body.  I used to love running, but my orthopedist told me if i keep running, I may need knee surgery 10 years down the line, and that just seems like a hassle that I don’t want to get into. So I do about 20 minutes of elliptical work, getting my heart rate into the 130’s in the am.  Sometimes I will do a shot run to break up the monotony.  In the evening, I lift weight for 45 minutes, and then do 20-30 minutes of cardio, mixing it up between kettle bell swings, and the stair stepper machine.
  9. The kettle bell is really much more difficult than I had imagined, and I think I am going to concentrate on learning more about it.  It really gets my heart rate up, strengthens my core muscles, and there are many different exercises I can do with it

Varicose and Spider Veins

Venous insufficiency and varicose veins are not well understood by most physicians.  The etiology is varicose veins is usually linked to an underlying valve problem, whether its in the deep or superficial venous system.  Essentially all vein blood in the legs is supposed to move up towards the body.  Unfortunately, since we stand or sit most of the day, gravity is always fighting us and trying to pull vein blood back down towards the ankles.  There are one way valves in the deep and superficial veins that normally close and prevent the backward flow of vein blood.  When those valves are not working well, blood tends to back up the veins and cause dilatation of the veins.  Over time, this leads to permanent damage to the vein wall, due to loss of elasticity.  As a result, varicose veins develop.  Typically, the valve problem is in the superficial venous system.  Symptoms of venous insufficiency include varicose veins, swelling, pain and a dull heaviness of the legs, skin discoloration, and in severe cases ulceration of the legs, typically at the ankles

The Death of David Bowie

I dont exactly know why the death of David Bowie has affected me so much.  Maybe its because I remember discovering his art as a 16 year old when I was in boarding school in England.  The outrageousness of his act was a stark contrast to boarding school etiquette.  I drifted towards other musicians later in life .  It was the Sex Pistols and the Stranglers during my angry years.  Roxy Music during my mellowing years.  Then I rediscovered Bowie for the past 4-5 years.  I marveled at how diverse and talented he was.  But maybe it has affected me so much because it has put my own mortality into focus.  As a surgery resident and vascular surgery fellow,  you are bludgeoned into believing that you are the only one capable of getting anything done, and the world will collapse without you.  Now at the age of 55, I face another 30 plus years of living (average  life span of an American male is 84), of which maybe 15-20 years will be relatively good living, then another 5-10 years of more difficulty physically.  Not that I am in bad shape (to be discussed in a later post).  Its a remarkable tribute to the frailty of the human mind that it takes an event such as a death to make us think of our own situation.  Hopefully I am smart and focused enough to make the changes necessary for the next 30 years

Venous insufficiency and leg swelling

Perhaps one of the least understood problems we as vascular surgeons face is venous insufficiency.  Venous insufficiency affects approximately 200 million Americans, and is far more prevalent that peripheral vascular disease (PAD).  The reason why it is so under diagnosed is that it can take many different forms and symptoms, raging from leg swelling, to spider and varicose veins, to skin discoloration, to frank ulceration of the skin with non-healing wounds (see picture).  I will post another time about varicose veins and venous insufficiency. In this post, we will deal with leg swelling.  In my opinion, venous insufficiency is either the most or second most likely cause for leg swelling.  Typically, the swelling occurs below the knee, is relieved by elevation, and lead to minor discomfort, to severe pain.  The diagnosis is made by history and physical examination, followed by a venous Doppler.  The venous Doppler is best done by a vascular lab that is sensitive to studying vein valve function.  As obvious as this sounds, it is not often studies as a routine in most vascular labs.  Next time I will go into the work up and management of venous reflux and leg swelling

venous ulcer

Why do people get leg swelling?

Of all the patients I see in my clinic, leg swelling has to be the most prevalent cause for people to seek our help.  There is definitely an epidemic of people with leg swelling. I am just going to deal with the most common causes.  There are

  1. Medications side effects
  2. Venous insufficiency
  3. Deep venous thrombosis
  4. Lymphatic or venous obstruction

Of these, the most common causes are medication and venous insufficiency.  Lets deal with medication in this post.  The most common cause by far of leg swelling is blood pressure medication.  Specifically amlodipine (Norvasc) which is a very popular and effective medication for the management of high blood pressure.  a 5 mg dose of amlodipine is less likely to cause swelling as compared to a 10 mg dose.  The second most common drug that causes leg swelling is gabapentin (Neurontin).  So if you have new onset of leg swelling, make sure to check your medication side-effects.

Getting started

So I have been thinking about putting down all this stuff I have learned though 4 years of college, 4 years of medical school, 5 years of general surgery training, 2 years of lab research, 1 year of vascular surgery fellowship, and 23 years of vascular surgery practice!  I have forgotten more than I remembered, but there are definitely some things that are so repetitive in vascular surgery that I need to put them down in writing.  What we work up and take care of in vascular surgery is so alien to other physicians that it needs to be explored.  One of the first posts that I am going to cover is leg swelling issues, and work up and treatment options.  I see approximately 30-50 new patients a month, of whom at least 20 will be for evaluation of leg swelling