I have always loved food and always wanted to be a doctor. But if you’d told me five more years ago that food – not to mention a low-carb, high-fat ketogenic diet – could be medicine, I would have laughed. In retrospect, I guess fate has a knack for controlling arrogance.
A healthy childhood
As a child, I looked like the picture of health. I was slim and athletic. By the time I finished high school, I had set two state push-up records and run marathons in under three hours. I ate well, or thought I did. I was aware of the USDA healthy eating guidelines and made sure to check all the boxes regarding my healthy whole grains and five a day.
My fortune started to change soon after I turned 18e birthday. Despite my high calcium and vitamin D intake, my weight-bearing exercise routine, and no family history of low bone density, I gradually developed severe osteoporosis. As someone who loved to run, learning that I would probably never run again was overwhelming.
After extensive examination by some of the world’s best orthopedists and endocrinologists, I was faced with an “exclusion diagnosis”: Relative Energy Deficiency Syndrome (RED-S). RED-S is a gender inclusive term for the female athlete triad, which includes disorderly or restricted eating, irregular periods, and low bone density. The treatment for RED-S is more calories.
To me, even then, the diagnosis didn’t seem to quite match. I had normal body weight (BMI = 21 kg / m2). My hormonal panels were also all normal, including my testosterone and thyroid levels. I also had a good appetite and I was not consciously restricting, quite the contrary in fact. But there was no better answer back then. And, what did I know? I was not just the patient, but a patient child.
So I took my dietician’s advice and just stuffed myself five times a day until my gut was ready to burst. It’s less fun than it looks.
A few years later, at the age of 21, I started to experience particularly severe stomach pain after eating. Over a period of several months, the pain turned into bloody diarrhea and a colonoscopy revealed that I had ulcerative colitis, inflammatory bowel disease. Osteoporosis may have robbed me of the leak, but colitis stole more.
Food has become a chore and socialization has become a terror. Even sitting in a conference, I would get anxious when I felt a growl. Is it bleeding? Am I going to have to embarrassingly rush to the bathroom flashing my taillights red so the whole building can see? Honestly, if I had had the opportunity to eliminate my symptoms at the cost of never tasting food again, I would have accepted this offer in the blink of an eye… Jinx!
Soon after graduating from college and moving to Oxford to pursue my PhD, I had the worst colitis flare of my life. Over a period of a few weeks, I lost 20% of my body weight. One night the pain was so severe that the university rushed me to a local hospital at 2 a.m., where my heart rate was incidentally noted to be 28 beats per minute.
After three days of being pushed and pushed, I was fired with no improvement and no reasonable answer as to why I was collapsing. I spent the following days including my 23rd birthday, lying on my bed contemplating my options. To suffer? Pass away? I wasn’t suicidal at all, but at the same time the latter was starting to look more and more attractive than the first.
Or, I could try something completely different…
A step beyond the conventions
Emptied of hope, I looked for solutions outside of conventional medicine. I had no expectations, but also nothing to lose. Over the course of eight months, I tried probiotics, supplements, meditation, and a litany of diets – gluten free, casein free, low in FODMAP, SCD, vegetarianism, veganism – none of which helped. One diet I was hesitant to try was a ketogenic diet. I had been taught to believe that carbohydrates should be the basis of a balanced diet, that our bodies need carbohydrates for energy, and that a high fat diet would kill me prematurely. Nonetheless, I was desperate.
After a week of the ketogenic diet, my colitis symptoms disappeared and my fecal calprotectin, a marker of inflammation, increased eight-fold to its lowest level. Over the next few months, I stopped my colitis medication. Years later, I continue the diet and my colitis remains in remission. The osteoporosis also resolved, including improvements in bone density in my hip and femur that I didn’t experience while taking bone medication alone.
I also felt, and I feel, amazing! My athletic performances are mostly back. I can now do 25 one-handed push-ups with less effort than it took to walk the 25 feet from my hospital bed to the bathroom just a few years ago. I have not yet returned to the marathon, but I now see it as a possibility and it gives me immense joy. My brain feels like it’s on fire (in a good way) and I’ve been more productive as an academic on a ketogenic diet than ever before. After going keto, I was able to complete my PhD in one year and eleven months, as well as publish ten articles by the first author in the peer-reviewed literature and a book.
But for all that I love about athletics and studying, and as much as it probably seems like I’m not bragging about, the most important point I try to make is that a ketogenic diet has me restored health, vitality, energy and happiness to continue doing what I love. I’m still not sure if I’m just young and motivated, or if I’m a workaholic. But all I really care about is that I’m happy. One of the greatest pleasures of losing and regaining your health is that each day feels a little brighter because you no longer take what you took for granted.
i am not unique
“The most remarkable thing in my story is that she is not unique at all. “
I say these words so often that it quickly becomes my slogan. They express the fact that while my specific constellation of medical conditions was out of the ordinary, the arc of my story is all too common. The reason is as follows:
Step 1. The patient suffers from one or more metabolic diseases. He / she does not improve under conventional care.
Step 2. In desperation, he tries a well-formulated low-carb or ketogenic diet and improves dramatically.
Step 3. He discovers a community of people who have had the same experience and begins to wonder why this option is not offered as a common option by traditional medicine.
What I want?
Now, having completed my PhD (DPhil) in Ketogenic and Brain Metabolism at Oxford University, I am about to start at Harvard Medical School to pursue my MD. I have always wanted to be a doctor and my own health experiences have only reinforced and informed this motivation.
What I want now is to see widespread metabolic medicine. What I want is to do my little part to shift the medical landscape towards one that gives more thought to the underlying causes of metabolic disease. What I want is for doctors and patients to learn how good human nutrition, including a ketogenic option, can be used to treat these disease factors and improve patient outcomes. If I can do my little bit to help make this fantasy a reality, then everything I have experienced during my health journey (so far) will have been worth it.
I don’t know who you are and where you are in your health journey. Therefore, I apologize if I give the impression of throwing myself wise. I suspect I am very involved with you. Nonetheless, through my experiences in low carb and ketogenic communities, I have made a few observations about what makes people successful with a lifestyle change. In closing, I wanted to share these thoughts:
- Find a community. Changing your lifestyle is always difficult. This is especially true when you adopt a diet and lifestyle that is out of the ordinary for most people. You might receive strange looks or derogatory comments. Additionally, there is more misinformation in the media about low carb and ketogenic diets than there is any useful information. Separating fact from fiction can be difficult. To help resolve both of these issues, I strongly encourage anyone who is considering trying and maintaining a low carb lifestyle to seek out a community of people who have had experience with this lifestyle.
- Determine your indicators of success. What does real success look like to you? Maybe it’s having the energy to exercise, feeling mentally alert, having an HbA1c below 5.7%, losing inches from your waistline , be in ketosis, prevent cognitive decline, or treat inflammatory disease. Pick a few of your personal goals and determine metrics to assess them. This can include anything from a think journal or blood tests, or a combination of the two. There is nothing more inspiring than seeing that you are making progress. In truth, a simple thought journal can be the most powerful tool in your “data” arsenal.
- Failure is a given. Every day will not be perfect. You will be backing down at some point. Everyone does it. What really matters is whether or not you learn from your mistakes. Think. Why did I do this? How did that make me feel? How can I use this experience as a data point to deepen my knowledge of myself and thus progress in my health journey?
- Give yourself permission to put your health first. Life is full of choices, not all of them easy, and you may find yourself in a situation where choosing to put your health first creates a potentially uncomfortable social situation or may even offend someone. But is it so unfair to make your health the priority?
Finally, if you are about to begin your journey, talk to your doctor first. For those interested, you can find low carb practitioners here.