It has been a while since my last post. My brain doesn’t tolerate stress at all, and this spring was full of a lot of it. I feel like I’m slowly improving again, but on Sunday when I walked out of the grocery store completely overstimulated and cried in the car while Josh finished the shopping, it didn’t really feel like improvement. Note to self – I’m not quite ready for grocery shopping with the masses on the weekend.

A few months ago I had an interesting conversation with Coach Cindy. There has been talk among endurance athlete circles about the benefits of fat adaptation training, or high fat/low carbohydrate diets on increasing fuel efficiency. While there are many advocates of this approach, there are also many coaches and dietitians that do not believe these low carb diets are ideal. In general, Coach Cindy, does not recommend a low carb diet for the ultrarunners she trains, but she wondered if it might help me.

Ketosis is a metabolic state where the body utilizes fat for fuel instead of carbohydrates. There actually is fairly strong evidence that a state of ketosis might be beneficial in brain injury. Here is a nice review article with a lot of good links. I haven’t been able to find research directly involving humans with brain injury and ketosis, most studies are in animal models.

When I run ultramarathons, I feel amazing. Well okay, by the end my BODY feels awful, and I hurt, and I often wonder why the hell I run at all, and maybe I should just quit and take up Zumba, but my BRAIN feels amazing. I often become cognitively normal, and this state lasts longer the farther I run.

After my first 100 miler I was cognitively normal for 4 days. I couldn’t walk, and I had a huge fat ankle, but I could read, I could be on the computer for hours, I could stay focused on a conversation, and I had tons of energy. After my second 100 miler, this period of normalcy lasted for nearly 2 weeks! During and after these big events, I am in a state of fat oxidation. So the question is this:

Does my cognitive improvement come as a result of being in a state of ketosis, or is it due to increased oxygenation, increased dopamine levels, or all three?

I have kicked around the idea of the Keto Diet for a couple of years. So why haven’t I tried it yet? Well, there are several reasons. One is that my cognitive function is frequently…what is the word…sub-optimal. Figuring out what to eat, what to cook, and counting grams carbs and fat and protein seemed like more than I could handle. The second reason is that my husband isn’t so keen on the idea. Josh has been incredibly supportive of me through my recovery, but he might draw the line when I tell him to give up beer and donuts. I’m sure if I told him I needed him to do this with me, he would, but I’m not pushing it. The third reason is that we have leaned towards vegetarian cooking for years, and were even vegan for a time. We do eat meat occasionally now, but I really only cook meat once or twice a week, so it is a big mental, moral, and financial shift. The last reason, is that I really like carbs. I like granola, and toast, and pizza, and banana bread, and brownies, and ice cream, and pastries.

As a baby step, for the last few months I have worked on decreasing my sugar intake. It is not that I went to zero sugar, but I tried to be more mindful of what I was eating. It can be so easy to say, “I just ran 25 miles, I can eat whatever I want.” From a caloric standpoint, that is probably true, but sugar is still sugar, and I think we all know it isn’t good for us. Then this last month, I’ve been watching my carbs a little more. I still had oatmeal for breakfast, and might have pasta for dinner, but I tried not to reach for carbs for snacks, and tried to focus more on protein intake. Last week I met my former cognitive therapist, Sarah, from Colorado Brain Recovery for tea. Somehow I’ve managed to become friends with my treatment providers, and it is fun to talk with them about more than just my brain injury. We discussed the Keto Diet, and she encouraged me to give it a try.

Although there are several versions of the Keto Diet, the standard (and most researched) version is 75% fat, 20% protein, and 5% carbs. Here we are on day 3, and I’m feeling okay. I can’t say I notice any change, but from what I read it can take many weeks before that happens. Last night I got a Keto app to help keep track of my macronutrients, which are carbohydrate, protein, and fat.  I thought I was doing pretty good until I entered all my food for the day into the app.

These numbers are a bit skewed in that after I entered everything I was about 1000 calories under where I need to be, and that is not a good thing, so I made a quesadilla and ate that before bed. Overall, I’m not getting enough calories (and I thought I had eaten plenty), my carbs were good until the quesadilla, and my protein was more than it needed to be. The crazy part to me is the fat. HOW IN THE HELL AM I SUPPOSED TO CONSUME ANOTHER 101 GRAMS OF FAT?????????

One tablespoon of olive oil has 14 grams of fat. A large avocado has 30 grams of fat. Almonds have 45 grams in 1 cup. So basically, I have to drink 7 tablespoons of olive oil, eat 3 avocados, or have more than 2 cups of almonds. When I already cook with lots of olive oil, ate avocado, and had nuts all day, more of any of these seems awful. It is clear to me that if I am going to pursue ketosis, and continue my ultramarathon training, I need to find a professional to help me figure this out. The last big question is what to eat during my long runs. Most of my run food is carbohydrate based, so I’ll need to figure out something before Saturday.

Anyway, it is a work in progress, but I committed to trying it for at least a month. It might take longer than that to achieve the full effect, but I’ll try at lest that long. Brain injury recovery has a lot of ups and downs, and for a variety of reasons, this spring has brought a lot of down for me.  If ketosis can give me the relief from symptoms that running 100 miles provides, it will be worth giving up all the yummy carbs…I think.

For now I am trying, because I have not given up on getting better. I’m going to keep pushing forward and trying whatever I can. Although I don’t know the author, I saw this quote the other day and it made me smile:

Sometimes you may feel you’ve been buried. Perhaps you have been planted. Bloom.

To read about my ketosis experiment, check out my follow-up post here.