I’ve always loved food and I’ve always wanted to be a doctor. But if you had told me, even five years ago, that food – let alone a low-carb, high-fat ketogenic diet – could be medicine, I would have laughed. In retrospect, I suppose fate has a knack for checking arrogance.
A Healthy Childhood
As a child, I looked like the picture of health. I was lean and athletic. By the end of high school, I had set two state push-up records and was running marathons in under three hours. I ate well, or thought I did. I was aware of the USDA’s healthy eating guidelines and made sure to check all the boxes with respect to my healthy whole grains and five-a-day.
My fortunes started to change shortly after my 18th birthday. Despite my high calcium and vitamin D intake, weight-bearing exercise routine, and lack of a family history of low bone density, I progressively developed severe osteoporosis. As someone who loved to run, learning that I would probably never run again was crushing.
After a thorough workup by some of the world’s best orthopedists and endocrinologists, I was saddled with a “diagnosis of exclusion”: relative energy deficiency syndrome (RED-S). RED-S is a gender inclusive term for the female athlete triad, which includes disordered or restricted eating, irregular menses, and low bone density. The treatment for RED-S is more calories.
To me, even at the time, the diagnosis didn’t quite seem to fit. I was a normal body weight (BMI = 21 kg/m2). My hormone panels were also all normal, including my testosterone and thyroid levels. I also had a good appetite and didn’t consciously restrict — quite the opposite actually. But there was no better answer at the time. And, what did I know? I was not only the patient, but a child patient.
So, I complied with the advice of my dietician and simply stuffed myself five times per day until my gut was fit to burst. It’s less fun than it sounds.
A couple years later, at the age of 21, I started to experience particularly severe stomach pains after eating. Over a period of several months, the pains turned into bloody diarrhea and a colonoscopy revealed I had ulcerative colitis, an inflammatory bowel disease. Osteoporosis might have stolen running from me, but colitis stole more.
Food became a chore and socializing became a terror. Even sitting in a lecture, I would become anxious when I felt a grumble. Is this a bleed? Am I going to need to embarrassingly rush to the bathroom flashing my taillights red for the whole building to see? Honestly, if I had had the option to eliminate my symptoms at the cost of never tasting food again, I would have taken that deal in a heartbeat… Jinx!
Shortly after graduating 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 dropped 20% of my body weight. One night, the pain was so severe that the university rushed me to a local hospital at 2:00 am, where it was incidentally noted that my heart rate was 28 beats per minute.
After three days of being poked and prodded, I was discharged without any improvements and without any reasonable answer to why was I falling apart. I spent the next several days, including my 23rd birthday, prone on my bed contemplating my options. Suffer? Die? I wasn’t suicidal by any means, but at the same time the latter was beginning to sound increasingly more attractive than the former.
Or, I could try something entirely different…
A step beyond convention
Drained of hope, I looked for solutions outside 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-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 base of a balanced diet, that our bodies needed carbs for energy, and that a high-fat diet would kill me prematurely. Nevertheless, I was desperate.
After one week on a ketogenic diet, my colitis symptoms disappeared and my fecal calprotectin, a marker of inflammation, dropped eight-fold to its lowest level ever. Over the following months, I came off my colitis medications. Years later, I remain on the diet and my colitis remains in remission. The osteoporosis has also resolved, including bone density improvements in my hip and femur that I had not experienced while on bone medications alone.
I also felt, and feel, amazing! My athletic performance is mostly back. I can now do 25 one-hand push-ups with less effort than it took me to walk the 25-feet from my hospital bed to the bathroom only a few years ago. I’m not back to marathon running yet, but I now see it as a possibility and that brings me immense joy. My brain feels like it’s on fire (in a good way) and I’ve been more productive as an academic while eating a ketogenic diet than ever before. After going keto, I was able to complete my PhD in one year and eleven months, along with publishing ten first-author papers in the peer-reviewed literature and one book.
But for all I enjoy athletics and academics, and for as much as it probably sounds like I’m not bragging, the bigger point I’m trying to make is that a ketogenic diet gave me back the health, vitality, energy, and happiness to pursue doing what I love. I’m still not sure if I’m just young and driven, or if I’m a workaholic. But all I really care about is that I’m happy. One of the greatest pleasures of having lost and regained health is that every day looks a little bit brighter because you no longer take what you have for granted.
I’m not unique
“The most remarkable thing about my story is that it’s not unique at all.”
I say these words so often that it’s quickly becoming my catch phrase. 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 motif goes as follows:
Step 1. Patient suffers from a metabolic disease or diseases. S/he fails to improve under conventional care.
Step 2. In desperation, s/he attempts a well-formulated low-carb or ketogenic diet and improves dramatically.
Step 3. S/he discovers a community of people who have had the same experience and begins to question why this option isn’t offered as a common option by mainstream medicine.
What I want?
Now, having completed my PhD (DPhil) in ketogenics and brain metabolism at the University of Oxford, I am set to start at Harvard Medical School to pursue my MD. I have always wanted to be a physician and my own health experiences have only strengthened and informed that drive.
What I want now is to see metabolic medicine made mainstream. What I want is to do my small part to shift the medical landscape to one that thinks more about the underlying causes of metabolic disease. What I want is for doctors and patients to be taught how proper human nutrition, including a ketogenic option, can be used to treat these drivers of disease and improve patient outcomes. If I can do my small part to help make this fantasy a reality, then everything I went through on my health journey (thus far) will have been worth it.
Words of advice
I’m not sure who you are and where you are along your health journey. Therefore, I apologize if I give off the impression of casting myself the sage. I suspect I am very much in this with you. Nevertheless, through my experiences in the low-carb and ketogenic communities, I have made a few observations about what makes people successful upon adopting lifestyle change. In closing, I wanted to share those thoughts:
- Find a community. Lifestyle change is always difficult. This is particularly true when you adopt a diet and lifestyle that are out of most people’s ordinary. You might receive weird looks or disparaging comments. Furthermore, there’s more misinformation in media about low-carb and ketogenic diets than there is helpful information. Separating fact from fiction can be hard. To help address both these problems, I highly encourage everyone who plans to attempt and maintain a low-carb lifestyle to seek out a community of people who have lived experience with this lifestyle.
- Determine your metrics for success. What does real success look like to you? Maybe it’s having the energy to exercise, or feeling mentally sharp, or getting your HbA1c below 5.7%, or losing inches off your waist, or being in ketosis, or preventing cognitive decline, or treating an inflammatory condition. Choose a few of your personal goals and determine metrics to assess them. This can include anything from a reflection journal or blood tests, or a combination of the two. There is nothing more inspirational than noticing that you’re making progress. In truth, a simple reflection journal may be the most powerful tool in your “data” arsenal.
- A failure is data. Not every day will be perfect. You will backtrack at some point. Everybody does. What really matters is whether or not you learn from your mistakes. Reflect. Why did I do this? How did this make me feel? How can I use this experience as a data point to further my knowledge about myself and, thereby, progress 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 in which choosing to prioritize your health creates a potentially awkward social situation or may even offend someone. But is it so unfair to make your health the priority?
Finally, if you’re about to start your journey, talk to your doctor first. For those interested, you can find low carb practitioners here.