Cycling keto with PSMF

I am a woman in my late 40s who is perimenopausal AND diabetic AND who always struggled with weight and insulin resistance (I still do, even after having been keto since 2016).

I’ve been carnivore-ish for the last couple of years now and this post will discuss how I’m experimenting with cycling keto with PSMF.

In this post, I’ll talk about…

My background with dietary habits – Changes from S.A.D. to keto to carnivore

I was keto before it was cool.

A good chunk of my 2015 was spent researching better ways to manage my diabetes than what I was already doing, which was following American Diabetes Association guidelines 90% of the time for almost a decade after my diagnosis of type 2 diabetes.

Then, in 2016, I found what seemed to be the Holy Grail—the ketogenic diet.

Fast forward to first the two and a half years of my keto life, I basically followed a low carbohydrate & high fat, and minimal protein eat habit. My life was beginning again for me, or so I thought (read on).

There were a few days in the beginning months of my new lifestyle where I had so much energy that I didn’t even know I lacked! I was plowing through my apartment and clearing things away that had clogged up my life for years…because another thing keto did for me was remove mild depression I wasn’t even fully aware I had.

This keto shit is literally a mood-lifter.

How I failed with keto & what I learned

People say keto is one of the greatest appetite suppressants. While I wasn’t always hungry while I was keto, but I could find myself eating really well…even on days when I shouldn’t have been hungry.

A lot of it was psychological, and I was definitely eating when I didn’t need to.

I suffered embarrassing hair loss and still had bloating and digestion issues.

My type 2 diabetes was still pretty stubborn, but I blame that on the fact I was also experimenting with low carb baking (dumbass!) for my cookbook and for family events.

Anyway…I felt SO good that I got a bit too confident and was practically chugging fat because I knew it was good for me.

Okay, that’s a bit of an exaggeration.

But clearly, I was still spending too much of of my free time obsessing over food, creating new recipes & sharing them with people, and basically discussing or thinking about food all day and craving variety (again, mostly blaming my wanting to develop recipes all the time).

It was clear I was busy trying to create things for others and not focusing on staying the course.

None of this was healthy, but insanity, even though I wasn’t sticking to one thing long enough to really know results.

Additionally, I was still trying different ways to sweeten my coffee without sugar—basically hopping from stevia to erythritol, back to stevia, trying monk fruit, etc. and back to stevia again.

Excuses, right?

Discovering and switching to carnivore

Around late 2018, I started to see a trend. People I respected in the keto community were leaning toward a carnivore lifestyle, and I quickly tuned in and decided to try it.

At first, I still was eating some veg, but decided to consciously increase my protein to a minimum of 25% of my daily caloric intake, which automatically bumped down my fat macro limit to no higher than 70%, so I went with it. I felt better immediately and I was not finishing my meals (which weren’t very large to begin with, when I was doing normal keto).

After awhile, I was eliminating more vegetables and feeling even better. I decided I liked this and referred to it as ketocarnivore (meaning I ate mostly only animal products and only a few plant products, while strict carnivore means only meat and salt and water).

It’s no wonder I felt better… in retrospect, when I was doing regular keto, I was eating 5% carbs, 68-73% fat, 19-21% protein. I needed more protein!

Holy shit. When I look at those protein macros again, I am aware it’s really not enough. I kept adhering to that rigid idea that keto wasn’t a high protein protocol (it isn’t, but it is still important for anyone wanting to lose weight to definitely eat more protein than I was).

Besides, I was still indoctrinated into the idea of too much protein causing gluconeogensis, but of course learned later that gluconeogenesis a demand-driven process, not a supply-driven one (in other words, “Steak does not equal cake.”)

Anyway, I loved being carnivore-ish. Getting used to eating mostly only meat* took me some time, but I knew I still had parts of myself that needed healing, so I just dove right in. Basically, I tried to just eat my protein first at each meal, and very little vegetables, and although I was raised to love veggies (I still do like them), I didn’t really miss them.

Most of the meat I ate was red meat from beef and pork, and occasionally some white meat like pork (loin/chops) or chicken, and still ate eggs and sometimes fish (but not enough, I think). Olives, pickles, sauerkraut, some bits here and there of onion, garlic, tomato filled my plate, and I still drank coffee and tea. I just mostly stopped eating heaps of veg like I used to. And often, I’d have some kind of European cheese for dessert. I still also ate seafood (cod, salmon, tuna, and crab are what I like) once a week or so.

Then guess what happened? After not even 7 months of this carnivore-ish routine, my A1c came back as 5.8%. My doc praised me, and also still strongly recommended a statin (I’ll go down that road in some later post) but wasn’t a jerk about it.

I practically flew home on wings that day. Was I dreaming?

Never thought my A1c could get to a lower number because when I first started keto in 2016, it took a long time to where I finally got my A1c down to 8% (I was 11% at diagnosis) and I had been hovering around 7%-ish for what seemed like forever (about the entire last year or so that I was keto). I was addicted to looking at the printout from the doctor’s office and seeing this new number.

This ketocarnivore stuff was the way of life for me, I convinced myself.

Less than 6 months later, I started to figure out how to calculate my A1c on my own based on the 2-3 daily blood glucose readings I had been taking religiously for years (I still do). I got down to an A1c of 5.6% and boasted about it online. This was the day I had been waiting for, after years of hard work.

And doing a ketocarnivore diet the last 2 years definitely healed me in a few ways: It was GREAT for hunger & mood, it repaired my hair/nails, made them shiny and strong, and helped with my sleep…all these things were even more improved than with just keto.

Lessons I learned from both keto & carnivore

I intended to stop getting all dietary fat from anything except meat/fish/eggs, but still ate full fat cheese, still used butter for cooking, and added HWC to my daily morning coffee.

I was clearly still addicted to dairy, and it’s probably the cause of my downfall (alright, I still am addicted, but I’m going to work on it).

So for weight loss, carnivore wasn’t ideal for me because of the way I was doing it. To be clear, I’m not at all blaming carnivore for that which are my own problems as a result of my own choices.

Being diabetic along with carnivore presented a few issues for me.

One thing was that I couldn’t stand meat-mouth after meals and I have weak tooth enamel so instead of brushing after every meal, I would have cheese as my dessert because I was also addicted to chewing gum to solve that, but even sugar free gums spiked my blood glucose (yes, I tried ALL OF THEM). That was hard because cheese is addictive and not easy for me to limit.

Now…I’m digging into cycling keto with PSMF

What is PSMF?

The PSMF (protein-sparing modified fasting) dietary approach (along with less dairy) which sounds like a good experiment for me bc I’m fat af again.

The idea is that you focus on lean protein such as light chicken/turkey, white fish, eggs (mostly whites), and still keep it very low carb and also lower fat, usually no more than 40-50 g of fat (for me, that means no more than 30 g of fat on those days).

The PSMF dietary practice has been written about by Ted Naiman, Maria Emmerich, and a few others. I’m following the version that Emmerich has illustrated in a few of her website articles and books, because I know she has dealt with insulin resistance in the past and like me, is also a woman over 40, so she has more experience that would align with my own. Your mileage may vary.

While I LOVE low-carb vegetables, some (broccoli, cauliflower, cabbage, brussels sprouts) are very goitrogenic for me, and I have to go easy on them because they also make me bloat like crazy.

On the days when I’m doing PSMF, I’ll stick to small amounts of iceberg lettuce, celery, asparagus, green beans, cucumber, zucchini/yellow squash, sauerkraut, pickles/olives & some herbs. I also sometimes enjoy cabbage, but I have it cooked very well.

The PSMF approach seems to allow for a good amount of protein to minimize muscle loss while still reducing calories to a very low but safe threshold because you’re more strict with watching fat/energy intake.

Research shows keeping protein intake up and fat intake down when you still have an abundance of stored fat to burn (as I do) is more beneficial than just traditional fasting.

Why try cycling keto with PSMF?

My justification for cycling keto with PSMF is twofold:

1. I could never do a completely lean carnivore lifestyle eating only lean meat all the time, but at the same time, I need to amp up my lean protein intake to avoid muscle loss on fasting days and still be satisfied somehow

and

2. it’s very easy for me to go overboard with fat consumption on a LCHF approach such as keto and ketocarnivore

..so I’m researching ways to do this that won’t suck. I’m thinking balance. Another reason why I’m following Maria’s approach to this is she shows how PSMF can be done in concert with a ketogenic lifestyle (and it is a great recommendation).

What can I eat on PSMF?

The only real difference between eating a regular “keto” diet and PSMF is that you’re using the fat and protein macros as levers that go up or down.

If you have body fat to burn, cycling PSMF with keto a couple of days a week helps do that…you’re still eating keto-friendly foods, just the kind that are lower in fat.

Example of how I’m cycling keto with PSMF:

Morning: 3-4 oz of protein
Midday: 6 oz of protein, 1 vegetable
Evening: 8 oz of protein, 1 vegetable

Bites: up to 2 ounces of low-fat cheese per day, and bouillon, discretionary additional protein

As needed to control hunger during the first 3 days, eat protein. Beverage at least 3-4 quarts of water daily. I try not to skip meals, because fitting in this much protein into less than 2 is VERY hard to do.

Allowable food examples on PSMF days:

The following is what I eat… your preferences may vary. I also suggest referencing this chart for PSMF swaps!

Meat/Fish

Save your beef and bacon for keto days, and on PSMF days, use ham in place of bacon, and turkey or chicken instead of beef. Yes, you could just also eat lean beef when you want it. You can also eat pretty much any white fish, unbreaded. I love cod, and I can eat half a pound at a time with lemon and salt & pepper.

Eggs

Egg whites are not very tasty to most people, so you could add in a yolk or two to offset the unpleasantness. It depends on where you like to get your fat from. I add a lot of flavor in the form of spices when I make an omelet and put one or two yolks in so as to not have it taste completely dry. Asparagus, fresh tomato, dill, and sauteed mushrooms are all great additions to omelets. Maybe even a little melted mozzarella or other low fat cheese.

Vegetables

If you love low carb veggies, PSMF is a good diet plan because you can use nonstarchy veg to fill out the rest of your plate of lean protein. I like to use lettuce such as iceberg and a little bit of zucchini or celery, all of them are non-bloating for me.

But with as much protein as the macros call for, I tend to keep the veggies down to a 1/2 cup or so per meal, because protein is extremely filling…even lean protein.

What do PSMF macros look like?

Cycling keto with PSMF macros

Thanks to the KetoAdapted macro calculator, the math is done for you, so figuring out PSMF macros made it pretty easy. You just enter in a few details and it will provide you with suggested macros for cycling keto with PSMF

Below is a sample of the difference between macros for a day of higher fat intake (typical keto days) and PSMF day macros:

How I’m doing with PSMF so far…

To say it was not easy to eat that much protein that first day of PSMF is an understatement. I did, but not without also eating a bit more fat just by happenstance… because I was almost out of lean protein the day I started, and had only fatty cuts on hand. I just got so full I simply couldn’t eat any more of anything, much less protein.

Calling it a small win anyway, considering I also had the combined challenge of it not being payday until the next day so I couldn’t go to the store to stock up on lean meat (I ate the last of of my eggs and lean ground beef), PLUS only having mostly high-fat foods in my fridge having been LCHF so long (I’m going on 5 years!

Thankfully, I got to the store a day later. I bought some chicken, turkey, lean beef, lettuce, feta cheese, and green beans, so I’m ready to try to kill it again on Friday and Saturday (today’s Thursday, and Sunday will be Easter as I write this).

Today is day 7 of cycling keto with PSMF (the day I edited and published this), which is the 5th non consecutive day of eating PSMF the other 2 days I followed my keto macros.

So how did I feel?

Overall, full. Just so full I’m almost uncomfortable. I think I am doing it wrong.

I also noticed bloat, so I’m wondering if I have an intolerance to egg whites and/or low fat dairy. I was eating a lot of both, mostly cottage cheese, and I ate one of those mozzarella string cheese sticks with my omelet and my lunch for all 4 days.

Instead of the heavy cream I was used to putting in my coffee daily, I used half & half (2 tablespoons in my morning coffee and 2 in my after dinner cup). So I’m cutting down on those to see if it helps.

It turns out I calculated my macros incorrectly, so for the first 4 days, I was eating incorrectly (the image I included here in the illustration is the adjusted ones). I accidentally entered in something wrong on the calculator last Wednesday and thought my protein macros for keto days was 132 g, and my PSMF days, 166 g. I tried hard to eat that much protein and almost made myself sick.

Today I’m only going to have up to the amount of protein called for on the correct macro illustration.

Bottom line: Make sure you understand what you’re doing

And be careful…

Alternating PSMF is important

The idea is that you don’t do PSMF regimen strictly for long stretches, or at least, not every day for weeks straight, as that would be very unhealthy—but you alternate days that you follow it.

Some people are cycling keto with PSMF this way: PSMF for a week and then back to a week of regular keto or carnivore, while some people alternate PSMF 2 days in a row and keto/carnivore 1 day, then back to 2 days straight of PSMF (whichever works best).

There are also people who are following PSMF and then alternate with “cheat” days or meals (basically not following any dietary restrictions and mostly eating a S.A.D. aka standard American diet), which to me, seems counterproductive in terms of healthy eating, and would not work for me. In my observations of those people, I found they are not diabetic like I am, and diabetics need to be very strictly low carb in our dietary habit.

I still love to eat ketocarnivore…

…and I still recommend a keto/carnivore approach to life! I don’t blame carnivore for anything. I’m just going to be focusing on cycling in leaner high protein days until I’ve reached a healthier weight that I can maintain. Because the fact of the matter is that I’m still eating a mostly animal-based diet, just leaner animal products, a few days per week.

And it doesn’t mean I have to turn in my keto card—I’m STILL KETO, it’s just that instead of getting my 70-80% fat macros from dietary fat, PSMF just helps my body find and burn off more of its stored fat.

I still believe carnivore is great because it healed me! People have proved it’s good for treating cancer, Lyme disease, chronic pain, depression and anxiety.

It’s also great for people who are heavy into stamina performance exercise such as running long distances. I also believe (along with many other people) that carnivore is the ultimate elimination dietary protocol because if you’re only eating meat and drinking water, you can figure out what it is that’s been creating issues in your body if you add one thing back at a time.

I started cycling keto with PSMF a few days ago and today is my ketocarnovore day, so as I’m editing this, I’m sipping a bulletproof coffee while I’m at work, and for dinner, I’ll have pork chops on the grill, and some green beans sauteed in butter with garlic! I plan to share my experience with anyone who’s interested.

Concluding thoughts on PSMF:

The first one leads into the second, so I tried to break it up a bit in order not to seem rambly!

1. In my opinion, PSMF IS considered a crash diet.

You must be careful when cycling keto with PSMF. Even if you have a lot of weight to lose, it is recommended that people do not follow PSMF for more than a short period of time (a week on and off, a few days a week, NOT for 3 months straight) because people have reported feeling weak, etc. (look up rabbit starvation, it is hard for humans to subsist on only lean protein for very long without feeling ill and causing undue stress on their body).

2. The scale isn’t everything.

It’s BEST to follow this type of protocol after having been keto for awhile, because the ketogenic diet is so healing, that PSMF could be too drastic a change to your body.

The reason we’re fat and have been for years isn’t because we just ate too much fat or overeat in general, there’s usually some foundational issue in our bodies that causes us to put on weight or hang on to it for longer than other people. Also, we didn’t get fat overnight. We need to be gentle with our bodies and take time to lose it the right way, which helps us keep it off the right way.

3. Understand what foods HEAL your body and what foods damage it.

This is why I almost always try to eat “clean” keto (avoid seed oils, processed keto packaged foods, most sugar substitutes, etc. and I don’t follow the “if it fits your macros” approach—just because something fits my macros doesn’t mean it’s good for me.

The lean protein approach in cycling keto with PSMF will help build back muscle as well as protect existing muscle tissue from loss while being very low-cal, but make sure to hit your fat allotment so you aren’t damaging your body.

Fat helps with satiety too, but on PSMF lean proteins really do fill you up to the point where appetite is suppressed for a long time, just not as long as with keto, because of the fat intake being higher.

PSMF Resources/More info:

• Macro Calculator for PSMF & Keto

• The P.E. Diet, by Dr. Ted Naiman

• Protein to Energy Ratio Calculator

• 30-Day PSMF & Ketogenic Meal Plans at KetoAdapted by Maria Emmerich
  
• Rabbit starvation – the dangers of lean protein diets
  
• More than You Ever Wanted To Know About Protein & Gluconeogenesis

* A few years before I went keto, I used to eat what many people would consider “clean” (fruit, veg, whole grains, no butter, only cooking with canola, etc.) and was almost vegetarian for most of my life.

I say this because I only ate meat occasionally and it was almost always lean meat, PLUS, I was never a big meat person until I forced myself into a more protein-heavy dietary approach to try to fix my diabetes.

As a result of finding keto, I started sharing my recipes online with people and they loved them enough for me to put them in a book, “Diabetic to Ketogenic: Reclaim Your Health with Real Food”.