CHAPTER 8

NAVIGATING YOUR TRANSITION TO BURNING FAT

Now that you’ve modified your diet to follow the fat-burning eating plan, your body will need to make the switch from burning glucose for fuel to burning fat. Be patient. This is a multistep process that can take anywhere from a few days to a few months, depending on your current health, your commitment to your macronutrient targets, and your metabolic flexibility as you begin to burn fat.

MMT is highly customizable to you and your body, and it may take a while to find the foods and practices that enable you to become fully fat adapted—I’ll go into more detail on this in the next chapter. The aim of this chapter is to help you make the smoothest transition you can and get ahead of any possible challenges before they become big enough to potentially derail you.

WHAT’S HAPPENING WITH YOUR METABOLISM

Before you begin to burn fat, you must first use up the glycogen that is now stored in your skeletal muscles and your liver. In their book The Art and Science of Low Carbohydrate Performance, researchers Jeff Volek, Ph.D. and R.D., and Stephen Phinney, M.D. and Ph.D., estimate that glycogen stores in the average person top out at somewhere between 400 and 500 grams, of which 100 grams are stored in the liver. That translates to somewhere between 1,600 and 2,000 calories. If you have a lot of muscle mass and have eaten a high-carb diet, your stores may be higher than that.

Each gram of glycogen is stored with 3 to 4 grams of water, which means that as your stores are depleted, you will also lose this water weight, typically almost immediately after you begin restricting your carb intake. This is great news if one of your goals is weight loss.

As you can probably guess, burning 1,600 to 2,000 calories will only take a day or two—less time if you’re active and more time if you’re sedentary. But making the transition to burning fat isn’t as simple as running through your glycogen. You also have to keep insulin levels low because insulin inhibits lipase, the hormone-sensitive enzyme that breaks down fat. Not only that, but you have to keep to this lower level for a couple of weeks to several months to fully activate your body’s fat-burning system. Longer times are required for those who have profound insulin and leptin receptor resistance, especially if they are not using water fasts (covered as On-ramp #3 in Chapter 7 and again in more detail in Chapter 10).

Initially, your body will likely alternate between burning ketones, fatty acid, and glucose, which your liver can manufacture from excess protein, the breakdown of muscle tissue, or the freeing up of glycerol, which forms the backbone of triglycerides.

When you run out of glycogen, you may experience cravings for carbs and sweets, or feel hungry, because your body isn’t particularly adept at burning fat for fuel yet. This temporary energy deficit may tempt you to sneak a few more carbs here and there, or to overeat protein, but this will backfire because it will keep you in this transition longer by supplying more glucose and more insulin. This will only delay the shift to burning fat.

As your glycogen stores become depleted, your liver takes on a larger role in maintaining a healthy level of blood glucose (“glucose homeostasis”). Before you started eating a high-fat diet, insulin and another pancreatic signaling hormone called glucagon were primarily responsible for tightly regulating your blood sugar levels. Now metabolic sensors in your liver are assuming that role, and they will at first seek to restore glycogen through the production of glucose, either from protein you’ve consumed or by breaking down skeletal muscle and/or using glycerol if you are consuming enough fat.

When your glucose levels are elevated, this will impair lipase from burning fat for fuel. It’s only when you eliminate the interference of high glucose—either from dietary sources or from manufacture in the liver (gluconeogenesis)—that you begin to ramp up your fat burning. The longer and more consistently you restrict your intake of carbs while also limiting protein to 1 gram per kilogram of lean body mass or lower, the more efficient your liver will be as it figures out how to make this switch to burning fat for fuel.

The more compliant you are in the beginning of MMT, by really sticking to your macronutrient ratios and logging all the food you eat, the smoother this transition will be. Initially, even seemingly insignificant amounts of carbs will tend to cause a rise in your glucose, which will impair your fat burning. If you binge on carbs in the transition phase, you’ll replenish your glycogen stores and lengthen the time it takes for you to shift to burning fat as your primary fuel.

As a general rule, the younger and healthier you are, the faster you can move through this transition. A school-age child can make the switch in 24 to 36 hours. While kids can transition much quicker, this does not mean they should be on this program unless they have intractable seizures or cancer.

Folks in their 20s and 30s have the easiest time of it, while people in their 40s and 50s will generally face a little more of a challenge (unless you are already fit and following a whole-foods, Paleo-like diet). Those in their 60s and 70s will likely need to be very committed to make the switch. But if this is you, don’t be discouraged; I started MMT at 61 and it only took a few weeks to shift to fat-burning mode.

If you are in your 80s or older, you can absolutely adopt the diet—it will likely just take a bit longer. Elderly individuals need to be monitored very carefully to prevent muscle loss (sarcopenia). The bottom line is that the sooner you get on board with MMT, the more easily you’ll be able to sustain it and continue to enjoy the health benefits as you get older.

USE YOUR BLOOD GLUCOSE READINGS TO GAUGE YOUR PROGRESS

Remember that you want to test your blood glucose levels two to three times a day: when you first wake up, just before you eat your first meal of the day, and just before you go to bed. During this transitional period, your glucose readings may show great variation, but erratic readings may be due to the fact that your meter is only a screening tool; just redo the test (see below). Even if the results are initially hard to interpret, as you continue with the eating plan you will see your readings settle down into a more predictable pattern.

Your blood glucose readings provide powerful feedback on how appropriate your food choices are: if your glucose numbers are high, it suggests that you’ve eaten too many net carbs and/or too much protein, although there can be other factors at work (see the sidebar on the next page for those).

While you will likely see spikes and dips in the beginning, you will get more adept at choosing foods that keep you in the fat-burning zone, and you will start to see your early-morning and late-night readings smoothing out over time. Even then, expect the occasional spike. Just remember: your focus is on the trend over the course of several days, or even weeks, and your reward is watching your glucose numbers go down and become more stable. That means your insulin isn’t working as hard either.

Reasons Why You May Be Getting a High Glucose Reading

It can be alarming to measure your blood glucose levels and see some unexpectedly high readings. Here are some common triggers that may explain them:

• Menstrual Hormones: Glucose readings tend to be higher in the days just before the start of a woman’s cycle.
• Inflammation: Injury, surgery, or illness can all lead to inflammation, which also causes a rise in blood sugar.
• Too Much Protein: Eating more than adequate protein throughout the day or at a particular meal can trigger the liver to manufacture new glucose through the process of gluconeogenesis.
• Equipment Limitations: Home blood glucose meters can be off as much as 20 percent in either direction. If you get an unusual or unexpected reading, immediately do another glucose test, using the same finger but a different blood drop. If you get a significantly different reading, do a third test, and take the average of all three.
• Noncompliance: Seemingly insignificant amounts of net carbs can disrupt your blood glucose levels. You may not even realize that your food choices have sugar in them, so if you are getting higher readings than you expect, look back on the food you’ve eaten in the last couple of hours. This includes reading labels.
• Illness: A cold, the flu, and seasonal allergies all stimulate the immune system, resulting in a natural rise in steroid hormone—and one of steroid’s effects is to increase glucose levels.
• Exercise: If you have exercised vigorously in the hours prior to a high reading, it can mean that you ran out of ketones or you haven’t made the shift to making ketones yet, triggering your body to break down muscle and convert it to glucose for fuel. Non-intense and gentle exercises like walking and yoga actually tend to lower glucose levels.
• Stress: Don’t underestimate the impact of stress on blood glucose levels. When you experience real or imagined stress, you are likely to release adrenaline and cortisol, which trigger the manufacture of glucose.
• Poor Sleep: Each morning, your circadian rhythm prompts a release of cortisol to help you wake up, and cortisol triggers the release of glucose. After a night of too little sleep, your circadian rhythm and hormone balance are disrupted, which can lead to a surge in blood glucose levels.
• Chemo and Radiation: These treatments trigger inflammation that causes a rise in blood glucose—but you can take comfort in the fact that if you weren’t doing the diet, your blood glucose would be a lot higher.

WHEN YOU EAT MATTERS

A way to enhance your transition to fat burning is to begin to experiment with regular periods of fasting. There are many ways to do this, and many powerful benefits to reap, all of which I cover in Chapter 10. For the time being, aim to finish your last meal at least three hours before bedtime, and then wait as long as possible before eating breakfast the next day. This will help you ease into my favorite form of intermittent fasting, which I call Peak Fasting.

THE SIZE OF YOUR MEAL MATTERS

Ideally, it is best to time your biggest meal for before your most active period of the day so your muscles—which remain responsive to glucose even when you’re fat burning—will remove most of the extra glucose and insulin from your blood before they have the chance to disrupt your new fat-burning metabolism. Also ideally, you’d divide this largest meal in half and eat the second half 60 to 90 minutes after the first half, as this results in less nitrogen stress on your kidneys.

You also want to spread your protein consumption out over the day, limiting your protein at a given meal to about 15 grams. This makes it less likely that an excess of amino acids from protein will be converted into glucose by the liver, and it will also ease the detoxification burden on your kidneys. This is especially important if you already have some kidney insufficiency, with a serum creatinine level above 1. If this sounds like a low intake of protein to you, remember that excess amino acids are also a powerful stimulus to activate mTOR. (If you’d like a refresher on this information, refer back to Chapter 3.)

Especially during this transitional period, plan on having at least one or two high-fat snacks during the day. This will help tamp down any hunger or cravings and keep you feeling full and satisfied. (See the sidebar for several high-fat snack suggestions.)

COMMON SYMPTOMS EXPERIENCED DURING THE TRANSITION TO FAT BURNING AND THEIR REMEDIES

As you make the switch to burning fat and your body relearns how to burn fat instead of glucose for fuel, it is normal to go through a period where you experience one or a couple of common symptoms. You can manage the intensity of these symptoms by deciding how quickly you’ll change your diet, but you can’t totally avoid all of them: your body is learning a new way to fuel itself, so expect a glitch or two as it finds its way.

Here are the most common symptoms and simple ways to ward them off:

• Dehydration: As you transition to burning fat, your kidneys will start handling sodium differently. This will encourage your body to release more water and with it, some electrolytes as well. Make sure you are drinking water throughout the day. Miriam counsels her patients to also sip on homemade chicken, fish, or beef broth that has been salted with Himalayan salt, as it will replace electrolytes you may lose. (That said, keep your broth consumption to a cup or so as it contains amino acids that can be converted to glucose in the liver.)
• Nausea: If you look at a fatty food and feel nauseated, adding a supplement high in the fat-digesting enzyme lipase can help you break down fats more easily. Look for a supplement with pancreatin, which contains lipase. Ox bile is another supplement that will help emulsify the fat and allow you to better absorb it.
• Brain fog: Your brain can’t oxidize fatty acids for fuel but it will begin to use ketones for energy right away. In the early days, ketones only meet about a quarter of the brain’s required fuel; for the rest of its energy needs, your brain will still be dependent on glucose. Over time, your brain will transition to deriving more of its energy—as much as 60 to 70 percent in some people—from ketones. So any brain fog you may experience initially is going to get better over time as your brain adjusts to using ketones for energy. Again, taking a little more coconut oil or MCT oil (to the level that your digestion can accommodate without stomach upset) can help.
• Muscle cramps: This is a very common symptom related to a change in electrolyte balance that is part of the normal switch to fat burning. You can restore some electrolytes by increasing your salt intake with ½ to 1 teaspoon of a healthy salt like Himalayan salt. Another option: take an Epsom salt bath—Epsom salts contain magnesium, a natural muscle relaxant that you can absorb transdermally. (A warm, salted bath is also a wonderful way to relax.) Additionally, most are not aware that vitamin K₂ (not K₁) is a potent inhibitor of muscle cramps, especially if you have night cramps. Take it before bed; it worked wonders for me.
• Fatigue: You may have lowered the glucose in your bloodstream by reducing the amount of carbs and protein you’re consuming, but you may not have improved your fat burning enough yet to make up more of the energy that glucose had been supplying. The resulting energy deficit can lead to feelings of fatigue.

  You can use black coffee or tea with added healthy butter, coconut oil, or MCT oil to help ensure that you’re getting enough fat. If your fatigue lingers for a couple of weeks, consider having a blood test to determine your carnitine levels. L-carnitine is a transporter for long-chain fatty acids, ferrying them across the inner mitochondrial membrane where they are oxidized for energy. If it’s not in plentiful supply, your mitochondria will still use ketones and medium-chain fats, but oxidation of longer-chain fats slows down. Carnitine can be the key that unlocks that gate. (The jury is out as to whether or not carnitine may be problematic for people with cancer, so, if in doubt, leave it out.)

• Heart palpitations: This is common and is usually associated with dehydration and electrolyte loss. The remedy can be as simple as drinking a glass of water—try that first, and move on to a cup of salted broth if they don’t subside. Also consider increasing magnesium and/or potassium supplementation, both of which frequently help, but check with your physician first. And if the problem persists, be certain to have it evaluated by your physician.
• Constipation: This is a common complaint for people in general and it can be an even bigger issue for people with cancer because prescription pain relievers, chemo, and changes in how you digest your food can all contribute to the problem. The best way to ward off constipation is to make sure you are eating plenty of fiber and staying well hydrated. You can sprinkle freshly ground flax seeds over anything you eat, and have big salads with nuts and seeds and plenty of extra virgin olive oil. You can also soak flax seeds overnight and use them in your smoothie. Organic psyllium is another useful fiber supplement.

  MCT oil is also renowned for its ability to get your bowels moving; refer back to Chapter 5 for guidance on how to introduce it slowly. If you get GI upset, go back down to a level that’s comfortable and stay there. Probiotics will also help relieve constipation. It’s best to get them from traditionally fermented foods, such as sauerkraut and kimchi, but a high-quality supplement can be helpful if it’s challenging for you to eat fermented foods every day.

NUTRIENT-DENSE SMOOTHIE RECIPE

Makes 1 smoothie

I love using smoothies to take in a lot of nutrients in one tasty swoop. Below are the ingredients I use to make my twice-daily smoothie, which is low carb, high fat, and moderate protein. I typically include everything on this list, although it does fluctuate depending on what I have available. Don’t be intimidated by the long list of ingredients. Try to incorporate everything in the foundation, and add optional add-ins as you see fit.

Foundation:

1 teaspoon to 1 tablespoon MCT oil (depending on tolerance)

½ to 1 avocado (depending on preference)

1 scoop organic greens powder

1 tablespoon organic whole-husk psyllium

1 to 3 ounces frozen organic fruit

1 to 3 droppers full of stevia (to taste)

2 tablespoons raw organic cocoa butter

1 tablespoon organic chia seeds

1 tablespoon flax seeds (soaked overnight)

Optional add-ins:

1 tablespoon black cumin or black sesame seeds (soaked overnight)

1 teaspoon hawthorn berries

½ teaspoon pau d’arco powder

½ teaspoon ground organic egg shells

1 teaspoon food-grade diatomaceous earth

1 teaspoon trumpet mushroom powder

Directions:

Combine everything in a blender—I use a one-quart NutriBullet. Fill with water nearly to the top. Blend for approximately two minutes. Enjoy!

MANAGING YOUR EMOTIONS DURING TRANSITION

As is true with any significant change, if you are feeling hopeful and confident, you will be better equipped to make a smooth transition to a fat-burning diet. Taking charge of your health in this way can be quite a dramatic shift from how you’ve dealt with health issues in the past: by simply responding to orders from your doctor. You may feel unqualified to take on this responsibility. Or, you may feel reluctant to give up bread, cookies, chips, or even foods that you once thought were healthy. Or, you may be facing a frightening medical diagnosis that has left you feeling overwhelmed or even depressed.

If you are considering this eating plan, or even reading this book, because someone who cares about you is pushing you to try it, take my advice—wait. If you make these changes simply to please someone else, you are less likely to truly commit to the eating plan. Without commitment, you are more likely to quit at the first real challenge and blame the diet, when in actuality you simply weren’t ready to embrace these changes. If that’s the case, let the ideas that I’m presenting in this book continue to percolate in your mind. I hope that someday in the near future you’ll feel more ready to embark on this adventure.

Another peril in starting MMT while in a state of emotional turmoil is that you are more likely to turn to food for comfort or you will be easily discouraged by any little bump in the road—one high glucose reading may leave you with doubts that undermine your confidence and commitment.

Transition Tip: It’s normal to have some cravings when you first start MMT. These are typically easily to deal with if you are prepared with some high-fat snacks (see for ideas). If you are craving comfort food, however, no number of fat bombs will satisfy you. Then you need to ask yourself the question, What else can I do that will make me feel loved and cared for? Turning back to high-carb foods at this juncture will only prolong or derail your transition, and ultimately that’s not a very loving thing to do to yourself.

Spend some time thinking about why you are making these changes. Think beyond weight loss and include improvements you want to see in your health. Write these down so you can refer back to them in moments when you’re tempted to revert to old eating habits. Be specific so you can honestly assess the progress you’ve made.

Another powerful strategy is to visualize yourself healthy the way you want to be and attach as many positive emotions to that image as you can. Write this down and regularly reflect and meditate on this state. It is especially important to seek to experience as many of the positive emotions connected to achieving this goal as possible; this will radically increase your likelihood of attaining it.

I am also a strong advocate of the Emotional Freedom Technique (EFT) as a powerful tool to mediate emotional stressors. EFT is a DIY, needleless form of acupuncture that entails tapping on specific points on your face, arms, and hands while repeating positive affirmations. I’ve written about it extensively at eft.mercola.com. If you run into emotional roadblocks along your MMT journey, I highly recommend exploring EFT. You can do it on your own, or find a certified practitioner; the information I’ve compiled on my website will provide you with resources and help you decide on the approach that suits you best.

EXERCISE—BUT KEEP IT MODERATE

As your body adjusts to burning fat instead of glucose as your primary fuel, it’s best if you keep to moderate levels of activity. Strenuous exercise at this time can interfere with your ability to keep glucose low by breaking down muscle tissue, which is then recycled into glucose by the liver.

One way to determine if your workout was too strenuous is to measure your blood glucose before and after your exercise session. If it’s higher than 10 to 20 mg/dL after your workout, you know that you’ve triggered the liver to manufacture more glucose. If this happens, go for a 30-minute walk (or swim or take a gentle bike ride) to allow your muscles to take up that glucose. This is preferable to leaving it in your bloodstream, where it can cause an uptick in insulin.

Walking is a fantastic form of exercise for nearly everyone. In addition to regulating your blood sugar, it reduces cytokines, signaling molecules often associated with inflammation. Walking improves mood and self-esteem, and just as importantly, the more time you spend walking, the less time you spend sitting—which is a risk factor for nearly every major chronic disease. You don’t need much to reap the benefits. Multiple studies show that just a few hours of walking a week lowers the risk of breast cancer.

Most days, I walk barefoot on the beach for one to three hours and use the time to clear my thoughts, make phone calls, and go through the stack of books and journal articles stored on my Kindle—all this while deriving the health benefits of sun exposure (wearing shorts and no shirt) and grounding. By being in direct connection with the earth, you establish an electrical connection that provides positive ions stored in the ground, which can then neutralize free radicals in the body (for more information on this, please see my previous book, Effortless Healing). I don’t consider this walk to be exercise—rather, I view it as pleasurable movement with the added benefit of reducing the risk of obesity, stroke, coronary heart disease, breast and colon cancer, type 2 diabetes, and osteoporosis while also improving mental health, blood pressure, and blood lipid profiles.1

I am also a strong proponent of high-intensity interval training, so I understand if you are reading this section and thinking, No way am I only taking walks for exercise. Remember: keeping workouts light is only temporary. Once you are through the transition process, it is likely that you will be able to return to your high-intensity workouts.

For some of Miriam’s clients, maintaining high-intensity exercise despite their disease and new eating pattern is a quality-of-life issue: the thought of backing off, even if it is temporary, is enough to keep them from fully committing to needed changes. She counsels them that there are still many metabolic advantages to adopting a high-fat diet, but they need to understand that their intensive workouts can slow or even derail their progress unless it is very carefully managed and monitored. (Ketone supplementation and Peak Fasting are particularly valuable to athletes.) It is ultimately your decision to make—but you want to make it with your eyes open. The book The Art and Science of Low-Carb Performance is an extremely valuable guide if both a high-fat diet and high-intensity exercise are important to you.

KNOW THE CHALLENGES

After working with hundreds of clients, Miriam is acutely aware of the most common challenges people face when adopting a fat-burning eating plan. Be proactive and stand ready to face them head on and you will lessen the likelihood that any of these common issues will derail your efforts or cause your commitment to waver.

• Variety. Relying on a small number of foods—the same big salad at lunch, or having nuts for a snack every single day—can get old over time. It can also prompt you to seek out foods that are not part of your fat-burning eating plan. If food boredom is an issue for you, you will have to challenge yourself to try out new recipes; there are literally thousands of them at your fingertips via a simple Internet search (also, see the sidebar for several websites with many high-fat-friendly recipes). Simply put “low carb” or “ketogenic” into a search engine along with the name of your favorite meal and you are likely to find several recipe options. Just five years ago, you couldn’t find MMT-friendly recipes this easily, but the rise in popularity of this style of eating and people’s willingness to share their favorites has made discovering new fat-burning snacks and meals incredibly easy. But you need to be careful and analyze the net carbs and protein, as many of these recipes will need to be modified.
• Subtle—or not-so-subtle—social pressures. When you are out to dinner with friends or at a party, it can be daunting or uncomfortable to explain why you’re not eating the pasta, or the rice, or even the quinoa. Perhaps you’re getting raised eyebrows in your own home from loved ones. It will take resolve on your part not to have “just a bite” to keep the peace. If you’re attending a social event, eat before you go, or bring an MMT-friendly dish with you that everyone can enjoy, such as deviled eggs, nuts coated in butter and salt and roasted at a low heat, or a macadamia nut hummus.

  Most likely, your friends and family will need to be educated about the benefits of your plan, especially if they view it as an extreme weight-loss diet; being able to serve them something delicious can go a long way here. It helps if you keep the emphasis on the foods you can have, not on the foods you aren’t eating. If you present your plan as a special diet instead of a restrictive diet, people may be open to learning more, and may even follow suit, especially once they see the positive changes in your health.

• Newness of the diet. For most people, MMT is a significant change from their usual diet. You will need to find ways to incorporate more fats when you are no longer eating things like mashed potatoes or toast with jam. It may take some time to build a new habit of reaching for vegetables and fats instead of sandwiches and chips. So it is best to start off with a limited number of simple and reliable meals so you don’t get overwhelmed at every meal. You can then gradually expand your repertoire as your comfort level and desire for variety increase.
• Environment. Hopefully you did a pantry sweep, as I discussed in Chapter 7. But setting up your kitchen so it is easy to make MMT-friendly meals and avoid temptation from old favorites is a journey, not a destination. You may still think you need to buy chips for the kids, for example, or perhaps you only had the energy to empty out one cabinet when you got started. The thrift factor can be an issue too; many people are reluctant to rid their cabinets of food that is not spoiled and is conventionally viewed as healthy. Expect, too, that as you discover more recipes, you will realize you need a few more staples. Keep in mind that a well-stocked MMT-friendly kitchen will inspire you to keep moving forward with your plan.
• Travel. Whether you’re going to be out all day running errands or planning a longer trip, you’ve got to think ahead about what you will need to have with you while you’re away from home. I always travel with a set of staples, such as up to a dozen avocados to add to smoothies and salads, canned sardines or anchovies for healthy protein choices, powdered MCT oil, and a mixture of nuts and seeds along with all my supplements. I put the avocados in a cardboard tube that fits in my luggage to prevent them from being crushed. I then add them to my smoothies and salad. This volume nearly fills one checked bag but it is more than worth it to me to not be dependent on the typically terrible food choices that are available when I travel.
• Celebrations. Here’s a common scenario: It’s your birthday, and your daughter made you a cake. What do you do? You want to honor her effort, but if you eat a piece, it can derail your progress for several days, even weeks, as one transgression often begets another. In this situation, it’s enough to acknowledge the effort and take the lead in cutting a piece for everyone at the party, adding, “You make such beautiful cakes! Thank you so much for thinking of me.” Other times, you may be able to skirt the issue entirely by offering a suggestion as to how this special person can truly please you. For example, you may say, “What I would really love right now is a cup of tea!”

  Another option: you can prepare MMT-friendly foods (again, this is where an Internet search for “grain and sugar-free cheesecake,” for example, comes in very handy). But even better, whenever possible, think of new ways to celebrate birthdays, holidays, and anniversaries. Keep the focus on the company and the reason for the celebration, not on any particular food.

• Things going well. Let’s say you see your glucose readings are trending lower and you’ve lost some weight. It’s very tempting to think you’ve been so successful in meeting your goals that you don’t need to follow the eating plan anymore, or to get so complacent that you no longer tend to details such as weighing your intake. At these times you may need to remind yourself that there’s always room for improvement. So instead of dropping out, set some new and even more ambitious goals!

Deciding how long you want to continue with the MMT eating plan depends a lot on what you expect to gain. If you have cancer, you may always want to eat this way, especially if it results in an amazing and unexpected response. Otherwise, you can basically remain on the program over the long term by following the principles of feast-famine cycling, which I cover in Chapter 10.

If you’re committed to the idea of MMT but are having a rough time with these or other common challenges, or any other aspect of the eating plan, I strongly recommend you seek help from a health coach or a nutritionist who is trained in supporting high-fat diets. A professional can help you troubleshoot your issues by asking questions about what’s working and what’s not and then looking at your food diary and data such as your glucose readings and making some targeted suggestions. in combination with the overall support they provide, this extra bit of coaching can make all the difference between success and failure. MMT is such a powerful plan that you want to make sure you haven’t given up on it too soon, especially if the problem had an easy fix.

Often, people who seek out Miriam’s help do so because they are feeling overwhelmed by all the changes. But if they already understand food basics and are comfortable with preparing meals from scratch, quite often she can get them past their trouble spots and help them feel much more confident in only three or four hours. It’s not a big investment, but the payoff is huge. Another plus is that most people with extensive experience here offer their services online or through phone- or web-based video consultations.

To that end, Miriam and I have worked with Certified Nutrition Specialists to provide a training and certification course for physicians and nutritionists. You can go to their site (www.NutritionSpecialists.org) to find a consultant.

Using MMT to Optimize Conventional Breast Cancer Treatment

In July 2015, Denise was in Hawaii, on vacation with college friends, celebrating their 60th birthdays. Drying off at the beach, she noticed what felt like a bruise on her left breast. She wasn’t terribly concerned—she and her friends had been snorkeling, boogie boarding, and hiking volcanoes. Surely she’d just gotten bumped and hadn’t noticed.

Fast forward to August 2016, when Denise learned she had Stage IIIA lobular breast cancer. She and her husband immediately launched into intense research mode, reading up on treatment strategies, cutting-edge breakthroughs, recurrence and survival statistics: information they would need for the many complicated choices a breast cancer patient must make. After a few weeks, they began to close in on a plan that they believed would maximize Denise’s odds of survival.

By September, Denise was receiving a hormone inhibitor plus a chemo pill, therapy designed to shrink the tumor and suppress the hormones that allow some breast cancer cells to thrive. She also decided to adopt a ketogenic diet in an effort to both deny cancer its primary fuel source and to lose weight. At five feet five, Denise weighed 223 pounds. Her research had shown her that fat itself, especially belly fat, was her primary source of cancer-promoting hormones. She’d read the scary fact that women who did not get their weight down to a healthy range had a much higher rate of recurrence and earlier death.

Denise started working with Miriam Kalamian to develop a sensible plan for managing breast cancer. In her case, that also meant limiting estrogen-heavy dairy products, so Denise adopted a reduced-calorie, light-dairy ketogenic diet.

As Denise puts it, “I love carbs, but when faced with my own mortality, I love my husband and kids more. And I need to be here to take care of my mother, who has Alzheimer’s.” She adapted easily to her new plan: eggs for breakfast, avocado bacon boats for lunch, five squares of Lily’s dark chocolate (sweetened with stevia) for a snack, and salad, sautéed mushrooms, and pick-your-protein for dinner. She rounded that out with blackberries or almonds and coconut for dessert. At the movies she’d have a Cocommune bar, which is “very close to an Almond Joy,” she reports. At restaurants she ordered salmon, broccoli, and a salad. Instead of mashed potatoes at Thanksgiving, she served mashed cauliflower with lots of butter and it was a hit with her guests.

Denise added, “I got on with my life and believe that I’m truly, actually lengthening it with my food choices. I’ve dropped seventy-five pounds. I feel healthy and energetic.” Even while on chemo, she restarted dance and aerobic classes. Her sleep pattern improved, and as she notes, “I look pretty dang good. And my husband jokes, ‘Fighting cancer seems to agree with you.’”

No stranger to dieting, Denise was pleased to discover that cravings and hunger pangs, a bane of her past efforts at weight loss, disappeared in about 10 days, and after that, sticking to the plan was fairly easy. She does caution, “If you cheat, you’ve got to go through those ten very hard days again. Not worth it.”

With few exceptions, Denise kept to her plan through a round of radiation in April and May of 2016, adding in intermittent fasting with the aim of reducing the side effects of treatment and increasing the cancer’s sensitivity to radiation. She did so by not eating for 16 hours before each treatment. She drank a lot of water to stay hydrated but kept her food intake to a 5-hour window in the afternoon.

After drug therapy, a diet upgrade, a mastectomy, and radiation, Denise is considered cancer free. But, as with all breast cancer survivors, her recurrence risk is considered high, so Denise is likely to continue with a hormone inhibitor for five to seven years. She also plans on staying on the ketogenic diet for at least that long. Her logic: “While I’m starving any cancer remnants of hormones, why would I not starve them of carbs and sugar as well? Preventative maintenance seems crucial. I do not want to have to go through this again!” Denise’s efforts have succeeded on so many fronts. Why wouldn’t she want to stay with a plan that’s working for her?