Body2build

So, you want to start a CKD. Now, what the hell is a CKD you ask? Well, a CKD (cyclo ketonic diet) is simply a diet that consists of two cycles: low/no-carbohydrates and high-carbohydrates.  A Keto diet is something that we all hear from Atkins, which is basically high fat, moderate protein and Low/No carbs. Yet, this type of diet, although very effective for the average person it’ doesnt work well enough for the needs of someone wanting to get really lean.

Do not expect to gain muscle on this program.  Once your muscle glycogen is depleted, your workouts become a pain in the butt, you are sluggish and muscle loss can occur.  The main goal of Ketosis is to have no glycogen in the liver so glucagon can be released.  Basically, it all boils down to the following:

Day 1-6 you eat High-Fat/Moderate-Protein/Low-No-Carbohydrates, then Day 7 you eat HIGH-GI carbohydrates and low-fat, in order to achieve super compensation and refill muscle glycogen. (this will ensure quality training throughout every CKD cycle you do)

Setting up a CKD (6days Ketosis/1day Carb-Up)
First-off, let’s figure out your BMR (basal-metabolic-rate).  Take your weight and multiply it by 12=daily calorie intake without a deficit.
(100lb person) Example: 100lb x 12cal= 1200cal…1200cal=BMR
Everything I put forth will revolve in one way or another around your BMR.
6/1 ratio (6 days in ketosis/1 day carb-up)
Figure out your BMR…(basal-metabolic-rate)=calories needed to maintain current weight
weight x 12=BMR….(EXAMPLE: 100lb x 12=1200 cal a day)

Use the following fat/protein ratios w/ BMR deficit:
Ketosis:
Day:
1-> 85%fat/15%protein–BMR-5%
2-> 75%fat/25%protein–BMR-10%
3-> 65%fat/35%protein–BMR-15%
4-> 70%fat/30%protein–BMR
5-> 70%fat/30%protein–BMR-10%
6-> 65%fat/35%protein–BMR-15%
Carb-Up:
Day-7-> (CARB-UP) BMR+30%  Everyone’s favorite part

So, how do you calculate these percents and BMR. Well, let’s use a 200lb person as an example of this.
EXAMPLE BASED ON 200lb PERSON:
200lb. x 12cal=2400cal (BMR)
Ketosis: Days 1-6:
Day 1: 85%fat/15%protein– BMR-5%
2400cal (BMR) x .05=120cal (is 5% from BMR)
2400cal (BMR) – 120 cal (5%deficit)=2280cal for day 1
Fat ratios for day 1
2280cal x .85 (that is 85% fat)=1938cal from fat
Fat has 9 calories/gram
1938cal divided by 9cal/gram=215g fat for day 1
Protein ratios for day 1
2280cal x .15(that is 15%protein)=342 cal from protein
Protein has 4 calories/grams
342cal divided by 4cal/gram=86 g protein for day 1
Totals for Day-1: 215g fat/86g protein

Now, you might ask, why is the protein so low?  Protein can keep you out of Ketosis and, remember, everyday you are in Ketosis, you are burning fat while preserving muscle because Ketones (hence the name Ketosis) are protein sparing.  Protein can convert to glycogen at almost 58% efficiency, so you see why excess protein is a bad idea.  Plus, strictly from a scientific standpoint, a person can maintain current muscle mass at merely a 15%protein ratio, while no muscle gain is possible, maintenance is a very feasible idea with these ratios.

Day 2: 75%fat/25%protein BMR-10%
2400cal (BMR) x .10=240cal (is 10% from BMR)
2400cal (BMR) – 240 cal (10%deficit)=2160cal for day 2
Fat ratios for day 2
2160cal x .75 (that is 75% fat)=1620cal from fat
Fat has 9 calories/gram
1620cal divided by 9cal/gram=180g fat for day 2
Protein ratios for day 2
2160cal x .15(that is 15%protein)=324 cal from protein
Protein has 4 calories/grams
324cal divided by 4cal/gram=81 g protein for day 2
Totals for Day 2: 180g fat/81g protein

Day 3: 65%fat/35%protein BMR-15%
2400cal (BMR) x .15=360cal (is 15% from BMR)
2400cal (BMR) – 360 cal (15%deficit)=2040cal for day 3
Fat ratios for day 3
2040cal x .65 (that is 65% fat)=1326cal from fat
Fat has 9 calories/gram
1326cal divided by 9cal/gram=147g fat for day 3
Protein ratios for day 3
2040cal x .35(that is 35%protein)=714 cal from protein
Protein has 4 calories/grams
714cal divided by 4cal/gram=178 g protein for day 3
Totals for Day 3: 147g fat/178g protein

Day 4: 70%fat/30%protein BMR
2400cal (BMR)
Fat ratios for day 4
2400cal x .70 (that is 70% fat)=1680cal from fat
Fat has 9 calories/gram
1680cal divided by 9cal/gram=186g fat for day 4
Protein ratios for day 4
2400cal x .30(that is 30%protein)=720 cal from protein
Protein has 4 calories/grams
720cal divided by 4cal/gram=180 g protein for day 4
Totals for Day-4: 186g fat/180g protein

Day 5: 70%fat/30%protein BMR-10%
2400cal (BMR) x .10=240cal (is 10% from BMR)
2400cal (BMR) – 240 cal (10%deficit)=2160cal for day 5
Fat ratios for day 5
2160cal x .70 (that is 70% fat)=1512cal from fat
Fat has 9 calories/gram
1512cal divided by 9cal/gram=168g fat for day 5
Protein ratios for day 5
2160cal x .30(that is 30%protein)=648 cal from protein
Protein has 4 calories/grams
648cal divided by 4cal/gram=162 g protein for day 5
Totals for Day-5: 168g fat/162g protein

Day 6: (same as day 3) 65%fat/35%protein– BMR-15%
2400cal (BMR) x .15=360cal (is 15% from BMR)
2400cal (BMR) – 360 cal (15%deficit)=2040cal for day 6
Fat ratios for day 6
2040cal x .65 (that is 65% fat)=1326cal from fat
Fat has 9 calories/gram
1326cal divided by 9cal/gram=147g fat for day 6
Protein ratios for day 6
2040cal x .35(that is 35%protein)=714 cal from protein
Protein has 4 calories/grams
714cal divided by 4cal/gram=178 g protein for day 6
Totals for Day-6: 147g fat/178g protein

Essential Fatty Acids: fish oil, flaxseed oil, sesames seed oil, sunflower seed oil, grape seed oil, olive oil, peanut oil

Orbit Nutrition has macadamia nut oil that is really great as well.

You want to know how to do this the easy way.  So, here is a simple way to break down your Ketosis ratios:
1)Set calories at: 12 cal/lb
2)Set protein intake: typically 0.9 g/lb. Protein has 4 cal/gram
3)Set fat intake: take protein calories and subtract them from total calories, then divide by 9 to get grams of fat.

In practice, most people end up eating about 1 gram of fat for every gram of protein. Ketosis almost always establishes with 1/1 ratios. (fat/protein -grams-)

CARB UP TIME:
DAY 7: carb up BMR+30%
EXAMPLE FOR A 200lb PERSON:
2400cal (BMR) x .30= 720cal
2400cal + 720cal=3120cal
70%carbs/20%protein/10%fat
CARBS:
3120 x .70= 2185 cal from carbs
Carbohydrates have 4cal/g
2185cal divided by 4ca/g=546g carbs
PROTEIN:
3120 x .20=624cal from protein
Protein has 4cal/g
624cal divided by 4cal/g=156g protein
FAT:
3120 x .10=312 cal from fat
Fat has 9cal/g
312 divided by 9=35g fat
Totals: 546g carbs/156g protein/35g fat

SAMPLE CARB UP: (6meals) 200lb person
1-2: 150 g liquid glucose polymers like carb powders ( carbo max, dextrose) w/ 1 scoop protein
3-4: 75 g of liquid and solid glucose polymers (frosted flakes,honey-nut-cheerios..etc) w/ fat-free milk w/ 1/4 cup walnuts
5-6: 50 g of complex carbs (low GI) oatmeal, brown rice, beans, yams, sweet potato w/ 1/4 cup walnuts
AVOID FRUCTOSE:   Why is it that people say to avoid fructose?  I’ve heard that quite a few times, and was curious why. How important is this? Fructose resupplies the liver with glycogen first, if the liver is full, then via the pentose phosphate pathway, all additional fructose goes to FAT.

I know that every reader wants a simple way to figure out a carb up, so here it is:
1) Set total calories at: 16 cal/lb
2) Set protein intake: typically 0.2 g/lb. Protein has 4 cal/gram
3) Set fat intake: usually 0.1g/lb. Fat has 9cal/gram
4) Set carb intake: add protein and fat calories and subtract it from total calories, then divide by 4 to get grams of carbs.
In practice, most people end up eating about 2.7 grams of carbs for every lb of weight.

So, what type of workout and cardio do you have to do while on CKD. Here is a sample workout routine based on a 6/1 CKD. (6day Ketosis/1day carb-up)
Day:
1- 30 min cardio morning(empty stomach)/workout: Chest, Upper-Back, shoulders, arms, traps, abs
2- 30 min cardio morning/ workout: Legs, (includes, calfs, hams,quads), lower-back
3- 45 min cardio morning OR 1 hour cardio during the day
4- SAME AS DAY 3
5- 30-45 min cardio AM no workout
6- 30 min cardio AM/ full body workout = circuit training 3-5 times (very light 20-25reps)
7- before carb-up…early in AM do a full body circuit workout 3-5 times (very light 20-25reps), then IMMEDIATELY begin CARB UP.

(Cardio) I suggest using HIIT cardio and sLow cardio alternating.  HIIT means to “sprint as hard as you can for 20-30 seconds and then “jog” for 60-90 seconds.  Whatever equipment you can use to get that hear rate up will work.  sLow is the boring cardio but less taxing.  You will keep your heart rate around 120-135 bpm. 

Please take a serving of BCAA’s before doing you AM cardio/weigh training to fight muscle breakdown.

(DAY 1-6) For each body part do 1 exercise for 3 sets of 8-12 reps after necessary warm ups.  Try to get close to failure on each work set.  If you want you can start with your heaviest set after your warm ups and drop the weights as you fatigue…AND YOU WILL FATIGUE. 

(Day 7) You can simply do dips, chins, band work, walking lunges, curls, sit ups, push ups.  Time yourself for 30-45 seconds per exercise.  Rest after each circuit as needed. 

Supplements you need for CKD:

FIBER –anything from Walmart or Target is fine

Multi Vitamins/Minerals

AdipoKinetix  or MHP Dren

Ephedrine 

BCAA’s

Glutamine Peptides

Creatine

HOW TO TAKE THEM:
Take multi two times a day (recommended dose); one in the morning and one in the afternoon (around 2-3pm)
Take each 1-3 pills AdipoKinetix or MHP Dren with 25mg of ephedrine 2-3 times a day.
Take Fiber supplementation 2 times a day (morning,bed)

From Iron Addict:

Use will depend on budget. Here is what I would do with Aminos based on different budgets.
Big budget 10 grams EEA’s 10 grams BCAA"s 10 grams glutamine before at least 3 meals a day. On a training day, 10 gram glutamine and 10 grams EAA’s right before the workout, 30 grams BCAA’s during workout

Less Budget 5 grams EEA’s 5 grams BCAA"s 5 grams glutamine before at least 3 meals a day. On a training day 5 grams glutamine and 5 grams EAA’s right before the workout, 30 grams BCAA’s during workout.

Less budget 5-10 grams BCAA’s before at least 3 meals a day and 30 grams BCAA’s during workout
Less budget and the cheapest way to use them and still have tangible results is 30 grams BCAA’s during the workout.

As far as what kind of protein to use, use what you can tolerate. As you know I think whey sucks. Most people can handle the Team Skip blend which is 33 whey isolate, 33 egg, 33 casein. Don’t add BCAA’s, EAA’s or Glute to this.

You DON’T want to mix your BCAA’s or glutamine with anything as it reduces or stops the signaling effects they provide.

Eric Serrano says his lab research shows 10 grams of EAA’s to be the anabolic equivalent of 40+ grams of protein. I believe him based on results. Sucks they are the most expensive.
The BCAA’s should be the 4.1.1 mix which is nice as it s the cheaper of the two generally used mixes.

OOPS, I forgot to add that 3 grams of taurine with any of these is a great idea.

WHAT INTERRUPTS KETOSIS?
The only supplements that seem to reliably interrupt ketosis are vanadyl (seems to affect liver glycogen status) and citrimax (Hydroxycitric acid).  Citric acid (found in diet sodas) kicks some people out of ketosis, but does not affect everybody.  Aspartame also seems to affect some people but isn’t consistent. The anti-oxidant n-acetyl-cysteine can give a false positive for ketosis.  Basically, the only way to really negatively affect ketosis is by raising blood glucose or affecting liver metabolism.

by Lyle McDonald, CSCS

Introduction

As the Cyclical Ketogenic Diet (CKD) becomes more popular among natural bodybuilders, a great many questions have arisen regarding any and all manners of topics. One of the primary has to do with exercise on a CKD. First and foremost, individuals want to know what types of exercise can and can not be sustained on a CKD. Secondly questions arise as to what is the optimal training structure to maximize either fat loss or muscle gains on a CKD.

To answer these two questions, a lot of topics have to be covered ranging from exercise biochemistry to the hormonal response to different types of exercise to the implications of a diet which does not contain

carbohydrates during the week. The goal of this article will be to discuss the CKD primarily for fat loss. For reasons beyond the scope of this article, the CKD is most likely not the optimal diet for mass gains.

What is the CKD?

The Cyclical Ketogenic Diet, CKD, is a general term to describe diets such as The Anabolic Diet (by Dr. Mauro DiPasquale) and BODYOPUS (by Dan Duchaine). While there are many variants, the most common structure for a CKD is 5-6 days of strict low carbohydrate eating (less than 30 grams per day) with a 1-2 day carb-loading period (where carbohydrate intakes is roughly 60-70% of the total calories consumed). The idea behind the CKD (which will be discussed in a later article) is to force the body to burn fat during the lowcarb days, while sustaining exercise intensity by refilling muscle glycogen stores during the weekend carb-load.

Some Basic Exercise Metabolism

To better understand the effects of a CKD on exercise performance, we have to look briefly at how different forms of exercise affect fuel utilization in the body. There are four potential fuels which the body can use during exercise: glycogen, fat, protein and ketones. Except under certain conditions (which will be mentioned when necessary), protein and ketones do not provide a significant amount of energy during exercise. Therefore this discussion will focus primarily on glycogen and fat use during exercise. To simplify this article, exercise will be delineated as either aerobic or anaerobic (which will include interval training and weight training).

Aerobic Exercise

Aerobic exercise is generally defined as any activity which can be sustained continuously for periods of at least three minutes or longer. Examples would be walking, jogging, cycling, swimming, aerobics classes, etc.

The primary fuels during aerobic exercise are carbohydrate (muscle glycogen and blood glucose) and fat (from adipose tissue as well as intramuscular triglyceride) (1,2). At low intensities, fat is the primary fuel source during exercise.

As exercise intensity increases, less fat and more glycogen is used as fuel. At some intensity, sometimes called the "Crossover point", glycogen becomes the primary fuel during exercise. (3) This point corresponds roughly with something called the lactate threshold. The increase in glycogen utilization at higher intensities is related to a number of factors including greater adrenaline release (3,4) decreased availability of free fatty acids (5), and greater recruitment of Type II muscle fibers (3,6,8). The ketogenic diet shifts the crossover (i.e. lactate threshold) point to higher training intensities (3) as does regular endurance training (4).

Under normal (non-ketotic) conditions, ketones may provide 1% of the total energy yield during exercise (8). During the initial stage of a ketogenic diet, ketones may provide up to 20% of the total energy yield during exercise (9). After adaptation, even under conditions of heavy ketosis, ketones rarely provide more than 7-8% of the total energy yield which is a relatively insignificant amount (10,11,12).

Generally, protein use during aerobic exercise is minimal, accounting for perhaps 5% of the total energy yield. With glycogen depletion, this may increase to 10% of the total energy yield, amounting to the oxidation of about 10-13 grams of protein per hour of continuous exercise (14). This is at least part of the reason that excessive aerobic exercise, especially under low glycogen conditions, can cause muscle loss while dieting.

Studies on ketogenic diets (2 to 6 weeks) find a maintenance (15, 16) or increase (17,18) in aerobic endurance during low intensity exercise (75% of maximum heart rate and below). At higher exercise intensities (around 85% of maximum heart rate which is likely above the lactate threshold), as glycogen use increases, performance decreases on a ketogenic diet (19).

Anaerobic Exercise

While anaerobic exercise refers generally to any activity which lasts less than three minutes or so, most individuals are interested in the effects of a CKD on weight training. However athletes involved in sports such as sprinting, or any activity lasting less than three minutes, will have the same considerations discussed in this section.

Weight training refers to any activity involving the use of heavy resistance which lasts less than three minutes (i.e. it is anaerobic). Weight training is slightly more complicated to discuss in terms of fuel use than aerobic exercise. For very short activities (less than 20 seconds), muscles use ATP (adenosine triphosphate) which is stored directly in the muscle. Activities lasting greater than 30 seconds will rely on the breakdown of glycogen (carbohydrate stored in the muscle). During anaerobic exercise, fat can not be used directly as a fuel (1).

Relatively few studies have examined the effects of carbohydrate depletion on resistance training. In fact no studies have studies the effects of a ketogenic diet on weight training performance. However since weight training can only use glycogen for fuel, we can logically conclude that carbohydrates are critical for weight training performance. In fact, this is the primary reason to insert the carb-loading phase of the CKD on the weekend: to sustain high intensity exercise performance while still deriving the benefits of ketosis. Other issues pertaining to glycogen levels and depletion appear below.

The Hormonal Response to Exercise

The hormonal response to exercise is important from two standpoints. First and foremost, manipulation of the type of exercise done on a CKD can affect how efficiently fat loss or muscle gain occur. Second, to most rapidly enter ketosis (which requires a depletion of liver glycogen), certain types of exercise will be more effective than others. The primary hormonal response to both aerobic and anaerobic exercise are discussed below.

There are several hormones which are affected by aerobic exercise depending on exercise intensity and duration. They primarily impact on fuel utilization.

Catecholamines:

Adrenaline and noradrenaline are both involved in energy production. The catecholamines raise heart rate and blood pressure, stimulate fat breakdown (lipolysis), increase liver and muscle glycogen breakdown, and inhibit insulin release from the pancreas (20). Both adrenaline and noradrenaline increase during aerobic exercise although in differing amounts depending on intensity of exercise. Noradrenaline levels rise at relatively low exercise intensities stimulating FFA utilization in the muscles but relatively low levels of liver and muscle glycogen breakdown.

Insulin:

During aerobic exercise, insulin levels drop quickly due to an inhibitory effect on it’s release from the pancreas by adrenaline (20, 21). The drop in insulin allows free fatty acid release to occur from the fat cells during exercise. Lowering insulin is also important for establishing ketosis. Despite a decrease in insulin levels during exercise, there is an increased uptake of blood glucose by the muscle. An increase in glucose uptake with a decrease in insulin indicates improved insulin sensitivity at the muscle cells during exercise.

Glucagon:

As the mirror hormone of insulin, glucagon levels increase during aerobic exercise (20). Thus the overall response to aerobic exercise is pro-ketogenic in that it causes the necessary shift in the Insulin/Glucagon ratio to occur.

Thus the overall response to aerobic exercise is to decrease the use of glucose and increase the use of free fatty acids for fuel. This is beneficial from the standpoint of establishing ketosis, as will be discussed in greater detail below.

Weight training affects levels of many hormones in the human body depending on factors such as order of exercise, loads, number of sets, number of repetitions, etc. The primary hormones we are interested in which are affected by weight training are the androgens (primarily testosterone, growth hormone and IGF-1. With the exception of testosterone, the hormonal response to weight training primarily affects fuel availability and utilization (22).

Growth hormone (GH):

GH is a peptide hormone released from the hypothalamus in response to many different stimuli including sleep and breath holding (23). Although growth hormone is thought to be muscle building, at the levels seen in humans, it’s main role is to mobilize fat and decrease carbohydrate and protein utilization (24).

The main role of GH on muscle growth is most likely indirect by increasing release of Insulin-like Growth Factor 1 (IGF-1) from the liver (24). The primary stimulus for GH release with weight training appears to be related to lactic acid levels and the highest GH response to training is seen with moderate weights (~75% of maximum), multiple long sets (3-4 sets of 10-12 repetitions, about 40-60 seconds per set) with short rest periods (60-90 seconds). Studies using this type of protocol (generally 3X10 Rep maximum with a 1′ rest period) have repeatedly shown increases in GH levels in men (25, 26) and women (27,28) and may be useful for fat loss due to the lipolytic (fat mobilizing) actions of GH. Multiple sets of the same exercise are required for GH release (28).

Testosterone

Testosterone is frequently described as the ‘male’ hormone although women possess testosterone as well (at about 1/10th the level of men or less) (4).

Testosterone’s main role in muscle growth is by directly stimulating protein synthesis (23,29). Increases in testosterone occur in response to the use of basic exercises (squats, deadlifts, bench presses), heavy weights (85% of maximum and higher), multiple short sets (3 sets of 5 repetitions, about 20-30 seconds per set) and long rest periods (3-5 minutes). Studies have found a regimen of 3X5 rep max. with 3′ rest to increases testosterone significantly in men (25,26,30) but not in women (27). It is unknown whether the transient increase in testosterone following training has any impact on muscle growth.

Insulin like growth factor 1 (IGF-1)

IGF-1 is a hormone released from the liver, most likely in response to increases in GH levels (31). However the small increases in GH seen with training do not appear to affect IGF-1 levels (32). More likely, IGF-1 is released from damaged muscle cells (due to eccentric muscle actions) and acts locally only to stimulate growth (33,34).

Exercise and Ketosis

In that ketosis indicates that the body has shifted to using fat as it’s primary fuel, and since only five to six days exist per week to be in ketosis, a question which arises is how to most quickly establish ketosis.

Aerobic and anaerobic exercise have somewhat differential effects on ketosis and are discussed here.

It has been known for almost a century that ketones appear in higher concentrations in the blood following aerobic exercise (35). The overall effect of aerobic exercise below the lactate threshold is to induce or enhance ketosis. Liver glycogen decreases, insulin decreases, glucagon increases and there is an increase in free fatty acid levels in the bloodstream.

Aerobic exercise can quickly induce ketosis following an overnight fast. One hour at 65% of maximum heart rate causes a large increase in ketone body levels but the ketones do not contribute to energy production to any significant degree (36). 2 hours of exercise at 65% of maximum heart rate will raise ketone levels to 3mM after 3 hours. High levels of ketonemia (similar to those seen in prolonged fasting) can be achieved five hours post-exercise (36).

During high intensity exercise, the same overall hormonal picture described above occurs, just to a greater degree. Adrenaline and noradrenaline both increase during high intensity activities (both interval and weight training). The large increase in adrenaline causes the liver to over-release liver glycogen raising blood glucose (4,20). While this may impair ketogenesis in the short term, it is ultimately helpful in establishing ketosis initially. Insulin goes down during exercise but may increase after training due to increases in blood glucose. Glucagon goes up also helping to establish ketosis. Probably the biggest difference between high and low intensity exercise is that free fatty acid release is inhibited during high intensity activity, due to the increases in lactic acid (5).

Glycogen Levels and Depletion

To understand how to optimize training for a CKD, a discussion of glycogen levels under a variety of conditions are necessary. As well, some estimations must be made in terms of the amount of training which can and should be done as well as how much carbohydrate should be consumed at a given time.

Muscle glycogen is measured in millimoles per kilogram of muscle (mmol/kg). An individual following a normal mixed diet will maintain glycogen levels around 80-100 mmol/kg. Athletes following a mixed diet have higher levels, around 110-130 mmol/kg (37). On a standard ketogenic diet, with aerobic exercise only, muscle glycogen levels maintain around 70 mmol/kg with about 50 mmol/kg of that in the Type II muscle fibers (38,39).

Fat oxidation increases, both at rest and during aerobic exercise around 70 mmol/kg. Below 40 mmol/kg, exercise performance is generally impaired. Total exhaustion during exercise occurs at 15-25 mmol/kg. Additionally when glycogen levels fall too low (about 40 mmol/kg), protein can be used as a fuel source during exercise to a greater degree (14).

Following total depletion, if an individual consumes enough carbohydrates over a sufficient amount of time (generally 24-48 hours), muscle glycogen can reach 175 mmol/kg or higher (38). The level of supercompensation which can be achieved depends on the amount of glycogen depleted (40,41). That is, the lower that muscle glycogen levels are taken, the greater compensation will be seen. If glycogen levels are depleted too far (below 25 mmol/kg), glycogen supercompensation is impaired as the enzymes involved in glycogen synthesis are impaired (42). A summary of glycogen levels under different conditions appears in figure 1.

Figure 1: Summary of glycogen levels under different conditions

Condition Diet Glycogen

level (mmol/kg)

48 hour carb-up High carb 175

36 hour carb-up ~150

24 hour carb-up ~120-130

Athlete Mixed diet 110-130

Normal individual Mixed diet 80-100

Normal individual, Ketogenic diet 70

Aerobic exercise only

Fat burning increases 70

Exercise performance decreased 40

Exhaustion 15-25

Glycogen Depletion During Weight Training

Having looked at glycogen levels under various conditions, we can now examine the rates of glycogen depletion during weight training and use those values to make estimations of how much training can and should be done for the CKD.

Very few studies have examined glycogen depletion rates during weight training. One early study found a very low rate of glycogen depletion of about 2 mmol/kg/set during 20 sets of leg exercise (43). In contrast, two later studies both found glycogen depletion levels of approximately 7-7.5 mmol/kg/set (44,45). As the difference between these studies cannot be adequately explained, we will assume a glycogen depletion rate of 7 mmol/kg/set.

Examining the data of these two studies further, we can estimate glycogen utilization relative to how long each set lasts. At 70% of maximum weight, both researchers found a glycogen depletion rate of roughly 1.3 mmol/kg/repetition or 0.35 mmol/kg/second of work performed (44,45).

Rates of glycogen depletion during weight training at an intensity at 70% max

Depletion per set 7.5 mmol/kg/set

Depletion per repetition 1.3 mmol/kg/rep

Depletion per second of work 0.35 mmol/kg/second

Designing the Workout

With all of the above information presented, we can go through the steps to develop a CKD workout for fat loss. The goals of the workout are:

1. Deplete muscle glycogen in all bodyparts to approximately 70 mmol/kg by Tuesday as this will maximize fat utilization by the muscles but will not increase protein utilization.

2. Maximize Growth Hormone output (which is a lipolytic hormone) on Mon/Tue with a combination of long sets, multiple sets, and short rest periods.

3. Maintain muscle mass with tension work outs on Monday and Tuesday.

4. Deplete muscle glycogen to between 25 and 40 mmol/kg on Friday to stimulate optimal glycogen supercompensation.

5. Stimulate mass gains during the weekend of overfeeding with a full body tension workout (a high rep depletion workout is also an option)

6. Use cardio to quickly establish ketosis and enhance fat loss

The primary goal that still needs to be discussed is how much training is necessary to achieve goals #1 and #4.

We will assume a lifter has completed a 36 hour carb-up, ending Saturday evening, with a muscle glycogen level of 150 mmol/kg in all major muscle groups. To deplete to 70 mmol/kg in the first two workouts, this person needs to deplete:

150 mmol/kg – 70 mmol/kg = 80 mmol/kg of total glycogen.

Using the rate of glycogen depletion listed above we see that

80 mmol/kg divided by 1.3 mmol/kg/rep = 61 total reps.

or

80 mmol/kg divided by 0.35 mmol/kg/sec = 228 seconds of total set time.

Assuming an average set time of 45 seconds (10-12 reps at 4 seconds per repetition) this level of glycogen depletion would require approximately 5-6 sets per bodypart.

For the Friday workout, our lifter now wants to deplete muscle glycogen to between 25-40 mmol/kg before starting the carb-up. This would require a further glycogen depletion of

70 mmol/kg – 25 mmol/kg = 45 mmol/kg

70 mmol/kg – 40 mmol/kg = 30 mmol/kg

30-45 mmol/kg.

This would be

30-45 mmol/kg divided by 1.3 mmol/kg/rep = 20-30 reps

30-45 mmol/kg divided by 0.35 mmol/kg/second = 85-128 seconds.

The CKD Workout Routine

With the above estimations for sets and reps having been made, we can develop a sample workout routine. The format for the CKD week is:

Day Workout type Diet

Sunday: 30′+ of low intensity cardio in Ketogenic

morning to establish ketosis

Monday: Tension weight training workout Ketogenic

Tuesday: Tension weight training workout Ketogenic

Wed/Thu: cardio optional for fat loss Ketogenic

Fri: Full body workout Ketogenic prior to workout

Begin carb-load after

workout

Saturday: No workout Carb load

Sample workouts appear below.

Mon: Legs and abs

Exercise Sets Reps Rest

Squats 4 8-10 90"

Leg curl 4 8-10 90"

Leg extension OR 2 10-12 60"

feet high leg press

Seated leg curl 2 10-12 60"

Standing calf raise 4 8-10 90"

Seated calf raise 2 10-12 60"

Reverse crunch 2 15-20 60"

Crunch 2 15-20 60"

Total sets 24

Tue: Upper body

Exercise Sets Reps Rest

Incline bench press 4 8-10 60"

Cable row 4 8-10 60"

Flat bench press 2 10-12 60"

Pulldown to front 2 10-12 60"

Shoulder press 3 10-12 60"

Barbell curl 2 12-15 45"

Triceps pushdown 2 12-15 45"

Total sets 20

There are two options for the Friday workout. One is to perform a tension workout to stimulate growth during the carb-load. The second is to do a high-rep depletion workout, which should be done in circuit fashion solely to deplete muscle glycogen.

Sample Friday tension workout:

Exercise Sets Reps Rest

Leg press 3 8-10 90"

Leg curl 1 10-12 60"

Calf raise 2 10-12 60"

Bench press 3 8-10 90"

Wide grip row 3 8-10 90"

Shoulder press 1-2 10-12 60"

Undergrip pulldown 1-2 10-12 60"

Total sets 14-16

Sample circuits for Friday depletion workout:

leg press, dumbbell bench press, cable row, leg curl, shoulder press, overgrip pulldown, calf raise, triceps pushdown, barbell curl, reverse crunch.

leg extension, incline DB bench press, narrow grip row, seated leg curl, lateral raise, undergrip pulldown, seated calf raise, close grip bench press, alternate DB curl, twisting crunch.

squat, flat flye, cable row, standing leg curl, upright row, overgrip pulldown, donkey calf raise, overhead triceps extension, hammer curl, crunch.

Since the intensity is lower (roughly 50-60% of maximum) glycogen depletion per set will also be lower. Additionally, 20 reps will only require about 20-40 seconds to complete. Assuming glycogen had started at 70 mmol/kg, it will likely take 4-5 circuits to fully deplete glycogen.

Perform 10-20 quick reps per set (1 second up/1 second down). Take 1′ between exercises, and 5′ between circuits. The sets should not be taken to failure; the goal is simply to deplete muscle glycogen. Many trainees complain of nausea during this workout, which is caused by not resting long enough between sets.

References

1. Eric Hultman "Fuel selection, muscle fibre" Proceedings of the Nutrition Society (1995) 54: 107-121.

2. Edward F. Coyle "Substrate Utilization during exercise in active people" Am J Clin Nutr (1995) 61 (suppl): 968S-979S.

3. George Brooks and Jacques Mercier "Balance of carbohydrate and lipid utilization during exercise: the "crossover" concept" J Appl Physiol (1994) 76: 2253-2261.

4. "Physiology of Sport and Exercise" Jack H. Wilmore and David L. Costill. Human Kinetics Publishers 1994.

5. Romijn J.A. et. al. "Regulation of endogenous fat and carbohydrate metabolism in relation to exercise intensity and duration" Am J Physiol (1993) 265: E380-391.

6. Vollestad, NK et al. "Muscle glycogen depletion patterns in type I and subgroups of Type II fibers during prolonged severe exercise in man" Acta Physiol Scand (1984) 122: 433-441.

7. Gollnick, P.D. et. al. "Selective glycogen depletion in skeletal muscle fibres of man following sustained contractions" J Physiol (1974) 241: 59-67.

8. "Exercise Metabolism" Ed. Mark Hargreaves. Human Kinetics Publishers 1995.

9. Elia, M. et. al. "Ketone body metabolism in lean male adults during short-term starvation, with particular reference to forearm muscle metabolism" Clinical Science (1990) 78: 579-584.

10. Bergstrom, J. et. al. "Diet, muscle glycogen and physical performance" Acta Physiol Scand (1967) 71: 140-150.

11. Edmond O. Balasse and F. Fery "Ketone body production and disposal: Effects of fasting, diabetes and exercise" Diabetes/Metabolism Reviews (1989) 5: 247-270.

12. Wahren J. et. al. "Turnover and splanchnic metabolism of free fatty acids and ketones in insulin-dependent diabetics at rest and in response to exercise" J Clin Invest (1984) 73: 1367-1376.

14. Lemon, P.R. and J.P. Mullin "Effect of initial muscle glycogen level on protein catabolism during exercise" J Appl Physiol (1980) 48: 624-629.

15. Phinney, S.D. et. al. "The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capacity with reduced carbohydrate oxidation" Metabolism (1983) 32: 769-776.

16. Phinney, S.D. et. al. "Effects of aerobic exercise on energy expenditure and nitrogen balance durin very low calorie dieting." Metabolism (1988) 37: 758-765.

17. Phinney, SD et. al. "Capacity for moderate exercise in obese subjects after adaptation to a hypocaloric, ketogenic diet" J Clin Invest (1980) 66: 1152-1161.

18. Lambert E.V. et. al. "Enhanced endurance in trained cyclists during moderate intensity exercise following 2 weeks adaptation to a high fat diet" Eur J Apply Physiol (1994) 69: 387-293.

19. Hargreaves M. et. al. "Influence of muscle glycogen on glycogenolysis and glucose uptake during exercise in humans" J Appl Physiol (1995) 78: 288-292.

20. "Exercise Physiology: Human Bioenergetics and it’s applications" George A Brooks, Thomas D. Fahey, and Timothy P. White. Mayfield Publishing Company 1996.

21. Wade H. Martin III "Effects of acute and chronic exercise on fat metabolism" Exercise and Sports Science Reviews (1994) Vol 22: 203-231.

22. Katarina Borer "Neurohumoral mediation of exercise-induced growth" Med Sci Sports Exerc (1994) 26:741-754.

23. William Kraemer "Endocrine responses to resistance exercise" Med Sci Sports Exerc (1989) 20 (suppl): S152-S157.

24. Rogol, A.D. "Growth hormone: physiology, therapeutic use, and potential for abuse" ESSR (1989) 17: 353-377.

25. K. Hakkinen and A. Pakarinen "Acute hormonal responses to two different fatiguing heavy-resistance protocols in male athletes" J Appl Physiol (1993) 74: 882-887.

26. Kraemer, W.J. et. al. "Hormonal and growth factor responses to heavy resistance exercise protocols" J Appl Physiol (1990) 69: 1442-1450.

27. Kraemer, W.J. et. al. "Changes in hormonal concentrations following different heavy resistance exercise protocols in women." J Appl Physiol (1993) 75: 594-604.

28. Mulligan, S.E. et. al. "Influence of resistance exercise volume on serum growth hormone and cortisol concentrations in women" J Strength Cond Res (1996) 10: 256-262.

29. Griggs, R.C. et . al. "Effect of testosterone on muscle mass and protein synthesis" J Appl Physiol (1989) 66: 498-503.

30. Schwab, R. et. al. "Acute effects of different intensities of weight lifting on serum testosterone." Med Sci Sports Exerc (1993) 25(12): 1381-1385.

31. Kraemer, W.J. et. al. "Responses of IGF-1 to endogenous increases in growth hormone after heavy-resistance exercise" J Appl Physiol (1995) 79:1310-1315.

32. Katarina Borer "Neurohumoral mediation of exercise-induced growth" Med Sci Sports Exerc (1994) 26:741-754.

33. R. Smith and O.M. Rutherford "The role of metabolites in strength training I. A comparison of eccentric and concentric contractions" Eur J apply Physiol (1995) 71: 332-336.

34. DeVol, DL et. al. "Activation of insulin-like work-induced skeletal muscle growth" Am J Physiol (1990) 259: E89-E95.

35. J. H. Koeslag "Post-exercise ketosis and the hormone response to exercise: a review" Med Sci Sports Exerc (1982) 14: 327-334.

36. Edmond O. Balasse and F. Fery "Ketone body production and disposal: Effects of fasting, diabetes and exercise" Diabetes/Metabolism Reviews (1989) 5: 247-270.

37. John Ivy "Muscle glycogen syntehsis before and after exercise" Sports Medicine (1991) 11: 6-19.

38. Phinney S.D. et. al. "The human metabolic response to chronic ketosis without caloric restriction: physical and biochemical adaptations" Metabolism (1983) 32: 757-768.

39. Phinney, S.D. et. al. "The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capacity with reduced carbohydrate oxidation" Metabolism (1983) 32: 769-776.

40. Zachweija, J.J. et. al. "Influence of muscle glycogen depletion on the rate of resynthesis" Med Sci Sports Exerc (1991) 23: 44-48.

41. Price, TB et. al. "Human muscle glycogen resynthesis after exercise: insulin-dependent and -independent phases" J Appl Physiol (1994) 76: 104-111.

42. Yan Z. et. al. "Effect of low glycogen on glycogen synthase during and after exercise" Acta Physiol Scand (1992) 145: 345-352.

43. D.D. Pascoe and L.B. Gladden "Muscle glycogen resynthesis after short term, high intensity exercise and resistance exercise" Sports Med (1996) 21: 98-118.

44. Robergs, RA et. al. "Muscle glycogenolysis during different intensities of weight-resistance exercise" J Appl Physiol (1991) 70: 1700-1706.

45. Tesch, PA et. al. "Muscle metabolism during intense, heavy resistance exercise" Eur J Appl Physiol (1986) 55: 362-366.

In recent media, low carbohydrate diets have been THE fad for almost everybody in America wanting to lose weight. From your secretaries, elementary school teachers, and desk clerks, to bodybuilders, models, actresses, and athletes.

However, there is a huge difference between those who follow an Atkins plan and those who follow a cyclical ketogenic diet (CKD). Atkins is a low carb plan for those who are quite sedentary, walk maybe 3 times a week at the most, and just follow normal everyday activities. So forget Atkins here. The CKD is for those who’s main concern is true fat loss and muscle preservation—muscle for sports and high intensity activities.

My opinion for those who practice Atkins is that while they do lose fat, there is much water loss and most importantly muscle loss. Something we athletes do not want. A CKD is a true fat loss diet that works undeniably, if followed properly and strictly. Yes, low carb diets can be hell at first, but after two to three weeks, there have been anecdotal reports from many dieters that the cravings for carbohydrates decrease. This route to fat burning is unlike any traditional diet all the low-fat diet authors and FDA people have been advocating in history.

I got turned onto this diet a few years back when I got tired of cutting fat and still not being able to lose those last percentage points of bodyfat without losing hard earned muscle. I would start a low-fat diet, and be a either a social misfit (not going out with my friends to party or not going out to eat). Or in the worse case, feel so deprived of delicious junk foods I missed and bail out on the diet all together. One advantage to this diet is that there is no true restrictions on food. One may eat anything labeled a “food”! Well, almost. I’ll explain later.

How the diet works.

The science behind the CKD is simple. Carbohydrates in the diet cause an insulin (a “storage” hormone) output in the pancreas. It is used to store glycogen, amino acids into muscles, while causing excess calories to be stored as fat. So common sense asks me, “How can one try to break down fat, when your body is in a storage-type mode?” Difficult to do, indeed. That is why it makes perfect sense for step one to be cutting carbs.

The next thing that happens in your body is the rise in catecholamines (a “fat mobilizing” hormone), cortisol (a “breakdown” hormone), and growth hormone. Now your body realizes there’s no more carbs to burn for energy, so it must find another energy source: fat.

This usually happens during a metabolic condition called “ketosis.” This is when your liver is out of glycogen and starts to produce ketones (by-products of fatty acids). You can check your status of whether or not you are in ketosis with urinalysis strips you can pick up at any local drug store called “Ketostix.” Just urinate and see if it turns color. If so, you have ketones in the urine.

When the body is fed fat and protein, it will use dietary fat along with bodyfat for energy with protein going towards repair.

As a side note, there is another reason why this diet makes the most sense to use while keeping muscle. When one follows a high carbohydrate, low-fat, reduced-calorie diet, there’s a point when some bodyfat is burned, but when the body is still in a carbohydrate burning metabolism while trying to lose “weight,” it will strip down precious body protein to convert to glucose for energy.

On the other hand, during fat metabolism, protein cannot be converted into free-fatty acids for energy. Although there is no scientific research done on this, there have been reports from followers that there truly is a “protein-sparing” effect. It makes sense doesn’t it? Where else would the body look for fat energy when all dietary fat is burned? Bodyfat.

Diet Requirements Mon. to Fri.

The phrase “working smarter, not harder” applies here more than any diet one has tried. One must fully understand what they must do in order to optimize their goal. To set a CKD up, one cannot just expect to cut all carbs in the diet, train hard, and lose fat! Although some have come up with variations to this plan, the one stated in this article, I have found, has worked for myself (it got me to 6% BF), and other clients I’ve trained to the leanest, hardest they’ve ever been.

First, to set up the diet, write down your lean mass weight. Not your total weight, dough boy. If you weigh 200, but have 20% bodyfat, your lean mass weight would be around 160 pounds. Multiply this by one, getting your grams of protein requirements for a day. Make sure you eat at least one gram of protein/pound of lean mass! This is important in recovery from workouts and enough nitrogen retention to keep muscle. Next, multiply by four, to get your protein calories. Here, it is 640.

The rest of your caloric requirements for the day should be fat. Here is the catch: you must eat fat to burn fat. There’s no way around it. There are many advantages to dietary fat on this diet: Feeling of fullness since fat digestion is slow (less hunger), tastes great, and lowers blood glucose levels (lowering insulin and allow all the fat burning hormones to do their job).

So how much fat? I always recommend starting out with a 500 calorie deficit from your maintenance calories. If you don’t know, it is usually 15 times body weight (full body weight here) depending on an individuals metabolic rate. So here, the example would need 3000 calories a day to maintain weight, and 2500 calories to begin fat loss.

2500 minus 640 (protein calories) is 1860 which works out to be around 206 fat grams a day. Now as you go deeper into the diet, and find the need to restrict calories more, you must cut fat calories, not protein.

The Weekend Carb Load

Since muscle glycogen is the main source of energy for anaerobic exercise such as weight training, we cannot simply deplete all stores while working out and not fill them back up. If that does happen, be rest-assured that the body WILL use protein for fuel then. But this won’t happen on the CKD.

Your one and a half days of “freedom” allow you to do two things: First, reward your carb cravings from the previous days, allowing you to enjoy pleasures like pizza, pasta, breads, etc. Second, eating these things are physiologically rewarding as insulin levels run high, storing amino acids and carbs, as glycogen, into the depleted muscle allowing you to be able to workout again the following week.

Your “carb-up” should begin Friday night and last until around midnight Saturday. Now the next important issue to address is how many carbs. Some lucky individuals find that they eat whatever they want for the 24-30 hour time interval and receive perfect glycogen compensation, while others rely on a better statistical number.

What has been recommended by other authors of the CKD is 10-12 grams of carbs per kilogram of lean mass. Again, time to do math. Our example had 160 pounds of lean mass, so divide that by the conversion factor of 2.2, and we get roughly 73 kg.

100 Grams of easily digested liquid carbs along with around half as many grams of carbs in protein (here 50) as a whey shake or something of that nature should be taken right after the last workout (which I will address in the workout section of the article) when insulin sensitivity will be at its greatest.

A few hours later this individual will start to spread the remaining 630 grams of carbs, along with the important number of 160 grams of protein (remember, keep this constant) during the remainder of the compensation period.

So what about dietary fat? I know you’re reminding yourself, “Didn’t this guy mention pizza?” Yes, I did. And here’s why. During the first 24-30 hours of carbing up, the body will use all dietary carbohydrates to refill glycogen, protein for rebuilding, and get this: fat for energy. Still?

Just like the previous five and a half days. Makes sense. When all the carbohydrates are being used for more important functions (muscle), what else is there to be used? However, you can’t just eat all the fat you want. Keep grams of fat intake below your body weight in kilograms. Again, here our example will keep is fat below 73 during the carb-fest.

By anecdotal reports, this should keep fat regain minimal to nil. Keeping fat intake extremely low has even caused some extra fat burning during the carb up!

As stated before, some dietary fat should be eaten to slow digestion and keep sugar levels stable. Whether it be saturated, unsaturated, or essential fats, is the dieter’s decision. All have nine calories per gram. (Note: there is a claim that essential fatty acids such as flax seed oil increase insulin sensitivity within the muscle cells, in turn, increasing glycogen intake.)

In Case You Missed It

So here’s how it breaks down during the week: Sunday through Friday afternoon , you will follow the low carb diet outlined above. Eat fat and protein all day everyday except on workout days because after workouts, you will need to consume strictly just protein—no fat or carbs.

Some have found to enjoy a protein shake afterwards because they are easily digested. Do whatever works for you. But fat is not logical since you want the protein to fuel the healing process as quickly as possible and fat will only slow it down.

Friday afternoon, around two hours before your last workout of the week, eat two to three pieces of fruit. This will get your body/liver ready to start the carb loading and give you some energy for that final, dreadful workout (trust me, during the first few weeks, you will not want to do that final workout, but you must). Then from Friday night until Saturday at midnight or until bed, eat those carbs!

CKD Workout

Now, the question is, how do we workout to optimize muscle preservation and keep our metabolism up while dieting? Before we get into that, one must realize that during any dieting scheme there is one thing that must be done, and one thing that must not be done.

First, you must keep training volume lower than your usual routine. Overtraining is probably the number one killer in motivation, it deprives sleep, and hinders fat loss.

Second, you must not fall into the myth of lighter weights with higher reps. You got your muscle by benching 240, and you have to bench 240 to keep that same muscle! Or at least around that area! Okay, now that we have that established, here’s what we do:

On Monday and Tuesday we will work our weaker body parts, rest or cardio on Wednesday and Thursday mornings, Thursday do our strongest body parts, and Friday a combination of the Monday/Tuesday workouts in a loop format. The workout I have found to work optimally for myself and my clients is this:

(Note: You may feel free to tweak, shake, and turn this example upside down.

Everybody is different, so find what works for you.)

MONDAY: Chest, Back, Abs

High intensity workouts with 60 sec rest between sets, 90 sec rest between

each exercise

(this excludes all warm up sets)

Bench 3 sets, 6-10 reps

T-bar Row 3 sets, 6-10 reps

Incline bench 3 sets, 6-10 reps

Latpulldown to front 3 sets, 6-10 reps

Dips or Decline bench 3 sets, 6-10 reps

Shrugs 3 sets, 6-10 reps

Flys (any type) 2 sets, 10-12 reps

Reverse flys 2 sets, 10-12 reps

Stiff-leg deadlift 3 sets, 10-12 reps

Rope ab crunch 3 sets, 10-15 reps

Reverse crunch 3 sets, 10-20 reps

TUESDAY: Shoulders, Arms

Same intensity mentioned before

Behind the neck shoulder press 3 sets, 8-10 reps

Military press 3 sets, 8-10 reps

Preacher curls 3 sets, 8-10 reps

French press or “skull-crushers” 3 sets, 8-10 reps

Shoulder raises (any type) 2 sets, 8-10 reps

Hammers 3 sets, 8-10 reps

V-bar tricep press 3 sets, 8-10 reps

Forearm curls 2 sets, 8-10 reps

Reverse forearm curls 2 sets, 8-10 reps

Wednesday: Rest or Cardio

Thursday morning: Rest or Cardio

Later on Thursday: Legs

Same intensity mentioned before

Squat or Leg press 4 sets, 6-10 reps

Lying leg curl 4 sets, 6-10 reps

Standing calf raise 4 sets 6-10 reps

Leg extensions 4 sets, 10-12 reps

Seated leg curl 4 sets, 10-12 reps

Seated calf raise 4 sets, 10-12 reps

Friday night: Final Workout

Same intensity mentioned before

Bench 2 sets, 6-10 reps

T-bar Row 2 sets, 6-10 reps

Incline bench 2 sets, 6-10 reps

Latpulldown to front 2 sets, 6-10 reps

Behind the neck shoulder press 1 set, 8-10 reps

Military press 1 set, 8-10 reps

Either curl exercise 2 sets, 8-10 reps

Either tricep exercise 2 sets, 8-10 reps

Stiffleg deadift 1 set, 8-10 reps

Normal floor ab crunch 2 sets, 10-20 reps

Reverse crunches 2 sets, 10-20 reps

Start the carb up for 24-30 hours!

Aerobics

Before we go on, I want to address the cardio/aerobics issue. Some people find that for the first month on a CKD, cardio/aerobics is not needed. However when fat loss does start to slow down a bit, that is when most start adding 30 min. sessions on their off days. Be careful though, you do not want to hinder your Thursday leg workout. So experiment and try to only add aerobic sessions if you feel you have to.

Supplements

HCG Worthless as Weight-Loss Aid

Stephen Barrett, M.D.

Human chorionic gonadotrophin (HCG) is a hormone found in the urine of pregnant women. More than 50 years ago, Dr. Albert T. Simeons, a British-born physician, contended that HCG injections would enable dieters to subsist comfortably on a 500-calorie-a-day diet. He claimed that HCG would mobilize stored fat; suppress appetite; and redistribute fat from the waist, hips, and thighs [1]. There is no scientific evidence to support these claims [2-13]. Moreover, a 500-calorie (semi-starvation) diet is likely to result in loss of protein from vital organs, and HCG can cause other adverse effects. Gabe Mirkin, M.D., has noted:

At one time, HCG was the most widespread obesity medication administered in the United States. Some doctors liked it because it assured them of a steady clientele. Patients had to come in once a week for an injection [14].

Government Regulation

In 1976, the FTC ordered the Simeon Management Corporation, Simeon Weight Clinics Foundation, Bariatrics Management Corporation, C.M. Norcal, Inc., and HCG Weight Clinics Foundation and their officers to stop claiming that their HCG-based programs were safe, effective, and/or approved by the FDA for weight-control. Although the order did not stop the clinics from using HCG, it required that patients who contract for the treatment be informed in writing that:

THESE WEIGHT REDUCTION TREATMENTS INCLUDE THE INJECTION OF HCG, A DRUG WHICH HAS NOT BEEN APPROVED BY THE FOOD AND DRUG ADMINISTRATION AS SAFE AND EFFECTIVE IN THE TREATMENT OF OBSITY OR WEIGHT CONTROL. THERE IS NO SUBSTANTIAL EVIDENCE THAT HCG INCEASES WEIGHT LOSS BEYOND THAT RESULTING FROM CALORIC RESTRICTION, THAT IT CAUSES A MORE ATTRACTIVE OR “NORMAL” DISTRIBUTION OF FAT, OR THAT IT DECREASES THE HUNGER AND DISCOMFORT ASSOCIATED WITH CALORIE-RESTRICTIVE DIETS [15].

Since 1975, the FDA has required labeling and advertising of HCG to state:

HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or “normal” distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets.

Promotion By Kevin Trudeau

Negative studies and government action reduced the use of HGC injections for weight control close to zero. However, their promotion by infomercial king Kevin Trudeau may cause their use to increase. His 2007 book, The Weight Loss Cure They Don’t Want You to Know About, claims that “an absolute cure for obesity was discovered almost fifty years ago” but was “suppressed” by the AMA, the FDA, and “other medical establishments throughout the world.” Trudeau further claims that until now, “this miracle weight loss breakthrough has been hidden from the public so that drug companies can make billions of dollars selling their expensive drug treatments and surgical procedures for obesity.” The alleged cure consists of HCG injections plus 50 to 60 required and recommended do’s and don’ts [16].

In September 2007, the FTC charged Kevin Trudeau with violating a court order by misrepresenting the contents of the book. In infomercials, Trudeau falsely claimed that the book’s weight-loss plan is easy to do, can be done at home, and ultimately allows readers to eat whatever they want. Previous FTC action had led to a court order banning from using infomercials to sell any product, service, or program except for books and other publications The order specified that he not misrepresent the content of the books. The FTC is now charging that he violated that narrow exemption [17].

References

Simeons ATW. The action of chorionic gonadotrophin in the obese. Lancet 2:946-947, 1954.
Asher WL, Harper HW. Effect of human chorionic gonadotrophin on weight loss, hunger and feeling of well-being. American Journal of Clinical Nutrition 26:211–218, 1973.
Bosch B and others. Human chorionic gonadotrophin and weight loss. A double-blind, placebo-controlled trial. South African Medical Journal 77:185–189, 1990.
Carne S. The action of chorionic gonadotrophin in the obese. Lancet 2:1282–1284, 1961.
Craig LS and others. Chorionic gonadotrophin in the treatment of obese women. American Journal of Clinical Nutrition 12:230–234, 1963.
Frank BW. The use of chorionic gonadotrophin hormone in the treatment of obesity. A double-blind study. American Journal of Clinical Nutrition 14:133–136, 1964.
Greenway FL, Bray GA. Human Chorionic Gonadotrophin (HCG) in the treatment of obesity: a critical assessment of the Simeons method. West Journal of Medicine 127:461–463, 1977.
Shetty KR, Kalkhoff RK. Human chorionic gonadotrophin (HCG) treatment of obesity. Archives of Internal Medicine 137:151-155, 1977.
Lebon P. Treatment of overweight patients with chorionic gonadotrophin: follow-up study. Journal of the American Geriatric Society 14:116–125, 1966.
Lijesen GK and others. The effect of human chorionic gonadotrophin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis. British Journal of Clinical Pharmacology 49:237–243, 1995.
Miller R, Schneiderman LJ. A clinical study of the use of human chorionic gonadotrophin in weight reduction. Journal of Family Practice 4:445–448, 1977.
Stein MR and others. Ineffectiveness of human chorionic gonadotrophin in weight reduction: a double-blind study. American Journal of Clinical Nutrition 29:940–948, 1976.
Young RL and others. Chorionic gonadotrophin in weight control. A double-blind crossover study. JAMA 236:2495–2497, 1976.
Mirkin G. Getting Thin. Boston: Little Brown & Co., 1983.
In the matter of Simeon Management Corporation et al. Order, opinion etc., in regard to alleged violation of Secs. 5 and 12 of the Federal Trade Commission Act. Docket 8996. Complaint, Oct 15, 1974. Final Order April 29, 1976.
Trudeau K. The Weight Loss Cure They Don’t Want You to Know About. Alliance Publishing, 2007.
FTC: Marketer Kevin Trudeau violated prior court order. FTC news release, Sept 14, 2007.

A carb cutoff is simply allowing no carbs, other than fibrous, after a certain time. If you are on a typical 9-5 schedule, 6:00 pm is a good time to cut off your carbs – with exception of post workout (which would be about 50 grams of HIGH GI carbs).