When you realize the impact whole, plant-based foods combined with therapeutic ketosis can have on your cancer outcome, you will want to start immediately. You’ve already read the guide on getting started with therapeutic ketosis and know what foods to focus on (guide coming soon). The sticking point for some can be finding a manageable workflow for ensuring the meals you eat are making your body stronger and cancer weaker.
Remember your goal: A GKI (Glucose-Ketone Index) less than or equal to zero for as much of the time as possible, under 3.0 always. A complete guide to GKI is here.
To accomplish this, you’ll need to plan your meals in advance to ensure you’re staying under macro limits, and weigh and measure everything you eat to ensure it is tracked. The first few months are strict but eventually you’ll have a feel and can go off blood tests alone.
In this post:
- Planning and Tracking Workflows that Work
- Tips & Troubleshooting Therapeutic Ketosis
- Additional Keto for Cancer Resources
A workflow that works
Below is the workflow that I found worked best for me, along with step-by-step instructions to hopefully make the transition easier for you.
- Plan the day’s eating in advance in Cronometer (or your meal tracking app of choice)
- Adjust exact amounts as you prepare your food
- Track your GKI in Cronometer
- Adjust your macros and eating schedule at the end of the week based on how your GKI responded to certain foods and patterns of eating.
If you have a workflow that you like but it still isn’t working for you, click here to jump to troubleshooting tips to make functional food therapeutic ketosis easier.
1. Plan the day’s eating in advance to ensure the right therapeutic ketosis macros
In the early days after my diagnosis I did this in MyFitnessPal just because that’s where I’d been tracking my eating for years and years (CalorieCount the decade before that). I eventually made the switch to Cronometer and am blown away by how much easier it is.
Set aside time to plan out what you will eat for the week (or few days if that’s more your style) and enter everything into cronometer. I usually use the desktop version for this planning step so I can easily move back and forth between cronometer and the recipes.
You can find recipes that contain appropriate, healing foods on this website and across the web. “Raw vegan” recipe sites are a great source of whole foods recipes that are plant-based that don’t include grains or legumes — just be sure to substitute fruits and sugars. Similarly, “vegan keto” recipe sites can have some options but be wary of processed ingredients. Over time, you’ll want to build a collection of go-to recipes, preferably already entered in Cronometer, that you can re-use.
For the 98% of people with a BMI of 19 or above, (calculate your BMI here), you will generally need to stay below your calorie, net carbohydrate, and protein limits in order to remain in the therapeutic GKI range. Fat and fiber have no limits but are also not “goals” so you don’t need to have concerns about not eating enough fat. Similarly, given that you are eating whole, plant-based foods, you should have no problem consuming plenty of fiber.
For those who are underweight, I strongly recommend you work with a nutritionist or nutrition-informed doctor. I’ve worked with stage 4 patients who were underweight at diagnosis and were able to gain weight during treatment while following this way of eating despite regular water fasting.
It’s important to remember that, while traditional nutritional ketosis is generally achieved by treating net carbs as a limit, protein as a goal, and fat as a target, both net carbs and protein must be treated as limits to achieve deep, therapeutic levels of ketosis. This is because the body will convert any excess dietary protein into glucose.
As you enter the food you plan to eat, keep an eye on your macronutrient targets and make adjustments to your plan as needed. For example, if you had a higher carb lunch and dinner planned, maybe you save one of those meals for the next day and swap in a lower carb alternative .
The above screenshot represents a pretty standard day for me:
- Fasted in the morning drinking only green tea.
- A late lunch of my favorite healing flax-oil vinaigrette (immune-boosting garlic,powerfully anti-inflammatory flaxseed oil, anti-inflammatory apple cider vinegar) with sauerkraut for probiotics; Brazil nuts for immune-boosting selenium; broccoli sprouts for cancer-killing sulforaphane; flax seeds for anti-inflammatory omega-3 fatty acids, powerful lignans and protein; cucumber for deep hydration; and avocado for fats and deliciousness.
- Dinner of my favorite spicy Thai-style dressing (cancer-fighting garlic and ginger, tasty fats) tossed with cabbage and raw broccoli for sulforaphane and topped with cancer-fighting cilantro and protein-packed hemp seeds.
- Chia seed pudding for dessert with omega-3-rich, protein-packed chia seeds, MCT-rich coconut milk, anti-oxidant-rich cacao powder and cinnamon, and a few drops of vanilla and stevia for even more deliciousness.
In fact, once I knew that 1) the macros worked so well for me, 2) my GKI remained low after eating this way, and 3) I loved every bite, this became my standard Thursday. I now just copy and paste it from one week to the next. Of course, it’s not the same every day – I like to change up the vegetables or proportions, add shiritake noodles and zoodles, serve it as a salad or as crudites and dip.
I make my best guess for the amounts of each food I’ll be eating while I plan out my meals and then refine when I’m actually preparing the food.
2. Adjust exact amounts as you prepare your food
Planning is critical but it only helps if you follow the plan. (And what are the odds your clove of garlic weighs exactly 4 grams?)
Measure, track and record your planned food
I usually use the cronometer app on my phone for this and have it open beside me as I prepare my meal. Alternatively, if I’m making something messy, I’ll use a pen and scratch paper and transfer to cronometer later. Either way I work as follows:
- Place a bowl on my food scale and “tare” to set the weight to zero.
- Chop my first ingredient and add it to the bowl, trying to get as close as reasonable to my planned amount.
- Record the actual amount in cronometer.
- Hit “tare” and add the second ingredient.
Over time you will get a feel for the weight of your common ingredients. I can tell you by looking whether two Brazil nuts are 7 or 8 grams and estimate the weight of an avocado half within 10 grams. In the beginning, though, it’s vital to measure so you really understand how these foods impact your GKI.
Measure, track and record your UNplanned food. Before you eat it.
It is absolutely critical to record any additional food, unplanned treats, or “cheats.” Do this not to judge yourself but simply to learn so that you can help yourself heal. Go ahead and grab that extra handful of almonds but record it in Cronometer. Before you eat them.
Seemingly harmless snack foods tend to be the ones most likely to raise your GKI and understanding that linkage is vital to your survival. If you ended up eating 4 quest bars because you had a horrible chemo day and shit yourself at work (direct experience, friends), do not judge yourself. See the event as a great experiment opportunity to understand how that kind of comfort eating will impact your GKI. Approach it with curiosity and non-judgement while being open and honest with yourself.
3. Track your GKI in Cronometer
I found it useful to track my GKI every morning and evening in the first several weeks of therapeutic ketosis and then daily until I had established a routine that worked.
The rhythm that worked best for me was to test in the morning about an hour after getting up but before eating any food (just coffee, tea and medications) and in the evening before eating dinner. On a handful of selected fasting days, I tested at 3-hour intervals just to understand my natural, daily GKI curve. I also like to test new foods before and after eating them. You can read more detail about the ways I use GKI testing here.
When you record both your “Blood Glucose” and “Ketones (blood)” in Cronometer, it will automatically calculate your GKI and can provide you a visual graph of its changes over time.
The morning measurement will tell you a lot about how your body responds to the food you ate the previous day (the amount and macro ratio) with color on your sleep, stress and exercise, all of which can impact GKI.
If any GKI measurement is significantly higher than the previous day, it likely means that something raised your blood sugar in unintended ways. Look for too many carbs, too much protein, artificial sweeteners, or processed foods as potential causes. Alternatively, it could be the “dawn phenomenon” of naturally increased blood glucose upon waking, stress or a poor night’s sleep. Make a note of any new or irregular exercise, sleep or emotional events in Cronometer when you record your metrics for later reference.
Your GKI measurements are also an opportunity to adjust your planned eating. If your GKI is higher than expected, you may want to be stricter about the foods you are eating – either by monitoring macro amounts. removing any processed food, or spending a longer time fasted during the day.
4. Adjust your macros and eating schedule at the end of the week based on how your GKI responded to certain foods and patterns of eating.
I like to reset each week with a slightly longer fast from dinner Sunday to dinner Tuesday (or sometime Wednesday or Thursday). After a week of eating, this fast is a chance to reset my GKI to more deeply therapeutic levels. It’s also a delightful break from food prep and dishes. I use that extra time as an opportunity to analyze the previous week and plan the next week’s meals.
Evaluate your GKI graph and notice any spikes or trends. Is your morning measurement always higher than afternoon? Did you have a big spike the morning after eating that keto “nutrition” bar or indulging in a glass of red wine? Consider avoiding those if the pattern persists. Did you tend to snack in the evenings after finishing your planned food? Consider saving more of your macro allotment for after dinner.
Return to step 1 and plan the next week taking these observations into account.
Tips & troubleshooting to make achieving a therapeutic GKI easier
Therapeutic ketosis isn’t easy — although it’s easier than chemo or radiation and certainly beats the potential alternative, death.
Honestly, getting into therapeutic ketosis is easy. All you have to do is not eat. Unfortunately, that’s not a sustainable solution which is why we jump through all these hoops to maintain therapeutic ketosis while eating.
The tips below may help you in the difficult early days and, I promise, it does get easier. You may end up loving this way of eating and, like me, committing to it for what may now be a very long life.
Prepare your own meals
This way of eating obviously isn’t conducive to eating out. In the early days, I strongly recommend declining invitations centered around food and drink. Instead of going out to eat with friends, consider:
- Meeting for tea or coffee instead
- Meeting for a walk – anything from window shopping to hiking
- Taking a yoga or meditation class together – including an online video class
- Getting a couples massage- even if you’re not a couple – or visiting a foot rub spa
- Watching a movie or tv show together
- Playing the cancer card and explaining that you need rest
It’s not just restaurants, the same tip applies to well-intentioned caregivers who may not understand that your way of eating is actually a form of medical treatment. Even sweet Brad, who fully understood that my diet was medicine, rarely remembered to weigh and measure ingredients when he treated me to a night off from cooking.
Find a few meals that you can eat over and over again
If you don’t already have it, try to develop a taste for chia seed pudding , my flax-garlic-Dijon salad, or similar staples that will allow you to more meet your daily functional nutrition goals while staying within your macros.
When you find a meal you like that works, don’t be afraid to recycle it. If you start to get tired of it, see if you can reinvent the same ingredients in another way, such as turning salad dressing into zoodle sauce or salad into cabbage wrapped tacos.
Make batches and meal prep
I personally don’t prepare meals in advance as things like freshly chopped garlic and freshly ground flaxseeds have more nutrition than pre-chopped and ground. If freshly preparing each meal from scratch isn’t realistic for you, though, don’t let that stop you! Cooking in batches and meal prepping can save tons of time.
- Fat bombs like this turmeric “golden milk” variation can be made in huge batches and stored in the freezer for months.
- Dressing recipes can be doubled or quadrupled and stored in the fridge for the next day (stir in flaxseed oil only before serving, if using). Use the “Recipe” function in Cronometer to calculate macros for the whole batch and then record only the amount you eat when preparing your food.
- Soups are another opportunity to double or triple a recipe and store the leftovers in the freezer for later.
- Vegetables can be pre-chopped on grocery day and stored in the fridge for snacks and salads.
Also, keep in mind you will likely be practicing some form of intermittent fasting which will eliminate the preparation time of at least one meal.
Minimize any additional food prep for others
You have cancer. You need to prioritize your own healing. If you’re cooking for other family members they get to eat what you eat or make their own. In the early days Brad ate my meals and would occasionally cook up some chicken to have on the side. He’s now 100% committed to my way of eating just because he feels so good.
My heart breaks for the single mothers who are diagnosed with cancer and forced to juggle childcare, work, and healing. It’s an impossible situation – they want to savor every moment with their precious children, fight for as much time as they can have with them, and need to work to pay for it all.
Wherever possible, call on your caregivers or whatever community options are available to help reduce the burden when possible.
Keep your motivation close
Remember why you are eating this way: if you don’t, you could die.
I mentioned in the Guide on How to Start Functional Therapeutic Ketosis that, shortly after my diagnosis, I made a list of my reasons for living. Whenever I was struck by a craving for food that would not actively help me heal, I referred to that list to remind me that no sandwich/ pizza/ taco/ whatever was worth making cancer stronger. At that time, there was no expectation that I would ever be healed but I was motivated simply by the idea of having a little more time with the people I love.
Work with a nutritionist
I created this blog and wrote this series of posts in the hope that others will heal themselves the way I did. I was so lucky to have the background, education and resources to spend time reading books, researching the latest studies, bothering scientists and attending conferences to inform my metabolic protocol.
My hope is that the information in this collection of posts is everything you need to get started or fills in any holes in your own research. If it’s not, I’ve also done got myself certified as a nutritionist so that I can offer one-on-one assistance.
It doesn’t have to be me who helps. A functional keto-friendly dietitian or nutritionist, nutritionally-informed doctor or metabolically-up-to-date cancer coach can help you.
Things a professional can do for you:
- Help you calculate your macros
- Provide weekly meal plans that fit your macros and preferences – even enter them into cronometer for you
- Help you analyze GKI results relative to your recorded habits
- Create and help you interpret GKI curves
- Provide encouragement to stick to your goals
- Answer any questions
The Charlie Foundation is a great source of keto professionals who can help you with therapeutic ketosis.
What if I throw up?
Chemo. Radiation. I’ve been there and am incredibly sympathetic. Speaking straight from an “achieving therapeutic ketosis” perspective, vomiting is no problem. Unless you’re underweight, in which case it’s important you work with a health care professional on any dietary changes, vomiting won’t have any negative impact on your GKI. Since studies done to date show the best results with a “calorie restricted ketoenic diet” compared to ketogenic diet alone, the loss of a meal won’t hurt you.
From a tracking perspective, I usually delete about half of any meal after I flushed it down the toilet and am sure to note the incident in my log since the stress of the treatment that caused the vomiting could raise my blood sugar a bit.
What if I have to travel?
If you must travel,
- Pack as much of your own food as reasonable. See this article on good travel foods.
- Research restaurants ahead of time to identify the ones that have dishes you can eat.
- Don’t stop tracking! Estimate portions as closely as you can.
- When in doubt, fast.
I traveled through shockingly salad-bereft expanses of China and Southeast Asia eating just streamed broccoli from restaurants and my travel stash of almond butter, chocolate and flackers. It was a transition for me to experience new cultures without indulging in their food but it was also a valuable lesson in detaching my reward centers from junk food.
When in doubt, you can always fast.
Other posts in this series include:
- How to start a functional therapeutic ketogenic diet
- What to eat on a functional therapeutic ketogenic diet
- Complete guide to GKI (Glucose-Ketone Index) tracking
- Complete guide to fasting for cancer: How to Fast (and Why)
Any other questions? Add them to the comments below and I’ll do my best to answer or point you towards someone who can!