Ketogenic diet

[Arnie Pye]

I'm struggling a bit with calculating a protein target. If it's 1g protein for each kg body weight, I'd get 60g/day. If it's 1g protein for each kg lean weight, I'd get 40g. But most menu plans seem to have about 80g+.

What is everyone else on?

I think some sources which suggest a level of protein that is needed per kg of body weight are giving the smallest amount of protein required to avoid protein malnutrition and related diseases. But the amount needed to make people function optimally would be higher. This is often the case with nutritional suggestions for vitamins and minerals - the recommended amount is the smallest amount required to avoid disease, not the amount to make people feel optimally well.

 

[adambeyoncelowe]

You can still go into ketosis with unlimited protein on the first two weeks of Atkins, so it may not be super-essential to worry about. 60g sounds fine, but you may not have that much.

The hard part is having so much fat, I find!

 

[Keela Too]

The hard part is having so much fat, I find!

Nope! Not a bother with this for me!

Slices of butter; hunks of cheese; double cream; never trimming the fat off bacon; loads of mayo on salads! I LOVE this way of eating!

Seriously, I no longer miss the sugar, or the bread or any of that high carb stuff. (Okay, I still love the smell of toast , but I can distract myself from it with something else.)

And as a bonus, without feeling hungry - ever, the extra pounds I gained whilst on Tenofovir are now melting off easily. (Slowly sure, but with no real effort.)

The things I find most difficult to restrict are milk in my coffee, and milk kefir.

 

[Hutan]

@Sasha, the targets I worked to are 5000 kJ, with 30g carbohydrates (10%); 86g fat (65%); 75g protein (25%). (Oh, and 25g of fibre.) If I do exercise (e.g. walk the dog), the grams of each allowed increase. I have been able to achieve those targets fairly well, although I may be eating a bit more fat than I record as I liberally splash the olive oil and butter around. I'm a small woman. These targets have resulted in a level of ketones of 1 to 1.5 (I forget the unit).

I agree with @leokitten that it's important to have a ketometer. That way you can adjust your targets, as it's the level of ketones (and your blood sugar) that matters.

I ate some French toast yesterday morning, I was making it for my son and it looked really good. Nice grainy sourdough. Yesterday afternoon I got the shivers and other feelings of an imminent infection. No significant gastrointestinal disturbance though. Today I have a headache and thinking is really hard work, I have ulcers in my mouth. I feel quite ill.

I know it sounds as though I have not been following the diet very well, but there's only been three deviations in the month. I guess I thought I was challenging the diet, seeing if carbohydrates make me feel bad. And also, it has taken me a while to really understand that this isn't like a normal diet, where you can have a cheat day without a great deal of consequence (in fact, alternating between limiting and not limiting food in a normal diet is probably a good thing). @adambeyoncelowe explained it well:

On the subject of symptoms returning after eating carbs again...

If you do keto for a while then start on the carbs again, you'll get an insulin spike and resulting trembling, nausea, dizziness, weakness, etc, which is very much an effect of quickly reintroducing refined carbs into your body. It's possible you'd also get your symptoms back, too, but it's hard to say how quickly that would take.

You'll quickly learn to avoid carb-heavy foods if, like me, you hate that insulin spike. Carbs simply don't taste as nice for me, either, while proper fats start to taste very succulent and nourishing so long as I'm following the diet. If I go back to a carb-heavy diet, however, I quickly start craving carbs again.

The problem with this is that it makes evaluating the ketogenic diet very hard on an individual basis. I obviously can't just dip into carbohydrates and draw any conclusions from how I feel in the short term. I need to compare a good period of time on the ketogenic diet with a good period of time eating normally. But today I'm doubting my ability to evaluate this diet.

I'm pretty sure I feel better on this diet, maybe quite a bit better. The only times I have had a headache or crashed this last month have been after going out of ketosis. I have started to think about taking on a directorship in my professional field.

But is this a placebo response? Is it just that spring is here now and I always feel better when there is more sun and warmer temperatures? Is it just the random fluctuation of this illness? I need to get to the doctor, own up to trying this diet and somehow convince her to check my cholesterol levels. Today, with this shocking headache and feeling ill, it feels very hard to properly evaluate the diet on my own. I think we need some well conducted trials done on it.

 

[leokitten]

Nope! Not a bother with this for me!

Slices of butter; hunks of cheese; double cream; never trimming the fat off bacon; loads of mayo on salads! I LOVE this way of eating!

Seriously, I no longer miss the sugar, or the bread or any of that high carb stuff. (Okay, I still love the smell of toast , but I can distract myself from it with something else.)

And as a bonus, without feeling hungry - ever, the extra pounds I gained whilst on Tenofovir are now melting off easily. (Slowly sure, but with no real effort.)

The things I find most difficult to restrict are milk in my coffee, and milk kefir.

For me like @Keela Too it’s not at all hard to get enough fat on the diet, it’s to get adequate protein. I’m supposed to eat 100g protein a day and I have to actively think about getting in protein to meet the goal. With fat it’s so easy...

 

[leokitten]

@Trish and everyone - been reading a bit on gut issues since my last posts and also been on threads on PR regarding SIBO and d-lactate acidosis.

Trish regarding your idea on SIBO or other gut dysbiosis being the underlying reason PWME who significantly improve on IF and keto is very interesting, been giving it a lot of thought.

After reading papers on the topic I was posting on PR that evidence is somewhat suggestive of why IF and keto might help us if there is SIBO or d-la.

If there is an imbalance or translocation of flora which thrive on carbs, which happens in SIBO and d-lactate acidosis, and these bacteria are producing molecules which promote gut immune system activation or get into the bloodstream and cause many ME symptoms, then this is something worth thinking about.

I never had any traditional SIBO symptoms or major gut issues, but I read many people with ME and fibromyalgia don’t and they were still found to have it after breath testing.

There is a huge overlap between ME symptoms and d-lactate bacterial overgrowth as well. While it’s not full blown acute d-la acidosis like short bowel syndrome people get, with ME it could be subacute.

I always feel the best on fasting days, better than on all the other days when doing keto. Regular amounts of carbs make my ME deteriorate full throttle. It’s reallt weird.

 

[leokitten]

One interesting piece of evidence I’ve read is that d-lactate is thought to interfere with cellular respiration, namely pyruvate and l-lactate metabolism. Here’s one of a few papers which mentions it

D-Lactate altered mitochondrial energy production in rat brain and heart but not liver

 

[ScottTriGuy]

A real eye-opener about the nutrition industry on this STEM Talk podcast interview with investigative journalist Nina Tiecholz - highly recommended: https://www.ihmc.us/stemtalk/episode-52/

There are many parallels between the researchers and nutrition industry pushing the 'fat is bad, carbs are good' dogma, with the CBT/GET 'researchers' and insurance industry pushing the 'ME is psychosomatic' narrative.

Perhaps not surprisingly, with the nutrition industry its also about following the money...and careerism.

Beyond my own positive experience going low carb, based on this interview (I've listened twice now), I'm more convinced low carb is pro-health.

And I'm going to stop buying fish oil, there is no evidence its helpful. And won't be going vegan, no evidence its healthier.

She refers to this research, that is not widely known or acknowledged, as 'silent studies'.


Interestingly, Fiona Goodlee really had Nina's back when her paper about how the US Dietary Guidelines were not based on the available evidence, was published in the BMJ and there was a lot whack of push back.

From wiki:

In February 2015, the US Dietary Guidelines Advisory Committee (DGAC) released its report, written to provide a foundation for the 2015 Dietary Guidelines for Americans, and The New York Times published an op-ed by Teicholz criticizing the committee and its work.[14] The Arnold Foundation funded further work by Teicholz on the DGAC report, which published in the British Medical Journal in September 2015.[13][15] In the BMJ article, Teicholz continued the themes of her book and her February op-ed, and wrote that the DGAC showed bias against fat and meat and did not use all the available evidence, and that members had undisclosed conflicts of interest.[11][16] The BMJ circulated a preprint of the article with a press release, and Teicholz' claims were widely covered in the media.[13][16][17][18]

Teicholz' claims were harshly criticized by the DGAC, the US Department of Health and Human Services, the Center for Science in the Public Interest, and others, including a petition signed by 180 scientists, and they called for BMJ to retract the article or issue corrections.[11][13][16][19][20] The BMJ issued a correction in October 2015 and another in December 2016, the latter with a statement that after an independent review of the paper, it had decided not to retract it.


So if Goodlee with stood the pressure of those heavy hitters without buckling, it doesn't seem like she's going to reverse and retract any time soon. (Mind you, it would seem Goodlee is on the right side of evidence on the Tiecholz paper.)

However, perhaps it would be helpful if we could get Nina Tiecholz to also sign the letter @dave30th ?

 

[Keela Too]

Interestingly, Fiona Goodlee really had Nina's back when her paper about how the US Dietary Guidelines were not based on the available evidence, was published in the BMJ and there was a lot whack of push back.

However this should also mean she could be resistant to pressure from the BPS cabal? Unfortunately she seems to see them as being “right” - not sure why.

 

[Sasha]

Just wondering how everyone is doing who has been attempting this...

How are things with you, @leokitten?

 

[Skycloud]

I'm wondering whether people undergoing this diet change have had adverse bowel habit changes. I understand that constipation can be an issue - has anyone found this to be the case?

 

[sb4]

I have managed to settle into ketosis this time around. My BP was high for a few weeks and a few heart symptoms but it seems to have settled down a bit. I am eating less than half what I was eating before.

I feel my POTS is more stable, less downward swings (after carb meals). I feel a little off but that could be other things I'm doing. The problem is my gastroparesis has been playing up again. It's alright for now but when I run out of excess body fat to burn (which should be in a few weeks) it could be a big problem when I up calories.

I'm now thinking if I lower protein to less that 50g, would I get away with 50g carbs without symptoms? This would help my gastroparesis some. The brain needs roughly 30g glucose and rest of body 20g on ketosis according to chris masterjohn. So if I eat 50g carbs and keep protein bare minimum perhaps I will stay in ketosis? Difficult to get in nutrients this way though.

 

[Hutan]

I'm still sticking with the diet for now; I do seem to be better with it. I despair slightly at the thought of sticking with it for months/years more.

Getting enough fibre seems to be important for me to have good gut function, but, if I do, things are fine. I have found konjac noodles are great (virtually all fibre and very few calories). A bowl of chicken broth with leftover veges and protein and konjac noodles and good seasonings like sesame oil, ginger and chilli is a tasty lunch (and quick to microwave if chicken stock is in the fridge).

I used to often get post-prandial pain for several hours, intense enough that I couldn't breathe in deeply without a reflexive gasp of pain. I thought it might have been caused by gastroparesis? Anyway, I haven't had that happen while I have been on the diet.

 

[leokitten]

I’m still doing well on this diet, much the same as described before. As long as I stay away from carbs the symptom improvements persist.

I tested going back on a regular healthy diet with carbs for two days and what I found is that it takes around two days for ME symptoms and severity to return to the way they were before. This delay has made me wonder whether it’s something in our gut that could be driving symptoms.

 

[sb4]

takes around two days for ME symptoms and severity to return to the way they were before.

Could also just be your liver filling up with glycogen.

These numbers are probably wrong but your liver can store 100g glucose. On ketosis it will be around 0g. So if you ate 100g carbs in the "healthy" diet on the first day, most of it will go to refiling glycogen. So perhaps the 2nd day you would only start noticing symptoms?

 

[leokitten]

Could also just be your liver filling up with glycogen.

These numbers are probably wrong but your liver can store 100g glucose. On ketosis it will be around 0g. So if you ate 100g carbs in the "healthy" diet on the first day, most of it will go to refiling glycogen. So perhaps the 2nd day you would only start noticing symptoms?

Would our body and cells keep us in ketosis while it’s filling glycogen stores when our blood has plenty of glucose? From my understanding you come out of ketosis right away, but I could be wrong.

I know it might be a stretch, but a theory could be that gut dysbiosis (SIBO, subacute d-lactic acidosis), leaky gut, and dysbioic bacteria in this mix could thrive on carbohydrates and produce some biochemical(s) that make it into the bloodstream and impair carbohydrate metabolism in mitochondria.

While on an ultra low carb diet they are suppressed. When you eat carbs again it take some time for their population to become active again, grow, and produce the damaging biochemicals in large enough quantities again.

 

[leokitten]

I'm wondering whether people undergoing this diet change have had adverse bowel habit changes. I understand that constipation can be an issue - has anyone found this to be the case?

ME caused me constipation during the chronic phase. I never had constipation my entire life. During the acute phase I had IBS and diarrhea.

After going on this diet the constipation greatly improved.

 

[Amw66]

Nope! Not a bother with this for me!

Slices of butter; hunks of cheese; double cream; never trimming the fat off bacon; loads of mayo on salads! I LOVE this way of eating!

Seriously, I no longer miss the sugar, or the bread or any of that high carb stuff. (Okay, I still love the smell of toast , but I can distract myself from it with something else.)

And as a bonus, without feeling hungry - ever, the extra pounds I gained whilst on Tenofovir are now melting off easily. (Slowly sure, but with no real effort.)

The things I find most difficult to restrict are milk in my coffee, and milk kefir.

Sadly much harder without dairy .

 

[Sasha]

Dr Oystein Fluge mentioned at today's Stanford Symposium some patients benefiting from keto diet but that it's only anecdotal so far:

 

[Alvin]

Merged thread

For those who may want to try a keto diet since its been mentioned a few times i came across this link
I am not recommending trying the diet, just that i happened across this article and it may help someone who already decided to try it

The keto diet is, clearly, a major diet overhaul. But that doesn't mean just your dinner plate suffers—your entire kitchen (well, at least the stuff you keep in it) has to be totally revamped, too.

That means saying goodbye to all those quick-cooking items you always keep on hand for lazy nights (we're talking to you, quick-cooking rice and frozen french fries), and hello to some slightly more perishable foods that are higher in fat and protein like meat and full-fat dairy.

But before you go filling your grocery cart with bacon and cheese galore, know that you’ll want to opt for good-for-you sources of unsaturated fat and protein—like fish and avocado, instead, says Lyssie Lakatos, R.D.N., of the Nutrition Twins. “Since this diet is primarily coming from fat, choosing healthy sources of fat is important,” she says.

https://www.womenshealthmag.com/weight-loss/a23494478/keto-diet-grocery-list/