On the keto diet? Ditch the cheat day

[apod]

I came across this article the other day (apologies if it's been posted on the board elsewhere):

On the keto diet? Ditch the cheat day
https://www.sciencedaily.com/releases/2 ... 112657.htm

Short-Term Low-Carbohydrate High-Fat Diet in Healthy Young Males Renders the Endothelium Susceptible to Hyperglycemia-Induced Damage, An Exploratory Analysis (Nutrients 2019)

https://www.mdpi.com/2072-6643/11/3/489

The often embraced 'cheat day' is a common theme in many diets and the popular ketogenic diet is no exception. But new research says that just one 75-gram dose of glucose -- the equivalent a large bottle of soda or a plate of fries -- while on a high fat, low carbohydrate diet can lead to damaged blood vessels.

One week of high-fat, low-carbohydrate feeding that leads to a relative impairment in glucose homeostasis in healthy young adults may predispose them to hyperglycemia-mediated endothelial damage as well as a reduction in endothelial function. The findings also suggest that a short-term HFD and acute glucose excursions may reduce FMD via separate and non-synergistic mechanisms. Increased susceptibility of the endothelium to hyperglycemia-induced damage provides evidence that the combination of a HFD with glucose ingestion could be detrimental to vascular health. These findings are especially relevant given the recent increase in popularity of low-carbohydrate, high-fat diets. These new findings suggest that if young, healthy males are following such diets, a temporary lapse in adherence with consumption of a food causing a glucose spike might lead to acute endothelial damage.

While the last study that went around with the milkshake was easier to dismiss, in this study, it was just a meal containing 75g carbohydrates from glucose in the context of a low carb diet. Diets like the bulletproof diet come to mind, where carb "refeeds" are recommended fairly regularly with starches like white rice, which is essentially a 75g+ dose of glucose.

This makes me rethink my carb cycling strategy a bit more, in that the carbs should probably be those associated with endothelial health (eg. blueberries with cacao powder, pomegranate, etc.) rather than something like white rice.

[TheBrain]

Apod, thanks for posting this information. I find it alarming. I’ve recently been through SIBO treatment, including 14 days of an antibiotic called Rifaximin. I need to rebuild by gut microbiome (which was probably never healthy), and I’m being encouraged to eat more carbs to feed my gut flora. I’ve been thinking of having two higher carb days per week, while otherwise remaining on my mildly ketogenic diet. I haven’t committed to that yet, but I’m experimenting a bit. I have to be careful, as I have gotten some glucose spikes, and my ketones have been measuring lower, even under .4.

So I’m not sure what to do. I’d bet that eating foods like blueberries and pomegranate would be better choices than white rice (or milkshakes!).

I’ve been wondering if I should ditch the ketogenic diet altogether, at least for a while. But I can imagine a lot of glucose spikes from doing that. I wonder if there’s a safe way to wean off the ketogenic diet. However, the ketogenic diet resolved my reactive hypoglycemia. Might it come back? Frankly, that’s the only obvious benefit I’ve derived from being on this diet (though it’s a big one). I have not experienced the sharper cognition or increased energy that others talk about. However, I’ve had other health issues to resolve (mold toxicity and SIBO). Working on those issues has brought about those benefits, although I’m not yet where I need or want to be.

[mike]

You might try some slower acting carbs like yams. You might also try adding protein instead, since that will raise sugars more slowly.

[TheBrain]

You might try some slower acting carbs like yams. You might also try adding protein instead, since that will raise sugars more slowly.

Mike, thanks for the suggestions. I’ve been experimenting with sweet potatoes. I do fine with 1/2 cup, a bit more if I eat more protein.

I’m now taking Summer Bock’s two-month Gut Rebuilding course. She had a live coaching call yesterday and gave me lots of suggestions. I have to listen again, take notes, and decide what I’m going to implement. Summer is an integrative medicine nutritionist, herbalist, and health coach. She used to have terrible gut health and healed herself. One thing she did, and she’s recommending I do, is continuous glucose monitoring. Obviously, that would help me much more easily track how I respond to foods. She can eat two bananas and not have a glucose spike, but puffed rice gives her a huge glucose spike. (She used to have reactive hypoglycemia, like I did, and healed it w/o using a Keto diet.) She’s also recommending Rx strength digestive enzymes and 4-6 hours between meals in an effort to get my migrating motor complex (peristalsis) going. Among other things...

[Tincup]

A couple of things stand out for the study. One is that the subjects were adapted for one week, a short time to adapt. Two is that a 75 g dose of glucose by itself is a strong challenge to the body. Mixed meals probably have a much more muted effect.

A lot of the "cool kids" in the low carb/keto space have been wearing continuous glucose monitors to see what happens. I decided to join the crowd and ordered an Abbott Libre 14 day reader and separately a 14 day sensor off eBay. I understand if you have an iPhone 7 or better (I don't) it can take the place of the reader. I was at a conference a month ago and chatted with a doc who was wearing one and how much he learned from it.

My supposition is that if you keep glucose excursions low (I think Peter Attia has said he aims for <10 mg/dL increases & he says he is not now keto), you will minimize any negative impact.

[TheBrain]

A couple of things stand out for the study. One is that the subjects were adapted for one week, a short time to adapt. Two is that a 75 g dose of glucose by itself is a strong challenge to the body. Mixed meals probably have a much more muted effect.

A lot of the "cool kids" in the low carb/keto space have been wearing continuous glucose monitors to see what happens. I decided to join the crowd and ordered an Abbott Libre 14 day reader and separately a 14 day sensor off eBay. I understand if you have an iPhone 7 or better (I don't) it can take the place of the reader. I was at a conference a month ago and chatted with a doc who was wearing one and how much he learned from it.

My supposition is that if you keep glucose excursions low (I think Peter Attia has said he aims for <10 mg/dL increases & he says he is not now keto), you will minimize any negative impact.

Tincup, do let us know what you learn from wearing a continuous glucose monitor. Summer Bock wore such a monitor for six months!

[apod]

A couple of things stand out for the study. One is that the subjects were adapted for one week, a short time to adapt. Two is that a 75 g dose of glucose by itself is a strong challenge to the body. Mixed meals probably have a much more muted effect.

A lot of the "cool kids" in the low carb/keto space have been wearing continuous glucose monitors to see what happens. I decided to join the crowd and ordered an Abbott Libre 14 day reader and separately a 14 day sensor off eBay. I understand if you have an iPhone 7 or better (I don't) it can take the place of the reader. I was at a conference a month ago and chatted with a doc who was wearing one and how much he learned from it.

My supposition is that if you keep glucose excursions low (I think Peter Attia has said he aims for <10 mg/dL increases & he says he is not now keto), you will minimize any negative impact.

Here's some old notes from when I wore one, several months adapted into HFLC:

cgm-1.jpg

Just a banana, oat bran, or sweet potato with a low GI load was enough to spike my BG. The effect disappears after a week or so of daily moderate (150g+ net carb) loading once your pancreas gets back in the habit of releasing insulin quickly, your liver is faster at shutting off GNG, and muscles are more equipped to take up glucose (GLUT4 receptors?)

[TheBrain]

Just a banana, oat bran, or sweet potato with a low GI load was enough to spike my BG. The effect disappears after a week or so of daily moderate (150g+ net carb) loading once your pancreas gets back in the habit of releasing insulin quickly, your liver is faster at shutting off GNG, and muscles are more equipped to take up glucose (GLUT4 receptors?)

Apod, how would you describe your current diet? What are your current macronutrient ratios?

[apod]

Just a banana, oat bran, or sweet potato with a low GI load was enough to spike my BG. The effect disappears after a week or so of daily moderate (150g+ net carb) loading once your pancreas gets back in the habit of releasing insulin quickly, your liver is faster at shutting off GNG, and muscles are more equipped to take up glucose (GLUT4 receptors?)

Apod, how would you describe your current diet? What are your current macronutrient ratios?

I'd like to get back in the habit of a longer fasting window and stricter ketosis. Lately, I have a bit of an undulating macro ratio. For the most part, I stick to low-gi veggies for the bulk, some grassfed / wild meat for protein, avocado + nuts + evoo for fats, then I top off with berries with cacao and cinnamon for the carbs. It's maybe 70F / 20P / 10C, occasionally going much higher on the C in place of F with sushi, fruit, and sweet potato. When I go ramp up the C, it's generally post-workout.

As an example meal, this afternoon I had 3 pastured eggs (soft boiled) over beet noodles with a couple cups of black coffee, I had this with maybe 2.5oz or so of pecans + a few brazil nuts, a little piece of 88% dark chocolate, a scoop of magnesium, 2 capsules of krill oil, a b-vitamin, and a little bit of glycine and creatine -- this was a pretty low-to-moderate carb meal for me, but in the context of my overall diet, it has a relatively insignificant effect on BG / ketosis. I'm planning on going for a long walk and a 40m jog this afternoon to get a break from my desk.

[slacker]

[quote="apod"]beet noodles

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