A high dietary sodium intake is associated with increased risk of nephrolithiasis likely by causing increased urinary calcium and decreased urinary citrate (28, 66, 73, 74). For every 100 mmol/day increase in dietary sodium intake, urinary calcium increases by an average of 40 mg/day in non-stone forming adults and by up to 80 mg/day in hypercalciuric stone formers (66, 74-76). A low sodium diet reduced urinary calcium and recurrent stones in hypercalciuric stone formers (76, 77). Stone formers are therefore recommended to limit their dietary sodium intake to less than 2300 mg/day (or 100 mmol/day) which is equivalent to 5.9 grams of salt (sodium chloride) (27-29).
SusanJ wrote:What type of urine analysis have you had done? Do you know if you have hypercalciuria or hypocitraturia? How is your oxalic acid output now?
PeterM wrote:Lastly, if you have an opinion, or would hazard one, do you think continuing a ketogenic diet at 2000 mg of sodium is unwise? I can’t imagine going back to being pre-diabetic, but I can’t imagine being a stone former either. A conundrum.
BREAKFAST VS. INTERMITTENT FASTING
First, there's a fairly large body of scientific research showing that breakfast skipping is associated with increased risk of obesity, hypertension, insulin resistance, diabetes, and cardiovascular disease. Meta-analyses have shown the magnitude of effect is huge, too. Regularly skipping breakfast increases risk of type 2 diabetes by 55%, increases risk of cardiovascular disease by 21%, and increases all-cause mortality by 32%.
I reviewed the science on breakfast benefits here: https://www.thepaleomom.com/breakfast-i ... e-answers/
Or, if you'd prefer to listen: https://www.thepaleomom.com/podcast-bre ... tant-meal/
Eating breakfast is strongly associated with healthier eating over all, but additional research points to a bigger reason for breakfast benefits. Studies have shown that breakfast skippers display a disrupted cortisol rhythm, with a prolonged morning spike of cortisol, high cortisol levels later in the day, and exaggerated cortisol release in response to stress. Conversely, regular consumption of breakfast is associated with lower stress levels, better regulated cortisol, and better physical and mental health, including reduced depressive symptoms.
And, studies of intermittent fasting show that, even though skipping breakfast does increase energy expenditure slightly for the day (by about 90 calories, the equivalent of walking for 14 minutes), it comes at the expense of higher inflammatory responses and a whopping a 54% increase in a measure insulin resistance (postprandial HOMA index) after lunch. Furthermore, while some studies have shown that an early time-restricted feeding window (where we skip dinner instead of breakfast) has modest cardiometabolic benefits (a small improvement to insulin sensitivity, blood pressure, and oxidative stress), it also comes at the expense of elevated morning cortisol and a potential interference with or shift in circadian rhythm.
I reviewed the science on intermittent fasting here: https://www.thepaleomom.com/intermittent-fasting/
Or, if you'd prefer to listen: https://www.thepaleomom.com/podcast-int ... t-fasting/
NEW SCIENCE ON EARLY BREAKFASTS
The new study presented last week was designed to further our understanding of the impact of breakfast versus time-restricted feeding on glucose tolerance and insulin sensitivity. And while we're still waiting for the peer-reviewed published paper on this study to be available, the data released so far is fascinating!
The researchers analyzed data from the National Health and Nutrition Examination Survey, which included 10,575 adults. They divided participants into three groups depending on the duration of their feeding window: <10 hours, 10-13 hours, and >13 hours per day. Then, the researchers created six subgroups based on feeding window start time. What they discovered is that the duration of feeding window did not matter. Instead, regardless of feeding window length, eating breakfast before 8:30am reduced insulin resistance and improved fasting blood glucose levels.
I think this makes a whole lot of sense when we think about the impact of breakfast on cortisol and the relationship between cortisol and insulin. What this data implies is that having breakfast within that first hour (or maybe two) after waking blunts morning cortisol and improves cortisol regulation throughout the day. But, if we delay breakfast past the natural morning cortisol spike, the harm to cortisol regulation throughout the day is already done.
It's another study showing that breakfast is super beneficial, and it adds to our understanding of timing: an early breakfast is best!
Compared to the breakfast eaters and on the control task visit only, breakfast skippers had higher circulating cortisol from arrival to midafternoon (p<0.01) and during the snack buffet (p<0.05). Furthermore, the lunch-induced cortisol reaction was larger in the 'skippers' (p=0.03). On both stress and control visit days, the diurnal cortisol amplitude was significantly (p=0.02) blunted in breakfast skippers. Self-reports of chronic stress did not differ between the groups. These data indicate that habitually skipping breakfast is associated with stress-independent over-activity in the HPA axis which, if prolonged, may increase risk (e.g., hypertension) for cardiometabolic disease in some people.
SusanJ wrote:PeterM wrote:Lastly, if you have an opinion, or would hazard one, do you think continuing a ketogenic diet at 2000 mg of sodium is unwise? I can’t imagine going back to being pre-diabetic, but I can’t imagine being a stone former either. A conundrum.
It is a conundrum. I'm still sorting out the keto thing, which I find to be tough when eliminating nuts. I just can't seem to get enough fats or maintain weight without them (short of doing shots of EVOO). I avoid coconut as much as possible because it whacks my lipids pretty severely. I'm in the same boat as you, and too many carbs send my numbers towards pre-diabetic. I hear your pain.
That said, I'd give 2000mg and keto a whirl, and just be very attentive to oxalate load. I highly recommend the spreadsheet in the Facebook "Trying Low Oxalates" group. It does help to see the amounts per serving so that you're not inadvertently overdoing the daily intake. Fortunately (or maybe unfortunately), I know when I've overdone oxalates because I get symptoms within a few hours, including joint pain.
PeterM wrote:I have always imagined there was an unhealthy user bias going on among breakfast skippers and their poorer metabolic outcomes. So I will read deeper and adjust accordingly. As an aside, I am stunned by how much extra sodium I have been consuming despite an almost exclusively whole food diet. Mustard alone was adding 500 mg daily. Sheesh. Again, appreciate your thinking. It’s really helped.
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