Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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GeorgeN wrote:
apod wrote:On wikipedia, it's mentioned that potassium supplementation is limited to 100mg -- were you taking 20x doses or more per day? It seems like I've read that potassium supplements are erosive to the GI? I'm curious if magnesium citrate or malate might work here? (I'm currently supplementing Mg glycinate/lysinate.) I am noticing a decreasing potassium intake with decreased carb intake, and I can add up a good amount of protein in a narrow eating window... hmm, I might have to investigate uric acid now. Tricky.
The recommended intake is 4,700 mg/day http://www.webmd.com/a-to-z-guides/pota ... c-overview

I also have afib and high K+ intake (along with magnesium to bowel tolerance) is part of my strategy to keep afib at bay. The 99 mg limit is by FDA on pills. The reason for this is that people with damaged kidneys can't urinate out the excess and it can be harmful or fatal. For those of us with normal kidneys, this is not an issue. Huge amounts of potassium (from memory, like 20g at one time) can be fatal. So is injecting it. I've taken 4.5 grams 2x/day in bicarb form without issue for extended periods of time. Potassium chloride can be hard on the stomach. Citrate was fine for me and bicarb is absolutely no problem.
Got it, I'll have to further investigate potassium supplementation. It's interesting, on Cronometer I can pull up a little chart of my (rough) potassium intake. A couple grams does seem about right into the lower carb intakes (20 pills per day), as VLC might push potassium down to around 3g/d. Easy for me to over-analyze this stuff.
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Do you usually take the bicarbonate with food, or do you take supplemental potassium on an empty stomach?

I've also been supplementing creatine (often with a high protein meal) -- it looks like this increases uric acid / gout risk as well. And BCAAs increase uric acid / gout risk (I've been looking into supplementing these around exercise)... What a theoretical pain.

This seems like a good excuse to up my avocado and coffee intake. :)
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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apod wrote:Do you usually take the bicarbonate with food, or do you take supplemental potassium on an empty stomach?
I take on empty stomach usually or with food. Most recently I was taking 1 tsp of this https://nuts.com/cookingbaking/leavener ... onate.html morning & evening. Haven't worked out the chemistry recently. I'm sure I did at one point. "There is approximately 19,500mg of potassium per 50 gram serving." Not sure how much is in a tsp right now. I'd just put it in water, stir and drink.

My mostly raw vegan Gundry E4 diet is pretty high in K+ now, so I don't usually supplement presently. I've tested serum K levels and they are usually in the low 4's range. Good enough for the afib. Doesn't handle the citrate part, but again not worried. The only supplement in my life that I NEVER miss is the mag to bowel tolerance. Without it, my afib would be back instantly. All the rest I play with taking or not taking & quantity. For example, my recent 48 hour fast - was only water except for di-magnesium malate powder morning & night.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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Here is a set of slides, prepared by the Ketonix creator, explaining the relationship between serum & breath ketones and also blood sugar: https://prezi.com/fyszdxhi2x4_/breath-v ... edium=copy
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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I stumbled across some great LCHF videos on this YouTube page today:
https://www.youtube.com/user/lowcarbdownunder/videos

It looks like they have the lectures up from the 2016 Low Carb Veil conference.

It was interesting listening to the Rosedale speech, recommending <0.75g/kg of protein, viewing dietary protein restriction as having more potential than carbohydrate restriction with regard to chronic disease prevention. At <45g of protein per day for my bodyweight, I would imagine the amount of preserved lean muscle mass is trimmed down lower than what I would like to maintain. I would be curious if this could be hacked by eating higher protein lower in leucine+methionine (like gelatin, or simply glycine), or if leucine + other BCAAs could be used intra-workout to maintain the benefits of a higher-protein diet with a low-protein diet. If I recall, Attia mentioned the intra-workout signaling here from BCAAs to be fairly short-lived.

While investigating a few different meal plans, it seems like I can rack up a pretty good amount of BHB (and simultaneously cut back on a bunch of insulin) with 2 meals in a small eating window if I move most of my protein and "slow-carbs" to the second meal, which should ultimately maintain higher levels of ketones through the day -- at 100g carbs/d it looks like I'm up around 1.2mmol when I wake up and 2.4mmol a few hours after lunchtime. Although, more veg+fruit seems like a more well-rounded approach (more polyphenols in the diet / less burden on the kidneys?) Interestingly, exercise drops me down to around 0.5mmol. At 200g carbs/d I was peaking around 0.6mmol with a large gap between breakfast and dinner, and somewhere in between I maintain 0.8-1.2.

I wish the breath-meters were more accurate (review) -- the blood strips are kind of expensive (and ultimately, not very useful for the non-diabetic low-carb dieter aside from checking for curiosity's sake.)
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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apod wrote:I would be curious if this could be hacked by eating higher protein lower in leucine+methionine (like gelatin, or simply glycine), or if leucine + other BCAAs could be used intra-workout to maintain the benefits of a higher-protein diet with a low-protein diet. If I recall, Attia mentioned the intra-workout signaling here from BCAAs to be fairly short-lived.


I wish the breath-meters were more accurate (review) -- the blood strips are kind of expensive (and ultimately, not very useful for the non-diabetic low-carb dieter aside from checking for curiosity's sake.)

leucine+methionine are what both Drs. Rosedale and Gundry are looking to avoid, because they activate mTOR and spike IGF-1.

I was at Vail, and in the Q&A session (not sure if it made the video as I've not watched), I mentioned to Rosedale that Gundry had us on a 20g/day animal protein restriction for limiting the leucine+methionine. Gundry does not limit us on veg. protein as long as the veggies are from his approved list {edit - as I've noted elsewhere, for E4's Gundry restricts animal fats so we only eat white fish, shell fish (preferred) or omega3 or pastured eggs - this is because he's observed the animal fats spike sdLDL}
Matrix 20160307.pdf
. Rosedale said this was a good approach. He also mentioned that there is a lifespan/performance tradeoff (this may have been a few days before Vail at another talk I was at).

I think the breath meters are accurate, once you understand what you are measuring. Acetone is a product of making acetoacetate from lipids. If acetoacetate is not used immediately, it is converted to betahydroybuterate for storage. If needed, betahydroybuterate is converted to acetoacetate for use. Hence the betahydroybuterate reading is a function of the making and use of acetoacetate over time. Hence serum betahydroybuterate and breath acetone don't correlate. If you drive your acetone levels high, then betahydroybuterate levels should climb. This is what happened when I water fasted for 48 hours 10 days ago. My actone levels were ~64-68 ppm (which is moderately high nutritional ketosis) on the second day, my serum betahydroybuterate readings climbed from ~2.5 mmol/L in the morning to 5.6 mmol/L right before I broke the fast (I did not exercise that day). Since I care more about production of ketones than storage, I prefere the acetone meter.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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apod wrote: While investigating a few different meal plans, it seems like I can rack up a pretty good amount of BHB (and simultaneously cut back on a bunch of insulin) with 2 meals in a small eating window if I move most of my protein and "slow-carbs" to the second meal, which should ultimately maintain higher levels of ketones through the day -- at 100g carbs/d it looks like I'm up around 1.2mmol when I wake up and 2.4mmol a few hours after lunchtime. Although, more veg+fruit seems like a more well-rounded approach (more polyphenols in the diet / less burden on the kidneys?) Interestingly, exercise drops me down to around 0.5mmol. At 200g carbs/d I was peaking around 0.6mmol with a large gap between breakfast and dinner, and somewhere in between I maintain 0.8-1.2.
Those are some amazing ketone numbers. Your physiology must be very fuel-flexible (carbs, fats).
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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This post from keto, T1 diabetic, MD and triathlete Keith Runyon is very interesting.
https://ketogenicdiabeticathlete.wordpr ... us-topics/

He also has his Ketonix readings in the link.

In this chart from the post, what is amazing to me is the number of symptomatic hypoglycemic episodes - dropping from 2-5/week to 0-3/year. Very dramatic.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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GeorgeN wrote:leucine+methionine are what both Drs. Rosedale and Gundry are looking to avoid, because they activate mTOR and spike IGF-1.
Hmmm... I'll be curious to hear what Attia comes up with if he ever gets around to publishing his ideas on balancing longevity / performance. Combining carbohydrate restriction with protein restriction, light calorie restriction, and exercising fasted with large fasting windows, I'd imagine that I would soon see the transition from a paleo sprinter physique to that of a vegan marathoner. Tricky.
GeorgeN wrote:Since I care more about production of ketones than storage, I prefer the acetone meter.
That's very interesting to see the inverse relation with glucose. I guess this is a potentially useful metric, different from tracking BHB, (plus! it's free + easy once you have the monitor.) A bit unnecessary for me and a steep price-point, but very cool from a gadget-lover's perspective. I'm curious -- Do you get a taste or a feeling in your lungs when you're in deep ketosis? In the past, whenever I would drink alcohol... even just a couple beers, I could feel it on my breath, and I get a very similar sensation with ketones above 1mmol (with an occasional 'taste') that doesn't seem to really disappear, so much as I get used to it.
aphorist wrote:Those are some amazing ketone numbers. Your physiology must be very fuel-flexible (carbs, fats).
I'm guessing there's a decent amount of glycogen depletion going on, and these net carbs aren't as bioavailable as cronometer might assume, where it might be more diet+exercise related than physiology (although, I did well on high-carb refeeds with low TGs and I have little body fat, where I should be fairly insulin sensitive in theory.)

At 100g carbs it seems to break down to ~50g fiber, with the remaining 50g likely containing a good amount of RS. Yesterday, I did an easy jog (~2mi), a few sets of bodyweight dips, weighted pullups, and threw in a few reverse pyramid deadlift sets starting at 240lbs... then, I ate breakfast around the 18hr fasted mark (with these 25g of net carbs coming from cooked+cooled+oil soaked+oil topped vegetables where my two largest sources of dietary sugar seem to be coming from pistachios and macadamia nuts.) With more carbohydrates, it's a similar diet for me, but I can eat much larger salad bowls worth of plants. I'll be curious to see how this affects the next round of lipid testing, where I should have a pretty good idea of what seems to work for me, then I can ease up on the tracking or look to other metrics. :geek:

Just going by feel, I dig the energy and clarity of the LCHF diet... although, I could go for some sushi rolls and baked potatoes. :D
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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George do you also take Magtein along with your di-mag?
Very interesting how you can keep afib at bay just with supplement, good for you.
Not sure if any other doc told you, but not so common to be able to do. You hear n=1 stories, but in reality most people fall back into meds.

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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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Surfrank57 wrote:George do you also take Magtein along with your di-mag?
Very interesting how you can keep afib at bay just with supplement, good for you.
Not sure if any other doc told you, but not so common to be able to do. You hear n=1 stories, but in reality most people fall back into meds.
Aloha Frank
Hi Frank - yes, I take Magtein, but its 96 mg of mag/day - a rounding error with the other mag I take. It is also a late addition to my routine. I've kept the afib under control since Nov of 2004 with mag, potassium and taurine. It is a routine I created. Two months into my afib journey, I had an episode that would not convert and lasted 2 1/2 months. One cardio told me digioxin was his favorite med. My afib has a vagal trigger. I knew that digioxin was toxic for vagal afib and refused to take it. He got tired of me and referred me to his EP partner. When I described my presentation to him, he said that "I was obviously vagal and there were certain meds he would not prescribe for me." That was a big step forward. After a Holter monitor session, he said, "you are doing well out of rhythm (<100 BPM in afib), why don't you stay that way." I said I wasn't happy about that and proposed a "Plan B." He would cardiovert me. I would try to keep myself in NSR with electrolytes and he would prescribe flecainide on demand. I would use a loading dose (300 mg) of flecainide to convert myself when the electrolytes failed. He agreed and I've been doing this ever since. I had to create the electrolyte routine myself. I used ECG and r to r recording heart rate monitors to iterate and titrate the electrolytes to a formula that works for me. I also detrained, as chronic fitness was my path to afib. My mantra is now the "minimum effective dose." I avoid any long duration cardio training. I'm still very active. I do HIIT as well as bodyweight training using programs designed for military special operators. I know that long duration, high heart rate cardio activities can be a trigger, so I minimize them. In the last 3 years, I've only used flecainide twice. It generally converts me in 1-2 hours. I also found out that excess calcium consumption from food made my system much less stable. On my LCHF diet, I was stress eating wheels of brie during my divorce. My normally good afib control diminished significantly. It took me 18 months to figure out it was the calcium. Once I quit the cheese, my excellent control returned.

I'm very aware that most can't follow my lead. I've participated in a lone afib forum online for most of my afib time. Some have certainly been able to do this, but many can't. There are several reasons - one is people are different, one is that I think there is a point of no return, if one waits too long, there is too much remodeling that has occurred, lastly most aren't diligent to not miss a dose of mag and don't seem to understand taking it to bowel tolerance. I know if I miss, afib will result. When we did a two week paddle raft trip down the Grand Canyon, I took about two pounds of mag with me and never missed a dose.
apod wrote:
GeorgeN wrote:leucine+methionine are what both Drs. Rosedale and Gundry are looking to avoid, because they activate mTOR and spike IGF-1.
Hmmm... I'll be curious to hear what Attia comes up with if he ever gets around to publishing his ideas on balancing longevity / performance. Combining carbohydrate restriction with protein restriction, light calorie restriction, and exercising fasted with large fasting windows, I'd imagine that I would soon see the transition from a paleo sprinter physique to that of a vegan marathoner. Tricky.

I'm curious -- Do you get a taste or a feeling in your lungs when you're in deep ketosis? In the past, whenever I would drink alcohol... even just a couple beers, I could feel it on my breath, and I get a very similar sensation with ketones above 1mmol (with an occasional 'taste') that doesn't seem to really disappear, so much as I get used to it.

At 100g carbs it seems to break down to ~50g fiber, with the remaining 50g likely containing a good amount of RS. Yesterday, I did an easy jog (~2mi), a few sets of bodyweight dips, weighted pullups, and threw in a few reverse pyramid deadlift sets starting at 240lbs... then, I ate breakfast around the 18hr fasted mark (with these 25g of net carbs coming from cooked+cooled+oil soaked+oil topped vegetables where my two largest sources of dietary sugar seem to be coming from pistachios and macadamia nuts.) With more carbohydrates, it's a similar diet for me, but I can eat much larger salad bowls worth of plants. I'll be curious to see how this affects the next round of lipid testing, where I should have a pretty good idea of what seems to work for me, then I can ease up on the tracking or look to other metrics.
I'm not calorie restricted and my fiber is mostly from nuts, non starchy veggies (very large salads) and RS - typically at least 50g, with 80-90g total carbs and 60 g protein with 20 g from animal sources - I don't track it often. Also, most is raw, except for the steamed asparagus and less frequent yuca fries or plaintain fries or pancakes. I do fast 22 hours/day. I'm 6'0", 175#, 60 years old and my body fat is estimated at 12-13% from the US Defense Department correlations. My waist is 33" and I don't have the "vegan marathoner" look - I've got relatively tree trunk thighs and well developed arms and shoulders.

I don't really notice any difference between 0.5 mmol/L and 5.6 mmol/L in how I feel. Some talk about how much better their brain works & etc. I don't notice that. I can go as long as I want without eating and exercising fasted is what I always do. I ski the steeps hard at 11-13,000' non-stop for 6-7.5 hours a couple of times a week. I rock climb for 5 hours. I can fatigue my muscles (mostly because of lack of skill with both climbing & skiing), but I don't need to eat for energy.

As to lipids, Gundry wants our sdLDL 30mg/dl or less and I can do that on this diet - I do follow his instruction to avoid animal fat with the only animal protein being shellfish (preferred), white fish or omega3/pastured eggs and this is limited to 20g of protein/day (about a 4 oz serving). He reports all the NMR particle count lipids, but ignores them, saying their purpose is to make people want to take statins...
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