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

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

Post by SusanJ »

Circ, we're both 3/4s and the same height and weight, so I'll watch how you navigate this.

When I ate more animal protein, used coconut oil and reduced carbs, my LDL-p went up about 40%! When I dialed that back and ate more starchy vegetables and added some starches (arrowroot, tapioca with nut flours), my LDL-P dropped over 40% but my A1C went into pre-diabetic. Like you, I have my moments with histamine, but right now I can handle some avocado now and then.

But I certainly can't eat fish everyday, because there is no such thing as fresh fish where I live. Frozen is the best I can do. I throw in some chicken or nuts on other days, use more olive oil, and most likely eat too many carbs in a day to be in ketosis. I don't have a meter, so don't know. But we'll see where I land on my next lipid and blood sugar tests.

So, like you, I wonder if this might be some damned-if-you-do, damned-if-you-don't diet issue with being 3/4... :lol: but also :cry:
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Julie G
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

Post by Julie G »

Circ, it was Dr. Stephan Cunnane who suggested those of us with a deficit need a minuscule BHB level to compensate for our decreased cerebral hypometabolism: .3-.5 mmol. FWIW that low level isn't quite enough for me. I wake up around .5 mmol and throughout the day get up to 2.0 at the most. I typically stay in the 1.0s- still pretty mild. That level has addressed my wacky BG and cognitive issues issues and makes me feel at least "a decade younger." ;) Luckily, when I concurrently restrict SFA, my LDL-P stays decent- 881... so it feels like a win/win for me.

Here's a link to the thread where we discuss Dr. Cunnane's work from the NYC conference. It intermittently spans pages. Here's a relevant section that might be helpful:
Dr. Cunnane reiterated Dr. Gibson’s position that cerebral hypometabolism drives AD pathology- not amyloid plaque. They both contend that amyloid/tau pathology occurs downstream of reduced cerebral fuel. Cerebral hypometabolism is the earliest manifestation of Alzheimer’s pathology and may present an opportunity for intervention, especially if used preventatively.

In addition to Alzheimer’s patients, Dr. Cunnane suggested that there are three other groups of patients who exhibit cerebral hypometabolism and may be able to benefit from ketone therapy:
-APOEε 4 carriers,
-Polycyctic Ovarian Syndrome patients (new to me!)
-insulin Resistance patients

He used the analogy of a clogged gasoline filter when describing these patients impaired ability to utilize cerebral glucose. His research has demonstrated that ketones can maintain up to 65% of brain fuel requirements when glucose can’t be utilized effectively. As Martha shared earlier, he stated that using ketones does NOT inhibit your ability to be able to use glucose simultaneously or at a later time. Babies begin life in ketosis. We all shift to a ketotic state during sleep. Our brains are very well adapted to using ketones and shifting between using glucose and ketones as fuel.

Dr. Cunnane suggested that ketones can be created in three ways:
-prolonged fasting
-strenuous exercise
-diet, particularly by using medium chain triglycerides

Optimal brain function depends on adequate fuel uptake. Dr. Cunnane suggested addressing the glucose deficit as early as possible in at-risk patients to adequately nourish neurons, allowing them to function more effectively to prevent amyloid/tau pathology.

Like Dr. Gibson, Dr. Cunnane was very humble and gracious. He repeated many times that he could give no authoritative advice until we had more information. He never pushed this therapy; just presented his evidence.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

Post by circular »

Wow, all this is so helpful. I do have the Precision Xtra now. Have gone through two boxes of ketone strips in about a week :lol: :shock: :? $$$

I had heard that the electrolyte replacement issue is ongoing while in ketosis. I'd prefer to think that after being adapted I don't have to think about it beyond normal intakes???

I've been wanting to gain muscle for years now. I used to be much fitter until all my health problems turned up about seven years ago and severely impacted my ability to exercise.

Julie thank you! You added and copied exactly what I'd been trying to find. It's been on my mind for some time. This is really hitting home now that I've been reviewing my PCOS history.

An odd thing is that I've tried to go keto two or three times before but my hunger was so crazy reducing carbs I just couldn't get close. I don't know if this has anything to do with it:
These pilot data suggest that PCOS-related inflexibility in fasting-related switching between lipid and carbohydrate/protein utilization for carbon metabolism may contribute to enhanced weight gain.

http://www.ncbi.nlm.nih.gov/pubmed/24765590/

A key here is that keto adaptation may be more difficult for women with PCOS. I think I've never experienced a lot of weight gain because I've always had a healthy diet and lifestyle, relatively speaking. This would also certainly cause a problem with the e4 need to switch to keto at night and at other times even in the absence of the ketogenic diet!

Digression > After Dr. Gundry told me I need to get off the bad lectins I got some steadiness and saw some improvements. We hear about lectins gumming up the immune and hormonal systems (when I went of gluten ~ the big kahuna of the lectin world ~ my PCOS hormones immediately became normal) … I keep having a suspicion that in some people lectins will somehow tie in with insulin resistance ... and maybe even fasting-related metabolic switching as described above? Are low carb diets helping women with PCOS in part because they're lower in lectins? From Dr. Gundry's not peer reviewed page on lectins: 'Since Lectins are used by plants and animals as part of cellular communication systems, many researchers including myself believe that plants use Lectins to disrupt cellular communications in animals.' (http://www.drgundry.com/articles/Lectins/) Sorry for waxing terribly theoretical, but I need to log these thoughts in case they help someone else or future research sheds light one way or the other.

Anyway, once off lectins I was emboldened to try the keto again. This time I had the meter and also got far enough into it, highest 1.7, to catch the wave. But like all new surfers, I was easily overcome by the keto flu undertow as well as realizing I needed better bearings to know what I was doing and what to expect during adaptation. It was harder than I expected at times. Now I'm out of ketone strips but venturing back into these strange waters.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

Post by Stavia »

Circ I slid into it very slowly and it was painless. I slowly increased my fat percentage and my fasting periods. Ketosis isn't an on-off switch, rather it's a spectrum IMO.
When I was testing I was running at 0.3 to 0.8.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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Stavia wrote:Circ I slid into it very slowly and it was painless. I slowly increased my fat percentage and my fasting periods. Ketosis isn't an on-off switch, rather it's a spectrum IMO.
When I was testing I was running at 0.3 to 0.8.
This is interesting as I've read long and hard as to how to adapt slowly (and not go through the unpleasant adaptation period). Most say it isn't possible, so good to know it worked for you.

Here is my keto story:

I've been keto adapted since Oct '09, if memory serves. I did it the Atkins Induction way - 20g carbs/day for a few weeks. I didn't know about electrolytes mitigating "keto-flu" then. My adaptation period lasted about two weeks and was not fun. I recall literally not being able to contract muscles on a rock climb. I ached & etc. I've kept afib in remission for >11 years with high quantity magnesium and potassium supps. During the conversion period, I had this feeling my electrolytes were out of balance and that afib was likely. I added a lot more potassium. This did not ward off a 3 AM afib episode (vagal trigger - a common time for me). I converted with 300 mg flecainide, which is what I would always do. However this time my heart rate was ~125 after conversion to normal rhythm. This was unusual, usually it'd be 80 after flec for a while. I took a bunch more mag (as a mag chloride solution) and watched the heart rate slowly drop into the 80's over 10 minutes. Never had a keto related afib episode after that. Have read of other afibbers who've had issues with electrolyte shifts causing afib during conversion.

Subsequently I've maintained my significant intake of mag and potassium in my mostly successful quest to keep afib in remission. I do salt my food, but not excessively. Also, since most of my diet is prepared from scratch (and mostly raw), it is low sodium by nature. One time, I did have a low sodium experience. I was skiing with friends. I'm typically an energetic person. This time I was pretty reserved and fairly low energy. I went in at mid-day and a friend gave me a cup of miso soup - basically salt in water (back then, I never ate lunch, today I fast 22 hours/day). When I went back out, I was back to my normal very hard charging self and my poor friends had a hard time keeping up.

Until I learned I was 3/4, my diet was a more "typical" keto diet. Meat, fat and non-starchy veggies, with an emphasis on the first two. More recently, I've consulted with Dr. Gundry and follow his "Matrix" protocol as modified for E4's. This means no land animal fat, 20g/day (generally a 4oz serving) of animal protein (limited to shellfish, white fish or omega3/pastured eggs). The rest of my diet is mostly raw vegan - no grains, legumes or starchy veggies (with exception of a few resistive starches). When I ran it through Chronometer it was ~60g total protein, 80-90g carbs of which >50g were fiber and about 80% fat calories. The fat comes from unfiltered EVOO, avocados & nuts (macadamia, pecan, walnut, hazelnut). Additionally, Gundry prescribed 1 g DHA/day (about 4.8g/day of fish oil supps total). I eat a few berries - blue, black & rasp. I don't test ketones with the Precision Xtra frequently, but commonly they'll be >1 mmol/L in the morning. One day I tested two hours after eating (I fast 22 hours/day) & I was at 0.8. If I test with urine strips, I'm typically at 15 mg/dL (the second color level). As previously posted, my most recent A1C was 4.7%.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

Post by circular »

Thanks for the new accounts.

George I think maybe it's not as hard to transition to below 1. I feel pretty much the same under 1. My adaptation symptoms were more pronounced above 1, yet so were the best results. It was a roller coaster zone. Phinney and Volek indicate that's where the most therapeutic levels are, so that's probably where the body has converted more fully to keto and the transition effects are more notable? Not sure if this is a generalizable concept.

It should also be noted that once adapted at length at higher ketones using a meter, the urine strips will generally show lower ketones so make it appear as if one is less into ketosis. Is that right?

I like the idea of just measuring carbs to start to keep them low, and see if that gets one to a desired level of ketosis. This really simplifies the transition if one's not already tracking everything and short on time. Later one can track fats and proteins too if desired. But if it's not working tracking everything may help one gauge the contribution protein is making toward their glucose burning.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

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circular wrote: It should also be noted that once adapted at length at higher ketones using a meter, the urine strips will generally show lower ketones so make it appear as if one is less into ketosis. Is that right?

I like the idea of just measuring carbs to start to keep them low, and see if that gets one to a desired level of ketosis. This really simplifies the transition if one's not already tracking everything and short on time. Later one can track fats and proteins too if desired. But if it's not working tracking everything may help one gauge the contribution protein is making toward their glucose burning.
Yes on the lower urine strip readings: a) urine ketones are excess; b) the body gets better at using them over time (so less excess); c) the body converts urine ketones (acetate? from memory) to other forms (beta hydroxy buterate? again from memory) so less excess. The serum meter reads beta hydroxy buterate, I think (without looking up).

For most people, protein intake is fairly constant. Protein has a lesser effect on ketosis than carbs. Unless you are eating big pieces of meat or many eggs all the time, you shouldn't be in the range where protein is an issue. Some of the meat/fat guys can get there where it is an issue.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

Post by circular »

Helpful again George, thx.

Stavia, I'm curious, do you note any changes at your level of ketosis other than the meter reading? I realize now the Cunnane material that it's helping. Just wonder if you feel any different. You seem healthier overall than me and Julie (?) so maybe you feel better at lower ketones, or you're just content to know it's helping?
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

Post by Stavia »

Yes Circ I feel very well. I've luckily never had blood glucose fluctuations. But running at a low ketone level makes me able to fast very easily. I manage until lunchtimeish from dinner the night before very easily, and I'm not ravenous any more late afternoon. It's definitely caused a reduction in appetite.
I managed a 26 hour fast with my colonoscopy today with ease, no dizziness or hunger. Also managed a 28 hour one last Yom Kippur (and that's no water either).

And I feel generally healthier and heaps sharper than 18 months ago but there are so many interventions I couldn't say what role the ketosis played. If I do eat carbs/sugar I feel no different cognitively so dunno.
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Re: Ketogenic Diet: Transitioning, Experiences, Reasons, Cautions ...

Post by circular »

I wonder how long it takes to notice the absence of the blood sugar swings. I do feel satiated in a nice way while I'm satiated, but come time to eat again I have to eat huge meals to get back into that space. After a 12 hour fast breakfast was:
  • Two 12 oz cups of coffee with 1 tbs coconut oil and 1/2 tsp grass-fed ghee each,
    One small to medium carrot
    About five cups red leaf lettuce with about 4 oz cod and two tbs EVOO
    One whole avocado
    Small apple
    Microwave muffin that included an egg, 1 tbs coconut oil, 1 tbs macadamia nut oil, 1 tbs coconut flour, 1 tbs tiger nut flour and odds and ends. (Those muffins are my last resort after eating the rest and still being hungry. They seem to plug the hole but I don't want to eat those every morning.)
(My big salad with all the raw veggie variety comes at dinner.)

Hopefully I can get that down at most to everything but the muffin and have it hold me.

I've just had a snack of 1/2 cup coconut cream chocolate mousse. During this transition I'm somewhat liberal in what foods I'm eating within my larger parameters. I can fine tune that later. I can't see eating this mouse every afternoon, but it makes a filling occasional snack. I tried freezing the rest to see if it comes out like ice cream.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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