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

[circular]

Dr. Bredesen was okay with my fasting insulin of 1.2. But he said we should keep an eye on it.

I take it you mean that he didn't really want it lower, or may not above 1.0, but that he didn't specify? That's at least a helpful guide for now. You'd be a good one to ask him what his lower limit is

When did you score a fasting insulin of 1.2? I would think you would have been in ketosis then?

[TheBrain]

Circ, Dr. Bredesen didn't specify a number, so I'm not sure at what point he'd think fasting insulin is too low. The next opportunity I have, I'll ask him where he thinks that cutoff is.

I got the fasting insulin of 1.2 on 1/14/16. My FMP ordered a retest because she was concerned about the 1.6 result for my second MEND Therapy protocol (I had that blood drawn on 11/20/15). My endocrinologist and PCP were quite pleased with both results. They each said that because my fasting glucose was fine, the low fasting insulin was fine. However, if my fasting glucose had been high, that would have indicated a problem that required further investigation.

I might have been in ketosis all the way back in November! Here I am now, eating more carbs per my dietician's recommendation, and I'm in mild ketosis. I never would have guessed this, given that I still wake up hungry in the middle of the night.

On a completely unrelated subject:
I actually feel like crap today. Didn't get enough sleep. I woke up hungry in the middle of the night, as usual, but then woke up too early and couldn't get back to sleep. I'm stressing over whether to adopt a German Shepherd named Layla from a rescue. She looks like a sweetie, but she had severe heartworms and two other parasite infestations and almost died. Plus, she has epilepsy and skin allergies (so she most likely has a gut that needs healing).

My husband has asked me, "Do you really want to adopt a basket case? I guess it would be good karma." She is worm-free now, but I'm trying to find out if she has permanent damage to her heart and other organs. She probably does. But I'm waiting for a call from the rescue for more details about her health. I'm more the one who wants to adopt her, but I can sense my husband might be willing if I tug at him a bit. He's concerned about medical costs and heartbreak down the road. Some dogs like Layla don't live a full life. She's 4 years old now.

[circular]

They each said that because my fasting glucose was fine, the low fasting insulin was fine. However, if my fasting glucose had been high, that would have indicated a problem that required further investigation.

Ah, that makes sense.

I might have been in ketosis all the way back in November! Here I am now, eating more carbs per my dietician's recommendation, and I'm in mild ketosis. I never would have guessed this, given that I still wake up hungry in the middle of the night.

Funny that!

On a completely unrelated subject:
I actually feel like crap today. Didn't get enough sleep. I woke up hungry in the middle of the night, as usual, but then woke up too early and couldn't get back to sleep. I'm stressing over whether to adopt a German Shepherd named Layla from a rescue. She looks like a sweetie, but she had severe heartworms and two other parasite infestations and almost died. Plus, she has epilepsy and skin allergies (so she most likely has a gut that needs healing).

My husband has asked me, "Do you really want to adopt a basket case? I guess it would be good karma." She is worm-free now, but I'm trying to find out if she has permanent damage to her heart and other organs. She probably does. But I'm waiting for a call from the rescue for more details about her health. I'm more the one who wants to adopt her, but I can sense my husband might be willing if I tug at him a bit. He's concerned about medical costs and heartbreak down the road. Some dogs like Layla don't live a full life. She's 4 years old now.

A good friend and her daughter each got a dog in recent years in similar circumstances. It's been a mixed bag for sure and both dogs have needed a lot of $$$$ medical care and attention, definitely not a stress reducer/sleep enhancer. Even when things are going well the stress over the pets is simmering on the back burner. OTOH, maybe the benefits are good medicine for you too? It may be that Layla's 'purpose' is to put you in touch with what a pet can do for you, but that she's not the right one; i.e., would a more trouble-free pet (normal kinds of 'troubles') fit your circumstances better?

[SusanJ]

Alysson, maybe being stressed about the decision is telling you something. Sometimes we think we should do something, but our intuition might be telling us otherwise.

But, fur baby love is a funny thing. We adopted 2 older dogs, both abused, and our dear Daisy needed Chinese meds ($$), regular meds ($$), acupuncture ($$) to combat severe arthritis and a lot of love to get past the abuse. But she was full of life and attitude till the end.

Are you a seasoned dog owner? Could you handle a seizure without major stress? Can you stuff pills down a dog's throat without a struggle? Maybe to know more about your concerns, take her to your vet for a full checkup and talk about the details of her past health. At least you'd go in to any decision armed with the realities of her conditions.

One trick I use is to write down all my concerns before going to bed - it gets them out of your mind and on to paper. Otherwise your brain thinks it has to remind you every 2 minutes about the dilemma.

And I hope you sleep well tonight.

[TheBrain]

Thanks, Circ and Susan, for your thoughts about adopting a dog with health issues. Susan, it sounds like your fur baby Daisy was worth it.

My husband, Tim, and I are seasoned German Shepherd owners. When I married him, I also married his dog. But Tim had him since he was a puppy. He was a great dog, really no issues at all. Since he died many years ago, we have rescued three German Shepherds, one at a time. In July, it'll be two years since our last dog died. It hurts so much when they go, but we love the breed and the companionship of a dog.

Our rescue dogs all had abandonment issues, but they each had their own issues as well. The first one would start fights with other dogs, so we had to manage that. The second one would nip people (though she never nipped us), so we had to manage that. The third one hated being alone and had major separation anxiety. We tried to train her to be okay being alone, but that never worked. The last few years of her life, we managed to almost never leave her alone.

So we are adept at dealing with emotional traumas and naughty behavior, but health issues like Layla has would be a completely new experience for us. I've been told that phenobarbital controls her seizures, though I can imagine a time when a seizure might break through. I think I'd be okay with that. She takes prednisone for the skin allergies. I think gut healing will likely address that (and I do know a lot about that, as does Tim). Long-term use of prednisone is not good. Tim has always been the one to stuff pills down our dog's throat, and I'd like that to continue. But the probable damage from the heartworms is the health issue that concerns me most.

I am so touched my Layla's story, and I feel a deep inner desire to help her and give her a good life. It's more like common sense says don't adopt her, but my intuition says adopt her.

Tim was on board initially but then woke up early two days ago, worrying about how much her medical costs would be over time. That's when the conflict began. We both have to be on board with this, of course. I wouldn't want to pressure him into anything. This evening, he has softened around this matter. We'll see what tomorrow brings.

[Silverlining]

Alysson...couple of comments....good for you on the adoption! You're certainly experienced in dog therapy. I think it's a tossup between addressing emotional dog issues and physical dog issues...all of the above stresses me out because I love my fur babies SOOOO much. I think you guys are doing a very thorough job of analyzing the situation from all angles and I feel you will make the best decision for all concerned. This summer, we're going on a 7 week West Coast vaca and have made the decision to leave my 7 yr old aussie at home with my son moving in during that time. We're taking my 2 yr old dachshund. The aussie doesn't travel well and is neurotic (the doxie is a travel champ, as long as he gets food, he could care less about anything in life lol). But my aussie will have separation anxiety, which just breaks my heart

My latest fasting insulin level is 1.9, fasting glucose 91 and A1c 5.5...and this with occasional exogenous insulin use, low carb most days and exercise to lower higher spikes...sigh...it's an ongoing battle.

My Hashimotos was diagnosed 20 years ago from a routine TSH test. I was referred to endocrinology and had very high antibodies. I've taken generic synthroid ever since. My antibodies are gone now and like you, I'm on a high level (150mcg) levothyroxine for my size. My doc says my thyroid is mostly dead now due to the antibodies attack? I've always questioned the idea that you can diet your way out of hashimotos...but I've never given that a run...

[TheBrain]

Alysson...couple of comments....good for you on the adoption! You're certainly experienced in dog therapy. I think it's a tossup between addressing emotional dog issues and physical dog issues...all of the above stresses me out because I love my fur babies SOOOO much. I think you guys are doing a very thorough job of analyzing the situation from all angles and I feel you will make the best decision for all concerned. This summer, we're going on a 7 week West Coast vaca and have made the decision to leave my 7 yr old aussie at home with my son moving in during that time. We're taking my 2 yr old dachshund. The aussie doesn't travel well and is neurotic (the doxie is a travel champ, as long as he gets food, he could care less about anything in life lol). But my aussie will have separation anxiety, which just breaks my heart .

Silver, thanks for your comments. I hadn't thought of it being a toss up between emotional vs. physical issues with dogs, but I see that now.

Yesterday, I got a reassuring email from the rescue's medical coordinator. She wrote: "Layla came through that [heartworm] treatment beautifully, and tested negative for heartworm infection at her most recent annual exam in late March of this year. It is also true that she will undoubted have some permanent scarring in her pulmonary artery and (perhaps) other organs from the previous infection. However, she’s 'functionally' normal, meaning that she can romp and run hard without any signs of reduced heart or lung function. This has been my experience with other dogs after heartworm treatment, too. In 10+ years of volunteering with GSRA and watching quite a few dogs go through heartworm treatment, I have never seen one go on to live other than a completely normal life."

Of course, she concluded that there are no guarantees about a dog's health and that we should talk to our vet about our concerns. Apparently, heartworm infestations are very common in the southeast.

So we will meet Layla tomorrow after my 1st appointment with a functional medicine MD. If she appears to us to be functionally healthy, we'll probably move forward with a two-week trial period. But we'll sleep on it and not make a decision that day.

Ultimately, I'm sure it's best that you not take your aussie on that 7 week trip, given his/her issues. Still, I know that heartbreak you're talking about. But do have a fabulous time on your trip regardless. My husband and I have done one and two month camping trips in our VW van across the country. We have so many incredible memories and plan to do more traveling like that in the future.

My latest fasting insulin level is 1.9, fasting glucose 91 and A1c 5.5...and this with occasional exogenous insulin use, low carb most days and exercise to lower higher spikes...sigh...it's an ongoing battle..

It sounds to me like you are managing this issue fairly well, considering. Our bodies can be so demanding of us.

My Hashimotos was diagnosed 20 years ago from a routine TSH test. I was referred to endocrinology and had very high antibodies. I've taken generic synthroid ever since. My antibodies are gone now and like you, I'm on a high level (150mcg) levothyroxine for my size. My doc says my thyroid is mostly dead now due to the antibodies attack? I've always questioned the idea that you can diet your way out of hashimotos...but I've never given that a run...

Some people (certainly not most) can go into remission from Hashimoto's after going gluten free and not need to take meds anymore, but my understanding is that it would need to happen early on. Twenty years later, it's probably too late to get off the meds because the antibodies do destroy the thyroid gland over time.

I follow Izabella Wentz, PharmD, a pharmacist who developed Hashimoto's and then went into remission after finding her root causes. She did a ton of research into root causes and has written an excellent book that I recommend titled Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause. For example, infections (such as from yersinia) are a major root cause of Hashimoto's.

Have you ever had an ultrasound of your thyroid? We should have them periodically to rule out thyroid cancer because we are at higher risk for it. I had my first one last year. The endocrinologist said I had no nodules or anything suspicious looking but that my thyroid is small due to the disease process.

I don't know if you'd be interested in the free online Healing Hashimoto's Summit from June 13-20, 2016. I've signed up. I figure I might learn something useful. I think part of the reason I'm on such a high dose of meds is that my body isn't converting T4 to T3 very well. Maybe I'll get some ideas about that. Here's the URL:

http://healinghashimotossummit.com

[TheBrain]

Two days ago, I felt like crap; I was stressed, sleep deprived, and exhausted. That night, I slept seven hours straight, which almost never happens for me. I usually wake up in the middle of the night hungry and need to eat a snack and then take Klonopin in order to get back to sleep.

After seven hours of sound sleep, I actually felt somewhat refreshed. I probably got the most deep sleep I’ve had in a long while because I took no Klonopin. However, I was very, very, very hungry when I woke up.

So at 6:45 am, my ketones were at .5, and my FBG was at 98. My FBG has never measured that high, and I believe it went that high due to gluconeogenesis. As most of you probably know, gluconeogenesis is a catabolic process, where the body uses its own muscle tissue to create glucose.

These results suggest to me that my body was preferentially choosing gluconeogenesis over ketosis. If that’s the case, that’s obviously not ideal.

Then, I took my thyroid meds and had to wait before consuming any food. I drank my keto smoothie from 8–8:30 am. At 10:30 am, my ketones were at 1.0 (rather than over 2, which is where they’ve been landing two hours after my keto smoothie). My FBG was 94, which is still high for me.

So my ketosis didn’t go as deep as usual from my keto smoothie. I’ve learned from Dr. Daniel Kalish that we can’t burn fat very well when we are doing a lot of gluconeogenesis. So perhaps that’s why I didn't go as deep.

Meanwhile, I’ve been going through my medical test results over a period of years, deciding what to upload to the patient portal for the functional medicine MD I’m seeing for the first time tomorrow.

I’m seeing a pattern of lowish total serum protein, lowish total globulin, lowish albumin, and therefore a lowish albumin/globulin (A/G) ratio. I’m using the term “lowish” because these numbers are in the lab’s reference ranges, but the numbers have been noted as low by functional medicine practitioners/approaches going as far back as January 2011 to as recently as my MEND protocol.

In addition, my last stool test (from April 2014) showed that my pancreatic elastase (which indicates pancreatic enzymes) was really low. My doctor at the time said this indicated that my digestion and absorption were less than optimal. I told her I was taking digestive enzymes, and she said they weren’t working. I switched to another brand (and other brands since then), and I can’t really tell a difference between them. But I keep taking them.

I’m looking at the results of a stool test from March 2012 and even then my pancreatic elastase was less than ideal (though not “really low”).

So… I have a hypothesis that I’m waking up hungry in the middle of the night because I’m not sufficiently absorbing the protein I eat (and maybe the fat as well). At some point in my 40s, I needed to increase my protein consumption as well as ensure that I had protein at every meal. The main reason was to avoid hypoglycemic reactions, but I also began craving protein (not sweets or salt).

Does this make sense to you? Or might you have a different interpretation of these findings?

[marthaNH]

Alysson, are you sure about the business of gluconeogenesis being a catabolic process of the type you describe? I am not really fluent in these concepts, but I've been reading a lot off and on lately and your description didn't seem to square with my developing understanding. I wish I could expand on the topic, but I can't without wasting everybody's time .

Good luck with this.

[TheBrain]

I'm not going to claim I understand anything 100 percent, but yes, that is my understanding.

I'm looking at notes from a Mercola interview from the recent Chronic Lyme Disease Summit. The title of his interview was "Improving Mitochondrial Health." He was talking a lot about the health benefits of a high-fat diet and ketosis. I have notes I took that say if you fast too long and your body isn't ready for it (i.e., sufficiently keto-adapted), your body will use protein from your lean body mass and convert that to glucose. As a result, you will lose lean body mass. That is a catabolic process.

Mercola recommends that when you're fasting, you should measure your blood glucose when you get up and then every 30 minutes thereafter. Your blood glucose should be dropping for a period of time. When it starts rising, that means you are breaking down the protein in your muscles for sugar. That's when you need to eat. (He didn't say this, but I would guess that you can learn over time how long you can safely fast without having to measure every 30 minutes every day.) But he says that fasting too long is a type of fasting that is "fatally flawed."

In my case, for my glucose to rise to 98 from sleeping 7 hours straight without waking up for my usual middle-of-the-night snack, the only explanation that makes sense is gluconeogenesis. I did my weights routine today to try to offset that catabolic process.