Ketogenic Diet Re-Cap

[princesslinda]

My mom never had DKA...she just had high ketones on her urinalysis, which the docs were super concerned about as she had limited renal function. Again, this was likely triggered by her own failure to control her blood sugars, which she took responsibility for, early on choosing her idea of "quality of life over quantity." She got neither, BTW.

Again, my concern is that some new poster may have renal issues they are not aware of, and starting a diet that causes them to stay in ketosis may further damage their kidneys.

Mother was supposed to follow a very strict diet limiting protein, sodium, potassium and the like. She didn't do what she was told of course, feeling the damage was already done. I think developing renal failure is one of my greater fears regarding diabetes.

[samorgan]

I haven't seen anything indicating that normal levels of ketones pose any threat at all to kidneys, though protein, sodium and potassium are well known. I will now research it further. Thanks.

In any case, I think ketones in the context of high blood sugar and insufficient insulin is always cause for great concern, whether it actually explodes to DKA or not.

My mom never had DKA...she just had high ketones on her urinalysis, which the docs were super concerned about as she had limited renal function. Again, this was likely triggered by her own failure to control her blood sugars, which she took responsibility for, early on choosing her idea of "quality of life over quantity." She got neither, BTW.

Again, my concern is that some new poster may have renal issues they are not aware of, and starting a diet that causes them to stay in ketosis may further damage their kidneys.

Mother was supposed to follow a very strict diet limiting protein, sodium, potassium and the like. She didn't do what she was told of course, feeling the damage was already done. I think developing renal failure is one of my greater fears regarding diabetes.

[princesslinda]

In any case, I think ketones in the context of high blood sugar and insufficient insulin is always cause for great concern, whether it actually explodes to DKA or not.

I agree, which is why I worry about new members/newly diagnosed diabetics starting a diet that causes them to spill ketones when we don't actually know what condition their kidneys are in, and they may not know either (though it's a pretty good bet that as a newly diagnosed diabetic they have high blood sugars and either insufficient or inadequately used insulin).

Each of us can and should do whatever we can do to keep blood sugars in line, but we also need to know where we stand physically before starting something than could potentially cause problems.

[notme]

I couldn't agree more with both you and Linda, Salim. However, what we have to go on is what we are told by our doctors and I do believe that people should check with their doctors for advice and then make their choice about diets that make any radical change in your body chemistry. We aren't doctors nor are we scientists here, we are people with good theories and life experience. I would hate for anyone to take our advice without talking to their medical team since there may be other health issues involved. Linda has a concern since there is a family history of kidney disease and early death in her family. I would be too.

[MCS]

I will add one more thing, I achieved a 4.8 A1C without being in ketosis. Ketosis is not essential to achieve normal BG level.

[jillybean]

I will add one more thing, I achieved a 4.8 A1C without being in ketosis. Ketosis is not essential to achieve normal BG level.

I'll add to that that I have never once even tested for ketones, so I have no idea if I've ever been in ketosis, how long I may have been in ketosis, etc. I do know that I've never had any of the common side effects that I've seen others mention when initially entering ketosis (sensitivity to smells, bad breath, lack of energy, etc.). So maybe I've never truly been in ketosis, or maybe my body just doesn't care :P

When Googling/researching, I don't believe that the extremely strict ketogenic diets used for such conditions as epilepsy are not quite the same as those we are likely doing for our own health benefits. A medical ketogenic diet isn't really directly comparable to what most of us do. The medical ketogenic diet, from what I've read, is typically prescribed at a ketogenic ratio of 4:1 (4g fat to every 1g carb or protein). In contrast, I usually end up with about the same number of grams of each fat and protein (but more calories from fat since fat has more calories per gram than protein). Granted, I probably eat more protein than most because of the surgery I had, but a 4:1 ratio without serious planning and guidance would be pretty difficult to achieve.

[samorgan]

I would guess that you have been and frequently based on your descriptions. As for those "side effects", I've been in ketosis most of the last two years and without any break for many months now and I've never had any of those, either.

My side effects are extreme mental alertness, high energy, near complete lack of hunger even if I miss an entire meal and ability to function through the day even if I get very little sleep. Oh, and 100% "regular" movements something I've never experienced before at any point in my life. Did I mention runaway euphoria and gratitude for getting diabetes for what it led me to? That's a long list of "side-effects", but I hang in there for the sake of my BG!

Yes, the Ketogenic Diet (with a capital 'K') used for epilepsy is pretty extreme. The diet that doctors arrived at by trial and error for diabetics prior to the invention of insulin was very similar to the way many of us eat and less harsh than the one for epilepsy. (There's a great book on line somewhere originally from 1917 which has been re-printed where you can read dozens of these successful cases one by one in full clinical detail.)

I think it is correct to call any diet which GENerates KETOnes and puts one in KETOsis a "ketogenic" diet, at least linguistically and that's what I mean when I use the term.

I'll add to that that I have never once even tested for ketones, so I have no idea if I've ever been in ketosis, how long I may have been in ketosis, etc. I do know that I've never had any of the common side effects that I've seen others mention when initially entering ketosis (sensitivity to smells, bad breath, lack of energy, etc.). So maybe I've never truly been in ketosis, or maybe my body just doesn't care :P

When Googling/researching, I don't believe that the extremely strict ketogenic diets used for such conditions as epilepsy are not quite the same as those we are likely doing for our own health benefits. A medical ketogenic diet isn't really directly comparable to what most of us do. The medical ketogenic diet, from what I've read, is typically prescribed at a ketogenic ratio of 4:1 (4g fat to every 1g carb or protein). In contrast, I usually end up with about the same number of grams of each fat and protein (but more calories from fat since fat has more calories per gram than protein). Granted, I probably eat more protein than most because of the surgery I had, but a 4:1 ratio without serious planning and guidance would be pretty difficult to achieve.

[notme]

While I love your enthusiasm for your diet, sadly, I have experienced those side effects. Fatigue was really mostly when I was very active. During a regular day where I was not super active, I didn't notice much of a difference. However, when I was trying to ride bikes or play disc golf, I was not able to continue because of extreme fatigue. It takes a lot to make me quit. I also was not really hungry, but it really was more because I felt like I had a lump in my stomach. It felt like undigested food just sitting in my upper gut. I would eventually get hungry, but the lump was still there. I have backed off and added my normal berry smoothie to my diet and it has helped.

I am glad it is working for you and wish you continued success. However, it isn't for everyone (or at least not for me). Those side effects are very real for some of us.

[jillybean]

Those side effects are very real for some of us.

I know for most folks, the side effects are temporary and dissipate after contuing on with the diet, but I do also know a handful who just can't get over that hump and feel so awful on a very low-carb diet that they just can't handle it. If you've got those side effects and have been hanging in there for more than a month, I think you're doing amazingly well, and if you never get over those side effects and can't continue to live with them so go off the diet, at least it sounds like you made a true effort and didn't just throw in the towel after a day or two.

I think that, for some of us, we've simply been eating carbs and whatnot for so long that when we try to flip it around, our bodies rebel, even if it might actually be a healthier way of eating; healthy or not, our bodies aren't accustomed to functioning on that type of diet, and I don't think every body is able to make that transition. At least, that's my common sense, non-medical perspective.

So, as per usual, we're right back to pointing out that we're all different, and different things work for different people. You are a unique individual - just like everybody else :P

[VeeJay]

Those side effects are very real for some of us.

I experienced fatigue when first eating VLC. Turned out I needed more salt. After increasing salt for a few days, my energy returned. Nancy, I know this is a YMMV thing, and this may not help you specifically.... I just mention this for anyone else who is not having as many issues as you and may benefit from my experience.

I've never achieved the high energy/alertness level as Salim, though. But, then, I'm a low-energy kind of person - always was.

[raffi]

Nancy, my experience has been more like Salim's. While I don't know if what he is eating matches mine at all, I know that I am eating lots of things that keep my digestive system working. My carbs are made up of lots of veggies (squash, asparagus, mushrooms, jalapeño peppers). I also eat some yogurt almost every day along with lots of flaxseed. While I do eat meat and cheese, it is not the bulk of my food, the bulk really comes from veggies and salads. I do know if I eat less veggies and more meat/cheese, I can feel much like you described.

[Abra]

Salim and Raffi, I don't know whether you've already done this somewhere, but I'd love to see an example day's diet for each of you. I've been doing LC, but not ketogenic, for about a year and a half. Unsatisfied with my numbers and glacial weight loss, I'm ready to try something different. Let's say I want to eat 1800-2000 calories a day at which rate I think I'd still lose weight slowly.

[jillybean]

Salim and Raffi, I don't know whether you've already done this somewhere, but I'd love to see an example day's diet for each of you. I've been doing LC, but not ketogenic, for about a year and a half. Unsatisfied with my numbers and glacial weight loss, I'm ready to try something different. Let's say I want to eat 1800-2000 calories a day at which rate I think I'd still lose weight slowly.

I'm not Salim or Raffi, but I'll jump in anyway. Here's a day where I had 2056 calories and ended up with 6.54% of calories from carbs (34g, 13g of which were fiber, but these totals include total carbs, not net), 27.69% from protein (144g), and 65.77% from fat (152g):

- protein shake: 1.5 cups unsweetened almond milk, 1.5 scoops whey protein powder, 1 tablespoon almond oil
- colby & monterrey cheese snack (individually wrapped things I buy at 7-11)
- large baked chicken thigh marinated in miso ginger vinaigrette, side of broccoli with butter
- shredded parmesan cheese (microwaved to make cheese crisps)
- stiry fry of stew beef, mixed veggies (mostly green beans and soy beans), garlic chili pepper sauce, cooked in sunflower oil
- 2 slices American cheese
- 2 servings of Blue Diamond Habanero BBQ flavored almonds

Okay, secret's out: I LOVE cheese :P

[samorgan]

Potassium deficiency is another common cause. I have found many people just eat too little when attempting VLCKD. Or, they eat too much protein and too little fat since it seems the vast majority only focus on "grams of carbs" as the be all and end all of this diet. I have many (non-diabetic) family members attempting VLCKD. Several have tried more than once and they make a lot of mistakes. My 15 year old daughter was "determined", but gave up after a single day!

In short, when you make all these changes, there are many things which have changed besides reducing carbs. The biology says that reducing carbs "per se" should not be responsible for any of those side effects at least after allowing for a adjustment period (cold turkey from a long-term addiction) as described by Jill. So, there may be many things which could be tweaked before passing judgement on VLCKD as such.

But if it is too unpleasant, many may just choose another way instead with of course is everyone's personal choice. In that sense, sure it "doesn't work" (or didn't) for that individual but as unscientific as most of our attempts are, I doubt if that is truly the case most of the time.

This is just the fate of a treatment regimen which remains in pariah status outside of the mainstream. If, like in 1917 it was being administered in a clinical setting by qualified medical personnel, I'm sure the results would be quite different - in a positive direction.

My son-in-law who is a doctor, no less, told me that he did "low-carb" for a period of time but stopped because he detected "muscle loss" or a failure to gain muscle when working out. As an MD, he should know that reduced carbs per se could not possibly cause that (he is still very lipophobic, likely the actual cause), but he convinced himself and went back to low-fat, high-protein based on his "trial of one" experience.

I experienced fatigue when first eating VLC. Turned out I needed more salt. After increasing salt for a few days, my energy returned. Nancy, I know this is a YMMV thing, and this may not help you specifically.... I just mention this for anyone else who is not having as many issues as you and may benefit from my experience.

I've never achieved the high energy/alertness level as Salim, though. But, then, I'm a low-energy kind of person - always was.

[raffi]

Sorry I was not able to respond earlier, it's been a busy day.

Breakfast: omelet (1 large or 2 small eggs, 6 slices of pepperoni or some other meat, grated Parmesan cheese, couple of table spoons of blue cheese dressing) small (20g) slice of toast with butter.

Lunch: veggies stir fired in oil (squash, asparagus, mushrooms, onions, jalapeño pepper, walnuts, flaxseed). I use olive oil or coconut oil. Salad with blue cheese dressing Some left overs from the last nights dinner.

Dinner: Veggies and salad similar to lunch, a bit of whatever my wife makes for the rest of the family. If it is lower carb meat sort of think, I have a normal helping. If it is a high carb thing, I have either a vers small helping or just skip it.

Snacks would be one of the following: Yogurt with almonds, flaxseed and a few blueberries; veggies (celery, radishes, bell pepper, jicama); Nuts; Salami and cheese.


The toast at breakfast (and any other bread product I eat) is home made from fresh ground whole wheat (we buy wheat in 50lb bags).