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keto diet for pdh inhibtion

Discussion in 'General ME/CFS Discussion' started by JollyRoger, May 27, 2017.

  1. JollyRoger

    JollyRoger Senior Member

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    The latest research on cfs found a inhibition of the pdh enzyme that converts pyruvate into Acethyl-CoA. Pyruvate is made of carbohydrates.
    What about the beta oxidation of fat?
    Is there also a problem?
    If not would be a keto diet a treatment for it?

    Ps:there's also a genetic disease with deficits of pdh and the only treatment is a keto diet.
     
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  2. AdamS

    AdamS Senior Member

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    My personal experience was that removing carbs/sugar actually made me a bit worse energy wise, particularly my mental fatigue. It may vary from person to person. Some days I can eat great, pace perfectly and still feel like a zombie.
     
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  3. JollyRoger

    JollyRoger Senior Member

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    I read that there is a so called " keto flu".

    ---------
    Keto flu is the name given to a set of symptoms some people experience when first starting keto. It’s not actually a flu and definitely not contagious, but it can become quite tiring. Keto flu symptoms are very similar to that of your regular flu and can last anywhere from a day to a few weeks! You may experience

    fatigue
    headaches
    cough
    sniffles
    irritability
    nausea
    -------

    But afterwards?
    How long did you try it?
     
  4. AdamS

    AdamS Senior Member

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    I tried a virtually zero carb diet for 6-8 weeks, can't say I experienced keto flu but perhaps I wasn't in ketosis. I was coming out of a pretty horrendous relapse at the time and could barely focus on TV for 5 minutes without having to close my eyes.

    Contrary to all the theories i'd read, the biggest improvement in mental fatigue and functioning i've had is actually since I started re-introducing sugar, carbs (and even alcohol) into my diet. I can now watch a full film (at a struggle) and even survived 2 busy days in London the other day (again at a struggle with lots of taxi journeys to avoid pushing).

    Perhaps I only have a partial block to PDH, i'm not sure. I pace extremely well now, I can't work yet but haven't crashed or had PEM in a few months. I know that Cort over at Health Rising has discussed Ketogenic diets quite a bit and i'm sure some other members will chip in with their experiences, oddly what makes some people feel better seems to make others worse with this illness.
     
  5. arewenearlythereyet

    arewenearlythereyet Moderated, no explanation given

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    I did keto for a while and have settled for a 50:25:25 calories from fat:protein:CHO.

    My carbs are d ribose ( one third) with a little sugar and an equal amount of starchy carbs. These are spread out throughout the day and the total amount of daily carbs is 100-150g. So moderate.

    I had far more gut issues on ketogenic similar to high carb. I make changes very slowly and was ketogenic for at least 8 weeks so more than enough time for the gut to reestablished to the change. The middle ground works best for me. I put this down to the fact that the metabolic block is obviously partial or there is some other need for it other than immediate energy (maintaining blood sugar levels, making d ribose, accompanying vitamins and minerals etc).....most things in nature are not absolute after all. It's possible that the slow trickle of carbs makes blood sugar crashes less...I'm speculating.

    Edit: don't know why @Valentijn favourite emoji has appeared in the text. I've kept it in fir my own amusement
     
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  6. JollyRoger

    JollyRoger Senior Member

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    Okay - so not a good recommendation!
    But then there must be problems with beta oxidation, too.
    Dr.Myhill recommends a Stone age diet and the discovery of the latest research could confirm it.

    But there's always a difference between theory and practice....
     
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  7. arewenearlythereyet

    arewenearlythereyet Moderated, no explanation given

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    I don't think there is any scientific evidence that suggests that the paleolithic was the epitome of human development. Most of our digestive system is way older than that and the diversity of foods we can eat is part of our success as a species. Myhill is almost religious about the philosophy of her diet but in principle everything is broken down to simple sugars amino acids and fatty acids once you're at the business end of nutrient absorption.

    My view is ....eat a yoghurt if you want ...it won't kill you and you might make your life easier. This is one of the areas that make me doubt her and anyone recommending specific foods are eliminated from the diet if I'm honest. The big exception is food allergies, but I don't think that's where she is coming from.
     
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  8. JollyRoger

    JollyRoger Senior Member

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    @arewenearlythereyet
    So what do you think about Dr.Myhills theory?
    I tested ATP and the function of the Mitochondria and it was very low.
    I just have to find the cause .....
     
  9. Basilico

    Basilico Florida

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    I ate a very low carb diet for about a year. I never got the 'keto flu', but then I often don't react to things the way others do, so at the time I didn't think anything of it.

    Towards the end of that low carb year, I realized that my fatigue had been slowly and steadily getting worse. Frog in boiling pot situation. I decided to switch things up and started eating high carb/low fat. I felt noticeably better for a while (maybe a few months) then it kind of leveled out. At this point, I'm eating a fairly balanced diet that is a little more skewed toward carbs, which seems to be what my body is good with.

    I know that some people (especially ones with specific neurological issues) do very well with a keto diet. But I don't think it works for everyone. I think it's worth trying - if for no other reason than to write it off.

    My husband is currently doing some interesting experiments using Ketones to try to bypass the potentially dysfunctional pyruvate stage. Once he has more experience with it, I'll probably post about it here. Early results are showing a noticeable energy boost that he didn't get from eating low carb.
     
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  10. arewenearlythereyet

    arewenearlythereyet Moderated, no explanation given

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    Well...I have read a lot of her web content and aone of the papers she co-authored. I have her book "its mitochondria not hypochondria" on my kindle still awaiting a read though. My opinion of her based on what I have read is that she is a well meaning GP, but research is not really her field. This is apparent by her style of speculative query and the way she builds her hypothesis. This leads to quite a bit of "so whats" and quite a lot of glossing over and contradictions in her advice.

    Its clear a lot of us have problems with energy production although this appears to be less about dysfunctional mitochondria and more about blocked transport to fully functional mitochondria.



    With regard to mitochondrial dysfunction, she needs to have credit for pushing this angle, and for providing testing and advice to give a level of validity to peoples illness but recent studies have moved on from her original position (as I understand it). The devil will be in the detail and I'm hopeful that we will find out more this year with all the work being done by the open medicine foundation. Fingers crossed...we are all awaiting the next installment with bated breath. If only I could get the box set up front.
     
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  11. ryan31337

    ryan31337 Senior Member

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    Hi @JollyRoger,

    There are a few (long) threads on here about keto diets. It certainly gained some more interest again recently with the discovery of PDH issues, I understand a well known patient/activist (Jennifer Brea) also advocated strongly for it. Some have found it intolerable due to poor fat metabolism, some tolerated it but didn't improve, others found it very helpful but only for a limited time.

    Personally I've been in ketosis for 8 months and have found it to be hugely helpful. Before starting I had progressively worsened to mostly housebound and unable to function much for more than a couple of hours a day, becoming very symptomatic and having huge energy crashes every few hours. Within a week or two of starting the diet I was able to function much better. I could sit up at my desk and think clearly again, I could manage light mental work for long stretches, I could leave the house & cope with some slow exertion without onset of migraine, shortness of breath and exhaustion.

    Whether my improvement had anything to do with PDH I do not know. I suspect that the dietary change helped with several other issues I have, which are not universal to the ME population - though I'd imagine are more common than most patients realise.

    The first and most significant being reactive hypoglycemia, as recognised by the endocrinologist who put me on the ketogenic diet. If you have POTS/Dysautonomia as a major part of your ME/CFS then you should have a high suspicion of postprandial glycemic problems. It seems dumb to me now that I didn't realise I was crashing hard an hour or so after eating meals 3x times a day, especially so if I'd had a carb-loaded meal. It never crossed my mind, much like the problems maintaining orthostasis had presented for many years, as they both came on so insidiously. The keto diet really smooths out blood glucose fluctuations and banishes so many hypo symptoms & sleepiness caused by these fluctuations with a matter of days.

    The second benefit I had from cutting carbs & restricting food types was the positive effect on controlling SIBO, which in turn seemed to be driving some sort of MCAS-like reactions to most foods - complete with another flavour of fatigue and other substantial symptoms.

    Thirdly I wonder if the anti-inflammatory nature of the diet also plays a part more generally.

    I think the take away message I'd want to impart would be if you have ME/CFS and any symptoms consistent with reactive/postprandial hypoglycemia I would definitely consider trialling the diet, especially if POTS/Dysautonomia is also present. 20+ years of ME/CFS here and it never occurred to myself or doctors at any point that carbs could be driving problems until they became very significantly disabling, more so than any other aspect of the illness.

    Ryan
     
    Last edited: May 27, 2017
  12. A.B.

    A.B. Senior Member

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    I'm not sure if this goes against the theories. With impaired PDH, you can still metabolize sugar via glycolysis, just less efficiently. Compensatory mechanisms seem to include burning more amino acids and fats, but it could also include burning more sugar via glycolysis.

    Glycolysis gives you 2 ATP per glucose molecule. It also leaves pyruvate which can then be used in the Krebs cycle.
    One Krebs cycle gives over 20 ATP I believe.
     
  13. JollyRoger

    JollyRoger Senior Member

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    My diet is a high carb diet.
    I never noticed it.
    After reading of this special diet for cfs I tracked my macros....70% carbs.
    A change to 70% fat would be a big change.
    Everyone is different so I do my own n=1 trial.
     
  14. ryan31337

    ryan31337 Senior Member

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    Good luck :)

    Before the reactive hypo problem got bad I would often find that carb-loading would pick me up and reverse a PEM day somewhat.

    I was never obese nor had high fasting glucose, but just before switching to the keto diet I was gaining weight steadily, had fatty liver infiltration and worsening liver function tests. Inappropriate hunger & thirst became a real issue, I was eating so much & so frequently but clearly none of it was being used as it should! These things just slowly creep up over time so hard to spot...
     
  15. Tunguska

    Tunguska Senior Member

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    This is strikingly similar to the logic I use, but I see it more as an argument to 1) fix SIBO (or fructose malabsorption/other), in order to allow you to tolerate fructose so that you can then 2) consume sugar (sucrose or natural glucose+fructose, 100g minimum) spread out during the day to keep blood sugar stable, avoiding much bolus starch or pure glucose. Using sugar this way is straight out of diabetes playbooks, but it gets avoided because of the fear of fructose (even though fructose helps liver regulate blood sugar, while the negative liver effects are exaggerated), and then because of real SIBO and gut problems. This doesn't necessarily exclude keto but considers it a temporary solution for 1 at best.

    ***

    If you still want to do a keto or low carb diet there isn't that much left to say about it other than you'll require Carnitine at some point and that it's best done including significant calories from short-chain fats (coconut/mct/octanoic-acid oil, as much as your gut can tolerate) - I personally would never attempt it again without these. There are other problems but you'll find out in time. Low carb diets should act as a workaround to the PDH problem, but I'm convinced we can do better.
     
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