Lack of chatter about the Ketogenic Diet

[Crux]

Many people at the keto threads on reddit report vast improvements in blood markers : glucose, insulin, etc.
You may have to read through them, because much of the conversation is about weight loss.

https://www.reddit.com/r/keto/new/

The keto science thread has more articles about just that.

https://www.reddit.com/r/ketoscience/new/

There are posters there who have been on keto for 2-9 years, and they are thriving !

Many of the negative issues I've noticed on those threads involve micronutrient and mineral deficiencies.

 

[ljimbo423]

I am sure a large part of the keto diet benefit I am getting currently is due to starving the bacteria of carbs - a more extreme version of low FODMAP, which had already proved helpful short-term.

I tried a keto diet about a year and a half ago, but couldn't get past the keto flu, even after 4-6 weeks. The keto flu got me so turned around, I decided that treating the gut was a useless cause. So I went back up to about 150-200 grams a day of carbs again.

I felt good for about a week, but by week 3, my symptoms had come back profoundly worse than they had been in several years. After that experience with the carbs, I am certain that sibo and/or dybiosis is a core issue in causing devastating symptoms for me.

So I switched to the specific carbohydrate diet (SCD) and started feeling better again almost immediately. After a few weeks, I stopped getting benefits. About 3-4 months ago, I started adding in antimicrobials, very slowly, to kill off the dysbiosis. After a couple of weeks of adjustment to a dosing routine, I started feeling much better.

Less PEM, more energy and more clarity of mind, I continue to improve and continue to slowly increase the antimicrobial supps. I like the SCD because it allows carbs that are absorbed quickly enough, so they feed the dysbiosis very little. If I could tolerate the keto diet I would still be on it and I wish I could.

I have noticed the worst carbs for me are the starchy carbs, like potatoes, rice, oatmeal, pasta etc. that don't get fully digested and feed the dysbiosis. Congrats on how well you are doing with the keto diet!! Keep up the good fight.

 

[trishrhymes]

@ljimbo423 , Can you explain SCD and what antimicrobials you use please. This sounds useful. Thank you.

 

[ryan31337]

So I switched to the specific carbohydrate diet (SCD) and started feeling better again almost immediately. After a few weeks, I stopped getting benefits. About 3-4 months ago, I started adding in antimicrobials, very slowly, to kill off the dysbiosis. After a couple of weeks of adjustment to a dosing routine, I started feeling much better.

Less PEM, more energy and more clarity of mind, I continue to improve and continue to slowly increase the antimicrobial supps. I like the SCD because it allows carbs that are absorbed quickly enough, so they feed the dysbiosis very little. If I could tolerate the keto diet I would still be on it and I wish I could.

Thanks for sharing - glad you're feeling better.

You and @trishrhymes may find this interesting, perhaps a more formally defined version of what you have discovered works for you: https://sibotest.com/handouts/SIBO_Diet_FINAL.pdf

That's the diet my nutritionist champions. I'm just waiting for SIBO test results to guide the choice of anti-microbial component before getting started. Ironically the restrictive phase of it is less restrictive than I currently eat

 

[Sidereal]

May I ask, do you feel anything helped you recover from the periods of significant food & histamine intolerance/MCAS? Its a shame that we lose one possible avenue of treatment if minimising reactions through restrictive diet guarantees further microbiome disruption. Given that before starting this diet my blood glucose was all over the place and my blood pressure was sometimes north of 200/120 at rest when having reactions... going back is not a great alternative.

Yup, been there, done that, with attacks of severe hypertension (normally hypotensive). The MCAS topic is complex and I don't want to go too far off-topic but I've written a bit previously about how I got rid of this symptom:

http://forums.phoenixrising.me/inde...need-help-with-words.42390/page-3#post-779752

In short: a very low fat close to zero fat diet consisting of plain, peasant-style home-cooked meals replete with resistant polysaccharides that survive transit to the distal colon where I believe the main gut dysbiosis action is. After adhering to a strict regime for several months, I was in a position where I could begin reintroducing all sorts of foods. These days I can eat any food without a reaction, even yeast, vinegar and MSG-laden Chinese takeaway. I noticed immediate benefits from restricting fat, within a week the vertigo and the worst of the food reactions was gone.

In nature eating keto year round would only happen in cold environments, cold thermogenesis increases dopamine , norepinepherine, etc massively. This would probably solve depression etc.

ME/CFS patients are already in a stressed catabolic state. They cannot activate their mTOR pathway. For more info you can see @nandixon's recent posts about the recent Fluge/Mella and Naviaux research.

This means that all the usual advice out there--fasting, cold thermogenesis, ketosis, caloric restriction etc.--for people with "normal" diseases like depression, obesity, heart disease, autoimmunity etc. is the exact opposite of what we need.

 

[Sidereal]

Many people at the keto threads on reddit report vast improvements in blood markers : glucose, insulin, etc.
You may have to read through them, because much of the conversation is about weight loss.

https://www.reddit.com/r/keto/new/

The keto science thread has more articles about just that.

https://www.reddit.com/r/ketoscience/new/

There are posters there who have been on keto for 2-9 years, and they are thriving !

Many of the negative issues I've noticed on those threads involve micronutrient and mineral deficiencies.

I don't think anybody would claim that there aren't people who have been eating this way for years and thriving--there clearly are such people. I know a couple myself. That doesn't mean that the diet is generally safe or effective for everyone.

Any hypocaloric diet that results in 5-10% body weight loss will typically result in "vast improvements" in blood markers. The key ingredient is creating a negative energy balance and losing weight, not ketosis. Ketosis does not improve energy expenditure as some low carbers have claimed. People are simply eating fewer calories because of spontaneous appetite reduction on that diet.

In fact, a meta-analysis just published reported that decades of research shows that a low fat diet actually results in slightly more fat loss and energy expenditure than low carb when food intake is strictly controlled. The difference is trivial but it is statistically significantly in the direction of the low fat diet meaning that metabolic ward studies directly refute the claims of low carbers of metabolic magic that's supposed to occur in ketosis.

Gastroenterology. 2017 Feb 10. pii: S0016-5085(17)30152-X. doi: 10.1053/j.gastro.2017.01.052. [Epub ahead of print]
Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition.
Hall KD, Guo J.
Abstract
Weight changes are accompanied by imbalances between calorie intake and expenditure. This fact is often misinterpreted to suggest that obesity is caused by gluttony and sloth and can be treated by simply advising people to eat less and move more. However, various components of energy balance are dynamically interrelated and weight loss is resisted by counterbalancing physiological processes. While low carbohydrate diets have been suggested to partially subvert these processes by increasing energy expenditure and promoting fat loss, our meta-analysis of 32 controlled feeding studies with isocaloric substitution of carbohydrate for fat found that both energy expenditure (26 kcal/d; p<0.0001) and fat loss (16g/d; p<0.0001) were greater with lower fat diets. We review the components of energy balance and the mechanisms acting to resist weight loss in the context of static, settling point, and set-point models of body weight regulation, with the set-point model being most commensurate with current data.

There is no research demonstrating benefits of ketosis for "hard" outcomes like disease and death, just proxy markers like weight loss and blood glucose. Studies of low carb diets are typically short-term, six months to a year, two years at the very most. Long-term follow-up typically shows roughly the same modest weight loss outcomes regardless of which diet group the patient was randomised to.

It is possible for some people to reverse their diabetes, kidney failure, heart failure on a hypocaloric diet consisting of white rice, table sugar and fruit juice. Have a look at the Kempner rice diet. This research was done just after WW2 at Duke University, not exactly an unknown institution. Just because some diet restores normal glucose/insulin metabolism doesn't mean it's an optimal way to eat long term. It's possible to reverse diabetes with fasting or a protein-sparing modified fast of 600-800 calories a day. Again, it doesn't mean that eating that way forever is good for your body.

https://deniseminger.com/2015/10/06...-a-call-for-some-evolution-of-thought-part-1/

Of course, you won't find information like this in low carb books or keto reddit which present a very one-sided view.

The ketogenic diet typically results in total and LDL cholesterol elevation which is usually hand-waved by low carbers as irrelevant. While I agree that cholesterol doesn't cause heart disease, dyslipidemia is probably an indication of increased LPS translocation from the gut via enterohepatic circulation which will of course hit the liver the hardest with stress/inflammation.

 

[Crux]

Sure you can loose weight with low fat, But , fat is essential, without it we die.

Even protein restriction can result in weight loss, but it's unsustainable. It will result in malnutrition, then death.

With carbohydrate restriction, the body adjusts to make its own.

More and more studies are being done with ketogenic diets for a variety of conditions, especially neurologic ones.

In ME, there are many neurologic symptoms.

I believe there is potential for a carefully guided ketogenic diet to aid ME patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321471/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617125/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709725/

 

[anne_likes_red]

Just a note re cold induced thermogenesis - Brown adipose tissue activation, in response to regular cold stimulus , activates Mtorc1 primarily via PKA - different pathway than the akt one. Not sure if that's one reason why some pwme might feel some positive effects with more cold (or more specifically - more internally generated heat in response)? Cold habituation is a different beast to cold shock/stress. Not all respond well, and certain genetics play a part no doubt.

 

[ljimbo423]

Can you explain SCD and what antimicrobials you use please. This sounds useful. Thank you.

The SCD, is the specific carbohydrate diet. The carbohydrates allowed on the diet are chosen because they are absorbed fast enough in the GI tract, to not feed dysbiosis/sibo.

I like the fact that is not so restrictive as many diets and it allows things like oranges, ripe bananas, pineapple, honey and dextrose. Here is a link to a list of allowed and not allowed foods. For antimicrobials, I am using oil of oregano liquid (for flexible dosing), cinnamon (powder, for flexible dosing) and oregon grape root (a source of berberine).

I can't stress how important it has been and is for me to slowly make changes, even in my diet. I slowly cut back on carbs over a couple of months and I very slowly started and went up on the dosage of antimicrobials.

The die off is just too much to handle if I make these changes too fast and it makes me feel like giving up, even though I continue to experience great improvements overall, the die off makes me loose perspective of the gains I have made.

Now, I listen to my body and if the die off is making me miserable or debilitated, I back off whatever I'm doing and try it at a later time, making smaller changes, more slowly. So, low and slow it is!

 

[ljimbo423]

You and @trishrhymes may find this interesting, perhaps a more formally defined version of what you have discovered works for you: https://sibotest.com/handouts/SIBO_Diet_FINAL.pdf

The diet you put a link to, looks very much like this one. Which is a combination of a low FODMAP and SCD. That is the diet I'm on actually. I started on the SCD, then cut out the high fodmap foods also, just to make sure I was covering all the bases.

Ironically the restrictive phase of it is less restrictive than I currently eat

The diet shouldn't be a problem for you then, a downhill ride.

 

[sb4]

Any hypocaloric diet that results in 5-10% body weight loss will typically result in "vast improvements" in blood markers. The key ingredient is creating a negative energy balance and losing weight, not ketosis. Ketosis does not improve energy expenditure as some low carbers have claimed. People are simply eating fewer calories because of spontaneous appetite reduction on that diet.

You say spontaneous appetite reduction but doesn't it make more sense that you're body is able to count leptin better and so makes you less hungry. This wouldn't happen on high carb.

 

[Tunguska]

I like the fact that is not so restrictive as many diets and it allows things like oranges, ripe bananas, pineapple, honey and dextrose. Here is a link to a list of allowed and not allowed foods.

Completely coincidentally the carb and diet choices that have worked best for me in the recent past largely (all the carbs at least) seem to fall under SCD. Those choices definitely do not cure my gut, nor help it substantially (and I question the long term), but they eliminate a lot of blowback on the rest of my body and give the best sustainable energy level I can seem to reach.

(cut out the sentence about oregano oil from the quote very intentionally; that stuff wipes me out worse than any 'safe' antibiotic did)

Just a note re cold induced thermogenesis - Brown adipose tissue activation, in response to regular cold stimulus , activates Mtorc1 primarily via PKA - different pathway than the akt one. Not sure if that's one reason why some pwme might feel some positive effects with more cold (or more specifically - more internally generated heat in response)? Cold habituation is a different beast to cold shock/stress. Not all respond well, and certain genetics play a part no doubt.

I was fairly convinced the subjective positive effects were probably largely norepinephrine (maybe cortisol for some people), but that's interesting nonetheless. (cold thermogenesis was something I tried quite a bit in the past)

 

[ljimbo423]

Those choices definitely do not cure my gut, nor help it substantially (and I question the long term), but they eliminate a lot of blowback on the rest of my body and give the best sustainable energy level I can seem to reach.

I also think that long term, the SCD would not the best diet for me either. Once I get my gut healthier, I want to add more carbs and more prebiotic foods. Although I have heard that I might need to stay on a fairly low carb diet, to prevent a return of the dysbiosis. I think prebiotic foods are crucial to maintain a healthy gut, but only after I re-balance the dysbiosis.

(cut out the sentence about oregano oil from the quote very intentionally; that stuff wipes me out worse than any 'safe' antibiotic did)

The oil of oregano also gives me the worst die off of any of the anti-microbials I take. I bought a non-standardized liquid oil of oregano, so that it wouldn't be as strong and so I could start at just one drop a day and very slowly go up from there. The die off from the anti-microbials seems to be getting milder as time goes on.

I just went up 100mg on the oregon grape root I take, a few days ago and felt no die off at all. In fact, I have felt an increase in energy instead. I started the anti-microbials about 4 months ago, so maybe I am reaching a place were the die off is lessening when I go up on the dosage. Fingers crossed.

 

[anne_likes_red]

I was fairly convinced the subjective positive effects were probably largely norepinephrine (maybe cortisol for some people), but that's interesting nonetheless. (cold thermogenesis was something I tried quite a bit in the past)

Well this is my understanding, based on five years experience, after quite a long period of acclimation that needed to be carefully managed - and I could still have managed it better!
The sympathetic response is short term when at first you're exposed to a level of cold stress you're not acclimated to. Once acclimated, BAT has increased as well as become metabolically much more active and responsive (non shivering thermogenesis - this feels incredible btw!!). The result is improved HRV in response to cold stimulus as well as exercise I believe, and quite probably fasting too. Apparently once cold acclimated you stay "BAT responsive" for up to six or seven years even if you stop regular cold exposure. I don't know if that's true or not but it would make sense I think for longer term survival?

I was a good responder for a person who'd had chronic low body temperature for decades. Not all are, so perhaps genetics? But people are being given bad advice all over the internet about now people with chronic illness should approach cold exposure/therapy whatever you want to call it...possibly a bit like Ketogenic diets, fasting etc?
Equally there is bad advice about cold exposure being bad for you...b/c of the initial sympathetic response, when cold habituation actually lowers sympathetic activation and facilitates a shift toward increased parasympathetic activity.

It's pretty popular right now for fit and active people to take really icy plunges (and post selfies lol) - a la Wim Hof method or others. They can probably afford more extreme sympathetic challenge. PWME more than mildly affected need to take a completely different approach to adapt safely.

I'm still getting over hearing it was a 'thing' in the 1980s to put PWME in ice baths...presumably with no gradual acclimation or basic understanding of how that occurs in a healthy person let alone one whose not.

 

[Tunguska]

Once acclimated, BAT has increased as well as become metabolically much more active and responsive (non shivering thermogenesis - this feels incredible btw!!).

I agree the non-shivering makes you feel like superman.

What can I say at this point (I didn't expect to write this much about it in keto thread tbh). It was something I did years ago and although I trained myself to love it, I also largely got worse over time (though I doubt caused by it at least not alone) and I would highly hesitate to recommend it to anyone nowadays. Yeah similarly to keto diets, although it's much easier to cycle and integrate cold thermogenesis. I had and still get extremely poor circulation (/ low body temp, like you), and the cold felt like an empowering way to face it and it did work to some extent. But nowadays I come out much better increasing it by other means, it just took time to find them.

I know there's a special adaption to cortisol but I don't think the norepinephrine response ever entirely goes away, it's just part of the fat burning and the experience. But I haven't read about this in years so it's possible there's newer info available with the popularity it gained.

(side note: I really don't have much to add on the keto diets themselves, because the other posters covered it really well and beyond)

 

[serusaert]

in light of the discussion about ketogenic diets in this thread, i am adding back some semi-carbs to the ketogenic diet - namely, this modified starch by UCAN: https://www.amazon.com/gp/product/B00DFTWTSY/ref=oh_aui_detailpage_o02_s00?ie=UTF8&psc=1

for most people, it doesn't kick them out of ketosis (so far so good here) and i am hoping that it will help improve energy production (ATP).

thoughts/suggestions?

edit:

and here is the promo interview with a keto/sports/guru science-type:

seems like it could help support energy production...

 

[Asklipia]

Apparently once cold acclimated you stay "BAT responsive" for up to six or seven years even if you stop regular cold exposure. I don't know if that's true or not but it would make sense I think for longer term survival?

It has been true for me and my husband.
Because we moved to another country, when I was 35 years old, I had to stop swimming every day in a cold sea, but after that for 8 years I lived in a house with no heating whatsoever with no problem. That was around London, not a warm climate, and I was working at my desk most of the day.
The same happened when I had another go at it a few years ago. The results are still going on even though I have stopped voluntary cold exposure at the moment.
In fact, apart from the sign that we are never ever cold anywhere, there is another sign : we both have a vague apricot skin colouring, as though we had been sunbathing in the last year, which, because of all kinds of reasons, we have NOT.
So I think that the "BAT responsiveness" does indeed last.

 

[Lolinda]

Has anyone tested their plasma amino acids while on a keto diet?
Ketosis makes the body use glucogenic aminos for gluconeogenesis. I ended up with the heavy amino acid deficits below... (Though, I do not understand the low lysine, which is not a glucogenic amino.)

The test was fasting, in the morning. I definitively did not eat too little protein: the day before I had a total of 87.8g protein, mostly from a whooping 290g grilled chicken hearts, my favourite treat
I repeated the test another two times: same result.

Found a study on plasma aminos in epileptic kids eating keto diets
"Lower blood levels of alanine occurred on
all three diets"

If anyone reading this has a plasma amino profile on keto or off keto pls post! I am very curious!

 

[Learner1]

How's your gut absorption?

My aminos run low, too, but not that low, as I supplement those that are low, but I've had issues with some of the same ones.

Glutamine is needed for gut health and to make glutathione. Methionine is really important - it interacts with homocysteine and leads to making glutathione. Your glycine isn't very high either... you may have a glutathione problem and toxicity due to the deficiency.

Tryptophan and tyrosine are used for neurotransmitter production. Lysine is used by the immune system.

You didn't give your height/weight - I'm 178cm, 70kg and eat about 95g of protein a day. I eat keto/low carb Paleo plus supplements. Protein estimates for sick people are between 1.2 and 1.8g/kg (for healthy people, its .8g/kg).

So, you can either eat more protein, supplement more, or increase absorption. Most of us have gut dysbiosis/SIBO/leaky gut/food allergies, so it might be a good place to look.

If you increase supplementation, I've found time of day makes a difference in how I feel. 5-HTP and glycine to promote sleep, tyrosine in the morning to perk me up, etc.

 

[Basilico]

Once acclimated, BAT has increased as well as become metabolically much more active and responsive (non shivering thermogenesis - this feels incredible btw!!). The result is improved HRV in response to cold stimulus as well as exercise I believe, and quite probably fasting too. Apparently once cold acclimated you stay "BAT responsive" for up to six or seven years even if you stop regular cold exposure.

This didn't hold true for me. About 5 years ago, I got really into cold thermogenesis. I was taking ice baths almost every day for a period of a few months. There were no improvements in health, so I couldn't see a justification to continue them. The ice baths increased my tolerance to cold weather, but it was VERY short lived. Within a few weeks of stopping the ice baths, I returned to baseline.

I was low carb paleo for about a year, and within that time period I ate a strict keto diet for a few months. My health did not improve during that time, in fact, it slowly got worse. My energy improved after I went back to higher carbs then slowly returned to baseline (the level it was at before keto). My husband also has done a keto diet with no benefits.

Interestingly, eating an extremely low carb or keto diet really screws up my husband's blood glucose. We just recently did an experiment where he was eating a keto diet for 3 days, and upon reintroducing carbs to his diet, his glucose spiked really high and didn't go down as it should. It took a few days for it to re-normalize. Every time he eats low carb for an extended period of time, this happens. Which makes me seriously confused about the claim that keto diets improve insulin sensitivity, because in his case the opposite consistently happens.