OT - Thanks to Janknitz and DreamStalker (diabetes/diet)

[Janknitz]

Dreamstalker, I was listening to a podcast interviewing a physician who uses ketosis. I cannot remember who it was, so I'll have to see if I can find it--perhaps Jason Fung?

At any rate, the physician recommended against exogenous ketones (specifically ketone salts), and I don't remember why, either, so I'll have to look for that, too.

From what I understand, the exogenous ketones have only a very short term effect, and they are expensive. Being "in ketosis" doesn't necessarily guarantee weight loss. I haven't lost any weight in the past few years, and I'm often in ketosis.

[jnk...]

Those salts may be particularly useful to a professional athlete with medical support staff or to a special forces member who is highly educated and in tune with his body and has already trained his body for effective ketosis transition, so that he has a tool for yanking his metabolism around in a hurry when that is needed.

DreamStalker's background puts him on the cutting edge of some research, I believe. And that means that many things that he mentions are very powerful tools that are not the sorts of things that most of us kids should ever play around with at home. But that's one of the things that make his posts so interesting and thought-provoking to me. He was responsible to say directly as he did that no one should do anything based on his statements alone. They are touchstones for research and education. Very valuable stuff.

[Goofproof]

As far as threads here go, they should all be as helpful. XPAP or not! No drama queen posts, no in fighting. Just useful information, on a subject we all can use, making our lives better.

I'm not planning on going wholehog on it, just cutting way back on both food and insulin, and lowering my A1C. Jim

[lilly747]

. . . Keto diet solved my insomnia and . . .

Interesting!

I hadn't thought about it until you said that, but I too have had fewer awakenings during the night since starting this approach.

Yeah, well it depends on the root cause of the insomnia, and there are a lot of reasons for it.

If you have blood sugar dysregulation that is causing your cortisol to spike in the middle of the night or before you go to bed (your body trying to rise your low blood sugar because you can't burn fat), then ketosis puts a stop to that.

[Janknitz]

Ketosis tends to disrupt my sleep. Interesting.

[DreamStalker]

Well I would say that my background of having found this forum almost ten years ago is what has put me on the cutting edge of health science … or rather seeking it out. It was this forum that made me realize that putting my own health in other people's hands was not a wise way to go through life. As most of us quickly discover – learning the details of our own health condition(s) and taking control of their management and/or cure is the best strategy and in our best interest for a successful outcome … whether it be sleep apnea, heart disease, diabetes, obesity, or whatever.

As for the physician who has recommended against ketone salts … that may have been Dr. Richard Veech. As I noted previously, he is very old school. He believes the risk of adding sodium to our body is greater than the benefits we get from the relatively small amount of ketones we get from the salts (much less than the ketone esters that he works with). The ketone salts are basically molecules of beta-hydroxybutyrate with a sodium cation attached to one end of the ketone and a calcium at the other (the ketone has a net negative charge and the positive charged cations are needed to make it chemically stable). Once ingested, the cations are stripped off leaving the ketone in the blood as well as the sodium and calcium for the body to either use or be removed by the kidneys. The other problem he has with the ketone salts is that when they are made synthetically (as they are currently) rather than by our own liver, there are two forms of the ketone …. 50% of each as d-beta-hydroxybutyrate and l-beta-hydroxybutyrate. Only the d-beta-hydroxybutyrate is made by our liver and occurs in nature and how our body reacts to the unnatural l-beta-hydroxybutyrate version is currently unknown. I'm not sure how D'Agostino and others who are also researching exogenous ketones feel about the unnatural l-beta-hydroxybutyrate version – so until then, that is why I don't plan to use them on a daily basis. I guess I just want to see if they make me feel like superman … the way cpap did when I first started treating my OSA.

Ketosis does not seem to have an effect on my sleep although sometimes I wake up cold and other times I wake up hot in the morning. I suspect my thyroid is adjusting my body temperature but I cannot say whether it is due to going in or out of ketosis because I'm also currently experimenting with hypothermal therapy (using ice packs to chill my brown fat tissue in order to make it more sensitive). It is the latest cutting edge health science stuff I've come across – to learn how to control my autonomic nervous system along with yogic type breathing techniques and meditation. I came across this autonomic nervous system control technique by this crazy Dutch guy named Wim Hof .... but he has done some amazing stuff with his approach and supposedly, the US Department of Defense is also interested in his super human techniques. Anyway, I'm just curious to see if this may be a possible cpap substitute approach to treating my sleep apnea … it is a far reach I know but just hanging around warning people about how our modern civilization is collapsing right in front of our eyes does not seem to be gaining any traction.

Anyway, I hope y'all have fun playing around with ketosis.

[DreamStalker]

As far as threads here go, they should all be as helpful. XPAP or not! No drama queen posts, no in fighting. Just useful information, on a subject we all can use, making our lives better.

I'm not planning on going wholehog on it, just cutting way back on both food and insulin, and lowering my A1C. Jim

Jim -

I hope your wife is getting better and that you are still on the path to lowering and eventually eliminating your insulin needs. I say go ahead and eat the whole hog, bacon does the body good.

Take care old friend.

[DreamStalker]

snip .....
From what I understand, the exogenous ketones have only a very short term effect, and they are expensive. Being "in ketosis" doesn't necessarily guarantee weight loss. I haven't lost any weight in the past few years, and I'm often in ketosis.

That is true. However, ketosis does provide the hormonal conditions for weight loss. Insulin is the key. As long as the food one eats stimulates the release of insulin (or as with diabetics who inject themselves with insulin), the body cannot release body fat stores with insulin flowing through the blood system. That is why people who simply cut caloric food intake and try and burn off calories with exercise will release water weight (from burning glycogen stores) and never release the fat stores if the reduced food calories still contain carbs that raise insulin in the blood. On the other hand, if one removes carbs from their diet (ie. ketosis), insulin is not released and so long as caloric output is greater than caloric inputs, then body fat will be released and turned into ketones for fuel.

Also, keep in mind that dairy and protein can also release insulin even though most consider them to be ketogenic food types. People often confuse a ketogenic diet with a paleo diet ... they are different in terms of dairy and protein intakes. So limiting daily protein to less than 5 ounces for women and about 6 ounces for men (about the size of the palm of your hand) is optimal for ketogenic weight loss.

There are plenty of basal metabolic calculators on the internet for anyone who prefers to count calories rather than just periodically fast for a week or two (the best way to lose weight with ketosis). Just figure out your basal metabolism and start off with a daily caloric intake of ketogenic foods less than or equal to your basal metabolism and walk for 30 minutes a day to start losing weight.

The average person burns about 25% of their caloric output just with their brain ... and of course the less active a person is, the greater that percentage goes up. So if you want to lose weight, put yourself into ketosis then lower your caloric intake and/or increase your caloric output -- or as Dr. Jason Fung's seven-year old son simply put it .... just stop eating and learn to start fasting. I think fasting with a mixture of short periods (daily intermittent and 4-day fasts) and long periods (2 weeks or longer) is the best approach for most all health related issues that the average person has to deal with.

[Goofproof]

Last night was a supprise, according to what I ate after supper, I guessed my sugar would be really high, but I only shot up 45 units not my usual 60. At 5am I got up felt bad checked and my sugar was down to 40, I used a peanut butter cup and 3 Hershey Kisses to correct, this time I guessed correctly, nine hours later I was at 115. Much better correction than I normally make.

Wife is back to normal, she may have made a mistake with her meds. Two ER visits in 3 weeks hurts. Jim

[DreamStalker]

Last night was a supprise, according to what I ate after supper, I guessed my sugar would be really high, but I only shot up 45 units not my usual 60. At 5am I got up felt bad checked and my sugar was down to 40, I used a peanut butter cup and 3 Hershey Kisses to correct, this time I guessed correctly, nine hours later I was at 115. Much better correction than I normally make.

Wife is back to normal, she may have made a mistake with her meds. Two ER visits in 3 weeks hurts. Jim

Very glad to hear that your wife is back to normal. Yes, ER visits always suck.

Just remember -- that if you can eliminate all the carbs from your diet, you can eliminate the use of any insulin, which eliminates the blood sugar drops that make you feel bad, which eliminates the need for more sugar/carbs to counter the low blood sugar caused by too much insulin .... so eliminating carbs takes you out of that blood sugar roller coaster and vicious cycle.

[BlackSpinner]

Stress will also throw your insulin out of balance. When I was taking care of my mother, the slightest stress, like a visit to the doctor would throw it out for a day or two, so 3 visits to ER with the wife could do quite a number on you.

[Janknitz]

Last night was a supprise, according to what I ate after supper, I guessed my sugar would be really high, but I only shot up 45 units not my usual 60. At 5am I got up felt bad checked and my sugar was down to 40, I used a peanut butter cup and 3 Hershey Kisses to correct, this time I guessed correctly, nine hours later I was at 115. Much better correction than I normally make.

It's possible that your dinner DID raise your blood sugar a lot, but it may have been very slowly so that your test did not catch the peak. And perhaps you are making enough of your own insulin that when the insulin finally caught up with the carbs it dropped your BG down too low.

If you haven't read it, Dr. Bernstein's Diabetes Solution might be very helpful for you. I particularly like "The Laws of Small Numbers--Big Inputs make big mistakes; small inputs make small mistakes" http://www.diabetes-book.com/laws-small-numbers/

In other words, if you are not spiking your blood sugar really high, it's much easier to adjust to bring it back to a normal rather than a hypo range. And if you do go hypo, a little bit of glucose to bring it back is better than a lot. Here's a way to bring your blood sugar back up from a hypo in a more careful, controlled way: http://www.phlaunt.com/diabetes/14047370.php

[brain_cloud]

Something about being in ketosis is confusing the hell out of me.

All the accounts I've read make it sound like the production of ketones is something that occurs after the available glucose, and then the glycogen in the liver, are depleted. At that point, the body switches over to burning fat. Fatty acides are converted to ketones in the liver and released into the bloodstream. And now you are in "fat burning mode". And this process takes some days to occur.

But consider the following case: a person who consumes, say, 2K calories per day. 20% protein, 40% carbs, and 40% fat. Let's say this person is in an approximate energy balance situation--neither gaining nor losing weight over a long period of time. Well then, this person must be burning both carbs AND fat simultaneously. If they were using the carbs only for fuel, then the fat would be being stored and so the person would be gaining weight.

But this is not at all how the accounts I've read say things go. They say, or imply, that the body can use fat for fuel only after it has depleted glucose, and the person is either fasting, or else consuming minimal carbs for some time. Now the person I described above that has equal carb and fat ratios cannot be in ketosis--they are eating too many carbs for that. But they must be burning the fat they consume, or else it would be stacking up, which it is not.

So what is going on for a person who is consuming some fat, but is not in ketosis, and is also not gaining weight? Where is the fat that they are eating going to?

[jnk...]

For a simplified summary of ketosis (well, simple enough for me to understand part of it, anyway), I found this to be helpful to me: http://blogs.scientificamerican.com/min ... antageous/

My highly uneducated (or, should that be, lowly uneducated?) understanding is that the descriptions of how the metabolism works (especially in how it gives priority to certain macros for energy) are painted with very broad brushstrokes. The models used by some nutritionists, much like the work-a-day models used for electricity by electricians, are clunky representations based on simplified working theories. But the overall idea of ketosis in many circumstances revolves around how to foster and support the body's choice to optimize itself for fueling the brain during times of low consumption of carbs. The degrees of that optimization can be framed with terminology that makes it sound as if it were an all-or-nothing deal ("in ketosis" or "not," based on lines in the sand for ketone levels in the blood [mild, medium, or extra-crispy!]), but the body's energy systems are obviously, as you point out, much more complicated than that and highly individual when examined at a deeper interactive level. Many hormonal factors are at play.

[DreamStalker]

Something about being in ketosis is confusing the hell out of me.

All the accounts I've read make it sound like the production of ketones is something that occurs after the available glucose, and then the glycogen in the liver, are depleted. At that point, the body switches over to burning fat. Fatty acides are converted to ketones in the liver and released into the bloodstream. And now you are in "fat burning mode". And this process takes some days to occur.

But consider the following case: a person who consumes, say, 2K calories per day. 20% protein, 40% carbs, and 40% fat. Let's say this person is in an approximate energy balance situation--neither gaining nor losing weight over a long period of time. Well then, this person must be burning both carbs AND fat simultaneously. If they were using the carbs only for fuel, then the fat would be being stored and so the person would be gaining weight.

But this is not at all how the accounts I've read say things go. They say, or imply, that the body can use fat for fuel only after it has depleted glucose, and the person is either fasting, or else consuming minimal carbs for some time. Now the person I described above that has equal carb and fat ratios cannot be in ketosis--they are eating too many carbs for that. But they must be burning the fat they consume, or else it would be stacking up, which it is not.

So what is going on for a person who is consuming some fat, but is not in ketosis, and is also not gaining weight? Where is the fat that they are eating going to?

First of all, I’m neither a biochemist nor a medical professional but my understanding of ketosis is that it is somewhat more complex than how you have proposed. You’ve made a few statements of assumptions and thrown in a hypothetical person to pose a question of energy balance and macronutrient partitions.

First of all, glucose is never completely “depleted” – because we do have some cells that are unable to use ketone bodies. Red blood cells for example and I’m not sure exactly, but I think some very specialized neurologic cells also lack the mitochondria required to oxidize ketone bodies. So there is always some level of blood glucose needed – which both the liver and kidneys are quite capable of making without any dietary inputs from carbohydrates (any medical handbook will state that carbohydrates are “non-essential” nutrients). The liver and kidneys are able to create blood glucose from either or both amino acid proteins or fatty acids through a process known as gluconeogenesis.

As for when the liver makes ketone bodies, this process is quite complex (which I won’t pretend to understand all of the biochemical enzymatic and peptide reactions involved) with the release of some hormones and the suppression of others. For example, insulin for one must be suppressed before the liver will produce ketone bodies. So your assumption that glucose and glycogen be depleted before ketones are produced is not entirely correct because it is actually the lack of blood insulin that triggers ketone production. A minor detail perhaps but important nonetheless since it pertains to your hypothetical person. A middle-aged obese person with metabolic syndrome who is very insulin resistant for example will respond very differently to your proposed 2K caloric macronutrient distribution than a young 20-something physically fit tri-athlete with super high insulin sensitivity.

Your other assumption that it takes days for ketosis to occur is incorrect. So first, what is ketosis? Ketosis is generally defined as a metabolic condition where the blood ketone body known as beta-hydroxybutyrate is measured as being greater than 0.5 mmol/L. So it is possible for the liver to produce ketones without actually being in ketosis as defined by blood ketone levels. Not forget that some are able to produce ketones while fasting over night during our sleep. Does it mean that those of us who produce ketones during our sleep are in ketosis? Maybe yes maybe no … depends on whether you can wake up to check your blood ketone levels to make an accurate determination. What does take days for some and weeks for others is to become “keto-adapted” (having the enzymes and ketone transport mechanisms to get the ketone bodies into your cellular mitochondria for oxidation and ATP energy production). Again hormone releases and suppressions signal the body to gather and/or create the enzymes and transport mechanisms to become “keto-adapted”. It has also recently been discovered that the ketone bodies themselves trigger epi-genetic changes at the cellular level in order to become keto-adapted and that this may be responsible for many of the new found benefits of being in ketosis.

So anyway, to answer your final question(s) re: the hypothetical person you have described as being in steady-state energy balance – this person is likely a youthful person with a very high insulin sensitivity (ie. very muscular … I used to be that way when I was a young pup). So the carbs would be immediately and completely sucked up as muscle glycogen and during rest, the dietary fat would be cycled through with body fat to be processed though gluconeogenesis, along with any excess protein, to maintain a steady-state condition with liver and muscle glycogen as well as body fat and thus body weight. If blood glucose levels then drop below the body needs (such as when running a marathon or during other extreme physical endurance activity), then temporary exercise ketosis will likely be induced by your hypothetical subject and at that point the energy balance would go into a deficit. However your subject would then respond to hunger hormones (such as ghrelin) to make up the difference by eating more at a later meal and if restricted from doing so would only then express itself as body weight loss.

Oh and one other small complication I forgot to mention ... gut fauna/flora. You are not just feeding yourself when you eat. And have you ever seen undigested foods in your poop ... take a look sometime -- not everything you eat becomes part of your body composition.