Wasting away again in ketogenic-ville

My eyesight just sucks tonight, so I didn't go through the whole thread. So if someone already mentioned this, just ignore me.

Think twice about going on a ketogenic diet if you have gout or have been told you had high uric acid levels. Ketones bully out the uric acid to leave through the kidneys. As a result, the concentration of uric acid increases and crystallizes in your joints (and apparently can also affect your heart). It is possible to find the 'sweet spot' of carbs vs. uric acid issues if you can stand the pain without medication. Mine is about 70 grams of carbs a day. So, yeah, low carb isn't possible for me beyond a few days, but lowish carbing is.

SewTired wrote:My eyesight just sucks tonight, so I didn't go through the whole thread. So if someone already mentioned this, just ignore me.

Think twice about going on a ketogenic diet if you have gout or have been told you had high uric acid levels. Ketones bully out the uric acid to leave through the kidneys. As a result, the concentration of uric acid increases and crystallizes in your joints (and apparently can also affect your heart). It is possible to find the 'sweet spot' of carbs vs. uric acid issues if you can stand the pain without medication. Mine is about 70 grams of carbs a day. So, yeah, low carb isn't possible for me beyond a few days, but lowish carbing is.

Thanks - never been told of gout or high uric acid. Under what circumstances would someone get tested for uric acid?

When they complain of gout symptoms (far more likely to be male, btw) and have a diet high in processed food, fat and alcohol.

I understand that it can be very important to drink a LOT of water and not to overdo the protein intake, especially if one has gout tendencies, kidney or certain kidney-stone issues, or uric acid troubles in general.

Keep the urine clear. Keep protein intake moderate, not high. Keto is NOT a high-protein diet.

What Jeff said ... and not mind the nonsense about titrating carbs or fearing dietary fat to mitigate gout because water and potassium (25 to 50 grams daily K-citrate neutralizes any gout/kidney stone issues) are your friends ... carbs are not.

Daily protein requirements should be held between 0.5 to 1.0 grams per Kg of "lean muscle mass" if you want to get scientific about it ... or about the size of a can of tuna for the averaged sized male (just make sure it's sans Fukashima spiced to avoid added and unnecessary nuclear calories). If you want to gain muscle mass while in ketosis, you can always add 5 grams of BCAAs (branched chain amino acids, specifically leucine, iso-leucine, and valine) to your water, during middle of your exercise workout period .... but it tastes like krap so add to small water bottle and gulp it down then chase it down with extra H2O as needed ... if you are not working out while in ketosis, BCAAs won't do much good. Nonetheless, a proper ketogenic diet (< 20 g carbs and 60 g to 120 g protein w/ remainder as fat and fiber) is protein sparing ... meaning the body will recycle amino acids as needed to maintain muscle mass. Maintaining your daily protein requirements to 60 to 120 grams also means that uric acid build up is highly unlikely and potassium from vegetables/nuts may be sufficient. You need salts anyway ... so taking a pinch of sea salt every 4 to 6 hours during the day will maintain Na and K so that you need not worry much about K-citrate supplement unless you are indeed having gout/kidney stone issues.

Thanks jnk, DS,

I suspect that I'm still overdoing the protein - I consider it the 'methadone' to the carbohydrate 'heroin'. However it's still better than my old diet. I'm not too concerned about the gout issue because I was eating all the stuff that causes gout before, and have been able to reduce quantities of the latter thanks to reduced cravings.

We have what seems to be a fairly good health food shop near my home and it was no problem to find the ion supplements in citrate form. However the person looked at me like I had two heads when I asked about BCAA and leucine. I suspect that is more of a bodybuilder type thing and prices are probably better online anyway. If I can resume my former habits, I will be doing 12km/day of strenuous biking (over some of the steeper parts of Mt. Royal) and doing dumbbell lifts with moderately weight (circuits with 15 reps) so suspect I'd be a candidate for the BCAA.

I can't believe how much the K and Mn supplements have helped - the 'flu' feeling has been totally replaced with a general feeling of wellbeing.

Regarding whether I am actually 'in ketosis', can I ask how does one approach testing? as noted earlier I'm using the blood tester and it's been quite straightforward to use. I have heard that the optimal value is 2 mmol/L, but anything over 0.5 is indicative of some level of ketosis. I measure ketones (and do weigh-in) late afternoon right before dinner, as this is usually my largest meal of the day. My highest value has been 1.4, but it often drops back to around 0.6 probably meaning I've overdosed on proteins. Is there any value to also measuring glucose levels?

I'm also curious: do high ketone levels mean that reflect a high supply of lipid fuels? or the restriction of carbohydrate fuels? what types of dietary mis-step would cause ketones to go way down, and does that matter?

My wife is actually slowly accepting this, although it is still a very grudging acceptance. I will probably ask for some help in addressing her critiques in another post.

Thanks again, this has been really helpful.

Hi Leptic,
I'll admit I haven't read all of this post but wanted to say did you know protein will turn to glucose in your body through the process of glucogenesis? Just so you know it's important not to overeat protein.

mummmz wrote:Hi Leptic,
I'll admit I haven't read all of this post but wanted to say did you know protein will turn to glucose in your body through the process of glucogenesis? Just so you know it's important not to overeat protein.

Yes thanks that is what I was alluding to above. It seems the body is sneaky in its quest to get carbs if at all possible... Step 1 was to taper off carbs, step 2 will be to taper down the protein (I think the methadone/heroin analogy is not too far off).

The goal is to have your body burn fat for fuel. The side effect of this is a release of ketones. The more fat you burn, the more ketones released. The focus is burning fat for fuel.

In the interest of science you could consider tracking your ketone levels over a day. Say taking a reading once every hour. This would provide some information as to how your body is using fuel.

In the same vein tracking glucose levels over a couple of days would add to the information you have on how your body is burning fuel.

Ultimately the goal is to have clarity of thought, feel rested and at peace, and have energy to pursue all the activities you have a chance to participate in throughout the day. Body function measurements have there place but don't loose sight of the ultimate goal.

leptic wrote: … snip
I'm not too concerned about the gout issue because I was eating all the stuff that causes gout before, and have been able to reduce quantities of the latter thanks to reduced cravings.

Correct. Gout risk is enhanced by ketosis only if you are already at risk and K-citrate should mitigate that should it become an issue for you.

leptic wrote: We have what seems to be a fairly good health food shop near my home and it was no problem to find the ion supplements in citrate form. However the person looked at me like I had two heads when I asked about BCAA and leucine. I suspect that is more of a bodybuilder type thing and prices are probably better online anyway. If I can resume my former habits, I will be doing 12km/day of strenuous biking (over some of the steeper parts of Mt. Royal) and doing dumbbell lifts with moderately weight (circuits with 15 reps) so suspect I'd be a candidate for the BCAA.

Yes. BCAAs are generally found at stores that provide body building supplements or online. Be aware that you do not want to overdo either the protein or the physical exercise … better to build up slowly as you become keto adapted.

leptic wrote: I can't believe how much the K and Mn supplements have helped - the 'flu' feeling has been totally replaced with a general feeling of wellbeing.

Hopefully you meant Mg and not Mn.

leptic wrote: Regarding whether I am actually 'in ketosis', can I ask how does one approach testing? as noted earlier I'm using the blood tester and it's been quite straightforward to use. I have heard that the optimal value is 2 mmol/L, but anything over 0.5 is indicative of some level of ketosis. I measure ketones (and do weigh-in) late afternoon right before dinner, as this is usually my largest meal of the day. My highest value has been 1.4, but it often drops back to around 0.6 probably meaning I've overdosed on proteins. Is there any value to also measuring glucose levels?

The ideal blood ketone levels depend on your goal(s). For cancer remission therapy, 5 to 7 mmol/L is the target. For neurologic disorders such as epilepsy, ALS, Parkinson’s, Alzheimer’s, and traumatic brain injuries, a target between 3 and 7 mmol/L may be appropriate. For optimal reversal of the metabolic syndrome diseases such as obesity, hypertension, diabetes, PCOS, hyperlipidemia, heart disease/stroke risks, and of course the primary disorder of hyperinsulinemia and insulin resistance – an effective therapeutic range is between 1 to 3 mmol/L. For peak physical endurance capacity/performance, by competitive or amature athletes as well as by Navy Seals and other high performance military professionals, a minimum target range above 0.75 mmol/L should be maintained understanding that the levels above 0.75 will vary significantly according to physical/mental exertion. Then lastly, for those seeking longevity, the objective is to minimize the absolute production of insulin hormone and mTOR (mammalian target of rapamycin) enzyme over the course of your lifetime … so ketone levels are not as important except for use as a surrogate bio-indicator of insulin levels. Interestingly, it is leucine that stimulates mTOR, and to a lesser degree insulin too. So depending on your goal(s) … compromises are necessary. You can strive for longevity or optimal physical performance, but not both at the same time.

I track glucose in addition to ketones because I want to better understand how my body responds to various environmental factors from dietary nutrition to physical exertion to sympathetic and parasympathetic stimulation, etc. – simply for the general scientific and observation of my own body.

For those who cannot afford to measure their blood ketones, tracking glucose is better than nothing …. As long as they understand that monitored glucose levels can miss insulin spikes caused by certain proteins, specifically but not exclusive to milk proteins. In general, people in deep ketosis (above 2 or 3 mmol/L) will maintain steady average blood glucose levels in the low to mid 60’s mg/dL while keeping post prandial glucose levels under 100 mg/dL after ketogenic meals.

I’ve also been collecting data to test the use of cheap breathalyzer devices for correlation to blood ketone measurements … to see if these cheap breathalyzers can be used as a cheaper alternative to buying blood ketone strips which can get expensive for high daily sampling rates for ketones. The devices are found on eBay and designed to measure blood alcohol but also inadvertently measure blood acetone levels and thus a good proxy for blood ketone levels. So obviously, if you are not drinking alcohol, then the measurement should be of the blood acetone (another primary ketone substrate produced by the liver in conjunction with beta-hydroxybutyrate). The more expensive breathalyzers may not work because they exclude the measure of acetone but if you get pulled over and the cop asks you to take a breathalyzer test – it would still be safer to kindly request a blood test because being in ketosis may show a false positive for blood alcohol with a breathalyzer device.

leptic wrote: I'm also curious: do high ketone levels mean that reflect a high supply of lipid fuels? or the restriction of carbohydrate fuels? what types of dietary mis-step would cause ketones to go way down, and does that matter?

Ketone production by the liver is signaled by insulin levels … elevated insulin reduces blood ketones while suppressed insulin stimulates ketone production. The body is a symphony of numerous hormones and enzymes all of which affect each other’s production. However, insulin is the master … and all others submissively bow under its power. And so your blood ketone levels will vary throughout the day as do your insulin levels.

Insulin is suppressed when glycogen storage is depleted. The body has two major glycogen storage depots, the liver (about 100 to 125 grams of glycogen) and muscle tissue (varies by individual but average anywhere from about 300 to 600 grams of glycogen). Liver glycogen is converted and released as blood glucose as needed by various tissues in the body, whereas muscle glycogen can only be released through myocellular metabolic conversion into ATP energy used for muscle contractions – and of course the liver will only release its glycogen as blood glucose when insulin is suppressed …. the same as when liver converts lipids into blood ketones.

Ergo, for ketones to go way down, insulin must be elevated. So what causes insulin to become elevated? Dietary carbs and certain proteins (primarily whey and casein but others too like leucine – so keep BCAAs to less than 5 grams per day) as well as elevated blood glucose levels produced by the liver as previously noted, via gluconeogenesis.

Becoming well “keto adapted” takes time on average about 6 weeks for “normal” people. It all depends on the individual’s insulin sensitivity/resistance. Those with higher insulin resistance (lower sensitivity) may take longer or shorter… everybody is different in how quickly they respond to developing metabolic transport mechanisms and mitochondrial adaptations -- only cellular mitochondria can convert ketone substrates into ATP. High intensity exercise, depending on the type, can either stimulate the growth of new additional mitochondria and/or stimulate the growth in the size of existing mitochondria as well as the production of needed enzymes and other transport mechanisms.

leptic wrote: My wife is actually slowly accepting this, although it is still a very grudging acceptance. I will probably ask for some help in addressing her critiques in another post.

Sorry but that’s your personal problem …. she either has trust in your ability to make your own decisions or she doesn’t.

Thanks DreamStalker, for the really detailed and helpful post.

Couple comments:

- yes meant Mg, not Mn (use Mn all the time for something else - not dietary)

- my wife is a tough cookie who's not afraid to challenge anything and everything, which is the way I like it. Sorry if looks like was looking for marriage counselling - what I meant was that she asks good questions/comments sometimes that I don't have the answer to, and thought others might. These include:

- isn't this just the Atkins diet? I had a friend on the Atkins diet and they lost tons of weight but gained it all back...

- if I commit to a restricted carb diet, will the negative impact of carb-rich food like bread be magnified if I lapse or decide to go back?

- aren't all restrictive diets are doomed to failure? (I completely disagree with this one; she was advocating the usual calorically restricted diet, which seems to be the worst kind of restriction; I don't feel I'm giving up anything because cheeses and yoghurts readily replace the satiation from carbs, and while I admit to using protein as a crutch I think it will be easier to taper off that than carbs)

But thanks again - this is both helpful and really interesting. There is probably no better argument than the fact that I am losing weight and have demonstrably better energy levels.

Yes, it's a diet very similar to Atkins and if you go back to eating the way you used to you WILL gain the weight back and lose the health benefits. Just like any other diet. But I've found this way of living (as opposed to a diet) very doable for SIX years now and haven't gained the weight back.

Yes you will have a negative impact from carb rich foods because your body isn't set up to process them any more. Simple solution is to stay low carb and appreciate the negative consequences of carbing up as a reminder of why you don't eat them anymore.

I don't know if this is doomed to failure. Ask me in another six years.

Thanks Jan,

Janknitz wrote:Yes, it's a diet very similar to Atkins and if you go back to eating the way you used to you WILL gain the weight back and lose the health benefits. Just like any other diet. But I've found this way of living (as opposed to a diet) very doable for SIX years now and haven't gained the weight back.

I quite agree that the keto diet (or my imperfect implementation of it) seems quite sustainable. I also think the association with the Atkins diet is a bit unfortunate, since it has a reputation as a 'fad diet' and seems to have been attacked in its day over a lack of evidence and other controversies. Despite that, LC seems to have withstood the test of time and continues to attract interest even in the mainstream medical community.

Yes you will have a negative impact from carb rich foods because your body isn't set up to process them any more. Simple solution is to stay low carb and appreciate the negative consequences of carbing up as a reminder of why you don't eat them anymore.

That is good to know.

I don't know if this is doomed to failure. Ask me in another six years.

My response on that (to my ever-skeptical wife) has been "I don't know what else to do, and I just can't go on feeling as badly as I did".

I will give some background that might sound like bragging but is really meant to show how far I had fallen. In my youth (teens, early 20s) I was a nationally ranked competitive athlete, and later entered a very competitive police service including intensive physical/paramilitary training (was among top 2 in academy for physical including running, swimming, circuit). I think this experience bred a kind of arrogance that made me feel like I could eat whatever I want, based on a naive feeling of invincibility and CICO logic. By the time I hit my mid 20s I outgrew the risk/thrill/glamour seeking phase and went back to school, later achieving some success in academia (which my recent health issues have threatened to negate). Now I mostly just want to be a decent parent, spouse, and teacher. By May of this year I had so much visceral fat that tying my shoes was difficult and I was getting out of breath climbing one flight of stairs (even though I have a large frame and didn't 'look' overweight other than getting a bit jowly). I am 'only' 51, and have young kids who will in their 20s when I'm in my 60s.

The trajectory I saw for myself was really dire, and I am very glad to be finally addressing this. It was a big step to overcome my arrogance/denial and admit that I was allowing myself to get old, fat, and (perhaps most upsetting) slightly senile...

So with that I wish you another six years of low-carb success and health!

leptic wrote:Thanks DreamStalker, for the really detailed and helpful post.

Couple comments:

- yes meant Mg, not Mn (use Mn all the time for something else - not dietary)

- my wife is a tough cookie who's not afraid to challenge anything and everything, which is the way I like it. Sorry if looks like was looking for marriage counselling - what I meant was that she asks good questions/comments sometimes that I don't have the answer to, and thought others might. These include:

- isn't this just the Atkins diet? I had a friend on the Atkins diet and they lost tons of weight but gained it all back...

- if I commit to a restricted carb diet, will the negative impact of carb-rich food like bread be magnified if I lapse or decide to go back?

- aren't all restrictive diets are doomed to failure? (I completely disagree with this one; she was advocating the usual calorically restricted diet, which seems to be the worst kind of restriction; I don't feel I'm giving up anything because cheeses and yoghurts readily replace the satiation from carbs, and while I admit to using protein as a crutch I think it will be easier to taper off that than carbs)

But thanks again - this is both helpful and really interesting. There is probably no better argument than the fact that I am losing weight and have demonstrably better energy levels.

Well although it sounds like she (your wife) has the skepticism of a scientist, she apparently has not researched the scientific background of nutrition as we have .... you did take a look at the current scientific evidence on nutrition that has lead you (us) to a decision to use a ketogenic diet right? As a scientist, you didn't just take my word for it right?

Therein lay the answers to your wife's questions .... understanding the science behind ketosis and how it affects the human body .... and some of us, myself included, have already provided you with reference links to research. Some of the links are to the complex biochemistry and physiology behind ketosis and some links are for a lay person such as a Hill Billy inTennessee. Now I'm not hating on Tennessee Hill Billys -- it's just that those are Butter Bob Briggs' target audience and he does an absolutely fantastic job of getting the correct message across to the less scientifically inclined.

Anyway, NO. It is not just the Atkins Diet ... perhaps based on similar principles but not the same. DO NOT buy Atkins Diet products at your grocery store and expect optimal results. The Atkins Diet has been bastardized for corporate profits and those products are quite toxic. Even the original Atkins Diet allowed for corporate toxins like all the KFC chicken you could eat and toxic fats like industrialized vegetable and seed oils. The only liquid (at room temp) oils that should even be considered are olive and avocado oils (perhaps macadamia nut too). Atkins did not promote periods of fasting either.

Ask her if an alcoholic restricts alcohol and sees benefits, will those benefits go away if the alcoholic starts drinking alcohol again? Hopefully she can understand that analogy.

If people were to restrict toxins from their diet like arsenic, and pesticides, and fungicides, and lead, and radioactive fallout .... would those diets also be doomed to failure? That last question is just absurd and hopefully she can take the Socratic method of criticism as well as she can dish it out.

We have all had, and continue to have, battles with arrogance and denial in many aspects of our lives.

Your posts on this board show that you have won, and are continuing to win, battles against both enemies.

I wish you success in your keeping up that battle, as we all must.

@DreamStalker: Dude! Go easy on us hillbillies!! Robust self-sustaining mountain farmers have traditionally been some of the most gifted day-to-day scientists of our age. Just sayin'.