Wasting away again in ketogenic-ville

Sir NoddinOff wrote:

Okie bipap wrote:A lot of people on this forum think getting exercise means ripping open a bag of chips and petting the cat while watching TV.

That's a triathlon! (rip bag, pet cat, watch TV)

Seriously, thanks very much to all for the replies. I will try to think through this carefully - I had thought about low carb diets before and have colleagues who have gotten federal grants to study the impact of ketosis in cognitive aging (I don't know if they're in a position to offer diet advice but there seems to be something to the phenomenon).

I'm very interested in what the dietitian has to say. Since keto and fasting go against conventional calories in, calories out advice and the medical establishment still clings to the diet heart hypothesis, most dietitians tend to be very negative toward both approaches. Especially since the metabolic improvement with subsequent weight loss doesn't sell a lot of weight loss surgical procedures.

But there are "good ones" out there who have learned to think outside the box, do their own research, and actually read and understand the literature with their critical thinking skills intact. Hope you get one like that.

I think you may be going about this backwards. Getting your body away from needing constant infusions of sugar for energy (sometimes referred to as being "fat adapted") BEFORE you attempt fasting will Make fasting much easier and more effective. Be aware that the first few days of keto can make you feel terrible--it's affectionately referred to as "keto flu" because you will feel like you have the flu. Drinking a lot of fluid with plenty of electrolytes (sodium, potassium, and magnesium) will help. Once you are over that hump, fasting will be much easier, though people still complain that day 2 of a fast can be rough.

Make sure you look for truly experienced resources. People here are well meaning but may know very little. Dr. Jason Fung has an excellent YouTube series on fasting that is a companion to his website Intensive Dietary Management and his book.

For keto the best resources are "The Art and Science of Low Carbohydrate Living" and "The Art and Science of Low Carbohydrate Performance". Both by Phinney and Volek. There are many supportive and knowledgeable face book groups for fasting and keto.

Janknitz wrote:I'm very interested in what the dietitian has to say. Since keto and fasting go against conventional calories in, calories out advice and the medical establishment still clings to the diet heart hypothesis, most dietitians tend to be very negative toward both approaches. Especially since the metabolic improvement with subsequent weight loss doesn't sell a lot of weight loss surgical procedures.

But there are "good ones" out there who have learned to think outside the box, do their own research, and actually read and understand the literature with their critical thinking skills intact. Hope you get one like that.

I think you may be going about this backwards. Getting your body away from needing constant infusions of sugar for energy (sometimes referred to as being "fat adapted") BEFORE you attempt fasting will Make fasting much easier and more effective. Be aware that the first few days of keto can make you feel terrible--it's affectionately referred to as "keto flu" because you will feel like you have the flu. Drinking a lot of fluid with plenty of electrolytes (sodium, potassium, and magnesium) will help. Once you are over that hump, fasting will be much easier, though people still complain that day 2 of a fast can be rough.

Make sure you look for truly experienced resources. People here are well meaning but may know very little. Dr. Jason Fung has an excellent YouTube series on fasting that is a companion to his website Intensive Dietary Management and his book.

For keto the best resources are "The Art and Science of Low Carbohydrate Living" and "The Art and Science of Low Carbohydrate Performance". Both by Phinney and Volek. There are many supportive and knowledgeable face book groups for fasting and keto.

Thanks - I think what I'll do is try to print out some 'peer-reviewed scientific literature' (god I am starting to hate that phrase) to show her and ask about. I had good results in the past with this approach. Will let you know what I dig up and how it's received.

The reason I am pursuing this is based on a combination of:

• 1) scientific literature I've read (you know, "a new study says...")
  2) observations in my own research (although unpublished and not duly scrutinized through peer review)
  3) my own personal experiences in sport, diet, and health

You have to understand that anything that could even be perceived as remotely 'faddish' carries a real stigma in academic circles. This is getting somewhat better (since even fads are worth understanding, and sometimes they have a basis in truth). I think that ketosis is pretty mainstream as these things go, however. I actually hired a very smart guy in my lab who did his Ph.D. on metabolic and dietary factors (including ketosis) in dementia - his Ph.D. supervisor was a well-respected academic dietician/researcher who is doing quite a lot of work on ketosis. I'll definitely pursue when I go back to work later this month.

Hi, it's good to have some idea of what you're talking about when you see a prof, and to do some of your own research, but I've also found that when you go in to see e.g. a doctor and you come with a fixed agenda backed up with 'research' etc, the profs tend to then be steered (consciously or otherwise) to all of it, rather than coming to it as a clean slate and possibly with ideas you haven't considered or are unaware of. And you may leave with the same stuff you came in with, but not really a new or better take on what you want help with. Just something to think about...

Julie wrote:Hi, it's good to have some idea of what you're talking about when you see a prof, and to do some of your own research, but I've also found that when you go in to see e.g. a doctor and you come with a fixed agenda backed up with 'research' etc, the profs tend to then be steered (consciously or otherwise) to all of it, rather than coming to it as a clean slate and possibly with ideas you haven't considered or are unaware of. And you may leave with the same stuff you came in with, but not really a new or better take on what you want help with. Just something to think about...

Thanks - I agree you have to be very careful how you introduce this kind of thing (definitely not 'sledgehammer' approach). However, if you work collaboratively then I have had good results with this approach in the past (a treatment success that wouldn't have happened without PubMed).

I am VERY new at this approach, myself. So I am by NO means an expert, but here are my takes on a few of your questions:

leptic wrote: 1) is the 'water and coffee fast' I've heard mentioned considered to be a good option? what exactly does this entail? (other than the obvious)

The coffee helps curb appetite, helps vacate the intestines more quickly, and encourages further intake and expulsion of liquids, which is very important during a fast. Also important for a fast is keeping up vitamin and mineral balance--as I understand it as a lay person. Starting with a fast, in my opinion, can jump-start the ketogenic process and lead into very-low-carb eating without cravings getting in the way. It is sort of a cold-turkey versus gradual-cut-down sort of thing.

leptic wrote: 2) I had also hoped to use my time off to re-establish my exercise habits, but suspect this should wait until after the fast. Comments?

Very intense exercise can complicate a fast, and intense exercise during low-carb intake is only useful if doing it for a metabolic reason that professional athletes and experienced supervised body-builders might employ. Otherwise, gradual and tentative should be the watchwords until ketosis has set in comfortably for a while. In my personal opinion and experience. Keeping up good aerobic is necessary for me to feel well, so I did some walking, treadmill, and elliptical--just not as intense as usual.

leptic wrote: 3) because it's unlikely my wife will subscribe to this idea, does anyone have tips on how to limit carb intake when living with others? I suppose I can start offering to cook more (especially if my energy increases through cpap and/or diet) which will give a bit more control.

Naturally, you will find your own way with this. But my experience is that it isn't an issue. I put a summary up on the refrigerator door to explain what I was going to attempt. Here is what I wrote up for myself as a personalized intial approach that my wife was onboard with right away. Your approach may vary from mine:

FASTING DAYS (72-hour limit):
Daily Multivitamin
Water (a LOT), Coffee
Broth and electrolytes when needed

DIET LIST FOR NONFASTING DAYS:
Daily Multivitamin
Broth
Green leafy veggies (a LOT)
Onion, Tomato, Pepper, Avocado
Garlic, Olives, Pickles, Mushrooms
Oil (extra-virgin olive, coconut, avocado)
-----Also, in moderation:
Eggs (pastured or omega-3 whole, if possible)
Fatty fish (salmon, trout, tuna, mackerel, shrimp)
Meat (red, poultry)
Cheese (cheddar, goat, cream, blue, mozzarella)
Yogurt, Sour cream, Cottage cheese (full-fat only)
Butter, Cream (grass-fed if possible)
Nuts (almond, walnut)
Seeds (flax, pumpkin, chia)
Nut butters (peanut, cashew, almond)
Almond milk

NO:
X –Grains (wheat/corn/rice), Potato
X – Beans, Peas, Carrots, Chickpeas
X - Sugar/Fruits (other than berries)

I believe your other questions have been well-addressed.

Keep us informed!

-jeff

Thanks - I think what I'll do is try to print out some 'peer-reviewed scientific literature' (god I am starting to hate that phrase) to show her and ask about. I had good results in the past with this approach. Will let you know what I dig up and how it's received.

Good in theory but if the dietitian you meet with is a CICOphant you will not have good results. They are taught by rote (fascinating podcast with Diana Rogers who just got her RD, here: http://balancedbites.com/podcast-episod ... a-rodgers/). I think that most people have not the slightest clue about nutrition except EVERYONE has tried CICO. The ones who end up with dietitians already failed CICO-because it doesn't work. But they dutifully either try again when a dietitian tells them to and then get blamed for the failure, or they nod their heads and keep on eating just the way they always have. So most dietitians are usually unprepared for knowledgable patients who do their own research and are self directed to help themselves. Since most people who walk in their office don't even know what a carb is, they are ill-prepared to handle an empowered patient. Sound familiar, CPAPers???

Anyway, let's hope you get a good one who delights in the empowered patient, but don't waste your time and breath convincing any other type unless you enjoy beating your head against a brick wall.

My doc sent me to a dietician. His words were something like this: "I am sending you to our dietician because that's what I'm supposed to do. But between you and me, I as your doctor believe you'll do best on some sort of low-carb approach. You don't have to tell our dietician I said that."

One other question -

If I were to bring some literature to my appointment with the dietician, what would the low-carb/ketosis advocates here consider to be the most compelling documentation of the safety and efficacy of these approaches? I am talking about articles in peer-reviewed journals, not consumer-oriented books.

Thanks for any suggestions!

You don't think it might look like you're telling her her business? I am absolutely an advocate for DIY, be in control, etc, etc., but when you first go to a professional for help (as opposed to vindication of your own ideas) it might not be a bad idea to first hear what they have to say and then bring up your stuff, at least the stuff that maybe fits with what they might have said... If all you're going for is to get confirmaton of e.g. JNK's (or anyone else's) diet, I wonder how smart that is. I mean if you go fully prepared to not hear what they say, and go home feeling righteous because you didn't (tho' consideration might show that they do have new things to pass on), you could end up back where you started, a 'victim' of random internet info and no direction dedicated to your situation. Just sayin .

All that being said of course, she? may be a total dork.

Trust me, you will have just as much compelling documentation of low carb as a successful and safe 10-yr approach as the diet "expert" will have for the efficacy of any high-carb-approach 10-yr success.

Short-term, anything can work. Long-term, all we got is anecdotal and patchwork pseudo-meta, since no one can afford to monitor all diet and confounding variables for decades.

In other words, you will arrive as much of an expert on long-term diet as any "expert" on diet. And if you don't believe me, ask to see the "expert's" literature documenting long-term safety and efficacy of whatever the diet "expert" offers. There is none.

The way I look at it, if a money "expert" claims he can handle my money better than I can, he is free to make suggestions, but it's my money and I'll face the consequences of my choices. Same with how one raises his kids. Same with how one eats. There are no compelling studies available to tell someone definitively how to handle things like money, kids, or diet for long-term success. But that's OK for those larger aspects of life. You put faith in the authority who sounds most reasonable to you and whose approach you can utilize in your circumstances and then you trust your, uh, gut, on the rest.

But, studies? Bottom line is that it can be proven that protein is needed. And it can be proven that fats are needed. But no study has proven that carbs are needed. My body has trouble with carbs. That's enough for me.

But, in harmony with Julie's point, I would never recommend my diet to anyone else, ESPECIALLY someone whose body has no trouble with carbs. I consider myself an exception and I am NOT an advocate for the way I eat. I actually consider my diet extreme, but less of an extreme (to me) than what medical science has to offer at the moment.

My info was only in response to someone who has already decided to go that route and is only looking for anecdotal info about it.

Bariatric Dr./Dietician ? I imagine they'll have you on lots of fries & Cheetos, and, on their schedule for a nice, profitable surgery in no time. Maybe a better course would be to seek out a "keto-literate" dietician from the outset. I suspect that they may be kinda' scarce and keeping a low profile, similar to the Lyme-literate doctors and their "maverick" ideas. My registered dietician (former) started out by showing me the ancient food pyramids and digging around in a toy box for rubber facsimiles of food items and telling me to eat starches 5 times a day ! Thanks, but, no thanks. Lately, I've been getting my diet advice from Dr. Fung et al. Good luck. ~~ https://www.google.com/?gws_rd=ssl#q=jAson+fung

Maybe you and the dietician could sit and watch an interview with the former president of the American Society of Bariatric Physicians, Dr. Mary Vernon.

https://www.youtube.com/watch?v=kaquSijXJkQ

I would probably, NOT, however, go to her for tax advice.

http://www.forbes.com/sites/robertwood/ ... 8f6c751f40

Julie wrote:You don't think it might look like you're telling her her business?

It doesn't have to go that way.

I am absolutely an advocate for DIY, be in control, etc, etc., but when you first go to a professional for help (as opposed to vindication of your own ideas) it might not be a bad idea to first hear what they have to say

I would think that, before they say anything, the professional will have to ask something like "so Mr. Leptic, what brings you here today?"

and then bring up your stuff

I would think it would be very common for a dietician to be confronted with questions about popular diet programs, and I would hope that they are happy that someone is consulting their advice rather than just reading stuff on the internet. This is the experience I have with pharmacists - they are a great resource that is really under-utilized. Rather than immediately self-medicating, I try to ask their advice whenever possible and they seem quite happy to be consulted. Often they recommend things I didn't know or wouldn't have thought of, and they have never taken offence that I started out asking about a specific product which they ended up discouraging for my application.

at least the stuff that maybe fits with what they might have said...

Well I hope I'll be able to go into the consultation with an open mind.

If all you're going for is to get confirmaton of e.g. JNK's (or anyone else's) diet, I wonder how smart that is.

Hmmm. I don't think I said that's what I was going for, and I wouldn't consider that very smart at all

I mean if you go fully prepared to not hear what they say, and go home feeling righteous because you didn't (tho' consideration might show that they do have new things to pass on), you could end up back where you started, a 'victim' of random internet info and no direction dedicated to your situation. Just sayin .

Honestly I have never seen a dietician before, and have absolutely no idea what she will say.

All that being said of course, she? may be a total dork.

There's only one way to find out!

Julie wrote:You don't think it might look like you're telling her her business?

PS here's one script that such a consult could follow:

Dietician: so, Mr. Leptic, what brings you here today:

Me: I was recently diagnosed with sleep apnea, and I gather that losing some weight might be beneficial in terms of the apnea and for my health in general. I tend to be especially tired after meals, and have pretty intense cravings for food during the day. A number of people have suggested I look into a low-carbohydrate diet, because it can apparently reduce insulin fluctuations and there seems to be some evidence that it can be a safe and effective means of weight-loss. I thought it would be a good idea to discuss this with a professional though, to get your thoughts on whether such a diet could be appropriate for me and whether there are alternatives you think I should consider.

Dietician: get out of my office you jerk, how dare you tell me my business!

Me: are you kidding?

Dietician: yes sorry - people tell me I have a strange sense of humour. Let me tell you what I think about this...

[to be continued after I have the actual appointment]