Do you really need to drink eight cups of water a day?

[Nancy LC]

Do you really need to drink eight cups of water a day? (http://www.bbc.co.uk/news/magazine-24464774)
We are able to tolerate losses in water relatively well, whereas even slight over hydration can be far more dangerous

Hyponatremia: sodium imbalance

Drinking more and more water just dilutes sodium and can cause many ill-effects and even death.

It is such a pervasive belief that drink loads of water is lovely... even on a LC diet where you tend to lose a lot of sodium anyway. I always get a bit steamed when people are suffering from low sodium there's always someone telling them to drink more water.

[anglgrl]

One of your previous posts convinced me.
I cut down my water about a month or two ago.

[Nancy LC]

Good! Did it help with any symptoms?

[Verbena]

I must be a very contrary person LOL! I have never been very fond of plain old water, but purchased a Sodastream a few months ago (as I am quite fond of carbonated mineral water, but can't justify the expense), and have upped my daily intake to around 2 liters, on top of the copious amounts of black tea I drink every morning. While on a short trip this last weekend, and away from both my tea and carbonated water I could feel the dehydration - dry mouth, especially in the morning, chapped lips (always a problem, less so with lots of liquid), a general feeling of things being "off". Back home, and back on routine, I feel much better. I have mentioned on other threads that I also seem to have an opposite effect when it comes to sodium; adding it into my diet made me feel awful, and raised my blood pressure to an unacceptable level, and I am doing much better back on my relatively low salt regimen.

[anglgrl]

Good! Did it help with any symptoms?

Not that I noticed. But I definitely don't feel worse. And it's a huge relief to not have to drink that much water. I swear I'm not as thirsty as I used to be. Which would make sense if I'm not flushing all the sodium out of my body.

[Nancy LC]

I noticed when I drink tea my mouth gets very dry, then I have to either drink more tea or drink a bunch of water. My sister has dry mouth all the time and I bet it is because she literally drinks gallons of the stuff (unsweetened, fortunately).

[deirdra]

Before I moved to a dry climate I had headaches almost daily and the only water I drank was with the aspirin. Now I drink ~2L of water (green tea, SodaStream creations & some plain) each day and I never get headaches except for when I'm too busy or involved in something and skimp on water. A glass or two of water (without the aspirin) usually cures the headache in 30-60 minutes.

[RobLL]

How much water you should drink is a complicated question. I was getting up 2-3 times a night, so dropped back. Some have said one can go by color of urine. White too much. Yellow OK. Orange Bad. Others have questioned that.

Now I just drink if thirsty. Coffee covers most of my needs.

[dan_rose]

Comments:

1) It's hard to imagine our ancestors drinking 2 litres a day.

2) When I've been on holiday France & Italy, they appear to drink very little apart from espresso and wine which are both diuretic.

3) Recently read that the body creates 10% of its water from mitochondrial ATP synthesis.

4) A large percentage of most of the foods we eat is water so the requirement for liquid water on its own might not be that high.

5) It's the tannin in tea that gives you a dry mouth - It can be prevented with more milk / cream or by brewing for less time.

[Nancy LC]

#2 isn't really accurate. Coffee will cause you to excrete a slight amount more liquid than water and only the non-habituated. Coffee and wine still count as liquid. :D

[teaser]

Darker urine just as often means you ate something particularly nutritious, like liver. I've never been able to work up much enthusiasm for micromanaging the colour of my urine.

[Nancy LC]

Yes, I can do all kinds of things to my urine by eating various foods:

Beets, red
Asparagus, bright yellow-green and stinky
Coffee, dark almost brown
Vitamin B supplements, neon yellow

[Benay]

After reading this newspaper article, I see where you got your ideas about not drinking so much water.

The article was based upon one study of extreme athletes. Good study, well designed. Interesting findings. But I don't see how it applies to people on LCHF diets? For one thing, I doubt if the cyclists had much fat on them and they were not cycling for weight loss. So generalizing from one study of a specific population to an entirely different population doesn't seem reasonable to me. Although the newspaper article was interesting, all its conclusions seem to have been derived from this one study. I wonder what Westman, Volek and Phinney would say.

[Oldbird]

I tried drinking more water besides all the coffee I put away, all it did, was get me up numerous times in the night. Now I drink when I'm thirsty.

I'm almost sure the '72 Atkins book didn't advise drinking copious amounts of water.

[JEY100]

Westman says eat when you are hungry; drink when you are thirsty. "It is important to drink an adequate amount of fluid per day" and under Beverages, "Drink as much as you would like of the allowed beverages, but do not force fluids beyond your capacity. The best beverage is water"

[Benay]

Jey, I think the key notion is "forcing fluids." Don't force it.

I am a "drinker." I was a drinker before I went low carb and nothing has changed. I have friends who are not drinkers. I notice the difference when we travel together. We start out the trip, each having a bottle of water. By the end of the day, they are still working on the same bottle and I have refilled mine.

I don't have my NANY with me at the moment, but didn't they say something about checking urine for hydration levels? If clear--very very light--hydration is good to too good. The darker the less hydrated. Color is also affected by type of food eaten as other posts have stated.

[JEY100]

The Clinic program is as simple as it can get, eight pages vs. the hundreds of pages in NANY. It was designed to be used in clinical trials. There is no chitchat about the color of urine. :lol: ..Copied the instructions in quotes word for word.

[Benay]

Jey, I am not familiar with 'the clinic program.' Where did you find it?

[JEY100]

Duke Lifestyle Clinic in Durham, NC :thup:
I read NANY and realized Dr Westman's clinic was a half hour from my home.
The plan, with a few minor variations, is in the back of Why We Get Fat by Taubes, highly recommend that book. Also sells a little booklet through Amazon so other bariatric doctors can use it with their clients: http://www.amazon.com/Low-Carbohydrate-Ketogenic-Diet-Manual-ebook/dp/B00D3MSJQ4

[Benay]

Thanks Jey, I do have Westman's Ketogenic Diet Manual. I agree, it is a basic outline and not explanatory. Also, I read Jimmy Moore's chapter on the difference between Ketogenic and Atkins.

NANY is Atkins and not Ketogenic. I agree with Jimmy, they are different. NANY explains many concepts that have been heretofore unexplained. One of them is the need for adequate hydration. So I don't expect an outline such as the Ketogenic Diet Manual to explain the rationale and research behind the research protocol. I do expect rationale and research evidence from books like NANY. I found the explanation, evidence and examples in NANY convincing.

[Nancy LC]

How about what a kidney specialist says?

"Drink at Least 8 Glasses of Water a Day" - Really? (https://geiselmed.dartmouth.edu/news/2002_h2/08aug2002_water.shtml)

Urine color?
It's a short leap of logic to think that if a lack of water is bad for for you then hydration must be good - purifying, cleansing water washing through your organs must be beneficial, detoxifying. It surely improves your skin, helps you think, reduces your risk of kidney stones and turns your urine a lovely light, straw/champagne colour rather than the fetid orange syrup you produce at the end of a long day where you haven't had time to drink.

So I've looked through the literature and I found a review article saying all of this and more. It was written by a group of respected physicians from American and French hospitals and it clearly supported the widely held belief that you should drink two to three litres of water a day.

It said that people with a high urine output have a lower rate of kidney stone disease, that the flushing action of the water may reduce the risk of a urinary tract infection (especially in women after sex). Perhaps most importantly, they referenced a surprising study which showed that paradoxically an increased intake of water increased the risk of bladder cancer. But only tap water. And there's the clue.

A footnote at the end of the article explained that what you thought was a scientific article in a scientific journal is in fact a supplement, sponsored by a major mineral water manufacturer. All of the authors received honoraria from this company, which also provided medical writing assistance. So this isn't research, it's marketing.


This stuff is an information cascade. So many people believe it is true that that must be proof it is true. :-)

[Benay]

Both of these are good comments Nancy, and although they don't seem to be evidence based, they are logical. I am not sure what population is the target population for these comments, but they do make sense.

As Westman et all in NAFNY state, starting on a LCHF diet is diuretic. Especially that large fluid loss during the first weeks. That is the population of reference--not the general population on the standard high carb diet. So, here, they are talking about replacing lost fluids, as well as the electrolytes lost along with those fluids, especially sodium.

They go on to say that the LCHF diet will continue to be diuretic but will not be to the same extreme. You do, however, need to keep replacing those lost fluids.

In other words, they are talking about a specific population with specific needs.

So, since I am comfortable with the clinical and research expertise of Westman, Volek and Phinney, I will follow their advice regarding fluid and electrolyte replacement on a LCHF diet. It works for me. That does not mean it will apply to every one.

Thanks for the food for thought.

[inflammabl]

NANY is Atkins and not Ketogenic. Seriously? JM actually said that?

[teaser]

Here's what Jimmy says;

Nutritional ketosis, in which the body burns fat to generate ketones for energy, can only be brought on by a low-carb, moderate protein, high-fat diet. an Atkins-style low-carb diet may or may not meet those requirements, since its focus tends to be more on restricting carbohydrates as the primary function.

He doesn't say that Atkins is a non-ketogenic diet, he just says that it's not necessarily a ketogenic diet--it's possible to eat enough protein to interfere with ketosis.

He also mentions that Phinney and Volek first coined the phrase "nutritional ketosis" in NANY, though.

[inflammabl]

I can't tell. Are you defending his statements?

[teaser]

Just trying to clarify.

[Benay]

Jimmy's Keto Clarity book has an entire chapter demonstrating the difference between low carb and ketogenic. Not possible to quote the entire chapter.

Perhaps, as Teaser has said, the significant difference is the protein/fat ratio while holding carbs to a minimum.

Atkins Induction 2 weeks holds total carbs to 20 grams or less. But for most people, Induction is time limited. Also, during Induction, protein consumption is calculated according to lean body mass. It can be adjusted for age and gender.

Ketogenic is a long term strategy which not only maintains a very low total carb count, it also cuts way down on protein consumption. It is a very high fat diet. 80% or more of total calories or calculated grams. I don't think any Atkins book calls for that degree of dietary fat with the exception of his "Fat Fast" which was designed as a short term strategy to interrupt a plateau.

So ketogenic versus Atkins boils down to time limits and protein consumption. On Atkins, you can keep total carbs down for as long as you like, but you have to cut protein too to create a ketogenic diet.

I love my protein too much to sustain a ketogenic diet for any length of time.

[inflammabl]

Benay, you know JM isn't a scientist, right?

[Nancy LC]

Both of these are good comments Nancy, and although they don't seem to be evidence based, they are logical. I am not sure what population is the target population for these comments, but they do make sense.
Pretty much everyone. The article isn't a study, it is commentary about how this "drink lots of water" thing got started and it is pointing out that there is no science behind drinking lots of water, but plenty of marketing.

Yes, we need liquid, but we get a lot of it from coffee, tea, and everything we eat and drink.

Funny how we trust our bodies to tell us when we need to sleep. We don't just randomly try to make ourselves sleep, but we've grown entirely distrustful of our sense of when we should drink.

[Oldbird]

Pretty much everyone. The article isn't a study, it is commentary about how this "drink lots of water" thing got started and it is pointing out that there is no science behind drinking lots of water, but plenty of marketing.

Yes, we need liquid, but we get a lot of it from coffee, tea, and everything we eat and drink.

Funny how we trust our bodies to tell us when we need to sleep. We don't just randomly try to make ourselves sleep, but we've grown entirely distrustful of our sense of when we should drink.Exactly! :thup:

[Meme#1]

I read somewhere that many of us walk around in a dehydrated state especially people like me who live in a climate that is warm to scorching hot 11 months out of the year.
I've also read that we store toxins in our fat so I do think it is really important especially in the first few weeks of induction when doing Atkins to make an effort to drink more water than usual to help the kidneys flush out these toxins.
Your kidneys will thank you and if anyone is taking medicine, more water is a good idea.
Many people don't realize but over the counter meds like Aleve, when it was only available by prescription had a long write-up that came with the prescription on the side effects, one of which stressed the importance of drinking more water because this med. taxes the kidneys (in so many words).

[Nancy LC]

I read somewhere that many of us walk around in a dehydrated state especially people like me who live in a climate that is warm to scorching hot 11 months out of the year.
I've also read that we store toxins in our fat so I do think it is really important especially in the first few weeks of induction when doing Atkins to make an effort to drink more water than usual to help the kidneys flush out these toxins.
Can you find actual scientific studies to back these things up? What? No?!?

https://geiselmed.dartmouth.edu/news/2002_h2/08aug2002_water.shtml


He observes that we see the exhortation everywhere: from health writers, nutritionists, even physicians. Valtin doubts its validity. Indeed, he finds it, "difficult to believe that evolution left us with a chronic water deficit that needs to be compensated by forcing a high fluid intake."

Despite the dearth of compelling evidence, then, What's the harm? "The fact is that, potentially, there is harm even in water," explains Valtin. Even modest increases in fluid intake can result in "water intoxication" if one's kidneys are unable to excrete enough water (urine). Such instances are not unheard of, and they have led to mental confusion and even death in athletes, in teenagers after ingesting the recreational drug Ecstasy, and in ordinary patients.

And he lists other disadvantages of a high water intake: (a) possible exposure to pollutants, especially if sustained over many years; (b) frequent urination, which can be both inconvenient and embarrassing; (c) expense, for those who satisfy the 8 x 8 requirements with bottled water; and (d) feelings of guilt for not achieving 8 x 8.

Other claims discredited by scientific evidence that Valtin discusses include:

Thirst Is Too Late. It is often stated that by the time people are thirsty, they are already dehydrated. On the contrary, thirst begins when the concentration of blood (an accurate indicator of our state of hydration) has risen by less than two percent, whereas most experts would define dehydration as beginning when that concentration has risen by at least five percent.
Dark Urine Means Dehydration. At normal urinary volume and color, the concentration of the blood is within the normal range and nowhere near the values that are seen in meaningful dehydration. Therefore, the warning that dark urine reflects dehydration is alarmist and false in most instances.
When I hear, or read, this sort of folksy wisdom that "everyone knows is right"... my skepticism bubbles to the surface.

[BeerNpasta]

Funny how we trust our bodies to tell us when we need to sleep. And it really does tell us!

but we've grown entirely distrustful of our sense of when we should drink. ???

Swirl in the mix of chemical additives to modern food and drink, and yes we're having to second guess what our bodies are telling us..... Is it a chemical induced craving or real?

[Nancy LC]

Swirl in the mix of chemical additives to modern food and drink, and yes we're having to second guess what our bodies are telling us..... Is it a chemical induced craving or real?
Thirst Is Too Late. It is often stated that by the time people are thirsty, they are already dehydrated. On the contrary, thirst begins when the concentration of blood (an accurate indicator of our state of hydration) has risen by less than two percent, whereas most experts would define dehydration as beginning when that concentration has risen by at least five percent.
Which chemicals are those and, if they're so insidious as to shut off your sense of thirst, why are you eating them? :lol:

[leemack]

I drink an amount that I feel good at - I feel hydrated a 3-4 litres of fluid, as long as two litres of that is water. Less than that and I feel 'dry' and thirsty and headache-y.

My kidney function tests have always been fantastic. My guide is what works for me.

[Benay]

Benay, you know JM isn't a scientist, right?

Yes I do know Jimmy is not a scientist. Neither is Gary Taubes. But both seek clarification from scientists. Westman is Jimmy's co-author, read every page of the manuscript, and steered Jimmy away from mistakes. In addition, Jimmy's book is riddled with quotes from current LC scientists including Volek and Phinney. He did a lot of research for the book in addition to doing a long term ketogenic diet himself.

I admire him for testing things out on himself and publicly posting his results on a regular basis. Like Atkins and Mike Eades, Jimmy has struggled with his weight and BG for years. That he is willing to share what he has learned is helpful for me.

I tend to use what is helpful to me. As a retired researcher and teacher of research methods at the university/post graduate level, I look very closely at the methods used in publicly published research and critique it for myself before I accept or reject it. I am very critical of research that is based upon an inadequate literature review (like the USDA Guidelines). I am also very critical of conclusions not based upon hard data. I am particularly critical of recommendations that generalize beyond the selected sample. But this is just me and highly colored/influenced by my background. I do not like sloppy work.

And just as another aside, I have been reading dieting research since the 1970's (before computers) with an eye toward discovering the characteristics of a successful dieter. And, like Jimmy, I tried all the published diets, and attended for profit weight loss programs, as well as university programs and OA, all without success. It wasn't until I tried PP that I lost significant weight and kept most of it off. Reading about dieting can probably be categorized as a hobby. I have read a lot of trash along the way too. So when I see someone experimenting on himself, I read more of that person's journey.

Sorry for the long winded answer to your brief question. For some reason I felt I had to defend myself.

[Nancy LC]

Don't dis Gary Taubes. He's got an amazing background. If there's anyone that can marry science and journalism together, it is him.

http://garytaubes.com/biography/
Biography

Gary Taubes (born April 30, 1956) is an American science writer. He is the author of Nobel Dreams (1987), Bad Science: The Short Life and Weird Times of Cold Fusion (1993), and Good Calories, Bad Calories (2007), which is titled The Diet Delusion in the UK. He has won the Science in Society Award of the National Association of Science Writers three times and was awarded an MIT Knight Science Journalism Fellowship for 1996-97.
Born in Rochester, New York, Taubes studied applied physics at Harvard and aerospace engineering at Stanford (MS, 1978). After receiving a master’s degree in journalism at Columbia University in 1981, Taubes joined Discover magazine as a staff reporter in 1982. Since then he has written numerous articles for Discover, Science and other magazines. Originally focusing on physics issues, his interests have more recently turned to medicine and nutrition.
Taubes’ books have all dealt with scientific controversies. Nobel Dreams takes a critical look at the politics and experimental techniques behind the Nobel Prize-winning work of physicist Carlo Rubbia. Bad Science is a chronicle of the short-lived media frenzy surrounding the Pons-Fleischmann cold fusion experiments of 1989.

Jimmy is a good man, but he lacks the ability to separate good science from bad -- as most of us do. He posts some sketchy stuff on Google+ from time to time, like a recent thing about ibuprofen extending lifespan. Sure, it does in mice and fruit flies, but it is easy to extend the lifespan of short lived things. Not so easy in humans.

[Benay]

I did not dis Gary Taubes. You have misread me.

[inflammabl]

I tend to use what is helpful to me. As a retired researcher and teacher of research methods at the university/post graduate level, I look very closely at the methods used in publicly published research and critique it for myself before I accept or reject it. I am very critical of research that is based upon an inadequate literature review (like the USDA Guidelines). I am also very critical of conclusions not based upon hard data. I am particularly critical of recommendations that generalize beyond the selected sample. But this is just me and highly colored/influenced by my background. I do not like sloppy work.
outstanding response. I to do not like sloppy work. Few things are more frustrating than doing month's worth of work and finding out that a mistake was made along away.

I don't have such a high opinion of Jimmy Moore.I think he's good for giving enthusiasm but he's too quick to put a narrative to things when they have not been established. I am not as confident as you that dr westman proof read Jimmy Moore's book as closely as we would like.

I'm away from my home computer now posting from my cell phone and finding it very difficult to put together a well written response. Hopefully after I get home I'll have the motivation to respond in detail.

[Benay]

Here is a list of references on adequate hydration. I found several googling "adequate hydration." This one includes funded research projects. Several agree with Meme's statements.

http://familydoctor.org/familydoctor/en/prevention-wellness/food-nutrition/nutrients/hydration-why-its-so-important/bibliography.html

Here is a really neat interview with Jeff Volek at a 100 mile marathon competition won by a low carber. (He doesn't look like the typical marathon runner!) He and Steve Phinney were there to see the difference in performance between low carb and high carb runners. He has a very nice answer to the question on hydration in this population later in the interview.

http://www.meandmydiabetes.com/2012/08/11/western-states-100-low-carber-wins-ultramarathon-steve-phinney-and-jeff-volek-study/

[Nancy LC]

Just combed "The Art and Science of Low Carb. Living" and there's no reference to how much you should drink, but there's a ton there on how sodium depleting a low carb diet. It also explains how you can't hang onto other minerals when you're sodium depleted and your body will actually tear down muscle to get more potassium.

You excrete sodium when you pee (and sweat).

Drink tons of fluid and you pee a lot.

Now, if you are very good about getting your 5g of sodium per day, then it might not be such an issue because you can better hang onto your liquid.

I'm referencing page 149 (in my Kindle book) of that particular book.

Athletes have different requirements. They lose a lot of water and sodium by sweating and breathing hard. However, so many times I hear about another marathon runner dying from hyponatremia because they drank too much during their run.

Ideally they should weigh themselves before a run and then after, only replacing exactly what they lost during the run. If not, then they risk having low sodium because they simply lose too much of it and it becomes too dilute. Nasty and deadly.

[aj_cohn]

We don't just randomly try to make ourselves sleep, but we've grown entirely distrustful of our sense of when we should drink.

I have a vague memory of someone writing a book on that. Something something "problem,"? No — "Omni" something. Darn it! It's on the tip of my tongue!

[Liz53]

Are you thinking of Lights Out (http://www.amazon.com/Lights-Out-Sleep-Sugar-Survival/dp/0671038680)?

[aj_cohn]

Are you thinking of Lights Out (http://www.amazon.com/Lights-Out-Sleep-Sugar-Survival/dp/0671038680)?

Liz, I was being ironic. Nancy's quote is the thesis of the famous (well, at least I thought it was famous) book The Omnivore's Dilemma (http://smile.amazon.com/Omnivores-Dilemma-Michael-Pollan-ebook/dp/B000SEIDR0/ref=sr_1_1?ie=UTF8&qid=1419560601&sr=8-1&keywords=The+Omnivore%27s+Dilemma) by Michael Pollan.

[Liz53]

Totally missed the irony. I read The Omnivore's Dilemma some years ago - imo the last good book Pollan wrote (before he started instructing us on How and What to Eat).

I would have never connected Nancy's quote with that book, though.

[Nancy LC]

I read Omnivore's Dilemma and I don't recall them saying anything remotely like what I said. It mostly came from Dr. Valtin, kidney specialist who has investigated the water issue.

[Benay]

Just for the fun of it, I went to the index of my hard copy of Westman, Phinney & Volek's The New Atkins for a New You. to see what they had to say about water consumption and hydration. Most of the references are in the section on Induction.
19, 96 diuretic effects
18, 67-68, 96, 108, 187 intake
18, 77, 95, 106 in weight loss
hydration was not in the index, just water.

"Atkins naturally has a diuretic effect . . .which is why drinking plenty of water and other fluids is important . . .to ensure you don't deplete your stores of electrolytes." page 18 "WATER POUNDS AND FAT POUNDS. pg 19 "fluid loss can be too much of a good thing...To manage this problem, simply drink plenty of water and other fluids and make sure to consume a minimum of a half teaspoon of salt each day."
67-68 "DRINK REGULARLY ...many people are borderline dehydrated much of the time--your body releases a hormone that makes your kidneys retain salt and water, but does this at the expense of wasting your body's stores of potassium.....People often misread the body's signal for more fluid as hunger, so staying well hydrated also helps you not overeat....To determine if you are drinking enough fluids, simply check the color of your urine, which should be clear or pale yellow. ...Individual needs vary" etc etc etc
96 "A low carb diet is naturally diuretic which flushes sodium and water from your body."

These are just some of the things that struck me about adequate hydration on a low-carb diet. I like their approach which seems sensible. They don't seem to be advocating drinking fluids as only replacing fluid, they include electrolyte imbalances that need correcting as well. They do go on to say that 8 glasses of water a day is not a hard and fast rule for everyone. There are many factors that go into adequate hydration and each individual will have different requirements.

I do like the Westman et al approach. They are reasonable rather than rigid. I like the fact that they are clinicians as well as researchers and draw on a wide variety of experiences as well as their own research data that has not yet been published. This approach works for me but may not work for anyone else.

[Oldbird]

Thank you Benay, it seems that all we need is a common sense approach.

[Benay]

I read somewhere that many of us walk around in a dehydrated state especially people like me who live in a climate that is warm to scorching hot 11 months out of the year.
I've also read that we store toxins in our fat so I do think it is really important especially in the first few weeks of induction when doing Atkins to make an effort to drink more water than usual to help the kidneys flush out these toxins.
Your kidneys will thank you and if anyone is taking medicine, more water is a good idea.
Many people don't realize but over the counter meds like Aleve, when it was only available by prescription had a long write-up that came with the prescription on the side effects, one of which stressed the importance of drinking more water because this med. taxes the kidneys (in so many words).

Meme, you have good recall of basic physiology. We do store toxins in fat cells when we don't destroy and flush them out right away. And yes, we lose fluid as sweat if temperatures rise high enough. People in Florida, where the humidity is high, notice it more than people who live in desert areas where sweat evaporates almost as soon as it hits the skin. Some cultures induce sweat through sweat lodges/saunas to rid themselves of toxins. Others induce sweat by exercise and hot baths. We also lose fluid, as well as toxins, from our lungs--just breathing, from our gut (not enough fluid makes us constipated), as well as from our kidneys. People with poor kidney function require dialysis to rid their bodies of free floating toxins in the blood. So we are constantly excreting fluids. And those fluids carry electrolytes and toxins with them. So, when we shift from carb burning to fat burning, our fat cells give up their stores of whatever they they have been hoarding and release them into the blood stream. Our job is to try to help the liver and kidneys do their job efficiently. Rehydrate what has been lost. it is not an either/or situation of replacing electrolytes or fluids; it is a both/and--we need to replace lost fluids and electrolytes. End of lecture.

[Jamackarch]

love it. :)

[Meme#1]

A friend who had a fat biopsy for certain reasons let me know what toxins they found in her fat and it was frightening.
My Atkins book also talked about toxins deposited in our fat. Sorry no page number or links, just from memory.
I do live in an area of Texas that is sub-tropical so we drink water constantly throughout the year.

[Benay]

A friend who had a fat biopsy for certain reasons let me know what toxins they found in her fat and it was frightening.


Thanks Meme,

I can imagine! Not only do we store what we eat and drink but also (smog/air pollution) what we breathe and what we absorb from our skin.

I am horrified by Nina Teicholz description of what is happening in restaurants that use vegetable oils (not Olive Oil) for cooking. I am going to be very careful from now on where I go to eat. Those toxins/sludge are lethal quickly!

No need to give chapter and verse for the Atkins book, I can find the page easily.

[Lessara]

I know due to my diabetes I need to drink 3 liters of water. (My doctor's orders) also if I am low carbing she wants me to drink 1-2 more liters of water.

[Benay]

I know due to my diabetes I need to drink 3 liters of water. (My doctor's orders) also if I am low carbing she wants me to drink 1-2 more liters of water.

Wow, that sounds like a lot of water! Have you found any references that support that recommendation? Did she tell you why she wanted you to drink so much water? Just curious.

I don't have my table of references in front of me, but I think 4 liters is an imperial gallon whereas 4 quarts equals a US gallon. In other words, a liter is a larger quantity than a quart. Or is it the reverse? 5 liters of fluid a day seems like a lot..

I wonder if she is worried about your kidney function. As a diabetic, there is some cause for concern -- or is that a valid statement? I have also heard that GPs on the whole have heard that the Atkins Diet will give you kidney problems so the extra fluid is to counter balance that too.

[Meme#1]

Also-Keep in mind that some meds are metabolized through the liver and some meds are metabolized through the kidneys.

[CMCM]

I seem to be thirsty and need to sip a lot. However, I no longer count how many glasses of water I drink nor do I have a particular goal. I drink to my needs, which I know is plenty but not excessive.

[Oldbird]

I know due to my diabetes I need to drink 3 liters of water. (My doctor's orders) also if I am low carbing she wants me to drink 1-2 more liters of water. My goodness that's a lot of fluid! 1litre = 1.76pints.

[Liz53]

I seem to be thirsty and need to sip a lot. However, I no longer count how many glasses of water I drink nor do I have a particular goal. I drink to my needs, which I know is plenty but not excessive.

This. If you're thirsty, drink water. If you're not, don't. Unless you have special reasons like Lessara. The amount you drink may change from day to day and it will change with different climates. When I lived in Houston I drank a lot more water. I didn't have to think about it, I was thirsty more often.

Benay, the nephrons in your kidneys are not damaged by proteins, they are damaged by sugar and hypertension. Now if they are already damaged, they may have trouble filtering proteins and that's when the recommendation to reduce protein comes in. But there are plenty of doctors who think low carb (and perhaps higher protein) is the way to go even with advanced kidney disease. Just the other day I was reading in Dr Bernstein's book that some forward thinking dialysis centers recommend that their patients add olive oil to the diets to make up for calories lost when cutting back on carbs and protein.

[Benay]

This.Benay, the nephrons in your kidneys are not damaged by proteins, they are damaged by sugar and hypertension. Now if they are already damaged, they may have trouble filtering proteins and that's when the recommendation to reduce protein comes in. But there are plenty of doctors who think low carb (and perhaps higher protein) is the way to go even with advanced kidney disease.

If I could just get my friend's GP to read this. Otherwise Liz you are preaching to the converted (or is it saved?) In other words, I already knew this. What made you think I didn't? If I gave you the wrong impression of my ignorance of basic human physiology, I apologize. It was my friend's GP (a physician) who went ballistic when my friend said she wanted to go on an Atkins diet. The GP was almost screaming that all that protein would destroy her kidneys. It wasn't me. Blame the Ancel Key's trained physician.

I plead ignorance to the effects of long term diabetes on kidney function. So are you saying diabetes (free floating BG) creates dysfunctional kidneys? What about increased insulin levels to counteract the BG? Does that impact the kidneys too? Although both my brothers died from congestive heart failure that I attribute to their diabetes, they never tested out as having any kidney dysfunction. And they didn't have hypertension. So my question about the relationship between diabetes and kidneys was an honest one based upon my lack of experience. Thanks for trying. I am glad to see there might be a slight shift in thinking on the part of some MDs about protein in the diet.

[Liz53]

If I could just get my friend's GP to read this. Otherwise Liz you are preaching to the converted (or is it saved?) In other words, I already knew this. What made you think I didn't?

I plead ignorance to the effects of long term diabetes on kidney function. So are you saying diabetes (free floating BG) creates dysfunctional kidneys? What about increased insulin levels to counteract the BG? Does that impact the kidneys too? Although both my brothers died from congestive heart failure that I attribute to their diabetes, they never tested out as having any kidney dysfunction. And they didn't have hypertension. So my question about the relationship between diabetes and kidneys was an honest one based upon my lack of experience. Thanks for trying. I am glad to see there might be a slight shift in thinking on the part of some MDs about protein in the diet.

Sorry, i mis-read your initial post on the extra water for kidneys because of low carb. I know you are well read and well educated. It's curious to me that docs recommend extra water for those with early kidney disease, but as kidney failure approaches, water is limited. I sometimes wonder if all that extra water doesn't tax the kidneys.

The nephrons as i understand it (and as best as i can remember, i'm on a plane and don't want to spend the extra $$$$ to research this at the moment), the nephrons are fed by small capillaries which get gummed up with AGES. I don't remember for sure but i also assume that the increased pressure of hypertension can blow out those same capillaries. Once the blood supply to the nephrons is compromised they begin to fail.

Both my parents had severely compromised kidneys before their death, both prob brought on by smoking. My mom was on dialysis for a few weeks. Ugh. My cat also has had advanced kidney disease for almost 6 years and is thriving on a high protein, grain free diet.

[Benay]

Liz, thanks for this information --much appreciated.

Thanks for mentioning your cat with renal disease. I have an 11 yr old dog with renal failure. The vet has her on hypertension meds which is controlling her disease. Her half sister died of renal failure before I found out what was wrong with her--she just lost her appetite. So when her older sister lost her appetite, I headed to the vet to see if she had the same problem.

All my dogs are/have been on low carb diets from birth so it is not carb related. Too much protein and not enough fat? That's quite possible.

None of my other puppies from the same mother have had the same complaint, so I am not sure of the genetic component-- but these are the only 2 I have ever had with this disease and they did have the same mother.

So for my dog, the issue is hypertension not carbs -- but it could be the protein/fat ratio. I will have to look into this.

[Liz53]

Liz, thanks for this information --much appreciated.

Thanks for mentioning your cat with renal disease. I have an 11 yr old dog with renal failure. The vet has her on hypertension meds which is controlling her disease. Her half sister died of renal failure before I found out what was wrong with her--she just lost her appetite. So when her older sister lost her appetite, I headed to the vet to see if she had the same problem.

All my dogs are/have been on low carb diets from birth so it is not carb related. Too much protein and not enough fat? That's quite possible.

None of my other puppies from the same mother have had the same complaint, so I am not sure of the genetic component-- but these are the only 2 I have ever had with this disease and they did have the same mother.

So for my dog, the issue is hypertension not carbs -- but it could be the protein/fat ratio. I will have to look into this.

With cats, especially Persians, renal failure is very common. Most persians have very small kidneys and the are easily taxed, so there is definitely a hereditary component. In fact the breeder warned my mom (who had my cat first) to give her spring water only, not tap. I don't know if there were originally dietary recommendations that may have helped, my dad changed her diet after my mom died. i am of the impression that protein does not *cause* kidney disease, only aggravates existing kidney disease and then only maybe. She's 18 now and is remarkably vigorous for a cat who has had known crf for almost 6 years.

[inflammabl]

So now that we are discussing cats and dogs, I'm assuming the thread is thoroughly hijacked.

I tend to use what is helpful to me. As a retired researcher and teacher of research methods at the university/post graduate level, I look very closely at the methods used in publicly published research and critique it for myself before I accept or reject it. I am very critical of research that is based upon an inadequate literature review (like the USDA Guidelines). I am also very critical of conclusions not based upon hard data. I am particularly critical of recommendations that generalize beyond the selected sample. But this is just me and highly colored/influenced by my background. I do not like sloppy work.

And just as another aside, I have been reading dieting research since the 1970's (before computers) with an eye toward discovering the characteristics of a successful dieter. And, like Jimmy, I tried all the published diets, and attended for profit weight loss programs, as well as university programs and OA, all without success. It wasn't until I tried PP that I lost significant weight and kept most of it off. Reading about dieting can probably be categorized as a hobby. I have read a lot of trash along the way too. So when I see someone experimenting on himself, I read more of that person's journey.

Sorry for the long winded answer to your brief question. For some reason I felt I had to defend myself.

Criticizing researchers doing inadequate literature review warms my heart. So Benay, what is the scientific, quantified, definition of nutritional ketosis?

[Benay]

Criticizing researchers doing inadequate literature review warms my heart. So Benay, what is the scientific, quantified, definition of nutritional ketosis?

You know, Inflamabl, I just don't know. I can't answer your question. You and I seem to be reading the same literature so your best guess is as good as mine. I don't recall reading a study that quantified nutritional ketosis but I will be happy to look for it. I am somewhat obsessive about getting my questions answered--or I wouldn't ask them.

So lets both go on a search to see if we can answer your question. Are you game?

[inflammabl]

I've found a definition of ketosis and another for nutritional ketosis. The former I believe. The latter I do not as I have not seen the data and I am not confident the method was applicable to LCers. As the latter is the crux of JM's argument it is important to pin it down and take it apart.

[Oldbird]

Benay, take note of your signature.. :lol:

A Happy and Healthy 2015 to all here. :)

[Benay]

http://www.lowcarbfriends.com/bbs/nutritional-ketosis-high-fat-low-carb/797488-basics-nutritional-ketosis.html I've found a definition of ketosis and another for nutritional ketosis. The former I believe. The latter I do not as I have not seen the data and I am not confident the method was applicable to LCers. As the latter is the crux of JM's argument it is important to pin it down and take it apart.

Would you mind sharing these definitions?
----------------------------------
Here is a “definition” of nutritional ketosis based upon the Volek and Phinney books. Blood ketones somewhere in the range of 0.5 to 3 mmol/L—whatever that means. [/URL] http://www.lowcarbfriends.com/bbs/nutritional-ketosis-high-fat-low-carb/797488-basics-nutritional-ketosis.html (http://lowcarbdiets.about.com/od/glossary/g/what-nutritional-ketosis.htm)
____________________
This definition is from Wikpedia—for what it’s worth: Ketosis /kɨˈtoʊsɨs/ is a metabolic state where most of the body's energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis where blood glucose provides most of the energy. It is characterised by serum concentrations of ketone bodies over 0.5 millimolar with low and stable levels of insulin and blood glucose.[1][2] It is almost always generalized, with hyperketonemia, that is, an elevated level of ketone bodies in the blood throughout the body. Ketone bodies are formed by ketogenesis when liver glycogen stores are depleted. The main ketone bodies used for energy are acetoacetate and β-hydroxybutyrate,[3] and the levels of ketone bodies are regulated mainly by insulin and glucagon.[4] Most cells in the body can use both glucose and ketone bodies for fuel, and during ketosis free fatty acids and glucose synthesis (gluconeogenesis) fuel the remainder.
___________
The medical dictionary gives no hard data: [URL]http://medical-dictionary.thefreedictionary.com/ketosis
----------------
Here is another with no reference: How do you know when you are in nutritional ketosis? http://www.lowcarbfriends.com/bbs/nutritional-ketosis-high-fat-low-carb/797488-basics-nutritional-ketosis.html When you are in nutritional ketosis, your body is converting your stored fat into ketones that are sent into your blood stream to be used for energy. The more fats you’re burning, the more blood ketones you will have.

Since I love playing with data, once I discovered that blood ketones can be measured directly and accurately, I immediately bought the test kit. After a pinprick, a drop of blood is placed on a test strip that is measured by a small machine.

A ketone measurement between 0.5 – 3.0 mmol confirms that you are in nutritional ketosis.

The primary resource I used for this was The Art and Science of Low Carbohydrate Performance
-----------
The New Atkins for a New You (pg 287) talks about nutritional ketosis but gives no numbers. It is not listed in the index.
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Pg 103 of the Coconut Keto Diet talks about ketones in his chapter on Dietary Ketosis, but does not reference the data. He does have a very long list (49) of publications as the basis for the chapter in his bibliography at the end of the book but does not directly reference them.

“The level of ketones normally present in the blood after an overnight fast is usually 0.1 to 0.2 mM/L but can be as high as o.5 mM/L. . . .Ketosis after a water only fast does not become substantial until 3-5 days have elapsed. After a week or more of fasting (or carbohydrate restriction) non-diabetic individuals have ketone levels of about 5-7 mM/L.” He goes on to say these levels do not get any higher no matter the length of the fast. “You can’t go in to ketosis unless your carbohydrate consumption is low” (below 40 GM/day)

My paraphrase: On a no-carbohydrate diet you will go into ketosis in 2-3 days. On low-carb--depending on amount of carb-- It usually takes 5-7 days.
-----------------
I looked at the 2002 version (Quill edition) of the Atkins New Diet Revolution. Chapter 6 discusses ketosis which he renamed lipolysis – a term that never caught on. He does not give numbers. Among his many references to studies is the Beniot 1965 study that many others refer to; as well as 1980, 1983 a,b Phinney studies. I get the impression that it is Volek & Phinney who coined “nutritional ketosis.”

In the early works, the concern seemed to be to differentiate simple ketosis from ketoacidosis. Today's work--Volek and Phinney -- wants to specify even more specifically by using the term 'nutritional ketosis.'

This is just a swift perusal of the first page of references in a Google search and the books at my elbow. How are you doing?

[teaser]

Ketosis /kɨˈtoʊsɨs/ is a metabolic state where most of the body's energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis where blood glucose provides most of the energy. It is characterised by serum concentrations of ketone bodies over 0.5 millimolar with low and stable levels of insulin and blood glucose.[1][2] It is almost always generalized, with hyperketonemia, that is, an elevated level of ketone bodies in the blood throughout the body. Ketone bodies are formed by ketogenesis when liver glycogen stores are depleted. The main ketone bodies used for energy are acetoacetate and β-hydroxybutyrate,[3] and the levels of ketone bodies are regulated mainly by insulin and glucagon.[4] Most cells in the body can use both glucose and ketone bodies for fuel, and during ketosis free fatty acids and glucose synthesis (gluconeogenesis) fuel the remainder.

I'd switch "most of the body's energy supply" there to "most of the brain's energy supply." Even in starvation, most of the body will be fueled by free fatty acids, not ketones. If we're going to agree on a definition of nutritional ketosis as being the state where most of the brain's energy is supplied by ketones--well, I've seen Jeff Volek in interviews stating that when 1.0 millimolar of ketones are in the blood, as much as one-half of the brain's energy supply might be provided by ketones, so assuming he's correct, maybe that's a decent cut-off point from that perspective. The definition above contradicts itself, I think--because .5 millimolar is too low for ketones to be most of the brain's energy supply, let alone the body's.

Since this isn't like pregnancy--you can be a little ketotic--it's all about agreeing on a degree of ketosis.

[inflammabl]

When you are in nutritional ketosis, your body is converting your stored fat into ketones that are sent into your blood stream to be used for energy.
This poster was incorrect. Ketosis can use either dietary fat or stored fat.

How are you doing?
I've been down that road already and came back unsatisfied.

I get the impression that it is Volek & Phinney who coined “nutritional ketosis.”
I think teaser said that in this thread. For something so important, I'd think it would have a better definition.

[Liz53]

I've been down that road already and came back unsatisfied.

I think teaser said that in this thread. For something so important, I'd think it would have a better definition.

What do you think is missing from the definition? What WOULD satisfy you?

Have you had your appt with Dr Westman yet? Perhaps he can shed some light for you?

[inflammabl]

What WOULD satisfy you?
Probably nothing. :) There is a level of certainty where I will shut my mouth though. :D I'm never satisfied in my own research. I tend to take big swings while being very skeptical of work I didn't lay hands on.

I would like to know where JM gets his assertion than a serum ketone level of 0.8 is optimum. I don't think there is a good basis for it and, again, it's the crux of his argument.

Have you had your appt with Dr Westman yet?
I was wondering if anyone remembered! We had a good time, talked a lot about stuff but not optimal ketosis and he said I would really like the LC cruise. I've got a bunch of blood tests to do. I'll post an update when I get the test results.

[Liz53]

Probably nothing. :)
I would like to know where JM gets his assertion than a serum ketone level of 0.8 is optimum. I don't think there is a good basis for it and, again, it's the crux of his argument.


I was wondering if anyone remembered! We had a good time, talked a lot about stuff but not optimal ketosis and he said I would really like the LC cruise. I've got a bunch of blood tests to do. I'll post an update when I get the test results.

I assume JM found that .8 was optimum for HIMSELF. I do not recall him telling us we should all do what he did, instead I remember him encouraging us to use our meters and keep data like he did to find our own optimum levels.

I gotta admit I'm a little envious of you working with Dr Westman. I definitely want to hear your update.

The abstract expressionist painter Willem DeKooning spoke of dissatisfaction in his own work (and an art critic, I think, termed it Divine Dissatisfaction). De Kooning used it to propel himself to push further and further to express himself more articulately (visually). Hopefully you can use your dissatisfaction to find the answers you seek.

[inflammabl]

My wife accuses me of being like a wolf. Two modes: hunting and playing.