Hello,

I used to frequent this forum years ago - I think it was around 2000...I was doing general low carving (carb restriction). I am here again, this time trying the Ketogenic diet. I wonder if there are others who are also starting this diet? Anyway, happy to be back!

Welcome back, Keto
There are many on this forum who do some version of a Ketogenic diet, even if they fall into it accidentally by doing a strict Atkins/Westman diet.

I reserve the term for a true therapeutic Ketogenic diet where you are monitoring blood glucose and ketones to keep a tight ratio of 1 or lower, but it has become a popular term used everywhere this year. Even Time magazine had an article on it, "it is all the rage"!
http://time.com/4609015/ketogenic-diet-explained/

Since you don't have to lose weight, Do you have a medical condition you are trying to manage with it? Amy Berger and I are in the minority on this view of when Ketogenic is necessary, but she has some good posts to help evaluate when its use is beneficial. http://www.tuitnutrition.com/2015/0...-ketogenic.html and Keto myths http://www.tuitnutrition.com/2016/1...diet-myths.html and others in her series of rants

All that said, I try to maintain Ketogenic ratios since I have a history of cancer and have been doing Dr Westman's diet for six years. So much information is now available on keto everywhere on the internet. I have Maria Emmerich's two latest Keto books (Quick & Easy, Cleanse) from our library, of all places. The newest Cleanse one is in Costco too. All rather amazing considering that a few years ago people were still eating egg white omelets in non-stick pans and now they embrace 80% fat

All the best,

Hi Janet,

Thank you very much for taking the time to write! I will check out the links you have provided. I probably should have written more of my background in my original post.

I got interested in the Ketogenic Diet after reading a book called "The Art and Science of Low Carbohydrate Performance" by Dr. Phinney and Volek. Evidently, DR. Phinney is one of the top researchers and experts in the field of nutritional ketosis and the Ketogenic Diet. (Their target numbers are 60-75% fat and 15-30% protein.) My goal is to get my body to adapt to burning fat for fuel (keto-adapted) instead of burning glucose for fuel. Evidently, keto-adaptation (which is different from getting into ketosis) takes several weeks, but I would like to try it. Dr. Phinney does not especially advocate using keto sticks because this tool only tests one type of ketones (acetoacetate) and acetoacetate gets converted to beta-hydroxybutryrate once you are keto-adapted (the book is pretty techinical.)

The reason I am doing this is to 1) improve my athletic performance and 2) Improve my cholesterol and glucose panel.

I am a competitive volleyball player (at my age - 58, which is surprising, right? I play in a co-ed competitive league with a bunch of young people) have been feeling very sluggish lately, and get so very tired. It could be the age too, but I know plenty of old people riding bikes for hours on no end, so I wanted to improve my athletic performance. Another thing is I am prediabetic with high cholesterol (A1C of 5.7 last time, and I managed to lower my cholesterol with phytosterol, but I don't want to do that.)

I am sorry to hear about your cancer, but I have read some cancers are glucose driven, so it makes sense.

One question - Which sub forum should I be posting under if I have questions in regards to the Ketogenic Diet?

Thank you!

Best forum for keto diet questions would probably be the "General low carb" sub-forum. The only subforum committed to a specific plan that gets much traffic is the Atkins one. I think there are just so many different plans out there these days that people that it's hard to pin people down to a specific plan sometimes--I've been influenced by Atkins, the Eades, Dr. Bernstein, Dr. Fung, etc.

I agree with Jey that the word ketogenic is sort of overused, I benefit from a diet that's probably more ketogenic than usual--I say probably because I don't have a blood ketone meter, and usually don't measure blood glucose--but my diet is very tight, 65 grams of protein a day and about 20 grams glucose, it's possible I'm not in ketosis, but if I'm not at this level of intake, that would make me a bit of an outlier. Go to a lot of keto facebook pages, or at least pages with keto in the name, and people will tell you that protein can't take you out of ketosis, maybe harmless advice if you're 24, male, and trying to cut for a bodybuilding competition, but very bad advice if you're looking for a therapeutic effect that does require a higher level of ketosis--I use the diet for improvement in mood, I'm bipolar and have social anxiety. In proper keto, I write paragraphs like this one, blah blah blah but if I eat a less ketogenic diet, a lot of the time I'll be too shy, or look too critically at what I've written and end up deleting it. I also have a tendency to binge which disappears entirely when I eat at these levels. Double my protein intake and leave carbs the same, and a serving of peanuts becomes a pound (which of course makes my intake even less ketogenic), but I can be happy eating an ounce of peanuts and stopping there, as long as I fit it into that protein and carb limit.

As far as the urine strips go--I do think that they're better than nothing, you can assume that you're in some level of ketosis if they're turning colour, it's just not that quantitative.

This seems a bit rambling, but I'm going to post the whole thing anyways, just to not give in to social anxiety.

Ah, for performance, good for you still playing volleyball. Going full-on keto will help you beat those youngsters. And I agree with teaser that "at our age" moderating protein will likely be necessary, more to the 15% side than 30%. In Maria Emmerich's new book, she writes 50 to 75g protein for "most people"..right where teaser is.
Phinney & Volek are your top resources for performance, the DietDoctor website has a number of Dr. Phinney's and Dr. Volek's lectures which will give you more information than the book. https://www.dietdoctor.com/?s=phinney&st=any Also the IHMC series of lectures has had both for talks on performance https://www.youtube.com/watch?v=cSKDsI0i2uM Also Dom D'Agastino..the entire IHMC YouTube channel of lectures is great. Then there are all the athletes who have gone Keto...Ben Greenfield did extensive tests on it a few years ago already. So many Keto sites for performance but it is another world, and like Reddit the quality of the advice can be iffy. My doctor wrote a book with Phinney & Volek so I lean to reseachers like them for information. When I want to check my glucose:ketone ratio (which is not often due expense of strips ) it is BHB in blood.

Thank you very much for your replies.

teaser,

Yeah, I agree - I am not interested in a blood monitor either (or very expensive sticks) just to check my BHB either. It's great your way of lowcarbing is working for you. Keto or not, if you are getting the outcome you want, that's all that matters.

Janet,

I do enjoy Phinny's video's also. He is rather entertaining, don't you think? I do see so much information online, and I agree - we need to be selective, and I think Phinney is a good one to stick with. Him and Jason Fung do not seem to agree on benefits of intermittent fasting, which seems kind of interesting. Your glucose:ketone ratio thing sounds interesting.

What do you all think about physiological insulin resistance? I get that as a lowcarber, you become more insulin resistanct (your body is slow at releasing insulin when carb is ingested, since your body is used to burning fat for energy, but not carb, hence you will have to eat carb for a few days to get your body accustomed to handing carbs, to even get an accurate GTT test, etc), but what I don't get/understand is why the fasting glucose level goes up for many LCHF individuals (maybe this is the case only for people with a starting normal/semi-normal blood sugar, I don't know...) and more so over time and eventually, even A1C. This is a bit concerning to me, because although my high peaks are stunted with the Ketogenic Diet, my fasting glucose has been registering higher; in fact a little over 100 now which I am not used to (was lower before) and don't particularly like. I know protein changes into glucose to some extent, but my protein intake is not high (I just started fitday and it tells me the last 3 days consumption was 21% protein 70% fat and 8% carb)... What's your opinion on this? Phinney doesn't address this as far as I know.

I think you don't know what your blood glucose will do until you try it. My blood glucose is fairly dull, like I said I haven't checked it lately. Eating Atkins, probably around 100 grams of protein and 20 grams of carbs, it generally shows in the 80s or 90s. If I drop the protein down to around 60-80 grams, I'll show in the 70s or 80s, more often in the 70s. I've tried wasting a bunch of strips and measuring every hour or so--usually it will dip down to the 60s about once a day. Also, testing showed that my highest glucose of the day wasn't after meals, it was after the stress of doing deadlifts. I could go from 80 to 140 with a set of deadlifts. Eating more ketogenically, blood glucose still goes up with deadlifts, but it's more like 10 to 20 points.

I would like to get a ketone blood meter some day and see how well mood actually correlates with blood ketones.

I sort of got on this whole thing by accident. A few years ago, a friend went hunting near my house, he got a deer. Called up in a panick because he couldn't get it home alone. We had ATV's but you couldn't get to the deer with them. Ended up carting it out in the dark, with a fellow only slightly more than half my age--but the rests were all for him. Earlier that day, I'd made some fat bombs to snack on, supposed to last for the week. But I binged and ate them all that morning. So I was sort of stuffed, didn't get any other food in. Helped with the deer, got home, didn't eat much, went to bed. Got up in the morning and worked out--and was shocked at how energetic I was. Also had a great pump--something I'd sort of lost over the years. People say you need the carbs for that, but that's not all that's going on, I think some aspect of insulin resistance was still affecting me even on a low carb diet. I checked my blood glucose--and it was in the 60s, the lowest I'd seen before that was a 72, and that was after drinking what I thought was a diet coke but turned out to be a regular coke in a grey special edition Christmas can.

Thank you for your post teaser. I definitely did notice my BS up after my last volleyball games (which got pretty intense - kind of like interval training) - Actually more so with this keto diet than before. Or I should say before the keto, I just assumed my BS was high due to the carb load before my exercise, but now, with almost no carb with low protein, it was high after exercise. I researched and evidently, this is pretty common - Like you suspected, vigorous exercise causes your BS to spike due to stress hormones going up. I wonder if this will stop once we get keto-adapted? I don't know, but I would like to know. My base BS is much higher than yours, and I don't want my BS to end up where prediabetics are because my Doc will freak.

It sounds like you are on the hypoglycemia side of things - 60's is a little too low? It sounds like you had your own GTT test - Like I said, people who don't eat carb cannot handle high carb. With sugar ladened coke, your sugar level most likely went up too high and came down too low.

Anyway, from what you said, I don't think you have the problem I have - my fasting glucose level creeping up on LCHF. But you did say you haven't been checking so I don't know for sure. I would be so happy to have a fasting glucose of 80's wit this diet. I will stick with this diet, but I want to know what this physiological insulin resistance is about - is it transient? What can be done about it? Or it is our ultimate fate?

Maybe hypoglycemic in a strict sense of less blood glucose than usual, but I doubt in the sense of insufficient blood glucose for well being.

I guess one more thing to ask is how much you're actually eating? Ketogenic ratio is one thing, ketogenic load another. You're obviously not at a point where you should be cutting calories, so maybe you could use a bit more fat in your diet?

Funny you should ask about PIR. In January 2013, after 2.5 years LC, my BG per lab was 101 after drifiting up from the 80s, and I had been seeing 100-115 a lot at home. And when I restarted fasting this week, darn if the 100s didn't come back (though this morning was 80 again, so who knows? I now take the accuracy of home meters with a big grain of salt ).

Anyway, I wrote Dr. Westman (a patient can communicate direct) an email subject Does “Physiological Insulin Resistance” exist? And does it matter?
Part of his answer was: "I think you are making an assumption in each question below, that the 'normal values' and 'predictive ability' of measurements used routinely today in medical/preventive care, have predictive ability under nutritional ketosis circumstances.
ALL of the predictions about low carb diets were false, when data from other 'mixed diet' circumstances were used to predict what would happen under low carb conditions. In other words, you are comparing 'apples to oranges' (okay: 'bacon to brie')."

He pulled Dr. Phinney in to add to the conversation. Part of Dr. Phinney's answer was (back in Jan 2013):
"All of this was 'purely academic' until last month, when a well-regarded research group in San Francisco published a paper in 'Science' demonstrating heretofore unknown beneficial effects of beta-hydroxybutyrate (BOHB, the principal 'ketone' in human metabolism -- see attached paper if you are interested in the hard core science). What this group showed was that BOHB is a potent regulator of a group of genes that determine our body's defenses against oxidative stress, and that this effect is achieved at levels of BOHB in the blood are easily achieved on a well-formulated ketogenic diet.

Put another way, what Eric Verdin's group has shown is that besides being an excellent and continuously available fuel for the brain (as long as dietary carbs are kept low and protein moderate), BOHB is also a potent signal that stimulates genes protecting us from oxidative stress. This observation answers a number of questions that have been bugging us for a few decades, such as how a well-formulated ketogenic diet can reduce the body's level of inflammation.

So if your diet is keeping your level of oxidative stress low, then this should be reflected by a normal level of HbA1c independent of how 'high' your glucose and insulin levels might stray. And as Dr. Westman noted, the usual normal range of for fasting insulin from 3-17 has never been validated for keto-adapted humans (and given this range, none of your values are 'high'). [My fasting insulin is usually less than 5, that lab it was 9 something, so up but not bad]

All of us who were trained in allopathic medicine (ie, those of us with an 'MD' after our name) have been inculcated with a passion for reductionism. We want to attribute everything to just one causative 'agent'. In the low carb arena, insulin is an inviting reductionist target; so much so that some of our esteemed colleagues have openly declared "war on insulin". In truth, however, insulin is just a communication from some of the body's more basic responses. By analogy, declaring war on insulin is about as logical as declaring war on telephones if you don't like getting robo-calls."

Both doctors are entertaining, and I now add Dr. Fung to that select group. He has answered the "why did my BG rise when fasting?" many times on his site and DietDoctor. One of them:

Q: Should i worry if my blood sugar while fasting goes up to in the 140’s [Around 8]?

A from Dr Fung: This is quite common, and due to breakdown of glycogen or production of new glucose in response to some of the hormonal changes of fasting. It is neither good nor bad.

Think of it this way. Your body is simply moving sugar from its stores (glycogen and fat) and pushing it into the blood. Here your body has a chance to burn it off.


Seeing 99 is Ok but 101, I freak out...which is completely silly, especially with a home meter. These small rises in BG when you are eating a very ketogenic diet or fasting should not be compared to the normative values of labs for SAD folks, and there is a logical hormonal reason for them to do so. Most of my reading on PIR was from back then, but easy to find with Google. For myself, if I stray from VLCK on holidays and eat more carbs, BG goes back to the 80s very quickly.

Thank you very much teaser, and Janet, for your replies.

teaser,

Thank you for your tip on the fat intake. I have tried to do more fats at the for dinner, as well as having my dinner earlier and the last two days, my GS is down in the 80's so it is looking good.

Janet,

Thank you for your detailed answer (and sharing what Jason Fung said). Unfortunately, I didn't understand the physiological insulin resistance explanation of your doctor (BTW, it must be nice to have him on your side :-) or Phinney, except the part about "as long as A1C is low, it's OK even if insulin and fasting BG is high". It was just too technical. If you can bring it down a notch or two, I might get it ...

Don't worry, I've never completely understood PIR either, but figure I have a world class LC researcher as my doctor and he assures me all is well, so at some point I have to go with it

This was the article I was using back in 2013 but now that I read it again, it is probably more confusing. http://ketopia.com/high-blood-sugar...and-metabolism/

Dr Westman's response, as it is with Cholesterol as well, is that the lab values, the ones they take from a large sample of customers to establish the "normal range" you see on your blood tests, is based on SAD eaters. Ketogenic dieters may have different "normals", e.g. Maybe our top BG normal should be higher because our body is pushing stored energy into the blood in the morning.
This explanation was even clearer with my Trigs...they have been around 30 for years now. One year there was a note from the lab that they retested and checked the Trig number because it was below "normal range"...but low Trigs are "normal" for Ketogenic.

I decided months ago that I was going to stop measuring my bg's. Despite eating very low carb, the number was often elevated above 100 although never above 120 and hardly ever as low as 80. I figured that I was eating a ketogenic diet consisting of only real foods. I just couldn't do better than that so why worry. A few weeks ago I did a home HBA1C test. It was 4.9. The last time I did it it was 5.0. I figure I'm doing ok so no more measuring for me.

Jean

Thank you so much for your reply! I understand what you are saying.. And your triglycerides number is so very good (something to strive for! Funny they even rested it!). I imagine your HDL is good as well.

Thank you very much for your response, and sharing your thoughts. I hear you - I feel the same way about my fasting glucose, but so far, it has been lower, so I will wait and see how it fares later on...

As for the home H1C tests, just a word of warning - I would not trust the results at all. You can do a search online - it doesn't seem to matter which product - they do not work. I bought a couple of the kit myself before doing online searches, and the results were way, way off from the actual lab test. Not even close.