Question for GeorgeN

Pretty much 24/7 NSR has left me with little motive to visit this site which is in stark contrast to my situation several years ago when I followed Afibbers almost religiously. I had a series of outbreaks 8 months ago but they were nothing like the 48 hour episodes I use to endure. My regimen is pretty much the standard trio of supplements plus a bunch of others often talked about by Jackie.

What brings me here today are some thoughts I've had recently about ketogenic diets. I've been back and forth about the subject a number of times and whenever I do start to think about ketones I always recall George's endorsement which was my very first encounter with the subject. So my question for you George is whether your thinking about the benefits of eating a fairly strict ketogenic diet have changed over the years?

Thanks so much..



Edited 1 time(s). Last edit at 06/20/2015 11:53PM by Josiah.

Josiah,

I've been on the edge of a modestly ketogenic diet for a number of years. My currant variant is mostly raw, mostly plant based (low lectin - no grains, legumes or nightshades or high starch veggies) with relatively low saturated fat - most of the fat comes from high polyphenol extra virgin olive oil (unrefined) & avocados. I do eat pastured or omega 3 eggs and shell or white fish. Right now, 'cause I'd not been too strict (and my insulin and blood sugar were creeping up), I'm also fairly caloric restricted. After a few days, the blood sugar is now responding nicely - 75 mg/dL fasting.

So not the "popular" keto diet of relatively high meat & fat plus a few non-starchy veggies.

I pretty much eat off this list, but with the above exceptions, avoid animal/dairy fat (cause of my genetics): <[www.dropbox.com]

"Keto" diet implies a focus on macro nutrients (carbs, protein, fat). I also pay a lot of attention to micro nutrients Terry Wahls and her program to keep MS in remission - her TedX talk is worth watching <[terrywahls.com] <[terrywahls.com] , tracking nutrients (free tracker) <[cronometer.com] , gut microbiome <[www.drperlmutter.com] and autoimmune - hence Dr. Gundry's Matrix diet linked above (he's coming out with a book addressing autoimmune issues this fall). Gundry is one of the few who tests for ApoE4 gene and modifies his protocol based on the results - E4 is at higher heart and Alz Disease risk.

George



Edited 1 time(s). Last edit at 06/21/2015 01:24AM by GeorgeN.

Thanks a lot George. So if I understand you, your commitment to ketogenic is primarily for blood sugar control, but having the E4 variant of the ApoE gene precludes a lot of animal fats.

Josiah,

Yes that is a good summary.

A ketotic diet is one way to control insulin.

From my recent look at the data, insulin control is even more important that glucose (for both heart, Alzheimers and other chronic illnesses), fasting glucose being a fair indicator of insulin. That is fasting glucose can be normal (85 mg/dL or less, in my book), and you can still have an abnormal and excess insulin response. This is also true with post prandial glucose tests, such as an oral glucose tolerance test.

Dr. Kraft's point <[www.amazon.com] is that even many with normal glucose have abnormal insulin responses.

<[www.youtube.com]
<[www.diabetes-epidemic.com]

I'd like to see fasting insulin <5mIU/ml. For those in the US, you can order your own tests through <[www.walkinlab.com] to be drawn at a LabCorp near you. If you don't or can't do this, then a mirror or cloth tape can be used - you want essentially no belly fat.

George

Another thought. For afibbers, there is a risk of an electrolyte shift if they go keto - mostly during the several week conversion from a carb diet to a VLC (very low carb) one. This is because insulin signals the kidneys to either conserve (high insulin levels) or excrete (low insulin levels) sodium. When you go very low carb, adequate protein (protein in excess can also stimulate insulin), insulin levels will drop dramatically and signal the kidneys to dump sodium. This can also cause the kidneys to also dump potassium. Hence, if you do go VLC, best practices are to supplement with potassium and SODIUM (up to 5 grams/day). See Volek & Phinney's books <[www.artandscienceoflowcarb.com]#

The electrolyte supplementation can also mitigate what is known as "low carb flu" during the conversion.

Very early on, I got an afib episode during the VLC conversion. This was 5 years ago, and I was not aware of the admonition to supplement with sodium. More recently, I experience the "muscle tiredness" that can be associated with the electrolyte issue while skiing. In the middle of the day I ate miso soup, which is essentially salt and water. My energy level was hugely improved.

Just to have long periods of low insulin, right now I fast 22 hours out of each day, with a 2 hour eating window.

George

Hi George and thank you for taking the time to go into such detail. I haven't read Dr. Bernstein's book on ketosis but plan to do so as I'm helping a person who is working on lowering her consistently-elevated glucose level so she can avoid becoming a diabetic. I'm quite sure she is insulin resistant as well. Does Dr. Bernstein address the cause of insulin resistance in his book?...or Dr. Kraft... in this new source you mention?

Thanks,
Jackie

Hi Jackie,

Kraft isn't really a treating book. His point is he did (making this up from memory) 1) 3,000 autopsies (he says autopsies are only done today in a suspicious cause of death. Before they were much more routine) In these autopsies, what he saw convinced him that insulin was the primary cause of heart disease. 2) 14,234 one hundred g/glucose oral glucose tolerance (OGT) combined with a simultaneous insulin profile. His data show that even for those with normal fasting glucose and normal OGT many had abnormal insulin profiles.

As for Bernstein, you can read quite a few of the important chapters of his book online here <[www.diabetes-book.com] It is an excellent resource for someone with insulin resistance.

Another reference is Hans' International Health News where the Cambridge Diet is reported on. See <[www.yourhealthbase.com] <[www.yourhealthbase.com] <[www.yourhealthbase.com] Basically IR & T2 diabetes is "cured" with a low calorie diet in fairly short order.

It turns out my fasting blood sugar had crept up. So I went to eating once a day eating about 1,000 calories/day 60 g carbs of which 30 are fiber (still a big Walhs/Gundry salad), 50 g of protein from eggs & shrimp and the rest from EVOO & avocados. Took a few days, but my fasting sugars are now in the 70's and my ketones are around 3 mmol/L. This is a very low calorie diet for me. I still paying a lot of attention to feeding my mitochondria and microbiome.

George

George,

I'd like your opinion on my mystifying situation. This year and last my fasting glucose has been 95 which is a mystery because of the type of diet I have been following. When it was tested last year I had been on a diet recommended by an environmental doc who felt that I had been exposed to toxic mold. I had been following the diet for about nine weeks when I had my bloodwork done. My diet consisted of meat, fish, chicken, non-root veggies, nuts (roasted at home). No fruit, dairy or grains. It did use sea salt liberally on my salads. Around Christmas I added in very dark chocolate, and some coffee. At this point I have added in fruits and dropped the chocolate and coffee, but am still testing at 95. This seems incredible to me. My indulgence is cashews so I am not sure if this type of nut would increase insulin. Also my A1c is 5.3.

I have always considered myself hypoglycemic, in fact this was confirmed several years ago by s glucose tolerance test.

My functional med dr. didn't raise an eyebrow at the 95 fasting glucose either. I'm just baffled as to why I could follow such a strict diet and still have such high numbers. Could it be the metoprolol or eliquis?

Lynn,

I don't know about the meds. Here is an article on beta blockers <[diabetesupdate.blogspot.com]

Have you correlated your glucometer with a lab test? You can order your own <[www.walkinlab.com] if you live near a LabCorp (there are other internet services that will provide this service). I recently figured out my Bayer Ascencia Contour probably reads 10-15 mg/dL too low. It is consistent, but low.

Cashews are a carby nut. You might put a days worth of food into <[cronometer.com] (free) and see what comes out for macronutrients and carb levels.

Long term low carbers can experience high fasting glucose - browse the LC sites for info.

What is your fasting insulin? This is really more important than the glucose. If it is <=5 then you may not need to worry - can order through the Walkin Lab link above.

The A1C correlation with long term glucose is based on an assumption about red blood cell life - I think about 6 weeks. However under low glucose conditions the cells live longer and under high glucose conditions they live a shorter time. If they live longer, then they have longer to glycate. <[chriskresser.com]

{edit} Another thought, what is your glucose before a meal, then an hour afterward? Do your meals spike your glucose much? Don't know how much meat you're eating, but excess protein can cause glucose spikes. Those who are eating a "ketogenic" diet have found that excess protein intake inhibits ketone production.

George



Edited 1 time(s). Last edit at 06/24/2015 01:46PM by GeorgeN.

Last year's labs indicate that fasting insulin was 4.7, the glucose numbers were lab results as well. I have a glucometer, but have never taken the time to learn how to use it. I have been using chronometer for the last month which was what prompted me to drop fruit because carbs were going slightly over 100 each day. Without fruit I can keep them pretty low, but I see that the cashews did me in yesterday.

I find it intriguing that you are meat free, does that mean chicken too? I tried that for a few months a couple years ago, but I began experiencing more etopics, almost daily, and it subsided when added near back into my diet. I have wondered if it was an amino acid issue since the only amino I take is taurine. Do you use any other aminos?

Interesting about meat spiking glucose. I'll have to get that meter out and have ago at it.

Lynn,

My ApoE4 gene does not do well with animal fat, including chicken. I'm not a fan of grain fed animals as I think their fat is full of omega 6 fats. If I eat animal fat it is from grass fed animals. I do eat omega3 or pastured eggs, shell and white fish. I do supplement with taurine - 4g/day.

George