Ketosis Week 2

A very interesting week!  Having been in Salt Lake City from day 7 to day 11 was challenging–no car, no grocery store, no microwave…completely at the mercy of hotel, conference, and restaurant food.  Luckily I had a great pocket-sized travel scale (made by Salter, $29.95 on epicurious.com) to help me out, but most of the meats I ate while away were not my usual fare.

Day 8 (2/7/13)

  • Morning blood glucose:  90
  • Morning blood ketones:  1.4
  • Morning urine ketones:  moderate
  • Evening blood glucose:  96
  • Evening urine ketones:  high (80)
  • Protein:  76 g
  • Fat:  103 g
  • Carbohydrate: 23 g
  • Protein:Fat (cal) ratio = 1 to 3
  • Calories 1276

Foods:  turkey sausage, olives, cucumber, romaine lettuce, berries, balsamic vinaigrette, mint tea (no caffeine), smoked salmon, lamb, anchovies, endive.

Notes:  Very hungry with mild headache first thing in the morning and again at midday, but no appetite at dinnertime.

Day 9 (2/8/14):

  • Morning blood glucose:  91
  • Morning blood ketones:  1.4
  • Morning urine ketones:  high (80)
  • Evening blood glucose:  112
  • Evening urine ketones:  high (80)
  • Protein: 81.5 g
  • Fat:  106.3 g
  • Carbohydrate  20 g
  • Protein to fat ratio: 1 to 2.8
  • Calories 1357
  • Exercise:  none

Food:  Lamb, pork sausage, bacon, chicken, cucumber, romaine lettuce, balsamic vinaigrette, avocado, smoked salmon, BBQ beef short rib

Notes:  Very hungry with mild headache in the morning. Forgot my scale today while out and about, so overshot my protein grams.  Sleep disrupted (nightshade reaction from BBQ marinade, which contained poblano peppers and tomato–misunderstanding with waitstaff).

Day 10 (2/9/13)

  • Morning blood glucose:  102
  • Morning blood ketones:  1.2
  • Morning urine ketones:  moderate
  • Evening blood glucose:  92
  • Evening urine ketones:  high (80)
  • Protein:  81.5 g
  • Fat:  106 g
  • Carbohydrate  12 g
  • Protein to fat ratio: 1 to 2.9
  • Calories  1319
  • Exercise:  snowshoeing ~1 hour

Foods:  pork sausage, romaine, cucumber, avocado, balsamic vinaigrette, chicken, blueberry tea (no caffeine), bacon, smoked pork ribs, creamy italian dressing.

Notes:  This was first morning that I wasn’t extremely hungry with a headache first thing in the morning–I felt fine. Overshot protein again.  Appetite much lower all day.  After snowshoeing, when everyone else felt hungry, I was completely uninterested in food.  Easily sat in an ice cream/chocolate cafe with other people without any temptation whatsoever.

Now that my appetite has come down and I’ve completed 7 full days on my original plan of ~75 g protein (yet continue to see high blood glucose levels and only modest blood ketones), time to adjust the plan.

NEW PLAN:  Continue max carbs 30 but reduce protein to see if I can get ketones up to at least 4.0 mM and blood glucose down into the 60′s (Seyfried’s “zone of metabolic management”).

Day 11 (2/10/13)

  • Morning blood glucose:   91
  • Morning blood ketones:  1.2
  • Morning urine ketones:   moderate
  • Evening blood glucose:   94
  • Evening urine ketones:   moderate
  • Protein:  64 g
  • Fat:  91 g
  • Carbohydrate  16 g
  • Protein to fat ratio:  1 to 3.2
  • Calories:  1135
  • Exercise:  carrying luggage around to and from airport

Foods:  smoked pork ribs, pork sausage, romaine, olives, Italian dressing, duck, chicken broth, lemon juice, duck fat, fish oil.

Notes:  Mild headache in the morning but appetite low today. Traveled back from Utah.  Finally home where I have total control over my food again!

Day 12 (2/11/13)

  • Morning blood glucose:  79  (better!)
  • Morning blood ketones:  2.0  (better!)
  • Morning urine ketones:   high (80)
  • Evening blood glucose:  70
  • Evening urine ketones:   high (80)
  • Protein:  54.4
  • Fat:  134
  • Carbohydrate  30
  • Protein to fat ratio:  1:5.5
  • Calories:  1566
  • Exercise:  none

Foods:  Bacon, Guacamole, Olives, Turkey, Duck fat, Pork Sausage (meats left over from trip).

Notes:  Sleep light, eyes feel dry (this always happens when I eat olives). Hungry mid-day and at 8 pm, but not ravenous.  Very sleepy from 12:30 to 1:30.  Queasy early evening.  I usually do not eat pre-packaged guacamole–it was an experiment because there were no ripe avocados at the store and with protein so low, I needed to add more fat (and psychologically hard to adjust to even less meat, so ate too much fat?). The guacamole contained some onion and jalapeno, neither of which agree with me.  I don’t know if it was the extra fat intake and/or the guacamole itself which caused the sleepiness and queasiness.

Ketones and blood sugar clearly seem to care most about protein grams (as some of you had commented), and it is interesting to see how rapidly the ketones responded to the reduction in protein intake.  This gives me hope that If I lower protein even more, the ketones and blood sugar should fall into range quickly.

Day 13 (2/12/13)

  • Morning blood glucose:   63  (now we’re talkin’)
  • Morning blood ketones:  3.8  (wow)
  • Morning urine ketones:   max (160)
  • Evening blood glucose:  76
  • Evening urine ketones:   max
  • Protein:  54 g
  • Fat:  103 g
  • Carbohydrate:  13 g
  • Protein to Fat Ratio: 1 to 4.3
  • Calories:1262
  • Exercise:  none

Foods:  Chicken liver, Duck fat, Lamb, Olives, Cucumber, Fish Oil, Romaine, Avocado, Balsamic vinaigrette (new brand for me).

Notes:  Sleep light, eyes dry, mild tinnitus (ringing in ears), but felt better within an hour of waking. I got hungry at lunchtime, so I eyed the 2 little lamb chops in my fridge.  I thought to myself:  ”there is no way that those 2 wee lamb chops are going to do the trick.” Even worse, when I calculated how much protein I could have for lunch, I realized I should only eat ONE of these mini-meats.  Uh-oh. I cooked only one of them, and stared at its teeny tiny-ness, feeling like I could have easily eaten TEN of them.  But I ate just the one, and within 10 minutes I was not hungry any more. Wow. Sleepy late afternoon and took a nap.

I was aiming for 50 g protein today to see if I could get ketones up to 4.0, but didn’t realize that the avocado contained protein, so overshot by 4 grams.

Day 14 (2/13/13)

  • Morning blood glucose:  69
  • Morning blood ketones:  4.1  (success!)
  • Morning urine ketones:  max
  • Evening blood glucose:  79
  • Evening urine ketones:  High (80)
  • Protein:  51 g
  • Fat:  75 g
  • Carbohydrate:  18 g
  • Calories:  925
  • Protein to Fat ratio:  1 to 3.3
  • Exercise:  50 min walk

Foods:  Duck, Romaine, Cucumber, Avocado, Bacon, Smoked Salmon, Balsamic Vinaigrette, Kalamata olives

Notes:  Mild headache and dry eyes in the morning (I should really get rid of the olives…but they are so helpful–they have no protein, and are very low-carb and very high fat).  Bloated/heavy all day (?new vinaigrette yesterday?)

Day 15 (2/14/13)

  • Morning blood glucose:  69
  • Morning blood ketones:  4.6
  • Morning urine ketones:  max

Weight change over past week:  down 1.8 lbs
Total weight change since day 1 (14 days ago):  down 6.2 pounds

Notes:  Mild headache/dry eyes in the morning.  Bloated/heavy feeling again (I’m going to throw that vinaigrette away).  Not hungry in the morning.

Reflections on week 2:

While it’s still early in this experiment, it seems that protein grams are the most important driver of ketone levels–not calories, not fat grams, not protein to fat ratios. I am happy to see that I don’t need to eat MCT oil (which I’ve heard is terrible), palm fruit oil (which I know I don’t like or tolerate well), or increase fat grams any more to achieve high ketone levels.  Some of you very smart people who are very experienced with ketogenic diets were begging me to lower my protein intake sooner, and you were clearly right, but I was in no hurry with this experiment and wanted to wait at least a whole week to observe my own patterns.  I also wanted to stick with the protein intake recommended by the “experts” in the field for a full week to see if it would work for me (clearly not). I was also too hungry during week 1 to even think about eating less protein yet…anyway, thanks for not strangling me out of frustration!

Appetite level was very unstable during week 1 but really came down during week 2. On the final day of week 2, I was perfectly satisfied eating less than 1000 calories.  I wasn’t even trying to limit my calories that day, I just happened not to want any more food.

With appetite so much lower, I’m hoping I can cut back on the salads, because I feel better when I eat mostly meat.

I suspect that if I were to raise my calories by raising my fat intake, I would stop losing weight, but some of you have said that this isn’t true and that I should eat a lot more fat.  At least right now, I have no desire to eat any more than I’m eating, and my ketone levels are nice and high, so I feel no need to raise my fat intake.  My logic tells me that if I eat more fat, my body will burn more of that fat and therefore burn less excess body fat, which is the goal.  However, I would like to experiment with this once I’m fully keto-adapted.  After I’ve been in deep ketosis for a full month, I will try adding in more fat calories just to see what happens.  Or, if I get hungry, I will add more fat, of course.  I have no desire to be hungry on this plan–after all, one of the benefits of a ketogenic diet is supposed to be excellent appetite control.

What this experiment means for cancer patients

Of course this is just my own personal experience, and yours may be very different. However, it gives me hope that cancer patients may be able to rapidly achieve Seyfried’s “zone of metabolic management” by strict protein and carbohydrate limitation rather than fasting.  It does not appear as if calorie restriction is necessary, as he suggests (based on his mouse experiments).  My ketones rose nicely regardless of how many calories I ate.

Keep in mind that I’m not eating dairy products, which may raise insulin levels (see my dairy page), and therefore interfere with deep ketosis.  So, if you limit your protein and carbs but are eating a lot of cheese, heavy cream, sour cream, etc. and you find your ketones are not rising enough, you may want to eliminate dairy for a few days to see if that helps.

In the future, once I’m well adapted to this diet, I will be doing a variety of mini-experiments to see how (my) ketone levels, appetite, and weight are affected by things like dairy, artificial sweeteners, caffeine, excessive fat intake, etc., so stay tuned!

If there are specific experiments you’d like to see me try, feel free to suggest them in the comments below.

Goals for the coming week:  

To figure out how to present my data in graph or table form for easier reading

To further explore the relationship between fat grams, calories, and ketosis

To eliminate olives and the new vinaigrette to see if energy, sleep quality, bloating, and mild morning headaches improve.

To maintain blood ketones at 4.0 or higher

To bring morning and evening blood sugars into the 55 to 65 mg/dL range and keep them there.  What will I need to do to achieve this? I don’t think I should lower protein or calories any further…Will I need to increase exercise?  Get rid of all plant foods?  [Plant foods = carbs].  I have always felt best when I eat no plants at all, but while adjusting to the ketogenic diet I was pretty hungry and had to eat something….

Tune in next Thursday morning!

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  • Ted M

    MCT Oil is awesome. I don’t understand what you have heard the problems with it are? To get a full understanding of my perspective on MCT oil check out http://www.bulletproofexec.com and type “MCT Oil” in the search box.

  • http://profiles.google.com/nancy.milligan Nancy Milligan

    Verrrry Interesting! Despite Dr. Phinney saying I wasn’t getting enough protein when I limited it to .8 (kg of ref. weight) it would seem it was too high for me to really get into the sort of ketosis I probably needed.

    Since it seems like you and I have a lot of the same kinds of issues with blood glucose staying rather high on low carb, difficulty generating many ketones, difficulty losing weight, maybe Phinney/Volek’s protein recommendations are two high for the likes of us.

    Thanks for being a guinea pig. I might just follow you down this path. Just need to find some good high fat, low protein items to eat. I’ve always felt like I’m sensitive to dairy products, they make my body hurt. I also tend to gain weight when I use them.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Nancy

      I’m so glad the posts are helping you, and I’m actually a very happy guinea pig at this point. I was not a very happy guinea pig for the first week or so, but now that I’ve learned a few things about how to do this better, I’m very excited to keep going! I’m very sensitive to dairy as well (in the same ways that you are–of course!), but regardless, am curious to see how heavy cream will affect my experiment next month.

  • Libby

    Hi Dr. Ede–So glad I discovered you and your blog. Have been following your ketosis experiment with interest as it is something I have been looking into. Just started this ketosis stuff about a week ago and am still trying to work out the ratios. However I am finding that I am very hungry in the mid to late afternoon, so I am impressed with how you are progressing. It seems that once the ratios are dialed in and the blood sugar and ketones are at the proper levels this will hopefully dissipate.

    Apart from the ketosis experiment, I am in agreement with your philosophy about health and diet and also that everybody’s chemistry is unique. I am trying to read everything on your website –it will take awhile–going to watch the “Little Shop of Horrors” next. I seem to feel best without much vegetable matter as I have Crohn’s Disease, currently in remission but still have to very careful about what I eat, especially the vegetables! So I go from periods of very little veg (eating only the ones I tolerate well) to periods of this can’t be healthy, I need more vegetables. Most recently was the early January “green smoothie” experiment which just about sent me into a flare! Need to learn to ignore that little voice in the back of my head saying this can’t be healthy, eat a huge salad or some broccoli and just go with what works for me and my health.

    Thanks!

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Libby

      Thanks for reading and thanks for sharing your story with us here! If there’s one thing I’ve learned about vegetables, it is that people with digestive problems usually feel better if they avoid most of them as much as possible. I would be very interested in your opinion of my veggie video if you’d care to share it once you’ve seen it. I am convinced that I will suffer no nutrient deficiencies without vegetables so long as I eat some liver occasionally. There are some fruits that masquerade as vegetables–cucumbers, avocados, tomatoes, peppers, etc. and these may agree with you better than true vegetables, such as broccoli and onions. The best way to figure out which veggies bother you is to experiment with each veggie family one at a time. Good Luck!

      • Libby

        Thanks for the response! I do seem to do better with some of the fruits that masquerade as vegetables but try to limit my nightshades (so not a lot of tomatoes or peppers). I will definitely let you know what I think of the veggie video once I watch it.

        Had read recently that I might need to be adding in some liver, hoping I can get some quality liver from the farm where we purchase our most of our meat. I will look around on your site but any favorite ways to prepare liver (especially for a new liver consumer)?

        • http://diagnosisdiet.com/ Dr. Ede

          Hi Libby
          I can’t tolerate nightshades myself, so I understand. As for liver preparation ideas, I am definitely not your gal…I am the worst cook in the whole world! I just cut chicken liver into small pieces and saute it in duck fat until it’s brown on the outside and cooked through the center. Not too exciting…

  • bill

    Dr Ede:

    Consider your balsamic vinegar first. High probability it has sulfites/sulfates in it. There is also a high sugar content in balsamic. Sulfites/sulfates may contribute to headache/migraine. If you switch to distilled white vinegar, your salads will taste (just about) as good, with the caveat: use a high quality extra virgin olive oil, not a chemically extracted kind.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Bill,

      Thanks for the helpful suggestion! Yes, I agree, that vinaigrette has got to go. I did add the carb count into my daily calculations, but that stuff has so many ingredients in it that it’s impossible to say which one (ones) may have been the culprit. I threw it away this morning:)

      • http://profiles.google.com/nancy.milligan Nancy Milligan

        I have a vinaigrette recipe you might be able to adapt:

        1 C. olive oil
        1/4 C red wine vinegar
        1/4 C balsamic
        1-2 cloves of garlic
        1 tsp of salt

        It’s truly the best salad dressing I’ve ever had. I’ve substituted various vinegars when I’ve run out of one or the other, and it was still delicious. Sometime I might try using 1/4 cup of lemon juice.

        I have one of those salad dressing bottles some company sells. I bought their box of dry dressing and threw it out, but I love the bottle.

        • http://diagnosisdiet.com/ Dr. Ede

          Hi Nancy
          Thanks for the recipe! I will try it without the garlic (of course that doesn’t agree with me either…) I should really make my own dressings, so this will be great to try.

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Ted

    1. I certainly did not mean to offend anyone with my MCT comment…I’ve heard through the grapevine that MCT oil adds no flavor to food and can cause gastrointestinal symptoms (especially diarrhea). I’m sure this may not be true for everyone, but I’ve heard it from quite a few people. If it works for some people, great. In honor of your comment, I will add an MCT oil experiment to my list of ketogenic experiments to try along the way to see how it affects me personally. I’ll start with one tablespoon. We’ll see how it goes!

    2. If my ketones are already above 4.0, I don’t see the need to add a costly, highly refined oil to my regimen. I can’t help but wonder if those people who need to turn to MCT oil to raise their ketones aren’t simply eating too much protein (and/or dairy) to get into deep ketosis without it. Having read a bit about MCT oil, I have come to think of it as the sugar of fats…meaning that it is a refined burst of energy–not particularly natural–however, whether it is beneficial or not I can’t say.

    3. Theoretically it makes more sense to me to try to access and burn my own excess body fat than to take in an external source of quick fat-based energy. I want the majority of the ketones in my blood to be coming from my own body if I’m trying to lose weight. Perhaps that thinking is simplistic, and I may turn out to be wrong, but I’ll try it in the near future and see what happens.

    • Ted M

      Dr. Edes,
      That is a reasonable approach to MCT Oil. I’ve never thought about the fact that your keytones are already at 4.0 so MCT may be a moot point. If you have too much for your body to handle it will send you to the restroom quickly. Start with as little as a teaspoon and move up every few days as your body adjusts to it if you incorporate it into your experiment. Thank you for keeping us in the loop.

      • http://www.facebook.com/snooptaco Elaine Shields

        Yes, if you do the experiment, don’t start with a T, it will hurt your stomach! Do a teaspoon at a time, and be sure not to have it on an empty stomach. (Sautee some meat or veggies in it instead.) It gave me terrible, terrible cramps when I was first adjusting to it. I liked it because it helped me be in ketosis without having to have as strict a diet as you are having. Then when my appetite decreased and I felt more stable, I transitioned to having a stricter diet and less MCT oil. Lately I have just been adding a teaspoon to my tea in the morning, in lieu of caffeine, for a burst of energy. Makes me wonder if it is doing more harm than good!

        • http://diagnosisdiet.com/ Dr. Ede

          Hi Elaine

          I will take your advice and start with a teaspoon, but I can’t say that I’m looking forward to this experiment…it won’t be until at least next month, but I’ll post about it when it’s time.

    • http://profiles.google.com/nancy.milligan Nancy Milligan

      MCT Oil utterly rips up my intestines, worse than coconut oil.

      • http://diagnosisdiet.com/ Dr. Ede

        Gee, I cant’ wait…

  • Eknola

    Thank you for inspiring me to try this again. I won’t measure blood ketones for a week so as to save those precious strips and not be demoralised. I do use mct oil (1 tbsp 2 x day) with 2 tbsp of pastured heavy cream in my tea which helps me get enough fat. Nothing terrible about mct oil though one’s “response” is dose-related so start with half a tsp and see how you do. It’s great to take on the road. Though I was eating the recommended protein grams last time, I suspect it was too high for me.

    Have a great Week 3. Looking forward to hearing all about it.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Eknola
      It’s a great idea to set the strips aside for the first week–good luck this time around! And thanks for the MCT oil tip…duly noted…

  • Someone, Somewhere

    Hi Dr. Ede,

    Very interesting. Thank you for sacrificing your comfort in the name of science and health :)

    I can relate, to some extent, to your struggles with balancing protein and fat:

    I am not explicitly aiming for ketosis or measuring anything. I’m just following my gut—as well as some knowledge about nutrition and human evolution—to try to find ever-increasing levels of health and happiness through diet. I imagine that I’m never hungry in the morning and can easily wait until the afternoon or even evening before feeling a need to eat anything suggests that my body is leaning at least somewhat in the direction of ketosis, no? I would measure my ketones, out of sheer curiosity, but I hate blood, and even for the urine strips, I don’t have money to burn.

    As I’ve said numerous times, my diet consists only of meat, fruit, salt, and water. What makes it even more restrictive is that I try to eat only animals that eat the diets that nature intended for them: grass-fed beef and wild seafood (I welcome other suggestions for meat that fits this bill). As I’m sure you know, most grass-fed beef and wild seafood is quite lean. Even when I buy the fattiest cuts of grass-fed beef (which I eat significantly more than wild seafood, mostly because I’ve found better deals on it), I’ve found that I still find myself craving more fat. At one point, I was roasting slabs of grass-fed beef fat, but I got tired of it quickly, so I stopped. Today, though, I’m starting a new experiment: Instead of throwing away the liquid fat that drips off the roasted cracklins, I’m going to save it, chill it, and slather it—homemade tallow—on my steaks after cooking.

    Nutritionally, here’s what I think is interesting about my experience: I find that if I eat unlimited meat—unless it is extremely fatty meat or supplemented with fat such as tallow—my body is not fully satiated. This seems to lead me to overeat protein and undereat fat, because my body eats more protein than it wants in order to get the interlaid fat, but once it reaches its saturation point on protein (which is higher than the amount it actually wants), it still hasn’t gotten as much fat as it wants. I’m not sure, biochemically, how the body responds to overeating protein and undereating fat, but I can tell you that I don’t feel best when I do so. I imagine you can relate…

    • Maria

      I think it is called rabbit starvation.

  • Kitty

    Hi,

    Yes, you are right, I stay medium Keto because i just eat to much protein and as you said so well, I also could eat 10 chops instead of one.

    I really, really need to cut down on my protein and see what happens as my blood Keto is no longer going any higher than 1.7 way to much protein….probably in one day, I eat one weeks allowance….

    I already read most mentioned books, but getting reed of carbs is one think but still hanging on to the protein. Will need to let them go

    Day 33 today and no much progress due to way to much protein

    I think it starts sinking in NOW, I am starting tomorrow

    Having a hard time letting go of my two coffees a day, such a social habit here….

    Thanks so much

    Kitty

    • http://diagnosisdiet.com/ Dr. Ede

      Good luck with your new experiment, Kitty–I hope you will be successful! One step at a time…I’m having a hard time letting go of my salad dressing and my olives, even though I’m certain I’d feel better without them. It’s hard being a human being, no?

      • Kitty

        Not sure what could be the problem with salad dressing, maybe because you do not support olive oil or any other? I make such easy lovely keto salad dressings with oil, some lemon, pepper, salt, garlic and spices….I so love this
        I am sure this is Keto approved and no reason to deprive me of it
        I love my salads

        • http://diagnosisdiet.com/ Dr. Ede

          Everyone is different; I have trouble with many salad dressings, but that does not mean that most people do. Most people do fine with salad dressings–so please don’t follow my patterns, because they will be different from yours. My diet is much more restrictive than most due to food sensitivities and I am not recommending my diet for anyone else…

    • Maria

      We are much in the same boat: too much protein and I love my coffee with cream. Plan on lowering protein as of today, and ditch the coffee for lent. Good luck to you!

  • Kitty

    Question 1:

    Why wanting to be in this High range of Ketosis, just as to be able to help your patients, is the range 0.5 till 3 not high enough as per Dr. Phinney book ‘Performance’ or do you need to use it to help cancer patients?

    Or is it better for weight loss, where 0.5 till 3 will not give you those results?

    Question 2:

    What is the final say these days on animal meats and saturated fats: bad for one as some says or good for one? This is getting so confusing with the info out there as it does matters as one eats saturated fats on a Keto diet

    Thanks

    • http://diagnosisdiet.com/ Dr. Ede

      Kitty, these are EXCELLENT questions.

      1. Ketones above 4.0 seem to be important for cancer and seizure management, but you are right–I have neither cancer nor seizures, so why go to such extreme ketone levels? The first answer is because yes, I wanted to see what it would take to achieve Seyfried’s “zone.” The second is that even though my ketones were in a range that Phinney/Volek would have been happy with, my blood sugar levels were still far too high to be healthy. As for whether higher ketones are better for weight loss, I have absolutely no idea, but I hope to figure it out:)

      2. If you haven’t read my fats page (under the foods tab) yet, there is lots of information there that can answer some of your questions. If you’ve already read it and still have questions, please let me know and I’ll try to answer them!

      • Kitty

        Thanks, I did go and read the article

        Have you also a link to cholesterol as my high cholesterol from a very low one before start bothering me
        Thanks

        • http://diagnosisdiet.com/ Dr. Ede

          Please see the cholesterol page, under the foods tab.

  • http://twitter.com/JudyTsafrirMD Judy Tsafrir, MD

    This is really fascinating and useful and I enjoyed reading all the comments as well.

    I wanted to mention one thing that caught my eye was that on one day you mentioned that you experienced tinnitus. I have been having a problem with tinnitus that comes and goes of late, and have begun to suspect that for me it is correlated with high histamine levels. I have only begun to link this symptom as well as others with histamine intolerance, and the diet that you are following is very high in histamine.

    I try to follow a low carb GAPS diet and many of the foods that I like alot and eat regularly are very high in histamine. In addition, I tend to cook a large pot of stew or soup and then eat it all week, and histamine levels rise in left overs as they sit in the fridge. I don’t know if your tinnitus was related, but I thought I would pass it on, as its not something that I was aware of previously, I look forward to reading the next installment.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Dr. T
      I already wrote a response but it won’t seem to take, so I’m writing another one. If the original one also shows up, that’s why:)

      Thank you for sharing your insights–I must admit I don’t know much about histamine, so if you have more to share about which foods in my diet are highest in histamine before I have time to look into it myself, please feel free! Tinnitus used to be a constant and major problem for me until I changed my diet 6 years ago. Now it only happens every once in a while, and is mild and brief when it does. I know that I did not have any tinnitus at all last summer when I was eating all meat for 90 days.

      • Marijke

        I noticed that I usually have tinnitus when I am detoxing. Having a headache in the morning could also be a sign of detox.

        I like reading your blog: it gives me new ideas. I will see what going in the direction of ketosis could do for me.

        • http://diagnosisdiet.com/ Dr. Ede

          Hi Marijke
          Very interesting–I hadn’t considered that possibility!

          • Marijke

            My experience comes from following the GAPS nutritional program for 3½ years. This program works at building a healthy gut flora and at detoxification. At the age of 65 I realized that in hindsight I had followed
            the wrong diet all my life. I also had had many amalgam fillings from a young age, so toxic mercury was around as well. This gave me quite a bit of opportunity to store unfavorable waste products in my body. These waste products are toxic and the body puts them away in places where they do the least harm. When the body is induced to detoxify, by whatever program of diet, the hidden waste products are mobilized into the blood to be excreted by the lungs, the skin, the kidneys or the liver. When this blood reaches the brain, it may give you a headache. Circulating toxins can also make you feel tired, cold or out of breath.

            Something similar happens when you eat something that you are intolerant to, especially vegetables. I understand that the digestion of vegetables is mostly done by bacteria in the gut. The human body uses the products produced by the digestion of these bacteria. When you do not have the right bacteria in your gut to digest a specific vegetable, the vegetable is not digested right and undigested molecules are taken up into the blood through the gut wall. When this blood reaches your brain it can give you a headache in a similar way as above.

            I learned an interesting thing from the blog Cooling Inflammation. The bacteria that you need to digest a specific vegetable like to live on that vegetable. Sure, that is what they like to eat. When you eat a tiny amount of that vegetable raw, washed just lightly with water to remove the sand, it will not bother you and you get some of these bacteria in your gut. When you increase the amount you eat slowly over time, you will find that you can digest the vegetable that you were first intolerant to. I tried this a number of times and it worked for me.

    • Kitty

      Just to share that I get it when eating an all raw mainly fruit diet and I quite liked it as it like put me in a mediation state and I knew when the ringing started I would feel at Peace. Really, I have tried this a few times over many years and this always has been my experience but never knew why

  • Maria

    That is great, Dr. Ede! I am eagerly following you. I have been doing the ketogenic diet myself for almost a year and hit a stall in Nov. I am thinking that my protein is too high but I find it hard to lower it. I like 75g but I need to go down to 53g to be at 0.8g of IDEAL body weight. Have you read Primal Body Primal Mind? Highly recommend it!

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Maria
      Wow, ketogenic for almost a year–that’s amazing! I wish you luck going forward. I haven’t read that book yet but thanks for the recommendation (so many books…so little time…)

  • Cyn

    Gary Taubes had remarked in the Q&A of his lecture that excess protein is converted to glucose *unless* your fat ratio is greater than 80% of total calories.

    In one discussion group, the calorie theory was under discussion & one lean fellow experimented on himself & added an extra 2000 calories a day in dietary fat to his normal high fat, low carb maintenance level of 2500 calories for a total of 4500 calories a day – an extra 14,000 calories in a week – which according to the calorie theory should add 4# but he lost 1# (I assume due to the high fat ratio)

    Have you tried virgin coconut oil – I personally have no qualms about melting a spoonful in my mouth before meals.

    Thank you for sharing your experiments!!

    • http://diagnosisdiet.com/ Dr. Ede

      Thanks for sharing this information, Cyn–I will do my best to sort out whether excess fat calories throw me out of ketosis or stall weight loss once I am fully keto-adapted next month. Unfortunately I cannot tolerate coconut oil at all, so that is not an option for me:(

    • Kitty

      Please do I get this right? If one eats a diet with over 80% fat of total calories then excess protein will not be converted to glucose?
      I did eat the last two days a diet of 83% fat and put on weight on both days…..
      Have put on about 5kg since leaving my vegan raw diet and eating a Keto diet….so I am not a happy chappy but had to leave my vegan diet due to low blood sugar which Keto has solved for me

  • Cyn

    I wish there was an experimenter to follow your path but *without* the fasting period to see if Seyfried’s “zone of metabolic management” could be achieved sooner that he remarks. I wonder if either a low protein or a >80% dietary fat ratio would accomplish the same goal.

    He doesn’t seem to acknowledge the need to limit carbs “if the calories are low enough” – I’m wondering if he experimented with depleting glycogen with low carb versus fasting. All that I have read indicates that the body goes into the same state with no carbs as it does with fasting.

    • http://diagnosisdiet.com/ Dr. Ede

      I wish the same thing, but at this point don’t want to go out of ketosis just to try it, of course. I’d be willing to bet that someone trying this for the first time could easily get into deep ketosis by strictly limiting protein and carbs instead of fasting. I bet it would take less than a week, but I really don’t know…maybe Eknola (see comment below) will be trying this?

      • Eknola

        Yes, that’s what I’m doing this time: carbs 0-15gm, trying to keep protein at 60gm. Dropping the carbs isn’t much of a problem but reducing protein is difficult. So taking Danny Albers advice, I’m dropping the high intensity exercise for a while and adding slowish 5000m rows to powerlifting and my daily 5 mile walks.

        I do have ketostix and they are showing ketones in the 1.5 range. Last time I tried this my glucose levels seemed high so I’ll start measuring again and see if reduced protein helps.

        • Kitty

          Reducing proteins for two days let shoot my blood Keto’s up right away and reduced my Glucose level to 65 where normally with protein, it stays around the 80 maybe 90 sometimes.
          Yes, Dr. Ede is right, protein make all the difference, but such a low protein diet is not for me as fats make me hungry, yes, indeed they do, protein calms my appetite (which is big and always was)

      • Kitty

        I have tried Keto diets many times over the years. Have just eaten low carb, normal food portions and it never has taken me more than 2 days to get in medium Keto. This is my experience
        I once did a vegan diet high in raw greens, nuts and oils and tons of avocado which gave my irregular heart beats and missing ones as a hig fat diet does to me to and I was in deep Keto all the three months I did it. Then I got protein cravings and my heart bothered me as did not think I could continue without the avo’s, so I gave up. I was very lean those three months without measuring foods or weighing myself (I always have that put back all the weight problem, it never seems to leave me)
        FYI

        • http://diagnosisdiet.com/ Dr. Ede

          It sounds as if avocado may be a problem food for you? Also, please see the comments section of the fruits page for more information about how avocado can cause an increase in blood sugar.

          • Kitty

            My blood sugar readings are very low, Fasting around 65 these days, but will check the article thanks

            Regards

          • http://diagnosisdiet.com/ Dr. Ede

            Avocado can raise blood sugar 90 mins to 4 hours after eating, which means that it may not have an effect on fasting readings the next morning. The only reason I mention it is that if avocado causes a minor blood sugar peak after you eat it, the peak is likely to be followed by a little dip, and this instability may be contributing to increased appetite. What concerns me more for you is the other reactions you have to avocado, particularly the heart effects.

    • Eknola

      Cyn, I was able to get there with 1,000 calories, all fat and two days of fairly heavy exercise to deplete glycogen. I happened to have bloodwork done while conducting that experiment and noticed my cholesterol shot way up which was very disturbing for my doctor but my triglycerides were quite low as was my insulin which was out of range even though more than half the fat came from dairy. But it was unsustainable for me. However if I had seizures or a cancer that responded well to a ketogenic diet I’d manage. But I probably wouldn’t be exercising the way I like to.

  • Cyn

    NEW PLAN:
    Day 10 Continue max carbs 30 but reduce protein

    Since carbs convert 100% to glucose but protein only converts 58% – wouldn’t it be more effective to eliminate carbs as much as possible? 50g protein = 30g carbs

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Cyn–yes, this is definitely on the list of experiments to come!

  • http://www.facebook.com/raymund.edwards Raymund Edwards

    Hello Dr Ede , Thankyou for your terrific blog , it is full of information .

    I follow a keto diet and care for my mum who is an epileptic ,A lot of little things can make a big difference.

    For example tweaking fatty acids , sometimes we need more EPA and DHA , Mono oils seem great, We have started using a lot of more macadamia oil (which contains Omega 7 a shorter chain mono oil )

    Here is a big one in my opinion ,, Magnesium ..It has effect on so many things
    Including Cholesterol and Triglyceride and blood sugar.

    Maybe even your tinnitus ?

    http://www.dailymail.co.uk/health/article-1359265/Daily-pill-stop-ringing-ears.html

  • http://twitter.com/JudyTsafrirMD Judy Tsafrir, MD

    Many delicious low carb staples are high in histamine, like avocado, bacon, any aged meat or fish, smoked salmon. Here is a good link and a good site:
    http://www.food-intolerance-network.com/food-intolerance/histamine-intolerance/histamine-levels-in-food.html

    I am curious about the fact that your tinnitus disappeared with the all meat diet. Was the meat fresh? Its not possible to have a histamine free diet, its in everything, what seems to matter for some people is the critical mass. For me the tinnitus is accompanied by a racy feeling inside that feels like elevated cortisol levels. Like my system is keyed up.

  • RoseNunezSmith

    I’m so glad you’re doing this experiment. I’ve been eating a “zero-carb,” meat and eggs diet for over three years now, and while I feel good and have excellent labs, I was curious about my ketone status. Following Jimmy Moore’s advice, I got a blood ketone meter and the expensive strips, and was shocked to find I wasn’t even remotely ketotic.

    I’m interested both for weight loss (like you, I’ve found weight loss to be nearly impossible, even on a low-carb diet — hence my zero-carb way of eating — and if I veer even slightly from a meat-only diet, the weight piles on very quickly), and as a cancer intervention, Both my parents died of cancer, and cancer appears frequently in my birth family. And I have to admit, I’d love to lose this last 15 or 20 pounds that simply won’t go away, although that is quite a bit lower on the list than avoiding cancer.

    It’s striking to me that we have had such similar struggles with weight (will you add me to your growing “internet twin” list, lol?), and that you too found you were barely ketotic, even with the ultra-low-carb diet you were eating. I wonder if the different results achieved by people on identical diets can be at least partly explained by the ease with which their bodies produce ketones. People who turn ketostix dark when they drop their carbs to 50g a day, for instance, obviously are churning out plenty of the little buggers (at least, the acetoacetate ketone body), In my early low-carbing days, I saw very quickly that if my carb count went anywhere close to even Atkins-induction levels of 20g, the sticks stayed pink for me (although I could turn them nearly black at close to zero CHO).

    After I went ZC, and lost the next big batch of weight (and a bunch of other medical problems, too — woot!) the sticks stopped turning at all. I had assumed I was what the bloggers call keto-adapted, and that my blood must be thick with beta-hydroxybuterate ketones. Boy, was I surprised when I did those first few tests and got back the “trace” readings.

    My first few attempts to bring my ketone levels up ended poorly: I used cream the very first time, and got my number to 1.2 mmol/L, but I also gained a lot of weight (so much for the idea that you can’t be in ketosis and gain weight), and had awful gastritis, which is my usual response to cream, so I quit. The second run involved just limiting protein (80g of protein means such tiny pieces of meat — argh!) and adding lots of butter. I just got too hungry and gave up. Reading that you pushed past the hunger and have found a kind of early peace with this new way of eating makes me want to try it again.

    I’m so happy to find someone with your calm, measured approach, and documentarian instincts, doing this experiment online. Your work here will be very helpful to a lot of people. Sorry for the long comment, but your recent series has really inspired me! :)

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Rose

      Thank you so much both for sharing your very interesting diet experiences and for your nice comments about my online experiment. I was a little nervous about posting these experiences so publicly, but from the feedback so far, it feels as if it was the right thing to do. I’m so glad that it is helpful to people–that is exactly what I was hoping for.

      I, too, gain weight and get hungry when I add dairy to my plan, and can relate to all of your experiences, so welcome aboard the twinmobile! I guess we’ll have to call it something else now…since we are now quadruplets…and who knows how many other long lost siblings we have out there who may be part of the silent majority who read but choose not to post?

      I love the image of one’s blood being “thick with ketones” and the image of metabolically luckier people “churning out plenty of the little buggers.” Fun language:)

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Raymund
    Thank you very much for your kind words; I ‘m so glad you like the blog:)

    I hope your mum is doing well (I’m assuming she follows a keto diet as well?)

    Unfortunately I can’t tolerate nut oils at all, so I’ll have to stick with fatty meats. I have not personally researched Magnesium yet but hope to do that at some point in the future (so many topics to get to the bottom of!). My tinnitus only occurs when I eat certain foods that bother me. When I was eating an all (fresh) meat diet last summer, I never had it at all. This week I’m shifting to all fresh meats and I am pretty sure I’ll feel a lot better…we shall see!

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Dr. T

    Yes, last summer I did a fresh meat diet. I didn’t count protein or fat grams, or measure ketones or blood sugar, I just limited calories. I know from experience that I feel best when I eat only fresh meats; it’s just not always logistically possible. I have, however, recently discovered some simple ways to keep meat with me for special circumstances, so I shouldn’t have any more excuses:) I am transitioning to all fresh meat this week to remind myself of how much better it is.

    It is very interesting that your tinnitus seems to always come with that racy feeling…sometimes mine does and sometimes it doesn’t…I definitely agree with your critical mass theory, because I can usually get away with small amounts of certain foods without a problem. I will look into the link you provided asap! Thank you very much for this helpful information.

    • http://www.facebook.com/snooptaco Elaine Shields

      Dr. Ede, do you mind sharing what you discovered in keeping meat with you for special circumstances? :) I have a very last minute 4 day trip ahead of me starting tomorrow and am really dreading how I am going to manage staying in ketosis! Also I will be following this topic closely because I too suspect a histamine intolerance……

      • http://diagnosisdiet.com/ Dr. Ede

        Sure. It’s not very exciting, and it’s going to sound strange, but I use Beech-Nut turkey baby food because it’s portable and has no added ingredients–just turkey and turkey broth. I like to add olive oil and salt for flavor b/c otherwise it is quite bland. I prefer to use duck fat, because I tolerate it better than olive oil, but when I don’t have access to refrigeration, that is not an option. It also comes in chicken and beef, but I don’t like the chicken flavor and I have never tried the beef flavor (poultry agrees with me best).

        • http://www.facebook.com/snooptaco Elaine Shields

          Thank you so much for sharing! I would have never thought of that…

        • Kitty

          Hello,

          Following you and doing Keto myself since just over one month. Will never be able to stick to such a high fat diet, it did it for two days and this was enough, my irregular heart beats just put me off, but I must admit that I added avocado and they always give me the same irregular heart beats once I eat to many of them, like two a day for 4 days, then my heart start beating. On the two high fat days (83%), I just kept being hungry and feeling my heart. It seems to me that only protein calms my hunger down and then of course I return to low Keto readings but still staying in what Phinney says between 0.5 and 3 blood ketones

          My body rejects such a high fat eating system, or is it me? Atkins inductions is much better for me I think with lower Keto readings.

          Did you read Dr. Freemans latest book Ketodiets? They are using now the Atkins Modified Diet system ( induction phase) also to heal people

          Please could you tell us how you know or found out which foods agree with you and which ones not? I would like to do this myself

          Thank you

          • http://diagnosisdiet.com/ Dr. Ede

            Hi Kitty

            Is it all types of fat or avocado fat in particular that your body doesn’t like? Avocado contains other things besides fat that may be bothering youI.

            I have not read Ketodiets but will add it to my long list of books to read…

            I discovered my foods list by trial and error–I kept a food and symptom journal for about 6 months and looked for patterns, then gradually eliminated foods that seemed to bother me. To be sure, I would later add a suspicious food back to my menu to see if the same problem would occur. I don’t know of any other way to do it, unfortunately.

          • Kitty

            Yes, Dr. Ede, not else fat wise troubles me, only the avocados
            I read that some people are allergic to them, but they are such a great filling food for me
            I still eat them and hope my body will adapt, maybe
            So good for bowel movement to
            Thanks for your reply

          • http://www.facebook.com/todd.kedes Todd R. Kedes

            when first adjusting to ketosis, the heart muscle immediately reacts to ketones for some reason and can palpitate or speed up. Very common. it’s a GOOD sign! It eventually gets used to all that energy. Perhaps it’s due to the fact that the muscles cannot use/convert the ketone bodies yet.

  • http://www.facebook.com/snooptaco Elaine Shields

    I think it is very interesting that you are getting such high readings from the ketostix! I wonder if they will decrease as you get more adapted, or if sometimes they do correlate to high readings with blood ketone levels? I thought they weren’t a “reliable” means to determine your true level of ketosis…. and it seems to be widely believed that if you start to not register a reading in the ketostix that you are finally keto-adapted? It’s all very confusing to me!

    I also wonder if you would have achieved ketosis even more quickly if you had begun with eating <60 g protein a day , and if that first week would not have been so hard/you wouldn't have been so hungry? Surely there would still be a tough period of adaptation, but I wonder if it would only be a couple of days. I will have to muster up the courage the drop my protein down to this level and report my findings :) I really admire you for doing these experiments! It's definitely encouraging and makes me want to try harder to achieve deeper ketosis.

    I wonder if you would be able to test taking BCAA's/Leucine when you do further mini experiments down the road? I wonder if you take them, if they could give you more flexibility in your diet , probably in a similar fashion to taking MCT oil. Obviously it would be optimal to just eat all meat and not have to supplement with anything, but for parents of young kids with epilepsy or just any general folk out there who have trouble making this diet sustainable, taking these supplements could make all the difference for someone who found the diet impossibly restrictive/otherwise undoable. Just a thought!

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Dr. T
    I explored the link you included and it was reassuring to see that fresh meats are naturally low in histamine. This may be one of the important reasons why I tolerate fresh meats best. Thanks for calling my attention to this!

  • http://profiles.google.com/nancy.milligan Nancy Milligan

    Dr. Ede, this is your twin again, we’ve been discussing your experiment on lowcarber.org and a few questions and suggestions have come up.

    Is the physiological insulin resistance that long term low carbers get a problem? We’ve read a bit about it on Hyperlipid (where Peter seems to think it isn’t an issue) and on Paul Jaminet’s blog where he seems to think it is a problem and he wants people to eat “safe” starches.

    In the back of my mind is the admonition from Phinney about how much muscle can be lost if you don’t eat enough protein. It would have been neat if you’d gotten a muscle scan before and after. Yeah, easy for me to say because I’m not paying for it. I did look into here where I live and it looks like it costs about $150.

    I know that Jimmy Moore’s dexa scan hasn’t shown any loss of muscle but I think he’s not all that low in protein either.

    My last comment is about dry eyes. It seems to be a very common symptom of ketosis, that and constipation. Phinney/Volek recommend increasing your sodium consumption to 5g a day, which is a whole lot more than most of us get. Does that help with the dry eyes at all?

    Of course, Paul Jaminet believes that dry eyes, mouth and constipation are because mucin production is minimized in ketosis because there’s a glucose deficiency. That never made a lot of sense to me since my blood glucose reading never get all that low.

    Anyway, those are some of the crowd-sourced thoughts of us from lowcarber.org.

    Looking forward to the chocolate post!

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Twin

      I really appreciate the crowdsourcing help! Thanks, crowd!

      I haven’t looked into the long-term physiological insulin resistance myself yet, but will do that at some point…if only I didn’t have to sleep and see patients I would know everything already:) All I can say at this point is that insulin resistance is not always a bad thing. It spares glucose for the brain, for example. I think insulin resistance may only be a problem if you’re eating too many carbs…because that really taxes the insulin system. Insulin’s primary purpose is not to process carbohydrate. It is to act as a growth hormone under certain special conditions (childhood/adolescence, pregnancy, etc.). Maybe the body is only supposed to be sensitive to insulin under certain circumstances. I don’t know enough about this topic yet to say anything more intelligent than that yet…

      I’d never considered a muscle scan, and shouldn’t pay for one right now, but even if I could, it might be confounded by exercise…which I plan to add back to my regimen very soon. Theoretically I believe the opposite to be true of carbs and muscle–it is well-established that body protein is broken down regularly on standard low-calorie diets that contain significant carbohydrate (see carbohydrate page and also low-cal diets page). I doubt muscle loss is an issue with ketogenic diets, but I really don’t know for sure. I don’t know, maybe I should invest in this scan after all…I’ll think about it…

      My eyes are only dry on certain mornings upon waking (for about 30 mins), and at least for me, it’s been about olives. Yesterday I ate zero olives for the first time in many days, and no dry eyes this morning. I have never had constipation on an all-meat diet, even when I did it for a full 90 days last summer. I believe constipation is about what IS eaten, not about what is NOT eaten, if you follow me. I used to have a major problem in this area before I changed my diet 6 years ago, so I am no stranger to the issue. When I ate a “standard” Atkins diet over 10 yrs ago for a month or more, it was a major issue, for example. For me it seemed to be about nuts, dairy, crucifers, and soy foods (also see my blog post about constipation if you haven’t already).

      The fact that my blood sugar levels were so much higher on 75 g of protein than on 50 g of protein suggests to me that my body wasn’t using that extra protein to build muscle or enzymes or mucus or anything else…it was just turning it into blood glucose–far in excess of what anyone needs in the bloodstream. Unhealthy levels of blood glucose. Even according to the Jaminets, hyperglycemia is perilous. I do agree with them on that. How would they propose I lower my blood glucose below 90′s then? I was already eating very low carbs, and even low calories on many days. Lowering protein really did the trick.

      On pages 32 and 33 of the Jaminet’s book, they write several paragraphs about the “dangers of glucose deficiency” and cite exactly zero sources to support their bold claims. I find that to be very unfortunate. It doesn’t mean that the theory is definitely false, or that it may not be true for some individuals, but without any evidence, it will remain in my mind as a belief of theirs that each individual would need to test for him/herself.

      Thanks, twin, for your continued interest and the great questions–much food for thought!

      • Todd

        As far as I know, mucin is consisting of amino acids, one of which (forget the name) is found in connective tissues of the animals. Some people don’t eat enough ribs, or gelatinous foods (or bone broths) and hence get dry-eyes. A little gelatin goes a long way. Dr. Ede, I still haven’t read the following two weeks of your post (catching up) and this is great, we all need this N=1 you’re doing! However, i just wanted to suggest a hypothesis, that protein intake tolerance can increase with even fewer carbs, that they are somehow inversely related. Especially the more metabolically compromised you are. I would wonder what your results would be on a ZC diet (0-5 g per day) like Rose above and I do, in terms of protein tolerance, and hence, an ability to feel a bit less restricted. The ratio of ketone production and insulin levels are related, and combined with carb intake, the ratios are not only inversely related but also at ever increasing/decreasing rates. It’s almost a logarithmic/exponential relationship, so that for each gram of carb less below 20g, say, the decrease in ketone production, usage and inuslin basal rates increase/decrease at an accelerating rate! So 5 g is way different than 10, and perhaps their difference, and the related protein sensitivity to BG levels are as different as 10 and 20g CHO intakes. The ultimate is getting to zero plant matter and seeing your tolerance levels for protein and finding that number.

        • http://diagnosisdiet.com/ Dr. Ede

          Hi Todd

          Yes, as you’ll see in weeks 3 and 4, I did go to completely zero carb. I’ve eaten zero carb for long periods of time over the past few years quite happily ( I ate zero-carb for 90 days straight last summer, but did not yet have a website). Last summer I did not count protein grams, so this was the first time I’d tried combining zero-carb with limited protein. This low-protein (50 g), zero carb plan turned out to be unsustainable and felt as if it was worsening my health, so I stopped it 2 days ago. I know there are some women out there who have been successful limiting their protein to 50 g (or even less in some cases), and Dr. Rosedale’s recommendations would have me perhaps eating even less protein than this, but for my physiology, it felt unsafe.

    • http://www.facebook.com/raymund.edwards Raymund Edwards

      Yes , My mother is on a keto diet .
      Regarding dry eyes , it is often matter of making sure there is enough omega 3s

      Enough is likely to be individual thing.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360504/

      • http://diagnosisdiet.com/ Dr. Ede

        Hi Raymund
        Thanks for writing back–yes, omega-3 intake is one of the factors in dry eyes. I do take omega-3′s almost every day (sometimes I forget). But for me the dry eyes have been food-related. I removed olives from my diet 2 days ago and the dry eye problem is gone.

    • http://www.facebook.com/raymund.edwards Raymund Edwards

      With , physiological insulin resistance again I think the omega 3 connection is important as to whether it matters.

      This is a good blog on it imo ( excerpt below ) , with some very good references to follow up

      esp this fellow (Hulbert) –> http://www.sciencedirect.com/science/article/pii/S0005273612000156

      I think that these researchers have failed to take into account that again humans never consumed palmitate alone, always with omega-3 PUFAs DHA and EPA, and paleolithically always low carb. Palmitate and n-3 PUFAs balance the fatty acids and cholesterol of the cell membranes, providing structure and rigidity and important hormone signalling (see Hulbert below). The authors appear to also have forgotten or failed to reconcile the evidence for Palmitic acid in IMPROVING immune function (see last 2 citations below). Additionally the authors fail to recognize the role of high dietary carbohydrates, its downstream increase of LA omega-6 content in muscles, high dietary omega-6 intake or the role of dietary omega-3 PUFA deficiencies in instigating Metabolic Syndrome.

      http://drbganimalpharm.blogspot.com.au/2009/09/palmitic-acid-mice-skeletal-muscle.html .

  • Kitty

    To Dr. Ede,

    Talking about cholesterol, mine has gone up from 154 (on raw vegan) to now 220 on my Keto diet, my Triglycerides are low, I measured this myself with a proff. meter, but it does not show anything else like HDL ‘s etc
    I must admit this increase bothers me and worries me even when I read that high cholesterol no longer is an issue
    Did you test your cholesterol levels before and now and after a only meat eating diet?
    I also one followed a meat only diet for months on end, at three meals a day, could eat what I wanted and lost weight, stayed there and never moved from there on till I became worried about my health and gave it up
    In fact it was meat, fowl and fish and seafood and NOTHING ELSE and I became thin and stayed that way
    But with all the ‘bad’ meats today and the farmed fish I think this would be a problem as no wild nor grass fed meat is available where I am
    Regards

    • http://diagnosisdiet.com/ Dr. Ede

      I had my cholesterol tested last summer before going on my 90-day all meat diet but haven’t had it checked since then. I will get it checked again once I’ve been in ketosis for a while. I would recommend having your HDL checked, because LDL and total cholesterol are very confusing and unhelpful numbers, whereas HDL and Triglycerides are very helpful. I know that finding perfectly healthy wild meats is very difficult, but I also think that even an imperfect (conventional) meat can be healthier for the body (or at least my body) than most plant foods, which aren’t perfect either…

      • Kitty

        wow…..a strong statement, I mean this in a kind way of course. I only eat now meat again since about one month and not sure if I want to continue

        I hardly at any yesterday and my stool was normal for the first time. Meat is so constipating for me. Today I have perfect bowel movement which is such a problem on the Keto diet. I had for this reason ordered the Magic Noddles (for bran) but still waiting for them as it was a real problem for me. Remove animal products and everything goes back to normal. I was a vegan for the last 4 years or even longer and thin and I felt healthy but I could not sole my low blood sugar levels

        I am doing for a while now, starting yesterday a Keto vegan diet in principle but with some fish now and then this is according Dr. Young and his pH Diet for Diabetics…..this pH thing makes it all so confusing even more….I did it for 3 months, was in keto and became very slim but then became afraid from the Keto thing as I knew nothing at that stage, now all I do is researching the subject as much as I can

        Thanks
        Maybe it is true what they say, one man’s meat is another man’s poison

        • http://diagnosisdiet.com/ Dr. Ede

          Yes, again, please don’t go by my patterns–my diet is very unusual. There are some meats I don’t tolerate well either.

  • Carole McMurray

    Another twin here…there are a lot of us! I just discovered your site today and have been reading through everything–fascinating!

    I’ve been experimenting for quite a few years, mostly documenting food and exercise, as well as weight fluctuations, but not as systematically as you have done! I first tried Atkins in 2003 and was astounded at how wonderful I felt, and how easily the weight dropped even while not exercising at all (due to a ski injury at the time). It wasn’t until 2006 that I confirmed I had celiac disease, so at that point the light bulbs went on and I realized one huge reason I felt so good on Atkins was the lack of gluten. More experimenting later on, and I concluded my lifelong issues with dairy were well founded. I also discovered issues with many vegetables (esp. nightshades) and most fruits, all starches, and couldn’t handle much sugar despite the fact that I often ate too much of it! I could feel sick and quite weird if I ate too much sugar, yet I never tested with even borderline glucose levels. Sugar is and always has been my biggest challenge, unfortunately. Thank goodness I’ve never been a soda drinker!

    Through my experiments I’ve found that I actually feel best and lose weight best via a mostly meat/egg/poultry/fish diet with small amounts of leafy greens. Weight loss stalls when I add in even occasional berries or other low glycemic fruit. Fruit seems to stimulate my hunger and triggers cravings, which then leads to eating too much sugar, like chocolate caramels, for example (oh…those caramels). I can stall even at very low calorie levels depending on what I’m eating, and I long ago decided that this was all way more than calories in-out or calorie levels. That said, I have narrowed my successful weight loss formula down to 5-15g carbs daily for best results, and when eating that low I often end up with something crazy like 800 total calories. This is natural, not intended, and is a result of really muted appetite, I’m sure. And then I am always trying to figure out how to raise fat levels without going too high on protein. And figuring out how much protein I should eat is also problematic.

    At 5’6″ I took my weight from a high of 173 to a low of 139, but it took many different attempts over a 13 year period as I chipped away at it. I spent a few years at aroun 163, couldn’t get below that. I’m at 150 right now and trying to lower it back down again, but finding it slightly challenging to stay on course so I’m about to really tighten things up again and lower the carb levels. Being at 20-30 as I am now isn’t working well. In Nov. 2011 I was at 139-140, and then maintained that fairly well for a year within a 5 lb range, at which point I just ate too much sugar and weight slowly crept upwards to where I am now. I had been experimenting with careful, controlled eating that was largely low carb but which allowed, as it turned out, too much fruit, or too much starch, various other things which shouldn’t have been enough to cause weight gain, but they did. I can pop up 3 pounds in just a couple of days, although I realize it’s probably water bloat. Right now I’m ending a 4th week of a mostly Atkins type diet structure. I lost from 153 down to 147, then back up to 150 right now. Very frustrating, but I had allowed too many things into my diet, I can see that.

    Conclusion: For whatever reason, I simply have to stay at extremely low carbs and pretty much a meat based diet with minimal lower carb veggies and no fruit, plus severely restricted or possibly no dairy. I’ve had dairy issues my whole life, and have reduced dairy down to about 3TB half and half in my cappuccino every day (boy do I NOT want to give this up!!) and an occasional ounce of cheese (not daily), that’s it. I’ve experimented and haven’t found an obvious connetion with this level of dairy and weight gain or stalling. In any case, I just have to be so careful and vigilant, and yes, let the calories end up at a low level that makes the typical nutritionist’s alarm bells start clanging wildly. But that’s what it is, and perhaps at 62 I really do need way fewer calories than I used to. I think I must be fairly keto adapted because I can go back into totally strict low low carb with no apparent effects. However, no matter what I never go beyond trace reading on the ketostix. Is that adaptation?

    I’ll add that on this diet I have incredible energy for exercise, no issues there. I can eat an egg and bacon breakfast, then ski with plenty of energy for a good 5 hours, with only a bit of meat and cheese for lunch, at most. I’ve lately been on a 5 to 6 day a week exercise program, with 3 days of weight workouts and 5 to 6 days of cardio. Plenty of energy for that, too, so I can’t believe how I’m eating is negative. I feel fantastic, no meds other than half a HCTZ pill for bp, which is managed by this level. My goal, of course, is to eliminate that pill eventually.

    In any case, I’m fascinated here, and I’ll be following your blog and am anxious to see how your experiments go.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Twin #5 (quintuplet?)

      Thank you for reading and for sharing your history–these stories are so interesting and validating for me–and I’m sure for many others of us, as well. Your experiences do mirror mine in many ways. Until this year, I had never taken protein grams into consideration—only carbs and sometimes calories and often exercise. This protein limitation has been a real eye-opener for me, as I’m losing more weight, more reliably, and more peacefully than ever before this time around, despite being older than I’ve ever been before (48) and not adhering lately to my usual daily rigorous exercise regimen (I’ll be adding that back in soon to see what happens).

      I wonder if you’ve ever counted protein grams before or measured blood ketones before? So far (and it’s very early in my experiment, so maybe too early to say), the number of fat grams and the fat to protein ratio do not seem to matter at all. It seems to be carb and protein restriction that matter.

      • Carole McMurray

        I’ve always been aware of protein, and worried that I never got enough. I eat meat, but often don’t eat meal and opt for veggie type meals instead. I’ve been counting calories, protein, carbs of course, and fat. On some of the low carb discussion boards people are always saying that you need more fat….that Atkins is a high fat, moderate protein, low carb type regimen. I plug all my food and exercise into a nice little computer program called Perfect Diet Tracker, which I like fairly well. Now I’m paying attention to the % of the components and currently aiming for protein around 63g, 57 to 96g fat max, and carbs as far under 20g as I can manage, with 10 or fewer definitely being most effective. My problem is this: to raise my fat levels, I end up raising the protein as well. A lot of the time I’ll end up fairly equal with fat and protein, and now I’m thinking my protein has often been too high.

        No, I’ve never tested blood ketones, don’t know how to do that. I’ll look into that more if it’s something I can do myself at home. I’ve rarely gotten a reading on the ketostix, but that may be because I’ve done low carb eating for so very long, despite too many cheats.

        As for exercise, I’ve tried to analyze what I haven’t been doing and exercise seemed like a possible missing link for me….I do exercise, but probably not regularly enough. I can get into a 5-6 times per week regimen for a few weeks, then taper off and not do anything formal for a week or two or three or more, and then get off it entirely. For the last 4 weeks I’ve been on a specific exercise program that is very reasonable (since I usually overdo exercise). I’m doing the Bill Phillips 5/25 plan, which I really like so far. It’s 5 circuits of 5 weight exercises done 3x a week, and it only uses dumbbells and body weight so it can be done anywhere, although I happen to do it at the gym. The cardio component is 3 days a week too, and is a HIIT structured workout of an equivalent of 2 minutes walk, 2 minutes jog, 1 minute all out, repeat this pattern 5 times. I’m not a runner, so I do this on the elliptical. The only thing different I’ve done with his 6-day program is more cardio: I pretty much do the HIIT cardio every day, and I’m doing that because I just think I need to crank up my metabolism and that’s the way to do it. So the workouts are reasonable due to a shorter time doing them (max of 30 minutes), but it’s daily, and for me at this point in time, I need it. RESULTS: I can see some already. I’ve definitely whittled off some mid-section fat even though in 4 weeks I’m only down 4.5 pounds so far. I tried on some pants and various other clothes yesterday at the end of 4 weeks now, and there was a difference even critical little old me can see! The clothes definitely fit better, less muffin top with pants, smoother lines with certain dresses. So I think I’m on the right track with this.

        Beyond all this, I got a bit careless with food this last week, had a couple of small glasses of wine, a few carmels here and there, popcorn once at the movies, some mashed potatoes (sigh). I bloated up, weight went up 3 pounds. I was at 147, suddenly it was 150.4. If I want to keep the weight going down, I clearly see I have to almost entirely stay away from carbs. Green leafy veggie carbs, that about it, all I can get away with. Sad but obviously true for me. Now the big question is WHY am I so carb/sugar sensitive? This is what drives me bonkers. Yesterday, I ate a perfect profile in terms of calories/fat/carbs/protein. Today I was down a pound so bloat/water retention was going away. So I see what I have to do, overall.

        • http://diagnosisdiet.com/ Dr. Ede

          Hi Carol

          4.5 pounds in 4 weeks is excellent, by the way. Exercise has never really helped me lose weight but it has always helped me to feel and look my best. For me, at least, weight control has always been about carbohydrates, but now that I’m in my late 40′s, it seems to be about carbs AND protein (and probably fat and calories too, but that remains to be seen..).

          There is information about blood ketone measuring supplies in my blogpost called “ketogenic diets for cancer and beyond” if you are curious.

          As for why so many of us have broken carbohydrate metabolism, we can only guess, but the prime suspect is refined carbs (very new to our diet). Other possibilities include modern medications such as antibiotics, and environmental toxins.

  • Too Steep

    Hello Dr. Ede. Firstly, thank you for having the courage and taking the time to write your blog. These forums are so helpful to so many.

    I read “The Art and Science of Low Carbohydrate Performance’ a few weeks back, and was very intrigued by the prospects of changing my metabolism, so I embarked on a HFLC diet on Sat Jan 26. Today is day 23, and I am perplexed.

    I have been using a Precision Ultra blood meter to test my ketones daily. Last week from Saturday to Wednesday, I was at 2.1, 2.5, 3.4, 2.5 and 3.2 (some variation in time of day). Suddenly with no change in my diet (I’ve been logging and eating very similar foods), it dropped to 1.4 on Thursday and Friday, and 0.8 yesterday and today! And yes, I feel particularly weak and tired, since I haven’t eaten any carbs.

    Do you know if there is an explanation for this? Is this part of the keto-adaptation process? I still have not had the positive ‘aha’ experience that others report, even during the time when I was consistently measuring 2+. I.e., I haven’t felt any positive changes yet, and still suffer from hunger and poor sports performance. The drop in blood ketones is quite surprising to me, since I haven’t changed anything. Ideas?

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Too Steep
      I am not an expert on ketogenic diets by any means, so I can only guess and ask questions. There are others who have visited this site who have much more experience than I do, and perhaps they will chime in with their thoughts.

      My understanding is that keto-adaptation typically takes at least 3 weeks. The body becomes more efficient at using ketones as it adapts to a ketogenic diet, which means that fewer may be generated because fewer may be needed. However the fatigue and weakness don’t sound like healthy adaptive responses.

      I am curious to know if you are getting enough protein, fat, and calories–do you keep track of any of these, by any chance? Do you measure blood sugar? Perhaps there is a nutrient, vitamin, or mineral deficiency?

      • TooSteep

        Thanks for the reply Dr. Ede. I have journalled my diet in general terms, but without precise measures. I’m definitely getting enough calories, as I seem to have added about 3 lbs in the last 3 weeks (I am not looking for weight loss). I’ve been trying to get ~ 90g of protein a day (170 lb 6’0″ male). With carbs around 30g/day, I must then be getting enough fat. I could easily have a nutrient deficiency – I’ve been trying to consume gelatinous broths and leafy greens to get a lot of minerals. The strange thing is that my diet was very effective at getting me into solid ketosis by day 11, but then on day 20 my blood ketone numbers dropped sharply, without any discernable dietary change. I guess I’ll just try to cut back the protein a fair bit and see what happens. Do you know if the types of fat eaten can have a dramatic effect on ketosis?

        • TooSteep

          I have not tested blood sugar. It sounds like I need to start doing that to see if it provides insight.

          • Todd

            too steep, if you are new to ketosis and also exercising while trying to adapt, that can lead to sugar spikes and usage of your glycogen stores. Any insulin reactions to that will lower your ketones. It’s highly NOT advisable to exercise, especially any HIT type exercise while adapting to ketosis, partly for this reason. Also, you will keep your muscles accustomed to glucose metabolism for the ATP production. You don’t want that. In addition, you might want to lower carbs down even more. I am not you, but if I have above 8 or 10 per day my ketones also start dropping. Good luck…

        • http://diagnosisdiet.com/ Dr. Ede

          Hi TS
          It will be interesting to see what happens as you gradually reduce protein. It certainly did the trick for me, anyway. Phinney and Volek recommendations would have had me eating about 75 g of carbs but I’ve found 50 to be right for me so far. As for fat and ketosis, I’ll be doing some experiments in the near future to test this out, specifically with dairy fat. If you eat dairy, you may want to consider removing it for a week to see if that helps (dairy fats are very different from other animal fats), but as for differences between different kinds of animal fats from different kinds of meats, I really don’t know. The keto experts suggest that certain kinds of vegetable fats can be helpful in ketogenic diets, but I don’t tolerate them very well. Take a look at Dr. Rosedale’s book and also Phinney and Volek’s other book (The Art and Science of Low Carbohydrate Living) for more thoughts about that. Good luck figuring out your ideal ratios!

          • RoseNunezSmith

            75 g of carbs? Am I reading that right? Or is that a typo, and it should say “protein”?

            Great discussion in these comments. I’m riveted! :)

          • http://diagnosisdiet.com/ Dr. Ede

            Oops…right you are…I meant 75 g protein!

  • MDAPebbles67

    I am so glad to have found your Blog. I consider myself Primal (a form of Paleo), but I have been experimenting with nutritional ketosis since December. I have a family history of cancer and metabolic syndrome. I am obese and have a binge eating disorder. I had one 25 day clean HFLC run, but then I binged and have not been able to get back into it. I have concluded that I may have been eating too much protein (80-100g) to reach the deep NK that I need to avoid binging.

    Questions:

    I am a 5’10″ woman. How do I figure my max protein level?

    During my 25 day clean period, I often felt lethargic and “down” Have you experienced this?

    Related to the above question, Do you supplement salt? Some experts recommend using regular bouillon for this purpose, but it has some nasty ingredients. In any case, I never supplemented more than 2 grams. Maybe I’ll try the 5g recommended by P & V.

    I also believe that I became dehydrated during my experiment. How much water do you drink?

    Thank you and good luck on your continued experiment.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi there
      As for protein recommendations, they vary from expert to expert (there is some info on my blog post entitled “Ketogenic Diets for Cancer and Beyond.”) Some figure it based on current weight and some use “ideal” body weight and some use “lean body mass.” In any case, all of the expert calculations significantly overestimated the amount of protein I would need to achieve my goals, so I would recommend trying different levels for yourself for a few days at a time and measuring ketones if you can (at least urine ketones if the blood ketone strips are not affordable for you). Phinney and Volek recommend between 83 and 173 grams for a 5’10″ woman. I guess I’d start at 75 g if I were you and lower it from there if necessary. I can tell you that at my current ketone levels of approx 4.0, my appetite is practically nonexistent, which is unheard of for me.

      I do not feel dehydrated, I eat plenty of salt (as much as I feel I want)–but do not keep track of salt grams. I drink when I’m thirsty…

      I have not felt down or lethargic. Those feelings may have been due to eating too much protein and not being in ketosis, or due to the ingredients of the diet itself (which I think make a big difference, at least for me).

      I wish you luck in figuring out what will work best for you and am very hopeful about your situation!

  • bjjcaveman

    Love to read about another n=1 experiment with ketosis! Great posts!

    • http://diagnosisdiet.com/ Dr. Ede

      Thanks for reading, bjjc!

  • bjjcaveman

    I just wrote a post about my first 60 days of nutritional ketosis and wanted to share it with you and your readers. I figure that it could be another source where you can compare information along with Jimmy Moore’s site. While I haven’t quite had the success that Jimmy has had, I do feel tangible progress nonetheless.

    http://bjjcaveman.com/2013/02/20/first-60-days-of-nutritional-ketosis/

    • http://diagnosisdiet.com/ Dr. Ede

      Terrific, thanks so much for sharing this with us!

  • nick bagot

    What a fascinating experiment. Such commitment is truly inspiring. My own interest in the ketogenic diet is depressingly urgent. Three weeks ago I was running around, happy as anything. Today I’m resting up after having a major lump removed from my head. With the limited time I’ve had to research this subject, it seem ketosis could be my best shot at getting my kids through school. So, my question is practical: I live in London and need to find someone to help me do this. Do you know of anyone I could contact? Thank you again. That was a tough one to take for team. I hope to be a new and interesting test cade, too.

    • http://diagnosisdiet.com/ Dr. Ede

      Hello, Nick

      I’m so sorry to hear that you are dealing with cancer, and sincerely hope that you will be able to find a nutritional approach that will help the body to remove cancer cells. I listed a few resources below one of my articles, and have copied them below:

      Miriam Kalamian (www.dietarytherapies.com);
      Hamilton, Montana. Master’s level nutritionist who used a ketogenic diet
      to help her 4 year old son with brain cancer.

      Matthew’s Friends is an parent-run site about the use of ketogenic diets in children with epilepsy: http://site.matthewsfriends.org/

      The Charlie Foundation, which promotes the use of ketogenic diets in the treatment of children with epilepsy here: http://www.charliefoundation.org/

      Also, one of my readers posted this recommendation on one of my cancer articles:

      Tod wrote: Try Elaine Cantin’s book “The Cantin Ketogenic Diet” which is available on Amazon. She aslo has a Facebook page “Elaine’s Alternative Tips For Cancer” where various people ask questions and give comments. She
      successfully cured her own breast cancer with her diet. Her diet is a moderate
      protein, high fat diet, no processed foods at all and NO carbs or sugar and
      lots of veggies, especially green ones and things like red cabbage and
      cauliflower to name some. She also has some ketogenic friendly recipes for
      desserts like muffins and cookies in the book for those of us with a sweet
      tooth. ;-)

      I would also recommend Dr. D’Agostino’s site, http://ketonutrition.net/?page_id=34

      He lists more resources there; here are a few:

      DietTherapies.com (Ketogenic Diet Consulting)

      Samra Savioz (Ketogenic Diet Consulting)

      KetoTherapeutics (Ketogenic Diet Consulting and Food Plans)

      I wish you the best going forward!

  • http://www.facebook.com/profile.php?id=743365027 Sandy Bahr

    This is my first time on your site. I was just told about it today. I have been on a ketogenic diet experiment myself to see how it would affect my diabetes and my blood sugar. I am 4 months into it now. I also found that I didn’t have success until I got my protein down to about 55 grams a day. I have to keep my fat level at more than 70%. Any change from that and I would find blood sugar numbers going right back up and wasn’t able to stay in ketosis despite keeping carbohydrates at less than 25 grams a day. It took several weeks to tweak the diet to fit me and I kept going back to Volek & Phinney’s book for more information. I shared some of my journey with my Facebook group but I didn’t keep detailed reports as you have. Within 3 weeks of the diet my blood sugar was pretty normalized and varied in the morning between 79 and 90. Now, four months in it is still the case for me along with after meal blood sugar no higher than about 105. I’d like it to be lower but I’ve found that in order to consistently have numbers all under 90 I have to be eating less than 900 calories a day and I just don’t feel that doing that everyday would be healthy for me.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Sandy
      Welcome; and thank you for sharing your experience here. You have had much more success than I have–congratulations! I just started a “regular” ketogenic diet, aiming for ketones of at least 1.0 and blood sugars less than 90, but I’m only 4 days into it, so too early to know how it’s going yet. I’ll post more about it on Thursday after a whole week. I completely agree with you that eating less than 900 calories per day would be really tough. Each person has to find his/her own way to make the diet work for the long-haul.

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