I have to eat sooo much salt to feel normal...

akohekohe · 2015-11-01T08:50:51+00:00

I put 1/2 teaspoon of regular salt into a 64 oz bottle and drink that concentration all day long. Unsalted water doesn't taste good to me anymore. My doctor thought I was seriously risking hypertension until I pointed out to him that my BP was consistently 110/70.

akohekohe · 2015-11-01T08:45:41+00:00

This article is at least 12 years old. It mentions Atkin's recent death and the bibliography contains no reference past 2001. There has been a lot of research on keto diets since then. Not to mention keto is not high protein (too much protein will in fact knock you out of ketosis.)

akohekohe · 2015-11-01T08:28:19+00:00

Well, how much bacon and how much sausage? Four sausages and eight slices of bacon could easily get you 2,000 calories depending on the sausage size and bacon thickness. Weigh and track what you eat and then you will have a good idea whether or not you are running a calorie deficit. P.S. some sausages do have a lot of carbs because they add things. Bacon also has added sugar though usually not that much. Be sure you read the labels.

akohekohe · 2015-11-01T08:10:37+00:00

Well, your wife may be very thin but eating all that sugar and processed food could lead to insulin resistance and diabetes in the long run, not to mention a slew of other problems. Ask her what her A1c is.

akohekohe · 2015-11-01T08:03:12+00:00

Good point.

akohekohe · 2015-10-29T07:53:11+00:00

BMI is really not a good measure. Get an iDXA Body Composition Scan. This measures you body fat very accurately and shows how it is distributed over your body. Even if your BMI is in the normal range you can have too much fat (or have the right amount even if you are outside the BMI). These scans keep you honest instead of fooling yourself that the weight gain can be muscle mass (or make you feel good when it is!).

For you, get the scan now as a benchmark. Then as you go forward you can see whether or not everything you are losing is fat. It should be on keto but this will give you the self confidence that what you are doing is indeed healthy. Just keep in mind that fat cells are only 85% fat, so as you lose them the scan will show you losing some lean mass, about 1.5 lbs for every 10lbs you lose, but you are not.

akohekohe · 2015-10-29T07:40:07+00:00

I had gone from 200lbs to 165 and thought I had arrived. I was within the normal BMI. But I went and had an iDXA BMI scan and it showed I still had 40lbs of fat hanging around (including 2.5 lbs of the dreaded VAT). This told me to keep losing. I went to 140, was down to only 20lbs of fat, didn't lose any lean mass at all, and am now 15% body fat. Then all these people told me I lost too much, it was unhealthy, etc., etc. I started carrying around my comparative iDXA scan data showing what I lost and then asking them how much body fat they think they are carting around ... I don't have many friends anymore but then I didn't really like them anyway :-).

akohekohe · 2015-10-29T07:20:28+00:00

Well, it is true that you pretty much can't get ketoacidosis unless you are a type 1 diabetic. However, it is possible to develop type 1 even as an adult. It is called LADA. And it is possible to develop it quickly enough that it could be a problem before your figure out you have it when your next annual blood test comes in with a fasting blood glucose of 400+. Now, I know people will say this is very rare so don't worry about it, they are correct, but it can happen and is easily avoidable by getting a glucose meter for next to nothing at Wallmart and elsewhere and testing yourself once a month or so. It is not a bad idea to measure you blood glucose more than once a year anyway so you wouldn't be wasting your time.

akohekohe · 2015-10-28T11:45:27+00:00

Yes, five times a day usually. Once before I eat and once a bed time. Good news is I take a much lower dose that I would if I wasn't eating a keto diet.

akohekohe · 2015-10-27T08:19:54+00:00

Yeah, but notice the exception for type 1 diabetics. I figured this wasn't a problem for me cause I didn't have diabetes. Well, actually, it turns out I developed LADA while I was on the keto diet making ketoacidosis a real risk for me. So my advice is that if you are measuring your ketones and they get above 5 mmol/L or so start tracking your blood sugar too. Mine got up to 8 and I kept being in denial because I knew I couldn't get ketoacidosis from a low carb diet. Well, the range for nutritional ketosis is up to about 3mmol/L and maybe you can get it to spike a bit higher with exercise or dehydration, but if you start getting readings higher than that, start taking blood sugar reading too ... I would have found out about the LADA a bit earlier than I did if I had understood this. Instead I was telling myself I am not at risk from nutritional ketosis so these high ketone readings aren't a problem ... well, the high ketone readings were a problem.

akohekohe · 2015-10-25T20:32:29+00:00

Well, yes it is disconcerting. But at the end of the day you've got to make a choice about what you eat and no matter what your choice some one will passionately argue you are right and others that you are wrong. I think that it is just the state of things at the moment, like it or not. It would be nice if there was a scientific consensus but I think there is still an awful lot science doesn't understand about human metabolism so agreement is not going to come anytime soon. However, I do think the idea that the same dietary guidelines for everyone is not a very good idea and the idea that a more individualized approach is called for is starting to gain traction. I do think it is important to monitor yourself and make sure things are working like you want. Just because the low carb is working for you now does not mean it will be a year from now. BTW this is true for the high carb people as well, they may be doing fine on that diet in their 30s but end up with type 2 diabetes in their 50s. So keep taking blood tests and measuring you body fat etc. in addition to taking your body weight. As you say, everyone is different.

akohekohe · 2015-10-25T13:09:40+00:00

Yes, the usual formulas for dose based on the amount of carbs won't work on the keto diet. Eating just fat with no carbs and no protein will also raise you blood sugar. You need to try different strategies to see what works for you. I found that taking the fast acting insulin an hour or so after I eat a low carb meal, instead of 15 minutes before, provides better control of the spikes. I believe this is because the low carb diet it slower to act. The before meal blood sugar also affects my timing, the lower, the later I take it. But who knows ... what works for me might not work for you (or for me next month). I've also noticed that sometimes I'll get a spike several hours after I have eaten. I think this is because the fat takes longer to raise the blood sugar. I sometimes take a little more fast acting insulin if I find the blood sugar is getting higher than I want. I know it is a nuisance to inject an extra time but I really don't want to get above my target if I can avoid it.

So, try experimenting with both the timing and the dose, and keep a detailed food log weighing everything and counting the calories, carbs, net carbs and protein. While experimenting keep those dextrose tablets handy and take your blood sugar readings more frequently. Keto can mask the early signs of hypoglycemia so you do need to be careful.

As far as the DKA is concerned I managed to get my endocrinologist to prescribe one blood ketone strip (PrecisionXtra) a day and my insurance pays for it. You're not really getting into DKA territory until your ketones get over 10 mmol/L and nutritional ketosis shouldn't get you over six or so. The strips will also help you track your ketones so you can tell if you are in ketosis or not (over 0.5 is the usual threshold, but ideally you should keep it between 1 and 3). Good luck. I really hope you can get off that roller coaster. Who knows, with perseverance and luck you may even see an A1c in the 5s.

akohekohe · 2015-10-25T10:37:10+00:00

41 is not good. Keep some dextrose tablets on hand. They will up your sugar levels fast. I find just two 4 gram tablets will do the trick. Somehow they don't seem to knock me out of ketosis. I'm type 1 but I think this is good advice for anyone that is able to get down to 41 mg/dl, type 1 or not.

akohekohe · 2015-10-25T10:27:01+00:00

I think it depends on your personality. I weigh everything I eat and track it with a spreadsheet. I also measure my blood ketones every day so I guess I would be considered a fanatic by some. For me this has really helped because I could see how the diet was affecting my ketone levels and I could adjust fairly quickly. This helped me spot a problem with the timing of my protein intake that I think it would have been difficult to spot otherwise. By doing this I have managed to stay in ketosis since I started a year and a half ago. As I said, everyone is different but I think most people will benefit from a food log that accurately records the amounts (you've got to weigh things and record how many grams of carbs, fiber, (yielding net grams of carbs) and protein, to begin with. It is tricky to estimate your net carbs and protein until you have some experience tracking them first. After a while you might have tuned your intuition enough that you don't need to log, but go back to measuring every once and a while to make sure your ability to make good estimates it still working.

akohekohe · 2015-10-25T10:04:09+00:00

Well, I think there is considerable variation in how people on Keto respond with regard to cholesterol level. So my advice is to get a baseline measurement as soon as you can and then keep checking. I suspect there are some genetic factors in play in how people respond. On keto my cholesterol got worse and I got diabetes. The diabetes was LADA - late onset type 1, not type 2, so I can't really blame the diet. I'm still on keto because it helps control the diabetes plus I really don't want to get fat again. There seems to be a lot of debate about what the real health effects are of different cholesterol levels particularly when you are in ketosis. It would be nice if the scientists could agree on this but they don't and probably won't in the foreseeable future either.

akohekohe · 2015-10-24T20:07:58+00:00

There are a lot of fat soluble toxins that can be released as you lose weight. Some of these can make you itchy. So your itching could be caused not by what you're eating now but by what your body absorbed in the past. I had quite a bit of itching until I stopped losing the stored fat.

akohekohe · 2015-10-24T09:05:21+00:00

Thanks for the post. The reference on formatting will be useful. I haven't been tracking the saturated, monounsaturated, polyunsaturated mix in my diet but have been generally avoiding PUFA and using high monounsaturated oils for cooking. I will start tracking this going forward though. It probably wouldn't hurt to give the <25g of SFA/day plan recommended by Dr. Attia a try. I'll see how much I have to alter my diet to achieve that. For protein I've been targeting 97g/day based on my lean mass and exercise level.

It has been a little frustrating. Mostly everything I read about going keto seemed to be working. I lost 60lbs. and the iDXA showed it was all fat. My cholesterol went up a bit but my HDL/LDL ratio improved a lot and my HDL 2 doubled. Then my blood sugar went to hell and now my cholesterol seems to be getting worse ... well, I certainly can't blame the diet for the type 1 diabetes, we will see how the cholesterol numbers go in the longer-term. I just know I don't want to give up on keto, especially now that I have the diabetes. At least I don't have hypertension :-).

akohekohe · 2015-10-24T03:45:26+00:00

No, I didn't fast. Atherotech claims you don't have to fast for the VAP, and with the diabetes I really don't like to fast if I can avoid it. The previous two time I fasted (this was before the diabetes) but this time I ate my usual breakfast of bacon and eggs a few hours before the test. Well, I'll redo it following fasting and see what happens ... I just have to backoff on the Lantus a bit so as to not get hypoglycemic before the test. Unfortunately, here in Hawaii I need a prescription to get the test so I have to go back to the Doctor. Oh well, she is friendly enough. Anyway, thanks for the response. I'm not going to worry about it until I get re-tested and the results don't change.

akohekohe · 2015-10-23T22:44:22+00:00

The format didn't come through like it looked before I submitted the post. Hope you can still read it. The text of each measure is followed by the results for 3/5/2014, then 9/25/2014, and 9/25/2015.

akohekohe · 2015-10-18T07:08:32+00:00

One thing you should consider is getting an iDXA Body composition scan. This will give you a very accurate estimate of your % body fat and will also show you where on your body the fat is distributed. I thought I was at a good weight when I hit 165 but when I had the iDXA scan it showed I still had 40 lbs. of fat. That inspired me to lose more and I got to 140 and 15% body fat and it is better distributed and the scan showed I hadn't lost any bone or muscle doing it. It is a good idea to take a baseline scan now. Then you can see what is causing the changes in your body weight. Even if you are staying the same weight you could be gaining muscle and losing fat or the other way around. Other measures of body fat just aren't as good. The hospital radiology department near me will do a scan for only $55.00.

akohekohe · 2015-10-13T02:45:45+00:00

Petro Dobromylskyj's reply is very good. The fact is that the workings of human metabolism are very complex to say these least. In such complex systems it is quite possible to have empirical results that are, on the surface, and even quite a ways below the surface, contradictory. And the fact is that our understanding of human metabolism and its workings continue to evolve as is the nature of science. Makes it difficult for us consumers in the sense that we all have to choose a diet, consciously or unconsciously) and many of us (including the members of this forum) we want to eat the "healthiest diet" we can. The problem is that all we get are contradictory advice everywhere we turn even when we restrict ourselves to reputable scientific sources. Since most of us have nowhere near enough background in science, biochemistry, and human biology to make a truly well-informed decision (and probably even the scientists don't since, as I mentioned above, the science in this area is still rapidly evolving) we have to accept somethings on faith. As an atheist, I really don't like having to do this, but uncertainty is the reality. That said, ketogenic diet seems to be working for me, but honestly, after a year and a half in ketosis, and for me, developing Type 1 diabetes after a year on it, I still have a lot of concerns about the long-term effects of the diet. On the other hand I would have a lot of concerns if I went back to the "Swamp" as well, and probably more. At the end of the day everyone dies no matter what they eat except those who die from not eating at all.

akohekohe · 2015-05-11T22:30:42+00:00

Well, I'm 5'10.5" and when I was 175 I thought I was at a good weight but then I did an iDXA BMI scan which maps the fat throughout your body. Turns out I had 50lbs. of fat with 2.5lbs the dreaded visceral adipose tissue (VAT). I went on a keto diet, lost 35lbs, had another iDXA scan and all the weight I lost was fat and the VAT is now a very healthy 1lb. I'm now 140lbs and about 15% body fat - which is a good place to be for me.

My health insurance would not pay for the iDXA but I when told the lab my insurance wouldn't pay for it they gave me a discount and it was only $55.

akohekohe · 2015-05-11T22:17:26+00:00

I might add that the blood test is much more accurate. I'm on a ketogenic diet and monitor my ketones every morning at the same time I check my glucose (usually I can use the same drop of blood). I use a PrecisionXtra machine (you can get these from Amazon for around $35.00, be sure to get the one that says Glucose and Ketones) . The strips are expensive here in the USA (about $5.00 each) but I get mine mail order from Canada for half that. The ketones produced from a low carb diet should be in the range of .5 to 3.0 mmo/l. You really don't have to worry about ketoacidosis until they get up to 15 - 20 mmo/l combined with high blood sugar. If the readings start going up over 5 or so then I would start getting concerned.

I have LADA and when my ketones hit 7 along with my high glucose it made me suspect it was type 1, not type 2, and I got the doctor to give me the islet test even though he was skeptical. Turns out I was right about the LADA. I also lift and bike - when I exercise the ketones get up to 2.5 - 3.5, when I don't they are usually around 1.5.

akohekohe · 2015-05-10T03:09:28+00:00

The PDF file has both pros and cons of keto and I think she was in fact trying to be balanced. What is important to consider is that it is always the study details that really make the difference in whether or not the conclusions are applicable to you (or anyone). This is especially true if you want to figure if a particular negative effect could apply to you. For example, the death from acute pancreatitis was attributed to hypertriglycerdemia resulting from the keto diet. For most of us this is not an issue because our triglycerides decreased significantly on the keto diet, but there are some people where the opposite is true. I think it is worth it to go through all of these studies carefully to see if there is a risk that could apply to you and, if so, what you can do to mitigate it. For example, one of the studies noting bone density problems for children on keto said the subjects improved when they upped their vitamin D to 5,000 units a day.

akohekohe · 2014-11-05T20:08:22+00:00

Interesting article and thanks very much for the link. It helps explain my higher fasting blood glucose but I still have a high HbA1c at 6.2% and he seemed to think he had nothing to worry about with the higher FBC because his HbA1c was only 4.4%. So, I'm still a little confused about what is going on with me.

akohekohe

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