Ketogenic Diet Month 4

Scale OMG licensedI know I sound like a broken record, but I love this diet…more with each passing day. It’s a deep, meaningful, and abiding love.  I blush and become inexplicably emotional when I think about my diet. I would like to serenade my diet with romantic songs on a moonlit night and buy it a ring to symbolize my undying commitment to it (shhh…don’t tell!).

 

 

 

While I am thrilled with the ongoing weight loss, it’s about so much more than weight loss. The combination of moderate ketosis and avoidance of foods that can cause inflammation and food sensitivity reactions has resulted in reliably excellent mood, energy, appetite, stamina, concentration, confidence…you name it, this diet takes care of it.  As some of you may know, I have been in the throes of a major relocation this summer, from Harvard University in eastern Massachusetts to Smith College in western Massachusetts, a logistically complicated undertaking requiring sustained physical and mental effort over the past 2 months.  This diet has allowed me to function at a very high level from dawn to dusk every single day without fail.  I have moved many times in the past but it has never been this manageable.  No matter how hard I’ve needed to work moving large items to and fro for hours on end, I’ve never once felt sore or tired.

Here’s my low-tech graph for this month [my ongoing apologies to you technophiles out there...I know, I know...one of these days...]

vertical graphYes, there are a few missing data, because as I drove back and forth across Massachusetts I would sometimes forget either my ketone meter, or my scale, or a device battery would die on me…but such is the life of a moving woman.

  • Morning glucose range:  low 70′s to high 80′s
  • Waist circumference= 88 cm (down 9 cm in 4 months)
  • Body fat percentage (Tanita home scale) on day 84 = 34.5%
  • Body fat percentage on day 119 = 31.5%
  • Weight on day 84 = 144.2 (BMI = 24.0)
  • Weight on day 119 = 139.8 (BMI = 23.3)
  • Weight loss since day 84 = 4.4 lbs
  • Total weight loss since day zero (4 mos ago) =  16.4 lbs

As a reminder, I eat zero to 30 (net) carbs per day and have been aiming for 80 grams of protein or less per day.  You’ll notice that there are a few days when I exceed my goal of 80 grams, typically during times of particularly strenuous or prolonged exercise, letting hunger be my guide.  I don’t worry about fat grams, calories, or fat to protein ratios at all.

My diet consists almost entirely of roasted chicken (with skin), duck (with skin), duck fat, turkey, fish, chicken liver, zucchini, spinach, plantain chips, berries, lettuce, small amounts of black coffee, and salt.  I’ve been avoiding chocolate entirely.  Every once in a while I eat beef, pork, or a very small amount of cheese, or when at a restaurant might order something that includes a cream, wine, or butter-based sauce, but these don’t usually agree with me, so I keep them to a minimum, and most days I completely avoid them.  I steer clear of preserved, smoked, cured, aged, fermented, canned, and processed foods whenever possible.

As you can see, most of the weight loss during month 4 occurred towards the end of the month.  My theory about this has to do with exercise.  I wanted to get in shape this summer and found I had great energy as I continued to adapt to ketosis, so I was intentionally MUCH more active during month 4.  Whenever possible, on days when I wasn’t constantly active because of the relocation process I made sure to go to the gym for an hour, and varied my workout considerably–stair climbers, power yoga, circuit training, rebounding classes, free weights, dance classes, etc.  I didn’t try to run during month 4 at all because it had gotten so frustrating.

During the first half of month 4 it was clear that I was building muscle and getting into shape, so I was not disappointed that weight loss seemed to be minimal at first.  The drop in body fat percentage supports this theory.  I don’t think I’ve ever weighed less than 140 pounds as an adult. As you may imagine, I am quite happy with my progress.  Reader Marcd requested a photo, so see comments section below for a recent picture.

I’m also pleased to report that I’m finally able to run again!  I was able to run effortlessly for 40 minutes twice in the past week, which makes me very happy; I’d really missed running. Clearly adaptation to a ketogenic diet for me has been a very slow process but well worth it.

I can see that I still have more body fat to lose to achieve optimum physical condition, but it’s hard for me to estimate how many more pounds I will need to lose to accomplish that goal.  I would guess that a weight of approximately 125 pounds might be ideal for me.  I have no interest in being underweight or going to extremes, so I’m happy to adjust my goal depending on how things go.  What amazes me is that I have complete confidence that I’ll be able to continue to lose weight until I’m satisfied with the final result.

I hope that some of you will be attending the Ancestral Health Symposium in Atlanta later this month and that you’ll come say hello–I would love to meet you! My presentation on nutrition and mental health is scheduled for 3:25 pm on Friday Aug 16th.  Here is the complete schedule.  For those of you who can’t be there, once a video of the presentation is available, I will post it on this site.

I hope you are all enjoying the summer!

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  • http://nigeepoo.blogspot.com/ Nigel Kinbrum

    Hi,
    I’ve recently started following your blog. A Ctrl F for “Sleep” came up negative, so I wondered whether being in ketosis for long periods had any adverse effect on your sleep? I’m asking this because levels of serum catecholamine hormones e.g. cortisol & adrenaline/epinephrine are usually elevated during ketosis.
    Cheers, Nige

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

      Hi Nige
      This is a very good and complicated question. Early on I had many nights of poor sleep but this may have been due to food reactions or lack of complete adaptation to the diet. When I removed preserved/processed foods my sleep improved dramatically, probably because these foods contain biogenic amines (please see my blog post about histamine intolerance). Most nights I sleep well now:)

  • Tee

    Love your blog Dr. Ede. I have been reading a lot about what to eat for someone with hypothyroidism. Most has said not to eat low carbs but it appears you are eating low carb. Am I missing something?
    Confused.
    PS Good luck at your new location.

  • Marijke

    Hi dr Ede,

    It is very uplifting to see that you are doing so well. I have come from GAPS to ketosis, although the difference is more in the details than in the overall composition of the diet. I am older than you are and still have toxins to get rid of from my body. Once that goal has been reached I look forward to have just as much energy as you do.

  • Di

    ‘I love this diet…more with each passing day. It’s a deep, meaningful, and abiding love. I blush and become inexplicably emotional when I think about my diet. I would like to serenade my diet with romantic songs on a moonlit night and buy it a ring to symbolize my undying commitment to it’ ………aaahh, you sound like you are in Ketopia!!!!

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

      :)

  • Someone, Somewhere

    Dr. Ede, nice work! I’m inspired by your progress, and very happy for you. I look forward to hearing more in future months :)

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

      Thanks, SS!

  • Marcd

    Current picture please :)

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

      Fair point, Marc! Below is the most recent photo I have, taken on 7/14/13 at a family gathering.

  • Natalya

    Wow Dr. Ede,
    You are looking downright slim! Of course how you are feeling is a bigger plus. Well done, delighted for you. Love the first paragraph too. Btw…the graph might be the same, but it is much clearer. Your blog continues to be a help. Thanks.

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

      Thank you, Natalya, and I’m so glad the posts are helpful!

  • Andrew Findlay

    Hello,
    Interesting post and interesting stats. I have some questions, please.
    1. You eat a lot of poultry fat. Are you not concerned about the high omega 3/6 ratio? Suggest to cut skin and fat and eat breast with bacon/lard/avocado for better ratio.

    2. I’m curious as to why beef doesn’t agree with you. Have you tried grass fed beef? After being on Paleo for 2 years and when I have corn fed beef, I get nauseous. I cannot do keytosis as I lose body mass too rapidly and cannot afford to, so have some low glycemic carb on exercise days.

    3. Why do you avoid chocolate? I eat 99% and now enjoy the flavor. High in sat fat.

    4. Why avoid fermented foods? They are great for the gut.
    5. Interesting how your fats some days peak well over protein. Must be that poultry fat. I can only do that by eating coconut fat/milk.

    6. Many reports that acid PH which seems to be a result of protein diet is haven for cancer. Any theory/fact on this?

    Thanks
    Andrew

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

      Hi Andrew, and thanks for the great questions.
      1. I do not tolerate bacon or lard or avocado or coconut, which is why I use poultry fat. For more details, please see my early ketosis posts that follow the cancer series (Ketosis Week 1 through Ketosis Week Zero)
      2. I don’t know why beef doesn’t agree with me very well. In fact, grass-fed beef often bothers me more than conventional because it is almost always aged, and therefore contains high levels of biogenic amines (please see my post about histamine intolerance).
      3. I do not tolerate chocolate either, unfortunately…
      4. I do not tolerate fermented foods, most likely because of the biogenic amine content.
      6. I haven’t thoroughly researched the acid theory of cancer, but everything I know about cancer so far seems to point much more strongly to refined carbohydrates than to protein–please see cancer posts and carbohydrates page for more background information.

      • Andrew Findlay

        Thanks for your response. I’ll read more into your other writings.
        Andrew

  • bill

    I’m not usually effusive, but I have been known
    to say, “I really, really love this way of eating.”

    Glad to hear you love it too.

  • Kitty

    Good Day,

    Must say I loved the Keto diet to, I would say it was the best and I never once cheated, in 4.5 months but did give up due to terrible heart pounding most of the day (not fast heart beats) and shortness of breath when laying down to sleep at night. Have been checked out by the Medical and all is normal, what could it be? Any idea? I see in other Keto Forums that people have the same problem. What would you suggest if you met people like me?
    Thanks a lot

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

      Hi Kitty
      I had this same problem when I was on the stricter version of the diet (the Seyfried version, eating 50 g of protein per day). When I started the diet up again after failing the Seyfried version, I no longer had the heart pounding issue. However, I don’t know if that is because I had made some menu changes to minimize my exposure to biogenic amines (avoiding processed/aged/fermented foods) and/or because I raised my protein allowance…

      • Kitty

        Hi Dr. Ede,

        I hope I can sort this problem out as I also love a Keto diet. The 3 x 3 months I tried different version like the pH diet, then Dr. Atkins type diet and then the last one Dr. Gabriel Cousens Diet of the Tree of Life, I did not eat any of the foods you mentioned (processed/aged/fermented foods)
        But still all three of them did this to me. I did follow a low protein diet in some of the three cases. So, the protein may have been an issue, but then after increasing it on the meat diet to around 100 which my body wanted, there was no difference, the pounding did not go away even after I did it for a total of 4.50 months, in all cases, it was never less than 3 months, usual a bit longer as I tried and tried to find a solution

        Now, something I did ignore all those months was DRINKING WATER as I am older and never thirsty I must have been very dehydrated according to some reading I did. The strange thing is that I felt well on all levels EXCEPT the heart pounding which worried me and then the shortage of breath which followed it when going to sleep or in the night

        I want to re-start again but adding 8 glasses of water every day.

        But as found out as soon as I added starch back (and weight and not feeling good on it like a return of Low Blood Sugar) it went away in a short time, maybe my body was stocking up on water again, was no longer dehydrated and all settled (like now) heart pounding wise. But then I have those horrible LBS episodes, I cannot life like that either…
        Anything sending me in the right direction other than your reply would be greatly appreciated, like the story of other people who have encountered the same maybe
        I have not followed your story since a while and wonder if you had your cholesterol checked as mine on the Atkins type version of the Keto diet went up from 154 to over 300 and when going back on a mainly vegan diet, like in the last months, after three months it was down to 167 now with all values correct according to my blood tests
        My doctor is puzzled to

        Thanks so very much,

        • Patrick

          First thing that comes to my mind is…are you getting enough sodium? I’ve found that if my carb intake is very low I need to make sure I get enough salt or I’ll feel the effects of low blood volume…weakness, headache, heart rhythm disturbances, shortness of breath, anxiety, etc. Hope this helps.

          • Kitty

            Good day Patrick,

            I would say that I eat enough salt as I like salt with a raw vegan diet. So that will not be the problem. I had my electrolytes checked and they were fine to: potassium etc. My proteins were just at the border line of enough, so I may start with adding some more protein as this has seem to help Dr. Ede
            My only real problem is heart rhythm disturbances and shortness of breath after meals due to high fat meals I suppose but

            I always had plenty of energy after the initial weeks

            I will add 8 glasses of water a day which I have neglected and some more protein. Hope it helps as I am really battling if I no longer can do Keto as I feel terrible again, put on weight and have Low blood sugar…Keto was best for me
            Dehydration may be the cause, here salt will help for sure

            Thanks for your ideas

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

          Hi Kitty
          I have cholesterol levels posted in the blog article entitled “Ketosis Week Zero” and will be posting more recent values soon. Real Woman Anne will also be posting soon with an update that will address her cholesterol levels, too.

    • Marissa

      I had something similar and found that when I started taking a Vitamin D supplement, this went away. Might you be Vit. D deficient?

  • Maria Armstrong-Doula

    I am with you in the love affair with ketosis! It’s been 17 months and I don’t think I will ever change this diet. The one time I went higher carb for two weeks (summer fruit induced LOL), I felt miserable and went right back to ketosis.
    Congratulations and thank you for posting your journey!!!

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

      Congratulations to you, too, Maria!

      • Maria Armstrong-Doula

        Thank you! Almost 100 pounds gone!

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

          WOW!

  • Robert H

    Hi Dr. Ede, moved to Northampton! I live in Greenfield, and work at UMass. I hope you will give a talk or presentation in this area sometime. I’ve been following a very similar way of eating for over 2 years now, lost the excess 40 pounds I’d gained, feel much better, and have been maintaining at 145 for close to a year with no problem. I don’t have the problems you mention with beef or chocolate or fermented foods. I eat a lot of hard cheese, mostly cheddar, almonds, some greens, and sometimes have Cabot high fat Greek yogurt with blueberries. I’d like to try the plantain chips you mention. The only sweet I have now is a little bit of plain stevia with my coffee or tea. I have found that most sweet things that I used to like (like Virgil’s Zero Root Beer) are just TOO sweet. I don’t pay too much attention to protein levels but my fat is always in the 80% range, and carbs generally below 50 g/day. I love this way of eating, and can easily see myself eating this way for the rest of my life. Having lost the weight and lost the terrible heartburn I used to have, I am a very happy guy. Thanks for all the information you share.

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

      Hi Robert
      Love your neck of the woods so far, I must say:) Would love to give a talk here once I get my bearings and get settled in to my new job and hope to meet you when that happens. Congratulations on your success! The plantain chips have been nice for me because they are not sweet–they are starchy and salty like a potato chip but they are technically a fruit, so they don’t seem to bother me the way potato products do. I can get away with eating about an ounce of them per day, spread over the course of a day and they satisfy my wish for crunchy/salty. They are available at Whole Foods in the bulk dried foods aisle.

  • Lisa

    Dr. Ede, thank you so much for sharing your keto journey with us. I’ve found it especially inspiring as a 40 something female who has struggled to lose weight. If you could give some advice to yourself 6 months ago, what would it be?

    Thanks again, I look forward to your further updates

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

      Hi Lisa
      I’m so glad that other people can benefit from my trials and tribulations:) Hmmm…6 months ago–that was February, just as I was starting my Seyfried ketosis experiment (see post entitled “Ketosis Experiment Week 1.”) I would have told myself to have faith–that even though I believes my metabolism to be especially challenging, I, too, could use a ketogenic diet to lose weight. There were points at which I felt very disheartened because I had seen other people easily lose weight on a ketogenic diet but wasn’t sure I could do it, especially given all of my food sensitivities. I also kept slipping off the plan last year due to frustration and carbohydrate cravings, so it took me a long time to be able to put together more than 3 weeks of strict protein/carb limitation. But once I was finally able to do that, I found the diet worked just as well for me as it did for so many other people, which was very reassuring and encouraging!

  • mombot369

    Welcome to the neighborhood Dr. Ede! I live about 30 minutes from Northampton – it’s a great area and I think you’ll have fun exploring it once you get settled. A good place to shop in town is the River Valley Market. It’s like Whole Foods before it went all corporate.

    This is my way of eating as well and it keeps my prediabetic blood sugars completely normal. For people mentioning heart pounding I found for myself that supplementing with magnesium is a great help. Natural Calm is good and magnesium oil rubbed into the skin is also excellent. Patrick’s info on getting enough sodium is right on the money, too.

    Good luck! Judi

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

      Hi Judi
      Thanks for the warm welcome! I love it here so far:) Yes, I agree that the River Valley Co-op is a great place and I am already a member and frequent shopper there, so great minds think alike:)

  • http://lowcarbbetterhealth.blogspot.com/ Rebecca Skvorc Latham

    The NK that I am doing now has only been for two weeks. Starting in July 2012, I did it for four months before slipping out of ketosis. I began anew two weeks ago. You can see by my charts that I had several months of gradual weight gain culminating in a diagnosis of Type 2 Diabetes. That’s when I knew that I had to get serious and fast and forever.

  • http://lowcarbbetterhealth.blogspot.com/ Rebecca Skvorc Latham

    This is a list of my posts on my results. Feel free to not post this as a comment. I just wanted you to see how it is going for me. http://lowcarbbetterhealth.blogspot.com/2012/10/nutritional-ketosis-results-by-week-and.html

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

      Hi Rebecca
      I took a look and it seems you are doing very well–congratulations and keep up the good work!

      • http://lowcarbbetterhealth.blogspot.com/ Rebecca Skvorc Latham

        Thanks, and I’ll be very interested to see how you continue to do. By the way, what do you think of my change from eating 57g of protein to eating 90g of protein? Some say it is too much and some say it is not enough.

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

          As long as you are staying in ketosis and making progress towards your goals, I wouldn’t worry about it. Everyone is a bit different. Protein requirements may vary by body size, age, personal metabolic rate, and activity level.

  • Elaine Shields

    Hi Dr. Ede,

    I’m so happy that the diet is working so well for you! Congrats on the weight loss, too. You look great!

    Also I’m surprised that you found a snack food that you are able to enjoy on a daily basis! I have never tried Whole Foods plantain chips but now I want to try them. What type of oil are they fried in?

    Anyway congratulations again! Glad to see your hard work is paying off :)

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

      Hi Elaine
      Thanks for the positive feedback–the plantain chips are fried in refined palm oil. If only I could find a manufacturer that fries them in duck fat:) I still have to be careful with plantain chips, because if I eat more than about 10 at a time, it will trigger cravings to eat the whole container. I don’t eat them every day, just as a treat from time to time, but it is nice to have found something crunchy and salty that seems to agree with me.

  • Terri Fites, MD

    Very interesting. Thank you for posting and blogging.

  • Dr. MikeG

    Hi Dr. Ede,

    I am very interested in your self-experiment …

    Do you take a daily Multivitamin and Omega-3 Supplement?

    Greetings from Germany,

    Dr. MikeG

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

      Guten Morgen, und Gruesse aus Amerika, Herr Dr. MikeG! I do not take a multivitamin but I do take Fish Oil and vitamin D.

  • Natalya

    Hi Dr. Ede,
    I was wondering if you have taken the time this summer to soak up some sun? It sounds like you have not been doing a lot of dedicated lollygagging (Is this an oxymoron?!). When my health adventure started I would get acute ‘solar dermatitis’, sun induced rash. Who knows what pathway was broken. W diet changes, and probiotics, it is now gone. Stephanie Seneff suggests that the D3 we make is very different from the D3 supplement we can take. (She has interesting ideas on health and nutrition.) You still have a couple months before Vitamin D winter at your latitude. Hopefully you can catch some rays!

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

      Hi Natalya
      Sorry for the delay in getting back to you. Yes, thank you, I got lots of sun this summer–more than usual. Of course now that the sun is receding, I will be reintroducing supplements soon, even though I agree they are not the same as our own naturally-produced vitamin D. Hope you are enjoying the last few weeks of the summer!

  • Daisy Rose

    Hi Dr Ede, thank you so much for your blog!

    I am following a KD because I had swooping blood sugar highs and lows, despite previously eating a complex carb diet; intolerances to certain carb foods; chronic fatigue type symptoms, which have not been so bad over the last several months; sleep problems and a mood disorder. Blood sugar and mood has remained more stable since being on the diet, and I have been able to fall asleep very easily, whereas before this diet I was not able to at all. However, it is no longer possible, to think, after now getting into nearly my sixth week of doing this diet, that it is ‘keto flu’ I am experiencing – despite it taking me nearly 4 weeks to get into nutritional ketosis, which only happened after adding MCT oil to my diet, which pushed my blood ketone level above 1.3mM, never getting higher, no matter what time of day I test, and not dropping below 0.7mM. I have been eating less than 20g carbs net (including leafy green veg), protein between 60 – 70 g day. Appropriate for my body weight and energy expenditure. Coconut fat and MCT oil making up the deficit of calories – to manage to eat a total of between 1,200 to 1,500 cals a day. I was not really overweight, but have lost nearly 9lbs which I am happy about – presumably some of that ‘water weight’.

    I did have several days of feeling really well…but now this is my third day of feeling so awful – dry eyed (this is not that uncommon, apparently, when following LCD – yet so little is mentioned about it!), low body temp (which was happening when I was at my worst with the CF), can’t think straight, and no energy (but more a lack of stamina than any sense of flu like symptoms, which I get with the CF), also feeling vaguely nauseous. Constipated (I am drinking adequate water). No hunger pangs at all.

    I came across this article written by Dr Cate suggesting that thyroid levels can become imbalanced with such a drastic change of diet; and like she says in this article – she gives the example of a bear going into hibernation – that is just what I want to do. Find myself a cave and go to sleep!:

    http://drcate.com/going-low-carb-too-fast-may-trigger-thyroid-troubles-and-hormone-imbalance/comment-page-2/?doing_wp_cron=1375964343.5524570941925048828125

    She suggests, as do others, that it is sometimes a good idea to re-introduce some carbs back into the diet to stop these symptoms, and hopefully the thyroid levels will return to normal, if that is what is creating these symptoms in me now.

    As I write to you, I am making a little brown rice to eat, to introduce a little carb back and see if this helps address these immediate symptoms, because I realise I cannot go on another day feeling like this. I am in a dilemma regarding all this! Of course, nothing is as clear cut as things seem; but I am very disappointed that various experts in the field of LCHF Diets are not pointing out the problems that can happen attempting such a diet and way of eating. I am grateful to Dr Peter Attia for at least mentioning he didn’t honestly know why some women, do not seem to do so well on a KD when pre and menopausal. I am post menopausal and although I took bio-identical progesterone in the premenopausal stage, I don’t now, and I never
    suffered hot flushes. And, now, I am sure, for me, who already had a thyroid
    that I suspected was not functioning optimally before the diet, is now seriously in distress.

    If I reintroduce some starchy carbs back – less than 100g to start with, no doubt this will take me out of ketosis, certainly as I was struggling to get into ketosis when eating max 20g net carbs. From the way Drs Volek and Phinney describe in their book ‘The
    Art and Science of Low Carbohydrate Performance’ it seems, to me, they are saying your body either operates by using carbohydrates for fuel OR ketones once the body is no longer ingesting enough carbs, it will then adapt to making and using ketones – which they say usually takes between 1 and 4 weeks…so, I guess, I am asking if I am no longer in ketosis, how can my body adapt to a low carb diet? Yet, as Dr Cate’s article suggests, as do Drs Paul and Shou-Ching Jaminet in this one – http://livinlavidalowcarb.com/blog/paul-jaminets-response-to-the-critics-of-his-safe-starches-concept/11920.

    Will this mean I can eventually try to go back to being in nutritional ketosis,
    or not?

    I have friends who are doctors and they are so sceptical of the whole LC thing anyway. One looked at me with the deepest alarm when I told him about it, and my own doctor would not support me in this. I feel overwhelmed now, by feeling I am weakening my already not too strong body and mind. I really can’t think straight at all, and unsure what to do. Would love any insights from you Dr Ede.

    I do so apologise for writing such a long comment/question as I know you must be so busy. I have so appreciated your blog for a while, and I know you had difficulties in the
    beginning with the diet – yet, now, your body seems to have adapted and you
    feel (and look) great! Long may this continue for you :)

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

      Hi Daisy Rose
      I am sorry for the long delay in my response to you. I’m sorry also to hear you’re having trouble adapting to this diet–I have to say I had my own struggles for sure during the first few weeks but I stuck with the diet and gradually felt better and better and better…reintroducing carbohydrates will likely put you back to square one, but the next time you try it again, if you decide to, you may want to try it a bit differently. One possibility is simply slow adaptation, but another possibility is that the kinds of foods you are eating on a KD are making you tired. I know that was true for me during my earlier attempts–I was eating too many cured, aged, fermented things like olives, vinegar, sausages, etc. When I switched to fresh/frozen animal proteins the problem with fatigue went away. However, it did take several months before I was able to run without getting tired. You may want also to write to Dr. Rosedale on his website, as he is responsive to individuals’ questions about problems with adaptation.

      • Daisy Rose

        Dear Dr Ede,
        Thank you for even bothering to reply. I appreciate it.
        As to what you mentioned – I introduced more ‘good carbs’ as to re Paleo (no grains) – sweet potato and now pumpkin and squash which are a favourite, but not that much. Brazil nuts, which my body seemed to love, and apparently good for selenium and the thyroid. This seemed to help my body temperature, which did start to climb within about a week; but still dry eyes all the time. I am eating very clean, as in no cured or fermented foods – all fresh produce.
        My stamina did sort of return; and then since I am under a lot of stress emotionally and physically my CF symptoms have returned. However, I do not think the diet is now affecting and causing these. In fact, there is some evidence, I think, that as I am not eating any gluten that I now no longer have a foggy mind. Some long gaps in thinking, yes, and, not being able to concentrate, but this is not the same. Also, interestingly, I am not depressed – I wonder how much gluten can influence mood, too?
        I was avoiding all dairy, so reintroduced some Greek yoghurt the other day, to see if this would help the dry eyes – lack of mucous I was told – and this has helped; and no ill effects in me.
        This is all so fascinating. It helps to see one as a subject for study, I find, especially when one feels so crap, and trying to find out why!
        Before becoming so unwell physically I was training as a psychotherapist; I do not think enough heed is given to the foods we eat and ingest along with potential environmental toxins that could potentially cause, or at least exacerbate mental health symptoms.
        I find so few doctors or professionals in the medical or the mental health field take both sides seriously. It is so good to find some who are. Thank you for being one yourself; and for sharing some of your and your family’s history. It is so encouraging to those of us, who also came into the profession I have chosen, because of my own and my family’s history. My current conditions, health wise, continue to inform me and give me so much more informtion about truly listening to someone and not making any ‘given’ judgement about what should or should not be done in treatment.
        I will certainly look at Dr Rosendale’s website.
        Thank you for reading and responding as you do.
        All very good wishes, Daisy Rose

  • MikeS

    Dr. Ede:

    Glad to hear you’re doing so well on your ketogenic
    diet. I myself have recently completed nearly two ketogenic months and
    am doing well, although I have to admit that previously I had few major
    problems other than nearly resistant hypertension that seems to respond
    only to drugs. I also have to admit that ego has played a role also.
    I’ve lost at least 2-in, or perhaps 4-in, and about 6 lbs — about 4 in fat, from Tanita. Seemingly endless energy, better sleep, terrific cholesterol numbers — if they really mean anything.

    Sorry I was away and not reading email much when you latest post came out. Hope you are still reading comments.

    Not to rain on our parade, but I wonder if you have seen this post from Steven Leach at the American Gut project::

    http://humanfoodproject.com/sorry-low-carbers-your-microbiome-is-just-not-that-into-you/

    He presents some preliminary data from an ambitious effort to
    identify, through DNA sequencing, the gut microbiomes of 20,000
    people, who will provide them fecal samples. You can find details here:

    http://humanfoodproject.com/americangut/

    The initial data of the project have little to do with the alarming picture he paints:
    that low-carb diets can lead to serious starvation of our
    intestinal microbiome.

    I haven’t had a chance to delve into his reference- heavy
    critique and frankly, I’ve got to rely on experts here. This is out of
    my league. Hope you’d be able to provide some thoughts.

    Here’s an (extended) excerpt from Mr. Leach’s post

    ….fewer overall carbohydrates – especially when you start dropping below
    75-100g a day – translates into a dramatic drop in the amount of food
    reaching your colon where the vast majority of your intestinal microbial
    community resides. (There are exceptions to every rule, but follow my
    logic for a moment).

    When it comes to the health and well being of your gut microbes,
    nothing matters more than fermentable substrates (You can read about here, here, here, here, here, here, here, here, here
    – you get the idea). As the rules/tenants of basic microbial ecology
    go, a reduction in fermentable substrates derived from carbohydrates
    means
    less energy sources for the microbes – who depend on host-derived
    substrates as well, as in the case of mucin-degraders like Akkermansia.

    As fermentation drops, so to does the byproducts of fermentation which
    include short chain fatty acids (primarily acetate, butyrate,
    propionate), organic acids, and gases like hydrogen. All of this can and
    will dramatically shift the pH of the colonic environment. As it stands
    in a healthy or normal gut, the pH of the colon changes from proximal
    to distal end, being more acidic in the proximal (front) end than the tail end –
    mainly as a function of more rapid fermentation as food items empty from
    the small intestine. As the pH shifts to being more alkaline from less
    fermentation, a number of shoes begin to drop (or can).

    A less acidic environment means acid sensitive groups of bacteria,
    like those in the Phylum Proteobacteria, which includes a who’s who of
    bad guys like strains of E. Coli, Salmonella, Vibrio, Helicobacter, might
    bloom – not a good thing. You see the same blooms following antibiotic
    treatment. In addition, as pH shifts away from acidic, the genus
    Bacteroides can also bloom as well, gaining an ecological niche in this less acidic environment courtesy of a low carb diet. For those of you keeping score, many talk
    about the American gut in general being dominated by Bacteroides as a
    function of our high fat, high sugar diet. The reality is, it might have to do with what we are not eating – dietary fiber (of all kinds).

    The all-important butyrate producers Roseburia spp. and Eubacterium also
    drop in abundance as pH shifts away from acidic as well. A drop in
    fecal butyrate and butyrate producing bacteria was demonstrated in an elegant study
    comparing diets of varying amounts of carbs. Given the importance of
    butyrate in colonic health, any dietary strategy that potentially shifts
    pH away from acidity as a function of reduced fermentation, might contribute to various forms of IBD.

    So, low carb equals a less acidic colonic environment due to the drop
    in fermentation (and I presume harder, and less frequent stools as a
    function of reduced biomass from bacteria – or maybe not). As pH shifts,
    prospects for opportunistic pathogens increase, as does opportunities
    for gram-negative bacteria like Bacteroides and Enterobacter. When you
    add this up – and a lot of more shifts in the microbial ecology of the
    low carb gut – you most certainly have a classic case of microbial
    dysbiosis – as the name implies, an imbalance. This dysbiosis can lead to issues
    associated with IBD, autoimmune disease, metabolic disorders and so on.
    But again, a large cohort of low, low carb dieters has never been looked
    at using 16S rRNA methods. So the jury is still out – but will be
    fascinating to see.

    A bit of a paradox in all of this is the increased likelihood that a
    low carb microbial community will most certainly lead to increased gut
    permeability – a well-known phenomenon whereby microbial parts (lipopolysaccharides, which leads to metabolic endotoxemia)
    and whole microbes themselves (bacteremia) leak from the intestinal
    track into the blood, leading to low-grade inflammation that is at the
    root of metabolic diseases such as type 2 diabetes, obesity and heart
    disease. So it is a paradox that a leaky gut that can be triggered from a
    low carb (high fat) diet – and a possible increase in gram-negative
    bacteria and a reduction in healthy bacteria like Bifidobacterium –
    doesn’t result in weight gain as demonstrated in study after study in
    mice and humans. Weird.

    I hope people do not take this as some kind of attack on low carb
    diets – couldn’t be farther from the truth. There is NO AGENDA. Again,
    NO AGENDA. (It’s worth noting I consume a high fat, high protein, high
    fiber diet). Just wanted to point out some obvious concerns (maybe
    unfounded) and that if we get a large enough sample of low carb folks in
    American Gut, we might be able to provide some interesting insight – or
    not. Who knows, maybe low carb folks have super healthy gut microbiota
    (whatever that is).

    That’s it from Mr. Leach.

    • Daisy Rose

      Gosh, the more you try to learn…the more there is…and darn, it gets so confusing :)

    • Annlee

      Well … I’ve been VLC and mostly keto for almost a year (another week or two) … and my experience has been “easy” — as long as I have sufficient sat fat in the diet, it’s quick, it’s never uncomfortable, and things pass quite easily. It is less frequent – but I’ve had NO gut dysbiosis. In my prior SAD-based diet, then losing weight counting calories, wheat reliably had me with the urgent flavor of IBS – and I can tell when I’ve gotten some hidden wheat (as a road warrior, I eat out too much). Keto is my best friend.

      • Daisy Rose

        Hi Annlee, I’ve just been reading your comment here…and, I am intrigued by you saying you have been VLC and mostly keto for the last year. Does that mean Vegan or Vegetarian Low Carb? I am extremely interested if you are managing it, as I was vegetarian for decades and I was eating that way for ethical reasons mostly (and health – the irony), However, I started eating fish to eat enough protein (and because fish oils are meant to help alleviate depression), and because now I have found, if I don’t, and replace my protein source with a veggie option it seems to take me out of ketosis. May I ask what sort of protein you eat? Hope you don’t mind me asking.

        • Annlee

          Sorry! VLC == Very Low Carb. I eat mainly meat, eggs, and some dairy (cheese, heavy cream, butter). A little veg – I find vegetables useful mostly as a vehicle to deliver tasty sauces. One square of Lindt very dark (85-90%) chocolate per day, if I remember. Some nuts, mostly roasted mixed nuts with sea salt, and very occasional berries.

          There was a period of adaptation, and I have slowly gravitated to less and less plant matter – and I find myself more and more satisfied with that.

          We buy 1/4 grass-fed/grass-finished cow from a local ranching family, and for other quality meat we shop Whole Paycheck, except bacon – I get large blocks there from WalMart and consider that my 20% (on the 80/20 rule).

          Make sense?

          • Daisy Rose

            Dear Annlee, Thanks for writing back. Ah, I see, quite funny really as the ‘V’ stands for very…and really the complete opposite diet to what I was thinking :)

            I now seem to have adapted to what I am eating now in a LC way – but my body as of now seems to like and need particularly dark greens; not so much the ‘starchier’ pumpkin/ sweet potato it really needed to get me from the HC diet I was on. I don’t do well with a lot of any dairy at all; and only a very little Greek yoghurt eaten as a dressing on dishes; occasional Mozzarella cheese (I get very dry eyes if I don’t have a little dairy; but too much and I wind up craving foods, which never happens when I don’t eat dairy on this diet). Nuts seem to suit me too; oily fish; avocados, eggs. Coconut oil and Virgin Olive Oil my fats.

            I find it so interesting how different people are in how they adapt to eating in this way – or any way, really. Everyone needs to discover for themselves, it seems, what suits them.

            Really glad what you eat suits you. Thanks for sharing.

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

      Hi Mike
      Sorry for the long delay in my response–AHS presentation, new job, etc. etc…but thank you for the detailed information and questions about the microbiome–a HUGE topic I have yet to wrestle with in the kind of detail I like to before forming an opinion. All I can say right now is that all of my GI and and other chronic health problems are completely gone on my current diet. It sounds as if you feel much better on a KD as well, even though you didn’t have major health problems to begin with. Anyway, I hope to delve into the microbiome literature in the future and write about it on this site or give a talk about it…I fear that much of the research may be tainted in the same way that most nutrition research is–complicated by poorly-done animal studies, lack of attention to composition of diet, biased questions, etc.

    • MikeS

      Dr Ede:

      Thanks for the reply. I’m glad you are thriving (as I continue to, incidentally) on a ketogenic diet.

      I understand your situation and I’m looking forward to your incisive analysis. Best of luck in your new position.

      I’ve been mucking around the HMB literature. But without real
      grounding in a great deal of essential foundational knowledge, I feel
      utterly lost in trying to implement the practical dietary steps I should
      be taking to optimize health minimize risks — gastrointestinally
      speaking.

      I like the way someone once referred to the human microbiome
      (HMB) as “The rainforest in our gut.” Imagine being set down in the
      middle of a rainforest as a naif and told to develop a full
      understanding of its flora and fauna, and which of them to eat and in what
      quantities, and how to measure the effects of what one had eaten. That’s
      my quandary. As is apparently, medical science itself. The fog of war
      is oftimes exceeded only by the fog of science; the fog, that is, that
      precedes discovery.

      One fascinating paper I’d like to bring to your attention, for
      your reading delectation is: “Intestinal mMicrobiota, Probiotics and
      Mental Health: from Metchnikoff to modern advances,” an extensive
      three-part open-access comprehensive review of the HMB:

      http://www.gutpathogens.com/series/metchnikoff

      The paper’s scope is larger than the title suggests: it covers a variety
      of disease states that were –and those that are now thought to be–
      related to the gut; it also delves into the history of efforts to
      understand the gut-brain-body connection even before Metchnikoff; . It
      has an incredible amount of information on the use of low-carb,
      ketogenic, and probiotic dietary practices from the mid-19th century
      onward. In short, it’s a tour de force. Great medical history too, If you don’t know the name Henry Cotton, MD, you’ll never forget him after reading this paper.

      One practical way to approach the way out of the “rainforest,” might be to query some of the centers of modern ketogenic application for epilepsy, such as Johns Hopkins. They must have confronted the issue of how many carbs, and what type are necessary –if any at all — to maintain gut integrity, and prevent that old bogeyman –autointoxication — even as they are curing the epilepsy.

      Also, I wonder if Volek and Phinney (The Art and Science of Low-Carbohydrate Dieting) have dealt with this issue . Honestly, I haven’t even taken these steps myself, but I plan to, and I’ll report anything of interest I find.

      Again, best wishes in all your endeavors.

  • JohnH

    Looking forward to viewing your Ancestral Health presentation.
    Hope it is available soon!

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

      Hi John
      Thank you for your interest! I heard rumors at AHS that the videos will be posted much sooner than they were last year…here’s hoping:)

  • Patti

    Hi Dr. Ede,

    There aren’t any nutritionists or doctors in my area who know anything about NK. I have been trying to get into NK for two months now, and each time I fail. I find myself mindlessly walking towards the frige looking for fruit, sugar, ice cream (fyi – my family eats these foods because they are not interested in NK), and I can’t stop myself. I am stuck because it happens each time I get my carbs down under 30 grams. Do you have any suggestions to help me?

    Thank you!
    Patti

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

      Hi Patti
      I am no expert on NK but I have a few thoughts that may be useful. The first is that it can take a few weeks to adjust to the very low carbohydrate content of a ketogenic diet, but the carb cravings do usually go away within only a few days for most people. When they don’t go away fast, it could mean that you are including something in your NK diet that is triggering carb cravings. The most common culprits are dairy products, caffeine, and artificial sweeteners. The other common problem is eating too many grams of protein. I hope this helps a bit…

      • Daisy Rose

        Hi Patty & Dr Ede,
        Hope you don’t mind me responding too…I found that when I introduced dairy back after weeks of none I was fine, when I had just a spoonful of Greek yoghurt on top of a salad or veggies, but the minute I tried to eat it as a dessert I find myself craving more and more.Ugg! Had to stop eating it like this. In fact, I ‘d say avoid all dairy if poss. I seem to need it, as I related below in a post, I get really dry eyes if I don’t. And, yes, same for me with caffeine and artifical sweeteners. Without, I don’t at all. It is wonderful! Such freedom from the tyranny of cravings, and eating because of them. They are so powerful. Good luck to you. And, thanks again Dr Ede for confirming something I needed to read :)

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

          Thanks for chiming in, Daisy Rose! The more the merrier:) Some people are lucky and can get away with dairy…I know I wish I could!

          • Daisy Rose

            We are all so unique, even if we have some similarities – well, we are all human :)…but, it so bears thinking about. I can’t believe how many so clever (and perhaps too well trained?) professionals think we fit a ‘template’. I found it so eye opening the fact that you are so intolerant to nearly all vegetables. How in the last three months my whole way of thinking has changed. I was vegetarian for decades, and now I realise that because of my own less extreme intolerances some of my staple foods were contributing to my mental instability and my lack of physical well being. Not the entire cause, but a large factor, I now believe.
            I am so sorry your diet is so restricted. However, so glad you are now thriving on it. People look at what I eat now – and it is a banquet in comparison to your meagre meals; but I would not for anything diverge from it, apart from to experiment and see what I can possibly add in the future.
            Thanks again for this blog and all you are doing professionally.
            Best wishes from a very wet London, England

        • Patti

          Daisy Rose,

          Thank you for letting me know about what foods cause cravings with you too. Yeah, when I eat yogurt, forget about it, all I want is sugar.

          Patti

      • Patti

        Hi Dr. Ede,

        Thank you for your response. I think you might be on to something for me regarding the sugar replacements. I have been using them to get me over the NK hump, but I think that is why I couldn’t get rid of the sugare cravings. I haven’t had any for the past 5 days, and I am craving sugar a little but not like I was when I was using the substitutes. Also I gave up caffiene and dairy during this time as well. I had gone back over your post looking for some type of direction. It sucks that caffiene, dairy, and sugar substitutes cause cravings.

        Thanks again.
        Patti

  • mark

    Hi Dr Ede

    Can i ask why you choose to only have beef and pork occasionaly? also do you not have any lamb? on the subject of fish since you mentioned about amines do you not find these cause a problem as fish especialy tinned is meant to have high amount of histamines.

    thanks

    mark

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

      Hi Mark
      I have been experimenting with red meats more often lately and I think I may be discovering that the AGE of the meat might determine whether or not it bothers me. I had been leaning towards grass-fed meats but grass-fed lamb tends to come from far-away (New Zealand, typically) and grass-fed beef is almost always aged on purpose for at least 2 weeks. As for pork, I am still trying to figure out whether I have a pork sensitivity or not. I have great difficulty with tinned fish, probably because of the biogenic amines, as you say.

  • Geraldine

    is it ok to be on a ketogenic diet with hypothyroidism? thank you for your response

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

      Hello, Geraldine
      I cannot provide medical advice on this site, however, theoretically, a ketogenic diet should be safe for most people with hypothyroidism. Some believe that ketogenic diets can cause hypothyroidism because thyroid hormone levels can be lower on ketogenic diets. However, according to Dr. Rosedale, this is a healthy development, allowing the body to run “cooler” and more efficiently. The kind of low thyroid activity associated with the ketogenic diet does not cause hypothyroidism symptoms such as depression and constipation, because it is not a disease state but a natural adaptation to ketosis.

  • Sarah

    The thing about meat is, it’s not that easy to get really fresh meat, or at least fresh enough not to cause histamine intolerance symptoms. Lately I have been eating this frozen chicken that is better quality, and most of the time, it’s alright, although that depends on proper handling. (Like no thawing and refreezing) I find that long cooking times increase histamine reactions. I would worry about the hypothyroid question, too on a ketogenic diet.

  • Steve Bergman

    “I’ve been avoiding chocolate entirely.”

    Just a tip, in case you are interested in chocolate. There are a few ways to do it in a LCHF fashion. Firstly, there’s Lindt’s 90% Cacoa Dark Chocolate bar, which is not terribly high in carb (or sugar). Then there is unsweetened baking chocolate. I put an oz in the steamer till melted, and then sweeten with stevia liquid. (You can steam it with stevia leaves if you object to the extract.) That’s 8.65g total carb – 4.8g fiber = 3.85g net carb per oz. (Most of that is insoluble fiber, btw.) Another possibility is unsweetened baking cocoa. (1.33g net carb per tablespoon) Add the oil of your choice. I like safflower or EVOO. Extra virgin coconut is particularly delicious. Again, you can use whatever technique you prefer to sweeten. Or, you can acquire a taste for unsweetened chocolate/cocoa. I’ll sometimes just grab a square of the unsweetened baking chocolate and enjoy it unmelted and unsweetened.

    BTW, I’ve been doing LCHF for a little over a year now. And like you, I’m quite happy with it. People often think of it as a weight loss diet, when in fact it’s really a healthful lifestyle, overweight being one of the things it can correct. The fact that I’m able to keep my BMI at 22.5 more easily at age 50 is just one of the benefits.

    Also, I enjoyed your “Little Shop of Horrors” talk. It’s about time more people pointed out that what passes for science in the field of “nutrition science” would not be tolerated in any field of real science. Nutrition “scientists” call RCT’s the “gold” standard, (paying faint lip-service to the idea corrolation != causation) when in fact, in real science, it’s the *only* standard. It’s so tempting to try to believe that the epi-studies really mean something, since the alternative is to admit that we know a hell of a lot less than we thought we did. Imagine devoting your entire career to collecting and shuffling epi-data statistically, as some of the folks at HSPH have done. The Correlation != Causation pill must surely be a bitter one to swallow.

  • Sarah Kane

    I wanted to add that I also have trouble with starch along with histamines. Lots of vegetables seem to cause trouble for me. Most non starchy fruits seem okay. I think histamines contribute to the hunger and hypoglycemia problems. Staying off starch and keeping histamines low seem to help on hunger and hypoglycemia. Sugar and most fruit don’t appear to cause trouble for me. The book called “The IBS Low- starch Diet” has been helpful in identifying problem foods for me, because I have found almost any starch in my diet, very often at all, causes trouble for me. I use iodine to help find hidden starch in food. I just thought that sharing experiences with dietary problems might help begin to get this sorted out.

  • Marissa

    Hi Dr. Ede –

    I’ve found your site very helpful. Thank you for the wide variety of diets you explore. I was wondering if you are ever concerned about the limited variety in your diet. While I don’t necessarily have a ketogenic diet, I do eat a limited amount of high-nutrient foods that I seem to be able to tolerate well to deal with SIBO (mostly meat, root vegetables, olive oil, and occasionally rice and corn – no dairy or gluten and rarely fruit). Seeing your list of what you eat encourages me, because I often find myself eating from the same 10-15 foods, and even what variety I have seems to come from the same food families. How important in your opinion is it to have a varied diet if the nutritional quality of foods seems to be good? When I think of the way people must have traditionally ate, I can’t imagine them having access to the kind of variety we have, but I also read all the contemporary literature about “eating all the colors of vegetables” or pursuing variety, and I get a bit overwhelmed. Also, do you eat the same foods every day or do you practice some kind of rotation? Thanks!

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

      Hi Marissa
      I’m so glad you have found the site helpful. I do not worry one bit about lack of variety. As long as I am sure to include some liver in my diet about once a week, I believe I am receiving all the nutrients necessary to run a body. I do worry about the grains (rice/corn) because they can interfere with nutrient absorption. I agree that many of our ancestors may not have had access to much variety, especially those not living in tropical areas…I do not practice any type of rotation but I do try to eat a little differently each day so I won’t get too bored:)

      • Free Test Subject

        Subject: Depression episode started with keto adaptation
        diet.

        I am in my second week of trying to do NK. Should I quit? My Precision xtra blood
        monitor has arrived and my keto strips will be here later today.

        History: I have been experimenting to varying degrees
        with paleo/primal/ grain free diets for over 5 years. Soon after, I learned I had early menopause. I was 39. Later that year, part of my liver was removed for living organ donation (for my child). As a result, I do not have a gallbladder. I started BHRT (progesterone and testosterone) in 2010. My problems have always
        been low level depression (treated once for several months in early 20′s) as well as fatigue (no energy to exercise) also always anxiety. I have maintained a weight of 115 lbs. – I believe this is due to my sensitive gut. I am 5’3, so not skeletal by any means
        and actually very curvy. I dislike being hungry and always had a fat tooth. I was a vegetarian for over 2 years and
        started eating meat again in 2000 during first pregnancy. I have been trying to eat it regularly since, although I prefer dairy- cheese and yogurt (milk bothers tummy but I love it) – veg and fruit. I have cut out all grains for
        past 2 weeks. This was no problem as I was eating very little grain in past 2years. For past week have removed fruit and starchy veg. I do have frozen raspberries in smoothie in the am. I drink an espresso in the am too and small coffee after lunch. I am not hungry. I think I need to eat more-esp protein. Yesterday, for lunch, I had a some omelette with
        greens and half avocado with lime. Dinner: Dozen hazelnuts, 3 slices cheese with Belgium endive salad. I know no protein and not enough fat. Also 1 square 90% Lindt. Magnesium, potassium, vit D. Need to remember to take my fish oil…For past 2 days I have eaten three tsp of salt during the day. I would have eaten more in the evening but my family had pizza and since I was not hungry I didn’t
        go out of my way.

        I have never posted to blog before but since psychiatry
        is your specialty I thought you may advise. I have only seen people state that their depression and mood swings get better with NK not worse. I am irritable.Mood and energy improvement were my motivation for trying to do NK. I feel that I have invested too much effort to quit but fear that I may have a biological mood disorder that prohibit this kind of diet. I need to be able to function as I have 2 kids.

        I am willing to be used as a test subject and to begin to record my intake. Any advice would be appreciated.

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

          Hello, FTS
          Thank you for your question. Your situation is a bit complicated and I cannot give personal medical advice on this site, however, I will do my best to comment from a theoretical point of view. Caffeine can cause insulin, blood sugar, and stress hormone imbalances, so that is one potential source of mood issues. If you are not eating enough protein (55-60 grams per day would be a ballpark estimate for your size) then that can theoretically cause irritability and fatigue as well. Additionally, there may be some foods in your diet which are making you fatigued, depressed and irritable due to possible food sensitivites. From what you have shared above of your diet, there are several “common culprits” on your menu, including dairy, nuts, eggs, and chocolate. During early adaptation to ketogenic diets, which can take several weeks, fatigue and moodiness can occur while your body learns to burn fat instead of carbohydrate for fuel, so another possibility is that you are not fully adapted yet. Best of luck~

          • Patti

            Hi Dr. Ede,

            You haven’t posted an update on your blog since August, will you be doing one soon.

            Thank you,
            Patti

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

            Hi Patti

            I know…I know…I feel terrible about it but have simply not had the time, and it appears as if I won’t have time until Smith College winter break, which begins just before Christmas. I hope to post during the holidays, and thank you for your interest~

  • donnies82

    Recently I was REALLY low on cash and debts were eating me from all sides! That was UNTIL I decided to make money.. on the internet. I went to surveymoneymaker dot net, and started filling in surveys for cash, and surely I’ve been far more able to pay my bills!! I’m so glad, I did this!! With all the financial stress these years, I really hope all of you will give it a chance. – rvk0

  • Kara

    Hello there, Dr. Ede!

    I find your blog SO helpful! I’m here on Day 1 of a ketogenic diet, and I’m so happy to have found your website.

    Basically, I have celiac disease, and ADHD – Inattentive. I’m currently a veterinary student in Saint Kitts. Over 6 months of living at home/being poor preparing for my move, I ate with my obese family after being on the paleo diet- I gained 25 lbs in a matter of 6 months, and I’m now tipping the scales at 160 lbs, 5’2″, and a BMI of 29. I have 33% body fat. I’d really like to get down to 120 lbs and I think a keto diet is the way!

    Anyways, I can’t wait to get started. Right now, I’m waiting for some meat to come in on the island, but I’m mostly eating lacto-fermented vegetables (I don’t tolerate raw veggies), olive oil, coconut oil, tuna fish, mahi mahi, eggs, and kerrygold butter. Once finals are over I will go grocery shopping and hopefully they will have pastured beef.

    I can’t wait to see what this does for my ADHD. I failed a course my first semester of veterinary school, repeated learning disability testing for accommodations, and my psychologist thinks I’m crazy for not going back on ADHD meds, where I had a 4.0 GPA, but lost all personality and was majorly anxious.

    Sorry- Long story short, do you have any information about the connection between a ketogenic diet and an ADHD cure?

    Thank you so much! I cannot WAIT to see your next blog post!

    Sincerely,
    -Kara

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

      Hi Kara
      Good luck with your ketogenic experiment! As for ADHD and diet, I have 3 blog posts devoted specifically to that topic, although none of the posts are about ketogenic diets and ADHD, because to the best of my knowledge there are no scientific studies of the KD in ADHD. If you type “ADHD” into the search box on the home page of my site you will find the ADHD articles. Let us know how you do on the diet!

      • Kara

        Thank you! I did read those posts! I’m just on a search for information, but there doesn’t seem to be any studies or too much of a known connection!

        My Dad, also ADHD, was on Atkins induction for about a year (so a ketogenic diet restricted to 20 grams of carbs). Once off of induction, he increased his carbs and his symptoms reappeared. Now he’s on Wellbutrin (off of atkins) because he has a vegetarian/low fat/high carb girlfriend who says it can’t be healthy, but that’s a different story.

        I believe it is. I’m on Day five and I feel great, and I’m down water weight (~10 lbs) right away! I can’t wait to see where this takes me. Thank you for responding, and I will keep you updated! I hope your ketogenic experiment has continued to go well!

  • Mel

    Hi Dr Ede
    Just hoping you might be able to comment on my situation! I have just started on NK, after being mostly paleo the last two year between chocolate binges!! I have a history of IBS and am extremley sensitive to most FODMAPs so am interested in experimenting with a vegetable free diet. My problem is that I’m not quite sure how to get enough fat and less protein if I don’t include dairy. I’m pretty sure I’m sensitive to dairy and get bloating, pimples etc. I’m just wondering whether to give it a month with diary and if it hasn’t improved then take it out of my diet or whether to take it out now and try adding it back in down the track. I have been eating heavy cream and brie cheese because they are both high in fat and low in protein. I was suprised to learn that both salmon and beef are quite a bit higher in protein than fat so am not sure how to avoid over eating protein if I remove dairy. My first day on NK I had 20g(10%) of carb (mostly from berries), 70g of protein(35.7%) and 106g from fat (54.15%). This was from only two meals though so if I remove the dairy and eat three meals then I think I will be getting too much protein. Do the percentages matter. I was thinking I should be around 20% protein and 70% fat? Avocados are out for me as they are a FODMAP and I don’t like the taste of extra virgin olive oil. I’m cooking with dripping or tallow at the mo. I’ve also tried eating coconut oil neat but it makes me nauseous that way. I am about 66kg and 164cm. Love your blog. Thanks Mel.

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

      Hi Mel
      I personally have not had to worry about percentages. As long as I keep my protein under 80 grams per day and my carbs at 30 grams or less per day, it doesn’t seem to matter that I can’t eat dairy fats or most other fats popular with ketogenic dieters. The only fats I seem to tolerate well are animal fats and olive oil.

  • AmyL

    Will the ketogenic diet not work, or have a substantially diminished
    chance of working, if a person gets steroids (dexamethasone) the day
    prior to, the day of, and the day after chemo, every two weeks. The
    non-IV dose is 8 mg. I don’t know what’s delivered via IV prior to the
    chemo (vin/doc/avastin).
    Cancer is Lung Stage IV; not operable because of 3 small brain mets.

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

      This is an interesting question, because corticosteroids such as dexamethasone can cause an increase in blood sugar. While I cannot give personal medical advice here, I cannot think of a reason why the ketogenic diet could not be followed anyway, regardless of the occasional steroid treatments. It may not be as effective as it might be without steroids, but it may be helpful nonetheless.

    • AmyL

      Thank you, Dr. Ede.

  • http://diagnosisdiet.com/ Dr. Ede

    Hello, Larry

    Sounds like you are making excellent progress!

    Volek and Phinney make the following recommendations in their book “The Art and Science of Low Carbohydrate Living” (a book about ketogenic diets):

    If your daily carbohydrate intake is below 60 grams per day, you should be sure to get 2 to 3 grams of sodium per day. If you do that, you should not have trouble with low potassium levels.

    I have personally not had to supplement my diet with potassium for many months. If you are worried about your potassium level you can have a simple blood test to see if it is within the normal range or not.

  • http://www.scatterbraintures.com/ Scatterbraintures

    Question: Are you still getting hungry when you drink coffee?

    I’m on a keto-ish diet (week1) but I don’t track what I eat and my stats. Because my brain couldn’t process that right now (if I do, I might end up not doing the diet execution itself)

    I think I get more hungry when I drink coffee.

    • Melani Orr

      try it with MCT Oil

      • http://www.scatterbraintures.com/ Rae

        Thanks!

        • Jane Me

          Actually, any kind of fat should do the trick, not just MCT Oil. Heavy cream or butter work for me.

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

      Hello, Rae

      Yes, the caffeine in coffee can cause blood sugar and insulin roller coaster effects, and is therefore one of the things that can trigger carbohydrate cravings in sensitive people. I personally have found that caffeine reduces my appetite for only a few hours, and then as it wears off I begin to crave carbohydrates.

  • James

    Have just been enjoying all of the wonderful information on your site. What are your thoughts on adding carbs after a hard workout. I have about 30-40 grams (usually add frozen cherries, blueberries to a protein shake) after working out and very few carbs otherwise. My protein and fat ratio is about 2:1 in favor of protein. This may be just the dogma I am following about the carbs though. Though not ketogenic I really enjoy the low carb diet. Also, I have found intermittent fasting a wonderful approach, but it comes easy as I was never a big breakfast person (16 hour fast daily).

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

      Hi James

      Glad to hear you are enjoying the site! I haven’t researched the pros and cons of carb loading after heavy workouts, but my own personal experience with intense exercise and the ketogenic diet is that I did not find it necessary to increase my carbohydrate intake afterwards for any reason. However, you are adding very little carbohydrate to your diet after your workouts, so I wouldn’t describe what you are doing as “carb-loading”, by any stretch of the imagination:) I wonder what happens for you if you do not eat the berries after working out? Just curious.

  • Helen

    Hi Dr Ede,
    I was just wondering what your thoughts are (or if you’ve seen/done any research) on the effectiveness of a Ketogenic diet for someone without a gall bladder?
    regards,
    Helen

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

      Hi Helen

      Quite a few people have posted this excellent question on my various ketogenic diet blog posts. It seems it can be challenging to eat a high-fat diet if you do not have a gallbladder. I have not personally researched this topic in enough detail to give a more intelligent answer than that, unfortunately…but common sense would tell me that one may need to spread fat intake out over the course of the day and see how much can be tolerated without causing gastrointestinal distress…

  • Iris

    I’ve been on keto for 3 months or so now, i’m probably just now getting my macros more correct for leanness. I, too, experienced a lot of difficulty running since this way of eating (ran pretty dang well before, ) and i got really discouraged with not being as fit as i was before eating this way. i was always lean and started keto’ing to get healthier.
    however, lately, i’ve noticed my body fat has definitely increased. i haven’t gained weight, per se, but my body composition has gotten softer / fattier. i’m so discouraged! granted, i haven’t been working out as hard because my adaptation has been kinda rough.
    will my body fat percentage start to decrease? i feel like i keep getting skinny fatter!
    i’m confused, because i keep reading about how people keep getting leaner and lose body fat as they keto, but i am not losing body fat!
    tx!!