Ketosis Week 4

Number 4 licensedNo shortage of lessons this week in my little Ketogenic Klassroom. Viruses, hormones, hunger, red meat, and a long-awaited dairy experiment! Even though I wasn’t the happiest of campers this week, I am  curious about what the coming weeks will bring and remain dedicated to the process! I’m sure we’ll figure it out…

 

 

[This post belongs to a series of articles about cancer and ketogenic diets.  To begin with the first cancer article, click HERE.  To begin with week 1 of my ketogenic diet experiment, click HERE.]

Day 22 (Feb 21)

Morning notes:  I feel fine this morning other than minor residual cold symptoms. Not hungry.  Given the questions people had last week about this heart pounding phenomenon, I am adding blood pressure and heart rate values to my data.

  • Morning blood glucose:  66
  • Morning blood ketones:  3.8
  • Morning urine ketones:  max
  • Weight change past 24 hours:  down 0.2 lb
  • Total weight loss so far:  9.4 lbs
  • Waist circumference change since day 7:  down 5 centimeters (I forgot to take measurements on day 1)
  • Evening blood glucose:  88
  • Evening urine ketones:  max
  • Blood pressure:  100/69
  • Heart rate:  71
  • Protein:  52 g
  • Fat:  81 g
  • Carbohydrate:  0
  • Protein : Fat (cal) ratio =  1 : 3.5
  • Calories:  924

Foods:  Chicken liver, duck fat, Beech-Nut turkey, fish oil/vit D, tuna sashimi, salmon sashimi, olive oil Notes:  Slept from 10:30 p to 3:30 am and had a dream about a big chunk of Alaska falling into the ocean and flooding Harvard Square.

Day 23 (Fri Feb 22)

Morning notes:  Eyes dry and vision slightly blurry for about a half hour after waking, then fine after eating. Day 1 of hormonal cycle.

  • Morning glucose:  77
  • Morning blood ketones:  4.3
  • Morning urine ketones:  max
  • Weight change past 24 hours:  down 1 lb
  • Total weight loss so far: 10.4 lbs
  • Evening glucose:  78
  • Evening urine ketones:  max
  • Protein:  50 ??  (40 g + roasted chicken skin)
  • Fat:  105?? (85g + roasted chicken skin)
  • Carbohydrate: 0
  • Protein to Fat ratio (cals) =  1 to 4.8
  • Calories:  1135

Foods:  Beech-nut turkey, duck fat, chicken skin. Notes:  Physically felt lethargic, heavy, slow, drained today but mentally clear, focused, and productive (worked a full day). Appetite was fine until evening, when it became very strong.  I wasn’t exactly sure how to count values for the roasted chicken skin, so I may have under-eaten today. Stomach growly, cold, tired, heart poundy.  Slept from 9:30 p to 1:30 am and woke up extremely hungry, so I tested my blood ketones and blood sugar:

  • Blood ketones 2 am:  5.2
  • Blood glucose:  72

So I ate more chicken skin and some tuna fish + olive oil, which helped.  Because it was the middle of the night I wasn’t sure whether I should add their values to Friday or Saturday totals, so I added the chicken skin and 1/2 of the tuna values to Fri and the other half of the tuna values to Saturday. Went back to sleep from 4:30 am to 6:15 am (poor quality, light sleep). The roasted chicken skin weighed 50 g but I was unable to locate any nutrition data for roasted chicken skin by weight on the internet.

  • New protein total:  46 grams + chicken skin
  • New fat total:  93 grams + chicken skin
  • New protein to fat ratio (cals) = approx 1 to 4
  • New calories total:  1108 + chicken skin

Day 24 (Sat Feb 23)

Morning:  Woke feeling unrefreshed, very hungry, slightly lightheaded, lethargic, heartbeat strong. I think I need more food (perhaps due to hormonal cycle, if you follow me…)

  • Morning glucose:  86
  • Morning blood ketones:  4.4
  • Morning urine ketones:  max
  • Blood pressure:  91/59
  • Heart rate:  69
  • Weight change past 24 hours:  no change
  • Total weight loss so far: 10.4 lbs
  • Evening glucose:  79
  • Evening urine ketones:  max
  • Protein:  52
  • Fat:  143
  • Carbohydrate:  0
  • Protein to Fat ratio (cals) =  1 to 6.2
  • Calories:  1287

Foods:  Ground New Zealand lamb, roasted beef fat.

I ate my entire protein allotment for the day by 10 am because I was so hungry.  It helped a lot. Notes:  I’m clearly not getting enough of something lately–not enough calories?  Not enough protein?  Not enough fat?  Who knows…I’m starting by adding more fat calories, but if that doesn’t do the trick, I’ll need to raise my protein.

Afternoon/evening appetite was low, but I ate some beef fat anyway as an experiment to raise my calories.  It made me feel a little queasy and gave me a mild headache to eat plain fat, but it took away the heart pounding sensation I’ve had for the past 3 weeks…interesting…and took my appetite down to zero.  My energy improved a bit, as well. But my sleep was bad–slept from 9:30 p to 2:00 am, then awake until 5:00 am, back to sleep until 6:30 am.  Sleep quality was lousy–very light, with lots of detailed dreams.  In one of them, Rita Moreno was the superintendent of the Boston public school system.

Day 25 (Sun Feb 24)

Morning notes:  Woke feeling unrested, with creasey skin (beef fat? lamb?), but otherwise better than the past 2 mornings.  No ravenous hunger or pounding heart, but somewhat hungry with low energy. My cold symptoms are almost entirely gone. Given that my blood pressure is on the low side, my energy has been on the low side, and that my hormonal cycle is practically nonexistent this month, I’m pretty sure I’m not getting enough protein.

  • Morning glucose:  77
  • Morning blood ketones:  4.4
  • Morning urine ketones:  max
  • Blood pressure:  90/64
  • Heart rate:  65
  • Weight change past 24 hours:  down 0.4
  • Total weight loss so far:  10.8 lbs

Mid-morning Notes:  Two hours after eating a breakfast of chicken and duckfat (21 grams of protein + 29 grams of fat for a total of 374 calories), I still felt a bit lightheaded and cold and fuzzy-headed. I went to the supermarket (I am lucky to live right next door to a Whole Foods), and strolled through the aisles while waiting for the butcher to carve me up some beef fat (how weird), but nothing looked appealing.  I was not hungry, but I felt I needed more nutrition.  I went back to the meat counter to see if my beef fat was ready and overheard the butchers’ conversation.  Butcher number one: “How much should we charge her for this?” Butcher number two: “Don’t charge her anything.”  Butcher number one:  “But we have to charge her something for it, I just don’t know how much it should cost.” Butcher number two:  “But we usually just throw it away!” I walked home with my (free) beef fat–thanks guys!  I didn’t feel like doing anything except sitting and staring…so I decided to do a few little experiments.  First I checked my 2-hour “post-prandial” (after-meal) values:

  • Glucose:  88
  • Ketones: 4.0
  • Blood pressure:  89/60
  • Heart rate: 68

In honor of Pippin (from The Fellowship of the Ring), and my time living in Germany, I decided to have a “second breakfast” (or “zweites Frühstück”).  This consisted of tunafish and duck fat (13 g protein and 227 g fat).  Then I checked my values after 2 more hours:

  • Glucose:  82
  • Ketones:  5.1
  • Blood pressure:  95/62
  • Heart rate:  68

Now for brunch I’m going to have the rest of my protein grams (chicken) and the same amount of fat grams as in the first two breakfasts, but in the form of heavy cream.  I’ve wanted to do a dairy experiment for a long time, but wanted to wait until I was firmly in ketosis first.  I have long suspected that dairy can throw some people out of ketosis but have never tested this idea before. I waited 2 more hours and re-tested everything:

  • Glucose:  93
  • Ketones:  3.8
  • Blood pressure:  92/66
  • Heart rate:  74

The cream caused a bit of upper respiratory irritation, making me feel like coughing whenever I took a deep breath.  It also gave me a very mild headache and I felt warm.  So those are the highest blood sugar and lowest ketone readings I’ve had in a while.  Was it the cream?  We can’t be sure yet, because, as you know, I haven’t been testing my values throughout the day like this, so this may be a normal trend, but a few more experiments will give us better clues.  I will eat the rest of my fat calories as heavy cream today, and we’ll see if my values continue to go down.  It will be especially interesting to see what my values are tomorrow morning, since I have lots of previous data for morning values. I won’t go any higher on my fat grams today than yesterday, so that we can do the cleanest experiment possible.

  • Evening glucose:  91
  • Evening blood ketones:  4.4 (phew)
  • Evening urine ketones:
  • Protein:  50 g
  • Fat:  157 g
  • Carbohydrate:  0
  • Protein to Fat ratio (cals) =  1 to 7
  • Calories:  1622

Foods:  Chicken, canned tonno tuna, duck fat, pastured heavy cream

Notes:  My tablespoon measure must be very inaccurate, because I was measuring out cream in tablespoons and had calculated I’d need 9.5 tablespoons of cream to bring my total fat grams today to approximately the same as yesterday.  However, by the time I got to 9.5 tablespoons, the pint of cream I’d bought was practically empty, and a pint contains 16 tablespoons…oops…so I overshot my fat/calories today and this may affect the experiment.

In the afternoon and evening I found myself distracted by thoughts of food–dancing through my head were images of chocolate cupcakes, giant balls of fresh mozzarella cheese, grilled burgers, and all kinds of yummy things.  I was getting mouth-watering hankerings for…well…just about anything. I told myself that if I don’t eat dairy tomorrow, I should be free of these intrusive, delectable daydreams.  My productivity and mental energy was pretty good today, though. It was hard not to eat anything more, but I didn’t want to interfere with the experiment by eating more fat than I did yesterday.  Other dairy effects (known to me from my past experiences with dairy):  eyes felt puffy, ankles retained fluid and felt heavy, and face was slightly pink.  I felt mildly energized in the evening, which is a big change from the past few weeks.

Very hard to fall asleep because simply not tired.  The cream had a mild stimulant effect, which surprised me.  In the past, whenever I’ve occasionally used cream, it’s typically been with coffee, usually as a way to wake myself up after a poor night’s sleep, so I chalked up any stimulating effect to the caffeine in the coffee, not to the cream.  Slept from 1am to 5:45 am and had lots of dreams.

Day 26 (Mon Feb 25)

Morning notes:  Slightly creasey skin and scattered little aches and pains, but subtle.  Very slight sore throat, slight sinus headache, and my breathing still felt a bit irritated–meaning when I breathed in, I felt a little like coughing.  These symptoms feel different from lingering cold symptoms.  However, I did not have hunger signals this morning–no lightheadedness, lethargy, or poundy heart.  No food cravings this morning, thank goodness.

  • Morning glucose:  84
  • Morning blood ketones:  3.0 (hmmm…)
  • Morning urine ketones:  max
  • Weight change past 24 hours:  no change
  • Total weight loss so far:  10.8 lbs
  • Blood pressure:  89/66
  • Heart rate:  66
  • Evening glucose:  83
  • Evening blood ketones:  2.7
  • Evening urine ketones:  high
  • Protein:  50 g
  • Fat: 92 g
  • Carbohydrate:  0
  • Protein to Fat ratio (cals) =  1 to 4.1
  • Calories:  1103

Foods:  Chicken, duck fat, fish oil/vit D, beef fat

Notes:  While I can’t be 100% sure that it was the cream that caused my food cravings yesterday, seemed to spike my blood sugar a bit, and dropped my ketones this morning, I have no other explanation–especially for the ketones.  This is not the first day I haven’t seen a change in weight–it’s the second–but the other day may have been due to hormones?  The change in energy level is a welcome change–was that due to the cream itself or due to the drop in ketones?

Sleep: 9:30 pm to 4:15 am, lots of dreams

Day 27 (Tues Feb 26)

Morning notes:  Other than vague abdominal aches, I feel fine. No heart pounding, no strong hunger.  Very mild residual cold symptoms.

  • Morning glucose:  77
  • Morning blood ketones:  4.5
  • Morning urine ketones:  max
  • Weight change past 24 hours:  up 0.4 lb
  • Total weight loss so far:  10.4 lbs
  • Blood pressure:  89/66
  • Heart rate: 66
  • Evening glucose:  82
  • Evening urine ketones:  3.6
  • Evening blood pressure:  102/69  (much better, but is this just a beef reaction?)
  • Evening heart rate:  76
  • Protein:  52 g
  • Fat:  142 g
  • Carbohydrate:  0
  • Protein to Fat ratio (cals) =  1 to 6.1
  • Calories:  1552

Foods:  Chicken, duck fat, fish oil/vit D, ground New Zealand lamb, roasted beef and beef fat, caffeine-free mint tea

Notes:  Felt a bit lightheaded mid-morning so ate some more food.  I don’t know if the vague abdominal symptoms are hormone-related or dairy-related, but I suspect they are hormonal, since I am also just a little bit prone to sentimentality this week.  For example, I felt tears welling up during an episode of Everybody Loves Raymond where the family has a funeral in their backyard for a hamster named Pumpernickel.  Normally I find that scene pretty funny.

I’ve been trying to use roasted beef fat for extra fat/calories but if I eat more than a little bit, my stomach feels quite queasy and I get a mild headache.  No fat goes down as nicely as cream does:)  I intentionally ate a lot of extra fat today (ugh) to see what would happen to my energy and ketones, because if I can’t improve my physical energy, I won’t be able to exercise, and I do miss that.  If increasing fat calories won’t do it, I’ll need to raise protein, of course.  But will that raise my blood sugar and drop my ketones too much?

I had eaten all my protein and fat calories by 1 pm, felt lousy for a few hours, napped briefly a couple of times midday, then mind felt more awake and I was not lightheaded anymore.  I didn’t get any rush of physical energy.  I didn’t eat anything more for the rest of the day, even though at times I felt like having something fresh and citrus-y or something starchy to cut/absorb all the grease I’d eaten.  It was hard to fall asleep, and sleep overnight was horrendous.  10:30 pm to midnight (are you kidding me?) then very broken/light sleep until 4:45 am.

Day 28 (Wed Feb 27)

Morning notes:  Heart poundy, veins stand out a bit (this is a common effect of certain foods on my body), mild tinnitus, and sl bloated/heavy feeling.  I am attributing these effects to beef products, which I usually avoid, but I’m having a hard time finding fat that is appealing to eat on its own.  I am envious of those of you who can eat cheese, cream, coconut oil, nuts, and eggs. Any ONE of those things would make this diet much easier for me. The beef fat I got for free from Whole Foods was streaked with actual beef, which was hard to tally.  I know I’m a bit sensitive to beef proteins, so this likely added to the problems created by eating so much extra beef fat yesterday, which I suspect also bothers me. Unfortunately I will clearly have to avoid these foods from now on.

  • Morning glucose:  65 (probably because I hadn’t eaten since 1 pm day before)
  • Morning blood ketones:  3.9 (either extra fat doesn’t seem to spike ketones or I underestimated how much beef was in the beef fat and overate protein)
  • Morning urine ketones:  max
  • Weight change past 24 hours:  none
  • Total weight loss so far:  10.4 lbs
  • Blood pressure:  95/67
  • Heart rate:  72
  • Evening glucose: 77
  • Evening blood ketones:  4.3
  • Evening urine ketones:
  • Protein:  50 g
  • Fat:  90 g
  • Carbohydrate:  0
  • Protein to Fat ratio (cals) =  1 to 4
  • Calories:  962

Foods:  Ground New Zealand lamb, olive oil, caffeine-free lemon tea, caffeine-free mint tea.

Notes:  Wednesdays are my longest clinical days–10 hours plus on call at night.  I ate all the food I’d brought with me by about 1pm–no more protein grams left.  I was fairly  hungry by early evening but was still able to concentrate and function very well at work. Very annoying dry cough all day.  Sleep was terrible again–slept from 10:30 pm to 1:00 am–woke feeling warm with poundy heart, dry eyes and creasey skin. Didn’t feel hungry, though.  This feeling is familiar to me and feels mostly like a food reaction.  Blood pressure 86/63 and heart rate 72. Back to sleep from 2 am to 6 am but very light/broken.

Day 29 (Thurs Feb 28)

Morning notes:  Tired.  Mild tinnitus.  Not hungry.  Feel a bit bloated/heavy with slightly creasey skin.

  • Morning glucose:  81
  • Morning blood ketones:  5.2
  • Morning urine ketones:  max
  • Blood pressure:  97/64
  • Heart rate:  61
  • Weight change past 24 hours:  up 0.4 lbs (could be fluid retention)
  • Weight loss past week:  0.6 lb
  • Total weight loss so far:  10 lbs
  • Change in waist circumference over past week:  up 1 cm
  • Total change in waist circumference: down 4 cm
  • Percent body fat (according to Tanita scale):  35%
  • Change in body fat in past week:  down 1.5%
  • Total change in percent body fat so far:  down 3%

Reflections on Week 4

This current plan is not sustainable for me and is clearly not healthy.  Perhaps if I’d been able to comfortably eat more fat, it would have worked, but my blood pressure, energy, and hormonal rhythms are telling me that I need to change the plan.  I would have been willing to tolerate some fatigue and some hunger, which some people experience during the first 2-3 weeks of keto-adaptation, but it’s been more than 3 weeks and these have not been the only worrisome signs, so time to increase protein intake.

Food Sensitivities:  My original goal for this week was to eat the same things every day to make for a cleaner experiment, but when I was eating only chicken, turkey, tuna, and duck fat, I felt I wasn’t getting enough nutrition, so I wanted to add some red meat.  Beef tends to bother me, so I added lamb.  Problem is you can’t buy lamb fat, and I needed to add fat to manage hunger.  I was hoping that my problem with beef was only with the meat itself and that I’d be able to tolerate beef fat better than beef protein, but it seems as if beef fat doesn’t agree with me very well. I was hoping lamb would be an easy everyday food, but lamb doesn’t seem to agree with me very well, either? I don’t know, maybe I’ll try it again in the future.

Energy level:  I may not have been in ketosis long enough (it’s been 25 days) to be fully adapted–for some it can take up to 5 weeks, I understand–so I am hoping that this is why my physical energy is generally low.  It may be that, despite the fact that I’m generating plenty o’ ketones, my cells are not yet good at burning them for fuel.  I had originally intended to add some exercise this week, but I didn’t feel like I could do that yet.

Virus:  My cold virus seems to be lingering; although symptoms are very mild, they are not comletely gone. I am concerned that I’m not getting enough protein to kill it off once and for all.

Hormones:  I was not expecting to have a practically nonexistent cycle this month.  It’s never happened to me before.  When I looked into it on line, it turns out to be a well-known side effect of ketogenic diets for women, yet there is not a single word about this potential issue in either Dr. Rosedale’s book nor in Phinney and Volek’s books.  However, these experts do not ask people to aim for ketones of 4+ mM, either.  According to Dr. Rosedale, while one is losing weight on his diet, the body is naturally focused on maintenance and repair, not on reproduction, and that all makes sense, but I am not interested in extreme dieting to the detriment of normal, healthy body function.

Blood sugar:  My blood sugar occasionally flirts with 65 mg/dL (the upper end of Dr. Seyfried’s “zone of metabolic management” for cancer patients), but it only goes that low when I haven’t been eating enough.  I may need to abandon this goal, since the only way I can think of to reduce my blood sugar even further would be to reduce protein even further, and I can’t do that.

Ketones:  When these are in the 5+ range it feels more like starvation (based on my experiences with fasting on days 1 through 4) than dieting, and doesn’t feel healthy.  I feel cold, sluggish, and can’t sleep.  A lot of my symptoms are found in people with anorexia and I have no interest in becoming anorexic for the sake of science…While there isn’t enough data yet to say exactly how fat grams affect ketone levels, there is some suggestion that increasing fat sometimes can raise ketone levels.  However, I cannot seem to find a type of fat I can eat that is appealing and doesn’t bother me.  I purchased a small container of red palm fruit oil this week and had a tiny taste of it–it was perfectly horrid–nauseating, nasty, perfumey stuff.  I wish I could purchase chicken or duck skin to roast and add to my menu, but so far haven’t been able to find such things.  Those of you who can tolerate heavy cream, cheeses, egg yolks, coconut oil, nuts, etc. are very lucky! Enjoy!

For people without cancer or seizures, who are just using this diet to lose weight, improve function/performance, manage mood swings, or manage appetite, does the degree of ketosis matter?  Most people seem to report good weight loss and energy with ketone levels in Phinney & Volek’s recommended range of 0.5 to 3.0 mM.

Sleep:  My sleep could have been affected by my red meat experiments this week (beef, lamb) and/or by the diet itself, which does cause insomnia for some people. However, given that I’ve had some good nights of sleep on this diet when I avoid foods that tend to bother me and my ketones are under 5, I’m inclined to think the majority of the blame for this week’s lousy sleep belongs to red meat.

Dairy:  I found the dairy experiment very interesting.  The carbohydrate cravings were wild, and dairy did seem to lower ketones and raise blood sugar.  However, a single days’ experiment is not much to go on, so I’ll repeat this experiment from time to time.  Also, my fat grams and calories that day were higher than usual, so that may have thrown things off.  Next time I do it I will make sure it’s not a hormonal week and I’ll keep the calories and fat grams in check.

Timing of Meals:  My tendency was to want to eat most or all of my food in the morning.   Dr. Rosedale recommends dividing meals throughout day, but I was too hungry in the morning to be able to do that every day.  Dr. Phinney, when interviewed on Jimmy Moore’s podcast Ask the Low-Carb Experts, said it isn’t known whether it is better to divide meals or to eat once a day.  To listen to the interview, click HERE.

Weight:  Unimpressive weight loss this week.  I was eating a lot more calories this week (on purpose) and also eating foods that probably bother me and can cause bloating (notice waist circumference higher).  Hormones may also be playing a role by causing some fluid retention?

Protein vs. Fat vs. Calories:  I’ve tried increasing fat and calories to increase my energy, blood pressure, and ketones and reduce the hunger I’ve had this past week, but I haven’t been very successful.  I am very concerned that I’m not getting enough protein–as evidenced by nearly nonexistent hormonal cycle, low blood pressure, low energy, poor/slow recovery from cold virus.

Side effects I’m not having:  Muscle cramps, constipation.  Ketogenic diets are notorious for causing these side effects, but not for me.  I continue to believe that constipation is primarily a result of food choices, as opposed to lack of carbohydrate.  To read my blog post about foods and constipation, click HERE.

What does this mean for cancer patients?

I wish I were a better guinea pig for those of you considering ketogenic diets for cancer treatment, but it appears as if my food sensitivities may make it difficult for you to use my experiences to tell you what this kind of diet would be like for you.  I am going to have to raise my protein this week in order to be able to feel well and function, and this will likely lower my ketones and raise my blood sugar.  However, if you are able to tolerate fun fats like coconut oil, butter, cheese, sour cream, mayonnaise, etc., you may be able to achieve Seyfried’s target zone without raising your protein intake.  If there’s anyone out there who has been able to reach his target zone without raising protein, I’d love to hear from you.

Ideas Anyone?  If you have a suggestion or criticism about my ketogenic experiment, I’m all ears!

Goals for Week 5

Increase protein to see if I can improve my blood pressure and energy.

No red meat–I want to see if my sleep will normalize without it.  I have to get better sleep…

If blood pressure/energy improve, would love to add exercise (I miss it) to see how it affects blood sugar and ketone levels.

If unable to do an exercise experiment, I will do a caffeine experiment instead.

I asked my primary care doctor to order a list of lab tests for me and she agreed to order some of them (she is very conservative and completely uninterested in my food/diet experiences).  I am happy to report I’ll be changing doctors in April.  I will order the rest of the tests I want for myself and hope to post results of all tests in next Thursday’s post, along with my results from last summer, when I was eating a much more varied, non-ketogenic diet, so stay tuned!

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  • Carol L

    Can you tell us about your fluid and electrolyte intake? You mention tea but not total quantity of fluids. Sodium loss with this type of diet is described, have you been supplementing?

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

      I drink lots of plain Poland Spring seltzer and filtered (Britta) water, and put salt on everything I eat. I’m not tracking any of this, though…I suppose I could…

      • Nancy M.

        Phinney and Volek mention one should get about 5g (a huge amount) of sodium on a ketogenic diet. Not doing so, they say, will cause a lot of the symptoms of carb flu, plus your body will tear down lean body mass to get to the minerals it needs.

        This is detailed in “The Art and Science of Low Carb. Living”.

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

          Yes, thank you Nancy–I re-read Phinney and Volek and Rosedale last weekend to see if I could figure out how to feel better on this diet, and was reminded of the salt recommendations. 5 g of salt is equal to about 2 tsps of salt, and I am certain I ate at least that much salt every day (I eat a lot of salt because it’s one of the very few seasonings that doesn’t bother me). However, from now on, I will track it to be sure, thank you.

  • Charles Grashow

    “nearly nonexistent hormonal cycle, low blood pressure, low energy, poor/slow recovery from cold virus.” This diet is making you very unhealthy – I suggest you rethink and change

    • Tyler

      I agree with Charles. This seems unhealthy and doing more harm than good. It’s almost painful to read.

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

        Again, sorry for any pain I may have caused you. I really am fine, and promise you I would not continue any experiment at the sake of my health. I concluded this week (and I tried to make this clear in my post, but perhaps it’s not clear enough), that this plan is not healthy for me and I won’t be continuing it.

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

      I agree completely, which is exactly why I am increasing my protein this week, if you read through to the goals on the bottom of the post.

    • Dr. Cory Altabet

      Eating multi meals and typical carb intake all your life puts certain catabolic pathways to sleep for such a long time that they will atrophy so to speak. Then jumping into the deep end they way Dr. E. did will result in an inability ti maintain functions as the body lag with the ability to serve the body energy from stored fuel. Her body is in conservation survival mode. It takes years of undoing catabolic weakness to be able to go at it the way Dr E. is doing Starting off with intermittent fasting with non ketogenic meals is a good starting point and then gradually working your way cyclically toward heavy ketosis. Even still some may have permanent catabolic damage and be unable to maintain ketosis for any length of time with out the energy mobilization deficiency kicking in. I dont think we are designed to be in a constant state of ketosis permanently. I am a firm believer in cycling in and out of ketosis for a more balanced metabolism leading toward a better and longer life. .Dr. E’s side effects are pretty exaggerated and I suspect they will remain to a significant even though she will adapt to ketosis.

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

        I agree that this is very likely the case–that jumping headfirst into deep ketosis can’t possibly be healthy–at least it hasn’t been for me. I agree that carbohydrate processing mechanisms are unlikely to be the only damaged pathways in us older, metabolically challenged types, so it would make sense that fat metabolism, ketone metabolism, and amino acid metabolism may also be damaged and may not respond readily to major shifts in dietary patterns.

        The reason I did this was to put Dr. Seyfried’s cancer treatment recommendations to the test, and I am certainly not happy with the results. There were points at which I felt pretty good along the way, but they were short-lived. It is very clear that I was not getting enough nourishment. My plan now is to experiment with moderate ketosis (nutritional ketosis, ala Phinney/Volek) to see how that goes. This would allow quite a bit more protein. But for this week, I’ll do whatever it takes to get back on the right track.

        • Dr. Cory Altabet

          To a degree i believe you can strengthen catabolic pathways as you can strengthen muscles from exercise but like with exercise (ie weight training) you have to take breaks to heal and recover in between workouts or you will break down as in “over training”. this is why I turned to cycling my ketosis long ago so that after a bout of ketosis I break it as soon as things get stale then go back when things feel right. Now I can go longer periods on ketosis even with exercise eating once per day but even after 5 years of doing so staying ketosis or low carb non ketogenic too long gives me the issues related to energy deficiency..Perhaps there is permanent catabolic damage in all of us who have multi-mealed and carbed up for a life time. however, My son who now sixteen has been doing ketosis cycling for 3 years while eating once per day. his results show that clearly his primal catabolic ability has not been damaged significantly as he can endure longer bouts of ketosis while being intensely athletic. He is a champion wrestler and weight lifter.

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

            Hi Dr. A
            Very interesting, especially re: the comparison between you and your son. I have never been in ketosis long enough to know what it would feel like to be in the groove, let alone to know what it would feel like to fall out of it, so I look forward to experiencing these patterns firsthand. Thank you for sharing these insights here!

        • Peter Walsh

          Dr. Ede. Dr. Seyfried is a mouse researcher and as such, his recommended ratio and restriction is not sustainable. You said “that jumping headfirst into deep ketosis can’t possibly be healthy” So what happens if a human, or any other animal, runs out of food for a few days? Ketosis is the body’s way of converting stored energy (fat) to energy, which it does very efficiently.

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

            Hi Peter

            If by ratios you are referring to the protein to fat ratio, ratios up to 1:4 have been used safely for decades in people with seizure disorders, so I don’t think it’s the ratio…it may have been that I wasn’t able to eat enough calories (despite trying to eat as many as possible), because of my food limitations, or it may be that some people are more metabolically flexible and adapt more quickly to these changes than others, or it may be that I simply wasn’t eating enough protein, I don’t know…

            As for creatures running out of food, yes, we are supposed to be able to deal with that, but that doesn’t mean it’s ideal or comfortable or compatible with good daily performance (which I needed to sustain in order to work at my various jobs). It’s possible that I just needed more time to adapt to the situation, but couldn’t afford it, given how bad I had started to feel. Maybe I have some bizarre biochemical defect that doesn’t allow me to adapt to starvation and I’m meant to be culled from the herd:)

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

    Dear Dr. Ede,

    You are a trooper. This is not an experiment for the faint hearted. Thank you so much for doing this and for so generously sharing your experience. I think it will be helpful to so many people.

    I am on a big histamine intolerance kick. It has made such a huge difference for me in my sleep quality, anxiety, mood, and energy. I was not eating a ketogenic diet, but I was eating a very low carb diet with fresh meat, cured meats, fish, nuts, avocados, some cheese, and the bulk of my diet was from left-overs. I follow the GAPS healing protocol which recommends long simmered soups and stews and fermented foods. I would make a big pot of soup and eat it for 3-4 days as my main food. All of the foods I was eating were high in histamines. Proteins that age develops higher levels of histamines, cheeses, cured meats, aged meats. Fermented foods have high histamine levels, sauerkraut, alcohol, vinegars. Left overs sitting in the fridge became higher and higher in histamine as the days passed. Once I figured this out and only ate food that was freshly and preferably quickly cooked, like quickly cooked turkey strips rather than a long simmered turkey stew, and avoided the foods that are considered to be high in histamine, I had a dramatic improvement in my well being. Many of the symptoms you were experiencing could be linked to histamine intolerance. Pounding heart, dry eyes and blurry vision, poor sleep quality, body aches. Some of the foods you were eating like the fish, both fresh and canned is high in histamine, as is the beef and lamb potentially, as its aged.

    I know I have written to you about this before, but I cannot refrain from mentioning it again. I hope you do not mind. Maybe I am seeing everything at the moment through histamine-colored glasses due to my own dramatic response to lowering the histamines in my diet. I can’t tell you how much better I feel. I am still steep on the learning curve, and when I have eaten something that I did not realize had a high histamine content, I go on to then sleep horribly, have a headache. and the anxiety returns.

    I wrote a post about it last week, and will probably continue to blog about it because I am fascinated. Here is the link to the post;

    http://69.195.124.83/~judytsaf/histamine-intolerance-gaps-and-low-carb/

    It puts one between a rock and a hard place to try and eat low cab, let alone follow a ketogenic diet when histamine intolerance is involved.

    The fats are not a problem, but it would be interesting to see what would happen if you only ate the freshest meats quickly cooked in addition to the fat that is not high in histamine.

    All the best with your experiment. It is really fascinating and again thank you so much for sharing it with us.

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

      Hi Dr.T
      Thank you so much for sharing your experience with and knowledge about histamine with me(us). I look forward to reading your post and exploring this topic further ASAP (seeing patients today and tomorrow). I hope to read tonight!.

      • Someone, Somewhere

        Dr. T: I just read your post on histamine intolerance. Fascinating. This explains so many of the problems I’ve experienced in the past. Even just yesterday, I ate some freshly ground, nitrate/nitrite-free fish sausage, and it gave me a headache. I then ate some one-day-old roast chicken, and the headache got worse. Bacon and other preserved/canned/cured meats have given me headaches, anxiety, tinnitus, tachycardia, etc. for as long as I can remember. Looks like it’s time to switch to fresh, quickly cooked meats altogether! Thanks again for sharing about this :)

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

          This is so exciting. I am so glad that it is helping you sort out the mystery. For me, it has made sense of many symptoms that have literally been plaguing me since childhood, constipation, insomnia, easy bruising, hypotension, low grade anemia. Its like a rosetta stone.

          • Someone, Somewhere

            Dr. T: I feel the same way. Thanks again for sharing what for me, as well, is nothing less than a rosetta stone.

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

            This immediately makes me think of tyramine, too, which I avoid if I want to avoid headaches. Many tyramine containing foods overlap with histamine containing foods, so I have considered histamine intolerance before, but I read that a way to tell whether or not it’s histamine intolerance is to take an anti-histamine when you are reacting to a food (i.e. develop a headache). If the headache goes away, then it was because of the histamine. This didn’t work for me and didn’t get rid of my headaches unfortunately, so I ruled histamine intolerance out. Do you know if there is validity to the antihistamine test, Dr. T? Bacon and other preserved/canned/cured meats give me major reactions as well, but so do avocados, bananas, all nuts, peanuts, pumpkin seeds, raw onion, soy, anything fermented and any meat that is more than a day old. These are all high tyramine foods! Anyway I will read your post now, thank you for sharing this info!

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

      Hi again Dr. T

      I just finished reading your excellent blog post. It is very illuminating. I have always done best with fresh meats, myself–anything smoked, processed, canned, aged, cured, or even “fresh” in one of those vacuum-sealed packages that extends refrigerator life can be bothersome to me. When I was eating my all-meat diet last summer for 90 days, I felt mostly terrific–and i was eating primarily (frozen) duck, tuna/salmon sashimi, roasted chicken (from Whole Foods already roasted or a pastured chicken roasted myself). Chicken almost never seems to bother me…

      As for the the plant foods that can be high in histamine, it’s much harder for me to comment, since most (non-fruit) plant foods bother me. Fresh fruits of most kinds don’t tend to cause me any problems except for those I associate with carbs/fructose (appetite increase, weight gain, yeast symptoms). I am so glad you are feeling better and it’s wonderful that the information you have shared is helping so many others, as well!

      I had thought “fresh” ground New Zealand lamb might be an ideal red meat for me, since it’s grass-fed and not related to beef or pork, but it didn’t seem to agree with me, and it occurs to me that, as you are pointing out, it has traveled a long way to get here, and therefore can’t be very fresh after all. So here’s my question–how are we to know which meats are freshest? Are frozen meats freshest? What about fish? Is frozen at sea best? I am so glad to hear you are feeling better, by the way:)

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

        Hi Dr. Ede,

        There is a site called the Failsafe Diet, which has alot of interesting information about food intolerances and sensitivities. There is one post on minimizing amines in Meat, Dairy and Eggs. When I read it, I thought OMG, how could anyone figure out a way to live like that, especially if they are carbohydrate intolerant. I could only imagine adhering to the recommendations if I had exhausted all other options and was terribly ill. Its so overwhelming what the writer is recommending. Nevertheless, I think it contains a lot of very useful information and food for thought. The writer addresses the vacuum packed issue. Here is the link:

        http://failsafediet.wordpress.com/the-rpah-elimination-diet-failsafe/minimising-amine-formation-in-meat-dairy-and-eggs/

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

          Thanks so much–this theory would go a long way towards explaining why I do so much better with poultry and fish than red meat. I am keenly aware of the vacuum-packed and aged meat issue and try to avoid both whenever possible, and pork is the hardest meat for me to tolerate, even when very fresh. This is very illuminating…I appreciate your thoughtful feedback about this issue!

  • Kurt

    Very interesting to follow – thanks for posting!

  • bill

    Have you had a complete thyroid panel? Including T3 and rT3? (TSH is not a useful indicator). See Dr Davis on the Wheat Belly site – links under “thyroid” and “iodine”

    After starting on thyroid supplements (T3), being cold ceased to be a problem. It did increase my heart rate, but not my blood pressure.

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

      Hi Bill

      I had some thyroid testing done this morning; it included a TSH and a free T3, but I don’t believe it included a reverse T3. I was only cold at certain points–when my ketones were very high, it seemed to me. However, I will be posting my lab work next week, so we shall see…

  • bill

    rT3 seems to be of utmost importance, as you probably know a large percentage of your T4 can be changed into rT3 to your detriment. The only way to know this is to have it measured.

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

      Hi Bill
      Just called to add on the rT3 test so I hope it will be available for posting next week.

  • http://diagnosisdiet.com/ Dr. Ede

    Hello, Raymund, and thank you kindly for sharing cheese wisdom! I don’t tend to have good luck with cheeses, unfortunately, but please keep in mind that I have numerous food sensitivities that most people don’t have to contend with. The aged/moldy cheeses are especially hard on me, so I avoid them completely, whereas milder cheeses such as mozzarella and cheddar are not as bad. Dairy in general just doesn’t agree with me. However, the information you have posted may be of great interest to those who can tolerate dairy, so thank you.

  • bill

    Now I remember what I was going to post.

    I use heavy whipping cream quite a bit.

    It is noticeable, buying several different brands and lots of each, some contain much more fat than others, randomly. It may be that when the company needs to deliver product, a bit more milk slips past the separators to fill quotas. Or maybe it’s the beginning of a run (more fat) or the end.

    Some containers will have much more lactos than others.

    This is why nutrition science is so difficult. Can you ever be sure what every food you consumed consisted of?

    I guess you can only do your best.

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

      Yup, we can only do our best:) There is actually one brand of cream sold at Whole Foods which contains 8 g of protein per serving!!! I hadn’t noticed it until I tried the cream (which is organic/pastured and tastes wonderful) but then got all kinds of symptoms I associate with milk proteins. I even wrote to the company to ask why their cream had so much protein in it but they didn’t respond (this was months ago).

  • Jeff

    Why not try eggs or liver for protein (there’s also fat in both) perhaps cooked in lard? It seems that you are under-nourished with micro-nutrients, and these two are the most nutrition-dense foods on the planet.

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

      Hi Jeff
      Thanks for the suggestions–I agree. I do eat chicken liver once a week but you have made me realize I may need to eat it more often. Unfortunately I can’t tolerate eggs, but I do like chicken liver.

      • Jeff

        Whole foods has grass-fed beef liver – probably one of the best available nutrition sources, perhaps better than chicken livers (especially if they’re from conventionally-raised chickens). It is too bad that you cannot tolerate eggs, though…..

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

          Yes, grass-fed liver is so much better than conventional; I’m just leery of anything from a cow right now…

  • Someone, Somewhere

    Hi Dr. Ede,

    Thanks again for subjecting yourself to such discomfort, in the name of science. I am both impressed and grateful.

    Quick question: I keep reading you mention duck fat as a dietary staple. I believe you wrote something awhile ago about cooking it similarly to how I suggested you cook beef fat. Would you mind elaborating?

    How are you buying this duck fat? Are you buying (or receiving gratis, as I also do when the butcher is in a good mood) slabs of isolated fat, like you do with beef fat? Or are you simply referring to the liquid drippings from when you roast duck? In other words, are we talking duck-cracklin’s, duck-lard, or both?

    If we’re talking duck-lard, do you eat it by the spoonful (ew) or spread on something else (e.g., meat)?

    I’ve recently started eating duck as a result of hearing about it from you. I found that I definitely prefer it over chicken (when I can afford it). Thank you for the inspiration to try duck! I’ve been looking for fresh duck eggs, since I’m chicken-egg-intolerant, but so far, I’ve had zero luck finding them :/

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

      Hi SS
      I buy rendered duck fat from Savenor’s in Cambridge (Julia Child’s old haunt)–a wonderful place which I like to call my “frozen zoo.” I use the duck fat (which is pure white and soft at room temperature) like most people use olive oil–I saute with it and also use it as a dipping sauce for meat (particularly dry meats, like white chicken and turkey). I add a lot of salt to it. As for eating it by the spoonful, I agree–ew!

      • Someone, Somewhere

        I wish I had known about Savenor’s back when I lived in Cambridge, but then again, I probably wouldn’t have cared, because I was a vegetarian living off of Harvard’s award-winning (no joke) dining hall food!

        I saved the drippings from my latest batch of roasted beef fat, so I might try the same with dry meat. I also saved the drippings from the last time I cooked muscovy duck legs, and the fat was out of this world! (I confess that I spread it on some highly refined gluten-free English muffins, because that was the only thing in the fridge at the time, and I was ravenous.)

        I might have to hunt down some rendered duck fat where I live in the San Francisco Bay Area, or else keep roasting my own duck and keeping the fat :)

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

      SS, I have seen it at Whole Foods too!

      • Someone, Somewhere

        Thanks, Elaine. I’ll take a look :)

  • Nancy M.

    I had a couple of thoughts about fat sources. How about rendering the beef fat and skimming out the beef proteins. You can do that with butter too and make ghee. Maybe those would agree with you more.

    Also, there was something in the news about a sort of tick bite organism that makes people allergic to red meat. Maybe this is your issue?

    I was laughing at your dreams, they sound as crazy as mine get. I wasn’t laughing at your insomnia… that’s just awful.

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

      Hi Nancy

      Glad you enjoy the dream bits–trying to lighten up an otherwise not too entertaining week! Thanks for the suggestions, as well. One of the reasons I was roasting the beef fat instead of buying it rendered was to have something sort of solid and food-like to eat when I ran out of protein grams for the day. I have tried ghee and it affects me the same way butter does, unfortunately. I may try rendered beef fat at some point in the future, but for the near future, I want to avoid the red meat and fat derivatives so as not to become a masochist:)

  • Tyler

    Dr Ede, I am very sorry that I spoke too soon! I was in class while reading your progress and didn’t get down to the weekly reflection before I had to pack up stuff to go to next class, so that’s why I left the hasty comment about how detrimental this experiment seems to be for you. However, I have read the full post now, and am very glad to see you are going to change things around.

    Do you think it would be possible that you have some case of leaky gut? Considering the abundance of foods that don’t agree with you. I heard this in a podcast, so it could be completely off, but it crossed my mind so I figured I would mention it.

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

      Hi Tyler

      Please, no worries, I am very happy to hear negative as well as positive comments–honest feedback of any kind is welcome. I realize my experiment will generate a wide variety of reactions and I learn from all of them:) However I am definitely making major changes to my experiment this week because I want and need to feel healthy.

      Also, I do think I have leaky gut, yes. I must, since almost everything I eat except for fresh meat and just a few other very bland foods seems to bother me!

  • Elizabeth Bowler, MD

    Hi Dr. Ede;

    I have been following your experiment with great interest. Thank you for being willing to subject yourself to this and for sharing your results with everyone, I think the BP and HR additions are very helpful (although I am a bit concerned about the 2/28 HR of 61 – hypothyroid?) I look forward to reading about your experience with increased protein, I am hopeful that you will feel better. Off now to read Dr. T’s histamine post!

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

      Hi Dr. Bowler
      Thanks for your interest–I was a relatively happy guinea pig until this past week, so definitely time to change the plan. It was really the blood pressure and change in my hormonal patterns that concerned me most. No worries about the heart rate–I ate a normal diet today and my heart rate was 79 just now. I had blood drawn this morning and should have thyroid tests available to post next Thursday.

      • http://www.facebook.com/people/Jonathan-Swaringen/100000250965440 Jonathan Swaringen

        I’m curious about how much seafood you’ve been eating…I forgot to take note of it…Seafood is the focus of Jack Kruse’s Epi-Paleo due to various reasons described in his brain gut series mostly.

        http://jackkruse.com/brain-gut-6-epi-paleo-rx/

        Without the right amount of Iodine your Thyroid could be having issues on really low carbohydrates. I’ll go back and look…but didn’t notice that much if any seafood…mainly fish oil which I’m not if it contains all of the important nutrients in fish. Its just the fat so its missing part of it.

        I’m wondering what your hormone tests would show in regards to the Thyroid and the Endocrine system in general. Iodine if not at a proper level might cause issues especially if your drinking water which is Fluoridated. Fluoride will take up space in the Thyroid if you don’t have enough Iodine which could be causing major issues.

        I’m not sure if you are aware of the Fluoride issue…I avoid it by getting RO water. If I could afford it I would get a whole house filter.

        Thanks for the posts its a very interesting read.

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

          Hi Jonathan
          Thank you for these thoughts. I was eating some sashimi, some smoked salmon, and some tuna, but will definitely increase the seafood for this next phase, because I love fresh fish. The first week of the experiment I spent mainly in Utah, where seafood wasn’t always available, and by week 3 I was feeling like I needed to emphasize red meats because it seemed to me they might be more nutritious, but for this next phase, which will be plain ol’ nutritional ketosis, I will enjoy plenty of fish:) I should have some thyroid tests available to post next week.

      • Elizabeth Bowler, MD

        Hi Dr. Ede;
        Very glad to hear that your HR came up nicely. I’m looking forward to your labs next week (you might wish to consider a 25-OH Vitamin D, in light of your lingering URI, makes me wonder about deficiency). Have a great week!

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

          Hi Dr. B
          Yes, indeed–a vit D will be among the tests, so I’ll post that as well. Thanks for your concern and have a great weekend!

  • mnwz

    Dear Dr. Ede, Can you describe how you compute the Protein: Fat (cal) ratio? Thank you!

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

      Hi mnwz
      Sure– for the protein portion, I multiply the number of protein grams by 4 calories per gram to obtain protein calories. Then I multiply the number of fat grams by 9 calories per gram to obtain fat calories. Then I put them side by side with a colon in between:)

      • mnwz

        Thank you!

      • Peter Walsh

        Where on earth did you find this formula for obtaining ratios? The standard way to do it is weight. fat grams:protein grams + carb grams.

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

          The sources I read before starting this experiment were: Seyfried, Rosedale, and Phinney and Volek. Only Phinney and Volek discuss ratios, but they specifically and repeatedly refer to caloric ratios, which is why I calculated my ratios this way (and why I specifically labeled my ratios as calorie ratios to avoid confusion). This may not be correct according to other sources–which source are you referring to as the standard? One major problem I have noticed along the way is that every reference I see gives slightly different advice. After seeing your comment today I poked around the internet and looked up some articles about ketogenic diets on PubMed and still found very conflicting or vague information about ratios, so if you have a standard source I should be using, I’d welcome that.

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Cyn

    Lots of good feeback here, thanks!

    Yes, nutritional ketosis and optimal performance guidelines are very different from Seyfried’s recommendations, and it may have been unwise to try Seyfried’s recommendations without properly keto-adapting first, but my goal was to follow his instructions, and he did not recommend any adaptation phase. I wouldn’t recommend this approach to anyone based on my own experiences, but cancer patients and seizure patients may require special rapid induction, carefully monitored by skilled nutritionists.

    I did not supplement potassium, so I will take that into consideration for this coming week, thank you. I was definitely eating plenty of sodium, but will start keeping track of this for the sake of good experimentation.

    I unfortunately can’t tolerate seeds of any kind…or cream cheese…or butter…but really wish I could:)

  • http://diagnosisdiet.com/ Dr. Ede

    Hello, TooSteep
    I appreciate your continued interest and am glad that my strange experiment has been of some use to you:) I am jealous of your dairy tolerance! I also appreciate the link and will check it out this weekend! Good luck to you, too, with your new ketone goals…feel free to keep us posted if you wish!

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Giorgina (great name!)

    Excellent questions. I think (and hope) that plain old nutritional ketosis (ketones much lower, protein higher), would be comfortable and much easier than this, but we shall see, since that will be the next phase of my strange experiment… I hope that part of my experiment will be more useful and more inspiring than this last phase for you!

    I am 48 but had had zero signs of menopause or peri-menopause prior to this experiment. Everything had been completely normal and fine until this month. I do not know enough about fat and hormones to say anything intelligent about the fat cell theory yet but it would be a great subject for a blog post, so I’ll add it to my list of topics to research. I aim to rivet:)

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

      In our ZIOH group, we are at least half women of all ages, eating meat and drinking water. Some for years.

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

    Hi Dr. Ede! Thank you so very much for sticking with this experiment for so long. I can’t imagine how difficult this last week must have been getting so little sleep! If there’s one thing I hate, it is not getting sleep. As you know, I was doing a version of the ketogenic diet, but was not measuring anything and just going by how I felt. When I first measured my ketones they were only at 0.4-0.6.You inspired me to start my own ketosis experiment (day 9 here!) and I am tracking all of my data diligently so I can hopefully decipher some sort of meaning from the changes I make. I feel like absolute crap, though. While I’m mentally alert, I am physically drained and all I want to do is sleep! No insomnia here, but I have ravenous hunger, spaciness, negative thoughts…..however no migraines and so I know it is working at least on that front! It’s interesting that my migraines stop as soon as I produce ketones, way before my body begins to efficiently burn them for fuel. (Not complaining here!) Have you noticed any positive changes in your mood throughout this? I look forward to hearing more next week, and hopefully you will be feeling much better by then :)

    One thing I’m confused about is how the urine ketone strip readings are so similar to your blood ketone readings…is this a sign that we don’t need the expensive blood strips or is it too soon to tell?

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

      Hello, Elaine

      Yes, sleep is very important, I agree! I’m sorry you are feeling so lousy (with exception of migraines). How high are your ketones? How low is your blood sugar? I feel much better when my ketones are lower, I’m finding. Be careful–my experiment was bordering on unsafe and I don’t want anything bad to happen to you. If you don’t own a blood pressure cuff, check your blood pressure at a local pharmacy to be sure it is in a safe range (upper number should be at least 100).

      As for urine ketones, I think the reason why they have been so consistently matching up with the blood strips is that the ketones were so extremely high. I think that they will be less accurate in lower ranges, but I will see this week, since I’m going to aim for higher protein and lower ketones this week so I will feel better.

      Feel free to keep us posted if you wish~

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

        Hi Dr. Ede,

        Ketones are averaging 1.5 and fasting glucose 73. I was eating 60-70g of protein but have felt so ravenous the past week that now I’m eating more like 110g, and 2100 calories! Carbs still <30. I was trying to eat 1400 calories so either that was too low or my protein was just too low. Good idea to check on blood pressure…I will do that this weekend.

        Thanks for explaining about the urine ketones, that's a good point. So far mine have been matching up as well, though they are always slightly higher at night.

        On a side note, I just had a full pituitary panel done and while everything is "in range" according to the lab's standards, my TSH is 3.4, which is too high for the new standards that endocrinologists are supposed to be going by! Apparently different labs have different standards though so 3.4 is normal at one hospital and abnormal at another. Also my Free T-4 is 1.1, which is below the median. This could explain some of my symptoms….need to find a new endocrinologist so I can get it sorted out. I wonder if I am slightly hypothyroid and it is a little exacerbated by this diet (feeling cold and so tired and sluggish….I was feeling it before the diet, too, but not like this) or if it is really just the adaptation to burning ketones for fuel. I'll be interested to hear what your thyroid test results are!

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

          Hi Elaine
          If there’s one thing I would not do again is tolerate hunger on this diet–I mean for the first few days while initially adjusting, fine, but any ongoing hunger I think should be viewed as a reason to eat more calories. I was hoping if I just made it past week 3 I’d be better adapted and the occasional hunger would disappear, but that didn’t happen. I’m so glad to hear that you are listening to your body and eating more. I’m also glad to hear that you will be consulting with specialists to make sure you are healthy and safe on this diet. Your ketones and blood sugar look good to me!

  • Marijke

    Hi dr Ede,

    According to a table I found, heavy cream contains 0,5 grams of lactose per tablespoon of 10 grams (at least in the Netherlands). That explains the carb cravings you had.

    Are you able to eat ghee? It is very easy to make from butter and it contains just the butterfat, no proteins or carbohydrate. Let me know if you want a description.

    My own experiment without any number testing is going well. I feel good and have great sleep. I can eat some carbs without problems, so I have a little potatoe in the evening. I have been low carb for some years so that might make it easier for me. The problem I have is muscle cramps. I try to add more salt to my food and that seems to help. I eat just two meals a day.

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

      Hi Marijke

      Interesting…I had wondered if cream might contain hormones, as well, that could contribute to cravings, insulin production, and weight gain…

      Thank you for the ghee suggestion–I have tried ghee in the past but it feels exactly the same to me as butter, unfortunately.

      Sounds like your own experiment is going very well! I had forgotten to mention that, last summer, when I was eating an all-meat diet for 90 days, I had muscle cramps. Interestingly, I haven’t had them at all this time around. I wonder in retrospect if they were due to excessive protein. I had some blood work drawn at the time and the only problems my doctor could find were vitamin D deficiency and folate deficiency, so I added liver to my diet and that seemed to help. Phinney and Volek recommend Slo-Mag–have you tried that?

      • Marijke

        Hi dr Ede,

        I am just halfway through Phinney and Volek. I suppose Slo-Mag is a magnesium supplement. I do take magnesium and have done so for years. It works against muscle cramps too and it is essential for the formation of strong bones.

        I think my experiment is going relatively easy because I have been on the GAPS program for more than three years. I just had to add more fats and remove two eggs from my program. I hope your next week will be better.

        Thank you for inspiring me to take this next step!

  • http://diagnosisdiet.com/ Dr. Ede

    Dear Charles

    1. Nowhere on this site will you find me promoting any one “ideal” paleo-style diet. IMO, a Paleo diet is any pre-agricultural, whole foods diet, regardless of composition–from all-meat or mostly -meat to Okinawan style (mostly plant, high-starch). In fact, the whole point of my site is to provide information that people can use to design the diet that works best for their own personal chemistry. See my FAQ page and my “about” page.

    2. Nowhere on this site will you find me saying that (unrefined whole food sources) of carbohydrate are bad for everyone. My opinion is that some of us have damaged or broken carbohydrate metabolism and can unfortunately no longer tolerate even “healthy” or so-called “safe” carbs. Believe me, if I could eat them, I would be eating them. I love them, and wish they loved me back. See my blog post about carbohydrate sensitivity.

    3. Low-carb does not equal ketogenic, and ketogenic does not necessarily mean extremely ketogenic (ala Seyfried). However, there is plenty of scientific, historical, clinical, and anecdotal experience (including my own) that standard low-carb diets are safe and healthy and well-tolerated. I have eaten a very low carb diet for most of the past 3 years without any problems whatsoever. I am very new to ketogenic diets. See my post about ketosis week 1.

    4. I can only guess that you do fine with whole food sources of carbs and are therefore perplexed by those of us who have been forced to turn to low-carb diets to regain or maintain our health, but I could be wrong. Would you feel comfortable sharing some of your own personal history with us.so that we can see and appreciate where you are coming from?

  • Chris

    For fat sources I wonder if you can have ghee? or maybe MCT oil.

    There are a few of us also working on this experiment for ourselves-for weight loss and cancer/diabetes prevention. We have a support group/thread at Mark’s Daily Apple (the forum for Mark Sesson’s Primal Blueprint). You might come over there and see if anyone has ideas for you. We do also have a recipe group, that has ideas for ways to get fat into the diet.

    I appreciate you taking the energy to take such detailed notes, it is your willingness to do this that spurred a few of us on. Thanks!

    • Chris

      I forgot to mention that many in our group have found homemade bone broths helpful for hunger and nutrition. And I think magnesium for the heart pounding.

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

        Hi Chris

        Thanks for the info re: MDA–I will definitely check it out, and I am so glad to know that my odd little experiment is useful to some people!

        I wish I could tolerate ghee, but it affects me in the same way that butter does. I have yet to try MCT oil, but that’s on my to-do list. I am putting it off b/c I’ve heard it can be tough on the digestive tract, so I’m not looking forward to it…I don’t want to get a reputation as a masochist:)

        I have made bone broths in the past, but have not been making them this past month because I would have had no way to calculate their protein/fat/calories for my experiment…

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Jonathan

    Yes, I have a freakishly large number of food intolerances, ’tis true:(
    I have spoken with quite a few physicians about it to no avail. I am about to change my primary care physician to one with a more holistic approach and hope she may have some ideas for me.

    I have tried pastured/grass-fed heavy cream and that doesn’t seem to be any different, unfortunately. I have never tried raw dairy but would be willing to give it a try!

    • http://www.facebook.com/people/Jonathan-Swaringen/100000250965440 Jonathan Swaringen

      Thanks for the replies. Hope to try some raw dairy in the future myself…as I haven’t had a chance to either. I’ve read many good things about it though.

      Apparently not being raw really messes with dairy. There are quite a few interesting things about it at Weston A. Price site.

      http://www.realmilk.com/

      http://www.westonaprice.org/

      Both sites have a great amount of information. The milk website is mostly about milk of course though.

    • TooSteep

      I have an odd experience to report concerning raw dairy:

      I live in Canada where raw dairy is illegal. But about 5 years ago, I had access to it for about 3 months, when a local guy was driving to WA to get a weekly supply. So I was drinking about 1 litre of raw goats milk a day for those 3 months.

      I packed on about 12 lbs of lean muscle mass during those months! I lost it after losing my source of raw goats milk. And I’ve never been able to do it before or since, in spite of using comparable weight training routines.

      Some day I’ll go live in the US for 3 months and try it again.

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

        Intriguing! I assume you have tried this with pasteurized goat’s milk and it didn’t work. I would love to explore the science behind raw vs processed dairy foods and post about it…it’s on the to-do list…Thanks for sharing this interesting tidbit…

  • http://www.facebook.com/people/Jonathan-Swaringen/100000250965440 Jonathan Swaringen

    I’m curious where you found your holistic doctor? I think you said you already found one?

    http://paleophysiciansnetwork.com/

    I figured I’d post my source for holistic health practitioners. Hope you found a good one as the right doctor is very important for getting at the root of problems. Conventional doctors just treat symptoms sadly.

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

      Hi Jonathan
      I’m going to try the Marino Center for Integrative Health in Wellesley, MA.

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

    Interesting – thank you very much!

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

    Hi Dr. Ede! Todd here again…
    Why do you not render your beef fats? Make sure it’s fresh fat and that would get rid of any beef proteins (or amines). I have jars of rendered fats (from beef, chicken to goose) from when i make Gribbeness (cracklin’) or pemmican (for travel). The rendered beef fat is soft with the texture of potatoe puree, and in fact, i put globs next to the hamburgers i made for two guests yesterday, one not even a low-carber, and told them to eat it with the hamburger juices and they loved it! The other melted it into the hamburger and also loved it that way. anyway, it’s a great way for upping your fat ratios. And yes, it sounds like you’re not getting enough protein, especially if you had just been ill. Why not eat when hungry but just eat the meats with more fats and see if that works? Eat the fat FIRST. It seems to matter for weight-gain loss and satiety. I’m wondering if it allows letpin to communicate with the hypothalmus before insulin reactions to protein come and encumber that…anyway, keep up this amazing work. I looked over the site about amines briefly, recommended by Dr. T below, is this backed up by science? I definitely have lots of those symptoms. I think it is possible to eat this way, but more emphasis on the freezer and not buying just once per month, like i’ve been doing. I will try that. And, lastly, there must be some butchers or special hungarian ethnic stores where you can purchase goose skin. I can 100 meters outside my door, so i guess i’m lucky. And free chicken skin (but i do react to too much of that, too). And according to the FAILSAFE diet, chicken skin is not a good thing…unfortunately, because it’s so damned good boiled, then deep fried in rendered beef and goose fats with salt and white pepper. :-)

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

      Hi Todd

      I am scared of beef products right now, but might try your rendered fat idea in the future…I’m not optimistic, though, since ghee affects me the same way butter does, for example. My next plan is to do the all-meat diet but with more protein, and I like your idea of eating the fat first.

      As for the amines issue, I’d like to look at the science of it myself, and if I can learn anything about it, I’ll write a blog post about it. My pattern of reaction to meats seems to fit nicely with the theory, but I haven’t looked at primary sources yet, which will be important.

      And wow, goose skin in your backyard–you are one lucky guy:)

  • MDAPebbles67

    Now, that was a rough week. Sorry. Thanks for doing this experiment.

    My feeling is that you are not eating enough. The problem is how to get more food in without setting off food sensitivities. Some of us at MDA are lowering out protein intake, but trying to keep calories at BMR level or better. At 5’10″ I am aiming for 60-75 g protein and about 1700 cals minimum. Feel free to check out out Nutritional Ketosis thread as mentioned by Chris above and linked here. http://www.marksdailyapple.com/forum/thread77549.html

    Also, many of the NK group track food on My Fitness Pal. We look at each other’s food diaries for inspiration.
    I hope this next week is better.

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

      Hi Pebbles

      Thanks for the sympathy:) I wish I could have found a way to test the theory about my issues being fat or protein or calorie-related, but I was not feeling well enough to do that.

  • bjjcaveman

    Dr. Ede,

    I just wanted to let you know that I completed the experiment where I attempted to decreased my overall protein intake to see if I could replicate a similar jump in blood ketones that you experienced:

    http://bjjcaveman.com/2013/03/02/what-happens-when-i-try-to-cut-protein-down/

    It was much harder than I thought, and despite a slight elevation in ketones (not out of my typical range for the past 81 days of my own ketosis experiment), the hunger and difficulty I experienced just wasn’t worth it.

    I was reassured to see your conclusions with this most recent update. I hope you don’t mind that I linked to you a lot and quoted from this post!

    Thank you for your self experimentation.

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

      Hi bjjc
      I just read your post and am glad that you wisely increased your protein intake again. I have no problem with the links/quotes, of course–I hope they are useful to people. It’s curious to me how some people have been able to somehow comfortably eat so much less protein; we are each unique. It’s certainly not the plan for me! I know lots of people who have been able to safely and comfortably lose weight at nice moderate ketone levels of about 0.7 to 1.5, but the cancer/epilepsy treatment ketone levels were not sustainable for me.

  • Peter Walsh

    Hi Dr. Ede, It has been my observation over the years that a ratio of 4:1 or higher for adults is certainly not sustainable for the following reasons. If you start with the premise that your body needs approx. .8 grams of protein per kilogram of lean body mass for an adult, you want to keep Carbs at <12 grams per day then you have to make up the rest of your kcals in fat. Therefore, if your desirable body mass is 120 lbs you would need approx. 43 grams of protein to maintain muscle mass. + 9 grams of carbs is 52 grams combined or 208 kcals + 132 grams of fat,1,188 kcals = 1396 kcals at a ratio of 2.5:1 and that would be restricting your calories by a approx. 200 kcals per day. If you were a child or a sacrificial mouse you could do with a ratio of fat grams to protein + carbs of 4:1 but as you can see it is not doable for an adult. But thanks for trying.

  • bjjcaveman

    Dr E,

    I discovered that despite being in ketosis and having low fasting AM sugars, my HbA1c was still 5.7%.. and I just wrote a 2 part blog post trying to explore why. I think I’ve come to a reasonable conclusion, but just wanted to get your take as well… since this may be something that will affect you if you were to check your HbA1c in the future.

    http://bjjcaveman.com/2013/03/04/the-effects-of-nutritional-ketosis-on-hba1c/

    http://bjjcaveman.com/2013/03/06/the-effects-of-nutritional-ketosis-on-hba1c-part-2/

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

      Hi bjjc
      Just read your post–very interesting! My only question is: do you know what your fasting blood sugars tended to be prior to starting your ketogenic experiment?

      • bjjcaveman

        While I didn’t check them as rigorously as I do now, I can give the fasting values that I have when i did my annual blood tests:

        8 months into Low carb – 84 mg/dl
        on a Standard carb diet – 81 mg/dl

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

          Thanks! I find this very interesting–it may simply be that a ketogenic diet has not really had much effect on your blood sugar levels, and that this is why it hasn’t had any effect on your HbA1c?

          • bjjcaveman

            I think that is what I can conclude so far. The slow carb diet had an equal effect as a ketotic diet no my blood sugars.

            The puzzling thing for me that caused me to explore this more was that having an hba1c of 5.7% which is equivalent to an average blood sugar of 117 mg/dl just didn’t make sense with anything else and I felt compelled to figure out why!

            thanks for taking the time to give me your feedback!

  • mks8500mda

    Wow! What a rough week for you. Glad to see you lived (and learned) through it. Now it’ll be interesting to see the effects of adding protein.