Keto Talk (episode 1): Kidney Stones, Gout, And Heart Palpitations On Keto
WORLD’S 1ST REUSABLE BREATH KETONE ANALYZER NOTICE OF DISCLOSURE: Paid sponsorship Today we officially kickoff this brand new podcast dedicated to answering listeners questions about the low-carb, moderate protein, high-fat, ketogenic diet. It’s called Keto Talk with Jimmy Moore & The Doc (now available to listen and subscribe on iTunes) featuring 10-year veteran health podcaster Jimmy Moore from “Livin’ La Vida Low-Carb” and Arizona osteopath and bariatric physician Dr. Adam Nally from “Doc Muscles.” These two are a keto power pair ready to take on your most pressing questions about this way of eating. This is Episode 1 and we get started off with a bang. ENJOY! KEY QUOTE: “If you cheat on your ketogenic diet, then you are at risk of a kidney stone or gout. The point is if you’re gonna cheat, you’re gonna pay for it.” — Dr. Adam Nally Here’s what Jimmy and Adam talked about in Episode 1: – The beginning of this new podcast devoted to keto – How Adam uses ketogenic diets with his patients – Adam’s father who died early from diabetes issues – Follow Jimmy and Adam on Periscope – Whether keto creates or prevents kidney stones – Why it’s not a good idea to cheat on your low-carb diet – How cheating, not keto, is what leads to gout – Whether a ketogenic diet causes heart palpitations – How to best balance your electrolytes starting keto – The problem with caffeine on your cortisol levels NOTICE OF DISCLOSURE: Paid sponsorship There are three ways you can listen to Episode 1: 1. Listen at the iTunes page for the podcast: 2. 3. Download the MP3 file of Episode 1 [25:30] WE NEED YOUR FINANCIAL SUPPORT OF THIS PODCAST! Adam and I are committed to answering all of your questions about low-carb, high-fat, ketogenic diets on this p Continue reading >>
The Connection Between Paleo And Gout
I think there are two issues here: what causes gout and what to do once you have it. It is pretty clear that fructose is the major villain, as Peter at Hyperlipid and Taubes so amply demonstrate. Some extensive research on gout has been done by HK Choi. However, neither of them speak to the problem of treating gout. Obviously, eliminating fructose is the first step, but elevated uric acid levels have a tendency to stick around even after reducing or eliminating fructose from your diet. A potential problem with a paleo approach is that, according to Lyle McDonald in his Ketogenic Diet book, ketones compete with uric acid for elimination through the kidneys. So, if one is eating a VLC paleo diet, ketones in the urine could mean less uric acid elimination. I had my first gout attack in April 2009; my uric acid levels were 7.8 mg/dL. I was eating paleo at the time, and fairly LC (less than 75g/day); I think the attack was triggered by exercise (I had just started some HIIT). I continued to eat LC, and went VLC (20 g or less per day) for about two months before my test in November 2009. The result: uric acid level of 9.6 mg/dL! To be fair, uric acid levels are supposed to be lower after an attack, but I didn't expect that kind of jump. One issue that is pertinent here is the acid/alkaline issue. A lot of it is new agey, vegetarianism hokus pokus, but some of it isn't. Uric acid is a weak acid, and more soluble in a alkaline environment, making it easier for elimination. I read about this study on PubMed, and started taking sodium bicarbonate in water, once in the morning and once at night (1/2 tsp each dose). I also made my own magnesium bicarbonate water (recipe here) to limit sodium intake and increase magnesium. I did this for about a month before my last test. Results: u Continue reading >>
Could A Ketogenic Diet Alleviate Gout?
More than 8 million individuals in the United States have gout, a disease that can cause intense recurrent episodes of debilitating pain, inflammation, and fever. The cause of gout is the accumulation of urate crystals in joints, which continuously reactivate the immune system, leading to activation of the most common type of immune cell in the blood, neutrophils. These periods of immune reactivation are known as flares, and are driven by a protein complex called the NLRP3 inflammasome. Recent work from the laboratory of Vishwa Deep Dixit, professor of comparative medicine and immunobiology, has shown that the ketone body β-hydroxybutyrate can specifically inhibit the NLRP3 inflammasome. Ketones are byproducts of fat break-down in the liver that can serve as alternative metabolic fuels for the brain and heart during periods of low carbohydrate intake, such as fasting, or ketogenic diet. To test if elevating ketones protected against inflammation during gout, a postdoctoral fellow in Dixit’s lab, Emily Goldberg, and an associate research scientist and clinical veterinarian in comparative medicine, Jennifer Asher, and their colleagues collaborated to develop a novel model of gout flares in rats. They found that feeding rats a high-fat, low-carbohydrate ketogenic diet increased β-hydroxybutyrate levels and protected rats from the joint swelling, tissue damage, and systemic inflammation normally seen during gout. “In isolated neutrophils, β-hydroxybutyrate completely blocked NLRP3 inflammasome activation, even when provided at low concentrations that are physiologically achievable through dietary modification,” said Goldberg. She speculated that specifically targeting the NLRP3 inflammasome to reduce inflammation during a flare could improve gout patients’ outcom Continue reading >>
Gout Patients: Dinner Cancelled
A recent study by Yale University also shows that altering the diet could also be a possible therapeutic approach to use against gout: the ketone bod β-yhydroxybutyrate, which can specifically inhibit the NLRP3 inflammasome, is the basis for this. The scientists’ rat feeding experiments suggest that a particular diet could also help people with gout – without weakening the defence function of the immune system to bacterial infections at all. Rats with gout which received a ketogenic diet, in other words one especially high in fat and low in carbohydrate, formed elevated levels of β-hydroxybutyrate, which largely protected joints in the rats against swelling. What’s more, tissue damage and systemic inflammatory reactions occurred with this diet only in a weakened form. Once a “privilege” of rich old men, it is now a widespread disease Gout was once considered a “privilege” of wealthy, older men with a debauched lifestyle. Today, it affects a broad spectrum of the population – including women as well. Uric acid – the end product of purine metabolism – is considered to be the trigger for gout. Should the uric acid concentration in the blood reach its physiological solubility limit, precipitation of sodium urate occurs in the tissue. Attacking the urate crystals often backfires Gout occurs when urate crystals accumulate in the joints. There they continually stimulate the immune system, which responds through the activation of neutrophils. This process is controlled by a protein complex which is called the NLRP3 inflammasome. Gout manifests itself as strong joint pain, inflammation and fever. The treatment of gout patients aims to, among other things, reduce the concentration of uric acid in the body of patients. Yet paradoxically, general urate-reducin Continue reading >>
Gout And Keto
There’s loads more to it than simply blaming red meat or whatever is this weeks uric acid demon food. Some people with high uric acid never experience gout, whilst others with low levels get it often – and vice versa, it’s all about CLEARANCE and avoiding the feedback loop. Simply put – swapping out pig for fish won’t fix the clearance issue, it may reduce the build-up ever so slightly, but I seriously doubt it. Short version for ketards is ketones compete with uric acid for flushing, so that period where you are just acclimatising is when it’s most likely. Once you are using your ketones effectively the uric clearance thing isn’t an issue. The worst thing someone susceptible to gout can do is go back and forth from carby to keto and never fully adapt – this is gout limbo, and I’m guessing a good way to develop kidney stones in the long term. As it stands I consider it a catalyst feature – as in whatever susceptibility I have toward joint issues lays dormant until something ELSE happens. One catalyst that semi-correlates is food, each of the last few times I’ve experienced pain it’s been within a day or two of Thai food – but a confounder is that each time I also drank a bunch of beer too. Another is 12+ hours on a chair when I’m in research and writing mode that promotes poor circulation, so probably inducing some kind of mild thrombosis which is enough to start a cascade of events that end up in inflammation of a joint/nerve. And each time seems to be within days where I’ve experienced a twisting/whatever of an ankle/knee too for some reason. It’s a reflective problem which gets itself into a feedback loop. I’ve researched far and beyond the whole “it’s cos you eat red meat and wine brah” thing from years ago, it’s nothing to Continue reading >>
Ketones
Glucose (a type of sugar) is the body’s main energy source. What are Ketones? Glucose (a type of sugar) is the body’s main energy source. When the body can’t use glucose for energy, it uses fat instead. When fats are broken down for energy, chemicals called ketones appear in the blood and urine. This is known as ketosis. When the body is in ketosis it is actively using fat stores as an energy source. Ketosis can happen for one of two reasons: You do not have enough insulin in your blood. If there simply isn’t enough sugar available e.g. as a result of a low carbohydrate diet. Using fat as an energy source is perfectly natural. For example, if you are fasting either by choice (on a diet) or you are stranded without food, the body needs to be able to use stored fat for energy. But the process is controlled by insulin. A Ketogenic diet primarily works by lowering insulin levels, producing ketones and increasing fat burning. It is an effective weight loss diet that is now well supported by scientific evidence. Ketogenic diets can improve metabolic health by improving insulin function, reducing inflammation and promoting fat loss all of which greatly reduce the risk of or improve existing obesity, type 2 diabetes and heart disease. Suppressed appetite. Increased energy levels. Improved glucose control. Improved mood. Rapid weight loss (10% weight reduction in approximately 40 days). Ketones become a problem when you do not have enough insulin to control ketone production properly, such as with Type 1 diabetes. When too many ketones are produced too quickly they upset the delicate balance of the body’s chemistry and can lead to a problem called diabetic ketoacidosis (DKA). DKA is dangerous, but the good news is that you can usually stop it from developing. People wh Continue reading >>
Raspberry Ketones
Maybe you've heard the claim that raspberry ketone supplements can melt away fat and prevent weight gain -- even if your diet is high in fat. But what are they, and can they really do that? Raspberry ketones are natural chemicals that give raspberries their enticing aroma. When ketones are taken from raspberries, they can be used to add fragrance and flavor to things such as colas, ice cream, and cosmetics. Experts say that investing in a bottle of raspberry ketone supplements amounts to little more than wishful thinking. And it may or may not be harmful. In one small study, people who took 200 milligrams of raspberry ketones combined with 1,200 mg of vitamin C daily for 4 weeks lost weight and body fat. But the study did not follow good scientific methods. It doesn't show whether any benefit was from either the vitamin C or the raspberry ketones or from the combination. Until more is known, experts say you're better off holding onto your money. Instead, stick to a healthy, balanced diet and regular exercise. Both of those have been shown to be effective ways to manage weight. Raspberry ketones in food and cosmetics are generally considered safe. But no one knows what short- or long-term effect raspberry ketone supplements could have on your overall health. No study has been done to document potential side effects. There are also no studies that look at potential drug or food interactions. The fact that raspberry ketones chemically resemble other stimulants suggests the potential for certain side effects. And there are anecdotal reports of jitteriness, increased blood pressure, and rapid heartbeat among people taking raspberry ketone supplements. Without scientific evidence, no one can say what dosage of raspberry ketone supplements, if any, might be safe to take. Talk Continue reading >>
Sore Joints From Too Much Protein
Eating a large amount of protein will not directly cause your joints to become sore. However, regularly consuming protein in excess of your body's need for the nutrient can contribute to the development of medical problems that result in sore joints. You can decrease your risk of these conditions by staying within the recommended daily allowance of protein specified by the Centers for Disease Control and Prevention for your age and gender, and by choosing low-fat or plant-based protein sources. Video of the Day A high-protein, low-carbohydrate diet can cause your body's concentration of ketone compounds to rise as fat instead of glucose is metabolized for energy. High levels of ketones increase the risk of gout by increasing the amount of uric acid in your blood. Excess uric acid builds up in the joints -- particularly the joints in the feet, toes and knees -- and causes them to become painfully inflamed. People who suffer from gout are advised to limit the amount of animal-based protein they consume since meat, poultry and fish are rich in purines, the substances that the body breaks down into uric acid. MayoClinic.com recommends that you eat no more than 4 to 6 ounces of fish, poultry or meat daily if you have gout. Joint Inflammation Animal proteins like meat and eggs contain large amounts of omega-6 fatty acids. High intake of these fatty acids causes an increase in the activity of cyclooxygenase-1 and cyclooxygenase-2, two enzymes that are responsible for triggering inflammation within joints. Arthritis Today reports that eating too much omega-6 fatty acid-containing foods can increase the pain and inflammation that people with arthritis experience in their joints. To decrease the soreness, individuals with arthritis should focus on eating plant-based proteins in p Continue reading >>
A Ketogenic Diet, The Short Version
A ketogenic diet (link is external) is one that encourages your body to rely less on sugar-based fuels and rather to turn to fat and ketones (produced in the liver by metabolizing fat) for fuel. The benefits of a consistently ketogenic diet are primarily recognized in the sphere of neurological problems, where there has been evidence of benefit in treating obesity, type 2 diabetes, high cholesterol, epilepsy, Alzheimer’s and Parkinson’s Disease A ketogenic diet is one that encourages your body to rely less on sugar-based fuels and rather to turn to fat and ketones (produced in the liver by metabolizing fat) for fuel. Some folks notice improved mood, sleep, mental focus, blood sugar regulation and reduction of general inflammation. Once you are adapted to a ketogenic diet, going in and out of ketosis intermittently is thought to yield some of the longevity, anti-inflammatory and cancer-fighting benefits previously attributed to calorie restricted diets. Staying in ketosis makes it easier for many people to maintain weight loss. For a good discussion of that process, as well as the research behind that observation, you can read this blog post from the "low carb dietitian" here (link is external). A ketogenic diet is one that encourages the body to burn fat for fuel and in that process fat burned in the liver produces ketones and a state of ketosis. We naturally burned fat and produced ketones for fuel when we were breast-feeding infants, if we were so lucky to have wise mothers! Since then, most bodies have lost the knack for burning ketones, which is too bad because our sugar-craving brains would be content with a lot less sugar if our bodies remembered how to supply our brains with ketones. (Ketosis is not to be confused with diabetic keto-acidosis which is life-thr Continue reading >>
Gout And Ketogenic Diet
How Gout and the Ketogenic Diet Affects You A ketogenic diet is a diet with extremely low or no carbohydrates diet which makes the body go into a state known as ketosis. When the body is in the state of ketosis, the carbohydrates levels are low and this causes the blood sugar levels to drop and the body begins to break down fat to produce energy. Normally, the body relies on dietary energy sources as well as on the stored energy, which in most cases is always in the form of stored fats. When the body is exposed to ketogenic diet, it implies that the dietary carbohydrates will be kept very low, thus leaving the body to rely on stored fats to provide the primary source of fuel, a process which also ends up producing ketones from the stored fats. It should be noted, therefore, that a ketogenic diet is a high fat diet and not a high protein diet as has always been portrayed. Studies have suggested that high fat low carb ketogenic diet can help to alleviate the symptoms of gout. Gout symptoms are normally triggered by the NLRP3 inflammasome with the aid of neutrophilis. What happens is that the NLRP3 activates the 1L-1B pro-inflammatory cytokine which then leads to bouts of intense pain at the joints, fever, as well as the destruction of the joints. According to the studies conducted on rodent models, researchers induced gout in rats by injecting 1.25mg of monosodium urate on the knee, after which the knee’s thickness was measured and pathology analysis performed on the menisci and the ligaments. Human subjects were also used during the research where steroid free adults between the ages of 18 and 45 years and adults above the ages of 65 years. All the participants in the studies were not fasting at the time when there peripheral blood was collected. The studies concluded Continue reading >>
9 Surprising Triggers Of Gout Pain
How to fight gout pain Gout is an excruciatingly painful form of arthritis that often affects the feet. Dietary factors, such as red meat and alcohol, can trigger gout pain. However, medications and medical conditions can be a problem too, says Kenneth G. Saag, MD, a rheumatologist at the University of Alabama at Birmingham. "Non-food items are the major risk factors for developing gout," he says. Here are nine such triggers, which could be causing your gout pain. Aspirin Aspirin drives up the amount of uric acid in your blood. At high enough levels, uric acid deposits in joints (especially in the big toe and fingers) and forms the razor-sharp crystals responsible for gout. If you take low-dose aspirin to reduce your risk of heart disease, don’t skip your daily pill for fear of gout. Instead try to avoid other gout risk factors (such as food triggers). If your uric acid levels are still high, medications can help reduce them, Dr. Saag says. For occasional pain, acetaminophen (Tylenol) or ibuprofen (Advil) might be better for the gout-prone. Diuretics Diuretics help reduce blood pressure by flushing water and salt from the body. At the same time, they block the excretion of uric acid from the kidneys, which can allow uric acid to accumulate to gout-causing levels. Although switching to a different blood-pressure drug may help, some people get the best results with a diuretic, Dr. Saag says. In those cases, combining diuretics with medications that slow the body’s production of uric acid, such as allopurinol (Lopurin) or febuxostat (Uloric), can help. "Quite a few people take both," Dr. Saag says. Dehydration Dehydration can have many ill health effects, and gout is one of them. "Dehydration can increase the blood uric acid concentration, and in susceptible individual Continue reading >>
My Experience With Exogenous Ketones
Last year I wrote a couple of posts on the nuances and complexities of ketosis, with an emphasis on nutritional ketosis (but some discussion of other states of ketosis—starvation ketosis and diabetic ketoacidosis, or DKA). To understand this post, you’ll want to at least be familiar with the ideas in those posts, which can be found here and here. In the second of these posts I discuss the Delta G implications of the body using ketones (specifically, beta-hydroxybutyrate, or BHB, and acetoacetate, or AcAc) for ATP generation, instead of glucose and free fatty acid (FFA). At the time I wrote that post I was particularly (read: personally) interested in the Delta G arbitrage. Stated simply, per unit of carbon, utilization of BHB offers more ATP for the same amount of oxygen consumption (as corollary, generation of the same amount of ATP requires less oxygen consumption, when compared to glucose or FFA). I also concluded that post by discussing the possibility of testing this (theoretical) idea in a real person, with the help of exogenous (i.e., synthetic) ketones. I have seen this effect in (unpublished) data in world class athletes not on a ketogenic diet who have supplemented with exogenous ketones (more on that, below). Case after case showed a small, but significant increase in sub-threshold performance (as an example, efforts longer than about 4 minutes all-out). So I decided to find out for myself if ketones could, indeed, offer up the same amount of usable energy with less oxygen consumption. Some housekeeping issues before getting into it. This is a self-experiment, not real “data”—“N of 1” stuff is suggestive, but it prevents the use of nifty little things likes error bars and p-values. Please don’t over interpret these results. My reason for shari Continue reading >>
Steve Phinney And Richard Johnson: Ketones, Uric Acid, High Fat And Health
Note from Steve Phinney: What this shows is that uric acid goes up promptly in the same time frame that ketones go up, but after 4-6 weeks, despite ketones staying up, uric acid starts to come back down. Based on these data and my clinical observations in thousands of patients, uric acid returns to or below pre-diet baseline within 6-12 weeks despite the person remaining is a state of nutritional ketosis. Thus, when I’m asked how long ketoadaptation aks, I generally respond that some aspects of it take 6 weeks or more. This graph, by the way, shows blood uric acid levels from the untrained subjects (VT) and bicycle racers (MIT) at various times over 4-6 weeks of sustained carbohydrate restriction (aka keto-adaptation). LISTEN (50 Minutes) EDITOR’S NOTE: Sometimes, the divide between experts who advise against a high-fat, low-carb diet and those who recommend it seems larger than the Grand Canyon. But occasionally, top thinkers from both sides break through to discover common ground, along with new paths for exploration. With that in mind, here’s a discussion between two nationally recognized health researchers which refers to the uric data in this chart . . . and more. To see the charts in larger format, click on them, and they should enlarge. Before going to the transcripts of this interview, here’s more background: Dr. Steve Phinney is emeritus professor of medicine at UC-Davis and a world-renowned expert on high fat diets, including how they affect uric acid levels. Dr. RIck Johnson is a professor of medicine at the University of Colorado who’s an expert on fructose metabolism (fructose accounts for much of the sweetness in table sugar and in high fructose corn syrup). Johnson’s expertise on fructose ties him back to uric acid. Johnson writes: “Our work Continue reading >>
Will Eating A Paleo Diet Cause Gout?
This article is part of a special report on Red Meat. To see the other articles in this series, click here. A common question I get from readers is whether a Paleo-type diet will increase their risk for gout. Gout is a type of inflammatory arthritis caused by elevated levels of uric acid in the blood, forming crystal deposits in the joints, tendons, and surrounding tissue. Gout typically affects the feet in general and big toe joint specifically, and causes severe pain and swelling. In the past, gout was referred to as a “rich man’s disease”, as it typically affected the upper class and royalty who could afford “rich” foods like meat, sugar, and alcohol. Uric acid is a byproduct of the metabolism of purines, one of two types of nitrogenous bases that form the basic structure of DNA and RNA. While purines are present in all foods, they are typically higher in many of the foods emphasized on a nutrient-dense Paleo diet, such as red meat, turkey, organ meats, and certain types of fish and seafood. Patients with gout are often advised to reduce or eliminate these purine-rich foods with the goal of preventing excess uric acid production, thereby reducing the symptoms of gout. And research has confirmed the association between high purine intakes and acute gout attacks, suggesting that those diagnosed with gout would benefit from a reduction in purine-rich foods. (1, 2) So, do we need reconsider recommendations to eat foods like liver, sardines, red meat, mussels, and other traditional foods? Do these nutrient-dense, purine-rich foods really cause gout? Are those of us following a Paleo-style diet putting ourselves at greater risk for this painful, debilitating condition? Does eating meat and fish increase your risk for gout? Inflammation as a cause of gout attacks Continue reading >>
1: Kidney Stones, Gout, & Heart Palpitations On Keto
Today we officially kickoff this brand new podcast dedicated to answering listeners questions about the low-carb, moderate protein, high-fat, ketogenic diet. It’s called Keto Talk with Jimmy Moore & The Doc (now available to listen and subscribe on iTunes) featuring 10-year veteran health podcaster Jimmy Moore from “Livin’ La Vida Low-Carb” and Arizona osteopath and bariatric physician Dr. Adam Nally from “Doc Muscles.” These two are a keto power pair ready to take on your most pressing questions about this way of eating. KEY QUOTE: “If you cheat on your ketogenic diet, then you are at risk of a kidney stone or gout. The point is if you’re gonna cheat, you’re gonna pay for it.” — Dr. Adam Nally Here’s what Jimmy and Adam talked about in Episode 1: – The beginning of this new podcast devoted to keto – How Adam uses ketogenic diets with his patients – Adam’s father who died early from diabetes issues – Follow Jimmy and Adam on Periscope – Whether keto creates or prevents kidney stones – Why it’s not a good idea to cheat on your low-carb diet – How cheating, not keto, is what leads to gout – Whether a ketogenic diet causes heart palpitations – How to best balance your electrolytes starting keto – The problem with caffeine on your cortisol levels WORLD’S 1ST REUSABLE BREATH KETONE ANALYZER NOTICE OF DISCLOSURE: Paid sponsorshipTHE WORLD’S FIRST EXOGENOUS KETONES SUPPLEMENT NOTICE OF DISCLOSURE: Paid sponsorshipLINKS MENTIONED IN EPISODE 1 – SUPPORT OUR SPONSOR: Get the 2015 Ketonix breath ketone analyzer from Ketonix.com – SUPPORT OUR SPONSOR: Try the KETO//OS exogenous ketones supplement – Jimmy Moore from “Livin’ La Vida Low-Carb” – Dr. Adam Nally, DO from DocMuscles.com – Jimmy Moore on Periscope Continue reading >>
