Is Constant Ketosis Necessary – Or Even Desirable?
162 Comments Good morning, folks. With next week’s The Keto Reset Diet release, I’ve got keto on the mind today—unsurprisingly. I’ve had a lot of questions lately on duration. As I’ve mentioned before, a good six weeks of ketosis puts in place all the metabolic machinery for lasting adaptation (those extra mitochondria don’t evaporate if/when you return to traditional Primal eating). But what about the other end of the issue? How long is too long? I don’t do this often, but today I’m reposting an article from a couple of years ago on this very topic. I’ve added a few thoughts based on my recent experience. See what you think, and be sure to share any lingering questions on the question of keto timing and process. I’ll be happy to answer them in upcoming posts and Dear Mark columns. Every day I get links to interesting papers. It’s hard not to when thousands of new studies are published every day and thousands of readers deliver the best ones to my inbox. And while I enjoy thumbing through the links simply for curiosity’s sake, they can also seed new ideas that lead to research rabbit holes and full-fledged posts. It’s probably the favorite part of my day: research and synthesis and the gestation of future blogs. The hard part is collecting, collating, and then transcribing the ideas swirling around inside my brain into readable prose and hopefully getting an article out of it that I can share with you. A while back I briefly mentioned a paper concerning a ketone metabolite known as beta-hydroxybutyrate, or BHB, and its ability to block the activity of a set of inflammatory genes. This particular set of genes, known as the NLRP3 inflammasome, has been linked to Alzheimer’s disease, atherosclerosis, metabolic syndrome, and age-related macular d Continue reading >>
Journey Into Ketosis Part Ii
TL;DR This is a journal of my first month of ketosis. A quick recap of Part I: Ketosis is when your body metabolizes fat instead of sugar as its primary fuel source. To enter ketosis you must eat fewer than 50 grams of carbs per day for a minimum of two weeks, and ideally 60-80% of your diet is fat. You can measure blood ketones with over-the counter-tests. Ketones are the preferred fuel for organs like your brain, heart, and muscles. Ketosis is safe and all humans show improved blood lipid profiles, profound anti-inflammation, and weight loss with lean muscle mass preservation in ketosis, better than any other diet. May 2014: The Descent Of Insulin I had just returned from a two week long trip to Israel and Jordan. On the flight back I finished reading The Art And Science Of Low Carbohydrate Living, which answered all my questions about ketosis. (The Art and Science...Performance is a wonderful, short follow up, and Keto Clarity is on the to-read list.) I had been "paleo" for about five years, which for me meant avoiding grains and most sugars. I was not striving for high fat, and I still occasionally craved sugar. One way to know you've achieved ketosis is measuring blood levels of beta-hydroxybutyrate, or BOHB. It's the fuel your liver produces when it metabolizes fat. Your organs, especially your brain, consume it copiously. You can measure BOHB by pricking your finger with a Precision Xtra lance, bleeding on to a ketone test strip, inserting the strip into the Precision Xtra, and waiting. It will spit out your blood ketone density in milligrams of ketones per millimoler of blood. The (semi-arbitrarily) decided on level for a human to be in "nutritional ketosis" is a minimum of 0.5 mg/mmL. I was eating "low carb" for five years, so I figured this was easy, and I was Continue reading >>
Last Hours Of Living
Dying patient Last hours of live Transitioning Once transitioning process started, discuss the goals of care with family (may be patient if he is able to) Several patho-physiological changes occur as patient is transitioning Patient develops multiple signs & symptoms as they are getting closer to death The S/S are devastating to patients and staff & friends & family. Control each symptom effectively, May require contineous care, family / friends needs access to patients 24/7 Aggressive resuscitative measure are fruitless The degree of family distress seems to be inversely related to the extent to which advance planning & preparation occurred. Spending time in preparation of families is very worthwhile Physicians, nurses & hospice staff need to have a clear understanding of: signs & symptoms pathophysiology pharmacological / non-pharmacological approach changes encountered surrounding the dying process : Decreasing Appetite/Food Intake, Wasting, Decreasing Blood Perfusion, Renal Failure, Decreasing Level of Consciousness , Terminal Delirium, Loss of Ability to Swallow,Pain, declining in all aspects of life Weakness/Fatigue : functional decline Decreasing Fluid Intake, Dehydration Neurological Dysfunction: An Overview Loss of Sphincter Control Changes in Respiration Loss of Ability to Close Eyes Manage other s/s Most common S/S are: functional decline, dependent on all ADLs, anxiety, dyspnea, delirium, death rattle, nausea, worsening of discomfort / pain. Place of death: * 59-81% wants to die at home. * 20% of dying patients are having rough time due to transition between hospital / home/ nursing home/ assisted living facilities. *Recognize transitioning and help them die peacefully at home *45% of deaths occur under hospice care in USA * Place of death of hospice patient Continue reading >>
Aid-in-dying Loophole: Advocates Want You To Know You Can Stop Eating And Drinking
Guest contributor One sunny day in the spring of 2012, Kathleen Klein sat in a car by the California coastline with her 84-year-old mother, Jackie Wilton. The two women had been quietly gazing at the view, watching seagulls along the shore. “I’m ready to go,” Klein recalls her mother saying. “Not go home...Go.” Klein didn’t need the clarification. Her mother had been speaking of wanting to die for years, ever since Wilton was diagnosed with an unspecified dementia a few years before. Wilton’s memory had become significantly impaired. But even before her diagnosis, Wilton was clear: She wanted to die before she became severely incapacitated. Not long after the conversation by the water, Wilton asked Klein explicitly for help in ending her life. In interviews and a recent blog post, Klein remembers wanting to help her mother, but of being unwilling act illegally. Even if Wilton had lived in one of the five states with an aid-in-dying law, she would not have qualified for such aid from a physician. That would have required a doctor’s determining that she would likely die within six months. Given the usual course of chronic, progressive dementia, Wilton would likely have lived much longer. So Wilton needed another option for ending her life. Soon Klein heard a radio interview about "the possibility of helping someone die by letting them stop eating and drinking,” she wrote. “The way I understood it, it was the only legal form of assisted suicide.” Klein mentioned the scenario to her mother. Wilton said she would think about it. A few days later, Wilton again mentioned wanting to die. “I asked her if she remembered the idea I had run by her. She didn’t, so I told her again. I suggested we give it a try (a ‘dry run,’ we called it) for a day and s Continue reading >>
Sudden Cardiac Death In Association With The Ketogenic Diet.
Abstract The ketogenic diet is a high-fat, low-carbohydrate, adequate-protein diet that is used to decrease the frequency of seizures in patients who have refractory epilepsy. Despite its positive effects in some patients, there are potential adverse effects. Two complications related to the ketogenic diet are selenium deficiency, which has been associated with impaired myocardial function, and QT prolongation as documented on electrocardiography. Reported here are two cases of death in a child on the ketogenic diet for seizure control. In case 1, the child who died of complications related to torsade de pointes, with documented QT prolongation; post mortem examination revealed selenium-deficiency cardiomyopathy. In case 2, a child experienced QT prolongation while on the ketogenic diet and later died suddenly at home. Both children exhibited selenium deficiency. These two cases suggest that patients on the ketogenic diet require monitoring of the QT interval by electrocardiography, myocardial function by echocardiography, and selenium levels before and during the ketogenic diet. Continue reading >>
Does The Ketogenic Diet Cure Candida? The Ketosis-candida-mercury Link
You’ve been on the Ketogenic Diet for a while now and you’ve been promised weight loss, more energy, clearer head, better sleep or possibly even ascension? But instead you got some or all of the following? weight gain stiff neck fatigue brain fog heart palpitations head pressure burning sensation in the mouth insatiable thirst impaired breathing / coughing / shortness of breath headaches nausea stiff joints muscle stiffness depression insomnia rash bloated, painful intestines constipation or diarrhea white coated tongue phlegm or mucus or the feeling of having a “frog” in your throat just overall feeling more miserable But you aren’t willing to give up on the diet just yet because you were told all those negative symptoms you’ve started to experience were due to your body adjusting from a sugar to a fat burning metabolism? Or that your mtDNA was being repaired? That you just need to stick through it, or drink more water or take a few supplements? That in order to get well you have to get sick first? That the insomnia really is you having more energy and hence needing less sleep? And yet it’s been weeks, months, or more than a year but you still experience those symptoms and you’re not really feeling well and – surprisingly – you have actually GAINED some weight?! If so, then it might be time to consider that the Ketogenic Diet is actually making you sick. WHAAAAAT??!! How could that be? You ask. And: Who am I to suggest such blasphemy? I’m a former Keto Fanatic, someone who had been on the Ketogenic Diet for over 1 year until I realized that ketosis was wrecking havoc with my body, and now I’m here to tell you all about it. How did I get into the Ketogenic Diet? Did I go from eating pizza and drinking Cola straight to eating 4 eggs for breakfast Continue reading >>
Symptom Relief For The Dying Patient
Physical, psychologic, emotional, and spiritual distress is common among patients living with fatal illness, and patients commonly fear protracted and unrelieved suffering. Health care providers can reassure patients that distressing symptoms can often be anticipated and prevented and, when present, can be treated. Symptom treatment should be based on etiology when possible. For example, vomiting due to hypercalcemia requires different treatment from that due to elevated intracranial pressure. However, diagnosing the cause of a symptom may be inappropriate if testing is burdensome or risky or if specific treatment (eg, major surgery) has already been ruled out. For dying patients, comfort measures, including nonspecific treatment or a short sequential trial of empiric treatments, often serve patients better than an exhaustive diagnostic evaluation. Because one symptom can have many causes and may respond differently to treatment as the patient’s condition deteriorates, the clinical team must monitor and reevaluate the situation frequently. Drug overdosage or underdosage is harmful, and both become more likely as worsening physiology causes changes in drug metabolism and clearance. When survival is likely to be brief, symptom severity frequently dictates initial treatment. About half of patients dying of cancer have severe pain. Yet, only half of these patients receive reliable pain relief. Many patients dying of organ system failure and dementia also have severe pain. Sometimes pain can be controlled but persists because patients, family members, and physicians have misconceptions about pain and the drugs (especially opioids) that can relieve it, resulting in serious and persistent underdosing. Patients perceive pain differently, depending partly on whether other fact Continue reading >>
Ketosis Vs. Ketoacidosis: What You Should Know
Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>
Keto To Stay Alive With Cancer
Yes, the title of this blog entry is provocative, it is provocative for a reason. I am tired of hearing about cancer patients dying because they were told there was nothing they could do, or they agreed to the standard treatment even if that treatment didn’t have good statistics associated with it. It is important to understand how cancer cells proliferate in order to understand why something so simple as staying on a ketogenic diet can keep cancer at bay. All cells require fuel to produce ATP for energy and proliferation. Under a normal western modern-day diet, that fuel is glucose. Under conditions of extremely low carbohydrate and moderate protein intake, that fuel is fat. All cells but cancer cells can utilize ketone bodies (specific fats) as their fuel source. Cancer cells require 19 times the amount of glucose as a normal cell for their ATP production. They can only use this one pathway to fuel production. When serum glucose levels drop below 80, cancer cells start having difficulty staying alive, let alone dividing. In instances of low fat and high carb dieting, when someone misses a meal, they often feel weak and dizzy. But when eating a high fat diet with very low carbs, that bad feeling is not there, even when missing a meal. It’s not there because their brain is happy with ample fuel for activity. That fuel is fat. Almost all of my cancer patients come to me thinking they haven’t been eating too many carbs, but almost all of them have signs of insulin resistance, including higher than normal fasting glucose levels and difficulty bringing their serum glucose levels below 80 on the “induction” phase of the keto diet. Until very recently, American institutions had not been looking at ketogenic dieting as a way to treat cancer or to boost treatments. Th Continue reading >>
Ketogenic Diet And Alcohol Effects On Ketosis Is It Keto Friendly?
Ok, first thing is first, before we get into the Ketogenic diet and alcohol’s effect on ketosis; that is most western cultures drink far too much. Now I know most people (those on a keto diet included) don’t want to hear that, and I’m not trying to be a party-pooper, but I’m here to tell you the truth as I know it, not to tell you what you want to hear. Anyway, there’s a little room for debate depending on how you read the evidence on whether there’s room in a Ketogenic Diet for alcohol and whether alcohol will throw you out of ketosis, it may or may not, but there are certainly side effects to be aware of, some very dangerous. Ketogenic Diet and Alcohol Effects on Ketosis I’ve read quite a few articles and forums about keto and alcohol and almost all of them dance around it looking for some loophole in the figures to squeeze in some amount of alcohol. Many try to satisfy the vast majority who think giving away alcohol on a keto diet will be a deal breaker. They all try hard I have to say. Let’s be real, if you’re dying to fit alcohol into your ketogenic diet and it’s a must have for you, I doubt the small amount that could possibly fit in will satisfy you. Here are a few things to consider if you’re to drink alcohol while trying to maintain a keto diet: You will undoubtedly get drunk much quicker on a ketogenic diet than if you weren’t. Hangovers will be worse, as you know a keto diet flushes your body of water retention and the chances that you’ll be staying hydrated while drinking is slim, alcohol is notorious for dehydrating you. Even if alcohol itself doesn’t kick you out of ketosis, when tipsy self-control goes out the window, you’re likely to eat whatever is in front of you. If you are determined to include alcohol in your ketogenic Continue reading >>
The Ultimate Guide To A Ketogenic Diet
Time to talk Keto. A Ketogenic Diet is a diet with very low or no carbohydrates. Any guide we make will cover everything we can think of to make this the single best resource around, and due to that, you may want to skip some sections. Like always, we will start with the history of this famous diet, get into some science, and blow you away with all the practical advice you will ever need. For those who want to skip ahead, we included a quick table of contents for this very long (6,000 words or so) article. The Legendary Beginning of the Atkins Diet I very well could have made several articles on the Atkins Diet alone. Yes, this is a fad diet. Unlike most fad diets (Cabbage soup, I am looking at you), the ketogenic diet is based on science. Albeit, the sciece of just one study. The story goes like his, the future Dr. Atkins stumbled upon a study in the Jama network, a leading scientific research collective. After reading the study, which was designed to test fat loss on a medical diet, Dr. Atkins invented the Atkins Diet around 1958. My beef with Atkins is the connection of Atkins to real ketogenic science. The connection is a well-known study by Dr. Wishnofsky. The study proved a diet high in fat, and with moderate protein will cause weight loss. The Atkins Diet claim was that this study demonstrated that you could lose weight without a caloric deficit if you eat the right magic meats and fats. Wait, Lose Weight Without a Caloric Deficit? Atkins claimed that the study proved you could lose weight without a caloric deficit. Is it true? Partly. Including water weight you drop from ketosis, you can lose weight without a caloric deficit. My problem with this is Dr. Wishnofsky never said this. The study was not about some magic weight loss combination. (Yes, I link to the st Continue reading >>
The 4 Ketosis Symptoms You Should Be Looking For
Ketosis is the condition in which your body begins burning fat instead of carbs for its energy source. The benefits of ketosis range widely, but some of the best include: fat loss increased endurance less cravings shredded physique neurological optimization But how do you know when you’re in ketosis? Are there symptoms that you’re in ketosis? Is there a way to “feel” like you’re in ketosis? Obviously the best way to see if you’re in ketosis is to test you breath, blood, or urine. However, we’ve constructed the following list to help you detect the signs that you’ve transitioned into ketosis and turned your body into a fat burning machine! If you’ve been on the Ketogenic Diet for at least a week, run through this list of ketosis symptoms, and see if they fit what you’re experiencing! 1. Ketosis Breath A popular report from many low-carb and keto dieters is that their breath is less than desirable. The smell has been compared to fingernail polish remover, which is believed to come from the presence of acetone. Acetone is, of course, a ketone body, and is also found in many brands of nail-polish remover. 2. Keto Flu After a life full of ingesting large portions of carbs for energy, dropping carbs and moving into ketosis can often result in ketosis symptoms known collectively as the “keto flu.” It’s not unheard to feel light-headed, fatigued, or anemic when your body runs out of carb stores and begins turning to fat for its fuel source. You might feel irritable, or short-tempered; this is your body’s natural reaction to having sugar removed. Much like an addict in rehab, when you cut out mass amounts of processed sugars, you turn into a bit of a monster. Ketosis symptoms also include nausea, or stomach aches. These can be caused by your stomach r Continue reading >>
The Cost Of Dying: Simple Act Of Feeding Poses Painful Choices
A small plastic tube is all that stands between survival and starvation. The benefits of a feeding tube — helping elders who have forgotten how to eat — seem so obvious that it is used on one-third of demented nursing home residents, contributing to a growing device market worth $1.64 billion annually. Except it does little to help. And it can hurt. Decades after the tube achieved widespread use for people with irreversible dementia, some families are beginning to say no to them, as emerging research shows that artificial feeding prolongs, complicates and isolates dying. The tale of the feeding tube, known as percutaneous endoscopic gastrostomy (PEG), is the latest installment of “Cost of Dying,” a series exploring how our technological ability to stave off death creates dilemmas unimaginable decades ago, when we died younger and more quickly. Food is how we comfort those we love; when all other forms of communication have vanished, feeding remains a final act of devotion. So the easy availability of feeding tubes forces a wrenching choice upon families: Do we say yes, condemning a loved one to dependency on a small plastic tube in their stomach? Or do we say no, consenting to their death? Blessing, then a curse Tubes are useful as a nutritional tool for patients struggling with a critical illness, such as Lou Gehrig’s disease, or recovering from stroke, cancer or anorexia. But if no turnaround is in sight — particularly in elders with progressive neurological illness — they can be a dreadful mistake, medical researchers now say. For families praying for a reversal, or just the gift of a few more days, the decision to insert a tube into the stomach can initially feel like the right choice. The device helped sustain Fran Cole’s beloved mother when Parkins Continue reading >>
What Is Ketosis?
"Ketosis" is a word you'll probably see when you're looking for information on diabetes or weight loss. Is it a good thing or a bad thing? That depends. Ketosis is a normal metabolic process, something your body does to keep working. When it doesn't have enough carbohydrates from food for your cells to burn for energy, it burns fat instead. As part of this process, it makes ketones. If you're healthy and eating a balanced diet, your body controls how much fat it burns, and you don't normally make or use ketones. But when you cut way back on your calories or carbs, your body will switch to ketosis for energy. It can also happen after exercising for a long time and during pregnancy. For people with uncontrolled diabetes, ketosis is a sign of not using enough insulin. Ketosis can become dangerous when ketones build up. High levels lead to dehydration and change the chemical balance of your blood. Ketosis is a popular weight loss strategy. Low-carb eating plans include the first part of the Atkins diet and the Paleo diet, which stress proteins for fueling your body. In addition to helping you burn fat, ketosis can make you feel less hungry. It also helps you maintain muscle. For healthy people who don't have diabetes and aren't pregnant, ketosis usually kicks in after 3 or 4 days of eating less than 50 grams of carbohydrates per day. That's about 3 slices of bread, a cup of low-fat fruit yogurt, or two small bananas. You can start ketosis by fasting, too. Doctors may put children who have epilepsy on a ketogenic diet, a special high-fat, very low-carb and protein plan, because it might help prevent seizures. Adults with epilepsy sometimes eat modified Atkins diets. Some research suggests that ketogenic diets might help lower your risk of heart disease. Other studies show sp Continue reading >>
Adenohypophyseal Changes In Patients Dying Of Acute Renal Tubular Necrosis ‡
Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. These references are in PubMed. This may not be the complete list of references from this article. Articles from The Yale Journal of Biology and Medicine are provided here courtesy of Yale Journal of Biology and Medicine Continue reading >>