The Ketogenic Diet Part 15 How to Avoid Some of the Side Effects

I started this series in 2012 and predicted the next wave of “Keto Madness” would occur.  It did, so I am adding to the original 14 blog series with some new and I think, useful information.

While there is plenty of blow back against high fat ketogenic diets from people who fear any change from the status quo I will simply tell you I have been around long enough to know fads and trends when I see them.

Anyone remember the “grapefruit diet”?  TRX?  The Reebok slide?

Not all fads are bad.  Many are great and their fading out is simply a manifestation of our sound byte society- we must always have something “new” even if something old worked great.

Case in point the “ketogenic diet”.  It’s actually old.  As a matter of fact, it’s been around for about 100 years but as anti-keto people are quick to point out it was only used for kids with seizure disorders before the days of effective anti-epileptics.  Oh yeah, it was used in Type 2 diabetes back in the day.  Oh yeah it was and still is also effective as an adjunct to brain tumor therapy.

And probably a ton of other things as well. The statement that no long-term safety studies have been done is also misleading.  A recent study compared it to high carb low fat and both were identical for weight loss.  I doubt it!!!!!  People who do studies rarely know much about how to administer a correct diet, especially when they want a desired outcome.

But this blog is not about fighting with the anti-keto people primarily because I will tell you that ketogenic diets are a fad and will fade into the sunset when people finally decide they can’t live another day without bread, crackers and pastry.  Which often happens!

But as with all fads there will remain a dedicated hard-core group of people that still use the “fad” and love the results (I still have my Reebok slide!)

So, on the chance that you might be one of those people I want to share my experiences and a little bit of the science behind them so you can have a good result.

I also want to remind you if you care less about the science and more about guidelines, you should check out The Horrendous Diet.

First let me say that I believe that calorie restriction, sometimes severe and even total (as in 2-3 days of fasting) is a useful if not essential part of a diet.  I start me keto runs with a minimum of 7 days of a calorie intake of less than 500 a day and a carb intake of no more than 40 grams.

I check both blood sugar and ketone bodies with a finger stick meter and shoot for blood sugars of less than 50 and ketones of 3-4.

During this week it is necessary for me to take an occasional salt tablet to prevent lightheadedness.

I do experience fatigue although it is not debilitating.  I simply cut my aerobic workouts in half distance wise and my strength training by 25% in weight.

During this time there is a rather drastic change in my body.  The fat literally melts off and I will lose around 10 pounds.  Some of this is water but most of it is not.

From a practical standpoint one of the keys to avoiding side effects is to maintain a reasonable number of calories.  So, this makes one question the word “diet”.  These days a diet has come to me a specific type of eating habits rather than something designed for weight loss.

If you become a long term keto practitioner you will not really be on a “diet”.  So please keep this difference in mind.

For me inducing ketosis is easiest with rather harsh short-term dieting as noted above.

During this time, you are most likely going to experience something called natuiresis or loss of salt from the kidneys. This is usually experienced as light headedness and is often mistaken for “low blood sugar”. As practicing doctor, I saw hundreds of people who were convinced they had low blood sugar.  I was rarely able to document a true case however.  I honestly think most of those people were experiencing carbohydrate addiction syndrome where a few hours without carbs causes feelings off mental confusion (mild) and a sugar that was dropping but not abnormal.

When you actually go into ketosis you are liable to have extremely low blood sugars to a degree that would make your doctor urinate in their pants and admit you to the hospital.  The huge difference is that this will be accompanied by a much higher level of ketones which your body uses as fuel so you will be in no danger.  You might spend the first days of a calorie restricted diet with some of these feelings however.  They are normal and not dangerous unless you are an insulin dependent diabetic in which case you should never be on this diet anyway!

My lowest documented blood sugar was 36, a full 50 points below normal and it was accompanied by moderately high ketones and NO symptoms.

If you experience light headedness it will respond to a salt tab or half of one and do not be afraid to do this.  If you are on blood pressure meds you should consult your doctor who will likely tell you avoid salt at all costs even if your blood pressure is not salt sensitive.

Your blood sugar will not drop until your ketones rise so it is highly unlikely that you will experience light headedness due to low blood sugar.

You may become mildly irritable during the first 3 days of the calorie restricted ketogenic diet. But this will pass.

Now let’s deal with the infamous “fatigue” issue that is most often reported by the anti-keto lobby.

Again, this is mainly an issue of calorie restriction and if you are not in a hurry to get into ketosis and lose weight and body fat you can be a little more lazy with the calories and just focus on the types of food you eat.

A good break down is to shoot for a normal calorie intake (normal for most people is 500 calories more than they need to maintain body weight so keep in mind you may still need to cut calories), with 60-70% fat intake 20% protein and less than 10% carbs.  If you want it in grams, keep your carbs below 50.

For reference this is 1.5 pieces of bread per day so you DO need to watch carbs carefully.

Now here is where we get into hormone science.  If you focus on insulin and its effects in the body you will pretty much get the picture.

Most people and most diets are high carb, except for the ketogenic.  The problem is that calories really are not calories.  The effect of the gut microbiome notwithstanding, high carb diets keep the insulin levels high, inhibit fat burning cause a short cycling of leptin (the I’m full hormone) and ghrelin (the I’m hungry hormone) which leads to the “need” to eat frequently.

This is dramatically illustrated by long distance runners who are keto adapted (takes a few months!) versus long distance runners who are not.  The keto adapted runner is using fat for fuel.  For example, a 170-pound man with a body fat of 10% (keto people have lower body fat because they use it for fuel) has 17 pounds of fat or in excess of 40,000 calories as potential fuel. While this is artificial because your body never runs purely on one fuel even in starvation, you can at least see that someone who can use fat for a primary fuel source can last a lot longer without eating.  If the run is say 100 miles this person would need 10,000 calories which would not exhaust the fat supplies.

A non-keto runner will be a slave to the insulin/blood sugar cycle and need to gobble high sugar gels every hour at least.  While the activity may blunt some of the negative effects of high sugar it is at the very least not an efficient way to do it.  Having run in excess of 75 miles under both circumstances and not having to stop to eat or worry about hunger is a big plus for the endurance athlete.

Ok back to insulin.

The presence or absence of insulin not only determines how calories are handled, it determines your body’s ability to burn or store fat.  More insulin, more fat storage. Less insulin, less fat storage.

This is why in spite of some studies that suggest otherwise ketogenic diets will lead to a leaner and generally lighter human being.

The problem with ketogenic diets is carbohydrates.

I have come across people who “can’t live without pasta, bread, pastry etc.”

These are people who simply cannot tolerate any discomfort or break in routine for the 3 days or so it takes to overcome these cravings.  These people should not attempt a ketogenic diet because the risk is they will eat high fat and high carb long term and that diet is deadly.  But again, it’s the carbs not the fats.

I tested just about every level while on the ketogenic diet long term.

My inflammatory markers went down.  There were no vitamin deficiencies. My body weight dropped over 30 pounds and in my late 50’s I had a 6-pack with a body fat of about 12% which is not all that low.

My cholesterol however caused concern.  My doctor who happened to be one of my residents a decade or two ago stated, “Your cholesterol is borderline high at 200, you should probably be on a statin.”

I pointed out my HDL cholesterol (the good kind) was 101, my triglycerides were 53 an my “bad” LDL cholesterol was 79 giving me a risk ratio of less than 0.5 (normal is 2.5 to 4).

Such is Big Pharma’s influence that he again repeated, “Your cholesterol is borderline high- you should be on a statin”.

When I pointed out the in-depth analysis revealed all the particles were the best kind, light and fluffy, he repeated, “I think you should be on a statin.”

I am not on a statin!

Those values were attained on a ketogenic “diet” of about 1500 to 2000 calories a day and remain the best I have ever had.  Not to mention the 30+ pound weight loss.

It baffles me why there is so much resistance to this diet among medical professionals and dieticians many of who are fat!  To them I say try it for yourself for 6 weeks and honestly answer the questions I have posed- are you leaner, are you lighter, have you broken the habitual eating habit created by Kaiser Wilhelm I of Austria who instituted 3 square means a day as the Western Standard to improve worker productivity?

Most people think 3 square meals a day was created by doctors and scientists, not industrialists!

Now let’s revisit fatigue.

Your body is not stupid.

When you reduce your calorie intake in a rather sudden fashion it will hit the panic button and do several things.

  • Turn down your metabolism primarily by reducing secretion of adrenergics (epi and nor epi) from the adrenal medulla. The mild stress of short term calorie restriction may induce increased cortisol from the adrenal cortex, but this is a slower acting hormone and will not overcome the effects of reduced adrenergics. This will make you calmer and maybe even more fatigued.  In terms of nervous systems your parasympathetic (slow and calm) will win out over the sympathetic.
  • Your thyroid will potentially reduce thyroid hormone secretion but more likely the peripheral conversion of the pre-hormone known as T4 will reduce and the active form, T3 will be lower.
  • The net effects of 1 and 2 is a slower metabolism which makes sense if you are calorie restricting. Remember our genetics and epigenetics evolved in a time of calorie and especially carbohydrate and protein scarcity. Hence, we are “designed” to treat them as precious. Sadly, at this time in our history both calories and carbs are so plentiful its ridiculous. As you may have guessed if you maintain ketosis and a more normal calorie intake your metabolism will adapt and not slow down. You will be able to run jump and play like you always did.  But you will have to wait longer for the fat and weight loss. If you calorie restrict as I recommend, you will be able to return to the non-fatigued state fairly fast when you restore your calorie intake.  Just avoid doing it with carbs!
  • With calorie restriction you will also experience some protein or muscle loss. The body will spare protein in ketosis but not with ketosis and calorie restriction. Keep in mind that this muscle mass loss will not happen for several weeks and thus you may be able to avoid it all together.  Frankly you body winds up looking so young health and attractive you may not even care!  But if you are a typical 19-30-year-old testosterone driven make you are going to be bummed out by getting smaller and want to keep your calories up.  Higher protein intakes will not stimulate gluconeogenesis (burning protein to make sugar) unless you are calorie restricted. If you look at my percentages of fats, carbs and proteins above and stick with them you’ll be fine.  If you decide to go long term with ketogenic diets then either increase your overall calories within these percentages or increase your protein intake and understand it may slow down your fat loss.  It will also slow down your muscle loss.  A true ketosis diet with a moderate degree of calorie restriction will have your body burning about 85% fat, 10% protein and 5 % carbs.
  • If you do not calorie restrict but still keep the carbs low and the proteins higher you may even be able to gain net muscle even though your body weight will be lower.

So, to summarize a few concepts and how you might “fight them” if you need to or want to:

  • Light headedness can be combated by extra salt
  • Muscle loss can be combatted by increasing calorie intake and or increasing protein intake
  • This is important: Many “muscle heads” have adopted BCAA (branched chain amino acids) in their routine and adrenergic stimulants of which there are a ton out there. Most people are clueless as to why but here it is- BCCA can be used by the muscle as fuel as opposed to most other Aminos that are only structural.  Using BCCA as a protein supplement is a great low-calorie way to prevent muscle loss during ketosis.  Same with creatine although it will blunt your weight loss somewhat. Using adrenergic stimulants* is most likely muscle building as well. Contrary to popular myth this is not just because they get your “jacked or psyched” to work out harder. They may actually directly stimulate muscle growth. Drugs that block the adrenergic axis like beta blockers will cause muscle loss, and inhibit ketosis.  If you need them take them but ask your doctor if there might not be something a little less detrimental to your weight and fat loss efforts.  Good luck getting them to agree!
  • Other agents that will preserve muscle but are out of the scope of this talk are anabolic steroids, growth hormone and other agents that affect male sex hormones.
  • Finally, I want to leave you with a few thoughts
  • Most eating is actually habitual (although it may be “hormonally habitual”. Once you’ve been in ketosis for a week or so you will see how totally your eating habits have ruled your eating behaviors
  • The vaunted 6 pack is a function of diet not exercise and there is no better way to get one than a keto diet.
  • The “High Fat is Deadly” agenda leads to all kinds of irrational behaviors from health care professionals and especially dieticians. You will hear things like “avoiding a major food group” cannot be healthy”, avoiding an essential food group cannot be good for you and the like. Carbs are actually the only non-essential food group out there. For 50 years America has gotten fatter on low fat diets.  For 50 years Big Food has engineered cheaper and cheaper sources of addictive sugars.  And now finally our poor, traditionally thinner because they could not afford food, are among the fattest segment of the population. To all the docs and dieticians who hate what I am saying I offer this challenge: follow the above recommendations for a few weeks and see if you don’t look healthier.  Then check any blood test you want including blood sugar and cholesterol and see if they are not among the best values you have ever had.  Most will simply scoff and remain fat and on drugs.

*If you are over 40 or have a history of rapid or irregular heartbeat, nervousness, depression or high blood pressure DO NOT use adrenergic stimulants without the expressed consent of your doctor!!!!

This blog details my personal experiences that started way back before keto was popular (2012). It is not meant to be substituted for medical advice nor to diagnose mitigate treat or prevent any illness. While I am not “selling anything “and exercising my right to free speech here, there is a disturbing trend among alphabet agencies to challenge anything and everything that does not maintain the status quo.

Be aware and research for yourself.  Don’t just rely on blogs and websites! And when you ask your personal physician what he/she thinks, you will get responses from; “Well that’s not proven!” to “That is unhealthy quackery!”  Instead of asking them if they ever tried it, just take a good long look at how healthy they look.  Keto diets are not for everyone!

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