hi Laz, can you tell me your reason for this?
Life. Be in it.
No, no skin in the game and I'm really not getting emotionally charged about this at all. Just basing my conclusions on what I have seen in people and what the current science seems to support.
Originally Posted by choppedliver
Well there was one thing that did get me a little emotionally charged to even start this. It was you pointing to the man rather than his ideas. Attempting to use his own poor health (if that is in fact true) to bolster your opinion. I thought that in poor taste for a fella who has had type I diabetes since the 1940's. But, I likely overreacted to what you actually wrote.
But back to what we are saying here. I already agreed that someone like the OP may not need a ketogenic level diet. So that is not really an issue. It is my opinion that in cases that are NIDD a VLC state is not necessary. The difference between mine and your opinion is that I don't see it as inherently harmful either. There is sufficient evidence that it is safe in the long term from what I have read. Some people actually do prefer VLC and do quite well on it. So in the instance of someone like our OP here, it would be a patient by patient basis with consideration to lifestyle and preference given. Evidence based medicine is really three pronged. Its based on clinical studies, but also takes into account clinician experience, and patient preference. Many seem to forget that last one.
I am curious though. I really have not seen "autoimmunity disease" stated as a side effect to a VLC diet anywhere. In fact I've read several opinions that are quite the opposite stating VLC cured their autoimmune disease. What mechanism are you saying would be the cause of .... say Hashimoto's thyroiditis (as shown my antibody test of course, or any other autoimmune dysfunction if you like)?
And I'm never against new studies. I think a VLC and LC with ADA guidelines as control study of type I, type II, and pre-diabetics with followup over a long time frame is an excellent idea.
Last edited by Neckhammer; 08-24-2013 at 06:49 AM.
I hate to point this out. And I don't like to lead anyone on. But there is already significant literature on autoimmunity. Albeit indirectly via low triglycerides: Hypotriglyceridemia, which most ketogenic dieters experience. Look it up. Admittedly, it's not established science. But if true, that would explain why so many of the Doc's patients are hypothyroid. Because they all have trigs under 50. You virtually do if you're ketogenic. Some even under 30, if you can believe it. And they all think they're healthy! Bernstein's own trigs are 45, not as low as I thought; I thought he would be close to 30. He has immune issues. No wonder.
Originally Posted by Neckhammer
Actually I have seen some opinion on the correlation between combo of very low trigs, low to normal TC, and high HDL with autoimmune issues. I honestly haven't read the original data on it myself yet though. I do believe there is much to be done in the research arena regarding that though. From what I have been told though these were things found in "normal" dieters, not specifically VLC. I think we need to tread lightly here. Just look how F'd up we made things when we assumed certain cholesterol levels where "bad" and lowering would be better. But yeah, an interesting area of research right now.
Originally Posted by choppedliver
Last edited by Neckhammer; 08-24-2013 at 06:09 PM.
To: TheyCallMeLazarus: I know I threw a lot of numbers at you, and I just can't get over your incredible generosity. We thank you so, so much. Most of what you are saying and recommending makes a lot of sense to me. I agree, the low Hdl & dense Ldl has really scared me for quite a while. It is not brand new information, and my Husband Steve does know that he needs to exercise a lot more. He used to be very athletic, so that is a plus. He is not a man who is lazy or blase about his health (or anything), but what inadvertently got in the way is that he was taking care of me; I had been diagnosed with permanent nerve damage in both hands ~ 7 years ago, had spinal fusion, other surgeries... It was bad. He is an incredible man who puts his family before himself. The good news is that through physical therapy, nutrition (didn't realize then that I had started down the Primal path) & non hand intensive exercise, ~ 90% of the once unbearable pain I was in is gone. (My pain M.D. is fairly stunned). So, It's time for me to help this incredible Husband of mine.
Steve is very disciplined, has stuck to no sugar or starches, kept up exercise & finally turned the corner on ketosis. So, he wants to stick with it. I'm wondering, since he is so disciplined, is there any harm in him sticking with the keto route? The reason he wants to stick with it is: He has turned the corner; the "carb flu" is gone & energy keeps increasing. Also, he can lose weight without being hungry now. The only way in the past that he was ever able to lose weight was by reaching keto, which was prescribed by his M.D. father back when his dad was in practice helping patients with weight loss. This is why we have been "bent on ketosis", as an apparently exasperated forum member described us. That being said, I understand that what used to be a good way to go (keto) may not apply best to his current medical conditions.
The most non-keto recommendation he would have difficulty with is the fasting. He's in a very high stress office job, & hunger even without fasting was a problem until ~ 1.5 weeks ago. (Actual hunger, not mindless stress eating). I'm hoping this wordy explanation offers some insight into my Husband & wonder if it affects your view of keto for him. (I'm not disagreeing with you, but trying to show that I think he would need detailed, compelling info to go out of ketosis now that he has turned the carb flu... corner). I feel almost guilty asking more of you, but if he should ditch keto at this point please help us understand why.
Re the PUFA's, I realized a source had slipped by me. I often use Sprout's organic salad dressings, with soy as the primary oil. So, it may be non GMO, but its still a PUFA. So, I'll be making all of our dressings with organic olive or avocado oil. (These are also the only oils I cook with, in addition to organic butter + starting to use coconut oil). We have virtually eliminated pre-made/ pre-packaged foods in the past couple of months & rarely eat out since we can't really know what is in those foods. No grains or sugars, either.
I have seen Ghee before & wonder if organic butter is interchangeable? Also, what do you mean my "mixed meats"?
Besides our keto musings, we understand (and appreciate!!!) what you are saying. The only other question I can think of is what types of exercise do you recommend? Steve loves mountain biking, & I've been encouraging some weight lifting to increase muscle mass. (This used to be my forte, but I don't mean classic bodybuilding- Way excessive)!
Your info about carb timing (& much more) makes so much sense. We're really looking forward to anything & everything you have to say. I can't begin to tell you how grateful we are to you. Thank you, Laz!!!!!
Last edited by geckotreefrog; 08-25-2013 at 02:52 PM.
What are the lab ranges for TSH? Even without them I would want to see freeT4 and freeT3 tested.
Originally Posted by geckotreefrog
I am thankful to be able to help people. I spend a lot of time helping people that pay me, so it seems rather disingenuous of my personal mission to never do it for free. I usually take 2-3 people a month for free to try out what I have to say. On here it is no different I will try to answer your questions as best I can.
Disclaimer: I don't go strictly by studies or medical journals or places like this for what I recommend....I think the biggest disconnect the nutrition crowd has with a doctor is that of compliance....for me, I recommend what has WORKED, with actual humans, when attempting many different regimens. I am not terribly interested in what a study said about X or Y. I have read most any I get my hands on, but when you have to actually treat people you learn that studies are one thing; recommendations to sick people are another....I say this because it informs most everything I say. In most cases, I have tried, or know other docs who have tried, a given regimen. I recommend what I do ONLY because thus far, in my patient base and with my tools at hand, it is most effective. It may sound small, but it's a very big deal on my end.
1) Ketosis and mixed meats: The problem I have with going VLC on a person with marked metabolic syndrome is three-fold. On one hand, it makes long-term glycolytic exercise very difficult. I realize that some can train up to the point of being able to perform in ketosis, but this is a minority, and usually a limited expectations minority. For most people, putting them on 20g carbs a day and then recommending hours of walking, a HIIT routine, or a heavy lifting routine, is going to make them feel like trash and perform badly....seeing as I believe one of the biggest hurdles for most of my patients is to gain that "eye of the tiger" mentality to their training, whereupon they do it all on their own, surpassing any expectations you might have, anything that might compromise energy levels is a non-starter.
Second, "ketosis" is not specific enough....and that is where my mixed meats rec usually comes in with my patients. I have had patients that are technically in "ketosis", on diets of 90% sausage, bratwurst, and especially hot dogs. These kinds of foods can, if prepped well, contain huge punches of calories not found in standard cuts....also, they are nearly impossible to find them in non-conventional forms....so perhaps I misspoke in outlawing them. I have just found, again with actual people, that if you give a ketotic carb limit, you get a guy that eats hot dogs by the dozen everyday....I would say to have them in strong moderation, and try to find them in grass-fed forms. I give out tons of venison sausage to my patients all the time, so I apologize for being mistaken there....my overall recommendation is that I do not like ketosis, as practiced by most people, in regards to fighting metabolic syndrome. I get someone who was 85% carbs for cals and get an 85% fatty/cheap meats for cals.
Third, for most of my patients it is not sustainable to be in ketosis for months and years at a time. The biggest problem you run into is the mentality that this will happen fast, and it won't for anyone....I love the line my nutritionist uses "This isn't a sprint. This isn't a marathon. This is getting up every day to run, regardless of how you feel, and learning to love it."
2) Fasting....it is a tool for producing three beneficial things at once. First, it's almost always hypocaloric, so he will almost certainly lose weight. Second, a lot of studies as well as my own experiences have seen it improve blood panels, especially BG markers, unusually fast. Third, it makes their meal planning easier....again, compliance over YEARS is the holy grail.
As an aside, I do what I can to never bring up the word "fasting" until they are in the second phase. By then, especially if they are starting to eat more fats and exercise more, it is not that hard to adjust to....that said, it is usually one of my most difficult transitions. I don't shoot for the moon; I will settle for 12 hours and let them take it from there.
The reason for this, in simple terms, is that at-base our bodies have two distinct phases: Fasted and fed. The fed state lasts, depending a lot on the meal, for 4-6 hours after eating. Some high protein and fat meals take even longer....here is what every diabetic must understand. If you don't hear anything else I say, hear this.
By its very definition, a person with metabolic syndrome does not experience "real hunger"....that is part of their disease. In a diabetic, the entire means in which glucose enters the cell, insulin, is dysfunctional. What this means is that even in the PRESENCE OF AVAILABLE FOOD for the cell, it does not get in....this is what we call "insulin resistance". The result is that a person with metabolic syndrome, even on a cellular level, is "hungry" even though food is available.
Ever wonder how a 600lb man is "JUST STARVING ALL THE TIME!?!?" This is how....
I use the only antidote I know of to defeat this, and it is painful....deprivation. Diabetics are really hungry people. I know. I see it every single day...defeat that, and you defeat the disease, eventually. Sorry to make it that simple, but it is.
When I get someone that can fast 18 hours without eating the plaster off the walls, they get a blood panel; 99% of the time they aren't sick anymore.
I believe that a primary driver of diabetes is explained NOT just in the well-known sugar to insulin pathway, but in the fact that for most people a true "fasted" state never really exists...in this view, metabolic syndrome is caused by the fact that insulin, and thus the beta cells of the pancreas that dictate it, never experience down-regulation...this hormonal impact, the almost neglected impacts of glucagon and its myriad of co-hormones, combined with the toxicity of high glucose itself, all contribute to disease.
Going VLC can mimic this, but for me it is still not a truly fasted state. It would get very pedantic quickly to go further into it....suffice to say that i am of the opinion that a lot of the "western diseases" are caused not by the foods alone, but by the FREQUENCY of the feeding itself. Again, this is mostly based on experience, although there is considerable literature on it as well. I have had diabetics continue to eat trash, and decide to only eat it 8 hours a day in a window, and get better faster than people doing more traditional means. Something is going on there.
For exercise, I would recommend 2 days of heavy lifting per week, if he is able. Do compounds, as heavy as he likes. It has a hormonal impact many others (like Sisson) have gone into....then a few days of LISS such as hiking, slow cycling, etc. This is usually where I give a lot of freedom anyway. Diet is 90% of it for a NIDDM patient.
I would keep carbs at the levels I suggested, with mild "fasting" (I.E. don't eat every 3 hours, then sleep, then repeat). I am not saying VLC isn't effective, but in my experience it is less so than what I use and cannot be sustained nearly as well.
Hope this helps Anything more, just ask.
Last edited by TheyCallMeLazarus; 08-25-2013 at 06:04 PM.
Trigs below 50. That's the warning sign. It could be the same mechanism which lowers triglycerides this low which overlaps with the pathogenesis of intestinal permeability. Much research has to be done, yes. But if I were a careful consumer, I would steer clear of ketosis, if I can, and will try to get my trigs above 50, certainly above 35, as I have seen some extreme ketogenic dieters go under. 50-100 is optimal, not 0-50.
Originally Posted by Neckhammer
I was seriously confused what was meant by "mixed meat'. I understand now.
Thanks for that response Lazarus, very helpful. I'm sure there are many who appreciate it.
Life. Be in it.