Monday, October 26, 2009

Renal stones and the OD

There have been comments from two people on the blog recently who have developed symptomatic kidney stones. Very symptomatic in one case.

I did a quick Google for kidneys stones and found that they can occur in up to 10% of the population, peak incidence between 30 and 50 years of age. A "significant" portion are asymptomatic.

So why should two people on a high fat, lowish protein and low carbohydrate diet develop symptomatic kidney stones?

That depends on what you think is happening and what actually causes kidney stones. There is quite a lot of information on PubMed about the physiology involved. One of the core findings is that magnesium is lost in to the urine under conditions of hyper insulinaemia and/or hyperglycaemia, most especially under hyperglycaemia.

Some of the core observations were made by Djurhuus, predominantly looking at type one diabetics. While he accepts that elevated insulin causes Mg loss in the urine, hyperglycaemia appears to be the main drive. This gets to the point where you can correlate magnesium deficiency with HbA1c in type one diabetics. As an elevated HbA1c suggest relative insulin deficiency in this group, then hyperglycaemia appears to be the problem.

It's open to speculation whether Mg deficiency is a specific cause of metabolic syndrome or a result of the hyperglycaemia associated with it, but there is undoubtedly a clear association between the two.

Once you have mangled your magnesium status you appear to be wide open to calcium based stones.

In fact metabolic syndrome might be enough to trigger calcium stone formation on its own, especially if you are not thinking about magnesium status...

But the message I get is that Mg, Ca and PO4 are lost through the kidneys under glucose/insulin dysregulation. These strike me as the reason for the massive requirement of both calcium and magnesium in diets which promote hyperglycaemia. Calcium and magnesium are elements. You don't "break them down", they're there to stay unless you put them down the loo. If they are so essential (which they are) I doubt your body would do this if it was working correctly.

So we have hyperglycaemia and/or hyperinsulinaemia as the most likely cause of urinary calcium, magnesium and phosphate loss.

Once these ions are in to the urine subsequent stone formation depends on urine concentration and pH. In alkaline urine you get magnesium based struvite, in acid urine you get assorted calcium derived stones.

Ultimately urinary stones appear to be a common feature of metabolic syndrome. They may well be present in much more than 10% of this population. What happens when you have metabolic syndrome and suddenly start living within the carbohydrate limits imposed on you by that syndrome? When you suddenly become normoglycaemic and norm-insulinaemic?

I doubt any of us starting out on low carbohydrate diets gets an MRI done to check if we have renal stones before we begin, just on the off chance. A sizeable number of the population drawn to low carbohydrate eating might well carry asymptomatic renal stones. The stones then begin to dissolve once people stop peeing their bones down the loo. How many will convert a large asymptomatic renal pelvic stone to a smaller stone which can enter the ureter to begin its agonising journey to the bladder?

Some, it seems!

I have vague memories of Kwasniewski and Lutz both warning about this feature of stone dissolution, and a similar scenario with gall stones dissolving and entering the bile duct too.

Of course all of this may be total BS and the case might be that saturated fat causes renal stones. You could always just ask any cardiologist.

The flip side to all of this is that the management for osteoporosis might just be normoglycaemia...

Peter


BTW Djurhuus did an intervention study supplementing Mg in type 1 diabeteics. It REDUCES insulin stimulated glucose uptake! It's hard to see what is happening here. Usually type 1 diabetics are exquisitely insulin sensitive until some joker pumps then full of insulin then says "there's the bread, eat it to stay alive". Then it's not so clear what might happen to insulin sensitivity in the medium to long term. Anyway, Djurhuus didn't seem to find Mg to be a panacea of any sort. Dropped the LDL particle count thought FWIW!

55 comments:

pyker said...

In the treatment of childhood epilepsy with a ketogenic diet, renal stones are sometimes a side effect [why, I don't know, and yes, I realize the OD is not strictly ketogenic], but this seems to be effectively mitigated via potassium citrate supplementation.

Dennis said...

Hi there! I am a US radiologist, and a long time fan of your blog.

Would you mind putting up pointers to the recent stone comments?

I am 54, have been eating low carb for about about a dozen years, and have had two major episodes of symptomatic renal stones requiring procedures in the past six years. I have calcium oxalate stones, and am hyperoxaluric, and hypocitriuric. My fasting blood glucose is about 100, and I am not overweight. Many of my favorite foods (chocolate, nuts, beets, spinach, etc.) are high in oxalate. I have cut them way back, and have started drinking milk whenever I have a food with oxalate. I was drinking a cup of lemon juice a day for several years for the citric acid, but got sick of doing that, and quit. In the last year I started doing Vitamin D3, 6000 IU/day. This past summer I started passing many tiny stones, which weren't actually troubling me. I wondered if the Vitamin D was the cause, so I cut back to 4000IU/ day, and started magnesium citrate and potassium citrate supplements, with no more stone passing. I am planning to check a Vitamin D level before I make any other changes.

It has been hard to know what to do. I hope you continue to rummage around in the stone literature!

(BTW, stones are better seen on CT than MRI.)

All the best to you.

gunther gatherer said...

Hi Peter,

It makes sense that normoglycemia would prevent stones from forming if you're not losing magnesium. The interesting point is WHAT would trigger them to start shrinking.

I'm thinking this could have something to do with changing the pH of your urine, assuming you already have asymptomatic stones. The reason this is coming to mind is that I did paleo (no dairy, high meat and veggies) for two years before switching to OD.

Now it's been 2 years on OD. It was only once I was on OD did I start eating high fat dairy and butter regularly. I'm talking at least half my daily calorie intake.

So logically, if this would change the pH of my urine, in addition to MUCH lower meat intake and almost no veggies, could this be what shrinks the stones? Not exactly the normoglycemia caused by the OD, but the dietary components themselves?

gunther gatherer said...

I must add that the 2 paleo years before OD included lots of fruit too.

I note this because my oxylate stones became symptomatic (ie, small enough to fall into the ureter) only AFTER I dropped the high protein and fructose and took up dairy again. A major urine pH change in that? Perhaps.

I'm sure the stones formed in my kidney during my 35 previous years of eating crapola on the SAD, but it's interesting to note that even a Cordain-style paleo diet for 2 years didn't shrink them, though it certainly improved my insulin sensitivity and digestion.

bamboo said...

Hi, Just for context, I'm a 27yo woman and I've been on high-fat, low-carb (ketogenic) diet for a couple of weeks and I passed a largish Uric stone and had pain in my kidney area as if there were more coming, but no have as yet and now (a few days after passing the stone) the pain has subsided.....

It was definitely a Uric Acid stone because it was soft and brown and oval shaped.

Thanks for your post Peter!

So - it seems unlikely that stones develop fast then? (Not in weeks in any case - unless Uric stones are different?) So maybe the stone(s) are from my previous low-fat,high-protein,med-carb diet (which I have been on for many many years in an attempt to lose weight).

I was speaking to someone about it in a casual way and they said it used to be always deemed a good thing that you passed a stone - i.e. it's passed so that means it's not staying in your body and getting bigger and bigger anymore.

But unless Dennis has had his stones dormant for more than a dozen years it seems his low carb diet is causing them?



Some obvious questions:

How long do stones take to form and is that different for different types of stones?

What diet is best to avoid stones forming? (Again, different reasons for different stones?)

If you have stones, what diet is the best for breaking them up? (Following Dennis, maybe one high in VitD for calcium oxalate stones; following Gunther, maybe full fat dairy for some stones? Come to think of it I've never ever eaten so much full fat dairy as I am doing now.)


Everyone told me to drink more. Is it as obvious as that - will stones dissolve if you drink more? What about the whole lemon juice/olive oil thing? Does that really help?


Thanks. It's obvious that I'm not as concise and/or scientific as you guys, so do bear with me.

bluets said...

curious. i am exquisitely sensitive to my magnesium levels - i run on the somewhat deficient side if i'm not supplementing heavily. i think i tend to normoglycemia but it's been a long time since my last round of blood work...

on a low carb diet, what could cause chronic low magnesium levels?

Matt Stone said...

It is true that glucose metabolism has a huge link with utlization of calcium and phosphorous. As a scholar/student of both Melvin Page and Nancy Appleton, there's no doubt that having a high fasting glucose level parallels an alteration in calcium to phosphorous levels in the blood.

When this happens, calcium is rendered unusable and then becomes harmful - leading to kidney stones, plaques, and other problems (the Western diet, high in dairy calcium while inducing glucose metabolism issues, is a bad combo.).

But as we've seen, eliminating carbs from the diet doesn't equate to proper fasting glucose levels or proper calcium to phosphorous levels in the blood. Just like "Pooti," who once blogged about eating an all-meat diet, the ketogenic diet made her glucose levels higher, not lower, than her prvious moderate-carb diet.

My recent glucose testing experiment also backs up the idea that there are more factors in glucose regulation and insulin sensitivity than just glycemic load of the diet.

You can run from carbs, but you can't hide. The liver will secrete glycogen (and you'll have gluconeogenesis as well), and with the ketones triggering insulin resistance as you've suggested, glucose levels go up (hyperglycemia) and remain up for a long time - still inducing compensatory hyperinsulinemia.

My vote is that a low-carb, especially ketogenic diet induces hyperglycemia and hyperinsulinemia in some people, and leads to kidney stones just like a mixed diet with refined sugar often does.

I would question low-carb's ability to reduce fasting glucose and insulin levels before I questioned the theory about what causes kidney stones.

DancinPete said...

Since switching to a paleo diet 8 months ago, I've developed both Kidney stones, and Dry Eyes. I can't be sure that the kidney stones didn't start back when I was on the SAD.
My laymans research has implicated that both of these conditions may be linked to Magnesium and B6 deficiency. I didn't think this was possibly as my diet contained what should have been ample amounts of both. However, I've learned that gluconeogenesis uses up a fair amount of B6 converting proteins to Glucose.
My other theory is that suddenly switching to a low carb diet and intermittant fasting, burns through all your glycogen stores, and all the water associated with it. This could cause temporary hydration level fluctuations, which creates contentrated urine, allowing any excess elements to crystalize and form stones.

I was wondering if anyone with a little more knowledge can tell me if either of these theories are feasible?

I've since started supplementing with both B6 and Mg, and will hopefully cure both conditions at the same time.

StephenB said...

I've ordered some potassium chloride just for that reason. I had been counting on K2-MK4 of 5 mg/day to prevent any stones or soft tissue calcification, but I realize that on my high fat diet I risk skewing the sodium/potassium ratio towards sodium (hello, bacon). It would be nice if KCl-cured bacon were available.

_flo said...

Hi Peter,
not much time to read through all the comments, so maybe someone wrote that before, but apparently an excess of acetyl-CoA (which "shows" as ketone bodies in urine) and actually any compound that at the end produces hydrogen ions causes acidosis and may affect kidneys.

http://forum.dr-kwasniewski.pl/index.php?topic=2342.msg58137#msg58137

Krissie said...

What about the implication of Bacteria in kidney stones? Here are 2 exerpts:
Researchers have discovered that certain type of bacteria, Oxalobacter formigenes, may reduce the risk of recurrent kidney stones by as much as seventy percent.

These bacteria are naturally found in the intestines and are capable of degrading oxalate. Oxalate is a major component of kidney stones.
(from Science Daily...the site won't open right now, so I can't give a link)

and:
Scientists now have inside information to use in the fight against Proteus mirabilis -- a nasty bacterium that can cause kidney stones, as well as hard-to-treat urinary tract infections....
....urease, an enzyme produced by P. mirabilis, which breaks down urea in the urinary tract, reduces the acidity of urine and leads to the formation of kidney or bladder stones. Once a stone begins to form, bacteria stick to the stone and live within its layers, where they are protected from antibiotics.
(http://www.vetscite.org/publish/items/002984/index.html )

blogblog said...

Inuit children consume only 1/40th the amount of calcium as western children but have normal calcium levels

Abstract
FOR INUIT CHILDREN, A TRADITIONAL DIET contains 20 mg of elemental calcium per day, well below the recommended daily intake. To identify alterations in intestinal or renal calcium absorption, 10 healthy Inuit children (5 to 17 years of age) were given a standardized calcium load (Pak test). Five had hypercalciuria (hyperabsorptive in 3 and renal leak in 2), a frequency markedly different from that for white children (p < 0.004) and not explained by calcitropic hormone and serum calcium levels, which were normal. There was a preponderance of the bb vitamin D receptor genotype (8 of 10 subjects; p < 0.01 for comparison with white populations). Dietary calcium absorption appeared to be more efficient in these Inuit children, with an increased frequency of hypercalciuria associated with the bb genotype. This may represent a genetic adaptation to dietary constraints and may predispose to nephrolithiasis or nephrocalcinosis if standard nutritional guidelines are followed.

Adaptation of Inuit children to a low-calcium diet
Elizabeth A.C. Sellers, Atul Sharma, and Celia Rodd
CMAJ. 2003 April 29; 168(9): 1141–1143.

Peter said...

Hi all,

Interesting comments, I'm working through them!

Peter

Ace said...

Aha! Another piece of the puzzle falls into place!

I've been tracking my magnesium status for years. It has been low, and very difficult to correct. I knew that some people leaked mag through their kidneys, but I didn't know that it was caused by hyperglycemia. I'm pre-type2 diabetic, and have been insulin resistant for many years, so that explanation definitely fits for me.

I passed one kidney stone maybe 10 yrs ago, and have a large one that's stuck in my left kidney. It will be interesting to see if my change to Paleo (with dairy) about 6 months ago has any effect, on top of my now normo-glycemia and extra magnesium and Vit D supplementation.

A relative of mine who is now in his 90's, a very bright man who was a practicing urologist for many decades, gave me some advice about kidney stones. For people who are prone to getting them, and particularly those who pass many smaller stones, he recommends drinking two glasses of water before bed -- enough so you have to get up to urinate in the middle of the night. He says that the extra fluid flow helps prevent stones from forming.

Bris said...
This comment has been removed by the author.
Bris said...

re: Pyker

The modern Ketogenic Diet used for childhood epilepsy is absolutely bizarre. It consist mainly of non-starchy vegetables and vegetable oil. It causes extreme gastrointestinal distress and the kids absolutely hate it. The original Ketogenic Diet was based on fatty meat and cream and was reasonably well tolerated.

Recent studies have shown that a diet based on fatty meat is equally effective and much better tolerated.

pyker said...

Bris--

That is truly bizarre. The takeaway for me from this area was the interesting fact the ketogenic diets help in the treatment of childhood diabetes, and that potassium citrate supplementaion reduces the incidence of kidney stones for those undergoing this. I hadn't gone as far as to look at the specifically recommended diet. That's horrible. I guess fat phobia colors everything.

Bris said...

Pyker:

The main problem with the epileptic Ketogenic Diet is that it restricts water intake to keep ketone concentrations high. It is also high in oxalate from all those veggies.

The traditional Inuit diet - which is also ketogenic - contains no oxalate and extremely low levels of calcium and magnesium - so no risk of kidney stones.

Jim Purdy said...

"Usually type 1 diabetics are exquisitely insulin sensitive until some joker pumps then full of insulin then says 'there's the bread, eat it to stay alive'. "

OMG!

Peter said...

Hi Pyker,

Yes, renal stones are probably the commonest complication. In the original ketogenic diets there was also quite marked water intake restriction too, which I always felt contributes to the precipitation of minerals, but there has to be a message re ketosis.

The citrate supplementation is very interesting. The TCA requires citrate to run and this is normally produced from oxaloacetate, which in turn come from pyruvate, from glycolysis. Does the citrate act at this point, ie are you using it to blunt ketosis by allowing the TCA cycle to cycle? ie are we looking at a less ketogenic diet?

Dennis, how does that fit with your perception of citrate? I realise that most people with bladder stones are eating a ton of carbohydrate and the situation has to be different here, but the association of kidney stones with ketogenic diets suggest that something along these lines might be going on... Do you run in ketosis?

I see from blogblog's comments at the vitamin D receptor subtypes might be important n terms of who does what with D3 and calcium. If I'm reading the abstract correctly plus some pubmeding on bb vs BB VDRs it looks like some people will have a higher calcium throughput per unit in the diet at a given level of D3 in the blood. So normal diet, normal D3, normal calcium in the blood but high uptake and output. I guess mixing this gene with eating beets might not go...

Thanks for the heads up on scans, over here in Europe we tend to get what's on the menu as not all hospitals will have both CT and MRI.

Gunther, pH will affect different stones differently, lack of minerals in the urine probably allows dissolution along a concentration gradient. Also, in response to Krissie about bacteria, the oxalate degraders is news to me but bacteria can generally use any energy containing compound that doesn't defy the laws of chemistry to metabolise. Proteus and stones is covered in the rheumatoid posts, yes, real. Also there are usually nanobacteria in the core of calcium based stones. In the anaerobic conditions of the urinary tract I doubt they are burning fat, glucosuria might feed them nicely.

Matt, I don't doubt that ketosis raises blood glucose in some people. The record holder I am aware of managed 8.0mmol/l fasting blood glucose on what was similar to a fat fast for difficult weight loss. This is too extreme in my book and is one of the reasons I do edge of ketosis not sustained marked ketosis. I would expect the AUC for 24h glucose and insulin to be quite low still but 8mmol/l is glycosuric for some people and will be producing glycation that no one wants.

Hi Dancin Pete

I don't expect vitamin/mineral deficiencies on paleo diets though, I can see why eating lots of veggies might produce an oxalate intake above what we might be adapted to. Glycogen metabolism frees up water and re formation needs it back, but in general I don't se why drinking shouldn't sort that quite easily. The B6 for gluconeogenisis isn't something that I've looked in to as I tend only to eat enough protein for my needs, about 60g/d and get my glucose needs largely from eating carbs. You could use this as another argument against zero carbing but it's not one I've followed or checked. Generally meat is a good source of B6... Not awful for Mg either.

Flo and StephanB, I'll have to dig my renal physiology texts out to go through K+/H+ transport in the kidneys. One of those things you know inside out for exams but fades after a few years!

Bris, these are the links

http://www.ncbi.nlm.nih.gov/pubmed/14694049
http://www.ncbi.nlm.nih.gov/pubmed/15207798

Jim, there are all sorts of insulin protocols but if you advise a high carb diet you will need industrial doses. The margin for error means that getting it just right is impossible. Bernstein has the best answer so far. Mind you, as insulin pumps and continuous glucose monitors get joined up it will be progressively easier to poison yourself with glucose on your dietitian's advice without ODing on insulin and having to eat a bucket of carbs to stay alive...

Peter

Nigel Kinbrum BSc(Hons)Eng said...

My personal experiences:

During 2002, my pituitary ceased to function TSH-wise (not diagnosed until December 2002). My body temperature decreased & my weight increased. In an attempt to keep my weight under control, I increased my protein intake & reduced my sugary & starchy carbohydrate intake. This had the desired effect.

In November 2002, I had right renal colic and was found to have a large uric acid stone in my right kidney and a smaller one in my left kidney. I had hyperuricaemia & hyperuricuria.

Levothyroxine restored my thyroid hormone levels and potassium citrate + citric acid (Effercitrate) tabs alkalinised my urine. I still had hyperuricaemia & hyperuricuria and was diagnosed with Metabolic Syndrome due to impaired glucose tolerance on a OGTT.

Supplementing with 5,000iu/day Vit D3 commencing in 2007 eliminated the hyperuricaemia & hyperuricuria and my last OGTT result was normal. Ultrasound scans of my kidneys show no stone formation.

I've also been taking 600mg/day Ca + 400iu/day Vit D3 (Adcal-D3), 300mg/day Mg & 15mg/week Vit K2 since 2003, as I had low (-2SD) lumbar spine density then. By 2006, it was normal.

Dennis said...

Peter, I think that I developed my stone burden during the years I was eating lots of meat, low carb/high oxalate vegetables, nuts, and chocolate. Whether it was because of that diet, or for some other reason, I do not know. I have received conflicting medical advice about diet for stone disease. Initially I was told to avoid calcium (which I wasn't getting a lot of). After my second significant episode, I was told to increase calcium (to complex oxalate in my gut), avoid oxalate, and drink artificially sweetened lemonade. The urology department at the University of Wisconsin has been promoting lemonade for people like me. But it was hard to get any work done, with all that lemonade passing through me. So I moved on to lemon juice and now citrate supplements. One of the standard dogmas of stone treatment is high fluid intakes. I wonder if that is right. It seems reasonable to avoid supersaturation of calcium oxalate. But if I am trying to increase the citrate concentration of my urine, it would seem to be better to have low urine volumes. I find forcing fluids very unpleasant, and it is hard to imagine doing it for the rest of my life, especially if I am not convinced that it is beneficial.

Over the years, I have tried to stay near the edge of ketosis. My wife doesn't like how I smell when I am ketotic. Now that you mention it, I am less likely to become ketotic after citrate (either lemon juice or pills). In the last year or so, from reading your site and others, I have significantly increased my fat intake (animal fats, cream, butter, coconut oil), decreased my protein, and nearly eliminated plant foods(I do have wine with dinner.) Milk is my main source of carbohydrate, and I do have a little chocolate.

Here are a couple of review articles on stone disease:
http://www.jci.org/articles/view/26662
http://www.medscape.com/viewarticle/576926

Peter said...

Hi Nigel,

That seems to fit in quite well with the ideas up for kicking around in this post...

Dennis,

Lookie here.

Maybe 50% of your carbs as galactose is worse than 50% as fructose!

Also thanks for the background input. Always interesting how these ideas work in the real world.

Peter

Taka said...

Hi Peter,
I think you should also go check on the tophi in joints. They have similar nature as the kidney stones and start making troubles when they dissolve. The uric acid sand is released from the protein capsule and its grinding between the joint surfaces damages the cartilage. What causes them in the first place is excessive cellular apoptosis (e.g. due to dieting or less insulin/IGF-1 which kills the defective/mutated cells) because the DNA from dying cells is being turned into the uric acid. There is of course also the fructose/phoshpate metabolism connection as stated by Cordain.

It looks to me that most (if not all) of the people benefiting from the OD are actually celiacs. For some individuals carbs seem harmless if not accompanied by other dangerous substances such as the PUFAs ...

Taka

Peter said...

Hi Taka,

Well that's interesting! Imagine Cordain knowing about the fructose/phosphate/uric acid link. There really is hope there. The tofi do sound interesting too, a bit like a coping stratagem being undone by LC. I remember one person on a LC discussion group in the early days of the current LC epoch who had a flare of gout when doing Atkins induction.

With the coeliac issue I would tend to feel this could be the case, the interesting aspect is what portion of the population is coeliac, obviously ignoring stupidity like blood tests to define coeliac.

Peter

Dennis said...

Thanks, Peter. Strong work!

I had hoped that galactose was better for me than fructose, but I guess not. Many of the paleolithically oriented people have argued against milk, but I have read that the Maasai do well on their traditional diet of milk, blood, and meat, so I was OK with my doctor's recommendation to drink more milk. But now I guess it is cream instead of milk for me. I can live with that.

The study you linked mentioned B6 deficiency. I take a multivitamin with 25 mg/day, so hopefully I am not deficient. You have mentioned that you supplement D3. You have written about fish oil, but I wasn't certain if you took any. Do you supplement anything else?

Peter said...

Dennis,

The Masai drink milk which has been sat all day in the tropical sun in a container which previously held yesterday's milk. When we were holidaying in South Africa the "Maas" I bought in local supermarkets was a cultured milk. Delicious, but the girls on the tills were always worried that I'd made a mistake and that I would be expecting fresh milk! Possibly not a lot of galactose there.

Yes, I supplement with egg yolks daily and liver occasionally. I'm currently very much on the fence re D3 at the moment given a background of a low carb animal fat diet. I take my fish oils when I remember, which is most of the time!

Peter

Dillon said...

Peter,

I'm ZC and due to finances eat eggs from caged hens, pork belly, value mince, supermarket butter and cream etc.

I supplement with about 9g fish oil a day (2430mg epa, 1620mg dha) to balance out the O6.

I also take 10,000IU D3 per day (2 capsules; am + pm).

I'm wondering if my fish oil & D3 intake is excessive or even detrimental?

How would I figure out what amount of O3 to take to balance my cheapo meats?

Keep up the great work!

pyker said...

Dillon-- For D levels, there's a blood test for 25(OH)D level. The recommendation seems to be between 50-80 ng/mL as optimal. Dr. Cannell of the Vitamin D Council recommends starting with 5000iu/d for a few months before getting tested. There's also a blood test for omega-3, an "index" and 6:3 ratio. While I have tested my 25(OH)D levels, I've never done the omega-3 test so can't comment personally on it.

Peter said...

Hi Dillon,

Testing is great but if you are as broke as I have been on occasions, you might settle for 5g/d of fish oil and a little D.

None of the old timers who got me started ever supplemented D or omega 3s... They all eliminated omega 6s as far as possible and said eat meat and fat....

After that it's icing on the cake. I've done what you are doing. It works. Test if you can but...

Peter

Nathan said...

Hi Peter, what brand of fish oil are you currently using or recommend? Is 5g/d still an appropriate dosage. thank you

Peter said...

Groan, the icing on the cake reference was a complete accidental pun and was not intended to denigrate testing if you can afford it!

I use Holland and Barrett's high strength fish oil as it's medium priced, comes on offer frequently and doesn't seem to be the floor sweepings. Again, if it has to be ultra executive, from fish caught on gold line at midnight on Halloween before it does any good, well, there's no chance for me then...

Peter

Dillon said...

Hi Peter / pyker,

Thanks for your responses.

Being the poor sod I am I too get my fish oil from ZipVit, Healthy Direct etc. whenever there's a bulk sale on. Dropping my 9 pills to 5 will help the budget.

In the UK can I just ask my GP for a D3 test?

I take SSRI's for chronic depression and they do the job of keeping me alive. After years of boatloading carbs for the "mood enhancement" without effect I've found ZC/High Fat to be a far better option.

Funny how I've reverted to my childhood preferences; I remember loving fat as a teen, chewing the fat of steaks and chops (people would leave their fatty "unhealthy" food and give it to me), smothering any ham, chicken etc. in butter as it just tasted better!

Keep up the great work.

DP

Peter said...

Dillon, I think it depends on your GP. If you get on well and he/she is reasonably clued up they will test, especially if you have a D "associated" issue like depression. Others will take any request as a threat. I've been very lucky with my GPs.

You would probably have to specify 25(OH)D3, they might not be fully clued up on testing. It's far from routine.

Peter

BTW Chris at Conditioning Research pointed me to this post on Seth's blog. Ultra anecdotal but fascinating!

Dillon said...

Hi Peter,

Can't say I get on "well" with my GP. I only see them for reviewing the happy pills. IMO they're glorified drug-pushers but at least my drug of choice does the trick :-) Over the next couple of years I want to wean myself off of the SSRI's and plan to do it this slowly.

Seth's blog post about the power of pork belly/bacon is interesting, especially as my sleep sucks and I eat 6 pieces of pork belly a day, but perhaps I need to eat a whole pack (10 slices, Morrisons 3 for £10) and raw? :-/

I've been toying with the idea of increasing my fat intake to even hgiher levels, by consuming a pot of double cream a day in addition to current intake, and see what effect it has on my mood. The only issue is I always get churned up about calories (brain games) but I think I'll just suck-it-up (literally) and see what happens.

Regards,

DP

Peter said...

Raw, hee hee! Well I've had a discussion off blog about raw vs cooked food. As far as I'm concerned no one that I know who has helped themselves using a LC approach would have attempted it with raw meat. Maybe it's better, maybe not. For people to give up bread and sugar is hard enough, to replace them with raw bacon is for the people on the far edge of self experimentation. Fine to look in that direction, but traditional LC delivers the goods most of the time!

Peter

Dillon said...

Hi Peter,

Agreed, I don't think raw is for me just yet!

I actually find ZC very easy from an adherence point of view. My biggest problems are all "in my head", due to depression, eating disorder etc.

I've not felt as good as I do on ZC for a long time. Weight or fat loss has never been the issue with me (skinny bugger), it's always mental and body image.

Thanks,

DP

Peter said...

Hmmm, just a thought, you might feel even better with just enough insulin to put a little weight on. The "in your head" stuff is powerful, but observational stuff on the SAD or equivalent here suggest a BMI around 26 might be better than 20. That puts me up the creek (low BMI too)!

When a friend started on an all meat diet for MS control we set her up with a fixed portion of white rice to keep her well out of ketosis. For compliance reasons she just ate zero carb, all meat, plus added rice to keep insulin levels from bottoming out. Going via routine gluten free LC had failed to stabilise her. Veggies were added back once she was stable, got rid of the rice then. But white rice does seem quite safe as grains go if you want to adjust insulin/weight/ketosis/immune function... Keeps it very simple.

Peter

Dillon said...
This comment has been removed by the author.
Dillon said...

Hi Peter,

One thing to note, I actually have to work quite hard to eat the amount of food I do and thereby keep my weight up.

Left to "natural" appetite I'd eat less and probably weigh less as well.

Being hyper-skinny naturally is all well and good but I like being slightly heavier therefore the food quantities.

Perhaps I should just follow nature and be the guy in the tribe who does the persistence hunt? :-)

DP

Peter said...

So long as you would accept being the member of the tribe least likely to survive if hunting went badly wrong....

Peter

Dillon said...
This comment has been removed by the author.
Dillon said...

>> Veggies were added back once she was stable, got rid of the rice then. <<

So are the veggies still keeping her out of ketosis now?

Peter said...

Re the deleted ASDA comment: Yes, no need to store energy reserves on your body if you have a larder!

Re ketosis. Yes, I hope so! Fruit actually makes it quite easy...

Peter

Dillon said...

Hi Peter,

Funny, I sometimes think how I wouldn't survive if I crashed into a cold sea or got stranded somewhere. Not much fat on me for keeping warm or generating energy :-(

So your friend stays out of ketosis mainly with vegetables or fruits?

I don't eat any carbs (except for any trace amounts) so guess I'm now running on ketones but think I'll get some ketstix to be sure.

I know you get asked this a lot, but for the thickies; what's the crack with staying out of ketosis?

Thanks,

DP

Tim TerlegÄrd said...

What is deciding the pH of the urine? I read this

http://www.thepaleodiet.com/nutritional_tools/acid.shtml

but is that all true? To me it looks like most people should have osteoporosis if that was true.

Peter said...

Tim,

Humans do very well on diets ranging from 90% of calories from carbs as subsistence agriculturalists in Tanzania through to near 100% animal, 300g/d protein, among the Inuit. Not a urinary pH meter in sight. Cordain has some weird ideas, lots of them!

Peter

Sanjeev said...

Tim TerlegÄrd said...

What is deciding the pH of the urine? I read this

http://www.thepaleodiet.com/nutritional_tools/acid.shtml

but is that all true? To me it looks like most people should have osteoporosis if that was true.

>>>>>
this review helped me out

http://www.jacn.org/cgi/content/full/24/suppl_6/526S

Cordain's stuff is written as if he thinks that blood, bone and kidneys exist in one compartment instead of mostly-segregated compartments

This below also makes logical sense but logic doesn't always rule in these things, and the review article has a little bit that casts doubt on this

http://www.4.waisays.com/


If you believe some of the standard vegetarian literature, "on a high protein diet your body will be in net calcium deficit every day"

follow that to its logical conclusion, the fully adult Inuit or Yupik has less calcium in their body than when they were a baby.

Makes a LOT of sense, doesn't it?

Peter said...

Hi Sanjeev,

I found a few nits to pick with the calcium as a cause of osteoporosis, not the basic concept, but with things like high fat diets causing lethargy. This is incomprehensible to me but probably accepted by most mixed diet eaters. It's incorrect if you omit the sucrose.

What really I like is his question "What accelerates aging of the bones?"

The answer is the same as for all other systems: Insulin.

Who is the chap with the website? Is it the author of the Med Hypoth paper?

Peter

New York said...

Similar to Dancin' Pete, I've been low carbing away for about 6 months.. but recently I've gotten a kidney stone - as well as some weird symptoms with cold hands and feet as well as some aches.

My research suggests b6 deficiency, and I've been taking supplements for a couple of days with mixed results. I've also had dry skin issues on and off for the past couple of years. Seeing my doctor soon.

But I can't see how I could be deficient unless maybe I'm consuming antinutrients like nuts or something. The glucogenesis thing is interesting.

peaceandquite said...

I just wanted to comment on bamboo's comment about her stone being uric acid. I am a lab tech, and I used to analyze kidney stones, and the uric acid ones were always orange or yellow-orange. Brown ones were most often calcium oxalate.

Also, the man who trained me stated that soda pop, particularly the phosphoric acid, was a large culprit in the formation of kidney stones for many.

Peter said...

Hmmmm, phosphoric acid and fructose make a great combo then. Someone should market it!

Peter

machinehead said...

@Dennis - supplementing Vit. D for someone who is prone to stones is possibly contraindicated. If you must supplement Vit. D, it is your best bet to add Vit. K2 MK7 200-300 mg per day as long as you are not on a blood thinner. K2, Vit. A, and Vit. D are a trio that work together. The K2 may help reduce calcium deposited in soft tissues.

I have also read that there are certain gut bacteria that bind to oxalates. The specific one, more that half of people loose after childhood. I have read that certain commonly found probiotics can help do the same function of binding oxalates in the gut so that they don't enter the bloodstream.

Regarding the keto diet and childhood epilepsy causing stones, I would really wonder what the out come of that study would be if they were not using so much processed dairy as a fat source, for example if you did more of a paleo/whole food/MCT oil style of diet where you could raise carbs to around 50 grams a day and stay in ketosis. Just a thought.

machinehead said...

@pyker, I am interested in info regarding preventing stones using potassium citrate. I just had a large stone removed (I am hoping it is an artifact from my pre-paleo/whole foods lifestyle, but early on in paleo, I mainlined spinach and kale smoothies and sweet potatoes), but want to be sure I don't repeat that nightmare. If you can point me to any info regarding dosing per day, that would be helpful. Thanks.

Peter said...

From the Freedmans' book: Formulas for liquid/tube feeding. Fat sources are Microlipid (safflower oil emulsion), Canola oil and/or "vegetable oil". I would be very wary of these as bulk fat sources. Their recipe's for real food are very reasonable, but there is an underlying acceptance of PUFA oils as healthy in the text of my copy...

Peter