Friday, November 27, 2009

A brief discussion of ketosis

This is an opinion post about ketosis. Is it good, bad or necessary?

Let's get the religion out of the way first. I follow an eating pattern loosely based around Dr Jan Kwasniewski's Optimal Diet. I vary from the OD in that I tend to vary my protein sources somewhat more than specified, I think a little omega 3 supplementation is worthwhile, that having a "normal" vitamin D level is probably worth while (though this is an interesting subject) and in that I specifically avoid gluten and most other grains. So I do my own thing somewhat, while still keeping a heavy emphasis on animal fat, egg yolks and trying to keep to real food as far as I practically can. When I say I avoid ketosis because Kwasniewski says avoid ketosis, that's religion.

My follow on problem from this that, when you can get hold of the data, Kwasniewski is usually correct. My even bigger problem is that, when you get beyond simple diet information, some of JKs ideas are very far off the wall. And some of the off the wall ones also seem to be correct to me, which is a little uncomfortable! So religion is a real non starter.

The first paper which had me thinking was this one:

"Both the pre-and post-exercise levels of adrenaline, noradrenaline, and cortisol were enhanced"

This is the sort of thing I file as interesting. That is, until the anecdotes trickle in about people who have gone to extreme ketogenic diets and have developed abnormal cardiac rhythms. You know the thought train that grabs you when you discover LC eating, that moment of realisation: Carbs are bad. Followed by: All carbs are bad. Most people can do zero carb with absolutely no problem. With reasonable protein intakes it is really very easy and doing a "Stefansson", using an all meat diet, is not difficult. But a few people will get in to problems. If you are wired for a heart problem along the lines of Wolff Parkinson White Syndrome, cranking up your adrenaline and noradrenaline levels might not be a good idea. If you have atrial fibrillation, ditto.

This is the effect of a water fast on sympathetic nervous tone:

"After 17 days of TF [total fasting] norepinephrine (NE) and epinephrine (EPI) urinary levels showed a two-fold and nine-fold increase respectively, but they became undetectable at the end of TF"

So increased sympathetic tone seems to be a feature of both fasting as well as ketogenic eating. It does look as if the effect is transient during fasting, so this may also be the case in ketogenic eating, but I have no data on that. The fact it may well be transient is no consolation if you have been admitted to a cardiology ward via A&E due to severe palpitations!

An aside: Hyperglycaemia is also a potent elevator of serum catecholamines and seems to be the routine trigger for atrial fibrillation.

The next issue has to be renal stones. Anyone who has looked at the RECHARGE trial enrollment criteria will immediately have noticed that kidney stones are an exclusion criterion. Now kidney stones are a complex issue. Anyone who has treated a cat or dog for struvite urinary stones will be well aware that they are exquisitely diet responsive. Shrinking a 1.5 cm asymptomatic renal stone to a 0.5cm stone which then wedges in your ureter will again have you in the A&E department pleading for morphine. But you don't want to live with the stone for ever and it might well dissolve in situ anyway, but maybe not! But the bottom line is that you might easily develop a symptomatic stone from an asymptomatic one.

This having been said there is undoubtedly a high incidence of very symptomatic renal stones using the Ketogenic Diet for epilepsy management, there are loads of papers covering this. It is difficult to say whether these are directly ketosis related, are due to some of the bizarre lipid choices made by cholesterophobe dietitians for the diet or are to do with the chronic dehydration which was part of the original Ketogenic Diet. There are a few other possible explanations, but I feel there is a source for concern here.

While we are talking about the epilepsy Ketogenic Diet, let's also cover pancreatitis. I've got the Freedman's third edition of their classic "The Ketogenic Diet". The index does not include pancreatitis and the recipes tend to use real foods. There have been a number of deaths from pancreatitis on the Ketogenic Diet. None of the case reports are available to me in full text, so I cannot see what sort of fats were given to these children. Certainly Vanitallie's pilot study of using the KD for Parkinsons management suggested using unsaturated fats as the lipid source (to lower cholesterol, dontchano). Do this and you deserve whatever is coming your way.

OK, fasting hyperglycaemia. I have this mildly on a low carbohydrate, high saturated fat diet. My FBG is about 5.5mmol/l, ie 100mg/dl. I've discussed it here.

But I do know at least one person who can achieve a FBG of 8.0mmol/l on a deeply ketogenic diet. This is 144mg/dl and not a number that I would personally wish to sustain for any period of time. This is not a standard response to marked ketosis, but unless you are checking you blood sugar levels, how would you know that it wasn't your response? A few carbs should reverse this.

Muscle cramps. Anyone who went from a normal carbohydrate based diet to Atkins induction knows all about these. You faff around with magnesium or potassium supplements and they seem to help a bit, sometimes, maybe. But upping your carbs works beautifully. You would almost certainly adapt out of this with time, but short term it can be a problem.

Finally, auto immunity. Hyperglycaemia is probably the immunosuppressive aspect of diabetes. There can be costs to pay when improving immune function if the trigger for an autoimmune problem is still present. This is close to religion as it is purely based around non scrutineered anecdote from Lutz' Life Without Bread. He is particularly talking about multiple sclerosis. His clinical experience (not always the best guide, but better safe than sorry) suggests a sudden drop to 72g/d is too fast and can promote a flare. Kwasniewski has nothing to say about this but always seems to use the OD as a sudden onset protocol. Lutz suggests staged drops of carbs over several weeks. He certainly would appear to caution against going ketogenic. I guess this would eventually be a non problem and ketosis is probably neuroprotective in its own right. In the short term, take care.

Of course the flip side is the use of water fasting in rheumatoid disease.... YMMV!


I have to say that I am not anti ketosis. I drift in and out of ketosis as I'm quite active in a non-gym kind of a way. I suspect that by now I am VERY adapted to this. I'm a bit loathe to increase my carbs much above where they are now because I, in common with many other people, have better gut and joint function when I restrict starches. Adding a little glucose in the form of a chocolate truffle or two after my main meal is a pleasant way of augmenting the vegetables that were in the main meal but it's getting away from real food...

So I have some respect for the potential complications of ketosis, especially sudden onset. There are undoubtedly many plus sides, but nothing is ever completely problem free.



Unknown said...

Poor description about ketosis, most bits of it completely irrelevant.

Peter said...

Shrug, as if I could give a d@mn!

Jenny said...

Actually, this is an excellent discussion that brings up important points.

One issue you neglected to mention is "euthyroid syndrome." Lyle Macdonald's excellent book, The Ketogenic Diet mentions it can be a long term symptom of ketosis. Years ago the Eades admitted to supplementing T3 in their long term low carb diet patients and posted about it on their web site.

One problem with the starvation studies you cite is that they are of necessity short term. Some of us, self-included, of us who have pursued very low carb diets for years have found our energy levels do start to plummet. This doesn't happen to all, but it happens to some.

In my own case, with each long stint of eating at ketogenic levels, the effect kicked in earlier.

I currently maintain a carb intake that is about 15 g a day above the ketogenic boundary (65 for me as I'm small). If I eat at a level too close to the boundary I will gain and lose glycogen too easily--which results in water dumping.

Winalot said...

Hi Peter,

Interesting as I recently tested myself via Ketostix and found I'm in Ketosis all the time. Makes sense as my diet is fairly regimented and practically ZC.

We've discussed perhaps spiking insulin to increase BMI somewhat and this post poses some other health questions.

Thing is I "feel" great this way, no depression, lean body mass, energy etc., and feel loathed to experiment right now.

Perhaps blood work might show something if I can pursuade my GP.


Winalot said...

OT: When you add butter to your mince do you pour off the dripping or keep it? I've been pouring everything onto my plate and even though a whole packet of mince goes down easily I can suffer slight nausea some time later. Only since I've been keeping the dripping though. The only time I get a similar feeling is if I drink a lot of cream at once (say couple of pots at a time).

LeenaS said...


I'm not saying who's right and who's not, but this post (just as some other JK's thoughts) seem to fit well with what I've heard in lc forums during these years. And also with my personal experiences.


Unknown said...

Great post as usual, Peter. Since you mentioned stones in dogs and cats in the post I was wondering if you thought sharing our high fat diet with our dog was a good or a bad idea for the dog's health. We still feed her commercial dog food twice a day, but we also let her have some of the animal fat we eat -- bits of butter, high fat yogurt and kefir, bacon fat, etc. She's a twelve-year-old golden retriever who is lean and in great shape. Don't want to give her stones or something, though.

Anonymous said...


Thank you so much for collecting these thoughts in one post. You have briefly put on the hat of opposing counsel and that's always a useful exercise. I'll see if I can obtain some of those KD references full text and if I can I'll email them.

I am reassured that everything you mentioned I am familiar with, including the weirdness of JK's Homo Optimus!

Briefly, I think the sympathetic tone increase is transient for most people.

I noticed after ketoadaptation that I have somewhat less lability in heart rate with psychological stress than before. I run and lift weights on a 15 hour fast routinely.

I think the stone issue is most likely a phenomenon of dissolution and mobilization into the ureter, but it could be dehydration related to decreased meal frequency and lack of thirst formerly stimulated by bagels and potato chips.

I find myself sort of stuck in ketosis. Here is how. My carb intake is so low that I have significant physiologic insulin resistance. With only two meals a day, I find it hard to add enough carbs at each meal to get out of ketosis without spiking my BG. Normal meal with loads of protein and fat and maybe 5-10 g carbs from veggies and nuts ppBG is maybe 115 max, increase carbs to 50 with the same meal and its ppBG of 140. fBg is about 90 in the AM. I just wonder if it's worth it to add potatoes if I feel fine without them - makes the diet more complicated, not less.

Can I assume you dismiss the "too much oxidative stress with ketosis" idea or do you have no opinion on that?

Finally, do you think there is any possibility that staying in mild ketosis versus no ketosis but LC could protect more against cancer (perhaps by absolutely minimizing insulin effects, if not a weak Seyfried selection against nascent cancer cells)?

Love these opinion pieces - more to read and think about now.

Robert McLeod said...


In euthyroid syndrome the thyroid isn't at fault. That's the reason for the 'eu' (true; normal) latin prefix.

Basal metabolism is controlled by a complex set of feedback loops starting with the pituitary and ending with the deiodinases. Euthyroid is generally one of two things: poor thyroid-stimulating hormone output from the pituitary (say, from high cortisol levels), or messed up D1/D3 activity ratios. D1 primary converts T4 to the active T3 form while D3 tends to pull another iodine off T3 and convert it to T2.

The liver seems to be the controller of D1/D3 activity but this isn't super clear in the literature yet. The central nervous system also plays a role and in humans, skeletal muscle is an important source of D2, which is probably why big muscular mean have high basal rates.

MarkD said...


You don't post often, but whenever you do they are always great!

This is thought provoking stuff. It's good to see a low carber give some thoughts to the downsides...

Keep up the good work - Mark

Steve Parker, M.D. said...

Peter, thanks for providing measurements in mg/dl when appropriate.


ItsTheWooo said...

This description helps me to understand why carb restriction/ketosis is antidepressant for me.

My depression is endogenous (catecholamine deficient). The way I feel when eating less is much more emotionally normal, motivated, energetic, with signs of higher SNS. This makes sense. Carb restriction boosts my catecholamines.

Most people assume "stress" is depression, so most people use food to boost their mood (actually what they are doing is sedating themselves and numbing from stress).
Food invariably makes my depression worse or triggers episodes because food knocks down catecholamines/stress response. I am not hyperglycemic for any amount of time.

For health I tend to agree ketosis isn't optimal, glucose is a nutrient, and it is well established the stress dominance of a glucose restricted diet f*cks your body up.

I also believe a lot of the metabolic problems people have can respond to supplements like chromium GTF and inositol. So that they find they tolerate normal food better without necessitating very low carb. This happened for me. I'm on leptin, but leptin alone didn't do the job.

rosenfeltc said...

itsthewoo, what do you mean it's well established stress dominance of a glucose restricted diet f*cks your body up?

There is a Man who has been eating zerocarbs for 9 years of which that last 5 years of that have been only pemmican, he is 51 years old and looks like he is only 30. Not only that but his wife was able to overcome lymes disease by switching to a pemmican only diet. Not only that but their two sons of age 3 and 5 have eating nothing but pemmican their entire lives (so no carbs) and they have never had to go to a doctor for anything.

My point is that just because there isn't enough actual studies on long term ketosis or carnivorous diets that doesn't mean they are unhealthy.

Unknown said...

There is a Man who has been eating zerocarbs for 9 years of which that last 5 years of that have been only pemmican, he is 51 years old and looks like he is only 30.

who is this man

Aaron said...

Peter, now I know why I keep coming back to your blog. You are willing to modify your habits if the data warrants it -- btw, you have a great sense of humor too!

Once again, you do what works for you, and that is all the matters.

I've been commenting for years that I get nervousness and other stimulant like symptoms on a low carb diet -- your findings seem to suggest this. Even after months of trying to adapt -- I could not fully adapt to a your kind of diet.

I think this is very akin to the difference between people who can tolerate coffee and those that cannot. I cannot tolerate caffeine -- I bet a buzz, and then crash hard. I believe a lot of people who tolerate low carb well have strong adrenals that can tolerate caffeine quite well -- and I bet there is a correlation.

I, having weaker adrenals, need the relaxing effect of serotonin from carb intake. And don't get me wrong -- I'll never go super high carb, even I get too sleepy from that. Everyone has to find the right balance for their own brain.

Unknown said...


Thank you for mentioning cramps as a possible consequence of a low carb diet. Woudld you explain the connection? For years, I used to eat a relaxed Zone diet with ~130g of carbs per day plus multivitamin and did not suffer from cramps. About a year and a half ago I switched to the O.D. I eat ~50g carbs per day and gave up the multivitamin. I have had trouble with nocturnal foot cramps for the past year. About 7 days ago, I started taking a fish oil supplement in the hope that the vitamin D would improve my calcium level and end the cramps. The past 5 nights have been cramp free. I am thrilled to have "normal" toes again. I'd like to understand what all is happening.


Echolight Studio said...

good post. the more we learn about diet, the less we should accept dogma. everyone is different, and to blindly assert that someone should adopt a guru's dietary protocol and ignore one's own reactions (it happens) is to invite disaster.

i can speak for no one but myself (neither can anyone speak for me). my body is not my best friend regarding diet. i have to be very careful about macronutrient intake. when i eat too many carbs, i become hypoglycemic with artificial highs and crushing lows; when i eat too few carbs, my blood pressure goes up and i feel overly stimulated. not good.

i feel best on a fairly high fat, fairly low protein, low carb paleo diet, and never allow myself to go into a disastrous state of ketosis. but again, thats me.

bottom line: find out what works for you, and listen to your body.

Daniel said...

Great post! Aaron, I have a similar response to yours. When I have insufficient carbs (for me maybe around 75-100 grams per day), I become too aware of my own pulse and sense some irregularity in my heartbeat (though I don't think it's at the level of AF or PVCs). I've never investigated much but I did find some research indicating that insulin is a vasodilator, leaving me to believe that, for me, an extremely low carb diet is vasoconstrictive. Peter/others, does that make sense as a possible explanation for my experience?

blogblog said...

It is important to remember that hunter-gatherers always combine ketosis with high levels of physical activity.

The cathecholamine response is simply a mechanism to utilise glycogen to increase blood glucose - the 'flight or fight' response. You will only notice the symptoms of physiological stress caused by elevated cathecholamines if you are sedentary. Simply taking a walk will rapidly reduce cathecholamine levels and reduce heart rate and blood pressure.

gunther gatherer said...

This is excellent Peter and long-awaited in my case. I was wondering if you think your ability to stay at such a low weight so effortlessly was not so much the lack of carbs but their presence in your diet. Lots of low carbers lose weight initially but fail to reach their goal weight. Many also gain it back, even while still on the diet. Perhaps the secret is being fat-adapted, but not allowing the body to get used to ketosis as a normal state.

Anonymous said...


Gyan said...

1) Are there no studies on these questions for Inuit and Masai populations?
FBG, insulin levels, etc.

2) Cancer does not seem to be in the diabetic-heart -kidney-pancreas continuum. Many people with normal sugar levels do develop cancer and most diabetic never develop it.
Is it known that people with metabolic syndrome develop cancer with a different rate than the general population?

blogblog said...

Masai diets are high protein and high fat but they are not ketogenic. A Masai warrior would typically consume 150-200g/day of lactose from milk. Young and old Masai also eat grains.

Sorin said...


Diabetic patients have an increased risk of most forms of cancer.

Type 2 Diabetes major risk factor for cancer:

Diabetes linked to bowel cancer:

Diabetes increases cancer mortality risk

zach said...


Diabetics are at increased risk for many cancers, a simple google search will reveal studies on this. Also, while the Masai consume a lot of fermented milk, they also consumed a good bit of sweet (fresh) milk, full of lactose, so I don't they were in ketosis with the other carbs they got from grains. Lactose in whole milk doesn't seem to be as harmful as other sugars.

Gyan said...

So the association between glucose level and cancer exists. But does the correlation also exist between insulin level and cancer?

LeenaS said...

Gyan, this seems very possible. Or at least the longevity studies of nematodes (and others) seem to indicate towards this hypothesis.

However, optimum might not be "the lowest possible insulin levels" but just the "opimally low" or "low enough" levels?

Peter said...

Hi all,

OK, that's me surfaced from too many shifts and a (finally) successful house sale and with plans for a move from rented accommodation to our new home in about two weeks time before legging it down to Norfolk for an extended mid Winter chocolate festival. No idea how much posting will go on, I'll just see how it goes... I expect to spend the Solstice itself shifting cardboard boxes rather than celebrating!

Hi Gyan,

I doubt blood glucose level has anything to do with cancer directly, CVD is far more likely related to hyperglycaemia. Insulin is probably the driver of cancer and glucose is a marker of elevated insulin when the insulin fails get high enough to achieve normoglycaemia. Cancer with normoglycaemia is quite possible if you have a strong enough pancreas to pump out enough insulin to normalise blood glucose even in the face of an onslaught of fructose and sunflower oil. Making enough insulin to cover a starch diet without the hepatic and systemic insulin resistance following on from fructose/linoleic acid might well be healthy. But then you wouldn't have metabolic syndrome. There is at least one group, in Sweden I think, who consider the common cancers to be merely another facet of metabolic syndrome. I think they are probably correct.

LeenaS, yes, too low is not good, at least on the SAD. I have at least one paper somewhere (it doesn't throw itself at me) in which very low fasting insulin was associated with some increase in all cause mortality. Elevated fasting insulin was worse, but there was a definite U or J curve, so common in biology. Of course quite how anyone ends up with a very low fasting insulin on the SAD is an interesting question (the answer to which might explain increased all cause mortality) and might not be reflected in a low fasting insulin due to a low carbohydrate diet...


mtflight said...

This is a great post, as usual! Very interesting (applicable) to me.

As you may remember a friend of mine who went on the Protein Sparing Modified Fast, felt the abnormal rhythm and was diagnosed with WPW (and had subsequent ablation surgery).

I myself have experienced the benign PJC: Premature (AV) Junctional Contractions.

From experience, I thought they happened during ketosis, and possibly they do at the beginning.. but I've also experienced them a day or so after going to high carb from low carb (regimen slippage: pizza time or visiting a SAD restaurant chain). In these cases, magnesium supps. seem to do the trick to get rid of them (or perhaps it is simply masking the time it takes the systems to go into homeostasis).

High carbs = magnesium loss. Initial ketosis = potassium loss (magnesium too??)

I've read potassium depends on magnesium as well... possibly an explanation to how high carb and very low carb may both be triggers?

Edward Edmonds said...

The abstract of the first paper was interesting as the VO2 max increased and LT was shifted on the ketogenic diet. I find this in my own experience since switching to a LC diet. From most long distance runner's perspective a LC diet is ludicrous and the only way to enhance VO2 max is through aerobic conditioning.

Even more tickling is that the Kenyan runners from the Maasi tribe that were on a traditional LC milk, meat, and blood diet were some of the greatest runners the country produced with long careers while the rest of the running world was and still is "carbo loading". Interestingly since the tribe has consumed more and more corn while some of their athletes reach the top quickly they also quickly burn out just as quickly.

Melodie said...

I myself am interested in the effects of ketosis for athletes.

I personally have noticed an increase in stamina during my physical activities.

Have a safe move. :-)

Melodie said...

Forgot to click on 'follow-up comments'.

Unknown said...

Peter.. This is sort of off topic, but related. What do you think of fasting and intermittent fasting? Fasting of course leads to ketosis and probably even more rapidly in those of us that are fat adapted.

Peter said...

Paul, I don't really know. It's not something I've ever needed to do, last time I did a 48h fast I felt fine and the OD concept, to which I moderately well comply in many ways, does actually suggest the ideal pattern is 2000-3000kcal per day in one meal, two if you can't manage it all at once. I usually end up with three meals or two plus chocolate...


Wittrockiana said...

1. The diet in the study you linked to only lasted 3 days. Adaptation to a ketogenic diet is (I believe, off the top of my head) 3-6 weeks.

2. Insulin causes the kidneys to reabsorb sodium. When insulin is low, either from fasting or ketosis, people lose a lot of sodium. It's called natriuresis.

3. When your blood pressure drops, as it will if you lose a lot of sodium and the water that goes along with it, the adrenal glans secrete aldosterone, which causes the kidneys to reabsorb sodium at the expense of potassium. This can be avoided with consuming more sodium. (Phinney & Volek recommend 3-5g Na.) When people on low carb or ketogenic diets supplement potassium, they are actually counteracting the loss of potassium from insufficient sodium.

4. Low intracellular magnesium will cause the ROMK potassium ion channels in the kidneys to waste potassium regardless of sodium intake.

Does this mean that dietary carbs are necessary for good health, or does it mean proper Na, K, and Mg supplementation is necessary for a successful low carb/ketogenic diet?

Zorica Vuletic said...

My focus is on mg at the moment. I believe that if I correct my mg levels then the Na/K will correct itself down stream. We shall see.

I do notice benefits so far after a month of transdermal mg supplementation. I also injest the mg oil (chloride) without ill effects. I have also got a mg malate yesterday which I will also add to my mg. Nothing more though. I chose malate due to it's known effects on skeletal muscle absorption in particular so correct me if I'm wrong.

For Na I use sea salt. For K I use ACV with the mother culture. I think I am slowly getting a lot better compared to a month ago. There are two things I am noticing more than other markers: 1. I feel calmer. 2. My skin pigmentation has seemed to improve/darken and/or even out in complexion. I am very happy for this since I rapidly seemed to have lost colour in December and was looking pale. *I also take vit D3 and Vitex too.

Wish me luck for the upcoming months for continued improvement. It took a year to 'recover' and then on top of that I had so much trial and error learning which made the recovery a lot slower than it probably should have (no money for labs etc.)

Debbie said...


I have Wolfe, Parkinson White's. I have been ablated. I had pre-ventrical and pre-atrial as seen on a heart monitor contractions during excercise leading to shortness of breathe and very heavy extremities. (It was very hard to move). I went on a low carb diet <50g carb/day, lost weight and do not have arrhythmias during exercise - EXCEPT when I cheat and have more than 50g carbs in a day. It takes a day or so to get back to "normal" for me depending on the period of time I cheated. This is a repeatable effect which I still have 3 years after going low carb and 4 years after ablation. This year after Christmas, I ran across the parking lot to my doc's office - initial BP 82/47 with HR 92; 10 minutes later BP 100/60, HR 72 - Christmas is a carby holiday. 75 days later and no cheating; I cross country skied over 20 miles, all above 10,000', with 4,000'of climbing, in 4 days with no arrhythmias, and 30# on my back.

Zorica Vuletic said...

Debbie, that's great news! Obviously LC is the best solution for you.

Do you take any additional supplements, or are you lucky enough to maintain optimal health simply from good diet?

mtflight said...

Hello Peter! I love what a great resource your blog is. I have recently, after reading Volek and Finney's book, and learning a bit more about mTOR, been restricting excess protein and including more fat. It seems to somewhat parallel JK's OD in terms of fat being the fuel of choice. Their emphasis is keto-adaptation, long term ketosis, deep ketosis.

Part of the "traditional clinical" ketogenic diet are the very forbidden seed oils. The issue here is "political correctness" --God forbid they raise your cholesterol with butter or cream. As was pointed out, linoleic acid is not so great to prevent tumor growth. Hopefully the low mTOR would help offset that insult. Ok all this for another topic.

I am surprised that the amount of fat in the OD alone is not reason to be in ketosis almost all the time, Finney/Volek style?

Peter said...

Oddly enough it was only an hour ago that I picked up my copy of "The Ketogenic Diet" and browsed the recipes. Infant formula is VERY, VERY, VERY heavily biased towards omega 6 PUFA. Like very biased. The Protons thread says this is bad. The clinical result is occasional uroliths and occasional fulminating pancreatitis. The older child recipes are mostly butter and cream based but no conventional nutritionist would fail to substitute PUFA for butter...

I feel the PUFA are the problem in ketogenic diet trials. What happens when you lower carbs without developing insulin resistance? Probably renal stones.

Ta again for the UCP1 paper and the yet-to-be-posted-on C57BL/6 mouse paper. Nice.


Olga said...

Hi Peter,

I was wondering what your thoughts are on the Jaminets book "the perfect health diet" and their concept of safe starches. They suggest, that as long as you're not diabetic, you can eat up to 100 g of either, rice, potatoes, yams, or any other starchy fruit or vegetable. They also recommend about 50 g of protein, and most of the dietary calories should come from saturated fat. I guess it's still considered to be low carb, but would obviously keep you out of ketogenesis most of the day. Any comments would be appreciated.

Here is their website:

Peter said...

Hi Olga,

I don't read terriby much on the net on specific dietary advice sites, so I don't know the subtleties. If you go back to the old timers of LC Lutz had a very sensible approach. He used 70g/d of carbs, so 100g/d is not so very different, especially if you feel driven to exercise. If you are diabetic then 100g/d will, I agree, be catastrophic. If you run permanently on 100g/d when you are not currently diabetic you are betting that you will not become diabetic in the next 30 years. Obviously on an SAD like diet you WILL develop insulin resistance over the next 30 years. Will this happen on 100g/d of real-ish Food? Will it happen on 30g/d of real Food?

Ask me in 30 years time...


Unknown said...


Sorry to activate comments on such an old post, but I was wondering how you avoid ketosis on such a low-carbohydrate diet? Do you eat more carbohydrate than the amount prescribed by Dr. Kwasniewski? I came across this article because I have WPW.

Thank you for your time.

Peter said...

Hi Unknown,

It's been a bit of a battle to stay out of ketosis, especially as I've retired and have enormous scope for exercise, which I've always enjoyed though I've not been to a gym since my teens.

So now I spend quite a lot of time in ketosis and if I refuel after a 50 mile bike ride using double cream my urinary acetoacetate looks like 16mmol/l, though in reality it's probably under 10mmol/l. Urinary sticks grossly overestimate, but then BHB is usually about 4 times the AA level so even a guestimate of 10mmol/l AA is a LOT of ketones...

So I'm not strict about trying to avoid ketosis any more. Not worrying seems the best advice, unless it's about blood glucose.


Amir Timur said...

HI Peter. Been reading your blog for years, and having retired myself(for 2020), gave me time after half a decade to come back to reading about nutrition. I feel like strongly ketogenic/low carb dieting has retreated from the scientific debate, but I feel you are probably one of the remaining blogger scientists who would still back it up.

I want to ask you a couple questions about this.
The perfect health diet guys did a post on dangers of very low carb(Zero?) diets and addressed this question of renal stones.
Your ideas?

I do want to say that the explanation seems plausible, especially as I have personally experienced bouts of Gout during phases of lengthened hypocaloric eating or trekking while eating low carb.
I also want to ask you about whether palmitic acid is atherosclerotic regardless of whether that atherosclerosis is a risk. Finally what is your take on gastrointestinal cancers on the optimal diet. PHD thinks its a deficiency of mucin production.
For now I am sticking to low grains/ saturated fats but thinking of switching to more starches soon

Would love for you to weigh in.

Peter said...

Hi Amir,

It's many years since I've thought about Paul Jaminet's ideas.

Different stones will have different aetiologies.

The modern diet used for epilepsy management in the USA is execrable (full of seed oils) and I failed to become interested in exactly why it is so bad. The role of healthy user bias and DHA/EPA intake comes to mind re stones, not that I much love these nowadays. What I mean is that people who supplement fish oils eat a "good diet". In modern days "good diet" = gout. Maybe... And oxalate intake is high if you are keen on ground almonds and on spinach, as I was at the time without personal problems.

The gout flares are interesting. The commonest side effect of reducing uric acid levels using allopurinol is an acute flare of gout. My own hypothesis is that dropping uric acid with LC eating could do the same. Dropping insulin might too, gout is, after all, simply part of metabolic syndrome. Strict LC +/- hiking might well drop insulin and activate urate mobilisation in the joints, which flares gout.

I think trying increasing starch intake is a perfectly reasonable thing to do. Using n=1 is what many of us have done to trial things. If you are happy with Paul's ideas it will only take a few weeks to see if they suit you.

Oh, palmitic acid. I love palmitic acid. Atherosclerosis is cause by insulin and massively progressed by linoleic acid.

But then I am very biased...