My Thoughts on Low-Carbohydrate Ketogenic Diets, Part 2

When I first started this website a little over a year ago, I did so with the intention of discussing low-carb diet research and other low-carb topics. So I want to thank any long-time (well, at least a year!) followers who have stayed with me despite my veering off course now and then.  In the beginning I was very green with respect to the benefits carbohydrate restriction as a viable option for blood sugar and weight management (in my training as a dietitian, the Atkins diet was routinely dismissed as unhealthy and unsustainable), and I began spending a lot of time on dozens of low-carb sites, including many with a Paleo/Primal approach. The Paleo diet seemed quite healthy:  It was based on whole foods, grass-fed meat, and organic plant foods. However, it contained a lot less dairy and nuts than I was eating and which I continued to consume in fairly large amounts.

In the latter part of 2011, I began adding in some starchy foods like sweet potatoes and rice based on recommendations found on various Paleo sites. Although I'd been consuming 30-35 grams of total carbs per meal at that point with occasional postprandial hyperglycemia, the addition of starchy foods definitely worsened my blood glucose control, particularly after lunch and dinner (for some reason my post-breakfast readings were and are almost always good).  Researching other people's online experiences with reintroducing starch reassured me that this was likely a temporary thing that would improve as my body adapted to eating this type of food again. I continued eating the same way and monitoring my blood sugar about three or four times a week. 

I tried not to get too upset seeing my readings routinely in the 150s-170s and occasionally as high as 200 1 hour after eating, telling myself it would eventually get better. But after 9 months, it never did. Even replacing the starches with an equivalent amount of carbohydrate from fruit or dairy didn't help. Although others may be able to tolerate higher amounts of carbohydrate after a reasonable adjustment period, I had to admit that this wasn't the case for me.  I was already eating pretty low carb (about 90-110 grams total or 65-80 grams net), so where to go from there? Obviously, lowering my carb intake was the only thing I could do, short of medication. And since my fasting blood sugar has remained normal, there weren't a lot of pharmalogical options anyway.

In researching my ADA article on low carbohydrate diets, I found a study in which many subjects on a very-low-carbohydrate, ketogenic diet (VLCKD) achieved such significant improvements in blood sugar that they were able to greatly reduce or even discontinue their diabetes medication. There is also research on the hormonal benefits of VLCKDs for polycystic ovarian syndrome (PCOS) as well as weight loss. In addition, I found  many online anecdotal reports  of improved mental clarity and well being with this approach.  So I decided to reduce my carb intake further and begin eating  a VLCKD containing 40-50 grams of net carbs per day. To be honest, although I've been eating low-carb for about a year and a half, I had some sort of mental block about not wanting to go into ketosis. I'd done enough research to know it wasn't dangerous, but I still resisted the idea on some level. A few months ago I wrote a post stating I didn't think it was necessary for most people. Turns out it may have been just what I needed.

Although it's only been 6 days, the results so far are pretty impressive.  My highest 1-hour postprandial reading has been 128, but most of the time I'm well below 120, and after 2 hours below 100.  I haven't seen numbers like this in such a long time, and I must say it's a welcome change!  In addition, I feel great, with more energy and focus but less 
hunger -- not a  surprise given my previous unstable postprandial blood sugar coupled with the appetite suppression of ketosis.  I've lost a couple of pounds, which I know is water. I routinely count calories when I eat (again, that dietitian training!), and I'm consuming the same 1500-1800 I've been doing for years, so I don't anticipate losing any additional weight, nor do I want to.  I know I'll be perfectly happy eating a very small amount of fruit and avoiding starches entirely (maybe a small bite of dessert once in a while). Not to sound obnoxious, but anyone who knows me personally would say I'm a pretty disciplined eater (sometimes annoyingly so). In addition, I like all kinds of food and look forward to experimenting with very-low-carbohydrate recipes.

It's quite apparent to me that eating at a ketogenic level is not only safe but could be very desirable for people with blood sugar or weight management issues. In my previous post, I said, "Starting off at ketogenic levels may provide a psychological benefit due to early rapid weight loss that usually occurs, but there is certainly no indication to remain in perpetual ketosis for weight management purposes." But maybe for some people eating at this level indefinitely is appropriate. The T4 to T3 conversion problem I mentioned in that post most likely is due to cutting calories and losing weight rather than lower carb intake per se, as it occurs with all types of diets. I know that several doctors who follow the same VLCKDs they prescribe for their patients -- including but not limited to Dr. Steve Phinney, Dr. Jeff Volek, Dr. Jay Wortman, and Dr. Richard K. Bernstein -- enjoy this way of eating, remain very healthy, and plan to continue for the foreseeable future. Of course, I still feel people should decide how many carbs they feel comfortable eating based on their blood sugar levels, weight, and most importantly how they feel. I don't think a ketogenic diet (or a nonketogenic low-carb diet, for that matter)  is for everyone, and I may ultimately decide it's not the best fit for me. But I'm excited to learn more about the benefits of eating very low carb and will likely be blogging about these sometime soon.

***  I will end with my standard advice to always consult with your physician prior to adopting a low-carbohydrate diet or making any other dietary changes. You may also find the following books very helpful:
The Art and Science of Low Carbohydrate Living by Dr. Stephen D. Phinney and Dr. Jeff  S. Voleck
Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars by Richard K. Bernstein, M.D.


References:
1. Yancy WS, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab 2:34, 2005 
2. Mavropoulos JC, et al. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab 2:35, 2005 
3. Manninen AH. Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood "Villains" of Human Metabolism. J Int Soc Sports 1(2)7-11, 2004. 

---