[Ketogenic] I'm in ketosis...now what ?

[Joyful]

Hi, guys. Okay, so I've been doing the paleo/keto diet on my own now for almost a month. I tested w/ the ketostix last night and am somewhere b/t the small and moderate - I guess that means I'm in ketosis, but now what do I do ?
Keep eating the same ? Change something ? Not really sure where I'm going w/ this. I can say that my last seizure was on March 17. It was a grand mal, but haven't had any since.

Any advice ?

 

[Pricilla]

You can sort of play around with it, for example if you test in the dark range and eat more carbs the next day it will turn lighter. Then you can back off carbs and alter your diet a bit and when you test again it will be dark. However the amount you exercise and activity level plays a part because your body will use the ketones for energy. I think if you are in ketosis it doesn't matter which color it is, you are still in it. it just matters how much your body is using vs how much is disposed in the urine. Ive read people who have been in a really long time don't even register, but they are still in it and eating the same things, and loosing weight.
Someone can correct me if I'm wrong, but thats what I've experienced so far.

 

[MrE]

The key to ketosis is in ur toes...

jk...just use your best calm judgement...but have an aggressive attitude like Judge Dredd...

Hope that helps 8)

 

[Joyful]

Thanks, Pricilla. So what does all of this mean ? I think I need to do more research on the ketogenic diet to find out just what it is I'm trying to do here - yes, you read that correctly! I mean, I know that w/ the keto. diet you are supposed to get yourself in ketosis - but not sure why. Does being in ketosis help prevent seiizures ? Is my goal w/ all of this to stay in ketosis so to prevent the seizures ?

Please excuse my ignorance on this!

 

[Pricilla]

it has been proven in children to reduce or eliminate seizures. I just read an update on here from @karenb in the thread called Efficacy of Ketogenic Diet and it has lots of links and her son is now seizure free. (congrats to her and her son!)

I don't think there are the same results documented in adults, but I found out about it doing research after my first episodes and thought "well it can't hurt right?"

I just started reading all I could on the internet finding recipes and advice. Thats what led me here

others may be much more helpful as they have been at this a lot longer than i have.

 

[Joyful]

Thanks again. I've been learning alot about it - did some more research of my own.

What I've got to do now is follow some type of meal plan - my books should be in by today or tomorrow - am using the internet for ideas 'till then.

The following is a quote from the epilepsy foundation
website in reference to the ketogenic diet:

" The diet is usually not recommended for adults, mostly because the restricted food choices make it hard to follow. Yet, studies done on the use of the diet in adults show that it seems to work just as well."

So, it seems likely that it should help adults also - I don't think it's that hard to follow.

 

[Pricilla]

i can't remember where i found it (I've been all over) but there was a meal plan this guy made and he had the nutritional data right beside each one that showed the carbs, fiber, so forth.
I copied his meal plan and then branched out using his as my template. It worked pretty well.
i don't think its that hard to follow either!!! I just switched out the bad things like flour for almond flour and made some adjustments. I have not missed or craved one thing, and feel satisfied and full all day. it takes getting used to it, but now I'm good.
the hard thing is eating out at resturaunts, but since i can't drive I've been eating at home all the time, and that is a breeze!

 

[Bernard]

FYI, ketosis may not even be the key factor in controlling seizures. This was reported back in 2006 as a result of initial research in the Modified Atkins Diet (and Low Glycemic Index Treatment diet):

This study raises important questions on the current use of the traditional ketogenic diet. The first is whether higher ratios with more fat, less protein, and fewer carbohydrates are truly necessary for efficacy. Our results also question whether ketosis is as important as previously reported (10,12). Eighty percent of children with a loss of large urinary ketosis over the study period did not lose seizure control, and the same percentage with trace or zero ketosis at 6 months were still improved. Preliminary efficacy of a low–glycemic index diet with lower levels of ketosis also suggests this may be accurate (13).

We had some discussion some time ago with Dr. Mainardi (starts here, but it's a bit hard to digest) discussing a possible explanation for the therapeutic mechanism, but to my knowledge, nothing has been determined conclusively yet.

 

[masterjen]

I just wish you were doing this under direct medical care. Where I live the epilepsy department will support an adult patient's choice to start the ketogenic diet however they do extremely close monitoring, even involving a hospital stay in the starting phase in some cases. The rational for this is that even the initial phases of the diet change is seen as a stress to the body, and may trigger seizures and/or drastic changes in body chemistry that can be life-threatening. The diet seems to be less of a risk for children in these respects, from what I have read.
I do wish you luck though, of course, that the diet works for you and I look forward to reading updates as to how you are doing

 

[Cint]

The following is a quote from the epilepsy foundation
website in reference to the ketogenic diet:

" The diet is usually not recommended for adults, mostly because the restricted food choices make it hard to follow. Yet, studies done on the use of the diet in adults show that it seems to work just as well."

So, it seems likely that it should help adults also - I don't think it's that hard to follow.

Maybe the diet isn't that hard to follow, but you need to make sure you're still getting the vitamins and minerals your body needs because the diet as well as the AEDs can deplete the body of these. So, are you also seeing a dietician?

I have Diabetes and because I basically follow the low-carb diet, my endocrinologist says I am low in Vitamin D, due to Keppra. I also see the dietician at his office on occasion.

http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

Because the diet does not provide all the vitamins and minerals found in a balanced diet, the dietician will recommend vitamin and mineral supplements. The most important of these are calcium and vitamin D (to prevent thinning of the bones), iron, and folic acid.

 

[Cint]

I just wish you were doing this under direct medical care. Where I live the epilepsy department will support an adult patient's choice to start the ketogenic diet however they do extremely close monitoring, even involving a hospital stay in the starting phase in some cases. The rational for this is that even the initial phases of the diet change is seen as a stress to the body, and may trigger seizures and/or drastic changes in body chemistry that can be life-threatening. The diet seems to be less of a risk for children in these respects, from what I have read.

:agree: Especially when the adult has TC seizures, they do need to be closely monitored in the hospital as these seizures could be life-threatening. The keto-diet is less of a risk for kids. It was originally designed by the Epilepsy Foundation for kids with hard to control seizures, particularly for Lennox-Gastaut Syndrome.

 

[AlohaBird]

I have lived in some level of ketosis for most of the past six years. Never been hospitalized, never saw a dietician. It's really not that hard. It's really not that drastic.

And calling a ketogenic diet nutritionally imbalanced is silly. Ketogenic foods, e.g. meat, eggs, green veggies, are some of the most nutrient dense foods in the world. A person in ketosis is definitely getting more fat in their diet that the average person but they are also getting way more nutrients than their pizza and soda eating friends.

That said, the issue of AEDs hindering nutrient absorption is a real concern so a supplement might be a good idea but this is true for everyone on AEDS. It's not about the ketosis.

A typical ketogenic day's food for me might be this:

Eggs for breakfast
A protein smoothie with banana and coconut cream for lunch
A steak with a side of asparagus for dinner

Yep, we have to call in dietitians and doctors to see if something that radical is safe.

 

[Joyful]

Okay, well tonight I wasn't home and we HAD to pick up some fast food. I ordered a double burger, just the meat, no bun or anything else. I hope that didn't mess things up!

 

[Matthew74]

I'd like to chime in. I'm a big fan, but Ketogenic diets can be dangerous! I did less than 20g of carbs between October and January, with something more liberal the summer before. My ketosticks were 40 to 80. Over time my nearly (or actually) constant simple partials all but disappeared. I felt better, my brain fog was gone, I had more energy, and could get along with hardly any sleep when necessary. However, it caused or contributed to some problems which can be summed up as aging at a tremendous pace. I'm sure I wasn't getting enough nutrition, and I'm not sure that my body was able to handle all the the fat. I'm off the diet now and my seizures are coming back. Children on the diet experience a slowing of growth, which they can make up once they get off the diet. Kidneystones can be a problem. Constipation is a problem.

Based on my experience I would say that no one should do it without an epileptologist and a nutritionist who really know what they are doing. Johns Hopkins has an adult program. Something that would help a lot is getting a nutritionist to sign you up for the Charlie Foundation Ketocalulator, which will take a lot of guesswork out of it and help you maximize nutrition. If you are doing something less extreme, like Atkins, etc. it may not be as critical, but I would still advise regular blood tests with a team that knows what they are doing. I DID have a team, but they didn't know what they were doing, and were no help. Eventually I saw a qualified dietician, but it was too late.

I would consider doing it again in time with proper help. The hardest thing is locating food. If you don't have a great grocery everything is low fat and crammed full of sugar. Even the carbs in heavy cream start to add up. Sugar free stuff isn't. You have to be careful about quantities of vegetables. I REALLY missed healthy food. After the diet, the first time I ate a whole pear I thought I was in heaven. About the only thing you can safely order in a restaurant is a bunless cheeseburger (no American cheese) with bacon. You have to take cream with you everywhere.

Less restrictive diets are great if they are working for you. One thing the diet did for me is enlighten me as to how much pointless corn syrup and other added sweeteners are in everything. Carbs per se, like fruit, vegetables, or grains aren't bad for you (unless you are allergic). The gallons of corn syrup in low fat products is. No wonder people are so fat, it's not because they have pasta once and a while, it's because there are more than 2 tablespoons of sugar in fat free yogurt!

 

[AlohaBird]

Hold the phone. A sub 20g/day of carb diet IS extreme and potentially dangerous but that is not at all necessary for ketosis. Matthew, it sounds like you took a good thing and pushed it too far. (Although I'm not sure what you mean about "aging at a tremendous pace" as a symptom. How do you measure that?)

This is a helpful program for calculating your dietary requirements for a sensible keto diet.
http://keto-calculator.ankerl.com

Also , the "old school" extreme keto diets once used for extreme cases of refractory pediatric epilepsy have a major flaw in them IMO in that they relied so heavily on dairy products. This is the cause of the reported digestive and kidney stone issues. If you structure your plan around meat, eggs, and fish with side orders of green veggies and occasional fruit, there is no problem. What kind of grocery store does not stock meat, eggs, fish, veggies, and fruit?

I totally agree that it is reprehensible how much sugar is put in products just to tickle your tastebuds and get you to eat more. That does not mean that pasta is benign however. Pasta and all flour products turn into sugar the minute they hit your blood stream. Whole wheat bread actually causes a greater blood sugar spike than a candy bar.

 

[Matthew74]

You are right it is extreme, but my ratio of fat to protein and carbs was only 2:1 or 1:1, where kids start on 4:1 and often stay on 3:1. It was only by reducing my carbs so low that I was able to get good results. Even then I never got to reduce my meds.

The problem with the fruits and veggies was that the quantities I could eat were so small that I couldn't eat them like a normal person. Toward the end I tried adding them in more, but had to do things like eat a quarter of a small apple a day (decadence), or a little pinch of green beans, and a prune. Otherwise I stuck to leafy vegetables and radishes. I used to lust after bananas, apples, and bunches of asparagus!

My problems. After I had begun low carb for the FIRST TIME IN MY LIFE the following things happened. This is like a 6 month period. I got little blood spots on my skin. I got grey hair in my beard. I began having prostate symptoms. An old back injury slowly got worse until suddenly it became disabling, at the end I was essentially bed ridden. This is because the herniated disk I had tripled or more in size from July to February. I had to have surgery. My cholesterol, which wasn't checked before I went on the diet, continued to increase to abnormal levels, which isn't supposed to happen. I was always constipated. I got microscopic crystals in my urine, which is a risk of kidney stones. My calcium got too high. My creatinine level got too low. This is just my experience, which I know is unusual.

I only wanted to point out that if you are trying to push ketones you have to reduce carbs and increase fat in some form, and it can cause problems for some people. You really have to maximize nutrition through eating as much vegetables and fruit as you can, along with supplements, and it can be hard to do without a lot of guidance and planning. If I had had more help I might have done better and not had so many problems.

 

[Matthew74]

It's a tragedy that dietary therapy, in any form, is not available for adults at most of the worlds best hospitals. We know it works.

 

[AlohaBird]

Wow. That sounds like you had a whole host of health issues clustering. Hard to sort out cause and effect there. E.g. the prostate issues you mentioned could be the cause of a lot of your other complaints. it sounds like your hormonal system was out of whack.

I'm not convinced that lowering carbs was the root however. If you were not getting adequate nutrients, that could be part of the puzzle. High carb foods such as grains however are really very low in anything resembling nutrients. If you were getting a lot of your calories from whipping cream (you mentioned carrying it with you everywhere) that could also be a big factor. Dairy sensitivity (which does not have to be GI related) can cause systemic inflammation which may have had something to do with you disk problem. Not to mention the hormones that are fed to lactating cows.

I agree that a keto diet does need to be well thought out (not just eating sticks of butter and thinking that magically makes everything right.) The point I was trying to make though is that it is perfectly doable with a modest amount of net research.

Also just because you are going ketogenic does not mean you need to get carbophobic. That sounds like that is what happened to you with you 1/4 apple. Sub 20g/day carbs is into carbophobia land. If you stay with under 50 a day, a lot more culinary possibilities open up without compromising ketosis.

Some resources I recommend for anyone who is interested:

"Primal Body, Primal Mind" the website and book title by Nora Gedgaudas
Livin' La Vida Low Carb website and book "Keto Clarity" by Jimmy Moore
"The Art and Science of Low Carbohydrate Living" by Phinney and Volek.
The website of Dr. Georgia Eades diagnosisdiet.com

 

[AlohaBird]

It's a tragedy that dietary therapy, in any form, is not available for adults at most of the worlds best hospitals. We know it works.

:agree: This is why we take matters into our own hands.

 

[Joyful]

I guess I should mention here that I'm not really on the ketogenic diet per say. I mean I don't weigh or measure my food or anything like that. I guess what I'm doing is a combination keto/paleo, meaning that I've simply cut out all grains, dairy, legumes and sugars. Plus I use coconut oil and extra virgin oive oil alot. But, I am in ketosis.

I also agree w/ the above statement.