The good, the bad, and the confusing. . . . I am fascinated by this experience and I love this diet, but it continues to leave me with more questions than answers. This week, my biggest challenge was being sick on a ketogenic diet and the associated struggles with maintaining ketosis and energy.
Note: this post was originally published on Aug 1, 2013. It was edited to streamline content and improve graphics in June 2016; therefore some older comments may pertain to content that was removed during revision.
This post is part of a series describing my attempt to follow Dr. Seyfried's dietary recommendations for cancer. To start at the beginning, please go to the first post: "Seyfried’s Ketogenic Cancer Diet: My Fasting Jump-Start to Ketosis."
Day 15 (2/14/13)
Notes: Sleep was terrible—slept for 3 hours then wide awake from 1:30 am to 5:00 am, then back to sleep, slept through the alarm. Woke up with mild headache and dry eyes, and felt slightly bloated. Mild cough and sore throat. Not hungry at all in the morning.
Day 16 (2/15/13)
Notes: Mild headache and dry eyes in the morning. Slightly bloated. Cold symptoms continue. Appetite was nice and low and I was able to work a very full and busy day without any problems other than feeling a little irritable. Sleep horrendous again.
Day 17 (2/16/13)
Notes: A bit hungry in the morning (stomach growly, slightly lightheaded). Cold symptoms worsening. No dry eyes (no olives yesterday). One hour after eating leg of duck I felt sleepy and achey. I wonder if the meat wasn't fresh enough (it was one of those vacuum-packed meats with a longer shelf life) or if the protein grams were too many too eat all at once? I checked my blood sugar out of curiosity and it was 84. I napped for 90 minutes. I avoided olives, vinaigrette, bacon, and avocado today. Slept MUCH better.
Day 18 (2/17/13)
Notes: Cold symptoms worsening. Appetite very low today. By 7 pm, I had only eaten about 500 calories and was not hungry at all. Sleep did suffer; I slept from 10:30pm to 1:15 am, and then again from 4:30 am to 7:15 am. At least this tells us that the vinaigrette itself, without any avocado or bacon, is enough to throw my sleep off significantly. Ketones much lower this morning, but I suspect this was due to that duck leg—one problem with unprocessed meats is that you can only estimate their nutritional content, as it varies so much and is never listed on the package. All you can do is weigh it, look it up on line (where all the values are different), and hope for the best.
Day 19 (2/18/13)
Notes: Cold is much worse today. I was nervous about trying the Emergen-C drink because it is sweet, but it only has 6 g of carbs. I don't really believe in vitamin supplements but thought I'd give it a try. Appetite remains very low. I slept beautifully.
Day 20 (2/19/13)
Notes: Cold symptoms improving. Today I've started a mostly-meat diet so I can eliminate more variables and see if I can get to the bottom of these patterns.
I was a bit hungry today—occasional stomach growling, occasional visions of bowls of ice cream dancing in my head—but we're talking mild, easily ignored, fleeting thoughts. I don't know if this was because my ketones were lower, or I was withdrawing from carbohydrates (did zero carb for first time today). Slept most of the afternoon.
Day 21 (2/20/13)
Notes: Woke with dry eyes, achy. Fatigue, cough continue from my cold (which I'm renaming the Virus from the Underworld). Hungry first half of day (stomach gurgly, slightly lightheaded, vision slightly blurry) so ate all my protein by 2pm, then slept the rest of the afternoon, and woke up feeling much better. I took the advice of one of my readers (SS) and tried roasting some beef fat. However, I never did get hungry, so I had a small amount just to try it and walked away. Slept beautifully.
Reflections on week 3
One consistent sensation I've had during the past 3 weeks has been an awareness of my heartbeat. For the most part, it's not faster than usual, just more noticeable. Actual pulse never higher than about 80.
Blood sugars were higher most of this week, but this may have been due to the Virus from the Underworld. Illness, inflammation, injury, stress—all of these things can temporarily raise cortisol levels (the body's stress hormone), which, in turn, cause an increase in blood sugar. Diabetics are no stranger to this phenomenon, because they have to adjust their medications during illness accordingly. Unfortunately, I switched to zero carb at around the same time my cold turned a corner and my blood sugars were turning a corner, so can't be completely sure which factor was more important.
Being sick on a ketogenic diet
Since changing my diet about five years ago, I have rarely been sick. Prior to that, I used to be quite susceptible to catching whatever was going around, but since 2008 I have had, at most, one mild cold every winter—typically lasting only a couple of days, and usually not bad enough for me to call in sick to work.
The arrival of the Virus from the Underworld makes me wonder if this diet has weakened my immune system somehow, or if at least the transitional process of keto-adaptation has temporarily affected my resilience to viral infection. Of course there's no way to know for sure. For all I know, this virus would have been ten times worse if I'd been eating a standard high-carb diet. Time will tell. I am reassured by the fact that many people I know have had more colds and flu-like illnesses this winter than usual, so it could just be a bad year.
Another possibility is that my terrible sleep (caused by foods that don't agree with me) weakened my ability to fight off the little devils. This is likely to have been a contributing factor, regardless.
A third possibility was that eating foods that don't agree with me weakens my immune system. My usual diet is a mostly meat diet with a few cucumbers, some lettuce, a few olives, and small amounts of other plants that don't bother me too much. I don't typically eat bacon or avocado, or if I do, I only eat a little bit. I had added them in this month to increase my calories and fat because I had to limit my meat intake so much. But it's clear I can't get away with that. It could be that these foods added to my body's histamine load and worsened my cold symptoms. [Please see my post "Freshness Counts: Histamine Intolerance"]
One thing I can say for certain is that this extremely low-carbohydrate diet has NOT caused mucin deficiency. Believe you me, I would have WELCOMED a mucus deficiency with open arms. The belief that "glucose deficiency" makes it hard for the body to produce mucus has not proved true in my particular case, and I have the stack of empty Kleenex boxes to prove it. If that stuff had a street value, I could have paid off my medical school debt by now.
Weight loss and ketosis
I did not embark on this experiment with the purpose of losing weight, but it is interesting to note the steady weight loss. I have never been on any diet for three weeks and seen the scale reading go down every single day. In fact, I have never experienced any three-week period without at least a few fluctuations upward. I just always thought they were par for the course.
I know what many of you must be thinking: "Of course she's losing weight—she's eating so few calories!" True enough. But I'm not one of those people who believes that calories don't matter. I used to WANT to believe that, but my life experience has told me otherwise. But here's the thing: there is no way in the world that I could eat this few calories comfortably on any other diet on the planet. I am not intentionally keeping my calories low. I am simply not hungry most of the time.
Hunger is different in ketosis
Hunger while in ketosis, as I've mentioned before, is a completely different experience than on any other diet I've tried. It manifests as a bit of subtle stomach growling and a funny feeling in my head—not quite lightheadedness or headache—it's hard to describe. It's very intellectualized: "I should eat something soon." And if I don't or can't eat something for a while, nothing bad happens. The feeling simply persists until I have something to eat—a surprisingly small amount of food will take those feelings away within a matter of minutes. This diet is peaceful. I do not think about food (except when I'm planning my meals, doing my calculations, and writing about it). I am completely free of food obsessions, "emotional eating", and all of the physical and emotional symptoms that typically accompany a standard diet (whether I'm trying to lose weight or not).
Ideal protein intake
I have a lot of information about this topic on my protein page, but here are my estimates:
- The IOM recommends I eat at least 53.5 grams per day
- The WHO recommends I eat at least 51 grams per day
- Phinney and Volek, in two of their books, recommend I eat at least 75 grams per day, based on my height. That was clearly too much for me, as evidenced by my Week 1 experiment. However, in their book The Art and Science of Low Carbohydrate Performance, they recommend I base my protein intake on lean body mass instead, which would translate to 57 grams per day.
- Dr. Rosedale recommends I eat 77 grams per day, based on my body measurements, but 47 grams per day, based on my estimated lean body mass (using my home Tanita scale—which I recommend).
- One of my especially savvy readers, melancholyaeon, recommended 50-60 g of protein per day. (She was quite right about its dramatic effect on blood sugar!)
For one more week, unless anything happens to suggest my protein is too low, I'll leave it at 50-52 grams per day and see how it goes.
Goals for week 4
- Add exercise to see how it affects ketosis and blood sugar
- Continue zero-carb, all-meat diet with only olive oil and splashes of lemon juice as non-animal foods.
- See if I can get back into Seyfried's "zone" (blood sugars 65 mg/dl or below and ketones at least 4.0 mM)
- It will be nice to have this cold behind me because it's really throwing a monkey wrench into my experiment. But we learn from these real life experiences regardless . . .
To see whether I reached any of these goals, read the next post "Keto for Cancer: Week 4—Keto-adaptation Challenges." If you are interested in starting a ketogenic diet yourself, see my online guide: "Ketogenic Diets 101."
Gilbert DL, Pyzik PL, Freeman JM. The ketogenic diet: seizure control correlates better with serum beta-hydroxybutyrate than with urine ketones. J Child Neurol. 2000;15(12):787-790.
van Delft R, Lambrechts D, Verschuure P, Hulsman J, Majoie M. Blood beta-hydroxybutyrate correlates better with seizure reduction due to ketogenic diet than do ketones in the urine. Seizure. 2010;19(1):36-39.