Tag Archives: ketogenic diet

March 12, 2013 · 8:12 AM

Potential Problems With Major Carbohydrate Restriction

Caprese salad, naturally low-carb

Caprese salad, naturally low-carb

Ketogenic Diets

First, let’s define ketogenic diets.  For most folks, that means eating under 50 grams of digestible carbohydrate daily.

Your body gets nearly all its energy either from fats, or from carbohydrates like glucose and glycogen. In people eating “normally,” 60% of their energy at rest comes from fats. In a ketogenic diet, the carbohydrate content of the diet is so low that the body has to break down even more of its fat to supply energy needed by most tissues. Fat breakdown generates ketone bodies in the bloodstream. Hence, “ketogenic diet.” Also called “very-low-carb diets,” ketogenic diets have been around for over a hundred years.

What Could Go Wrong?

Long-term effects of a very-low-carb or ketogenic diet in most people are unclear—they may have better or worse overall health—we just don’t know for sure yet. Perhaps some people gain a clear benefit, while others—with different metabolisms and genetic make-up—are worse off.

If the diet results in major weight loss that lasts, we may see longer lifespan, less type 2 diabetes, less cancer, less heart disease, less high blood pressure, and fewer of the other obesity-related medical conditions.

Ketogenic diets are generally higher in protein, total fat, saturated fat, and cholesterol than some other diets. Some authorities are concerned this may increase the risk of coronary heart disease and stroke; the latest evidence indicates otherwise.

Some authorities worry that ketogenic diets have the potential to cause kidney stones, osteoporosis (thin, brittle bones), gout, and may worsen existing kidney disease. Others disagree.

Soon after adoption of very-low-carb eating, dieters may have headaches, bad breath, easy bruising, nausea, fatigue, aching, muscle cramps, constipation, and dizziness, among other symptoms. “Induction flu” may occur around days two through five, consisting of achiness, easy fatigue, and low energy. It clears up after a few days.

Very-low-carb ketogenic diets may have the potential to cause  low blood pressure, high uric acid in the blood, excessive loss of sodium and potassium in the urine, worsening of kidney disease, deficiency of calcium and vitamins A, B, C, and D, among other adverse effects.

Athletic individuals who perform vigorous exercise should expect a deterioration in performance levels during the first three to four weeks of any ketogenic very-low-carb diet. The body needs that time to adjust to burning mostly fat for fuel rather than carbohydrate.

Competitive weight-lifters or other anaerobic athletes (e.g., sprinters) will be hampered by the low muscle glycogen stores that accompany ketogenic diets. They need more carbohydrates.

What About Adherence to the Diet?

It’s clear that for many folks, compliance with very-low-carb diets is difficult to maintain for six to 12 months.  Some can’t do it for more than a couple weeks. Potential long-term effects, therefore, haven’t come into play for most users. When used for weight loss, regain of lost weight is a problem—but regain is a major issue with all weight-loss programs. I anticipate that the majority of non-diabetics who try a ketogenic diet will stay on it for only one to six months. After that, more carbohydrates can be added to gain the potential long-term benefits of additional fruits and vegetables, legumes, and whole grains.

Or not.

People with type 2 diabetes or prediabetes may be so pleased with the metabolic effects of the ketogenic diet that they’ll stay on it long-term.

The most famous ketogenic diet is Dr. Atkins New Diet Revolution.  I’ve put together one call the Ketogenic Mediterranean Diet.

Steve Parker, M.D.

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February 12, 2013 · 7:32 AM

Once Again, Low-Carbohydrate Ketogenic Diet Beats Low-Calorie For Overweight Diabetes

Kuwait City and Towers

Kuwait City and Towers

A low-carbohydrate ketogenic diet is safe, effective, and superior to a low-calorie diet in type 2 diabetics, according to a report last year in Nutrition.

Kuwaiti researchers gave 102 adult overweight diabetic men and women their choice of diet: 78 chose ketogenic, 24 went low-calorie.  Average age was 37, average weight 211 lb (96 kg).  The study lasted six months.  The ketogenic diet was very much Atkins-style, starting out at 20 grams of carbohydrate daily.  Once good weight-loss progress was made, and if carb cravings were an issue, dieters could increase their carbs in small increments weekly.

This is all they said about the low-calorie diet: “Participants in the low-calorie diet group were given appropriate guidelines and a sample low-calorie diet menu of 2200 calories is presented in Table 1” (it’s typical and reasonable).

What Did They Find?

The low-carb ketogenic dieters lost 12% of body weight, compared to 7% lost by the low-calorie dieters.  Furthermore, the ketogenic dieters showed significant lowering of total cholesterol, LDL cholesterol (bad cholesterol), and triglycerides.  HDL cholesterol (good cholesterol) rose.  The low-calorie dieters seem to have had a significant drop in LDL cholesterol, but no changes in the other lipids.

Fasting blood sugar levels dropped significantly in both groups, but more in the ketogenic dieters.  Both groups started with fasting blood sugars around 162 mg/dl (9 mmol/l) and fell to 108 mg/dl (6 mmol/l) in the ketogenic group and to 126 mg/dl (7 mmol/l) in the low-calorie group.

Glycosylated hemoglobin (hemoglobin A1c) levels fell in both groups, more so in the ketogenic dieters.  The drop was statistically significant in the ketogenic group, but the authors were unclear about that in the low-calorie dieters.  It appears hemoglobin A1c fell from 7.8% to 6.3% with the ketogenic diet (the units given for glycosylated hemoglobin were stated as mg/dl).  In the low-calorie dieters, hemoglobin A1c fell from 8.2 to 7.7%.

What’s Odd About This Study?

The title of the research report indicates a study of diabetics, but only about 25% of study participants had diabetes (total subjects = 363).  (The figures I share above are for the diabetics only.)

Glycosylated hemoglobin, a test of overall diabetes control, is reported in Fig. 1 in terms of mg/dl.  That’s nearly always reported as a percentage, not mg/dl.  Misprint?

None of the participants dropped out of the study.  That’s incredible, almost unbelievable.

The low-calorie diet was poorly described.  Were 140-lb women and 250-lb men all put on the same calorie count?

Food diaries were kept, but the authors report nothing about compliance and actual food intake.

Clearly, some of these diabetics were on insulin and other diabetic drugs.  The authors note necessary reductions in drug dosages for the ketogenic group but don’t say much about the other dieters.  They imply that the drug reductions in the low-calorie group were minimal or nonexistent.

Grand Mosque of Kuwait

Grand Mosque of Kuwait

So What?

Calorie-restricted diets are effective in overweight type 2 diabetics, but ketogenic diets are even better.

The effectiveness and safety of ketogenic diets for overweight type 2 diabetics has been demonstrated in multiple other populations, so this study is not surprising.  We’ve seen these lipid improvements before, too.

The favorable lipid changes on low-carb ketogenic diets would tend to reduce future heart and vascular disease.

I know little about Kuwaiti culture and genetics.  Their contributions to the results here, as compared with other populations, is unclear to me.  Type 2 diabetes is spreading quickly through the Persian Gulf, so this research may have wide applicability there.

Steve Parker, M.D.

Reference:  Hussain, Talib, et al.  Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes.  Nutrition, 2012; 28(10): 1016-21. doi: 10.1016/j.nut.2012.01.016

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July 21, 2011 · 2:00 AM

Spanish Ketogenic Mediterranean Diet Cures Metabolic Syndrome

The very-low-carb Spanish Ketogenic Mediterranean Diet cures metabolic syndrome, according to investigators at the University of Córdoba in Spain. 

The metabolic syndrome is a collection of clinical factors that are linked to high risk of developing type 2 diabetes and heart disease.  Individual components of the syndrome include elevated blood sugar, high trigylcerides, low HDL cholesterol, high blood pressure,  and abdominal fat accumulation.

Spanish researchers put 26 people with metabolic syndrome on the Spanish Ketogenic Mediterranean Diet for twelve weeks and monitored what happened.  At baseline, average age was 41 and average body mass index was 36.6.  Investigators didn’t say how many diabetics or prediabetics were included.  No participant was taking medication.

What’s the Spanish Ketogenic Mediterranean Diet?

Calories are unlimited, but dieters are encouraged to keep carbohydrate  consumption under 30 grams day.  They eat fish, lean meat, eggs, chicken, cheese, green vegetables and salad, at least 30 ml (2 tbsp) daily of virgin olive oil,  and 200-400 ml of red wine daily ( a cup or 8 fluid ounces  equals 240 ml).  On at least four days of the week, the primary protein food is fish.  On those four days, you don’t eat meat, chicken, eggs, or cheese.  On up to three days a week, you could eat non-fish protein foods but no fish on those days. 

How’s this different from my Ketogenic Mediterranean Diet?  The major differences are that mine includes one ounce (28 g) of nuts daily, less fish overall, and you can mix fish and non-fish protein foods every day.

Regular exercisers were excluded from participation, and my sense is that exercise during the diet trial was discouraged. 

What Were the Results?

Metabolic syndrome resolved in all participants.

Three of the original 26 participants were dropped from analysis because they weren’t compliant with the diet.  Another one was lost to follow-up.  Final analysis was based on the 22 who completed the study.

Eight of the 22 participants had adverse effects.  These were considered slight and mostly appeared and  disappeared during the first week.  Effects included weakness, headache, constipation, “sickness”, diarrhea, and insomnia. 

Average weight dropped from 106 kg (233 lb) to 92 kg (202 lb).

Body mass index fell from 36.6 to 32.

Average fasting blood sugar fell from 119 mg/dl (6.6 mmol/l) to 92 mg/dl (5.1 mmol/l).

Triglycerides fell from 225 mg/dl to 110 mg/dl.

Average systolic blood pressure fell from 142 mmHg to 124.

Average diastolic blood pressure fell from 89 to 76.

So What?

A majority of people labeled with metabolic sydrome continue in metabolic sydrome for years.  That’s because they don’t do anything effective to counteract it.  These researchers show that it can be cured in 12 weeks, at least temporarily, with the Spanish Ketogenic Mediterranean Diet.

ResearchBlogging.orgVery-low-carb diets are especially good at lowering trigylcerides, lowering blood sugar, and raising HDL cholesterol.  Overweight dieters tend to lose more weight, and more quickly, than on other diets.  Very-low-carb diets, therefore, should be particularly effective as an approach to metabolic syndrome.  It’s quite possible that other very-low-carb diets, such as Atkins Induction Phase, would have performed just as well as the Spanish Ketogenic Mediterranean Diet.  In fact, most effective reduced-calorie weight-loss diets would tend to improve metabolic syndrome, even curing some cases, regardless of carb content. 

Most physicians recommend that people with metabolic syndrome either start or intensify an exercise program.  The program at hand worked without exercise.  I recommend regular exercise for postponing death and other reasons.

Will the dieters of this study still be cured of metabolic syndrome a year later?  Unlikely.  Most will go back to their old ways of eating, regaining the weight, and moving their blood sugars, triglycerides, and HDL cholesterols in the wrong direction.

Steve Parker, M.D.

Reference: Pérez-Guisado J, & Muñoz-Serrano A (2011). A Pilot Study of the Spanish Ketogenic Mediterranean Diet: An Effective Therapy for the Metabolic Syndrome. Journal of medicinal food PMID: 21612461

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July 9, 2011 · 10:42 AM

Dr. Jay Wortman Chooses Ketogenic Diet for His Type 2 Diabetes

 The Low Carb Diabetic blog posted a video of Dr. Jay Wortman discussing treatment of his own type 2 diabetes with a very-low-carb ketogenic diet.  Well worth a listen if you’re skeptical about whether it works.

Steve Parker, M.D.

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January 30, 2011 · 7:34 PM

Exercise, Part 3: How Much Is Enough?

Now that you know the health benefits of exercise (see Parts 1 & 2 of this series), it’s a little easier to understand those crazy people you see jogging at 6 a.m. in below-freezing weather. I’m sure you’re ready to join them tomorrow morning. Right?

Here’s some good news. Most people following both the Ketogenic and Low-Carb Mediterranean Diets are able to lose excess weight and improve glucose control without starting an exercise program. Many—but certainly not all—will be able to maintain a stable, reasonable weight and glucose control long-term without ongoing exercise. However, for the reasons previously outlined, I recommend you start a physical activity program eventually.

Later in the series I discuss 1) who needs to get medical clearance from their personal physician before starting an exercise program, and 2) how certain diabetic complications make exercise more dangerous.

(I must warn you that athletic individuals who perform vigorous exercise should expect a deterioration in performance levels during the first three to four weeks of any very-low-carb ketogenic diet. The body needs that time to adjust to burning mostly fat for fuel rather than carbohydrate. Also, competitive weight-lifters or other anaerobic athletes (e.g., sprinters) will be hampered by the low muscle glycogen stores that accompany ketogenic diets. They need more carbohydrates for high-level performance.)

How Much Exercise?

All I’m asking you to do is aerobic activity, such as walk briskly (3–4 mph or 4.8–6.4 km/h) for 30 minutes most days of the week, and do some muscle-strengthening exercises three times a week. These recommendations are also consistent with the American Diabetes Association’s Standards of Care–2011. This amount of exercise will get you most of the documented health benefits. It’s OK if you want to wait until you’ve lost some of your excess weight, but I probably wouldn’t.

For the general public without diabetes, the U.S. Centers for Disease Control and Prevention recommends at least 150 minutes per week of moderate-intensity aerobic activity (e.g., brisk walking) and muscle-strengthening activity at least twice a week, OR 75 minutes per week of vigorous-intensity aerobic activity (e.g., running or jogging) plus muscle-strengthening activity at least twice a week. The muscle-strengthening activity should work all the major muscle groups: legs, hips, back, abdomen, chest, shoulders, arms.

Please note that you don’t have to run marathons (26.2 miles) or compete in the Ironman Triathlon to earn the health benefits of exercise. However, if health promotion and disease prevention are your goals, plan on a lifetime commitment to regular physical activity.

Parts 4 & 5 of this series review strength training and aerobic exercise.

Steve Parker, M.D. 

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December 12, 2010 · 2:00 AM

Ketogenic Diet for Alzheimer’s Disease?

Alzhiemer's is "the long goodbye..."

Ketogenic diets have seen a resurgence in the last two decades as a treatment for childhood epilepsy, particularly difficult-to-control cases not responding to drug therapy.  It works, even in adults.  That’s why some brain experts are wondering if ketogenic diets might be helpful in other brain disorders, such as Alzheimer’s disease and Parkinson’s disease. 

I’ll save you some time and just give you the conclusion of a 2006 scientific article I read: maybe, but it’s way too soon to tell.

ResearchBlogging.orgThe article is called “Neuroprotective and disease-modifying effects of the ketogenic diet,” from researchers at the National Institutes of Health’s National Institue of Neruological Disorders and Stroke.  Sounds promising doesn’t it?

The article goes into detail about how the ketogenic diet might be good for brain health.  Dr. Emily Deans would be very interested in that, but most of my readers not.  Two-and-a-half pages on non-human animal studies, too. 

What is this “ketogenic diet” for epilepsy?

The most common ketogenic diet for childhood epilepsy is the one developed by Wilder in 1921.  It was a popular treatment for epilepsy in the 1920s and 1930s.  Fats provide 80 to 90% of the calories in the diet, with sufficient protein for growth, and minimal carbohydrates.  Since carbs are in short supply, the body is forced to use fats as an energy source, which generates ketone bodies—acetoacetate, acetone, beta-hydroxybutyrate, largely from the liver.

So what?

Not much.  This article may have been written to stimulate future research, and I hope it does.  I just searched PubMed for “ketogenic diet AND Alzheimer” and came up with nothing new since 2006. 

Could the Ketogenic Mediterranean Diet prevent or alleviate Alzheimer’s disease?  At this point, just flip a coin.

Steve Parker, M.D.

Reference: Gasior M, Rogawski MA, & Hartman AL (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioural pharmacology, 17 (5-6), 431-9 PMID: 16940764

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November 22, 2009 · 2:00 AM

Low-Carb Ketogenic Diet for Overweight Diabetic Men: A Pilot Study

A low-carb ketogenic diet in patients with type 2 diabetes was so effective that diabetes medications were reduced or discontinued in most patients, according to U.S. researchers.  The 2005 report recommends that similar dieters be under close medical supervision or capable of adjusting their own medication, because the diet lowers blood sugar  dramatically. 

Methodology

Twenty-eight overweight people with type 2 diabetes were placed on the study diet and followed for 16 weeks.  Seven people dropped out, so the analysis involved 21, of which 20 were men—the study was done at a Veterans Administration clinic.  Thirteen were caucasian, eight were black.  Average age was 56; average body mass index was 42.  The seven dropouts were unable to come to the scheduled meetings or couldn’t follow the diet.  No dropout complained of adverse effects of the diet.

Results

Participants were instructed on the Atkins Induction Phase diet, which daily includes:

  • under 20 g carbohydrate
  • one cup of low-carb vegetables
  • two cups of salad greens
  • four ounces of hard cheese
  • unlimited meat, poultry, fish, eggs, shellfish
  • a multivitamin

At the outset, diabetes medication dosages were reduced in this general fashion: insulin was halved, sulfonyureas were halved or discontinued.  If the participant were taking a diuretic (fluid pill), low doses were discontinued; high doses were halved.

Study subjects returned every two weeks for diet counseling and medication adjustment (based on twice daily glucose readings and episodes of hypoglycemia).  Food cravings and/or good progress on weight goals triggered a 5-gram (per day) weekly increase in carbohydrate allowance.  In other words, if a participant’s weight loss goal was 20 pounds and he’d already lost 10, he could increase his daily carbs during the next week from 20 to 25 g.  Carbs could be increased weekly by five gram increments as long as weight loss progressed.  [This is typical Atkins.]   Food records were analyzed periodically.   

Results

  • hemoglobin A1c decreased from an average baseline of 7.5% down to 6.3% (a 1.2% absolute decrease and 16% relative drop)
  • the absolute hemoglobin A1c decrease was at least 1.0% in half of the participants
  • diabetic drugs were reduced in 10 patients, discontinued in seven, and unchanged in four
  • average body weight decreased by 6.6%, from 131 kg (288 lb) to 122 kg (268 lb)
  • triglycerides decreased 42%, while cholesterols (total, HDL, and LDL) didn’t change significantly
  • no change in blood pressures
  • average fasting glucose decreased by 17% (by week 16)
  • uric acid decreased by 10%
  • no serious adverse effects occurred
  • one hypoglycemic event involved EMS but was treated without transport
  • only 27 of 151 urine ketone measurements  were greater than trace

My Comments

The degree of improvement in hemoglobin A1c—our primary gauge of diabetes control—is equivalent to that seen with many diabetic medications.  I see many overweight diabetics on two or three drugs and a standard “diabetic diet,” and they’re still poorly controlled.  This diet could replace the expense and potential adverse effects of an additional drug.   

In August this year I blogged about a study comparing the Atkins diet with a traditional low-fat diet in overweight diabetic black women in the U.S.  As measured at three months, the Atkins diet proved superior for weight loss and glucose control.

This study at hand is small, but certainly points to the effectiveness of an Atkins-style very low-carb ketogenic diet in overweight men with type 2 diabetes.

Steve Parker, M.D.

Yancy, William, et al.  A low-carbohydrate, ketogenic diet to treat type 2 diabetes [in men].  Nutrition and Metabolism, 2:34 (2005).   doi: 10.1186/1743-7075-2-34

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November 10, 2009 · 2:00 AM

Low-Carb Ketogenic Diet Beats Low-Glycemic Index Diet in Overweight Type 2 Diabetes

42-15653241

Avoid the needle with a low-carb ketogenic diet

Duke University (U.S.) researchers demonstrated better improvement and reversal of type 2 diabetes with an Atkins-style diet, compared to a low-glycemic index reduced-calorie diet.

Methodology

Ninety-seven overweight and obese adults, 78% women and 40% black, were randomly assigned to either:

  • a very low-carb ketogenic diet (Atkins induction phase, as in Atkins Diabetes Revolution) or
  • a low glycemic-index index calorie-restricted diet (The GI Diet by Rick Gallop). 

Thirty-eight were in the Atkins group; 46 in the low-glycemic index (low-GI) group.  Seventeen dropped out of each group before the end of the 24-week study.  Average weight was 234.3 pounds (106.5 kg); average body mass index was 37.  The Atkins group averaged 13% of total calories from carbohydrate; the low-GI cohort averaged 44%. 

Results

Both groups lost weight and had improvements in hemoglobin A1c, fasting insulin, and fasting glucose. 

The Atkins group lowered their hemoglobin A1c by 1.5% (absolute drop, not relative) versus 0.5% in the other group. 

The Atkins group lost 11.1 kg versus 6.9 kg in the other group. 

The Atkins group increased HDL cholesterol by5.6 mg/dl versus no change in the other group. 

All the aforementioned comparisons were statistically significant. 

Diabetes medications were stopped or reduced in 95% of the Atkins group versus 62% of the low-GI group.

Total and LDL cholesterol levels were unchanged in both groups. 

Triglycerides fell significantly only in the Atkins group.

My Comments

You may be interested to know that this study was funded by the Robert C. Atkins Foundation.

One strength of this study is that it lasted for 24 months.  Many similar studies last only eight to 12 weeks.  A drawback is that, with all the drop-outs,  the number of participants is low. 

The GI Diet performed pretty well, too, all things considered.  Sixty-two percent reduction or elimination of diabetes drugs—not bad.  For a six-year-old book, it’s still selling fairly well at Amazon.com.  That may be why they chose it as the comparison diet.

The diet with fewer carbohydrates—Atkins induction—was most effective for  improving control of blood sugars.  So effective, in fact, that the researchers sound a note of warning:

For example, participants taking from 40 to 90 units of insulin before the study were able to eliminate their insulin use, while also improving glycemic control.  Because this effect occurs immediately upon implementing the dietary changes, individuals with type 2 diabetes who are unable to adjust their own medication or self-monitor their blood glucose should not make these dietary changes unless under close medical supervision.  

[Not all insulin users were able to stop it.]

Overall, lipids were improved or unchanged in the Atkins group, despite the lack of limits on saturated fat intake.  A common criticism of the Atkins diet is that it has too much saturated fat, leading to higher total and LDL cholesterol levels, which might raise long-term cardiovascular risks.  Not so, here. 

When you reduce carbohydrate intake, the percentages of fat and protein in the diet also change.  In this Atkins diet, protein provided 28% of daily calories, and fat 59%.  In the low-GI diet, protein provided 20% of daily calories, fat 36%.  The beneficial effects of the Atkins diet probably reflect the low carbohydrate consumption rather than high protein and fat. 

The Atkins induction-phase diet was clearly superior to the low-glycemic index diet in this overweight diabetic sample, without restricting calories.

Steve Parker, M.D.

Reference:  Westman, Eric, et al.  The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus.  Nutrition & Metabolism 2008, 5:36   doi:10.1186/1743-7075-5-36

Additional Reading

Samaha, F., et al.  A low-carbohydrate as compared with a low-fat diet in severe obesity.  New England Journal of Medicine, 348 (2003): 2,074-2,081.

Boden, G., et al.  Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes.  Annals of Internal Medicine, 142 (2005): 403-411.

Vernon, M., et al.  Clinical experience of a  carbohydrate-restricted diet: Effect on diabetes mellitus.  Metabolic Syndrome and Related Disorders, 1 (2003): 233-238.

Yancy, W., et al.  A pilot trial of a low-carbohydrate ketogenic diet in patients with type 2 diabetes.  Metabolic Syndrome and Related Disorders, 1 (2003): 239-244.

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October 3, 2009 · 7:06 PM

My Ketogenic Mediterranean Diet: Day 33 + Magnesium Review

CB022214Weight: 159 lb

Transgressions: 12 oz  of 7-Up carbonated beverage

Exercise: none

Comments

I accidentally drank a 7-Up at the hospital physician’s lounge: the diet 7-Ups were right next to the regular 7-Ups in the refrigerator.  It had 39 g of carbs, all sugar of course.  I didn’t realize what I’d done until too late; the texture finally gave it away.  I rarely drink 7-Up in any case.  My favorite diet soda is Fresca.  Nothing wrong with 1-2 daily for most folks.  If I were going to cheat on purpose, it wouldn’t be with soda pop.  Snickers bar is more like it!

My nutrient analysis of the un-supplemented Ketogenic Mediterranean Diet suggests that it may be deficient in magnesium.  Here’s a summary of magnesium physiology from UpToDate.com and Medscape:

Role of Magnesium

Influences properties of cell membranes.  Helps regulate other mineral levels: sodium, potassium, calcium.  Works with enzymes, particulary in energy production.  Helps with protein production.  Most of our magnesium is in our bones.

Sources

Leafy greens, nuts, legumes, animal proteins.  [All but legumes are on the Ketogenic Mediterranean Diet.]

Effects of Deficiency State

Abnormal EKG (an electrical tracing of heart activity).  Abnormal heart rhythms, especially ventricular arrhythmias.  Weakness, convulsions, loss of appetite, low blood levels of calcium and potassium, seizures, apathy, delirium coma.

Causes of Low Magnesium

Gastrointestinal or kidney losses: vomiting, diarrhea, diuretics, genetic disorders, several kidney-toxic drugs little used in the general population, small bowel bypass surgery, inability to absorb from intestinal tract.

Miscellaneous: marked dietary deprivation, diabetes, alcohol abuse, high blood calcium levels, ketogenic extremely high-fat diets used to suppress epilepsy (usually in children: up to 10% have low magnesium).

Implications

Hmm…, causes of magnesium deficiency include …ketogenic extremely high-fat diets used to suppress epilepsy…  The ketogenic anti-epilepsy diet may be even lower in carbohydrates than is the Ketogenic Mediterranean Diet, so fewer leafy greens (and nut-free?).  Since I don’t treat children with epilepsy, I haven’t done much research into the anti-epilepsy ketogenic diet yet. 

One Centrum multivitamin/multimineral supplement contains only 13% of the recommended “% Daily Value” of magnesium.  Might be a good idea for KMD dieters to take an additional magnesium supplement, probably available over-the-counter at pharmacies, supermarkets, or health food stores.  Or get a blood level of magnesium drawn periodically.

-Steve

 

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September 12, 2009 · 5:55 PM

My Ketogenic Mediterranean Diet: Day 12

MPj03089510000[1]Weight: 162.5 lb

Transgressions: none

Exercise: none

Comments

Finally, some “movement.”  I discovered why I hadn’t lost weight lately.  Constipation.  A known adverse effect of ketogenic weight-loss diets that are often low in fiber.  I’ll admit I’ve been prone to constipation in the past if I didn’t get adequate fiber.  Expert nutrition panels recommend adults eat 25-30 grams of fiber daily.  My average fiber intake for the last three days is 11 grams.  Will start sugar-free Metamucil powder.  TMI? 

-Steve

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