The skeptical cardiologist spent an interesting week in ketoland, counting carbs, and turning ketostix purple, but ultimately decided this was not a world he wanted to inhabit long term. During that week I paid 1.99$ to download William Banting’s “Letter on Corpulence”(available here for free.) Banting, writing in 1869, first popularized a low carb, high fat diet for obesity with this pamphlet. He starts it off with these words:
“OF all the parasites that affect humanity I do not know of, nor can I imagine, any more distressing than that of Obesity, and, having emerged from a very long probation in this affliction, I am desirous of circulating my humble knowledge and experience for the benefit of other sufferers, with an earnest hope that it may lead to the same comfort and happiness I now feel under the extraordinary change,—which might almost be termed miraculous had it not been accomplished by the most simple common-sense means.”
The pamphlet was enormously popular and sold over 60,000 copies. Banting donated his 225 £ of profit to various charities, including:
Charles Dickens, twice President of the Printer’s Pension Society and also did some writing. In the Pickwick Papers, he describes Joe, the Fat boy, who was perpetually falling asleep. Pickwickian Syndrome was the early medical term for what is now sleep apnea.
“£ s.d. To The Printers’ Pension Society, at the Anniversary Dinner, in March, 1864, per Chas. Dickens, Esq. .. .. 50 0 0″
In my last post, I closed with a paragraph describing the benefits I had experienced of consuming a really high fat, very low carb diet: more energy, less sleep needed, asthma cured, wrinkled skin “melting away. This was supposed to be a humorous parody of how enthusiastic supporters of fad diets feel after they have jettisoned their bad eating habits but apparently most readers, unaware of my dry sense of humor (or perhaps not familiar with David Cronenberg’s The Fly) took this seriously. Certainly, if I had felt significantly better on the Atkins diet I, like William Banting, would still be on it. Alas, if anything, I felt worse. My sleep was unaffected. Unllike, Robert Atkins, who noted his sleep requirements went from 8 hours a night to 5 hours a night, my sleep patterns were unchanged. Energy levels in the morning were good but periodically in the afternoon, especially after even minor exertion but particularly after an intense workout, I would feel uncharacteristically exhausted. Although my weight dropped 3-4 pounds this is typically what happens if I cut out alcohol from my diet for a week so it’s hard to say what the independent role of the extremely low carb intake and ketosis was. My blood pressure dropped during the week and I had to cut back on my blood pressure medications to avoid dizziness. There were too many other variables occurring simultaneously that week (weight loss, lack of alcohol consumption) to know if this was independently associated with the ketogenic diet, however. To be fair, supporters of ketogenic/Atkins diets warn us that during the initial weeks, we may feel worse, experiencing the so-called “low carb flu.” To fully test it I should have stayed on it for 3-6 weeks and entered a maintenance phase in which I could have consumed more carbohydrates. However, after a week of having to analyze in detail the carb or net carb content of everything that I consumed, I realized this was not something I wanted to do long term. For the significantly obese like William Banting who struggle to achieve weight loss the ketogenic/Atkins diet is likely to be a much better experience than for someone like me who is not overweight. Banting’s diet prior to his “miraculous change” consisted primarily of bread, milk and beer and it is likely that cutting out the bread and beer alone would have had a dramatic effect on his weight and well-being. My adventure in ketoland inspired me to update my dietary recommendations , the pdf of which is here (What Diet Is Best For Heart Health). It would nice if we had some sort of genetic test that would tell us what diet is perfect for us. Unfortunately, until that is developed, trial and error is the only viable approach. Some, like William Banting, Robert Atkins and the lady at zerocarbizen.org will thrive on very low carbs whereas others, like Dean Ornish and Nathan Pritikin prosper on a very low fat diet. Most individuals will be served best by a diet of real, minimally processed food with lots of different vegetables growing both above and below ground and eaten in moderation. Unbantingly Yours -ACP N.B. Here, in a nutshell, in Banting’s own words ,is the essence of the Banting diet: “I never eat bread unless it is stale, cut thin, and well. toasted. I very seldom take any butter, certainly not a pound in a year. I seldom take milk (though that called so, in London, is probably misnamed), and I am quite sure that I do not drink a gallon of it in the whole year. I occasionally eat a potato with my dinner, possibly to the extent of 1 lb. per week. I spoke of sherry as very admissible, and I am glad of this opportunity to say, that I have since discovered it promoted acidity. Perhaps the best sherry I could procure was not the very best, but I found weak light claret, or brandy, gin, and whisky, with water, suited me better; and I have been led to believe that fruit, however ripe, does not suit me so well taken raw as when cooked, without sugar. I find that vegetables of all kinds, grown above ground, ripened to maturity and well boiled, are admirable; but I avoid all roots, as carrot, turnip, parsnip, and beet. ” Excerpt From: William Banting. “Letter On Corpulence.” Foster, 2014. iBooks. https://itun.es/us/fOKP3.l
Many readers have asked what the skeptical cardiologist thinks about a unique and interesting addition to the personal cardiovascular monitoring space that offers long-term ECG
11 thoughts on “A Farewell to Ketosis: Banting, Dickens and The Roots of Atkins”
Well I would say one week is a bit short to conclude. I read the PDF. It is clear. The Mediterranean diet is a good one. What do you think of the Okinawa (old) diet? Based around sweet potatoes. The life expectancy studies are quite interesting.
Thanks for bringing the Okinawa diet to my attention. I’ll probably write a post on it at some point. This Guardian article (https://www.theguardian.com/lifeandstyle/2013/jun/19/japanese-diet-live-to-100) is a well-balanced review of the topic. I like the ending which looks at the habits of the Guinness record long-livers from various countries: “The oldest person ever to have lived, Frenchwoman Jeanne Calment, who died in 1997, aged 122, was a noted chocoholic who doused her dinner in olive oil and drank red wine daily. The man the Russians once claimed as their oldest, sawmill worker Magomed Labazanov, who died last year, aged an undocumented 122, recommended wild garlic. Britain’s oldest person, 113-year-old Grace Jones of Bermondsey, is quoted as preferring “good, English food, never anything frozen” and enjoys a glass of sherry with friends from time to time. And Britain’s oldest man, 109-year-old Ralph Tarrant smoked until he was 70 and likes a whisky. For the record, his favourite meal is cottage pie.”
“My blood pressure dropped during the week and I had to cut back on my blood pressure medications to avoid dizziness. There were too many other variables occurring simultaneously that week (weight loss, lack of alcohol consumption) to know if this was independently associated with the ketogenic diet, however.” It feels weird telling this to a cardiologist, but that’s actually quite common when first going into ketosis, and can be mitigated or eliminated entirely by dramatically increasing your sodium intake (blasphemy, I know!), and decreasing your blood pressure medication (fun fact — that is one of the benefits of keto — normalizing things like blood pressure). The ketones attract sodium (due to being anionic, as I recall), and in the first week or two, the body isn’t very efficient at using them (that whole “use it or lose it” thing), so it’s basically like being on a diuretic, and if you don’t replace the sodium, you actually risk sodium deficiency. That need decreases after adaptation, since you’re flushing out a smaller amount of the ketones your body produces. In short, broth is your best friend. Bonus points if you make your own. “Energy levels in the morning were good but periodically in the afternoon, especially after even minor exertion but particularly after an intense workout, I would feel uncharacteristically exhausted.” Odds are good that was at least in part due to the issues you were experiencing with your blood pressure. However, this is also common as your body adjusts to a different primary fuel source. You’re basically “bonking” at the moment, not unlike carb-dependent marathon runners when they don’t refuel, since the lower carb intake depletes glycogen, but doesn’t replace it like it used to, and the body is still used to using it as the primary fuel source. The body adjusts over time (the number I’ve seen is about 6 weeks), after which endurance, especially, skyrockets, due to the higher threshold at which the body has to use sugar for fuel. Dr. Peter Attia has some fascinating data on his athletic performance changes when he first went keto — http://eatingacademy.com/how-a-low-carb-diet-affected-my-athletic-performance (you’ll also be interested in his data for cardiovascular health markers — http://eatingacademy.com/how-low-carb-diet-reduced-my-risk-of-heart-disease ). Also, as counter-intuitive as it may seem, it’s easy to undereat while in keto. You stated in your last post that you tracked on MyFitnessPal. Did you pay any attention to your caloric intake? It’s entirely possible that you may have been undereating for your activity level. Your statement of eating 123g of fat and 26g of carbs in your last post comes out to just over 1200 calories. If we assume your protein intake equaled your fat intake (which isn’t out of the realm of possibility, though I suspect is a high estimate), we have (123*9)+(26*4)+(123*4) or about 1700 calories. Considering that’s the amount for me, a woman, to lose a pound a week while doing nothing but sit at a desk all day, that means your intake is probably way too low, since you’re a man (which adds 500 calories to your needs compared to me) and are likely on your feet at least part, if not most, of the day. Add in moderately intense workouts, and less of a need to lose weight, and you’re probably a good 800-1000 calories short of your caloric needs. No wonder you’re getting tired. “However, after a week of having to analyze in detail the carb or net carb content of everything that I consumed, I realized this was not something I wanted to do long term.” It could be the program you were attempting to do, but you’re overthinking it. Avoiding heavily processed foods (like Atkins bars) and favoring fatty meat and non-starchy vegetables will get you at least 80% of the way there without even really trying. Most of the alternative, look-alike stuff sucks compared to their traditional counterparts, anyway. Yes, there’s a learning curve, but you didn’t become a cardiologist overnight, either. I propose you try it again. This time, giving it the fair shake it deserves. Stay on it for at least a month, before you make a decision on it. Also, it might help to go into it with a better attitude. Responding to the “how long have you been on it?” question with “too long” after a whopping 5 days shows a mindset of failure from the outright. As the saying goes, “if you think you can, or you think you can’t, you’re right.”
Why attack attitude ? And why mix emotion with research ? To date there is no long term studies to establish the efficacy of this rather unbalanced diet . While you are actively pushing this diet – it is quite possible that you are damaging your body heavily- being aggressive might be a symptom . Pl try to be dispassionate in your rhetoric and research.
The so-called “low carb flu” is completely avoidable by paying close attention to one’s electrolytes. Since carbohydrates require the body to hold in excess water to process them, as well as a ton of other vitamins an minerals, it is easy to see why the body begins dumping excess water held that is no longer needed. Of course, since electrolytes are a very delicate balance, as even Gatorade ads would show us, once water is being dumped, sodium begins to dump as well, and without replenishment of both on a regular basis, so do magnesium (in which most people are already woefully deficient due to soil depletion, restricted diets, GMO’s, pesticides, etc.) and potassium, both of which are critical in heart health. This dumping/balance process increases muscle fatigue, as your muscle mitochondria is being changed to work on ketones instead of or in addition to glucose. While this does cause a temporary decrease in performance, once the conversion process is completed, the upper ceiling on performance is raised dramatically, leaving far more potential for improved athletic performance. This is particularly accurate since as long as the athlete has stored body fat, s/he may continue the performance without having to refuel, as ketones may continue to be produced, whereas the body will eventually run out of glucose stores. Since you wouldn’t run your car’s engine at hard and heavy exertion while you are in the middle of rebuilding it, why so would you expect to be able to continue to perform exercise at previous levels while you are rebuilding your body’s internal engine? Also, why are the only resources you referenced in this journey woefully outdated? Without additional information that has been added to more recent version of a LCHFMP (low carb, high fat, moderate protein) dietary plan, you essentially took a “knife to a gun fight.” I prefer to be properly armed in the battle for my health and long life!
It’s too bad you didn’t just get your sodium levels up to completely and totally prevent what people call “Keto flu”, which is simply low electrolytes that is 100% preventable. Low blood pressure should’ve been a clue… Smh
Low blood pressure and fatigue should have been a clue. Ketosis causes sodium losses. You need something like 3-5g/d sodium intake if you want to avoid the “keto flu.”
I didn’t pick on your sense of humor and thought you were serious about needing less sleep and wrinkle improvement. I wonder if anyone picked up on your ketotic breath??? Sometimes it’s easy to give up alcohol and sometimes not … So many interesting wines to taste out there, well-crafted creative cocktails and fine independent brewery beers that MUST be sampled! Nice post as usual! 🙂
I am sorry you didn’t get any benefit. For me, the Keto diet has been wonderful in removing my arthritic pain and sorting out blood sugar. It increases energy and makes thinking clear! It should be promoted as some people’s solution, because it really is. Perhaps you should try it again with more patience?
You might finf this interesting http://www.nytimes.com/2016/04/30/books/walt-whitman-promoted-a-paleo-diet-who-knew.html Walt Whitman Promoted a Paleo Diet. Who Knew? In 1858, when Walt Whitman sat down to write a manifesto on healthy living, he came up with advice that might not seem out of place in an infomercial today. “Let the main part of the diet be meat, to the exclusion of all else,” Whitman wrote, sounding more than a little paleo. As for the feet, he recommended that the comfortable shoes “now specially worn by base-ball players” — sneakers, if you will — be “introduced for general use,” and he offered warnings about the dangers of inactivity that could have been issued from a 19th-century standing desk. “To you, clerk, literary man, sedentary person, man of fortune, idler, the same advice,” he declared. “Up!” http://ir.uiowa.edu/cgi/viewcontent.cgi?article=2206&context=wwqr Manly Health and Training, With Off-Hand Hints Toward Their Conditions
During that week I paid 1.99$ to download William Banting’s “Letter on Corpulence”(available here for free.) Banting, writing in 1869, first popularized a low carb, high fat diet for obesity with this pamphlet. He starts it off with these words:
11 thoughts on “A Farewell to Ketosis: Banting, Dickens and The Roots of Atkins”
Well I would say one week is a bit short to conclude.
I read the PDF. It is clear. The Mediterranean diet is a good one. What do you think of the Okinawa (old) diet? Based around sweet potatoes. The life expectancy studies are quite interesting.
Thanks for bringing the Okinawa diet to my attention.
I’ll probably write a post on it at some point.
This Guardian article (https://www.theguardian.com/lifeandstyle/2013/jun/19/japanese-diet-live-to-100) is a well-balanced review of the topic. I like the ending which looks at the habits of the Guinness record long-livers from various countries:
“The oldest person ever to have lived, Frenchwoman Jeanne Calment, who died in 1997, aged 122, was a noted chocoholic who doused her dinner in olive oil and drank red wine daily. The man the Russians once claimed as their oldest, sawmill worker Magomed Labazanov, who died last year, aged an undocumented 122, recommended wild garlic. Britain’s oldest person, 113-year-old Grace Jones of Bermondsey, is quoted as preferring “good, English food, never anything frozen” and enjoys a glass of sherry with friends from time to time. And Britain’s oldest man, 109-year-old Ralph Tarrant smoked until he was 70 and likes a whisky. For the record, his favourite meal is cottage pie.”
“My blood pressure dropped during the week and I had to cut back on my blood pressure medications to avoid dizziness. There were too many other variables occurring simultaneously that week (weight loss, lack of alcohol consumption) to know if this was independently associated with the ketogenic diet, however.”
It feels weird telling this to a cardiologist, but that’s actually quite common when first going into ketosis, and can be mitigated or eliminated entirely by dramatically increasing your sodium intake (blasphemy, I know!), and decreasing your blood pressure medication (fun fact — that is one of the benefits of keto — normalizing things like blood pressure).
The ketones attract sodium (due to being anionic, as I recall), and in the first week or two, the body isn’t very efficient at using them (that whole “use it or lose it” thing), so it’s basically like being on a diuretic, and if you don’t replace the sodium, you actually risk sodium deficiency. That need decreases after adaptation, since you’re flushing out a smaller amount of the ketones your body produces.
In short, broth is your best friend. Bonus points if you make your own.
“Energy levels in the morning were good but periodically in the afternoon, especially after even minor exertion but particularly after an intense workout, I would feel uncharacteristically exhausted.”
Odds are good that was at least in part due to the issues you were experiencing with your blood pressure. However, this is also common as your body adjusts to a different primary fuel source. You’re basically “bonking” at the moment, not unlike carb-dependent marathon runners when they don’t refuel, since the lower carb intake depletes glycogen, but doesn’t replace it like it used to, and the body is still used to using it as the primary fuel source. The body adjusts over time (the number I’ve seen is about 6 weeks), after which endurance, especially, skyrockets, due to the higher threshold at which the body has to use sugar for fuel. Dr. Peter Attia has some fascinating data on his athletic performance changes when he first went keto — http://eatingacademy.com/how-a-low-carb-diet-affected-my-athletic-performance (you’ll also be interested in his data for cardiovascular health markers — http://eatingacademy.com/how-low-carb-diet-reduced-my-risk-of-heart-disease ).
Also, as counter-intuitive as it may seem, it’s easy to undereat while in keto. You stated in your last post that you tracked on MyFitnessPal. Did you pay any attention to your caloric intake? It’s entirely possible that you may have been undereating for your activity level. Your statement of eating 123g of fat and 26g of carbs in your last post comes out to just over 1200 calories. If we assume your protein intake equaled your fat intake (which isn’t out of the realm of possibility, though I suspect is a high estimate), we have (123*9)+(26*4)+(123*4) or about 1700 calories. Considering that’s the amount for me, a woman, to lose a pound a week while doing nothing but sit at a desk all day, that means your intake is probably way too low, since you’re a man (which adds 500 calories to your needs compared to me) and are likely on your feet at least part, if not most, of the day. Add in moderately intense workouts, and less of a need to lose weight, and you’re probably a good 800-1000 calories short of your caloric needs. No wonder you’re getting tired.
“However, after a week of having to analyze in detail the carb or net carb content of everything that I consumed, I realized this was not something I wanted to do long term.”
It could be the program you were attempting to do, but you’re overthinking it. Avoiding heavily processed foods (like Atkins bars) and favoring fatty meat and non-starchy vegetables will get you at least 80% of the way there without even really trying. Most of the alternative, look-alike stuff sucks compared to their traditional counterparts, anyway. Yes, there’s a learning curve, but you didn’t become a cardiologist overnight, either.
I propose you try it again. This time, giving it the fair shake it deserves. Stay on it for at least a month, before you make a decision on it. Also, it might help to go into it with a better attitude. Responding to the “how long have you been on it?” question with “too long” after a whopping 5 days shows a mindset of failure from the outright.
As the saying goes, “if you think you can, or you think you can’t, you’re right.”
Why attack attitude ? And why mix emotion with research ? To date there is no long term studies to establish the efficacy of this rather unbalanced diet . While you are actively pushing this diet – it is quite possible that you are damaging your body heavily- being aggressive might be a symptom . Pl try to be dispassionate in your rhetoric and research.
The so-called “low carb flu” is completely avoidable by paying close attention to one’s electrolytes. Since carbohydrates require the body to hold in excess water to process them, as well as a ton of other vitamins an minerals, it is easy to see why the body begins dumping excess water held that is no longer needed. Of course, since electrolytes are a very delicate balance, as even Gatorade ads would show us, once water is being dumped, sodium begins to dump as well, and without replenishment of both on a regular basis, so do magnesium (in which most people are already woefully deficient due to soil depletion, restricted diets, GMO’s, pesticides, etc.) and potassium, both of which are critical in heart health.
This dumping/balance process increases muscle fatigue, as your muscle mitochondria is being changed to work on ketones instead of or in addition to glucose. While this does cause a temporary decrease in performance, once the conversion process is completed, the upper ceiling on performance is raised dramatically, leaving far more potential for improved athletic performance. This is particularly accurate since as long as the athlete has stored body fat, s/he may continue the performance without having to refuel, as ketones may continue to be produced, whereas the body will eventually run out of glucose stores.
Since you wouldn’t run your car’s engine at hard and heavy exertion while you are in the middle of rebuilding it, why so would you expect to be able to continue to perform exercise at previous levels while you are rebuilding your body’s internal engine? Also, why are the only resources you referenced in this journey woefully outdated? Without additional information that has been added to more recent version of a LCHFMP (low carb, high fat, moderate protein) dietary plan, you essentially took a “knife to a gun fight.” I prefer to be properly armed in the battle for my health and long life!
It’s too bad you didn’t just get your sodium levels up to completely and totally prevent what people call “Keto flu”, which is simply low electrolytes that is 100% preventable.
Low blood pressure should’ve been a clue… Smh
Low blood pressure and fatigue should have been a clue. Ketosis causes sodium losses. You need something like 3-5g/d sodium intake if you want to avoid the “keto flu.”
I didn’t pick on your sense of humor and thought you were serious about needing less sleep and wrinkle improvement. I wonder if anyone picked up on your ketotic breath???
Sometimes it’s easy to give up alcohol and sometimes not … So many interesting wines to taste out there, well-crafted creative cocktails and fine independent brewery beers that MUST be sampled!
Nice post as usual! 🙂
I am sorry you didn’t get any benefit. For me, the Keto diet has been wonderful in removing my arthritic pain and sorting out blood sugar. It increases energy and makes thinking clear! It should be promoted as some people’s solution, because it really is. Perhaps you should try it again with more patience?
I’m glad it has worked so well for you. Perhaps as I age I will gain more patience and try it for a longer stretch.
You might finf this interesting
http://www.nytimes.com/2016/04/30/books/walt-whitman-promoted-a-paleo-diet-who-knew.html
Walt Whitman Promoted a Paleo Diet. Who Knew?
In 1858, when Walt Whitman sat down to write a manifesto on healthy living, he came up with advice that might not seem out of place in an infomercial today.
“Let the main part of the diet be meat, to the exclusion of all else,” Whitman wrote, sounding more than a little paleo.
As for the feet, he recommended that the comfortable shoes “now specially worn by base-ball players” — sneakers, if you will — be “introduced for general use,” and he offered warnings about the dangers of inactivity that could have been issued from a 19th-century standing desk.
“To you, clerk, literary man, sedentary person, man of fortune, idler, the same advice,” he declared. “Up!”
http://ir.uiowa.edu/cgi/viewcontent.cgi?article=2206&context=wwqr
Manly Health and Training, With Off-Hand Hints Toward Their Conditions