For Whom The Ketosis Tolls

The skeptical cardiologist has gotten a lot of comments in the last week on both his “farewell to ketosis” post and a mysterious post consisting of simply “Br.”
On some level I feel like I’ve let down the low carb, high fat community by exiting ketoland prematurely. Certainly, the many ketophiles who pointed out the error of my path in ketoland have made excellent points.
One commenter wrote that side effects:

“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)”

Having read Atkins and other LCHF writers (including Peter Attia) pretty closely, I was aware of this and doubled or tripled my salt intake. I was dissolving salt into water and drinking multiple cups per day.  Also, if you read my posts on salt consumption, you’ll see that I don’t advocate across the board cuts in dietary salt, and thus I  commit dietary blasphemy with regularity.
In fact, I’ve written, with respect to salt loss by tennis players and by my hypertensive patients during the summer, the following:

“These variations in salt loss in the context of large variations in cardiovascular physiology and blood pressure regulation between individuals is further support for abandoning the ultra-low salt limits suggested by the AHA and the USDA.”

Also, I think dietary blood pressure lowering is awesome and as I mentioned, I cut back on my blood pressure meds and monitored my blood pressure regularly.
In response to another good point from a commenter on my statement that, “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,” I can only say, “mea culpa.”

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.

If/when I do it again, I’ll have a pretty instinctual understanding of what to do. It’s possible that my reasons for exiting ketoland relate more to a desire to consume proscribed items like beer, cocktails and large amounts of parsnips.
Another comment was “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?”
I wouldn’t say I was engaging in hard and heavy exertion during my week in ketoland; walking a couple of miles to and from a restaurant or riding my bike at a moderate pace plus weights was the extent of it.  Perhaps that was too much to ask of my aging car’s engine as I retooled it’s fuel.
As to the references being outdated: William Banting writing in the 1700s is not recent enough for you?
Seriously, I was primarily delving into what Robert Atkins had promulgated and I utilized his Diet Revolution book,  first published in 1972; but I also referenced recent writings of Peter Attia and Andreas Eenfeldt.
Speaking of outdated references published in 1972 (and in a blatant attempt to reestablish my low carb cred), I highly recommend Paul Yudkin’s “Pure, White and Deadly.”  Yudkin, a British physician and nutritionist, concluded that increased sugar consumption was the major dietary cause of heart disease. Unfortunately, this scientific concept went up against the great and powerful Ancel Keys and the (now increasingly discredited) concept that dietary fat causes heart disease.
As Robert Lustig wrote in his introduction to the 2012 edition:

“The Pharisees of this nutritional holy war declared Keys the victor, Yudkin a heretic and a zealot, threw the now discredited Yudkin under the proverbial bus, and relegated his pivotal work to the dustbin of history, as this book went out of print and virtually disappeared from the scene. The propaganda of “low-fat” as the treatment for heart disease was perpetuated for the next thirty years. And the cluster of diseases (obesity, diabetes, hypertension, lipid problems, heart disease) collectively termed the “metabolic syndrome” increased in a parabolic fashion under the canopy of the sugar industry and their propaganda machine.
But good ideas die hard. Larger studies started to demonstrate that serum triglyceride levels correlated with heart disease, with sugar consumption being the primary driver. And there wasn’t one type of LDL, there were two: large buoyant LDL, driven by dietary fat, but which was neutral in terms of heart disease; and small dense LDL, driven by dietary carbohydrate, and which oxidizes quickly, driving atherosclerotic plaque formation (hardening of the arteries). The Atkins diet was now being taken seriously. Carbohydrates started to assume center stage in promoting metabolic disease, with sugar consumption implicated as the most notorious carbohydrate.”

The nutritional Holy Wars rage on. This omnivore, although an apostatic ketotic, genuflects before the wisdom of Yudkin.
UnPhariseeically Yours,


6 thoughts on “For Whom The Ketosis Tolls”

  1. Yudkin’s given name was John. And he was an even sharper pencil than we give him credit for today – his many low carb weightloss papers, from the late 50’s to the early 80’s, propose a “paleo” explanation of obesity and why low carb works, are brilliantly reasoned, and have stood the test of time as well as his sugar hypothesis.

  2. Getting into ketosis the FIRST time is the worst. It’s like any addiction. You know you can “feel better” if you just eat. So it’s very easy to dump the process. But if you can stick it out, the rewards are huge. That’s what I meant in my last comment about having patience. Patience is not just an attitude of age, it’s an attitude of stickability even though you don’t feel good. The scientists can go on and on with their “evidence ” but the real evidence is the countless number of personal anecdotes from people who actually DO it. I have been in ketosis for years. If I “fall off the wagon” my body seems to know the way back into ketosis without all the fuss I originally endured. Try again!

  3. With regard to Dr Lustig and sugar
    Q. A lot of the recipes in your book use fruit to add sweet flavors. Was this a way to limit refined sugar?
    A. Exactly. People always say to me, “What about fruit? It has sugar.” But I have nothing against fruit, because it comes with its inherent fiber, and fiber mitigates the negative effects. The way God made it, however much sugar is in a piece of fruit, there’s an equal amount of fiber to offset it.
    There’s only one notable exception: grapes. Grapes are just little bags of sugar. They don’t have enough fiber for the amount of sugar that’s in them. But I have nothing against real food, and that includes real fruit. Eat all the fruit you want. It’s only when you turn it into juice that I have a problem with it, because then it loses its fiber.

    • I’ve never been a fan of grapes, unless they have been squashed and fermented for a while. Perhaps my body and my sugar stat recognize them as “little bags of sugar”.
      However, fruit is frowned upon my true ketophiles. They are generally OK with berries in small doses, treated as a dessert.
      This was another issue I had with ketoland. I really like my berries and full fat yogurt and even my small jar of full fat yogurt has 7 carbohydrate grams.

      • 7 grams of carbs is pretty low. I’m in low ketosis most of the day, most days, pretty easily eating around 50 to 100 grams of carbs per day. I’m not anal about my dairy and fruit carbs and apples and bananas don’t seem to kick me out for long if at all. I also do intermittent fasting. I eat from ~noon to 8PM. I do my exercise either first thing in the morning or at noon and then eat after. I think that high exercise levels and intermittent fasting makes keto much easier to maintain.
        I’ve dropped about 42 lbs, 28 of which were on low carb/ intermittent fasting. Only the last 7 lbs were on keto. I have no issues transitioning between keto and regular and back. But, I think I’ve been fat adapted to a degree all my life due to long hikes with very little food and running in the mornings (5-10 miles) with no calorie intake. Around 10 years ago I got on the sports drink/carb loading thing and I’m pretty sure it was a big part of my weight gain issues.
        I’ve gone from training for triathlons to a much more manageable workout schedule and have dropped weight easier than when I was in my 20’s and 30’s in spite of being horribly insulin dysfunctional (A1c 5.6% trig/HDL 9.7 ). My A1c is now 5.0 and trig/HDL is 2.0 (7 lbs ago).


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