ADHD and other letters: Adjusting and Unlearning

The first response to an ADHD diagnosis is often relief, excitement, even delight. Having answers, feeling that you might not actually be “lazy, crazy or stupid”, finding out that medication might give you the ability to restructure your life – all that is wonderful. This is especially true for people like me, who are born problem-solvers. We like answers and explanations and solutions.

It’s less clear after that. I’ve read that some experts liken it to a grief process (although I’m not sure where bargaining comes in).

What I did find was that, after the initial excitement and euphoria wore off, I was intensely frustrated and disappointed. Continue Reading

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This Keto Life: It’s nice to be validated

When you tell people you’re eating keto, you get some weird responses. Sometimes those responses are perfectly normal, like “what the hell is keto?” and sometimes there’s a lot of “hmmm, and you say you eat a lot of fat…?” and a lot of reserved judgement (which is fine; at least it’s being reserved) and people privately considering that they’re going to have to visit you in hospital when you have a heart attack and how on earth are they going to resist saying “I told you so, you pseudo-scientific noob.”

That’s okay. I have some of those thoughts about other people’s decisions, and most people handle this in a pretty mature way with the understanding that what goes in my stomach is my business, and what goes in their stomach is their business.

However, at the moment, I am wallowing in a giant pile of smug. The disclaimer is that this is not “smug” meaning “I am doing a sensible thing and you are all idiots who are not doing that thing” – different things work for different people (and there’s hopefully a good explanation for why carbs make me feel sick, and I’m pretty damn aware that most people don’t have have that experience). This smug is more “I am doing a sensible thing for me and it is working stupendously well.”

I just had a checkup with my doctor, and we had a gander at my most recent lipid panel. My total cholesterol is, unsurprisingly, what would be considered “high” by most standards. Not dangerously high, but high. This would be a concern if the scientific thinking on cholesterol hadn’t undergone a massive shift over the last decade or so, where even LDL vs HDL is a vast oversimplification (not even all LDL is actually problematic; just small pieces of LDL).

My ratios, however, are amazing. My LDL/HDL ratio is very low. My triglyceride/HDL ratio is staggeringly low. And my GP said that my HDL was some of the best she had ever seen. And my raw triglyceride measurement is also very low.

I said that was a relief, because even though I’d done enough research and trawling of the primary literature, when you go against popular medical advice, there is always a kernel of doubt (you sometimes feel like you’re being treated as an anti-vaxxer when you feed yourself eggs and hollandaise as a perfectly sensible lunch).

“Well, if you really want to double check, we’ll do a cardiovascular risk assessment.” So she took my blood pressure (96/66 – BAM!), and ran the numbers, and it all came back in a big fat green zero. Some of that is because I’m a pre-menopausal, 34 year old woman – my risk is pretty damn low as it is – but a lot of it is these improved ratios. One day I might sum up my discoveries about cholesterol and how it seems that how it actually works is significantly different to what was thought thirty years ago (and salt), and that will involve a lot of reading and referencing and an actual kind of science journalism that I haven’t really attempted on this blog before.

In summary: my GP, who is marvellous, but not particularly radical, is quite happy with me eating keto. She’s happy with my numbers; and since I have a great deal of trust in her, I’m happy with my numbers.

Now, if this had panned out another way – if it looked like my situation was getting worse while on keto, and if this doctor that I trust was concerned – I would have felt extremely conflicted. I don’t want to go back on a standard diet, or try a low fat/high carb diet. Not only does it make me feel sick (and break out in acne, and get more abscesses, etc.), but my palate has gotten quite used to regular doses of flavoursome fats, and I think it would be difficult to manage. I also still have my fun sensory processing issues which make it impossible for me to eat a lot of raw veggies (ie, vegetables that haven’t been prepared in fats, which these days is how I consume them).

I suppose I would have tried to find a way to make it work, but it would have done a number on me.

It turns out that keto really is my path to health. And honestly, although I mostly trust my research, I’m also aware that I’m not a biomed-head, I don’t have that background in human health, and it’s a load off my mind to have it all confirmed by a medical practitioner who knows what my numbers mean.

Now, if I could just stop eating muffins when I’m on holiday, I’d be set.

 

O Bendy Gymster: The Range of Motion

The younger student held up a rack of tubes. “So should I give these a quick spin in the centrifuge?” she asked.

I counted. Five tubes. “Nah. Just a quick vortex to mix them, and then just give them each a flick.”

She frowned. “A flick?”

“Yeah, like this.” I picked up a tube, and flicked it with my wrist twice until the liquid settled cleanly in the bottom. I do use the centrifuge for things that really need to be spun – i.e., separating out layers, separating out supernatant, pelleting DNA – but if I’ve just given something a quick rattle on the vortex and want to make sure no liquid has been flung up into the lid, I just flick the tube.

(NB for non-lab types: You need to make sure there’s no liquid in the lid before you open the tube, because otherwise you’ll lose your reagent/sample/whatever when you open it, and then you may cry. Also, flicking the tube does not work for the really titchy 200ul tubes)

The student, who was both a hard worker and a quick study, picked up another tube and attempted to replicate my movement. Her wrist moved very slowly, like she was waving a pom-pom. The liquid in the tube didn’t shift in any appreciable or useful way.

I blinked. “Maybe a quick spin in the centrifuge,” I agreed.

Later, I turned to a colleague. “Do you flick your tubes?” I asked, curious. “Like this?” I picked up one of my samples from the bench and demonstrated.

My colleague gave me a blank look for a second, and then laughed. “No. How do you even do that?”

It wasn’t until a year later when my first physiotherapist bent my feet inwards…

“Tell me when it hurts.” “Sure.” “…no, really, tell me.” “But it doesn’t hurt.” “Aha!”

…that I discovered I was hypermobile and that my joints exhibit an extraordinary range of motion.

For the most part, that’s a bad thing. Being hypermobile means a greatly increased risk of injury (all the local physios know me well). It means it’s easy to overstretch. It’s easy to accumulate connective tissue damage which means it’s more likely that you will strain, sprain, wear and tear at that point in future. It means you don’t move right, and things hurt more, and most activities are far more tiring than they are for most people. Sometimes it means orthostatic issues with blood pressure, gut cramps (because there’s collagen in your intestines too, and that has consequences), and other less predictable effects.

But it’s not all bad.

I just got back from an extremely excellent field trip. On the last day, my foot slipped while descending a step-ladder from the top deck of a boat. Ironically, I’d been about to brace myself so someone could pass me a drum.

My foot slid out from under me, but I gripped the handrail; my flailing shoulder popped forward a little bit (little subluxation, but not full dislocation), yanking at the tendons; my weight landed on my wrist, which was hyperextended; the shoulder snapped back in, aching like a bastard; and I held.

If I wasn’t hypermobile, I probably wouldn’t have been able to catch myself before going arse over tit down onto the mid deck, doing myself far worse injury.

If I wasn’t hypermobile, the shoulder probably wouldn’t have stretched enough to go out and in again the way it did. It’s bad – in a broad sense – that this happened, and it’s probably done some unseen damage to the complex bits and pieces that make up the shoulder joint; but my shoulder is fine. It was fine within about ten minutes, and that’s held.

The wrist, though, turned out to be an injury, and I won’t be flicking any tubes for a while. It’s a very minor injury, but it’s where the muscle attaches to the ulna, so it will take longer to heal than it would if it had torn near the belly of the muscle.

The moves I have to avoid in order to allow healing?

Hyperextension in the rotation of my wrist.

What I’m learning now – and what I didn’t know before this latest injury – is how much I deliberately hyperextend my wrist.

Flicking tubes is just one thing.

I also use wrist hyperextension to increase the leverage when I open jars (I work in a museum. I open a lot of specimen jars).

When I’m driving, I use wrist hyperextension to get the wheel to turn further in a single movement (especially when backing down our literally mountainous driveway).

When I put my backpack on, I swing it around my wrist to get it on my shoulder.

It turns out I use that extra wrist rotation to help fold fucking laundry.

So yes, this is all a bit of an adjustment for me. I’m not even kidding. I even have to be careful when doing cross stitch that I try to hold the needle with my wrist in a neutral position. In addition to all the recruitment exercises that target my hips, glutes, core, calves, arches, and shoulders, I now have exercises to target my wrists – all things designed to increase my proprioception and awarenss of my joint position so I can avoid over-extending.

There’s just one problem: over-extending my wrist is useful. I’m not sure it’s possible to teach myself not to do it. I’ve taught myself not to lock my joints, not to hunch all the time, to consciously engage my postural muscles – all difficult things – but they didn’t involve much sacrifice (although locking joints is useful when you have underdeveloped postural muscles).

So the journey of the bendy gymster acquires another layer, another problem joint, and another exercise for maintenance.

Mostly what I learned from this is how much I actually use my hypermobility for extra leverage, without even being aware of it.

This Keto Life: Why Keto? or MMM! TASTES LIKE INSULIN

When someone wants to overhaul their diet, be it for reasons of nutritional improvement, managing intolerances or weight loss/gain (body recomp), there is no shortage of advice to be found on the internet. Unfortunately, as a friend of mine put it, there’s also a giant bucket o’crazy.

Why, you may be wondering (and I strongly suspect several people in my life of wondering, which is not a bad thing), did I go for this very low carbohydrate deal instead of just trying to refine a “balanced diet”? It seems like a weird choice to many people, and it’s very hard to say, “I did some research” without sounding like a die-hard graduate of Google University.

The fact that my research includes the primary literature and critiques thereof is, I think, a big deal, but then we enter into a grey area of whether or not it should trump the decades old all-things-in-moderation, calorie-counting advice.

I did try that. I have done Lite’n’Easy. The main reason I did it is because I have a lot of food anxieties, and emotional panic around meal planning: the idea of paying someone else to plan the meals and hand them over was incredibly appealing, and it would force me to confront some of my triggers in a safe way (i.e., at home, where no-one will see my response, which incidentally does occasionally involve vomiting).

It’s not that Lite’n’Easy didn’t “work” for those goals. It did. There are now a few more things I can eat – it took hard work, and it was exhausting, but I had the extra emotional energy because now I wasn’t panicking about the decision making.

However, it’s pretty pricey, and long-term it gets a bit dull, and it wasn’t resolving my other issue.

The other issue is the big, fat, spanking arrow pointing me towards low carb.

The other issue is my insulin response.

For a long time, I didn’t know it was my insulin response. I thought it was fructose (I am, among other things, not able to effectively absorb fructose in my gut). I thought that sucrose (since it’s a disaccharide made up of half-fructose) was setting off that issue, and that’s why it made me feel sick.

The problem was timing. Fructose malabsorption is a gut issue. It takes a little while for food to get to your gut. Meanwhile, sugar also takes about twenty minutes to hit your bloodstream.

Here’s the problem: the sick feeling I get from eating really sweet stuff happens within seconds. Seconds. The sweeter the taste, the stronger the feeling (and the final nail in the coffin is my recent realisation that even stevia – in sufficient quantities – elicits this response, despite containing no sugar. I’ll explain). It’s a nasty feeling: a sort of falling sensation, followed by abruptly feeling so hungry that you feel sick, and then – maybe about twenty minutes to half an hour later – an extended anxiety/panic/fight-flight sensation. This is because of the cephalic phase insulin response which in me appears to be extremely overenthusiastic. Insulin is released before the sugar (or, sadly, replacement non-sugar sweetener) hits your bloodstream, in order to clear available fuels out and make way for the incoming fuels (be they sugar, fatty acids, protein, etc); this is why as you eat, your appetite can increase (“I totally did not think I was hungry but *munch munch* I am ravenous!”).

And, of course, the only way your brain knows that you’ve eaten something sweet before it absorbs any of it is the taste. More is released as you eat, and as your blood sugar goes up – that’s a bit more straightforward – and, of course, if your blood sugar goes down too far (once all the insulin has come out to play and sucked it all up), out comes glucagon (or a variety of other hormones) to release it back into the bloodstream. A rapid sugar crash can also stimulate the release of stress hormones such as cortisol and noradrenaline, which incidentally explains the fact that I get panicky and stressed as well after a sugar crash.

The fact, therefore, that I feel sick almost instantaneously suggests that my body is responding to the taste – it can’t be responding to anything else because I haven’t actually absorbed it yet.

Therefore, it must be insulin.

If high insulin makes me feel sick (and I already knew from talking to a couple of specialists that high fasting insulin is correlated with hidradenitis flares and other inflammatory issues that I have), then obviously the best way to deal with this particular metabolic quirk is to keep insulin low.

There does not appear to be any drawback to keeping insulin levels low (unless you have Type 1 Diabetes, which is a very specific metabolic situation). I haven’t been able to find anything, other than people complaining that adaptation is hard, which it is.

At the same time, there appear to be extraordinary benefits to keeping insulin low. Lower insulin promotes better metabolic health: lower overall cholesterol (although the benefit of this is genuinely debatable now that we have more refined techniques for subdividing serum cholesterol into different categories), lower triglycerides (not really debatable – this is undeniably a good thing, barring a completely groundbreaking study that would show otherwise at this point), lower blood pressure (again, up to a certain point, that’s a good thing – too low is possible). There are other benefits, although they are mostly in the “we have supporting evidence” category rather than “it’s solidly proven” category.

And in my case, it promotes “not feeling sick” which I can totally get behind.

The absolute best, number one, beats-all-comers method for keeping your insulin levels low is to reduce sugar and other carbohydrates. Since this naturally means increasing fats in the diet (you can’t live off protein – google “rabbit starvation” if you don’t believe me), it was necessary to do a bit more research and confirm that fat wasn’t the demonic beast it has been made out to be, and the primary literature has absolutely confirmed this.

(What this all means is that, if you want yoghurt, the absolute worst thing you can do for your metabolic health is pick the low fat, full-of-sugar yoghurt. It’s sold as the healthy option and this drives me bonkers, knowing what I now know)

This is how I selected “keto” (aka very low carb) as my dietary option. This is how I weeded through the big ol’ bucket of crazy when it comes to nutritional advice. I took a symptom that I have – one that is known, one that I can personally detect and feel (although yes, it has been confirmed with a few blood tests. The fact that my fasting insulin went from “crazy crazy high” to “kind of a bit too high” after quitting wheat was informative) – and worked from that. High levels of fasting insulin are correlated to many (not all) of my weird problems.

Now, this all makes a certain amount of logical and narrative sense, but there are still people who will ask why I don’t go for a “balanced” diet, with “all things in moderation”, and my response will be that I don’t eat arsenic in moderation either, and sugary things basically are like poison to me (fast-acting in terms of nausea, slow-acting in terms of overall inflammation problems and knock on health effects).

“Just a tiny bit of arsenic? Live a little!”

No. I don’t wanna feel sick.

Unfortunately, it now also seems like I need to be avoiding a certain dose of alternative sweeteners as well.

I came to this terribly tragic discovery last week. I’ve been experimenting delightedly with low-carb baking, and along with that, I use liberal amounts of stevia as a sweetener. I ate a piece of my glorious low carb raspberry cheesecake and immediately felt sicker than if I’d downed an Allens raspberry (my very favourite lolly). The same thing happened when I ate one of my low carb shortbreads.

Now, initially, when I made these things, I added less than the recommended amount of stevia, because I don’t have much of a sweet tooth. What I love about cheesecake is primarily the texture – the soft creamy filling and the biscuity base. A hint of sweetness (to overcome the sourness of the almond meal in the base and the cream cheese in the filling) honestly should be enough for me to enjoy it. For shortbread, I do need a bit more sweetness (relatively speaking).

But the second time I made these things, I followed the recipe more closely (I’d swapped to liquid stevia, which is much more concentrated, so I felt I should be precise), and that’s when I started to feel so sick. Husband also reported that it was much sweeter this time around.

Since then, I haven’t made the cheesecake again, but I have made the shortbreads – several times – and if I only add a quarter of the recommended sweetener, I’m fine.

It looks like there is a threshold of sweetness to my response, and I need to juggle and stay below that threshold, no matter what sweetener I use, in order to avoid a nauseating insulin spike. Stevia is definitely safer for me than most other sweeteners – I’ve found that my worst insulin response (as sweeteners go) is inspired by sucralose (Splenda). Aspartame and sorbitol are okay. Xylitol is perfectly fine as far as blood sugar is concerned but my gut does not like it and there are some pretty hardcore consequences (I can probably have it in small quantities).

Incidentally, an insulin spike of that size will shut down ketosis for longer than I’d like, which means that I will be getting a bit less energy from the fats that I eat, and I will not be as efficient in my workouts, so I have multiple reasons to avoid it. It also will cause water retention, which will irritate my joints and lead to inflammation, and then of course, if I have a highly inflammatory internal environment, I may get some of my other special symptoms. Much better to avoid the whole mess.

In summary, I targeted my fancy eating plan to my personal symptoms. This is one reason why, although I do recommend dropping carbs for most people, I also add that very low carb, ketogenic diets are not for everyone. Not everyone has my crazy intolerance of sweetness and carbohydrate (although it seems to apply to more people than you might think, based on some anecdotal evidence).

For me, this works.

This Keto Life: early days and explanations

I recently decided that I was tired of feeling sick after eating breakfast. Breakfast was a low G.I. (glycaemic index, for those of you not down with the lingo) fruit free, wheat free, nutty muesli. It was delicious. It was also topped with low fat vanilla yoghurt.

For most people, these would probably be reasonably healthy options. Not so for the Kate. For someone who is not technically insulin resistant (numbers leaned that way, last time they were tested, but weren’t over the line) or diabetic, I have a ridiculous response to sugar.

My breakfast choices have become more and more lean. First, no fructose. Okay, well, that cuts out wheat and a lot of grains, and anything with dried fruits… Then, low G.I. Well, that cuts out a lot of sugary cereal… anything with honey (also a fructose issue)… uhm…

And I stayed on my nutty muesli for a while before I started to feel sick again.

It’s what happens when, after waking up in the morning, ravenously hungry and tanking on low blood sugar, I feed myself a whackload of carbohydrates, and then I get an insulin spike and an eventual sugar crash. The definition of “whackload” is, of course, relative, but it turns out that for me, it’s a pretty low number relative to what a lot of people experience.

And I just cracked. The blood sugar fluctuations, the insulin spikes, all of it; I don’t eat much wheat, I focus on low G.I. carbohydrates where I can (for the most part. The occasional pizza binge was just a fact of life), and still there’s the blood sugar tanking anxiety, frustration as I struggle to find something I can eat that’s not full of wheat or some other source of fructose, something that won’t set off my weird sensory triggers (some textures and smells; notably salad) and make me panic and/or throw up.

That’s it. I was tired of feeling ill after eating.

So I have gone low carb, or more specifically, low carb-high fat (LCHF), the ketogenic diet wherein you go through a potentially upsetting induction process as you train your body to metabolise fats by denying it carbs. I did extensive research and reading on the subject (my god, I know more about nutrition and metabolic biochemistry than I ever have in my entire life, what nutrients different organs absorb and in what different forms they absorb them, and I am now reasonably convinced that livers are basically wizards), and I eased in, at first.

I started cutting a few things here and there. Dropped to about 100g carbs/day. Realised that it wasn’t actually that hard, so I dropped a little further, and now I’m below 50g, which is the mark at which my body should start swapping to ketosis (the production of fat-containing ketone bodies to power the brain and muscles as opposed to using sugars), and have been for about two weeks. A lot of people recommend going below 20g/day for induction, just to fast track the process, but I don’t feel the need to fast-track it. It will happen as it happens, and below 50g/day should be plenty low enough to get the ball rolling.

I’ve been lucky. Prior to this, I wasn’t eating a hugely sugary diet overall (in spite of the occasional cake or pizza, which is now sadly off the menu lest it interrupt the induction of ketosis), and most of my carb sources were relatively slow-release, which means that I haven’t suffered through the dread “keto-flu”, where people feel really quite sick for a few days as they adjust and as various gut flora die off to be replaced by different gut flora.

I’ve been a little tired. Had some headaches. It was recommended I increase my electrolytes (insulin tells your kidneys to hang on to sodium and various salts, and when the insulin levels in your body fall, you flush out a bunch of salts, so you want to stay on top of sodium, potassium and magnesium in particular), and I did, and bam, headache gone, in under 20 minutes.

That’s it. That is really all that happened in my initial keto transition (usually keto-flu is the first 3-4 days). I’m now just hanging in for full keto-adaptation as my body upregulates the production of ketosis-related enzymes and downregulates all my carb-digesting enzymes.

Now, as far as the insulin/sugar issues go: this has worked a fucking treat. It has been amazing. I am not ravenous in the morning. I do not feel sick after eating. My energy lasts longer.

But wait, there’s more.

I sleep better. This is apparently a mixed bag; apparently a lot of people sleep worse when they start keto. I’m wondering if they were big bread or pasta eaters prior to this, and the disruption to their usual metabolic process is the problem and hopefully it will settle. But a lot of other people report sleep improvements, and so far, I sleep like a goddamn log. Even when Amos wakes me up with his insistent barking demands to be allowed outside to eat possums and secure the perimeter, I wake up, tell him to settle, and then after a few minutes I conk out again.

(side note because I can’t let it alone: you don’t yell at a dog for barking, by the way. It’s not because I think it’s “mean”, it’s not because I’m being “soft”, it’s just because it simply doesn’t work. They just think you’re barking back and you can have a lovely conversation. A loud conversation.)

I have more energy. It’s true that this only lasts until I put a certain amount of stress on my body (more on that below), but I am more alert and clear headed than I have been in a long time. I feel awake rather than constantly fuzzy and foggy and frustrated.

I am more calm. Things that previously would have upset me… just don’t. It’s not that things don’t bother me, they do, I just don’t get excessively anxious or panicky or furious about it. I can be angry in a calm way if I need to, which is great, because excessive emotion in a non-calm way has, historically speaking, made me feel sick (probably adrenaline related, and losing all my blood sugar). Things that frustrate me are merely frustrating, not the end of the world. I am not giving myself nearly so many “chill out and get some perspective” pep talks.

My digestion is significantly improved, concerning which I shall not go into any more detail and we can all be very thankful.

We (as a household) are cooking more, because preparing food without carbs means less restaurant visits and take away (for the most part. Tapas works well!), and as a consequence I am actually eating more vegetables, believe it or not. I am seeing kitchen time as a problem solving exercise (i.e., how can I get nutrients x, y and z without eating carbs or anything I really don’t like), instead of opening the box of triggery food anxieties.

I no longer feel bloated.

Low carb high fat means exactly that, so while I am not eating sugar, or bread, or pasta, or rice, or cake, or biscuits – I am eating lots of very fatty foods. Energy’s got to come from somewhere, and you can’t get it all from protein (excess protein is converted into glucose anyway, so it defeats the purpose, really). So: butter, cream, bacon, cheese, eggs, macadamia oil, nuts…

Best. Diet. Ever.

And just in case anyone is not up with the fact that fat does not in and of itself make you fat, I am in fact losing weight. And still gaining muscle.

There are downsides!

While I’m adapting – i.e., still upregulating all the various chemical bits and bobs necessary to induce and sustain a high level of ketosis – I don’t have as much ready access to energy as I did when my bloodstream was flooded with carbs. Entirely to my surprise, I managed to put my weights up at gym, but I cannot run. I really can’t. I just finished Couch to 5K, and have been used to running continuously for 25-30 minutes – now I can manage about a minute.

You can sustain high level athletic performance if you are fully keto-adapted, but only if you’re very consistent about it, and only if you get enough salt (see below).

But Kate, isn’t fat really bad for you?

No.

Look, if you’re eating a diet that has bucketloads of carbs and fats, then yes, fat is going to get shunted into storage (what I prefer to think of as insulation; your mileage may vary), but that seems to be about it (although there is more nuance to be found on what fat cells actually do and what hormones they secrete).

This is because of the insulin spike associated with carbohydrate/sugar consumption (just in case anyone is not aware: sugars are carbs. They are simple carbs, and perhaps what all other carbs aspire to be. Carbs get broken down into sugars in your body). Insulin is there to tell your body to absorb all the blood sugar, to try and keep it all in normal range rather than sitting way up high, because consistently high blood sugar is genuinely toxic. This is more important than absorbing fats and converting those to energy, so insulin shuts down that process. You have to use up the excess blood glucose first, then you can start burning fat (except that if your body is not adapted to using fats, this is not an efficient process).

Simple summary: if insulin is high, fats will not be mobilised for energy.

The mobilisation of fats for energy by the liver results in the formation of ketone bodies (basically a useful way of repackaging fat so that it is easier for organs and muscles – particularly the brain – to use). If you have enough of these hanging out in your bloodstream for easy use, you will have plenty of energy to function, and above a certain level you will be able to maintain all sorts of athletic pursuits just as if you had carbs hanging about in there instead.

But in order to keep ketone levels high enough, you can’t interrupt the process by eating carbs – if you do, up comes the insulin, the ketosis screeches to a halt, and you have to (1) consume the energy provided by the carbs and (2) wait for the insulin to subside before ketosis kicks in again (although if you are fully adapted this is a lot quicker than it is at the start).

But I thought ketones were poisonous! Isn’t ketosis, you know, that bad thing?

No, that’s ketoacidosis. Not the same thing. That’s when your ketones get insanely high (nutritional ketosis should get you to a maximum of about 5 mM in your blood, although individual maxima will vary; ketoacidosis has you at about 20mM). It’s a risk for people with type I diabetes. Keto might not be for them, or at least, it needs to be more carefully managed.

You absolutely cannot do exercise without carbs or sugar.

You absolutely can, but there are important caveats. I’m reading a couple of books on these issues at the moment, and so I will soon know more (I like knowing things!). At this point the caveats are primarily:

  • do not interrupt ketosis. You need your ketone levels to be high enough for your body to have ready access to energy if you’re going to do marvellous things like cycle long distances or lift heavy weights.
  • Eat a moderate amount of protein. You want enough to maintain lean muscle mass, but not so much that your liver starts using it to make glucose (and it will), because – see above – that will interrupt ketosis.
  • SALT

What do you mean, salt?

I mean salt. Specifically, sodium (although the magnesium and potassium are very important as well). Most people are all about getting less sodium in their diet, and that makes good sense for the most part – unless you are restricting carbohydrates. If you are restricting carbohydrates, you are probably eating more whole foods and less processed things (for the most part) and this means you are consuming less salt. You’ll need about 3-5 grams per day, but only if you are restricting carbs.

This is because, among its many other magical talents, insulin changes the way your kidneys process water and salts. You flush salts a lot faster on a ketogenic diet, and believe it or not, your muscles need sufficient sodium to function. Without sufficient electrolytes, you will experience the fatigue and the cramping and the headaches and discomfort that a lot of people experience on the ketogenic diet – and which is the main reason for many people, including more physically active people, abandoning it. Depending on how you manage your diet, you should be getting enough magnesium and potassium from elsewhere, but it’s worth chugging some extra of those as well (don’t overdo it) if you’re not sure.

I only recently came to this realisation, and since I have started ramping up the sodium intake, I am feeling miles better. The most common suggestion for getting enough sodium does involve drinking broth.

This would be fine if I actually had any inclination to make broth. The backup plan for people like me is to drink “boullion”, a.k.a., “stock”.

This means that I actually heat up a mug of chicken stock in the microwave and drink it.

Isn’t that gross?

Actually, yes. I’m waiting on a better solution that doesn’t involve just pouring sodium chloride on my hand and licking it, because that is even more gross. Vegetable stock is actually undrinkable (I tried, thinking it might be better, because I prefer it when I used to make risotto). I have actually done shots of salt water. This is stupendously gross but at least it’s quick, and then I can just drink a gallon of water to get over it. My concern is that saltwater can be quite caustic and I’m not sure if this will damage my throat.

All the same, it has definitely led to improvements in how my body functions on a keto diet.

Edit: I recently made the discovery that some stock is more drinkable than others. I was trying to drink Campbell’s “Real” Stock, and it was pretty gross, even though that’s the brand I prefer to actually cook with. Then I swapped to Continental, and it basically tastes like Cup-a-Soup, and if you add cream, it tastes like Cup-a-Soup Cream of Chicken, so… basically like my childhood. This is much, much better.

But you need carbs. For, like, life.

Nooooo, I don’t. Admittedly, most people don’t recommend you go zero carb. Not only is it extremely difficult to maintain for some people (i.e., me. Most of the things I eat on a low carb diet have a negligible carb content, but they would add up if my budget for the day was zero!), but it’s good to have a little bit of a buffer there.

To be fair: while your muscles and organs are not very picky about what sort of energy they use, your brain is limited to two sources: glucose, and ketones, and it still needs to get at least a little bit of its energy from glucose even if you are getting happy results on your ketone-o-meter. Fortunately, your liver to the rescue: your liver is perfectly capable of making glucose from protein via gluconeogenesis, and this will be plenty to supply half the brain’s energy needs.

(this is one reason that I think livers are basically wizards that live under your ribcage. They do magic)

I still think this is a bad idea. People have been telling me I need lots of healthy whole grains my whole life.

And the fact is, for a lot of people, the “healthy whole grains” model is probably okay. It may be stressing your body out a little bit more, but if you are reasonably sensitive to insulin and thus able to tolerate carbohydrates well, then I very much doubt even the most enthusiastic low-carb dietitian would tell you to change what is working for you. This is not something I am likely to get evangelical about; it’s only something I’d even suggest if someone is worried about their blood sugar cycle and energy levels relating to that, and even then only if they actually want to talk about it (food discussions can be a bit triggery, I am no different).

However, a lot of people don’t have a good response to insulin; there seem to be a lot of people who, like me, feel sick after breakfast, and who spend their day chasing their own tails as their blood sugar cycles up – and down – and up – and down, decades before it gets bad enough to cause Type II diabetes (which it will often do); and for those people, restricting carbs, ditching the “healthy whole grains”, and ramping up the fats instead, is a much better idea, especially if you either supplement fibre, or eat fibrous low-starch veggies (there are lots of veggies on a keto diet when done properly).

Look at it this way: low-carb and ketogenic diets are extremely – and increasingly – popular, in spite of the fact that it’s a very difficult transition to make at first.

Most people feel quite sick at the start, and they have lowered energy following that for at least two weeks (I’m in the latter part of this period); they can’t eat a lot of the things they have been used to eating their whole lives, and I’m not just talking about cakes and biscuits and popcorn. No bread, no pasta, no rice; no healthsome muesli; no pastry, sweet or savoury; no sugar in the coffee; a dramatic reduction in milk (contains sugars in the form of galactose); no chickpea batter (my Indian meal selections have been drastically reduced); no lentils; and some things are surprisingly high in carbohydrate content that you might not expect (always check the nutritional information on the packet).

That is a very high barrier to entry for most people; so why are so many people picking it up?

Well, for starters, it does lead to very rapid weight loss (and no, it’s not all water weight, that’s just the first week, and as long as you are getting enough salt and protein you shouldn’t lose muscle mass either), and that’s compelling for a lot of people – but there are other actual health benefits worth mentioning (other than not feeling sick after eating which, as we’ve seen, is my primary motivation).

Their serum triglycerides usually go down.

Their body fat percentage almost always goes way down.

Their low density level cholesterol (LDL) usually goes down. It is worth mentioning, though, that a minority of people experience a temporary increase in LDL – this is usually linked to weight loss, but if not, it is readily repaired by swapping out some of the saturated fats for monounsaturated fats (i.e., out with the butter – noooo! – in with the macadamia oil – om nom).

Their HDL – the “good” high density cholesterol level – goes up (see all the links above).

They stop craving food in cycles (the onset of hunger, I’ve noticed, is a lot softer on keto than on a regular diet).

Fasting insulin and blood glucose obviously go down (see all the links above, I got sick of Google Scholar, but there are heaps of others if you have a look).

People maintain keto because, once they are fully adapted, they feel better. Quality of life on sustained keto is pretty good. I’ve only been doing this for two weeks and my track record on diet alteration is not good and I am still vowing I will never go back, just because it is so nice to not feel slightly ill all the time.

It’s not for everyone. If nothing else, a lot of people will balk at the amount of salt and fat they have to work into their diets after decades of being told those things are bad for them, and as I said, there are people who are very insulin sensitive (that’s a good thing) who will not see any need or reason to try it out. There are also people for whom the social pressure to eat grains will be too much – I am trying to get my head around the fact that going to the movies is no longer inextricably linked with popcorn (I love popcorn, I’m not even kidding), and on an emotional level that has been surprisingly difficult!

And yet I don’t think I can trade this clear headedness, this sense of satiety, this extraordinary get-up-and-go that I have – I can’t trade it in for a bucket of popcorn, or a really good pizza. It’s not worth it.

So I’ll be sticking to it for a while. Watch this space.