Keto Confidential EP013: Insulin Resistance

Terms In This Episode (0:45)

Pancreas – The pancreas is a unique organ that has two distinct bodily functions. It is both and exocrine glad that secretes pancreatic enzymes that helps in the digestion and metabolism of foods, as well as an endocrine glands which regulates blood sugar levels by producing and secreting the hormone insulin. Because of this dual purpose, the pancreas is made up of two distinct types of tissue. The exocrine tissue that secretes pancreatic enzymes makes up about 90 – 95% of pancreas. The other 5 – 10% is comprised of endocrine tissues that secrete the hormones insulin and glucagon. This particular area that contains beta and alpha cells is known as the isle of Langerhans.

Alpha Cells – Alpha cells are a specific type of cell in the islet cells of the pancreas that produce the hormone glucagon. These alpha cells make up 40% of the total cells in the islet of Langerhans. Glucagon keeps you from becoming hypoglycemic during times when food and or glucose is in short supply. It does this in two ways, the first is by stimulating the liver to convert or breakdown stored glycogen into glucose through the process of glyco-neo-lysis which is the Latin term for breaking down a sugar molecule into glucose. The second is by actually causing your body to produce endogenous glucose from amino acids and fats a process known as glyco-neo-genesis, which is the Latin term for the creation of glucose. For the remainder of this podcast we will only by examining the secretion of the hormone insulin. I will address the hormone glucagon in another podcast.

Beta Cells – Beta cells are a specific type of cell in the islet cells of the pancreas that produce the hormone Insulin. These beta cells make up 50% of the total cells in the islet of Langerhans. It is primarily though the production of the hormone insulin that our bodies regulate our blood sugars.

Insulin – Insulin is the hormone that is produced by the beta cells the islet cells in the pancreas in an area known as the ‘islet of Langerhans’. It is the hormone that regulates carbohydrate, protein, and fat, metabolism. It drives the cells in our body to take up glucose that is circulating in our blood stream reducing blood sugar levels. It is the hormone that signals the muscle cells in our bodies to take up and use amino acids to promote the growth of muscle tissue. Insulin prevents the release on endogenous glucose that is produced by the liver, and it inhibits the release of stored fat from the cells in our body.

Endogenous – Simply means produced from within. In the case of insulin when I refer to endogenous insulin I am referring to insulin produced by the beta cells in your pancreas.

Exogenous – Simply means produced from without or from outside sources. When I refer to exogenous insulin I am referring to pharmaceutical grade insulin that you inject into the subcutaneous tissues of your body to help lower blood glucose levels.

Glucose Toxicity – Glucose toxicity is a state in which the beta cells of the pancreas have decreased the production of insulin due to an increase in insulin resistance. This state of glucose toxicity then worsens the condition of type 2 diabetes by causing beta cell damage and or death due to chronic hyperglycemia. This cellular damage and death reduces the pancreas’s ability to produce insulin and leads to even higher levels of circulating blood glucose, a vicious and dangerous cycle.

Main Topic (4:15)

  • Diabetes is a problem of hormone dis-regulation.
    • In T1D, the majority of beta cells that produce endogenous insulin are either destroyed or die off generally from an autoimmune response. Not enough Insulin production.
      • T1D need to inject themselves with the hormone insulin multiple times a day to maintain safe blood sugar levels.
      • For T1D, then the question is not whether they need insulin, but rather how much insulin do they need.
  • In T2D, the beta cells are damaged or destroyed generally by the over production of insulin due to the stimulation of gross amounts of glucose in the blood stream.
    • When the beta cells become damaged and or destroyed, insulin production falls off and blood sugar levels rise.
      • Once this happens, T2D, are generally prescribed subcutaneous insulin or oral anti-diabetic medications and may soon have to contend with the same risks of hyperglycemia and or hypoglycemia that T1D have to deal with on a daily basis.
  • Insulin resistance can occur in as little as a few years or it may take as long as 10 – 15 years for your body begins to build up a resistance to this over production of insulin.
    • The beta cells have to produce even more insulin in order to try and keep your blood sugars within a normal range.
    • Over production of insulin or stress that the beta cells have to withstand that causes them to become damaged and start to die off. A process know as apoptosis.

Insulin Resistance and Beta Cell Damage/Death

According to the article ‘Mechanisms Of Pancreatic B-cell Death in Type 1 and Type 2 Diabetes’ “Chronic exposure to elevated levels of glucose and fatty acids causes beta cell dysfunction and beta cell apoptosis (or cell death) in type 2 diabetics. Exposure to high glucose has dual effects, triggering initially glucose hyper-sensi-tization and later cell death via different mechanisms.” The article ‘Apoptosis In Pancreatic Beta Islet Cells in Type 2 Diabetes states “In T2D, insulin resistance with visceral obesity leads to a glucose toxicity effect (or highly toxic levels of blood glucose), which accelerates beta cell death.” Later in the same article it states “Glucose is the main fuel, which stimulates insulin secretion….and chronic hyperglycemia causes beta-cell glucose toxicity, and eventually leads to beta cell death”.

High levels of circulating blood glucose causes the beta cells to produce extra amounts of insulin to try and decrease your blood sugar levels a process known as hyperinsulinemia. Over time, chronic hyperinsulinemia leads to insulin resistance. In simple terms our bodies cells build up a tolerance of sorts to insulin. So in order to lower the circulating blood sugar levels, the beta cells in the pancreas kick it up a notch and produce even more insulin. The problem is, your beta cells can only do this for so long before they start become damaged from being in this hypersensitive state in which they are over producing insulin. As your Hgb A1c increases, so does your insulin resistance.

  • Hgb A1c of 6.5 – 7% had an increased insulin resistance of 9%.
  • Hgb A1c of 7.1 – 8% had an increased insulin resistance of 14%.
  • Hgb A1c of 8.1 – 9% had an increased insulin resistance of 18%.
  • Hgb A1c greater than 9% had a 29% increase in insulin resistance.

So you can see as your Hgb A1c becomes higher than 6.5% you become increasingly insulin resistant which means the beta cells in your pancreas have to work harder. Unfortunately, over time, the harder they have to work, the less efficient they become. So where does the ADA recommend that physicians maintain their patients Hgb A1c levels. That’s right, about 7%. So if your physician keeps your Hgb A1c somewhere in the 6.5 – 7.5% range, then their goal is to keep you in an insulin resistance state of about 9 – 12%.

Reduction of Beta Cell Function Related to Cellular Damage/Death:

  • Hgb A1c of 6.5–7% increases beta cell function, increasing insulin production.
  • Hgb A1c of 7 – 7.9% promotes a marked decrease in insulin production must likely due to damaged cells and the beginning of beta cell death.
  • Hgb A1c of 8 – 9% reduces beta cell function by 37% due to damage and or beta cell death.
  • Hgb A1c of 9% or greater had a 62% decrease in beta cell function due to glucose toxicity and

    beta cell death.

Think of this way. If you owe more more money than you make you have two options. You can increase your income or decrease the amount of money you spend. To increase your income, maybe you take on extra hours at work, or you get a second part-time job. So instead of working 40 hours a week, you are working 60 or 80 hours a week. Now you may be able to handle this extra work load for a limited amount of time, but eventually you begin to become overloaded, tired, and cranky. As you become more fatigued, your immune system becomes weakened due to lack of sleep and rest. You become less productive and eventually, the continued physical and emotional stress makes you sick. In other words you are literally working yourself to death. So while working extra hours or taking on another part-time job may be a viable option in the short-term, in the long-term it can cause irreparable damage. A second or better long-term option would be to increase your workload temporarily, while decreasing your expenditures before you work yourself into an early grave.

The same is true for the beta cells in your pancreas. As your hemoglobin A1c rises into the 6 – 7% range, the beta cells start working overtime and secrete more insulin to try and lower your blood back into the normal non-diabetic range of less than 5.8%. As your blood sugars continue to rise above 7%, the productivity of you beta cells decreases, they can no longer keep up with the workload and they become damaged. Because the other cells in your body are becoming more resistance to the increased amount of insulin production, and the beta cells are less productive, your blood sugar levels remain high or actually increase. As your Hgb A1c climbs to the 8% range not only has your insulin resistance increased by 18%, but the function of your beta cells have decreased by 37% due to cellular damage and death. Now your body and endocrine system is being attacked from two fronts. Once your Hgb A1c becomes greater than 9%, your insulin resistance has increased to 29%, but the biggest problem is that high levels of circulating blood glucose has created a pool of glucose toxicity that has decreased your beta cell function by 62% due to damage or cellular death. Essentially the strain of increased blood glucose in T2D is working your pancreatic beta cells to death.

At this point, you are already on oral anti-diabetic medications, and most likely subcutaneous insulin. And in all likely hood your doctor has placed you on some form of American Diabetic Association (ADA) diet. Keep in mind that the ADA recommended goal is to keep your beta cells in a state of hyper-sensitivity or overdrive at around 7% (or about 150 – 155 on your blood glucose monitor). So at this point you have two options, you can maintain the status quo by adding more medications to lower your blood sugars in the form or more insulin, which guess what? Increases your insulin resistance even more. Or you can choose to try and attack T2D at the source and decrease the amount of circulating blood glucose in your body by decreasing the amount of carbohydrates you eat each day.

So the decision is yours. You have to chose your specific path, change you diet, or embrace that idea that you may need to take anti-diabetic medications for the rest of your life. No one else can make that decision for you. As for me I was on both oral diabetic medications and subcutaneous insulin. As my diabetes progressed and I ended up in the emergency room as a result of these medications I decided enough was enough and I embraced the ketogenic lifestyle. And just in case your wondering,I had my labs drawn on December the 12th, 2018 and my Hgb A1c is 5.2, and it has been at this level for more than 18 months. That’s the power of ketosis and the ketogenic diet.

Anyway, back to insulin resistance and glucose toxicity. Now that we know at which specific Hgb A1c levels are toxic to your beta cells, the next questions is can your beta cells recover from this damage? Can they be healed? Can we reverse the process of insulin sensitivity and glucose toxicity?

To find the answers to these questions we need to examine some more research. According to J.J. Meier in his article ‘Beta Cell Mass In Diabetes: A Realistic Therapeutic Target? published in Diabetologia magazine. When examining the effects of treatments designed to lower blood glucose and how they affect beta cell turnover, one key aspect determining the fate of your beta cells is the body’s demand for high levels of insulin secretion. It is this constant stimulation of insulin secretion due to either high blood glucose levels as well as the use of oral anti-diabetic medications such as Glyburide and , Glucotrol each of which are a class of medications known as sulfonylurea’s. While used to treat T2D, sulfonylurea’s can make the problem of hyperinsulinemia worse as they increase your endogenous production of insulin production. So if your beta cells are already stressed and over producing insulin adding a sulfonylurea which pushes the beta cells to produce even more insulin can cause even more beta cell damage and ultimately lead to increased rates of beta cell death.

The article goes on to say, that “while the increased demand of insulin secretion can lead to beta cell damage and potentially accelerate the loss of beta cells in type 2 diabetes, the induction of a rest period in which the beta cells are not overly taxed by insulin secretion appears to give them much needed protection. This rest period allows beta cells to recover from the stress of having to over produce insulin due to insulin resistance, and increasing beta cell longevity”.

Catherine Gleason and her associates at the Pacific Northwest Research Institute found that high levels of glucose increased insulin resistance, and that the quicker that glucose concentrations were lowered, the greater the recovery of insulin resistance. However, when it came to glucose toxicity which can result in beta cell death, their findings indicate that there is a small time frame in which full recovery from glucose toxicity is possible. In essence, the sooner that your hemoglobin A1c returns to a normal level of less than 6.5%, the better your chances are for decreasing or stopping beta cell destruction.

Their findings also indicate that glucose toxicity happens over time rather than happening at a specific blood glucose level. Because of the gradual ongoing process, the shorter the period of glucose toxicity, the greater the degree of recovery. Overall their findings indicate that while beta cell damage and exhaustion occur during the early stages of T2D, it is more likely to be reversible, whereas glucose toxicity which occurs later is less likely to be reversible. Therefore, early recognition and effective treatment of hyperglycemia in T2D’s is vital in preserving residual beta cell function.

So yes, insulin resistance and glucose toxicity are reversible. As with most things, the sooner the better, especially when it comes to glucose toxicity. The bottom line, reducing the amount of glucose circulating in your blood is the easiest way to give your beta cells a needed break so that they can recover from all the damage related to the overproduction of insulin and glucose toxicity.

So, what happens when you reverse your insulin resistance and bring your Hgb A1c back to normal levels? Will your beta cells recover from all of that cellular damage? What about the beta cells that have died off due to glucose toxicity? More importantly, can your body produce new pancreatic beta cells to replace those that you have lost? The good news is that you do not have a finite amount of beta cells in your pancreas. A healthy pancreas not bogged down with hyperinsulinemia or glucose toxicity will continue to produce pancreatic beta cells throughout your lifetime. Or that is at least the current consensus among researchers. What they cannot seem to agree on is the overall frequency of beta cell replication in the adult pancreas. However current thinking is that beta cell replication is extremely low in adults and it continues to slow as we age. Because research on human pancreatic cells is difficult, determining the specific number or the speed in which your beta cells replicate as you get older is inconclusive. Your best option is to adopt preventative measures to try and reverse the damage that has already been done to your pancreas and preserve as much of your beta cell function as possible while you still can. The strategies you can use to help preserve your pancreatic beta cell functions on is what we are about to discuss next.

Now that we know at which specific Hgb A1c levels are toxic to your beta cells, and that your beta cells can recover form this damage. How can you reduce your circulating blood glucose levels without the addition of more medications to reverse your insulin resistance? Or is that even a possibility? That is what we are about to discover.

Most researchers agree that from a clinical point of view, one of the simplest ways of inducing beta cell rest is to reduce the bodies insulin demand by either improving insulin sensitivity or by lowering blood glucose levels. One of the easiest ways to reduce the bodies key demands for insulin production is through dietary measures. Primarily by limiting or eliminating foods which cause a substantial rise in blood sugar levels after they have been consumed. Foods that contain a large amount of carbohydrates such a simple sugars, and starches such as bread, rice, pasta and other grain by-products should be restricted. In addition, starchy vegetables such as corn, potatoes, and other tubers should be eliminated or severe restricted.

Initially, diet alone may not give the body enough time to recover from insulin resistance or cellular damage. Physical activity can also increase the effectiveness of the bodies ability to absorb and utilize circulating blood glucose thereby reducing the need for additional insulin production. Studies have also shown that moderate physical activity also increases insulin sensitivity which enhances the effectiveness of endogenous insulin production. Having said that sometimes, dietary measures and increased physical activity alone are not enough. Especially if you have elevated Hgb A1c levels greater than 8%.

I realize that for some of you physical exercise may not be an option. Whether it is related to obesity, or declining health is irrelevant. In such cases you may initially need to be placed on oral anti-diabetic medications such as metformin or exogenous insulin until you are able to implement proper dietary measures. However once you adopt a ketogenic diet in which dietary carbohydrates are restricted to less than 20 grams of net carbs per day, you will start to see a substantial decrease in the daily blood sugar readings. In fact, many type two diabetics find that their insulin resistance quickly diminishes, and they are often able to substantially reduce or totally eliminate the use of subcutaneous insulin injections just as I did.

So there you have it, three specific strategies to combat insulin resistance and glucose toxicity. Adopting a ketogenic lifestyle, increasing the amount of daily or weekly physical activity, and finally, adding or increasing the amount of anti-diabetic medications. Dietary management. Of the three, the adoption of the ketogenic diet and lifestyle is the easiest and requires the least amount of physical work. No matter your age, health, or economic status or you can embrace the ketogenic lifestyle for very little cost. Physical activity helps, but not everyone is able to participate. In fact, for people who are morbidly obese, physical activity may actually have a negative impact on their health. And finally medications. It would be better if we did not have to take them, but you may need to need them especially when you first start tackling insulin resistance and glucose toxicity. By adopting a ketogenic way of living you may quickly find that you can start incorporating some light to moderate exercise in your daily or weekly routine. Doing so will only increase your rate of success. As you get further along in your ketogenic journey, like me you may be able to get off of your insulin because you have reversed your type 2 diabetes and are no longer insulin resistant or suffer form glucose toxicity. Just keep in mind that the ketogenic lifestyle is indeed just that. If you have type 2 diabetes and you go back to eating a high carbohydrate diet, then all of the problems that you have just eliminated will come crashing back down upon you.

Some things to consider about this episode. 1) In T2D, as your Hgb A1c rises, the beta cells in your pancreas become more susceptible to damage due to increased demand. Over time, this damage leads to a decrease in the number of beta in the pancreas due to cellular death. 2) A decrease in the number of beta cells means the remaining cells have to work harder in an attempt to produce even more insulin to combat your high blood sugar levels which leads to more cellular damage and death. A vicious cycle that is hard to break while eating the high carbohydrate diet(s) such as those recommended by the ADA. 3) Let’s be honest, as we age our beta cell production may naturally decreases, but for T2D this risk is elevated due to the long term complications of an increased demand for insulin production. The sooner you can decrease the workload of your pancreas, the more and healthier your beta cells will be throughout your lifetime. Possibly keeping you from having to increase your use of subcutaneous insulin. 4) For type 2 diabetics, a ketogenic diet in which you consume less than 20 grams of net carbohydrate per day will not only decrease your insulin resistance, but help you to lose visceral fat. 5) As you begin to feel the benefits of the ketogenic diet such as improved energy, weight loss, and increased stamina. You will be able to become more active which will in give you another valuable tool to help you decrease your insulin resistance.

As always, you can find additional information regarding this topic in the show notes on my website at www.ketoconfidential.net. You can also find links to all of our podcasts by clicking on the Podcast Archives link located on the home page.

You’ve Got Mail (30:00):

On December 17, 2018 in response to KCP005 ‘The LCHF Diet’ podcast Deva writes: “Thank you a bunch for sharing this, you actually understand what you’re speaking about!” Well thank you Deva, I appreciate your kind words, and I hope that you continue to enjoy the podcast.

If you have any feedback regarding anything you have heard in this or other episodes, or you just want to drop us a line with a question or two, or you just want to share your success story with us, you can send me an email at todd@ketoconfidential.net. Please note that any questions you have, may be answered in one of the upcoming episodes of the ‘Keto Confidential’ podcast. If you do not want to send me a email, you can call and leave me voice message at 469-526-3665. Just keep in mind that I will be playing your voice mail in the podcast during the ‘You’ve Got Mail’ segment in the podcast. So if you do not want your name used in the podcast, please make sure you mention that in your message.

Recipe Of The Episode (32:45):

Wow, it’s only five days to Christmas, so I wanted to share with you one more of my keto holiday recipes. Today’s holiday keto recipe is for my keto eggnog. This recipe is very similar to the custard recipe that I use to make to my keto crème brulee. The only difference is the addition of almond milk which makes it, well a drink as opposed to a cooked custard. In addition, I will be sharing with you another salad dressing recipe, this time it’s my keto version of Ranch dressing.

Even though we raise our own free range chickens and I am not at all concerned about salmonela, I cook or temper the eggs for my eggnog. It is quite a bit easier to make if you use raw eggs, but as I make a virgin version (no alcohol) for the kiddo’s, I go with a cooked eggnog. To make our eggnog you are going to need the following ingredients:

12 egg yolks (carbs 7.2 grams)

¼ teaspoon liquid sucralose or other keto sweetener to equal ½ – 1 cup sugar

1 quart Heavy Cream (carbs 28 grams)

1 quart of almond milk, unsweetened

3 – 6 ounces of rum, whiskey, or brandy (optional)

1 tablespoon vanilla extract (carbs 1.6 grams)

¼ teaspoon ground nutmeg

¼ teaspoon ground cinnamon

Separate the yolks from the egg whites and combine the egg yolks, vanilla, and sucralose, or other low-calorie sweetener in a metal bowl and whip with a wire whisk until light and fluffy.

Pour the heavy cream into small saucepan and bring to the scalding point (just before it boils). Remove the saucepan form the heat and with a ladle, gradually add the hot cream into the yolk mixture about a ½ ladle at a time while stirring rapidly to keep the eggs from curdling. Once the eggs are tempered, add the egg mixture to the saucepan and bring up to about 160 degrees.

Remove the saucepan from the heat and pour the contents of the saucepan into a bowl or large container and place it in an ice bath to stop the cooking process. Once the cream and egg mixture have cooled, add the almond milk and mix thoroughly with a wire whisk. Cover and place in the fridge until ready to serve.

I tend to make this eggnog in one big batch so that they whole family can enjoy it and allow the drinker to add the alcohol to their individual glasses. The alcohol is optional, and while bourbon, brandy, rum, or whiskey do not contain any carbohydrates, some people believe that it can slow down ketosis. Anyway, no matter how you make it, just take care and please do not drink and drive during the holiday season. The life you save may not only be yours but that of your family as well.

Total Recipe (about 72 ounces, or Nine 8oz servings)

4069 Calories, 40.4 grams protein, 418 grams fat, 38.2 grams, net carbohydrates.

Per 8 ounce Serving

508 Calories, 5 grams protein, 52 grams fat, 4.7 grams net carbohydrates.

Made with ½ Gallon of Almond Milk

Total Recipe (about 104 ounces, or 13 8oz servings)

4189 Calories, 44.4 grams protein, 430 grams, fat, 42.2 grams, net carbohydrates.

Per 8 ounce Serving

322 Calories, 3.4 grams protein, 33 grams, fat, 3.24 grams, net carbohydrates.

Homemade Keto Ranch Dressing

Now there are two different approaches to making your own LCHF Ranch dressing. The primary difference is whether you use fresh herbs or dried herbs. I have made it both ways, but as I generally keep dried herbs on hand, I almost always use dried herbs in my Ranch dressing and in many of my vinaigrette’s as well. While it is true that fresh herbs have more essential oils and do taste fresher, I have found that most people have the necessary dried herbs and spices in their pantries. As dried herbs and spices are cheaper as well as being more shelf stable, I will be using them in this Ranch dressing recipe. To make this recipe you will need the following ingredients:

Homemade LCHF Ranch (Yield: 2 cups, 32 tablespoons)

1 cup LCHF mayonnaise or any mayonnaise with 0 carbs

1 cup heavy whipping cream
1 ½ teaspoons dried parsley, divided
½ teaspoon dried dill, divided

¾ teaspoon garlic powder

¾ teaspoon onion powder
½ teaspoon salt
1 drop of liquid sucralose (Optional)
1/8 teaspoon ground white pepper
1/8 teaspoon paprika

Combine all the ingredients in a bowl and mix well with a spoon or wire whisk until smooth. You can use more or less whipping cream depending on how thick you like the your Ranch dressing. Refrigerate for at least 1 to 2 hours before serving, although I find waiting 24 hours before using yields a better flavor. The dressing will thicken up a little after being in the fridge for a couple hours. If you wan to use this as a Ranch dip for vegetables, then use ¼ less heavy whipping cream. If you like you Ranch and little thinner, hen add ¼ cup of unsweetened almond milk. The great thing about using almond milk to thin the dressing some is that it only contains 0.25 grams of net carbs, so it does not impact the nutritional value of the recipe, and it has a neutral flavor profile. You could of course just use plain water or a ¼ cup of bone broth.

Anyway, you can keep this dressing in fridge for about 10 to 14 days if using homemade mayonnaise, up to 4 weeks for commercially prepared mayonnaise. You can use an immersion or traditional blender or food processor to make this dressing, but you will want to process the ingredients just until they are well blended. You do not want to over process the dressing or you will and end up with Ranch style heavy whipping cream.

Total Recipe – Calories 2470, protein 3.8 grams, fat 271 grams, carbohydrates 10.5 grams

Per Tablespoon – Calories 77, protein 0.12 grams, fat 8.4 grams, carbohydrates 0.33 grams

The following are a few of the variations that I have made over the years. I am sure there are many other possible combinations so I encourage you to experiment and expand your palate.

  • Bacon Ranch – Add 4 to 6 slices of crispy bacon chopped fine.
  • Buffalo Ranch – Add 3 to 4 tablespoons Louisiana Hot Sauce.
  • Buttermilk ‘Style’ Ranch – Substitute ½ cup sour cream for ½ cup of mayonnaise.
  • Chipotle Ranch – Add one chipotle pepper (smoked jalapeño) and one teaspoon of the adobo sauce. Remove the seeds if you wish as they contain most of the heat and do not attribute to the flavor of the dressing.
  • Fiesta Salsa – Add ¼ to ½ cup of your favorite LCHF salsa.
  • Santa Fe Ranch – Add 3 to 4 tablespoons of salsa verde (green chile salsa) or Hatch green chilies.

I find that when making any of the variations that have solid ingredients such as the ‘Chipotle’, ‘Fiesta Salsa’ and ‘Bacon’ ranch etc. That combining the ingredients in a pint mason jar and pureeing them with my emulsion blender before adding the mayonnaise helps give the dressing a smoother creamier texture. That’s all there is to it, my delicious variation of Ranch dressing, the most popular salad dressing used in the United States.

For more information regarding any of the recipes from this podcast, you can check out my keto food blog ‘CulinaryYou’ at www.culinaryyou.blogspot.com where you can find step-by-step instructions as well as pictures of the recipe(s) featured in this episode.

References:

Cnop, Mariam, et. al, Mechanisms Of Pancreatic B-Cell Death In Type 1 and Type 2 Diabetes: Many Differences, few Similarities, Diabetes, Vol 51, supplement 2, December 2005.

Gleason, Catherine, et. al., Determinants of glucose toxicity and its reversibility in the pancreatic islet B-cell line, HIT-T15, Pacific Northwest Research Institute, and Departments of Pharmacology and Medicine, University of Washington, Seattle, Washington, 2000.

Kim, Mi Kyung, et. al, The Effect of Glucose Fluctuation on Apoptosis and Function of INS-1 Pancreatic Beta Cells, Korean Diabetes Journal, 2010.

Lim E.L. et. al, Reversal Of Type 2 Diabetes: Normalisation Of Beta Cell Function In Association With Decreased Pancreas And Liver Triacylglycerol, Diabetologia, 2011.

Marlon E. Cerf, Beta Cell Dysfunction and Insulin Resistance, Frontiers In Endocrinology, March 27, 2013.
Meier, J.J., Beta Cell Mass In Diabetes: A Realistic Therapeutic Target?, Diabetologia, 2008.

Misa, Siddhartha M.D. (2016). Reversing Diabetes: the High 5 Way, Educreation Publishing,

New Delhi, India.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Living. Beyond Obesity LLC.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Performance. Beyond Obesity LLC.

Stanojevic, Violeta, Habener, Hoel. Evolving Function and Potential of Pancreatic Alpha Cells, Department of Health and Human Services, 2015.

Tomita, Tatsuo, Apoptosis in pancreatic B-islet cells in Type 2 diabetes, Bosnian Journal of Basic Medical Sciences, 2016.

Weir, Gordon, Bonner-Weir, Susan, Glucose Driven Changes in Beta Cell Identity Are Important for Function and Possibly Autoimmune Vulnerability during the Progression of Type 1 Diabetes, Frontiers in Genetics, 2017.

Weir, Gordon, Bonner-Weir, Susan, Five Stages of Evolving B-Cell Dysfunction During Progression to Diabetes, Diabetes, Vol. 53 Supplement 3, December, 2004.

 

KCP012: Why The American Diabetic Association (ADA) Diet Is Killing You

Terms In This Episode (1:01):

Before we dive into to day’s topic, let’s examine the following terms or definitions so that you have a clear understanding of just exactly what is that we will be talking bout.

Standard American Diet (SAD) – The standard American diet or SAD diet, also known as “The Western Pattern Diet”. It is a diet or eating pattern that contains high amounts of red meat, dairy products, and eggs. On Average the typical SAD diet is comprised of about 50% carbohydrates, 15% protein and 35% fat. It is this high concentration of carbohydrates which are then processed and turned into glucose by your liver that puts you at risk for developing diabetes, metabolic syndrome, cardiovascular disease, and morbid obesity.

American Diabetic Association Diet (ADA) – There is no official 1800 or 2000 calorie ADA diet. What the ADA does recommend is a calorie restricted diet based on their “My Plate Method’ and or the Diabetic Choices Diet. The my plate method promotes the simple idea that your plate should be divided into three distinct portions. According to the American Diabetic Association website this means that for each meal, the calories from your plate should contain 25% carbohydrates from grains and starchy foods, 25% from protein, and 50% from non-starchy vegetables. The Diabetic Choices Diet is based on the concept of food exchanges or choices. Each day depending on your prescribed caloric range, you can have a certain number of starches, meats, vegetables etc. Keep in mind these recommendations are current as of 2017, and come straight from the ADA website.

Eating Patterns – An eating pattern is a term used to describe the foods or groups of foods that a person chooses to eat on a daily basis over time. Some of the eating patterns listed on the ADA website include: Mediterranean, vegetarian or vegan, low carbohydrate, low fat, and the low sodium or DASH (Dietary Approaches to Stop Hypertension) diet. While the ADA does not specifically promote any of these eating patterns, they recognize that each may be a viable option for treating type 2 diabetes. Regarding eating plans the ADA states “Studies show there are many different eating patterns that can be helpful in managing diabetes. In the long run, the eating pattern that you can follow and sustain that meets your own diabetes goals will be the best option for you.” So while you may use any one of these, or other eating patterns, you would still use the ‘My Plate’ or ‘Diabetic Choices Diet’ while eating these types of foods or foods from these food groups.

 

Main Topic (5:44):

So you have just left your doctor’s office and you have been told that your hemoglobin A1c is greater than 7%. That you have uncontrolled type 2 diabetes. Your doctor had written you a prescription for an oral anti-diabetic medication, and gave you some information regarding the disease, and scheduled you an appointment with a diabetic education nurse and or dietician. When you get home you begin researching diabetes and come across the 1800 or 2000 calorie ADA diets and various diet plans. What I did find on the ADA website are two different, but similar diets endorsed by the ADA to teach diabetics how to control their blood sugars. The first is known as ‘My Plate’, the second is the Diabetic Exchange or Choices diet. Plans such as:

The University of Michigan (1,800 calorie My Plate Diet)

The University Of Southern Alabama College Of Medicine (1,800 calorie Diabetic Choices Diet).

The United States Department Of Agriculture (USDA) ‘Dietary Guidelines For Americans.’ The most recent 8th edition of the USDA recommended dietary guidelines covers the years of 2015 – 2020 and can be downloaded for free from the internet. If you are interested in checking them out, and you can find a link for them in the show notes on my website www.ketoconfidential.net.

What is important about the USDA dietary guidelines is that they have created a specific range of caloric intake for men, women, and children based not only on age, but activity level. These daily caloric intakes range from 1,000 to 3,200 calories per day. On page 77 of the USDA dietary guidelines is the following statement. “The total number of calories a person needs each day varies depending on a number of factors, including the person’s age, sex, height, weight, and level of physical activity. In addition, a need to lose, maintain, or gain weight and other factors affect how many calories should be consumed….Estimates range from 1,600 to 2,400 calories per day for adult women and 2,000 to 3,000 calories per day for adult men ”.

So, if you are a physician, medical professional, or organization and your diabetic patients or clients are obese and you think that they need to lose weight, the easiest thing to do is get a copy of the USDA dietary recommendations go to Table A2-1, ‘ The Estimated Calorie Needs per Day, by Age, Sex, & Physical Activity Level‘ on page 77 and cross reference your patients age with their activity level and the chart will give you a suggested amount of calories that your patient or client should eat each day.

So what happens when your doctor or dietician thinks you need to lose more weight? It is really quite simple, they tell you to reduce the number of calories that you eat each day by about 400 – 600 calories or around 18 – 20% of your total dietary intake. So if you were currently eating 2,400 calories a day, the doctor would simply move down to the next column and suggest you eat 2,000 or less a day. Pretty simple right?

So why is there such a focus on the number of calories you eat each day rather then the number of carbohydrates you eat each day? The primary reason is that most medical professionals and the ADA believe that the reason that you are overweight is because of the amount of calories that you consume each day. This is the same reason that many big pharmaceutical companies that produce anti-diabetic medications as well as companies such as Weight Watchers and Jenny Craig promote calorie restricted diets. These diets are then printed and freely distributed to hospitals, doctors offices, and clinics labeled by these companies or organizations as the 1800 or 2000 Calorie Diabetic Diet’ which often gets referred to as the ADA 1800 or 2000 calorie diet.

It’s really that simple. I see our diabetic educators give this type of dietary information to diabetic patients all the time prior to discharging them home. In fact, I actually had this type of brochure given to me not only at my doctor’s office, but also when I went to my first diabetic education class. And to be honest, at the time, I thought it was an ADA approved diabetic diet. But, the reality is, these calorically restricted diets are not officially endorsed by the ADA. And if the ADA does not endorse these 1800 and 2000 calorie diets, the next questions is what are the ADA’s actual dietary recommendations. That’s what we are going to look at next. Two specific, but different eating methods that are officially endorsed by the ADA. The first is the ‘My Plate’ method, and the second is the Diabetic Choices Diet.

The ADA ‘My Plate’ Method (13:47)

The ‘My Plate’ method is touted as a simple way for diabetics to make food portion control easy. The idea is that if you make it easy, then the patient will be compliant with the ADA’s dietary recommendations. While it it true, the ‘my plate’ method is a quick and simple way to prepare your plate and control your portion size, it is still a poor dietary tool for type 2 diabetics. Let me rephrase that “if you want to reverse your type 2 diabetes, then the ‘my plate’ method will never work for you. Why you ask? Because the my plate method contains way to many carbohydrates each meal to get you into a state of nutritional ketosis.

Let’s examine the nutritional information regarding the ‘my plate’ servings. According to ‘Diabetes Forecast‘, the official magazine of the ADA. They list the ‘My Plate’ nutritional information as follows. A ½ cup of cooked or 1 cup raw starchy vegetables (1 serving) = 15 grams of carbohydrates,

a ½ cup of fruit (1 serving) = 15 grams of carbohydrates, a ½ cup of dairy (1 serving) = 12 grams of carbohydrates, and 1 serving of fat = 5 grams of fat.

So, I ran some rough numbers based on the recommendations on the ADA website using the ‘My Plate’ example. If you carefully measure out the recommended portions as proposed by the ADA each day you would be eating about 108 – 130 grams of total carbohydrates for three meals and two snacks, and 123 – 145 grams of carbohydrates a day for three meals and three snacks.

The following free downloadable copy of the ‘Create Your Plate’ brochure produced by the ADA. At the bottom of the brochure they recommended the following book ‘What Do I Eat Now, A Step-By-Step Guide to Eating Right With Type 2 Diabetes‘. If you followed just the meal recommendations in this book you would be consuming 135 – 180 grams of carbohydrates per day following the 45 – 60 gram meal recipes. Or 195 – 210 grams of carbohydrates using the 65 – 70 gram recipes. These numbers do not however include the two snacks that are recommended by the ADA, so you need to add an additional 30 grams of carbs to the total daily intake bring them to a total of 165 – 210 grams of carbohydrates per day for the 45 – 60 gram meal recipes. Or 225 – 240 grams of carbohydrates for the 65 – 70 gram recipes.

If 50% of the energy from the SAD comes from carbohydrates. And you were to eat 1,800 calories a day. That means that 900 calories of the SAD is made up of carbohydrates. To determine the number of grams of carbohydrates we divided 900 calories by 4, because each gram of carbohydrate contains 4 calories, that comes out to 225 grams of carbohydrates per day. Wow, that’s pretty close to the 165 – 210 grams of carbs for the 45 – 60 gram carb per meal plan. And as good as or better than the 225 – 240 grams of carbs per day for the 65 – 70 gram carb meal plan recommended in the book ‘What Do I Eat Now, A Step-By-Step Guide to Eating Right With Type 2 Diabetes‘.

So if the total amount of carbohydrates consumed is the primary cause for the rise in your blood sugar as the ADA proposes, then why do they not endorse the ketogenic diet which promotes carbohydrate restriction to control your type 2 diabetes. In fact, the numbers indicate that a 1,800 calorie diet using the recommended ‘My Plate’ method is not really any better than a 1,800 calorie SAD diet that contains about 50% carbohydrates. Which I admit is not what I expected. And I ran the numbers a couple of times just to make sure they were right.

The Diabetic Exchange Diet (23:07)

The concept is relatively simple. The “diabetic choices” diet, groups foods into six different categories. Such as starches, fruits, vegetables, milk, meat and meat substitutes, and fats. One serving in a particular group is called a “choice”. Each serving in a choice group contains about the same amount of carbohydrates, protein, fat, and or calories as another choice. One serving of starch or fruit contains 15 grams of carbohydrates, one serving of milk contains 12 grams of carbohydrates, one serving of lean meat contains 7 grams of protein and only 1 – 3 grams of fat, and one serving of fat contains 5 grams of fat.

The number of exchanges or choices you can have each day depends on….you guessed it, the number of calories you are allowed to eat. According to the book ‘The Ultimate Diabetes Meal Planner: A Complete System for Eating Healthy with Diabetes‘, the diabetic “choices” method supplies about 1,800 – 2,500 calories per day depending on the foods selected. In fact, the description of the book which is sold on the ADA website, states “Ultimate Diabetes Meal Planner includes weekly plans for breakfast, lunch, dinner, and snacks, along with detailed recipes that make using the 16-week meal plan easy. The overall calorie count—based on 1500, 1800, 2000, 2200, or 2500 daily calories—lets you choose the right diet, whether you’re looking for weight loss or just healthy living.

I addition, step two in the ‘How To Use This Book’ section of the ‘Ultimate Diabetes Meal Planner’ reads as follows “During the meeting with your healthcare team, you should ask how many calories you should be eating per day. The meal plans in the Ultimate Diabetes Meal Planner fall into four daily calorie levels: 1500, 1800, 2000, and 2200 calories per day. Find out which of these levels works best for your health needs.

Looking for more information, I downloaded an 1,800 calorie Diabetic Choice sample menu from the University Of Alabama College of Medicine just how many carbohydrates are in an 1,800 calorie diabetic choice diet. The University Of Alabama sample menu consists of: 8 starches, 3.5 fruit, 3 milk, 5 vegetables, 6 meats, and 5 fat servings which comes out to 197.5 grams of carbohydrates. The typical 1,800 calorie SAD diet in my previous example contained 225 grams of carbohydrates, which means there is only a difference of 27.5 grams of carbohydrates between the 1,800 calorie SAD diet and the 1,800 calorie Diabetic Choice diet. I will be honest, I never thought these two diets would contain such similar amounts of carbohydrates.

But what about fat? We know that healthy fat not only supplies calories, but is a necessary part of making us feel full helping to curb our appetite. Unfortunately both the ‘My Plate’ and the Diabetic Choice diet are low fat diets. Again I quote from the ‘Ultimate Diabetes Meal Planner’ “None of the recipes in The Ultimate Diabetes Meal Planner contain more than 3 grams of saturated fat and most contain no trans fat. Fat packs more calories per gram than any other nutrient, so if you are aiming to lose weight, it is especially important to lower the amount of fat in your daily meals”.

Yes, fat contains more then twice the calories than carbohydrates, but it is the consumption of healthy fats in the diet that is the cornerstone of the ketogenic diet. Because you eat a diet that is low in carbohydrates, your body begins to burn stored fat. In turn, because the calories you do eat are high in fat you have high levels of satiety which means that overall you eat less calories. Not because you are restricting calories, but simply because you are not hungry. Through the power of ketosis, you are able to tap into your stored fat reserves which then causes you to lose weight. This can never happen while you are eating the ‘My Plate’ or Diabetic Choice Diets. You will never be able to get into a fat burning state eating this amount of carbohydrates.

I want you to understand, I am not saying the ‘My Plate’ and Diabetic Choice Diets will not help you to lower your insulin levels. Any reduction in carbohydrates is going to have some effect, but the carb counts in these two ADA recommended diets is to high. What I am saying is neither of these diets will help you to reverse your diabetes, they simply contains two many carbohydrates to get you into the fat burning state of nutritional ketosis. Following these dietary plans will leave you dependent on insulin or oral diabetic medications for the rest of your life, and in my opinion that is not acceptable.

The ADA Position On Recommended Treatment For Type 2 Diabetes (32:04)

So, if the ADA believes that controlling or reducing the number of carbohydrates you consume each day is effective at reducing your blood sugar why hasn’t the ADA been more aggressive in adopting a more restrictive carbohydrate approach to managing type 2 diabetes? Why do they promote such high carbohydrate diets as the ‘My Plate’ method and the ‘Diabetic Choice Diet’ for type 2 diabetic patients. And lastly, why hasn’t the ADA adopted the ketogenic diet as a safe and effective way to treat type 2 diabetes?

According to the ADA position statement ‘Nutrition Therapy Recommendations for the Management of Adults With Diabetes.’ Type 2 diabetes is a progressive disease that will only get worse as you get older. That there is no specific cure or way to reverse your diabetes, that at best, you can only hope to minimize your complications. And I quote,“Due to the progressive nature of type 2 diabetes, nutrition and physical activity interventions alone without pharmacotherapy are generally not adequately effective in maintaining persistent glycemic control over time for many individuals. However, after pharmacotherapy is initiated, nutrition therapy continues to be an important component of the overall treatment plan.”

So how does the ADA actually gauge the effectiveness of their recommended treatment options? Well the gold standard for measuring the effectiveness of treatment modalities of type 2 diabetes is by measuring your hemoglobin A1c. Your hemoglobin A1c is the bio-marker that indicates the average amount of circulating blood glucose that you have in your blood stream over the last three months. In the United States, depending on the lab or clinic you use, a normal non-diabetic hemoglobin A1c is 4 – 5.6%. So if your HgbA1c is less than 5.6%, you are considered non-diabetic, a hemoglobin A1c of 5.7% – 6.4% indicates you are pre-diabetic, and a hemoglobin A1c of 6.5% or higher classifies you as diabetic.

According to the ADA, the World Health Organization (WHO), the Indian Health Services (IHS), and the center for Medicaid and Medicare Services (CMS) the recommended guidelines for a targeted glycemic goal in patient’s with type 2 diabetes is to reduce and maintain the patient’s HgbA1c to about 7%. The American Association Of Clinical Endocrinologists (AACE) recommend that physicians keep their patients HgbA1C around 6.5%.

Their standard of care is to regulate your HgbA1c so that it maintains a level of about 7% which still keeps you in the diabetic range. Why? Because they would rather use medications to keep you in a slightly higher A1c range, rather than implementing stricter dietary controls to help you reverse your diabetes. As far as the ADA is concerned, the best that you can hope for is to reduce the long term complications of the disease. This is the message that many diabetics hear. It it was the same message that was relayed to me by both my doctor and my diabetic educator when I was diagnosed with diabetes.

But here’s the thing….it is a LIE….Type 2 diabetes is reversable. I have reversed my diabetes by embracing the ketogenic lifestyle and adopting the ketogenic way of eating. My current hemoglobin A1c is 5.2%, before I started on the ketogenic diet my hemoglobin A1c was 7.1%. I have been able to stop taking my insulin, and I am off my blood pressure medications. But I am not alone, there are thousands of people who have reversed their type 2 diabetes just as I have with the ketogenic diet. But you will never be able to reverse your type 2 diabetes as long as you follow the dietary recommendations of the American Diabetic Association. I am sorry, that’s just the plain honest truth. I admit it took me along time before I came to this conclusion, and I am glad that I discovered this ketogenic way of living. I honestly believe that it saved my life, and it can save your life or the life of someone you love.

You’ve Got Mail (39:30):

If you have any feedback regarding anything you have heard in this or other episodes, or you just want to drop us a line with a question or two, or you just want to share your success story with us, you can send me an email at todd@ketoconfidential.net. Or you can give us a call at 469-526-3665 on your phone and leave me a voice mail that will be played in this segment of the podcast.

Recipe(s) Of The Episode (44:15):

The holiday season is upon us, and we all need some quick and easy keto type snack or party foods so this week I will sharing with you my quick and easy keto version of deviled eggs, as well as my version of Chipotle’s Restaurants ‘Chipotle’s Honey Vinaigrette’ salad dressing that has been ketofied and that’s, well delicious. So let’s get started by making my delicious deviled eggs which not only taste fantastic, but only contain 0.4 grams of carbohydrates per ½ egg serving. To make these deviled eggs you will need:

12 eggs, boiled

¼ to ¾ cup of mayonnaise

2 tablespoons dill pickle relish

2 – 3 drops of liquid sucralose or 2 – 3 teaspoons of powdered keto sweetener

½ teaspoon onion powder

½ teaspoon garlic powder

¼ paprika

Add one cup of water to the bottom of your Instant pot or electric pressure cooker, then place the steamer basket and then one dozen eggs on top of the basket. Cook the eggs on 6 – 7 minutes. Then cover the release valve with a tea towel and release the pressure. Remove the eggs and place them in an large bowl containing ice and water and allow them to cool for 5 – 10 minutes. I use this method because it make perfect eggs every time and they are easy to peel. You can use other methods to cook your eggs, but if you have an electric pressure cooker and try this method, I guarantee you that you will never make boiled eggs any other way.

 

One you have cooled and peeled your eggs, you want to cut them in half length wise and remove the cooked yolks and place them in a bowl. Once you have removed all the yolks, place the boiled egg whites on a plate or deviled egg container and prepare your filling.

 

In order to make the filling, you are going to need to take a fork and mash the yolks filling until it takes on a crumbly texture, which is kind of hard to describe, but don’t worry, the yolks will become nice and creamy when you add the mayonnaise. Once you have mashed the yolks, add all of the dry ingredients and the dill pickle relish. Once these are incorporated you start by adding the mayonnaise ¼ cup at a time and blend it with your fork or a spoon.

 

Now, I do not want to say that making deviled eggs is an art form, but the amount of mayonnaise you use will determine the texture of the filling. If you like a creamier filling then you will need to use more. If you like a slightly more dense texture then use less. As for sweetener, this is a matter of personal preference and it is optional. We like over deviled eggs to have a slight sweetness. When I was a child my mother made deviled eggs with Miracle Whip, so to give my deviled eggs that same sweetness, but none of the carbs, I use dill pickle relish with 2 – 3 drop of liquid sucralose. You can however omit the sweetener. To finish up your filling you want to salt and pepper it to taste, again this is a personal preference, but if you want a good starting point then you can use ¼ teaspoon of each.

 

Once your filling is to your liking, it’s time to fill your eggs. In the restaurant we would use a piping bag with a star tip to make them nice and pretty. At home, I take a plastic zip lock type sandwich bag and fill it with a spatula making sure to close the top. Then you cut one corner off the bag and fill the cavity of each half of your egg whites. Sprinkle a little paprika on the top if you so desire for presentation and place them in the fridge until you are ready to serve them.

 

Nutritional Informational (½ Cup Mayo)

Total Recipe (24 ½ Egg Servings)

1695 Calories, 143 grams of fat, 73 grams of protein, 10 grams of carbohydrates

Per Serving (½ Egg)

70 Calories, 6 grams of fat, 3 grams of protein, 0.4 grams of carbohydrates

Nutritional Informational (¾ Cup Mayo)

Total Recipe (24 ½ Egg Servings)

2069 Calories, 185 grams of fat, 74 grams of protein, 10 grams of carbohydrates

Per Serving (½ Egg)

86 Calories, 7.7 grams of fat, 3 grams of protein, 0.4 grams of carbohydrates

Chipotle’s Honey Vinaigrette

The original Chipotle recipe calls for the use of honey, hence the name ‘Chipotle Honey Vinaigrette’. However my keto version substitutes liquid sucralose for the honey. When I originally created this recipe I used Splenda as my keto sweetener, so if you are new to the ketogenic way of eating and are on a limited budget, the Splenda will work just fine. You can of course use any sweetener you wish, in order to get the sweetness equal to 2 – 3 teaspoons of sugar. Using one chipotle chile makes this recipe mild, so if you like your dressing to have a little more heat then go for 2 chipotle chilies.

¾ cup olive or canola oil

¼ cup red wine vinegar

1 – 2 chipotle pepper’s

2 – 3 drops of liquid sucralose or (2 – 3 teaspoons Splenda)

1 teaspoon salt

½ teaspoon adobo sauce

½ teaspoon garlic powder

½ teaspoon cumin

½ teaspoon oregano

½ teaspoon black pepper

Combine all the ingredients in a pint mason jar, then take your immersion or stick blender and place it in the jar and puree the ingredients for about 10 – 15 seconds. That’s all there is to it. If you do not have a stick blender, then you can combine all ingredients in a food processor and process to puree chipotle pepper and combine all the ingredients. With the food processor still running drizzle in the oil until the salad dressing becomes an emulsion.

Total Recipe – Calories 131, fat 11 grams, protein 0.7 grams, carbohydrates 9 grams

1 Tablespoon – Calories 8.1, fat 0.68 grams, protein 0.04 grams, carbohydrates 0.56 grams

So there you have it, my version of Chipotle’s ‘Chipotle Honey Vinaigrette’. I really like this dressing, and it has become one of my favorites. Making it with one chipotle makes it more wife friendly, as my wife does not care for too much heat, and she thinks Chiptole’s version is a little hot. Personally, I like it made either way. That’s the great thing about making your own dressings and condiments, it gives you total control to use the type and amount of ingredients you wish.

Links From This Episode:

Dr. Jason Fung and Megan Ramos’s Intensive Dietary Management (IDM) Website

The Intensive Dietary Management (IDM) Podcast

Dr. Eric Westman’s Healthy Eating And Living (HEAL) Clinics Website

 

References:

Carbohydrate Counting & Diabetes: What Is Carbohydrate Counting? National Institute Of Diabetes and Digestive and Kidney Diseases, June 2014. Accessed December 1, 2018.

Diabetes Diet: Create Your Healthy-Eating Plan? www.mayoclinic.com, Accessed December 1, 2018

Diabetes: Meal Plan Ideas, 1800 Calories Per Day. University Of Michigan Comprehensive Diabetes Center. Last revised 11/13/2015. Accessed November 17, 2018.

Gray, Alison, RD, Nutritional Recommendations For Individuals With Diabetes. Comprehensive Endocrinology Textbook. Last revised May 31, 2015.

Hamilton, Lara, RD, CDE, Foods For Your Plate: Healthy Foods to Fill Your Plate. Diabetes Forecast Magazine, November 2015.

Higgins, Jaynie, AC, CPT, Groetzinger, The Ultimate Diabetes Meal Planner: A Complete System for Eating Healthy with Diabetes, The American Diabetes Association, 2009-16.

Hirsch, Irl B. MD, The Death Of The 1800-Calorie ADA Diet, Clinical Diabetes, April 2002.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Living. Beyond Obesity LLC.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Performance. Beyond Obesity LLC.

Ross, Tami RDN, LD, CDE, MLDE, Geil, Patti MS, RDN, LD, CDE, MLDE, FAND, FAADE, What Do I Eat Now? A Step-By-Step Guide to Eating Right With Type 2 Diabetes 2nd Edition, The American Diabetes Association, 2009-15.

Spritzler Franziska, RD, CDE, How Many Carbs Should A Diabetic Eat?, Healthline Red, November 16, 2016.

Tan, Evelyn PharmD, Polello, Jennifer MHPA, MCHES, and Woodard, Lisa PharmD, MPH, An Evaluation of the Current Type 2 Diabetes Guidelines: Where They Converge and Diverge, Clinical Diabetes 2014 July; 32(3): 133-139.

The ADA Diet Myth, Diabetes Forecast, The Healthy Living Magazine, March 2011.

The Sad Consequences of the Standard American Diet (SAD). www.atkins.com, Accessed November 20, 2018.

The 1800 Calorie Meal Planning Guide For Diabetics, University Of Southern Alabama College Of Medicine. Accessed November 10, 2018.

What Are Trans Fats? American Heart Association, Accessed November 28, 2018.

Wheeler, Madelyn MS, RDN, FADA, FAND, CD, Food Lists For Diabetics Get An Update: Nutrition Guides Offer New Items and replace “Exchanges” with “Choices”. Diabetes Forecast Magazine. June 2014.

 

 

KCP011: Keto Accountability Show Notes

After listening to episode 10 “The Carbohydrate Withdrawal” podcast, I noticed a few errors which need correcting. First, I mentionedthat the recommended amount of potassium per day was 3 to 4,000 mg per day. According to the National Institute of Health (NIH), the actual recommended amount of potassium required each day for an adult is about 4,700 mg per day. Second, The Diet Doctor website states that most people can safely supplement their diet with up to 1000mg of potassium per day (about 13meq). I apologize for any confusion or inconvenience this may have caused.

Terms In This Episode (01:46)

Accountability – As individuals we are accountable for not only our successes, but also for our failures. We cannot blame our lack of success on our partner or spouse, our physician, or our social or economic status. Only we can take responsibility for our own individual actions or lack of action. I realize that sometimes this is a bitter lesson to learn, to realize that we have created the situation that we are currently in. Just in case you wondering, the most common trait found amount unsuccessful people is lack of accountability.

That’s right unsuccessful people are always looking for ways or opportunities to get out of taking responsibility for their actions. They are always looking for a way to blame someone else for their problems. I will be honest with you, I have been there. For years, I refused to take accountability for my dietary choices. I blamed my diabetes on my genetics, after all many people including my maternal grandmother are diabetics. I would not take accountability for my own actions or disease process. For many years, I ate what I wanted and took no dietary advice regarding my diabetes. I was unaccountable. This lack of accountability put me in a metabolic crisis in which I had to start taking insulin as well as oral diabetic medications to control my blood sugar. And still, I remained unaccountable. It was not until these medications made me so sick that I had to go to the emergency room that I decided to take control of my life and finally become accountable for my actions. So why did I refuse to be accountable for my actions? Two words, which are the next two terms of today’s podcast: ignorance and or lack of knowledge.

Ignorance – Is simply a lack of knowledge, or a state of being unaware. You can be unaware of the specific facts regarding a situation or experience, that is to say you have no knowledge of the specific facts, this is known as factual ignorance. Or you may suffer from objectual ignorance because you are unaware of a specific object and or a procedure, this is known as objectual ignorance. And lastly there is technical ignorance which is the actual absence of knowledge of how to do something or perform a specific task.

Now, Ignorance has nothing to do with your social-economic or cultural status, it is simply a lack of knowledge. We are all ignorant of something, that is to say we cannot known how to do all things, and we are not always aware of all the facts, and we cannot perform every task that we wish. While it is often used as a derogatory term, ignorance is simply a lack of knowledge. Before listening to this podcast you may have been ignorant regarding nutrition and the advantages of the ketogenic lifestyle. But because you have the desire to learn more about this subject you have probably conducted some research about this lifestyle. Maybe you listen to both this any number of other podcasts regarding the ketogenic lifestyle. And over time, you have slowly become less ignorant regarding ketosis and the ketogenic way of living by not only acquiring a new skill set, but by acquiring more knowledge, and that is our next definition.

Knowledge – If ignorance is a lack of knowledge, or a state of being unaware, then knowledge is the opposite of ignorance right? Well, yes and no. Knowledge is an awareness, or understanding of the facts of a particular concept or skill which is acquired through experience and or education. Knowledge however is not all encompassing. That is to say, you may have the knowledge of how an artist paints a beautiful landscape, but you may not have the skill to do so. So while on one level you have the knowledge of the concept, you may not have the knowledge of how to perform the actual skill. So you can actually be both knowledgeable and ignorant regarding a specific topic. To put it in plain terms there are specific levels of knowledge, and some people are more knowledgeable than others when it comes to certain topics or skills. Keep in mind, that knowledge is not specific to ones educational level. A medical doctor may be able to diagnose your medical problems, but he may not have not the required knowledge regarding nutrition or physical fitness.

As human beings, to acquire knowledge we need to have the ability to communicate either by spoken or written word. We need to have the intelligence or the capacity to understand that which we read or hear, and we have to have the ability of active reasoning in order to determine if what we have read or heard is true or false. As you listen to this podcast, you have to use not your ability to understand what I am communicating to you, but also your powers of deductive reasoning to determine if the information I am providing you is not only factual, but reasonable. I hope that you do indeed find this information informative, practical, and reasonable, but only you can make that decision.

Main Topic (07:42)

I know I covered a lot of information in today’s terms on accountability, ignorance, and knowledge, but I want to dig a little deeper into those topics and explain how they are fundamental in helping you to find success throughout your ketogenic journey. The emphasis will of course will be on accountability.

Accepting accountability for your health and well being is the biggest step you will take towards being successful with this new lifestyle. By accepting accountability you are acknowledging that you and you alone are responsible for your health and well being. That does not mean that you become your own doctor, that would be both dangerous and foolish. What it does mean however is that you become an active member of your health care team. But what does that mean? Well, you become the researcher, the experimenter, and the potential educational force behind your health care team. If you are lucky, your physician, physician assistant, nurse practitioner, or whoever is your primary medical adviser is will have some knowledge regarding the ketogenic lifestyle. However the likelihood of this happening is very small.

 

But lets be honest, your physician is busy. They have a ton of patients to see each day. We all know how long the wait is to the waiting room to see your doctor or NP only to spend about 10-15 minutes with them in the room. In addition, while yearly continuing education is a requirement of every medical doctor and nurse here in the United States, nutrition is one of those topics that is almost never covered. You may recall back in my introductory episode KCP000 that according to the National Institutes Of Health, medical students receive on average 23.9 hours of nutritional training during medical school. In addition, the Association Of American Medical Colleges, states that medical students receive about 700 contact hours of training per year during their four years of medical school which comes out to roughly 2,800 contact hours. That means that when your doctor was in medical school they spent less than 1% of their education on nutritional related topics.

 

My point here is that taking accountability of your health means you will need to do some of your own research into this way of living. The responsibility of teaching or presenting information to your doctor, nurse, diabetic educator, dietician or nutritionist is up to you. I understand that is a big responsibility, and you may wonder who are you to speak up and teach your medical provider anything? After all they have a degree in medicine, nursing, and or nutrition and you do not. Yes, that may be true, but you are an integral part of the medical care team. You have the right to refuse, question, and inquire about any procedures, medications or regimens that involve your health. You are in the drivers seat so to speak. Your medical adviser makes suggestions and recommendations, but ultimately you make the decision to follow that advice. You are accountable for your action or lack there of, not your physician. You must take an active role in your care if you want to be successful with this lifestyle. This includes educating your health care team regarding the benefits of the ketogenic way of living and how it can not only improve your health, but also the health of others that your medical team may be treating.

If your medical team is unaware of the ketogenic diet, then you need to provide them with information so that they can help you to make a safe and informed plan of care. That dosen’t mean that you arrive at your next doctor’s appointment with a 3-inch thick three ring binder crammed with information regarding the ketogenic lifestyle and expect them to read it because they will not. They simply do not have the time and or the inclination. Rather pick one or two relevant medical studies that you can bring with you. Studies that follow good clinical research protocols such as the studies at the end of the show notes.

 

Remember you need to be courteous and tactful, you are dealing not only with a medical professional, but a person. Being thoughtful in your approach will increase your changes of having a meaningful and effective dialogue with your healthcare team. If you go in there guns blazing demanding or telling them they need to read this new research on the ketogenic diet, their natural response will be to take a defensive posture and refuse. If this happens, then no one benefits, neither you, the physician, or any other patients that they may be treating that may be suffering from diabetes, metabolic syndrome, or cardiovascular disease.

By educating your health care team you are not only helping yourself, but the impact of sharing your knowledge with them may help them to better serve their other patients. Just think, you could be actively responsible for saving not only your own life, but that of countless others. And that my friends is an awesome feeling. If you are fortunate, then your primary care physician or specialist will be open to learning about this way of living. But lets be honest, not every doctor or health care provider will be interested. If they are not open to suggestion or do not wish to learn about this way of living, then you need to find a new physician or health care provider that is willing to listen to your input regarding your health care needs. Remember, your physician or nurse practitioner works for you. You pay their salary each time you visit their office. If they are unwilling to listen to your concerns about your diabetes, your symptoms of metabolic syndrome and cardiovascular disease, or they simply want to prescribe you more medications, then you need to find another doctor that will listen to your concerns and work with you towards helping you meet your ketogenic goals.

If you need to find a new doctor, then do so, but until then you need to be under the care of a physician or medical provider when you embrace this lifestyle. Do not make any changes to your diet or medications without consulting your doctor. To attempt this way of living without proper medial guidance can be dangerous and lead to serious harm if you do not have someone who can help you monitor and make adjustments to your medications as you travel down this path. Remember only you are accountable for your actions or lack there of. While you need to be accountable for your actions, you do not need to travel this path alone. I am here for you, if you have any questions regarding this way of living don’t forget you can drop me a line at todd@ketoconfidential.net.

Thomas Gray wrote “where ignorance is bliss, Tis folly to be wise.” This last line in his poem ‘Ode On A Distant Prospect To Eton College’ is often misinterpreted to mean that being in a state of ignorance is blissful or preferred. That a person who is unaware of the facts or situation regarding his circumstances is somehow happier or more content that someone who has all the facts. In theory, if you are ignorant or unaware of the dangers that surround you, then I guess in some perverted way of thinking, you would be in a state of metaphorical bliss. But, ignorance will not reverse your diabetes. Ignorance will not reduce your symptoms of metabolic syndrome. And ignorance will not reduce your waistline. When it comes to your health, ignorance is not bliss, it is simply a recipe for disaster.

Please keep in mind that when I talk about ignorance, I am not talking about someone’s lack of intelligence, but simply their lack of the facts of the situation. Two years into this ketogenic way of living and I am still ignorant when it comes to many aspects of exactly how and why the ketogenic diet works the way it does, but I am learning more each day. By continuing to practice this lifestyle everyday I acquire more information and knowledge, thereby reducing my ignorance. And as I gain more knowledge about ketosis, and the ketogenic way of living I become more empowered. And when you become more empowered you are able to make substantial changes that can impact and improve your life dramatically.

To borrow a phrase from Emeril Lagasse “it ain’t rocket science”. That is to say, you do not need to be a rocket scientist to figure out how and why the ketogenic diet works. In fact, really all you need to know is that it does work, that it will reverse your diabetes, that it will decrease your symptoms of metabolic syndrome and cardiovascular disease, and that it will help you lose weight. But that kind of gets back to our “ignorance is bliss” quotation. Do you really need to know how ketosis works to be successful with this lifestyle? Maybe not, but by having more knowledge about how the diet works, and how it affects your body and your disease process you can tweak the diet to fit your individual needs.

Despite what many people believe, the ketogenic diet is not a one size fits all diet. It never has been and it never will be. While we all share the same genome, we are all individuals. And if we are all individuals, then we need to make small minute adjustments to our way of eating in order to maximize the benefits of the ketogenic diet. The only way we can do this is by increasing our knowledge of ketosis and the ketogenic diet. Thomas Jefferson has this to say about the politicians of his time “they do not generally possess information enough to perceive the important truths, that knowledge is power, that knowledge is safety, and that knowledge is happiness.”

Yes, knowledge is power. Having the knowledge about the benefits of the ketogenic diet will give you the confidence to make the necessary changes to your diet. Having the knowledge will allow you to take control and safely make changes to your lifestyle. To become an active member of your healthcare team. To actively reverse your type two diabetes. To reduce your symptoms of metabolic syndrome or cardiovascular disease. To reduce your waistline. And to become an advocate and educator so that your new found knowledge may help and or change another persons life.

In many ways this episode of the podcast has been more on the motivational than scientific. But in order to be successful with this lifestyle, I believe it is important that you are motivated and that you…Say it with me “ take accountability.” We all need to reduce our keto ignorance by increasing our knowledge regarding this lifestyle. I encourage you to actively fact check your sources. Do not believe everything you read on the internet or hear in a podcast, about the ketogenic lifestyle even this one. Check my facts, if I have made a mistake, then let me know, by sending me a email at todd@ketoconfidential.net. Like you I am only human and as human beings we often make mistakes, but the important part is that we take accountability for both our success and our failures. And that we use these success or failures as learning tool. We all need to reduce our keto ignorance by actively increasing our knowledge regarding this lifestyle. At the end of the day, you need to take accountability for your actions or your lack there of if you want to successfully reverse your type 2 diabetes, decrease your symptoms of metabolic syndrome and cardiovascular disease, and reduce your waistline.

During this week of Thanksgiving, I would like to thank all of you for listening to this podcast. I hope that you have, or will find this lifestyle exciting and enjoyable as I have. I would like to give thanks to my wonderful wife and keto buddy who has been my biggest supporter and confidant during this journey. I am also thankful that we live in a country in which we have free speech so that I can present this life changing information with you without fear of retribution so that you too can improve your life. And with that I would like to leave you with one final thought on this week of Thanksgiving. Jefferson wrote: “We hold these truths to be sacred & undeniable; that all men are created equal & independent, that from that equal creation they derive rights inherent & inalienable, among which are the preservation of life, & liberty, & the pursuit of happiness;

You’ve Got Mail (22:35)

If you have any feedback regarding anything you have heard in this or other episodes of the keto confidential podcast, or you just want to drop us a line with a question or two, or you just want to share your success story with us, you can send me an email at todd@ketoconfidential.net. Soon, I will be adding a Google voice number to our website so that you can call in and leave an audio voice message that will be incorporated into the podcast, so stay tuned for further information regarding this new feature.

Recipe Of The Episode (25:14):

For the most part I am a carnivore, and before I started keto, all my favorite vegetables were the ones that contained all the starches so getting in my veggies was a problem. My solution was to start preparing and taking my own keto version of a chef salad to work each day for dinner. I generally do not eat salad at home, but it was definitely part of my work related eating plan and it still is to this day.

Most people think that a salad is a really healthy choice, so they take all the time and care to prepare a great looking salad and then cover it in a salad dressing that is full of carbohydrates in the form of sugars, and guess what? Your healthy salad is now a poor dietary choice. So in today’s podcast I am going to share with you my version of a great keto friendly chef salad. To make this salad you will need the follow ingredients:

1 ½ cups of chopped green leaf lettuce

½ cup fresh spinach roughly chopped

¼ cup cheddar cheese

2 slices of bacon chopped

1 boiled egg chopped

1 tablespoon Parmesan cheese

Salad Nutritional Information

210 calories, 13.2 grams of fat, 17.8 grams of protein, and 3.5 grams of carbohydrates.

Now, you can combine the ingredients however you like, but I put my cheeses together in a small square rubbermaid container. I then sit this container into a large square rubbermaid container and will the larger container with the salad greens. I separate the bacon and egg into two different zip lock bags and toss that on top of the salad greens and close the lid. You do not have to go to the trouble of separating all of the ingredients if you do not want to. But sometimes I get busy at work and do not get to eat my salad, thank goodness for fat adaption right? Anyway, by keeping the cheese, bacon, and egg separated until I am ready to eat the salad. If something happens and the lettuce gets old before I eat it, I haven’t wasted the other ingredients.

Looking good so far, but what good is a salad without a good dressing? Not a whole lot in my opinion. That’s why I will be adding an additional salad dressing recipe to each of the future episodes of this podcast. That is of course until I have covered just about every kind of salad dressing I can think of so that you will have a wide variety of keto dressing options. Today’s salad dressing recipe is one of my favorites, Thousand Island.

To make this dressing you will need:

¾ cup homemade LCHF mayonnaise or Hellman’s mayonnaise
¼ cup tomato sauce
2 tablespoons dill pickle relish

1 teaspoon apple cider vinegar

1 teaspoon pimentos, minced

3 drops of liquid sucralose (equal to 1 tablespoon teaspoon Splenda)

½ teaspoon salt

½ teaspoon onion powder

¼ teaspoon garlic powder

1/8 teaspoon paprika

1/8 teaspoon white or black pepper

Combine all the ingredients into a medium sized bowl and mix with a wire whisk until thoroughly combined. Then add the minced/mashed egg and mix again until thoroughly combined. Check the seasonings and adjust the salt, pepper, and sweetness to meet your individual tastes. Place the dressing in the fridge for 12 to 24 hours before serving. The dressing is good for 10 – 14 days depending on the ingredients that you used to make it. This recipe yields about 1 ¼ cups or 20 tablespoons. The nutritional value is as follows.

Total Recipe – 1,352 Calories, 142 grams of fat, 8.53 grams of protein , 10.7 grams of carbohydrates.

Per Tablespoon – 68 Calories, 7.1 grams of fat, 0.4 grams of protein , 0.53 grams of carbohydrates.

Just for comparison, one tablespoon of Kraft Thousand Island dressing contains 40 Calories, 3 grams of fat, 0 grams of protein, and 1.5 grams of carbohydrates. While 1.5 grams of carbohydrates dosen’t seem like much, keep in mind most people put about 3 to 4 tablespoons of dressing on their salad. Using the Kraft Thousand Island dressing would add 4.5 to 6 grams of carbs in the dressing alone. Using my recipe your salad dressing only contains 1.6 to 2.1 grams of carbohydrates. That’s 67% less carbohydrates. So as you can see making your own salad dressing is definitely work the small amount of time it takes to make.

Nutritional Information

Chef Salad (No Dressing)

210 calories, 13.2 grams of fat, 17.8 grams of protein, and 3.5 grams of carbohydrates.

Keto Thousand Island Dressing (1 Tablespoon)

68 Calories, 7.1 grams of fat, 0.4 grams of protein , 0.53 grams of carbohydrates.

Chef Salad (3 Tablespoons) Keto Thousand Island Dressing

414 calories, 34.5 grams of fat, 19 grams of protein, and 5.09 grams of carbohydrates.

The End (30:59):

Well guys, that’ it for this episode of the Keto Confidential podcast, if you have found this content useful, then please subscribe, and take a few seconds to rate this episode in iTunes, and write a quick review so that others may benefit from this information. More importantly, If you know someone that is struggling with obesity, metabolic syndrome, or type 2 diabetes, then please share this podcast with them so that together we can help them reverse their diabetes, and reduce their complications of metabolic syndrome and obesity. Once again, I would like to thank you for listening. So until next time, be safe, and stay keto strong my friends.

Links:

Keto Thousand Island Dressing

References and Studies:

Bhanpuri, et al, Cardiovascular Disease Risk Factor Responses To Type 2 Diabetes Care Model Including Nutritional Ketosis Induced By Sustained Carbohydrate Restriction At 1 Year: An Open Label, Non-randomized, Controlled Study. Cardiovascular Diabetology, 2018.

Halberg, Volek, Phinney, et. al, A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. Diabetes Therapy, February 7, 2018.

McKenzie, et. al, Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Journal Of International Medical Research (JIMR Diabetes), 2017.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Living. Beyond Obesity LLC.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Performance. Beyond Obesity LLC.

Status Of Nutrition Education In Medical Schools, National Institute Of Health, American Journal of Clinical Nutrition, April 2006; p.83-84.

 

 

KCP010: Carbohydrate Withdrawal (A.k.a. Keto Flu) Show Notes

Correction: There are two corrections that I would like to make in the show notes that I did not notice until this podcast was already produced and released for publication: First, I mentioned that the recommended amount of potassium per day was 3,000 to 4,000 mg per day. According to the National Institute of Health, the actual recommended amount of potassium required each day for an adult is about 4,700 mg per day. Second, The Diet Doctor website states that most people can safely supplement their diet with up to 1000mg of potassium per day (about 13meq). These corrections have already been made to the show notes. I apologize for the inconvenience.

Terms In This Episode (0:35):

Addiction – Ia a chronic condition of “brain reward” in which a person is dependent or addicted to a particular substance. It is characterized by the inability to consistently abstain or control one’s cravings. While you can be addicted to any number of substances, for the purpose of this podcast we will be talking about carbohydrate addiction. As mentioned in an earlier episode, Gary Taubes in his book ‘The Case Against Sugar’ explains that carbohydrates and sugars stimulate the same pleasure centers of the brain that cocaine does. Thereby creating an addiction or need for more carbohydrates and sugars. While carbohydrates and sugars are in no way as destructive to your body as cocaine, they are still highly addictive substances. For most people this is not a problem. However, if you are a diabetic and or suffer from metabolic syndrome, then this addiction can cause you significant problems.

Withdrawal – Is the stopping or removal of a service or substance. In the context of the ketogenic lifestyle, withdrawal is the removal or severe restriction of dietary carbohydrates which leads us to our next definition.

Carbohydrate Withdrawal – Also known as the “Keto Flu” carbohydrate withdrawal is a series of symptoms similar to those felt by people who have contacted the flu virus. Because the symptoms of carbohydrate withdrawal mimic those of the flu, you may suffer from headaches, muscle aches and pains, chills, weakness, and irritability. While the symptoms are similar to those of the actual flu, it is important to note that you will not, or should not experience any fever.

 

Main Topic (2:38):

So you have been researching the keto lifestyle for some time now, and if you are like me, probably for to long. But you have finally decided to give it a try. The reasons why you chose this path are really not relevant at this point. Maybe your diabetic, suffer from metabolic syndrome, or morbid obesity. Maybe you just want to give up processed foods and sugars. There are a ton of different reasons to embrace this lifestyle, but the biggest hurdle to your journey is getting started. If you have not already listed to my previous episode KCP009 “Getting Started On Keto” then click on the hyperlink “Getting Started On Keto” to listen that episode.

So you have gathered your basic supplies and keto food stuffs and your excited about getting started. I know I was. And even though I had collected a massive amount of information about the ketogenic lifestyle, The one thing I somehow overlooked was the process of going though carbohydrate withdrawals. I am not sure if I was so focused on the benefits of this lifestyle that I did not see the forest for the trees so to speak, or if no one was simply talking about these symptoms. Nevertheless, like anyone who restricts dietary carbohydrates, I experienced these same withdrawal symptoms. For me personally the symptoms of carbohydrate withdrawal or keto flu lasted about 4 days. My wife on the other hand did not experience any symptoms of carbohydrate withdrawal. That brings us back to one of the main points that I have been making throughout this podcast. That is while we are all share the same human genome, we are individuals and our bodies each respond differently to specific foods, drugs, hormones, and stressors.

Personally, I experienced carbohydrate withdrawal symptoms for about about 4 days. I started my ketogenic journey on a Thursday night, by Saturday morning, I was experiencing all the symptoms of keto flu. Lethargy, muscle pain and aches, headaches, brain fog, and lack of energy. For me, these symptoms lasted until sometime Sunday afternoon. I remember this because I started my ketogenic journey on the weekend that I was off work, and by Saturday evening, I was really hoping that I would feel better before I had to return to work on Monday. Fortunately by Monday, I felt quite a bit better, but I was not feeling 100% until about Tuesday. My wife on the other hand, never seemed to have any symptoms of carbohydrate withdrawal. It is possible that I had these symptoms and she did not was that I used to eat a really heavy carbohydrate based diet. Probably more than 300 grams per day, and I restricted myself to 20 grams of less net carbs and continue to maintain this amount even two years later. My wife on the other hand, shot for a goal of 100 grams of net carbohydrates per day. So my carbohydrate restriction was five times greater than hers.

Did the severity of my carbohydrate restriction lead me to have these symptoms of carbohydrate withdrawal while she cruised through this transition without any effects? It’s possible. The thing is, while the majority of people will experience some of the symptoms of carbohydrate withdrawal, not everyone will. I believe there are two major factors that affect how your body reacts to the restriction of dietary carbohydrates. The first being, the amount of dietary carbohydrates you eat each day prior to starting this way of eating, and second, the severity of carbohydrate restriction you impose upon yourself.

If you are a carb-o-holic, and you consume a ton of carbohydrates each day, and you severely restrict your daily carb intake to 20 net grams of less a day. Then you are going to feel some of the effects of the “keto flu”. So there are two basic strategies that you can use to decrease the effects of carbohydrate withdrawal. The first is to start slowly and restrict your dietary carbohydrate intake to 50 – 100 grams of net carbs per day. The idea behind this strategy is, the less you restrict dietary carbs, the fewer and less severe the symptoms. The second strategy is to go what I call ‘full on keto’ and restrict your dietary carbs to less than 20 net grams per day. My personal recommendation is to go full on keto and restrict yourself to 20 grams of net carbs per day. Why? Because restricting yourself to only 50 – 100 net carbs per day does not guarantee that you will get into ketosis. It also dosen’t guarantee that you will not experience any symptoms of carbohydrate withdrawal or that they will be less severe. Remember, the choice is yours, but the sooner you get into ketosis, the sooner you will begin to reduce your symptoms of metabolic syndrome, reduce your Hgb A1c, and reduce your waistline.

So you have made the decision to start embrace the ketogenic lifestyle, you have chose a strategy of carbohydrate restriction. So what should you expect to happen next? Well, when dietary carbohydrates are restricted, the insulin levels in your circulating blood will begin to drop. As the circulating level of insulin decreases, your body begins to diuresis. In other words, you “pee more”. So as your urine output increases, your excrete more sodium. And generally, where sodium goes, potassium and magnesium follow. So your body will begin to lose sodium, potassium, and magnesium, while calcium and phosphorus levels are usually not affected. The result of this decrease in sodium, potassium, and magnesium levels in your blood creates an electrolyte imbalance which is generally harmless, it does however cause you to have flu like symptoms. Because of these symptoms the common term “keto flu” is often used when describing carbohydrate withdrawal.

So what exactly is the “keto flu”? It is simply your bodies reaction to the restriction of dietary carbohydrates. Because you are restricting the number of carbohydrates you consume, your body has less energy in the form of glucose to use for it’s metabolic functions. When your body does not have enough glucose to burn for energy, it has to find an alternative source of energy to supply your brain and other essential organs. This time frame from which your body begins the transition from being a sugar burner to one that burns ketones for energy is when you will experience the symptoms of carbohydrate withdrawals.

Most people will begin to experience the symptoms of carbohydrate withdrawal sometime around the 24 to 48 hour mark. The most common symptoms of carbohydrate withdrawal include: headaches, muscle aches and pains, chills, weakness, irritability, and dehydration. Other less common symptoms you may experience include: sugar cravings, brain fog, sore throat, nausea, insomnia, constipation or diarrhea. The severity of the symptoms vary per individual. While I experienced the more common symptoms, as I mentioned my wife did not have any symptoms of carbohydrate withdrawals. There are however a few things that you can do to help you through this transition period.

Earlier I mentioned that you will experience an increased loss of sodium, potassium, and magnesium do to the increased diuretic effect of transitioning to a ketogenic diet. One of the ways to minimize your symptoms is to actively take part in managing your electrolytes, and that is what I want to discuss next.

Common signs and symptoms of sodium deficiency include: fatigue, headaches, weakness and difficulty concentrating (aka brain fog). As you can see, these are some of the most common symptoms people experience. On average, your body needs 3,000 to 5,000mg of sodium each day. That translates to about 7 to 17 grams, or 1 – 3 teaspoons of salt depending on the type of salt. Making sure you get plenty of sodium each day while you are in this transition period is not difficult.

A few cheap and easy fixes to increasing your sodium intake is to drink one to two cups of bone broth each day, be liberal with the salt shaker when eating, and or add some common able salt to water and drink it. If you need a good bone broth recipe, click on the hyperlink for ‘The Banting Diet’. If you do not have any bone broth available you can make some instant broth or bouillon by using the powder or cubes. To make one cup of broth, you add one teaspoon of powdered chicken or beef bouillon to one cup hot water. The Knorr brand powdered chicken bouillon contains 870mgs of sodium per teaspoon, the beef 840mgs per teaspoon. Most commercial bouillon powders fall somewhere within this range. If you need to buy some for your pantry, just make sure you do not buy the ‘low sodium’ version as this kind of defeats the purpose. You could of course just mix one teaspoon of table salt which contains 2,325mg sodium in a glass of water, and drink it, but most people just do not like to do this.

Some common signs and symptoms of potassium deficiency include: muscle cramps, muscle twitching, and heart palpitations. On average, your body needs about 4,000 to 4,700mg of potassium each day. Which translates to about 4 to 4.7 grams. While the majority of your potassium should come from your diet, during this transition period the ‘Diet Doctor’ website recommends that a supplement of 1000mg per day is generally safe for most people as a dietary supplement. Most multivitamins contain about 100mg of potassium, and that is why a good multivitamin is recommended when you start on your ketogenic journey. There are a lot of different potassium supplements out there and almost all of them contain 99mg per tablet, no matter what the label on the front of the bottle states. Make sure you check the nutritional facts on the back of the bottle before you take any supplement to verify it’s strength.

Potassium supplementation is one of those things that you need to take care with, especially if you are taking a potassium sparing or potassium retaining diuretic as part of your daily medical regimen. If your potassium levels get to high you can start to have heart rhythm abnormalities. That is why at the beginning of each episode I mention that you need to see your primary care giver before starting this way of eating. For most of you the risk of this happening with potassium supplementation will not be a problem if you keep it below 400mg per day. Again, when in doubt check with your primary care giver.

Common signs and symptoms of magnesium deficiency include: muscle cramps, and muscle twitching, the same symptoms noted when you have a potassium deficiency. According to the National Institutes of Health (NIH) The recommended amount of magnesium you need each day is about 400mg a day. The majority of your daily magnesium requirements can be acquired from your diet. Foods such as green leafy vegetables, nuts, and seeds contain sufficient amounts of magnesium for most people, however some supplementation may be required. For people suffering from muscle cramps during this induction or even while on a low carbohydrate diet Phinney and Volek in their book “The Art and Science of Low Carbohydrate Living” recommend taking three (72mg) tablets for a total of 215mg of magnesium per day of “Slo-Mag” magnesium supplement. They also recommend similar generic brands such as “Mag Delay” which comes in 72mg tables and “Mag 64” which comes in 64mg tablets which are equally effective and somewhat cheaper.

Now, I have see many recipes for homemade “keto aide” on LCHF or keto forums and Facebook groups that use magnesium citrate as an ingredient to help with magnesium supplementation. On average, magnesium citrate contains about 300mg of magnesium, and 80mg of potassium per one fluid ounce. On the surface, that sounds pretty good, however, the problem with using a liquid solution such as mag citrate is that it is used to relieve constipation. In fact, on occasion, we use magnesium citrate in the hospital to relieve constipation. So in many people the liquid magnesium citrate can cause diarrhea, while the slow release magnesium tablets will not have this same effect. So if you are already at risk for dehydration during your transition, and you are drinking fluids such as a homemade “keto aide” electrolyte replacement drink made with magnesium citrate that can cause you to have diarrhea, you can become even more dehydrated. Which can increase the severity of your symptoms. This is why I do not use a magnesium supplement such as mag citrate in my recipe for a keto safe electrolyte replacement drink.

Now that we have covered electrolyte replacement, let’s look at some key things that you can do to help minimize or decrease your symptoms of carbohydrate withdrawal: 1) increase your fluid intake. Because of the diuretic effects of transitioning from a sugar burner to a fat burner causes diuresis, increasing your fluid intake is important. Good old plain water works great, try and stay away from diet drinks or energy drinks that have caffeine or other ingredients that cause diuresis until your transition period is over. If you want a good keto friendly electrolyte replacement drink, keep listening for he recipe I have been using for more than 2 years which I will be discussing in the recipe section of this podcast. 2) Increase your sodium intake. Drink some bone broth or even powdered bouillon, be liberal with the salt shaker, eat more salty foods, or you can go hard core and mix 1 teaspoon of table salt (2,325mg) in a glass of water and chug it down. Remember the recommended daily amount is 3,000 to 5,000mg of sodium a day. 3) Take a good multivitamin. This is a good and cheap way to make sure you get the necessary and additional vitamins and minerals you need during your transition period. 4) If you are having muscle cramps, or muscle twitching you may need to take a potassium or magnesium supplement. On average, your body needs about 4,700mg of potassium, but keep your supplementation at 1000mg (13.4meq) or less per day. The recommended amount of magnesium you need each day is about 400mg a day, so take no more than 200 – 215mg per day in pill form. The majority of your magnesium supplies should come from the food you eat each day. 5) Avoid strenuous exercise until your transition period is over. Exercise can increase the severity of the symptoms that you are experiencing. And 6) eat more fat.

I just want to add one word of caution here. I have talked a lot about vitamin and mineral supplementation in this episode. And yes, I do recommend a good multivitamin as part of your daily regimen and I have taken one for many years before I began keto. Having said that, before I began my ketogenic journey, I did not know about mineral supplementation and how it could possibly decrease my symptoms of carbohydrate withdrawal. So I did not supplement my diet with sodium, potassium, or magnesium. If like me you take a multivitamin, then you need to take the tie to read the label and look at the amounts of vitamins and minerals supplied. Then if you want to supplement with potassium or magnesium, you need to account for the amount of each in your daily multivitamin so that you do not take to much each day. So take your time, do a little math if necessary, and remember if you are taking any diuretics you need to consult with your medical practitioner before engaging in this lifestyle. They may not agree with your choice, but you need to at least give them the opportunity to guide you safely through this process.

 

Recommended Daily Electrolyte Needs for Adults:

Sodium – 3,000 to 5,000 mg per day.

Potassium – 4,000 to 4700 mg per day.

Magnesium – 400mg per day.

 

You’ve Got Mail (21:18):

There is no listener mail today, but I wanted to use this section of the podcast today do some house keeping work so to speak. When I first started this podcast, my goal was to create a weekly podcast, but what I have found is that over time, it takes me about 10 to 14 days to write, record, edit and produce each episode. Because I have a full time job, and a small farm to run, I simply cannot get everything done that I would like in seven days. So the Keto confidential podcast will be going to a scheduled bi-weekly release date. If and when I can produce the podcast in less than 14 days I will go ahead and release it for syndication. I just wanted to be up front and honest with you as for some people not having the podcast come out every seven days per my initial goal is somewhat inconsistent.

As I mention in episode 9 ‘The Getting Started‘ podcast, you need to set yourself goals when you embrace this lifestyle. Then you need to reevaluate your goals, and make changes as necessary to meet those goals. So following my own advice, my new goal is to produce a new episode of the keto confidential podcast every two weeks. I appreciate all the kind words and your continued support. Having said all of that. If you have any feedback regarding anything you have heard in this or other episodes of the keto confidential podcast, or you just want to drop us a line with a question or two, or you just want to share your success story with us, you can send me an email at todd@ketoconfidential.net. Soon, I will be adding a Google voice number to our website so that you can call in and leave an audio voice message that will be incorporated into the podcast, so stay tuned for further information regarding this new feature.

 

Recipe Of The Episode (23:03):

This weeks recipe is my version of homemade Gatorade called “Frugalade” that I created back in 2012 way before I was keto. I has about the same electrolyte replacement as Powerade and Gatorade drinks 270mg sodium, and 55mg potassium per 20 ounces and it cost about $0.29 per gallon to make at the time. My keto friendly version which I call “Frugalade F2” has all the same electrolytes, but uses a keto friendly sweetener so it contains no carbohydrates. To make my Frugalade F2 you will need to following ingredients:

2 packages store brand or Kool-Aid powdered fruit punch

½ teaspoon liquid sucralose (or keto sweetener equivalent to ½ to 1 cup sugar)

¾ teaspoon Morton kosher salt (1440mg sodium)

1/4 teaspoon Morton Lite salt (290mg sodium, 350mg potassium)

Add the salts, sweetener and powdered drink mix or kool-aid to your one gallon container. Then heat a pint (2 cups) of water in your microwave, or ‘hot shot’. Then add the hot to the one gallon container and shake until all the salts are dissolved, then top off your container with water to make one gallon. I divide the Frugalade into old 20 ounce Gatorade bottles and refrigerate for easy portion control, but you can just leave it in the one gallon container. Once cold, drink it as you would any sports electrolyte replacement drink. That’s it, takes less than five minutes to make, and costs you less than $0.30 per gallon compared to about $6.00 for a gallon on Powerade or Gatorade

How does it compare to Gatorade or Powerade?

Frugalade F2 (20 ounces)

Calories – 0, sodium 270mg, potassium 55mg

Gatorade G2 © (20 ounces)

Calories – 0, sodium 270mg, potassium 75mg

Powerade Zero © (20 ounces)

Calories – 0, sodium 250mg, potassium 57mg

To use a sports metaphor, I think that’s a slam dunk win for my Frugalade F2 when compared to the commercially produced Gatorade G2 or Powerade Zero products. Keep in mind that if you are using my recipe or Gatorade G2 or Powerade Zero during your transition period, these drinks all contain sodium and potassium and you need to account for that if you plan on using other oral mineral supplements. For more information regarding this recipe, you can click on the following hyperlink ‘Frugalade F2’ and it will take you to the complete article on my keto food blog, ‘CulinaryYou’ where you can find step-by-step instructions as well as pictures of the recipe featured in this episode.

 

The End (27:05):

well guys, that’ it for this episode of the Keto Confidential podcast, if you have found this content useful, then please subscribe, and take a few seconds to rate this episode, and write a quick review about it so that others may benefit from this information. More importantly, If you know someone that is struggling with obesity, metabolic syndrome, or type 2 diabetes, then please share this podcast with them so that together we can help them reverse their diabetes, and reduce their complications of metabolic syndrome and obesity. Once again, I would like to thank you for listening. So until next time, be safe, and stay keto strong my friends.

 

Recipe Links:

Frugalade F2: A Keto Electrolyte Sports Drink

Bone Broth Recipe (As featured in KCP002 ‘The Banting Diet’)

 

References:

Atkins, Robert, M.D. (1972). Dr. Atkins’ Diet Revolution: The High Calorie Way To Stay Thin Forever. New York, NY: David McKay Company Inc.

Do You Need Electrolyte Supplementation On A Keto Diet?, www.dietdoctor.com, Accessed October 2018.

Magnesium Fact Sheet, National Institute Of Health: Office Of Dietary Supplements, Accessed October 2018.

Magnesium Citrate, Michigan Medicine: The University of Michigan, Accessed September 2018.

Potassium Fact Sheet, National Institute Of Health: Office Of Dietary Supplements, Accessed October 2018.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Living. Beyond Obesity LLC.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Performance. Beyond Obesity LLC.