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The Doctors Lounge - Primary Care Answers

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Forum Name: Nutrition & Diet

Question: ketosis


Nihao - Mon Jul 25, 2005 2:39 pm

I have just started a diet that promotes ketosis as the key to rapid weight loss. This is day 4 and my fingers have become swollen. I had a check up right before I started this diet that included a bone density test, blood work, thyroid, and heart check. Everthing is fine. I am 36 years old and NEED to lose 80 lbs. I began to put that weight on after the birth of my first child, 5 years ago. I had a second child 13 months later. Before children, I was extremely active and my average weight was 115 lbs. I believe that the weight gain has been a product of serious life changes (stay home mom now) and some Depression issues. Are my swollen fingers a serious symptom? I am told that the feelings of weakness and hunger will subside but no one has any info on swollen fingers. Also have been getting killer Headaches. How long is it safe to do this? The first 2 to 3 days I felt pretty good until I tried to work out. My work out seemed to go fine...but afterwards I felt Nausea and shaky for the rest of the evening and today...swollen fingers!
jenner - Tue Aug 30, 2005 4:21 am

Ketosis is not a natural state the body wants to be in... in fact, in diabetics, a prolonged state of ketosis can result in ketoacidosis, which can be life-threatening.

For the rest of us, ketones are used for energy when glucose (which is the preferred source of fuel for the brain) is insufficient/unavailable because of carbohydrate restriction... so that might explain the Headaches. Also, are you sure you are consuming enough calories in general and drinking enough water?? It is especially important to make sure your fluid intake is adequate when following a low-carb diet because consuming (and digesting and absorbing and utilizing) an excessive amount of protein generates a lot of nitrogenous waste products, which must be flushed out; just keep in mind that there has not been enough research to investigate the effects of excessive protein consumption on kidney function and the renal system as a whole.

Speaking of renal problems, as for the swollen fingers, I would suspect edema (water retention)... and believe it or not, one of the best ways to relieve this problem is to drink more water!
MaryAnn RN - Sun Feb 26, 2006 8:33 pm

Low carb (carbohydrate), high protein diets are the latest dieting craze. However, before you jump on the band wagon, you may want to consider a few things:

Low carb (ketogenic) diets deplete the healthy glycogen (the storage form of glucose) stores in your muscles and liver. When you deplete glycogen stores, you also dehydrate, often causing the scale to drop significantly in the first week or two of the diet. This is usually interpreted as fat loss when it's actually mostly from dehydration and muscle loss. By the way, this is one of the reasons that low carb diets are so popular at the moment - there is a quick initial, but deceptive drop in scale weight.

Glycogenesis (formation of glycogen) occurs in the liver and muscles when adequate quantities of carbohydrates are consumed - very little of this happens on a low carb diet. Glycogenolysis (breakdown of glycogen) occurs when glycogen is broken down to form glucose for use as fuel.

Depletion of muscle glycogen causes you to fatigue easily, and makes exercise and movement uncomfortable. Research indicates that muscle fatigue increases in almost direct proportion to the rate of depletion of muscle glycogen. Bottom line is that you don't feel energetic and you exercise and move less (often without realizing it) which is not good for caloric expenditure and basal metabolic rate (metabolism).

Depletion of muscle glycogen leads to muscle atrophy (loss of muscle). This happens because muscle glycogen (broken down to glucose) is the fuel of choice for the muscle during movement. There is always a fuel mix, but without muscle glycogen, the muscle fibers that contract, even at rest to maintain muscle tone, contract less when glycogen is not immediately available in the muscle. Depletion of muscle glycogen also causes you to exercise and move less than normal which leads to muscle loss and the inability to maintain adequate muscle tone.

Also, in the absence of adequate carbohydrate for fuel, the body initially uses protein (muscle) and fat. the initial phase of muscle depletion is rapid, caused by the use of easily accessed muscle protein for direct metabolism or for conversion to glucose (gluconeogenesis) for fuel. Eating excess protein does not prevent this because there is a caloric deficit.

When Insulin levels are chronically too low as they may be in very low carb diets, catabolism (breakdown) of muscle protein increases, and protein synthesis stops.

Loss of muscle causes a decrease in your basal metabolic rate (metabolism). Metabolism happens in the muscle. Less muscle and muscle tone means a slower metabolism which means fewer calories burned 24 hours-a-day.

Some proponents of low carb diets recommend avoiding carbohydrates such as bread, pasta, potatoes, carrots, etc. because of they are high on the glycemic index - causing a sharp rise in Insulin. Certain carbohydrates have always been, and will always be the bad guys: candy, cookies, baked goods with added sugar, sugared drinks, processed / refined white breads, pastas, and rice, and any foods with added sugar. These are not good for health or weight loss. However, carbohydrates such as fruits, vegetables, legumes, whole grain breads and pastas, and brown rice are good for health and weight loss. Just like with proteins and fats, these carbohydrates should be eaten in moderation. Large volumes of any proteins, fats or carbohydrates are not conducive to weight loss and health.

The effect of high glycemic foods is often exaggerated. It's does matter, but to a smaller degree than is often portrayed. Also, the total glycemic effect of foods is influenced by the quantity of that food that you eat at a sitting. Smaller meals have a lower overall glycemic effect. Also, we usually eat several types of food at the same time, thereby reducing the average glycemic index of the meal, if higher glycemic foods are eaten. Also, glycemic index values can be misleading because they are based on a standard 50 grams of carbohydrate consumed. It wouldn't take much candy bar to get that, but it would take four cups of carrots. Do you usually eat four cups of carrots at a meal?

Regular exercisers and active people also are less effected by higher glycemic foods because much of the carbohydrate comsumed is immediately used to replenish glycogen stores in the liver and muscle.
By the way, if you're interested in lowering Insulin levels, there is a great way to do that - exercise and activity.

Much of the weight loss on a low carb, high protein diet, especially in the first few weeks, is actually because of dehydration and muscle loss.

The percentage of people that re-gain the weight they've lost with most methods of weight loss is high, but it's even higher with low carb, high protein diets. This is primarily due to three factors:

1. You have lost muscle. With that comes a slower metabolism which means fewer calories are burned 24 hours-a-day. A loss of muscle during the process of losing weight is almost a guarantee for re-gaining the lost weight, and more.

2. You re-gain the healthy fluid lost because of glycogen depletion.

3. It's difficult to maintain that type of diet long-term.

4. You have not made a change to a long-term healthy lifestyle.

Eating too much fat is just not healthy. I know you've heard of people whose blood levels of Cholesterol and triglycerides have decreased while on a low carb, high protein diet. This often happens with weight loss, but it doesn't continue when you're on a diet high in fat. There are literally reams of research over decades that clearly indicates that an increase in consumption of animal products and/or saturated fat leads to increased incidence of heart disease, Strokes, gall stones, kidney stones, arthritic symptoms, certain cancers, etc. For example, in comparing countries with varying levels of meat consumption, there is a direct relationship between the volume of meat consumption in a country and the incidence of digestive cancers (stomach, intestines, rectal, etc.).

Sorry to be so winded, but wanted to answer all of your questions.

MaryAnn RN

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