Ketosis in a Nutshell – Part 4, Happy Campers More

shrimp (boiled), lemon juice, fresh cream, may...

shrimp (boiled), lemon juice, fresh cream, mayonnaise, salt, chervil (Photo credit: Wikipedia)

Nutritional Ketosis and Weight Loss

The other significant intentional use of nutritional ketosis has been for weight loss and weight control.

To be clear, nutritional ketosis is just one tool that can be used to assist with weight control. It is not suitable for everyone. Even for the people who do find it useful, the benefits will not be limitless. Many factors are involved in weight control, such as sleep and stress – it does not all come down to diet.

OK, Now for the Stories of Happy Campers –

Uhm, wait….

Yes, I do have some stories for you – two in particular make for very interesting reading. The most fascinating is the personal story of Dr. Atkins himself.  I will get into these stories, but first it is important to discuss some areas of confusion.

It is not such a simple matter to find stories for the topic of weight loss as it was for the previous topic of epilepsy control. Why? In the situation of ketogenic diets for epilepsy control, nutritional ketosis has been the agreed-upon target from the beginning (although this is changing with some of the less strict dietary regimes of the past decade).  The people were following strict diets that would clearly induce ketosis and these were consistently maintained over time (in those who had success with their seizures). They were all under the guidance of professional expert teams and meaningful research data was collected and published. When considering nutritional ketosis in the context of weight loss, the situation is much less clear.

Isn’t following a low carb diet about the same as being in ketosis?

Don’t we know all about this from the wide use of low carb diets over the past decades?

When people follow a very low carbohydrate eating plan, such as what is commonly thought of as “the Atkins Diet”, most of them will be in nutritional ketosis. (I put “the Atkins Diet” in parentheses as often people are following some concept of their own of what the Atkins Diet is, rather than truly following Dr. Atkins’ actual recommendations.) Some people will not be in ketosis – for various reasons their metabolisms are resistant to going into ketosis and/or they may be consuming an amount of protein that is too much for them.  Some people may be testing to monitor over time whether they are in ketosis or not.  Some are not.  As people start to eat more carbohydrates or more protein, individual people will move out of being in ketosis at different amounts of carbohydrate or protein intake.

Therefore, everyone who is in dietary ketosis is eating a low carbohydrate diet (unless they are taking a ketone-producing medical product or eating high amounts of medium chain triglycerides). However, not everyone eating a very low carbohydrate diet is in dietary ketosis.  It is now very clear that you can be carefully following a very low carbohydrate diet – for example, staying below 20 grams of carbohydrates a day – and yet not be in nutritional ketosis to any meaningful degree.

Unfortunately, the two things seem to have gotten somewhat mixed up together in many people’s minds.  I think somehow being in ketosis – turning the urine test strip purple – has come to be commonly viewed as just the far end of the low carb spectrum. In reality, being in ketosis is a metabolic state of its own with effects and implications that go beyond just leveling out the blood sugar levels, or lessening swings in insulin or other benefits of lessening the strain on the body from carb intake above an individual’s tolerance level..

What’s the big deal? Why does this matter?

  • being keto-adapted can help weight loss and weight control
  • the changes that happen with ketosis, if not understood, can interfere with weight control by causing confusion and discouragement

How can being keto-adapted help with weight control beyond a low carb lifestyle?

(1) Being in sustained ketosis provides some degree of lessening of appetite (more below).  This knowledge has faded from awareness or not been appreciated for the invaluable tool that it is.

(2) Some people might have a benefit to their brain function that results from their keto-adaptation. (See previous post in this series.) We don’t know enough about this yet, but many people report improvements in mental energy, focus and mood – these effects could be expected to improve a person’s ability to control their weight.  Scientifically, these effects are quite plausible and I hope the current interest in research on ketosis and brain function will expand quickly.  This is just speculation, but it is even plausible that being in ketosis may favour improved function of the appetite/satiety control centres of the brain if these centres might be (hypothetically) metabolically compromised in their function??  This topic is particularly interesting in view of the current concept of “Type 3 diabetes” (see the second post in this series).

(3) There may be other aspects of being keto-adapted that might be helpful in weight control – for example, some people feel that their muscles function better when in ketosis and then find it easier to be active. Some athletes are now using keto-adaptation as a high performance strategy. See HERE and HERE and HERE.

How can ketosis cause confusion during weight loss?

If you are transitioning into ketosis and you are not well informed about what that means or how that can be expected to affect your body and your energy metabolism, you could be very confused or even distressed by changes you experience.  Without proper information, you might not even know you are going into ketosis.  You might not even understand that the way you are eating has made ketosis a possibility.

The same is true in reverse if you are in ketosis (intentionally, knowingly or not) and you unknowingly move into a slight degree of ketosis (where you are not really running substantially on ketones) or fully out of ketosis.

(1) rapid weight changes not related to changes in fat stores

When transitioning into ketosis, there is a rapid drop in body stores of glycogen, which causes a rapid drop in body weight from the weight of the glycogen and the water that had been associated with the glycogen. There is also a increase in sodium excretion, with some drop in body water from that, as well.  None of this weight is actually loss of body fat stores.  This can lead to false expectations of continued rapid weight loss.

Over time, the body adapts to the state of ketosis and there is some re-balancing in the body.  In terms of any regain of that body water, I don’t think there is much definitive to say at this point and it is bound to be highly variable between individuals.  However, to the extent that there were a slow regain of some of that water over the first 2-3 months, this would show up on the scales and falsely appear to be lack of progress in reduction of body fat.  The more dramatic the initial drop in body weight as water, the more chance that some return of that body water could, soon thereafter, give an impression of lack of progress in fat loss.

It can be very easy to move out of the ketotic state. One substantial serving of carbs can mean that the next day your body weight shoots up just as rapidly as it initially fell.  Only a very little bit of this would be actually fat – almost all of it would be water and glycogen.  This causes people great unhappiness and confusion and can precipitate a dark mood that then brings even further “off-plan” eating.

(2) changes in energy and sense of well-being

When you are transitioning into nutritional ketosis, you can feel quite “low” and tired for a few days or even a week or two as your body adapts to the new fuel mix.  Some people even call this “the Atkins flu”.  It will pass and there are ways to lessen these effects (such as increasing sodium intake – see Resources below).  The real problem comes if this is happening to you and you don’t understand why.  Once the transition period is well underway, people often feel better than they have in some time.  Imagine how confusing it is if these changes come and go unpredictably and with the real cause unknown and thus uncontrollable.  If the person moves out of ketosis for a few days, they may suddenly feel a real change in their sense of well-being.  If they then shift back into ketosis, it will take some days or a week or two again for them to get back to a keto-adapted state.

Without knowing the real cause for there mysterious changes in how they feel, they may incorrectly blame the problem on something else and start making other changes in their diet or lifestyle or health practices that can then lead to other confusions.  None of this bodes well for finding their best personal happy healthy stable eating pattern

(3) changes in appetite and cravings for starches and sweets

  • loss of the appetite-suppressing effect of being in ketosis
  • suddenly the brain is not getting the ketones it is adapted to, so it quickly starts using much more glucose than the liver has been used to supplying, potentially drawing down the blood sugar level.  When the brain gets hungry, it sends out signals to supply it with its emergency fuel – glucose.
  • when coming out of ketosis, for a few days the body is not fully adapted to glucose intake again and the blood sugar will go higher than it normally would, risking an exaggerated eventual insulin response which would compound the problem by causing an unusually sharp drop in blood sugar.  Remember that starch is pure glucose, so it isn’t just sugar that causes a flood of glucose into the body. The rapid drop in blood sugar would bring more hunger and a craving for carbs to bring the blood sugar back up. Repeat. Repeat again. By the time this roller-coaster settles down, several days have passed and the person has regained glycogen (and therefore a number of pounds) and can be very discouraged and also not understand what just happened to them.

Imagine a person who had become adapted to being in a sustained state of ketosis who then shifted their diet so slightly that they did not notice or did not think it was a significant.change. Imagine that person thinking that they were still following the diet, but they were no longer in ketosis.  They would not understand why suddenly they were both more hungry and having craving for carbohydrate foods.  They would just feel that “the diet stopped working” or “I don’t have the will power to stick to the diet”. A bit of extra hunger or craving, if due to being close to moving out of ketosis, can bring “a little nibble”, which would then be sure to bring a bit more hunger or craving.  As the ketone level then fell further, a few “nibbles” more would again cause more hunger, not relief of hunger. This hunger leading to more hunger is often the path that leads a person fully out of ketosis – and into a sharp spike and drop in blood sugar, as well, depending on the foods and amounts chosen.

There are many happy stories of sustained weight loss while eating low carb.

But very few that include (adequate) details about the topic of ketosis – although this can be expected to change dramatically over the next months.

Over the decades and until very recently, relatively few of the people who have reported their experience with low carbohydrate diets have included in those reports enough (or any) detail on their experiences with ketosis itself in order to be able to understand the impacts of nutritional ketosis on their experiences – both good and bad.

Thus, the stories of those people who actually experienced a sustained period of nutritional ketosis are, for the most part, not clearly separable from the stories of people who undertook low or very low carbohydrate diets without a period of being adapted to nutritional ketosis.  Generally, the stories of people who had problems with weight loss on low carb diets – or who found staying on the diet too difficult – do not contain information on whether they had attained keto-adaptation and what was going on with their ketosis situation during the time when they were having difficulties.

Stories of experiences with nutritional ketosis can be suspected within stories of people who have followed low carbohydrate eating plans.

When you hear or read stories of people’s experiences – good or bad – with following a low carbohydrate eating plan, keep in mind how their encounters with ketosis may have been a factor in their experiences with low carb.

Stories That are Clearly About Nutritional Ketosis for Weight Loss

(1) Patient Number 1 – The original Happy Camper using nutritional ketosis as an aid in his own weight loss – Dr. Robert C. Atkins.  Unfortunately, this post is getting too long already, so I will have to leave as this teaser – from how I read it, Dr. Atkins’ original focus was just as strongly on the vital role of nutritional ketosis as it was on the problems of carbohydrate intolerance.

(2) The story that is creating Major Buzz is Jimmy Moore’s recent experience, which he has been documenting in detail since the spring.  It should be pointed out that each person’s needs and medical situation is different, so his story is not intended to imply that his approach is for everyone or is the most healthful way for you to proceed.

I include it here because it highlights the difference between a very low carb diet and a targeted ketogenic diet.

I expect that few people would have an outcome as dramatic as Jimmy’s.  He obviously is able to go into a strong level of ketosis and feel very well while doing so.  People are very different in how readily they go into ketosis and how they respond to it. As I’ve said before, ketosis is not right for everyone. Jimmy’s response is in keeping with his earlier experiences of dramatic weight loss when he first went on a very low carb eating plan in 2004.  His results then were similarly “not typical mileage” – with a much more dramatic weight loss than many people achieve with the same diet changes.

(3) Jenny Ruhl’s recent experience – You have to scroll down to the comments section below her post to see where she reports that she did test positive for urine ketones throughout the trial 2 weeks, after the first couple of days. I include it here for some balance.  Also, it reflects some other people’s experiences that I have read about in the past months where the person has done blood testing for ketones and not had substantial weight loss when eating to satiety.  Note – in Jenny’s trial she did lose weight, but she remained hungry as she kept to a calorie cap.

What you eat is only part of the whole picture when it comes to what is determining your body weight (unless being in semi-starvation or putting up with chronic hunger, neither of which are tenable long-term).

Jenny is an extremely happy camper when it comes to a “to the meter” individually targeted lowering of carbohydrate intake as an essential aspect of controlling diabetes and glucose intolerance (see her other web site, facebook and books).

(4) Tommy Runesson in Sweden – very impressive weight loss, now stable at healthy weight.  Recently doing blood ketone testing and reporting this in detail on his blog.  Great blog for seeing the very tastey-looking food he photographs daily.

(5) More stories with testing of blood ketone levels are bound to be appearing in increasing numbers over the next months.  We really know only tidbits of info so far about this whole topic.

Places I would suggest to keep an eye out for more stories over the next months:

To be continued … this post has gotten too long.

Next: more on the topic of appetite reduction in nutritional ketosis and a look back almost 5 decades ago to the insights that started it all for Dr. Atkins.

Resources – Link to my page Resources – Low Carb and Ketosis

Related articles

Acellular carbohydrates as a critical concept

English: different sorts of Pasta

English: different sorts of Pasta (Photo credit: Wikipedia)

A missing piece of the puzzle in understanding the health impacts of the carb-containing foods that we eat?

Dr. Ian Spreadbury presents an intriguing and potentially ground-breaking concept in a paper recently published.  The full text of the paper is available free online.

Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity.

Spreadbury I.  Diabetes Metab Syndr Obes. 2012;5:175-89.

PMID:  2282663   Free PMC Article

This is a scholarly and well argued thesis. His key conclusion?

“A dietary pattern with carbohydrates exclusively from cellular low-density sources may remove the root cause of a range of our most prevalent diseases.”

There is some risk that his research and theories will be used falsely as an argument in favor of foods that are simply low in carbohydrate density.  In fact, his focus is on both the density of carbs in foods AND on whether the carbs (starch and sugar) are present within cells.

He also does not propose that simply switching from a long-term intake of high-carbohydrate-density acellular foods will instantly fix the problems that have been set in motion – such as impacts on the gut microbe population (the microbiome), inflammation and leptin resistance – nor simply erase the downstream outcomes such as obesity and diabetes.  He does propose that such a dietary change might bring great benefits and that over time the body would likely slowly at least partially recover.  He calls for research into these questions.

My attention was first brought to this paper by Dr. Jay Wortman on his blog, and it has received other attention.

It is likely to become much more widely known now that Dr. Andrew Weil has commented on it HERE and HERE. (Note: Weil’s previously broken link they now have fixed)

I don’t agree fully with Dr. Weil’s comments.  For example, his statement

 “If Spreadbury is right, the obesity solution is straightforward.”

is just so wrong I don’t know where to start.

I love this at the bottom of Dr. Spreadbury’s paper

“This work was not supported by funding.”.

Of course, there are other aspects of carbohydrate intake that still need to be taken into consideration – especially the impact of per-meal carb total intake (not solely the form of the carbs) on blood glucose control in diabetes – where there is a combined impact from carb food form and total.

Ketosis in a Nutshell – Part 3, Happy Campers Galore

the best part of whipped cream

the best part of whipped cream (Photo credit: thepinkpeppercorn)

Many people find that they are pleased (joyful even) to have the option of making use of nutritional ketosis to help them improve their health.

(terminology list at bottom of Part 1)

The numbers of those people are growing steadily as barriers to use of ketogenic diets fall:

  • in the neurological community, the diets have gone from being perceived as too onerous to use in all but rare cases – – to – – progressively becoming more practical and more palatable
  • in the weight loss community, use of nutritional ketosis has gone from often being perceived as an overly strict diet that a person will often “blow” and not use long term – – to – – being much better understood and developed into an eating style that many have adopted over many years with sustained health benefits
  • in both communities, people have gone from a situation with lack of support at the community and peer level – – to – – LOTS of peer support is now available online and in other forms
  • the day-to-day experience of the foods and the meals is much enhanced by the many recipe sources and “foodie” sites online
  • people are able to share their positive experiences with nutritional ketosis and network this information online
  • people are able to share their negative experiences with nutritional ketosis online and get trouble-shooting support
  • continued experience and research has shown that, while there is potential for side effects and there are certain cautions to keep in mind, with proper instruction in a nutritionally sound eating pattern and a reasonable degree of medical support, over-all nutritional ketosis can be used safely over time (with more intensive supervision needed for the stricter versions of the diet, for younger children, for people with more medical problems and medications – particularly during the transition phase)
  • particularly, one of the most important barriers has been concern over the safety of the very high fat intake that is an absolute requirement for long term use of nutritional ketosis.  Reams and reams and web page after web page have been written on this topic and I am not going to attempt a review of it here.  Research done on people following a ketogenic or very low carbohydrate diet in a clinical or research setting (and thus having received some instruction, support and lab monitoring) have not born out these concerns – although monitoring is important to spot the relatively small number of people who do not do well on such a diet.  Also, considerable doubt has been thrown on the concept that there exists any scientific evidence of harm from a high fat diet – at least in the absence of high glucose or a moderate or high carbohydrate intake (other than in those with specific genetic susceptibility).  The research has not separated out the impact of high fat from the impacts of glucose loads.

The availability of home blood ketone test meters and better understanding of their use is likely to substantially speed up the expansion in the use of nutritional ketosis (ketogenic diets) as it will likely help people achieve benefits more reliably and with less confusion and effort.

The Nutritional Ketosis “Nation” Comes from Two Founding Peoples:

(1) Ketosis for control of epilepsy in children

(2) Ketosis for weight loss

Nutritional Ketosis (ketogenic diet) for Epilepsy Control

  • for wonderful stories and pictures of people who have had dramatic recovery of their health from using a ketogenic diet for epilepsy control see HERE. This is a page of personal stories on the website of The Charlie Foundation.  Most of the stories are of kids, but some are reports by adults of their recovery with the diet when they were children.
  • more happy stories on the website of the U.K. organization Mathew’s Friends.  On their home page, click on About Us and then on Our Stories.

Short version

Although remarkably effective for many patients, the ketogenic diet for epilepsy control fell into obscurity as more and more medications, as well as surgical options, came into use.  It was remembered the way it was in the early decades of use  – suitable for a very small number of people, requiring a specialised team and hospitalization to undertake, being very challenging and unpleasant, and presenting medical side-effects and potential nutritional compromise, such as growth restriction.  Time has brought much progress, though.  Now, not only is the “classic” version of the diet much easier and more pleasant than it was in the 1920’s and 1930’s when it was first in use, but also there are less stringent versions of the diet as an option.  In the past two decades, it is the pleased parents of the recovered kids who have pushed the medical community to play catch-up in recognizing this critical medical intervention.  Clinical use continues to rapidly expand around the world and researchers are expanding the horizons of the potential uses of ketogenic diets in medical care.

Longer version

It was in the 1920’s that the “classic” form of the ketogenic diet was developed and first used for epilepsy. They knew that sometimes people with epilepsy would improve during periods of fasting or starvation.  Trouble is, they didn’t know what it was about starvation that caused this improvement – or if it was due to a combination of factors.  They knew that the level of ketones went up during starvation and they knew that there also tended to be dehydration.  Also, in starvation there were not the nutrients to allow for growth.

The diet plans were being developed to try to help with children who were in very serious and difficult medical circumstances.  These children had severe epilepsy that was not responding to other medical treatments.  For this reason, the most effective diet plan possible was the goal. The “classic” ketogenic diet involved all three of these factors combined together.*

  • The diets were designed for the highest promotion of ketone levels in the blood – meaning the least protein compatible with health, tiny amounts of carbohydrates, and the rest as fat – all measured exactly.  They were trying to mimic starvation as closely as possible.
  • There was a limit placed on fluid intake – both the total amount per day and the amount at one time.
  • In addition, the diets were designed with precision to give the children substantially fewer calories per day than the standard calculations said they needed – in fact, only 75% of their calculated needs. The plan was that a child would not lose or gain a pound (despite the fact that normally children grow).  The children were weighed often (e.g. monthly). If the child lost or gained any weight, the food allotment would be adjusted up or down to correct for this.

These diets were dramatically beneficial for many of the children.  Still, some did not benefit and some had partial improvement.  The most remarkable finding was that some children, if they had excellent seizure control, could return to a full normal diet after a couple of years without the seizures coming back.. They were effectively cured of their epilepsy.  Given that the stakes were so high, the degree of response was frustratingly unpredictable.   It could also be erratic – sometimes a child who had been doing well would have a brief recurrence of seizures for no identifiable reason. Sometimes the seizures returned and no adjustment in diet could be found that resulted in regaining seizure control.  The seriousness of the situation, the great hope for improving the lives of these children, the unpredictable and sometimes erratic nature of the response and the lack of helpful insights from research or lab tests all combined together to make it difficult to stray from the “tried and true” version of the diet plans.  The diet plans required intensive highly expert supervision and were extraordinarily stringent, difficult and nutritionally tenuous.

It isn’t hard to understand why the use of the ketogenic diet for epilepsy control fell into obscurity as more and more prescription medications for seizure control were developed – along with more surgical options.  It languished for decades.  Where it did remain in use, by a dedicated team at John Hopkins, the passing decades brought substantial improvements in the practical application of the diet. A big reason for the diet becoming easier and more pleasant to use was the fact that tables of the detailed nutrient content of all common foods became available, which was not the case in the 1920’s.  This, along with home use of highly accurate food scales, enabled the design of diets composed of a greater variety of normal household foods.  Still, the implications of these developments went un-noticed by the greater medical community.

It was the parents who changed all that.  The hospital team kept the knowledge alive and developed it to a more usable form.  It was the parents who insisted (INSISTED) on spreading the word about the life-altering potential of the ketogenic diet.  Why the enthusiasm for a dietary treatment that still, despite the improvements, was still difficult and a serious medical intervention?  Many children continue to suffer from severe epilepsy despite being tried on any number of medications, medications in combination and despite the availability of improvements in surgical options.

In the early 1990s, the desperation of the situation these children and families faced led to a resurgence of interest in the ketogenic diet.  With The Charlie Foundation and Mathew’s Friends anchoring the voices from the parents’ and patients’ side, the medical community has scrambled to keep up as demand for and use of the ketogenic diet has rapidly expanded, now world-wide. (It only sounds like hyperbole because it is such a good story.)

Recently, doctors were very surprised to serendipitously find that a much less strict version of a ketogenic diet (rather than the “classic Ketogenic Diet”) could be very effective for some people for epilepsy control.  This finding led to the development of a specific dietary program called the “Modified Atkins Diet”.  It is very much like the classic Atkins Diet, but with some tweaking to make it more steady in its effects.

Another more liberal version of the diet was developed in 2002 based on the Glycemic Index. This is a diet that keeps total carbohydrates low (not as low as the above two versions), but also focuses on the quality of the carbohydrate foods chosen. It incorporates carbohydrate foods that are slow to digest – meaning that the glucose from the food is absorbed from the digestive tract slowly.  Refined sugars and high GI starches are avoided.

Other diet variations are the MCT Ketogenic Diet, which incorporates MCT oil, and the Modified Ketogenic Diet.

There is one confusing aspect to the terminology about the diets.  The use of ketogenic diets for epilepsy has evolved, until recently, as its own little insular world.  There were no other deliberate medical uses of ketosis in the early decades.  Neurologists got used to using the term “Ketogenic Diet” to describe the very specific highly regularized diet program they were using (including fluid restriction, 75% calories with normal weight children, three meals of identical nutrient balance, etc).  Why not?  No one else was using the term.  Now this causes some confusion as, of course, this is just one possible version of “a” ketogenic diet (a sustainable eating pattern that causes the development of ketosis).  It is helpful to refer to this as the “classic Ketogenic Diet” or “Classic Ketogenic Diet”.  Unfortunately, those in the epilepsy diet community are so used to using these terms (and so often are speaking to each other and implicitly know what each other means) that often the term “classic” is left off.  This can cause some confusion. Also there seems to have been some lack of understanding as it seems that at least some in the neurological community did not understand that the Atkins Diet was intentionally designed to promote the development of ketosis in the early stages – to take advantage of the known appetite suppressing effects of ketosis (ref – Atkins 1973 book, see next installment of this series).

The more acceptable the diets become, the more reason researchers have to delve into the science of what is going on in the body in response to the diets and what other medical conditions might benefit from the use of ketogenic diets.  We still don’t know exactly how these diets cause their beneficial effects.  It is clear that not everybody needs the same combination of diet mechanisms to achieve similar levels of benefit – that is, some people need stricter, more ketotic diets and others do as well with less strict diets. (For more details on the research, see some of the medical papers listed (with links) at the bottom of Part 2 of this series.)

To reflect the new understandings, a term now being used is “Metabolic Therapy”, which incorporates the idea that there are a number of ways to manipulate metabolism that may be harnessed for treatment of neurological conditions.

To see videos of a one day conference in Toronto, March 2010, about dietary treatment of epilepsy, including the various diet options and the treatment of adolescents and adults, please visit my web page HERE

Nutritional Ketosis for Weight Control   ….. to be continued next installment

* some of the core Ketogenic Diet principles detailed in the 1996 book “The Epilepsy Diet Treatment: An Introduction to The Ketogenic Diet, 2nd edition” by John M. Freeman, M.D., Millicent T. Kelly, R.D., L.D. and Jennifer B. Freeman of the John Hopkins Pediatric Epilepsy Center.

Other Resources:

The Charlie Foundation – an American organization that has played a central role in the resurgence over the past 2 decades in the use of the ketogenic diet for epilepsy control.  The web site offers extensive information.

“The Charlie Foundation was established in 1994 in order to raise awareness about the ketogenic diet as a treatment for childhood epilepsy. The modern success of the diet has led to new demands on the medical community. In order to meet these demands, the Charlie Foundation has expanded its priorities to include educational programs for dietitians and neurologists as well as support for clinicians and researchers working to perfect its administration and discover its mechanisms.”

Mathew’s Friends  – an organization in the U.K. that similarly plays a central role in providing information and supporting access to treatment.  Extensive information is available on their website.

Books oriented to the dietary control of epilepsy:

The Keto Cookbook: Innovative Delicious Meals for Staying on the Ketogenic Diet

Ketogenic Diets: Treatments for Epilepsy and Other Disorders

Dietary Treatment of Epilepsy: Practical Implementation of Ketogenic Therapy

Fighting Back with Fat: A Parent’s Guide to Battling Epilepsy Through the Ketogenic Diet and Modified Atkins Diet

Ketone Testing Meters Compared

Jimmy Moore has an important post, on his Livin’ La Vida Low Carb blog, in which he compares the two available brands of blood ketone testing meters.


Included is some direct head-to-head testing done with the two meters.  It is also interesting to read the comments below the post for other people’s experiences.

Hopefully, if there is enough interest, a better unit with more affordable test strips will be developed – soon!

Jenny Ruhl reports her ketosis experiences

Jenny Ruhl has just posted another update – at the mid-point of her planned 2 week journey back into nutritional ketosis.  Jenny is very experienced in sustained ketosis, having spent 5 years maintaining nutritional ketosis in the recent past, plus years at a low carbohydrate intake above the point of significant ketosis  This unusual degree of personal experience, plus her extensive communication with others following low carb lifestyles and her broad knowledge of the research and the science, makes her reports especially valuable and insightful.

Her report is particularly important because she is one of those who don’t thrive when in ketosis, particularly over an extended period.  Individual differences in metabolism are very real.

Her post.

More on her history with nutritional ketosis, part of her discussions with Jimmy Moore on his Ask the Low Carb Experts podcast from September 20, 2012.  web page

Addendum Oct 15, 2012

Jenny posted about the outcome of her 2 week trial.  I commented on her trial and provide the link to her post in this excerpt taken from Part 4 of my Ketosis series –

Jenny Ruhl’s recent experience – You have to scroll down to the comments section below her post to see where she reports that she did test positive for urine ketones throughout the trial 2 weeks, after the first couple of days. I include it here for some balance.  Also, it reflects some other people’s experiences that I have read about in the past months where the person has done blood testing for ketones and not had substantial weight loss when eating to satiety.  Note – in Jenny’s trial she did lose weight, but she remained hungry as she kept to a calorie cap.

What you eat is only part of the whole picture when it comes to what is determining your body weight (unless being in semi-starvation or putting up with chronic hunger, neither of which are tenable long-term).

Jenny is an extremely happy camper when it comes to a “to the meter” individually targeted lowering of carbohydrate intake as an essential aspect of controlling diabetes and glucose intolerance (see her other web site, facebook and books).