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Discussion Starter · #1 ·
Interview by Dr Andreas Eenfeldt...

Low Carb Living | Dietdoctor.com

What do you need to know to successfully eat low carb for life?

Dr Stephen Phinney, MD, PhD, knows more about this than almost anybody. He has researched adaptation to very low carb diets (and exercise) for a long time. Here he shares this knowledge, as well as insights from traditional cultures who never ever ate a lot of carbs. Do you for example know what pemmican is?
 

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You beat me Frank. I was just about to post this video. It's an excellent discussion.
 

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Wow! Just wow! Great interview of the doctor by another doctor. Who said the doctor's advice is never right? These guys are amazing.

This has really validated and clarified something I stumbled on by myself about 8 months in. I called it at the time "zero tolerance". I found that slip-ups or "holidays" were just completely unacceptable and harmful for me and were giant steps back.

At the time, I believed that widely-held belief that one can jump back into ketosis (his term is much better: "keto-adaptation", since ketosis has a more general linguisic meaning and can cause some confusion) in 3 days. The doctor has found that it is more like 1 - 3 WEEKS to recover from a single deviation.

I also read a study showing that it took three weeks for the brain to switch from glucose to ketones 90% of the way, so the adaptation or transition was still ongoing after three solid weeks of a completely ketogenic diet.

For most people, this really needs to be done under medical supervision IMO. I think too many people would just not be able to pull it off successfully. Unfortunately, that is not an option for most people unless you happen to live near this Dr. Phinney or Dr. Mary Vernon or Dr. Jim Carlson or the others who can help. I believe and hope their numbers are growing and picking up speed.

Truly amazing and information-packed interview.
 

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The only thing I am not sure about is the length of time to get back into ketosis once you fall out ketosis.
 

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Frank, thanks, that is a fantastic video. I think the most important thing he said was that it takes 4-6 weeks to retrain your body. I know on a lot of other Diabetic Sites we always end up with a heated discussion about people who just can't do low carb. I really wonder if it is because they don't try it long enough to get results. I also find when I fall off the wagon it does take quite a long time to get back into a fat burning mode. Have you read his book? I think it would be quite a good read.
 
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This has really validated and clarified something I stumbled on by myself about 8 months in. I called it at the time "zero tolerance". I found that slip-ups or "holidays" were just completely unacceptable and harmful for me and were giant steps back.

At the time, I believed that widely-held belief that one can jump back into ketosis (his term is much better: "keto-adaptation", since ketosis has a more general linguisic meaning and can cause some confusion) in 3 days. The doctor has found that it is more like 1 - 3 WEEKS to recover from a single deviation.

I also read a study showing that it took three weeks for the brain to switch from glucose to ketones 90% of the way, so the adaptation or transition was still ongoing after three solid weeks of a completely ketogenic diet.
I find, by monitoring my basal rates, that glycogen stores may play a role. I take 20% jumps in my total basal insulin as follows:

high carb = 100%
less than 100g = 80%
less than 50g = 80% of 80% or 64%

I find when I take a vacation, my basal needs shoot back up very quickly; then it takes a couple of weeks to get them back down, about two weeks a notch.


For most people, this really needs to be done under medical supervision IMO. I think too many people would just not be able to pull it off successfully. Unfortunately, that is not an option for most people unless you happen to live near this Dr. Phinney or Dr. Mary Vernon or Dr. Jim Carlson or the others who can help. I believe and hope their numbers are growing and picking up speed.
Can you explain what you envision medical supervision consisting of? I'd love to ask my doctor, but I don't know what I'm asking for.
 

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Can you explain what you envision medical supervision consisting of? I'd love to ask my doctor, but I don't know what I'm asking for.
Unfortunately, I don't think most doctors would be willing or even able to help. You would have to be able to get to one of those who are knowledgeable and experienced in treating patients this way. They are few in number but appear to be growing. It is really taking off in Sweden with as many as 1 million people now on some kind of LC/HF diet (10% of the population!).

The amazing thing he brought out in this interview is that someone who is "trying" LC/HF but has either a slip, a "vacation" or an intentional "blow-out" only once or twice a MONTH may actually be scoring a ZERO in terms of keto-adaptation. From some of my other readings, I'm convinced that such "dabbling" might actually be quite unhealthy in several ways. From reading posts on a lot of forums, I think this covers a large number of people.

To be truly effective, it really has to be a way of life, not a "diet".
 
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The only thing that confuses me is the correct amount of protein. I know he says he never counts fat, that is how I do it too. But how do we know how much protein we need. I know if I eat too much protein, bgs do go up the next day.
 

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I think he meant he doesn't count as he goes. He does know all three ratios so at some poiint he does tally it all. I do it the same way. Day after day, I just eat instinctively knowing what foods to mix to stay as close as possible to my C:10;P;15;F:75 ratio. Once in a while, I'll run a typical day's food through a calculator to make sure I haven't strayed.

As for food sources of protein, you have to watch out for those which are too lean unless you want to drink a cup of heavy cream along with it! I would never touch chicken breast or sliced turkey sandwich meat. Chicken wings are about as lean as I get on that animal. Lamb is perfect but chunks, not neatly trimmed lamb chops. With beef, I stick mostly to boneless short rib, actual ribs or tri-tip.

Just calculate an actual day's food. If protein is too much over 15%, you might want to reduce it and/or increase the other two, which is the same thing.


The only thing that confuses me is the correct amount of protein. I know he says he never counts fat, that is how I do it too. But how do we know how much protein we need. I know if I eat too much protein, bgs do go up the next day.
 
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Mind you, I think this is much less important for a T1, since T1s typically don't have the issue of insulin resistance. As such, you only require NORMAL amounts of insulin to metabolize any glucose resulting from your food. T2s require ABNORMAL amounts of insulin in order to metabolize the same amount of glucose. Unlike T2s, T1s don't have problems with metabolizing glucose, only with producing insulin in order to do it.

Reducing carbs is still beneficial for T1s because it reduces the amount of exogenous insulin required and makes control easier, reducing the risk of both highs and lows - Dr. B's famous "law of small numbers".

The issue is quite different for T2s. Keto-adaptation (not mere low-carb) is much more important because SWITCHING our glucose-impaired cells from glucose to other fuels not only solves the excess BG proglem but also the insulin resistance problem by simply circumventing it.

Thus, T2s have much stronger reasons for wanting to go all the way to keto-adaptation, although it is a healthy option even for non-diabetics and likely for T1s as well.



I find, by monitoring my basal rates, that glycogen stores may play a role. I take 20% jumps in my total basal insulin as follows:

high carb = 100%
less than 100g = 80%
less than 50g = 80% of 80% or 64%

I find when I take a vacation, my basal needs shoot back up very quickly; then it takes a couple of weeks to get them back down, about two weeks a notch.




Can you explain what you envision medical supervision consisting of? I'd love to ask my doctor, but I don't know what I'm asking for.
 

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Discussion Starter · #12 ·
I haven't read his book (with Jeff Volek) yet, but I think I'll need to add it to my list.

The subject of keto-adaptation is interesting and it makes me wonder about what approaches will work... I know for myself going "cold-turkey" or using the induction phase was an important step... but I've been brow-beaten so many times by others who feel a gradual decrease in carbs is easier to manage that I hesitate to say "I told you so"... maybe it is a case of "horses for courses".

BTW... for those who might like to read more and have not yet seen it: this is an account by the Stefansson he mentions during the interview... Adventures in Diet - by Arctic Explorer Vilhjalmur Stefansson
 

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I eat mostly grassfed beef, is that too lean? I do eat a lot of coconut oil, butter, coconut milk and nuts so I do think I get enough fat. I rarely count, I eat instinctively too. It was interesting what he said about the European Explorers in the Arctic who ate the Inuit diet as oppossed to the preserved carbs they brought with them. He feels you only need the higher levels of Vit C when you eat carbs.
 

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Discussion Starter · #14 ·
Can you buy the fatty cuts and make sure to eat the fat as well? All my meat is grass-fed but I use regular ground, plus I'll cook it with coconut oil, bacon and of course some added butter.
 

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I really enjoyed that, Frank. My problem is I'm not eating enough fat for sure. I should gain some weight if I can wrap my head around that fact and up it more...90% sure will be a challenge for sure, but looks like my coconut oil and butter, some bacon grease is simply not enough to prevent me losing more weight. Hmm...how do you guys manage to get enough in? I wonder how much my couple of T. of coconut oil has in it?
 
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... looks like my coconut oil and butter, some bacon grease is simply not enough to prevent me losing more weight. Hmm...how do you guys manage to get enough in?
I'm still learning, but I've managed to up my fat intake by breakfasting on an omelette with lots of bacon (I hunt out the fattiest packages at the supermarket) and grated cheese. And at night, I make a luscious sauce with the pan leavings and double (heavy) cream. That goes over the steak/chops and the steamed vegies. Plus my favourite lunches are either smoked salmon on cos (romaine) lettuce, or a Caesar salad with lots of bacon, parmesan and Paul Newman's creamy Caesar salad dressing.
 

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I have cut way back on my carbs and since starting that I've found my basal rates on my pump have to be adjusted every few weeks. Yet I've also found that I haven't lost much weight which is disappointing. I need more knowledge about LCHF way of eating. Does anyone have recommendations about books I could read?
 

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Isn't all of this what Adkins promoted with his diets?

Also, is there an easy test to see if one is now producing ketones?
 

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Isn't all of this what Adkins promoted with his diets?

Also, is there an easy test to see if one is now producing ketones?
Not exactly. What Dr. Phinney is talking about, the ketogenic (or "keto-adaptive") diet is rather like Atkins induction phase but it just continues like that instead of increasing carbs like in the "maintenance" phases of Atkins. There has been more science in the meantime. Atkins was designed for losing weight, this is for long and healthy living.

Testing for ketones in urine is cheap and easy. Thanks to T1s having to watch out for DKA, the strips are available every where (even Wal-Mart) and our cheap. Positives are true but negatives not necessarily. If there are ketones in your urine then there are definitely ketones in your blood. What is in the urine is "spillover". If there are none in the urine, the most likely meaning is that there is none in the blood and you are not "keto-adapted" ("in ketosis" in Atkins-ese), BUT it is possible to be in ketosis and test negative if ketones were produced but fully utilized such than none spilled into the urine.

I've never seen that and have at least "trace" ketones every time I test.
 
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