Did home blood test today, ketones: 3.0, glucose: 75 and still feeling way worse than on carbs.
Cannot get fat adapted :(((
amwassil
(Michael - When reality fails to meet expectations, the problem is not reality.)
#43
Have you investigated that maybe you have fatty liver disease? An ectomorph with a belly gut is a symptom. Iām ectomorph and it took me 70 years to gain 35 pounds of excess - and it did not all end up around my midrift. It took all of 3 1/2 months to lose it when I started keto at the age of 71. Iām 6ā0" and have weighed 145 pounds since - Iām now 76. A sick liver makes things difficult.
jennasaurus
(Jenna Ericson)
#44
Based on the information you provided I was trying to understand what might be happening to you specifically and metabolically. I would say that you might have a problem with fuel partitioning.
This is speculative, but I think the types of fats you are eating (high amount of polyunsaturated fatty acids) cause that type of fat to be stored in muscle cells where you would otherwise store glycogen. This causes a breakdown in the normal process of metabolism because the glycogen made in your liver canāt get into the muscle cells as easily. This would cause a backup in the liver, possibly leading to that glycogen being converted into fat and stored there, meaning insulin resistance at the level of the liver (fatty liver). Likewise, I think this could also lead to increased visceral fat around other organs. You might be interested in this episode of Peter Attiaās podcast which describes something similar, but I think the episode refers to a different kind of fat as the root of the problem:
https://www.youtube.com/watch?v=OzZUnl3b49U&t=1895s
One thing you could try would be to eat mostly saturated fat and see if that makes a difference.
I think I can see why working out would make you feel better too. Your muscles would presumably utilize the fat stored in them so after you work out your glucose tolerance would be better.
csrss
#45
@amwassil @jennasaurus
Fatty liver is at least what I have, at least I had it 4 months ago. I am having all kind of liver issues for a long time in my life as well as pancreas issues, as well as chronic dysbiosis as well as anything else I am not aware of. Those issues are of course the reason as well I have started low-carb / keto.
Shatz
#46
I just wanted to say how impressed i am by what you have achieved in your journey so far. What a struggle. I hope the experienced folks on this forum will help you get to your goal.
Did you ever achieve ketosis on your 48h fasts?
jennasaurus
(Jenna Ericson)
#47
I wouldnāt be too hard on yourself 
Itās obvious that you are very knowledgeable and the level of dedication you seem to apply to things is something I look up to. Do you happen to be familiar with Lex Fridman and his podcast? You sort of remind me of him for some reason. I think he eats an almost carnivore ketogenic diet, but he doesnāt talk about it that much.
csrss
#48
@Shatz
I did. Well, it depends what to call a ketosis - apparently my ketone levels are pretty good, but in case of feeling good - couple of times, really. In all that period of 4 months already, I felt the proper ketosis (my vision is even brighter at those moments) - maybe 5, 6 times? Maybe 2 times during whole 100 OMAD / IF days period and yes, while fasting for 48h, around 36 hour of fast I was there.
@jennasaurus
Yes, of course I am basically following some of those guys, the knowledge they share helped me way more then relying on healthcare. At this point I feel 80% better then 4 months ago. But really want to implement keto, I just feel that thats the way to go for me.
PaulL
(Bacon is a many-splendoured thing)
#50
Fatty liver is caused by overwhelming a metabolic pathway in the liver with ethanol, fructose, or branched-chain amino acids. The same pathway handles all three, and it is strictly limited in its capacity. If you are eating sugar, removing it from your diet should help. If you drink, stopping the alcohol will also help. If you are trying to put on muscle, you might consider stopping for a time.
Dr. Robert Lustig did an experiment on patients of his paediatric obesity clinic at UC San Francisco, in which they removed all sugar and high-fructose corn syrup from the childrenās diets, replacing it with other carbohydrates. They found it took less than ten days for the fat in the kidsā livers to return to normal. (Remember that table sugar, sucrose, consists of a glucose and a fructose molecule bonded together. The body can handle glucose, but fructose in any quantity can overwhelm the liver and cause de novo lipogenesis.)
csrss
#51
Yeah, I know that. I have stopped all kind of sugars / alkohol / soda / cakes / candies - more then a 3 years ago. And lately got it again + inflammation, because of overeating carbs (but still not sweets) + enormous amount of stress and overworking + sedentary life style / work (work from home, 16h 7 days in a chair) + eating even more because of the above. This is why OMAD + low carb for last 100 days.
Msims
#52
Forgive my preamble, but Iām reminded of premed lectures I used to attend when I thought I wanted to be a doctor. A Dr. told of how new doctors had researched exiting (and rare) disorders. He called them Zebras. He warned of chasing Zebras and seeing Zebras where none existed. They exist, but a doctor could go their entire 40-60 year career and never meet one Zebra case. Obviously, the internet has made Zebras seem common. Anyway, some of the suggestions sound like chasing Zebras.
So, I didnāt read all the responses, but the search function didnāt show what I think may be the most likely non-Zebra culprit. Do you supplement for your electrolytes? Specifically salt, potassium, and magnesium. Salt being the most important and can cause all the issues you listed. Brain fog, muscle weakness, lethargy, etc. Dr. Phinney recommends 5000mg supplemental sodium minimum daily and maybe even more for those who are athletic. Iāve found the salt requirement to be especially important when beginning keto( or returning) and especially during fasted states.
mkefgen
(Martha Kefgen)
#53
You mentioned 6 months to stop white sugar and 3 months to stop wheat. If these two ingredients were a part of your lifestyle, fasting would be difficult.
richard
(Richard Morris)
#54
The fact that a 48 hour fast is so difficult is telling. The first time you do it itās always tough, but once you realize that āHey I didnāt eat and didnāt dieā itās an epiphany and for some reason that makes the second one easier ā¦. Usually.
You fasted every weekend for 100 days and it didnāt get any better. Thatās unusual and may tell us something important.
So when you fast you are running entirely on fat - itās just that itās all from internal storage. If you experience an energy shortfall, then some process in the chain between releasing fatty acids from fat cells, shipping them through your circulation attached to a lipoprotein called albumin, importing them into your cells, and transporting them across the 2 mitochondrial membranes to be then turned into energy is inhibited. Itās like somewhere along a garden hose someone is stepping on the hose and the flow at the sprinkler is insufficient.
There is a rare genetic case where that second last step - getting fatty acids across the mitochondrial membranes - is inhibited. Itās called Carnitine palmitoyl transferase or CPT I deficiency.
CPT I is a transporter protein that sits in the membrane of your mitochondria and is necessary to get fatty acids that you will turn into ATP and ketones from the inside of your cells, to the inside of your mitochondria where your cells turn fatty acids into ATP (with a side effect of making a few ketones).
Autosomal recessive CPT I deficiency (where to be affected you have to get a deficient gene from both parents) is very rare - around 300 cases have been documented. However if you had one CPT I deficient gene that would be more common and ā¦ just speculating here ā¦ it could be that one deficient gene just means someone is stepping lightly on your hose and you only notice a problem when you try to run 100% on fatty acids.
I know of at least one well known low carb person who personally has to eat slightly more protein, slightly more glucose, and slightly less fat than a standard ketogenic diet. When he tried a high fat regular ketogenic diet his triglycerides spiked to levels Iāve only seen in a frank type 2 diabetic (me - at 1111mg/dl).
That means his garden hose upstream of the inhibition - if we continue with my garden hose metaphor - was full to bursting of high pressure water. If you arenāt using fat for energy it pools in circulation, in other tissue, and in your fat cells.
There is one interesting hack that may be relevant. CPT transports long chained fatty acids, anything 16 carbons long and more. Medium and Short chained fatty acids have a different method of getting into the mitochondria. So if you got more dietary fats from sources of medium chain fats like coconut oil (100% MCFA), or short chained fats like butter (10% SCFA 27% MCFA 63% LCFA) or vinegar (100% is short chained). So maybe next time you fast and feel like hell try drinking a keto shake made with coconut oil, or just some butter. If this is the blockage then that little bit of extra energy that you can make from short and medium chained fatty acids might get you over the hump.
To sum up it is extremely rare but some people just can not get fatty acids into their mitochondria at a sufficient rate to fully supply their energy requirements.
Remember weāre not doctors, but maybe there is a conversation to have with your doctor about whether some deficiency in fatty acid oxidation could cause the symptoms you are seeing.
csrss
#55
This is extremely interesting reply - thank you!
This is exactly how it was - 100 days low-carb OMAD + 48h fast every weekend. For all this period, every 48h fast except for maybe 2-3 times I barely could get to the end, to the point where I was about to faint. Even OMAD thing was complicated because I was simply walking hungry all this time. But there is 1 thing - my blood glucose when doing 48h fasts - was 60. Maybe even lower. I have noticed that those couple of times when I was fine - blood glucose was around 72.
Back to present time.
Still stick with keto. Last week I have observed significant energy increase, above regular levels on carbs, for a 4 days out of 7. Hunger went away again and I am doing OMAD right now with no issues. But energy fluctuations are present, so at morning it goes really down to the point I can barely work, then more in the evening it goes up to a regular level - very unstable.
Ketone level: 3.1 mmol/L
Glucose: 70-75 mg/dL
The higher glucose - the better I feel. When glucose is around 70 - I still experience ketosis, because I am constantly in it, but it feels as well like something is blocking an energy, when glucose rises - I feel good, and sometimes (but I havent measured blood) - I feel good to the extreme like a ābeast modeā, unlimited strength, huge brain activity to the point when even vision colour changes to sort of reddish - so far in 4 weeks of doing keto I had 3 such episodes with a ābeast modeā - they all last about 10h, a then there is a drop below regular level. Next time I am going to check the blood while in this state.
About MCTs, - I think the closest I get with medium chain acids when doing bullet proof coffee - and yes, I feel instant increase in everything, but then it drops just after 15 minutes probably. So it doesnt really help much except for a great taste such a coffee has.
To sum it up, at least at that point I correlate low energy with low glucose - when it rises - I feel just fine, but nowhere I can find what is the optimal glucose level for ketosis. I can only find that perfect is around 80-90? But if oneās is in ketosis - does it apply? Can it be lower? Can it be 60 for instance and such person will be fine? No idea.
The idea with a gene mutation can be true as well or can be adding up to the whole. I was born in a very radioactive environment and experienced some crazy stuff in my life to the point of new veins creation in my hands in front my my own eyes - that was sick, but yeah, who knows what is there.
Anyways, Iāve done 4 weeks of keto, I feel a bit better at this point, basically 3 weeks was a murderous struggle, this week is a bit better, there is still sort of a dumb pain or a pressure in a head, weakness in legs but I still fighting - Iāll give it next 2 months. And yes, I am supplementing everything like salt, potassium, magnesium etc.
Hallie
(Butter Withaspoon)
#56
It sounds tough to figure it out, I hope the above answers help you.
Itās not advice, but Iām pretty sure I couldnāt do OMAD and do a fast every weekend if I was 6 foot 3 and 150lb, although I know you said that with your body type there is more fat on your frame than expected. I would not have enough energy to be active. OMAD for long stretches is good for maintaining body composition. If your fasting for 48 hours on the weekend, eating 2 good meals a day the rest of the week could help with fatigue and feeling like youāve hit a wall
csrss
#57
Yeah, and I have even gained 4 lbs again so back to OMAD + 48h fasts. Already done one this week and it was way easier on keto than previously on low carb.
But this kind of eating is just awesome - there is so much of a free time, especially with 48h fasts. If I would be 100% fat adapted I think it would be possible to eat just on weekends and not on work days, - in my case I can put tons of food in me, like 10k calories per day. That would be an achievement - IF 5/2 or 2/5, 2 days of eating, 5 days of fasting.
The hardest thing with not eating is absence of the process itself. Or just a bullet proof coffee with some 99% chocolate for 5 days in the morning just to fill the need for a ritual. IMO fat adaptation opens up a door to a completely new level.
PaulL
(Bacon is a many-splendoured thing)
#58
Weāve had queries on these forums from people whose serum glucose has dropped into that range, or lower, and they only knew about it because they had a glucose monitor. Otherwise, they were fine.
Cahillās study on fasting subjects in the 1960ās showed that by using a hyperinsulinaemic clamp, they could drive their subjectsā serum glucose to levels that are normally low enough to cause hypoglycaemic coma or death, but they were fine, because their ketone levels were in the fasting range (which is typically higher than the range normally seen in nutritional ketosis).
That doesnāt necessarily tell you anything about what is safe for you, however, especially if you have a problem with fatty acid metabolism.
csrss
#59
OK, thanks. So if my ketone levels are around 3 mmol/L - does that mean, I can metabolise fatty acids or I cannot? Because as of now I have no idea. Or ketone levels does not mean anything? Or ketones - are fatty acids?
PaulL
(Bacon is a many-splendoured thing)
#60
Ketones are partially metabolised fatty acids, just as charcoal is partially-burnt wood.
It is the liver that makes ketones for the rest of the body (the process is called ketogenesis). So obviously your liver cells are capable of metabolising fatty acids at least to the point of producing ketone bodies.
In the normal course of things, our skeletal muscle cells prefer to metabolise fatty acids and, once fat-adapted, generally refuse glucose and ketone bodies, so as to spare them for other cells (red blood corpuscles, for example, lack mitochondria and so must have glucose to live; heart muscle and brain tissue do very well on ketones).
As I say, this is the normal picture. What is actually going on in your case is another question. Given your ketone level, at least your liver is able to metabolise fatty acids to some extent.