I know a lot of folks on this site say their joint pain got better with keto. For that reason, I was hopeful. But the etiology of “pain” is probably hugely variable. My and my doctors best guess for me is that it’s an autoimmune condition that started after dealing with a long term Lyme infection. So, like seasonal allergies — another reaction caused by exposure to something foreign to the body, there might be no solution for me (outside of drugs). Still, I will keep trying. I’m out of ketosis right now and headed back in to get an honest assessment of how much better I feel when in ketosis. It’s been hard to say because pain comes and goes for a million uncontrollable reasons. I think (hope) I’m truly less symptomatic with lower glucose. Still trying to figure it out.
Paleolithic Ketogenic Diet
Thanks for the link! I’m for one hoping it becomes reality sooner rather than later. Here’s Fig4 for anyone interested:
From the article @ctviggen linked above, where Bob quoted the low ketone rationale and I quoted a couple responses afterwards the high ketone rationale:
What about people on long term ketogenic diets who still get astronomical readings? What’s going on?
A major factor not often mentioned in whether someone on a keto diet blows high or low ketones is overall calorie intake. How much food are you eating?
Ketones are generated when the amount of dietary fat available to be burned exceeds the supply of oxaloacetate (provided by protein or carbohydrates). It’s not that the body thinks, “This woman needs some ketones, stat.” It’s more like, “I’ve got too much acetyl-COA from all this fat, and I can’t find any oxaloacetate. Guess it’s ketones!” If you’re the type to use keto to justify chugging olive oil, you’ll generate lots of ketones simply because your fat intake is outpacing the supply of oxaloacetate. Keto athletes eating tons of calories will probably produce more ketones simply because they’re eating so much fat.
Ketones only result from partial oxidation of fatty acids when there are more than the amount of oxaloacetate present sufficient to oxidize them completely. So if the fatty acid supply remains below that amount, ketone synthesis remains at or close to baseline - enough to feed the brain.
Maybe ‘ketosis’ is a bit of misnomer and maybe something like ‘liposis’ would be more accurate. But we’ve got ketosis and it is technically correct.
There are studies showing an improvement in the immune system resulting from a ketogenic diet. Mostly this appears to result from the reduction in systemic inflammation, but increased HDL cholesterol also aids the immune system, since cholesterol is one of our defences against bacterial infections.
I have a Lyme-like fatigue disorder (unidentified, though apparently the result of a viral infection in 2006). The ketogenic eating has greatly reduced the fatigue effects. My asthma and allergies are now basically under control from diet and a daily antihistamine alone, whereas in some years before keto I required three or four inhalers daily. I have never been able to determine whether the relief of my knee pain was purely from the diet, or whether losing eighty pounds of fat is more responsible. The stiffness in my hands and other joints does appear, however, to be directly related to what I’m eating, as I mentioned.
I am sorry that you are not seeing similar results on your ketogenic diet; however, I should point out that my results were not immediate. In fact, I’ve been eating ketogenically for four years, and it’s only been in the past twelve to eighteen months that I’ve been able to largely dispense with my asthma meds (though there were a few episodes earlier this year that required a hit or two of albuterol). The arthritis relief was gradual, so I can’t pinpoint when it began, but I believe I first started being able to climb and descend the cellar stairs without pain after nine months to a year of full ketogenic eating.
I read a remark in another context, but it seems to apply here. And that was something to the effect that when we determine that something is a marker for a desirable state, our focus tends to shift from the desirable state to manipulating the marker.
The original context, if memory serves, was in relation to cholesterol and cardiovascular disease, but it applies to ketogenic eating, as well. Seeing ketones is a sign of eating properly, so ketones become the goal instead of the metabolic state that gives rise to ketones.
Paul Mason is beginning to make this point in his recent lectures. He states that he considers ketone level to be irrelevant, that what we want is the metabolic health from eating properly, of which the presence of ketones is merely an indicator. This point seems easy to lose track of, sometimes.
I suspect ‘ketosis’ carries some negative baggage because it was defined originally as pathology. If one had detectable ketones it meant trouble. We’ve learned lots more about it since those days of yore. As indicated by @PaulL immediately above, one of the things we’ve learned is that in the context of a healthy diet detectable ketones are a marker of metabolic health not pathology.
Acetoacetate is the ketone energy molecule. But it’s unstable and breaks down quickly into acetone which is vented generally via the breath. It’s mostly acetoacetate that so-called ‘pee sticks’ detect in urine as it vents directly via the kidneys and bladder. Fortunately, acetoacetate also converts spontaneously into its more stable form β-hydroxybutyrate which is detected in blood meters.
β-hydroxybutyrate is a very interesting molecule. While circulating throughout the body it acts as a hormone performing all sorts of good things. I’ve said many times that it’s better to have your innards awash in ketones than glucose and by that I mean precisely β-hydroxybutyrate. In this role, generally ‘more’ is better with the caveat that what’s detected by a blood test is only the portion in transit, not the portion actually doing good stuff in and around cells and organs. So low blood readings don’t necessarily indicate overall low levels.
In addition, the more β-hydroxybutyrate you’ve got the more of it the brain will use for its energy requirements. Since acetoacetate burns much more cleanly and yields more than twice the energy as glucose, your brain on ketones works more efficiently than your brain on glucose. I.E. more energy and less waste to deal with.
When it’s absorbed into a cell for energy, β-hydroxybutyrate breaks into acetoacetate from which the energy is then extracted by mitochondria in the cell.
Apparently this is true also of acetone and acetoacetate. They also appear to have as much of a beneficial effect on the brain as β-hydroxybutyrate does. I don’t know, however, if they have gene-signaling properties similar to those of β-hydroxybutyrate.
For me personally when I started to see Dr Cywes my blood work showed no trace of ketones…but also after a year on keto my triglycerides were 257 hdl was 43…he had me add more fat (saturated fat) not olive oil I bought a keto mojo eating the extra fat pushed me back into ketosis took a few days…after 3 months my triglycerides dropped to 177 my hdl is up to 58… and I’m supposed to add more fat…but in the same process I’ve moved over to carnivore and gained 5/6 pounds and now he wants me to add the fat from advocado and cream olives and see if I can keep the numbers going in the right direction…
He not sure if my body is being forced to make glucose because my protein lvl is too high or if it’s because I need the sugar because my insulin is still to high to access all my body fat…
So I find it interesting I seem to do better when im in ketosis I don’t chase a ketone number though if it says 0.5 that’s good enough or if it’s 2.0 I don’t care…
Very doubtful, although the final verdict on what exactly happens is still to be rendered. Protein does a lot of stuff before it gets used to make glucose, including used for its energy value. Gluconeogenesis is demand driven not supply driven and strictly regulated. Otherwise, your liver would busily convert all your muscle mass to glucose just because it’s there.
When insulin prevents fat utilization, your metabolism burns glucose, either dietary or synthesized. Gluconeogenesis can not synthesize sufficient glucose to run your whole body on it. That’s why if you don’t eat carbs every couple of hours you get hungry - your body’s way of saying you’re running out of glucose eat more! If you’re consistently hungry, then you’re burning mostly or exclusively carbs. If you’re not consistently hungry and not eating a lot of carbs, then you’re burning some fat. Might not be efficiently and might not make up for additional storage from the carbs you eat. But when one’s metabolism is messed up, nothing works right until stuff starts getting fixed. Staying consistently in ketosis is the best way to fix it, even if from time to time you gain some weight.
I actually find my ketone readings make more sense than my glucose. I use the old keto mojo and have been through two batches of strips and just got the new keto mojo for my birthday but haven’t used it yet.
I have a times down two tests consecutively on different finger pricks and have always gotten the same reading or a difference of 0.1. But it is expensive to play around too much with this.
It seems i am usually about 0.2 first thing in the morning and go up by about 0.2 every 4 hours or so- by dinner if i have fasted all day I am maybe up to 0.7 give or take. If I have HWC and/or MCT I can get my ketones up quickly in the AM. If I eat a mostly protein meal/snack it seems to drop them down.
My glucose on the other hand is very frustrating. I need to schedule a physical and ask for a CGM
Maybe this is why every few weeks I get a ravishing hunger that I just eat and eat and I don’t seem to get overly stuffed full I don’t cheat I eat pork rinds or more bacon or more meat… maybe I need the fuel cos I can’t access enough of my ownmy own …my insulin has dropped down but still not as low as Dr Cywes would like it he likes fasting insulin to be really low Mines at 7.8
@FrankoBear, would your family member be receptive to being supplied with reading materials about keto and cancer? Then he or she could form their own opinion.
Also, I would change my diet right away if I thought is would help a health problem, any kind of health problem. Oh right, I have! 
But, if some cancer researcher had lots of research to back up a diet change away from keto that could improve cancer outcome, I would definitely give it a shot.
Bone marrow question:
To have 200 g of bone marrow bone, how many kg of bones do we need to buy? (bones are quite heavy)
Thanks!
Hi, is the measurements in cooked weight or dry weight? If I have 150 grams of fat and cook it, a lot of the fat will be rendered out. And if you eat the 450g food volume recommended by them and still feel hungry, is it just the same ratio but more food?
So you cook a piece of meat and some of the fat melts out into the skillet. You eat that melted fat. Problem solved. Yes? 
Eating rendered fat is known to cause diarrhea though, so I won’t be doing that but I would like to know if paleo medicina’s measurements are cooked or uncooked weight
Hi everyone – I read through this entire thread last night. Fascinating and very helpful.
It looks like some of the main contributors don’t frequent this forum any more. But I’m wondering if anyone out there is still following the PKD or has in the past?
I’m 36M and I’ve been carnivore-ish for about a year now to heal leaky gut, SIBO, histamine intolerance, chronic sinusitis, fatigue, mental health, brain fog, and muscle pain. I’ve been pretty miserable for maybe 15 years. Trying to treat this now with various gut-healing and anti-histamine supplements and probiotics. Low or zero-carb has definitely helped, although I suspect that my functional medicine doctor thinks I’m bonkers (fiber heals the gut, you need carbs, etc).
Sometimes I’ll track pretty close to PKD, but I’ve never fully stuck with it (social pressures; enjoying the occasional fruit, veggie, or even bread; and very noticeable heart palpitations after high-fat meals). I’m considering a consultation with Paleo Medicina, but thought someone here might have some insights:
- Heart palpitations only in the hours after a very high fat meal. Need more sodium?
- How long does PKD typically take to heal the gut?
- Would you ever re-introduce plants or carbs?
- How do you handle restaurants (going on dates would be interesting…) and travel?
- Is exercise really so discouraged? No running, lifting, backpacking, etc.? That sounds rough.
Thanks!
Firstly, if you are eating palaeo, not carnivore (despite the fact that this is a carnivore thread), why is dating a problem? If you go out for a meal, just order a steak and salad, and skip dessert.
Secondly, exercise is useless for fat loss, but it has many other benefits. There are plenty of threads in our Exercise forum that should be useful to you.
Could the heart palpitations be the result of not getting enough magnesium? If so, then for palaeo, just be sure to get enough leafy greens, and for strict carnivore, make your own bone broth, simmering it long enough for the marrow to leach into the broth.
So… heart palpitations have been a very common discussion on this forum. You may want to do a search on them.
I frequently get heart palpitations. For me there are three causes:
- Not enough salt
- Not enough magnesium
- Too much histamine
From what I understand about the Paleo Medicina plan, it is more challenging to follow. There are certain organ meats that need to be added to the diet, the fat percentage is higher, and they have a quantity limit. If you are finding carnivore challenging now, you will definitely find following Paleo Medicina’s version even more challenging.
Now with that being said, how much do you want to feel better? I’ve heard they have great success. It is also possible that you wouldn’t have to follow their protocol forever. Once you are healed, you could probably relax the restrictions. How long that takes? Well, that depends upon you and your body. Everyone is different.
You might also want to look into the GAPS protocol. I don’t know much about it, but I’ve heard it is also very good for gut healing. I think that diet is based upon using broths.
I’m curious, who discourages exercise?
Hi Paul – Thanks for your reply. I think there might be a little misunderstanding. The Paleolithic Ketogenic Diet (PKD) is a specific therapeutic protocol developed by Paleo Medicina in Hungary. That’s what most of this thread is discussing.
It prescribes a specific amount of meat (~400 g), organs, unlimited fat, and a protein:fat ratio of about 2:1. It is definitely a carnivorous diet. In later stages, I believe, they allow the addition of certain fruits and vegetables that are fairly gut and keto friendly.
The clinic also suggests limiting exercise until your intestinal permeability has healed. In their experience, it delays healing. I’m not sure if I agree with that entirely, but they have worked with over 4000 patients. (I am not overweight and not concerned with weight loss.)
And thanks for the suggestion about magnesium. I’ve tried supplementing with magnesium, sodium, and potassium in various amount and ratios. Nothing has really helped the palpitations so far. Maybe my body just needs more time to adjust?