November 21, 2017

Let's Talk About Thyroid -- My Personal Story (Pt. 3/3...for now)

The first post in this 3-part series explored thyroid function in general, including what the different thyroid-related hormones are, the signs & symptoms of hypo- and hyperthyroidism, and what should be included when you have your thyroid hormones measured. (Reminder: TSH and T4 are not enough!) In part 2, we looked at the potential effects of low carb diets on thyroid function. As promised, here in part 3, we’ll do a deep-dive into my own personal experience with hypothyroidism. 

We’ll get into the gory details soon. But as Sam Beckett said in the final episode of one of the greatest TV shows of all time, Quantum Leap, “Instead of ‘once upon a time,’ let’s start with the happy ending.’” I started thyroid medication in January 2017 and here’s what’s happened since then: I’ve lost 17 pounds. My chronic constipation is gone. My hair no longer falls out in alarming clumps daily. My severe, longstanding, and unremitting depression is 89% gone.

This medication has been nothing short of life-changing for me. I still have a ways to go in several respects, but let’s just say that the reason I’m writing about thyroid at all is because, having gone through this experience, it is now almost like a religious mission to me to provide whatever information and help I can to people who are currently, right this minute, feeling as awful as I felt until recently. And I kind of hate saying that. I am as far from a religious (and low carb) zealot as a person can be. And yet, I now feel a compulsion to educate people so they can help themselves. As passionate as I am about the myriad benefits of low carb, and as much as I sometimes want to grab people at the grocery store and talk some sense into them, that is now far eclipsed by my fervor for proper thyroid assessment and treatment.

There’s so much to cover, I don’t know where to start. If you come to my blog for sensible information on low carb and ketogenic diets and don’t give two hoots (or even one hoot) about my thyroid odyssey, skip the rest of this post and wait until next time, when I’ll be back to posting my usual fare. On the other hand, if you suspect you have a thyroid problem, or you know you do and your medication is not getting you where you want to be, this is for you, my dears. You’re not alone.

October 25, 2017

Let's Talk About Thyroid -- Low-Carb or Ketogenic Diets and Thyroid Function (Pt. 2/3)

I left off last time saying we would look at the effects of low carb/ketogenic diets on thyroid function. Thyroid function is a hotly debated topic in the low carb world. While most people typically experience fat loss, better energy levels, and improved overall vitality on a low carb diet, in some individuals, measurements of thyroid-related hormones suggest that a low carbohydrate intake might be having adverse effects on the thyroid gland. Is it possible that a way of eating that has such wonderful benefits for so much of the body could be harmful for the thyroid?

The effect of low carb diets on thyroid health is quite the controversial issue. Some people following a low carb or ketogenic way of eating find that their T3 decreases after a while. At first glance, we might take this to mean that low carb causes a slowdown in metabolism, or maybe it has other negative downstream effects. On the other hand, physicians and researchers who’ve spent decades improving the lives of their patients with low carb and ketogenic diets have not reported adverse effects on thyroid function. So what’s the deal?

October 11, 2017

Let's Talk About Thyroid -- Intro: Thyroid Function & Testing (Pt. 1/3)

Long time readers of this blog know that I have been dealing with a low functioning thyroid for quite some time. Even longer than I, myself, realized, now that I look back and think about how long I’ve been plagued by the signs and symptoms. It’s been about five years that things were noticeable, including two and a half during which they were downright unbearable, but in evaluating back even further, individual symptoms popped up here and there going back longer than that. (Why did I let things go on for five years? Details on that in part 3.)

Being that I have far more personal experience with this than I wish I did, and being that I’ve had several clients with thyroid issues, it’s time for me to write in detail about thyroid function. I’ll start off with a general overview of thyroid function and how to properly assess the various hormone levels. In part 2, we’ll look at the potential effects of low carb or ketogenic diets on thyroid function, and in part 3, I’ll talk specifically about my own history and what I’m doing now. Those of you with no interest in any of this, move along; nothing to see here. (I do feel like I write too much about myself, but I think sharing my personal experience can be informative for those who are dealing with similar problems and who’d like to see the struggles and stumbling blocks I encountered, and how I emerged on the other side feeling much better. So yeah, part 3 will be about me, but my hope is that it will be helpful for others.)

On with the show!

October 4, 2017

Dining Out on a Low Carb or Ketogenic Diet

Q:  Can you dine out if you follow a low carb or ketogenic diet?

A:  Yes, of course you can.

I’m not sure why some people find this difficult, but since the question of how to do this comes up frequently on social media, it’s time for me to provide a little tutorial.

I’m always a little puzzled when people are traveling somewhere new and they ask locals on Facebook or Twitter for recommendations for keto or low carb-friendly restaurants. Every restaurant is friendly to these ways of eating, provided you know how to customize your order. (Okay, if it’s a restaurant that serves literally nothing but funnel cakes, cotton candy, and deep fried cheesecake, you’d be out of luck, but to my knowledge, such an establishment does not exist outside of state fairs in the U.S.)

Before I get into things, here are some caveats:

My advice for dining out on low carb or ketogenic diets is for people eating this way primarily for weight management and/or overall health. If you are following a strict Paleo or autoimmune protocol (AIP) diet, or you have severe intolerances to gluten, soy, dairy, or some other element, then obviously you will have to be more careful and some of my suggestions here won’t apply to you. If you absolutely must avoid these things, I would recommend getting familiar with a select few restaurants in your local area that you trust to prevent cross-contamination and whose staff is well-versed in taking special measures to ensure your food is prepared to your specifications. Stop by these establishments at an off time, when the manager and chef(s) might be available for a chat. (During a busy dinner service is not the time to give these folks your entire medical history.) If you are polite and diplomatic in explaining your needs, I don’t think they will be “bothered” by your special requests or think of you as “that guy” or “that girl.” It might even help to explain that if they are able to accommodate your unique and perhaps somewhat difficult needs, you will be quite happy to patronize their establishment frequently, and recommend that others do, too. Restaurants, nutritionists, mechanics—nothing helps us like word of mouth from satisfied customers.  

Things might be a little different if you’re strict Paleo for environmental or ethical reasons, or prefer to completely avoid certain ingredients on principle (e.g., canola, soybean, or corn oil, grain-fed meats, conventional pork and poultry, farmed fish, etc.). If you prefer to consume exclusively organic produce, grass-fed and pastured meats, poultry, and eggs (especially if they come from local farms), there might be restaurants in your area that can accommodate this, or at least come close. (If your needs or preferences are extremely restrictive, you might be better off just eating at home. I assure you, though, barring a severe allergy, an occasional bit of soybean oil or corn-fed beef ain’t gonna kill you.)

As for ketogenic diets, if you are following a strict KD wherein you really “need” to have a higher than typical amount of fat in each meal, simply request some extra olive oil or butter on the side. You can even bring your own. Keep olive oil in a small, leakproof glass bottle in your purse or the glove box of your car, and you’ll have it with you more often than not. (This is a good idea if you don’t trust a restaurant to give you “real” olive oil unadulterated with cheap, crappy oils.) This might not be a great idea in the dead of summer, when you wouldn’t want a bottle of olive oil hanging out 24/7 in your overheated car, nor in the dead of winter when the oil might solidify a bit (like it does in the fridge), but it’s no problem when the temperature isn’t at either extreme. (And if it does solidify, it will liquefy again after just a few minutes at room temperature, sped along if you hold the bottle in your warm hands for a bit.) You can do the same thing with coconut oil—take some with you if you need extra fat and you trust yourself more than you trust the wait staff.

Okay. Now that all that preliminary stuff is out of the way, here’s how to actually do this.

September 20, 2017

Ketogenesis, Measuring Ketones, and Burning Fat vs Being in Ketosis

This post is long overdue.

I cannot tell you how many emails I get from people fretting over their ketone levels. It’s time to set the record straight on this issue. I wish there was someplace I could refer people for reliable information on this subject, but I haven’t come across a blog post or podcast interview that explains things satisfactorily. At least, not to my satisfaction. And that is and always has been my goal in writing my blog: I explain things the way I would want someone to explain them to me, if I were new to all this. And since no one—as far as I know, anyway—has tackled this subject the way I would, I finally had to just sit down and write this. If you feel it’s educational, please share it in the low carb and/or ketogenic circles you frequent, because I know this issue comes up all the time in ketogenic forums and Facebook groups. (And if you know of other good resources on this topic, feel free to provide a link in the comments, and I’ll update this post to include it.)

Okay, here goes.

There are few issues more controversial regarding ketogenic diets than whether you should measure your ketones. There are valid reasons to measure, but there are also a lot—a lot—of misconceptions about measuring ketones and how to interpret the data. So let’s get into when and why it’s a good idea to measure, who doesn’t need to measure, and most important, what the numbers mean. (I said who “doesn’t need to” measure rather than who shouldn’t measure because if you want to measure, then go ahead. There’s really no should or shouldn’t here. But if you choose to measure, you need to understand how to interpret and understand the numbers so you don’t jump to illogical and false conclusions.)     

I will also be covering the difference between being fat adapted versus in ketosis. I tried to do it in a few posts awhile back, but I think I the way I explain it here is much better because I will show you the biochemical pathways involved so you will be able to see how it actually works. My hope is that this will go from a vague concept in your mind to, “Oh! NOW I get it!” And you will understand very clearly how you can absolutely, positively have a fat-based metabolism and lose body fat even if you’re not in ketosis. 

August 24, 2017

How to Cut Fat on a Ketogenic or Low Carb Diet (and Why You Might Want To)

Reduce fat intake? On a low carb or ketogenic diet?

Amy, have you done lost yo' mind?

You know people use the abbreviation “LCHF,” right? And that means low carb high fat, right?

Yes. Yes, I know. But remember what Ted Naiman, MD, said:

I’ve heard from many, many people who are struggling to lose body fat on a low carb or ketogenic diet. And while there are many possible reasons for this, the simplest, most obvious, and most common one is, they’re eating too darn much fat.

Too much fat?

On a ketogenic diet?

What is this madness you speak of?

Too much fat. On a ketogenic diet.
This is possible. It is, as they say, “a thing.”
Remember: when you reduce your carbohydrate intake to the point that your body must switch over to running primarily on fat for fuel, you go from being a “sugar burner” to being a “fat burner.” But what this means is that you’re burning fat. It doesn’t mean that the fat you’re burning will automatically and unfailingly come from your love handles and thunder thighs adipose tissue (your stored body fat). It could be coming from your fatty coffee, avocado smoothie, fat bombs, or a heavier-than-you-realize hand with nuts, cheese, and ranch dressing.

Bottom line: the more fat you eat, the less of a need your body has to tap into its stored fat to use for fuel. If you’re already lean and happy with your weight, this is no problem. You might need a bunch of fat just to maintain your weight. (I hate you. Lucky you.) But if you’re struggling with fat loss on low carb despite doing “all the right things” and being on-point with your diet, there’s a chance you’re simply overdoing the dietary fat.

It’s true. If your carbs are very low, then insulin will be pretty low, which is what allows you to get into “fat burning mode.” But just because insulin is low doesn’t mean you’ll magically drop body fat regardless of how many calories you take in. Even if you’re in ketosis, the food energy you take in still has to go somewhere. It has to be used or stored. And if you’re using the fat from your food, you’re not going to be using the fat from your hips or belly. After all, that’s what stored body fat is there for: as an energy supply to be used when there isn’t enough energy coming in. If you drink a cup of coffee loaded with 400 calories of butter and coconut oil, your body has no reason to use its backup supply of fat.

Am I saying it’s all about calories? After writing a post like this one, am I actually saying that?! No. It’s not all about calories, but it’s maybe a little about them. Contrary to popular opinion, you cannot eat unlimited fat and still lose body fat on a low carb or ketogenic diet. If you are following a strict ketogenic diet and adding extra fat to things in order to arrive at a “ketogenic ratio” in the ballpark of 75-80% of your calories from fat but you’re having a hard time losing weight, stop doing this! This is the single biggest mistake I see people making with this way of eating. (And I’ve done it, myself. Believe me; I’ve learned the hard way. The running joke on this blog is that I’m not allowed to keep mayonnaise in my house, because it starts as a spoonful with my food, but then, before I know it, it’s me, the jar, a spoon, and 3000 calories later...)

If you’re using a low carb or ketogenic diet for the purpose of losing body fat, you do not need to eat a super, super high-fat diet. If you’re using this way of eating to manage a specific medical condition that might require a high level of ketones for efficacy, that’s a totally different story. (See here for details on this.)

So, if your goal is weight loss, but you’re having a hard time, here are some tips for reducing fat intake while still keeping carbs low: