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ketoacidosis, vitamins, and rate of weight loss.

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20 Aug 2009 16:44 #3898 by loquat1
loquat1 created the topic: ketoacidosis, vitamins, and rate of weight loss.
Hello doc.,

You prob. don't remember me, but you recently treated me for a suspected kidney stone at Queen Mary's (Sidcup). We briefly discussed fasting, and you recommended this site to me. Well, here I am, and here are my questions:

1) I was re-admitted to QE 2 days after seeing you with the same excruciating pain (now in remission, thankfully). Whilst in hospital, I refused food for 3 days because I knew from experience that the pain would induce vomiting, and I didn't want to go thru that again. I'm T2 (controlled by diet & exercise), and the nurses were regularly monitoring by BG. By day 3 I was down to 3.2 mmols/l, and the nurse warned me that I was risking kidney damage from ketoacidosis if I did not eat. I still refused, so I was put on an IV glucose drip. My BG shot up to over 8 mmols/l very quickly, and the demands that I take food ceased. So my question: if my health was at such serious risk after just 3 days of nil by mouth, how on earth can I safely embark on a much longer fast without v. close medical supervision?

2) As far as I'm aware, the human body does not have more than just a few days store of Vitamins C, D and K, so how is it possible for us to fast up to 40 days or more without compromising our health? Does supplementation come into consideration during fasting, or do you consider this completely unnecessary?

3) I asked you about rate of weight loss during fasting, and you suggested roughly 1kg per day. This sounds excessive to me, and would mean I could only fast for around 10 days before I entered into starvation mode, as I do not have more than about 20lb of reserves. I have already conducted a few short fasts of 1-3 days duration, but want to try something much more adventurous. Bearing in mind my estimated reserves of body energy, would you agree that I was limited to no more than 10 days of fasting, based on your suggested rate of depletion?

Thx,
Costas

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20 Aug 2009 19:04 #3899 by TheFastDoctor
TheFastDoctor replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Thanks for the post Costas and yes I do remember you.

1. Blood sugar of 3.2 is just fine.. I have had a patient at 1.1, found him jogging in the mountains. Remember that ketones is an ALTERNATIVE for blood sugar. It is the way the body functions when living off your fat instead of food. So the drip simply put you back into anabolism. But I agree that you do need knowledgeable supervision for a fast if you have a metabolic condition. Problem is, nurses often just follow protocol, sometimes without understanding or considering the mechanisms. I do not believe your health was at risk from what you describe. There's just no way that a blood sugar of over 2.5 risks your kidneys.. one should ask whoever made that remark, what the mechanism of such injury would be and why specifically the kidneys..?

2. The traditional wisdom of stores of Vitamins.. interesting but debatable. I have personally supervised fasts (water only) for up to 45 days with absolutely no detrimental effects. It could be that you have such tiny stores while ANABOLIC, that is, that burning carbohydrates (blood sugar) need these, but likely when you're catabolic, then the burning of ketones might not. I never consider "supplementation". Not when eating and not when fasting. Sometimes vitamins, like antibiotics, can be valuable medicines however.

3. Bear in mind the rate of consumption is also determined by the size of your body. The 1 kg per day was observed in really big people. One of my patients lost only 9 kilograms in a 37 day fast.. but she was close to ideal weight when starting. Fat contains 35 kilojoules per gram and you can survive quite well on say 7000 kilojoules per day so the arithmetic is yours..

Thanks for the interesting issues you raised. Looking forward to some more intellectual stuff.

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.

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21 Aug 2009 00:49 #3900 by loquat1
loquat1 replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Thanks for your answers & reassurance doc. Much appreciated.

Let us assume, for the sake of argument, that the nurse was just using scare tactics to persuade me to eat. It didn't work, but still begs the question, as a T2 how long can I safely fast:

1. Without medical supervision?

2. With medical supervision?

a)And would I have to go to my GP for this? Daily? Weekly? F/nigthly?

b)Or phlebotomist? In which case, how often should blood samples be taken, and will she know what specific tests to request from the path. lab? Or do I have to tell her?

And, if I may, a couple of supplementaries:

3. Is improvement in insulin sensitivity directly related to the duration of the fast? Eg, would a 40-day fast give me double the sensitivity of a 20-day fast?

4. Would four 10-day fasts spread over say 4 mnths give me the same level of sensitivity as one 40-day fast?

Thanks again, and apologies if my questions are a little naive, or have already been answered elsewhere on this forum.

Costas

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21 Aug 2009 05:57 #3902 by TheFastDoctor
TheFastDoctor replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Hi Costas.

1. and 2. "Medical Supervision" is of course a matter of definition.. very few medically trained people know much about fasting. For example: Keto-Acidosis: This would only set in in the presence of HIGH blood sugar, like in diabetics, where the sugar is not getting into the cells. IF you find a medical person knowledgeable about fasting, then a hands-on approach is best. But I sincery wonder what a typical GP would know about the subject, and what s/he would look for and do.

Apologies for the vagueness but there is no clear-cut answer. It depends SO much on your individual response.

3. No, there's no linear relationship. But do bear in mind "Detos" consists of mobilization (fasting) plus elimination (see Hydro Therapies inter alia in FAQ's).

4. I have always been in favour of repeated shorter fasts rather than the occasional long one. Hopefully this answers also your questions 1 and 2: Even 1-3 days once a week will eventually achieve the same as one long fast, but much safer so. Long fasts should preferably be done in specialised facilities like a Hydro and I reserve them for the treatment of specific complex and serious metabolic conditions. T2 DM is an insidious low grade long term condition that needs a permanent change in lifestyle. This goes even further than your suggestion of 10 days X 4: I fyou do 3 days per week, ever week, that's a good 150 per year! And for variety, some weeks you could do 3 in a row, others every 2nd day..

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.

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21 Aug 2009 09:19 #3903 by loquat1
loquat1 replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Thx doc. You've pretty much confirmed what I've long suspected. Based on your advice, I think the pattern of the fasting regimen I should follow is quite clear - continuous short fasts, interrupted by the occasional longer fasts.

One more question to sign off with. Will I see an improvement in my cholesterol (last test was 6.2mmols/l) by following the above fasting routine?

BTW, it took me some time to find this site, because you called it fastconnection.com instead of fastingconnection.com. I was taken to various rail sites! But no harm done - found you in the end. Till nxt time, cheers.

Costas

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21 Aug 2009 14:49 #3904 by loquat1
loquat1 replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Sorry Doc., changed my mind. You don't get rid of me that easily!

I've done some b/round reading on the forum using the search tool on 'cholesterol'. If I understand your advice correctly, I have to binge on junk food (ie mainly animal fat) for a couple of meals prior to fasting in order to 'switch on' fat catabolism mode. This would 'train' my metabolic processes to leave my muscles & vital organs alone, and work instead on clearing out excess serum/arterial plaque cholesterol once glucose stores have been depleted.

I have just one problem with that. The only 'visible' animal fat I can tolerate (eg spreads, milk, cream, yoghurts, etc) are eaten in association with carbs, which again put my muscles back in the firing line, right? And the only 'invisible' fat I can eat (eg eggs, cheese, sausages, burgers, etc) come with a lot of protein. So again, I'm putting my muscles back in the firing line, am I not?

So I don't see how I can eat a high-fat meal and avoid carbs and/or proteins @ the same time. I have, however, recently started eating small quantities of coconut and walnut oil for general health reasons. If I consume a much larger portion of these oils prior to fasting, will they do as substitutes for my high fat binge? Assuming, of course, I can hold on to them!

Costas

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21 Aug 2009 17:40 #3905 by TheFastDoctor
TheFastDoctor replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Actually, Costas, you need that DOMINANCE of cholesterol food only for the last meal before the fast. It does not need to be a large volume, jou just want to settle your metabolism into burning, instead of producing, cholesterol. My own blood levels came down from 6.2 to 4.6 this way. Other junk is processed the same way: Whatever dominates your metabolism when you "enter" a fast, tends to be metabolised during that fast.

I understand your problem. If you can tolerate eggs, split them, have the white on protein days and the yolk just before the fast. Butter, cream or even vegetable oils can also do the trick. But please bear in mind we are NOT speaking here of an exact science.. Nature has her ways!

You cannot really avoid carbs and proteins, quite right. But the meal just need to be dominated by fat.. it does not need to be a large meal and because fats are so energy dense (twice that of carbs or proteins) you don't need a lot to get your body switched onto a fat based metabolism.

I think the nut oils you mention is a great idea.. provided your biofeedback agrees.

Best wishes!

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.

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21 Aug 2009 22:29 #3906 by loquat1
loquat1 replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Thx Doc., great stuff. But all this begs a further question that I have to ask, with apologies.

If a high-fat meal kick-starts fat metabolism going into a fast, then can we extend the analogy into the fast itself? Would a low-level consumption (say, 1 teasp. a day) of a saturated fat like coconut oil during the fast keep the system focused on fat metabolism, and further protect muscle tissue from the unwanted attention of catabolic processes?

I realize this breaches the principle of complete abstinence during a fast, but if the hypothesis is sound, that is a trade-off I'm willing to accept if it affords muscle tissue further protection.

Costas

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22 Aug 2009 17:43 #3907 by TheFastDoctor
TheFastDoctor replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
To some extent you are quite right. The only reason why I don't take oils or fats during the fast is that the taste buds "informs" the brain that you ate, which tends to re-stimulate the intestine and prevents it from going on holiday or perform maintenance.. plus we often find that this taste sensation can also trigger hunger.

These are not all that important and if a spoonful of an oil makes it easier for you, I would consider that a good valid trade-off. The volume just needs to be much less that your energy need so that you don't turn it into body fat!

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.

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24 Aug 2009 15:14 #3910 by loquat1
loquat1 replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Don't worry doc., no questions this time. Re your concern: 'The volume just needs to be much less that your energy need so that you don't turn it into body fat!'

Allow me to enlighten you this time. I quote from one of many websites that document the health benefits of coconut oil:

Another incredible fact about coconut oil is that even though it is a fat, it actually promotes weight loss!! The reason is again because of the healthy medium chain fatty acids. These fatty acids do not circulate in the bloodstream like other fats, but are sent directly to the liver where they are immediately converted into energy, just like carbohydrates. So the body uses the fat in coconut oil to produce energy, rather than be stored as body fat.

Medium chain fatty acids found in coconut oil also speed up the body's metabolism burning more calories and promoting weight loss. The weight-loss effects of coconut oil have clearly been demonstrated by many researchers. (There are a list of references in Bruce Fife's book The Healing Miracles of Coconut Oil.)


You can find the full story @:
www.alternative-healthzine.com/html/0108_2.html

among many other sites. Well worth your while checking these out if you ever find y/self with a few mins to spare.

I wasn't so much concerned about making the fast easier for me to see thru; more concerned about 'ring-fencing' my muscle tissue.

Based on your advice, just started the 1st of two 2-day fasts planned for this week - total 4 days fasting.

Take care now, & thx a bundle for all your help/advice.
Costas

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24 Aug 2009 19:00 #3911 by TheFastDoctor
TheFastDoctor replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Thanks for the enlightenment Costas.

However, I contend that whoever wrote the sentence

"Another incredible fact about coconut oil is that even though it is a fat, it actually promotes weight loss!! "

has unlikely passed primary school basic science. The "zero'th law of thermodynamics" (So called because it was found to be more basic than the first law) rightly states that we cannot create or destroy energy. Of course, since the advent of nuclear physics we know that matter and energy is interchangeable, but the basic law still holds. We can, after all, also not create or destroy matter, except by converting it (like in nuclear reactors) into energy.

Body fat represents a storage form of energy. If you take in more energy than what you use or excrete, you produce fat. Of course you can use some energy to build muscles, but that has a limit. And to build a gram of muscles needs only 17 kolojoules, whereas fat contains 35 kilojoules per gram.

IF a certain oil, like coconut oil, stimulates metabolism rate, one can argue that you could burn more energy as a result of what you took in, than what you actually took in. But this is highly unlikely, since oils are so extremely dense in energy (calories, joules). And I do not want to have a fast metabolism rate because that implies a fast rate of aging.

Thanks again for a very intelectually stimulating exchange.

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.

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24 Aug 2009 23:08 #3912 by loquat1
loquat1 replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Hello again Doc,

Thx for enlightening my enlightenment!!

Fair comment, but we are talking of relatively small quantities of oil here - in the order of 1-2 teaspoons a day, not a bowl full! In the context of a fast, when calorie intake is in any case severely restricted, I don't think that represents a serious challenge to an adult metabolism in terms of its ability to convert the whole lot into energy. Of course, if you eat enough of any oil or fat, you will gain weight if you don't burn at least the equivalent energy value of the oil consumed. That's taken as read.

And as you correctly observe, part of the equation includes a raised metabolic rate, which at least theoretically would have the effect of metabolising more energy than was consumed. In principle, I don't see how that is a million miles removed from your own advocacy of a high-fat 'junk food' last meal in order to prime the body for metabolising fats during the fast. My suggestion is that the same principle, assuming it is sound, can be extended into the fast itself, albeit at a much lower 'base level'. But I note your earlier objections to the idea of eating anything at all during the fast. Can I take it, then, that those objections do not apply to fruit juice fasts, for example?

As for raised metabolic rates accelerating aging, I would argue that it's prob. not worth worrying about something that is almost unquantifiable. After all, we are only talking about marginal rates of increase over relatively short periods. Assuming you drink tea or coffee, do you worry that the stimulants they contain are shortening your life? Yet I doubt they raise your metabolic rate any less than my coconut oil!

Anyway, you're the expert, & I don't want to appear too argumentative over relatively minor issues, so I'll let you have the last word if you want to come back on any of the points raised above.

Regards,
Costas

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25 Aug 2009 00:56 #3913 by TheFastDoctor
TheFastDoctor replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Thanks Costas. Indeed, as I mentioned in an earlier post, a teaspoon or so of fat or oil can indeed serve to keep the body in catabolism or the metabolism of fats. What I had a problem with is the formulation that one specific fat will make you lose weight.. bear in mind that all fats or oils are broken down in the small intestine by Lipases from the Pancreas with the aid of bile. Thus what ends up in the absorptive part is glycerol and a few fatty acids. It makes no difference really what the original fat was, except that of course some of the fatty acids will be unsaturated with Hydrogen if they are from a plant source.

Juice, of course, represents a diet, not a fast.

I do indeed worry about the stimulus of caffeine or tannin, and never allow it into my body.

I actually welcome argument, and do hope you are not offended by my offering it!

André

All my posts are "generic", based on my opinions and experiences only and are not intended to replace the advice of your own licensed medical practitioner.

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25 Aug 2009 11:05 #3915 by loquat1
loquat1 replied the topic: Re:ketoacidosis, vitamins, and rate of weight loss.
Thx again Doc. You've been a great help, & if I need any fasting advice in the future, I now know where to go.

How come I'm not surprised you don't drink tea or coffee?

Offended? Not in the least. Glad I've found a Doc. who doesn't mind being challenged about some of his ideas/advice.

God bless,
Costas

Oops, sorry. Bang goes my promise to let you have the last word!

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