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The Science Behind The "Low Carb Flu", and How To Regain Your Metabolic Flexibility
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May 25, 2012
11:03 am
xaevir
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Need help. I am 2.5 weeks into the diet and I sleep terribly. I slept better the first week into the diet maybe bc of the low carb flu symptoms. The sleep I am getting is just not deep enough. I am so tired during the day, its killing my work. Should I try sleeping supplements like melatonin or 5htp? I am at my wits end. Thank you.

May 25, 2012
11:44 am
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Halifax, UK
Gnoll
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I went through a phase of this, waking up in the middle of the night and feeling like I couldn't get back to sleep. As odd as it sounds, go with it - the anxiety about not sleeping is probably what's keeping you awake. Apparently, we sleep in four hour blocks, so it is perfectly normal to wake up in the middle of the night after a short period of deeper sleep and then have a few hours of light sleep.

Like the diet, it will normalise.

Supplements might well be okay for a short-term gain, but I don't think they're good for the long term. How about changing what you do in the evening? Go for a walk before dinner, eat, sit outside, read. Ensure that your sleep room is blacked out with no digital interference, not even standby lights. Also, try not to engage in digital activity before bed - no computer or TV for a good hour beforehand; read a book to spark your creative brain.

Stick with it and adapt your lifestyle to the positive goals.

Good luck ... it will normalise.

Living in the Ice Age
http://livingintheiceage.pjgh.co.uk

May 25, 2012
11:55 am
xaevir
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@Paul Holliday: Thank you for the help and the positive support. I need it right now. Right now I am wired and tired. I cant take a nap but also cant do any real mental work. This feeling kinda carries into my sleep. Its like I am never really awake and never really asleep. No rhythm. I hope it will normalise as you said. I am a programmer and my work has been horrible.

May 25, 2012
1:20 pm
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Halifax, UK
Gnoll
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... then I can whole-heartedly recommend getting outside and having a walk. Walk wherever you can - urban, rural, wherever, just get outside and walk. Try to find some views where you can take in horizons. It will clear your head, set you up for a productive evening and hopefully bring some relieving sleep.

Have you looked at herbal drinks? Chamomile is very soothing. Also, consider lavender for sleep - for me, it knocks me straight out! Some dried lavender in a bag under your pillow, or extract oil with a few drops on the pillow and turned over.

Living in the Ice Age
http://livingintheiceage.pjgh.co.uk

May 29, 2012
1:39 am
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xaevir:

It sounds like your circadian clock is screwed up.  Melatonin isn't magic, but it can help reset your cycle.  Take it soon before bed.

"Wired and tired" means cortisol may well be messing up your sleep patterns.  I don't recommend skipping breakfast in that case: make sure you eat plenty of protein and fat for breakfast, even if you're not very hungry.  And don't eat late at night: no "bedtime snack".  In your case, it's far better to go to bed a bit hungry and eat a big breakfast.

For me, exercise is the most important factor in restful sleep.  If I don't walk, or bike, or work out, or otherwise get myself tired, I sleep poorly.  As Paul said, go for walks -- during the day if at all possible.  Lift some heavy things.  Slam out some pushups, or even better, some burpees...again, during the day.

Light-blocking curtains are a sound investment unless you want to wake up at dawn.

Hope this helps!

JS

July 27, 2012
8:10 pm
Susan
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Hi J.S.,

Forgive this untimely response, but please count me as one of the females who does well eating breakfast & dinner, no lunch. (In the category of "things you don't understand yet", which I would guess is a very small category, indeed!) I tried to modify my routine for a Whole30 per ISWF recommendations: Eating 3 meals, and I found I was hungry and, therefore, snacking, much more often. The heck with that! Thanks for all the science.

July 31, 2012
6:50 pm
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Susan:

I think there's something to the old glucostatic hypothesis: low blood sugar really does make you hungry, and not all of us have perfect blood sugar control.  Sometimes eating more often simply gives us more opportunities to experience a bit of reactive hypoglycemia!

JS

September 30, 2012
2:16 pm
Heather
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Hi, JS ... Thanks muchly for the über-informative and useful site. I was pleased to find this page in particular. I have T1 diabetes and find that my blood sugar control is *much* better on a low-carb diet. If there were no other considerations (other than BG, I mean), I would probably fare best in ongoing ketosis. But I'm also quite physically active (rowing 3x/week, strength training, bicycle commuting), which creates a bit of a dilemma.

About one month ago, I shifted from low-moderate carb to VLC/HF, and while my blood sugars have been generally great, I can't say I'm feeling great while working out. Not totally crappy, but not at all 100% — even when I'm not working out (bit of fatigue). I'm also not, according to my blood ketone meter, in full ketosis — I don't know why, as I'm following the dietary recommendations of Phinney/Volek etc.

Things I'm wondering right now are whether I should reintroduce some good starches and try in my imperfect way to cover them appropriately with insulin, or if I should try more aggressively to keto-adapt (which might just mean waiting longer?), with the goal of maintaining excellent blood sugars.

I realize you can't possibly play endocrinologist to all of your web fans, but any thoughts you might have would be most welcome.

Cheers!

September 30, 2012
2:24 pm
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Halifax, UK
Gnoll
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Heather - from the sidelines, get some carbs in there! VLC is admirable, for folks who are fat, have metabolic derangement or brain issues, but fit and healthy people, especially active people can and should eat carbier foods.

Feed your fun!

While it is seriously good fun to climb a mountain fasted, hike 20 miles with nothing but a vial of body warmed coconut oil, active people need to feed themselves. Roots do this well. If your endurance is decreasing, eat more carbs; if you get fat, eat less. That's my yardstick.

Living in the Ice Age
http://livingintheiceage.pjgh.co.uk

September 30, 2012
3:00 pm
Heather
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Paul - thanks very much for the feedback. If it weren't for my T1 diabetes (ie "metabolic derangement"), the choice would be easy. But I also need to think about the long-term consequences of high blood sugars, which are pretty difficult to avoid when trying to match exogenous insulin to carbs.

September 30, 2012
3:59 pm
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Heather:

Keto-adaptation takes weeks, and is definitely a long-term commitment.  During the transition you'll be low on energy.  Even after you're done, you'll have excellent long-term endurance performance, but sprinting and shorter-term explosive performance will be impaired.  But it certainly seems like it would make blood sugar control easier!

Really it depends on how systematic you can be about your insulin dosage and response.  See Paul Jaminet's excellent article How To Minimize Hyperglycemic Toxicity for several ways to keep your blood sugar response slower (and therefore easier to control with exogenous insulin). 

And if you decide to go ketogenic, he's also written two great articles on how to make diets ketogenic but still nutritious (Part I, Part II).

Note: this isn't medical advice, just my own thoughts.

JS

September 30, 2012
4:00 pm
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Halifax, UK
Gnoll
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Okay ... I don't have the experience or qualification to advise further. That deeper understanding of blood sugar and achieved health is something beyond my experience.

I can help with a name, though - Steve Cooksey. Diabetic, ketogenic, paleo and winning!

Living in the Ice Age
http://livingintheiceage.pjgh.co.uk

September 30, 2012
10:07 pm
Heather
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Thanks very much, JS and Paul, for the info and references, all of which I will check out.

And, absolutely, I know this isn't medical advice.

My plan is to give keto-adaptation a few more weeks. If it's still not coming together for me at that point, I'll try some cautious re-introducing of yams and whatnot — probably just one meal to begin with and see if I can establish some reasonably reliable insulin:carb ratios.

Interestingly, a slower blood sugar response isn't necessarily easier to cover with exo. insulin (though I do understand the advantage of lower GI foods, especially for T2 diabetics). The insulin delivery needs to be paced accordingly — which can be done with a pump, but I've found in the past that a glass of juice can be easier to cover than mashed potatoes with butter/gravy. Argh.

Thanks again!

November 3, 2012
11:35 am
neopaleoman
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Just dropping a comment that I really find the site valuable and I'll be checking out your book. Thanks.

November 9, 2012
3:03 am
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Heather:

Any updates?

neopaleoman:

Let us know what you think...drop a note in the Talk forum.

JS

December 1, 2012
9:26 am
Katherine
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I always figured that being unable to sleep at night when you're losing weight was the natural response of the body, telling you to get up, go out, and kill something.

I don't have that issue since I gave up gluten almost 10 years ago. I sleep much better.

I remember low-carb flu symptoms. I haven't experienced it in many years. Being gluten-free and not eating substitute baked goods means I'm always pretty low carb. The past week I've been on a VLC diet and will be for at least another week or two. No symptoms.

December 3, 2012
7:14 pm
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Katherine:

I suspect it's like gaining muscle: it's difficult to gain muscle mass for the first time, but it's easy to gain muscle mass you've previously lost.

JS

December 8, 2012
9:03 pm
alan2102
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JS: "Are you familiar with any experiments in which (for instance) people's blood levels of PCBs were measured during nutritional balance, and again during fasting (which should release them into the general circulation)?"

Here are some clippings and references that might be of interest:

http://www.nutritionj.com/content/10/1/9
Review
Weight Science: Evaluating the Evidence for a Paradigm Shift
Linda Bacon1* and Lucy Aphramor2,3
[...snip...]
"there is emerging evidence that persistent organic pollutants (POPs), which bioaccumulate in adipose tissue and are released during its breakdown, can increase risk of various chronic diseases including type 2 diabetes [113,114], cardiovascular disease [115] and rheumatoid arthritis [116]; two studies document that people who have lost weight have higher concentration of POPs in their blood [117,118]. One review of the diabetes literature indicates 'that obese persons that (sic) do not have elevated POPs are not at elevated risk of diabetes, suggesting that the POPs rather than the obesity per se is responsible for the association' [114]."
references:
113 Lee DH, Lee IK, Song K, Steffes M, Toscano W, Baker BA, Jacobs DR Jr: A strong dose-response relation between serum concentrations of persistent organic pollutants and diabetes: results from the National Health and Examination Survey 1999-2002. Diabetes Care 2006, 29:1638-1644. PubMed Abstract | Publisher Full Text OpenURL
114 Carpenter DO: Environmental contaminants as risk factors for developing diabetes. Rev Environ Health 2008, 23:59-74. PubMed Abstract OpenURL
115 Ha MH, Lee DH, Jacobs DR: Association between serum concentrations of persistent organic pollutants and self-reported cardiovascular disease prevalence: results from the National Health and Nutrition Examination Survey, 1999-2002. Environ Health Perspect 2007, 115:1204-1209. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
116 Lee DH, Steffes M, Jacobs DR: Positive associations of serum concentration of polychlorinated biphenyls or organochlorine pesticides with self-reported arthritis, especially rheumatoid type, in women. Environ Health Perspect 2007, 115:883-888. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL
117 Chevrier J, Dewailly E, Ayotte P, Mauriege P, Despres JP, Tremblay A: Body weight loss increases plasma and adipose tissue concentrations of potentially toxic pollutants in obese individuals. Int J Obes Relat Metab Disord 2000, 24:1272-1278. PubMed Abstract | Publisher Full Text OpenURL
118 Lim JS, Son HK, Park SK, Jacobs DR Jr, Lee DH: Inverse associations between long-term weight change and serum concentrations of persistent organic pollutants. Int J Obes (Lond) 2010, in press. PubMed Abstract | Publisher Full Text

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Also:

Environ Health Perspect. 2009 Apr;117(4):568-73. Prevalence of metabolic syndrome associated with body burden levels of dioxin and related compounds among Japan's general population. PMID: 19440495 PMCID: PMC2679600 Free PMC Article

----------------------

Diabetes Care. 2007 Mar;30(3):622-8. Association between serum concentrations of persistent organic pollutants and insulin resistance among nondiabetic adults: results from the National Health and Nutrition Examination Survey 1999-2002. PMID: 17327331 Free Article

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Obes Surg. 2006 Sep;16(9):1145-54. Increased plasma levels of toxic pollutants accompanying weight loss induced by hypocaloric diet or by bariatric surgery. PMID: 16989697

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Metabolism. 2002 Apr;51(4):482-6. Increase in plasma pollutant levels in response to weight loss is associated with the reduction of fasting insulin levels in men but not in women. PMID: 11912558

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Am J Physiol Endocrinol Metab. 2002 Mar;282(3):E574-9. Weight loss-induced rise in plasma pollutant is associated with reduced skeletal muscle oxidative capacity. PMID: 11832359 Free Article

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Int J Obes Relat Metab Disord. 2001 Nov;25(11):1585-91. Increase in plasma pollutant levels in response to weight loss in humans is related to in vitro subcutaneous adipocyte basal lipolysis. PMID: 11753575 Free Article



December 8, 2012
9:30 pm
alan2102
Guest

JS: "Keto-adaptation takes weeks, and is definitely a long-term commitment. During the transition you'll be low on energy."

Note the title of the second-to-last reference in my post above: "Weight loss-induced rise in plasma pollutant is associated with reduced skeletal muscle oxidative capacity."

Hmmm. Is it possible that some of the problems of "keto-adaptation", such as fatigue, are due to large quantities of POPs (PCBs and other) being released from adipose tissue and poisoning skeletal muscle mitochondria, and/or liver mitochondria?

One of the problems with ketogenic and related diets can be very low fiber intake. Fiber is one of the few things that can carry fat-soluble POPs out of the body. (One of the others is the synthetic fat, Olestra -- which has been used successfully for that purpose.) If the newly-released POPs are not excreted, they will be re-absorbed and recycled (enterohepatically) for quite a while, until dribs and drabs of them finally find their way out. But at the same time, the high animal fat content of these diets makes it almost inevitable that more (fat-soluble) POPs will be ingested, without any good way to be excreted.

Maybe I'm overstating all this. Maybe it is not much of a problem. Or, maybe it IS a serious problem, for some people. Maybe individual variations in hepatic detoxicative processes, fecal flora, current dietary exposures to POPs (i.e. just how POP-laden is the food you're now eating?), extant (historical) body burdens of POPs, liver functional reserve (i.e. have you been a drinker? just how much have you abused your liver?), etc., all add up to serious problems for SOME people, and not so much for others. Maybe.

I think that fiber supplements, or even bile acid binding resins (which are fairly good at promoting the excretion POP-type crap), might be important for some people undertaking these very-low-fiber diets, particularly when large amounts of bodyfat are being mobilized. Apart from helping to sweep out POPs, fiber also has more obvious advantages, anyway.

December 9, 2012
4:55 am
alan2102
Guest

PS:

I forgot (until now, this morning) that activated charcoal also works for detox and is better for this purpose, gram for gram, than fiber or resins (though probably not Olestra). Charcoal is wonderful for pulling fat-soluble toxins out of the body. It actually pulls them out of the blood, believe it or not, using the intestinal wall as though a dializing membrane. This is why it is used in emergency medicine in some intoxications. It absorbs stuff sitting in the GI tract, but also lowers blood levels of stuff already absorbed (literally pulls it out of the blood; yes, I know, this is amazing, but true!). The only problem is that it is messy — a pain in the ass to use. You have to be very careful not to spill it on anything that you care about, because it stains like ink, and the fine powder seems to *want* to end up where it does not belong. But beyond that hurdle, it is great. Only other thing is that it does not provide roughage for promoting bowel function; only fiber can do that. Charcoal, as a bolus, is physically inert, like so much dirt. When I take it, I combine it with psyllium powder, to provide the bulk that the bowel needs to move things along. As you might imagine, it turns the stools black, and green (green probably from the bile, which it absorbs). Also stains the tongue black for an hour or so.

An alternative is Pringles Light potato chips made with Olestra (or just pure Olestra, if you can find it). More detail: bing for "pringles olestra PCBs" etc.; e.g.:
Eurekalert link
Yo-yo diet redistributes toxins in body tissue; Olestra+caloric cut boosts toxic excretion

Why bother with charcoal, vs. Olestra? No reason, except (maybe) that charcoal has about 200X more science behind it, and is known to absorb a very wide variety of toxins and carry them out of the body. As a general detoxificant, it has a lead that will probably never be surpassed. I think the reason that there were so many pop articles about Olestra as a detoxifier is that it was such a novel and funny idea. Story writers could not resist: "[haha] Guess what? Pringles[tm] chips are a health food! [haha, chortle]". Charcoal is not nearly as sexy.

I still think supplemental fiber would be a good idea, to help physically propel this crud OUT.

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