I did the very low carb, grain-free thing last winter for a couple of months, so this isn’t my first dance with a VLC-HF diet. I keto-adapt quickly, usually within a few days. My body is used to using fat for fuel, since malabsorption is a big problem when it comes to Crohn’s disease. No diet can cure Crohn’s, but the goal is to make life a little less uncomfortable. Before my diagnosis, I turned to diet because it was the easiest way to self-treat. I removed major allergens – wheat, dairy, eggs, and messed around with eliminating soy. This by default, made my diet much lower in carbs than is typical in the average diet. I felt much better eating that way, but it also raised a lot of eyebrows, since I was essentially “vegan”. As my disease progressed, diet was no longer enough, and I abandoned it, which obviously lead to further exacerbation and bonus diagnosis of kidney disease NOS (my husband believes the diet is what caused the delay in diagnosis because it did such a good job of addressing the inflammation in mild disease). The Low-FOPMAP diet, and SCD diet are both often recommended to treat the symptoms of IBS and IBD. The ketogenic diet takes it one step further by eliminating virtually all carbohydrates.
A ketogenic diet is defined as a diet that’s high in fat (75%), moderate in protein (20%), and very low in carbs (5%). Most guidelines recommend no more than 20 grams (a single slice of white bread has about 15 grams) of carbs per day, no matter the number of calories being consumed. A ‘normal’ diet has an average of 225-325g of carbs per day. That’s a lot! The only thing that the body won’t readily convert to glycogen is pure fat. Excess protein will be converted into glycogen (basically carbs created endogenously through an enzymatic process) by way of glycosylation. Fat does the same, but to a far lesser degree which is why fats are the foundation of the diet. I personally aim for 50g or less, because I already know my threshold (My urine shows ketones at carb levels up to 80g). Milk and yogurt both have natural sugars, making them higher in carbs and not appropriate for the diet. Hard cheeses, heavy cream, sour cream, and cream cheese all have high enough fat content, and most of the lastose has been digested by bacteria during the culturing process, that they’re suitable. Cottage cheese technically isn’t approved, but I limit myself to one serving per day and stay well within my limit. Non-starchy vegetables are allowed, as are small amounts of berries. The true focus is on healthy, minimally processed fats such as olive oil, butter, clarified butter, coconut oil, macadamia oil, and yes, even lard is considered a “good” fat since it closely resembles our own.
There’s a lot of misinformation spreading about low carbs diets, mainly that since they’re so high in fat, they have to be unhealthy and lead to things like high cholesterol, heart disease, and obesity. Science is in the process of bringing diet out of the stone ages, and saavy people know that current USDA food recommendations are based on which food sources are heavily subsidized by the government. It sounds like a conspiracy theory, but it’s true. It turns out, cholesterol ain’t that bad.
I questioned the safety of this diet given that I do have stage 4 kidney disease, and was told it’s not a problem since I’m having metabolic panels checked at frequent intervals. Dr. Google gave me peace of mind when I discovered that fructose/glucose is far more damaging to kidneys than protein, and in fact, some cases of diabetic kidney disease were reversed* after patients adhered to a very low carb diet.
More on kidneys, carbs, protein, and ketosis here.
Alright, now that I’ve given a little background, here’s the fun part: applying the science to real life. Please remember, I’m not an expert. I’m just a well-informed patient struggling to get her body to behave.
Here’s the good news: by day 2 I had a significant improvement in BM consistency and frequency, so the effects are noticeable early on. If it’s going to work for that purpose, you’ll know right away.
I am supplementing magnesium, calcium, b-vitamins, and a multi-vitamin, digestive enzymes, probiotics, and I oversalt everything. This is actually my normal supplement schedule, but it’s especially important with a ketogenic diet. Constipation is the #1 complaint by people using this diet as a means to lose weight. Super poopers rejoice!
The bad news: I failed on day 3 by eating a bowl of cereal and french fries, and dealing with the aftermath on day 4. When you slip up, you’ll know it too.
It’s definitely difficult to follow such a restrictive diet, particularly during the adjustment period while I’m developing new habits. It also doesn’t help that I’m a see food, eat food sort of person. Last year was made easier due to the fact that I was the only person in the house, and only buying food for myself.
As far as how I feel while eating minimal carbs? The only difference I notice is the faint smell of alcohol when I exhale. It’s impossible to tell if I have “keto flu” symptoms, such as nausea, fatigue, headache, and brain fog, because these are all symptoms I had beforehand from Crohn’s and CKD. That being said, I didn’t feel any worse (until I dove into a bowl of granola) than I did before. I also noticed that my reflux settled quite a bit, despite the high amount of fat. Another somewhat inaccurate parallel that is often drawn – “I must be having indigestion because I ate something greasy”. The difference is what the fat is consumed with. Think a fistful of walnuts versus a donut.
Will I continue this diet? I’m going to give it my best shot. Even if I can’t sustain it long term, I already know I can use it to control one of the more inconvenient symptoms of Crohn’s (diarrhea) with enough planning. Road trip, anyone?!
*at the very end of the summary, the doctor states this shows promise to isolate the component of the diet that has the positive effect to help develop a pharmacological agent that mimics dietary ketosis. That is absolutely asinine. The diet IS the component. It’s a metabolic state that can’t be reproduced into a pill, when a standard diet continues to be followed. Sure, it would help with patient compliance if that were possible, but it isn’t.