Increased inflammation on keto?
Why might you be experiencing increased inflammation on a keto diet? How do you lower cholesterol? When should you measure blood sugar? And what’s Diet Doctor’s point of view on the EHJ 2018 study finding an association between low-carb diets and all-cause mortality?
Get the answers to these and other questions in this week’s Q&A with me.
Please note that these answers do not constitute medical advice and no doctor-patient relationship is established. These answers are for general information purposes and you should discuss any changes with your healthcare provider.
Increased inflammation on keto?
We are experiencing increased inflammation (joint pain) on a keto diet. I also feel very acidic. We eat meat (not grass fed) and cheese/yogurt (some grass fed), vegetables. We are not eating keto sweets or alcohol. We have coffee in the morning.
Kathleen
Hi Kathleen.
Inflammation can come from multiple potential dietary intolerances. For some it is dairy, for others it can be eggs, and for many it is refined flours and grains.
The best way to find the culprit is to do an elimination diet. It can be cumbersome, but it is well worth it if you can find the culprit. If you are keto, you already did a great job cutting out the grains and flours, so that means now getting rid of all dairy and eggs and seeing if your symptoms resolve. If so, then you add one back slowly and see if they return. if they don’t resolve, then you dig deeper. Nuts? Nut flours? Veggies? Other potential causes?
Best of luck finding the culprit and continuing on your health journey,
Dr. Bret Scher
A response to the EHJ 2018 study?
I’ve searched through your pages for a reaction to the August 2018 European Heart Journal study Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality: A Population-Based Cohort Study and Pooling Prospective studies, which seems to have strong evidence against the keto and other low-carb diets, but couldn’t find any comments other than a brief note written before the study was actually published and only announced. Searches on other keto-oriented sites similarly drew a blank. This seems on the surface to be a strong study, and I’m sure your readers would appreciate an analysis.
Todd
Good question, Todd. I assume you are referring to this study.
Unfortunately, this study has a number of issues. The most glaring is that the people in the lowest quartile of carbs were still eating 40% of their calories from carbs, averaging 214 grams per day. So right away, if you wonder if this study applies to people truly eating low-carb (less than 20, 50, or even 100 grams per day) the answer is a resounding NO!
There was also a higher percentage of men, of less educated individuals, and smokers in that quartile introducing unavoidable confounding variables and healthy user bias. That is a big issue with these nutritional epidemiology studies and why we rank them as either weak or very weak evidence. Here is more about our evidence basing guidelines, and here is a link to our discussion on observational studies.
I hope that helps!
Best,
Bret Scher
How to lower cholesterol?
What do I need to do to keep it under 200? A recent blood test revealed its slightly elevated since my last result three months ago.
Derek
Hi Derek.
Please see our guide on cholesterol and low carb to get a more in-depth answer.
Hopefully that will address your concerns and help you understand the differences between total cholesterol, LDL and what the numbers mean.
All the best!
Bret Scher
When to test blood sugar?
I have been testing first thing in the morning, but now that I am fasting (16/8), does it make more sense to test just before breaking my fast?
Carl
Why not test both? Some people have a “dawn phenomenon” where the blood sugar is higher when they wake and can go down as the day progresses and they get closer to their first meal. I like to know if that is the case with my patients. Here is a link to our page explaining the dawn phenomenon.
Best,
Bret Scher
More questions and answers
Many more questions and answers:
Q&A
- MEMBERS ONLY
![Is low carb bad for exercise?]()
- MEMBERS ONLY
![Is low carb bad for the kidneys?]()
- MEMBERS ONLY
![Everything in moderation?]()
- MEMBERS ONLY
![Is low carb bad for the environment?]()
- MEMBERS ONLY
![Is low carb an extreme diet?]()
- MEMBERS ONLY
![Are there potential dangers with a low-carb diet?]()
![Women's questions introduction]()
- MEMBERS ONLY
![What is the main benefit of low carb?]()
- MEMBERS ONLY
![Does the brain need carbohydrates?]()
- MEMBERS ONLY
![Can low carb and keto help with PMS?]()
![Is low carb bad for gut bacteria?]()
- MEMBERS ONLY
![Why is low carb important to you?]()
More with low-carb doctors
- MEMBERS ONLY
![Part 8 of Dr. Jason Fung's diabetes course]()
- MEMBERS ONLY
!["Humans are not broken by default"]()
![Can low carb make it fun to be a doctor?]()
![How to help patients reverse type 2 diabetes]()
- MEMBERS ONLY
![Tim Noakes on trial]()
- MEMBERS ONLY
![The human body needs good saturated fats — Dr. Ken Berry]()
- MEMBERS ONLY
![LCHF and diabetes: science and clinical experience]()
- MEMBERS ONLY
![Launching the Diet Doctor podcast]()
- MEMBERS ONLY
![Challenging the dogma]()
![A global food revolution]()
![Diet Doctor Podcast #26 – Dr. Ignacio Cuaranta]()
- MEMBERS ONLY
![Why more protein is better]()
Keto also likely changes (favorably) the activity of the liver and pancreas in their conjunction with the gut.
Intermittent fasting also has an effect, more predictably shifting to butyrate-producing organisms.
Conversely, while you might shift a population balance, it is unlikely that you will be able to completely eliminate any given particularly undesirable species simply by going lchf. Extended fasting seems to have a more persistent effect on that regard, but even there bugs will often find a way to wait quietly until conditions are favorab!e for regrowth. So I think long term lifestyle changes are key.
Check out the information from Phinney & Volek at the bottom of this article.
https://www.dietdoctor.com/low-carb/fruits-and-vegetables
You may want to try our free two week challenge. We also have a lot of other recipes and meal plans you can use!
https://www.dietdoctor.com/low-carb/get-started
D. Walker
You do not need to take keto pills or supplements. Eating very low carb food you will be in ketosis. Please make sure and work with your doctor to adjust your dosage as needed as you begin eating low carb.
https://www.dietdoctor.com/low-carb/with-diabetes-medications
Super easy, blending a Dr. Udo probiotic capsule with a whisk, and setting the jar at room temperature for 36 to 48 hours, for the bacteria to grow, based on how "tangy" I like it. Then, overnight in the fridge, it thickens beautifully, and goes great with nut mix "grainless granola", and a handful of berries. Kingly breakfast!
I would suggest taking note of what you ate previously to the rash.
I would suggest taking note of what you ate previously to the rash.
I have been on KETO for about a year. Some Mornings I wake up with red burning lips. Then my main concern is that my feet have become very sore and the feet having been turning a shade darker just the foot up to the ankle. I have been to autopedic specialist and he said cannot find anything wrong. All blood test have come out clear. Please advise if anyone has had these issues.
I am sorry you are experiencing this and glad you are working with a physician as these are not expected potential side effects from keto.
Your experience sound like an allergy. You may consider allergy testing to determine your intolerances. Keto includes a broad range of foods to fit many lifestyles and allergies. You can begin by keeping it simple with whole, real foods that are very low in carbs, make sure you're getting adequate protein and add the fat of your choice for flavor to satiety.
Usually 3-4 weeks is the minimum.
Microbiome: a healthy microbiome is diverse. There will always be ‘bad bugs’ in your gut, like E. coli (the antibiotic resistant ones are a real problem), but they are in fact useful in a balanced, multifaceted ecosystem. Rather like flies clearing up poo, or sharks eating dead things. But you’re right, if fed lots of ‘poo and dead things’, their population will bloom, and we tip over into dysbiosis.