After 17 hours fast, only mild ketosis

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
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ShepR
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Re: After 17 hours fast, only mild ketosis

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Tincup wrote: Thu Jun 30, 2022 6:15 am
ShepR wrote: Tue Jun 28, 2022 9:02 pm I will check out and research the Keytone Esters.
The late Dr. Richard Veech ran a lab at the NIH for ketones for many years. This is an interview with him, you can click on the transcript to read it. I believe this is the product he developed. As mentioned, the product is expensive. However, I would expect an immediate response in your wife's cognition if there is one. It bypasses the production of ketones in the body by just consuming them. This article goes into the differences between ketone esters and salts (another exogenous form) .

Another ketone researcher is Dominic D'Agostino at the University of South Florida. This is his page and with info on other exogenous ketones. Sounds like you've explored the MCT & diet/fasting angle thoroughly. Your wife may be one who just doesn't make them (much), so exogenous sources would be the next step.
Yes, I believe there is something about my wife's case that may be very different. I came here because I am trying to figure out what we may have missed because, none of our interventions have yielded any reversal. Yet, when I listen to the doctors who were interviewed in Dr Sandison's Alz Summit, almost every one says "You can recover". It just has not worked for us. Her decline over past 2 years has been very slow. We will never know what would have happened if we had done nothing. Maybe we have slowed it, but we have not stopped it. So disheartening to hear happy talk how you can recover, when all our hard work has not paid off. Yet, I have not given up. That is why I came here. I will run down the links you gave me. Maybe by just focusing on exercise and ketones, we can get some movement in the right direction.
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ShepR
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Re: After 17 hours fast, only mild ketosis

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mike wrote: Thu Jun 30, 2022 8:59 am
ShepR wrote: Wed Jun 29, 2022 2:44 pm Mike, thanks for the rundown.

I think we are within the parameters of the Keto-Flex diet that Bredesen recommends. But you are right to suggest because wife has trouble getting into ketosis on that diet, we may have to go full keto, and keep it under 30g carbs a day. I just don't think wife can do it.

At one time about a year ago she was down to 93 lbs so we opened the gate to carbs in a limited way because it seemed to me (and her doc), more important to get her weight up than stick to the 60g carbs a day which she was on. We used Cronometer in 2020, 2021 and tracked and managed macros tightly, but when she lost so much weight.... and then she had 2 events of passing out. Scary. So after much testing, we decided the passing out was because of being underweight for her frame and her height. She now has her weight up to a pretty stable 107-109, and no passing out since February.
Shep,
I didn't mean to oversell reducing carbs. Your wife needs more calories to put on some weight. I'm suggesting to add fat big time to her diet. Your wife does not have any fat reserves, so has nothing to easily make ketones from except what she eats. She would need to break down muscle (or food protein), and if the body is going to do that, it will most likely just go straight to creating glucose. Ketone Esters would be a great experiment to try - sort of like adding nitrous oxide to your car's fuel mix. For Carbs, I'm just suggesting making some better choices. Has your wife checked her sugars? If she brings her sugars down after meals within a couple of hours, then she can have more carbs. If not, reduce carbs and add more fat to keep calories up.
I had not thought of that (no fat reserves). That is new info and helpful. Thank you. About 45 days ago I introduced fat bombs, but it messed us both up bowel wise. So I backed off on that. I think it was Tincup mentioned are we getting enough olive oil. Answer is yes. I load every salad with it.

I got an article from Tincup too on a type of esters that has worked for some. I will try that. I am setting up for a personal coach in hopes that the one-to-one will encourage exercise 2x per week. That should help too.

I like the nitrous oxide metaphor.

Re Sugars. I recently experimented with CGM and tried it for us both. There was a clear difference between us. Btw, I am a 2/3 APOE. When I ate carbs my glucose went up but not too high and came down pretty quick. When she ate carbs (example 3oz cooked hot sweet potatoes), her glucose shot up and took much longer to come down. I have started giving her Bergamot (400mg, and Berberine 500mg) 30 mins before main meal.

Here are the clues: Cold after after smoothie, prone to being cold when no reason., reaction to carbs (spikes that take a long time to come down), sleeping beyond 9 hours a day every day now, no ketosis even after 17 hours of fasting (blood strip- .1 to .4). Weight 107-109, and in the 40 years we have been together, her weight was more like 120-124.

What would you suggest for more fat?
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Re: After 17 hours fast, only mild ketosis

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ShepR wrote: Thu Jun 30, 2022 11:50 am Re Sugars. I recently experimented with CGM and tried it for us both. There was a clear difference between us. Btw, I am a 2/3 APOE. When I ate carbs my glucose went up but not too high and came down pretty quick. When she ate carbs (example 3oz cooked hot sweet potatoes), her glucose shot up and took much longer to come down. I have started giving her Bergamot (400mg, and Berberine 500mg) 30 mins before main meal.

Here are the clues: Cold after after smoothie, prone to being cold when no reason., reaction to carbs (spikes that take a long time to come down), sleeping beyond 9 hours a day every day now, no ketosis even after 17 hours of fasting (blood strip- .1 to .4). Weight 107-109, and in the 40 years we have been together, her weight was more like 120-124.

What would you suggest for more fat?
When you say that "her glucose shot up and took much longer to come down" - can you give me some numbers? What is before meal glucose, and after an hour and then 2 and 3 hours? What do her fasting glucose levels look like? How big are her swings from her lows to highs?

I had not heard about your use of olive oil before... Have you ever broken out your food intake into the 3 macros? How many grams/day of carbs, protein and fat?
Sonoma Mike
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ShepR
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Re: After 17 hours fast, only mild ketosis

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mike wrote: Thu Jun 30, 2022 12:12 pm
ShepR wrote: Thu Jun 30, 2022 11:50 am Re Sugars. I recently experimented with CGM and tried it for us both. There was a clear difference between us. Btw, I am a 2/3 APOE. When I ate carbs my glucose went up but not too high and came down pretty quick. When she ate carbs (example 3oz cooked hot sweet potatoes), her glucose shot up and took much longer to come down. I have started giving her Bergamot (400mg, and Berberine 500mg) 30 mins before main meal.

Here are the clues: Cold after after smoothie, prone to being cold when no reason., reaction to carbs (spikes that take a long time to come down), sleeping beyond 9 hours a day every day now, no ketosis even after 17 hours of fasting (blood strip- .1 to .4). Weight 107-109, and in the 40 years we have been together, her weight was more like 120-124.

What would you suggest for more fat?
When you say that "her glucose shot up and took much longer to come down" - can you give me some numbers? What is before meal glucose, and after an hour and then 2 and 3 hours? What do her fasting glucose levels look like? How big are her swings from her lows to highs?

I had not heard about your use of olive oil before... Have you ever broken out your food intake into the 3 macros? How many grams/day of carbs, protein and fat?
Mike, I truly appreciate your taking me on. Got some bad news this AM, new landlord in the mortgage industry. We have lived here 16 years, but house sold a year ago. He has raised the rent again. I thought I had until Sept 1, but he is demanding a decisions by July 12th.

Re your questions, I have documentation, but I am too upset right now to look it up. I need a little time to cool off and then get back to you. I have the records you asked.

Re; Macros. Yes, I was diligent. I used Cronometer, and set up macros according to Bredesen keto-flex (used guidance in his book). I have those numbers too but need time to recover the data and write it up in an understandable form.

I will get back to you.
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Re: After 17 hours fast, only mild ketosis

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ShepR wrote:Cold after after smoothie, prone to being cold when no reason., reaction to carbs (spikes that take a long time to come down), sleeping beyond 9 hours a day every day now, no ketosis even after 17 hours of fasting (blood strip- .1 to .4).
Being cold makes me wonder if the keto diet is affecting her thyroid. Have you have any thyroid tests done lately?

Keto has been shown to cause hypothyroidism in some people.

Hope your rental situation gets worked out soon!
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Re: After 17 hours fast, only mild ketosis

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SusanJ wrote: Fri Jul 01, 2022 10:37 pm
ShepR wrote:Cold after after smoothie, prone to being cold when no reason., reaction to carbs (spikes that take a long time to come down), sleeping beyond 9 hours a day every day now, no ketosis even after 17 hours of fasting (blood strip- .1 to .4).
Being cold makes me wonder if the keto diet is affecting her thyroid. Have you have any thyroid tests done lately?

Keto has been shown to cause hypothyroidism in some people.

Hope your rental situation gets worked out soon!
Hi ShepR (and Susan J!) Being cold is one of the symptoms of hypothyroidism. I am hypothyroid and first time I got Covid in 21', it attacked my Thyroid, ended up in the hospital, sleeping for three days. It takes time and healing to get the thyroid numbers back to normal. Checking the Thyroid numbers is a good idea. Sometimes ridges on the nails can indicate the same.
Also, my Doctor prescribed 40 hours of HBOT to go after Lyme and numerous co-infections, which cleared the Lyme bacterias, but still working on the rest of the co-infections. Does your wife have other infections?
Check out You Tube for "Yoga for Seniors". You will find many free videos to use as a daily exercise, that does build muscle. My daughter and her friends, all in their 40s, found "Yoga with Adriene" during the lockdown. She is a good teacher and has videos for Seniors.
How lovely that you are your wife's Champion!
Best,
AnnaM
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ShepR
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Re: After 17 hours fast, only mild ketosis

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AnnaM wrote: Sat Jul 02, 2022 7:00 am
SusanJ wrote: Fri Jul 01, 2022 10:37 pm
ShepR wrote:Cold after after smoothie, prone to being cold when no reason., reaction to carbs (spikes that take a long time to come down), sleeping beyond 9 hours a day every day now, no ketosis even after 17 hours of fasting (blood strip- .1 to .4).
Being cold makes me wonder if the keto diet is affecting her thyroid. Have you have any thyroid tests done lately?

Keto has been shown to cause hypothyroidism in some people.

Hope your rental situation gets worked out soon!
Hi ShepR (and Susan J!) Being cold is one of the symptoms of hypothyroidism. I am hypothyroid and first time I got Covid in 21', it attacked my Thyroid, ended up in the hospital, sleeping for three days. It takes time and healing to get the thyroid numbers back to normal. Checking the Thyroid numbers is a good idea. Sometimes ridges on the nails can indicate the same.
Also, my Doctor prescribed 40 hours of HBOT to go after Lyme and numerous co-infections, which cleared the Lyme bacterias, but still working on the rest of the co-infections. Does your wife have other infections?
Check out You Tube for "Yoga for Seniors". You will find many free videos to use as a daily exercise, that does build muscle. My daughter and her friends, all in their 40s, found "Yoga with Adriene" during the lockdown. She is a good teacher and has videos for Seniors.
How lovely that you are your wife's Champion!
Best,
AnnaM
Thanks SusanJ.

Yes, we have had many thyroid tests done since we started on the path with FM doctor in Jan 2020.
Currently she is taking Pure brand, Thyroid Support Complex, (has vitamins, ashwaganda, guggul, turmeric, L-tyrosine and forskohlii).
Early 2020, she tried levothyroxine, but wife has preexisting condition SVT, and the levo exacerbated it so was dropped.
If you look up symptoms of hypothyroidism, out of about 20 symptoms, she only had 3 - cold all the time, depression (but that can easily be attributed to the losses of abilities), and constipation (and that is another story - lots of work on gut issues).
Her FM doc seems satisfied with her thyroid markers(as of March 2022), but I am not. See below for the pattern.

Jan 2020 - TSH - 2.85
Jan 2020 - Free T3 - 2.5
Jan 2020 - Free T4 - 1.2

Oct 2020 - TSH - 2.52
Oct 2020 - Free T3 - 2.4
Oct 2020 - Free T4 - 1.3

Mar 2021 - TSH - 2.79
Mar 2021 - Free T3 - 2.3
Mar 2021 - Free T4 - 1.1

Jul 2021 - TSH - 2.45
Jul 2021 - Free T3 - 2.89
Jul 2021 - Free T4 - 1.34

Sep 2021 - TSH - 1.64
Sep 2021 - Free T3 - 2.00
Sep 2021 - Free T4 - 1.50

Mar 2022 - TSH - 2.16
Mar 2021 - Free T3 - 2.50
Mar 2021 - Free T4 - 1.40

I'm still just hacking my answers with this platform. I just hit the tab key and got completely unexpected change. Oh well. Hope you get this. I've got to hit the platform tutorial if I just had time. Feeling overwhelmed all the time.

RE: can we squeeze some more improvement in thyroid? I don't know. Markers improvement don't always mean symptom improvement. We could try Armour, which I am taking, and it definitely drove my TSH numbers down in 1 month. It has been a long while since we did the Levothyroxine. May ask doc to prescribe the Armour and see if cold hands improve.

It has been over 2 years. We have done Keto-Flex diet, Thyroid Treatment, Nystatin for gut bacteria, Intensive Hubbard Protocol for sauna detox with niacin, Sleep improvement, lowered stress, bought treadmill, but she has not been up to it so exercise and especially strenuous exercise is my next front. I have engaged her yoga teacher to do one-on-one exercise coaching 2x a week, beginning in 2nd week in July. Her o2 sat is good all night. APOE4 3/4 is a demon, and I suspect is (along with other unknown genes) is driving her case. I don't understand well, but wife also has positive markers for the MTHFR genes.

When I began this journey over 2 years ago, I thought I could take all my strength and knowledge from other walks of my life and apply it to this case and get the reversal that so many of Bredesen cohorts brag about. It is much harder than I thought. I have not had many wins along the way. Also, I do not have the medical interest or background for this. I have had to try and learn a language I was never interested in.

I needed a couple of years to learn just enough to ask intelligent questions, let alone understand the answers.

To everybody reading this thread, thanks for taking the time to be interested in helping out. Much appreciated.

Thanks again, Shep
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Re: After 17 hours fast, only mild ketosis

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AnnaM wrote: Sat Jul 02, 2022 7:00 am
SusanJ wrote: Fri Jul 01, 2022 10:37 pm
ShepR wrote:Cold after after smoothie, prone to being cold when no reason., reaction to carbs (spikes that take a long time to come down), sleeping beyond 9 hours a day every day now, no ketosis even after 17 hours of fasting (blood strip- .1 to .4).
Being cold makes me wonder if the keto diet is affecting her thyroid. Have you have any thyroid tests done lately?

Keto has been shown to cause hypothyroidism in some people.

Hope your rental situation gets worked out soon!
Hi ShepR (and Susan J!) Being cold is one of the symptoms of hypothyroidism. I am hypothyroid and first time I got Covid in 21', it attacked my Thyroid, ended up in the hospital, sleeping for three days. It takes time and healing to get the thyroid numbers back to normal. Checking the Thyroid numbers is a good idea. Sometimes ridges on the nails can indicate the same.
Also, my Doctor prescribed 40 hours of HBOT to go after Lyme and numerous co-infections, which cleared the Lyme bacterias, but still working on the rest of the co-infections. Does your wife have other infections?
Check out You Tube for "Yoga for Seniors". You will find many free videos to use as a daily exercise, that does build muscle. My daughter and her friends, all in their 40s, found "Yoga with Adriene" during the lockdown. She is a good teacher and has videos for Seniors.
How lovely that you are your wife's Champion!
Best,
AnnaM
Next meeting with doctor is 2nd week in July. I will ask for deep lyme/borrelia and other infections tests. She does have positive tests for metals (but not off the chart), Environmental toxins (moderate glyphosate, MTBE [pretty high]). Great Plaines OAT, revealed gut issues clostridia, which we treated with nystatin, followed by antibiotic, then gut repair. The OAT is challenging. I took a 3 day seminar from GPL to try and understand it.

Wife was doing yoga all through the lockdown for with same teacher she was with when the health club was open. Then for reasons I don't know, she quit yoga. It just wasn't working for her anymore. So I contacted same teacher last week and we worked out a 2x week exercise coaching schedule. I think the lockdown took a serious toll on wife's social life. We are in the Boston area, and people here were so freaked out by all the bad news on Covid, that things just came to a full stop for 2 years. She lost friends she used to walk with, church closed, and all we had was zoom. I set her up with her 3 sibs for weekly zoom meetings, but zoom is no substitute for face to face contact with hugs.

What I am saying is that right now she needs one-on-one contact.
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Re: After 17 hours fast, only mild ketosis

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Maybe talking on the phone with her siblings would help? And the churches are open now, with masks. I know the zoom gets tedious. Do check out one of the Doctors listed on Dr Bredesen's website at Apollo Health Co. They will have other ideas for you.
Good luck, and know that you are doing an incredible job for her!
Best,
AnnaM
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ShepR
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Re: After 17 hours fast, only mild ketosis

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mike wrote: Thu Jun 30, 2022 12:12 pm
ShepR wrote: Thu Jun 30, 2022 11:50 am Re Sugars. I recently experimented with CGM and tried it for us both. There was a clear difference between us. Btw, I am a 2/3 APOE. When I ate carbs my glucose went up but not too high and came down pretty quick. When she ate carbs (example 3oz cooked hot sweet potatoes), her glucose shot up and took much longer to come down. I have started giving her Bergamot (400mg, and Berberine 500mg) 30 mins before main meal.

Here are the clues: Cold after after smoothie, prone to being cold when no reason., reaction to carbs (spikes that take a long time to come down), sleeping beyond 9 hours a day every day now, no ketosis even after 17 hours of fasting (blood strip- .1 to .4). Weight 107-109, and in the 40 years we have been together, her weight was more like 120-124.

What would you suggest for more fat?
When you say that "her glucose shot up and took much longer to come down" - can you give me some numbers? What is before meal glucose, and after an hour and then 2 and 3 hours? What do her fasting glucose levels look like? How big are her swings from her lows to highs?

I had not heard about your use of olive oil before... Have you ever broken out your food intake into the 3 macros? How many grams/day of carbs, protein and fat?
Mike, can I upload any photos on this platform? I have a full month with notes, of her CGM data. More recently, on 6/30/22, I gave us Whole Foods clam chowder, and big salad for dinner. The clam chowder had few potatoes, and I also gave her about 4 saltine crackers with butter. Yes, I know this is heavy carbs, but I was experimenting to see what the effect of bergamot and berberine may provide. Prescription was to take 2caps each half hour before big meal. I did not get a baseline before dinner (you may assume 111-117), but 1 hour exactly after meal, her glu was 180. 2 hours after meal was 189, 3 hours after meal was 111. Sleeping glucose levels are around 100, at rest daytime levels without food are between 96-117, but ANY carbs cause a spike. The spike is within 1 hour to hour and half after dinner and range from 187 to 252. And it sometimes takes 2 hours to settle back to 111-117.
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