After 17 hours fast, only mild ketosis

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Re: After 17 hours fast, only mild ketosis

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Tincup wrote: Tue Jun 28, 2022 7:24 pm
ShepR wrote: Tue Jun 28, 2022 4:57 pm
Something here is new info for me. "Low insulin is required to make ketones" - Her last (fasting) insulin from Quest was on 3/7/22, 4.3 uIU/mL. What are your thoughts? Good or Not Good?
4.3 uIU/mL is good. Fasting insulin is pulsatile (from a PhD friend who studies it). So can vary a bit. However 4.3 isn't 12, 15 or 20, which are not good. This is low enough, she should be making some ketones. So she genetically may not make them much OR she is using them fast. There is a relatively new breath acetone device I've not used that is supposed to be pretty reliable. Acetone is more of a real time measure while beta hydroxybutyrate is a storage form. I'd need to look up the info on the device. As people are adapted for longer periods of time, their bodies get better at using ketones, so measurements tend to be lower. I have a 10 year old model breath acetone device, but it also spikes on methane, which is a by product of all the high fiber foods I eat. This competitor is not supposed to do that.

Trying some organic caprylic acid, seeing if you can get her up to 1 tbl at a time might be useful. Dr. Mary Newport's husband had early onset AlzD (he was in his mid 50's) and she started using coconut oil & MCT and saw a good response from him (he was a 3/4). She later tried a ketone ester (very expensive) with excellent results. I haven't looked at her site in quite a while, but here is a link.
You can make the treadmill more intense with hand weights.

Hand weights. I will try this. The challenge is always trying to adapt any regimen to her gradient level, so that she will actually be willing to carry it out. I learned a LOT with the 25 day sauna regimen. I think I can add hand weights to her regimen without too much complaint. Needs to be some way to use the weights, w/o holding in her hands though as it may lead to off-balance and a fall. I will check out the link(s).
If you join the FB Heavy hands group & ask that as a question, there are some creative folks there who might have a good suggestion. I think there are wrist weights as well as weighted gloves that might fit the bill. Dr. Schwartz wasn't fond of the wrist weights, but for your application, it makes sense.
I'm very interested to know which Keto Breathalizer you have mentioned. The one I bought in 2020 is called "KetoScan, real-time fat burning monitor". (measures acetone). It was a very consistent device. And was consistent with each of us.

I will check out the FB Group. Ty

I will check out and research the Keytone Esters. We did implement MCT Oil is early 2020 and ran with it religiously for months and months. Discontinued because I could not see any improvement after months of use. We tried 2 brands: Essential Bliss - 1tb = 8g Caprylic Acid -C8, and 6g Caprylic Acid C10. The other brand was natural force organic MCT oil. C8-6500MG, C10-4500MG, C12-1300MG / per TB

Good to know 4.3 insulin is good. Can you explain why, to make ketones, needs low insulin?
also very interested to think she may be keto adapted. but if she was, we have not seen any dramatic improvement in memory, processing speed, or executive function. (You said: As people are adapted for longer periods of time, their bodies get better at using ketones, so measurements tend to be lower)

Cheers and thanks for the input.
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Re: After 17 hours fast, only mild ketosis

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NF52 wrote: Tue Jun 28, 2022 6:36 am
ShepR wrote: Tue Jun 28, 2022 1:30 am We started the Bredesen Protocol around July 2019. We have the support of a FM Doctor who happens also to be an MD.

My role has been to take the book, and other inputs and interpret where we are in the process while being the best caretaker I can. It's my wife who has the cognitive decline. She is 72, an RN who was in practice in a hospital PACU up until Nov 2017. She has tested with 23&Me, and her status is 3/4, and some positives for MTHFR, although I don't understand it that well.

We first noticed the problems when she could no longer balance the checkbook (late 2018). She now has word finding difficulties, and anything that has to be calculated in time, such as "do this AFTER doing this". And her processing speed is very slow....The first problem we encountered was that I could get into ketosis but she could not. Even with 17 hours without food, she would only get .1 on the keto-mojo blood strip. This goes back to 2020, and just tried again last week. Nothing has changed.

Or FM doctor had no idea why that could be. (All we got was "of course you can, you're a man!"). I have listened to so many lectures by functional medicine prefessionals, and as the story goes, "we look for the 'why' not the 'what'...", but I have become discouraged with that and I sometimes wonder if they really mean it.

At this stage, I am writing to this group for ideas. I think her brain is literally starving. She has had a very slow decline, so perhaps some of our interventions have kept her for declining faster, but I feel that there must be something we can do, starting with solving the mystery of - why no ketosis. ...
Hi ShepR,

As a 70 year old woman who knows first-hand and from family members' surgeries the importance of skilled nursing from post-anesthesia care units (PACU), I want to recognize the breadth and depth of love, supports and efforts you are providing your wife. I also want to say that I imagine her highly skilled brain is working overtime to martial all her resources to keep going. Outsiders often forget to realize the workarounds that intelligent people have made while their brains are under assault.

Others are the experts on ketosis here, so I'll let them offer advice on that. But my non-expert opinion is that you are right: her brain is not able to translate the food provided into ketosis and is taking valuable muscle and protein away from everywhere.

You may want to focus on supplementing with MCT (mean chain trigylcerides) along with some more high quality proteins, carbs and calories, without worrying about getting into ketosis). Here are excerpts from recent articles that may be helpful, with some parts highlighted by me. The first abstract quoted below is from a 2021 article of a study with mostly women in Quebec with a profile similar to your wife: It seems to suggest that statistically significant improvements occurred regardless of achieving changes in the metabolic profile or "ketosis": A ketogenic drink improves cognition in mild cognitive impairment: Results of a 6-month RCT
Methods: Cognition, plasma ketone response, and metabolic profile were assessed before and 6 months after supplementation with a ketogenic drink containing medium chain triglyceride (ketogenic medium chain triglyceride [kMCT]; 15 g twice/day; n = 39) or placebo (n = 44)...[The kMCT kMCT drink was a 12% emulsion of Captex 355 (60% C8, 40% C10; Abitec Corp, Columbus, Ohio, USA) in lactose-free skim milk.]
Results: Free and cued recall... verbal fluency...and the Trail-Making Test... improved significantly in the kMCT group compared to placebo Some cognitive outcomes also correlated positively with plasma ketones. Plasma metabolic profile and ketone response were unchanged.
Efficacy and Safety of Ketone Supplementation or Ketogenic Diets for Alzheimer's Disease: A Mini Review
suggests why focusing on. strict ketogenic diet (KD) may not work for women like your wife:
...weight loss due to fasting is likely to accelerate cognitive decline, whereas maintaining stable weight and nutritional status are mandatory for patients with AD (23). Despite sufficient calorie intake, extreme carbohydrate restriction due to KD can profoundly affect diet quality. Low-carbohydrate diets are often low in thiamin, folates, vitamin A, vitamin E, vitamin B6, calcium, magnesium, iron or vitamin K. KD are typically low in fiber (40)...KD or MCT supplementation may represent promising options to fight against the cognitive symptoms of AD, especially in the prodromal stage of the disease
I've personally found the following article's explanations and recommendations useful, and respect the expertise of the authors:
Precision Nutrition for Alzheimer’s Prevention in ApoE4 Carriers Tables 1 & 2, on peg 14-15 of the PDF in the attached link, provide specific dietary and supplementation ideas that you may want to discuss with your FMD.

As someone who worked with kids with traumatic brain injuries (TBI) and has been interested in what happens in the "prodromal" MCI and mild or early stages of AD, I think your wife's difficulty with "do this, then that" is a function of "working memory"--the ability to hold new information for about 30 seconds before we act on it. You may notice that she can actually hold information that long if she doesn't need to manipulate it ("can you put on your sweater?") but "take this letter and put it on the front table" is a 2-step direction. For parts of her day that do require multiple steps, it can be helpful to use a chart using visual cues: a picture of a toothbrush may come before a picture of her hairbrush, which comes before a picture of her favorite lipstick--at 70, lipstick is one of the beauty routines I haven't given up!)

Similarly, one way around word-finding is to suggest "tell me more about it, or tell me what category it is in", for example if she's trying to suggest a food to get at the store, or an article of clothing she wants. And of course, since it's frustrating for her, it's always helpful to say "sounds like that word is hiding; how about we talk about how we used to take the kids to the beach in summer." Accessing long-ago memories may allow her to use fewer specific nouns and more emotionally-happy words.

You are showing every day what love and commitment look like--never lose sight of that!
Dear NF52,

Thank you so much for your remarks. One thing you said in particular gave me great relief. It is so hard to describe to someone what is going on with my wife. She was a PACU nurse for 17 years. In her role, and in her character that led to that role, she was highly responsible, and precise with attention to detail. As her executive function took a hit, she applied (and still does) all that to trying to keep up. She works very hard, but nobody on the outside can see her working, or how hard she is working just to do things we take for granted. You nailed it, and put it in terms I can hear.

(You said: As a 70 year old woman who knows first-hand and from family members' surgeries the importance of skilled nursing from post-anesthesia care units (PACU)......, I also want to say that I imagine her highly skilled brain is working overtime to martial all her resources to keep going. Outsiders often forget to realize the workarounds that intelligent people have made while their brains are under assault)

I am so grateful to you for those words. I hope to show them to her sisters, who do not yet understand.

Your second analysis was also spot on. I have already discovered that she responds more quickly to visual ques. In that I have learned to make body gestures to her while speaking to her. Instead of saying "Please come into the living room", I say it while making a gesture with my hand. Swallowing her Liquid glutathione, before taking the Ultravitamin spoon, I make a swallowing gesture while asking her to swallow. Word-finding, I had to laugh when you said "Please tell me what category it is in"... hahaha. I do that all the time.

You said: it's always helpful to say "sounds like that word is hiding".
Good one! Thank you so much.

For my discussion of MCT oil, please see my replies to Tincup. I don't yet know enough about this platform and posting/replying to include it here in an elegant way. I apologize for my ineptitude with the platform. Eventually I will get it right, although it may be a while.
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Re: After 17 hours fast, only mild ketosis

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mike wrote: Tue Jun 28, 2022 10:40 am
ShepR wrote: Tue Jun 28, 2022 1:30 am The first problem we encountered was that I could get into ketosis but she could not. Even with 17 hours without food, she would only get .1 on the keto-mojo blood strip. This goes back to 2020, and just tried again last week. Nothing has changed.
Shep, it could be that your wife's brain/body is using the ketones as fast as they are created. Can you describe in more detail what her diet looks like? It is likely that she needs more calories to put back on some weight. If she is eating dairy, then adding whole cream to her diet might help. As also mentioned, MCT could also help.

In regards to exercise, movement of any kind is critical. Walking gets the blood flowing. Sure, you want to try to up the level over time, but just starting is important. Adding strength training is also good = my wife uses videos. You could do with her.
Mike, thanks for your question.

What her diet looks like.
She gets up around 8-9am, and I get up at 12:30pm. Around 1pm, she has a smoothie (greens, half cup blueberries, 1 cup goat milk, TB Manna, TB Almond Butter, handful walnuts, organic choco powder, 1 Truvia, 4 cubes ice, Calcium/Magnesium powder.,,, OR I make her 2 eggs, with 2 strips bacon, and salad. Salad includes 500/50 greens, yellow bell pepper, cucumber, onion, radish, feta cheese (made with sheep milk), grated carrot.

Then we have pretty big meal at dinner:

We always have (one) of the following: between 2-4oz, flank steak, pork loin, organic Neiman's farm hot dogs, Wild caught Cod, Tuna salad, Whole Foods Broiler chicken.

OR, we have homemade beef stew (about 8 oz), Thai Beef curry (About 4-6oz), Whole Foods Lentil Soup

AND, a green veg with the meat, such as Broccoli with carrots, Asparagus, Cauliflower, Salad (as above but larger)

Following dinner, I sometimes make a "Blueberry Sunday" - 1/4 cup frozen bluberries, nutmeg, truvia, heavy cream, and a little almond milk. On rare occasions she has 1 square 70% chocolate.

On birthdays, Christmas, and Thanksgiving, we indulge in 1 slice of cake.

Food sensitivities show only mild alert on Casein. So I try and stay away from milk products.

Regarding exercise. It is my highest concern right now. In 2019, she was going to the Health Club 2x a week and doing yoga class and working out on the weight machines. Then Lockdown came to Boston, and the club was ordered to close. They never re-opened. So all through 2020 and most of 2021 she attended yoga over zoom with instructor from same Health Club. Then about 6 months ago, she didn't want to do it anymore. (I think she is suffering from isolation, and the zoom yoga just didn't cut it. So I have decided to try and get her into a 1 on 1 coach situation for strength training. I interviewed one coach from a gym very close to us and he seemed sensitive, knowledgeable of my intent (said strength training should drive appetite). When I visited the gym, it was big and 30' ceilings, good parking, and everybody in the gym was under 30. I am 79 and wife is 72. Coach said he has a private area in back of gym, where he meets and works with his clients, we got the tour, and the area was enclosed with blackout curtains, partitioning it off, and it was dark inside. Machines looked like they were maid for giants.

About a year ago I took her to another gym, which would involve me driving there because she does not drive. Mostly men were there. Big open space which I liked very much, but she was used to an intimate space at the old Health Club. I am afraid she wants something equivalent to what she had, and sadly, it is not going to be available around here. The lockdown took so much from us.

I don't know if you can find/access my comments to Tincup, but I covered the MCT oil and our experience with it. Believe me, though, we did it and we did it well and we did it for months to no effect that I could see,

I apologize for my ineptitude on this platform. Thanks for taking an interest and for sharing. You mentioned that perhaps she has become keto-adapted. Would you please drill into that some more? If she has become keto-adapted, would that account for low breathalizer readings? And for Keto-Mojo readings too?
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Re: After 17 hours fast, only mild ketosis

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ShepR wrote: Tue Jun 28, 2022 4:57 pm Hand weights. I will try this. The challenge is always trying to adapt any regimen to her gradient level, so that she will actually be willing to carry it out. I learned a LOT with the 25 day sauna regimen. I think I can add hand weights to her regimen without too much complaint. Needs to be some way to use the weights, w/o holding in her hands though as it may lead to off-balance and a fall. I will check out the link(s).
Here is a search on weighted gloves.
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Re: After 17 hours fast, only mild ketosis

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ShepR wrote: Tue Jun 28, 2022 10:13 pm What her diet looks like.
She gets up around 8-9am, and I get up at 12:30pm. Around 1pm, she has a smoothie (greens, half cup blueberries, 1 cup goat milk, TB Manna, TB Almond Butter, handful walnuts, organic choco powder, 1 Truvia, 4 cubes ice, Calcium/Magnesium powder.,,, OR I make her 2 eggs, with 2 strips bacon, and salad. Salad includes 500/50 greens, yellow bell pepper, cucumber, onion, radish, feta cheese (made with sheep milk), grated carrot.

Then we have pretty big meal at dinner:

We always have (one) of the following: between 2-4oz, flank steak, pork loin, organic Neiman's farm hot dogs, Wild caught Cod, Tuna salad, Whole Foods Broiler chicken.

OR, we have homemade beef stew (about 8 oz), Thai Beef curry (About 4-6oz), Whole Foods Lentil Soup

AND, a green veg with the meat, such as Broccoli with carrots, Asparagus, Cauliflower, Salad (as above but larger)

Following dinner, I sometimes make a "Blueberry Sunday" - 1/4 cup frozen bluberries, nutmeg, truvia, heavy cream, and a little almond milk. On rare occasions she has 1 square 70% chocolate.

On birthdays, Christmas, and Thanksgiving, we indulge in 1 slice of cake.

Food sensitivities show only mild alert on Casein. So I try and stay away from milk products.
Shep,

Looking at this diet, I would suggest that you have too many carbs and not enough fat. Everyone needs to find their own ideal level of carbs, but generally, that causes insulin to go up and ketones to go down. Many here would also find your diet too heavy on animal proteins, but that is the way I am as well. Carbs hide in many foods you might think are good for you - going through your list, here are some to cut down on
Fruit (SMALL amounts of berries only - fructose in general is not good, but berries have good stuff too)
Nuts (small amounts okay, not peanuts)
Many salad items (carrots, bell peppers, tomatoes, yellow onions) have many more carbs than you would think. In general, stay away from underground vegies / tubers and vegies that are really fruits.
Lentils - dried beans in general are not good.
70% chocolate still has added sugar...

Now, you need to up your fat. Most folks here would say that salads are made to carry Olive Oil. You say that you stay away from milk products, but you use heavy cream... If you are okay with heavy cream, use more. fat is your friend.

Once your diet shifts from carbs to fat, you should start to see more ketones. Once you are where you want to be, then you can maybe adjust to more carbs, maybe not.
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Re: After 17 hours fast, only mild ketosis

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mike wrote: Wed Jun 29, 2022 12:01 pm
ShepR wrote: Tue Jun 28, 2022 10:13 pm What her diet looks like.
She gets up around 8-9am, and I get up at 12:30pm. Around 1pm, she has a smoothie (greens, half cup blueberries, 1 cup goat milk, TB Manna, TB Almond Butter, handful walnuts, organic choco powder, 1 Truvia, 4 cubes ice, Calcium/Magnesium powder.,,, OR I make her 2 eggs, with 2 strips bacon, and salad. Salad includes 500/50 greens, yellow bell pepper, cucumber, onion, radish, feta cheese (made with sheep milk), grated carrot.

Then we have pretty big meal at dinner:

We always have (one) of the following: between 2-4oz, flank steak, pork loin, organic Neiman's farm hot dogs, Wild caught Cod, Tuna salad, Whole Foods Broiler chicken.

OR, we have homemade beef stew (about 8 oz), Thai Beef curry (About 4-6oz), Whole Foods Lentil Soup

AND, a green veg with the meat, such as Broccoli with carrots, Asparagus, Cauliflower, Salad (as above but larger)

Following dinner, I sometimes make a "Blueberry Sunday" - 1/4 cup frozen bluberries, nutmeg, truvia, heavy cream, and a little almond milk. On rare occasions she has 1 square 70% chocolate.

On birthdays, Christmas, and Thanksgiving, we indulge in 1 slice of cake.

Food sensitivities show only mild alert on Casein. So I try and stay away from milk products.
Shep,

Looking at this diet, I would suggest that you have too many carbs and not enough fat. Everyone needs to find their own ideal level of carbs, but generally, that causes insulin to go up and ketones to go down. Many here would also find your diet too heavy on animal proteins, but that is the way I am as well. Carbs hide in many foods you might think are good for you - going through your list, here are some to cut down on
Fruit (SMALL amounts of berries only - fructose in general is not good, but berries have good stuff too)
Nuts (small amounts okay, not peanuts)
Many salad items (carrots, bell peppers, tomatoes, yellow onions) have many more carbs than you would think. In general, stay away from underground vegies / tubers and vegies that are really fruits.
Lentils - dried beans in general are not good.
70% chocolate still has added sugar...

Now, you need to up your fat. Most folks here would say that salads are made to carry Olive Oil. You say that you stay away from milk products, but you use heavy cream... If you are okay with heavy cream, use more. fat is your friend.

Once your diet shifts from carbs to fat, you should start to see more ketones. Once you are where you want to be, then you can maybe adjust to more carbs, maybe not.
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.
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Re: After 17 hours fast, only mild ketosis

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ShepR wrote: Wed Jun 29, 2022 2:44 pm 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.
Hi ShepR, I am going to join in on this conversation. it is great that your wife’s weight is stable now. 93lbs sounds dangerously low, especially combined with fainting episode. As you are considering how to get ketones up without losing weight, one of the things Dr Bredesen recommends regularly is for people to follow a low carb, high fat diet most days of the week , but cycle out of ketosis and into higher carbohydrate consumption for one or two days a week. it is interesting that even though you were tracking macros when she was full keto, she kept losing weight. We’re you also tracking to be sure she had enough calories each day and wasn’t running up a caloric deficit ?

I would guess, as Mike suggested in his post, that more fats would be necessary for your wife to get into ketosis. I’m one of those people whose huge salad is a delivery system for huge quantity of olive oil! To keep weight on while trying to be in ketosis a lot of time, you may need to both add more fats, and also have days where the diet is relaxed and more carbs are eaten.

When you say you didn’t notice a difference with the MCT oil, do you mean improved cognitive function? Or did you also not notice that the MCT oil raised ketone levels?
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Re: After 17 hours fast, only mild ketosis

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ShepR wrote: Tue Jun 28, 2022 9:02 pm I'm very interested to know which Keto Breathalizer you have mentioned. The one I bought in 2020 is called "KetoScan, real-time fat burning monitor". (measures acetone). It was a very consistent device. And was consistent with each of us.
It was the Biosense device. There is a thread on it here.

Curious what you observed with the KetoScan? Was your wife making acetone? The device seems solid, though, from their FAQ, the sensor may spike on ethanol and methane (from gut biome fermentation of veggies).
I will check out and research the Keytone Esters. We did implement MCT Oil is early 2020 and ran with it religiously for months and months. Discontinued because I could not see any improvement after months of use. We tried 2 brands: Essential Bliss - 1tb = 8g Caprylic Acid -C8, and 6g Caprylic Acid C10. The other brand was natural force organic MCT oil. C8-6500MG, C10-4500MG, C12-1300MG / per TB
Your wife may not respond to the MCT's. I could never see that my mother did when I tried this with her a decade ago. My 4/4 wife or I may not be responders either. I've run my BHB from 0 to 8 mmol/L (on an extended water fast) and see no difference in cognition, same with my wife. I have friends who say they need to be at 1 mmol/L or above to function well cognitively.
Good to know 4.3 insulin is good. Can you explain why, to make ketones, needs low insulin?
also very interested to think she may be keto adapted. but if she was, we have not seen any dramatic improvement in memory, processing speed, or executive function. (You said: As people are adapted for longer periods of time, their bodies get better at using ketones, so measurements tend to be lower)
Basically, when insulin is low, the body starts using fat for fuel. Ketones are material part of this. If insulin is high, the liver doesn't make ketones. When you fast for a number of days, unless you are very obese or metabolically compromised, insulin drops very low and ketones (and fat utilization) increase. Eating a lot of carbs, or protein for that matter, will commonly drop someone out of ketosis. Dr. Ben Bikman goes into this in a short snippet and in more detail here.
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Re: After 17 hours fast, only mild ketosis

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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.
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Re: After 17 hours fast, only mild ketosis

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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.
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