Low Carb Doctors

There is now less than one week to go until ‘Low Carb International All Stars’ an online conference featuring an amazing line up of speakers.

Streamed across 3 times zones over 24 hours, there will be 3 separate live Q+A sessions, one for each time zone.

Streaming begins on Saturday 20th June.

Buy Tickets (USD) for Low Carb International All Stars - Online Conference at You Tube stream, Sat 20 June 2020 Buy tickets for Low Carb International All Stars - Online Conference at You Tube stream, Sat 20 June 2020 - Join an 'All Star' cast for this worldwide online Low Carb Conference. Presenters include Professor Timothy Noakes, Professor Robert Lustig, Dr David Unwin, Ivor Cummins, Professor Ben Bikman,...

Here is the latest video from Dr Paul Mason, a great summary of the science behind low carb eating:

Dr. Paul Mason - 'Evidence based keto: How to lose weight and reverse diabetes' Dr Paul Mason obtained his medical degree with honours from the University of Sydney, and also holds degrees in Physiotherapy and Occupational Health. He is ...

I have had a few questions about ketone levels and exercise.
Some people find that their workouts are not as good a few days into the fast. This makes sense as you have depleted your liver glycogen and are producing ketones for energy. Your muscles should still have a decent store of glycogen to use. Moderate intensity exercise is probably easier to cope with than trying to lift heavy weights at this stage. If you were fat adapted before the fast this may not apply to you.

Don't try to chase high ketone levels (if you are testing). At this stage you will be burning your ketones for fuel so your levels may not be high as you might be using them up. Some people do go quite high though.

Your insulin levels will be very low and your blood sugar level should have plateaued at a nice low level (Mine are running at about 3.1 on my continuous glucose monitor).

Keep up your salts and fluids and no heroics. If you are not feeling well end the fast. If you're feeling good we would love to have you keep going with us.

Thank you for the messages from those who have ended their fast - well done for a great achievement. Without being sexist it seems that the girls have had a tougher time than the boys overall. There are multiple reasons for this of course and everyone should be proud of what they have achieved and hopefully it will make the next time easier.

For those of you still with us the worst is almost certainly over.
Interestingly this time was actually much easier than September with only minor hunger pangs which settled quickly with cold water. The 2nd day was by far the hardest last time.
After some mild exercise tonight my blood sugar went from 3.7 (where it had been pretty much all day) to 4.7. My ketones are running at 1.3. Will be interesting to see what happens in the morning.
Overall feeling strong and looking forward to a good nights sleep.
Feel free to share your experiences and numbers if you are testing too.

So by now your insulin levels should be dropping nicely.

This is a good thing and one of the goals of the fast. As the insulin drops the kidneys excrete (wee out) more sodium. Be careful not to get into the cycle of just drinking more water because you are thirsty because if you just pass this water as well it will continue to deplete your sodium levels. You might start to feel dizzy or lightheaded and possibly have postural blood pressure issues (one possible measure of this is your pulse rate not going back to normal within 30 seconds of going from a lying to a standing position). Headaches, dry eyes and muscle cramps are common too.

The solution is to take in salt with the water. Aim for 2.5-3 teaspoons per 24hr period. You can get salt from bone broth/bullion etc as well.For most people more salt is not a problem but too little can be.

My dinner time hunger pangs went with a glass of cold water. I'm going to try for an early night tonight, hope you all get a good sleep.

For those of you joining us in the fast I hope you are feeling well. I would not normally have eaten yet today so for me things are as per my usual day. Lunch time is approaching so I have just had a full glass of ice cold water to help avoid any hunger pangs I might be feeling. I am keeping busy and have arranged to work through lunch time today (actually this happens most days anyway) . Also writing this post... At this stage salt and electrolyte abnormalities should not be an issue but will become so later. I will be making sure I get through my 2-3 teaspoons of rock salt and enough water to not be thirsty. This helps avoid any symptoms of dehydration like dizziness, dry eyes, feeling light headed etc. Remember don't fast if you're feeling unwell and one other condition to be aware of is gout which can be flared by fasting in some circumstances.

Hunger: Most of us tend to feel hungry about 4 to 6 hours after a meal (some people are adapted to one or two meals a day of course) - does that mean we will feel 4 times more hungry if we fast? Of course not. Remember that hunger starts in your mind! It is not a reflection of the amount of food in your stomach. The smell of your favourite food may make you feel hungry even if it is not long since your last meal. Also despite not having eaten for 12 hours many people are not that hungry at breakfast time. When you are hungry you can overcome the feeling of hunger by distracting yourself. This can be tough if you're preparing a meal for the kids of course. Maybe put a note on the fridge reminding yourself why you're doing this. Now you definitely will feel hungry when you're fasting but the hunger tends to come in waves. If you can ride out the hunger pangs they do go away. This also helps you learn when you're truly hungry and when you are just eating out of habit. Often drinking an ice cold glass of water helps the hunger pangs pass and those drinking coffee will also find that this helps. The same applies to drinking bone broth despite the lack of calories in any of these drinks. The first 2 days of the fast are usually the most difficult. Day 1 is usually OK because it's new and different but day 2 can be tough - stay strong, once you get past dinner time on day 2 things get easier (that was the group's experience last time) and then stay pretty steady from then on. The people that went beyond 3 days said there was little difference on day 4 or 5 to day 3 with regards to hunger. Sometimes just acknowledging that you're hungry is enough to help you move on, that's the great thing about doing this is in a group - use the rest of the group for moral support, but also only go as far as you are prepared to, it's not a contest, it's a personal journey.

Hi All, those of you joining us on the fast I hope you are having plenty of fat with your dinner. Ideally moderate protein as well. Stay away from the carbs and fructose for the next couple of days if you can as they make you hungry. Don’t forget your magnesium and salt. Try to get a good nights sleep. Let me know if there are any questions, I’ll do my best to answer them. I’ll send a little test through which you can repeat each day to test your thinking ability. For those testing ketones, 8pm is ideal and if you don’t mind sore fingers then when you wake up too. I’m excited to be starting Sunday night.

Getting ready for next week:
If you are planning to reduce or cut out your coffee then starting to cut back now will help.

Autophagy: this is still a somewhat poorly understood area but protein may inhibit this. Bone broth containing protein will make the fast easier but may also delay or inhibit autophagy. It breaks the boredom from a water only fast but may interfere with some of the health benefits.

Salt: make sure you have plenty available and some magnesium supplements (tablet or bath salts).

Starting to reduce your carbs if you aren’t already low carb will help reduce cravings and make fasting easier.

Hi All,
Following our very successful 3 day fast in September we are planning to do another one in the first week of December. Some people will be aiming to get to 5 days and others will drop out at 1 or two days. The idea is to challenge yourself and not to compete with others.

We are including you not as your doctors but as fellow travellers on our journey.

The rules:
1) There are no rules. You do as much or as little as you are comfortable with. This is not a competition, it is a personal journey to push your own boundaries as far as you are comfortable.
2) If you have any of the following conditions it is probably best to be checked out by your doctor before embarking on a journey like this:
a. Diabetes needing medication
b. If you have an eating disorder
c. Those taking medication that requires food intake.
d. Individuals going through growth such as children and adolescents.
e. Individuals who are pregnant or breastfeeding.
Consider delaying the fast if you have a cold or flu.

Timing
Our fast will start officially at 8pm Sunday December 1 and conclude at 8pm Friday December 6th. Feel free to adjust this time for yourself if you have social commitments that require you to alter it.

The beginning
In general the easiest way to enter a fast is if you are in a state of nutritional ketosis and are not too carbohydrate dependant. Of course anybody can fast in any state but ketones make the hunger easier to deal with and you will already be used to eating less frequently.
Don’t have a high carb meal as your last meal and also don’t overeat because you will feel hungry if you have distended your stomach and then it starts to shrink.

Fluids
If you are a coffee drinker and caffeine dependant then you will need to think carefully about if you are going to drink coffee. Coffee is an appetite suppressant so will help you fast but I am not drinking coffee as I am looking for maximum health benefit from the fast. If you do have coffee it must be black with no sweeteners of any kind.

We do not suggest drinking a set amount of water. Let your thirst guide you as to when you should be drinking. Drinking can also help the hunger pangs pass. If your urine starts to look dark or very concentrated you are probably not drinking enough. A rough guide would be 2-2.5 litres a day for an 80kg person but if you are drinking more or less than this and are not dizzy, lightheaded or going to the toilet too frequently then don't worry about keeping a close measure on this number.

The best drinks are bone broth/bullion/salty water. This provides some variety from just water but no calories. Another option is water with a thin slice of lemon in to add taste and suppress appetite but I will not be doing this.
Most herbal teas are fine but be careful because some (like Green Tea) have caffeine or other stimulants in them. If in doubt then best to avoid them.

What is important is to maintain your salt levels. Try to make sure you have consumed the equivalent of 3 teaspoons of salt in each 24 hour period. This will help you keep the water you are drinking in your body. As your insulin drops (which it will do on the fast) you will tend to lose more sodium in your urine so salt becomes more important as the fast extends. If the weather is hot or you are exercising then you may need more salt and water.

Magnesium can be taken orally or through your skin in a nice warm bath soaking them in over 20 minutes.

I suggest avoiding sparkling water (it can cause reflux).

No commercial electrolyte drinks/supplements allowed.

Exercise and work

I will be maintaining my usual work and exercise regime during the fasting period. It is up to you to decide if you are going to do so as well. Do not try to increase your usual weights programme during this time. Moderate aerobic exercise and your usual resistance training should be fine. Remember to increase your salt and fluid intake if you are sweating.

Ending the fast
Remember that your stomach has shrunk during the fast. Reintroduce food slowly and try to avoid foods which will spike your blood sugar levels (low carb meal) and then give you a nasty crash afterwards. This also avoids stomach pains from stretching your stomach too fast.

I suggest eating slowly over an hour or so and stopping well before you feel full.


Group support.

I will be monitoring this group closely so you can post questions or just provide moral support to the others joining us on the journey.

There is no shame stopping earlier than the 3 (or 5) days and for some people this may be the first time you have skipped a meal rather than just not eating for 3 days. You may also choose to do a ‘fasting mimicking diet’ where you massively restrict your calories for the 3 days and eat 1 meal a day rather than doing what we are doing which is essentially a 3-5 day water only fast. Do what you are comfortable with.

Blood Tests
Since we are starting on a Sunday night we are not tracking our blood tests this time. This is more about the mental journey than the physical effects. Once we have learned from this experience there are a series of blood markers we will probably track next time.

What to do with your extra time
One of the major advantages of not eating is that you will have at least an extra 90 minutes in your day. This can be used to exercise, do more work or perhaps even spending some time on personal reflection if you so desire. It can also be used for sleep if you are chronically sleep deprived like some of us tend to be.

Hunger
My advice is not to try to distract yourself from the hunger too much. It is good to experience what true hunger is to help understand when we are eating out of habit and when we are eating because we are truly hungry. I have found this very useful when doing 24 hours fasts in the past and it has helped me get rid of my ‘habit eating’.

Optional Extras
There are some totally optional extras which I will be sending more details about. These include use of a heart rate monitor and also some cognitive testing to see how your brain is functioning as time goes by. These are interesting but by no means necessary.

Conclusion
This is designed to be a positive experience. Healthy humans can fast easily for 30 days without any serious consequences (not that I’m recommending a 30 day fast) so a limited 3-5 day fast should not have any negative consequences. If you have lots of body fat then several months of fasting tends to be ok. It is not long enough a fast to create protein catabolism and so should not have any affect on your muscle mass. There may well be benefits in terms of autophagy or the body’s ability to heal and regenerate.

Remember to do only what you are comfortable with (although the fast is designed to take you out of your comfort zone). There are no prizes except personal satisfaction and hopefully some improvements in your health and a better understanding of your body and eating habits.

This is the fourth and last
https://youtu.be/DBkAE_fnKhs installment of a lecture delivered by Dr Paul Mason at the Low Carb for Doctors Medical Conference held in Melbourne (Epworth Hospital, May 2018).
Dr Mason reviews optimal CRP levels and how ketogenic diets often change biochemistry values, including uric acid, chloride and bicarbonate.

Interpreting blood tests part 4 - what is an ideal CRP and does my increased uric acid matter? This is the fourth installment of a lecture delivered by Dr Paul Mason at the Low Carb for Doctors Medical Conference held in Melbourne (Epworth Hospital, Ma...