Low Carb Rant/Question

blukitten
blukitten Posts: 922 Member
Hello Fellow PCOSisters!

I am 33yr F, with PCOS and hypothyroid. I am on 1000mg metformin and /westhroid pure 48.5 mg. I went to see my primary care doc/nutritionist.

He has put me on an even lower carb diet than I already was on, I was doing 120b carbs daily - with no grains/sugars other than my daily popsicle after dinner - 18cb/17 sugar.
He now wants me on 30g carbs a day- my fear is ketoacidosis with being this low and being on metformin. I am not diabetic yet or insulin resistant yet but my A1C was elevated and my insuline was high when he did blood tests recently
Does anyone have experience with this? I know it will help me lose the weight but I was already losing the recommended 2lbs per week with the 120 carbs. Is the 30 abnormal?

The 30 carbs is carbs per day not from protein or veggies- they are extra carbs.

I trust my doc but this is a little hard for me - I can have no grains including quinoa, no fruit- except berries- then only 1/2 C a day, 5-9 C veggies a day, 20 oz of protein a day, no snacking, if I must snack- has to be pork rinds- which I love. My biggest struggle is with the no fruit.

Replies

  • Dragonwolf
    Dragonwolf Posts: 5,600 Member
    Ketoacidosis and ketosis are two completely different states. Ketoacidosis is a state in which both ketones and blood glucose are elevated. It really only happens in people not capable of producing insulin (because both are regulated by insulin). Since you've been on metformin for a while, and your insulin is still high, it's not really a concern.

    For more details, check out this awesome article by Dr. Peter Attia -- http://eatingacademy.com/nutrition/is-ketosis-dangerous

    That said, if 30g doesn't include vegetables, then you can easily get far more carbs than the required amount to be in ketosis. Additionally, from the looks of your diary, your protein is way too high in general, let alone to support ketosis.

    Low carb, low fat, high protein like that is a road to failure and potential problems. I highly recommend reducing your protein to around 100g and increasing your fat accordingly, even if you continue with about 120g of carbs. Excess protein like that gets converted to sugar to use as fuel, which defeats the purpose of low carb.

    More generally, yes, 30g is completely normal for a low carb diet. Some people go even lower than that, and we're not talking about "extra carbs," even, but total carbs, even those from veggies. It's a useful tool for getting insulin down, among other things. I highly recommend checking out the keto and low carb forums on here, as well as the keto and xxketo forums on Reddit. They have a number of very valuable tools and information that will help you.

    I'm of mixed thought about your doctor's recommendations, and would recommend getting a second opinion from someone more experienced with sustainable low carb diets (check out the Paleo Physicians Network or Primal Docs for someone near you that would have this sort of background).

    On the one hand, I understand the idea that if your sugar and insulin are still running high to reduce your carbs, but on the other hand, if you're losing weight at 2lb/week, it seems like it'd make sense to see if the weight loss will fix the insulin resistance itself, and maybe tweak the diet a little.

    As for the fruit -- fruit is basically nature's candy. It's got great nutrients, but at the cost of a lot of sugar, and while it may be fructose, which doesn't raise blood sugar as much, that fructose gets sent to the liver to create fat. As a result, it can contribute to elevated triglycerides. You can get all of the same nutrients from meats and non-starchy vegetables, without all the sugar.

    Here's my suggestion, from looking at your diary:

    Set your carb goal to 120g and sugar goal to 30g. Try not to go over this from all carb sources (in other words, none of this "extra carbs" nonsense). Green leafy vegetables and other non-starchy veggies are your friends, though this amount gives you room for some starches, too, if you want them (though I wouldn't recommend it unless you're really active or you have thyroid issues).

    Set your protein goal to 100g. Try to get about it on average. It's okay if you're a little over or under, but don't try to go way over or way under. You need enough to retain lean mass, without getting so much that it's used for fuel and turned to sugar.

    Fill the rest with fat. Yes, it's going to be high. No, this is not a bad thing. Also, ignore MFP's saturated fat number. Get your fats primarily from saturated or monounsaturated sources -- fat on meat, butter, olive oil, avocados/avocado oil, coconut oil, etc. Favor Omega-3 fats over Omega-6 -- favor flax, fish, and eggs over nuts and seeds. Yes, that's right, saturated fats are your friend (coconut oil has actually been shown to improve blood glucose control).

    One of the things that I noticed in your diary is that you were rarely even below 150g of total carbs, and at least one time, you hit 300g. That's a ton, in my opinion (to compare, I average about 75g a day).

    Try this way for an interval (at least a month, but work with your doctor if you want and do it for the interval between checkups) and see where you're at.

    Also, I highly recommend checking out Paleo sites and cookbooks. They'll be grain-free by default, and more likely to fit within your macro budget as they're generally lower carb and low sugar (save the desserts, which will be a little higher, but still probably not as high as their non-Paleo counterparts).

    Here are a few to get you started:
    http://www.marksdailyapple.com/
    http://nomnompaleo.com/
    http://everydaypaleo.com/
    http://againstallgrain.com/
  • KnitOrMiss
    KnitOrMiss Posts: 10,103 Member
    Dragonwolf - not to hijack a thread, but a particular comment you made above caught my attention.

    You said, "Set your carb goal to 120g and sugar goal to 30g. Try not to go over this from all carb sources (in other words, none of this "extra carbs" nonsense). Green leafy vegetables and other non-starchy veggies are your friends, though this amount gives you room for some starches, too, if you want them (though I wouldn't recommend it unless you're really active or you have thyroid issues)."

    I wish I were more knowledgeable in all this, but I'm not yet. What affect do thyroid issues have on needing some starches, etc? I have hypothyroidism, which is controlled with medications that have brought my numbers into the normal range, but has had ZERO effect on my symptoms.

    I was looking at an iodine supplement Iodoral I think is what she recommended, because of ridiculous salt cravings that when I literally lick a bouillon cube, I perk up better than with a shot of caffeine, all of which are reported to be addressed with iodine supplements.

    I look forward to hearing any research or first-hand knowledge you have of the subject. Just a side note, I've noticed if I don't get some carbs in non veggie form, I have more of the bathroom side effects of the Metformin, but that could also be a complication of my not having a gallbladder...

    Thanks in advance, Carly
  • blukitten
    blukitten Posts: 922 Member
    Thank you for your response! I think I will try what you suggest Dragonwolf!
  • Dragonwolf
    Dragonwolf Posts: 5,600 Member
    edited October 2014
    KnitOrMiss wrote: »
    Dragonwolf - not to hijack a thread, but a particular comment you made above caught my attention.

    You said, "Set your carb goal to 120g and sugar goal to 30g. Try not to go over this from all carb sources (in other words, none of this "extra carbs" nonsense). Green leafy vegetables and other non-starchy veggies are your friends, though this amount gives you room for some starches, too, if you want them (though I wouldn't recommend it unless you're really active or you have thyroid issues)."

    I wish I were more knowledgeable in all this, but I'm not yet. What affect do thyroid issues have on needing some starches, etc? I have hypothyroidism, which is controlled with medications that have brought my numbers into the normal range, but has had ZERO effect on my symptoms.

    I was looking at an iodine supplement Iodoral I think is what she recommended, because of ridiculous salt cravings that when I literally lick a bouillon cube, I perk up better than with a shot of caffeine, all of which are reported to be addressed with iodine supplements.

    I look forward to hearing any research or first-hand knowledge you have of the subject. Just a side note, I've noticed if I don't get some carbs in non veggie form, I have more of the bathroom side effects of the Metformin, but that could also be a complication of my not having a gallbladder...

    Thanks in advance, Carly

    I don't have personal experience with hypothyroidism, but I know several people who do, and they usually state that they do better with some starches. It generally doesn't have to be much from what I've seen -- half a cup of rice a day or 1/2 to 1 sweet potato, for example, is generally sufficient. TSH is also increased by carbohydrate intake (for better or worse, since that's an adrenal hormone, not a thyroid one). Your mileage may vary, of course (some people with thyroid trouble have found relief with low carb, without starches, too), but it is something to consider.

    I generally defer research stuff on thyroid issues to http://www.stopthethyroidmadness.com/ , since it seems to be a good resource. It's got a lot of research and first hand accounts.

    Here's a blog post from someone with Hashi's on losing weight with low carb, which might be of more use - http://www.stopthethyroidmadness.com/hypothyroid-and-weight-issues/

    Also, Mark Sisson has a good piece (with references to a number of other pieces and research) on thyroid dysfunction in general that's worth a read -- http://www.marksdailyapple.com/hypothyroid/