Managing Potassium and Sodium On a Ketogenic Diet

A well-formulated ketogenic diet (WFKD) requires real food choices and preparation to maintain an optimum potassium intake.

Blog - Sept. 20 picture.

The sodium and potassium management by the kidneys and the changes in sodium handling during nutritional ketosis is makes this especially important.

Potassium and Mortality in the Balance

Potassium is the positively charged ion (aka electrolyte) that is predominate in the fluid inside all of the body’s cells, while sodium plays a matching role in the fluid surrounding our cells – including blood plasma. Keeping the two of them in balance is involves multiple hormones and organs, particularly the kidneys.

In order for nerves and muscles to function, the concentrations of positively charged potassium (K+) and sodium (Na+) have to be essentially equal across the cell membranes. If either this balance, or the in-and-out flow of these two electrolytes is impaired, nerves and muscles don’t work properly, endangering health and even life itself.

Because part of sodium’s role in the plasma is to maintain adequate circulation, it has been well characterized as necessary for normal blood flow. And in the case of high blood pressure, it is tempting to conclude that one just needs to restrict sodium intake to get it to come back down. While there is some truth to this (for people with salt-sensitive hypertension), for most people with high blood pressure, it involves the appropriate balance between these two electrolytes rather than a focus on the intake of sodium in isolation.

Recently, large studies have measured the actual amounts of sodium in a person’s urine. The most definitive results to date are from the massive international PURE study reported by O’Donnell et al. In this study, they collected urine from 102,000 people in 17 countries and then monitored health and mortality for 4 years. The lowest mortality was seen in people consuming 5 grams per day, which is about twice the current US recommended guideline for healthy adults. For sodium intakes substantially above or below this value, the associated mortality rates rise, generating a U-shaped curve.

See The Estimated Sodium Excretion chart below. *

Blog - Sept 20 chart 1

But the urinary potassium data from the PURE Study (See The Roles of Vegetables and Broth in Reducing Risk of Death chart below) tell a very different story. While low levels of potassium excretion are clearly associated with increased mortality risk, increasing levels in the urine up to 3-4 grams per day correlate with reduced risk. And in particular, the associated mortality at 1 gram per day is about double that seen at 3 grams per day. For this reason, we recommend incorporating real foods into a WFKD providing 3-4 grams per day of potassium.

See the Roles Of Vegetables And Broth In Reducing Risk Of Death chart below **

Blog - Sept 20 chart 2

The Relationship Between Sodium and Potassium Intakes and Urinary Excretion

Almost all of the sodium we eat gets absorbed, and then about 90% of that comes out in our urine. Therefore, urinary sodium is an accurate reflection of our dietary intake.

However, this relationship between dietary intake and urinary output is not quite as good for potassium. In most people, about 75% of dietary potassium is excreted in the urine. Thus, in the studies linking urinary potassium excretion to health a correction factor of about 1.3 should be applied. This means that in order to have 2 grams of potassium come out in the urine, one would need to consume 2.6 grams in the diet, and similarly to have 3 grams in the urine would require about 4 grams of dietary intake.

Practical Health Implications of Dietary Potassium

An important point to note here is that processing of meat to create luncheon meat, hot dogs, or bacon removes much of the potassium originally associated with that protein source and therefore should be restricted. In addition, if unprocessed protein sources are boiled or stewed, some of the potassium they contain comes out in the broth. Thus they should be prepared and served such that the broth or sauce is consumed to get the full benefit of their electrolytes and minerals.

Official Dietary Potassium Guidelines

The great majority of the population eats far less than the current estimated Adequate Intake value of 4.7 grams.

The reason it is only an estimate is because when dietary sodium is restricted, the kidneys tend to excrete more potassium to maintain the balance. This process is regulated by a series of hormones, with the main one being the stress hormone aldosterone. On average a sodium-restricted diet given to people with normal blood pressure increases this stress hormone more than 3-fold.

Getting Enough Potassium with a WFKD

From what we currently know about potassium needs for someone getting adequate sodium on a WFKD, 3 to 4 grams per day, appears to be an appropriate target to provide the necessary amount of potassium for health-related benefits.

This is an amount that is achievable with real foods.To begin, the right choices of protein that are prepared correctly will provide the first gram. On average, non-starchy vegetables that are consumed raw, sautéed or steamed contain about 200 mg per standard serving, so 4-5 servings of vegetables per day will provide the second gram. Nuts and seeds vary in their potassium content but range from 100-300 mg per ounce (oz), so 2 oz per day moves the scale closer to the 3 g per day optimum target.

Broth

The amount of potassium in home-made broth will vary depending upon how much meat remains on the bones used to prepare the broth. Typically, a pound of chicken carcass or meaty beef bones used to make a quart of broth will contain 200-300 mg of potassium per cup.

Technical Information on the Regulation of Electrolyte Balance

It is known that both total fasting and a ketogenic diet lead to an accelerated sodium excretion that increases water and salt loss through the urine. If this lost sodium is not replaced, the kidneys will reabsorb sodium. This process comes at the price of increased potassium excretion.

With consistent loss of potassium and/or chronically low intake of potassium the body will attempt to correct via the release of intracellular potassium from skeletal muscle.

It is clear that maintaining sufficient sodium and potassium intakes from the diet serves a number of important functions: potential mitigation of risk for cardiac events, preservation of plasma volume and muscle mass, and prevention or reduction of symptoms of the ‘keto- flu’.

The fail-safe endocrine system responsible for the tight regulation of electrolytes is commonly referred to as the renin-angiotensin-aldosterone system (RAAS). When plasma sodium levels are low (an intake of less than 3 grams per day), when blood potassium levels are significantly elevated (hyperkalemia), or when there is a notable reduction in blood pressure, RAAS is activated.

The cost for frequent RAAS activation is increased oxidative stress, increased vascular damage, measurable dyslipidemia * and potential sleep and mood disturbances.

Dyslipidemia * is elevation of plasma cholesterol, triglycerides (TGs), or both, or a low HDL cholesterol level that contributes to the development of atherosclerosis. Sourcehttps://www.merckmanuals.com/en-ca/professional/endocrine-and-metabolic-disorders/lipid-disorders/dyslipidemia

This compensatory activity of RAAS as well as increased sympathetic nervous system activity that together work to maintain electrolyte levels helps explain why we typically do not see a large decrease in blood pressure when sodium is restricted in most patients. In those who do not have salt-sensitive hypertension, these systems appear to adjust to dietary intake and manipulate sodium, potassium and fluid levels in order to maintain a person’s blood pressure.

The important role of potassium in muscle function and sodium in maintaining plasma volume are added considerations for individuals who exercise or engage in activity that results in a large volume of sweat loss. Due to the loss of Na+ and K+ in sweat, these circumstances may require additional electrolyte replacement in order to maintain performance, especially for those following a ketogenic way of eating. A good rule of thumb is about ½ tsp of salt 30 minutes prior to exercise and if exercise is performed at a relatively-high intensity in a hot environment, an additional ½ tsp of salt each hour may be warranted.

 For better health and well-being on a WFKD consume the recommended amounts of the electrolytes, sodium 3-5 g and potassium 3-4 g per day, will help support overall health as well as the success and sustainability of nutritional ketosis.

Talk to your doctor about your sodium and potassium needs, if you are taking a diuretic medication (aka, a water pill), if you have high blood pressure, if you have any impairment in kidney function, or if you have limited heart function (such as congestive heart failure).

This Post has been condensed fromThe Importance of Managing Potassium and Sodium as Part of a Ketogenic Diet by Stephen Phinney, MD, PhD, Jeff Volek, PhD, RD. Please see the original post for the scientific citations.

https://blog.virtahealth.com/potassium-sodium-ketogenic-diet/

I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

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May you Live Long Healthy.

Yours truly,

Lydia Polstra

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

Low Carb Grocery Shopping Guide with GAPS Recommendations.

Low Carb Grocery Shopping Guide with GAPS Recommendations

Blog - shopping.png

To succeed on your diet you need to start with a list of acceptable foods. See the tips and grocery list for a low carb or ketogenic lifestyle. For people (like me) who are following the Full GAPS diet as well, foods that are not permitted have been deleted or have a GAPS notation.

Grocery Shopping Tips

  1. Establish a routine — and stick to it

Stock up on essentials to avoid trips to the store.

Ensure your weekly shopping is always done by blocking out time that works best in you.

  1. Always shop with a grocery list

Plan meals and snacks for the week (or more) before shopping to make sure you buy everything you need.

Stick to your list so you will avoid temptations.

  1. Avoid shopping on an empty stomach

If you shop hungry, you may be tempted and suffer the consequences of a lapse.

  1. Focus on the perimeter of the store

The perimeter has non-starchy vegetables, berries, eggs, dairy, meat, fish and poultry.

Skip the inner aisles with processed carbs like chips and cookies.

Fresh fruit and vegetables is preferred but the next best frozen.

Shop inner aisle only for the diet-friendly condiments and oils, etc.

  1. Think twice about specialty “low carb” and “sugar-free” products

While a ketogenic lifestyle might include occasional low carb specialty products, the majority of your grocery bounty should be minimally processed, whole, nourishing foods.

When in doubt, read the nutrition label and ingredients list to make sure a product won’t derail your progress toward your health goals.

  1. Take advantage of online shopping

No time. Most chain grocery stores offer curbside pickup or home delivery services.

Use a saved or “Favorite” list on their shopping platform ahead of time to make ordering easier.

Key Items to Add to Your Grocery List

Produce

Asparagus

Avocado

Berries (strawberry, raspberry, blueberry, blackberry)

Beans (green, yellow, wax)

Bok choy

Broccoli

Brussels sprouts

Cabbage

Cauliflower

Celery

Cucumber

Eggplant

Garlic

Green beans

Greens, collard

Greens, spinach

Kale

Lemons

Limes

Lettuce (Romaine, arugula, spring mix, iceberg, endive, escarole)

Mushrooms

Onions

Peppers (green, red, orange/yellow)

Snow peas

Spaghetti squash

Tomatoes

Zucchini/summer squash

Meat, Fish and Poultry – Free Range if possible

Bacon*

Beef steaks

Deli meat (cured meats, e.g., salami and prosciutto) * GAPS: Look for a source that makes it from free-range meats and chemical free.

Canned tuna, salmon –  Try Vital Choice for mercury-free https://www.vitalchoice.com/#smile-home

Chicken (opt for skin on)

Fish

Ground beef (opt for 12% fat or greater)

Lamb

Pancetta

Pork steaks and chops

Sausage

Shrimp and shellfish

Turkey

Wild game (e.g, bison, deer, elk)

* Always scan the nutrition label, these often contain starchy fillers and/or added sugars.

Dairy Section

GAPS has recommendations for dairy to support intestinal health:

Asiago cheese Yes      May be used occasionally.

Blue cheese      Yes      May be used occasionally.

Brick cheese    Yes      May be used freely.

Brie cheese      Yes      May be used occasionally.

Camembert cheese      Yes      May be used occasionally.

Cheddar cheese, mild, medium, Yes Use freely

Cheddar cheese, sharp            Yes      May be used occasionally.

Colby cheese    Yes      May be used freely.

Cottage cheese, uncreamed (dry curd)           Yes      May be used freely.

Cream cheese  No

Edam cheese   Yes      May be used occasionally.

Eggs – Yes      Free-range.

Gorgonzola cheese      Yes      May be used occasionally.

Gouda cheese  Yes      May be used occasionally

Gruyere cheese            Yes      May be used freely.

Half and half – No

Havarti cheese            Yes      May be used freely.

Heavy cream – No

Limburger Cheese       Yes      May be used occasionally.

Manchego cheese        Yes

Monterey Jack cheeseYes      May be used occasionally.

Muenster cheese         Yes      May be used occasionally.

Natural cheeses          Yes

Parmesan cheese        Yes      May be used occasionally. Grate it, check to endure no added milk solids. You make your own crisps.

Port du Salut cheese   Yes      May be used occasionally.     

Provolone cheese        Yes      Although not listed with the other cheeses on page 140 of Breaking the Vicious Cycle, provolone cheese is legal.

Romano cheese           Yes      May be used occasionally.

Roquefort cheese        Yes      May be used occasionally.

Sour cream – No

Stilton cheese  Yes      May be used occasionally

Swiss cheese   Yes      May be used freely.

Yogurt – No, Make you own if possible. See the GAPS book for the recipe.

 Nuts And Seeds

Almonds

All natural peanut and almond butter*

Macadamia nuts

Peanuts*

Pecans

Pistachios

Sunflower seeds

Pumpkin seeds

Walnuts

*Look for ‘natural’ nut butters with no added sugar and avoid those containing hydrogenated or partially hydrogenated oils. Peanuts have a higher carb content than some other nut options, so proceed with caution when it comes to portion sizes.

Oils/Cooking Fats, Salad Dressings and Mayonnaise

* Avoid added sugar and additives by making your own salad dressings from oils with higher saturated and monounsaturated fat contents, such as olive, or avocado oil.

Oils:

Avocado oil

Beef tallow

Butter

Canola oil – GAPS, not recommended.

Coconut oil

Ghee

Lard

Olive oil, extra virgin

Palm oil

Safflower oil, high oleic

Miscellaneous Extras:

Almond flour

Almond milk (unsweetened)

Bouillon cubes – GAPS, not recommended.

Coconut flour

Coconut milk

Condiments: Ketchup, BBQ sauce, etc. (check the labels for sugar and chemicals)

Pork rinds

Sugar-free gelatin

Xanthan gum

Source:

  1. Low Carb Grocery Shopping Guide (Grocery List Print Out is in the website)

Anna Barnwell, MPH, MSW  Anna Barnwell, MPH, MSW on August 6, 2018

https://blog.virtahealth.com/low-carb-keto-grocery-shopping/

  1. Breaking the Vicious Cycle™ Legal­‐Illegal List (for GAPS and SCD) http://media.btvc.webfactional.com/media/editor_uploads/2013/11/btvc_legalillegal_list.pdf

I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise. 

I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader

Keto-Adaptation – Some Clues to Its Complexity

Human metabolism has evolved to be remarkably flexible in its ability to use a variety of dietary energy substrates. From a cultural history perspective, humans have demonstrated the ability to subsist for generations on up to 80% of dietary energy as carbohydrates at one end of the macronutrient spectrum to over 80% as fat (a ketogenic diet) at the other end. Given this wide range of dietary options, what is the optimum nutrient mix? Is one end of this spectrum better than the other? Or is it best to be somewhere in the middle? How long does human metabolism take to optimize its use of the dominant fuel provided? We know that a lot of disease symptoms and health indicators get much better soon after someone starts on a ketogenic diet.

Most people, including most nutrition scientists, appear to believe that the effects of a high fat diet can be determined after only a week or two. Thus most diet studies, particularly those assessing effects on physical performance, have typically been run for two weeks or less. And this is still the case, even though we published data over 3 decades ago showing that the process of adapting to a very low carbohydrate intake requires at least a month and likely quite a bit longer. How much longer? It depends upon what measure of adaptation one is following, and it is very likely that inter-individual variability is a factor as well.

While a ketogenic diet can put you into a state of nutritional ketosis in a matter of days, it can take weeks to months to become fully keto adapted.

How Long Does it Take to Optimize Ketone Metabolism?     Some assume that keto-adaptation occurs simultaneously with the build-up in the level of ‘ketones’ (beta-hydroxybutyrate) in the blood. This hypothesis is based on the assumption that all of the benefits of ketones are directly linked to the amount available in the circulation. But here’s the catch – in our controlled inpatient studies, blood levels of BOHB come up to a new steady state within a week of starting a ketogenic diet but one’s subjective and objective ability to do vigorous exercise takes anywhere from several weeks to a few months to recover and then stabilize. In other words, the process of keto-adaptation that allows for normal or increased exercise performance lags well behind the level of ketones in the blood.

The body’s ability to produce and defend muscle glycogen via gluconeogenesis can become finely tuned, but that this takes much longer than 4-6 weeks to occur.

Serum Uric Acid as a Biomarker for Keto-adaptation: An intriguing potential indicator of the body’s progress into keto-adaptation is the response of the serum uric acid content after initiation of a ketogenic diet. In healthy normal humans with initially normal blood uric acid levels, their values typically double in the first week of nutritional ketosis.

The figure below depicts the serum uric acid levels typical for a healthy person fed a moderate protein ketogenic diet for 12 weeks. The acute rise in the first week occurs simultaneously with the increase in blood ketones, but then the slow progressive decline occurs despite stable levels of dietary protein and blood ketones.

Blog May 31 keto chart -1.png

In other words, the initial rise in blood uric acid appears linked to the onset of nutritional ketosis, but then the body slowly adapts back to normal uric acid clearance despite sustained ketones in the blood.So what gives?

The best available answer to this question is the following: to protect the body’s acid-base balance against too much acid from the diet or produced by our metabolism, our kidneys have the capacity to identify and actively clear organic acids from the blood. To some degree, at the onset of nutritional ketosis, this seems to be indiscriminate – it treats uric acid and non-toxic levels of ketones all the same. So at the start of nutritional ketosis, these two organic acids compete for excretion, causing blood uric acid to rise despite no increase in its production.

Over time the kidneys adapt to normalize uric acid excretion in the presence of beta-hydroxybutyrate, this process takes a few months to occur.

During this recovery in the kidney’s handling of organic acids, other aspects of the body’s energy regulation and homeostasis are undergoing similar slow changes as well with the net effect resulting in the process of ‘keto-adaptation’.

Does Keto-adaptation Increase Mitochondrial Density?         Another potential structural change that might directly contribute to keto-adaptation would be an increase in mitochondrial density in muscle, brain, and other oxidative tissues. The dramatic shift in energy metabolism towards fatty acid and ketone oxidation would be expected to enhance mitochondrial function. This could occur by increased mitochondrial biogenesis (production of new mitochondrial), decreased mitochondrial damage and autophagy (mitochondrial breakdown).

It is understood that reactive oxygen species (ROS) cause structural and functional damage to mitochondria, and that nutritional ketosis decreases mitochondrial ROS production. This could result in a prompt increase in the lifespan of existing mitochondria.

Keto-adaptation as a Complex of Changes on Varying Timelines: To be sure, when someone initiates a well-formulated ketogenic diet, a number of changes are set in motion which may occur in parallel, but with widely varying rates of completion.  (For these changes click the Virta link below.)

Bottom line: Keto-adaptation will likely be defined as the net effect of many parallel responses to a well-formulated ketogenic diet, with these various responses occurring on differing timelines, and to differing degrees across individual phenotypes/genotypes. The timeline for full keto-adaptation will likely be measured in months rather than days or weeks.

Have more questions about nutritional ketosis? Check out Nutritional Ketosis and Ketogenic Diet FAQ https://2healthyhabits.wordpress.com/2018/11/02/nutritional-ketosis-and-ketogenic-diet-faq/

This Post has been condensed fromKeto-Adaptation by Stephen Phinney, MD, PhD and Jeff Volek, PhD, RD on January 23, 2018

https://blog.virtahealth.com/keto-adapted/

 I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

 I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

Top Posts for 2018

Today I will focus on the top 3 posts in 2018.  The ranking was based solely on the number of Blog Likes.

Your participation in liking posts and the insight you share in your comments means a lot to me.

Wheat Makes You Fat In Three Ways Posted February 9th, 2018
https://wordpress.com/post/2healthyhabits.wordpress.com/444

What is the Ketogenic Diet? Posted February 2nd, 2018
https://wordpress.com/post/2healthyhabits.wordpress.com/440

Ketogenic Diet App Posted January 1st, 2018
https://wordpress.com/post/2healthyhabits.wordpress.com/438

 In my Blog, Facebook and email Posts my goal is to maximize my physical performance and mental clarity, body composition, and most importantly my overall health with a wholesome diet and exercise.

 Please join me as I continue to explore the latest and compelling studies on Ketogenic and GAPS diets and the Super Slow High-Intensity Exercise Program.

Please consider following Lydia’s Blog https://2healthyhabits.wordpress.com

If you are interested in following my postings, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

Happy New Year.png

May you have a happy and healthy New Year,

Lydia Polstra

lpolstra@bell.net

Facebook https://www.facebook.com/2healthyhabits/

Genetics does not have to dictate my health.

Hello, my name is Lydia. I believe the best way to predict my future is to create it. To do that, I make it a habit to improve my health.

My goal is to maximize my physical performance and mental clarity, body composition, and most importantly my overall health with a wholesome diet and exercise.

Why am I so concerned, you may ask. My motivation came from watching my mother suffer from numerous illnesses. Her life was regulated by when she had to take her drugs.

I have been retired for a while and I have yet to experience any of her illnesses. I attribute that to eating a wholesome diet and exercise.

I supplement my diet with high-quality vitamins, mineral supplements.

In my posts, I focus on two diets: the Ketogenic (Low-Carb) and GAPS (Gut and Psychology / Physiology Syndrome) diets.

Continue reading “Genetics does not have to dictate my health.”