Ketogenic Diet Update: Six Months of Ketosis

Six months into a ketogenic diet is a sort of milestone among dietitians. It’s when the body really adjusts to the change—cholesterol settles down and other blood levels that have been out of whack do, too. Here’s where I am after six solid months of ketosis.

Hypoglycemia

My blood sugar has finally stabilized and the hypoglycemia appears to be under control! I think it’s from a combination of time for my body to adjust to the diet and eating so many calories in a day that I can get in enough carbohydrates. I’m eating 13.8 g of carbs each day; at the lowest, I was getting 3 g. It has stabilized enough that I can eat only two meals a day and can exercise without a blood sugar crash.

Migraine

I am less reactive to foods than I was before I started the diet, but everything I eat is still a migraine trigger. Certain foods are less bad than others and I’m slowly adding in more foods. Now that I’m back to two meals a day, I can take abortives after both meals and remain functional most of the time. (Someone will read this and inevitably be concerned about medication overuse headache/rebound headache. My doctor and I are on top of it.) Sometimes I barely feel the migraine attack at all. The last couple days, I’ve basically been back to where I was before the DHE infusions last summer—I still have a migraine attack every time I eat anything, but they mostly respond to medication (though I have fewer foods than I did then).

Weight

The weight loss seems to have stabilized, too. I’m remain at about 18 pounds below my ideal weight even though I try to eat 2,100 calories a day. I don’t know if I just need more calories on a ketogenic diet than I normally do or if I haven’t been hitting my calorie target. My guess is a bit of both. It’s easier to get in all my calories now that I’m on two meals a day, so we’ll see if I gain any weight.

Ketogenic Diet Ratio

When I noticed that I was no longer having hypoglycemic episodes, I increased my ratio from 3.75:1 to 4:1. It was too much—I went considerably deeper into ketosis, my migraine attacks became more frequent, and I lost weight. I also tried to decrease the ratio to 3.25:1 and a significant migraine attack ensued; it was too little. My sweet spot appears to be 3.75:1.

(I’ve learned that a 4:1 ratio is normally verboten for adults who aren’t in imminent danger of death because it’s impossible to meet protein needs within our calorie constraints. Since I have an extra 400 or 500 calories to play with, this doesn’t apply for me right now.)

Vitamin & Nutrient Deficiencies

So far, the diet has caused me to be deficient in iodine, potassium, sodium, chloride, and various B vitamins. I’ve been able to supplement (and use more salt) for everything except the B vitamins. A bad history with multiple different B vitamin supplement has me reluctant to try one. I think today is the day I’ll be brave.

Unexpectedly, my vitamin A is too high. It happens that the least migraine-triggering vegetables for me all happen to be high in vitamin A. Plus, vitamin A is fat-soluble and I always eat it in conjunction with a ton of fat.

Erratic Blood Work

My labs have been all over the place in the last six months. A level will be way high one month and back to normal the next without any change on my part. Almost every level that had been out of whack is back to normal or close to normal as of July 13. I won’t have my cholesterol checked for another couple weeks, but I’m actually hoping it will remain on the high end. One of the preventives on my list to try is a statin, which lowers cholesterol.

My Current Thoughts on the Diet

In summary,

• I’m not hypoglycemic
• I no longer have to eat more frequently than my meds can keep up with
• I’ve stopped losing weight
• My vitamin deficiencies are minor and so far manageable
• My labs are pretty good

Obviously the ketogenic diet hasn’t been a slam dunk for me, but it is helping. After spending May and June thinking I would have to abandon it any day, it no longer seems untenable. It’s not ideal and can’t be my final strategy, but it’s getting me through. Now my goal is to maintain the diet long enough to support an aggressive trial of five or six different preventives (not simultaneously). Realistically, that’s probably at least until the end of the year.