Why is nobody talking about ketosis?

[hmb13]

I'm on Day 7 and feeling like crap. I've had a blazing headache pretty much continuous since Day 2. At first I thought it was due to the caffeine withdrawal, but now that I'm on Day 7, it can't possibly be that. In addition, my head just feels like it's in a fog -- I can't concentrate or focus very well, my energy levels are incredibly low, my mouth feels like cotton and I'm drinking water constantly, and for the past couple days I've started to feel minor chest pains (like someone is squeezing my heart).

My cousin, who is a nurse, warned me this cleanse might send me into ketosis, which can become acidosis, and both conditions are unhealthy and put stress on the liver. Can someone please explain? Are my symptoms a sign of ketosis or acidosis? I was doing the Whole30 to hopefully change my relationship with food (always an adversarial relationship before -- restriction mentality) and to cleanse my gut from inflammatory foods, but so far it's just making me feel terrible. I had probably a 75% compliant diet before starting Whole30, so this hasn't been a huge shift for me -- what I'm experiencing *isn't* just "carb flu".

Here's what my typical meals have been:

Breakfast

-1 cup coffee (black)

-2 eggs & 2-3 slices of bacon, or 1/2 sweet potato & 2-3 slices bacon, or 1 C. spaghetti squash w/1/3 c. browned ground pork & sauteed sweet peppers (for any of these, I would use 1/2 tsp. or so of coconut oil in the pan)

-1/2 - 3/4 c. berries & bananas

Lunch

-Salad of mixed greens, assorted fresh veggies, 1/2 c. browned ground pork w/homemade balsamic vinagrette

Afternoon snack

-Handful of nuts, a piece of fruit, or fresh veggie slices

**Sometimes I'm so ravenous by the time I get home, I have to have another snack of a hard-boiled egg the minute I walk in the door in order to have enough energy to cook dinner

Dinner

I've been cooking a lot of the meals from the WellFed book -- Moroccan Meatballs over spaghetti squash with cumin carrots on the side, or Salmon a l'Afrique du Nord with Brussels Sprouts. Last night I had grilled lamb & veggie kabobs.

I've also been taking fermented cod liver oil supplements every day (I'm Vit D deficient).

Can someone please help? Do I just need to stick it out a while longer, or am I doing something wrong? I'm becoming ineffective at work between this constant headache and the low energy levels. My cousin is begging me to at least eat gluten-free oats or white rice so I get some energy that is more easily available to my brain.

Help before I give this up completely!

[Robin Strathdee]

First question: Do you exercise? If you do, there's no way your carb intake is enough to support your activity levels. If you don't, you could possibly be okay, but if you're used to a higher carb intake then your body is probably freaking out. I would suggest making sure you have a starchy carb at every meal and see if that helps your energy levels smooth out. The Whole30 is not intended to be a specifically low carb program, and from what I understand ketosis and ketoacidosis come from an extreme absence of carbohydrate in the diet (I'll check in with Melissa for confirmation).

Second question: Could you be coming down with an illness? It's really common for all the changes in your body during a Whole30 to temporarily lower your defenses and make you a little more susceptible to nasty little bugs.

I'm going to pass this question on to Melissa, too, in case she has anything to add.

[Emily]

I agree with your cousin that you need more carbs, but get them from sweet potatoes, spaghetti squash, acorn squash, butternut squash, pumpkin (I love this time of year) instead of grains. And hang in there- you are right in the toughest part.

[jhmomi]

Personally, I think your carb intake looks higher than what anyone beginning the induction phase (first two weeks) of Atkins would have. Ketoacidosis is extremely rare and generally only going to happen to an uncontrolled diabetic. (To clarify- ketosis and ketoacidosis are completely different medical issues. Sorry if putting these two statements together was confusing to anyone. I just attempted to explain ketoacidosis is rare and unrelated. For info from Melissa scroll down to her post please.)

For your headaches, make sure you stay very well hydrated (I know you said you have been drinking a lot). Drink more water than you think you need. If your carbs are low enough to put your body into ketosis (as with a low carb diet) then that generally flushes out excess fluids in your body and gives a drop in "weight" from water loss. If you lose a bit too much water, you can get a horrible headache, especially in warmer weather or with activity/exercise. I am particularly sensitive to this and always drink a huge glass of water or two at the first sign of a headache starting. Most of the time that is all I need to feel good again.

But Robin's question about your activity level is important. If you are very active, your carbs are probably a bit low. Hang in there and you should feel better soon. It's worth it!

One more thing - Were you eating much processed food before? Your sodium intake could have changed dramatically if you went cold turkey on processed foods and began your Whole30 last week. Maybe a little extra salt would help?

(I am an RN, but no expert on this. Just tossing out some ideas and thoughts for your consideration. GOOD LUCK!)

[Snappy Shark]

Hi there! Sorry that you're feeling so crappy.

In addition to upping the carbs, I think that you might need to eat more per meal in general. I'm on Day 15, and I'm just getting accustomed to how much I need to eat at each meal. My first week was a lot like yours - the fog, the dry mouth. For reference, I'm a 5'6" female, ~138 pounds (at Day 1, anyway - not sure what I'm weighing now) and I also had a ~75% clean diet. I am active, doing a combination of interval training, weights and jogging 4-5 times/week. I used to track my calories, and pre Whole30, I was doing a high fruit, low fat diet of ~1300-1400 calories per day. I know it's not in the spirit of the Whole 30, I was curious about my macronutrients ratios, so I plugged my daily food intake into an app and I'm eating a good ~2200-2500 calories per day, depending on activity levels.

In short - I feel like I'm eating like a horse. I'm not sure exactly what your situation was prior to starting the Whole30, but if you're not insulin sensitive yet, you're going to have a bit of a rough ride on your way there. Your meals look perfect, you just need to eat more. Pile on the veggies, maybe add another egg or two at breakfast or an extra half of an avocado at lunch. I am not a medical expert, but from what I understand about ketosis, you need to be at less than 50 grams of carbs per day, and with all of the healthy starches and fruits you're eating, you are nowhere near that.

Feel free to send me a message if you want to chat more or want advice about meal planning. Hang in there, I have confidence that this will work and you'll feel better soon!

Cheers,

AM

[CaseyD]

Stick it out. 75% paleo is a lot different than a perfect Whole30, so you weren't actually eating "like" this and yes, you will notice a change. I went from eating Whole30 compliant, with the only exception being dark chocolate and Diet Coke, to a perfectly clean Whole30, and I endured all the symptoms of someone new to this way of eating.

From what I understand, ketosis and acidosis are not the same thing. Besides, from what you're listing, you're not even eating a ketogenic diet, so while you may eventually enter in and out of ketosis, you're not going to be full ketogenic (which isn't acidosis either). And, if you really were doing a ketogenic diet, 7 days would not be long enough to see improvements in your energy levels either. That takes a few weeks. But, that's not what you're doing when you're eating sweet potato and squash.

It sounds like you're experiencing normal symptoms of hormones being regulated by this clean way of eating. Eat it for the full 30 days before you make any decisions. 7 days is just not enough to make any determinations. Maybe stop troubleshooting with your cousin as nurses are not nutritionists. She may not have any background in understanding how foods certain foods impact our bodies and may just be relying on the conventional wisdom we all were taught in health class. Use her as a resource for other medical questions, not related to diet! And, if you really do feel too low carb, eat more sweet potato and/or fruit. Doesn't take much as our body can only really use a limited amount of carbs at a time.

Hang in there and give it the full 30 days.

[Melissa Urban]

Folks mostly have it down here. Based on your meal descriptions and the fact that you can't make it from lunch to dinner without practically keeling over, (a) you're clearly very much still a sugar-burner, which means this "fat-adapted" transition is still underway and you need to be patient, and ( you are absolutely not eating enough. There is zero possibility of you being in actual ketosis with the current amount of carbohydrate in your diet (although it's probably not enough to sustain activity levels), and ketosis and ketoacidosis are two very different (and often confused, even by medical professionals) conditions that have absolutely nothing to do with one another.

Try eating more immediately. Add more protein, more carbohydrate, and perhaps more fat to every single one of your meals. If that's the issue, then you'll start to feel better right away - and I suspect that's exactly what will happen.

[hmb13]

Thank you all for your very quick and very useful advice. I *really* appreciate everyone's responses. I will do what I can to increase my food intake at each meal, though honestly, I am very full at each meal described above. I was trying to abide by the "limited snacking" rules of the program, which is perhaps why I was getting to the "keel over" state by the time I hit dinner. I also agree I need to add more good carbs -- in fact, I had a healthy helping of acorn squash tonight at dinner, and I did notice it helped my headache.

As for my activity level, it is normally sporadic due to my work schedule -- a 3-4 mi run here, a Jillian Michaels workout DVD there. But I have barely been able to make it through either one of these workouts so far on W30 due to my incredibly low energy levels. I'm hoping by incorporating your suggested revisions to my diet, I will be feeling better and have more energy for workouts soon. I am drinking enough water, though -- probably 2+ liters/day, if I had to guess.

Melissa, thank you for letting me know this is part of the transition from becoming a "sugar burner" to a "fat burner" -- it's a bit surprising since I thought I was eating what I thought was a fairly clean (hardly any processed foods), limited grains, limited dairy diet before. But it's helpful to know this is just part of the process.

Again, I truly appreciate everyone's feedback and support -- I will stick with it, making your suggested adjustments, and report back in a few days!

[LandShark]

Please do report back in a few days! I'm on Day 8 and had to do a urine test (to get a higher class of driver's license) and my doctor said I had protein in my urine. I googled that was all OMG MY KIDNEYS ARE FAILING. But then a friend said "relax dude, it's your low-carb/high-activity that's doing it. Here, eat a sweet potato."

But I know I'm still eating too much dried fruit. I'm still very much a sugar-burner. It's so hard to get through the Face Punchy phase without "soothing" myself with a Larabar.

Are these things related? I feel like the more I learn, the less I feel I know.

Sharkey

[hmb13]

So, the report back -- I'm feeling much better! I've focused on increasing my starchy carb intake and increasing my overall food intake, and the headaches seem to have disappeared and other symptoms subsided. Yesterday was actually the first morning I woke up and actually felt... *good*

Maybe it's the tweaks to the diet, or maybe I've just turned the "sugar burning" corner, but I'm finally starting to see the benefits and effects of this Whole30 thing!

So Sharkey - hang in there! I bet you'll be turning a corner soon, too! Back off the dried fruit and try a few more starchy veggies (sweet potatoes, squash of any kind).

Thanks again to everyone for your advice and support!