Can a Ketogenic Diet Help People with Acid Reflux?

If television commercials for prescription and over-the-counter antacids are any indication, acid reflux has reached epidemic proportions. Stomach acid has launched an all-out attack on people's digestion and quality of life, inching its way up into the esophagus and causing the pain and irritation commonly referred to as "heartburn." But stomach acid is a natural, normal, essential thing. Why does it cause so much trouble for so many people?

For the people who suffer from acid reflux, finding a natural remedy would be most welcome, because reflux can make eating—one of life's simple pleasures and joys—into a painful experience people dread. With this in mind, might there be a role for a ketogenic diet in addressing reflux?

Stomach Acid 101

Owing to the high incidence of acid reflux and gastroesophageal reflux disease (GERD), stomach acid has gotten a bad reputation. It's been portrayed as something to reduce as much as possible, or, better yet, completely neutralize. If only we could eliminate stomach acid altogether, we would have a permanent cure for reflux and indigestion, right?

Wrong.

Your stomach is supposed to be acidic. Very acidic. Between meals, an "empty" stomach has a pH of about 1-3, usually around 2. During a meal, when food is in the stomach, the pH rises to 4-5.

The pH scale measures acidity: 7 is neutral, lower than 7 is acidic, and higher than 7 is alkaline. It's a logarithmic scale, so a pH of 6 is ten times more acidic than a pH of 7, and a pH of 5 is a hundred times more acidic than a pH of 7, so you can see that even when the pH of your stomach rises in the presence of food, it's still highly acidic! To give you a better sense for this, lemon juice has a pH of about 2 and vinegar's pH is around 2-3. The pH of your empty stomach is only slightly less acidic than battery acid!

Not only is your stomach supposed to be acidic, but it must be acidic. The chemical breakdown of carbohydrates begins in your mouth, thanks to enzymes in your saliva. But the breakdown of proteins and fats begins in your stomach, and the primary conductor of the digestion orchestra is your stomach acid.

Think of proteins as strands of Christmas lights: multiple cords that are all tangled up. Job #1 of your stomach acid is to untangle these strands—a process called denaturing. When proteins are denatured, the enzymes in your small intestine that break them down into individual amino acids or small groups of amino acids (called peptides) have better access to them and are able to break them down properly.

Your stomach needs to be highly acidic not just in order to properly denature proteins, but also because the acidity signals other enzymes (such as gastric lipase, which is an early step in digestion of fats) to perform their functions, and these enzymes function optimally in an acidic environment.

Additionally, the stomach is supposed to be highly acidic so that the denaturing of proteins can occur relatively quickly, and your food can be passed along for the rest of your digestive tract to go to work on it. Food isn't supposed to sit in your stomach forever. Stomach acid is supposed to take care of the proteins, enzymes do some initial work on the fats and carbohydrates, and then the food is supposed to move along. Not only that, but when the food does move along, it, too, should be acidic.

The acidity of the partially digested food (called chyme) entering the small intestine signals the intestine to secrete bicarbonate ions, which neutralize the acid, creating an alkaline environment in the small intestine. This is crucial, because unlike the stomach, the digestive enzymes of the small intestine function optimally in an alkaline environment. You can see now that your stomach acid needs to be highly acidic, because it sets the stage for proper digestion not only in the stomach, but also in the small intestine, which is where the majority of digestion occurs.

What Causes GERD?

Contrary to popular belief, many individuals with acid reflux don't have too much stomach acid; they have too little. (1)

If you have too little stomach acid, or the acid you produce is not sufficiently acidic, food will remain in the stomach longer than it should. Some of the carbohydrates you consume—especially grains, but also other starches—may begin to ferment as they remain in your stomach for an extended period of time, and this creates gas.

This gas may put pressure on the lower esophageal sphincter (LES), which is a small bundle of muscles between your esophagus and your stomach. This sphincter is supposed to remain closed except after you swallow and food presses against it, causing it to open and allow the food to pass into your stomach. Most of the time, this is a unidirectional process—one way: food and beverages go from the esophagus into the stomach.

But it's not always unidirectional. Food and liquids can move from the stomach back up into the esophagus. If you've ever vomited, then you've had personal, unpleasant experience with the two-way action.

The thing is, the LES is an involuntary muscle—meaning, you can't deliberately move it, the way you can with your quads or your biceps. It opens and closes on its own. The opening of the LES during vomiting is a natural response to an emergency need to eliminate something toxic. But some people have a weakened LES that's more prone to opening in benign circumstances.

The problem with foods coming back up, or refluxing, into the esophagus is that, unlike the internal lining of your stomach, which contains a layer of mucus that protects it from being eroded by stomach acid, your esophagus contains no such protection. So when foods that have been exposed to stomach acid bubble back into the esophagus, the acidity causes burning and irritation.

But remember, this doesn't happen because the stomach is too acidic; it happens because it isn't acidic enough.

What Causes Reduced Stomach Acid? Stress

Stress is a major culprit—one people rarely think of when they think about indigestion and reflux. The cliché of a stressed-out executive grabbing a fast food lunch, eating it standing up, and then popping antacids for the rest of the day while running from one meeting to the next has a lot of truth to it.

If your sympathetic nervous system—responsible for the "fight or flight" state—is going full speed, it overpowers your parasympathetic nervous system, which is responsible for the "rest and digest" state.

The physical breakdown of food begins in your mouth, with chewing, but the biochemical aspects of digestion begin in your brain. If you're constantly stressed out, then your body interprets this as your being in a perpetual crisis, in which case digesting your food is not a top priority, so stomach acid secretion is reduced.

Prescription Antacids

Another cause of reduced stomach acid is prescription antacids. Two of the common types are proton pump inhibitors (PPIs) and H2 receptor antagonists. These drugs are prescribed to treat acid reflux, and also for stomach ulcers. Like so many pharmaceutical drugs, by suppressing the secretion of stomach acid, these drugs do help alleviate heartburn in the acute sense, but over the long term, they actually make things worse.

Many people with acid reflux don't need less stomach acid; they need more, so these drugs only address the immediate symptoms. They do nothing to correct the underlying problem. Perhaps this is why as much as 30-40% of patients don't respond to pharmacological treatment and 60% report residual symptoms despite drugs for acid reflux being a $12.5 billion dollar industry in the U.S. alone (2).

Other Causes

Other contributors to reflux in some people include smoking (3), high alcohol intake (4), and anatomical issues, such as hiatal hernia (5). (Hiatal hernia is a condition in which a small portion of the stomach protrudes through the diaphragm, putting increased pressure on the LES from below.) Obesity might be another factor in GERD—specifically abdominal obesity, where fat is mainly carried at the midsection.

Conventional Advice for GERD & Acid Reflux

Common recommendations provided for those with acid reflux include:

• Remain upright after eating: For individuals with a weakened lower esophageal sphincter, letting gravity do its job may help reduce the likelihood that food will travel back into the esophagus. This means standing or sitting upright, and not lying down or reclining after a meal. (It also means not eating a large meal right before bed.)

• Eat smaller meals: Smaller meals mean less food in the stomach, and therefore, potentially less likelihood for upward pressure on the LES to cause reflux.

• Avoid acidic, spicy, and fatty foods: While these foods may not be the primary cause of reflux, acidic foods may be more irritating to the esophagus when the LES is weakened. These foods include coffee, carbonated beverages, tomatoes and tomato sauces, lemon and other citrus fruits and juice, hot peppers, garlic, onions, vinegar, and other acidic foods. Chocolate and peppermint may also exacerbate GERD in some people.

• Lose weight if you are overweight or obese: A larger concentration of body mass in the abdominal area may mean increased pressure on the LES, potentially resulting in acid reflux. Certainly, not all overweight individuals experience reflux, and plenty of lean individuals do. So excess body weight is not an ironclad cause of reflux; it's simply one among many contributors that could be addressed if an overweight individual experiences frequent heartburn.

Alternative Approaches for GERD & Acid Reflux

Operating under the premise that GERD and acid reflux often result from insufficient stomach acid rather than an excess, some physicians and nutritionists may approach things differently from the advice above:

• Take supplemental HCl: Stomach acid is available in supplement form, as betaine HCl.

• Take apple cider vinegar before meals: Providing acid directly may help increase the stomach's acidity. Many people find a squeeze of lemon in their water helps aid digestion; perhaps this is why. Keep in mind that many cultures around the world consume pickled or fermented foods with their meals, especially when the meals are rich or fatty, such as the European tradition of sauerkraut or cornichons with sausages or pâté. Think of these acidic condiments as digestive aids.

• Don't consume large amounts of liquid with meals: For people who already produce insufficient stomach acid, it may be wise not to dilute what is produced with excessive amounts of fluid. Hydrate enough throughout the day so you're not overly thirsty at mealtimes. (You shouldn't require large amounts of liquid to "wash down your food.")

• Don't eat while acutely stressed: Relax! Allow that rest and digest part of your physiology to shine. Try not to eat in your car, standing up, or otherwise on the go. When possible, avoid conducting business during meals. Try to eat in a calm frame of mind and in pleasant surroundings. Easier said than done, especially if you're a parent of young children, but try to be as calm and unhurried as your circumstances allow.

Dangers of Antacid Drugs

As mentioned earlier, prescription antacids inhibit the natural, normal secretion of stomach acid. But stomach acid is essential for proper digestion, including liberation of vitamins and minerals from food.

The old saying, "You are what you eat" isn't quite accurate. You're not what you eat but rather, what you digest and absorb. So imagine the consequences for someone who has been dutifully taking a powerful antacid for years, maybe decades. Their absorption of key nutrients has been compromised for this length of time, which can affect any number of body systems and functions.

Owing to reduced absorption of calcium, zinc, iron, magnesium, and vitamin B12, long-term antacid use is associated with increased risk for several alarming outcomes: chronic kidney disease (6,7), iron deficiency (8), hypomagnesemia (low blood magnesium) (9,10), bone fractures (11,12,13), B12 deficiency (14), pneumonia (15), and dementia (16,17). People who consume these drugs for extended periods of time think all they're doing is reducing their stomach acid. They often have no idea that the consequences can be so dire.

Over-the-counter antacids may not carry risks quite as severe as prescription versions. Rather than preventing the normal secretion of stomach acid the way the prescription PPIs and H2 receptor antagonists do, OTC antacids buffer or neutralize acid that has been produced. Taken often, though, and over the long term, the way many individuals use them, it's possible for them to ultimately lead to some of the same conditions the prescription medications do.

Considering these very serious issues, it would be helpful to find a natural strategy for eliminating acid indigestion.

Enter carbohydrate restriction!

Ketogenic Diets for Acid Reflux

It may sound counterintuitive at first that a ketogenic diet could be beneficial for acid reflux. After all, conventional medical advice recommends avoiding fatty foods, so you might think a ketogenic diet would be contraindicated for individuals with acid reflux or GERD. Plus, some of the foods people frequently enjoy on ketogenic diets are cautioned against in traditional advice for reflux, such as the aforementioned coffee, dark chocolate, tomato sauces, garlic and onions. (According to that conventional thinking, butter in your coffee would be the worst thing you could do!)

Anecdotes abound on various blogs and forums, but there's also a solid body of scientific research corroborating what many people have discovered for themselves: However illogical it may seem at first glance, low-carb and ketogenic diets have proven very effective for relieving GERD and reflux.

If grains and other starchy carbohydrates are among the foods that increase pressure on the LES, it makes sense that eliminating them from the diet or dramatically reducing consumption of them would have a beneficial effect on acid reflux. (Some people on low-carb or ketogenic diets choose to consume grain in the form of low-carb, high-fiber wraps and tortillas, but even if these are part of someone's diet, the total amount of grain they're eating is still significantly reduced from a standard Western diet.)

Evidence Shows that Carbohydrates Aggravate GERD

Many people who adopt ketogenic diets for fat loss or some other goal find that resolution of acid reflux/GERD is an unexpected and pleasant "side-effect." One study reported on five patients who self-initiated low-carb diets and had resolution of GERD.

To be fair, three of them eliminated coffee, and all of them eliminated acidic foods, but the researchers noted that "carbohydrates may be a precipitating factor for GERD symptoms and that other classic exacerbating foods such as coffee and fat may be less pertinent when a low-carbohydrate diet is followed" (18).

Another study added weight to the possibility that carbohydrates are, indeed, a trigger for GERD symptoms. In a small cohort of adults with GERD, compared to a liquid meal containing 85 grams of carbohydrate, a liquid meal of the same volume but containing about 180 grams of carbohydrate resulted in greater total time experiencing reflux and a greater number of long reflux periods (lasting more than 5 minutes) (19).

A liquid meal of 85 grams of carbs is not something any good nutritionist would recommend for a low-carb or ketogenic diet, but this study wasn't specifically about a low-carb diet. It was designed to evaluate "the effect of different carbohydrate density on low esophageal acid and reflux symptoms," and it certainly did: the high-carbohydrate meal aggravated GERD more than the lower-carbohydrate meal.

A more formal study that did evaluate the effects of a ketogenic diet confirmed the efficacy of carbohydrate restriction: in a small prospective cohort, obese subjects began a ketogenic diet after undergoing a 24-hour esophageal pH probe test (which measures the pH of the esophagus). Within just six days, subjects had dramatic improvements in GERD (20).

The Johnson-DeMeester score is used to measure esophageal acid exposure. A score > 14.72 indicates reflux. At baseline, the subjects' mean score was 34.7, and after just six days it had dropped to 14.0. The percent of time during which their esophageal pH was very low (highly acidic) was cut in half, and they reported significant improvements in their symptoms via a standard GERD questionnaire that assesses subjective feelings of heartburn, pressure or discomfort inside the chest, a sour taste in the mouth, frequent gurgling in the stomach, nausea, a feeling of pressure or a burning sensation in the throat, belching, flatulence, and more (21).

This study is telling, because not only did the subjects report improvements in their own symptoms, but the reduced esophageal acidity was confirmed by direct measurement.

In the most impressive study performed so far, in a cohort of obese women, after just 10 weeks on a low-carb diet, in all subjects with a confirmed GERD diagnosis, "all GERD symptoms and medication usage had resolved in all women" (22). That's right - within only 10 weeks, all subjects with GERD had complete resolution of symptoms, including women who'd experienced symptoms twice daily or as often as 5 times per week. All medication, both prescription and over-the-counter, was discontinued.

The authors noted, "Contrary to long-held belief that higher fat intake promotes GERD symptoms; nationally representative data do not show a strong association between dietary fat and GERD. Thus, the present study provides important insights that contribute to the accumulating evidence of a role for dietary simple carbohydrates in GERD pathophysiology. We found that simple carbohydrates, particularly sucrose, contribute to GERD in obese women and the likelihood of having GERD was predicted by simple carbohydrate (total sugars) intake."

Take Home Message

It appears that ameliorating GERD and acid reflux has less to do with what you put in your mouth—antacids—and more to do with what you don't put in your mouth: large amounts of carbohydrate.

If you're living with discomfort and reduced quality of life from acid reflux, and food has gone from a pleasure to a pain, consider trying a low-carb or ketogenic diet.

You've got nothing to lose except maybe a few excess pounds, your reflux, and perhaps even your antacid prescription. If you've been on prescription antacids for a significant length of time, it is not advised to quit them cold-turkey. Find a physician who can help you get started with a low-carb approach and wean off your medication safely.

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Low-Carb Cauliflower Rice 3 Ways

Have you ever made flavoured cauliflower rice? Trust me, you need to give it a go! Skip the starchy sides, and make keto-friendly cauliflower rice instead: It’s the perfect partner for slow-cooked meat and flavourful sauces. With only 5 to 6 grams of net carbs per serving, this is the perfect ketogenic side for your Sunday roast, midweek curry, and tastes amazing even on its own.

I'd like to thank Emily Caruso of Hello Glow for reviewing my Keto Slow Cooker & One-Pot Meals Cookbook and creating a beautiful video to share my Cauliflower Rice 3 Ways. I've been making flavoured cauliflower rice with different herbs and spices for years and these are some of my favourite flavours.

The review and video show you how to make my Cauliflower Rice 3 Ways in a few simple steps are at Hello Glow.

For more information and a sneak peek of what's inside my new book, check out the announcement of my Keto Slow Cooker & One-Pot Meals Cookbook.

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Announcing My Beginner's KetoDiet Cookbook

Hi Friends,

I'm so excited to announce my new keto cookbook The Beginner's KetoDiet Cookbook! I've been working this book on for the last 8 months and I received the first early copy just a few days ago.

Working on this cookbook wouldn't be possible without you - my fabulous readers. I'm so grateful for your love and continuous support! Finally, I want to thank my publishing team at Fair Winds who worked so hard and have been amazing and supportive all those years!

The Beginner's KetoDiet Cookbook will be released on April 3rd, 2018 and is now available to pre-order on Amazon US (and all Amazon stores), Barnes & Noble (US), Indie Bound (US), Indigo (CA), Waterstones (UK) and Book Depository (UK).

Pre-order now to get up to 34% off!

Why Keto Beginner's?

Keto has been gaining popularity and over the last few years, more and more resources have become available. On one hand, this is great news because you can now find loads of recipes and information which were previously not available.

On the other hand, with more resources becoming available, more misinformation has been emerging making it hard to distinguish personal opinions from facts, and myths from truths. We simply live in a world of information noise. If you are new to the diet, it just becomes overwhelming.

I can almost feel the confusion and frustration in the e-mails and messages I receive on a regular basis:

Emma: "I never experienced keto adaptation or the energy boost everyone is talking about. I just feel tired and hungry. What am I doing wrong...?"

Lee: "I want to lose weight. How can I boost my ketones...?"

Melissa: "I stopped eating dairy, nuts and seeds but I'm still not losing weight. What else may be stalling me...?"

The main idea behind writing this book was to make low-carb lifestyle easy to follow, help people avoid common mistakes and dispel some of the myths.

When it comes to nutrition, we are all different and what works for one may not work for other people. No book can tell you what is the best approach for you - it's something you need to find out.

In my book I present science-based facts in a simple and accessible way so you can make informed decisions that work best for you.

What's Inside?

The Beginner's KetoDiet Cookbook is more than just a cookbook: apart from over 100 delicious recipes it includes an easy to follow guide to kick-start your diet.

• Over 100 low-carb, keto & paleo/primal recipes with several allergy-free options, detailed nutrition facts and tips on how to use leftovers.
• My story and why I started following a low-carb approach in the first place.
• The three phases of a whole-foods based ketogenic diet and how to maximise the benefits of low-carb eating.
• What you need to know about carbohydrates, protein and fats, including healthy keto foods to help you make the right choices.
• Foods high in electrolytes to help you avoid keto-flu.
• Suitable natural sweeteners and healthy fats, plus how to use them.
• Weight stalling and how to break through a stubborn plateau.
• Low-carb food swaps to help your transition from a high carb diet.
• How to use intermittent fasting to your benefit.

Allergy-Friendly Information

Allergy information is included for nut-free, dairy-free, nightshade-free, egg-free and vegetarian recipes.

• 94% of all recipes are nut-free or include a nut-free option
• 67% of all recipes are dairy-free or include a dairy-free option
• 45% of all recipes are nightshade-free or include a nightshade-free option
• 44% of all recipes are egg-free or include a egg-free option
• 43% of all recipes are vegetarian or include a vegetarian option

Additionally, you'll find recipes that are:

• ideal for intermittent fasting (high energy & nutrient dense recipes)
• high in electrolytes which are essential for your body and help you beat keto-flu
• most suitable for the initial phase

Pre-order now to get up to 34% off!

100+ Recipes & More Homemade Basics

• 20+ keto basics including Flavoured Butters, Garlic & Herb Focaccia, and Pesto.
• 17 Keto Break-the-Fast Dishes such as Spicy Chorizo Egg Clouds, Pizza Dutch Baby, Breakfast Chili Bowls, Jalapeño & Cheese Muffins, Abundance Breakfast Bowls and PB & Jelly Chia Jars.
• 9 Light Dishes and Appetisers including Crispy Ranch Chicken Wings, Tomato & Feta Bruschetta, and Multiseed Keto Crackers.
• 13 Nourishing Soups & Refreshing Salads including Cream of Mushroom Soup, Chicken Meatballs Pho, Nordic Salad, and Wedge Salad with Blue Cheese Dressing.
  
• 14 Quick & Easy Lunchbox Dishes such as Induction Unwich 2 Ways, Quick Tuna Melt Pockets, Avocado-Stuffed Power Balls, Bacon-Wrapped Patties with "Chimiole" and Mexican Chicken Bowls.
• 32 Energy-Boosting Fat-Fueled Dinners. You will find delicious keto meals such as Mushroom Stroganoff, Masala Cauli-Rice with Grilled Halloumi, Taverna-Style Greek Butterflied Sea Bass, Butter Chicken, Salisbury Steak with Quick Mask, Chicken Piccata, Induction Burger Stacks, Irish Pork Pie, and Induction Carbonara.
• 13 Drinks and Desserts including Electrolyte Aqua Fresca, Strawberry Cream Soda, Cheesecake Pockets 2 Ways, Czech Butter Cake, Tiramisu Crepe Cake, Chocolate Cupcakes with German Buttercream, and No-Churn Lemon & Raspberry Ice-Cream.

Here's a sneak peak of some of the recipes ...

Pre-order now to get up to 34% off!

Your Review Matters

If you like my cookbooks and want to support what I do, please, leave a review on Amazon. It only takes a minute to leave a review and makes a tremendous difference to authors like myself.

Reviews improve the visibility of books on Amazon and other stores, which means that with your help, my book will reach more potential readers interested in the ketogenic diet.

Thank you 🖤

Giveaway

To celebrate the launch of my new book, The Beginner's KetoDiet Cookbook, I'm giving away this beautiful KitchenAid mixer (in a colour of your choice). Anyone can join, no matter where you live. The lucky winner will be announced in a few days 😊

My question is: What would you like to achieve by following a keto diet?

a Rafflecopter giveaway

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How Does Our Diet Affect Circadian Rhythms?

Over the past hundreds-to-thousands of years, peoples around the world have thrived on a wide variety of diets. Food has changed a lot seasonally, geographically, etc.

What hasn’t changed? The 24-hour light/dark cycle to which our circadian rhythms are constantly entrained.

Circadian “Phase” Shifts

In general, your circadian phase is based on the 24 hour day, roughly 12 hours in the light, 12 hours in the dark (varies seasonally and geographically). Many hormonal and biochemical effects are influenced by this. Light, darkness, and food are what, in part, determines your circadian phase.

Circadian Phase Advance

Examples of this would be going to bed earlier and waking up earlier.

Similarly, wearing blue light-blocking at sunset to mimic the natural spectrum of sunlight, which has a higher blue:red ratio in the morning and less blue at night -- thus, wearing blue light-blocking glasses if you’re exposed to artificial light at night.

Flying from California to New Jersey shortens your day by about 3 hours. If you’re living by natural circadian rhythms, this means you’re going to bed 3 hours earlier (takes some time to adapt, but this is just an example).

Circadian Phase Delay

Basically, the opposite of everything above: for example, staying up late and sleeping in.

Flying from New Jersey to California lengthens your day by about 3 hours: if you’re living by natural circadian rhythms, you’re going to be really tired at bedtime.

Importantly, some preclinical studies suggest diet may play a role in this.

How Does Our Diet Affect Circadian Rhythms?

In assessing circadian rhythms in animal models, researchers monitor activity for a couple weeks in normal light dark cycles then turn out the lights and see if the activity patterns shift earlier (phase advance), later (phase delay), or don’t change in the following weeks.

The top half of the figure below shows the activity pattern of rodents fed a “Control” high carbohydrate rodent diet in a normal light/dark (LD) cycle and as you move downward, it switches to complete darkness (DD) (Oishi et al., 2009). This is what a phase advance looks like. You can see the periods of high activity (dark black spots) move progressively to the left, earlier.

The bottom half of the figure shows rodents on a ketogenic diet. The phase advance when switched from LD to DD is more robust.

In a similar follow-up study, the researchers next tested a very high protein diet (Oishi et al., 2012). As seen above, during normal light/dark conditions, activity was concentrated in the active phase. When switched to dark/dark, we see a similar phase advance as seen in the “Control” conditions above.

The bottom half of the figure shows activity during normal conditions and then switching to all darkness. Similar to rodents on a ketogenic diet in all darkness, rodents on a high protein diet show a more robust phase advance in all darkness.

What do the ketogenic and high protein diet have in common? They are both low in carbohydrates. In the first case, most of the calories were replaced with dietary fat; in the second case, most of the calories were replaced with protein.

In both cases, the animals fed ketogenic and high protein diets were healthier than standard (high carbohydrate) diet-fed animals. Animals exposed to dim light at night exhibit deteriorating metabolic health and a circadian phase DELAY (Fonken et al., 2010): don't do this.

The top half of the figure shows normal 12-hour light/dark cycle. The black bars indicate activity levels. Comparing the top to the bottom, more activity shifts from left to right, indicating animals being more active later in their active phase.

Diet Composition Matters But So Does Meal Timing

Bright light in the morning entrains the master clock in your brain. The food-entrainable oscillator (FEO) kickstarts circadian rhythms in peripheral tissues when you eat breakfast (eg, Polidarova et al., 2011 and Sherman et al., 2012).

These two events (ie, bright light and food intake) should be timed together to co-entrain central and peripheral circadian rhythms.

Take Home Message

If optimal circadian is your goal, follow a low carbohydrate and either high fat or high protein.

Avoid smart devices at night or get some blue-blockers to prevent a circadian phase delay. Eat well, sleep well, be well.

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Keto Raspberry & Cream Jellies

As you may know, I suffer from a compromised immune system and gut health is crucial for my day to day health and quality of life. I try to take both collagen and gelatin each day as part of my supplemental routine.

Why gelatin, you ask? Gelatin is a brilliant source of protein and amino acids. It helps to heal the gut lining by restoring a healthy mucosal lining in the stomach. It can help to seal the colon so that nutrients can be better absorbed.

For me? Gelatin is very high in anti-inflammatory amino acids such as glycine and proline which aid in reducing inflammation.

Wow! If it could fold my laundry, it would be the most perfect food ever. I like to make tasty little jellies to take my gelatin, it makes it feel like you’re having a lush treat each day.

These little jellies are like a bowl of raspberries and cream… in a solid form. Enjoy!

Preparation time

Hands-on:    20 minutes
Overall:     4 hours 30 minutes

Nutritional values (per serving, 2 jellies)

Total Carbs	1.8	grams
Fiber	0.7	grams
Net Carbs	1.1	grams
Protein	4.4	grams
Fat	7.7	grams
of which Saturated	4.8	grams
Energy	94	kcal
Magnesium	5	mg (1% RDA)
Potassium	31	mg (2% EMR)

Macronutrient ratio: Calories from carbs (5%), protein (19%), fat (76%)

Ingredients (makes 24 jellies)

• 1 cup heavy cream (240 ml/ 8 fl oz) - you can use coconut milk such as Aroy-D for dairy-free
• 1 cup fresh or frozen raspberries (123 g/ 4.3 oz)
• 2 tsp Swerve or Erythritol, or 4-6 drops of liquid Stevia
• ½ cup natural grass-fed gelatin powder (55 g/ 1.9 oz)
• 1 cup water (240 ml/ 8 fl oz)

Note: Sweetener can be used to taste. Natural grass-fed gelatin is by far the best gelatin to use for your gut health. You do need a bit more of it than the standard “baking” gelatin that you find at the supermarket, but it is by far better for you.

Instructions

1. In two small containers, place ½ cup of cold water and ¼ cup of gelatin. Allow to sit and bloom while preparing the other ingredients.
2. Place the raspberries in a small saucepan and sweeten to your personal taste, heat gently while smooshing with your spoon to release the juices.
3. Also, in a separate pan, add the cream and heat to a gentle simmer. Add one of the bloomed gelatin bowls into the cream and whisk until dissolved.
4. Blend and then strain the raspberries and return to a clean pan over medium heat.
5. Add the other bloomed gelatin to the berries and whisk until dissolved.
6. Set your jellies mould out on the bench (I just used an ice cube tray) and pour your mixtures into jugs to make pouring easy. You can make them all the same or you can have fun with the layers like I did.
7. Pour your first layer into your mould and place in the refrigerator to set. If you’re concerned about your mixtures setting while you wait, sit your jugs in a warm water bath to keep it liquid.
8. Once your bottom layer has set, gently pour your top layer over and refrigerate to set.
9. Jellies should be fully set after about 4 hours. Store, in a container, in the refrigerator for up to 2 weeks.

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Can Type 2 Diabetes Be Conquered Eating a Ketogenic Diet?

Type 2 Diabetes: A Growing Epidemic

Type 2 Diabetes (T2D) is a chronic metabolic condition that occurs when the body either doesn't produce enough insulin, or it is unable to effectively deliver insulin into cells.

T2D differs from type 1 diabetes in that the body still produces insulin. Because of the defective use of insulin, blood sugar builds up in the blood causing blood sugar levels to rise.

The goal is to consistently achieve normal blood sugar (glucose) levels to minimize risk of diabetes associated complications such as diseases of the eye, heart, nerves, kidney, digestion, feet, gums, blood circulation.

What Are the Risk Factors and Who is Affected by Type 2 Diabetes?

Age, genetics, food choices and environment (activity level, taking medication, etc.) are all factors that can contribute to T2D.

Type 2 diabetes originally coined as adult onset diabetes and its epidemic which has plagued us for over thirty-five years has risen from 108 million in 1980 to 422 million in 2014 (1). Once thought of as an adult disease type 2 has now expanded to include children.

Type 2 diabetes has effected children at the same rate as type 1 in the United States and is growing in other parts of the world: Canada, Japan, Austria, United Kingdom and Germany (2). Japan has seen an approximate fourfold rise in the incidence of type 2 diabetes in 6 to 15 year-olds, and between 8 and 45% of newly presenting children and adolescents in the U.S. have type 2 diabetes (3).

These staggering statistics are not just overwhelming because of the numbers, they are astounding because type 2 diabetes can be avoided and conquered simply with healthy diet and lifestyle choices.

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Image credit: The Lancet

What Are Healthy Blood Sugar Level Ranges?

For those who live with any type of blood sugar disorder (pre-diabetes, diabetes, etc.) the aim is to attain normal fasting blood sugar ranges through diet while minimizing or eliminating diabetes medication that increases the risk of blood sugar fluctuations. The aim is to achieve:

• A1C between 4 to 5.5% (also known as hemoglobin A1c, HbA1c, glycated hemoglobin or glycohemoglobin). A1C tells you your average level of blood sugar over the past 2 to 3 months.
• Blood sugar level below 100 mg/dl (3.6-5.4 mmol/l).

While public associations (American Diabetes association...) and government agencies (World Health Organization) recommend higher ranges for people with diabetes see the chart below (4), pay attention to the note under the table.

If you follow tables such as the one provided by the National Institute for Clinical Excellence (NICE) below, you may be misled into thinking your blood sugar is in a healthy range if it falls in the pre diabetes of 100-125 mg/dl.

	Upon Waking	Before Meals (pre prandial)	90+ Min After Meals (post prandial)
Non-Diabetic	-	4 to 5.9 mmol/L	under 7.8 mmol/L
Type 2 Diabetes	-	4 to 7 mol/L	under 8.5 mmol/L
Type 1 Diabetes	5 to 7 mmol/L	4 to 7 mol/L	5 to 9 mmol/L
Children w/ Type 1 Diabetes	4 to 7 mmol/L	4 to 7 mol/L	5 to 9 mmol/L

Note: The non-diabetic figures are provided for information but are not part of NICE guidelines.

After meal blood sugar range is especially important because it tells you how much that food or meal contributes to the rise in blood sugar otherwise associated with the risk of diabetes complications. So, eating foods that trigger the least blood sugar spike after consumption are the healthiest choices.

To avoid diabetes complications, maintain blood sugar in the non-diabetic normal range. These government recommendations are high if your personal goal is to "cure" your diabetes and stave off associated complications.

Can a Ketogenic Diet Help Put an End to Type 2 Diabetes?

Available treatment options (diet, exercise, medication, and insulin therapy) help keep blood sugar in range. However, none compare to a ketogenic diet.

The ketogenic diet (maximum of 50 grams of total carbs per day) is by far the best blood sugar management tool because the individual is not consuming sugar, or sugar formed through the ingestion of carbohydrate, and therefore excess sugar is not circulating in the blood. In essence the underlying cause of high blood sugar is removed. In fact there are many experts that support this ketogenic approach for treating type 2 diabetes (5, 6, 7, 8, 9).

The Ketogenic Diet Improves Blood Sugar and Cholesterol

Findings from a one-year randomized control study with obese type 2 diabetes volunteers was published in the American Journal of Clinical Nutrition. It compared a < 50 gram carbohydrate, 58% fat diet with a 53% carbohydrate 30% fat diet. Both diets produced weight loss and blood sugar improvements. The ketogenic diet resulted in "greater improvements in the cholesterol, blood sugar stability (vs. fluctuations), and reductions in diabetes medication supporting its use an effective strategy for the optimization of T2D management" (10).

While some may voice concern with the significant drops in blood sugar for those on medication who follow a ketogenic diet, it seems working with a physician to lower and eliminate medication would be wise rather than avoid a natural nutrition plan that can normalize blood sugar levels (11, 12).

How Many Carbs per Day?

When following a ketogenic diet, you should stay below 50 grams of total carbs per day. As evidenced in a study comparing a ketogenic diet (KD) consisting of 20 grams of total carbs a day (unlimited amounts of animal foods , i.e., meat, chicken, turkey, other fowl, fish, shellfish and eggs; limited amounts of hard cheese (e.g., cheddar or Swiss, 4 ounces per day), fresh cheese (e.g., cottage or ricotta, 2 ounces per day), 2 cups of salad vegetables and 1 cup of non-starchy vegetables) with a 55% high carbohydrate but low glycemic index diet (HCLGID).

It seems both had positive effects on blood sugar yet the KD resulted in significant improvements in hemoglobin A1c and body weight and high-density lipoprotein and cholesterol as compared to the HCLGID group (13).

For type 2 diabetes, what you don't eat is as important as what you choose to eat. While it may be confusing to read information from expert nutrition groups suggesting "Carbohydrates-Part of a Healthful Diabetes Diet" (14) understand that no matter what the portion by its very nature carbohydrates will raise blood sugar. This is counterproductive to any healthy blood sugar goal.

How Many Carbs per Meal?

Consume foods containing proteins, fats and carbohydrates with 5-15 grams of carbohydrates per meal (non starchy vegetables, fat full dairy products, nuts and seeds). Keep in mind that large amounts of low carbohydrate foods can spike blood sugar (tomatoes and tomato sauce, winter squash, berries, etc.) just like low amounts of high carbohydrate foods (starchy vegetables, bread, rice, pasta, cereal etc).

Additionally, the diet delivery method (online vs. in person) does not seem to change the ketogenic advantage. Type 2 diabetics improved glycemic control and lost more weight when following an online ketogenic program when compared with a conventional, low-fat diabetes diet online program (15).

Take Home Message

When managing type 2 diabetes, know that monitoring total carbohydrate intake is a critical factor for tight blood sugar control. Consuming less than 50 grams of total carbohydrates on a ketogenic diet, while also paying attention to any carbohydrate portion size, can allow diabetics blood sugar to hit the normal blood sugar range.

The best way to control blood sugar is to avoid sugar and foods that easily convert to sugar after it is consumed, such as carbohydrate foods and beverages, like cereals, bread and bakery products, soda and fruit juice, fruits and starchy veggies (potato, peas and carrots, corn) rice and pasta.

A ketogenic lifestyle is a powerful health optimization tool to help maintain normal blood sugar levels, lower or eliminate medication and reduce the risks of any medical health issues that follow uncontrolled blood sugar.

The KetoDiet App can be a primary resource for those who want to be successful while utilizing a ketogenic diet as a support for weight loss and blood sugar control. To find the recipe within your carb ranges to specify allergy preferences, use the filtering tool in Recipes.

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Sweet & Spicy Chicken Liver Bites

Are you a liver fan? If not you will be after trying these Keto Sweet and Spicy Liver Bites!

Think of these little bites as a cross between bacon wrapped jalapeño poppers (minus the jalapeño) and Millionaire's Bacon. You’ve got the heat from a bit of cayenne and paprika and some sweetness from a bit of Swerve.

Those two flavors combined with the savory bacon and the nutritional powerhouse that’s liver and you’ve got one great snack!

Preparation time

Hands-on:    10 minutes
Overall:     15 minutes

Nutritional values (per serving, 3 pieces)

Total Carbs	1.4	grams
Fiber	0.3	grams
Net Carbs	1	grams
Protein	27.6	grams
Fat	21.1	grams
of which Saturated	7	grams
Energy	309	kcal
Magnesium	32	mg (8% RDA)
Potassium	451	mg (23% EMR)

Macronutrient ratio: Calories from carbs (1%), protein (36%), fat (63%)

Ingredients (makes 4 servings)

• 12 pieces chicken liver (340 g/ 12 oz)
• ½ tsp sea salt
• 12 slices of bacon (450 g/ 1 lb)
• 1 tbsp granulated Swerve or Erythritol (10 g/ 0.4 oz)
• 1 tsp paprika
• ½ tsp cayenne, or to taste
• ½ tsp black pepper

Instructions

1. Preheat your ovens broiler and line a baking sheet with aluminum foil.
2. Sprinkle the chicken livers with salt and wrap each piece in a slice of bacon securing the end with a toothpick or skewer.
3. Mix the remaining spices together... ... and sprinkle both sides of the liver bites.
4. Broil for 6-8 minutes per side rotation occasionally until the bacon is crisp and the livers are cooked through. Serve immediately, or store up to 3 days and reheat as needed.
   

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Low-Carb Vegetarian Nasi Goreng

My healthy low carb take on a flavourful fried rice. Nasi Goreng simply means ‘fried rice’ but over at Keto Diet App we like to do things a little different so we’ve kept the carbs low, ditched all the preservatives and brought you a speedy weeknight dinner that’s packed full of flavour, nutrients and next to no washing up! Bonus!

This one’s vegetarian but feel free to add some cooked prawns, pulled chicken or pork if you prefer.

Preparation time

Hands-on:    20-25 minutes
Overall:     20-25 minutes

Nutritional values (per serving)

Total Carbs	13.6	grams
Fiber	4.8	grams
Net Carbs	8.8	grams
Protein	11.3	grams
Fat	29.9	grams
of which Saturated	11.6	grams
Energy	355	kcal
Magnesium	56	mg (14% RDA)
Potassium	643	mg (32% EMR)

Macronutrient ratio: Calories from carbs (10%), protein (13%), fat (77%)

Ingredients (makes 4 servings)

• 1 small cauliflower, florets only (450 g/ 1 lb)
• 2 tbsp virgin coconut oil (30 ml)
• 1 small yellow onion, chopped (40 g/ 1.8 oz)
• 2 garlic cloves, minced
• 1 small carrot, chopped fine into matchsticks (60 g/ 2.2 oz)
• ⅔ cup shredded savoy cabbage (47 g/ 1.6 oz)
• ½ cup sliced red pepper (46 g/ 1.6 oz)
  

Dressing:

• 1 tbsp extra virgin olive oil (15 ml)
• 2 tbsp toasted sesame oil (30 ml)
• 1 tbsp coconut aminos (15 ml)
• 1 tbsp grated ginger (6 g/ 0.2 oz)
• juice and zest from ½ lime
• 1 tsp chopped chilli pepper
• ½ tsp fish sauce
• salt and pepper, to taste

To serve:

• 4 large eggs
• 1 tbsp ghee or virgin coconut oil (15 ml)
• 2 tbsp chopped coriander
• ½ cup sugar snap peas, finely sliced (30 g/ 1.1 oz)
• ½ cup finely sliced cucumber (60 g/ 2.1 oz)
• handful of blanched almonds (28 g/ 1 oz)
• lime wedges
• salt and pepper, to taste
• Optional: Sriracha hot sauce for topping (you can make your own)

Instructions

1. Preheat the oven to 180 C/ 355 F (fan assisted). Prepare the dressing by mixing all the ingredients together in a small bowl.
2. Peel and finely slice the vegetables into matchsticks. Blitz the cauliflower florets in a high speed food processor until they resemble a rice consistency.
3. Heat 1 tbsp of coconut oil in a saucepan. Add the onion and fry on a low-medium heat for 3 minutes until soft. Add the garlic and fry for another minute. Add the carrot and cabbage and fry for a further 1 to 2 minutes until el dente.
4. Add 1 more tablespoon of coconut oil to the vegetables and stir fry the cauliflower rice altogether for a further 3 to 4 minutes. Stir through the dressing.
   
5. Place the almonds on a baking tray and roast for 5 to 6 minutes until golden. Fry the eggs in a little oil to your liking.
6. Place the cauliflower Nasi Goreng into bowls and top with sugar snap peas, cucumber, coriander, almonds and fried egg. Option to add chilli sauce, black pepper and an extra squeeze of lime. Best enjoyed fresh but can be stored in the fridge for 1 day.

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Are Keto and Low Carb Suitable for People with Thyroid Disease?

Thyroid hormones affect nearly every system in the body and have a profound influence on metabolic rate and overall health. Because of this, conditions such as Hashimoto's thyroiditis can cause symptoms that negatively affect quality of life.

Is a low-carb or keto diet helpful or harmful for people with Hashimoto's disease or other hypothyroid conditions? This article will explore the impact of keto and low-carb diets on thyroid health in different populations, along with providing guidance for optimizing thyroid health.

What Are The Functions of the Thyroid Gland Hormones?

The thyroid is a small, butterfly-shaped gland situated at the front of the base of your neck. It's also been compared to a small bow tie in terms of its shape and location.

The thyroid gland's function is to take the mineral iodine and combine it with the amino acid tyrosine to form monoiodothyronine (T1), diiodothyronine (T2), and the two major hormones, triiodothyronine (T3) and thyroxine (T4). Although the thyroid gland produces more than four times as much T4 as T3, only T3 is considered the "active" form of thyroid hormone responsible for its many effects. Moreover, T4 can be converted to T3.

When needed, T3 and T4 are bound to a protein called thyroid-binding globulin (TBG) and released into the bloodstream to be transported to tissues and organs throughout the body. In the liver and other organs, most of the T4 is converted to T3, which binds to specific receptors in your cells and produces a number of metabolic effects.

However, some of the T4 is converted to reverse triiodothyronine (RT3). RT3 is essentially an inactive "mirror image" of T3 that can bind to the T3 receptor and block its effects. Although the conversion of RT3 is normal, elevated RT3 levels are often seen in times of stress or illness.

In your body's cells, T3:

• Regulates metabolic rate and calorie burning
• Controls body temperature
• Influences heart rate
• Supports brain function
• Influences muscle contraction and retention of muscle mass
• Helps maintain bone health

A number of glands work together to make sure that your body has the right amount of thyroid hormones circulating in its system.

When thyroid hormone levels are too low, your brain's hypothalamus releases thyrotropin-releasing hormone (TRH), which stimulates the adjacent pituitary gland to produce thyroid-stimulating hormone (TSH). TSH then triggers the thyroid gland to increase its production of thyroid hormones and release them into the bloodstream.

By contrast, when circulating thyroid levels are higher than needed, the hypothalamus and pituitary gland produce and release less of these hormones, thereby decreasing the amount of thyroid hormone in the bloodstream.

However, in the case of thyroid disease, this system doesn't function the way it's designed to.

Thyroid Disorders

There are several types of thyroid disorders, but the two most common are Graves' disease and Hashimoto's thyroiditis.

Graves' Disease

Graves' disease is an autoimmune condition in which thyroid-stimulating immunoglobulin (TSI) antibodies cause the thyroid gland to produce more thyroid hormone than needed. Graves' disease is by far the most common underlying cause of hyperthyroidism, or elevated levels of thyroid hormone. Symptoms of hyperthyroidism are typically moderate to severe and include:

• nervousness
• weight loss, despite increased appetite
• difficulty sleeping/insomnia
• hand tremors
• sweating and heat intolerance
• rapid heartbeat
• increased stool frequency
• bulging eyes
• goiter (enlarged thyroid gland)
• decreased menstrual flow or skipped periods

Untreated hyperthyroidism can cause changes in heart rate and rhythm that can potentially be fatal. Graves' disease is treated with radioactive iodine, surgery, and/or antithyroid medication.

Hashimoto's Thyroiditis

Like Graves' disease, Hashimoto's thyroiditis (also known as Hashimoto's disease) is an autoimmune condition. However, instead of making antibodies that trigger the thyroid gland to produce more thyroid hormones, your body makes antibodies that gradually destroy the thyroid gland and impair its ability to make hormones, leading to hypothyroidism. The main antibodies responsible for Hashimoto's are TPO (thyroid peroxidase) antibodies and antithyroglobulin antibodies.

Hashimoto's thyroiditis is the most common cause of primary hypothyroidism, a condition in which the pituitary gland is making adequate TSH but the thyroid gland can't produce enough thyroid hormone in response. It is up to 10 times more common in women than in men, affecting an estimated 1-2% of all women (1). The development of Hashimoto's disease is strongly influenced by genes and environmental factors, such as infections, exposure to certain chemicals and drugs, and nutrient deficiencies.

Although a minority of people with Hashimoto's don't have any noticeable symptoms, most have one or more of the following, which can range from mild to severe:

• sluggishness and fatigue
• weight gain, despite normal or decreased appetite
• increased sensitivity to cold
• difficulty concentrating
• depression
• constipation
• dry skin and hair
• hair loss
• increased menstrual flow
• goiter (enlarged thyroid gland)

During the period of time that the thyroid is being destroyed, people with Hashimoto's may occasionally switch back and forth between symptoms of hypothyroidism and hyperthyroidism. For instance, they may go from being sluggish and gaining weight easily to briefly losing weight despite eating more. Over time, however, the entire system slows down as the thyroid becomes underactive and unable to produce thyroid hormones.

Hashimoto's thyroiditis is typically diagnosed by checking for elevated levels of TPO or antithyroglobulin antibodies in the blood. However, research suggests that although about 5% of people with Hashimoto's don't have thyroid antibodies in the blood, a thyroid ultrasound or biopsy will reflect changes indicative of the disease. These people tend to have milder hypothyroid symptoms than those with elevated TPO or antithyroglobulin antibodies (2).

It's important to have a thorough lab workup done if you suspect you may have thyroid disease. Here is a list of labs that can help identify thyroid issues.

Non-Hashimoto's Hypothyroidism

Some people have hypothyroidism that isn't due to Hashimoto's disease. Although these individuals typically have similar symptoms as those with Hashimoto's, their disease isn't autoimmune in nature.

Causes of non-autoimmune hypothyroidism include:

• abnormal growths of the thyroid gland
• certain medications, including some used to treat cancer, heart disease or depression
• defects in the pituitary or hypothalamus
• genetic defects in thyroid production (rare - usually present at birth or shortly after)

Treatment for Hashimoto's thyroiditis and other types of hypothyroidism include taking thyroid hormone replacement in the form of synthetic T4 (levothyroxine), synthetic T3 (liothyronine sodium), and/or natural porcine (pig) thyroid (Armour, Nature-Throid, or WP Thyroid).

How Do Keto and Low-Carb Diets Affect People With Normal Thyroid Function?

For decades, it's been known that starvation and very-low-calorie diets decrease the level of circulating thyroid hormones in the bloodstream (3, 4).

Low-carb and ketogenic diets have also been found to reduce levels of T3 in the bloodstream. This makes sense, as these diets have often been shown to induce physiological changes similar to fasting (5, 6).

And although a low T3 level alone doesn't indicate hypothyroidism, a recent study suggests that reduced thyroid activity may occur in some susceptible individuals who adopt a very strict keto diet.

In this 2017 study of epileptic children, 20 out of 120 subjects (over 16%) developed hypothyroidism within 6 months of starting a ketogenic diet therapy and were treated with synthetic T4 thyroid hormone (7).

Importantly, the classical ketogenic diet for epilepsy is severely restricted in carbs (typically less than 15 grams per day) and also low in protein. It's unknown whether adding in 10-15 grams of carb and increasing protein intake would have changed the results.

Indeed, decades-old research in healthy people suggests that the magnitude of carb restriction coupled with calorie restriction influences how much T3 levels decline.

For instance, a 1976 study of obese people showed that T3 levels dropped significantly during a carb-free 800-calorie diet but didn't change much on an 800-calorie diet providing at least 50 grams of carbs per day (8).

Yet even when calories aren't restricted, very-low-carb diets often lead to lower T3 levels in the blood. However, studies suggest that physical performance and metabolic rate don't appear to be affected by this reduction in T3 (9, 10, 11).

In one study of overweight type 2 diabetic adults who consumed a diet restricted to less than 20 grams of carbs daily, TSH levels decreased from 1.6 to 1.4 mIU/L, on average. This suggests that the study participants required less thyroid hormone, although T3 wasn't measured. In addition, they experienced several of the beneficial effects typically seen on keto diets, including weight loss and significant improvements in blood glucose control and insulin sensitivity (12).

It's important to note that the studies that have been done have been small and of short duration. It's likely that some people experience considerably greater changes in thyroid hormone levels - and their effects - than others do.

At this time, the impact of ketogenic and very-low-carb diets on long-term thyroid health remains controversial. Dr. Steve Phinney has suggested that being in nutritional ketosis improves thyroid hormone sensitivity, thus allowing the body to function at lower T3 levels. On the other hand, Dr. Atkins often prescribed thyroid hormone replacement for his patients whose thyroid levels dropped during the very-low-carb stages of his diet. And Dr. Cate Shanahan recommends that carb intake be reduced gradually in order to reduce potentially negative effects on thyroid health.

How Do Keto and Low-Carb Diets Affect People With Hashimoto's Disease?

A carb-restricted diet based on whole foods may be beneficial for several autoimmune conditions, including Hashimoto's thyroiditis. In fact, many people with Hashimoto's have reported improvement in symptoms after switching to this way of eating. Unfortunately, there is little formal research on keto and low-carb diets for Hashimoto's at this time. However, what exists is encouraging.

In a 2016 controlled study of 180 people with Hashimoto's disease, one group followed a high-protein, low-carb (12-15% of calories) diet. In addition, this group avoided goitrogens (compounds that interfere with thyroid function), legumes, eggs, dairy products, and gluten. The control group followed a standard low-calorie diet that didn't exclude any specific foods during the same 3-week time period (13). At the end of the study, the low-carb group showed the following improvements:

• a 44% decrease in TPO antibodies
• a 40% decrease in antithyroglobulin antibodies
• a 5% reduction in body weight

By contrast, the low-calorie group experienced a 9% increase in antithyroglobulin antibodies and a 16% increase in TPO antibodies. Additionally, although both groups lost weight, the low-calorie group lost more lean mass and less fat mass compared to the low-carb group.

Case studies also support the use of low-carb diets in diabetic and obese people with Hashimoto's, when used in combination with thyroid hormone replacement (14, 15).

Additionally, avoiding food high in carbs and sugar may be beneficial for digestive issues. One case-control study in 45 people found that 73% of those with Hashimoto's disease displayed evidence of fructose and/or lactose malabsorption that led to symptoms like bloating, cramping, gas, and loose stools (16).

How Low-Carb Should You Go If You Have Hashimoto's Disease?

The low-carb diets consumed by hypothyroid individuals in the studies previously discussed contained between 60-130 grams of total carb per day, which is outside the level of ketosis for most people.

Many clinicians who work with ketogenic diets for weight loss, diabetes, or other conditions recommend that their patients with Hashimoto's avoid a drastically carb-restricted diet of less than 20 grams of total carb per day.

Endocrinologist Dr. Broda Barnes, who spend decades researching thyroid function and worked with hundreds of thyroid patients, recommended a minimum of 30 grams of net carbohydrate (total carbs minus fiber) for individuals with hypothyroidism, in conjunction with thyroid replacement.

If you have Hashimoto's and want to follow a keto diet, it seems wise to avoid extremely severe carb restriction for extended periods of time.

Foods To Avoid or Limit With Hashimoto's Thyroiditis

Avoiding or limiting certain foods if you have Hashimoto's may help reduce symptoms or potentially even slow down disease progression.

Inflammatory Foods

Since certain foods are known to exacerbate autoimmune disease, removing them from your diet or sharply cutting back may potentially lead to improvement in symptoms and/or disease progression.

Here is a list of the most common offenders:

• gluten, in part due to the connection between autoimmune thyroid disease and celiac disease, which is characterized by an inability to absorb gluten
• other grains, especially those that contain gluten, such as wheat, barley, and rye
• legumes, including beans, lentils, and peanuts
• soy

Dr. Izabella Wentz, a pharmacist with Hashimoto's, reports that following the Autoimmune Paleo Diet (AIP) has been successful in helping many of her readers and patients reduce symptoms and thyroid antibodies. However, this approach is quite strict because in addition to the foods above, it excludes eggs, dairy, nuts and seeds, caffeine, and alcohol.

We are all different and what works for one person may not work for another. Start with the basic recommendations to follow a carb-restricted approach and avoid gluten, grains, legumes and soy. If the symptoms persist more than two months after making these changes, consider excluding some or all of the foods listed in the AIP protocol.

Goitrogens

Many plants contain goitrogens, compounds that can interfere with the thyroid's ability to take in iodine and inhibit the action of TPO.

Goitrogens are found in several healthy low-carb vegetables, including:

• bok choy
• broccoli
• Brussels sprouts
• cabbage
• cauliflower
• collard greens
• kale
• spinach

Because they provide antioxidants, micronutrients, and fiber, giving up these vegetables altogether isn't recommended. Fortunately, sufficient iodine intake can counteract the potentially negative effects of goitrogens.

In addition, fermenting, microwaving, steaming, or boiling these vegetables can reduce their goitrogen content by 33-50% or more, depending on the length of cooking time (17).

Nutrients To Focus On With Thyroid Disease Iodine

Because iodine is needed for thyroid hormone creation, getting enough in your diet is crucial. However, extremely high doses of iodine can be problematic as well. In one study, a portion of Danish children and adults who took part in a conservative iodized salt supplementation program were found to be at increased risk of developing autoimmune thyroid disease (18).

The Recommended Dietary Allowance (RDA) for iodine is 150 mcg for most people and 220 mcg for pregnant women.

Supplementing with iodine is a controversial area. While iodine deficiency is more prevalent in developing countries, anyone may become iodine deficient. On the other hand, too much iodine may have negative effects on your thyroid, such as increasing risk of autoimmune thyroiditis or goiter. Some experts recommend that people supplement with iodine because it counteracts the halogens (fluoride, chloride, bromide) that we're exposed to every day. However, others take a more conservative stance and argue that a balanced diet can provide all the iodine the body needs.

The best sources of iodine include seafood and iodized salt, which provides 100 mcg per ¼ teaspoon.

Selenium

Selenium aids in converting T4 into the active thyroid hormone T3. A recent 2017 review concluded that selenium supplementation may be beneficial in those with Hashimoto's thyroiditis who have low selenium blood levels (19). However, this must be coupled with adequate iodine intake.

The recommended daily intake for selenium is 100-400 mcg per day.

The best food source of selenium is Brazil nuts, which provide about 50 mcg apiece, on average. However, Brazil nuts vary in size and selenium content. Additional sources include other nuts, seafood, poultry, and meat, including organs.

Vitamin D

Researchers have shown a link between low vitamin D status and Hashimoto's thyroiditis (19, 20).

In one study, providing high-dose vitamin D therapy to deficient adults with Hashimoto's resulted in normalization of their serum vitamin D levels and a 20% reduction in TPO antibodies (20).

Sun exposure is the best way to increase vitamin D levels naturally. Vitamin D can also be obtained from regular consumption of fatty fish such as mackerel, salmon, and sardines. However, for some people, supplementation may be required in order to maintain serum levels within the optimal range of 30-60 ng/mL.

Take Home Message

Overall, it appears that although low-carb and keto diets reduce levels of thyroid hormones in the blood, this doesn't seem to impact health, ability to lose weight, or energy levels. On the contrary, many people respond to carb restriction with improvements in body composition, vigor, and health markers.

Additionally, a low-carb or ketogenic diet limited in inflammatory foods may be beneficial for those with Hashimoto's disease.

However, extreme carb restriction (ie, less than 20 grams of total carbs daily) on a long-term basis isn't advised for those with autoimmune thyroid disease. It is advisable that individuals with hypothyroidism, consume a minimum of 20 grams of net carbs (total carbs minus fiber) every day.

As with many things in nutrition, the optimal level of carb intake for thyroid health varies from person to person.. Monitoring how you feel and perform, your thyroid hormone levels, and your antibody status can help you create a personalized low-carb lifestyle that is optimal for you.

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