Dr. Amy Nett: A couple of different things here: Number one, I guess some of my questions would be, how old is the patient? Female or male? What’s their adrenal status? We’ve talked a lot about being cautious with low-carbohydrate diets and intermittent fasting. They’re not for everyone. Additionally you need to differentiate intermittent fasting from a ketogenic diet. These are two different things. Intermittent fast might be something just like having a fast of maybe 14 to 18 hours, where you’re not necessarily going to be using ketones. A lot of us have glycogen stores to run for maybe three days or longer without switching into ketosis, and I think we mentioned that some people can take about two weeks to sort of adjust their cellular machinery, their mitochondria to be able to utilize ketones. You mentioned that they did the diet for seven days. Again, I wouldn’t necessarily encourage a ketogenic diet unless this person has multiple sclerosis or severe morbid obesity with type 2 diabetes. There are very few times when I would advocate a ketogenic diet. That said, it often takes people about two weeks to get into ketosis, so I don’t think you have enough information after only seven days. If you do have a good indication for them to be doing a ketogenic diet, they probably need to follow that diet for about 14 days.
You’re mentioning some of the characteristic findings that people mention as they try to get into ketosis. They can feel like they have the flu, a little bit of brain fog. It’s not particularly enjoyable for a lot of people, so you want to think about whether or not there’s really a therapeutic benefit. If you want to help them get into ketosis, certainly again they need to be very careful. It’s hard to follow that low of a carbohydrate diet. You may want to review what they were talking about. You might want to have them using MCT oil. You can think about certain types of fats to help them get into ketosis. I have to remember if we have a handout on ketogenic diets because there’s also an amino acid that you can have patients take to help them get into ketosis. I think it’s leucine, but I’d have to double check that one.
Again, if there’s a good therapeutic reason and their adrenals can tolerate it, look at how many carbohydrates they’re actually taking in, recommend that it may take them two weeks to switch over to ketosis, and look at using something like MCT oil and, I think, leucine, but again, I’d have to double check that one. Also remember that intermittent fasting is not ketosis, so if someone doesn’t do well with a ketogenic diet, they might still be able to utilize intermittent fasting, but again, they still need to have their adrenals on board to be able to do that, and even intermittent fasting is not for everyone.