Hacker News Reader

Comment by kirykl | Hacker News Reader

Doing keto long enough however, your kidneys might wear out before your brain

It depends how you do it. My current approach relies on intermittent fasting for 18 hours (save it for coffee and salty water), and accasional 24-36 hours fast (approx every 6-8 weeks). Not a keto diet, but helps with training Ketons.

What salt are you using?

I use my tears when I see a cake I’m not allowed to have

We now have a new demonstration of autophagy.

I laughed, but in all seriousness I too was interested in the amount of salt he's using for this.

I keep tiny containers around to pick some up with the touch of a wet finger a few times a day. Helps me experiment with how much keeps the keto flu at bay. Also frequent MCT oil from a squeeze bottle.

Not OP, but I do a 36-hour fast once a week. I drink black coffee and water, but I mix one very small salt packet (probably no more than 1/2 tsp) in with one 8-oz glass of water around noon for "lunch". For the most part, that does well enough to stave off the next-day side effects.

why salty water? does milk/cream in coffee make it not fasting?

Anything that kicks off your metabolism will make it not fasting.

Isn’t a caloric deficit implicitly fasting though? Guessing there’s number of calories / time formula there.

Any time you eat calories, you're not fasting.

In some paradigms they consider it fasting up to 300kcals a day.

In some paradigms you are not even allowed to drink water and call it fasting.

The word fast means multiple things.

That is certainly the purist view. I just came off a 3 day fast and in that time I had some Benfotiamine, B-50 complex and Magnesium. Despite having zero calories and zero insulin impact they do have an impact on the bodies metabolism so a purist would also say I broke my fast but I reject that reality. Some of the times that I have fasted longer 5 to 7 days I also had Krill Oil (5 calories) and that also would break the fast according to purists. 5 calories are not going to shut off fat burning when I am in a 2700+ calorie/day deficit by BMR. When I actually break my fast I can feel the changes in the gut, mood, Ghrelin production, etc... Admittedly I am basing this entirely on a gut feeling. Either way my end goals are accomplished burning some fat, improving my overall feeling of wellness, improving my sleep, improving my vision so it works for me.

> Anything that kicks off your metabolism will make it not fasting.

That's the key part. Black coffee is key. I also sometimes go with tea or fruit infused water.

What kind of salt to water ratio do you use, just out of curiosity because I've been doing intermittent fasting for a while now.

I don't really measure it as I tune by taste these days. I usually soak a piece of lime/lemon overnight, and sometimes I add ginger or cumumber and a generous sprinkle of salt to a big water jar. I tried some of the other minerals additives, but really didn't feel lots of added value, so defaulted to pure salt.

Last I read, the evidence that fasting is beneficial beyond the caloric restriction is controversial at best. I would like to see you back up the claim with strong evidence.

> A Systematic Review and Meta-Analysis of Randomized Clinical Trials

>"despite these short-term benefits, FBS did not show superior long-term outcomes compared to CCR."

https://pubmed.ncbi.nlm.nih.gov/39458528/

From the same article abstract:

>However, [fasting-based strategies] improved insulin sensitivity, with significant reductions in fasting insulin (-7.46 pmol/L, p = 0.02) and HOMA-IR (-0.14, p = 0.02)

You can expect different modes between fasting and caloric restriction. You might even consider one mode "better", but what is missing is any evidence that it leads to difference in outcomes.

For a healthy individual it might not make a difference, but increased insulin sensitivity may help in (pre-)diabetics for instance.

>Studies have shown intermittent energy restriction to be efficacious in preventing and managing prediabetes and DM, with remarkable improvements in the metabolic and cardiovascular biomarkers of individuals with DM.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9534344/

Losing weight is only a bonus for me, you could lose weight by following a diet that exclusively consists of eating a cube of sugar every XX minutes if you wanted to. Where fasting shines is that it helps control hunger and energy levels. A normal person in the west is basically always in a fed state (bf, lunch, snack, dinner) to the point it's hard for most people to differentiate thirst from hunger from boredom.

I noticed this right away when I was fasting occasionally. I couldn't remember the last time I felt hungry! And after a bit, it was easy to differentiate "Primed to eat" from "Actually hungry", as well. We're creatures of habit.

Part of the reason I do ramadan as a non-muslim. There's something powerful in restricting your flesh for a period of time every year to reset things.

That is fair, there's a mental component that is hard to measure. For me, eliminating carbs from meals was much easier than fasting.

From what I’ve read fasting is more of an intervention for metabolic issues, helping to reduce insulin levels more dramatically. The study you linked to seems to support this.

> However, FBS improved insulin sensitivity, with significant reductions in fasting insulin

The issue, and why I think we’ve seen several high profile fasting advocates stop, is because they weren’t metabolically unhealthy, but were on extreme fasting protocols as if they were.

The way I read it, if you’re significantly overweight and have high insulin levels (type 2 diabetes or pre-diabetes), fasting can help get things under control quickly. However, once a person has regained metabolic flexibility and health, moving to something more balanced is likely a good idea. Just avoiding going back to a lifestyle that leads to chronically high insulin levels. Some amount of fasting probably makes sense, as has been practiced by most major religions in some form for thousands of years, but not to the same extreme as during the intervention.

There's entire books about this, and how insulin resistance / insulin "overdoses" are implicated in most metabolic disorders and obesity (above and beyond CI/CO energetics) and how Alzheimers is kind of just type 3 diabetes.

Try Outlive (very good) and Obesity Code (not bad so far - I'm 3 chapters in).

I've seen conflicting evidence that fasting triggers autophagy as well - I've seen some that suggest that it starts after just 18 hours and some that you'd have to fast for a week before you'd actually see autophagy kick in.

The milk in coffee is a pretty substantial number of calories, particularly if you have a programmer coffee habit.

> does milk/cream in coffee make it not fasting

almost certainly yes, that breaks the fasting .. milk specifically is fed by mothers to their young to gain weight a.k.a. not fasting

Wondering is there anything else I can put into coffee without breaking the fast? Thanks.

It seems like some people regard small amounts of fat to be allowable, specifically a bit of coconut oil in your coffee. At least it won't break the fasting of the carb processing machinery, so it shouldn't prevent you from going into ketosis.

Thanks! I will try out coconut oil later.

You're welcome!

Just keep in mind there's not much research about how this may change metabolism compared to a strict fast.

It may reduce any desired autophagy effects, which are unfortunately not very well-studied in the first place, but it may just es well increase them! I've seen both POVs argued in various articles.

The only actual scientific study I can find (1) does show some interesting effects on various metabolic markers, though (in rats).

1. https://pubmed.ncbi.nlm.nih.gov/38401196/

I hear this from barely healthy people all the time. Omg you're having too much lemon juice, too much salt, too much meat, too much butter, too much stinging nettle tea, skipping too many meals, on and on and on. Yet anyone I finally convince to eat like be literally changes their entire life so positively their entire world view and opinions about the medical field and government changes. Oh yes I'll worry about my kidney because I've stopped ingesting health destroying chemicals in basically all mass food, and focused on beef and fasting.

The government?

The government shapes diets both through guidance (food pyramid, “plates”, etc) and regulation. For example, a major criticism revolves around farm bill payouts that incentivize corn production, leading to cheap fructose that finds its way into everything.

Where does the buck stop, in this matter?

Removing Iowa as the first state in the primary season.

The FDA claims a sedentary 40 year old man needs 2400 calories a day, the same as a 17 year old incidentally. [1] Or that everybody just needs 50g of protein a day. [2] Then there's the fat vs sugar food pyramid nonsense that led to more than half a century of health degradation.

[1] - https://www.fda.gov/media/112972/download

[2] - https://www.fda.gov/food/nutrition-facts-label/daily-value-n...

2400 calories is very rational number, considering that Americans eat around 3800 on average.

I thought you were pulling numbers out of your magic hat.

It seems true. Sorry for doubting you.

https://www.usatoday.com/story/news/health/2024/10/14/weight...

I guess the 2400 for middle aged people is not that far off if in the 60s the average was right around there and people were healthier.

I'm about to say something that is easy to dismiss as bullshit, so feel free to, but you're right, people were healthier in terms of weight in the 60s, and right around that is when we changed dietary guidance to be carb-focused, low fat, etc. Since then, obesity has skyrocketed. The book Obesity Code covers this.

As sibling comments have pointed out, 3800 is availability, not consumption, so it's not an indicator of how much people do eat, just how much they could eat.

You can see it if you watch any US documentary filmed before the late 70s that shows ordinary people in the street. They're much fitter, and exercise for weight loss wasn't really a thing yet; people didn't jog. That's not far enough back that everyone was a farmer or laborer; there were plenty of fairly sedentary office workers. They also weren't starving; it was a prosperous time. They were generally eating meat-and-potatoes diets with plenty of animals fats (I have a 1960s barbeque cookbook that tells you to put a pat of butter on pretty much everything). And obesity wasn't a problem.

And since we started letting the government tell us how to eat healthy, not only has obesity skyrocketed, but so have diseases connected with it.

My parents were vegetarians in the 80s, also no weight issues. I don't believe it's carbs or seed oils or any of the modern scapegoats. Since they were eating plenty of that. They even had cake.

I think it doesn't matter what you eat as long as it isn't super processed. The one thing that's changed a lot in the 90s is more and more convenience food.

"processed" is also a modern scapegoat, unfortunately.

But all three are correct, I think: Food has gotten more laden with sugar, seed oils, and carbs because it's processed to be that way after we tried to go Low Fat for so long.

A conscientious vegetarian is probably eating damn near an ideal diet by avoiding all that.

But they were eating plenty of seed oils, and sugar in cake, and loads of bread.

So mostly carbs, but with a lot of fiber. It just goes counter to the current trend in major ways. I looked through the old cookbooks. The biggest difference is no processed foods. And maybe less microplastics.

It's hard to really appreciate how many calories are added to things like bread, just by virtue of changing the recipe to be more "USA tasty" (e.g., sugary). My EU friends always commented on how sweet everything is in USA, even store-bought bread. If we didn't do that, when we started reducing fat, everything would taste like hardtack. But 200 extra sneaky calories a day + insulin spikes from the refined carbs, and here we are - all fat.

That's true, "bread" in the US is atrocious. I recommend flour, water, salt, yeast. Amazing book if you want to get into home baking.

3800 on average?! What the hell. Makes me wonder why Americans aren't even more overweight than they already are.

The 3800 number was from the media misunderstanding/misrepresenting the data. The 3800 is calorie availability, not consumption. With calorie availability you take absolutely all food produced/imported and then divide by the population size. There's no reduction for waste, spoilage, inedibility, etc. [1]

Americans aren't eating anywhere near 3800 calories on average. 2400 calories is already a massive amount of food. That's 15 100g servings of chicken breast (cooked weight) for some baseline of what it means in terms of healthy food. Obviously lots of people are eating lots of junk that makes it easy to bring up the consumption, but it's still nowhere near 3800 on average.

[1] - https://www.ers.usda.gov/data-products/food-availability-per...

Using unseasoned cooked chicken breast as your proxy for healthy food is...less absurd than using grapefruit would be, but not as much as you might think.

At least add like a quarter teaspoon of olive oil, an eighth of a cup of whole grain rice, and a side of like some sweet potatoes with its own seasoning or something.

Straight chicken breasts is like the meme level of what celebrities have to eat to maintain their figure, not what a reasonable human diet looks like. Chicken thighs with the skin on are reasonably healthy.

2400 is a massive amount of food ... for some people. This is why averages are pointless as recommendations.

I'm 6'3", 200 lbs, I lift and I run - I would be in a caloric deficit at 2400 calories.

My wife would be in a huge surplus.

Hey man, we really need eight potatoes a day, ok.

That 2400 number?

It is an average. A guideline. And most countries give an average or range. And the US isn't the highest here: The official recommended averages I found after moving to Norway were higher than in the US and much more reasonable to keep to. (I'm female, my averages are lower).

That doesn't mean that the food pyramid is a good thing or that we've been giving good health advice. It also doesn't mean that our health advice is all that good now. We know more than we did before, but nutrition science seems tricky to do and even trickier to communicate well with the general public in ways that most people can follow. And that's before the disinformation from business interests and dealing with outright scams and lies.

Here's the thing: It may be that 2400 calories would take the average 40 year old male and only have him continue the socially acceptable weight gain of a few lbs a year. Or maybe the average (already overweight) male would maintain his weight at 2400 calories.

But in any sane world, that's like the 90th percentile of calories required when consumed with a carb-heavy american diet and I'd argue almost no sedentary person requires that much. Just plugging in the basal metabolic rate numbers gets something well below that.

Norwegian Institute of Health has a calorie calculator[1] based on scientific studies.

For a 40 yo male, 180 cm (5' 10") high and weighing 80 kg (176 punds), it spits out 1800 kcal at complete rest.

That then gets multiplied by a factor of 1.4-1.5 if you're a sedatary office worker, resulting in around 2400-2500 kcal.

This number is for maintaing weight. I used the calculator to find my 500 kcal deficit to lose weight, and based on my actual losses it seems quite accurate.

[1]: https://nhi.no/skjema-og-kalkulatorer/kalkulatorer/diverse/b...

I ran similar numbers and experiments over and over. In the end I found composition and "starting weight" matters quite a lot. https://jodavaho.io/tags/diet.html

You can easily go +/- 5-10 lbs at my height, just by choosing carbs over protein or fat, and it's not "Fat loss" or body composition, it's water weight associated with converting carbs to something your body can use.

Then a fast day drops you another 5-10 lbs for opposite reasons + burning glycogen stores. And that >10% swing in body "weight" is just noise on the calorie estimates if you plug it directly into such a calculator.

(as an example, if I choose 2000 calories of carb-heavy foods, I will weigh more, increasing my calorie "budget" to maintain weight b/c I eat more carbs, producing a higher weight, further increasing my calorie "budget", etc etc).

I can find 2200 for my 2 meter height, or 2500, or 1800, depending on input weight, and since input weight varies by day, and by caloric intake (due to food weight, water weight, and weight gain), it's not reliable to say the "average" person is healthy with 2400 calories. Because perhaps that person should be eating different foods or have 10 lbs less bodyfat to begin with!

I find you have to reverse-engineer it given what you know to be a healthy weight including muscle and fat composition.

> the medical field and government

Nothing about industries that have captured legislature?

Bayer/Monsanto (pesticide exposure, water contamination, cancer risk), Tyson Foods (antibiotic resistance, air and water pollution, respiratory illness), American Crystal Sugar Company (obesity, diabetes, heart disease), Koch Industries (pollution, weakened environmental standards), ADM (antibiotic resistance, pollution), Bunge Ltd (antibiotic resistance, pollution), Nutrien (fertilizer runoff, water contamination, cancer risk), Corteva (pesticide exposure, water contamination, cancer risk).

This is so on point, the big money in ag is pushing a lot of these conspiracies. If that's your argument for your diet, it's a shaky one.

I will go that far to admit I don't know what's the healthy diet in the end, because there's too much industry influence anywhere you look.

Beyond things that are provably carcinogen and specific genetic deficiencies its just calories. Every diet looks better compared to the standard American slop, but when tested against reducing caloric intake, every diet looks like the null distribution.

Dont be fooled. Just eat sensibly in amount and composition.

The composition of those calories impacts hormones in the body. Hormones do matter. If for nothing else, making it easier or more difficult to actually stay within that caloric budget.

Are eggs healthy this week?

We do seem to be in a pretty persistent anti-carb phase of diet culture, I wonder when we'll go back to low-fat.

Did you know that if you replace coffee with water in the morning, you can remove up to 95% of what little joy you had when you woke up?

I only recently tried coffee for the first time in my 40s. I didn’t understand the appeal, but I suppose it’s an acquired taste.

What I’ve seen over the years from occasionally being around coffee drinkers in the morning didn’t look like joy. It looked like addicts, unable to function and singularly focused, until they acquired coffee in the morning. When outside of their normal environment with quick and easy coffee, this seemed like an annoying burden to deal with.

I had a caffeine addiction from soda when I was in high school, which I broke in college. It led to chronic headaches if I didn’t have enough. In high school I didn’t put 2 and 2 together to know why I was getting the headaches and my dad was trying to push to take me to a neurologist.

Nothing about my experience with was joyful, nor has it looked like joy when someone wakes up in an unfamiliar city and is frantically looking for the nearest cup of coffee before they can talk about anything else. I’ve seen this from multiple people on multiple occasions.

Those people were addicts, and not by a bit but deep into it. They should first realize their condition and then apply measures to get out of the hole. I bet they also had very poor sleep quality (regardless of length).

Like crack addicts longing for their dose, I've also seen people not able to work as functional adults until they get their precious morning coffee shot, and when on holidays their company ends up becoming a burden, not able to improvise, not able to stay in uncommon situations without a coffee brewer nearby for a couple days.

I'm a coffee drinker, and I take it around 2 to 3 times a week. To be honest, it takes effort to reach those addiction levels; I don't think it can happen without taking coffee every. single. day., which seems way too much honestly. Like "needing to drink hard alcohol every day seems odd"-levels of wrong.

Coffee addict here. Like any addiction, the ritual is the scaffolding on which the whole thing is built. Sure, I'd get a headache or be groggy without it at first, but having an excuse to sit and sip a warm beverage for 15-30 minutes has become a peace-creating space for myself to think and prepare. When I go on vacation, it's much less important or pressing, because that ritual is broken. There are seldom adverse effects in those situations when avoiding coffee.

There's nothing about this that requires coffee, but habits require primers and repetition, and starting coffee is that primer, and the socially accepted aspect of it maintains those boundaries so it can be repeated. When we go on vacation, it all goes away.

I used to smoke cigarettes as a young kid, and 90% of the reinforcement of that was the ritualistic work smoke break where you sat and bullshitted with coworkers or friends outside for 15 minutes. Without that, the habit broke easily because smoking didn't actually reinforce or be reinforced by anything joyful.

It is easy to look down ones nose at coffee drinking, but the core tie is rarely some crippling physical addiction so much as a ritual that is itself enjoyable, and we all have those. Any guidance on breaking addiction usually centers on the rituals you've created around your substance.

> when on holidays their company ends up becoming a burden, not able to improvise, not able to stay in uncommon situations without a coffee brewer nearby for a couple days.

Exactly. This is why it was so memorable. They made their coffee problem my problem as well. Suddenly the entire morning was a frantic search for coffee. It’s not exactly the vibe I’m going for in the morning.

Same with alcohol too.

>I didn’t understand the appeal

My personal appeals are the anticipation of the next dose, and the initial rush I get from it. I feel smart, motivated, and capable during this rush.

Aside from this, I think the smell is great and I really like it cold, with a lot of milk. I quenches my thirst like nothing else.

> What I’ve seen over the years from occasionally being around coffee drinkers in the morning didn’t look like joy. It looked like addicts, unable to function and singularly focused, until they acquired coffee in the morning. When outside of their normal environment with quick and easy coffee, this seemed like an annoying burden to deal with.

It's shocked me that this view isn't more common. Caffeine dependence often looks like addiction to me too, and I honestly don't think it should be as normalized as it is. People should know what they are getting into before they get hooked on the stuff.

I'm personally somewhat dependent on ADHD meds, but at least I've known that and made an informed decision. If I stop them suddenly, it takes me around a week to return to normal-ish levels of energy, but other than that I don't have any headaches or pain or anything. I think for me that's more than acceptable.

I like this saying a lot, but I have found the opposite by experience. I stopped drinking coffee recently, and frankly, I found that coffee didn't add much positives to me, aside from the feeling of looking forward to drug myself. The evaluation of its effects after ingestion is bleak - my mood improved after 10 minutes for like 30-60 mins, then I was back to my normal feelings. I sweat a lot more, was more jittery, and much more irritable throughout my entire rest of the day. Which I didn't even know about, since I have been taking caffeine daily for 20+ years now.

Swinging from one extreme to another without a good research to back it up, always a sign for a good long term move for sure. But its good, please do some research on your body for the rest of mankind, we thank and salute you. I just hope you get your meat consistently in standards that pretty much surpass what we consider "bio" in say EU or Switzerland in most aspects.

You know, there is some middle ground. In southern Europe, people have consistently healthy diets without resorting to such extremes, while eating food that tastes massively better than what a general US consumers buy / are willing to spend money on.

I just returned from 1 week vacation in Italy, thats always a trip to a small universe of healthy gourmet food. That experience is unfortunately not very transferable outside country borders but can serve as great inspiration - ie pasta ins't very healthy unless cooked al dente, then it becomes much better for the body.

> ie pasta ins't very healthy unless cooked al dente, then it becomes much better for the body

That sounds absurd. I think you have been lied to.

Al dente pasta has a lower glycemic index than more cooked pasta (which logically makes sense), thus it can be better for you in that context.

So how many people have you finally convinced to "eat like be"? And what age are you?

Live long enough and you turn to dust I guess.

Joni Ernst already proved just how unpopular this line of rhetoric can be.

It's not the fact that we turn to dust -- we all understand that; but denying healthcare because you're gonna die anyway is messed up.

You have to deny healthcare at a certain point because there will always be resources you could throw at someone to extend life span. Where do you stop? We already have the means to help people live longer than we do but don't do it for everyone because how are you going to pay for that at scale? Or do you mean you just want healthcare paid for at the level that you in particular believe it should be?

You're not wrong. Ultimately the discussion boils down to whose values are we prioritizing by allocating society's resources. In the interest of supporting a culture of agency and self-determination the society should* be supporting the decisions of those most affected first.

* I hate the word "should" but in this case we are already contextualized within an implied value system so it is used in a simple determinative manner.

You're acting like DNRs don't exist.

People aren't hanging around consuming more and more healthcare for diminishing outcomes. Instead they're suffering long term or permanent problems from the US denying prompt, proven interventions.

The problem you're talking about doesn't exist.

It's effectively agreed upon that "heroic measures" while approaching EOL are both a bad use of funds and also of questionable value to the patient.

That said, the OP context was about denying healthcare to "the poors". Period. It has nothing to do with the slippery slope of "lost causes".

Bear in mind that the OP's political party is stridently against any sort of public health care options, and that's what is driving her stance.

Well humans don't seem to really learn anything that spans more than a generation or two, so there's plenty of time.

That's just the current culture, plenty of historical society's were more stable.

Ah, well, we will never see that again short of a Carrington event.

Technology is moving faster than any human or our societies can keep up with, and that is compounding over and over again.

I aspire to the "One Hoss Shay" approach. [0] Nothing is unnecessarily overbuilt, so everything works perfectly for a hundred years... then it all collapses to dust simultaneously. :P

[0] https://www.gutenberg.org/files/45280/45280-h/45280-h.htm

That was nearly my great-grandfather. Completely healthy until he was 103. Didn’t need glasses, walked without support, lived alone, completely there mentally and had a fantastic memory. Then he got shingles which affected his throat so eating was painful. He was dead two weeks later. Went from completely healthy to dead practically overnight.

Many people don't realise how evil and terrible shingles can be, thinking "oh it's just itchy skin." No. It is much, much worse than that, and it's very painful as well.

or your heart: https://drstanfield.com/blogs/articles/lean-mass-hyper-respo...

That has been a concern of mine. What is the latest on that?

I'm not sure what the stats are, but my anecdote is that two family members who did long term keto have both developed permanent renal problems in their 60s. They can now eat only very little protein.

The one person's Dr. told her that the main issue is that she was eating way too much protein. Which might mean she wasn't doing Keto quite right. But I don't know enough about the diet myself to say for sure.

Thanks, that's very interesting.

I was concerned about that and had my liver checked a couple of years ago but it might have been too early then. I'll brush up on that.

The kidney is the organ that deals with the nitrogen waste from proteins.

My guess would be this is just nonsense.

No one has an eating too much protein problem. The average person has a sitting on their ass problem that leads to all kinds of health issues, especially when combined with a too many calorie problem.

There is absolutely no evidence that long term high protein consumption leads to these things.

My anecdote is that I was diagnosed with stage 3 kidney disease, likely as a result of years of very high blood pressure. Four years later, using medication to get the blood pressure down to near-normal, and following a high-fat/keto diet, my kidneys were operating perfectly in the normal range. (I didn't tell my doctor about my diet, because I needed him to prescribe the BP meds and didn't want him nagging me about diet. One mention of "healthy grains" was enough.)

The "your kidneys will fall out" nonsense has been circulating since I first started hanging out on alt.support.diet.low-carb in the mid-90s. Probably since Atkins first published his book. It's superstition.

That's a myth.

Also high protein consumption is not a problem for kidneys.

There was a lot of bad science, this "protein is bad for the kidneys" comes from people who already had kidney issues from other reason beforehand, not from healthy people.

Reply on news.ycombinator.com