Ketogenic Diet

For right now, those interested in learning more about the ketogenic (modified Atkins Diet: MAD) should visit www.charliefoundation.org and adsk to join the facebook group "Living Well with Prader-Willi Syndrome." I will transfer info from the site to this page as best as I can.

Track Diet

Diet software for calorie counting and weight loss - DietOrganizer www.dietorganizer.com

Please note that you want the Windows or Mac -desktop- version, NOT the iPhone version because it doesn't track vitamins and minerals. Unfortunately, it also doesn't sync with the PC versions.

Fluid Loss

No, it's different from dehydration and has to do with the natural diuretic effect of low carb diets. I'll try to explain.

Higher carbohydrate diets where blood sugar and insulin commonly spike after meals cause a considerable amount of water retention in the body through 3 mechanisms -

(1) The body stores excess dietary carbohydrates in two main ways - as fat in fat cells and as glycogen in muscles (up to 300 grams in adults depending on muscle size) and the liver (around 100-120 grams in adults). Glycogen is stored in liver and muscle cells along with water at a rate of around 3-4 grams of water for every gram of glycogen.

(2) In addition, the elevated insulin levels typical of excessive carbohydrate intake cause water retention by inhibiting sodium excretion by the kidneys.

(3) The chronically elevated insulin levels associated with excessive carb intake also cause chronic subclinical inflammation throughout the body and brain which in turn also causes water retention (similar to how one's throat becomes swollen when it is inflamed by a strep infection).

When carb intake is significantly restricted as with a ketogenic diet, all of that excess water is released for elimination by the kidneys, for example, as glycogen stores are used for energy production, the associated water is released for elimination by the kidneys as urine. Similarly, as chronically elevated insulin levels drop due to reduced carb intake, more water is released for elimination because insulin is no longer causing the kidneys to hold onto too much sodium, and even more water is released when the systemic inflammation caused by chronically elevated insulin is reduced.

Electrolytes such as sodium and potassium are also lost in urine when all of that excess water is released and turned into urine by the kidneys. It can sometimes happen that too much sodium and potassium are lost if a large amount of excess water is released over a short period of time, for example, when someone who is overweight and insulin resistant radically changes their diet overnight from high carb intake to just 10-20 grams of carbs per day. The resulting electrolyte imbalance can cause symptoms such as foggy thinking, fatigue, sleepiness, muscle weakness and cramps, headache and nausea that low carb dieters call "keto flu." Parents starting children on the modified Atkins diet (MAD) therefore need to carefully monitor the child for those symptoms, especially during the first week and if the child was previously on a relatively high carb diet. Ensuring that children have adequate electrolyte intake is one of the reasons why I keep suggesting that parents use a diet tracking and analysis program.

"Keto flu" can be avoided (and of milder cases treated) by replenishing electrolytes, especially sodium. Ways to do that include -

• Drinking 1-2 cups of bouillon each day during the first week or so when starting the MAD.
• Using moderate amounts of salt and/or a potassium chloride salt substitute such NoSalt, LoSalt, Lite Salt, AlsoSalt, etc. on food. (Note that those with kidney or heart failure or diabetes should not use salt substitutes except under medical supervision.)
• Electro-Mix (www.vitacost.com/emergen-c-electro-mix) is zero carb and comes in individual packets of powder that are mixed with water (I mix it in a 20 oz water bottle) and provide a good amount of potassium as well as some calcium. I usually add 1/4 tsp of salt to it. Lara reports that Kian doesn't like it, I find it smells more lemon-lime than it tastes and can be mixed with other things without noticeably affecting their taste.
• Regular V8 juice has a good amount of both sodium and potassium, I use it diluted 1:4 with water (i.e., 4 oz of V8 juice with 16 oz of water) and sip it throughout the day.
• Low sodium V8 juice replaces some of the salt in regular V8 juice with potassium chloride, so it is a great source of potassium. I usually add about 1/4 tsp of regular salt to increase its sodium content. (I live in the desert where getting enough salt is especially important during the summer.)
• Avocados are a great source of potassium.
• Magnesium supplements can be used if diet analysis shows that its intake is low.