In this chapter we look at some of the common health concerns that may arise when Banting or following the LCHF lifestyle.
Otherwise known as carb flu, low-carb flu or induction flu, keto flu is basically carbohydrate withdrawal. It is common to hear beginner Banters complain about feeling pretty awful. Symptoms can include dull headaches, fatigue, dizziness, moodiness and aching joints. Some people describe feeling as if they are in a mental ‘fog’.
The degree to which people experience keto flu varies from person to person. Some feel a little under the weather for only a day or two, but others may take a few weeks to adapt. Some become convinced during this phase that they are unable to function without significant carbohydrates and throw in the towel. If you know what to expect, you can minimise the effects and push through.
Let’s face it, any major dietary or lifestyle change is bound to shake you up. For the better part of your life your body has been feeding off a significant quantity of carbohydrates, probably processed and sugar laden. Your body has adapted to these foods and switching fuel sources is going to throw things for a loop. There are two possible causes of keto flu. The first is a result of this adaptation to a different fuel source. Basically, your body is used to employing readily available glucose from carbohydrates and is now being forced to create glucose from protein and fat. This adaptation is perfectly natural, although somewhat complex, and it can take some time to work efficiently. One way of helping this adaptation process is to reduce your carbohydrate intake slowly. Instead of reducing your carbohydrate intake to 25 grams immediately, start at 150 grams and gradually reduce over a couple of weeks. This can easily be done by initially eating foods off the Orange Food List, such as sweet potato, butternut and fruit.
The second possible cause of keto flu is an imbalance in electrolytes. When we follow a low-carb diet, we experience a rapid reduction in our insulin levels. We know that excess insulin makes us store fat, but that’s not all. Excess insulin also makes the kidneys retain fluid, which is why many overweight people have oedematous legs (legs swollen with fluid). As insulin levels fall, the kidneys no longer retain the extra fluid and instead release it. It is common to hear new Banters talk about how often they need to visit the toilet! This is a good thing, but with this loss of fluid comes loss of sodium. As sodium is an essential electrolyte, it doesn’t take long before the loss of it in our body causes symptoms such as headaches, cramping and postural hypotension – a drop in blood pressure resulting from a change in posture (as you stand up from a seated or lying position, your blood pressure may fall, resulting in you feeling faint). This is easily rectified by taking in more sodium in the form of salt and drinking more water. Salt, you ask? Just like we need to get our heads around eating saturated fat, we need to understand that salt on a low-carb diet is not only good, it is necessary. Don’t use regular table salt, which has been refined, bleached and processed into almost pure sodium chloride and usually has anti-caking agents added. Rather get some Himalayan or Celtic salt, or any other pink or grey natural salt. These salts contain about 70 per cent sodium; the other 30 per cent is made up of other minerals and micronutrients, including iodine.
Another mineral we need to replace is potassium. Potassium is linked to sodium, so when you lose sodium, you lose potassium. Keeping up your sodium intake will automatically preserve some of your potassium, but you may need to supplement as well. Over-the-counter potassium supplements are fine, but if you are taking any medication for high blood pressure, you need to check with your doctor first.
While we’re replacing minerals, another important one that you may need to take is magnesium. A low-carb diet does not deplete magnesium in the same way it depletes sodium and potassium, but people who are overweight, insulin resistant or diabetic are generally deficient in magnesium. In fact, most people are probably magnesium deficient. It is estimated that approximately 70 per cent of us do not get the recommended daily intake of magnesium. Magnesium is a mineral used by every organ in your body in over 300 different chemical reactions. A shortage of magnesium can therefore cause problems. One of the most common is an increase in cravings. Often simply replenishing magnesium gets rid of many of the food cravings we have. The easiest way to get magnesium is from supplements – we will discuss all the necessary supplements in more detail a bit later.
One of the best ways to get these electrolytes is by consuming home-made bone broth. In countries where bone broth is commercially available, it is not as nutritious as the broth you can make at home. It does require a little time and the best way is to use a slow-cooker, but you can make it in bulk and freeze it. This can be a lifesaver in the first couple of weeks of Banting, and it also makes a great hot drink on a cold winter’s day. See page 238 for a recipe.
A final tip for combating the dreaded keto flu is to stay well hydrated. As excess fluid is flushed from the body when you start a low-carb diet, you can easily become a little dehydrated. There is no need to overdo the water intake, but keep in mind that the body is largely made up of water and it is essential for life. There are varying recommendations as to how much water we should drink, but, in truth, your water needs depend on many factors, including your health, how active you are and where you live. Generally, if you drink enough fluid so that you rarely feel thirsty and your urine is colourless or light yellow and measures approximately 1.5 litres per day (just estimate!), your fluid intake is probably adequate.
As we have already seen, ‘all that fat’ is not as much fat as you think. The reason people worry about eating fat after having their gallbladder removed is because they don’t realise that the liver actually produces bile. Bile has two important functions. It assists in the digestion and absorption of fats, and it is responsible for the elimination of certain waste products from the body, particularly haemoglobin from destroyed red blood cells and excess cholesterol. Bile flows out of the liver through a duct that joins with another duct coming from the gallbladder. Between meals, bile salts are stored in the gallbladder, and only a small amount of bile flows into the intestine. Food that enters the duodenum (the section of the small intestine immediately beyond the stomach) triggers hormonal and nerve signals that cause the gallbladder to contract. As a result, bile flows into the duodenum and mixes with the food.
When we remove the gallbladder, we remove the reservoir, but bile is still being produced by the liver. Instead of being stored, the bile is simply delivered directly into the small intestine. This means that when we eat fat, there is no bolus delivery of bile as there would have been from the gallbladder, but there is still bile available for fat digestion.
In the first few weeks after surgery to remove the gallbladder, it will probably be recommended to you to eat a low-fat diet while your body adjusts. Most people, however, do not notice any change in their digestion and do fine on Banting.
If you are nervous about changing your diet, we recommend that you try small servings of fatty foods to begin with.
Research indicates that it’s not the consumption of too much fat that causes gallstones, but too little fat. Contrary to what we’ve been told, it’s a diet high in grains, sugar and starch that leads to gallbladder problems.
We have seen that the purpose of the gallbladder is to store bile that it receives from the liver. When a fatty meal is consumed and the fat reaches the small intestine, the gallbladder gets a signal to release its contents into the small intestine. The bile then begins the emulsification process. The liver makes more bile and sends it to the gallbladder to wait for the next fatty meal. When there is too little fat in the diet, the gallbladder does not contract to release bile and therefore does not empty. Bile acids are made from cholesterol. When the gallbladder does not empty, the bile in it stagnates and thickens and its cholesterol concentration increases, resulting in the formation of cholesterol crystals and eventually gallstones.
In a study of 51 obese people on an extremely low-calorie (almost fat-free) diet, four developed new gallstones within a month. After two months, one in four had developed gallstones. Three of the participants had to have their gallbladders removed during the study.1 None had gallstones at the start. Other studies have shown that obesity and a high-carb diet independently contribute to gallstones and that diets higher in fat actually prevent gallstones.2
If you already have gallstones, eating fat may create a problem when the gallbladder contracts to expel bile. This is why conventional wisdom tells us to eat low fat or fat free and take painkillers to deal with any pain. This advice is not going to make the stones go away. In fact, it often makes the problem worse until surgery is necessary anyway.
You need fat in your diet for the gallbladder to function properly. If you have existing gallstones, eating fat may cause a problem initially, and it may be necessary to remove the stones and the gallbladder. But Banting is not the cause of the problem, and it is likely that at some point existing gallstones would have become a problem even on a low-fat diet and required medical intervention.
Constipation on an LCHF diet is not inevitable. Only some people who have not experienced constipation before become constipated when they start Banting, and in many cases these people have suffered some type of gut pathology in the past from eating a poor diet. Even the best of us suffer from constipation occasionally due to eating incorrectly or when stressed or travelling.
For beginner Banters, constipation is usually a transient problem that resolves within a couple of weeks, if not sooner. Depending on the damage we have done to our gut previously, it may be longer. One way to combat this is to drink enough water. If you don’t have enough water in your body already – if you’re dehydrated – the large intestine soaks up water from your food waste. This makes hard stools that are difficult to pass.
Remember that we have spent years killing off healthy gut bacteria by eating sugar-rich and processed foods and taking all sorts of medications that negatively affect our gut microbiome. For optimal digestive function we need to reverse this damage. Taking a course of good-quality probiotics can really help. Probiotics are bacteria that can be bought in supplement form as well as obtained from fermented foods like sauerkraut, yoghurt, kefir and kombucha. Different probiotics work for different health conditions, so ask your pharmacist or health shop which will be best for you. Be sure to get a reputable brand and check that the colony-forming units (CFUs) are in the billions.
Be sure that you are eating sufficient vegetable matter as well as sufficient fat. Many people start out on a diet by being too restrictive or by eliminating a large amount of vegetable matter and therefore fibre. Some people find that supplementing with psyllium husk helps to relieve constipation. Another source of viscous fibre that has been shown to help relieve constipation is glucomannan, a natural, water-soluble dietary fibre extracted from the roots of the elephant yam, also known as konjac. Banters may have seen this in the form of shirataki noodles.
There are many other ways of relieving constipation naturally. Some natural-health practitioners recommend two to three teaspoons of lemon juice or apple cider vinegar in a glass of water 10 minutes before a meal to help with the secretion of digestive enzymes, or ginger tea, which has been shown to stimulate peristalsis and regulate stomach acidity.3 Regular exercise may also help with bowel motility, even a brisk 15-minute walk.
Keep in mind that most commonly used laxatives are gut irritants and will damage the lining of the gut. Remember that we are trying to heal the gut, not damage it further. If your attempts to get your bowels working do not yield results, see your doctor.
Irregular menstruation (period appears twice in one month, spotting between periods, or no period at all) is not a common complaint, but everyone is different and scientists as yet do not know everything about hormones and how they respond to low-carb diets.
Your menstrual cycle maintains a delicate balance. Any weight gain or loss can impact on the production of hormones, specifically oestrogen, potentially changing the regularity and length of your menstrual cycle. Hormones generally have a hierarchy. Hormone A tells hormone B to tell hormone C to do something. Hormones interact with one another and the best way to find out what our hormones are doing is to measure them. Having said this, optimal hormone levels can be quite individualised and reference ranges are merely statistical norms. So it is important to look at symptoms too.
So, what causes hormone disruption?
Many things, actually, but for the purposes of this discussion we will keep it in the context of diet. Our body sees chronic nutrient restriction – whether from overall energy restriction, where we consistently consume less energy than we require for our daily activity and basic metabolic function, or restriction of a particular macronutrient (too little fat, protein or carbohydrate), or restriction of micronutrients (vitamins and minerals) – as a stress situation. If we add other stressors, like insufficient sleep, intense exercise or a high-stress job, we make matters worse. Everything from our environment to our sleep pattern to our relationships, age, diet and daily activity plays a role in how our body functions. Our body’s reaction to the perceived stress situation throws our hormone levels off balance, and it is this imbalance that can lead to menstrual irregularity.
What do you do if you are faced with a sudden onset of menstrual irregularity? Remember that no one has the same metabolic profile as you, or the same lifestyle stressors – so stay in the real world of your own experience rather than turn to Google. Pay attention to what else is going on in your body and in your life. How is your mood? How are your energy levels and physical performance? Are you sleeping well? What is your appetite like? What is the condition of your skin, your libido, your sense of overall well-being? All of these factors will give you clues as to your hormonal well-being.
Take a look at your diet. It is a good idea to keep a food diary to check your macronutrient intake. Write down everything you eat and drink in a day and make sure you are eating enough nutrient-dense foods. Review your eating pattern and ask yourself what might count as metabolic stress.
Have a nutritionist evaluate your vitamin and mineral status. You may need to be supplementing.
If you are fasting, stop. Fasting (significant caloric restriction) can be perceived as stress.
If you are skipping meals, eat three smaller meals a day.
Eat breakfast. While breakfast is not the most important meal of the day, and many people can skip it without any problem, if your body is stressed and your cortisol levels are raised, eating breakfast will help to lower them.
Stop sweating the small stuff. Being pedantic about every item you put in your mouth is not healthy. We are not suggesting you eat CRAP foods, but lighten up a bit.
Root out the other stress in your life. Be honest about your psychological environment, work, exercise routine, relationships and anything else that may be draining you.
If the problem of irregular menstruation persists for any length of time or if it interferes with the quality of your life, seek advice from your health-care practitioner.
Although many new Banters are eager to lose weight, one of the first things they ask about is what they can substitute for sugar and what they can have to satisfy their cravings for sweet foods.
One of the biggest causes of the current obesity epidemic and associated health problems is the overconsumption of sugar. Therefore, we do not advocate sugar substitutes, as sweet treats only serve to perpetuate cravings for sweet foods. A craving is the brain’s need for reward. It does not mean your body needs sugar. Craving is not the same as hunger, but a craving on top of hunger will feel a whole lot worse and you will more easily give in to temptation. So, make sure you are eating enough at mealtimes to feel satiated.
The best way to get off the sweet stuff is to go cold turkey. We won’t lie to you, it’s tough, but the result is liberating. Sugar is addictive and, if you’re really battling, we recommend reading Karen Thomson and Kerry Hammerton’s book Sugar Free.4
Here are some tips to help you through a sugar craving: