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Ketosis as therapy

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Ketosis as therapy

 

Heard of a few people doing this, feel free to share your experience :)

 

We're often centric on putting something in to remedy disease. Taking things out is often less favoured and easy. The nice  thing about a diet change is you regain choice of, and gain discipline of what you put into your body and hopefully a health outcome out of it. The second is you can often address the issues of poor health  Finding a diet and lifestyle that delivers improvements puts a feeling of health back in your conscious control.

 

I thought, what am I like with very low carbs? I tried exogenous ketones, looking for a fix. What happens with using willpower for better health?

 

I'm still using thiamine but now as a B150 complex and keeping balance in micronutrients including trace elements... my macronutrient profile was not delivering - I was perma-hungry on my relatively planty but carb-loaded diet... keeping up exercise and gardening but so up and down and moody, push through it I tried.... Why not change diet a bit/have another crack at nutritional ketosis? It's "trendy" but also interesting on paper.

 

"...changing diet triggers a deeper consciousness about you" Allowing you to "align your new eating habits with your other new ones in general"

 

Mice on higher glycaemic food showed more autistic behaviors, such as reduced social interactions and activities that seemed to serve no purpose, according to the study, while the low glycaemic mice saw their behaviours improve

 

 "Dietary lifestyle changes can have a positive impact throughout the lifespan and appear to not only reduce the risk of acquiring cognitive impairments, but can also attenuate existing impairments: a recent study showed that a 4-week low-saturated fat/low-glycaemic index (GI) diet resulted in improved memory performance and insulin metabolism in adults with amnestic mild cognitive impairment

 

In a healthy young student population those with better glucose regulation perform better on tests of memory, vigilance, planning and dichotic listening compared with those with poorer glucose regulation.

 

A higher-glycemic load diet was associated with higher depression symptoms, total mood disturbance, and fatigue compared to a low-glycemic load diet especially in overweight/obese, but also otherwise healthy, adults" [ref]

 

In ASD, all subjects on the KD had increased BHB, only 50% of subjects demonstrated significant improvements in some studies, some being super-responders with dramatic improvements in social affect. There have been improvement in case studies in hyperactivity, attention span, abnormal reactions to visual and auditory stimuli, usage of objects, adaptability to changes, communication skills, fear, anxiety, and emotional reactions

 

In more serious mental illness, evidence against the role of calorie restriction the mechanism of action of improvement in models, it seems to be more related to ketone bodies

 

I got into meal skipping first. Then low GI, then super carb reduction, then ketotarian. Eventually I was in measurable ketosis, over 1.5mmol/L.

 

Even just getting to breakfast skipping was hard enough without mood going way too low and symptoms initially.

 

Ketosis, it's nice for some conditions on paper but what's it like in reality? "...many people with certain mental disorders find it especially difficult to maintain thanks to the very symptoms they’re looking to manage". "...amid the excitement about the ketogenic diet, I think it’s important to point out its drawbacks as a psychiatric tool." 

 

I agree, if you're looking to use a more extreme diet for mental health "wait until your brain is relatively stable before any kind of diet change". I tried getting into ketosis with extreme distress as a baseline once, even helping it along with BHB and I don't recommend it. It didn't work and made things worse.

 

"...after two days of eating fewer than 30 grams of carbs, it hit — a period of low energy and weakness

I woke up achy and sluggish, confused and depressed. I was simply too tired to be nervous about anything. But my depression had deepened, sending me into a dull blue fog. Then ten days, each of them torturous."


1. Caloric restriction increases longevity, memory, quality of life and reduces risk factors for neurodegenerative and psychiatric diseases

 

"We suggest that switching between time periods of negative energy balance (short fasts and/or exercise) and positive energy balance (eating and resting) can optimize general health and brain health

 

The increase in autism tracks remarkably closely with the increase in childhood overweight or obesity during the same time period (data from autismspeaks.org and the US Centers for Disease Control), suggesting a causal link between lack of metabolic switching and autistic behaviours, potentially through BDNF expression and excessive mTOR pathway activation" [1]

 

"...metabolic programs relying on efficient fatty acid and ketone body oxidation are most of the time shut off in the modern lifestyle and have to be reintegrated in order to overcome the obesity epidemic – widely known as the breeding ground for most of the Western diseases"

 

The modern lifestyle promotes continuous fueling of adipocytes - most authorities in the Western world recommend at least 50% of the daily caloric intake as carbohydrates but we're losing metabolic flexibility. We have an environment of energy abundance, prolonged psychosocial stress and physical inactivity.

 

It is suggested that "...that the strong increase of diseases related to metabolic abnormalities is largely based on a deficit in metabolic flexibility induced by things like psycho-emotional stress, high meal frequency, physical inactivity etc"

 

It's suggested we need to get used to "periodic fasting or calorie restriction, occasional meal skipping, ketogenic diets and of course exercise. Intermittent fasting and longer-term caloric as well as carbohydrate restriction are parts of our genetic heritage" [ref]

 

There is abnormal hedonic behaviour displayed by diets with high-glycemic carbohydrates - today modern humans are surrounded by a plethora of rewarding stimuli in a nearby environment and through food, we are blunted to the point of reaching reward hyposensitivity

 

What happens with strict carbohydrate restriction to induce adaptation to ketosis?

 

- Improved memory function with a medium effect size in individuals with impairment in response to a relatively brief period of carbohydrate restriction designed to reduce insulin levels and induce ketone metabolism. Improved memory performance, potentially by regulating hippocampal function

- Upregulation of GABAergic tone, regulation of glutamatergic transmission (changes the ratio of GABA:glutamate in favor of GABA), dopaminergic and serotonergic modulation along with changes in kynurenine metabolism. Enhanced the availability of brain tryptophan and serotonin, later releases of endogenous endorphins

- greater satiety and reduced overall consumption - improved central insulin sensitivity

- enhanced cerebral blood flow and blood–brain barrier function

- reduced mammalian target of rapamycin (mTOR) expression, similar to the effects of the antidepressant ketamine

- dramatic up‐regulation in neuronal autophagy (sometimes referred to as cellular cleansing)

- may moderate the pathogenic relationship between stress reactivity and brain in limbic and prefrontal regions

- β-hydroxybutyrate increases the frequency of gamma oscillations and has a protective role in executive function in serious mental illness

- anti-oxidant/anti-inflammatory action

- increases the activity of a family of transcriptional repressors known as sirtuins and broad epigenetic regulatory activities at physiological concentrations, these may alter seeking behaviour, preventing excessive ethanol intake and relapse and facilitate extinction. Enhance GABAergic and glutamatergic plasticities in DA neurons and normalise hyposensitivity to GABA.

- activated brain PPARα: through this is likely to regulate expression of many genes encoding enzymes of amino acid/neurotransmitter metabolism and stimulation of PPARα improves cognitive function (reducing cognitive inflexibility, perseveration etc) in models of impaired cognitive function

 

The beneficial effects of caloric restriction may require only a short‐term reduction in caloric intake

 

Some of the things that temporarily flared up were transient worsening of AVHs and not enough energy to want to bother trying to socialise. I was temporarily in quite a negative mindset and not interested in much of anything.

 

Now there are a few elements:

 

1. Stability of mind, quite a notable difference in consciousness and anxiolysis. A calm, centred softness. Consciousness is becoming clear and slowly expansive again. Still struggling with my memory, eg ingraining things but we'll see how that goes. Normally I struggle with extreme perservation, feel "locked in" to loops, like I'm not in control, "driven" and akathisic. There feels like a liberating sense of me driving choice again. Even social interaction was a relatively normal experience without aberrant emotionality and odd stress responses

2. Lack of hunger and better sleep

3. Clean energy as needed and less inner mind chatter. Normally I feel heavy in body, mind and spirit but today I felt like having an unco grove to music to unwind a bit, just to loosen up a bit

4. A spiritual element. Feeling generally satisfied as I am with a clear horizon. Normally I'm on the chase for something... and then another thing.


While I'm trying to put minimal kJ in, it's interesting being in a state where you're burning and using fats, either what you put in, or your own, for energy. Instead of spiking blood glucose, you can get a feel for different fats and their uses.

 

 MCTs are nice for a quick boost and adapting to ketosis [1] and the initial stage but soon enough, you want to be running on healthier fats.

That said,  MCTs are the 'crack of fats' increasing BHB in a linear, dose-dependent manner and increasing total brain energy metabolism by increasing ketone supply [2], having  positive effects on verbal memory and processing speed in patients with impairments [3] and exerting anxiolytic and social effects [4]. Coconut oil may improve brain health by directly activating ketogenesis in astrocytes [5] and has beneficial effects on neuron survival [6]

 

If you want an interesting combo, try a carnitine source with your longer chain fats. Long-chain fatty acids (LCFA) require L-carnitine as a transporter into the mitochondrial matrix, while the MCTs do not. While most patients do not require carnitine supplementation [7],  Carnitine helps shuttle fatty acids across cell membranes to be oxidized by mitochondria, covering an important role in lipid metabolism, acting as an obligatory cofactor for β-oxidation of fatty acids by facilitating the transport of long-chain fatty acids across the mitochondrial membrane as acylcarnitine esters.

 

Oleic acid sources do seem to curb hunger nicely. There is reduced food intake in an oleate-specific manner [8].There is a hypoglycemic effect of oleic acid and the probable dependence of glutathione [9]

 

Watch out for saturated fats: these increase brain inflammation and activates the hypothalamic-pituitary-adrenal axis

 

Dietary lecithin may increase the efficacy of omega-3 supplementation when their intake is combined

 

[1] https://www.ncbi.nlm.nih.gov/pubmed/29951312
[2] https://www.ncbi.nlm.nih.gov/pubmed/29914035
[3] https://www.ncbi.nlm.nih.gov/pubmed/30367958
[4] https://www.ncbi.nlm.nih.gov/pubmed/29908242
[5] https://www.ncbi.nlm.nih.gov/pubmed/27430387
[6] https://www.ncbi.nlm.nih.gov/pubmed/28126466
[7] https://www.ncbi.nlm.nih.gov/pubmed/11879348
[8] https://www.ncbi.nlm.nih.gov/pubmed/27654062
[9] https://www.ncbi.nlm.nih.gov/pubmed/28214972

 

 

 

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Update on this, be careful with these "trendy" things. I got to quite a deep state of ketosis on this, went from nutritional ketosis to starting to get extremely depriving of food and it started to get to the same level of kind extreme territory I had as a teenager.

 

What are my experiences lately? You can take your consciousness (and suffering) to quite profound, sometimes uplifting and at times very scary places (ie for me going extremely catatonic and in a bad mindset) through these diets that people are broadly normalising and promoting.Yes, you can tap into some spiritual/altered states, maybe lose some weight but also very easily push it to the extreme of depriving yourself to really unhealthy limits, really quickly. It can easily become an eating disorder rather than a health thing, these diets and it's a gradual slide. So while mild nutritional ketosis seems interesting and kind of low GI stuff seems reasonable enough but yeah it easily swings into something less so, particularly for those of us who have struggled with such before...

 

I still feel the most healthy thing to do is change your relationship to food in a healthy way. Get some greater impulse control gradually, cut out unhealthy things and if you want, try something mild like intermittent fasting if depriving yourself takes your fancy.

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I have been on a 8/16 hr window intermittent fasting, paleolithic, ketogenic diet for about 6 months now.

I was actually a nay-sayer to those around me who were on this type of diet because I come from a bodybuilding background and had maintained the mindset of eat big, lift big and to refuel every 3-4 hrs.

Years of eating right and heavy lifting was amazing. While I was young and healthy. The inevitable onset of age, multitudes of injuries and severe inflammation found me searching for alternatives to help reduce those aforementioned anomalies attributed to my lifestyle and diet.

I was on the paleo diet whilst bodybuilding so that part of the equation was already complete, I trialed the combination of paleo & keto.

With noticeable health and wellbeing benefits shortly after I included intermittent fasting which I was hesitant to do due to the fact I'm a foodie - love to eat, and concerned with losing hard earned gains over the years by entering catabolism by ''starving the body''.

The first week or so was hell. Incredible food cravings and whilst fasting, people eating around me and the smell of cooking was driving me crazy. I maintained the fasting and did well to eliminate temptation to succumb by drinking a lot of green tea with peppermint which is acceptable whilst fasting. Once that initial week was over things got easier and a couple more weeks into it I no longer felt the desire to even think about deviating from the diet, my body fat content significantly reduced, my mood was elevated, maintained stress levels at an all time low, and my inflammation was almost non-existent. That is entirely due to the combination of an intermittent fasting, paleolithic, ketogenic diet.

I no longer lift heavy which I am sure is also a contributing factor, but I do try maintain a semi-regular frequency of mid-ranged intensity exercise.

This diet and lifestyle may seem quite complex however this is actually very easy once the initial week or so is over.

Although nutrition is key, I strongly believe as humans we eat too much. And that's coming from an ex-bodybuilding foodie.

Keep in mind here, that everybody is built differently and not everything will work or be beneficial to everybody.

The internet is filled with an immense amount of information as we all may know, so if anybody is looking at ways to combat anomalies such as minor ailments to more severe life changing conditions, all I can suggest is to first look at the lifestyle we live and remedy by way of diet and nutrition at first instance.

 

Peace & Love

 

 

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Thanks for sharing @thegreenriviera

 

One thing about diet changes is you can see how things affect you.

 

Going very minimalistic with food made me see how simple/easily neglected things were driving mood states.

 

One interesting thing is that through a relatively short period of depriving yourself a bit of food, I got a clean slate, not perma-impulsive hunger, to work with. You start to respect how things that you normally dismiss as driving mood changes do play a big role. It's like a nice reset and chance to see how the basics are driving symptoms. I've escaped carbohydrate cravings by eliminating them for awhile and interestingly they haven't returned to crippling levels.

A few interesting things I noted:

1. How much those fluctuations in blood sugar do destabilise your mood, change your cognition and how cutting out/reducing/playing with low GI carbs is quite useful just to see how it impacts you
2. Potentially how much changes in electrolytes drive mood changes. I've always supplemented things like calcium/magnesium but overlooked sodium and potassium as driving mood states.
3. How nice a quality planty diet can be for sustained clean sustenance
4. How different fat sources feel and likewise proteins
5. What it's like to experience different states of ketosis

 

Dietary electrolytes are related to mood

 

At the moment, I'm quite interested in what simple electrolytes do for mood and symptoms.

 

For both males and females it is recommended to keep sodium intake below 2,000 mg.

Potassium recommendation for males and females are 4,700 mg per day.

Magnesium intake for males should be between 330-350 mg per day, and females should intake about 255-265 mg per day.

Calcium suggested intake is 800 mg per day for both males and females.

 

Other factors:

 

Dietary patterns seem important in severe mental illness [1] and have in some populations been associated with things like depression, stress and social support satisfaction [2].

Four-Week Supplementation in healthy individuals with a multi-vitamin/mineral preparation treatment was "associated with significantly improved mood, as measured by reduced scores on the "depression-dejection" subscale of the Profile of Mood States" [3]

Individual vitamins:

Vitamin A: There is a longstanding notion that vitamin A plays a role in psychiatric illness likely based on the profound effects of retinoids on brain development and processes such as long-term potentiation (LTP) and mood regulation. Proposed to be a player and therapeutic in ASD: "supplementation is a reasonable therapy at least for a subset of children with autism" [4].

Vitamin B-group:

Thiamine (B1): Exerts antidepressant/anti-stress effects in animal models [5] and improved standard treatment in patients with depression [6] In a small study, thiamine supplementation significantly improved anxiety scores, general well-being and reduced fatigue in patients with Generalised Anxiety Disorder [7] "An improvement in thiamine status was associated with reports of being more clearheaded, composed and energetic. These influences took place in subjects whose thiamine status, according to the traditional criterion, was adequate." [8]

Not much has been done on B2 and B3 in psychiatry but they are proposed to play a role. A recent animal study suggests that B2 or B6 vitamins restored the levels of DA and reduced oxidative stress in brain [9]

B6: Inadequate amounts of vitamins B6 is linked with a higher incidence of depression and impaired neurotransmitter synthesis. It is proposed to be an effective therapeutic for some women (along with combinations) [10]. Improved attentional performance in males was significantly correlated with increased levels of vitamin B6

B12: Insufficient vitamin B12 status has been linked to poor neurodevelopment and cognitive decline. A significant improvement in depressive symptoms was observed after SSRI and vitamin B12 therapy in one study [11]

Folate: see https://www.psychologytoday.com/us/blog/integrative-mental-health-care/201709/folate-depression-schizophrenia-and-dementia

Vitamin C: adding vitamin C alone to citalopram did not increase the efficacy of citalopram in MDD patients [12]. That said, in animal models it exerts antidepressant effects dependent on the activation of the opioid system, especially µ-opioid receptors, which might be an indirect consequence of NMDA receptor inhibition elicited by ascorbic acid administration. It may involve an activation of GABAA receptors and a possible inhibition of GABAB receptors, similarly to ketamine. It might be dependent on the activation of PI3K and mTOR, inhibition of GSK-3ß as well as induction of HO-1. These are important mood targets.

Vitamin D supplementation, thought to modulate many areas of mental health, is associated with lower depressive and anxiety symptoms in psychotic illness [13] and addition of vitamin D to conventional antidepressive agents can improve antidepressive effect [14]. The core symptoms of ASD fluctuated in severity with changes in serum vitamin D levels in children: high-dose vitamin D3 regimens may ameliorate the core symptoms [15, 16]

Vitamin E (α-tocopherol) has been linked to a decrease in the frequency of depressive symptoms. α-tocopherol is a lipid modulator of the cannabinoid system [17] Vitamin E has pain-relieving, antioxidant, antidepressant [18] and anxiolytic-like activities [19]. A low dietary intake of vitamin E is related to altered mood and depression, depression is accompanied by significantly lower serum vitamin E concentrations, vitamin E intake being directly related to the depression score [20].The cognition promoting effects of omega 3 PUFAs may be dietary vitamin E status related [21] and recently, omega-3 and vitamin E co-supplementation was effective in improving parameters of mental health in some individuals with conditions of inflammatory basis [22].

Minerals:

Calcium: Ca and Mg may be involved in depression; however there are few data on these mineral nutritional statuses concerning depression and data from human-studies are limited. It thought that Ca intake is related to depression and mental disorders

Chromium: Seems to have important effects on insulin signalling and mood. Preclinical and clinical studies reported its potential antidepressant properties [23]. Chromium has shown the most promise for treating subtypes of depression that affect carbohydrate cravings and appetite regulation [24] In some women it "reduced mood symptoms and improved overall health satisfaction" [25]

Iodine: Deficiency causes brain structural alterations likely to affect cognition. Low iodine-rich food intake was associated with increased brain volume shrinkage [26]

Iron: Human studies link anxiety-driven behaviour and mood changes to poor iron status but excess iron in the brain is detrimental. It is proposed imbalanced iron metabolism plays a role in modulating anxiety and emotional behaviours [27]

Magnesium: Magnesium is effective for mild-to-moderate depression in adults. It works quickly and is well tolerated [28] Magnesium influences the neurotransmission involved in emotional processes, such as the serotonergic, noradrenergic, dopaminergic, GABAergic and glutamatergic systems.

Potassium: may be useful in the treatment of mood disturbances - low potassium levels may be linked to symptoms of depression.

Selenium: "Intake was associated with a general elevation of mood and in particular, a decrease in anxiety." [29] When taking the selenium the subjects reported a substantial improvement in mood at 100 mcg [30] Persons with low selenium status might experience relatively depressed moods [31] That said, another study found "no evidence that selenium supplementation benefited mood or quality of life in these elderly volunteers" [32]. It is suggested to play an important role in psychological functioning [33].

Zinc: Preclinical and clinical studies have demonstrated that zinc possesses antidepressant properties and that it may augment monoamine-based antidepressants [34] Meta-analyses support zinc for depression [35] It is proposed to cause general improvement in neuronal plasticity as well as reduction of neuronal atrophy and neuronal cell loss, modulation of the serotonergic system including postsynaptic 5-HT1ARs with a possible involvement of dopaminergic neurotransmission [36]. Peripheral Zn concentration may play a role in the physiopathology of some domains of cognitive function, "there was a significant positive correlation between plasma Zn levels and the concentration subcategory" [37]

Less/other mentioned:
Boron: Boron supplementation altered EEG such that there was a shift toward less activity in the low frequencies and more activity in the high, dominant frequencies of the EEG leading to improved psychomotor skill, and cognitive processes of attention and short term memory [38].

Choline sources: "The extent to which higher intakes of choline have the potential to enhance or influence cognition during childhood, adulthood, and/or age-related cognitive decline needs further investigation" [39].

Carotenoids significantly corresponded to global cognitive abilities including verbal learning, verbal fluency, memory recall, processing speed, and perceptual speed. Serum lutein, zeaxanthin, and β-carotene concentrations were most consistently related to better cognition. Serum zeaxanthin had significant relationships with most measures of cognitive function, with higher concentrations being significantly related to global cognitive performance,and better concept formation/abstraction. Serum concentrations of β-carotene were also significantly correlated to most measures of cognitive function. Serum lutein concentrations were significantly related to measures of global cognition, lower dementia severity, and executive function. Carotenoid levels have also been shown to protect cognitive function in older adults with mild cognitive impairment. Supplements have shown strong cognitive enhancement benefits over longer term studies

Review on omega-3: https://www.ncbi.nlm.nih.gov/pubmed/27472373/

[1] https://www.ncbi.nlm.nih.gov/pubmed/30359969
[2] https://www.ncbi.nlm.nih.gov/pubmed/29113038
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/26529011/
[4] https://www.ncbi.nlm.nih.gov/pubmed/29122693
[5] https://www.ncbi.nlm.nih.gov/pubmed/27825907
[6] https://www.ncbi.nlm.nih.gov/pubmed/26984349
[7] https://pdfs.semanticscholar.org/…/53c8c4dbfdccf441a16bcc14…
[8] https://www.ncbi.nlm.nih.gov/pubmed/9122365
[9] https://www.ncbi.nlm.nih.gov/pubmed/30413185
[10] https://www.ncbi.nlm.nih.gov/pubmed/28178022
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856388/
[12] https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25873303/
[13] https://www.ncbi.nlm.nih.gov/pubmed/30245372
[14] https://www.ncbi.nlm.nih.gov/pubmed/29460820
[15] https://www.ncbi.nlm.nih.gov/pubmed/29629638
[16] https://www.ncbi.nlm.nih.gov/pubmed/27868194
[17] https://www.ncbi.nlm.nih.gov/pubmed/21843633
[18] https://www.ncbi.nlm.nih.gov/pubmed/20144659
[19] https://www.ncbi.nlm.nih.gov/pubmed/30251258
[20] https://www.ncbi.nlm.nih.gov/pubmed/28531460
[21] https://www.ncbi.nlm.nih.gov/pubmed/29656360
[22] https://www.ncbi.nlm.nih.gov/pubmed/29306057
[23] https://www.ncbi.nlm.nih.gov/pubmed/24101396
[24] https://www.verywellmind.com/chromium-for-depression-1066922
[25] https://www.ncbi.nlm.nih.gov/pubmed/24237190
[26] https://www.ncbi.nlm.nih.gov/pubmed/29083437
[27] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253901/
[28] https://www.ncbi.nlm.nih.gov/pubmed/28654669
[29] https://www.ncbi.nlm.nih.gov/pubmed/1873372
[30] https://www.ncbi.nlm.nih.gov/pubmed/2096413
[31] https://www.ncbi.nlm.nih.gov/pubmed/8717610
[32] https://www.ncbi.nlm.nih.gov/pubmed/16181615
[33] https://www.ncbi.nlm.nih.gov/pubmed/12509066
[34] https://www.ncbi.nlm.nih.gov/pubmed/28299207
[35] https://www.ncbi.nlm.nih.gov/pubmed/28988944
[36] https://www.ncbi.nlm.nih.gov/pubmed/28319749
[37] https://www.sciencedirect.com/science/article/pii/S0531556518300639
[38] https://www.ncbi.nlm.nih.gov/pubmed/25063690
[39] https://www.ncbi.nlm.nih.gov/pubmed/29451849

 

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I stuck with a very low carb very keto-like diet, it was good for weight loss but I was so anhedonic... I'd dropped 10kg, my pants were falling off and I felt absolutely no sense of personal reward. Just warning you.

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