I would need some help for my father please.

[ec1968]

Hi JayMarck

Do you know if your Dad is taking statins to lower cholesterol?

 

[mcb]

...
There are variations of Paleo and some describe it existing on a spectrum. While that leaves a lot open to interpretation, Nora goes into the science of how the body responds to various foods (and non-foods as it were) to include a ketogenic metabolism. Although I'm not sure, I suppose that might be why she used the subtitle 'beyond the paleo diet'.
...

The 'beyond' reference is a subdued version of the original subtitle, which I never can remember without looking it up. It refers to the life extension/caloric restriction information, which she does not claim was a part of paleolithic diet.

 

[mcb]

...Alright. Step-by-step. With what Megan pointed out, cutting sugar/fructose would be advisable to go with. Besides fruits, do you know what else it could imply? Table sugar of course but what about honey and maple syrup? My guess is that it should be avoided as well.

But thing is if he cuts off sugar/fructose and gluten, he'll also lose a lot of his energy intake and since he works out in the gym, I don't think he'll agree unless he has another option as far as energy requirements are concerned. Your thoughts would be appreciated here.
...

On average, I believe that table (cane) sugar, maple syrup, and honey are all about 50/50 glucose and sucrose. The fructose content of honey varies. The more easily it crystalizes, the less the proportion of fructose. I think the main thing is to use sugar in all its forms sparingly. For carbivores, there are plenty of forms of starch to use for fuel.

I don't think gluten provides energy any more than opium does. It's in there for texture, as "glue," and to cause addiction.

Paul Jaminet's "Perfect Health Diet" might be useful as a "bridge" diet for someone moving toward paleo. It is basically a plant-heavy paleo diet with the addition of a lot of starch from foods like potatoes and white rice, but no other grains. There's no keto-adaptation in the standard version, but no need to go hungry for lack of choices either. His approach is geared for people that want the technical details, and half the book is citations, but it isn't necessary to understand all of it to follow the diet. It appears to me to be a relatively safe one, for people whose goal is just to adopt a healthier diet.

It is not, by the way, a diet that I would adopt myself or would recommend to people here in the forum. It is just hugely better than the Standard American Diet, which is as bad as it gets.

 

[Deleted member 8431]

Hi JayMarck

Do you know if your Dad is taking statins to lower cholesterol?

He does not.

On average, I believe that table (cane) sugar, maple syrup, and honey are all about 50/50 glucose and sucrose. The fructose content of honey varies. The more easily it crystalizes, the less the proportion of fructose. I think the main thing is to use sugar in all its forms sparingly. For carbivores, there are plenty of forms of starch to use for fuel.

Paul Jaminet's "Perfect Health Diet" might be useful as a "bridge" diet for someone moving toward paleo. It is basically a plant-heavy paleo diet with the addition of a lot of starch from foods like potatoes and white rice, but no other grains. There's no keto-adaptation in the standard version, but no need to go hungry for lack of choices either. His approach is geared for people that want the technical details, and half the book is citations, but it isn't necessary to understand all of it to follow the diet. It appears to me to be a relatively safe one, for people whose goal is just to adopt a healthier diet.

It is not, by the way, a diet that I would adopt myself or would recommend to people here in the forum. It is just hugely better than the Standard American Diet, which is as bad as it gets.

Good. I'll keep that in mind. Perhaps check the book as well. It will also depend on what my father wants to do about it. He might be more receptive to that rather that towards a too low carb diet. We'll see.

I don't think gluten provides energy any more than opium does. It's in there for texture, as "glue," and to cause addiction.

I meant that he would get less energy in the form of carbs from not eating gluten-containing stuff like bread, pasta, cereal etc. I know gluten is a protein, not a source of energy. And I know that it's effect on opioid receptors can indeed cause an addiction and sensation of well-being when consumed for instance while acting as a neurotoxin at the same time. Or something along these words.

Thanks again!

 

[Gaby]

Hello JayMark,

I had the opportunity to spend some time today digging a huge two-volume medical textbook which is only about the liver and got some understanding of what your dad has, or rather, what he is lacking. It is genetic, although the environmental factors probably played a HUGE role. You are doing well health-wise with the diet?

I'll post my notes of the book later on, but it seems to me that the diet is not only crucial, it can make the whole difference. Also a max effort to detox with FIR sauna and the cocktails posted in Detoxify or Die, keeping in mind the new info on liposomal vitamin C. If he is overweight or is not losing weight, he will have 0 chance of detoxing toxins that could be lodged in his fat since he was very young.

Having healthy cell membranes through animal fats and some Omega 3s is crucial, but also, having healthy mitochondria through ideally a ketogenic diet seems to me very important as well. All the while getting extra supplementation to help him make up for the deficit in detox abilities.

 

[Deleted member 8431]

Hello JayMark,

I had the opportunity to spend some time today digging a huge two-volume medical textbook which is only about the liver and got some understanding of what your dad has, or rather, what he is lacking.

Thank you. It is highly appreciated.

It is genetic, although the environmental factors probably played a HUGE role.

Would make some sense.

You are doing well health-wise with the diet?

Absolutely. This will be a great point to mention to him.

I'll post my notes of the book later on, but it seems to me that the diet is not only crucial, it can make the whole difference. Also a max effort to detox with FIR sauna and the cocktails posted in Detoxify or Die, keeping in mind the new info on liposomal vitamin C.

Will search about FIR sauna (do you have a good link?) and look for that book. I'll also check the vitamin C thread as I've also noted new info being added.

If he is overweight or is not losing weight, he will have 0 chance of detoxing toxins that could be lodged in his fat since he was very young.

He is not overweight. Has been a little bit (and that is very relative you know) but lost most of his "excess" fat a few years ago. So he ain't got much to lose now weight-wise. Are you implying that this could be problematic? Not too sure I understand what you mean by "or is not losing weight".

Having healthy cell membranes through animal fats and some Omega 3s is crucial, but also, having healthy mitochondria through ideally a ketogenic diet seems to me very important as well. All the while getting extra supplementation to help him make up for the deficit in detox abilities.

Seems like the best thing to do as far as I'm concerned as well. Of course, this won't bo done in the blink of an eye but I'll start with the basis and go through it with him one step at a time. We'll see what he decides.

Thanks a whole lot!

 

[Gwenllian]

I'll post my notes of the book later on, but it seems to me that the diet is not only crucial, it can make the whole difference. Also a max effort to detox with FIR sauna and the cocktails posted in Detoxify or Die, keeping in mind the new info on liposomal vitamin C.

Will search about FIR sauna (do you have a good link?) and look for that book. I'll also check the vitamin C thread as I've also noted new info being added.

http://cassiopaea.org/forum/index.php/topic,11185.0.html

Here you can find some websites where you can order one and some more information. It might be worthwhile to listen to the podcast, which you can find on the getfitt.com website, where the crew interviews Marc from getfitt about this FIR blanket.

Good-luck and all the best to your dad.

 

[Gaby]

He is not overweight. Has been a little bit (and that is very relative you know) but lost most of his "excess" fat a few years ago. So he ain't got much to lose now weight-wise. Are you implying that this could be problematic? Not too sure I understand what you mean by "or is not losing weight".

Only if he is overweight and stuck on that weight, that would be problematic. So here is a 101 on liver metabolism from the book "Beating and Treating Fibromyalgia and Chronic Fatigue Syndrome". It is very friendly, that is why I grabbed it from that book:

Thankfully, our liver works to neutralize harmful chemicals, viruses, and bacteria. It’s also first to process the nutrients delivered by the bloodstream. As the largest organ in the body, it filters two quarts of blood every minute and secretes a quart of bile each day. Bile is necessary for absorbing fat-soluble substances, including certain vitamins. It also helps eliminate toxic chemicals...

An optimally functioning detoxification system is necessary for providing good health and preventing disease. Many diseases, including cancer, rheumatoid arthritis, Lupus, Alzheimer’s, Parkinson’s, and other chronic age-related conditions, are linked to a weakened detoxification system. A poor detox system also contributes to allergic disorders, asthma, hives, psoriasis, and eczema. It’s associated with chronic fatigue syndrome, fibromyalgia, depression, and systemic candidiasis.

Two phases of detox

Unwanted chemicals, including prescription and nonprescription drugs, alcohol, pesticides, herbicides, and metabolic waste products are neutralized by the liver’s enzymes. There are two enzymatic pathways, phase I and phase II. Phase I detoxification enzymes are collectively known as cytochrome P450. The cytochrome P450 system is made up of 50–100 enzymes that attempt to neutralize toxic chemicals by transforming them into a less toxic form. Each enzyme is specially suited to certain types of toxins. Chemicals that can’t be neutralized are changed into an intermediate form. As the phase I enzymes neutralize toxins, they spin off free radicals. If there aren’t enough antioxidants to counter these free radicals, the liver may be compromised.

Phase I detoxification is inhibited by antihistamines, NSAIDs, azole drugs (antifungals), tranquilizers such as Valium and Klonopin, and antidepressants such as Prozac and Celexa. (Is it any wonder that FMS and CFS patients are told that their condition is “all in their head” when drugs make them sicker?)

Phase I is responsible for neutralizing most over-the-counter and prescription drugs, caffeine, hormones, yellow dyes, insecticides, alcohol, and histamine.

Phase II detoxification enzymes go to work on the toxins that the phase I enzymes turned into intermediate form. They do this by attaching minute chemicals to the structures. This process is called conjugation, and it neutralizes the toxins, making them more likely to be excreted through urination or defecation. Unfortunately, many of these intermediate forms are more toxic and potentially more damaging than in their original state. So an inadequate phase II detoxification system can cause all sorts of chronic illnesses.

A person suffering from poorly functioning phase II and overactive phase I detoxification is known as a pathological detoxifier. These individuals fill up doctors’ offices on a regular basis, because they suffer from a variety of ailments that seem to never go away. One illness is replaced by another as the patient tries one prescription after another. Neither the doctor nor the patient realizes that a compromised detoxification system is being further aggravated by toxic prescription medications.

Phase II is responsible for neutralizing acetaminophen, nicotine, and insecticides. It is comprised of the following conjugation processes:
• Glutathione conjugation requires vitamin B6 and the tripeptide (made from three amino acids) glutathione.
• Amino-acid conjugation requires the amino acid glycine. Low-protein diets and deficient digestive enzymes inhibit this process. Individuals with hypothyroidism, arthritis, hepatitis, and chemical sensitivities may suffer from poor amino-acid conjugation.
• Methylation requires S-adenosyl-methionine (SAMe). SAMe is synthesized from the amino acid methionine and dependent on folic acid, choline, and vitamin B12. Methylation detoxifies estrogen, testosterone, thyroid hormones, acetaminophen, and coumarin.
• Sulfation requires the amino acids cysteine and methionine and the mineral molybdenum. Sulfation is involved in processing steroids, thyroid hormones, food additives, certain drugs, and neurotransmitters. Individuals who can’t take certain antidepressants or have reactions to certain sulfur-containing foods may benefit from taking extra molybdenum, taurine, cysteine, and methionine.
• Acetylation requires acetyl-CoA and is inhibited by a deficiency in vitamin C, B2, or B5. This pathway is responsible for eliminating sulfa drugs, so individuals with sulfa allergies may benefit from extra vitamin C, B2, or B5.
• Glucuronidation requires glucoronic acid and detoxifies acetaminophen, morphine, benzoates, aspirin, and vanilla. Aspirin inhibits this process. Signs of deficiency include yellowish pigment in the eyes or skin not caused by hepatitis.
• Sulfoxidation requires molybdenum and detoxifies sulfites and garlic. You may be deficient in this enzyme if you have allergic reactions to sulfite foods or garlic, asthmatic reactions after eating, or a strong urine odor after eating asparagus. Individuals with a sluggish sulfoxidation pathway may benefit from taking additional molybdenum.
Fish oils, SAMe, broccoli, Brussels sprouts, and cabbage all stimulate phase I and phase II reactions. Choline, betaine, methionine, vitamin B6, folic acid, and vitamin B12 (altogether known as lipotrophic factors) stimulate bile production and its flow to and from the liver. Lipotrophic factors also increase SAMe and glutathione, which in turn spare the liver free-radical damage...

Here’s what you can do:
• Test your liver. I recommend phase I and phase II detoxification testing to my patients who can’t seem to get well. Individuals plagued with unrelenting poor health are usually saturated with poisonous chemicals.
• Explore alternatives to long-term prescription drugs like nonsteroidal anti-inflammatories. Work with your doctor.
• Severely reduce or eliminate alcohol, nicotine, allergic foods, and preservative-rich foods.
• Supplement with antioxidants to combat free radicals. Include vitamins A, E, and C; the mineral selenium; and pycnogenol.
• Enjoy foods from the Brassica family: broccoli, cabbage and Brussels sprouts. They contain phytochemicals that stimulate phase I and phase II detoxification pathways.
• Supplement with a formula containing an amino-acid blend. Glutathione is the most abundant and important liver-protecting antioxidant. Although it is readily absorbed from fruits, vegetables, and meats, depletion may occur during high or sustained exposure to toxins. Glutathione supplements are not readily absorbable, so supplement with its building blocks instead: cysteine, methionine, and glycine.
• Supplement with silybum marianum (milk thistle). The silymarin complex, particularly the silibinin component of milk thistle, protects the liver from free-radical damage. It prevents certain toxins from entering liver cells and stimulates regeneration of damaged liver cells.

Medical use of milk thistle can be traced back more than 2000 years. Over 30 years ago, intensive research on the liver-protecting properties of milk thistle began in Germany. Extensive research also may have led to the approval of a standardized milk thistle extract in Germany for the treatment of alcohol-induced liver disease and other diseases of the liver.

Milk thistle extract protects liver cells, both directly and indirectly. It is able to regenerate liver cells that have been injured, prevent fibrosis or fatty liver, bind to the outside of cells and block entrance of certain toxins, and even neutralize toxins that have already penetrated the liver. Milk thistle treatment can be effective even several hours after initial poisoning occurs, such as in the case of poisoning by death cap mushrooms. And there are no side effects.

Silymarin may also prevent the damage caused by certain drugs such as acetaminophen, antidepressants, and antipsychotic, cholesterol-lowering, and anticonvulsive drugs. One study showed that increasing the antioxidants in patients receiving psychotropic drugs reduced the production of potentially damaging free radicals in the liver.

Silymarin has been shown in animal studies to raise the glutathione levels in liver cells by as much as 50%. It also increases the activity of another antioxidant known as supraoxide dismutase (SOD).

Milk thistle may someday be the main treatment for hepatitis, a chronic viral infection of the liver that can lead to liver damage and, in some cases, liver failure. During a six-month treatment period in patients with chronic alcohol hepatitis, liver function test results normalized and liver enzymes improved over controls using placebo. The normal dose is 420 mg. in three divided doses (80% silymarin content) daily.

• Supplement with alpha lipoic acid. This powerful antioxidant compound helps recycle glutathione. It is both fat and water soluble, so it works in both mediums. Manufactured by the body in small amounts, it needs to be also obtained through the diet. It can help prevent and repair damage to liver cells and is being studied for its regenerative properties in neurological diseases including Alzheimer’s, multiple sclerosis, Lou Gehrig’s disease, and Parkinson’s disease. To increase liver detoxification and boost cellular energy, take between 200–400 mg. of ALA daily...
• Supplement with coenzyme Q10. CoQ10 is also known as ubiquinone, because of its nature to exist in all living matter. It is most abundant in the organs requiring the most energy: the heart and liver. It is a vital catalyst for energy; without it, the process of cellular energy ceases (which spells d-e-a-t-h). CoQ10, along with ALA, gives the spark to the power plants of the cells, the mitochondria...

So that is a synopsis of recommendations for those with sluggish liver problems from the book "Beating and Treating Fibromyalgia and CFS", keeping in mind that it addresses those on a crappy diet including gluten loaded foods.

Here are some relevant notes from "Hepatology - A Textbook of Liver Disease" by David Zakim and Thomas Boyer, 4th edition. This textbook is from 2003 and I haven't checked anything on the web and/or new information since then, this will be only some basics - underlying mechanisms that could shed some light into the root of the problem:

It takes years to eliminate a single dose of an unmetabolizable lipophilic (fat soluble) compound [toxic]. In adlibitum-fed rats constantly gaining weight, there is virtually no elimination [this suggests that people on a crappy diet may never eliminate toxins].

The Chemical Abstract Service's list of known chemical compounds contains more than 30 million unique substances [toxic compounds that the liver has to struggle with] and grew by 6 million in the year 2000 alone [probably they are not taking into account nanotechnologies and GMO foods...].

Xenobiotics - chemicals that are taken up by the body but not incorporated into the normal metabolic economy of the cell, that is, they are not used for generation of energy, catalysis, or structure [or at least, they shouldn't be!]

-Polar molecules: poorly absorbed into the body, but when absorbed, readily eliminated via the kidney.
-Non polar molecules: they are a special problem because of their affinity for membranes [fatty compounds]. They easily penetrate the membranes barriers of biosystems, such as the gut and skin, and are excreted poorly via the kidney because of protein binding and tubular reabsorption [in the kidney]. For biliary excretion to be efficient, a charged or water-soluble group is required.

Xenobiotic metabolism: it is mainly hepatic [in the liver], but also in the intestine, kidney, lung and skin [it suggests that if the liver is compromised, keeping an optimal gut health through the diet might compensate for what is lacking in the liver]

The liver is the place where most of the enzymes that catalyze [process] the metabolism of non-polar xenobiotics are located. [this refers to the detox pathways explained in the 101 liver metabolism]. It is also the main place for detox because that is where food and/or compounds [toxins] arrive when they are absorbed via the intestine [which emphasizes the importance of having foods which are friendly to our physiology, but also the importance of detoxing]

P450 System

-It is an oxidation system.

-It is an electron-transport chain associated primarily with the membranes of the endoplasmic reticulum [cool organelles inside the cell].

-There are P450 forms in mitochondria involved in normal physiologic pathways, i.e. bile acid synthesis and vitamin D metabolism.

-Also found in the nuclear membrane [meaning that this system is linked with the onset of cancer when they misfire or don't work]

-Its central protein is cytochrome p450.

-A family of heme-containing cytochromes are referred to as the CYP supergene family. The heme portion of the cytochromes is similar to hemoglobin. [emphasizes the importance of meat and/or organ intake, or so it seems to me]

-The cytochromes generally are termed p450, although certain forms are termed p448, P447, etc.

-"P" stands for pigment, and the 450, 448 or 447 refers to a characteristic of their visible light absorption spectrum.

-P450 is tightly bound to the membrane of the endoplasmic reticulum and is exposed at the cytosolic [external] face of the membrane.

-More than 30 different genes coding for cytochrome p450 have been identified in humans. They are grouped based on amino acid sequences. Forms that exhibit at least 40% sequence identity were said to belong to the same family.

-5 distinct families have so far been characterized in the human liver: CYP1, CYP2, CYP3, CYP7, CYP27.

-Forms within each family that are more than 55% to 60% similar are grouped together in what is referred to as a subfamily and identified by capital letters: A, B, C, etc. The individual forms within each subfamily are numbered sequentially: CYP1A1, CYP1A2, etc. To date, it has turned out that all the members of a subfamily have been found to lie adjacent to one another on the same chromosome forming a cluster.

There is tremendous variability between individuals, but the most predominant form of P450 in most human livers is CYP3A4. The 3A4 form can be as much as 60% of the total P450. CYP2C9 is also prevalent, as is 1A2 and to a lesser extent, 2E1. These four P450 generally constitute more than 90% of human liver microsomal p450.

More than 150 CYP3A4 substrates are known and of these, nearly 1/3 are already recognized as substrates for other forms of p450, and several are known to be substrates for at least 3 forms.

So from reading the above, it seems to me that optimizing the body's fat composition is essential, but also optimizing mitochondrial and gut health function. Eating trans fats is deadly, and so is taking toxins through foodstuff. Getting detox help is essential: vitamin C, anti-oxidants, FIR sauna. That alone could make him feel much better and get him motivated to follow through the diet and research all these topics himself. He has after all a good background to do it. But I would understand if he feels so crappy to get started up.

Avoiding the stuff that he has problem detoxifying is essential, including coffee. Getting some digestive enzymes seems very important too.

 

[mcb]

I should mention that there is a risk with using a "bridge" diet, such as the one I mentioned, because the person may not be willing to move beyond it to what is really needed. I think a ketogenic diet would be much better, but when there are a lot of health issues then it can be challenging to keto-adapt, and some way of easing into it could be necessary. There may not be any well-beaten path to follow to get there.

In the end, all you can do is pass the information along and see if he is willing to try it. It can seem like a huge thing, before doing it. If you can convey that it is not a big deal once you are adapted, that may help.

 

[monotonic]

MCT oil was invented to allow for higher carb intake while maintaining ketosis. Perhaps this would be helpful when transitioning for someone needing plenty of calories, though I don't know about the quality and origin of the oils used.

 

[mcb]

MCT oil was invented to allow for higher carb intake while maintaining ketosis. Perhaps this would be helpful when transitioning for someone needing plenty of calories, though I don't know about the quality and origin of the oils used.

It can help. Leucine also, supposedly. It depends on how much you want to make the change to a ketogenic diet. If it is being "prescribed" then many people will accept it from the "authority," at least for a time. (But some of the prescription diets can be nasty, if the person prescribing them doesn't know better.) I don't know if that will happen -- it didn't sound like it.

 

[Gwenllian]

JayMark, here is that link of the podcast. It is a real nice interview, OSIT.

http://www.get-fitt.com/videosandpodcasts.htm

 

[Deleted member 8431]

JayMark, here is that link of the podcast. It is a real nice interview, OSIT.

http://www.get-fitt.com/videosandpodcasts.htm

Thanks a lot!

 

[Deleted member 8431]

MCT oil was invented to allow for higher carb intake while maintaining ketosis. Perhaps this would be helpful when transitioning for someone needing plenty of calories, though I don't know about the quality and origin of the oils used.

It can help. Leucine also, supposedly. It depends on how much you want to make the change to a ketogenic diet. If it is being "prescribed" then many people will accept it from the "authority," at least for a time. (But some of the prescription diets can be nasty, if the person prescribing them doesn't know better.) I don't know if that will happen -- it didn't sound like it.

Would he have to first get into ketosis and then re-take carbs with the supplements in order to maintain ketosis while eating carbs?

Quite franlky, I'm a bit confused because he needs so much energy, I don't know how his body will be able to deal with fat and carbs at the same time, energy-wise.

What happens to carbs when you are in ketosis like in the case monotonic described (with the use of MCT oil)? How can the body use both as a source of energy at the same time? Dosen't sound very healthy to me going from one mode to the other. But I need more information to make my mind.

Wheeehaaa! That's a lot of stuff to digest! But it is very important so I'll keep gathering information for him so when I meet him, I'll have a lot of data to share (don't worry, I wont overload him). ;)

Thanks again, dear cassiopaea family!

 

[mcb]

MCT oil was invented to allow for higher carb intake while maintaining ketosis. Perhaps this would be helpful when transitioning for someone needing plenty of calories, though I don't know about the quality and origin of the oils used.

It can help. Leucine also, supposedly. It depends on how much you want to make the change to a ketogenic diet. If it is being "prescribed" then many people will accept it from the "authority," at least for a time. (But some of the prescription diets can be nasty, if the person prescribing them doesn't know better.) I don't know if that will happen -- it didn't sound like it.

Would he have to first get into ketosis and then re-take carbs with the supplements in order to maintain ketosis while eating carbs?

Quite franlky, I'm a bit confused because he needs so much energy, I don't know how his body will be able to deal with fat and carbs at the same time, energy-wise.

What happens to carbs when you are in ketosis like in the case monotonic described (with the use of MCT oil)? How can the body use both as a source of energy at the same time? Dosen't sound very healthy to me going from one mode to the other. But I need more information to make my mind.

Wheeehaaa! That's a lot of stuff to digest! But it is very important so I'll keep gathering information for him so when I meet him, I'll have a lot of data to share (don't worry, I wont overload him). ;)

Thanks again, dear cassiopaea family!

I don't understand prescription ketogenic diets myself. They got off on a bad footing by starving young seizure patients and then introducing the KD. Eventually somebody figured out that it was the ketones produced by the starvation and not the starvation itself that was useful, but pretty much none of the professionals involved understand nutrition in even a basic way (the ones trained in it are the worst) and they have come up with some pretty strange formulations.

As Paul Jaminet puts it,

How Not to Implement a Ketogenic Diet
Ketogenic diets used in clinical practice have often been terribly unhealthy. Doctors mistakenly assumed that since ketones are produced in starvation, starvation must be the best way to make a diet ketogenic. So they designed ketogenic diets to be starvation diets, deficient in glucose and protein.

Glucose and protein starvation cause a host of problems, especially in children...

Jaminet, Paul; Jaminet, Shou-Ching (2012-12-11). Perfect Health Diet (Kindle Locations 3114-3118). Simon & Schuster, Inc.. Kindle Edition.

(Note Jaminet's reference to his theoretical "glucose starvation." This is far from proven.)

Monotonic was referring to an elevated carb with MCT oil formulation. As far as I know that should work, although not as well as it might without the carbs. When you believe that carbs are "essential," however, this is what you come up with. Paul Jaminet (who does believe carbs are essential) again:

A Better Way: MCT Oil, Carbohydrates, and Protein
Fortunately, clinicians have gradually realized that starvation is both dangerous and unnecessary.

The better way is to meet carbohydrate and protein needs and to generate ketones not by starvation but by eating large amounts of medium-chain fats. These fats flood the liver, where they are disposed of by conversion to ketones, regardless of how many carbs are in the diet.

In epilepsy and probably all other diseases, it’s better to include carb calories in a ketogenic diet. A study using a blinded crossover design switched twenty epileptic children between (1) a zero-carb ketogenic diet and (2) the same diet with 240 glucose calories. On both diets, ketones were produced. The glucose group had fewer seizures...

Jaminet, Paul; Jaminet, Shou-Ching (2012-12-11). Perfect Health Diet (Kindle Locations 3131-3137). Simon & Schuster, Inc.. Kindle Edition.

So there is this strong belief out there that carbs are essential to a medical/therapeutic KD. I believe Jaminet has also suggested the use of leucine, in addition to or in place of MCT oil, to up the number of carbs that can be consumed while still elevating ketones, and Chris Kresser has picked up that idea as well, probably from Jaminet.

What bothers me about all this is that while a doctor might buy in to this elevated carb approach, it seems to be based on the premise that carbs are very good for you and that even a KD should contain quite a few. It might be hard to get the doctor to go along with eliminating the carbs. I'm also not so sure that using MCT oil is all that great of an idea, health-wise, and I don't know about supplementing with leucine either. It's sure not what I would want if it were me, knowing what I know now.

It was difficult for me to eliminate starch (the source of my carbs) from my diet. I had to try repeatedly. I can see why this belief persists that carbs are important -- most people give up too easily. You may have to fix quite a few things over a span of several years to make it possible, if you have a lot of health issues. It took me multiple tries over more than a year, but now my carb consumption is minimal and there are no visible complications from doing that. My blood glucose is still on the upper end of normal, and my ketones are "just OK," so there is more work to do. To me, this is where you would want to go.

Come to think of it, my "just OK" ketones are perhaps very good compared to what is typically seen with carb-heavy KDs. So there are two "pulls" in the direction of not eliminating carbs, and of trying to bring up ketones using other means. 1) Lots of otherwise smart people are convinced that eliminating carbs is dangerous and 2) people don't want to give up their carbs. They like them.

To me it makes sense, if somebody's life is on the line, to go for broke and eliminate carbs, although that could take a fair amount of time and effort. If that proves not to be an option for either of the reasons above or for some other reason, then you can look at how to raise ketones without eliminating carbs.

(What I mean by "eliminating carbs" is eliminating available dietary carbs. I do not eliminate all carbs; I consume foods containing indigestible carbs that feed gut bacteria, along with negligible amounts of digestible carbs.)

By the way, I found the above study that supposedly favored including carbs in the KD here:
_http://onlinelibrary.wiley.com/store/10.1111/j.1528-1167.2008.01740.x/asset/j.1528-1167.2008.01740.x.pdf?v=1&t=hcziyvyy&s=48ee0f79665f6c23f4b3f1f21a459207090f2efb

I noticed that there was no keto-adaptation period. If a child was keto-adapted, that was grounds for exclusion The experiment ran 11 days, with an extended follow-up to see how the subjects did on the KD that they had started during the experiment (it was quite effective). The treatment and control (placebo) groups were swapped at 6 days (crossover design), in the middle of keto-adaptation, and the resulting skew could be observed in the data. The authors of the paper acknowledged these issues and others (the 60 g/d of glucose administered to the control group was insufficient to terminate ketosis!) and recommended that somebody do another, better study.

I don't know where Jaminet read that the kids with glucose did better. I did not see that, but you could get that idea from just reading the abstract, due to an ambiguity in the wording.