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21 year old treating Crohn's and gastroparesis with Paleo... too much stress on body to LC/VLC?

Answered on September 12, 2014
Created July 27, 2011 at 11:24 PM

I am a 21 year old female who is treating Crohn's disease and gastroparesis with the Paleo diet to great success. The gastroparesis is a side effect of an allergic reaction to Humira, not diabetes related.

I am an athlete who spins, road bikes, and lifts to stay in shape. My cycling endeavors are around an hour, and my lifting some body weight stuff combined with kettleballs I took from my college ski team workout. I try to do these things 5x/week. I sleep pretty well, am cutting back on coffee to one cup a day, and don't have too much outside stress at the moment. My question is this: Why does my energy die and my head feel like it's going to explode when I attempt LC/VLC?

Because of the Crohn's, I keep my diet pretty simple and stick with grass-fed beef, wild caught fish, coconut oil, ghee, and leafy greens. Much else leaves me in a lot of pain. I eat carrots and sweet potatoes as my main sources of carbs, on workout days usually around 200g. On regular days more like 50-70g.

I am 5'5, 130 lbs. and really wanted to try ketosis to see if it offered any benefits to my Crohn's, and also to kick the 5 lbs I put on during my last semester of college. Stress + too much wine + no exercise = weight gain.

Everytime I get into ketosis (never used ketostix, but have the metal breath, strong smelling pee, all that jazz) it totally kicks my ass. I mean can't focus through the pain in my head. I have been able to do this for a couple of days at a time, struggling the whole way, but just end up feeling terrible. Also, the really high amount of fat causes pain in my small intestine, as that is where fat is digested and also where my Crohn's is concentrated.

After reading all of the banter on the site recently about low carb Paleo v. moderate carb Paleo, I feel like I am missing out on some of the benefits of the diet by having to eat so many carbs. I want to be keto-adapted! Why is my body so resistant? Is having the disease + being low carb just too much stress?

4145b36f1488224964edac6258b75aff

(7821)

on July 30, 2011
at 08:52 AM

Yeah. The physiologic state of ketones in the blood probably has nothing to do with Crohn's, but the way a diet effects the gut does. You can probably eat enough simple sugar to avoid ketosis and still heal your gut enough to avoid Crohn's (kind of like what the OP has done).

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on July 30, 2011
at 03:27 AM

Just wrote about this tonight. You might want to check it out. Friday July 29th. Good Luck.

100fd85230060e754fc13394eee6d6f1

(18706)

on July 30, 2011
at 02:52 AM

This is a great answer, but "Ketosis is probably irrelevant to Crohn's. The diet's effect on the gut is the important factor." is a bit contradictory. Maybe you mean that the fact that the diet is ketotic is not what makes it work, but is just a side-effect of removing sugar, starch and fiber?

9a5e2da94ad63ea3186dfa494e16a8d1

(15833)

on July 28, 2011
at 02:16 PM

Actually the usual advice is to keep it either very low intensity, or very high intensity. For biking that would mean slow and easy rides, or say 15-20 minutes of intense hill climbing and/or sprinting. Like instead of running now, I walk about 2-3 miles, and near the end, go to a field and do 10-15 sprints of 50 meters. I think this kind of exercise is a lot more compatible with low carb, and burns more fat and gives you more feel-good hormones too. Just IMHO -- good luck.

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:45 PM

You might like my blog post "Cave Biddy rips on traditional medicine" --> http://coconutandpearls.wordpress.com/2011/01/14/cave-biddy-rips-on-traditional-medicine/

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:42 PM

You're right, it is nerve wracking to think of dropping my cycling! As a competitive ski racer it has been the only form of exercise that really puts my quads in endurance shape for giant slalom. I have tried to do the walking/lifting thing, but my mistake seems to have been doing >10g carbs during this time. Maybe if I did more like 30-50 as you do and kept the cycling less strenuous (slower, less hill climbing) like a walking type exertion my head would feel better. I'm wondering if it is better for me to drop the training and go low carb, or if keeping my training and higher carb is ok too.

4145b36f1488224964edac6258b75aff

(7821)

on July 28, 2011
at 12:42 PM

You may have to pick and choose here - I was basically meat only for a year. No way could I have biked as much as you were (prior to diet I did a lot of cycling). But the investment does appear to have paid dividends, since now I rarely have pain or anything Crohn's-ish, despite challenging myself with various foods. You might just have to cut back on the cardio and intensity of your exercise for a bit... but it all comes down to your priorities.

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:30 PM

Great answer, this is more of what I was looking for. I used to SCD and my doctor (holistic approach, but PhD from Georgetown med) had me tested for the bacterial content of my gut and the dysbiosis was pretty bad. So I was thinking along the lines that a ketogenic diet would starve out any bad bacteria remaining in my gut. That being said, I've been eating SCD for three years and Paleo for one, so hopefully they've been starved out to some extent by having no refined carbs or sugar available to them. On SCD though I was having wayyy to much fruit, nut butter, and yogurt/cheese.

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:24 PM

Thanks for the article Lea, I hope your Dad is doing well. The food/energy diet is a great idea and what lead me to totally eliminate eggs and yogurt (even homemade... so sad).

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:19 PM

Thanks Roy, I wasn't really sure what you were getting at but that makes sense. I do feel very lucky to have been unable to take those medicines, even though that realization didn't come immediately. If they had worked for me I likely would never have found SCD and eventually Paleo.

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:17 PM

Thank you, I have a bottle of vitamin D from my doctor that has sort of fallen out of my routine, I will be sure so start taking it regularly! I try to get some mid-day sun everyday but that doesn't always happen. Broccoli make my stomach blow up like a balloon...

77877f762c40637911396daa19b53094

(78467)

on July 28, 2011
at 04:35 AM

thanks for responding LongHair. It obviously has everything related because meds derive from same food that Paleo's avoid. but whatever, the truth isn't meant to be talked about, not even here. And thanks Biddy for responding. YOu're lucky you're body responded instead of you having silent symptoms, that would have been much worse.

E5c7f14800c5992831f5c70fa746dc5c

(12857)

on July 28, 2011
at 02:57 AM

If your If'ing your likely pretty keto adapted.

E5c7f14800c5992831f5c70fa746dc5c

(12857)

on July 28, 2011
at 02:54 AM

Its definitely not too high. 100-150g is pretty much the bare minimum most paleo experts recommend and is a good starting point. Most people eating that little carbs are not doing nearly as much as you are.

667f6c030b0245d71d8ef50c72b097dc

(15976)

on July 28, 2011
at 02:23 AM

Why would you, especially at your age, want to limit carbohydrate? What is wrong with carbohydrate? All of our bodies are constantly burning both glucose and body fat all the time.

D339e72f83d333c470dbf282ccc76330

(10)

on July 28, 2011
at 02:05 AM

It does. Im confused when I see all the talk on here of people maybe having one sweet potato a day and eating 25g of carbs while training. Is 100-150g a day not too high? Thanks for your response, I think I might have bought into the ketomagic deal.

D339e72f83d333c470dbf282ccc76330

(10)

on July 28, 2011
at 02:01 AM

Probably downvoted because it's not at all an answer. But I was allergic to every med I was given (6-MP, Remicaid, Humira) so I take nothing and treat it with diet.

D339e72f83d333c470dbf282ccc76330

(10)

on July 28, 2011
at 01:59 AM

And the hydration and sleep are there. When I do VLC I could never manage a workout I feel so bad, so thats not really the issue

D339e72f83d333c470dbf282ccc76330

(10)

on July 28, 2011
at 01:58 AM

When I do VLC the only really obvious Chrons related pain is the lower right quadrant pain I described in the small intestine from digesting so much fat. I'm asking if my adrenals might be so shot because of fighting the disease that taking away carbs is just too much. Or could I try something else?

9a5e2da94ad63ea3186dfa494e16a8d1

(15833)

on July 28, 2011
at 01:56 AM

Sorry I didn't think it had anything to do with her question... she didn't ask about meds.

D339e72f83d333c470dbf282ccc76330

(10)

on July 28, 2011
at 01:55 AM

I was hoping to be able to use stored fat for energy more readily, I feel like the fact that I am so miserable VLC means that my body is inefficient at using ketone bodies. I do IF with an 8 hour eating window (9-5).

E5c7f14800c5992831f5c70fa746dc5c

(12857)

on July 28, 2011
at 01:48 AM

What does being keto-adapted entail? Could you not achieve the same effects with intermittent fasting?

77877f762c40637911396daa19b53094

(78467)

on July 28, 2011
at 01:44 AM

why down vote this? at least leave a comment why.

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9 Answers

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3
4145b36f1488224964edac6258b75aff

(7821)

on July 28, 2011
at 12:01 PM

I spent a year on a VLC/ZC diet to treat Crohn's. It seems to have worked well enough that I'm now eating a lot like you are.

In everything I've read, there's no suggestion that ketosis will have any effect on an autoimmune disorder, nor any reason to believe it would specifically have any effect on Crohn's. The Crohn's theory that I like the best is gut dysbiosis/weak gut lining (gluten etc) -> bacterial protein mimicking gut collagen -> confused immune response -> Crohn's. If you fix the first part of the chain by eliminating excess fiber and starches and healing the gut wall, you avoid the rest and voila, no more Crohn's.

Ketones are just alternatives to glucose. Glucose/ketone metabolism should have nothing to do with Crohn's, so don't force yourself into ketosis on that count. If you can find some actual medical evidence that suggests a benefit, that's a different story, but again I can't think of any theoretical reason or empirical evidence that it would matter.

To answer the actual question...

You feel like you're going to die and your head is going to explode for a few reasons:

1) You are not already keto-adapted and are no doubt attempting to keep up heavy activity levels. It took me months before I would say I was fully adapted, and I was never able to keep up the same level of physical activity that I was while carbed.

2) Even if you were fully adapted, you happen to be undertaking exactly the kind of activity which will punish a VLC lifestyle - high volume/intensity endurance work. (5x week hour bike rides assuming a decent pace). Maybe someone who has spent their life adapting to VLC could do better, but most athletes report needing more carb.

So, to sum up:

1) Ketosis is probably irrelevant to Crohn's. The diet's effect on the gut is the important factor.

2) Ketosis + lots of high intensity endurance == very difficult, especially if you just jump right in. If you really want to try, spend a few weeks adapting at a lower level of intensity and then start adding days/time back in to see if you can handle it. Throwing yourself into it will make you want to die.

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:30 PM

Great answer, this is more of what I was looking for. I used to SCD and my doctor (holistic approach, but PhD from Georgetown med) had me tested for the bacterial content of my gut and the dysbiosis was pretty bad. So I was thinking along the lines that a ketogenic diet would starve out any bad bacteria remaining in my gut. That being said, I've been eating SCD for three years and Paleo for one, so hopefully they've been starved out to some extent by having no refined carbs or sugar available to them. On SCD though I was having wayyy to much fruit, nut butter, and yogurt/cheese.

4145b36f1488224964edac6258b75aff

(7821)

on July 28, 2011
at 12:42 PM

You may have to pick and choose here - I was basically meat only for a year. No way could I have biked as much as you were (prior to diet I did a lot of cycling). But the investment does appear to have paid dividends, since now I rarely have pain or anything Crohn's-ish, despite challenging myself with various foods. You might just have to cut back on the cardio and intensity of your exercise for a bit... but it all comes down to your priorities.

100fd85230060e754fc13394eee6d6f1

(18706)

on July 30, 2011
at 02:52 AM

This is a great answer, but "Ketosis is probably irrelevant to Crohn's. The diet's effect on the gut is the important factor." is a bit contradictory. Maybe you mean that the fact that the diet is ketotic is not what makes it work, but is just a side-effect of removing sugar, starch and fiber?

4145b36f1488224964edac6258b75aff

(7821)

on July 30, 2011
at 08:52 AM

Yeah. The physiologic state of ketones in the blood probably has nothing to do with Crohn's, but the way a diet effects the gut does. You can probably eat enough simple sugar to avoid ketosis and still heal your gut enough to avoid Crohn's (kind of like what the OP has done).

3
9a5e2da94ad63ea3186dfa494e16a8d1

on July 28, 2011
at 01:54 AM

Some folks that post here report similar issues with very / low carb diets, some folks just seem to need some carbs (i.e. 150-200g) in their diet to maintain a good level of mood and energy. There seems to be a correlation between people who say they do better with more carbs, and those that work out a lot (a somewhat serious workout 5-7x per week). One theory is that doing cardio workouts every day causes your body to require more carbs to burn on a regular basis, it gets into a mode of "I'd better stock up on the glycogen if we're going to run 5 miles again tomorrow".

If you want to try a lower carb diet, you might decrease your overall activity, and go instead for brief, high-intensity workouts (i.e. the strength training you're already doing), little or no cardio (drop the biking and spinning), and more walks and hiking (i.e. low-intensity, longer duration). Many folks on the Paleo diet work out no more than 15-30 minutes 3x per week. This in combination with walking a total of 2-3 hours per week can take off the weight, and often fits better with a low carb diet.

I know that dropping the biking and spinning can seem crazy if that is your main workout outlet, but that is what worked for me. My main form of exercise used to be running 3-4 miles 3-4 times per week, and then I stopped running completely and switched to kettlebells, floor exercises and strength training. The result was that I lost about 6-7 pounds very quickly (including about 1.5 waist sizes, so I think it was all fat), in about 7-10 days, and my mood and sleep is way better, and as a bonus, I spend a lot less time working out. Inverting that statement, it seems that running 10-11 miles per week was keeping 6-7 pounds of fat on me, giving me worse mood and sleep, and I was spending more time on it than I liked. Interesting, no? Totally not what I expected, but I'm glad I tried it.

I generally eat about 30-50g carbs per day and am completely happy with that, though I generally like a low carb diet. I was having a bit of trouble with low carbs and running, I never seemed to gain any strength or endurance even running religiously every other day for 2 years. But the results from the strength training have been very quick and satisfying.

EDIT: reading over what I wrote, I realize that it's probably physically impossible to lose 6-7 pounds of fat in a week without surgery... nonetheless, I lost the weight quickly, kept it off, and have lost a couple of more pounds since then. Maybe not all fat, but I'm glad to be rid of it, whatever it was...

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:42 PM

You're right, it is nerve wracking to think of dropping my cycling! As a competitive ski racer it has been the only form of exercise that really puts my quads in endurance shape for giant slalom. I have tried to do the walking/lifting thing, but my mistake seems to have been doing >10g carbs during this time. Maybe if I did more like 30-50 as you do and kept the cycling less strenuous (slower, less hill climbing) like a walking type exertion my head would feel better. I'm wondering if it is better for me to drop the training and go low carb, or if keeping my training and higher carb is ok too.

9a5e2da94ad63ea3186dfa494e16a8d1

(15833)

on July 28, 2011
at 02:16 PM

Actually the usual advice is to keep it either very low intensity, or very high intensity. For biking that would mean slow and easy rides, or say 15-20 minutes of intense hill climbing and/or sprinting. Like instead of running now, I walk about 2-3 miles, and near the end, go to a field and do 10-15 sprints of 50 meters. I think this kind of exercise is a lot more compatible with low carb, and burns more fat and gives you more feel-good hormones too. Just IMHO -- good luck.

1
Medium avatar

on July 28, 2011
at 12:02 PM

I had Crohn's for decades and no longer have any symptoms at all. I avoid roughage (I extra microwave the abundant amount of broccoli I eat), sugar, wheat, anything fried, and most carbs. Also I believe vitamin D supplementation is also pivotal in vanquishing my crohn's. Be aware that you may need to take large amounts (I take 50,000 5 times a week but Ive had surgeries before and prolly don't absorb it at same level/rate as others). If you do the above I believe you will see drastic beneficial results.

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:17 PM

Thank you, I have a bottle of vitamin D from my doctor that has sort of fallen out of my routine, I will be sure so start taking it regularly! I try to get some mid-day sun everyday but that doesn't always happen. Broccoli make my stomach blow up like a balloon...

1
E5c7f14800c5992831f5c70fa746dc5c

(12857)

on July 28, 2011
at 01:51 AM

At your training load and age its no wonder your body responds negatively when you get rid of the carbs. There is no benefit to being "keto-adapted"(what does this mean?) for athletes maybe if you want to give up your training but I don't get the advantage of that.

Low carb ketosis is for people who have serious issues, epilepsy, chronic obesity etc. I don't think its appropriate at all in your case.

Does the diet with carbs not work for you? Or are you just interested in magical benefits of ketosis?

E5c7f14800c5992831f5c70fa746dc5c

(12857)

on July 28, 2011
at 02:54 AM

Its definitely not too high. 100-150g is pretty much the bare minimum most paleo experts recommend and is a good starting point. Most people eating that little carbs are not doing nearly as much as you are.

D339e72f83d333c470dbf282ccc76330

(10)

on July 28, 2011
at 02:05 AM

It does. Im confused when I see all the talk on here of people maybe having one sweet potato a day and eating 25g of carbs while training. Is 100-150g a day not too high? Thanks for your response, I think I might have bought into the ketomagic deal.

1
D9032e4f6540f9e6bcbb07143002bedd

(449)

on July 28, 2011
at 12:15 AM

The question I have is how is how does your Crohns react to Ketosis? Those side effects you mention don't seem in line with Crohns flare ups. I have a friend with Crohns and he is basically in remission thanks to strict paleo diet.

Is it possible your lack of focus is not related to diet, but perhaps poor sleep quality, poor hydration or something else? Your diet sounds very well dialed in to me.

I might suggest that if anything perhaps your cortisol is up from your high training schedule. What if you kept a good diet, went LC/VLC and cut out some of the cardio?

D339e72f83d333c470dbf282ccc76330

(10)

on July 28, 2011
at 01:58 AM

When I do VLC the only really obvious Chrons related pain is the lower right quadrant pain I described in the small intestine from digesting so much fat. I'm asking if my adrenals might be so shot because of fighting the disease that taking away carbs is just too much. Or could I try something else?

D339e72f83d333c470dbf282ccc76330

(10)

on July 28, 2011
at 01:59 AM

And the hydration and sleep are there. When I do VLC I could never manage a workout I feel so bad, so thats not really the issue

0
26b7615ef542394102785a67a2786867

on July 30, 2011
at 03:04 AM

I don't have Crohn's, but I have IBS, and am also active. VLC makes me feel like crap too, and is not sustainable. Not sure why, but we are all different. There are lots of people who feel great on VLC. Most, if not all, of the people who tout the benefits of VLC are among this group. ;)

If you really want to try to make VLC work, you should give up cycling/cardio entirely and get your body adapted to ketosis without working out. I would say the vast majority of people couldn't sustain at that level without at least moderate carbs.

If you're feeling good and performing at the level you want to while eating moderate 'paleo' carbs, I don't know why you'd want to force yourself to function on VLC, though.

0
100fd85230060e754fc13394eee6d6f1

(18706)

on July 30, 2011
at 02:48 AM

It often takes a week or more to adapt, but if it's that painful, a week is a long time. I've heard of rough transitions, but never pain in the head, wow!

What level of carbs are you trying to get to? Maybe a gradual approach would work better?

Since you currently do about 50-70 grams on non-workout days, and about 200 on workout days, maybe you could also make it more parallel to that. For example, go to 15-25 grams on off days and, say, 50-100 on workout days.

0
706f593d19a9ac235466d94e185b31b1

(10)

on July 28, 2011
at 06:46 AM

Hi Cave Biddy, It sounds like you need more food. As to your Crohn's, you know your crohn's best, but my Dad (who has Crohn's) simply can not eat leafy greens and unless they are super well cooked. Perhaps consider cooking all your veg matter and perhaps keep a detailed food/energy diary and see if you can see patterns in your energy and crohn's symptoms. Once your get all the benefit from your food (i.e. your crohn's allows you to absorb nutrients) you should get more energy too. Also this article might be worth a read http://paleodietlifestyle.com/you-and-your-gut-flora/
So glad to hear your trying paleo and not the cover up medicines! Good Luck!

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:24 PM

Thanks for the article Lea, I hope your Dad is doing well. The food/energy diet is a great idea and what lead me to totally eliminate eggs and yogurt (even homemade... so sad).

-1
77877f762c40637911396daa19b53094

(78467)

on July 28, 2011
at 01:36 AM

If you have crohns, you must have been percribed lots of medicine from a doctor who if you told you were doing Paleo, he/she would consider sending you to a physciatrist from being crazy. But we both know, Paleo is the best chance you have. So what have you done with all the medicine you are perscribed?

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:45 PM

You might like my blog post "Cave Biddy rips on traditional medicine" --> http://coconutandpearls.wordpress.com/2011/01/14/cave-biddy-rips-on-traditional-medicine/

77877f762c40637911396daa19b53094

(78467)

on July 28, 2011
at 01:44 AM

why down vote this? at least leave a comment why.

D339e72f83d333c470dbf282ccc76330

(10)

on July 28, 2011
at 02:01 AM

Probably downvoted because it's not at all an answer. But I was allergic to every med I was given (6-MP, Remicaid, Humira) so I take nothing and treat it with diet.

5ce36633c4c872b4eb5e45214f512f3d

(135)

on July 28, 2011
at 12:19 PM

Thanks Roy, I wasn't really sure what you were getting at but that makes sense. I do feel very lucky to have been unable to take those medicines, even though that realization didn't come immediately. If they had worked for me I likely would never have found SCD and eventually Paleo.

77877f762c40637911396daa19b53094

(78467)

on July 28, 2011
at 04:35 AM

thanks for responding LongHair. It obviously has everything related because meds derive from same food that Paleo's avoid. but whatever, the truth isn't meant to be talked about, not even here. And thanks Biddy for responding. YOu're lucky you're body responded instead of you having silent symptoms, that would have been much worse.

9a5e2da94ad63ea3186dfa494e16a8d1

(15833)

on July 28, 2011
at 01:56 AM

Sorry I didn't think it had anything to do with her question... she didn't ask about meds.

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