Tuesday, June 9, 2015

Ketogenic Diet and Sciatic Pain/Herniated Disc

I've continued to do more research on the Ketogenic diet I am on. It is working well for my own weight loss. I am down 15 pounds from when I started, have lost several inches, I have a lot of energy and don't miss or crave any of the foods I used to eat.  I am also free of the pain I once had due to inflammation in my big toes, right hip and right thumb.

While researching, I've come across this study: Ketogenic Diet Improves Forelimb Motor Function after Spinal Cord Injury in Rodents.

As many of you know, RLB was medically retired from the Army in December of 2013 due to his chronic and debilitating back pain. He was later diagnosed with Facet Syndrome and was able to live pain free after one Facet injection. The injections last for four months before the pain creeps back. Due to his medical care being provided through the VA, wait times for procedures are very long. He's had to fall back on drugs like Percocet to endure the pain while he waits for approval for the injections.

His last injection was in the beginning of April. Prior to his appointment, he started feeling new pain down his right leg. Immediately after the injection, he could no longer sit without excruciating pain. For two weeks he wore out his feet walking around. It was the only way he could have relief from the pain. He was exhausted and frustrated. He started taking Percocet again and eventually had to go back on Morphine to get sleep and rest.

His MRI revealed a herniated disc between L4 and L5. It wasn't until May 21 that he was able to speak with a neurologist to discuss his options. It was decided the first treatment they'd try was another spinal injection. The first available date with the VA was July 9.

As RLB tried to navigate the VA to get approval to utilize VA Choice (a new program to provide a temporary fix the backlog), he became increasingly frustrated with the pain and need for drugs. He had already read much of the research I had found on the Ketogenic diet and decided he had nothing to lose. If it worked for rats, it might work for him. He asked the neurologist if there was anything he could do to help with the pain with regards to his diet. "Sure, drink more water, stuff like that" was the response he got. RLB winked at me and made the decision right then that he'd take this into his own hands and start the Ketogenic diet.

His first day of a high fat/very low carbohydrate diet was Friday, May 22. On Saturday he told me he wasn't feeling any break through pain. On Sunday he started weening himself off of the Morphine. As of today he hasn't had Morphine for two weeks and has been weening himself off of the Percocet.

Today was the day his injection was scheduled (due to VA Choice approval) at our University Hospital. He met with an intern first who asked him his pain level. RLB told him about the diet he's been on and how he's been pain free since 24 hours after he started. He kept his appointment because he wasn't sure if he should still have the injection for further treatment of the herniated disc.

When he went to the surgical injection room, the Radiologist came in and asked him more questions. His recommendation was for RLB to keep doing what he is doing, the injection would be redundant since the steroid is an anti-inflammatory and designed to do exactly what his diet has done for him. RLB asked if he had any concerns about this type of diet to which he responded, "No, you're a fit man, there is no reason to not stay the proactive course you've been on."


Could this be typical? And if so, why isn't it prescribed? - I ask this tongue-in-cheek.


  1. This is all so awesome to read about. Just some notes from my perspective:

    It's all about INFLAMMATION. Go read Dr. Art Ayers blog, Cooling Inflammation. Read the whole thing. Overall health really is all about the microbiome in your gut.

    "Carbs" as a macronutrient class, are not inflammatory - per say.

    All of these benefits you both are experiencing do not mean you have suddenly both found 'the perfect diet' for the rest of your lives. "Low Carb" and "Ketogenic" diets "work" I think precisely because you cut out all the inflammatory foods that come from highly processed carbohydrate foods (cookies, candy, crackers, chips, cake, pastries, mass-produced breads and most other GMO based grains and oils).

    Consider it more of a therapeutic intervention that may take awhile to heal and recover from the damages done from years of eating bad food exacerbating any other conditions due to injuries etc.

    But you've already stated IIRC, that you guys know this, and do plan to add "carbs" back at a later date. I.e. - I was wondering if foods like broccoli, green beans, asparagus, brussel sprouts, spincach, kale, etc. cooked with good fats like butter, bacon grease, coconut oil, EVOO etc., are all "carbs" that you are "allowed" to eat on your version of the keto diet? Am I correct in assuming a keto diet just involves avoiding all the "starchy" carbs like potatoes, carrots, rice, pasta, cereal, etc.?

    Just remember this - one of the foundational tenets of the Weston Price foundation (the first place I began this journey of food, diet and nutrition awareness), is that a diet rich in healthy, nutrient-dense saturated fats, is protective and anti-inflammatory. As you well know, high fat food is satiating.

    In other words, be careful you don't fall into the "low carb" and "zero carb" dogma as the answers to all your problems...It may very well be the high fat part that deserves most of the credit! :-)

    1. Ketogenic Diets track "net" carbs meaning that you subtrcat dietary fiber from total carbs. This is why people are encoiraged and able to eat green vegetables while keto because they are high in dietary fiber which keeps the carb count low.

    2. Ketogenic Diets track "net" carbs meaning that you subtrcat dietary fiber from total carbs. This is why people are encoiraged and able to eat green vegetables while keto because they are high in dietary fiber which keeps the carb count low.

  2. Thank you for the link, Keoni. I'll go there next.

    We've added daily probiotics and prebiotics (potato starch in cold water) to our regimen.

    Being the human guinea pig that he's graciously become, RLB just had a smoothy (1/2 can coconut milk , 2 TBSP coconut oil, 2 eggs, 1 tsp unsweetened cocoa, 1 cup ice) with 2 of our fresh strawberries blended in.
    The strawberries weighed 50 grams and contained 2.3 grams of sugar, the coconut milk contains 1 gram of sugar. All total he had 3.3 grams of sugar (a little less than a teaspoon). Within an hour of drinking it, his sciatic pain shot down his leg and remained for about 30 minutes. It's gone now.

    So, sugar sources are definitely an issue for him.

    The big question for us is: Is it the ketones, is it the fat, or is it the lack of sugar that is relieving the pain? So we'll test it by having him eat enough carbs of good foods that he'll be out of ketosis and see what happens with his pain level.

    I read the zero carb sites but am not interested in the dogma of being strictly carnivorous. I do add several of the veggies you listed to our food. We have hundreds of pounds of potatoes growing in our garden, I really hope he'll be able to add those in to his diet without having pain. I'm already really sad about the strawberries.

  3. Did he not retain Tricare for himself as well as the family? If he did he doesn't need to bother with the VA at all. He can see a primary doctor of his choosing. The copay is the same as the family's and the coverage is essentially the same as active duty.

    Good to see you back online btw. Still silently reading.... well, except for today of course. ☺

    1. Hi Marie! Good to hear from you!

      Yes, we have Tricare. However everything associated with his back (and everything else listed in his file) has to go through the VA. From what I understand, Tricare does not like to cover that which the VA covers 100%. We're not in a Prime area and have to pay the Standard copay - 20% of an MRI, Neurologist, Radiologist, and everything else would have been very costly.

    2. Ouch, yeah standard is rough. We have to drive an hour north for the kids pediatrician (under Prime) as we don't live in the prime area either. We considered switching the kids to standard, but if God forbid anything terrible happened we would be paying out our eyeballs. Not worth it. I'll drive an hour north.

  4. The pain removal is likely down to the lack of insulin spikes. Insulin is actually a miracle worker in the body, until you get something really out of whack. Then it's your biggest enemy. (It's more important for muscle building than Testosterone, in Men, actually. But you produce a lot of it already)

    Your Husband is actually dealing with more than just the pain. He's retired, in-theater combatant. His nervous system is attempting to repair the stress the body has taken as well. What's happened with the diet change is that he's removed a chunk of inflammation, much like removing a thorn. But it'll still take the body a long while to repair.

    A form of the diet has been around since the 1930s. It's called the "Ketogenic diet for childhood refractory epilepsy". It's hung around but really only came back into common usage in the 1980s. I recommend the MCT Oil-based versions of it, as it's nutritionally complete, but it will slowly repair nervous system tissue. (Something they still haven't quite grasped, even if it's right there in the medical literature)

    Other ideas that are likely helpful:

    Methylation repair supplements: 5-THMF, TMG, Methyl-B12 and Glutathione.
    L-Glycine (given the descending pain pathway)
    Choline (normally suggest just eating eggs for this)
    Solid Omega 3 source

    The one issue, though, that the current diet has is that he'll eventually hit the "end point" of how much body Fat he can render away via Ketosis. If the Ketones are what is pushing a lot of the help to the nervous system, that end point will come fairly suddenly. (That's why MCT Oil is valuable, it produces Ketones by design)

    1. Thank you for this information, Looking Glass. I'll start looking into those supplements this morning.

      We're still unsure of what is causing the pain reduction, the ketones or the lack of carbs/sugar. The other night he ate a handful of nuts (pecans/almond mix) and a little pain came back. I estimate it was about 12 grams of carbs - mostly dietary fiber. He couldn't have kicked himself out of ketosis with that small amount could he?

      He has about 10 pounds of body fat left he could lose. Right now it's been a struggle to get enough calories in him. His body is in the adaption phase right now and in addition he's weening himself off of percocet. He says the symptoms are getting better - less nausea. We've upped his electrolyte/sodium intake.

    2. That should be "5-MTHF" for 5-MethylTetra HydroFolate. It's the active form of Folic acid. When the stress system has problems, the activation sequence itself can have problems using the Folic Acid properly, which I why I normally suggest that version.

      It's not the Ketones, though that probably helps matters, but the issue is highly likely the insulin response spikes and the nerves being extra sensitive in response. 12g of Carbs won't make much more than a blip on actual Blood Glucose levels, but it can signal Insulin. Further, given the pain system's actions, it's likely that the stress has simply built up and is really sensitive. (It likely kept him functioning better... until it took too much of a toll on his body)

      Some basic B6 probably wouldn't hurt either, though you should probably check the interactions with the drugs. That's the one area where things can get messy.

      Fried (no batter), grilled or baked chicken. Mustard, Butter or Vinegar for a sauce of some form. I've had good luck with those over the years.

      If there's 10 pounds to lose, then another 2-3 months it should be fine. But look into the MCT Oil in the mean time. I'll drop an email in the next 24hour or so, if you want to ask questions about this stuff more directly.

    3. I just ordered some L-Glycine, MCT oil, Omega 3 fish oil tabs, I've had him eating around 2 Tbsp coconut oil/day and will up that.

      Hopefully the L-Glycine will help him sleep, I read that can be one of its benefits.

      We'll add B vitamins too. He should be close to done with the Percocet, he's only had ibuprofen for the last 24 hours.

      I'll look into the 5-MTHF more soon.

      The insulin spikes make sense. Hopefully as time moves on he won't be so sensitive.

      Thank you so much!

    4. Hi, just wanted to see any update on how the pain levels are and how the diet is doing? Thank you very much.

  5. I'm glad you asked, fu, I just reread Looking Glass's excellent comments and was reminded of some things. Like he said, my husband has "run out of body fat" - it's the only thing we can think of that has changed. His pain has returned. He enjoyed 7 months being pain free. In November some slight pain returned. And now his pain is back full force and excruciating. He's back on meds for pain management as he awaits the VA approval for an injection. Now that I've read these comments again, I'm going to look more into MCT's and see if that will help him. He's lost 50 pounds since his heaviest weight. While he's not underweight, his body fat % is very low.
    For me, I've lost 32 pounds and six inches off my hips. :) the weight loss has slowed but my monthly measurements still show fat loss.
    My husband just had his annual lab work done. The results were amazing. He was "pre-diabetic" a year ago and today has a fasting glucose of 74. Also his triglycerides are down from 171 to 86. The tests also showed improved kidney and liver function. So, he is in excellent health outside of ...the pain.

  6. Due to weakening and imbalance of spine support structure Herniated Disc occurs. Following are some effective Herniated Disc Treatment like medication, rest, physical therapy, home exercises, and hydrotherapy, which can help patients to recover from the condition.

  7. Glad to hear that the diet is working both both of ya'll. Sorry that the pain has returned and hope he definitely get some relief! Through my brief research since I've been changing my workout routines and lifting heavy I came across reverse hyper machine which may be highly beneficial to herniated discs- see if your local powerlifting gyms has it, purchase one, or do the alternative ("poor man's" one but may not be as effective). You should definitely look into it and see if that may work for him.

    He's one of the greatest powerlifting coaches in the US and the world

    Also maybe look into complementing with accupressure, accupuncture, and as well as turmeric supplements (high quality with black pepper extract), along with the high quality fish oils mentioned above to help with anti-inflammation.

    Hope you all are doing well.

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