Dr. Atkins Advice on Exhaustion and Leg Cramps

This morning I was taking a stroll through some of the threads over at Low Carb Friends, and I ran into something that really disturbed me. A patient of Dr. Westman was there asking for help. She has been on the high-fat low-carb diet known as Nutritional Ketosis for 4 months now. She is eating 20 carbs or less, is losing about 1 to 2 pounds a week, but she feels horrible.

For some reason, she is not adapting to the state of Ketosis.

Despite a high salt intake, she's having excruciating foot and leg cramps, gets dizzy, and comes near to passing out during her gym activities. She says she has zero energy, so her gym routine has dropped from 5 days a week and 1 trainer session, to just the training. She is taking magnesium and potassium supplements, along with chicken broth every day, but nothing is helping. She's exhausted and feels horrible, and yet, they want her to continue with the regimen she's been on, even though it's not working for her.

That doesn't make any sense to me.

Typical Nutritional Ketosis Diet

I've talked about my experience with a standard Nutritional Ketosis Diet before. My own results were not good. I gained a lot of weight when I tried it. It's low in protein, super high in fat, and keeps you at an Atkins Induction level of carbs throughout the diet phase. Since my hunger never corrects itself when I go into the state of Ketosis, and I don't get that energy upsurge that those who have Insulin Resistance claim to get, I can really relate to just how badly this woman feels eating at very low-carb levels. That level would make me feel horrible too.

Typical Low-Carb Breakfast: Bacon, Eggs, and Cheese

She is eating an adequate breakfast of 2 eggs, 3 slices of bacon, and some coffee with heavy cream and stevia -- but she's eating no lunch. Just a snack 3 times a week of 2 ounces of nuts. Dinner varies, depending on what she is feeding her family, but an example she gave was a chicken breast breaded with pork rinds, broccoli with butter sauce, diet soda, and a Carb Smart ice cream bar.

That particular menu only gave her about 15 grams of carbohydrates per day.

That's more than a very-low carb diet, but less than one would eat on Atkins Induction. Plus, Atkins Induction is only for 2 weeks. After that initial 2-week period, you return carbohydrates to the diet in 5-gram implements per day, per week, until you find the "highest" level of carbohydrate you can eat and still lose a pound a week.

If You Don't Feel Good You Won't Stick With Low Carb

The sad thing is that there is no way this woman is going to stick to this long term if her energy level and the way she feels doesn't improve. She might be able to withstand the program long enough to lose the weight (she didn't say how much she needed to lose), but that isn't going to do her any good if she goes back to the way she was eating before, once she reaches goal.

Replies to her plea for help mostly focused on the type of magnesium she is taking, but a couple of folks did ask her about the small amount of food she was eating. Apparently, Dr. Westman encourages his patients to only eat twice a day, and stresses the need to eat fewer calories in order to drop the weight, so that's what she's doing. She is following her doctor's advice. Plus, she says that she is eating to her personal hunger level. It's just the way she feels and the leg cramps that are the problem.

What to Do About Leg Cramps and Exhaustion

Leg cramps comes from unbalanced electrolytes. Since a low-carb diet keeps your glycogen storage less than half full, the diet is very dehydrating, so leg cramps are common. Shedding the water the body stores to process glycogen eliminates necessary minerals, which have to be replaced. Drinking a lot of water, which she is doing, will do exactly the same thing. It sweeps calcium, potassium, and magnesium out of the body.

If you're having cramps, the most important mineral to replace is calcium, but adequate magnesium and potassium are also important:

"When there are leg cramps, extra calcium is in order, and there is often a kind of fatigue for which potassium supplements are the specific." (Dr. Atkins Diet Revolution, page 126.)

Dr. Atkins was really into vitamin and mineral supplements. He believed in optimum dosages, and not minimum requirements. Minimum daily requirements are only what will keep you alive, not what will produce optimal health and well-being. However, exhaustion isn't always about potassium. Sometimes, it's about losing more weight than the body can adapt to:

"A weight loss that is too rapid is more than the body can comfortably adapt to. And it isn't necessary to lose rapidly. It is more important to lose easily; and losing easily means feeling well all of the time. I can't emphasize this too much: Quick weight loss is not the primary thing we're after -- what we both want for you is an easy and lasting weight loss."(Dr. Atkins Diet Revolution, page 142.)

His advice for those who feel tired and ill on a low-carb diet is to raise your carb intake to the next level and see if that corrects the problem. Eating too few carbohydrates is just as stressful on the body as eating too many. This isn't a race, so the same could be said for calories. The goal of a low-carb diet is permanent weight loss, which means finding an eating style you can live with for the rest of your life. The goal isn't to get the weight off in any way you can. That usually backfires.

The Atkins Diet is Not Atkins Induction

A lot of people call what they are doing the Atkins Diet, when clearly it is not. The Atkins Diet is not Atkins Induction. Atkins Induction is a 2 to 4 week introductory period where you eat from a specific list of foods and try to keep your carbohydrate level to 20 net carbs per day, or less. This introductory period has the goal of getting you into the state of ketosis. Once you are comfortably in ketosis, you then return carbohydrates to your diet at a slow enough pace that the body continues to burn your body fat for fuel.

Low-Carb Ham and Green Bean Soup

If you don't return carbohydrates to your diet to discover your personal carbohydrate sensitivity, then you are not doing Atkins. You are doing something else. Doing something else is fine, but calling it Atkins can be confusing to newbies who don't understand what the Atkins Diet actually is. The Atkins Diet is a progressive diet. It is not 20 net carbs per day or less -- unless --- that is the only level that will allow you to lose weight. However, you won't know that until you try to add additional carbs back in.

Very low carbs will depress your metabolism and interfere with the way the body converts T4 thyroid hormone into T3, the usable form. For that reason, many people find that adding carbs back into their diet increases their weight loss! That is why the Atkins Diet is an individual diet fine-tuned to fit your likes, food tastes, weight-loss, and metabolic issues. It's not a cookie cutter diet where everyone eats from a specific list of foods and keeps to 20 net carbs per day or less. That isn't Atkins.

"OWL allows you much more choice. That means you can now craft a weight loss regimen that is uniquely yours." (Dr. Atkins' New Diet Revolution, page 147)

Dr. Atkins always left the rate at which you lose weight up to you, but he also cautioned patients and readers to be realistic. As long as you are free of cravings, you're satisfied with the food, and you feel good, the rate at which you lose the weight doesn't matter. What does matter is that you make lifelong, permanent changes in the way you eat and that you feel well while you're creating good food habits. Dizziness and problems exercising indicates you're having a problem converting fat into energy. If that's true for you, then upping your carbohydrate level and lowering your fat intake a bit might be a better option.