Menopause, perimenopause, and ketosis

• Perimenopause may last for up to 10 years. Achieving and sustaining ketosis is more difficult during perimenopause and menopause, including in personal and clinical experience.
• Declining estrogen can increase insulin resistance. Previously lean women with stable weight may begin to gain weight and undergo body-composition changes.
• Estrogen supports intestinal lining integrity. Lower levels can impair gut health and coincide with new food intolerances or irritable bowel symptoms.
• Changing estrogen levels interact with histamine and can aggravate histamine intolerance during perimenopause; it is uncertain how carbohydrate cycling would help this problem.
• Ketogenic eating can improve insulin resistance. Histamine strategies include restricting aged cheeses and cured meats, using diamine oxidase for histamine breakdown, and avoiding grains and legumes that can damage the gut lining; the book contains further examples. [1]
• Estrogen replacement therapy can be beneficial for some women.
• Psychiatric conditions stable for 10–20 years can worsen during perimenopause, sometimes requiring larger medication doses. Existing illness may intensify or new illness begin; research on this is limited.
• A woman maintaining ketosis at 50 g carbohydrate daily might need to lower intake toward 20 g. More exercise, reduced food intake, or fewer carbohydrates may also become necessary amid changes in estrogen, growth hormone, testosterone, and other hormones.
• Hot flashes, night sweats, and insomnia interfere with sleep. Inadequate sleep and stress can elevate stress hormones and glucose, decrease ketones, and impair metabolic health.

Carnivore diets, protein levels, and ketosis

• Eating only animal foods need not mean excessive protein. Higher protein intake can suppress ketones when a particular ketone level is desired, and excess intake is undesirable across diets.
• Unrestricted carnivore eating has coincided with increased body fat, poor appetite regulation, infrequent ketosis, and absent psychiatric benefits in clinical experience, despite negligible visible carbohydrate.
• Ketogenic carnivore eating can include meat, seafood, poultry, and tolerated eggs, alongside an individualized protein target; the book contains guidance, meal plans, and recipes. [1]
• After years of 80–95% carnivore-ketogenic eating, a return to 100% carnivore occurred about three and a half weeks earlier. An example day contained half a pound of shrimp, a duck breast, eight ounces of sirloin tips, and three tablespoons of duck fat.
• The example provided about 1,550 calories, with ketone levels around 1.5 during that period, without excessive protein or dietary carbohydrate.
• Shrimp and sirloin contain less fat than ribeye. Adding fats such as duck fat can alter macronutrient ratios and support ketogenic dietary targets.
• The adult protein RDA is 0.8 g/kg of body weight used as a standard, serving as a lower limit; 1.6 g/kg is a useful goal for muscle growth and maintenance. [2]
• For higher ketones, a practical protein range is approximately 1–1.7 g/kg of ideal body weight daily. Intake near 2 g/kg exceeds what most people need and often feels unpleasant; individualized adjustments around an intermediate target are necessary.
• Intake around 0.6 g/kg can jeopardize lean mass. Ketosis and muscle preservation must both be maintained; properly constructed ketogenic diets can support muscle growth, without DEXA or bioimpedance being used in these clinical consultations.

Appetite, cravings, and satiety

• A properly constructed carnivore diet, particularly without dairy, can allow appetite to regulate varying daily intake with less need for counting.
• The refined-carbohydrate-rich Western diet interferes with satiety and makes hunger, nourishment needs, and cravings difficult to distinguish. Repeated eating without satisfaction is abnormal.
• Transitioning to ketogenic or carnivore eating can restore recognition of genuine hunger and confidence in appetite signals, sometimes as a new experience.

Nutritional deficiencies and psychiatric health

• Psychiatric medication may be initiated without thyroid or B-vitamin screening; underlying nutritional and medical problems require evaluation.
• Deficiencies in essential nutrients can raise risk of psychiatric illness because brain function depends on them. Quantifying the separate risks is ethically difficult, and consequences vary by timing, duration, and severity.
• During pregnancy in particular, B12, choline, folate, iron, iodine, EPA, and DHA are important deficiency concerns. Animal foods supply the richest sources other than folate, and many people have shortfalls during pregnancy; the book details their functions. [1]
• Correcting nutrient shortfalls can improve mental health, sometimes greatly, but one supplement will not necessarily resolve depression, schizophrenia, or another psychiatric disorder.
• Profound B12 deficiency can take years to arise, while correcting it can produce major improvement in psychiatric symptoms. Prolonged deficiencies in pregnancy or early childhood can also leave lasting injury.
• Some documented adult depression cases have improved markedly with methylfolate; most outcomes of nutritional correction are less complete.

Folate, methylation, and MTHFR

• Synthetic folic acid undergoes different processing from natural folate. The recommended choice is to avoid folic acid and use forms such as methylfolate.
• Common MTHFR variants are gene variations, not rare mutations, and slow the processing of synthetic folate. Methylfolate can substantially improve mental health for some individuals.

Iodine and brain development

• Choosing noniodized specialty salts over iodized salt can remove a dietary iodine source. Fish, seafood, and seaweed provide iodine; children may differ in their acceptance of these foods.
• Iodine deficiency is widespread worldwide, particularly among children in less-developed countries, and inadequate thyroid hormones during brain development can result in intellectual disability.
• Adult iodine deficiency is difficult to assess, leaving its frequency and supplementation needs uncertain. The hypothesis of globally declining environmental iodine and universal human deficiency remains unestablished.

References

1. [04:01] Change Your Diet, Change Your Mind — https://www.hachettebookgroup.com/titles/dr-georgia-ede-m-d/change-your-diet-change-your-mind/9781538739075/
2. [11:04] Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids — https://doi.org/10.17226/10490