Keto and expertise, part 3 (I still have no idea what I am doing)

Right.

The methodological framework of this post, or this blog, is that I have issues. But my issues are all epistemological issues. I don’t know, I don’t know how to know, and I am not convinced you do either. Come on a journey with me, and learn how additional information still means no god damned conclusions.

In the previous two parts of this series I moaned about the ketogenic diet, went over my history with it, and talked about the difficulty of sticking with it not from a disciplinary standpoint, but from a lack of conviction that I was truly doing my body good with it. I am fine with the notion of science being something that is subject to revision, and that the best practices and advice of the scientifically minded constantly conform to the latest information. I see that as a positive. However, I also know that the process of turning this amorphous mass of information into proper, philosophically rigorous knowledge is slow, piecemeal, and definitionally never certain. We do not now have knowledge (rigorously defined) what we at best will have is ‘knowledge, to the best of our ability and information’1.

Try as I might, I cannot uncouple ‘knowledge’ from ‘certainty’. This is the case in any language I know. I would love to start asking people what percentage of confidence the word ‘to know’ means to them.

I digress. We were talking about diets.

Last I mentioned it I had fully committed to the keto diet, once again, despite a lack of certainty. Yolo, as the youths say. My justification was that it wasn’t going to kill me overnight. I started it, and stuck to it well enough. I through in a cheat day here and there, it went well enough, except I started to make my cheat days a little more extravagant than I would have liked. That was my undoing.  In my defense, life is hard, and between the global pandemic (these posts are written months in advance), the quarantine, the general solitude, and how stressful my work is, I had a collapse. I like carbs, so cookies were involved. So was a plate of damn pasta. It would have lasted just a day, but my eyes are bigger than my head and I over purchased cheat food. It would have only lasted two days, but my cousin came over randomly with a big ass plate of non-keto food, and I didn’t have the heart to tell him ‘fuck off I’m dieting’2.’

Suddenly there was a three day hole in my diet. But I bounced back, reasonably well.

Then, it hit me. A literally crippling case of gout.

When I told my cousin that I had gout, he wondered how the hell that happened, as only ancient roman emperors got gout. I dreaded telling my parents, as they tend to over react to pretty much everything. True to fashion, they heard ‘gout’ and understood ‘bone cancer’.

And it is weird that I got gout. It is not something people my age are known for getting, but it is not unheard of. The issue then becomes what do I do about it in light of a keto diet. Let’s consider the knowledge at hand.

  • Gout is caused by an access build up of uric acid.
  • The foods people eat on the keto diet tend to be high in uric acid.
  • Keto apologists would likely tell you that the diet affects uric acid build up in your body, counter-intuitively to what you would expect.

This gout kept me on the fat of my ass for over two weeks. It was no fun. I was on a strict keto diet throughout, hoping it would improve my situations. Maybe it did, but while I was rolling around my house on a chair unable to walk, I began to work through all the food i had, and was still too cripple to get to a supermarket. I was actually getting pretty confident that the gout would be going away rather soon. Three days into the flair up, I decided to make a nice little Niçoise salad, largely because that was what I had in the house. Of course, I made it with anchovies and tuna, which are delicious and (unbeknownst to me) foods one should avoid during flare ups of gout.

The next day was agony! I think I stayed in bed all day and hated my life and myself.

Suck on that, Keto apologists!

At some point during all this I ceased being a poor American and remembered that as a poor European, I was still entitled to medical care. I decided to forego my usual few days of cyberchondria for actual medical advice.

The Italian healthcare system gets a needlessly bad write up. I don’t want to seem like I am slandering it. If I failed to see a medical professional it was largely my own fault. While I did have a medical professional here, it was a person I had not seen since 2014. So it was not all that much of a shock when I swung by their office and found the practice shut down. I had been living abroad for some time. I later would try to see my dad’s doctor, and that too went south for reasons unknown. But in the meantime, I did go to a clinic and get a blood test. And while I couldn’t show the results to a doctor (yet) I was able to look them over myself.

They weren’t all that bad. High uric acid, and my urine showed that I had inflammation (between the gout and the other foot and knee injuries sustained while hopping my fat ass on one leg because of the gout, this wasn’t a shock), but beyond that I was fine. Even the problem I had had most of my life (high triglycerides) didn’t seem to be present.

I should be going to a doctor soon, assuming my luck turns around. I will ask them as well. I may not like their answer. It’s my father’s doctor, and that causes some pause from the fact that me and my dad do not see eye to eye on much of anything. This is also a country where there are plenty of practitioners who practice homeopathic medicine (proudly too! The fucking loons…). But even passing those too hurdles, there is still a chance that the doctor will be an old fuddy-duddy who won’t bother listening to any of the above nuance and just say “gout? Eat nothing but pasta for the next month and you’ll be fine. No red meat or cheese.’

Per usual, this post has gone on longer than I would have hoped and accomplished nothing. The point of all this is that I have no idea where to go next. Let’s review:

  • Was my gout provoked by what I was eating during my dieting, or by the three days where I stopped dieting? and how can I tell the difference?
  • If it was the latter, why then did it aggravate three days later, despite being back on the diet.
  • Now what?

I am likely sold on what I will do next. I have a freezer full of pre-made keto food waiting for me. Some of it is vegetarian. I will likely go back to the keto diet either way, with just a shit ton more veg involved.

But will I do it with confidence? Probably not.


1 Yea, I get that this can sound a bit conspiratorial, or at least the genesis of a conspiracy. Largely, I think this is all in good faith, all though a few bad instances will get through. 

2 Poor fucker. I’ve already had to tell him ‘Fuck off, I quit smoking,’ and ‘fuck off, I’m staying sober.’ I am no longer the fun cousin.

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