Hello Dr. Patrick,

I started the keto diet about 2 and a half weeks ago. I’ve lost around 10 pounds, but I’m not sure I can do it anymore. I’ve had diarrhea about 4x per day everyday since I started. And it’s pretty bad. Besides the diarrhea, I was able to maintain the diet. I of course like the amount of weight I lost, though most of it may be due to water weight, but I wanted to know what kind of diet you would recommend? I’m 26 years old, about 220 lbs. I would like to get back to about 190 lbs. I’m working out about 3x a week. Mostly cardio. I also intermittent fast from 9pm till 11am. I would love to hear your recommendations.

Thanks!

There is a pretty large variability of astaxanthin content in salmon (and other fish).

For example atlantic salmon has been reported to contain 6-8mg/kg of astaxanthin, where as (wild) ‘Sockeye’ salmon contains 26-38mg/kg of astaxanthin. Other high concentration sources include ‘Coho’ and ‘Rainbow Trout’ with >20mg/kg [1, see Table 1].

Thus choosing sockeye or rainbow trout would allow you to get a therapeutic dose (3-4mg) of astaxanthin with as little with as little as 110-160g of fish. Care still needs to be taken when choosing the source of your fish given risks of PCB contamination and mercury (depending on where the fish originated from, if it was farmed etc…).

This is of course separate from the whole potential concern of fish (specifically the high choline concentrations) and TMAO production, which is gut biome dependent. Paradoxically the fat in the oily fish has been shown to lessen some of the adverse effects of TMAO [2]. There is also evidence that omnivores or vegetarians / vegans with a higher adherence to the mediterranean diet had lower urinary TMAO levels [3]. As if anyone needed another reason to eat vegetables if you do choose to consume fish (or meat).