I have had the same results on a keto diet. When I stay away from alcohol, sugar, bread and any other high glycemic carbohydrates and stick mostly with good fats and proteins my PN is more manageable. I also try to avoid glutens. I recently had a bad experience I want to share and see if anyone else has had the same experience. Several weeks ago I bought some “gluten free” chips made with cassava and ate half a bag. Later that night I woke up with much worse burning in my feet and legs than I usually have at night. I finally had to get up. It took a couple of days to calm down. I learned on line that the cassava root contains a deadly toxin that can be eliminated by proper washing and preparation. It is widely used in Africa and Latin America. I suspect that in processing not all of the toxins are removed, just enough to be safe to eat. A couple of nights ago my wife bought some Bobs Mill “gluten free” flour and made really good banana bread muffins. I ate three muffins that evening and by 2:00 am I was awake with the same level of pain as I had experienced before after eating cassava chips. I checked the label and found the flour contained tapioca which is made from cassava. I also learned on line that people who regularly eat cassava can develop a severe form of PN that has a correlation to low levels of Thiamine (Vit B-1). My plan is to be careful to check labels to avoid cassava and supplement with B-1.

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