He's not doing Crossfit. He said he hasn't been doing any met-cons at all. That being said, if all he is doing is strength work 75 grams of carbohydrate/day is more than enough. I've made significant strength gains while on a ketogenic diet in the past. Strength work does indeed require glycogen, but strength workouts typically are not very glycogen depleting due to the lower reps and higher weights. You'd have to be lifting all day long to deplete glycogen stores doing strength work. Gluconeogenesis does a fine job of filling gaps in glycogen stores when strength training is the only training being done. Considered that he's not even low enough in carbs to be fully ketogenic, he's getting plenty of carbs to fuel his efforts from both gluconeogenesis and from the amounts provided in his daily diet.
Scott, Here's my take, for what it's worth:
Based on your overall symptoms and blood work, your probably having some problems with the b-vitamins. Your scaling around the mouth is indeed a sign that you may be deficient in one or more of the b-vitamins, which could indirectly interfere with metabolism of other b-vitamins. It's tricky with b-vitamins, and pretty complex. When your short on one b-vitamin the others are affected adversely and it can become difficult to identify the root of the problem. Your anemia could be caused indirectly by a deficiency which is screwing with b-vitamin metabolism or it could be caused by digestive issues, or maybe both. You need both hydrochloric acid and intrinsic factor to active vitamin B12. If either is lacking you can eat all the B12 in the world and you won't use any of it, because it must first be activated by HCL in the stomach and then by intrinsic factor in the small intestines. Deficiencies in HCL or intrinsic factor can be caused by stomach issues like atrophic gastritis or by infections like h. pylori. That being said if I were in your situation I would do the following:
1. Get a quality B-complex without folic acid (taking folic acid when B12 is really what you need can result in serious nerve damage. Plus the folic acid could mask the blood markers for B12 deficiency.)
2. get some B12
If the above 2 don't work then get checked out for h. pylori infection and see if you have any digestive issues going on.
Note: I'm not a medical professional. I'm a Dietetics college student who hasn't earn his RD yet. The information above is based on my current knowledge of B-vitamin deficiency and factors affecting such conditions. See a doctor and run these ideas by him/her.
There are dreams we’re taught are normal, whether it’s money or success or any of those things, but we shouldn’t believe in those things if they are not important to us. There is an ocean between our real lives and what is expected of us.” -Tim Lambesis