A warning!

(Keto butts drive me nuts) #72

Health reserve? Like my power up against wreck it Ralph?

(Consensus is Politics) #73

You hit on something I’ve been thinking a lot of lately. What happens when someone fat adapted (for over a year lets say) eats a high(ish) carb meal?

Not too long ago, one of the grand kids had stayed with us over night. She is 5, and wanted a “family fun night” (she just saw it on some TV show and that family was having a good time [lmao]). So I figured what the hell. I ordered a few pizzas. We played Uno. She had a great time. Until… She saw I was eating some pizza too! She knew my diet. She was shocked, and immediately scolded me. I assured her I would be fine, and not to worry about the diabetes coming back.

An hour later I got to thinking. What is my blood sugar right now? So I tested. It was 158. Normally never above 100ish. But then I’m never eating so many carbs.

So the thing that’s been on my mind; however, is this… Just how long would it take to get carb adapted again if I had to? Seeing as I’ve been fat adapted for well over a year now, I went from being insulin resistant T2DM, to being insulin resistant glucose sparring(?) due to fat adaptation.

I’ve tested this thought a few times. Had something carby, like a slice of pizza, and measured my BG, showing up at 130-150 range. Jump on my stationary bike for 20 minutes and its back down into the 90’s. Checked about every 15 minute after that for 2 hours and it remained on a downward trend to about 80 and stayed there.

I’m curious about studies on this. Just how long would it take a ketonian to actually go native again? This would also be testing T2DM. How long for it to re-appear? Obviously my BG reading at first glance proves my T2DM is still present, maybe not. It could just be the glucose sparring caused by my near zero carb intake for 16 months?

Someone must have looked into this by now. Any links?

Keto Vitae!

(Karim Wassef) #74

When you’re fat adapted, you actually become insulin resistant but in a good way and it’s temporary.

Let me explain.

When you’re not taking on carbs, your glucose drops and your body switches over to using ketones. Mostly.

There are obligate glucose consuming cells: red blood cells, internal part of the kidneys and some brain cells. These cells don’t have mitochondria and must use glucose. At this point, the body hormonally adapts to a low level of glucose by making sure that all cells that can use ketones ARE using ketones. It does this by making them insulin resistant so any glucose available goes to those cells that cannot use ketones.

Those are a minority of your total cells but the body prioritizes glucose for them and signal everyone else to stop accepting glucose = ketone usage only/mostly. This is why they are insulin resistant but not in a bad way.

Then you take in a ton of carbs or protein… suddenly there’s a glucose spike, and insulin goes up, but the majority of your fat adapted body isn’t interested in the glucose… so it stays high.

Eventually, your obligate consumers of glucose will use it, and at the same time your other cells will be pulling on ketones. In the meantime, the high insulin and glucose shut down glucagon and ketone production… so ketones plummet. Once they get low enough, the liver basically signals the insulin resistant cells to switch over to glucose… and then they start sucking down the glucose fast!

This happens very quickly once ketones drop because the number of fat using cells is so much more than the sugar users. So once they get on board, they will drain the glucose quickly… they become very insulin sensitive.

Then glucose drops fast and the liver triggers glucagon again and makes ketones… then you get back to normal.

It’s a rollercoaster and the liver is the master controller. It looks weird but it’s an amazing dynamic orchestra.

(Bunny) #75

Had you of jumped on that stationary bike before you ate that pizza it probably would not have put a dent in your ketosis and maybe even blood sugars if you are highly insulin sensitive? HOMA-IR?

(Ketoviking) #76

Sorry I’m gonna be the guy to make you spell it out for learning sake. I’m trying to understand why it would make a difference if he did exercise before he ate carbs if he was fat adapted. If your body is already running on fat despite your physical output why would using more energy cause any difference before consuming carbs? I’m trying to understand this for my hike this weekend. If I start hiking and midday hit a granola bar or something of the like will it just be consumed quickly or will it throw the process out of whack.

(Bunny) #77

Dr. Peter Attia is a pioneer in the ketogenic lifestyle and has been doing this a very very longtime (that is why I observe him closely) so he is definitely fat adapted, so this may answer your question?

”…(The especially astute reader will realize some of this glycogen debt will be replenished by protein and glycerol, the latter of which is liberated by lipolysis – see post on fat flux for a primer)…” …More

(Consensus is Politics) #78

‘If’ I regain my insulin sensitivity, I now have a new weapon in my arsenal, ‘if’ I think I may end up eating carbs, I just might be ok ‘if’ I deplete my glycogen?

I’m smelling a awful lot of ‘if’ with that plan. But I’m game. I’m gonna keep that idea queued up for the next time.

Keto Vitae!

(Bacon is a many-splendoured thing) #79

When the muscles become fat-adapted, they become physiologically insulin-resistant; that is, they down-regulate their insulin receptors, so as to spare glucose and ketone bodies for those cells that need them. I don’t see them suddenly becoming less resistant just because we ate a bit of extra carbohydrate. So I would fear raising my insulin level, since that had a large role to play in the metabolic disregulation that made me decide to go ketogenic in the first place.

I suspect that these statements about what a body does when we eat extra carbohydrate are the best guesses of someone who hasn’t thought everything all the way through.

(Consensus is Politics) #80

Which is why I’m searching for studies on the subject :wink:

(Karim Wassef) #81

Not sure where the confusion is?

Bunny’s response is basically that a depleted glycogen just allows the incoming glucose to be stored as glycogen. Basically, there’s less excess to cause blood glucose to spike.

My response was basically a known response of temporary insulin resistance when fat adapted.

(Bacon is a many-splendoured thing) #82

I would have thought that increased insulin would be required to bet the muscles and liver to take up glucose in order to store it as glycogen . . . hmm. . . .

(Karim Wassef) #83

Yes. Both things are true. Insulin is released and the glucose is converted to glycogen but this is a very small amount. The rest is blocked by temporary insulin resistance.

For example, I can eat a net 30g carb meal and my blood glucose can go to 100 and stay there for 8-12 hours… it slowly dissipates only when my ketones drop below one.

(Karim Wassef) #84

To be clear, there’s a difference between chronic insulin resistance and a temporary state.

Fasting and keto improves insulin resistance overall making us insulin sensitive.
However, while fat adapted, there will be a physiological insulin resistance that is mild and healthy.

there are lots of really good references here, but I picked a few really nice ones:

https://www.physiology.org/doi/full/10.1152/ajpendo.00580.2013

(Karim Wassef) #85

Dr Bikman refuses to call it insulin resistance. He prefers the term “physiological glucose intolerance”

(Kirk Wolak) #86

Do NOT Carb cycle! This video from Dr. Boz explains, it jacks you up, and you burn MUSCLE!
If you want to throw fuel on the fire. Do some fasting, or LONG/SLOW exercise. I walked 25.2 miles one day. It really burns the glycogen out.

And my neighbor did a cheat MEAL (OMAD), and enjoyed cheesecake factory food and cheesecake. No alcohol. He has been out of ketosis for 2 days now. Felt like crap for 2 days. Gained only 2 lbs (lost 71), but his glucose is elevated still. He is now fasting for 3 days to fix it. But if ONE MEAL, not outrageous, can wipe out a healthy person for 3 days, imagine eating for HOURS… Multiple insulin hits, totally telling the body to burn sugar.

(Kirk Wolak) #87

My experience tells me to avoid carbs on any regular basis.
But if it is a holiday, special celebration, etc.

The logic is this, and Tim Ferris says it too… Do a bunch of squarts before you consume (and even after) the dessert (the only think I would ever cheat with)… And this will deplete your leg muscles of glycogen. The incoming glucose can then be CONVERTED to glycogen, as opposed to stored in the liver and cells as FAT.

(Ketoviking) #88

So here’s another question. Say you go out of keto (keto practices) for a meal or let’s extend it to a 1-2 week situation (I’m thinking cruise) does it create a long term detriment getting back into ketosis? To simplify my question you see yo-yo dieters who are solid for a few months and then fall off. In a ketosis WOE every time you go back to the darkside does it inhibit your ability to move back into ketosis, or does keto WOE lose some of its affect?

(Bacon is a many-splendoured thing) #89

“Can,” not necessarily “will.”

Dr. Phinney is on record as saying that in such a case, it can take as long to re-adapt as it took to become fat-adapted in the first place, but experiences seem to vary.

(Kirk Wolak) #90

Great questions. And the key is YMMV (every body is different).
If you have been at your ideal weight for 15 years of keto, I believe you are good to go, 3-4 times a YEAR.

The study in question was WEEKLY, 2 days of eating carbs ~ 50% of calories (very easy to do).

But, test yourself. If one meal sets you back 3-5 days. A Cheat Meal/Day is STUPID every week, by definition. What about once a month? Depends. Are you doing Dexa Scans, RMR testing, IF, etc.

My OOPS Protocol (for me): the morning after, I FAT FAST if hungry. Then I FAST for as many days as it takes to lose ALL the weight gained (I gained 8lbs for my birthday). THEN I FAST one more day, to LOCK IT IN. (This avoids the YoYo bounce I got stopping that morning). And by this time, my glucose and ketone numbers look good, I feel reset, etc. I will add GENTLE Movement as time permits.

But you have to look at carbs as an ADDICTIVE substance. I spent 40 years teaching my body to consume carbs. It’s an old memory/old program. It runs very easily. And leads to binging, and gaining weight. Even after I am good, I risk falling off the wagon. But worse, my body is much better at that program than the KETO program. Until it isnt (Definition of Metabolically healthy, to me).

So, if I went on a cruise… And I did, I would focus on the bacon, and stuff I could enjoy. I truly enjoy how I FEEL eating this way. Then, I would allow myself a small dessert at lunch time, and schedule some activity to burn it off. I don’t want to be on a cruise to eat crap food and feel like crap. I want to LIVE…

My current attitude is simple. If I go somewhere that I can’t find anything to eat. I can fast, and have a cup of coffee. To avoid offending people, I use this line “I forgot I have a really important blood test in the morning!” (Everyone understands that! And it doesn’t matter it’s just my glucose and ketone tests!)

Being there is the important part. Eating is about fueling the body.

From someone who ate a large Sicilian pizza almost every friday. It’s been almost a year (and 117 lbs ago)… And I have ZERO desire. Not even for a FatHead Pizza. (Can’t tolerate Dairy, or Cheese, or cauliflower, or nuts, nut flowers)… I am carnivore, and bacon is my vegetable.

==
I think getting out of ketosis for 1-2 weeks risks never getting back in. I have been on group coaching calls with a BUNCH of people who fell off the wagon after a vacation, and regained ALMOST ALL or ALL of their weight in 6 months. I PREFER to learn from the mistakes of others…

So, @Pasiviking would you want to risk it? (Different if you are now metabolically healthy and this is truly your WOL/WOE)

(Karim Wassef) #91

My experience is that fasting + exercise can quickly bring you back into ketosis with no long term detriment.

Once you’re fat adapted, that ability stays with you even if you fall off for months or even years.

However, the temporary higher glucose is not good either. When you’re fat adapted, you are temporarily glucose intolerant so your cells won’t take it up and it stays in the blood until ketones drop sufficiently. So there’s a short period of time when your glucose and insulin are high because most of your cells aren’t interested in the stuff. They’re still happily humming along with ketones.

On the glycogen in the liver and muscle…

I remember (but can’t find the reference) and my own experience is that being fasted/glycogen depleted due to exercise does reduce the glucose rise. But for me, it’s usually due to high protein intake - not carbs. GNG is demand driven, not supply driven. When I am low on glycogen, eating protein does fill me back up - my DEXA scans show rapid muscle mass increase post-fasting.

So my interpretation is that the glycogen deficit creates a window where glucose (or GNG protein) is converted into glycogen … and then the window closes and the cells become glucose intolerant until the ketones are used up.

It could be the reverse- that we are glucose intolerant until ketones drop, then the glycogen gets refilled… I may have to collect more data points (every hour instead of three to six hours) after eating to capture the short term trend in glucose vs ketone recovery.