Does a healthy ketogenic diet cause irreversible insulin resistance?

#8

Thanks, Richard! It just seems like higher levels of glucose in the blood wouldn’t be great for our (tissue, organ, cell) health in general - but this is way past my level of understanding of cellular processes…

#9

@richard

Thank you. So in your opinion this is not a problem but rather an adaptation? If so, then would it be reasonable to assume that the body can adapt back to a higher carbohydrate diet after this process and become insulin sensitive again? Are there any studies showing that this is the case? Or might we all be heading for diabetes?

It sounds like in ketosis we may end up with pre diabetic fasting blood sugar and diabetic response to high glucose meals. This sounds like the opposite of everything I have learned about ketosis.

Everything else I have read showed it helping lower peoples fasting blood sugar, increase insulin sensitivity, etc. And now this is showing the exact opposite.

Please enlighten me if possible.

#10

@Madeleine

Thanks and Um… crap.

or not?

It’s hard to tell.

It sounds like one will have high fasting blood sugar and high (diabetic) postprandial blood sugar (if one ate enough glucose to equal a glucose tolerance test) while in keto, that is a bad thing, right???

But that going out of keto for a mere three days will fix this and you will go back to normal blood sugar.

So… keto causes temporary diabetes now?

But 150g carbs a day (low carb compared to the standard diet most eat) will keep blood sugar levels normal and healthy. So keto is… bad?

My diet world has been turned upside down.

What am I missing here?

#11

@brownfat

Thank you. What is your opinion about the article linked above? It sounds like, for all intents and purposes, ketosis causes a potentially reversible form of diabetes.

#12

@VLC.MD

Thanks. That’s what I always thought. However the results discussed above sound like quite the opposite. A sign of insulin resistance is high fasting blood sugar, which, according to the article linked below, is exactly what ketosis causes. What is your opinion?

#13

So the ketogenic diet has been shown to increase insulin sensitivity. This should be observable in the form of lower blood sugar. But it also causes chronic high pre diabetic blood sugar and a full on diagnosis of diabetes if given a glucose tolerance test. So it causes insulin resistance and full blown, potentially reversible, diabetes.

WHAT?

How can it be both???

What should non diabetic blood glucose levels look like while in keto?
#14

@Fry
I don’t think there’s any cause for alarm. LC and especially keto are fantastic for improving insulin sensitivity and reversing diabetes, and none of the information given or linked above is in contradiction to that. Once we’re super insulin sensitive and if we have long stretches of keto/vlc, some folks find that their blood glucose levels rise (a bit - not much) though their A1C stays low and their other health markers are still fantastic. “Adaptive glucose sparing” sounds like a better phrase, and I’m just hoping to understand that phenomenon a bit better.

#15

@Madeleine

Thank you. What about this selection of a comment by the author of the article:

"I’m presuming you’ve read Steve Cooksey? He is an example of a perfectly controlled T2 diabetic, drug free. He is fully healthy (as far as any of us can tell), but he can’t eat pizza after years of LCHF. Something changes permanently…"

So it causes chronic prediabetic blood sugar and may be irreversible. This sounds like a serious concern.

This comment conversation is also noteworthy:

"freakingout said…
I don’t know whether this post is still active. I was doing ultra low carb for 5 months (30 grams or less a day). During that time I had a FBG of 96 on a random test which gave me concern, as I’m usually in the low 80s. I quit doing ultra low carb over 3 months ago, and my fasting blood glucose is now 100-118. Post-prandial has gone as high as 162. So have I permanently made myself diabetic by this low carb diet? I would think that 3 months after going back to a more balanced diet, my glucose levels would have recovered.

5 AUG 2013, 02:47:00
freakingout said…
I was on an ultra low carb (ULC) diet for 5 months. A random blood test showed fasting blood glucose (FBG) at 96, which concerned me, as I’m usually in the low '80s. Since then, I have quit the ULC diet. I’ve been eating moderate carbs for 3 months now. Yet my FBG is now 100-120 and post-prandial can get as high as 162. Have I given myself diabetes from this ULC diet? It seems it is not reversing itself once I stopped ULC. I’m very worried that I’ve impaired my ability to eat carbs permanently.

5 AUG 2013, 02:50:00
Peter said…
Hi freakingout,

I think it is quite clear that there is zero evidence base for your having given yourself diabetes by carbohydrate restriction. The physiology is quite straight forwards, I see no reason why it should happen.

There are a stack of unknowns about your circumstances. I would be very concerned about a BG over 160mg/dl post prandially and would do whatever was needed to stop it going there. You have only two tools, LC and drugs. You need to know if you need drugs. You do need LC, on the most simplistic of generic observations…

Peter"

Peter states that there is zero evidence that carbohydrate restriction can give someone diabetes. However in his article he states that one would fail a glucose tolerance test and would be diagnosed diabetic and that his fasting glucose is pre diabetic. The in the above, first comment by peter, he states that “something changes permanently” and if this “something” is a permanent insulin resistance which would presumably cause permanent high blood sugar, isn’t that very close to diabetes caused by carbohydrate restriction?

Finally, don’t prediabetic blood sugar levels and a diabetic response to a glucose tolerance test strongly contradict LC and keto improving insulin sensitivity and reversing diabetes since these are symptoms of impaired insulin sensitivity and diabetes?

EDIT:

One more thing, this directly contradicts the idea that LC and keto are fantastic for improving insulin sensitivity:

From the article:“Well, the first thing is that LC eating rapidly induces insulin resistance.”

I am so lost. This is the opposite of everything I have learned about keto!

#17

@Fry
Deep breath… it sounds like Steve Cooksey was a T2D and even though he’s doing great, he isn’t insulin sensitive enough to be able to handle pizza, and the answer to FreakingOut makes sense to me.

A lowcarber failing a GTT just means that they’re not used to those extreme levels of sugar hitting the system. Richard’s preferred phrase “glucose sparing” kind of answers this one.

When someone who is already insulin sensitive dramatically lowers their carb intake, the glucose sparing mechanism is more likely to kick in, and even then it doesn’t seem to be a problem (which I think is the point of his article, right?).

I’m not sure where you are health/insulin-resistance-wise, but insulin resistant folks have a very different path.

Edited to take out references to the blog post (which I haven’t actually read!!)

#18

@Madeleine
Thank you. Doesn’t insulin sensitivity improvement include those that are insulin resistant? The diet is supposed to improve these things for diabetics and those that are pre diabetic and/or insulin resistant as well as those with normal insulin sensitivity. Yet if the diet rapidly induces insulin resistance this is utterly impossible and contradictory.

Also there is the issue of whether or not chronic pre diabetic blood sugar levels as mentioned by the author (he said his were above 100 when fasting which is pre diabetic) is detrimental to ones health and begs the question: do they keep getting higher until one’s fasting glucose levels are straight diabetic?

(Todd Allen) #19

The temporary physiological insulin resistance of a keto diet makes sense to me. However, my personal experience differs somewhat. I had very poor post prandial blood glucose response to most carby foods before keto as well as a nearly diabetic fasting blood glucose.

After a year of keto my fasting blood glucose is healthy, ~80 mg/dl, and lately I’ve been able to eat increasing amounts of carbohydrate with post prandial blood glucose remaining below 100 mg/dl, my somewhat arbitrary target. I’m not interested in doing OGTTs to establish my degree of insulin sensitivity compared to others and am content with how this is working for me so far. I did get my fasting insulin measured and it is now quite low. Most of my gains I attribute to fasting and losing weight, especially visceral fat. Eating keto is what makes fasting possible for me.

However we are all different and your keto diet is different from mine and everyone else’s. Even if keto works for most it could still make you diabetic and destroy your health. I don’t think there is any good substitute for monitoring as best you can how your body is responding to your diet and adjusting as needed.

Also, there are many many factors known to affect insulin resistance beyond diet macros: sleep quality, chronic stress, exercise, gaining/losing fat - especially visceral fat, muscle quality and quantity, a wide variety of toxins, numerous micronutrients, therapeutic thermal stress, etc.

#20

Yes, I think it includes especially those who are insulin resistant. Folks who are already insulin sensitive find that cycling in some carbs sometimes can be useful for various reasons, one of which might be to keep up the glucose -burning end of a flexible metabolism (? I have no idea… I’m just speculating here).

I’ve never heard of anyone getting diabetes from LC; there’s a lot that I can’t answer in detail about your questions but that - becoming diabetic from restricting carb intake - just doesn’t happen.

Here’s a question: how do we explain 100 fbg (in the blog author) but a 4.something A1c? Since the a1C is an average glucose reading over the longer term, I would take that as a very reassuring indication that the guy is not headed in a dangerous direction.

I’m pretty sure that Richard has gone into this question in depth at some point. Have you dug around the forum a bit? There’s something about this in Mark Sisson’s new keto book. I’ll type it out for you if it makes you feel better.

#21

I hope I’m not violating some copyright laws here, but @Fry, you sound really worried. Here’s something to tide you over. Mark Sisson goes into a number of long-term strategies once someone’s spent 6 weeks or so in keto. His favorite for those who are active and metabolically healthy is in and out of ketosis, with some activity and low carb but not 100% keto all the time (where as his recommendation for those who are metabolically damaged or compromised is long-term keto).

Here’s what he says at the end of a section where he goes into a few strategies that different people sometimes use:

IMG_2040
IMG_2040.JPG2448×3264 2.01 MB

(Todd Allen) #22

Jeff Volek video - keto reverses insulin resistance

(Jen ) #23

Just curious if you have consulted an endocrinologist or keto-friendly nutritionist about your concerns?

(Bacon is a many-splendoured thing) #24

The kind of insulin resistance discussed in the article is a healthy adaptation to fat-burning, in which (as I understand the article to be saying) muscle cells resist the insulin’s instructions in preference to burning fat, so the glucose level in the blood rises somewhat. That this is a healthy adaptation is shown (again, according to the article) by the fact that HbA1C remains low. This means that the hemoglobin in the red blood cells is not being glycated at a significant rate, despite the somewhat elevated serum glucose. It is not the same thing as diabetes, which is an insulin problem, not a glucose problem (although too high a glucose level becomes a metabolic emergency for the body). The fact that glucose levels decrease after only three days of eating carbs is another sign that this is neither a problem nor the type of insulin resistance that is the result of eating too much carbohydrate.

From the blog article, here is the blogger’s explanation of the phenomenon:

What is happening? Well, the first thing is that LC eating rapidly induces insulin resistance. This is a completely and utterly normal physiological response to carbohydrate restriction. Carbohydrate restriction drops insulin levels. Low insulin levels activate hormone sensitive lipase. Fatty tissue breaks down and releases non esterified fatty acids. These are mostly taken up by muscle cells as fuel and automatically induce insulin resistance in those muscles. . . .

This is patently logical as muscle runs well on lipids and so glucose can be left for tissues such as brain, which really need it. Neuronal tissue varies in its use of insulin to uptake glucose but doesn’t accumulate lipid in the way muscle does, so physiological insulin resistance is not an issue for brain cells.

However, while muscles are in “refusal mode” for glucose the least input, from food or gluconeogenesis, will rapidly spike blood glucose out of all proportion. This is fine if you stick to LC in your eating. It also means that if you take an oral glucose tolerance test you will fail and be labelled diabetic. In fact, even a single high fat meal can do this, extending insulin resistance in to the next day.

. . . . .

This now fits in to an overall pattern. Elevated non esterified fatty acids induce physiological insulin resistance and a higher than expected FBG level. A simple switch to higher carbohydrate eating (in myself) allows the normal underlying pancreatic and muscle function to show. It also fits in with the FBG of 3.5mmol/l found in the carbohydrate fuelled natives in the Kitava studies.

So do I worry about a FBG of over 5.5mmol/l?

Not while my HbA1c is 4.4%.

So the author, himself a Type II diabetic, has concluded that the rise in fasting serum glucose is perfectly normal, and that he is perfectly healthy, despite appearances.

P.S.—I edited the quotation slightly and added emphasis that seems relevant.

#25

@JayBee

I have had my a1c and fasting sugar tested and the results were normal.

Thanks for the suggestion but I have terrible insurance and it doesn’t cover anything but an md unless it was deemed necessary, so I cannot talk to either of those types of specialists. I am also poor.

#26

@PaulL

Thank you. I suppose then it would just depend on whether or not it actually is healthy to walk around with higher than normal blood sugar regardless of how one defines such a state in regards to one’s hba1c. I would like to find some actual science or studies or both that make it crystal clear that there is

A) no negative health effects from running technically pre diabetic blood sugar levels a lot of the time

and

B) That this is reversible.

Further, what if a non keto person had a fasting blood sugar level of 110 but a low Hba1c? Is this healthy as well? I am feeling like it is my lack of education that makes me confused but I imagine a standard trained md might be out of sorts here too. Pre diabetes is commonly diagnosed with this blood sugar reading. I imagine if one’s md who was not into keto saw one’s fasting blood sugar, as the author put it, “creeping up” to pre diabetic levels, regardless of what kind of diet one was on, they would be concerned. Further the author states in the comments that there are some kind of permanent changes possible (though he is not clear on what he means by this). I so wish there were more studies!!!

#27

@Madeleine

Thank you so much. That is very kind of you to try to watch out for my stress level lol!

The page you posted certainly makes me feel better. I am still a little perplexed by the section where he states “The rationale for refeeding is that if you maintain low insulin levels for a long time, your cells may become somewhat resistant to insulins signals…like a muscle atrophying from lack of use.” He doesn’t quite clarify why one would need to do this at all, particularly in light of his later statement …there are simply and absolutely no health objections to long-term keto…"

If there are no health objections to long-term keto, why is refeeding needed to balance insulin sensitivity?

Also interesting to note is that he flatly contradicts the statement by the author of the article (Peter) that “LC eating rapidly induces insulin resistance”. “a long time” is not rapid!

Is the author of the page an actual doctor and the article writer (Peter) just some guy? That would be convenient as I am fine with taking a doctors reassuring words over some guys concerning statements. However if both are legitimate doctors then it is a bit tougher to decide who to listen to…

(Bacon is a many-splendoured thing) #28

Yes, more studies would be a good idea. Be aware, however, that even if nutritional science should suddenly become rigorous and data-driven, there is no such thing as certainty in science. At best we can say things such as, “The preponderance of the evidence appears to indicate . . .” and “In 820 cases out of a thousand, we observed . . .”

If your assessment of the evidence as you’ve discovered it, and in particular from blog posts such as this one, leads you to doubt that keto is safe, then I would strongly encourage you to do what you need to do to stay safe and to adopt some other way of eating. For myself, I like having lost 60 pounds and six inches around the waist, even if I never lose any more. I like the way I feel. I like being free of my sugar/carb addiction. I will keep eating keto regardless, unless my metabolic markers fail to improve, in which case I will be looking around for another way of eating. Keto, however, is the only one I’ve seen so far that I like the looks of.