Does a healthy ketogenic diet cause irreversible insulin resistance?

#136

@SunnyNC, I’m sorry to be posting again when nobody did after my last posts, but I wanted to share the results of my first hours with the CGM, because it is nothing like I was expecting! It is much worse.

I’ve received it yesterday, after my OMAD. By the time it was ready to be scanned, I had finished eating about 2h prior. My OMADs are below 20g carbs.

Well, my BG has been jumping up and down and I haven’t eaten again. Only drank water. No coffee, no tea. No pills. No exercise. I haven’t even left the house, as I’m working from home these few days.

Whenever I move, like now I was washing my showerbox and washbasin, it went all the way up to 154 mg/dL. I stop washing, it goes down. I start washing again, it goes back up.

I go up the stairs, my BG jumps up to 120s. I brush my teeth. I wake up to pee. If I move, my BG moves. Up, then down. No food involved. I’m laying down now, trying to calm it down from the 154!

So, my problem isn’t just upon waking up, the dawn phenomenon thing. It is much worse.

I had written already about the fear that I just can’t adapt to using fat as energy. That’s the reason I had become a carnivore: I wanted to force my mitochondria into doing something. Getting more of it, or whatever. I want to do anything I can to get my FBG sorted. There’s no food I can’t stop eating. But I still felt miserable a few months into carnivore. Weak. Like with keto.

Then I spent summer traveling by bicycle and I just had to eat carbs. For the record, it was a super hilly country and I was mostly on trails rather than asphalt, carrying all of my gear to survive on the bike. I didn’t go crazy on carbs either, as they scare me. I lost weight, because I couldn’t eat enough (far from food, small places without options, on the trail) and CICO always works with me. It wasn’t a bad thing, because carnivore had made me put the most weight I had in my whole life.

Anyway. What I’m thinking: I’m very low carb. My weight is stable, so I’m probably eating enough. Most days, OMAD. I eat to satiety as we tell everybody to do in this forum.

But if I’m right, my body just can’t use fat as fuel, or super inefficiently, therefore, whatever I do that requires a little energy, it throws glucose in my blood to keep my muscles moving, my heart beating.

I don’t know what to do.

A few words about something I think it is related.
My heartbeat also jumps up. My heart has always been like this. I’m a fit person with the heart of a sedentary one. Last time I ran 20k, my average heartbeat was 182. My blood pressure is always between 100 and 60 (on the lowish side). My cardiologist agrees that that’s just the way I am.

(Michael - When reality fails to meet expectations, the problem is not reality.) #137

Stop keto now - start eating your preferred variation of SAD. Continue for the two weeks your CGM sensor lasts. Let us know what happens to your glucose. If you think that would be very inaccurate due to readaptation to high carbs, then continue SAD for a month then purchase another sensor and try again.

During my current CGM episode, the first week or so my glucose varied quite a lot - not like what you’re experiencing, admittedly - but more than I thought it would based on my previous experience. I discovered that 99 Liqueurs apparently contain lots of sugar. Stopped those and within a day my glucose plots got much more uniform and averaging lower overall.

My bet is, based only on what you’ve described so far, there is something amiss with your metabolism and going high carb will make it worse than what you’re seeing now. That’s the hypothesis. You can disprove by testing.

(SunnyNC) #138

Thanks for sharing your experience Corals! Give CGM a day to acclimated. It seems like you are having a similar experience as me, but much worse. There is so much controversy with too much protein, whether it can cause high BG. Extra Protein after muscle synthesis cannot be stored and is converted to sugar via GNG but lot of gurus out there that is not a concern. I think it does matter in my case.

You are right, high BG is harmful no matter the reason and if it’s easily reversibly or not. Most people don’t get this simple concept so it’s scary to think they insist it’s ok and provide useless references that talk about physiological IR, benevolent IR, glucose sparing etc. BS. These people are worse then than the vegan snobs. Keto only worked for me when I had 20lbs to lose, now that I am fit and athletic it’s causing high average BG. Sprinting has become hard too.
Thomas DeLauer has a new video that talks about this. He says take a break from Keto every 3 months, for 2 weeks. Check that out.
I am either getting on low dose metformin or stop keto by end of the month. I will keep you posted about my BG once I do.

(SunnyNC) #139

“few words about something I think it is related.
My heartbeat also jumps up. My heart has always been like this”

This will definitely cause liver to dump glucose, I have noticed when my heart rate goes up due to stress, or sprinting etc my BG spikes. And due to the so called physiological IR, my muscles don’t use the glucose and BG is high. In absence of diabetes/IR this is a sign of fat adaptation.

(SunnyNC) #140

The baseline for diabetics is much higher than normal folks. Their true IR is much worse and keto helps reverse it. In some healthy folks, once they get fat adapted, several months to a year after starting Keto, fat is the preferred fuel. So any glucose liver dumps via GNG is now not being used by muscle. You said you just started back on keto? If so give it a few months and then do GTT. It will falsely indicate diabetes. If you are carb cycling then this might not happen. That’s another reason I am considering doing carb cycling.

(Michael - When reality fails to meet expectations, the problem is not reality.) #141

You may have me mixed up with someone else. I’ve been in ketosis 5 consecutive years as of Jan 3. My current glucose is within the healthy range of normal folks and I have to try hard to get it above that range. Since I eat very little carbs, pretty much all of my glucose is derived from GNC.

I’m currently observing an interesting phenomenon while doing my second CGM experiment. I haven’t really said anything about it yet, but I will likely start a separate topic/discussion to explore it more fully. I may even buy another sensor for my FreeStyle Libre to get some data.

The initial observation is that consuming vinegar (I’m using red wine vinegar) seems to reduce glucose for several hours after consumption. I’m currently drinking about 2 tablespoons of vinegar prior to bedtime and find that my overnight glucose goes lower than previously. I’m also drinking citrate in the form of unsweetened lime juice daily, which may reinforce or confound the vinegar effect. To be determined.

Mike’s Excellent Glucose Monitor Adventure 2
#142

Michael, in years past I read everywhere that people took apple cider vinegar to lower blood glucose, so I’m not surprised by your outcome. However, I wonder if the body compensates by raising ketones. I suspect it does, especially in those of us who are fat adapted. I haven’t considered this before.

#143

My question is, even if the high blood sugar is caused by “physiological insulin resistance”… wouldn’t the high blood sugar still inevitably lead to blood vessel and organ damage as it does in diabetes?

(SunnyNC) #144

Interesting, I tried ACV and lemon juice myself and it did nothing for me. This shows how different everyone is. I have come to believe I am not a “hyper responder” meaning most things don’t affect me, positively or negatively. I can give a list of things from past where I did not respond like most others do but I’ll spare the details 0;) maybe I should try ACV longer, morning and before bed. It’s so damn hard to keep track of so many things. Looking forward to read about your RWV and citrate experience. And sorry, you are right. I mixed you up with someone else that had stopped keto and started it back up. 5 consecutive years, wow. congratulations!

(SunnyNC) #145

Yeap, that is exactly what I have been asking on this forum for months. And the response has been a link to some BS study that says PIR causes high FBG and somehow its magically ok. After much research, I believe while high insulin is bad, high BG is also bad or worse, regardless of the cause and will cause organ damage, neuropathy etc. Don’t believe anyone that says high average BG is ok if it’s due to physiological IR. That’s a load of BS. PIR itself might be ok as it is easily reversible but in the meantime if your fasting/avg BG is high you are damaging your organs via glycation/AGE. Hemoglobin does not know why BG is high. If it’s high, it glycates. Higher the BG, higher the glycation. Period.

#146

In case nobody reads this long post, a remark: I’ve noticed the daily graph the libre app gives doesn’t include the results when I read the sensor. It’s like an average curb and the highs are lower than my reading highs. Is that normal? For instance, I had a 191, but on the curve of the daily glucose, the app doesn’t show it.

@amwassil, I’ve done a test and my BG doesn’t fluctuate much. I’ve had a meal with about 50g of carbs and my BG only moved up by about 20 mg/dL. It stayed on that level for about 1h, though, before coming down a bit on the slow side.

In the meantime, exercising, or even brushing my teeth, got me even above 160 mg/dL. Basically, if I want to keep my glucose ok, I should be laying down 24/7/365, eating up to 30g of carbs per meal. Of course, I mean it as a sad joke.

@SunnyNC, I didn’t get the last thing you’ve written: “I noticed when my heart rate goes up due to stress, or sprinting etc my BG spikes. And due to the so called physiological IR, my muscles don’t use the glucose and BG is high. In absence of diabetes/IR this is a sign of fat adaptation.”

So, if I’m fat adapted, when I exercise it’s normal to have high BG, because my muscles won’t take the glucose my liver dumped in my blood? Are you sure? Because if that’s true, I could be fat adapted and that isn’t good for me, because I exercise a lot and that’d mean my BG would be high too often.

Test with a HIIT workout: 4 times running 3 min at heartbeat between 182 and 188. Between the running efforts, walking 3 min. My glucose rose to 191 mg/dL! I had not eaten anything in about 16h. It comes down “quickly”, but it stayed high, because I walked about 25 min to come back home after the whole HIIT. It was outdoors, 3°C (water freezes at 0°C) and I was under dressed, if that means anything.

Now, perhaps there’s a problem with the place I’ve put my CGM sensor. It stopped working several times, including right after it has hit the 191 with my HIIT workout. They called me from Germany and will replace my sensor. He told me I need to place it on flab skin right on the back of the arm, that the sensor is stopping sometimes because I’ve probably placed it on muscle.

I don’t agree with it, because I’ve seen so many videos of people with this sensor, including type 1 people, and I’ve placed mine even more to the back of my arm than most. But I do agree that this sensor may be defective.

Because:

I’ve been to my doctor. She’s my new doctor and I’m placing a lot of hopes on her, because she takes the time to listen and is very curious. I’ve told her almost scared of her reaction about my experiment with the CGM. She immediately took a finger test and wanted to compare. My glucose was above 120 on the CGM. On the tip of finger test, it was 103. I’ve told her there’s a delay of about 15 min and she already knew that, because she told me we’d wait. But my CGM stayed above 120 until I was already home. Much longer than the 15 min of delay between capillary glucose and interstitial the Abbot people claim.

I’m so hoping my sensor is really defective and I’m not THAT messed up!

She took my blood to test for lots of stuff. Everything I’ve asked to add, she did, too. And she told me she’ll get a CGM like mine to experiment with it. She sent me to an endocrinologist, because she thinks there’s something wrong with me. She thinks I’m doing everything right and since the results aren’t good, there must be something else. She took my blood to get more tests before I get to the endocrinologist, so that when he sees me, I already have the tests results. She thinks I may have an autoimmune problem and I’m attacking my own pancreas. So, on the way to type 1. In spite of a good c-peptide result.

And she gave me a prescription for metformin. I’ve decided to wait a few days until I have my new sensor, then I’ll test the new sensor for a couple of days and start the metformin.

About vinegar, I’ve tested it several months ago. It doesn’t help me. Cinnamon either. Basically, nothing works.

#147

I certainly see why you are concerned - especially in light of the equally increasing Hba1c.

Don’t get me wrong - I love the keto lifestyle and the plan is to stay on it for life. And while it appears this issue does not affect everyone on keto long-term, I would be worried too if my FBG and Hba1c began trending higher in the pre-diabetic or diabetic range. At least not until there are multiple conclusive research on why this will somehow not result in organ/blood vessel damage while on keto.

You could try to low carb for a month or so and see what happens to your BG. If the issue persists, then at least you know it’s not keto persay and you can consider going back on keto perhaps with Metformin as you mentioned earlier.

If it does get better on low-carb, then perhaps keto is just not for you and maybe healthy low carb is your next best alternative.

Unfortunately, even what is best for most people may still not be best for everyone.

#148

@Corals I apologize in advance for my ignorance, but from another post, I think you said your A1C is 5.7%. I thought that was an acceptable value(?) Is there any scientific evidence that demonstrates 5.7% is a problem?

My A1C hovered from 5.5-5.7 prior to keto. After 6 months on keto, I was 5.1. Now I am back to 5.5. Weird that it went back up, but I wonder how accurate or meaningful these tenths of percentage point differences are anyway.

I also wonder how meaningful the rapidly changing sensor readings are – especially since you say the graph does not even record them. I will wait for other users of CGMs to weigh in on that issue, and I am curious to hear!

(SunnyNC) #149

Corals, in T2DM, that’s the Hallmark of IR, isn’t it? Liver dumps sugar. Due to IR, muscles and adipose cells cannot soak it up. Similarly, if you are fat adapted, and you have PIR (aka adaptive glucose sparing) your muscles can’t soak sugar up. Maybe your liver will eventually learn not to dump so much glucose? IDK
This is exactly why some endos say keto is not for long-term. While I believe keto is a lifestyle, some folks like us need to cycle. 3 months Keto, 2 weeks non keto, for example. Or maybe talk to your endo if metformin will help (especially due to it’s other touted longevity benefits). Also I am thinking trying this: fast for 2 or 3 days, deplete all liver glycogen and see if your FBG normalizes.then add back protein slowly increments of 10g per day, starting at 0.5g/kg or 0.6g /kg,and check FBG and ketones till you find your threshold. I plan on doing this this week. I find it really hard to do moderate protein on Keto. Also I am getting weary of tracking so many things with so many variables.

Edit: I see you were already prescribed Met. Keep us posted if you start taking it.
I do hope your sensor was defective! Why sensor from Germany? Are you in the the US? If so libre 2 is only $36 per sensor. My insurance does not cover it but the price was capped at 36 (instead of 70 something). I called libre once and they sent me a coupon via email to redeem free replacement sensor. No waiting. Hope that helps.

(SunnyNC) #150

It’s all relative. 4.7 is better than 5.7. you can sear your meat in a broiler at 550F in minutes or bake at at 350F for hours. Still causing glycation end products, just at a different rate. For some folks like @Corals, myself etc, if avg BG is better on a non keto diet, then why do keto at all? That’s the discussion here. :slightly_smiling_face:

(SunnyNC) #151

That is probably the most sensible response I have received. Thanks! @Corals maybe for you too :slight_smile:

#152

How do you know? Here’s a paper that suggests 5.0%-5.4% is the range among non-diabetics that is associated with lowest all-cause mortality.

(SunnyNC) #153

I know I made so many posts here, so I wanted to summarize various thoughts from my previous comments, in light of my average BG/HbA1C creeping up, after 1 year of continuous keto lifestyle.

My options now are:

  1. Try cycling carbs and keto (3 months Keto + 2 weeks carb up)
  2. Metformin+keto (berberine, cinnamon, bitter melon, chromium, gymena etc does nothing for me)
  3. Try lowering protein on keto
  4. Keto without IF (larger eating window, maybe 12:12)
  5. Simply trust Keto, stop CGM and keep track of quarterly A1C and make sure it does not go up anymore. Maybe my body will find it’s sweet spot, maybe my liver will eventually learn not to dump glucose everytime I move!
  6. Quit keto. Do IF + a healthy version of SAD or Mediterranean (stick to valuable lessons learnt from Keto ie no more added sugars, processed food etc)

I am thinking my preferred sequence will be: 1, 2, 4, 3, 6, 5. Approaches 2-6 each for 2 months till one of them shows promise

Feedback welcome. Thanks my fellow Ketoers!

(SunnyNC) #154

Wendy, great point. I hade read that paper before. I looked into it again, it was published over 12 years ago, which in longevity medical research is outdated. Granted somethings don’t change but this study is just a correlation. Who knows what else affected the mortality? They did not even check insulin levels. Having 4.5 but ■■■■ load of insulin that’s keeping BG low is not good. With insulin levels in picture, that study is not applicable for keto dieters in my opinion. when you are in ketosis, the demand for BG is much lower. So 5.0 on high carb is excellent but on keto, it’s just good. I have also read articles from other longevity guru’s that suggest ketosis a1c below 5 is optimal. I don’t bookmark everything I read but you are welcome to further research to see if 5-5.4 is indeed the best or it is just one study based on correlational data. If I come across the article I am referring to I’ll share it here. Unfortunately, for every one paper that supports something, it’s easy to find another that suggests the opposite. That makes things really hard :frowning:

#155

Hi @Wendy198. My fasting blood glucose (FBG) was >100 mg/dL already on 3 different tests. Not home testing, but a real lab test. Adding to that, my A1c increased. 5.7 is considered prediabetes in continental europe, where I live. I started keto to get my FBG lower, but it’s higher and higher instead. So, I’m worried. I don’t want to become diabetic and the trend is in that direction.

The jumps of my glucose measured with the CGM, I’m trying to believe it’s a faulty sensor. Today it’s pretty ok, and I’ve even done interval training, though only sprints, instead of 4x4, or 4x3. As they say, fingers crossed.

But the thread is about FBG. It seems that for some of us, Keto makes it worse, instead of better. If that’s really the case for me, I need to find an alternative.

I don’t want to go crazy on carbs, because I obviously am insulin resistant. But very low carb isn’t good for me either, it seems. I need to find the right spot, carb wise.

My high A1c could be due to working out. When I eat, even more carby, my BG doesn’t move much up. Food isn’t my main problem.

@SunnyNC, ah, I get it. Indeed.
About fasting, I did try it already. It didn’t lower my FBG. I’ve fasted over 3 days. I’ve got the Metformin. I’ll start in a few days, one or two days after I get my new sensor. I could also try fasting for a few days before the metformin. I’ll decide based on the results of the new tests, the results of which I should be getting tomorrow, or on Tuesday.

One thing: I’ve had better sleep and my BG was less jumpy. A whole day where it only went above 140 for a brief moment, while I was doing HIIT. I’ve cut my effort time a lot on the HIIT, limiting my heart rate to about 170 max. But I’ve done more repetitions. I could keep my glucose from exploding upwards.