Does a healthy ketogenic diet cause irreversible insulin resistance?

#186

If you move to another thread, please tag me. Your experience interests me. You’re the only person I can interact about this who’s working on improving your glucose.

Yesterday, I’ve decided to eat carbs to see what would happen. I had chickpeas (prepared mass: 140g!) with half a medium cauliflower and 100g of goat cheese. This used to be one of my favorite meals pre-keto, minus the cauliflower. I haven’t calculated the carbs.

My BG was about 115. It went up to 141, then down to about 95, then back up to 110 where it stayed. The whole up and down lasted something like 2h. I was pleased to only see an increase of 26 mg/dL. If my baseline was 95, I could even consider eating chickpeas sometimes.

The reason I’ve decided to eat carbs: I’m about to give up on not taking meds and start metformin (MF). I thought it’d be good to test carbs before doing so, as a last experiment. I can’t eat stuff like bread and pasta, because anyway, I have no plans to eat things like that ever again. But chickpeas, if I could, I’d eat sometimes.

Anyway, in the meantime, I’ve been researching about MF. Lifestyle changes have a better result in avoiding T2D for prediabetics than MF and other medication. I couldn’t find a paper on the outcomes if one does the lifestyle changes AND the MF. If anyone knows of such a paper, please, share!

People always suggest trying to go carnivore: I’ve tried for a few months. It didn’t help my glucose and I’ve put on weight while doing it. Not good for me. I’d be interested to know if it works for others. Do you know of any prediabetic who consistently lowered FBG into non prediabetic levels after going carnivore?

I’m going to eat more carbs again today and see what happens. Then, MF.

(SunnyNC) #187

Hey Corals, I will be sure to tag you if I open a new thread. Unfortunately most MF or any other intervention studies related papers’ subjects are diabetics, morbidly obese etc. I don’t think government funds studies that anti-aging, improve wellness etc…cure and fix studies vs prevent. with that said, David Sinclair, Peter Attia, Sim Laand (you tube) have done lot of research but I don’t recall any of them talking about MF in the context of Keto induced PIR.
BTW, you had mentioned Virta health stopped publishing updated papers on long term keto intervention to lower A1C. Not only that, if you go to their FAQ/questions section, a bunch of links, all related to PIR/fasting BG increase , things we are concerned about this thread are broken. I got “page not found” when I clicked on those questions. Someone went and deleted some of the pages related to increased FBG, PIR but were not smart enough to delete the questions that takes readers to those links. This is so unethical. They should have updated those web pages with new info instead of completely deleting them them. This makes me thing we are on to something here.

If you do start increasing carbs again, then maybe hold off MF for a few more days to see if increased carb itself is enough to bring down your baselines, since your issue is related to PIR, adding carbs might eliminate PIR in a few days? you might not be in ketosis all day long but with the right amount of carb, you can get back into ketosis overnight and reap the benefits of ketosis for part of the day? IDK, just thinking out loud. Good luck with your carb experiment!

#188

Yes, I’ve noticed this too, @SunnyNC, in the Virta site! I’d call it lack of transparency.

Anyway, I came back to report something amazing. So, the day before yesterday, my OMAD was lots of carbs. The chickpea meal.

Yesterday, I’ve noticed my glucose was a bit different in the morning. In the middle of the night, it went close to 70 once and it was up and down, but small amplitude. Bad, but somewhat less jumpy. Then I wanted to eat carbs as soon as possible. I wasn’t hungry, but I wanted to have breakfast, to test the carb thing.

But I only found time to eat at about 15h. My work can be very intense. I had 2 zucchinis cooked in water with lots of spices, 150g of soft goat cheese (or was it sheep? I can’t remember). I had tea after the meal, two drops of a stevia liquid sweetener. I made a chocolate mug cake with 1 tsp of coconut flour and 45% cream, pure cocoa powder and 5 stevia drops, 1 egg. I covered my mug cake with… about 15g of jam. Jam normal people eat, with sugar. I also had about 100g of greek yogurt and about 20g of 70% chocolate. While keto, I’d never splash like this, no way! No sugar, no 70% chocolate, no 2 whole zucchinis in a meal.

Well, my glucose went up to 126, from about 105, or 106. After the meal, it went down… to just below 100! I couldn’t believe it!

In the evening, I went for a walk with sprints later. I walk about 30 min, then I do 30 min of sprints/walk. It’s a HIIT thing. And then I walk home, about 30min. I cut it short, totalling only 1h, because it was raining.

But what happened to my glucose was amazing! Instead of jumping up, it went down! You know they tell you exercise lowers your BG, but with me it never, ever did before. I was afraid of exercising since I put on the CGM sensor. I had a jump up to about 170 (!) when I went running HIIT before, 2 weeks ago.

My glucose stayed below 100 for most of the time ever since I had that meal! It had a few moments above 100, when I went to pee in the middle of the night. A max of 109, when before it’d get to 150.

I hope it wasn’t just a freak thing. I hope it workes like this the whole day today and tomorrow, etc.

My FBG today: 98! I know it’s close to 100, but it is below. I know CGM have an error. But it just didn’t happen before.

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That’s my CGM these last hours. First time I see this.

Was it the carbs? I don’t know. I’m hoping it was, because if I can keep this… wow! I’m so afraid it’s just a bleep and it goes back to the jumpy glucose I had all the other days!

About the MF, I’ve seen a paper related to prediabetes. Lifestyle changes were more effective. I think our FBG above 100 mean we are prediabetic.

I hope next time I post is to confirm the good trend, not to report disappointment that it was just a weird bleep.

For the record, before the CGM I used a normal finger glucose test (AccuChek). It was consistent with the high results of the CGM I was having.

I’m postponing the MF for as long as my glucose behaves. I haven’t counted the carbs I’ve consumed in my carbfull 2 OMADs. I’ll start counting again.

Another thing: I eat cow milk cheese, but these two days, I’m eating goat/sheep soft cheese. Perhaps this is helping. However, when I went carnivore, I also cut the cow milk cheese and it didn’t do anything for me.

Edit: now that I’ve learn how to upload a picture, here is a typical CGM for me, before today:

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Look at the jumps in the middle of the night, between 0 and 9h. The big jump in the middle of the day: a brisk walk! That’s me on keto. No processed foods, no veggies, no sweeteners. OMAD.

#189

You are not the only one. I am coming up on 2 years of Keto. My FBG was in 85-89 range pre keto. It is now always over 100. I too am concerned about this. The only way I can get by BG below 100 is to do intense cardio that pushes me into “glucose burning zone” for a sustained amount of time (eg fast cycling for say 45 minutes) but my BG quickly bounce back. It is like my body has upregulated gluconeogenesis even as my muscles are reluctant to burn glucose outside of a sprinting-like context. While I think there is evidence that ketones are a good thing to have, like many others I struggle at this point to maintain decent blood ketone levels.

I have never cycled off keto and some “experts” do favor this. I thought it would happen naturally but I went keto and never looked back. No cheats on thanksgivings, Christmas, birthdays, vacations, etc. I’ve been toying with eating oatmeal or something before I go to the gym. I have been reluctant on the idea that I want to keep my ketones up but maybe that is a lost cause and I need to try to restore glucose sensitivity. I honestly don’t miss carbs though

#190

That’s the whole question: on the one hand, we want to avoid carbs, on the other, our blood sugar increases. What can we do to continue avoiding carbs AND have a normal glucose? I’m trying changes in my aerobic exercise regime.

I’ve continue my experiments and I still can’t say what works best for me. At the moment, I’ve increased the time exercising, but I decreased the intensity. I mean that the time I spend on high intensity has been decreased. So, I jog about 6k, then I walk back home. Or, I walk 10k, doing sprints after the first 5k.

The reason is that when I do high intensity, my blood glucose jumps too high. I want to avoid that.

As for food: I’ve increased the amount of carbs on a few days. For instance, I’ve consumed about 60g of carbs yesterday. The other days, I eat less carbs.

The other thing: I’ve increased fiber. I was already eating fiber, but I’ve increased it a lot.

The fats I eat: I’ve changed completely. I’m getting my fat from fish, mainly.

I stopped doing OMAD and I’m doing 2MAD.

The results so far: my 7 day average glucose as measured by my CGM has gone down from 114 mg/dL to 103. The 30 day from 114 to 110. I’m very happy about that… if the trend is real. I need more time to know if it is real, or just a temporary thing. It could be just coincidence, due to a hormonal cycle, or something, and jump up next week. I’ll be very disappointed if it’s just a bleep.

I haven’t taken any medication. I’ve got Metformin from my doctor, but I haven’t opened the box yet. I’ve read lifestyle changes are more effective in avoiding diabetes and I’m giving my all to try to make it work.

I’m seeing an endocrinologist in the diabetes service of a hospital next week. I want his opinion. I’ll see another one at another hospital in a few weeks to have a second opinion.

My goals are to protect my kidneys and lower glucose.

If I knew keeping average glucose between 103 and 110 was ok, I’d just keep doing keto, exercising more.

Something I’ve noticed: now that I’m running less (down from 10-12k to 5-6k) and walking more, I mean, I’ve changed the proportion of my aerobic exercise time from high intensity to low and moderate for most of it, I started to see what one’s supposed to see with exercise, following the literature: glucose going down with exercise.

When I did more high intensity time, my glucose went up. Now, it goes up at the beginning of the workout, but then it goes down, to below 100 mg/dL slowly, and stays there more time than with any other intervention.

Unfortunately, it doesn’t stay below 100 time enough.

I’ve had fasting glucose below 100 a few times. The days after I eat more carbs and it is also linked to exercise, it seems. Time will tell.

I still don’t know what to think of it. Like I’ve said, it could be a bleep, something temporary completely unrelated to what I’m doing.

(Michael - When reality fails to meet expectations, the problem is not reality.) #191

Maybe it is. Please read the post I linked for your attention here:

(Joey) #192

Let’s say yes, indeed, your body has upregulated gluconeogenesis. For your sake, I’m hopeful that it has. Since you’re no longer slamming your system with exogenous glucose from a daily barrage of sugar/carbohydrates, this is what your healthy liver is designed to do - at its best.

Now, what I find curious is why you think your “muscles are reluctant to burn glucose?” What are you basing this fear upon?

Do you feel fatigued easily? Now that you’ve been fat-adapted and are not eating carbs, are you lacking strength or energy?

If not, then wouldn’t it make far more sense to infer that your muscles are therefore perfectly happy to burn the glucose they actually need?

And that your body is now doing the normal healthy thing in the absence of a metabolic roller-coaster ride on carbs (that would force your insulin to go bonkers - whipsawing your serum glucose to SAD-based levels of highs and lows)… and against which your muscles would eventually rebel?

So when your muscles demand glucose because you are taxing them through exercise, you don’t want them to get the glucose they are demanding? Why would you want to avoid this?

Wouldn’t you want your body to produce the glucose you need (i.e., via your very own highly functioning liver - the most evolved healthy way possible)… rather than getting the glucose your muscles need from some corn syrup-infused Corporate Food source found midway down Aisle 15?

If your muscles are demanding glucose when you exercise - and your liver is clearly producing it through gluconeogenesis - this is a clear sign that you are healthy and insulin-responsive.

Sadly, by observing the masses of people eating SAD which produces an exaggerated diurnal glucose/insulin cycle, we have embraced this phenomenon as the “lab normal” range.

It may be “normal” in the statistical sense, but it is clearly NOT healthy - as our Western health trends so clearly demonstrate.

A more moderated diurnal cycle of glucose (and equally important, less ferocious insulin cycle), with muscles that are sensitive to insulin (rather than muscles acting out in rebellion) is ideal.

If you’re not spiking your glucose through unnecessary carbs and associated sugars, you are allowing your body to do its natural thing… which is to produce its own glucose as demanded by muscles, organs and brain. And to having it used efficiently and as fully as possible given the exertion in which you’re engaged.

I encourage you to stop looking for things to be afraid of. Especially when you’ve got signs of good health, not disease or dysfunction. :vulcan_salute:

(Bacon is a many-splendoured thing) #193

Sometimes it seems that the rules change a bit on a low-carb diet. If you are not overloading your system with dietary glucose, is there reason to believe that the serum glucose level resulting from gluconeogenesis is necessarily unhealthy?

Dr. Paul Mason, a sports physician, in a lecture presented in an on-line conference for Low Carb Down under (and available on their YouTube channel), startled me with the assertion that he is no longer concerned about the absolute level of his patients’ glucose levels, so much as whether they are keeping within a fairly narrow range. In other words, he feels a patient with higher glucose that is stable is better off than a patient whose glucose may be lower, but who is experiencing broad swings.

If you are again experiencing the problems that most of us had before going keto—bloat, arthritis/joint stiffness, skin spots and tags, acne, skin that’s greasy in places and dry in others, the myriad aches and pains we associate with growing old—then I’d be concerned. Alternatively, if the only reason you know your glucose level is higher is because you’re measuring, then perhaps there is no reason to worry too much. Of course, that’s easy for me to say, and it’s your body, not mine.

(Michael - When reality fails to meet expectations, the problem is not reality.) #194

Very insightful! Just get the exogenous carbs out of your life and let 4 1/2 million years of metabolic evolution do what it’s designed to do.

(Joey) #195

Yeah. This ^^^ :point_up_2:

#196

This is just a theory, but I think what could be happening isn’t glucose sparing, but actually protein sparing. Protein utilisation becomes so efficient that previous amounts of protein that sustained the body becomes an excess and this higher meat consumption gets turned into blood glucose. These individuals that are showing an increase in fasting blood glucose could very well be overeating protein and just converting it to glucose.

(Bacon is a many-splendoured thing) #197

You could be right, but I though gluconeogenesis was supposed to be a fairly tightly-regulated process. In any case, protein is not generally metabolised, but rather is cleaved into its constituent amino acids, which are then re-combined into new proteins. The body’s limited ability to store amino acids generally means that the excess from the labile pool gets excreted in the urine, or so I understand. Somebody please correct me if I’ve got it wrong.

(Michael - When reality fails to meet expectations, the problem is not reality.) #198

I think this is pertient, so here’s the article by @amber referenced above here and here:

28%20AM

(Joey) #199

Slightly tangential to the topic, but only slightly …

I find, as others have reported, that when I enjoy a glass of dry red wine an hour or so before dinner (that’s wine, not vinegar), my blood glucose also drops by roughly 10 points (mg/dL) within about 30 minutes.

@SunnyNC Given your concern about the absolute level of glycolated RBC (which I respect even if I don’t personally worry re: the same concern), if you’re determined to get your HbA1c down one way or another, consider enjoying a glass of red wine as the sun sets? Might even help lower stress/cortisol too :wink:

FWIW, these days my BG meanders between mid-90s and mid 110-teens, and (1.5 hrs post-prandial) can even reach as high as 120 mg/dL. My sense is that highly restricted-arb eating + 2MAD + regular exercise are allowing my red blood cells to enjoy longer lives … so they have a chance to get more glycolated. If so, my wishful thought: HbA1c is a slippery metric for us healthy keto-eaters :crossed_fingers:

Anyhow, while my pre- vs post-meal glucose swings seem fairly minimal in the scheme of things, based on old lab reports I believe my fasting glucose level is about 10 mg/dL higher than it had been in my pre-keto days.

(Michael - When reality fails to meet expectations, the problem is not reality.) #200

I’ve noted elsewhere more than once that both ethanol and vinegar produce the same metabolic results: suppression of gluconeogenesis, enhancement of ketogenesis and clearing glucose from the blood. Up front ethanol generates aldehyde which is not a good thing but manageable in small amounts from time to time.

The crux for me is whether or not either is a viable tool to accomplish those things and whether or not it’s desirable to try to do so.

#201

Yes, that’s true protein does get cleaved into amino acids, but the body can utilize those amino acids to make glucose via gluconeogenesis pathway. I don’t know of any studies and this is just conjecture, but perhaps long time ketogenic dieters become more efficient with protein and more glucose in created.

(Michael - When reality fails to meet expectations, the problem is not reality.) #202

@_Andy

(Joey) #203

Musing again on this thread’s heading ("Does a healthy ketogenic diet cause irreversible insulin resistance?") prompts me to note that virtually all of the YouTube offerings on physiological insulin resistance (PIR) - observed as a keto-induced modest rise in fasting blood glucose - seem to agree on one central point… [Apologies if this was already addressed in the previous 200 entries to this thread]

If you want to “pass” an OGTT while on keto, eat some specified amount of starchy carbs for a few days beforehand. Then (we’re told) you will reactivate the glucose receptors in muscle tissue to their pre-keto insulin sensitivity and you shall obtain a more meaningful (acceptable?) result on your OGTT.

Putting aside confusion over the distinction between science and YouTube, if such guidance is correct, it suggests that whatever PIR results from longer-term keto, apparently it’s reversible in a matter of 2-3 days.

That’s in stark contrast to how long it takes for fat adaption to occur in LFHC/SAD eaters. Then again, most LFHC eaters going keto were eating SAD for their entire adult lives. By contrast, keto-eaters were likely doing so for a much shorter stretch of time. Perhaps that’s why restoration of insulin sensitivity in the muscular takes just a few days (compared to fat adaptation)?

None of which directly addresses @SunnyNC’s question seen elsewhere: Why would higher serum glucose in a carb-restricted eater be less harmful than the same glucose levels in a high-carb eater? Glucose is as glucose does, right?

[Personal note: As a guy whose FBG now hovers around 100 mg/dL and swings +/- pre/post-prandial by a modest 10-15 mg/dl, I’m not experiencing firsthand health angst, but of course the whole topic continues to intrigue me. All reliable science welcomed!]

(Bacon is a many-splendoured thing) #204

There are two main categories of amino acid, one of which is more easily converted into fatty acids, the other which is more easily converted into glucose, and I believe a few amino acids can be converted into both. While it used to be believed that every excess amino acid got converted into glucose, it is now believed that gluconeogenesis is more tightly regulated than that.

(Bacon is a many-splendoured thing) #205

Actually, I believe it is the other way round, and that the idea of eating some carbohydrate is to avoid looking too insulin-sensitive, not insulin-resistant. My understanding (which well may be wrong) is that glucose receptors are never down-regulated, even when we are fat-adapted. It is the damage to mitochondria from excessive glucose consumption, and the down-regulation of certain cellular processes required for fatty-acid metabolism that need to be reversed when we go keto, in the process we call “fat-adaptation” or “keto-adaptation.” I have never heard of anyone’s needing to readapt to glucose metabolism after stopping a ketogenic diet.

Remember that the other name for “physiological insulin resistance” is “adaptative glucose-sparing.” The logic behind the concept, regardless of how we choose to name it, is that skeletal muscles, once fat adapted, prefer to metabolise fatty acids and pass up ketones and glucose, sparing them for other organs and cells that need them. Yet when there is a need for explosive power, fat-adapted skeletal muscles can still immediately make use of the glucose that the liver sends them in the form of glycogen.

To me, it makes no sense that a muscle cell would lose the ability to metabolise glucose, because explosive power is often needed when running down a mammoth or in fighting a sabre-toothed tiger. Also, given how important it is to avoid hyperglycaemia and how skeletal muscle and adipose tissue are the two main glucose sinks, it would not make evolutionary sense for a cell to lose the ability to metabolise glucose. Fatty acid metabolism is not as crucial an ability.