Does a healthy ketogenic diet cause irreversible insulin resistance?

(You've tried everything else; why not try bacon?) #242

Doubting that the person is in a fasted state overnight is an assumption. It may well be a valid assumption, but reasoning beyond the data is what got our nutritional advice into such a state in the first place. What we really need is studies to determine the validity, or lack thereof, of that assumption. I don’t believe the overnight fast has really been studied, apart from studies on intermittent fasting. It would be interesting to hook someone up to a continuous ketone monitor and see the results. A CGM alone would not tell us enough.

Of course, if your assumption does hold true, then the rest of what you are saying is spot on.

On the other hand, that lack of hunger in the morning could actually be evidence to suggest that you were producing ketones overnight. That’s because, if your insulin remained high, it would be forcing the body to store glucose, thus rendering it unavailable to most of your organs. This is the typical explanation for why people on a carbohydrate diet are hungry so much of the time—the glucose they are eating is stored away, and not actually utilised. But on the other hand, if your overnight insulin dropped low enough to permit ketogenesis, that would be another explanation of your lack of hunger on awakening.

As I recall, during my carb-burning days, I’d go to bed hungry, but waken not wanting to eat until around 10:00 in the morning, when I’d get really hungry. On a ketogenic diet, I am usually not hungry from the evening meal until well after noon the following day, and when I do get hungry, the hunger is not so overpowering. (Cravings aside, of course, which is a whole different matter.)

(Robin) #243

I also attributed the afternoon slump to the carby school lunches, and in high school to the fast food they ran out for.

(Joey) #244

I always liked that quote from Max Planck.

Applied in this case, those of us with brains needing glucose will eventually die out - leaving behind only those of us with zero need for glucose. :wink:

#245

Saladino is now eating fruit. He found his BG was 96-103 in keto after 18 months. He says that eating fruit it is now mid 70s but with short excursions to 140.

(Joey) #246

Interesting. Although I rarely eat fruit these days, I find it silly to conclude that fruit is bad for health without considering how frequent, how much, in-season vs. every day, and other such factors - especially one’s nutritional context (i.e., low fat vs low carbs).

But given the choice, I wonder whether a narrow glucose range (96-103 mg/dL) is preferable to a wider range (70-140 mg/dL) in terms of longer term metabolic health, vascular inflammation, insulin resistance, lipid profile, etc.?

This seems to be the missing puzzle piece we keep returning to throughout much of this thread.

(You've tried everything else; why not try bacon?) #247

Paul Mason, the Australian sports physician, says that he’d prefer to see the former in a patient, rather than the latter. A doubling of serum glucose would definitely concern me!

(Joey) #248

Am inclined to agree (rather selfishly, given my stable/barely meandering glucose levels). But it would be nice to see some research in support of one view - or the other.

Does Paul Mason justify his preference?

(You've tried everything else; why not try bacon?) #249

I don’t recall his citing a reference, sorry.

(Bob M) #250

I’m not sure what to say about Saladino, other than some of the stuff he’s said had me wondering. He started eating honey and said over and over that his eating honey was proof that carbs don’t cause insulin resistance. Hint: it’s not. And then he’s said stuff about covid that was beyond wrong. So bad I stopped listening to him.

But I think if you are concerned about “high” blood sugar while eating few carbs, just eat some more carbs. Done. No more “high” blood sugar.

Personally, I don’t mind having “higher” blood sugar in the morning. And since there are zero studies to tell me whether this is “bad” or “good” (or immaterial), and I have no other metric that IS bad, I’m going to assume it’s probably not bad.

As for people eating SAD and having ketones, it depends. If they are athletes, they can eat high carb and still produce ketones when their glycogen dives. (Now, how well they USE those ketones, I’m not sure.)

As for Saladino’s hitting in the 140s while he eats carbs so he can “lower” his glucose, what’s his AUC? (Area under the curve) Maybe it’s higher? And even if it isn’t higher, what benefit is there? So he can say he changed a marker?

(Joey) #251

Yeah, Saladino confuses me; but perhaps that’s just me. He’s got genuine medical training; I certainly don’t.

Mentioning AUC makes me wonder… Even if the area is less, the shape of the curve would seem to matter within some bounds.

Just about every marker/parameter in the world of bio-health would seem to benefit from some level of variability. Some degree of stress-induced hormesis is how we adapt, grow, defend ourselves, etc. Pure stasis is rarely ideal.

But outside “tolerable” ranges, at the extremes, conditions invariably become toxic, leading to our untimely demise.

Perhaps Saladino is still young enough to play around with carbs and enjoy what he experiences. All I know is, at my more advanced age, I clearly don’t have the luxury of eating what he describes without feeling like crap, getting inflamed, reflux, foggy, etc. Oh, to be young again.

Absent scientific support, regardless of the area under the curve, I’m guessing that my slightly-meandering glucose levels are healthier for me (my brain, my arteries, my joints, my digestion, my liver…) at this time than a wilder roller coaster ride up and down. :vulcan_salute:

(Bob M) #252

I think it’s tough. For instance, I saw someone (on Twitter) complaining about people using CGMs to compare oatmeal and bacon, when oatmeal caused a “normal physiological response”. (And, of course, the implication was that bacon was “bad”.)

I had a hard time with this, as I ate oatmeal (or some other hot “whole” grain) for breakfast for years. The problem I had was I was freaking STARVING 15 minutes later. I was able to do it, as I went to school and couldn’t eat until lunch. But given the chance, I wanted more to eat.

Add 10+ years of SAD, and now I’m sure my blood sugar would shoot through the roof (and let’s ignore that it’d probably go higher just because I never eat carbs) and I’d be even worse off.

Between bacon and oatmeal, I’d choose bacon every time. I’ll take the detriment (assuming there is one) in nitrates for the benefits of (1) being full and (2) not being hungry for hours and (3) having zero blood sugar response.

I have a theory that a lot of us look though what I call “lenses”. Younger, healthier people who can eat oatmeal (or honey and fruit) and actually be full and think everyone else can be too. Us older folk that are freaking starving after eating oatmeal think everyone is starving after eating it. These are the lenses through which we happen to see the world.

Since I have been LC/keto for so long, I will eat fruit sometimes. Had strawberries we picked ourselves this year, for instance. But man, if I eat strawberries and yogurt, I want more. A few more bowls, please. Even if the blood sugar isn’t going to kill me, the cravings might.

So, like you, I limit what I eat, preferring to have smoother blood sugar throughout the day, with only occasional forays into carbs. And I pull back if I get cravings.

If people are concerned about “irreversible insulin resistance” (which I don’t think is a “thing”, by the way), maybe they should eat some carbs. Hell, stress will kill you way before anything else, so if you’re stressed and eating some carbs lessens that stress, eat some carbs.

#253

From the clip I saw recently Saladino was suggesting his BG area under the curve was lower now eating some carbs and his fasting insulin was if anything slightly better. His complaints were that after 18 months of ketosis he was having a lot of cramping and his testosterone was low. I had my testosterone checked last year after about 18 months of keto and indeed mine was terrible. Like 210 total T terrible. But I never checked it pre-keto. I’ve always been fairly muscular so my guess is that I used to have decent T levels but I don’t know. My free T4 was also at the bottom end of the normal range.

I paid out of pocket to get a bunch of labs last week. I’ll be interested to see the results. I might play around with somewhat higher carbs around workouts. By higher I mean like 50-80g per day.

In terms of SAD people and ketones, i seem to recall Phinney saying that non-keto tend to get 0.1 - 0.2 ketone readings. I only register around 0.3 at this point and is my current working definition of “ketosis”.

(You've tried everything else; why not try bacon?) #254

Now, we know that with a ketogenic diet, Vitamin C becomes almost irrelevant, since lowering insulin and producing β-hydroxybutyrate reactivates the body’s endogenous defenses against oxidation. We also have indications that thyroid hormone numbers are also less important on a ketogenic diet.

So what I’m speculating about here is whether the same thing might apply with testosterone on a ketogenic diet. Certainly eating a well-formulated ketogenic diet improves HDL (and LDL does whatever it does), and that’s got to have a beneficial effect, since cholesterol is the precursor from which testosterone is made. I’d say if one’s libido seems fine, and everything’s functioning as it should, that low testosterone could possibly not be the problem it is on the standard American diet.

I’m not claiming that this is actually true, mind you, because we have no data, but simply raising the possibility. And certainly I don’t see how eating carbohydrate and thereby raising insulin is going to help things. If one is still eating below one’s carbohydrate threshold, then insulin won’t go up enough to be a problem, but once it does, surely all bets are off. If Naiman is seeing a benefit from eating all that carbohydrate, then he must be pretty insulin-sensitive, but how long can that last, on a high-carb diet?

#255

Good points. I find my hunger is greatly diminished on keto so there is the possibility that lower caloric intake can by itself lead to hormonal changes.

I also think it is debatable whether ketosis is a normal human state or more of a “stressed” state. If the latter it might make sense to cycle out of ketosis some so the body doesn’t pare back on things like sex hormones.

Probably my favorite thing about keto is that I am not hungry much and never “hangry”. It suits my lifestyle. I can eat when convenient. I fear that adding in some allotment of carbs will make me more like the rest of my family - they are constantly melting down if they don’t get their “fix” every few hours!

#256

Here is the Saladino video I’m referencing btw

(You've tried everything else; why not try bacon?) #257

Since we appear to have evolved on a ketogenic diet, it seems to be stretching things to call keto a “stressed” state. In fact, in a state of restricted caloric intake, hair growth, nail growth, and the reproductive system are the first things to be severely limited.

In fact, a well-formulated ketogenic diet eaten to satiety has been known to correct infertility problems, to the point where, a few years ago, when our most-active members averaged a bit younger than they do at the moment, the term “keto baby” was bandied about fairly often, and women recovering from PCOS and other reproductive problems had to be warned to be careful, lest they become pregnant unintentionally.

However, I do agree that being able to go quite a few hours without food makes a delightful contrast from the days when I’d eat half a pound of spaghetti, fear my stomach was literally (not figuratively) about to burst, and still be hungry for more. I used to fear that I would re-enact that scene from Monty Python and the Meaning of Life, where just “wan more waffer-theen meent” did a diner in.

#258

I seem to recall, perhaps from Mark Sisson’s “Primal Diet” stuff, that our ancestors ate “only” 80 grams of carbs per day. That wouldn’t be keto but certainly close enough that bouts of ketosis would have been common. I’m not sure how we would know however. Have you seen evidence to suggest our ancestors were in ketosis most of the time?

My lineage is Scandinavian, I suppose that relative to those in more temperate climates these hardy folks would have been in ketosis much of the year.

I also have intuition, as a modern day hunter with modern assets, that securing game is difficult and I can’t imagine humans fighting to survive would have passed up plant foods when available.

#259

Here was my Testosterone result. It was actually 222 so better than I recall!

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(Joey) #260

@fitbod Not to pick on your “low” Tot Testosterone, at least as it’s reported, but these “Reference Ranges” always crack me up.

As you likely know, they are typically structured to represent +/- 3 standard deviations (capturing 95%) or +/- 2 s.d. (to capture 85%) of the population at large.

Implications? Well, ask yourself…

Are 85% to 95% of the general population healthy?

Public health stats strongly suggest that, no, they are not. Upwards of 70% are suffering from some variation of obesity, diabetes or metabolic syndrome.

So every time I see some lab result of mine that’s outside the “Reference Range” I ask myself:

“Am I glad to be outside the zone where 85%-95% of my neighbors fall on this metric? Or would I prefer to have the same blood levels that these folks have?” :thinking:

(Robin) #261

Hold the phone! No data? Are you telling me there is something related to a man’s libido and there has been NO research, funded by large pockets?
Was that meant for the humor category?