Does a healthy ketogenic diet cause irreversible insulin resistance?

(Michael - When reality fails to meet expectations, the problem is not reality.) #282

I really wish we didn’t have two nearly identical topics on this subject going simultaneously. Anywhooo…

I don’t recall whether it was in this topic or the other one (and I can’t find it in either) that @PaulL said my comment on my original keto experience where I related I was not hungry until the second day of my 4-day fast that maybe I wasn’t hungry due to ketones. My observations…

I have posted numerous responses over the time I’ve been a member of the forum describing how I experienced starting keto. On ‘day 2’ I experienced what I describe as carb hunger - the incessant, demanding-to-be-fed monster reminiscent of the flesh-eating plant in the film ‘Little Shop of Horrors’. On ‘day 3’ this became what I describe as keto hunger - the company accountant announcing at the monthly board meeting that outgo exceeded income during the preceding month and the deficit was covered by the cash account.

In my case, ‘keto hunger’ replaced ‘carb hunger’ on day 3, so I conclude that during both day 1 and day 2 I was not in ketosis. Whereas on day 3 I was.

(Michael - When reality fails to meet expectations, the problem is not reality.) #283

To answer the OP question unequivocally and emphatically: NO - it does NOT!

This interview with Dr Ben Bikman is about 30 minutes too long because the interviewer loves to hear the sound of her own voice. But the content pertinent to this topic starts at 46:00, which where I’ve queued the video.

PS: I found it really helpful to open the transcript and read as Bikman talks.

(Joey) #284

Good stuff. If anyone is interested, here are snippets from BYU’s bio page on Dr. Bikman:

Biography

Dr. Bikman’s research focus is to elucidate the molecular mechanisms that mediate the disruption that causes and accompanies metabolic disorders, such as obesity, type 2 diabetes, and dementia. Driven by his academic training (Ph.D. in Bioenergetics and postdoctoral fellowship with the Duke-National University of Singapore in metabolic disorders), he is currently exploring the contrasting roles of insulin and ketones as key drivers of metabolic function. He frequently publishes his research in peer-reviewed journals and presents at international science meetings.

“Much of our recent work is focused on the pathogenicity of the hormone insulin. Insulin, while necessary for healthy living, elicits significant and harmful changes in tissue metabolic function when chronically elevated. Several projects have stemmed from this work, including a focus on the varying effects of dietary macronutrients (e.g. carbohydrates vs. fats) on insulin homeostasis, the effects of insulin on brown adipose tissue (and metabolic rate), and insulin-induced brain alterations.”

Education

  • Doctor of Philosophy, Bioenergetics , East Carolina University (2008)*
  • Master of Science, Exercise Physiology , Brigham Young University (2005)*
  • Bachelor of Science, Exercise Science , Brigham Young University (2003)*

Memberships

  • American Society for Investigative Pathology (2017 - Present)*
  • Mitochondrial Physiology Society (2012 - Present)*
  • The Obesity Society (2012 - Present)*
  • American Diabetes Association (2011 - Present)*
  • American Physiological Society (2010 - Present)*
(You've tried everything else; why not try bacon?) #285

Since I have already seen this video linked—by you—in three other threads this morning, I am puzzled as to why you felt it necessary to link it yet one more time. It feels a bit excessive to me. Don’t you trust us to notice it the first time?

(Michael - When reality fails to meet expectations, the problem is not reality.) #286

Short answer: You, yes. Maybe three or four other members.

Longer answer: Lots of different folks are reading different topics. If I think a link is pertinent I will post it in those topics I think it relevant for the folks who may not be looking at the other topics where I posted it. I don’t see any problem doing so and I’ve been doing it since I joined the forum. Those who have seen it elsewhere can ignore. Or, just maybe it prompts them to recognize relevance they may not have noticed or thought about otherwise.

I should also mention that the forum software also keeps a running total of the ‘hits’ on links. So I can see how many folks have availed themselves of the info provided in the linked material.

(You've tried everything else; why not try bacon?) #287

So, if you are afraid that people will not pay attention the first time, what makes you feel that they will pay attention the second, third, fourth, or fifth time? At some point, you need to let the community’s response be what the community’s response will be.

(You've tried everything else; why not try bacon?) #289

It doesn’t matter. You make your offering to the community, and it is up to the community to do with it what it will. And if people aren’t looking at the video in the thread where you posted it originally, did it not occur to you that there might be a reason for that? This is why the software objects when you post the same link repeatedly.

Plastering the same thing all over the forums is not only unhelpful to the community, it is counter-productive for your purposes. It shouts that you don’t trust the rest of us to be capable of noticing something valuable unless you thrust it repeatedly under our noses. That kind of patronising attitude alienates people and makes them unwilling to pay attention to whatever good things you have to offer.

(Robin) #290

I saw it all 4 times and chose not to click all four times. I’m not blind, just not interested.

(Robin) #291

@amwassil Also… less is more.

(Joey) #292

@PaulL @amwassil This interesting thread is now reaching almost 300 posts and offers a useful exchange (at least useful to me!) on a range of topics…

Noting your disagreement re: the practice of multiple postings, may I suggest you start a separate thread to address that issue and/or consider utilizing the private message feature to hash it out futher? :vulcan_salute:

#293

I had watched this video and I found it refreshing that someone like Bickman said he also suffers from the same problem and that he doesn’t know if it is bad for health. He thinks it isn’t, but he doesn’t know.

Having a PhD doesn’t make everything you think automatically right.

I also noticed Bickman saying his brothers have a business of selling keto shakes, or something.

That’s THE problem with all of these internet dr, md, phd. They did something interesting and relevant, published some papers. Then they become popular and spend their time being interviewed again and again by people with an agenda. They’re pushed in saying things they don’t know, never researched, nobody knows the answer to. And they also eventually realize they have followers, followers do all sorts of weird things, including buying supplements and shakes, bars, etc, that they endorse. It probably pays more than research.

And then the good person who was a serious research spends a lot less time in the lab, doing research.

But continues to be on these youtube videos, repeating themselves.

Someone commented that one of these had launched a bet, or something, for someone who’d say this, or that. And people think that the lack of answer means he was right. A no answer means real science isn’t done on tweeter, nor youtube. Scientists also don’t go around with certainties. They finish their papers with “we need more research”, “the probability”, and such terms. All of these papers have p-values.

But on interviews, the p-values disappear. It suddenly becomes a certainty, a truth. Truth doesn’t exist in science. It is always and it will always be a work in progress.

Anyway, I was happy to know he’ll research on it. I had even posted about it somewhere in this thread, weeks ago!

#294

@SunnyNC, thanks for tagging me!

I’ve researched on the net for peer-reviewed papers on the main complications that I’m aware of related to diabetes: retinopathy, nephropathy, neuropathy… and what I’ve found is that the odds of having damage increase with blood glucose and they are already bad in prediabetic range. I was kind of “happy” to have a BG of max 105 after reading these papers. However…

However: my last libre CGM sensor was consistently about 10 mg/dL too low. It changes with the sensors. I had a sensor that was systematically about 15 too high. So, don’t trust the CGM. Test a few times with the finger test. And, yes, I know there’s a delay between BG and interstitial. Then, when you use a new sensor, test again.

As for my experiment, my A1c as estimated by the libre sensor us 5.3. I’m slowly bringing it down, but I think I hit a wall.

I’m currently on a bicycle climbing training trip and my needs in carbs mount. So, I’ll probably mess up my results by eating too many carbs. I’ve also noticed huge spikes when I’m climbing, mainly on two digits slopes (over 10% inclination slopes). With the meals, I’m getting a max of 150s even when eating lots of carbs. I’m doing 2MAD. With the climbs and gluconeogenesis, I get to 160s. It comes down, then back up. A rollercoaster. Oh, well… I’m also trail running and I also hit 160s with gluconeogenesis.

(Robin) #295

You’re hitting all the right points for me today. Thanks.

(Joey) #296

@Corals This is fascinating to me.

So many people (most?) note that their glucose levels rise in connection with exercise.

I consistently see my blood glucose level drop immediately following exercise (either HIIT cardio or HIIT strength-training). As I’ve noted elsewhere, my blood glucose meanders narrowly between mid-90s to as high as roughly 120 md/dL “spike” at 2 hrs post-prandial, then descends again to around 100 md/dL (typical “dawn” level)

But exercise immediately brings me from the upper to the lower end of this range (i.e., as much as 25 mg/dL) when measured right before vs immediately after.

This reduction actually makes sense to me since I’m burning up glucose in my bloodstream through intense muscular activity.

Frankly, I’ve wondered what the difference in our metabolic states is such that you observe rising glucose levels when active. I understand that gluconeogenesis produces glucose for us both… but for some, it seems to be a “replacement” (eventually refilling the tank, post-exercise) and for others it seems to be a “down-payment” of sorts?

Am curious as to why someone’s exercise-related glucose pattern (e.g., mine) would behave precisely opposite most others’ on such a consistent basis. :thinking:

[Context: I’m 2+ yrs diligent carb-restriction, 2MAD, no known metabolic dysfunction, perform HIIT aerobic or anaerobic most every day.]

#297

I’m happy you work as one should with the exercise, @SunnyNC. Pity it stays at the 100 and not lower. Now, even with the metformin, you stay at about 100? Did you test with blood glucose finger test to see if your libre isn’t lopsided?

You wake up with about 100? I’m interested to know what the metformin is doing. What differences have you noticed?

My average glucose continues to go down, even at the present madness. I’m also waking up below 100. But now the improvement is very slow. I hit a wall. I’m hoping to get through this. If my current protocol stops working, I’ll take the metformin.

I’ve noticed my glucose goes down as it is supposed to do only with very light exercise, like walking relatively slowly. And it was changing lately, before I’ve started this trip: going up, but then consistently getting back down, down to 80s during exercise.

But, the disappointing thing is that if I continue to exercise, it is as if it can’t stay down: it goes up again.

Exercising 2h, it had become quite ok, lately. But like now, exercising 4-7h, it is a rollercoaster. Perhaps it is the duration?

I’ve noticed something strange: I’m still in ketosis, even consuming more carbs. So, the exercise is using up all the energy from the carbs. I’ve tested after training and upon waking up. Ketosis. So, one can get away with a lot of carbs, depending in the situation.

I had started eating more, because I was losing weight and I don’t need to. But I’ve decided to lose 5% of my body weight anyway, to see if it helps. It’ll be the last experiment. When they get people to lower their glucose, it is always related to weightloss. Who knows? I’m just afraid of starting some bad yo-yoing and messing up my metabolism more than it is already messed up.

(Joey) #298

Nothing wrong with the idea of losing excess fat if that’s what you believe you’re carrying. But losing weight is not universally associated with lowering glucose. There are many people who are highly athletic, trim and seemingly fit (from outside appearances) who are diabetic and don’t realize it.

Dr. Tim Noakes (himself a life-long runner) explains this, including as he experienced this himself. But these situations invariably arose from the heavy carb-loading that athletes were instructed to engage in to enhance performance.

And so since you’re primarily limiting carbs, it’s extremely unlikely that losing weight will lower your general serum glucose levels (again, unless you really are carrying excess body fat - e.g., around the waistline). Below a healthy level of adipose tissue, you are essentially curtailing your body’s ability to store energy you might need for endurance and other constructive metabolic purposes (e.g., in case you become ill and need the slow sustenance of energy while your digestive system might be temporarily out of order).

(SunnyNC) #299

I am basing my comments based on CGM data, CGM estimated average BG. I just used A1C since it’s simpler. I should add, my variability is very low on both Keto and Slowcarb diet. Thats good news. I believe higher A1C or higher average BG (ABG) after variability is accounted for is worse than lower ABG. Why? Coz I read about experiments with sticky blood and increasing BG = increasing stickiness. Simple physics there. Now biology is more complex. Maybe my body can deal with the higher glycation on keto or may be not! Unless someone can conclusively prove one way or the other we have to pick a side. Please don’t hate me as I have repeated this same thought again and again. I don’t see any other way except repeat as my thoughts have not changed all this time based on this discussion or anywhere else. In fact all in the research I have been doing only confirms my doubt as more and more keto gurus are now “cycling” etc.

(SunnyNC) #300

My excercise related glucose pattern is in line with @Corals. I am even afraid to bring my HR up (I like to Sprint randomly for 30s or do jumping jacks while waiting for my coffee to brew) as it spikes my BG and it stays elevated. Darn CGM, ignorance is a bliss. I think being active leads to stress and might become chronic, elevated cortisol leading to elevated BG. I am not at all mentally or emotionally stressed otherwise. Infact I am lucky to have no stressors in my life for most part. If I go for a pleasant walk where my HR zone is below zone 1, BG is good, at or below baseline. Once I go over Z2, it shoots up my BG. I wonder if folks like Ed and Corals have different genetic makeup which causes a different metabolic response compared to folks like you. If someone has a research to study this in Charlotte, NC area, sign me up!
Note: I strictly track my sleep, HRV, resting HR, recovery, body battery and stress data via Garmin watch. Body battery and stress are highly related to diet, alcohol, how late i sleep, how much I sleep and how much of workout load I have. I make sure my recovery advisor says I am recovered before doing anything strenuous. I see a very strong and predictable correlation between all metrics EXCEPT BG. Infact I can easily predict what my body battery or sleep score is going to be just based on how my day went and what/when I ate/alcohol in any. Everything except what will my BG be when it wake up? Lmao. Don’t know what else I can add.

Edit @corals it won’t let me post a seperate reply. You asked about MF. Its not all good news. My avg BG is hovering around 100 still. But I also doing a high carb diet called slowcarb diet. One thing is my early morning BG is 90s now. The moment I wake up and starts my day, it goes to 100, 105 108 etc. There’s are times it’s 90s. Since I am not doing keto the past 3 weeks (infact I am not even low carb, eating a cup of beans with otherwise keto, 3 meals a day). I have a feeling my BG is from GNG. Currently my diet is high protein (beans, meats, eggs) I have a feeling if I switch back to high fat, adequate protein Keto plus IF (2 meals a day) along with MF my BG will be much lower. I have some reasons for my theory. I will definitely update you with my findings. Sorry my initial MF bubble bust, I had said it was magical. I realized my BG was low as I had ended a 48 hours fast 2-3 days prior to starting MF and also eating lower protein Keto. Sorry, it’s not great news you were hoping for. I just want to share my experience in a honest manner.
One thing I should add - I did not wait enough after I started slowcarb diet after I started MF. I was so ready to stop Keto and couldn’t wait. Now, if I fast for a full day, MF definitely lowers my fasting BG quickly to 70s. So it IS doing something. I don’t think it is helping with GNG due to high protein.
I had diarrhea the first week or so. It completely stopped. I started with 500 for a week, 1000 after that. Ok started the full 1500 this week. I don’t see difference between 1000 and 1500mg so far.
True test will be Clean adequate protein Keto+IF/2mad/MF for a week and check avg BG. I will do that and of March/early Apr and let you know. Please keep me posted if you do decide to start MF.

(Joey) #301

@SunnyNC Okay, my friend, now you’re weirding me out. Sounds like you’re becoming your own worst enemy. :unamused:

Don’t know where to start, so I’ll just jump in with lots of unsolicited (and unwanted) advice:

  • If you truly think exercise is bad for you, you’ve clearly lost your way.
  • Yes, you do have a major stressor in life. It’s you.
  • No, you do not need to measure anything else. Put the metrics aside.

Seriously, you need a vacation from yourself. Stop reading the statistics pouring out of your devices and slow down … listen to your body … attune yourself to how your body is actually feeling.

Perhaps someday you can gain additional insights from measuring crap. But for now, your health and enjoyment of life will more likely improve if you turn off the data. It’s not helpful in the least.

Okay, I’m off the soapbox. Please take my comments in the constructive spirit in which they’re intended. :heart::vulcan_salute:

#302

Thank you for the update, @SunnyNC!

On my side, I’m still wearing a CGM sensor and the trend is still ok! My average glucose is going down. Slooooooooowly. What I’ve observed:

  • during the night, my glucose goes slowly down and continues to go down during the day until I get up;
  • when I get up, I get glucose dump and it goes a bit up, but most days below 110 mg/dL. After that glucose dump, it goes continuously down and stays between about 75-90.
  • when I eat, it goes a bit up, since I’m eating more carbs (but still very little carbs), but it goes down quickly. The peak: always below 130 mg/dL, mostly below 110 mg/dL, actually;
  • when I exercise: oh my, it goes down, as it is supposed to do, except when I do high intensity. What a joy to see it behaving!
  • When I do high intensity: it goes up, but then it comes down, no rollercoaster.

So, the rollercoaster is gone. I hope for good. I’m afraid to be too happy only to be disappointed in a few days, because I’m not sure I trust the Libre.

What I think worked: exercise. I think the diet is an accessory, in my particular case. I’m eating keto, but higher carbs days, since I exercise so much at the moment (2h/day, almost everyday). Last week I was exercising about 5-7h/day.

Please, keep me posted on your progress. I think it is a wonderful thing that your glucose is still around 100 with all the carbs you’re eating. That’s encouraging! Perhaps after a period of adaptation, it’ll come down.
I’ve read MF only really works after several weeks, for many people.

EDIT: I forgot to talk about a book I’ve read: Blood sugar 101, by Jenny Ruhl. It’s for diabetics and it is very good. It talks about the questions I was asking myself, meaning, at what blood sugar level damage starts. I had already found the information researching on my side, but the book was reassuring and she also has a website with the newest research. I highly recommend it! It is also very anti-dogmatic. I highly recommend it!