Doug - Its refreshing to read a response that finally does not say high BG is OK on keto for XYZ reasons and vehemently defend keto diet.
I dont remember all the past A1Cs. I am fairly young, healthy and fit, so it was not something I even thought about. I do know that my highest pre keto lab measured A1c was 5.5 (fasting BG was 85 at that time). That was in Nov 2020. 5.5 was shocking to me, that when I started keto and serious running and fitness regimen. 3-4 months into clean keto, it dropped lab A1C dropped to 5.2, but fasting BG was upper 90s. 5.2 is what my CGM was estimating. So I know CGM data is good. When they called me to discuss the results, high fasting BG was the only concern they mentioned, other than LDL having gone up. but HDL and TG was the best it has been so I was not concerned about LDL, even though my Doc was. She is definitely not up to date on new science, for sure. 3 months after that, my (CGM) A1C jumped to 5.6, a month later it 5.7 officially putting me in pre-diabetes range. I will now look like an idiot if I go to my Doc complaining about my high FB and increasing average as she clearly stated I need to “add more carbohydrate and eat at least one extra meal” when my Fasting BG and LDL went up.
Yes, my family is plagued with diabetes. I am guessing its mostly due to poor lifestyle choices and diet. Genetics may have a role, who knows! That is the reason I proactively went keto. My pre keto A1c of 5.5 was after a bout of crappy eating, parties, binging and not exercising. (got a house and was dealing with construction for a year) I knew I was going down a bad path, that is the reason I got my base lab work done and started keto. I have a feeling, if I had gone back to my normal healthy eating and exercise patterns, that also would have dropped my A1C after 3 months, so I definitely cannot credit keto alone for the initial drop in A1C. But I do know I can credit keto for the high HDL and low TG as I know my HDL was not good even when I was eating super healthy and working out 6 times a week preketo.
I totally agree with you on comment “above this avg BG, it is bad as this is when glycation starts” but that have not seen that data anywhere. According to Lusting, we are all constantly glycating/browning… compare a low flame to high heat, both eventually brown, low just takes longer. So I believe lower BG still causes glycation but at much lower rates. So lower the BG the better, that’s where being in ketosis has an advantage. With ketones powering most of the energy demand, we can allow BG to go lower than the typical 70 and still feel great. In the beginning “honeymoon phase” of keto, I have had BG in 60s at night and I still felt just fine. It even went to 57 one time. I only knew I was that low because the reader alerted me, I felt great. BG always returned to 70s, 80s in a few minutes.
Regarding - "**“Each 5% increase in time in range (70-180 mg/dL) is clinically beneficial.” – this is because that report is geared for diabetics. For a diabetic that would be a great target. You are right, they have the range all the way up to 180 to account for post prandial spikes. In my case, post prandial is pretty much the same as fasting a I eat less than 5% to no net carbs during my meals.
my new update is -
I am suspecting my high fiber and/or moderate (but on the higher side) protein (causing high GNG) could be an issue. This definitely was not an issue in the past. So if I can confirm through further monitoring and tracking that high fiber/protein on keto is bad, for me, then keto is not for me. I love my high fiber and protein, in the lack of carbs. This past week, I have eaten the healthiest foods, tracked everything on my fitness pal, ran every day, did some HIIT, been in calorie deficit, tracked ketosis, ate minimum protein for my height/weight/BF%. The only difference all that made so far is my BG is lower at night, when I sleeping. Average BG dropped 3 points, not a lot for all the sacrifice but I want to give it a 2 week shot. It still starts going up at early mornings (dawn effect, ofcourse) and continues to stay high all day long. If I go for a long walk or jog, BG goes down to 80s but it goes to 100s within 30 mins. I am guessing this is due to glucagon dominating in absence of insulin or due to hepatic IR induced by keto diet. If I have to resort to medication to control my FBG, then I might as well do a regular non-keto healthy diet and I am pretty sure my physiological IR will vanish and I will have good BG control. This is the reason I am getting another round of bloodwork done end of Jan to get a new baseline before I stop keto. However, given all the other benefits of Keto, I am willing to consider metformin as it is supposed to have other benefits (longevity, gut microbiome, higher HDL etc).Another option I am considering is CKD or TKD. This is all more trouble and work than what I “signed up” for when I went keto. I have 3 more weeks to continue tracking and researching before I decide my next approach. I would love to hear from others who have done some research around this issue or have some data to share.