Does a healthy ketogenic diet cause irreversible insulin resistance?

#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.

#156

I’ve found an interesting interview of Dr Bikman.

It seems he has the same problem we’ve been talking about here and now he got funding from a commercial company to research on it. I’m looking forward to what he’ll come up with, even though the funding source makes it a for-what-it-is-worth research.

If anyone wants to listen to the interview, it’s on youtube and the name of the video is “Surprising symptoms related to metabolism + why glucose may rise on keto (Ben Bikman & Casey Means)”. He doesn’t really answer the question as the name of the video suggests. He talks about the problem and that he’s going to investigate it with funding from Levels.

I’m sorry for him he suffers with this problem too, but on the bright side, at least he’ll be more motivated to find answers, I suppose.

I’ve been reading a lot about glucagon in the meantime.

I also think I may have found a way to get lower glucose in the morning, but I need more time to test it: I’ve noticed that if I do things that rise my BG earlier in the day, including eating, my BG gets lower and lower at night. So, I need to sleep early, then do exercise and eating before, say 15h. I need to test it several days to see if it really works. I’m on it.

If somebody with the same type of problem would be willing to try, we could perhaps start a thread to share all we try and the results. Who knows we can find a way to help ourselves?

(SunnyNC) #157

I had a faulty sensor so that set me back a bit.
I got my baseline test done on Jan 28th. I got my results, A1C is now 5.7 (up from 5.1). So at this point I don’t care what the experts say, higher fasting BG due to PIR = BAD
I did a 48hr fast last week and my FBG was significantly lower, around 80-90 all day long after 36 hours. My guess is that without all the extra protein and GNG, my liver was not dumping sugars. So makes me doubt the so called expert saying high protein is ok and pushing carnivore (Ken Berry, for example with his bogus proper human diet).

I too got metformin and I already started on Friday. Haha beat you too it but I have GOOD news for you Corals. I started with 500mg extended release. My FBG dropped to 85 next day. OMG. I am SO happy. It is indeed living up to it’s hype.
Reg my latest blood work:
I had stopped most saturated fats since Dec. Mostly using organic EVOO and Avacado oil for fats. My total cholesterol dropped to normal range. LDL is still elevated but dropped a lot compared to last test. Not worried as my NMR looks good otherwise. Post keto Tri and HDL were already excellent and still good. So for me only tangible things Keto is helpful is with Tri, HDL and not being hungry. It made me pre diabetic.

I am now going on Keto + reduced saturated fats+ Metformin+berberine. I will track for a few days and post an update. For now Metformin seems like a magic pill (minus the minor GI issues, but I am sure it’ll subside). I will add carb cycling after a few weeks once I establish my new post metformin baselines. Wish me luck :slight_smile:

(Robin) #158

Great news! How wonderful to have the drug work it’s magic while you now continue to do everything within your own power too.

(Joey) #159

@SunnyNC Greetings! I’m late to this lengthy thread and have probably missed some key thoughts along the way, but I’ll accept your invitation for feedback and leave a thought or two…

This got me thinking. Perhaps an “elevated” A1c isn’t always what it seems when evaluated in isolation.

Just like an elevated LDL can mean vastly different things in different feeding contexts (see: Dave Feldman’s Cholesterol Code), perhaps there’s a parallel to be considered with A1c results?

More specifically: both my wife and I have serum glucose levels that consistently land on the higher side of the “normal” range. Her level typically even flirts with the “pre-diabetic” designation. Yet we don’t eat extraneous carbs (e.g., beyond what’s in our leafy greens, eggs, etc.) for the past 2+ years.

Our bodies need SOME serum glucose to function, right? So where’s it coming from? … Seems pretty clear that our glucose levels are derived from gluconeogensis - i.e., our bodies are producing glucose as needed.

It’s demand driven - not supply driven. Put differently, our livers (and kidneys) are doing their healthy thing on our behalf. And we have serum glucose levels to prove it.

If you have elevated glucose and you’re not eating carbs, I would submit for your consideration that it may very well be a sign of health - not illness.

@ctviggen This is an excellent point with respect to HbA1c. Assumptions about blood cell longevity play a significant role in defining (and interpreting) this metric.

As with most averages in biology, a presumed “3-month” lifespan is precisely accurate for NONE of the individual blood cells. It’s a statistical construct - not a reality. As such, A1c it should be interpreted with the humility needed to recognize that you could easily drown in a lake that’s 6 inches deep… on average.

[ASIDE: If a cohort of newborns is expected to live an average of 72.1 years, the chances of any one of those babies living to precisely 72.1 years is roughly zero. So unless the distribution of actual ages is perfectly linearly distributed surrounding that average, then using the mean age as a denominator for some other statistic easily yields a skewed combined statistic that can be misleading.]

This doctor sounds like she’s likely to do more harm than good. If you haven’t begun looking for a replacement, now might be a good time to start.

Hopefully these stray thoughts are taken in the constructive spirit in which they’re offered. Otherwise, feel free to ignore. :roll_eyes:

#160

Good luck Sunny. Glad you found something that seems to be working!

#161

That’s fantastic news, @SunnyNC! Thank you for sharing!

I’ve received a new sensor to replace mine. I’m hoping it is really faulty and that with the new sensor, my glucose is ok. I know that’s just wishful thinking and a bit of being in denial.

I’ve learned in another thread of someone who got normal FBG by doing alternate days: fasting one day, then doing keto the next and repeat. I’ll give it a try and then try the metformin. I’m postponing the metformin, because my dream is to find some way to control glucose with diet and exercise.

My observations, though, if my sensor isn’t defective, are all negative: the problem is that if I move, my glucose jumps up. So, I wake up in the middle of the night to pee. I’m at a 95 mg/dL, say. Then I go to pee. Back to bed, I measure again: 150 mg/dL. I didn’t run a marathon! I just went to the loo across the corridor.

And it goes down very slowly.

I was up from the couch to prepare my food. No cooking, all raw. My glucose jumped from about 105 to 130. I’ve eaten, it stayed the same, hovering at about 125. Now, about 3h later, it’s still 118. I’m afraid to get off the couch to drink water and have it at 150 and start it all over again.

Exercising doesn’t work: I walked a little under 2h this morning. Glucose up to 150 at the beginning, then down to about 130, slowly down to 110. I’ve postponed eating until it was 105.

Do you see these jumps when you move?

I’ve experimented with HIIT. It worked wonders for my resting heart rate. From 70s to low 60s after 1 HIIT session. I couldn’t believe it! It helps that I’m trying to sleep more.

But for glucose, no, HIIT doesn’t help, steady state doesn’t help, walking doesn’t help. On the contrary: I move, glucose jumps upwards. Did you see this effect with yourself?

Anyway, I’m hopeful my sensor is really defective and that with the new one, at least exercising and doing light work in the house won’t make my BG jump up. I’m applying the new one on Tuesday.

@SomeGuy, I don’t think we’re discussing if our BG is due to gluconeogenesis, or something else. The point is that our BG is going up and some of us aren’t willing to wishfully think that’s ok. Perhaps one day it’ll be shown that it is ok. I so hope so! But it isn’t the case at the moment. Why risk it? We’re trying to fight it (the high BG).

By the way, Feldman doesn’t say high LDL is ok either. Read the FAQ of his site. I’ve just did. Sorry if I’ve misunderstood you.