Does a healthy ketogenic diet cause irreversible insulin resistance?

(Michael - When reality fails to meet expectations, the problem is not reality.) #162

What is ‘diabetes’ in fact? It’s disregulation of glucose metabolism. In evolutionary terms, GNC is meant to provide whatever glucose is required by those cells that can not utilize ketones or fatty acids, thus it’s demand driven not supply driven. GNC is not a process to flood our system with glucose just because you ate more protein than you absolutely need. In those of us who have normal glucose metabolism, eating more protein than required just means more urea excretion. Diabetes interferes with the process. Even those of us with ‘relatively’ normal glucose metabolism can over time create glucose disregulation by eating carbs. What human beings were not designed to do is eat a lot of carbs.

PS: I guess I should add that T2D is a result of physical dysfunction that maybe won’t be offset merely not eating carbs. Not eating carbs is just a necessary, but not necessarily sufficient requirement.

(Bacon is a many-splendoured thing) #163

I would tend to disagree, actually. The late Dr. Joseph Kraft, a diabetes researcher, maintained that Type II diabetes was not dysregulation of glucose metabolism, but rather, insulin-resistance, which could be diagnosed (in many cases) as early as two decades before glucose got obviously out of control. Dr. Kraft maintained that the insistence on using serum glucose levels as the diagnostic deprived many patients of the opportunity to deal with their disease long before it became obviously problematical.

In fact, in keeping with this theme of insulin-resistance, many researchers into Alzheimer’s disease have taken to calling it Type III diabetes, in order to emphasise that the problem lies with insulin-resistance in the brain cells.

(Joey) #164

To clarify, I’m not saying “don’t worry about glucose, everything’s just fine.” But I’m pointing out that if you’re not eating carbs yet your glucose level is high, you may need to reset what a “healthy” level looks like - as you are clearly putting your metabolism in a much better place.

The lab “ranges” and “norms” for serum glucose are based on a carb-laden SAD-eating population may be entirely overblown as a reference for a restricted carb-eater. If the only source of glucose in your bloodstream is coming from your own body (and you have a healthy liver), it’s hard to imagine that it’s bad for you. At least it’s hard for me to imagine :wink:

I do agree that Dave Feldman (much to his credit) is scrupulously careful not to draw conclusions before more RCT-based science is in on his hypotheses about elevated LDL. But the anecdotal evidence has grown fairly compelling that lean mass hyper-responders (LMHR) - about 1/3rd of keto WOErs - wind up with sharply lower trigs, markedly higher HDL, and LDL levels that reach new heights.

I happen to be one of those individuals so I’ve been doing a deep dive into the relevant peer-reviewed science - limited as it is at this time. It initially freaked me out (i.e., the skyrocketing LDL).

Not any more. Based on the reliable research I’ve read, the high LDL doesn’t trouble me at all it’s likely where my high energy and improved biomarkers are otherwise coming from. All other bloodwork/scans indicate that elevated LDL is of no concern. In fact, LDL is of questionable concern at any level based on the best most reliable research out there.

Feldman is trying to prove, through rigorous RCT-based research, that a sharply higher LDL in LMHRs is not associated with increased clinical atherosclerosis. Until his results are in, he’s honorably circumspect in making such public pronouncements.

Me? Somewhat less so :wink:

(Bacon is a many-splendoured thing) #165

In fact, he has a standing bet going to this effect, and has challenged the researchers in the field to come up with people who are lean-mass hyper-responders, have high LDL, and also have atherosclerosis. So far, no one has been able to take him up on this bet.

(Joey) #166

@PaulL Ok my friend … perhaps I’m giving him a bit more credit for being circumspect than he fully deserves. I’m a fan of his (having made a financial contribution), so I didn’t want to argue against @Corals point which, as it stands, may help keep him out of the legal crosshairs. :zipper_mouth_face:

EDIT: I’ll take it a baby step farther… Despite outlandishly elevated LDL levels, my coronary calcium volume and mass are both sharply declining based on my most recent CT scan. In other words, with stratospheric LDL levels, my atherosclerosis is being reversed. Meanwhile, Trigs-to-HDL ratio is running around 0.4x.

Sorry for these detours into glucose, LDL, etc. I understand the OP started this thread to address concerns re: keto causing irreversible insulin resistance.

(Michael - When reality fails to meet expectations, the problem is not reality.) #167

When I say ‘dysregulation’ that’s what I mean - the Big Picture. Insulin is part of glucose metabolism and I agree with Kraft that it’s likely the earliest marker that things are going haywire. Glucose is fuel and the job of insulin is to get it where it’s needed.

(Robin) #168

It’s these detours that usually give me new information! :vulcan_salute:

(SunnyNC) #169

Someguy, I appreciate your response. I hope you don’t take this the wrong GNG, PIR etc are all known and proven concepts. Most people on this thread are very aware of these concepts. This is such long thread so I understand why you might have missed how we got here. :slight_smile: The discussion we are having is that nobody has proven high BG due to GNG and PIR is ok. In fact Corals shared a link to a you tube video recently, where for the first time a Keto guru Bikman actually admits nobody has studied this and infact it might be harmful. I think Bikman is someone I can trust. Hyperinsulmania is bad, we all know that. High BG due to IR is bad, we know. Is high BG in absence of high insulin bad? Nobody has an answer to this. Bikman is presently doing a study with Levels CGM company to answer this question. Until we have a scientific evidence, I am going to assume high BG due to PIR is bad and it will cause same glycation damage as any other reason why BG is high.

(Joey) #170

@SunnyNC No worries … I’m not taking it other than how you likely mean it: in the spirit of using currently available science to gain a better understanding of how the human metabolism works.

“Known and proven” are slippery slopes. Being a “show me the science” kind of guy, take this critique whence it comes: Our scientific community has gotten far more wrong cumulatively over the centuries than we’ve yet to get right. Perhaps we’re finally past the tipping point, but with a little humility we ought to suspect not (yet).

I think we can all agree that what is “known and proven” and appears to be valid under certain conditions does not mean it is valid in other circumstances.

There are too many examples of this dynamic to list, but as keto forum members we’ve all got plenty of firsthand experience with this dynamic. A fat-rich diet in conjunction with carbs produces vastly different outcomes than the same fat-rich diet absent the carbs. Context is everything for many of the variables we study.

My personal context: Having no history of metabolic syndrome and having diligently restricted dietary carbs, lab tests show that my insulin sensitivity is off the lab charts. Yet I have consistently elevated glucose by “normal” (high carb-eating) standards. Since I don’t eat carbs, the glucose must be coming entirely through gluconeogenesis. I’m open to suggestion, but there seems to be nothing clinically dysfunctional about my metabolism and associated biomarkers.

I’m not simply telling folks with apparently elevated glucose not to worry. On the contrary, I’m asking them to think more broadly and consider whether they have reason to believe their glucose levels are symptomatic of a health problem given their own individual current context.

If so, what might they do about it? Reduce carbohydrate intake? I’m presuming they’ve already been doing that carefully over time. If they aren’t, then yes, I’d worry a LOT about elevated glucose.

But absent carb intake, I’d suggest to those with elevated glucose simply relax a bit … and not to let associations observed through epidemiological studies conducted on SAD eaters - from which most of what has been “proven” and is therefore supposedly “known” - raise their anxiety (and cortisol) in an unproductive way.

It’s entirely possible (unknown but not unproven) that the miracle of their body is doing exactly what it needs to be doing.

With goodwill and best wishes :vulcan_salute:

(SunnyNC) #171

“Do you see these jumps when you move?”
I do, but not nearly as sensitive as you. If I run, do anything to get my HR up it definitely goes up. One thing I can say is if I have a nice big meal with a little bit of carb (like 5-10%) and lay on the couch and relax/watch TV, that’s when my BG is lower. Walking after dinner and other commonly recommended strategies to keep my FBG low never worked for me.
For readers that are new, I want to reiterate that I am a fit, athletic, 18% body fat, active and healthy individual. High FBG is something that I started experiencing due to PIR after a year of doing clean keto diet and becoming fat adapted.

Metformin update: My FBG crept up a bit last couple days, high protein diet. Last 2 days, its in low 90s. (Vs mid 80s for 3 days before that). There are 2 things I can say for sure as of now (n1, anecdotal, applies to me)

  1. Fasting 36- 48hrs once in a while lowers my FBG baseline. However as a lean person, I don’t want to fast. Once it drops, it seems to positively affect my BG few more days once I start eating.
  2. Eating a lot of protein+fat later during the day keeps my BG elevated all night and all day next day.(prior to metformin). So my GNG goes on an overdrive, just not demand driven like some “experts” say.

Lot of people in lot’s of other blogs have had the same issue and now they all think it’s ok coz someone would say “oh it’s due to PIR, you are fine, your insulin is low, HOMA-IR will be ok” so they continue on happily.

As per my doc, MF is most effective in my scenario where FBG is high despite keto, due to dawn effect and excessive GNG. I will continue using MF and report back.

PS, while berberine didn’t seem to do anything previously, now with MF in picture, it seems to work in synergy. Too early to conclude anything but things are starting to look better.
As of today, my CGM average BG is 90, a whopping 20 pt drop from 110+ just 10 days ago.
My AM blood ketones have gone up since MF. Even if my BG was low 100s couple of days, my ketones were still higher and as a result ketomojo GKI showed moderate ketosis. I am definitely thank MF for that. I have tried everything in my power to have a decent GKI and MF is the only thing that helped, other than 36+ hours fasting.

PS 2, This last appointment, my MD seemed a little more “pro keto”. Someone suggested I find a new doc, I was considering that but seems like my be Doc has become more open-minded now. Unfortunately I dont know any LC PCP in Charlotte, NC South park area. If I get any of referrrals, I will be happy to check it out. Until then I am really happy that my current doc is starting to become friendlier toward my low carb lifestyle.

(SunnyNC) #172

Well said! Thank you someguy. Totally agree, this is a slippery slope. Maybe I am a pessimist and worried too much about my FBG being high while I am doing keto. Or maybe high FBG (despite clean keto) is still as bad. I guess I believe the latter right now and doing what I can to research further. In the mean time do what I can to keep FBG normal. Now is MF safe? I hope so. They might one day find out it’s not and causes XYZ issues. Who knows. All I can do right now is do a full blood work every 3 months and make sure keto+MF is not screwing anything up. I see you did a coronary calcium score. Congrats on the good results! My doc gave a referral for mine :slight_smile: , I am waiting for the appointment. My Insurance won’t pay for it to but this is another thing I want to do to see where things stand after a whole year of high fat diet. (I used to be really low fat, high carb, almost vegetarian before going Keto, so it was a drastic change).

(Joey) #173

Same here … so you got me thinking …

I’m also lean and fit (was a 2-mile daily jogger for 30 yrs) and I always ate low fat (and therefore lots of mostly “healthy” carbs, occasional sweets). Never had a lipid issue nor elevated glucose that concerned my physician.

I just went back and checked years of lab results and yes, confirmed that my recollection is accurate:

Within months, my lab-measured glucose levels increased promptly after cutting out all sugar and dietary carbs 2-1/2 years ago and have been higher than pre-keto ever since.

During this time, the lab also lowered it’s “normal” range (from upper-end of 110 mg/dL down to 99 mg/dL). So, between my personal increase and the lab’s reduction, I am now showing up in the “high” elevated zone.

Yesterday, my wife and I had our annual wellness visits with our internist. He spent an hour with us - looking over every lab result including glucose levels. He understands that we are not eating carbs for over 2 year and my wife’s glucose level is slightly higher than mine. Bottom line: knowing we don’t eat carbs, he expressed no concerns whatsoever with our labs and he encouraged us to continue doing exactly what we’re doing (while also encouraging my wife to do a bit more aerobic exercise).

None of this means it’s the right answer for you or anyone else. But I share this with you merely to suggest that not all medical practitioners hold the same opinion on what’s a problem vs what is not - depending on individual context.

Hang in there!

(SunnyNC) #174

@“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.”

Just wanted to add, in my specific case, GNG is NOT demand driven alone. I can easily prove that with my Chronometer protein logs CGM, and ketomojo data. If I eat 100+g protein, my FBG and avg BG is high all day long, dawn effect is much worse. If I cut down protein or fast, my FBG drops to "normal”. If it’s truly demand driven, then protein % should not matter. I wrote to Perfect Keto MD who says GNG is 100% demand driven and one can consume lot more protein but don’t think he replied. I believe due to Keto induced PIR, my liver is not sensing sugar or presence of insulin and dumping sugar. Seems like there is a disconnect better pancreas, liver, insulin and glucagon signalling, handling. In the end, this is the hallmark of T2DM and that’s exactly is why MF is so effective for T2DM. You make some interesting points so I wanted to write this so I can see what you think. Btw, like I posted earlier, just 500mg MF l lowered my FBG and avg BG to “desirable” values. That made me happy, lower stress = even lower BG. Hahaha.
Another consideration is that maybe it’s my genetics. I am of South Asian decent and I have been told that we are lower on insulin vs western and East Asian descent, which lends itself toward high BG. Unfortunately everybody is so different that it’s almost impossible to pinpoint the root cause of this conundrum. But I have learnt a lot and hopefully can use what I learn to make better choices!

(SunnyNC) #175

Great info, thanks for sharing! Btw, my total cholesterol was like yours in October 2021. It was considered elevated at low 100s. LDL was even more elevated. NMR was fine. Since then I replaced most saturated fats with EVOO and avacado oil. Sparingly used ghee or coconut oil sometimes. Jan 2022, lowered my total-c to 90s. LDL also got lower too but still slightly above range. So saturated fats seems to play a role. Ok have been reading high cholesterol is fine after taking into consideration HGL, TG and VLDL. But again, who’s to say what is true, so I replaced my saturated fats with monos, I honestly prefer taste of EVOO anyway so it was an easy decision.

(Alec) #176

Sorry I am late to your party.

I think you have one more option that you should consider. If your problem is your blood sugar remaining high despite a keto diet (as I understand it), have you considered going carnivore for a few months to see what that does.

Apologies if you have already tried this and I missed it, or you have already considered and rejected the idea.
Cheers
Alec

(Laura) #177

I was reviewing my A1C history and in 2018, it was 5.9, in 2019, it was 6.0, in 2020, back to 5.9. In 2021, after a bout of Covid, it was 6.4. In June 2021, it was 6.2 and in December, it was 6.1. I have been low carb since 2008 and never diabetic. I do know that all my adult life, my FBG has always been no lower than 100. So, probably for me, it runs a little high, just like my thyroid is always low.

My doctor is very supportive of the low carb lifestyle and is not at the ready with a prescription pad. I think I will keep him, lol.

It is very interesting how we all have different experiences with eating low carb or zero carb. Thanks for all the great info.

(Bacon is a many-splendoured thing) #178

The problem with observations is that we need a context to fit them into. Of course, if our conceptual framework is off base, then our interpretation of the data will mislead us.

Given a conceptual framework that considers glucose bad, there is no way to convince people that higher glucose on a low-carb diet might actually be the result of the body’s working to its designed specifications. Nor is there any incentive to study the matter, because “everyone knows” that glucose is bad. Yet it can’t be all bad, because the body manufactures it, when we don’t eat it (i.e., in the form of carbohydrate), and there is a certain irreducible minimum of glycation of our haemoglobin that the body seems to tolerate just fine.

An example of this conceptual problem is the large, government-funded epidemiological studies that show that cholesterol can’t possibly be the cause of cardiovascular disease. Instead of drawing the obvious conclusion from their data, the researchers who conducted these studies came up with various ways to discredit their own research, rather than admit that our cholesterol level does not determine our cardiovascular risk.

We’ve also known for the past four or five hundred years that fresh meat cures scurvy. It was only after the fresh meat was all consumed, and sailors in the Royal Navy were reduced to eating nothing but salt beef and ship’s biscuit, that scurvy on board ship became a problem. But by the time that Stefansson and Andersen returned from the Arctic, this had been forgotten in the wake of the discovery that Vitamin C also cures scurvy. It took a year’s worth of an all-meat diet to convince the researchers at Bellevue that the two men weren’t going to develop scurvy. In fact, Stefansson ate an all-meat diet until his death at age 82, and he never developed scurvy.

Yet because the Royal Navy found stocking lemons and limes to be an easier, cheaper, and more cost-effective anti-scorbutic than trying to maintain a supply of fresh meat aboard its ships during long voyages, we have people trying to show that fresh meat must somehow contain more Vitamin C than we think, rather than considering that a diet of fresh meat might differ significantly in key ways from a diet of salt beef and ship’s biscuit. And because ketones were known to kill Type I diabetics when ketogenesis got out of control, it wasn’t until the last ten years or so that anyone thought to study the connexion between β-hydroxybutyrate and the body’s endogenous defenses against oxidation—a connexion that makes Vitamin C unnecessary.

Until the matter is studied, this rise in serum glucose after years of ketosis cannot be called benign, but we shouldn’t leap to the opposite conclusion, either.

(Michael - When reality fails to meet expectations, the problem is not reality.) #179

I’ll add here my specific situation. I also have no history nor evidence of metabolic problems despite 70 years eating SAD prior to keto at the age of 71. I gained weight slowly during the decade of my 60s to be what I would now consider about 25-30 pounds above my ‘normal’ or ‘optimal’ weight. I suspect this may have resulted from incipient insulin resistance but I have no way to verify. At any rate, it took less than 6 months to bring my weight and body comp back to what it was at the age of 18. And I have maintained that weight and body comp for nearly 5 years continuous ketosis. If that’s not healthy then I don’t know what is.

With that said, I admit that I am surprised that my blood glucose level is pretty much straight down the middle of the normal range or during the night and early morning in the lower normal range. I have to conclude that whatever is going on is perfectly normal and healthy and GNC is doing what it’s supposed to do. Despite my misgivings about my aging brain running on ketones or not.

(Butter Withaspoon) #180

So many posts since I last read here. I hope you’re finding your way Sunny. Are you adding some carbs back in, carb cycling, fasting less to see if it was a stress response to pulling all the levers when you have low body fat?

I’m feeling great on a few more carbs (fresh unprocessed food) and not pushing fasting so much. I also improved my sleep, even though I was a good sleeper compared to what I hear from others. Surprise surprise- the one marker I was concerned about came down.

I think my body couldn’t easily keep up with my energy demands - having lower body fat and a high metabolic rate, not eating until lunchtime and sometimes doing a lot of exercise elicited too many increases in cortisol, adrenaline and the downstream effects.

I’ve heard it a few times* that people who are lean, fit and active should not pull all the metabolic levers as well hard as someone with more fat stores who is trying to reverse insulin resistance.

I listen to a lot of podcasts- can’t remember who :woman_facepalming:

#181

Thank you for the info, @SunnyNC. I also have my best glucose when I’m sitting on the couch. It sucks that we have this problem.

I’ve been watching videos of the keto gurus to see if I find something I could try. Yes, I’m that desperate!

Thomas Delauer shared his blood panel results and his FBG is also above 100. It’s 102 mg/dL. He explained that he was prediabetic before keto. So, the guy lost 80 pounds, or something like that, put on a lot of muscle, is careful about his diet, it seems (I had read his name here, but this was the only video of his I’ve ever watched), and he still couldn’t control his FBG. He says he’s been keto for several years.

The other sad one was from a video of Dr Phinney. At a certain point, he shared a graph where we can see the starting A1c of his patients (I understood it is an average) at less than 7.5. 1y later, about 6. Then it only goes back up: 2y it’s almost 6.5 and 3.5 years it is somewhere between 6.5 and 7, say 6.6. The graph appears at about 53 min into the video called "Dr Stephen Phinney - ‘the realities of sustained nutritional ketosis’. So, that’s probably why they didn’t publish a 3y, or 3.5 year paper. If it goes on like this, by year 5, they’re back where they started.

I’m using my new sensor now. Same bad glucose. Alternate day fasting isn’t helping either. My liver hates me.

I’ll start the metformin the day after tomorrow. I’ll report back.

A question, metformin only helps for a few years, or it works longterm? Do they know?