So, Dr. Annette Bosworth says that the fasting blood sugar divided by the fasting ketones needs to be less than 80 and ideally more around 40 or even 20. This seems completely impossible to me at this point because after three months being ketogenic my fasting blood sugar is still around 100 and my fasting ketones are around 1 which gives me a score of 100. I haven’t tried an extended fast past three days, but I want to. Dr. Bosworth said she starts fasting on Sunday and fasts until her morning ratio is 40 or less. Is this going to help me get more fat adapted? Dr. Bosworth also said that when she exercises her ketones go down and her blood sugar goes up which shows that her body is efficient at burning ketones for fuel instead of glucose. My numbers do the opposite. When I exercise my blood sugars finally get down in the 80’s and my ketones go up to about 2.5. I have lost 43 pounds and 24 inches in three months on keto. But if getting that morning ratio below 80 is how to know if I am truly fat adapted then I’m definitely not there yet. Overall this discussion just really derailed me and now I feel very discouraged. Sigh.
Does lowering my fasting glucose through fasting have long-term benefits?
Don’t get discouraged. It takes a while to recover. If you fast, you will achieve results.
I don’t get the results she suggests, however, and I’ve been low carb/keto almost 6 years.
The type of exercise also matters. Here, I did lifting (BBS) and HIIT:
Ketones went up (0.3 to 0.6, KetoMojo) or stayed the same (0.1 to 0.1, Precision Xtra), and blood sugar didn’t change.
You can also see that my ratio is bad. But after this long in ketosis, my morning ketones are always low and my blood sugar is high. Later in the day, this reverses.
I had an oral glucose tolerance test with insulin, and I got a normal response on that test. And I’m definitely fat adapted, too.
Thank you for your response. I’m trying not to overthink things. Is there a reason that my morning blood sugars are high around 100 and then two hours after eating bacon and eggs with a cup of coffee my sugars are down in the 80s?
Physiological insulin resistance. Your body is basically programmed to build up blood sugar in the morning, and this is in part due to an “insulin resistance”. I have the same thing, though I don’t eat breakfast.
So, once you eat breakfast, you’ve provided the “fuel” your body needs (via fat), and your ketones go up and blood sugar goes down. I always get my highest ketones and lowest blood sugar in the evening, and the reverse in the morning.
That’s one reason these simplistic rules don’t work: your values change throughout the day.
You may be more insulin-resistant than Dr. Bosworth is. After all, you’re newer at it than she is, and haven’t had as much time to heal. If I’ve learnt anything from being a member of these forums, it is that everyone is unique, and although things generally work the same for all of us, it’s in the individual details that the devil lies. So first of all, stop comparing yourself to other people. Just compare your numbers today with what they were at baseline, and give your body plenty of time to heal.
You can help the healing along by rigorously keeping your carbohydrate intake under 20 g/day (Dr. Colin Champ, a cancer researcher, says that this will significantly reduce our risk of cancer, as well as diabetes), and by giving your body enough calories to do the work it needs to do. So, while keeping carbs low, eat a decent but not excessive amount of protein, and fill in the missing calories with saturated and monounsaturated fat, so that your body has plenty of energy to heal. Things will improve soon, but you have to stick with this way of eating. Think of it like showering—the benefits quickly go away if we don’t do it every day!
PaulL has got it exactly right. Some have higher numbers in the morning, it is called the dawn effect. As you heal it will get better usually.
After going keto/lchf for 4 yrs now (2.5 of those at maintenance weight), my morning number can be above 100, no far but above it, and I have never had a diabetic DX. My HA1C is some where between 5.3 and 4.9, and was in the 5.5-5.3 range before I started keto for years.
UPDATE: I am excited to report that I took Dr. Bosworth’s advice to keep my eating window within the eight hours after sunrise and I have been fasting MWF and my morning glucose to ketone ratio came right down. This morning my glucose was 98 and my ketones were 2.6, which put my ratio (glucose divided by ketones) under 40! I could hardly believe that it would work within a week. I am also losing weight better, having more energy and really feeling fat adapted in my mood and cognition. Thank you Dr. Bosworth. This is exactly what I needed!