Glucose sparing?

(You've tried everything else; why not try bacon?) #48

You might want to remind your doctor that there is no known carbohydrate deficiency disease, and that the body only needs a very small amount of glucose circulating in the blood, which it is perfectly capable of manufacturing, if needed.

#49

That’s all it is man, it’s EXTREMELY common, just not in your doc’s world. In the keto world, it’s a well known thing.

May be the queue for a new doc, because that’s factually wrong. There’s not a human alive that (needs) carbs. I say that as somebody that does CKD/TKD and eats more carbs than more here, but that’s for performance in the gym and for muscle gain, still don’t (need) them though.

(Tony H) #50

Fingers crossed. I’d still like to lose 50 lbs so at this stage to undo all the years of abuse I have put my body through I think I should stay on keto for a while and do a reset and then maybe down the line look to start very slowly introducing some healthier carbs and hopefully I have a better reaction. Atm my energy levels are so low I’ve stopped exercising and Id like to get back into weight training a few times a week and really push for a healthier life. Ive always been somene who enjoys exercise but my sugar addiction has always kept me on the wrong side of fit and healthy, at 34 Im plenty young enough to take control of it. Thanks for your input people, appreciated.

(You've tried everything else; why not try bacon?) #51

You may even find that, once keto-adapted, you won’t miss the carbs, and won’t need to add any back in. It happens.

(Allie) #52

Energy levels will be low while your body is adapting to the different fuel source. You have to be patient while it gets used to the new way you’re asking it to operate.

Your doctor sounds like he is only going to add to your worries by feeding you bad info.

I’ve been playing around with adding carbs again for gym / muscle gains reasons but have now gone back to just proteins and fats as my body actually functions so much better without carbs now.

(Tony H) #53

Yeh Im only 2 days in and energy wise I dont feel great. My baseline fasting BG levels upon rising when eating carbs was usually between 5.3/5.7. Last 2 days Ive had 4.4 and 4.3 so automatically much lower on keto, yesterday had about 20g net carbs, first day little bit more. Is this normal this quick?

(You've tried everything else; why not try bacon?) #54

Yes, it’s normal. There are two processes: getting into ketosis, and fat- (or keto-) adaptation. The former happens very quickly, the latter takes weeks.

All it takes to get into ketosis is a low enough insulin level, and that is achieved by dropping the carb intake. How low carb intake has to go for someone depends on how insulin-resistant that person is, since the greater the insulin-resistance, the greater the insulin response will be to a given stimulus. (It is possible to regain insulin-sensitivity over time, but it won’t happen overnight, which is why we caution people not to be too eager to increase their carb intake too soon in the process.) But once insulin drops below a certain threshold, the liver begins manufacturing ketone bodies and what little glucose the body actually needs.

Fat-adaptation takes longer, generally six to eight weeks in most cases. During this period, athletes will notice a drop in performance. The reason is that skeletal muscles are being deprived of their accustomed fuel, glucose, and haven’t yet re-adapted to metabolising fatty acids, so in the meantime, they are limping along on ketones. The reason fat-adaptation takes time is two-fold: first, the mitochondria in the muscle cells have been damaged from years of metabolising glucose. They need time to heal and make healthy baby mitochondria. Second, there are other cellular pathways involved in metabolising fats, which have been deactivated from lack of use, and they need to be reactivated. Once the muscles have readapted to metabolising fatty acids, they will actually pass up glucose and ketones in favour of fatty acids, a state called variously “physiological insulin-resistance” or “adaptative glucose-sparing.”

All this takes a certain amount of time. You will notice your energy level rising again over the next few weeks, but in the meantime, go easy on the exercise. By the time you are fully fat-adapted, your endurance will be back at, or possibly better than, its pre-keto levels. Explosive power will take somewhat longer to return, but it, too, will eventually be as good as ever.

(Tony H) #55

Thanks Paul, very informative. I was watching how my blood levels responded to my food yesterday. Previously Id eat an apple and some peanut butter and my BG would go from 5.8-7.1 within 15 mins. Yesterday I ate a chicken salad with avocado and my bloods went from 5.3-6 but it was much slower, took several hours to reach that high and then obv come back down to low 4s during the night.

(You've tried everything else; why not try bacon?) #56

Of the three macronutrients, carbohydrate has the greatest effect on insulin. The reason is that carbohydrates (except for sugars, which are a bit different, chemically) are all glucose molecules linked in various ways. And glucose in quantity in the bloodstream is an emergency: if not dealt with, hyperglycaemia can cause damage, even death. So the insulin response is intended to drive excess glucose from the blood and into muscle (where it can be metabolised) and fat tissue (where it can be stored as fatty acids). As you can guess, too much carbohydrate over too long a period causes problems for the body, as muscle cells and fat cells get stuffed and start to resist listening to the insulin.

Fat, on the other hand, has a minimal effect on insulin, just enough to allow the body to make use of the fat. In the proper quantity, insulin is essential to life, because it helps every cell in the body use or store energy; it’s just that, like too much glucose, too much insulin also has a bad effect on the body over time. But this is why we suggest eating more fat to compensate for the lack of dietary carbohydrate: it won’t raise your insulin level enough to notice, and it is a much denser source of calories, so it takes less fat to get the same amount of energy.

The insulin response to protein depends on the context. Protein is not normally used to provide energy to the body, but is needed for various structural purposes. In a low-carb diet, the insulin response to protein is compensated for by another hormone that keeps the effect of insulin low (insulin and glucagon are both secreted by the pancreas, and they are the primary regulators of ketosis and other aspects of the metabolism). Because the liver will make glucose out of amino acids (which is what all proteins are made of), it used to be believed that excess protein intake would elevate blood sugar too high; nowadays we realise that the picture is much more nuanced than that, and the focus has now shifted from fearing to eat too much protein, to fear of not eating enough. Myself, I suspect the truth lies somewhere in between.

(Omar) #57

I thought the only reason my BG reading is between 80 and 95 is the protein (when 0 carb)

When reducing the protein/fat ratio, my BG can go down to 75 or lower.

With 150 grams of yogurt, my BG get up to 110 units

So in my case the protein does shift my BG from 70-80 range to 80-95 range.

I think if I eat more protein, I would expect my BG to exceed the 100 units.

I don’t have a keton meter. I am not sure if I get into ketosis with the description above. I usually do not think about that, I focus on energy level. I feel I get more energetic when my fat/protein ratio is high which is not always an option the way I am living.

#58

That’s fantastic, such good fasting blood glucose (FBG)!

Perhaps you could discuss with your doctor in terms of pros and cons. For instance, show your FBG and try to agree on continuing on keto while keeping an eye on your blood panel. Then reevaluate if anything bad starts to show.

(Tony H) #59

Yes this is my plan for now. How long after doing keto should I be giving my GP a nudge to look at my bloods and make sure body is happy? I had them all done last month and total cholesterol ratio was 3.21 which is apparently really good. Idk the first thing about it tbh but Id like to make sure that bloods are holding if not improving. Only thing that was off in my bloods was my bilirubin cus I have gilberts syndrome which is nothing to worry about and theres even studies suggesting its good for long term health.

(You've tried everything else; why not try bacon?) #60

Wait at least six months for things to settle. Many people find, for example, that their lipid numbers get out of whack during the first several months of a ketogenic diet. However, usually by six months the lipid numbers have stopped alarming their doctors, blood pressure and heart rate have begun to drop, liver enzymes have usually improved, and HbA1C and inflammatory markers have greatly improved.

Note that thyroid hormones are generally lower on keto than on a carb-heavy diet, but for most people this is not a problem, but simply an indication that their bodies are using the hormones more efficiently, so their thyroid doesn’t have to work so hard.

Also, Vitamin C is unnecessary in any diet that includes fresh meat.

(Tony H) #62

I just got off the phone to my GP having requested a blood test to look at my fasting insulin levels. I was told they dont do it and that they only look at HbA1c. She tried to tell me it’s basically the same thing. Anyone else in the UK found this? I have been referred to endo who I am assuming have the capacity to look at this but that may be a few months. My concern is that they will do a MMTT and I will just fail and be labelled diabetic due to me being on keto. I have read quite a lot about Physiological insulin resistance and how apparently it goes back really easily once you start to eat carbs again which was certainly not my experience. Whenever I eat any reasonable amount of carbs I feel very sick, muscle weakness and brain fog. So much so I felt I had no choice but to go back to keto. I am on day 5 of keto now and those symptoms have cleared up so I feel much better but long term my aim is to get my weight off and return to more of a balanced diet. Maybe I’ll change my mind in the mean time maybe I wont, we’ll see. The main reason for being alarmed about not being able to switch back is cus apparently it’s very easy so why wont my body switch back? My HbA1c as of last month was 5.1 so Im nowhere near diabetic but I am 50 lbs overweight. The only thing I could think of was that If I throw in 150g carbs but continue to eat 80g of fats then my body will choose the fats and leave the glucose with nowhere to go?

(You've tried everything else; why not try bacon?) #63

Not sure what an MMTT is, but it sounds as though you are talking about an oral glucose tolerance test (OGTT)?

This is not clear. What are you referring to, by the phrase “switch back”? Cells never lose their ability to metabolise glucose, if that’s what you are talking about. On the other hand, their ability to metabolise fatty acids does get shut down from lack of use over time. The brain fog goes away as soon as you get back into ketosis, because ketones are now feeding the brain again, but your skeletal muscles might need some time to readapt to using fatty acids in place of glucose and ketones (this is called “adaptative glucose-sparing” and “physiological insulin resistance,” the latter term being rather confusing).

Your doctor is right that HbA1C is a better overall marker of diabetes (though it isn’t perfect), so I’m not sure why you feel the need of a fasting glucose test. Try asking her for a continuous glucose monitor, and see what she says. Does the NHS give people the option of paying for certain things out-of-pocket, or would you have to try to see a private physician?

The last sentence is also confusing. If 150 grams of carbohydrate is enough to push your insulin above the fat-storing threshold, then both the fat in your diet and the excess glucose resulting from the carbs are likely to be stored as fat. The reason insulin does this is twofold: first, excess glucose in the blood stream can be dangerous, even fatal, so the excess needs to go somewhere safe (muscle and fat tissue, usually); and second, this is part of the mechanism, seen in other mammals, by which we fatten up for the winter. Human beings don’t hibernate, but apparently there has been no evolutionary pressure to dispense with this mechanism.

(Tony H) #64

MMTT is mixed meal tolorence test, Idk weather this is the same as OGTT. Im not sure I’ll be having one yet tbh I just know I have been referred to endo and just assumed this is what they will do. My biggest concern about endo is they they dont understand keto and what it does and just label me diabetic when they ram 75g of glucose into my system and my body freaks out.

By switch back I just mean my body be happy metabolising glucose as appose to just rejecting it which is what I assume is happening with me. I’ve been recording my BG levels quite a lot the past few weeks. Since going back to keto I’ve not seen them outside of 4.4 to 6.5 at any point. Last week when I was trying to consume 150g of carbs they fluctuated between 5.3/7.6 but almost immediately after eating Id get brain fog, muscle weakness, fatigue and sometimes nausea and if I ate too many carbs or fast releasing carbs it would be followed by a hypo.

I saw @lfod14 talking about this just being my body’s natural over reaction to reintroducing carbs which is very intuitive. I also saw him talking about him getting the same thing a few years back on a thread about physiological insulin resistance. So is that just something I have to fight through for my body to get used to carbs again? If so how slowly does this need to be done to stop the big overreaction. I am generally an all or nothing guy and I think I have a tendency to just go from 1 extreme to the other which obv my body will be shocked by.

The NHS only funds continuous glucose monitors for people with diagnosed diabetes so I would not qualify but I am assuming you can buy them but Im not sure. My blood glucose levels are not really something that concern me tbh as I feel that both with and without carbs they are OK altho my fasting with carbs a few weeks back were mostly mid to upper 5s territory but I have read if you have physiological insulin resistance that your numbers will be higher temporarily. This makes sense to me cus a month ago I got HbA1C of 5.1 and when looking a couple of weeks ago I rarely saw my sugars that low whilst trying to reintroduce carbs.

I didnt find my way to keto due to being diabetic or IR altho now I’ve learned a lot more about blood sugars I will absolutely have some level of IR cus I am for sure a sugar addict and always have been, I’ve been overweight my whole life. I’m currently 60lbs above my ‘ideal’ weight according to the NHS guidelines so was just attempting to get ahead of the game and start looking after myself, Im 34 and about to become a dad for the first time so getting healthy has become very important to me and it just appears to me that Ive caused way more problems than I started with! I will say tho I have started to lose weight on keto at a solid rate so I am very open to staying on keto short term but I would then like to be able to safely transition more to a low carb diet in time.

(Robin) #65

Although many here understand that keto or carnivoor is best as a lifelong commitment to your health… there are always going to be people like yourself who decide to use it temporarily for weight loss etc. There’s nothing wrong with that. You do you.
Having said that, after losing 60 pounds, you may observe that you feel so much better that you want to maintain a level that keeps you feeling better overall. Or you may start gaining back the weight and decide sweets aren’t worth it. Who knows?
Either way, congrats on being a new dad! What a ride! Glad you’re here.

(Jane) #66

If you have been overweight your entire life you will likely gain the weight back as you add carbs back in. Once you get to your maintenance weight you can experiment. You can always cut the carbs back again… just be aware it may (or may not) trigger the sugar/carb cravings again.

You need to give it at least 3-6 months to get over the craving for sugar and carbs. My husband went keto when I did to support me, even though he was not overweight and not diabetic. He was miserable the first 3 months and was so cranky I was almost to the point of begging him to go back to eating what made him happy.

And then one day after about 3 months… he was ok with keto. The cravings were gone, his brain fog gone, joint pain much reduced, sinuses clearer… He never went back to a SAD diet (thankfully) but added some carbs back into his diet that I cannot afford, like a bowl of oatmeal once a week.

He can still do a 42-hr fast with me easily so adding some carbs back hasn’t affected his fat-adaptation. And for him - it hasn’t triggered the sugar/carb cravings so that has worked for him and sounds like where you would like to get to. You won’t know until you try down the road.

(You've tried everything else; why not try bacon?) #67

As I believe I mentioned already, cells never lose their ability to metabolise glucose. Skeletal muscles will refuse glucose and ketones in favour of fatty acids, when insulin is low, but glucose (i.e., carbohydrate) intake sufficient to evoke an insulin response that exceeds the threshold will shut down fatty-acid metabolism and promote glucose metabolism instead, and the muscles will respond.

As I understand it, the hypo is a sign that you are still insulin-resistant. In other words, your pancreas has overcompensated for the carbs with too much insulin, which has inhibited ketone production while driving your glucose level too low. As long as there are enough ketones to feed the brain in the absence of glucose, you will not have hypos, which is why it is important not to overdo the carbs. If you keep carbohydrate intake low enough, you will not need so much insulin, and ketone production will be able to continue (too much insulin halts the production of ketones). And over time, insulin resistance diminishes, and the insulin response to carbohydrate becomes more normal.

(Tony H) #68

Does that mean you think it’s more pathological than physiological? And if so why would that not show any issues pre keto/LC?

I have ordered some keto strips. I currently have some general urine strips which show 8 different things. Ketones being one but it appears negative when I test. Are keto strips more sensitive?