GNG, protein and blood glucose re-visited

(Jenna Ericson) #4

The role of glucagon in insulin resistance is something I think it would be helpful to understand better, so these resources are great! Have you heard of semaglutide? It acts like human glucagon-like peptide-1 in that it increases insulin secretion, thereby increasing sugar metabolism (that’s from Wikipedia). It’s used for the treatment of T2D.

It does seem like 4.25 g protein/kg bodyweight is rather a lot of protein, unless you are very small. Independent of the glucagon issue, I think that might be too much, but it illustrates your point.

(Michael) #5

This was posted under the Show Me The Science. I think asking for science instead of opinion is therefore appropriate. If people were to give differing opinions, I would ask for the science regardless.

(Michael) #6

I know nothing about semaglutide as of yet. Still so much to learn it seems.

(Bob M) #7

What about data? While I’m not T2, I wore a CGM for over a year and never saw a blood sugar rise from protein. I ate 160+ grams of protein in single meals, no blood sugar rise. Over the course of 14 months, my average blood sugar over the course of a day was exactly the same.

image
image.png742×694 136 KB

On 11/21/17, I ate 162 grams of protein, the 5.7, 6.4, 5.8. You can see the next day, I had the same blood sugar, even though I was eating less protein per meal (it’s hard to eat 160+ grams of protein every meal, with low fat):

image
image.png783×534 46.3 KB

Unfortunately, this test was done right before Thanksgiving, so you can see higher carb meals the night before Thanksgiving (Wednesday, 22 Nov) and on Thanksgiving (Thursday, 3 Nov). 9.7 was Thanksgiving meal (healthy potatoes, homemade sourdough using Einkorn wheat).

After a while, I did not record anything, because my blood sugar was flat every day, as evidenced by the data shown above. If I showed you a day and asked you when I ate, you’d not be able to tell me. Some random days:

image

Within this context, it’s very difficult to say what protein is doing.

The one thing I did not do was try high fat, low protein for a week and high protein, low fat for a week to see if there was any difference in the curve. But that’s mainly because high fat is not sating for me, and I gave up eating high fat.

But I think your reliance on having people rebut you, when the evidence is all for high carb people, is mistaken. It’s like people who complain about certain metrics being off in people who are keto or carnivore – no one has ever tested this group of people to any extent. We don’t know what “normal” is.

And I’m not here to “rebut” anything, as I’ve tested myself enough to know that (1) I like and feel best and lose weight while eating higher protein, lower fat, and (2) I do not get sated eating higher fat and can easily gain weight doing so. Butter, for instance – I can eat as much of that as you want me to eat and not get sated.

So, regardless of the effect of protein (for ME, maybe not anyone else), I’m continuing to eat higher protein, lower fat.

(Michael) #8

Ok, let’s take a look at your numbers. How many grams of protein did you eat on the 20th? Did you only eat 160 grams on the 21st? What were the average glucose readings over those days? With almost no information given, all I can see is that you confirmed through one meal that your glucose went up just a little. Seems like the one data point matches expectations, so all good.

In terms of refuting the science, not me personally. I have not found a single study looking at long term (days) high protein intake. Have you?

(Jane) #9

I concur with Bob on protein for me personally. I am also not T2D and currently wearing a CGM to test my bodies various responses to food. Data here is n=1.

Protein does not raise my BG, although I didn’t test the quantity Bob did, but I never eat that much so didn’t see the point. I only care what my body does whern I eat my normal diet.

Maybe being diabetic makes a difference in how your body responds to protein?

(Robin) #10

My bad. You’re right, of course. I did not note where you posted.
Never mind me… carry on.

#11

This is a very timely post for me as I am experiencing the elevated blood glucose particularly the morning fasting blood glucose while eating an increased amount of animal-based protein in a low carb diet.

My traditionally trained primary care doctor sees the changes in my blood bio-markers as progressive pre-diabetes heading toward type 2 diabetes.

I have a fasting blood glucose this morning of 7.3 mmol/l and am in nutritional ketosis with blood ketones at 0.2 mmol/l. That fasting blood glucose says I am diabetic according to the Mayo Clinic who is measuring people not on low carb eating.

I think I’ll start with Dr. Ben Bikman and work my way into some comments from there.

Thanks for the signpost links Michael.

#12

Minor point/question here. I thought the range for nutritional ketosis runs from .5 to 3.0? Or do you mean something different?

(Edith) #13

I posted this question/comment on another thread, but people who need therapeutic ketosis, such as epileptics, have to eat very high fat with only 15-20% of their food being protein and carbs. If that is the case, it seems to me that having too much protein is something that may interfere with their need for a deep, therapeutic state of ketosis.

I haven’t read through your citations, yet; but I’m not surprised if there is something to blood sugar and an over abundance of protein.

#14

Good point Brian. My carnivore COVID brain forgot. Prof. Phinney and his 0.5 number. I guess I have been watching Ben Bikman videos and should have said, Despite having elevated blood glucose my liver is still generating measurable circulating blood ketones, so I suspect that I am in a low insulin state.

Then I look at my recent fasting blood insulin result (last week) and it is 18 mU/L. Interesting to note it was 9, then 12 when I was keto in 2019 and previously. Then shifting to carnivore it jumped to 15 (Oct '21) and 17 (April '22). it gets a bit complicated as I had a medical intervention adverse reaction in August 2021 that resulted in an immune-mediated polyarthritis, and I’ve been treated with steroids and hydroxychloroquine for about 6 months. And prednisone definitely pumps up the intrinsic stress response and blood glucose. Hydroxychloroquine isn’t without it’s own side effects. So, it’s complicated and confounded (now that I write it out). I’m just excited to see some ketones when, technically, I should have been kicked out of ‘keto’ (club).

I love the serendipity of your post Edith. For my situation. I know your post was in response to Michael’s topic. But it spoke to me. It might be better if I moved from ZC carnivore to PKD (Paleolithic Ketogenic Diet) protocol to hasten me out of this immune-mediated and inflammatory disease state. Thank you.

(Michael) #15

There is no maybe, the links clearly explain that there is absolutely a difference. Read 12, 13 or 18 for details.

#16

Thank you for the opening post. I will continue to work my way through it. My confusion in trying to improve my T2D seems to increase the more I learn, I’ve been on keto for about 8 months. My initial HbA1c was 8.6 although I believe at one point it was higher as I had already removed most sugar and processed foods 3 months prior.

My last test was 6.4. Three weeks ago my blood sugar readings dropped into the teens, stayed like that for about a week and a half. Now I’m back into the 120s and 130s. My diet hasn’t changed in this period.

I get frustrated because I definitely don’t understand any of the whys. So I appreciate the research you’ve done. The only thing I “know” is that while my A1c decrease is not moving down in a straight line, it is decreasing. More slowly than I’d like but even with my lack of understanding of all the science, keto is working.

I wonder if even among T2D with the same initial scores if some are more insulin resistant than others. For instance, I think I may have been diabetic long before I was diagnosed. My previous doctor would not give me my test results. One of the reasons I switched doctors.

So learning from others here on the forums helps me understand that there are many variables that I don’t comprehend but may influence my progress. So thanks again.

(Bacon is a many-splendoured thing) #17

While this is true, both Dr. Phinney and Prof. Volek have admitted that their definition is somewhat arbitrary. Dr. Phinney says they picked 0.5 as the bottom of the range, because that’s where they generally start to see the benefits of being in ketosis. But you will notice that in their studies of elite athletes, most of them had ketone readings of 0.2. I suspect it matters how long a person has been eating ketogenically; reports on these forums suggest that at some point after fat-adaptation, the liver cuts back on production and gets more efficient at matching it to demand.

As one wag here put it, you know you’re in ketosis if (a) you are eating less than 20 g/day of carbohydrate, and (b) you’re still breathing in and out.

Admittedly, I am no expert on this, but I watched a lecture recently on the therapeutic ketogenic diet, and the lecturer a recent study or two showing that a ketogenic diet with more protein in it can still be therapeutic. I’ll try and track the video down and will post a link if I can find it.

Maintain on 72 hr fast plus OMAD for 4 days after?
(Bacon is a many-splendoured thing) #18

According to work by Ralph DeFronzo and his team, cited by Taubes in The Case for Keto, the limit for staying in ketosis is just under 25 μU/mL.

#19

Exactly. When I was eating SAD/300+ grams of carbs a day, I’d register .2 on the blood meter in the AM after sleeping 8 hours, so there’s definitely a difference between that .2 and a .2 from someone who’s been ketogenic for weeks or month and super-efficient at using them up. I suppose using this logic it’d be “nutritional ketosis” for that fat-adapted ketogenic person whereas in my example it would be because that .2 reading was a result of “you slept for 8 hours and didn’t stuff anything in your face during that whole time…way to go.” :grin:

(L. Amber O'Hearn) #20

Hi there. It was one of my blog posts that introduced the phrase “GNG is demand driven” but no one understood what I meant my that, and it remains the most widely misattributed phrase I’ve ever coined, causing more confusion than clarity.

I wrote several posts trying to clear up the confusion and eventually gave up. TL; DR: the “demand” is not some nebulous perceived need for glucose, it is a biochemical signal, I:G. And GNG is concordant with, not opposite to ketogenesis!

Yes, T2DM gets a blood glucose rise from protein and so does a ketogenic metabolism. Yes, in ketosis, I:G tends not to rise with a single serving of protein. But it will rise if protein is high enough. In T2DM when both insulin and glucagon go up together in response to protein, one problem is that hepatic insulin resistance makes this look like much higher glucagon rise than insulin rise.

Here is the first post that attempted to clarify the original offending article (linked in the first paragraph).

https://www.mostly-fat.com/ketotic-blog/2013/01/protein-gluconeogenesis-and-blood-sugar/

New member- Arin
(Bob M) #21

“In response to protein, blood sugar rises on a keto diet”. Not for me. At least not that I’ve ever seen. One example:

image
image.png699×681 127 KB

But I’ve been keto since 1/1/14 and don’t have data for much of that time (GCMs are too expensive).

And, it’s a moot point for me anyway, as I get fatter if I eat high fat, whereas I continue to lose weight if I eat lower fat, higher protein. So, I eat higher protein.

(Michael) #22

Thank you for the validating post and taking the time to respond. I did not know you coined the term in the first place! I certainly agree it is all about the I/G ratio. As I understand it, glucagon responds slightly more to protein than does insulin, in the absence of carbs, especially after a few hours which may contribute to the effect. Did very many people send in data from protein ingestion experiments?

(Mark Rhodes) #23

Although you might want to try same protein and increased fat uptake. The only thing that would go up would be calories which most of us don’t follow anyway. Then yuou could see if that ratio not only changed you BG but if you had any other immediate changes, say in BHB if you still track