It's all about the insulin, isn't it?


(FRANK) #1

I have been low carb/keto for almost two years and not making much progress on weight loss. The problem is I am extremely insulin resistant. I follow macros based on my stats (287 lbs, 6’ 1’ 63 yo male) macros currently 120g protein 20 g carbs, the rest fat, all at a total of 1848 calories/day. My fasting blood sugars avg around 125 and ketones around 0.2

I am starting to think I really need to dial this in by reducing my protein intake and instead of focusing on carbs per se, dial in on the sugar content of foods. My understanding is if my insulin is high, I won’t lose weight. So logic tells me I have to focus on brining down that insulin.

Should I reduce my protein down to around 70 - 90 grams? Also, I think I need to pay strict attention to sugar substitutes that could be causing my insulin to rise.

Anybody else have problems like this? Any advice? This is getting really frustrating and I feel like I’m just pi$$ing in the wind.


(Eric - The patient needs to be patient!) #2

How often are you eating? Try to skip breakfast and do IF fasting. May be do 1 day fasts as well.

When you are insulin resistant artificial sweeteners can cause insulin to rise. I saw progress when I fasted more and gave up artificial sweeteners. Also resistance training can help burn muscle glycogen which can help with your metabolic state.

Of course resistance training during these times may be difficult to come by.


(Alec) #3

Frank
I feel an affinity: I am 56, 275lbs, 6’0. But it’s possible that’s where the similarities end.

No solutions (except maybe my recommendation at the end), but some thoughts:

  1. Your fasted BG does sound high, and I agree that does sound like severe IR. How long was the pre-test fast? Have you had an A1C test done?
  2. Your ketone level sounds low… it suggests to me that you are not burning fat well. What form of test are you using to get that ketone reading? Blood? Does this ketone level fluctuate? Do you get higher ketone levels at any point?
  3. Your calories for your size feels low. Have you tried varying your calories, ie going higher and then lower and seeing what happens?
  4. Have you had any success over your 2 years? If so, do you know what you were doing when that happened?
  5. This may not work for you, but I tell yer what works for me (better than keto): fasting. Have you tried fasting? I recommend you try a few 36-42hr fasts, and see what happens. If you’ve tried fasting, what regime and what happened?

As I said, no magic bullet, but some thoughts. Go well.
Cheers
Alec


(FRANK) #4

Thanks @Alecmcq. Pre test fast is always from 6PM the night before to around 6AM the next morning. Last A1C was 5.7. Ketones and blood sugar are tested via blood. Ketones do fluctuate between 0.2 on the low side to 0.7-8 on the high side. I have varied my calories but it doesn’t seem to matter.

The only real success I had was early on I dropped around 25 lbs, mainly initial water weight. I’ve done numerous 16:8 fasts but never really anything extended as you suggest. Maybe it’s time to give it a go.


#5

Are you active enough to support those calories? The last thing I’d do is reduce your protein. What’s your typical fat intake daily? Your ketone levels don’t matter. I’d stop overthinking insulin and focus on your macros probably not being right for you. You’re 6’3" @ 287, you should be eating more protein if anything. What’s your physical activity look like.


(FRANK) #6

Sedentary lifestyle - chained to a desk at work. Actually 6’ 1".


(Bacon by any other name would taste just as great.) #7

Your protein intake is within the range that we generally recommend, 1.0-1.5 g/kg lean body mass/day, assuming your lean mass is about 70% of your current weight. Your HbA1C is close to normal, so that is all to the good. If you have the full results of a recent blood test, it would be interesting to know what your inflammatory markers look like (such things as white blood cells, C-reactive protein, ferritin, etc.). Not to mention what your lipids are doing. Has your HOMA-IR score been calculated? That is supposed to be a fairly good indicator of our level of insulin resistance.

Dr. Stephen Phinney has said, in a number of lectures available online, that the first thing he tells patients who are feeling stuck is to cut back on the carbohydrate. If that doesn’t work, he tells them to eat more fat. The reasoning is this: first, the glucose in the carbohydrate we eat is the main stimulus for an insulin response. Therefore, when we are highly insulin-resistant, the less carbohydrate we eat, the better. Sugar (sucrose) should be avoided altogether, not only because of its glucose content, but also because the fructose can exacerbate insulin resistance in the liver (see Dr. Robert Lustig’s famous lecture, “Sugar: The Bitter Truth,” several recordings of which are available on YouTube).

Protein has an effect on insulin, but the degree depends on the dietary context. Too much protein can elevate insulin significantly, when eaten as part of a high-carbohydrate diet, but when carbohydrate intake is sufficiently low, additional protein is matched by a corresponding increase in glucagon secretion, so that the insulin/glucagon ratio remains low. It is this ratio, according to recent research, that determines whether we are in ketosis or not. In any case, a certain amount of protein is essential to the human diet, so the insulin response is what it is. Fat is the wild card in diet. It’s effect on insulin secretion is minimal, the bare minimum necessary for us to survive (insulin is essential to survival; we just need to avoid chronically elevated levels of it). This makes fat the ideal source of calories to replace the calories we are no longer getting from carbohydrate.

So, back to your situation. You may have to cut your carbohydrate intake even below its current level, in order to get your serum glucose and insulin to decrease. Your protein intake looks good, and you probably don’t need to alter it. We are supposed to have an instinct for how much protein to eat, so if you are feeling good eating that amount, then don’t worry about it. While it is not strictly necessary from the point of getting into ketosis, we do recommend avoiding vegetable oils (actually they are all seed oils), because of their excessive percentage of polyunsaturated fats, which can be inflammatory (systemic inflammation seems to be part of insulin resistance, somehow). Stick to sources of monunsaturated and saturated fats, such as butter/ghee, tallow, lard, and bacon grease. Fruit oils (avocado, coconut, and olive) have an acceptable fatty acid profile, as well.

The one concern in what you describe is your caloric intake. We strongly advise against eating to a specific level of calories, because that risks triggering the body’s famine reflex, in which it will cut energy expenditure to meet intake and hold on to stored fat reserves to get us through the hard times (fasting, interestingly, triggers a different response). The key is to eat enough that the body feels secure about shedding excess stored fat. And the simplest way to be sure to eat enough food is to add fat to each meal until our hunger is satisfied. Too much vegetable oil will nauseate you, so stick to the healthier fats I mentioned in the previous paragraph.

When we eat to satiety, the body’s hunger and satiation hormones work in concert to set our appetite to a level that lets us metabolise both the fat in our diet and the excess fat stored in our adipose tissue. If you do this, you will find that some days you will be very hungry, and other days not so much. This is normal, and over time the match between your energy intake (both from diet and from fat stores) will pretty accurately match your energy expenditure. On a bountiful diet, the metabolic rate actually increases, and the body finds ways of spending energy (and even wasting it, if necessary). Eating to satiety should let you go for hours between meals without hunger pangs. If you should need a snack, make sure it’s low-carb and high-fat, and eat more at your meals. Over time, you are likely to find yourself automatically eating only once or twice a day, because you simply don’t want more. And the less often we eat, the lower our insulin levels for most of the day.

Okay, that’s enough to hit you with in one go. But you should now have enough background to make intelligent tweaks to your diet. Let us know how you get on, okay?


#8

Well, I can’t claim to (know) what your RMR is, but I can tell you that at 39, lifting weights 5-6x week and doing cardio 2-3x week If I ate that much I’d gain, zero question about it. To be fair I’m rebuilding my metabolism but still. I’d up protein and lower fat. When you say “the rest fat” does that mean you’re not tracking that? I can’t lose for long if mine is over ~80g or so. Fat isn’t a freebie, even for keto.


(Bob M) #9

Not really. See this guy’s You Tube videos:

During the pandemic, I built up to 30 pushups, then went to pseudo-one arm pushups (one arm at 90 degrees away from the body, the other doing the pushup), have gotten to where I’m up to 12 of these per side. Now, in addition to these, I’m doing true “one arm” pushups (one arm behind back), but on stairs so that I’m on the fourth and third stairs right now.

You can do a lot with a little, especially if you train to failure, but a bit infrequently.


(Bob M) #10

I wouldn’t be so sure about fat. See this woman, who ate tons of fat on a PKD:

My position on fat is the following: I have no idea what’s best, other than high saturated fat seems way better than high PUFA.


#11

I’ve seen all the same stuff, but I’ve also seen no shortage of people like me that at one point buy into unlimited fat and then run into a stall that never goes away. Then with higher protein and less fat stall magically goes away and the fat starts coming off.


(Bacon by any other name would taste just as great.) #12

@ctviggen Bob, that was an interesting experiment of Siobhan’s. Do you know what year she did that? The date is given simply as November.

The results were as expected. I’d just like to see the same experiment performed with an N much higher than one. (And raw liver—ugh! I can’t believe she prefers it to cooked!)


(Bacon by any other name would taste just as great.) #13

That’s why I’d like to see Siobhan’s experiment repeated with a lot more subjects. There is plenty of room for individual variability, and it would be nice to have a picture of the range.

Are you familiar with Simpson and Raubenheimer’s protein-leveraging hypothesis? Their original study is quite dense, but I gather that their estimate of 15% protein is an average value over a range of intakes.


(Michael - When reality fails to meet expectations, the problem is not reality.) #14

No specific advice from me. In addition to some of the suggestions already offered, I’d add this. Keto is a metabolic normalization process that takes time. Sometimes the time frame for improvement is slower than we expected or wanted simply because the damage needing to be fixed is so severe. You don’t mention your age, so I’ll assume ‘middle age’, and guess that you spent a few decades eating SAD. Insulin resistant is a step below prediabetic which is a step below diabetic. So you’re not as bad off as you could be, but bad off enough. Excessive weight/fat is really a symptom of metabolic disfunction and often other stuff needs to be fixed before the weight/fat comes off. Individual variation plays a very big role in all this. Some folks sail through like a 12-meter yacht, others flounder and struggle for months or years. The end result of good health is worth whatever effort it takes.


#15

HI!!

Same as Michael in that specific advice ain’t gonna help you with what our personal experiences are. I don’t know your background etc.

and no it is not all about insulin :wink: a lot of variables come into play truly thru our individual lifestyles and med situations.

but from me I say NEVER decrease that protein level. Don’t do that, in fact UP protein and fat and get happy and nourished. Lower carbs to like the 10g total range…which is small but can give you like some mushrooms or few green beans or whatever into that meal for keto.

1800 kcals for you…small if ya ask me cause 287/6’1 and I am age 58 and 5’8 and eating more than you :slight_smile: and losing lbs. but slow now.

You are not eating enough to me at all. Eat all the meat/seafood/good fat and concentrate on healing and feeding the body.

Now don’t take this wrong truly…but 2 years and only the initial loss, what the heck else are you eating? cause at some point our little ‘extras’ kill us and we are not truthful to ourselves truly…those 1 or 2 times per month we ‘just eat at a function’ or whatever holiday etc and we blow it big time. NOT SAYING this is you, but if it is, take note. As much as when we want it all and in a tiny bit off plan, we pay the piper. I did just that. 2 years in and out of LC and ZC and one day I realized I was playing with ‘extra crap carbs’ in LC and one my ‘good carnivore’ days I was stellar but all this added up to NOTHING in progress.

So just a thought on it, and again, not saying you here but ??

Eat more meat/seafood/good fat. Simple as that and key then is STAY on plan. Give it the full boost on a basic reset back. That is my advice and wish you the best of luck to move forward.


#16

It’s not wise to eat when cortisol levels are high.

It’s all about the growth hormone to cortisol ratio.
nass2002.pdf (171.4 KB)

If you’re not exercising and/or drinking unhealthy stimulants(caffeine) which raise growth hormone. Then it’s best to not eat and hydrate and cover your important minerals like magnesium.

Bodyweight squats by holding onto your desk are effective at shifting the metabolism towards producing growth hormone.


(Bacon by any other name would taste just as great.) #17

Not to quibble, so please forgive me for pointing out that the late diabetes researcher, Dr. Joseph Kraft, just called it diabetes, whether diagnosed or undiagnosed. His belief was that irregularities in the insulin response to glucose load could predict, often twenty or more decades in advance, a diagnosis of diabetes, which, by the standard of care, is not made until insulin resistance becomes so great that glucose levels start getting out of control. Dr. Kraft called everything before that point “occult” (hidden) diabetes.


(Michael - When reality fails to meet expectations, the problem is not reality.) #18

‘Second and 15’ is not quite as bad as ‘third and 25’ then ‘fourth and punt’. I suspect that we will eventually discover that essentially all metabolic and related disfunction is ‘diabetes’ ie glucose/insulin damage, occult or obvious. Just different in degree and intensity of effects. Doesn’t Ivor Cumins call CVD ‘diabetes’? :point_up:


#19

Nope, but I’ll look into it!


(Eric - The patient needs to be patient!) #20

This is true and an eye opener. I think I had imbalances for 30+ years because high blood pressure at a young age. I was never declared diabetic but most of my blood work was worse than someone I know that is diabetic except the Glucose level.

I think this may also be true for young women with PCOS also. Starts early.