If you’re curious about protein and low-carb regimen, Dr. Ben Bikman is your doctor, and researcher friend. He enjoys challenging anti-protein bias in the medical community.
I have yet to leave a presentation of his, thinking, “my head is spinning. I better re-listen to all that he just said.”
First, thanks to all of you for the responses. That’s what makes this site awesome.
The reason for my original post is I have been doing keto for over a year with no progress on 1) weight loss and 2) improving my blood markers. My fasting BG levels are all over the place and consistently over 100. I’m convinced the reason for zero weight loss is because my my body is so f’d-up with insulin resistance. So my focus now has shifted to going carnivore until my blood sugars stabilize toward more normal levels. Then I’ll gradually add back minor carbs to get back to keto.
I want to get to the point where I can tell my doc to shove his meds up his a…
Seriously, can you switch doctors? Income deprivation is a solid change agent. My GP has come around, thanks to my success.
Secondly, I just happened across this direct answer to your question. You’ll find it here, I’ve set the start point to where he talks about your question:
From the YT transcript:
And then the protein issue I think dr. Ben Bikman has the most excellent YouTube video about this. He gave a lecture at low carb somewhere and basically if you’re eating a low-carb diet you can’t eat enough protein to initiate gluconeogenesis to any meaningful degree. Gluconeogenesis is not a push mechanism it’s a need it’s a demand mechanism, right? And so if your body needs glucose your liver can crank up gluconeogenesis in seconds and give your red blood cells and all the other cells all the glucose they need but you can’t eat enough protein on a low-carb diet to push your liver in them to making glucose it just doesn’t work that way biochemically and so many people have either never had the by the physiology and biochemistry lectures or they forgotten them it doesn’t work that way it’s not a push mechanism it’s it’s like you can you can lead a donkey but you can’t push a donkey it doesn’t work that way and so that’s what I don’t think you can eat enough protein on carnivore or low carb keto to initiate any kind of damaging gluconeogenesis I just don’t think it works that way.
Thought this was also an easy to understand explanation besides the ones given above:
Things are different if you have diabetes.
Insulin resistance means that between our fatty liver and insulin resistant adipose tissue, things don’t work as smoothly.
While your blood sugar may rise or fall in response to protein, needs to rise a lot more while you metabolise the protein to build muscle and repair your organs.
Unfortunately, people who are insulin resistant may struggle to build muscle effectively due to insulin resistance. Then the higher levels of insulin may drive them to store more fat in the process.[12] Becoming insulin sensitive is important!
The chart below shows the difference in the blood glucose and insulin response to protein in a group of people who are metabolically healthy (white lines) versus people who have type 2 diabetes (yellow lines).[13]
People with diabetes may see their glucose levels drop from a high level after a large protein meal and will have a much greater insulin response due to their insulin resistance. People with more advanced diabetes (i.e. beta cell burn out or Type 1 diabetes) may even see their blood sugar rise. Their ability to produce insulin to metabolise the protein and keep glycogen in storage cannot keep up with the demand.
Drawing on the brake/accelerator analogy, it’s not necessarily protein turning into glucose in the blood stream via gluconeogenesis, but rather the glucagon kicking in and a sluggish insulin response that isn’t able to balance out the glucagon response to keep the glycogen locked away in the liver.
Healthy people will be able to balance the opposing hormonal forces of the insulin (brake) and the glucagon (accelerator), but if we are insulin resistant and/or don’t have a properly functioning pancreas (brake), we won’t be able to produce as much insulin to balance the glucagon response.
Someone who is insulin resistant has normally functioning accelerator pedal (glucagon stimulating glucose release in the blood) but a faulty brake (insulin).
More insulin or less protein?
So, what is the problem here?
Why are Monica’s blood sugars rising?
Is it too much protein?
Or not enough insulin?
I think the best way to explain the rise in blood sugars is that there is not enough insulin to keep the glycogen locked away in her liver and metabolise the protein to build muscle and repair her organs at the same time.
Meanwhile, the glycogen pedal is pushed down as it normally would be in response to a protein which is driving the glucose up in her bloodstream.
There is just not enough insulin in the gas tank (pancreas) to do everything that needs to be done.
So, if Monica had a choice, should she:
- A. Keep her blood sugars stable and stop metabolising protein to repair her muscles and organs,
- B. Metabolise protein to build her muscles and repair her organs while letting her blood sugars drift up, or
- C. Both of the above.
Personally, I think the correct answer is C.
While it’s probably not wise to go hog-wild with protein supplements and powders if you have diabetes, swinging to the other extreme to target minimal protein levels is a sure way to end up with a poor nutritional outcome.
According to Simpson and Raubenheimer in Obesity: the protein leverage hypothesis (2005), people with diabetes may actually need to eat more protein to ensure that they have adequate amounts to build lean muscle mass given that higher levels of gluconeogenesis may cause more protein loss to glucose due to their insulin resistance.
”… One source of protein loss is hepatic gluconeogenesis, whereby amino acids are used to produce glucose. This is inhibited by insulin, as is the breakdown of muscle proteins to release amino acids, and therefore occurs mainly during periods of fasting (or low carb).
However, inhibition of gluconeogenesis and protein catabolism is impaired when insulin release is abnormal, insulin resistance occurs, or when circulating levels of free fatty acids in the blood are high. These are interdependent conditions that are associated with overweight and obesity, and are especially pronounced in type 2 diabetes (12,34).
It might be predicted that the result of higher rates of hepatic gluconeogenesis will be an INCREASED requirement for protein in the diet. …” …More
Related:
I should dump him and based on atomicspacebunny’s response I should see if she’d be my GP.
Thanks to both of you - greatly appreciated!
I hope people didn’t just skip over this.
People tend to get very zealous about breaking out their macros to micro levels. Food doesn’t tend to be “only fat” or “only protein”. As Mark says, ribeye steak has a little more fat than protein and it’s all wrapped up in a nice tidy package. Eggs are the same, a little more fat than protein all wrapped up in a tidy little package.
Real food! It’s what’s for dinner! 
I don’t know, Bri. Eating real food seems like cheating, somehow. And besides, it’s not complicated enough, lol! 
Its from the nutritional info… I’m guessing raw…but as steak is usually pretty quickly cooked I doubt you’ll lose much of the fat… I cook mine sous vide and then fast sear so don’t lose much of anything apart from some water.
I never got the sous vide thing. I just sear and eat. If the inside of the steak isn’t completely raw, it’s overcooked as far as I’m concerned. Brown crusty outside + totally raw inside = perfect steak.
I’ve been finding completely raw, period, to be a totally new experience. I used to prefer a crusty outside with a raw inside but the feelings I get from raw are something unprecedented.
Pittsburgh blue. I order them this way sometimes when I am at a nice steakhouse. If they don’t know what I am talking about I am concerned.
Yeah I’ve heard mixed results from going completely raw. I’ve done completely raw for a meal or two when I’m in a hurry, and I find it to not be very satisfying, but I’ve never done it on a remotely long term basis.
PUBLIC SERVICE ANNOUNCEMENT
I have to chime in here to mention that the article linked above has some accurate information but is also full of mistakes. The worst of these is recommending increased insulin for insulin resistance.
Rather than try to refute it line-by-line, I’m just going to link to a few articles that explain GNG and I:G ratio for anyone who’s interested in the science. Be warned though, it is a deep rabbit hole. 
Thanks for your attention. We now return to our reguarly scheduled programming.
Amy Berger does a great job of explaining a complex subject. I do have to take issue with one of her points though, which is …
(Note from Amy: you might see an acute drop in ketone levels, but first, who cares, and second, you’ll be right back to ketosis as soon as insulin comes back down. And remember: if your goal is fat loss or overall wellness, it’s more important to be fat-adapted than to be in ketosis 24/7 .)
For some of us, being in ketosis is the point of a ketogenic diet. My brain functions better in ketosis. When I make a mistake in my diet I suffer for it. I know that she understands this because of her research into Alzheimer’s Disease among other things. But the article is geared more toward fat loss as a goal.
Not insulin resistant, but stumbled into ketosis accidentally almost 2yrs ago by consuming large amounts of EVOO to ward off dementia (runs in the family).
Did the macro thing and really kept my protein low, until 2 months ago, stopped keeping track… now i’m eating way more protein and less vegies and feeling even better, and my ketone and glucose levels haven’t changed a bit… so, I agree, I see no evidence of GNG on 4 times the protein and my mind feels better, better attitude about life 
Bill
