21 replies to this topic

[NeuroGeneration]

tl;dr: I have high FBG (100-115) and postprandial for high sugar experiments (can get as high as 143), regardless of diet (it all started with keto, after which I progressed to VLC, paleo and now, 300+ g/day of mostly "clean" carbs), training or not training for 2 weeks, little sleep or a lot of sleep, etc. I am very lean, muscular and active, all of my blood markers are great (hba1c is borderline at 5.6), have no familial history, am not a high-risk ethnic group, and eat very "clean". Theories include potentially being unintentionally hypocaloric, physiological insulin resistance (but its been weeks), disruptive sleep, overtraining (though I believe I disproved this by taking 2 weeks off with the same #s), or something else altogether. Seeing endocrinologist who does not believe it is diabetes, but agrees it's odd. We're running labs next week. Until then, lab results are included in post below. ANY IDEA WHAT COULD BE GOING ON???

 

Hi Guys,

 

I've been searching for some answers on this issue for a while, and beyond picking up clues, haven't come to any solid answers. Any help is appreciated.

 

My issue is high fasting blood glucose (100 - 115) and relatively high post prandial (as high as 143, typically below 140). Now, before you jump to the conclusion of diabetes (which even my new endocrinologist, who's beginning to run tests doesn't think it is), please read on.

 

Throughout my life, I've had a high protein, high carb, low-fat (20-25%) diet, up until about 2.5 years ago. I read a Maffetone book and switched to low-carb, whole foods.

 

At first I think I went too far, because I was beginning to show signs of depression. I upped the carbs by a bit (1/2 box of Kashi GoLean Crunch each night!) and I felt better. About 15 months ago, I experimented with keto for 6 months. I fell into chronic depression. My friend reminded me, "don't you remember being depressed the first time?", but I was determined. I suspect a lot of the depression was due to terrible sleep, which was constantly interrupted by very low-carb cortisol / catecholamine spikes. I switched to low-carb paleo. Better, but not enough.

 

I bought a glucometer during my keto period to check if I was in ketosis. I was consistently above .7. One day I decided to check my FBG and saw that it was 110. This concerned me, but I then read about physiological insulin resistance (more on this below for those unfamiliar). I also seemed to have reactive hypoglycemia, because after experimenting with a few carbs, post prandial would sometimes drop into the 90's.

 

While in paleo, consuming 100-150 g/day of carbs, I pulled out the glucometer again, to find that my FBG was still the same (100 - 115). This concerned me. I decided that since I had done well throughout my life with high carb/protein, low fat, I would go back to it. This was about 4 weeks ago. My FBG is still the same, I feel tired when I wake up (I still move a lot in my sleep, but I'm not nearly as conscious when I wake up as I was during low-carb/keto; definitely more restorative than keto). My post-prandial can slightly exceed 140.

 

I'm a very active weight lifter and HIIT trainer. My stats below will tell you more about that – but the point is, I'm very much physically healthy, with plenty of muscle that's being depleted daily, theoretically thirsty to swallow up carbs. Also, I find it odd how my fasting & postprandial numbers are the same, regardless of how few or many carbs I ingest, the timing of my meals, whether I go a couple weeks without exercise or I train intensely for days...

 

Here's what I already know / have learned:

• Low carb can cause "physiological insulin resistance." This is well-known and accepted among low-carbers. They treat it as low/no long-term risk, though I don't think anyone has proven that to be the case. I'd prefer to have my blood glucose below 90.
• I'm aware of the dawn phenomenon, but that doesn't seem to be the case for me, since I see high numbers at other times, too.
• I once suspected overtraining, but have ruled that out after going two weeks without training, with no changes to my numbers.
• I may currently be calorically restricted. Could this be an explanation? With keto & paleo I was probably eating about 3,000 cals/day. I've come to learn that my basal rate is 1,900, my training uses 600 - 1000, and I walk 5+ miles /day, so my lifestyle probably burns another 1,000. In other words, I should probably be consuming closer to 4,000 calories. The issue right now is that I do not have the appetite to consume 4,000 calories of whole foods, so this week I decided to add in some gluten-free granola & fruits to up my numbers to be closer to my daily expenditure (at least for now, while trying to figure this out).
• I've included some notable quotes related to low carb / high blood glucose at the bottom of this post. Please at least read the quotes before you comment.

Stats (taken during paleo / moderate carb phase 5 months ago; may have been hypocaloric. I will have new stats in just over a week):

• Male, 29, 9% bf, 5'10 178lbs
• HbA1c = 5.6
• TSH: 1.82
• Free T3: 3.4
• Free T4: 1.2
• Test: 475
• Free Test: 66
  • Note: Libido is moderate to low with occasional spikes
• ALT / SGPT, ALP, Billirubin, Albumin, Tot Prot, Globulin, A/G Ratio all good.
• AST / SGOT slightly high (44); could be from alcohol 2 days prior or exercise 1 day prior.
• Kidney health, bone health, blood health, vitamins & minerals all optimal levels.
• hs-CRP: .02
• LDL: 150
• HDL: 90
• Triglycerides: 76
• I'm not gaining weight / fat, other than a small amount from upping my cals and not training much over the past 2 weeks (maybe 1% increase in bf%; I've had 7-10% bf since I was a child, regardless of diet and activity levels).
• My resting heart rate averaged 56 this week.
• My HRV info for this week:
  • AVNN: 1104
  • SDNN: 94.7
  • rMSSD: 67.5
  • pNN50: 31.53
  • LF: .301
  • HF: .116
• Activity:
  • Exercise 5-6 days/wk.
  • HIIT 2 days
  • weights 4 days
  • Most workouts are 45 - 70 minutes
  • I throw in some 5-6 mile cardio about 1x/wk
• I meditate daily and do not feel much anxiety / stress. Nearly all of my stress would be physiological.
• Diet & Sleep:
  • 2.5 years ago: Low-carb diet (not strict, but I'd estimate 150-200 g/day)
  • 1 year ago: I followed keto for 6 months; began blood glucose / ketone readings, noticed high levels of FBG. Believed it to be gluconeogenesis via physiological insulin resistance
  • 6 months ago: I switched to VLC / low carb (100-150g/day). Issue remained.
  • 1.5 months ago: I stopped experimenting with 2x weekly 16-18 hour fasts, after about 9 months
  • 1 month ago: I progressively added more carbs in.
  • Poor sleep for past 18+ months. I fall asleep immediately, but toss and turn a lot (video). I get about 3 periods of 40-50 mins of no movement per night.
  • When I'm low-carb, I consciously wake up, energized. When I'm higher carb, I wake up, though barely consciously. I fall back asleep more easily too, with carbs. I presume it's cortisol spurring gluconeogenesis?

Theories:

• I considered overtraining. I took nearly 2 weeks off with no changes, and have therefor ruled this out.
• I considered low-carb, so I upped my carbs into the hundreds of grams (300-400 /day).
  • Note, my mood is much improved after adding carbs back in, but blood glucose issues remain.
• I considered hypocaloric diet. Low carb paleo made me less hungry. Or, rather, not feeling the sensation of hunger as often (no more cravings for food). Over the past 2 weeks I've experimented and have found that I can eat more food than I thought, without feeling full. Being hypocaloric is a theory, leading to blood sugar regulation issues, but I haven't come across many papers on this.
• Poor sleep contributing to poor cortisol / blood sugar control, sparking a negative feedback loop?
• Stimulants. I removed them (coffee, tea) completely for a week with no effect.

 

Thoughts:

The fact that my numbers don't shift no matter what I do to my diet (add calories, remove calories, add carbs, add sugar, reduce training), my postrprandial never goes beyond 143 even when I have a "test" dessert fest and I never go below 80, I have no familial history, all other blood markers are great, I'm very fit, and these issues persist regardless of carb intake, makes me believe that it's not t1 or t2 diabetes.

 

Maybe I'm still not getting enough calories and need to continue to up them? This will be hard with "clean" calories; I think it would require cereals or sugary foods for me to go any higher with my intake at this point.

 

Some people on low carb forums state that it takes them 3+ weeks for their FBG to normalize after adding carbs back in (much longer than the 3 days for an OGTT that some quote). Maybe I take a little longer and should give it another week or two?

 

Maybe I need to change my final meal timing / size / macronutrient composition, to prevent gluconeogenesis during my sleeping "fast"? Though, I have tried lots of honey (3 tbsp) / cottage cheese (2-3 servings) / nuts (small handful) just before bed with no effect.

 

Maybe I'm totally off and it's something else altogether?

 

QUOTES / RESOURCES

"...asked about his gradual yet progressively rising fasting blood glucose (FBG) level over a 10 year period of paleolithic LC eating. Always eating less than 30g carbohydrate per day. Initially on LC his blood glucose was 83mg/dl but it has crept up, year by year, until now his FBG is up to 115mg/dl. Post prandial values are normal. He wanted to know if he was developing diabetes." http://high-fat-nutr...istance.html[1]

 

"Still, a complaint that one sees a lot from people who have been doing glycogen-depleting exercise and intermittent fasting for a while is that their fasting blood glucose levels go up. This is particularly true for obese folks (after they lose body fat), as obesity tends to be associated with low GH levels, although it is not restricted to the obese. In fact, many people decide to stop what they were doing because they think that they are becoming insulin resistant and on their way to developing type 2 diabetes. And, surely enough, when they stop, their blood glucose levels go down." http://healthcorrela...ing.html?m=1[2]

 

"Now I had something to tell my dad and others who'd been faithfully doing LC and became horrified, then scared, at fasting blood glucose measurements (which is primarily how the health community screens people for diabetes). I really didn't concern myself with it again—for all these last almost 7 years. OK, so long as post-prandial is fine (caveat: AFTER AN LC MEAL!), nothing to worry about; and combined with good HbA1c, and the fact that so far as we know, this condition will reverse in normal people after a few days of carbage, then just relax.

...That was until earlier this year when one of my collaborators, "Duck Dodgers," clued me into something. What if there are no populations on earth that we know of where you can observe the long-term effects of "physiological insulin resistance?""

..."then you would expect them to feature "physiological" insulin resistance—just like the thousands of LCers in various forums, my blog comments, and in my dad—right?" http://freetheanimal...hydrate.html[3]

[StevesPetRat]

Try thiamine.
If you require more details, ask.

[xEva]

NeuroGeneration, I did the read your whole post, only skimmed it, but this is very common in people who were recently in ketosis due to fasting or a ketogenic diet. It's good that you monitor your BG, that's the best thing to quickly learn what works for you (and how a lot of popular books about diets a wrong or at least incomplete).

First, it takes 2-3 weeks to adjust to living mostly on glucose (just as it takes a while to adapt to a ketosis). Second, paradoxically, increasing carbs --even simple carbs!-- at the last meal of the day, while at the same time eschewing fats, will get your BG in the normal range quickly. Also B5 and some other vitamins/supplements help, but not as fast as switching to higher carbs and low to no fats. You need to do this only for a while, a week or two, while you adjust. That was my experience.

This has to do with an ancient adaptation to "ketosis of starvation", when glucose is deliberately ignored by the skeletal muscles as 'protein-sparing' strategy. High levels of fatty acids stimulate this adaptative response (and fatty acids remain high after ketosis due to simple metabolic enertia, that's why eschewing fats for a while helps).

Also, you need to consider what diet is best for you long-term. You can be on any type of a diet if it is severely calory-restricted. But if your intake of calories is more or less normal, you have to choose either keto or carb. Remaining in this in-between land is no good, as it keeps your glucose levels chronically high and can lead to real insulin resistance.

Edited by xEva, 13 February 2015 - 06:41 PM.

[Darryl]

if your intake of calories is more or less normal, you have to choose either keto or carb. Remaining in this in-between land is no good, as it keeps your glucose levels chronically high and can lead to real insulin resistance.

 

Mei, S., Yang, X., Guo, H., Gu, H., Zha, L., Cai, J., ... & Cao, W. (2014). A Small Amount of Dietary Carbohydrate Can Promote the HFD-Induced Insulin Resistance to a Maximal Level. PloS one, 9(7), e100875.

 

This mouse study suggests maintaing low-glucose on keto diets may require surpassingly low carb intake < 5%.  Even 10% carbs, surprisingly, raised glucose more than 25% carbs. 

 

Also, at 58% calories from fat (mostly lard), insulin sensitivity (measured by liver/muscle IRS1/Akt phosphorylation) was blunted with even 0.1% carbs, but especially at 10%. So the lower glucose levels were simply from extreme keto, not any insulin sensitivity benefits.

 

If this translates to human physiology, it means everyone doing keto is insulin insensitive, and the only way to maintain low blood glucose and perhaps prevent aptly named glucolipotoxicity is to banish all carbs completely. Moderate keto isn't safe keto.

 

 

 

 

Edited by Darryl, 13 February 2015 - 08:38 PM.

[NeuroGeneration]

Thanks for your comments, guys.

 

xEva – I can understand why you didn't read the entire post :-) That said, I've been off of keto for a while. You may want to read this part of my post:

 

 

• 2.5 years ago: Low-carb diet (not strict, but I'd estimate 150-200 g/day)
• 1 year ago: I followed keto for 6 months; began blood glucose / ketone readings, noticed high levels of FBG. Believed it to be gluconeogenesis via physiological insulin resistance
• 6 months ago: I switched to VLC / low carb (100-150g/day). Issue remained.
• 1.5 months ago: I stopped experimenting with 2x weekly 16-18 hour fasts, after about 9 months
• 1 month ago: I progressively added more carbs in. Over the last 3 weeks I've probably been at 250-300+ grams /day.

 

 

 

 

Can you expand on this statement: "...you have to choose either keto or carb. Remaining in this in-between land is no good, as it keeps your glucose levels chronically high and can lead to real insulin resistance"? How do you define "in-between land"? For example, I've seen recommendations that people consume ~50 grams of fat /day at a bare minimum. Would 40carb:35protein:25fat or even 40:30:30 be a low enough fat ratio? If not, what would be?

 

Also, your statement would seem to suggest that paleo dieters (especially crossfitters, who tend to consume more carbs), carb-backloaders, and even mediterranean dieters (50:20:30) are on track to metabolic disorders. I'm not saying that this isn't possible (especially, paleo & carb-backloading), but I'm curious if I'm understanding you correctly.

 

For about a month I've been much higher on carbs & protein, and have reduced the fat substantially. My daily fat intake tends to be from 3-4 eggs, fish (4oz of sardines or salmon), 1 serving of whole goat milk yogurt with whey protein post-workout, 1% cottage cheese, sprinkles of olive or mct oil here and there on veggies, and 2x servings of guacamole with my eggs in the morning. I may also have a lean cut of grass-fed steak or liver once every week or so. Otherwise, the additional protein sources are whey, a Quest bar (or two, when I'm running around), and sometimes 2% greek yogurt or chicken breast. My carbs are coming from fruits (mixed berries, 1-2 bananas, 1-2 servings of frozen mango), veggies (tons of cruciferous veggies), ~1lb of sweet potato, 2 servings of oatmeal, and on heavy workout days, I "cheat" and add granola or cereal to the mix – otherwise my appetite / stomach wouldn't be capable of hitting my caloric expenditure. Is this too high in fat for the short-term? Long-term?

 

I must admit, I'm concerned about how aggressively I reduce fat and add carbs. Fat slows the absorption of carbs. I had granola yesterday with some diluted coconut milk immediately after a can of sardines and a navel orange, and after walking for an hour, I took my 80 min post prandial: it was 165!! Even after walking for 60 mins! Is this dangerous, or all part of the process of resetting my insulin sensitivity?

 

Darryl – thanks for that. Any idea of what the time span would be to return to normal insulin sensitivity, after reintroducing carbs?

 

StevesPetRat – interesting. I have thiamine. Starting today, I've purposely stopped taking all supplements, including multivitamins, until my blood tests on Tuesday. Depending on the results, perhaps I'll experiment with slowly titrating up on thiamine.

 

Any other thoughts would be appreciated.

Edited by NeuroGeneration, 13 February 2015 - 09:17 PM.

[xEva]

Neuro, you have to start by realizing that what you've been doing is not working. Forget diet books recommendations and find what works for you. There is no optimal carb/fat ratio for every one. If you want to go carb, you have to lower your fat. Try just for a few days and see if this works. You may go with low to no fat --in any form-- for as long as 2 weeks, until you get your fasting glucose in the normal range.

You remember how you were adapting to keto or low carb? It took you a while and you knew that your carb intake had to be minimal. Now you do the opposite: make your fat intake minimal, and when you adapt --you will know you adapted, when you fasting BG becomes normal-- then you can increase your fats. That's how you do it.

After that you can return to your diet as it is. I skimmed it and it does not look to me excessive in fats. The problem is that your metabolism has not switched fully to a carb-based diet and is remaining in a no man's land. That's the worst situation. The other thing you could do, if you want to keep your ratios, is to restrict your calories or increase physical activity.

Edited by xEva, 14 February 2015 - 06:49 AM.

[misterE]

Your body is undergoing gluconeogenesis excessively. xEva just mentioned the seemingly paradoxal effect of increasing carbohydrate intake on LOWERING blood sugar. This has to do with the fact that carbohydrates increase insulin and incretin hormones, which shuts of gluconeogenesis and transports glucose out of the blood. Fueling your body with greasy-protein (Ketogenic diet) forces your body to start synthesizing its own glucose. It does this by increasing catabolic-hormones like cortisol, glucagon, GH, catecholamine's and other hormones that turn protein into glucose. These hormones in excessive amounts also reduce insulin sensitivity, reducing the transport of glucose out of the blood. 

Edited by misterE, 19 February 2015 - 05:19 PM.

[Gerald W. Gaston]

@OP...Maybe I missed it but I didn't see any insulin test results.

[resveratrol_guy]

2 cents... Epidemiology trumps hematology. I don't think we should get overly excited about elevated fasting glucose in the case of low-but-not-zero-carb ketosis. For example, rapamycin (the stuff that extends lifespan in mice) has the same effect, courtesy of the mTORC2 pathway. There is no magical diet. Personally, I'd prefer to look at the epidemiological effects, in combination with genetic information when available, and basically just copy the diets which seem to maximize healthspan, let alone lifespan, in light of my own DNA. For most of us, this would appear to be something of the ketogenic variety -- when was the last time you read a competent research study that said low-fat diets (other than CR) were capable of regressing Alzheimer's or cancer? Maybe ketogenic diets don't extend lifespan, but if the only thing they do is impede these horrendous diseases, I'm on board. And I wouldn't attempt zero-carb, which is almost impossible to implement in practice. I'd rather be a diabetic centenarian than dead at 80 with optimal fasting sugar.

 

And furthermore, what in fact would diabetes mean in the presence of ketosis? Because the cells are burning more fat and less glucose, they're producing less pollution; that's a good thing. The only problem we'd have is the ramifications of high blood sugar -- in the strict sense of it being in the blood, not the tissues. This would produce some level of damage to the endothelium and circulating cells and proteins. No doubt, that wouldn't be a good thing. But if the cells themselves were in comparatively better shape, then they would be better equipped to deal with the increased level of AGEs. Mitochrondrial antioxidants and the right forms of K2 might further ameliorate these problems. Again, it's all about net effect.

 

[Hepoberman]

You could probably use more Riboflavin (Vitamin B2) as well as thiamine (already mentioned). Are you getting enough salt? Chromium? RS?

 

If you could find a doc who would run a Nutreval on you (only $150 via EasyPay A), you could fine tune your diet & supplements. This is probably the best way to get it right.

 

Hep

 

 

[NeuroGeneration]

@gwgaston – No insulin tests, because at the time of the tests I had no concern over FBG. I just had labs done a few days ago and I believe the doc included insulin – I should have the results shortly, along with Doc's opinion.

 

@hepoberman – I'm taking ThorneFX AM/PM, and use generous amounts of himalayan salt. I sometimes use RS, but often times have cooked and cooled sweet potatoes or white rice at this point.

 

@resveratrol_guy – I've had similar thoughts in regards to health (slightly elevated blood glucose may only be an issue for those on high carb diets / "true" diabetics, than those who are seeing the blood glucose rise as a result of gluconeogenesis). I also hear what you're saying in regards to ketosis and alzheimer's / cancer. However, through my 14+ month experience with ketosis and research, I have a slightly different opinion. Note, some of what I mention goes off on a tangent, and you may very well agree with a lot of it – I think we have relatively similar perspectives on this:

 

Much of our biology, while in ketosis, resembles that of starvation. In fact, the issue with blood sugar that I'm experiencing is covered in depth in multiple starvation studies; not nearly as much research has gone into ketosis & high FBG. During these periods of starvation (or, "quasi-starvation", as I'll consider ketosis to be), our bodies become super efficient at leveraging its own endogenous resources, as we see through processes like autophagy. Autophagy is the predominant explanation for the stagnation of certain forms of cancerous growths (e.g., brain tumors), in some instances. Perhaps the reduction in cancer risk is a byproduct of a necessary survival mechanism, as opposed to being standard procedure. Further, perhaps the occurrence of cancer in the first place is the result of modern lifestyle, including caloric excess and extreme environmental stressors, and was not nearly as common throughout human evolution. Speaking of which, I believe that ketosis, and/or fasting, would happen on occasion (not necessarily every week, but a few times per year, especially in winter seasons); going in and out of ketosis was necessary for survival, but not to be maintained for long periods of time. In other words, it was an acute, hormetic stressor.

 

Most people who experience success from ketosis are 1, overweight, and 2, eating tons of calories in the form of fat (in other words, not at all in a caloric deficit, which is more likely to have been the case during historical periods of starvation). I, on the other hand, am super fit (low bf%, high anaerobic & moderate aerobic activity levels), so don't have a significant store of energy in the form of fat; mine is predominantly muscle and lean tissue. Yes, I know I still have weeks worth of fat to live off of, but I'm quite confident that the body knows when it has some fat (a short runway) and a lot (a longggg runway). It would make sense that some people like ketosis, because they are losing weight - which may be all that it takes. Additionally, they may feel "good", but I'd also question how "good" that really is: perhaps it's *better* than being overweight, overeating and sluggish, but not nearly as good as I feel in my prime with a balanced diet. In other words, ketosis makes the less-than-healthy person go from a 3 to a 6 in terms of how they feel, whereas I go from a 9 to a 6. Additionally, I believe that many people confuse the high levels of cortisol and catecholamines from low-carb for being positive. However, I'd argue that sustained, chronically high levels of cortisol, neurepinephrine, etc. are not good for the long-term. Think about it: if cortisol is necessary for gluconeogenesis, gluconeogenesis is required for survival on low-carb, chronic cortisol is known to be damaging, and cortisol is known to screw with sleep – why would this be "ideal" for the body? Plus, gluconeogensis is an expensive, taxing process for the body to undergo, and often times results in loss of lean tissue.

 

I found that ketosis screwed with my sleep, mood and possibly my hormones, based on the disappearance of my libido. Every night, I was restless in bed after the 3rd hour of sleep, and not once got a good night of sleep over months and months of ketosis. I woke up tired and wired. I had extreme mood shifts – for a few hours I may be super excited and talkative (felt like Adderall; catecholamine spike?), only to get tired and fall into a depression. My attraction to females completely disappeared (no, I didn't gain an attraction for males, wise guy! haha). Based on my research, it seems reasonable to believe that my testosterone dropped significantly, while my cortisol rose, as a result of low-carb.

 

Taking a step away from myself for a moment, when we look at the diets of Blue Zone people, they ALL have "high" carb diets, by the traditional definition. Rice, oatmeal, potatoes, etc. Putting together my own experience and reactions to diets, combined with research and observations of the healthiest people (longest lifespan, or greatest athletes and their diets), I believe the following:

 

• The biggest issue with SAD / MAD is caloric excess, not that it contains carbs, fat and protein.
• The second biggest issue with SAD / MAD is the excess of sugar, trans fats, etc., which when combined with the prior point (excess), is literally deadly.
• The third biggest issue with SAD / MAD is food processing and everything that comes along with that – especially chemicals, like preservatives, that we don't have long-term safety data on; I'm open-minded about GMO, but with a watchful eye.
• Some people confuse chronic ketosis for being good, because of weight loss & excitatory neurotransmitters. However, historically, people weren't obese when they went into ketosis. For someone who is healthy, it's not ideal. And for someone who is overweight, I'd argue it should be used in cycles and with caution.
• High protein diets can shorten lifespan. It's a matter of balance between short-term gains (i.e., muscular gain) and longevity. Approximately 70 - 120 g/day of protein is more than enough for most. I consume more because of my current fitness goals, but realize it probably taxes my lifespan.
• It's important to look at your cultural history or genetics, when deciding how much of a macronutrient to eat. A person with pure blood from an indigenous people in Africa, who was never exposed to cultivated wheat products, probably can't handle nearly as many carbs as someone whose familial line had been cultivating and eating rice for nearly ten thousand years. Bring them to the US and I'd bet that they'd blow up from the standard american diet more quickly than I would, even with the same activity levels and basal metabolic rate. It's always important to keep this in mind.

 

The most important point: it seems that if you maintain a moderate caloric intake, consume natural ingredients, have ~100 g/protein per day, don't shy away from "clean" carbs, but consider activity levels when deciding how much, and consume the remainder in the form of healthy fats, you will be in great shape for a long life. The moment you go to an extreme, including ketosis, as more than a short-term hormetic stressor, you're setting yourself up for failure. I learned this the hard way over the span of more than a year.

 

I should have the results of my most recent blood test soon, and will share. Though, I will say that I've been sleeping better and the glucometer 5 days ago read 93 for FBG (the lowest it has been). I sense that I'm returning to "normal", and it was just a matter of taking a few extra weeks to get there.

 

 

[resveratrol_guy]

NeuroGeneration, I've found my thoughts drifting over many similar issues in my on-and-off experience with ketosis, IF, and other diets.

My short answer is that (1) ketosis is healthier than it seems because we're bombarded with horror stories of "keto flu" (people doing it wrong, for the most part), (2) carbotarians dominate in the lifespan olympics only because the longterm ketogenic diet is a recent phenomenon, and (3) the shortterm evidence is stacked heavily in favor of ketones vs. carbs, however challenging ketosis may be to sustain in real life.

So first of all, let's make it clear to those who are unaware: "keto flu" is a real disease which strikes during the adaptation phase. If you don't know how to adapt, then you'll never get over keto flu, and probably end up quitting (or ending up in the ER) because you feel awful. (Hyponatremia, headaches, nausea, disrupted sleep, etc.) I actually started on ketosis back in 2005, but gave up after a year due to horrendous keto flu episodes. (That's when I discovered that lemon Perrier helped the symptoms, perhaps due to the electrolyte content and acidity for digestion.) But at the time, I didn't know why I felt that way; nevertheless, being a dietary extremist, I tried to ignore the signals -- until I ended up falling apart due to poor sleep, which in fairness was only partly related to keto flu.

As to the Blue Zones (a book about 4 distinct centarian populations in the world), I was indeed in shock for a long time over the empirical fact that some of the longest lived people on earth eat beans and sweet potatoes. Granted, we're not talking about white bread and fries here, but still! It finally dawned on me that the Blue Zones are a false counterexample, because until very recently no one has been on a ketogenic diet for years at a time. Sure, many people living today have experienced periods of famine, or ate massive amounts of fat at some point, but you can't point to anyone who entered ketosis immediately following sexual maturity, then just sat there until they hit 100. The reason is clear: the ketogenic diet has only recently been taken seriously as a viable longterm diet, let alone a potentially salutory habit.

So for the next few decades, I don't think we'll be able to say whether or not "clean" carbs are more critical to longevity than ketosis. Granted, beans contain spermidine (memory) and colored sweet potatoes contain some wonderful compounds as well, which muddies the waters as well.

And I understand your point about epigenetic (even genetic) differences playing a role in the palatability of ketosis. There is no doubt that different people will experience different benefits and difficulties. OTOH, ketosis is so utterly fundamental to cellular biology that the differences should be surmountable. After all, even if your ancestors ate rice for 1000 years, you still have mitochondria with an energy pathway dedicated to BHB/AA burning. mtDNA is passed down exclusively through the maternal line, so it's extremely resistent to the sort of genetic muxing that occurs as the result of sexual reproduction. In other words, I don't think we're much different than dinosaurs in terms of ketogenic effects.

But as someone who has run the gammot of bizarre health issues, I must say, we worry too much about longevity at the expense of healthspan. Lying in bed all day because you're starving is no way to live to 100. (I did 44/4 IF -- 44 hours fasting, 4 hours eating -- for several months. I looked and felt great -- lying there doing nothing apart from a few hours per day.) Granted, I, too, have deep-seated doubts that a calorically-dense (if not calorically excessive) ketogenic diet is conducive to longer life. And in any event, the jury will be out on that one until long after we're gone. But what we do have is a mounting body of evidence that it does forestall the progression of the most horrendous chronic illnesses. As Aubrey DeGray has pointed out, sufficient delay of progression may be enough to get you to the next major rejuvenation breakthrough, so there's at least the prospect of increased lifespan.

And yeah, 70-120 g of protein per day is definitely robust. I'm still floored that ketoathlete Peter Attia downs 120 g/d (as of 2013). Starvation or not, the kidneys can't be liking that. (And BTW according to my own trial-of-one, bone marrow stem cells have no benefits for the kidneys, so we're still a long way off from kidney regeneration, despite progress toward the organ scaffolding process.) So as mundane as it sounds, kidney health may be the weak link in ketogensis -- again, muddying the statistics with protein intake vs. healthy ketogenics.

 

I think it's useful that you've drawn the distinction between "real" diabetes and this bizarre increase in fasting glucose which occurs in ketosis in the presence of modest carb intake. I doubt the latter is any more than a necessary evil on the way to better health (until we find out how to eat no carbs at all and still be happy). I recommend researching bitter gourd. It's an acquired taste, but more palatable after several days.

 

Time for another glass of whipped cream!
 

Edited by resveratrol_guy, 25 February 2015 - 10:58 PM.

[misterE]

Restricting carbohydrate consumption mimics type-1-diabetes, in a sense you are restricting insulin stimulation. And just like a type-1-diabetic who doesn't take their insulin, they develop ketosis and then ketoacidosis!!

[ceridwen]

I am concerned about the raised cortisol levels mentioned here. Cortisol attacks the hippocampus that coupled with the high glucose levels should ring alarm bells. However I desperate and though I am worried about the risks maybe it's the way to go. I hate fat I can't eat much of it so I doubt I'll eat very much when aiming for ketosis. Maybe that's the real reason why the diet is successful it inevitably leads to calorie restriction. I'll be dead soon anyway and it might just work.

[misterE]

The way to lower cortisol, is to eat more carbohydrates.

[NeuroGeneration]

So, here are my test results since changing to a moderately high carb diet. The first number is during low-carb paleo, the second number is from last week's blood test, with a diet containing 250+ g /day of carbs:

• HbA1c: 5.6 => 5.2
• Glucose (lab): 96 => 74 (!)
• Fructosamine: (not tested) => 216
• TSH: 1.82 => 3.17
• Thyroid Peroxidase AB: (not tested) => 10.3
• Insulin: <2 (!)
• FSH: (not tested) => 4.2
• Total Testosterone: 475 => 456 :(
• Free Test: 65.8 => 87 (not as high as I'd like at 29, but getting higher)
• Prolactin: 7 => 9.4

As you can see, my numbers are much improved ever since raising the carbs.

 

Two new questions, though:

 

1. How would you suggest I raise my Free Testosterone? I think it's quite low for my age. I've got the carbs back in, which helps, and I have saturated fats & cholesterol from meats. Any other *proven* methods?

 

2. I'm beginning to suspect that my poor sleep and daytime fatigue issues are due to my 3-4 eggs /day, and the fact that they contain choline. I've had very negative reactions to choline containing supplements before (CDP choline, DMAE, ALCAR, phosphatidylcholine), which included acute depression, irritability, and extreme fatigue. Has anyone ever heard of eggs being capable of doing the same? This post – though a bit over my head – discusses the impact that choline hypersensitivity, or excess acetylcholine, can have on people, including depression, excess cortisol, sleep disturbances, and high levels of GH (my sleep study indicates that I spend a lot of time in N3, the GH releasing phase): http://www.acnp.org/...1000095/CH.html

 

Any thoughts?

Edited by NeuroGeneration, 27 February 2015 - 02:49 AM.

[misterE]

Yes, you lowered your blood-sugar by eating more sugar. How is that possible? It's counterintuitive but: eating carbohydrates stimulates insulin which lowers blood-sugar, while restricting carbohydrates stimulates cortisol which raises blood-sugar, strange as it is, that is how it works in the body. In terms of increasing free-testosterone, that wouldn't provide much benefit. And in fact you would actually want most of your testosterone bound to SHBG, because SHBG is the main transport-protein that helps testosterone make it to its destination. Free-testosterone is substrate for dihydrotestosterone and estrogen. Free-fatty-acids (especially if they are polyunsaturated) inhibit the binding of testosterone to SHBG. The way to lower free-fatty-acids is once again to eat carbohydrates, which stimulates insulin, which inhibits lipolysis, which lowers FFAs, which helps with the binding of testosterone to its transport-protein. It has been shown that low-carb/high-meat diets decrease testosterone and raise cortisol compared to a high-carb/low-meat diets, which has the opposite effect.

Edited by misterE, 27 February 2015 - 04:14 PM.

[Hepoberman]

1) Of course, there are plenty of other things to consider but I wonder if you have ever assayed DHEA and/or considered supplementing DHEA?  If you are low in DHEA, supplementing it could raise T significantly. (It did for me) Are you getting enough Zinc? Quality sleep is important here too.

 

2) You could eliminate the eggs and see if the symptoms go away. (I'm skeptical) It sounds like you may benefit supplementing SamE.

 

It is amazing how we've followed very similar paths, thanks for your excellent articulation about so many of the details. I jumped on the high fat ketogenic band-wagon before I found I was carrying Apo4, D'oh! I've had to do a lot of backpedaling...

 

Hep

 

 

 

 

[resveratrol_guy]

So, here are my test results since changing to a moderately high carb diet. The first number is during low-carb paleo, the second number is from last week's blood test, with a diet containing 250+ g /day of carbs:

• HbA1c: 5.6 => 5.2
• Glucose (lab): 96 => 74 (!)
• Fructosamine: (not tested) => 216
• TSH: 1.82 => 3.17
• Thyroid Peroxidase AB: (not tested) => 10.3
• Insulin: <2 (!)
• FSH: (not tested) => 4.2
• Total Testosterone: 475 => 456 :(
• Free Test: 65.8 => 87 (not as high as I'd like at 29, but getting higher)
• Prolactin: 7 => 9.4

As you can see, my numbers are much improved ever since raising the carbs.

 

High blood sugar just has a bad name because it's usual clinical significance is (pre)diabetes. Not so in your case.

 

I think these results are consistent with what we'd expect after an insulin injection: your blood sugar drops and, subsequently, endogenous insultin production is downregulated. Indeed, that's the basis of the traditional treatment of type 2 diabetes, which is to administer insulin in order to combat high blood sugar. And it works just fine... for a while. The problem is that megadosing on carbs is a proxy for insulin injection in the sense that both will eventually result in a loss of insulin sensitivity. The response will be to require more insulin etc. in a positive feedback loop. This is a failed strategy for longterm remission from diabetes, unfortunately.

 

Yes, your ketogenic diet cranked up blood glucose (thank you, glucagon), but on the plus side, it did not seem to encourage your cells to mop up that glucose, so you were limiting AGE and ROS damage to your organelles, which is much more important than protecting blood-bourne proteins and easily replaced blood cells. It's not that I think that high blood sugar is preferable, but all else is not equal here: it's better to have glucose in the blood, than in the cells, especially when we're not currently exercising. And even under intense exercise, I'd much rather be burning premium gas (ketones) than regular unleaded (glucose) in order to minimize pollution.

 

Furthermore, anyone who has serious trouble adjusting to a ketogenic diet should strongly consider testing for their APOE4 status, as Hepoberman has evidently done. APOE4 is correlated with early onset Alzheimer's. And how would one best avoid that? According to Mary Newport, Richard Veech, and others, the use of a ketogenic diet is instrumental, despite the difficulty it presents to those individuals.

 

Edited by resveratrol_guy, 28 February 2015 - 07:36 PM.

[resveratrol_guy]

For the record, I just got my blood tests back, and I'm seeing evidence of insulin resistance, albeit less pronounced than what NeuroGeneration reported. Again, I don't think that this is metabolically equivalent to the effect of eating chips and drinking cola all day. But here is the data, for what it's worth.

 

[Brian]

This has to do with an ancient adaptation to "ketosis of starvation", when glucose is deliberately ignored by the skeletal muscles as 'protein-sparing' strategy.

 

Interestingly the mechanism for this appears to have been discovered in 2015. A class of long-theorized hormone called decretins. In flies the hormone has been named limostatin, in humans it appears to be Neuromedin U. This hormone can temporarily suppress insulin secretion during refeeding after fasting.

 

Researchers discover insulin-decreasing hormone in flies, humans

https://med.stanford...ies-humans.html

[xEva]

This has to do with an ancient adaptation to "ketosis of starvation", when glucose is deliberately ignored by the skeletal muscles as 'protein-sparing' strategy.

 
Interestingly the mechanism for this appears to have been discovered in 2015. A class of long-theorized hormone called decretins. In flies the hormone has been named limostatin, in humans it appears to be Neuromedin U. This hormone can temporarily suppress insulin secretion during refeeding after fasting.
 
Researchers discover insulin-decreasing hormone in flies, humans
https://med.stanford...ies-humans.html

 
I don't think it's the same. From the posts of people who fasted long-term and then went for this type of tests, they had normal insulin levels -- immediately after the fast. Looks like this newly discovered hormone works during a fast and just as they say in the article, it insures that nutrients are not used up right away (and 'nutrients' are produced during a fast: for example, glucose is produced in Cori cycle after physical activity).

Again, what the OP described is common after a fast or ketogenic diet and is similar to type 2 diabetes, which comes with high insulin levels. This high/normal insulin level fails to clear the glucose from the circulation though and the mechanism has been known for a long time: free fatty acids, namely palmitic acid, competes with glucose for entrance to Krebs cycle, displacing it.

This is the true protein-sparing mechanism and it works independently from insulin levels. It is triggered by high FFAs. What happens in type 2 diabetes is that insulin activates the pumps on the cell wall that bring glucose in, but high FFAs don't let it be utilized, which leads to toxic buildup of glucose in the cytosol. This causes the cell to start pumping glucose out. Insulin here only aggravates the situation. Remove FFAs and it all goes to normal. Being obese leads to chronically high levels of FFAs and that's how loosing excess fat 'cures' type 2 diabetes or why increasing carbs and eschewing fats helped the OP to normalize his blood sugar after a stretch on a ketogenic diet.

This has nothing to do with this new hormone though. The protein-sparing mechanism 'forbids' skeletal muscles to use glucose. They 'must' use FFAs and leave glucose for the cells that depend on it exclusively.

Edited by xEva, 23 January 2016 - 12:41 AM.