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Ketoginic Diet, Insulin, A1C and Blood Glucose

insulin a1c keto

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#31 Kinesis

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Posted 09 October 2017 - 05:36 PM

How about instead of the flat-out ketogenic diet, consider a low carbohydrate, low glycemic diet?  High carb, high glycemic is notorious for kiting blood glucose and insulin, but that doesn't necessarily mean the opposite extreme is the only alternative.  Keeping overall carbs low and quickly absorbed carbs (especially simple sugars) very low may not qualify as "ketogenic", but that doesn't mean it's not better than high carb high sugar.  Low carb, slow carb.

 

Eating lots of vegs, adequate protein, and plenty of high quality fats while keeping overall calories moderate is sure one heck of a lot better than either the standard American diet or the low fat, high carb alternative that was recommended for so long.  I just don't believe it's necessary or beneficial to go the opposite extreme except for limited periods to achieve some specific therapeutic effect (addressing epilepsy, etc.)


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#32 Nate-2004

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Posted 09 October 2017 - 07:50 PM

I don't know what's true anymore. 

 

I actually looked for Fung's cited source of that chart and while I see the journal exists I can't get the full text of it on sci-hub to come up. 

 

There are a lot of claims to the contrary and none of those citations state anything specifically about insulin resistance or sensitivity, it merely infers that conclusion from the data regarding insulin levels. So it's interpretive I suppose.

 

The claims that insulin resistance is higher in the morning explain that cortisol also spikes simultaneously as well as growth hormone and that in older people, since growth hormone doesn't spike much anymore, it's not as much of a problem. Who knows though? I have searched the web up and down and can't find anything conclusive or consistent on when insulin sensitivity is highest. 

 

I do agree with some posts out there saying that insulin sensitivity will soon begin to dominate talks about weight loss. 

 

As I said before though, Dr. Fung is not an expert in the field of endocrinology (he's a nephrologist) and I realize it's an argument from authority for now, but I will try to gather citations if I can.

 

 


Edited by Nate-2004, 09 October 2017 - 07:51 PM.


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#33 Nate-2004

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Posted 09 October 2017 - 07:55 PM

How about instead of the flat-out ketogenic diet, consider a low carbohydrate, low glycemic diet?  High carb, high glycemic is notorious for kiting blood glucose and insulin, but that doesn't necessarily mean the opposite extreme is the only alternative.  Keeping overall carbs low and quickly absorbed carbs (especially simple sugars) very low may not qualify as "ketogenic", but that doesn't mean it's not better than high carb high sugar.  Low carb, slow carb.

 

Eating lots of vegs, adequate protein, and plenty of high quality fats while keeping overall calories moderate is sure one heck of a lot better than either the standard American diet or the low fat, high carb alternative that was recommended for so long.  I just don't believe it's necessary or beneficial to go the opposite extreme except for limited periods to achieve some specific therapeutic effect (addressing epilepsy, etc.)

 

I'm coming off the keto diet back onto my normal diet which I try to keep in check that way but it's not always easy. 

 

However, something is undeniable here, my tremors have improved by 90% and the degree of tremor has reversed itself back by years of progression. I don't know if it's keto, or the mitochondrial dynamics protocol yet but I will soon find out what it is because this is unprecedented. You can actually see an improvement in my Overwatch scores as a result of this.

 

Personally I really hope it's just the fission/fusion manipulation. That would be a lot easier than having to eat keto just so I don't shake like a leaf all the time and freak people out and get embarrassed at every turn and find myself unable to enjoy life or function or operate a video game or iphone.


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#34 Kinesis

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Posted 09 October 2017 - 08:09 PM

I'm coming off the keto diet back onto my normal diet which I try to keep in check that way but it's not always easy. 
 
However, something is undeniable here, my tremors have improved by 90% and the degree of tremor has reversed itself back by years of progression. I don't know if it's keto, or the mitochondrial dynamics protocol yet but I will soon find out what it is because this is unprecedented. You can actually see an improvement in my Overwatch scores as a result of this.
 
Personally I really hope it's just the fission/fusion manipulation. That would be a lot easier than having to eat keto just so I don't shake like a leaf all the time and freak people out and get embarrassed at every turn and find myself unable to enjoy life or function or operate a video game or iphone.


Glad to hear something's working for you. It may well be that keto is the thing for now, but not necessarily forever. You could try liberalizing it occasionally and see how you do. With a little trial and error over time you'll find your personal optimum.
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#35 Advocatus Diaboli

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Posted 09 October 2017 - 08:20 PM

Here is an anecdotal account of essential tremor and a ketogenic diet. Here is a study which associates octanoic acid with improvement in essential tremor. Octanoic acid can be be found in palm oil and in coconut oil, both of which can be used in MCT (medium chain triglycerides) ketogenic diets.


Edited by Advocatus Diaboli, 09 October 2017 - 08:21 PM.


#36 Nate-2004

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Posted 09 October 2017 - 08:35 PM

Here is an anecdotal account of essential tremor and a ketogenic diet. Here is a study which associates octanoic acid with improvement in essential tremor. Octanoic acid can be be found in palm oil and in coconut oil, both of which can be used in MCT (medium chain triglycerides) ketogenic diets.

 

When I saw that is when I decided to try keto.

 

I am taking MCT oil with my keto diet, it's in my coffee every day. This may be what is causing the improvement after all. I see that octanoic or caprylic acid (aka C:8) makes up a good chunk of MCT oil.

 

If that is the case, then all I need is more MCT oil.



#37 Advocatus Diaboli

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Posted 09 October 2017 - 08:48 PM

As Kinesis implies (post #34), a little experimentation with varying amounts of OA capsules or of MCT oil may save you the hassle of a full-blown keto diet.


Edited by Advocatus Diaboli, 09 October 2017 - 08:48 PM.


#38 Nate-2004

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Posted 09 October 2017 - 09:08 PM

I got a quick response from Bikman shared with his permission:

 


Hi Nathan.
 
I’m not sure how to explain the differences (I confess I’ve not taken the time to explore this).  The study Jason shares is certainly valid and he’s accurately representing it.  
 
Here are some studies with contrasting findings:
 
If we define insulin resistance as a state with hyperinsulinemia and (likely) hyperglycemia, a LCHF KD diet does not cause insulin resistance.  If, however, a person defines insulin resistance as a state with normal fasting insulin and hyperglycemia (which I would argue is not insulin resistance), some people would fall into this category.  The reasons for those are poorly understood, but could be a result of cortisol or glucagon regulation.
 
Ben

Benjamin T. Bikman, Ph.D.
Department of Physiology and Developmental Biology
 
Also a follow up e-mail, he's copied in Jason Fung
 
Sure.  
 
Also, it’s important to note that none of the publications referenced (by my and Jason) are not fasting insulin—they’re insulin levels following an OGTT.  I’m actually having a hard time finding a purely fasted circadian rhythm of insulin.  
 
Jason, what do you think about this?  Do you have data on humans from a purely fasted state?  I swear I’d seen something from Cahill once, but no luck finding it now...
 
Ben
 

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#39 Kinesis

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Posted 09 October 2017 - 09:23 PM

Octanoic acid btw is also known as caprylic acid and can be bought in capsules as a stand alone supplement, eg from Swanson’s. Asprey’s Bulletproof also markets an octanoic acid triglyceride, the eight carbon fraction of MCT, as “Brain Octane”.

Personally I prefer a less refined product marketed as “liquid coconut oil” that contains the 8, 10 & 12 carbon fatty acid fractions of coconut oil - around a third of it is the 8 - but just to put the options out there ...

#40 Nate-2004

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Posted 09 October 2017 - 09:33 PM

I use Viva Naturals MCT oil which is apparently 100% caprylic acid to my knowledge. I have heard bad and good things about the 12 carbon Lauric Acid not to be confused with Linoleic Acid.


Edited by Nate-2004, 09 October 2017 - 09:34 PM.

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#41 Chupo

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Posted 09 October 2017 - 09:41 PM

 

I got a quick response from Bikman shared with his permission:

 

 


Hi Nathan.
 
I’m not sure how to explain the differences (I confess I’ve not taken the time to explore this).  The study Jason shares is certainly valid and he’s accurately representing it.  
 
Here are some studies with contrasting findings:
 
If we define insulin resistance as a state with hyperinsulinemia and (likely) hyperglycemia, a LCHF KD diet does not cause insulin resistance.  If, however, a person defines insulin resistance as a state with normal fasting insulin and hyperglycemia (which I would argue is not insulin resistance), some people would fall into this category.  The reasons for those are poorly understood, but could be a result of cortisol or glucagon regulation.
 
Ben

Benjamin T. Bikman, Ph.D.
Department of Physiology and Developmental Biology
 
Also a follow up e-mail, he's copied in Jason Fung
 
Sure.  
 
Also, it’s important to note that none of the publications referenced (by my and Jason) are not fasting insulin—they’re insulin levels following an OGTT.  I’m actually having a hard time finding a purely fasted circadian rhythm of insulin.  
 
Jason, what do you think about this?  Do you have data on humans from a purely fasted state?  I swear I’d seen something from Cahill once, but no luck finding it now...
 
Ben
 

 

 

Thanks for sharing that. It sure is confusing. Two studies saying one thing and two saying the opposite.  

 

I don't eat breakfast myself. It tends to make me hungrier the rest of the day and I end up keeping on eating. Maybe it's because I'm more insulin resistant in the morning. My BS is also higher in the morning.
 



#42 Nate-2004

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Posted 09 October 2017 - 09:54 PM

Same here, I avoid breakfast but I have been doing some fats in the morning like MCT oil for the past 3 weeks... and boiled eggs at times.

 

The more I read the more I am realizing that it actually is the MCT oil... I am so pissed.  I knew about 1-octanol 6 years ago and if they had just used the normal popular name caprylic acid I might have discovered MCT oil and been done with it. Why did they have to hide it behind octanol and not even mention MCT oil? My guess, so they don't tip people off into just buying over the counter, rather than buying some expensive drug by the name "octanoic acid".


Edited by Nate-2004, 09 October 2017 - 10:14 PM.

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#43 Heisok

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Posted 10 October 2017 - 01:58 AM

Nate, unless they have a newer product, Viva is C8, and C10. The only reason that I looked is due to thinking that I had tried most brands with claims of 100% C8 Caprylic Acid. Some believe that the C10 is better for some issues, but I would have to dig around for who did the analysis, and when.

 

PS You are being very smart in my opinion to ease back in to the Carbs. Something else to consider for your next round is the type of protein, the amount at 1 meal and the timing. If I add 9 to 18 grams of protein from Collagen Peptides, I seem to have a larger move in post postprandial B.S. If I eat 40 or 50 grams of protein with my 4 or 5 pm meal, I seem to have a higher fasting B.S. the following day.

 

For a long time on VL Carb, I had the fasting B.S. a little over 100 to about 108. Not bad, but I also started with fasting B.S. of around 99 to 108 for many years. It was when I saw a level in the 110 plus range, I decide to try Keto LCHF. Since changing my protein intake to around 40 grams for my first meal around 1 pm, and no more than 20 if I eat around 4 or 5 pm, I am in the low 90's to high 80's

 

UPDATE:
We, Viva Naturals, have recently made the switch from palm-sourced MCT Oil to coconut-sourced MCT Oil; we have found coconut to be a more sustainable source of MCTs. Please note that the fatty acid percentages remain identical (60% C8 and 39.7% C10), so now you get the benefit of having the same concentration from a more sustainable and widely used source of capric and caprylic acid.
If you have any questions about this change, please feel free to contact me directly at vivian@vivanaturals.com.
Sincerely,
Vivian
Viva Naturals Customer Care see less

By Viva Naturals Customer Care on October 20, 2016


Edited by Heisok, 10 October 2017 - 01:58 AM.


#44 Nate-2004

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Posted 10 October 2017 - 02:58 AM

Yeah so today I had an apple with peanut butter and some beans, which was 30g more than yesterday. Tomorrow I'll probably have around 120 carbs. I was staying pretty low, under 30.

 

Interesting, I suppose C10 isn't bad, C8 is what I need for tremor though.  I get C18 from palm oil for fusion.


Edited by Nate-2004, 10 October 2017 - 02:59 AM.


#45 normalizing

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Posted 10 October 2017 - 03:28 AM

its interesting that you consume coffee regularly and dont actually get tremors from that? because personally, caffeine in general is all that causes tremors in me



#46 Nate-2004

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Posted 10 October 2017 - 04:02 AM

Tremors do worsen slightly with coffee because of the rise in norepinephrine. It's a tough tradeoff for the otherwise ridiculously good feelings it gives me. The effect of caprylic acid (if this is indeed the active ingredient) appears to be about double or triple the effectiveness of propranolol without any noticeable side effects.


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#47 Nate-2004

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Posted 10 October 2017 - 04:11 PM

Another comment from Jason Fung:

 

Dawn phenomenon is normal in everybody, but exaggerated in T2D. Early morning spike in counterregulatory hormones is normal, and to prevent increase blood glucose, there is also a rise in insulin.


#48 Kinesis

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Posted 10 October 2017 - 05:24 PM

I use Viva Naturals MCT oil which is apparently 100% caprylic acid to my knowledge. I have heard bad and good things about the 12 carbon Lauric Acid not to be confused with Linoleic Acid.


The nomenclature is pretty scattered. Usually things called "MCT" oil contain the octanoic and decanoic (C8 & C10) acids aka caprylic and capric acids.  When in doubt, read the label.  "Liquid coconut oil" generally contains dodecanoic or lauric acid (C12) in addition to the C8 & C10.  I specifically use the latter because I want the lauric acid as well.  It is a medium chain fatty acid despite its usual exclusion in so-called MCT oil.  Ordinary coconut oil, in contrast, also contains myristic acid (C14) and a little of the longer chain carboxylic acids as well, though that's not the only difference; the proportion of C8 in liquid coconut oil is quite a bit higher than in coconut oil per se.

 

Part of the reason for my "liquid coconut oil" preference is that I use lots of it (more like a food than a supplement), just like most people would use vegetable oil, on salads (along with olive oil), in scrambled eggs, basically anything where it isn't going to get cooked at high temperature.  Though it is more heat tolerant than the concentrated C8 or C8-C10.  Because I use so much of it, I'm going to get plenty C8 without any necessity of adding a more concentrated product.  I also like the slightly soapy quality of the lauric acid containing products ... (lauric acid salts are ubiquitous in soaps and shampoos; possibly this standalone commercial value helps account for its absence in many MCT products) .. it may be nothing more than psychological, but I can almost picture the stuff helping keep my arteries scrubbed clean ....


Edited by Kinesis, 10 October 2017 - 05:50 PM.

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#49 Nate-2004

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Posted 11 October 2017 - 01:06 PM

I just retested my fasted blood glucose this morning and it was 133...

 

This is my third day easing off keto. I don't know what is going on anymore.

 

However I did go out to a concert and drank a bit last night and ultimately broke down and ate a piece of key lime pie, but drinking should result in lower blood sugar not higher no? I don't know. When I last tested my A1C it was 5.5% which worried me. I hate that I can't just test it whenever, I have to go to the doctor and get a lab ordered and then go to the lab and do that. It's frustrating.

 

http://care.diabetes...tent/24/11/1888

 

Here's an article on dawn phenomenon:

 

https://www.diabetes...awn-phenomenon/


Edited by Nate-2004, 11 October 2017 - 01:20 PM.


#50 Nate-2004

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Posted 11 October 2017 - 02:21 PM

I had a cup of coffee with half-and-half and splenda, with some of the mct oil and now my BG is 150 aaaaaaaa, what is going on? Am I suddenly diabetic? Thinking of getting an A1C done today or at least get an at home kit which I just discovered exists.



#51 Kinesis

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Posted 11 October 2017 - 03:59 PM

If you can't keep your FBG in a reasonable range without doing full-on keto, what about talking to your doc about metformin?  Possible knock-on life extension and health benefits...

 

Other possibilities ... intermittent fasting (I usually eat just once a day) ... moderate calorie restriction (article in this month's (2017-11) Life Extension magazine entitled "Calorie Restriction Slashes Glucose".  Combined with moderate low carb ...



#52 Nate-2004

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Posted 11 October 2017 - 04:52 PM

The CVS at home test I did today said my A1C is at 5.3% so depending on just how accurate that test is, my FBG is inexplicable... unless that's separate. I'd heard high A1C means more significant dawn phenomenon.


Edited by Nate-2004, 11 October 2017 - 05:04 PM.


#53 pamojja

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Posted 11 October 2017 - 06:01 PM

Don't trust a HbA1c very much, it can be altered by many things, like higher ascorbic acid intake, or shortened time of glycated haemoglobulin with certain kinds of anemia. My calculated A1c from measured mean serum glucose levels showed it actually should measure in average 0.5 higher than it does.

 

I use http://www.dtu.ox.ac...lator/index.php for getting a more accurate picture of my insulin resistance. You need a fasting insulin or C-peptide test along with fasting glucose for its calculations.


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#54 Nate-2004

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Posted 11 October 2017 - 10:12 PM

My glucose meter only tests glucose or ketones I dunno how to test insulin.

 

I don't have anemia and I don't take much vitamin C, though I get plenty through lemons in my smoothie or ice water and sometimes as I'm coming off the fission part of the fission/fusion cycle lately but that's kind of new and A1C is a measure of 8 weeks.


Edited by Nate-2004, 11 October 2017 - 10:12 PM.


#55 tunt01

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Posted 11 October 2017 - 10:14 PM

Don't trust a HbA1c very much, it can be altered by many things, like higher ascorbic acid intake, or shortened time of glycated haemoglobulin with certain kinds of anemia. My calculated A1c from measured mean serum glucose levels showed it actually should measure in average 0.5 higher than it does.

 

I use http://www.dtu.ox.ac...lator/index.php for getting a more accurate picture of my insulin resistance. You need a fasting insulin or C-peptide test along with fasting glucose for its calculations.

 

How do we interpret the values in this calculator?  Is there some kind of chart/graphic/table associated with these values?  I'm not even sure what they even correspond to.



#56 pamojja

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Posted 11 October 2017 - 10:25 PM

How do we interpret the values in this calculator?  Is there some kind of chart/graphic/table associated with these values?  I'm not even sure what they even correspond to.

 

The results given are calculated insulin resistance with a normal range of ≤ 1.2 (ratio),

insulin sensitivity, and beta-cell function. Both of the later with a normal range of > 80 %. Don't remember from which paper I got those ranges.

 

 

My glucose meter only tests glucose or ketones I dunno how to test insulin.

 

Fasting insulin or C-peptide can be tested by a GP.



#57 Heisok

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Posted 11 October 2017 - 11:01 PM

mrkosh1,

 

 I hope you will not mind my answering a couple questions with my perspective from using MCT's for around 3 years.

 

#1 I started with the C8, C10 and a little C12 versions. I was very careful to start slow. Maybe 1 teaspoon a day, working up to about 3 teaspons or more spread out. Then I switched to versions like Nate has been using with C8 and C10, but no C12. I still had no problems.

 

When "100 %" C8 became more common I took Brain Octane. I was very careful to start slow- 1 teaspoon a few times a day. I worked up to around 2 tablespoons per day. Never a problem. In total, I have used at least 12 months of Brain Octane, but maybe more. I have tried several others less expensive brands with the first one compared side to side with Brain Octane. I tasted them directly. I could see nor feel any difference. I used the brand for 10 bottles. I decided to try another brand, and it is at least as good as the other 2, maybe better. I decided to try a fourth brand, and it is at least as good. I have 3 brands right now.  I am at around 3 tablespoons per day. Some of the brands give a percentage range, which seems to be 95% or greater, with 1 brand claiming a consistent over 99% pure C8. Bulletproof does not disclose their exact percentage. I have not tested this enough to be confident, so I am not sure, but I think that if I take too much, I get a little dizzy.

 

# 2. You can put MCT on vegetables or salad or meat or legumes or anywhere you might use an oil. I do not cook with it. I also use it in coffee, but not with butter as I feel inflammation in my hands, some general stiffness and puffiness. I use carefully prepared homemade Ghee. The several brands of Ghee which I tried never tasted as good. I blend mine Ghee/Mct coffee with an immersion blender. It does not emulsify as well as using butter.

 

 

1) My concern with MCT Oil is the laxative effect. A few years ago I was consuming coconut oil as part of a low carb diet but before I could boost my dosage I ended up having horrible diarrhea (although I think I was overdoing it physically at the time too which also enhanced the effect). What dose are you taking and have you noticed any laxative effect?

 

2) How do you mix MCT Oil with your coffee? Do you blend it like the folks who make bulletproof coffee with grass fed butter do?

 

Added: I am not sure if I would recommend mixed C8 C10 C12 or whatever combination such as C8 and C10, of these to everybody. I will post why, with some links later when I have time.


Edited by Heisok, 11 October 2017 - 11:05 PM.


#58 Heisok

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Posted 11 October 2017 - 11:42 PM

This is one reason why I stick to C8 only MCT's.
 

http://www.longecity...es-and-ketosis/

 

I found some of Petro Dobromylskyj's writing, and subsequent comments concerning MCT's, butter and other fats related to insulin. I was a little worried after the first post in 2009.

 

In 2009: "Physiological insulin restisance: Guess what?" http://high-fat-nutr...ance-guess.html

 

In 2012: "Protons: The pancreas"  http://high-fat-nutr...s-pancreas.html

 

I was somewhat relieved by this statement in his 2012 writing:

 

"Please excuse the C8 value; as we all know, MCTs are shunted directly to the liver via the portal vein. They do not seem to feature too prominently in pancreatic superoxide generation and insulin secretion. It would take a ton of reading to see why and how they are handled differently to longer chain fatty acids. For the time being let's stay looking at C16 and longer as these make a much tidier story..."

 

My takeaway is to be more careful with my MCT intake. It has crept to a higher level due to attempting to maintain my weight after dropping my 24 hour fermented strained greek yogurt. Got a little worried about the amount of Casein that eating 12 ounces per day of that I was getting. Sorry to have taken your topic off on a tangent.

 

P.S. I discontinued Yogurt a long time ago.

 

This is another excellent thread about the possible insulin resistance effects of Keto, and I highly recommend reading it. I was a little afraid that you were going back up on Carbs too fast, but did not want to speak out of line.

 

http://www.longecity...arb-keto-diets/

 

Small quote: "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???"

 

 

 


Edited by Heisok, 11 October 2017 - 11:43 PM.


#59 Chupo

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Posted 12 October 2017 - 12:27 AM

I had a cup of coffee with half-and-half and splenda, with some of the mct oil and now my BG is 150 aaaaaaaa, what is going on? Am I suddenly diabetic? Thinking of getting an A1C done today or at least get an at home kit which I just discovered exists.

 

Before a glucose tolerance test, low carbers are recommended to consume 150 grams of carbs a day for three days before the test. Try that and then test on the fourth day.

 

HbA1c can be lower than expected on a low carb diet because you don't have the post-meal excursions. HbA1c could also be lower than expected because of the protective effects of ketones against glycated hemoglobin which is what HbA1c measures. http://www.ncbi.nlm....pubmed/24535268

 

Have you ever tried a very low fat, starch-based diet? My fasting blood sugar was never lower than when I did that, 70s - 80s. When keto, I'm in the 90s - 100s. You do have to adapt to it though. When I first did it, I got hypoglycemic symptoms a couple hours after eating - hunger and shakiness. When I stuck it out though, the symptoms disappeared after about three days.


Edited by Chupo, 12 October 2017 - 12:46 AM.

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#60 Heisok

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Posted 12 October 2017 - 04:03 AM

My preference for C8 has no relevance to your Essential Tremor. If the theory is that the MCT oil is helping, then why switch. Looking at the makeup of the Viva MCT at 60 % C8 and 39% C10, it is possible that they both play a role, but if not you are still getting the C8. The information which you mentioned for the E.T. I believe used C8 Octanoic or Caprylic Acid.

 

I mentioned in the other thread that I had read that the C10 Capric Acid (Decanoic Acid) worked for some things which C8 Caprylic Acid Octanoic did not. You likely already know to take what I write with scepticism, especially when looking at these studies. Here is what I was referring to.

 

"Recently, it has been established that decanoic acid has antiseizure effects at clinically relevant concentrations in vitro and in vivo (Chang et al., 2013; Wlaz et al., 2015) but octanoic acid does not, and with previous in vivo pharmacokinetic data indicating that decanoic acid penetrates the blood–brain barrier (Oldendorf, 1973), these data suggest that decanoic acid directly contributes to the therapeutic effect of the MCT ketogenic diet. Indeed, in vitro, decanoic acid is more potent than valproic acid [a branched chain fatty acid isomer of octanoic acid, that is commonly used in the treatment of epilepsy (Chang et al., 2013), and which has been shown to act on phosphoinositide signalling in seizure control (Xu et al., 2007; Chang et al., 2012, 2014a)]. Thus, it is unclear if ketones or decanoic acid provide direct, acute antiseizure effects during administration of an MCT diet, and by what mechanism. These questions are addressed here."

 

"Seizure control by decanoic acid through direct AMPA receptor inhibition"

 

"The medium chain triglyceride ketogenic diet is an established treatment for drug-resistant epilepsy that increases plasma levels of decanoic acid and ketones. Recently, decanoic acid has been shown to provide seizure control in vivo, yet its mechanism of action remains unclear. Here we show that decanoic acid, but not the ketones β-hydroxybutryate or acetone, shows antiseizure activity in two acute ex vivo rat hippocampal slice models of epileptiform activity. To search for a mechanism of decanoic acid, we show it has a strong inhibitory effect on excitatory, but not inhibitory, neurotransmission in hippocampal slices. Using heterologous expression of excitatory ionotropic glutamate receptor AMPA subunits in Xenopus oocytes, we show that this effect is through direct AMPA receptor inhibition, a target shared by a recently introduced epilepsy treatment perampanel. Decanoic acid acts as a non-competitive antagonist at therapeutically relevant concentrations, in a voltage- and subunit-dependent manner, and this is sufficient to explain its antiseizure effects. This inhibitory effect is likely to be caused by binding to sites on the M3 helix of the AMPA-GluA2 transmembrane domain; independent from the binding site of perampanel. Together our results indicate that the direct inhibition of excitatory neurotransmission by decanoic acid in the brain contributes to the anti-convulsant effect of the medium chain triglyceride ketogenic diet"

 

https://www.ncbi.nlm...les/PMC4805082/

 


Edited by Heisok, 12 October 2017 - 04:05 AM.






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