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High Blood Sugar On Keto

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Reactive Hypoglycemia

Reactive hypoglycemia is a condition in which the body reacts to a perceived catastrophic drop in blood sugar. I say perceived because during an episode, the blood sugar readings may be in the normal range, but still "feel" like low blood sugar to the person having the reaction. In my experience, hypoglycemia happens to most people when first beginning a low carb, ketogenic diet. It may be especially strong in people who have already developed insulin resistance or pre-diabetes from a chronic excess of carbohydrate intake. There are different types of low blood sugar causes. Transient hypoglycemia normally happens when most people who have been eating a high carb diet drastically reduce carbohydrate intake for the first time. This type happens during the first several weeks of carb reduction because the body has not had time to create the enzymes or metabolic state to burn internal fat stores for fuel. Basically there is a gap in the amount of carbohydrate available for fuel, and the process of accessing fat stores for fuel. The lack of fuel sources results in transient low blood sugar. Reactive hypoglycemia is more of an acute reaction to a very high carb meal. For instance, when Continue reading >>

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  1. 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]

  2. StevesPetRat

    Try thiamine.
    If you require more details, ask.

  3. 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.

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