There was a little girl, Who had a little curl, Right in the middle of her forehead When she was good She was very good indeed But when she was bad she was horrid. So goes the familiar poem by Henry Wadsworth Longfellow, and so goes most of our low-carb diets I suspect. When we are in diet mode and are deeply committed, we are very good indeed, but when we break and hit the carbs (and this includes yours truly) we are horrid. A paper in this week’s JAMA presents data confirming what I’ve long suspected: carb bingeing now and then could actually cause worse free radical damage than regularly eating more carbs on an ongoing basis. The paper titled Activation of Oxidative Stress by Acute Glucose Fluctuations Compared with Sustained Chronic Hyperglycemia in Patients With Type II Diabetes shows that patients with diabetes who have fluctuations in their blood sugars incur more free radical damage than those with high but not fluctuating blood sugar levels. Before we get into the nitty gritty of the paper, I will step back a little and go over some of the biochemistry involved so that the data will be more understandable to those who might not have a technical background. First, let’s look at how blood sugar is measured. The standard way is to draw blood (usually after the patient has fasted for 12-14 hours) and test it for a blood sugar level. Although this is the way that diabetics were monitored for years, it’s not a particularly accurate means of managing patients with diabetes. The fasting blood sugar test itself is reliable, but it only tells what the blood sugar is at the precise moment the blood was drawn–not what it was the week before or the day before or even the hour before. The typical drill was that diabetic patients would come to the office, have their Continue reading >>
How You Can Have High Blood Sugar Without Carbs
How You Can Have High Blood Sugar Without Carbs Can you have high blood sugar without carbs? Well, its important to look at common beliefs about high blood sugar first. High blood sugar is bad. Carbohydrates raise blood sugar. Therefore carbohydrates are bad. The theory is simple, and yet incredibly flawed. The truth is, you can have chronically high blood sugar even while religiously avoiding every starch and sugar in sight. Low-carb forums are littered with posts asking a very relevant question: Why is my blood sugar so high when Im not eating any carbs? The answer is simple, yet often overlooked. The Hormone that Raises Blood Sugar: No Carbohydrates Required If the body were an engine, glucose would be its fuel. Most people think glucose only comes from carbohydrates (sugar and starch), but protein can also be turned into glucose when there arent enough carbs around to do the job. This is called gluconeogenesis, and its performed by one of the major stress hormones cortisol. When you have high cortisol levels (from diet, lifestyle, etc.), the cortisol rapidly breaks down protein into glucose, which can raise blood sugar levels considerably. For some folks, this results in chronically high blood sugareven if they are on a low-carb diet. The trouble is, cortisol isnt just breaking down the protein you eat. Its doing something far more destructive. The body is quite a smart machine, and it has no problem taking detours to get energy if necessary. If your body isnt getting the energy it needs from your diet, it has a back-up source: its own tissue. It sounds kind of cannibalistic, eating your own lean body tissue for energy. I mean, I seriously doubt any one of you would relish cutting off a chunk of your leg for dinner. I know I wouldnt. But every time your body uses c Continue reading >>
Is Your Fasting Blood Glucose Higher On Low Carb Or Keto? Five Things To Know
This past spring, after 18 months of great success on the keto diet, I tested my fasting blood sugar on my home glucose monitor for the first time in many months. The result shocked me. I had purchased the device, which also tests ketones, when I was diagnosed with pre-diabetes in the fall of 2015. As I embarked on low-carb keto eating, I tested my blood regularly. Soon my fasting blood sugar was once again in the healthy range. I was in optimal ketosis day after day. Not only that, I lost 10 lbs (5 kg) and felt fantastic — full of energy with no hunger or cravings. Before long I could predict the meter’s results based on what I was eating or doing. I put the meter away and got on with my happy, healthy keto life. When my doctor ordered some lab tests this spring, I brought the meter out again. While I had no health complaints, excellent blood pressure and stable weight, she wanted to see how my cholesterol, lipids, HbA1c, and fasting glucose were doing on my keto diet — and I was curious, too. To check the accuracy of my meter against the lab results, on the morning of the test I sat in my car outside the clinic at 7:30 am, and pricked my finger. I was expecting to see a lovely fasting blood glucose (FBG) of 4.7 or 4.8 mmol/l (85 mg/dl). It was 5.8! (103 mg/dl). What? I bailed on the tests and drove home — I didn’t want my doctor warning me I was pre-diabetic again when I had no explanation for that higher result. The next morning I tested again: 5.9! (104). Huh??? For the next two weeks I tested every morning. No matter what I did, my FBG would be in 5.7 to 6.0 (102 to 106 mg/dl), the pre-diabetic range again. One morning after a restless sleep it was even 6.2 mmol/l (113 mg/dl). But my ketones were still reading an optimal 1.5-2.5 mmol/l. I was still burnin Continue reading >>
- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
- Got pre-diabetes? Here’s five things to eat or avoid to prevent type 2 diabetes
- Got pre-diabetes? Here's five things to eat or avoid to prevent type 2 diabetes
Low Carb Vs. High Carb - My Surprising 24-day Diabetes Diet Battle
Twitter summary: What I learned from doubling my carb intake: the same average blood sugar, but four times as much hypoglycemia, more work, stress, & danger. As a teenager, I ate a high carb diet that included lots of Goldfish crackers, white sandwich bread, pasta, and white potatoes. It was tasty, but it put my blood sugars on a wild roller coaster every single day. Things turned around in college when I learned about nutrition, got on CGM, and spent time with health conscious friends. I soon realized that eating less than 30 grams of carbs at one time was a complete gamechanger. I’ve stuck with that approach ever since. But is this lower carb method actually better for my blood sugars, or have I just been fooling myself? To find out, I took on a somewhat terrifying self-tracking experiment: 12 days of my usual, lower-carb diet, which averaged 146 grams of carbs per day (21% of daily calories). My carbs were primarily from nuts, seeds, vegetables, and a bit of fruit. 12 days of a higher-carb, high whole-grain diet, which averaged 313 grams of carbs per day (43% of my daily calories). My sources of carbs were NOT junk food: plain oatmeal, whole wheat bread, quinoa, wild rice, and fruit. Neither of these was unrealistic. My lower-carb diet was nowhere near Atkins level (20 grams per day), and the higher-carb diet was consistent with the “average” 45% carb diet in people with diabetes (according to ADA). Even though this was a one-person (n=1) experiment, I wanted to be as scientific and fair as possible: eating whole, unprocessed foods in both periods; counting and tracking every single gram of carbohydrate (LoseIt! app); wearing CGM 24/7 and downloading the glucose data to document what happened (Dexcom G5 and Clarity); taking insulin before meals (5-15 minutes pr Continue reading >>
High Blood Sugar In Ketogenic Dieters! Plus A Special Surprise (hint: Genotypes And Metabolism)!
A while ago Michael and I were discussing future article topics. There are truly a plethora of avenues to go down in this area of research and there is no lack of things to research and comment on. But even though I have a couple of pretty cool MCT articles sitting around on my desk, I want an interesting topic. I want something new. Something challenging. Besides, everyone is drinking the MCT koolaid these days. It’s become passe. (Also, it upsets my stomach and I have a personal vendetta against it. So there.) What’s new? There has to be something new! Michael pointed me to one of his old articles on physiological insulin resistance as an idea. I brushed it off at first. Dismissed it as a quirk. But then I thought about it. WHY does blood glucose rise in response to a low carb diet? It truly is an interesting question. What does it say about low carb diets if they induce an almost diabetic effect on circulating glucose? Thus my research began. This short abstract confirmed that it is normal for people on low carb diets to experience a rise in blood glucose levels. Because it’s a non-open journal (shame!), there’s a one-sentence explanation given: A decrease in first-phase insulin secretion may partially contribute to the short-term LC/HFD-induced increase in postprandial plasma glucose levels. First phase insulin secretion? There’s a first phase? So… There’s more than one phase to insulin secretion? I had no idea. Call me ignorant but I had no idea until this point that there was more than one phase to insulin secretion. This article delves deeper into the signaling involved in (what I learned is called) biphasic insulin secretion. The first phase of insulin secretion lasts approximately 10 minutes, and the second phase of insulin secretion picks up afte Continue reading >>
20 Reasons For Blood Sugar Swings
Upswing: Caffeine Your blood sugar can rise after you have coffee -- even black coffee with no calories -- thanks to the caffeine. The same goes for black tea, green tea, and energy drinks. Each person with diabetes reacts to foods and drinks differently, so it's best to keep track of your own responses. Ironically, other compounds in coffee may help prevent type 2 diabetes in healthy people. Many of these will raise your blood sugar levels. Why? They can still have plenty of carbs from starches. Check the total carbohydrates on the Nutrition Facts label before you dig in. You should also pay attention to sugar alcohols such as sorbitol and xylitol. They add sweetness with fewer carbs than sugar (sucrose), but they may still have enough to boost your levels. One study found that people with type 2 diabetes who switched to a vegan (or all vegetable-based) diet had better blood sugar control and needed less insulin. A boost in fiber from whole grains and beans might play a role, by slowing down the digestion of carbs. But scientists need more research to know if going vegan really helps diabetes. Talk to your doctor before you make major diet changes. Blood sugar can dip dangerously low during shut-eye for some people with diabetes, especially if they take insulin. It's best to check your levels at bedtime and when you wake up. A snack before bed may help. For some people, blood sugar can rise in the morning -- even before breakfast -- due to changes in hormones or a drop in insulin. Regular testing is important. One option is a continuous blood glucose monitor, which can alert you to highs and lows. Physical activity is a great health booster for everyone. But people with diabetes should tailor it to what they need. When you work out hard enough to sweat and raise your h Continue reading >>
Will Low-carb Diets Cause Blood Sugar Levels To Drop?
Video of the Day If you're accustomed to eating a very high-carb diet and suddenly switch to a very low-carb diet, you could experience rather dramatic drops in your blood sugar during the first few days or weeks of your transition. This low blood sugar can cause notably uncomfortable side effects and intense cravings. Carbs and Blood Sugar Your body converts consumed carbohydrates into glucose, a type of sugar. When the glucose enters your bloodstream, it leads to an increase in your blood sugar level. The pancreas produces insulin in response to spikes in blood sugar, which helps your body store the sugar for energy. This insulin release subsides when your cells absorb the sugar and your levels stabilize. In a healthy body, the surge of blood sugar and insulin is relatively moderate and keeps you evenly motoring through your day. When you eat lots of carbohydrates, your body's blood sugar remains consistently high and your system constantly pumps out insulin. This chronic elevation of blood sugar and release of insulin causes inflammation, an increase in fat storage and an inability to burn stored fat. Chronically high blood sugar levels increase your risk of disease, including heart disease and type 2 diabetes. You crave carbohydrates regularly for energy, because your body isn't efficient at using stored fat for fuel. How a Low-Carb Diet Impacts Blood Sugar If you regularly consume a large amount of carbohydrates, especially refined ones like white bread and soda, you may experience a notable drop in blood sugar when you drastically reduce your carb intake. In the first week of carb reduction, your body will seek to maintain your high sugar intake. You'll crave carbohydrates and may even feel weak because your body hasn't yet become efficient at burning fat for fuel Continue reading >>
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Why Low-carb Diets Aren’t The Answer
What raises blood sugar? The simple answer is carbohydrates. So why not just yank them out of your diet like weeds in your garden? Why not quash blood sugar by swearing off bread, pasta, rice, and cereal? Been there, done that. The low-carb craze is on the downswing, and that’s a good thing because over the long haul, very low carb diets simply aren’t good for you, as you’ll discover in this chapter. That doesn’t mean it’s not smart to cut back on carbs—but don’t go crazy. When low-carb diets first became popular, they seemed to be a breath of fresh air after the low-fat (and high-carb) diets that preceded them. Remember low-fat cookies, lowfat snack cakes, and low-fat everything else? With low-carb diets, suddenly people could load up on bacon and still lose weight as long as they were willing to eat hamburgers without buns and pretty much give up sandwiches and spaghetti. People were amazed at how effective these diets could be. Weight loss could happen very quickly, sometimes within days. And amazingly, it often seemed to come with added health benefits, including lower cholesterol, blood pressure, and triglycerides (blood fats linked to heart attacks.) The most extreme kind of low-carb diet was pioneered by the late Robert Atkins, M.D., whose first book, Dr. Atkins’ Diet Revolution, came out in 1972. It promised quick and long-lasting weight loss and prevention of chronic disease, all while allowing high-fat steak and ice cream. Since then, other, more moderate low-carb diets have allowed small amounts of carbohydrate-rich foods, but they still cut out most grains as well as starchy vegetables and even fruit. The Downsides of These Diets The Atkins diet and the many other low-carb diets that followed in its footsteps have turned out to be less effect Continue reading >>
Dear Mark: Does Eating A Low Carb Diet Cause Insulin Resistance?
157 Comments Despite all the success you might have had with the Primal way of life, doubts can still nag at you. Maybe it’s something you read, or something someone said to you, or a disapproving glance or offhand comment from a person you otherwise respect, but it’s pretty common when you’re doing something, like giving up grains, avoiding processed food, or eating animal fat, that challenges deeply-and-widely held beliefs about health and wellness. It doesn’t really even matter that you’re losing weight or seem to be thriving; you may still have questions. That’s healthy and smart, and it’s totally natural. A question I’ve been getting of late is the effect of reducing carb intake on insulin sensitivity. It’s often bandied about that going low carb is good for folks with insulin resistance, but it’s also said that low carb can worsen insulin resistance. Are both true and, if so, how do they all jibe together? That’s what the reader was wondering with this week’s question: Hi Mark, I’ve been Primal for a few months now and love it. Lowering my carbs and upping my animal fat helped me lose weight and gain tons of energy (not too shabby for a middle-aged guy!). However, I’m a little worried. I’ve heard that low carb diets can increase insulin resistance. Even though I’ve done well and feel great, should I be worried about insulin resistance? Do I need to increase my carb intake? I always thought low carb Primal was supposed to improve insulin function. Vince Going Primal usually does improve insulin sensitivity, both directly and in a roundabout way. It improves directly because you lose weight, you reduce your intake of inflammatory foods, you lower systemic inflammation (by getting some sun, smart exercise, omega-3s, and reducing or dea Continue reading >>
Low Carb - But High Sugars - Advice Please!
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Low carb - but high sugars - advice please! I wonder if I could get your thoughts. I'm T1, and had a bad hypo last year - following this I decided to go on a low carb diet, to limit the amount of insulin in my system at any one time. I'm much happier doing this, and can't now imagine going back to a high carb diet. I made the transition to low carb fairly slowly, and I did lose about 8kg in body weight (possibly as I wasn't really replacing the lost carb calories with protein/fat) - however, for the last 4/5 months, my average daily carb intake has been about 45-65g, and my weight loss seems to have now plateaued, as it's been fairly constant over this time. The low carb diet has certainly help control my sugar levels, with far less swing in the highs and lows, and generally confined to a narrower range - however, in the last month or so, I've found that I need much more insulin than normal, to maintain sugars in a good range. My long-standing ratio of 1u/10g carb just isn't working (by a long way), and sugars are frequently in the 12-15 range. Even if I take a 3 unit correction dose, the sugars might only reduce by say 2 or 3 mmol. This is very unusual for me - having been diabetic for around 15 years, I'm of course familiar with all the different factors that can cause insulin resistance or sensitivity, and clearly there are periods where you're going to be more or less sensitive than usual - but as my sugars have been high for around a month, I have to say I'm quite confused by this. I contacted my specialist diabetic dietician, who tells me that this is apparently a known issue with low carb diets - she tells me that people do quite often need to Continue reading >>
- Could going low-carb help you fight off diabetes? The usual advice for Type 2 is to eat plenty. But now a number of patients and doctors are leading a growing rebellion
- How Low Can You Go? Expert Advice On Low Carb Diets and Diabetes
- Low Carb vs. High Carb - My Surprising 24-day Diabetes Diet Battle
Why Your “normal” Blood Sugar Isn’t Normal (part 2)
Hi, I just found this site and would like to participate. I will give my numbers, etc. First, my last A1c was 6.1, the doc said it was Pre-diabetes in January of 2014, OK, I get it that part, but what confuses me is that at home, on my glucometer, all my fastings were “Normal” however, back then, I had not checked after meals, so maybe they were the culprits. Now, I am checking all the time and driving myself crazy. In the morning sometimes fasting is 95 and other times 85, it varies day to day. Usually, after a low carb meal, it drops to the 80’s the first hour and lower the second. On some days, when I am naughty and eat wrong, my b/s sugar is still low, and on other days, I can eat the same thing, and it goes sky high, again, not consistent. Normally, however, since February, my fbs is 90, 1 hour after, 120, 2nd hour, back to 90, but, that changes as well. In February, of 2014, on the 5th, it was horrible. I think I had eaten Lasagne, well, before, my sugars did not change much, but that night, WHAM-O I started at 80 before the meal, I forgot to take it at the one and two hour mark, but did at the 3 hour mark, it was 175, then at four hours, down to 160, then at 5 hours, back to 175. I went to bed, because by that time, it was 2 AM, but when I woke up at 8:00 and took it, it was back to 89!!!! This horrible ordeal has only happened once, but, I have gone up to 178 since, but come down to normal in 2 hours. I don’t know if I was extra stressed that day or what, I am under tons of it, my marriage is not good, my dear dad died 2 years ago and my very best friend died 7 months ago, I live in a strange country, I am from America, but moved to New Zealand last year, and I am soooo unhappy. Anyway, what does confuse me is why the daily differences, even though I may Continue reading >>
Why Do My Blood Sugars Rise After A High Protein Meal?
Complex issues often require more detail than you can pack into a Facebook post. One such area of confusion and controversy is gluconeogenesis and the impact of protein on blood sugar and ketosis. Some common questions that I see floating around the interwebs include: If you are managing diabetes, should you avoid protein because it can convert to glucose and “kick you out of ketosis”? If you’ve dropped the carbs and protein to manage your blood sugars, should you eat “fat to satiety” or continue to add more fats until you achieve “optimal ketosis” (i.e. blood ketone levels between 1.5 and 3.0mmol/L)? Then, if adding fat doesn’t get you into the “optimal ketosis zone”, do you need exogenous ketones to get your ketones up so you can start to lose weight? This article explores: the reason that some people may see an increase in their blood sugars and a decrease in their ketones after a high protein meal, what it means for their health, and what they can do to optimise the metabolic health. You’re probably aware that protein can be converted to glucose via a process in the body called gluconeogenesis. Gluconeogenesis is the process of converting another substrate (e.g. protein or fat) to glucose. Gluco = glucose Neo = new Genesis = creation Gluconeogenesis = new glucose creation As shown in the table below, all but two of the amino acids (i.e. the building blocks of protein) can be converted to glucose. Five others can be converted to either glucose or ketones depending on the body’s requirements at the time. Once your body has used up the protein, it needs to build and repair muscle and make neurotransmitters, etc. any “excess protein” can be used to refill the small protein stores in the blood stream and replenish glycogen stores in the liv Continue reading >>
Is Low-carb Eating Really Better For Blood Sugar?
A review of popular low-carbohydrate diets finds that while restricting carbs can reduce blood sugar in the short run, evidence in support of long-term benefits is lacking. While very low carbohydrate diets (LCD) promise to cut blood sugars, a review of popular LCDs finds that while very low-carb eating can reduce blood sugar in the short run, little evidence exists to show long-term benefits. The study, published online in the Journal of the American Osteopathic Association, reports that while LCDs may be “slightly better than low fat diets for weight and triglycerides management” they are “not superior for the management of blood glucose, blood pressure, or cholesterol levels.” However, researchers note that physicians should be aware that “available evidence for LCDs is limited because of variable definitions, lack of long-term studies, and lack of patient adherence.” Diets considered ranged from very low carb—less than 20 to 60 grams per day—to less restrictive diets that averaged about 130 grams per day. The American Diabetes Association says diets should be tailored to individual needs, but recommends starting at 45-60 grams of carbohydrates per meal. “Patients can likely follow a version of the low carbohydrate diet for longer than the studies suggest, but we don’t know the health effects of a very low carbohydrate ketogenic diet of less than 20 grams of carbs per day,” says Heather Fields, MD, an author of the study and a doctor of integrative medicine at the Mayo Clinic in Phoenix, Arizona. “With so few people adhering to a truly ketogenic diet long term [more than a year], we will likely never be able to study the health effects in a meaningful way.” Dr. Fields finds that if type 2 patients have not had success with a plant-based, who Continue reading >>
Why Your Fasting Blood Sugar Might Still Be High On Low Carb
It’s not too uncommon to have slightly high fasting blood sugar on low carb and keto diets. Is this a problem? It depends on your insulin levels, as outlined by Dr. Ted Naiman below. If you’re insulin sensitive, and have slightly higher fasting blood glucose, it’s likely just fine. More The dawn phenomenon – why are blood sugars high in the morning? Insulin Advanced low-carb topics Diabetes Dr. Naiman Earlier with Dr. Naiman All earlier posts about Dr. Naiman Continue reading >>
A Guide To Healthy Low-carb Eating With Diabetes
Diabetes is a chronic disease that has reached epidemic proportions. It currently affects over 400 million people worldwide (1). Although diabetes is a complicated disease, maintaining good blood sugar control can greatly reduce the risk of complications (2, 3). One of the ways to achieve better blood sugar levels is to follow a low-carb diet. This article provides a detailed overview of low-carb diets for managing diabetes. If you have diabetes, your body cannot process carbohydrates effectively. Normally, when you eat carbs, they are broken down into small units of glucose, which end up as blood sugar. When blood sugar levels go up, the pancreas responds by producing the hormone insulin. This hormone allows the blood sugar to enter cells. In healthy people, blood sugar levels remain within a narrow range throughout the day. In diabetes, however, this system doesn't work the way it is supposed to. This is a big problem, because having both too high and too low blood sugar levels can cause severe harm. There are several types of diabetes, but the two most common ones are type 1 and type 2 diabetes. Both of these conditions can be diagnosed at any age. In type 1 diabetes, an autoimmune process destroys the insulin-producing beta cells in the pancreas. Diabetics must inject insulin several times a day to ensure that glucose gets into the cells and stays at a healthy level in the bloodstream (4). In type 2 diabetes, the beta cells at first produce enough insulin, but the body's cells are resistant to its action, so blood sugar remains high. To compensate, the pancreas produces more insulin, attempting to bring blood sugar down. Over time, the beta cells lose their ability to produce enough insulin (5). Of the three nutrients -- protein, carbs and fat -- carbs have the grea Continue reading >>