New Trial: LCHF vs "Medium Carb Low Fat". Who Wins?

[desidiabulum]

It makes me sad that a gag of this quality, didn't get more likes.

It's dangerous to make jokes about eating cats on this forum

 

[desidiabulum]

I've been out of the game for too long. Still a bit rusty.

At least the cat has a beard.

Actually looks like a goatee -- can't see whether he's got a ponytail as well...

 

[CollieBoy]

Actually looks like a goatee -- can't see whether he's got a ponytail as well...

NO! it probably has a cat tail

 

[Dillinger]

This is a slightly off topic post (less so than the cat one but there we are) but as we have The Brainy Nerds Assembled I thought I'd give it a shot.

Is it the amount of insulin that inhibits ketosis (not ketoasidosis - I mean normal metabolic ketosis in the presence of insulin) or is it the consumption of carbohydrates that inhibits it?

I suppose that there is an insulin level above which you won't be in ketosis?

The reason I ask is that even on sub 30 gram / day carb consumption I rarely hit ketosis.

Yesterday I forgot to bring my insulin to work so had no insulin at lunch and instead just ate a somewhat unpleasant Mattesson's Smoked Pork Sausage (clocking in at zero carbs) and some Miso soup (which was about 1 or 2 carbs). When I got home my blood sugar was in the 8.0's but I had some good medium levels of ketones. Ordinarily I will take some insulin at every meal. I'm on basal/bolus so have background insulin coverage at all times.

Thank you Oh Wise Ones.

Dillinger

 

[paul-1976]

This is a slightly off topic post (less so than the cat one but there we are) but as we have The Brainy Nerds Assembled I thought I'd give it a shot.

Is it the amount of insulin that inhibits ketosis (not ketoasidosis - I mean normal metabolic ketosis in the presence of insulin) or is it the consumption of carbohydrates that inhibits it?

I suppose that there is an insulin level above which you won't be in ketosis?

The reason I ask is that even on sub 30 gram / day carb consumption I rarely hit ketosis.

Yesterday I forgot to bring my insulin to work so had no insulin at lunch and instead just ate a somewhat unpleasant Mattesson's Smoked Pork Sausage (clocking in at zero carbs) and some Miso soup (which was about 1 or 2 carbs). When I got home my blood sugar was in the 8.0's but I had some good medium levels of ketones. Ordinarily I will take some insulin at every meal. I'm on basal/bolus so have background insulin coverage at all times.

Thank you Oh Wise Ones.

Dillinger

I'm not one of the wise ones I'm afraid but that's an interesting observation-I hit ketosis easily but my pancreatic function is at a level still where I just about get away with 2 injections of basal insulin at present...I wonder if that would all change if a QA insulin was added to my regime and would I also not test positive for ketones on my sub 30 grams a day.

Regards

Paul

 

[mo1905]

I am even less wise and even thought about posting another cat pic ! Interesting though


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[phoenix]

This is a slightly off topic post (less so than the cat one but there we are) but as we have The Brainy Nerds Assembled I thought I'd give it a shot.

Is it the amount of insulin that inhibits ketosis (not ketoasidosis - I mean normal metabolic ketosis in the presence of insulin) or is it the consumption of carbohydrates that inhibits it?

I suppose that there is an insulin level above which you won't be in ketosis?

The reason I ask is that even on sub 30 gram / day carb consumption I rarely hit ketosis.

Yesterday I forgot to bring my insulin to work so had no insulin at lunch and instead just ate a somewhat unpleasant Mattesson's Smoked Pork Sausage (clocking in at zero carbs) and some Miso soup (which was about 1 or 2 carbs). When I got home my blood sugar was in the 8.0's but I had some good medium levels of ketones. Ordinarily I will take some insulin at every meal. I'm on basal/bolus so have background insulin coverage at all times.

Thank you Oh Wise Ones.

Dillinger

Don't think I'm one of those you are referring to but it is very much insulin that inhibits ketogenesis. I've no idea how much., how could you tell? There are some graphs that show insulin levels in 'normal' human beings in the Cahill paper below but I've really no idea how the figures relate to injected insulin.

QUOTE] a low glucagon/insulin ratio inhibits ketogenesis while a high glucagon/insulin ratio, as occurs with fasting or diabetes, favors ketogenesis through promotion of lipolysis in the adipocyte and stimulation of β-oxidation of free fatty acids in the liver.[/QUOTE]
Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes
http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1520-7560(199911/12)15:6<412::AID-DMRR72>3.0.CO;2-8/full
Your glucose levels still weren't above the renal threshold which would have caused them to rise more quickly , Cahill says that there is

"accelerated ketosis in fasting pregnant or lactating women or in any subject with marked renal glucosuria requiring increased gluconeogenesis, e.g., when the renal threshold is surpassed, as in type 1 diabetes"

Cahill : Fuel Metabolism in Starvation
http://www.med.upenn.edu/timm/documents/ReviewArticleTIMM2008-9Lazar-1.pdf

 

[Andy12345]

well if your all denying being the clever ones, he must mean me! yay!

not a scoob sorry, i can't even pronounce it

 

[Dillinger]

Don't think I'm one of those you are referring to

Of course you are Phoenix! Thank you

Dillinger

 

[andcol]

So I suppose the test would be type one with no latent insulin production only eat fat and watch what happens with their ketone level and report back to us and then have carbs without insulin and report on their ketone levels and then finally add insulin. No responsibility is accepted on whether you stay alive/health issues. Any takers for a home science test? Would also need to reduce all of your glucogen stores to a minimum as well.

I wonder if there is not some other hormone involved. The pancreas does get involved in lots of different cycles. There are quite a few that live without a pancreas so wonder if we can learn something from their response because they need other hormones other than just insulin.

 

[hanadr]

Most people misunderstand the concept of low carb diets. Many ,including dieticans, think that LC is necessarily high protein, which we know it isn't. and of course with Normal kidney function, protein would not be an issue. However many diabetics have some degree of kidney malfunction, so shouldn't overburden their systems with too much protein. Low carb needs quite a lot of fat to work properly. Any dietician who saw how much butter goes on my 1 slice of Burgen toast each day, would expect me to drop down dead with heart failure at any moment.. I also have *Cream [shock horror!!]* on my fruit, but eat little fruit. I do eat masses of veggies. so far I haven't seen any studies which show any adverse effects of eating a low carb high fat diet. I'd read them if I saw them.
Incidentally paleo isn't ecessarily low fat. Stone age man ate what he hunted and if his luck was in, he got a nice fat mammal to eat.
I'm nearly paleo, but my 1 daily slice of Burgen rules me out.
Hana

 

[andcol]

So you have a bowl of cream with fruit on top - sounds like heaven to me especially if that cream has been frozen. Do you prefer it whipped or runny?

 

[borofergie]

Is it the amount of insulin that inhibits ketosis (not ketoasidosis - I mean normal metabolic ketosis in the presence of insulin) or is it the consumption of carbohydrates that inhibits it?

I think that the answer is "almost any insulin", which is why ketoacidosis is a T1 thing. Even the most banged up T2 pancreas can produce enough insulin to put a brake on ketoacidosis.

I'll have a look through the Lyle MacDonald book this afternoon and see what he says.

 

[robert72]

Just checked my levels out of interest. Ketones 0.7, BG 5.9.

Only insulin currently working is 10u Lantus I had yesterday at 6pm and 5u Novorapid I had this morning at 11am (when my BG was 6.5) all I have eaten today so far is yoghurt and walnuts = 5g carbs/22g fat/13g protein.

My TDD of insulin is around 22u and my carbs around 30g

 

[Spiker]

Yesterday I forgot to bring my insulin to work so had no insulin at lunch and instead just ate a somewhat unpleasant Mattesson's Smoked Pork Sausage (clocking in at zero carbs) and some Miso soup (which was about 1 or 2 carbs). When I got home my blood sugar was in the 8.0's but I had some good medium levels of ketones. Ordinarily I will take some insulin at every meal. I'm on basal/bolus so have background insulin coverage at all times.

Thank you Oh Wise Ones.

Dillinger

I eat that sausage regularly and the blood sugar effect on me is definite. Either it has more carbs than reported, or I am converting a surprising amount of its protein to carbs. I think it just has more carbs than stated, something like 5% carbs.

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[Spiker]

I think that the answer is "almost any insulin", which is why ketoacidosis is a T1 thing. Even the most banged up T2 pancreas can produce enough insulin to put a brake on ketoacidosis.

I'll have a look through the Lyle MacDonald book this afternoon and see what he says.

Agreed, trace amounts of insulin will prevent ketoacidosis. But Dillinger is asking what prevents ketosis, not what prevents ketoacidosis.

This is also one of those cases when you have to clearly distinguish between what happens in non diabetic vs T1 vs T2, and be careful because most of the biochemical literature is talking about non diabetics. So I'm going to take a deep breath before putting my Brainy Nerd Hat on and answering.

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[paul-1976]

I think that the answer is "almost any insulin", which is why ketoacidosis is a T1 thing. Even the most banged up T2 pancreas can produce enough insulin to put a brake on ketoacidosis.

I'll have a look through the Lyle MacDonald book this afternoon and see what he says.

I believe very uncontrolled T2's can be at risk of another condition(Link below) but I don't believe I've personally seen anyone on this or any other Diabetes forums post about ever having it although it sounds just as nasty as Ketoacidosis.

http://en.wikipedia.org/wiki/Hyperosmolar_hyperglycemic_state

 

[Spiker]

Untreated T1s consume high amounts of carbs but go into ketoacidosis. Does this imply they are also in ketosis despite the presence of excess carbs? I'm pretty sure untreated T1s also do gluconeogenesis, which is why they lose weight, though that might just be the inability to add weight due to having no insulin.

Ketone metabolism is going on all the time. It never totally shuts off except maybe if you were totally starved of dietary fat and fat reserves, which is a point near to death. It's just a question of how much lipolysis and ketosis is going on relative to glycolysis. But for example heart muscle runs only (or is it just preferentially?) on ketones.

Some of the stuff I have read suggests that in lipolysis, after the beta oxidation of the fat, there's then a "switch" to determine if the ketones are used in ketosis or enter into the glycolysis cycle. I don't know what regulates that switch but it might be that if there is an abundance of carbs the ketones are switched into glycolysis instead of ketosis. But I might have misunderstood that and it might be just that the glycerol goes into glycolysis, always, and the beta-oxidation products go into ketosis, always.

I will wait for a higher level Brainy Nerd to weigh in here.



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[Spiker]

I'll have a look through the Lyle MacDonald book this afternoon and see what he says.

The caution with Lyle Mcdonald though is that he is talking about non diabetics. Unfortunately those of us trying ketogenic diets as T1 or T2 diabetics are in uncharted waters. There is little or no direct research, so there's a lot of reading between the lines of how the ketogenic biochemistry works in non diabetics, and how the normal [ie non-ketogenic] (pathological) biochemistry works in diabetics. Ketogenic states in diabetics aren't studied except as a Bad Thing.


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[borofergie]

The caution with Lyle Mcdonald though is that he is talking about non diabetics. Unfortunately those of us trying ketogenic diets as T1 or T2 diabetics are in uncharted waters. There is little or no direct research, so there's a lot of reading between the lines of how the ketogenic biochemistry works in non diabetics, and how the normal (pathological) biochemistry works in diabetics. Ketogenic states in diabetics aren't studied except as a Bad Thing.

I agree. For T2s I think that insulin resistance plays a key role. I can get into ketosis easily enough but it requires three separate things for me to stay there for any period of time:

1. Extreme carbohydrate restriction <<25g a day. I aim for nothing, but pick a few here and there from vegetables and things.
2. Protein moderation - I don't count protein grams per se, but I try and only eat meat with one meal. If I eat meat for lunch and dinner it knocks me out of ketosis.
3. Lots of exercise. Every day don't exercise my ketones go down.

I postulate that as a T2D I have higher circulating levels of insulin, and so it is more difficult to for me to get good levels of ketones.

The other thing to remember is that, no matter what anyone says, prolonged dietary ketosis (as opposed to starvation ketosis) isn't a natural state, so perhaps it isn't surprising that it is so difficult to stay there for extended periods....

Two weeks down, six more months to go.