Insulin Resistance and Fatty Liver

[Needing help!]

Hello,

I'm in a bit of muddle at the moment and would greatly appreciate any advice/tips anyone can offer on the best ways to reduce insulin resistance and tackle fatty liver?!
Basically, I'm really struggling with the symptoms of insulin resistance at the moment - constant fatigue, irritability, mood swings and huge cravings and hunger.
And I think my liver is going absolutely crazy at the moment - I always get BG spikes around 4am-ish and constantly wake up multiple times in the early hours drenched in sweat (sorry for the TMI!), and I always get huge hunger urges throughout the night when I wake up. (And yet when I test my BG it's high not the 3am dip/hypo normal people get).
I'm desperately trying keto and IF (one meal a day) - but even 15g carbs from just high-fibre veggies will still cause a BG increase of 2...
Is the problem the fact it's 15g of carbs in one go which will prevent me getting into ketosis?
But which would be better - fasting for essentially 22 hours a day to try and drive down insulin levels or reducing the carbs in that one meal even further?
But I'm just concerned about how few vegetables/fibre etc. I'd be getting if I minimised carbs even more as I need to try and fix my inflamed liver etc. too and just restricting veg won't be doing that any good?!
Any advice would be HUGELY welcomed!!

Thanks!

 

[Ronancastled]

I'm desperately trying keto and IF (one meal a day) - but even 15g carbs from just high-fibre veggies will still cause a BG increase of 2...

An increase of 2 isn't a problem, are you describing going from 5mmol/L to 7 then back to 5.
That's normal non-diabetic.

 

[Goonergal]

But I'm just concerned about how few vegetables/fibre etc. I'd be getting if I minimised carbs even more as I need to try and fix my inflamed liver etc. too and just restricting veg won't be doing that any good?!

Your liver will improve as the insulin resistance improves and reducing carbs and intermittent fasting will both help with that. There are a lot of myths around veg/fibre but the fact is you don’t need it.

This video explains a lot more eloquently and entertainingly (if that’s a word) than I ever could:
https://lowcarbconferences.com/dr-zoe-harcombe-what-about-fiber/

If you haven’t already, then check out Dr Jason Fung’s book on fasting.

Editing to add a link to this paper on low carb and fatty liver: https://diabetesonthenet.com/wp-content/uploads/dip4-3-102-8-1.pdf

 

[Needing help!]

An increase of 2 isn't a problem, are you describing going from 5mmol/L to 7 then back to 5.
That's normal non-diabetic.

It normally goes from around 5.5-6ish to 8 at 2 hours after eating - and it’s more the big rise considering how few carbs is it that concerns me… surely such little should not be causing a sustained rise of that level?! And it takes a good 4ish hours to fall back to baseline whenever I eat.

I mainly want to know what more I can do to actually get into Ketosis and lose weight rather than just control BG as I understand a rise to 8 isn’t a huge concern.

But the dramatic rises do happen all by themselves (thanks fatty liver….!) and I saw a BM of 12 at 4am this morning, so it’s not even just the food that’s a problem at the moment!

so infuriating as I feel I have zero control or even influence whatsoever over my body at the moment…

 

[Needing help!]

Your liver will improve as the insulin resistance improves and reducing carbs and intermittent fasting will both help with that. There are a lot of myths around veg/fibre but the fact is you don’t need it.

This video explains a lot more eloquently and entertainingly (if that’s a word) than I ever could:
https://lowcarbconferences.com/dr-zoe-harcombe-what-about-fiber/

If you haven’t already, then check out Dr Jason Fung’s book on fasting.

Editing to add a link to this paper on low carb and fatty liver: https://diabetesonthenet.com/wp-content/uploads/dip4-3-102-8-1.pdf

thanks for your reply and the useful sites - I’ve read Jason Fung’s book and I find it makes a lot of sense… but to be honest I’m just concerned that I’m literally *too* insulin resistance to ever be able to successfully get into ketosis.

I know it’s a long old fight and I shouldn’t be expecting any quick fixes (doesn’t stop me wanting them though haha!) but it’s just so disheartening to see zero progress after trying pretty much every trick I can think of… run out of ideas to ALSO do to try and actually help improve things

 

[MrsA2]

Sometimes our bodies need a short sharp shock to jerk them into action.
You could perhaps try longer fasts and/or full carnivore.

I'm not suggesting these as a way of eating for life (though many do) but as short term until that liver starts doing what it supposed to do. Once that's happening you could then find a way that suits you a bit better.

 

[Resurgam]

It normally goes from around 5.5-6ish to 8 at 2 hours after eating - and it’s more the big rise considering how few carbs is it that concerns me… surely such little should not be causing a sustained rise of that level?! And it takes a good 4ish hours to fall back to baseline whenever I eat.

I mainly want to know what more I can do to actually get into Ketosis and lose weight rather than just control BG as I understand a rise to 8 isn’t a huge concern.

But the dramatic rises do happen all by themselves (thanks fatty liver….!) and I saw a BM of 12 at 4am this morning, so it’s not even just the food that’s a problem at the moment!

so infuriating as I feel I have zero control or even influence whatsoever over my body at the moment…

It isn't a big rise - not for me when starting out, though I found that my blood glucose was more even eating at 12 hour intervals rather than 24 - though that is what I am doing at the moment as I weighed myself for a health check and found that I have put on a few Kg over the last 3 years.
It took a while to empty out all the reserves when I started eating low carb back in 2016, but sticking to the diet and doing some walking did the trick in the end.
Disturbed sleep is always a problem it is really disruptive, but I do notice that days when I can get out for a few hours are usually followed by better sleep.

 

[Goonergal]

run out of ideas to ALSO do to try and actually help improve things

I get it’s frustrating. Maybe just give it time. It’s also pretty hard to get enough nutrients from OMAD unless you really can eat a huge meal. Why not experiment with two smaller meals - one could be very small - in a 2 or 3 hour window. Or look at alternate day fasting to switch things up for your body.

I’m going to tag @bulkbiker as he was very helpful to me when I first started fasting. Hopefully he’ll have some ideas.

Another thing to consider is whether some of your symptoms are due to something else. Have you been checked for hypothyroidism, for example?

Hope you manage to work something out and keep posting - it’ll help with motivation.

 

[bulkbiker]

Hi @Needing help!
And thanks for the tag @Goonergal

I think we need a bit more info here.

How long have you been diagnosed and ideally what was your HbA1c?
How long have you been trying keto/fasting?

 

[Needing help!]

Hi @Needing help!
And thanks for the tag @Goonergal

I think we need a bit more info here.

How long have you been diagnosed and ideally what was your HbA1c?
How long have you been trying keto/fasting?

So the 'diagnosis' point is a tricky one - not technically been diagnosed diabetic but have been experiencing severe insulin resistance symptoms for quite some time now (lethargy, hunger particularly after meals, carb cravings, acanthosis nigricans...) but my HbA1C is not in diabetic range - but I'm sure that's because I've been doing fasting/only one or two meals a day for the past 2 years anyway so do not give my blood sugars a chance to be continuously elevated enough to raise my HbA1C significantly. So am currently awaiting an OGTT to potentially confirm a diagnosis (in the next week or so hopefully, just waiting for the appointment to come through).
But like I said - as I've been doing fasting for some years anyway, I feel like that's already taken away a 'trick' I can try to kick start/shock my body as it's already used to it...

So that just left the keto approach...
Which I've been trying for about 2 months now... admittedly I have had some set back days where the uncontrollable hunger urges - especially when I wake up at about 3am with sky-high BG anyway... have been a bit too much on some days and I've literally had to eat something that probably have countered all my keto efforts, but otherwise I end up in tears from hunger pains....
As I understand it keto is not something you can just half-**** and have a few 'cheat' days - it is literally PURE CONSISTENCY that would achieve it?
Any tips on how to push through those horrible times would be greatly appreciated because otherwise I feel I'm in a constant losing cycle...

 

[Metabolism_Boss]

Runaway appetite is a sign that your blood sugars are starting to go awry. I would suggest getting a glucose meter and start measuring what is happening to your blood sugar first thing in the morning, before meals and two hours after a meal. This will give you information on how variable your blood sugar readings are and how close to normal they are. If they are normal, then you might want to consider reduced carbohydrates rather than keto. If there is a problem and you are pre-diabetic, this site will give you lots of information on going low carb and the options you have. Keto is a tough lifestyle, but it has the huge benefit that once you are used to it, it is much easier to stick to.

 

[BorisP]

It normally goes from around 5.5-6ish to 8 at 2 hours after eating - and it’s more the big rise considering how few carbs is it that concerns me… surely such little should not be causing a sustained rise of that level?! And it takes a good 4ish hours to fall back to baseline whenever I eat.

I mainly want to know what more I can do to actually get into Ketosis and lose weight rather than just control BG as I understand a rise to 8 isn’t a huge concern.

But the dramatic rises do happen all by themselves (thanks fatty liver….!) and I saw a BM of 12 at 4am this morning, so it’s not even just the food that’s a problem at the moment!

so infuriating as I feel I have zero control or even influence whatsoever over my body at the moment…

it could be that you worry too much! how do you know if you have fatty liver? have you been diagnosed? refrain from making ANY assumptions before being checked by a medical professional!!!! forget about Keto if you are not moving/exercising enough. 5 mile walk should be the norm EVERY DAY and test your BG after each walk. 2 point "spikes" after meals are nothing. make sure you don't drink more that a pint on a good day and stay well clear of cigarettes.

If all else fails and you have elevated BG levels (and I don't see them right now from what you are posting) your doctor will prescribe some Metformin along with carb counting and exercise every day. don't expect your BG levels to drop without movement. for your information : anyone (BG under control or not) will have high BG levels after eating a bag of toffies. the question is if the sugar from the pack goes to any good use or it is stored as fat because if not it will just do the rounds in your blood until some of it is removed by your kidneys.
stay positive!

 

[Goonergal]

forget about Keto if you are not moving/exercising enough. 5 mile walk should be the norm EVERY DAY

Really? Do you have any evidence for that? Plenty on here reversing type 2/losing weight with minimal exercise.

 

[Oldvatr]

Here is some research into keto diet for NAFLD
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132133/
Seems to be of benefit.

And to add another UK study done by Dr David Unwin (who incidently used to be a forum member) who is an active GP
https://www.diabetes.co.uk/news/201...atty-liver-disease,-study-finds-94429859.html

 

[Needing help!]

it could be that you worry too much! how do you know if you have fatty liver? have you been diagnosed? refrain from making ANY assumptions before being checked by a medical professional!!!! forget about Keto if you are not moving/exercising enough. 5 mile walk should be the norm EVERY DAY and test your BG after each walk. 2 point "spikes" after meals are nothing. make sure you don't drink more that a pint on a good day and stay well clear of cigarettes.

If all else fails and you have elevated BG levels (and I don't see them right now from what you are posting) your doctor will prescribe some Metformin along with carb counting and exercise every day. don't expect your BG levels to drop without movement. for your information : anyone (BG under control or not) will have high BG levels after eating a bag of toffies. the question is if the sugar from the pack goes to any good use or it is stored as fat because if not it will just do the rounds in your blood until some of it is removed by your kidneys.
stay positive!

Thank you for your response - I'm really hoping much of it is too much worry and the reality is not as bad as I'm fearing!!
I have been diagnosed with fatty liver by an ultrasound, and as I'm experiencing fatigue etc. as one of my symptoms at the moment anyway I'm concerned that's linked to liver so I'm currently seeking out whether it's worth getting a liver MultiScan done to see if it's progressed to inflammation/NASH stage.

Thankfully I'm very active - I love walking and easily walk 6 miles a day, everyday, without fail. I've also been adding in resistance training over the last few months as I've heard that's a key part of reversing insulin resistance.
And I don't drink at all so alcohol isn't a problem!

My BG levels aren't ridiculously elevated if I can stick to the 15g carbs max, but even then I have been experiencing readings of 10-12 (and even 18 on one horrendous night... admittedly that one was after about 50g carbs after very restricted carbs for a fair while before that so that one was probably a rebound effect of a shock to my pancreas at a sudden amount of glucose!) normally around 3-4am... which from what I've read I'm interpreting to mean it corresponds with about the time when the liver decides to do a 'liver dump' to prepare for the day...!

I know blood sugar rises are completely normal and expected after carbs in everyone - it's just unfortunately my spikes are definitely being packed away into fat cells rather than muscle usage! (and the scales are unfortunately very happily demonstrating this despite eating way less than I ever used to!)

 

[Needing help!]

Here is some research into keto diet for NAFLD
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132133/
Seems to be of benefit.

Thank you for this!
It does seem from pretty much everything I read at the moment that keto seems to be the best way to tackle both my BG and liver issues.

I think part of my problem is I'm trying to be too restrictive with my diet - keto cuts out all carbs, for my liver (and weight) I'm trying to cut out saturated fats (but taking omega 3 supplements for the 'good fats' to help my liver), but also wanting to help the liver with an anti-inflammatory diet with suggests no diary (at least in the initial stage to give it a good detox) And to top it off I've been veggie for pretty much all my life also so I've got no meat protein sources....
So stuck on what I can bloomin' eat now! Pretty much living off fibrous vegetables (for nutrients/fibre/gut microbiome help) and a few nuts (and even they've got limits on them - like no peanuts for the liver apparently!)...
so so many rules and I'm just so tired!

 

[Oldvatr]

Thank you for your response - I'm really hoping much of it is too much worry and the reality is not as bad as I'm fearing!!
I have been diagnosed with fatty liver by an ultrasound, and as I'm experiencing fatigue etc. as one of my symptoms at the moment anyway I'm concerned that's linked to liver so I'm currently seeking out whether it's worth getting a liver MultiScan done to see if it's progressed to inflammation/NASH stage.

Thankfully I'm very active - I love walking and easily walk 6 miles a day, everyday, without fail. I've also been adding in resistance training over the last few months as I've heard that's a key part of reversing insulin resistance.
And I don't drink at all so alcohol isn't a problem!

My BG levels aren't ridiculously elevated if I can stick to the 15g carbs max, but even then I have been experiencing readings of 10-12 (and even 18 on one horrendous night... admittedly that one was after about 50g carbs after very restricted carbs for a fair while before that so that one was probably a rebound effect of a shock to my pancreas at a sudden amount of glucose!) normally around 3-4am... which from what I've read I'm interpreting to mean it corresponds with about the time when the liver decides to do a 'liver dump' to prepare for the day...!

I know blood sugar rises are completely normal and expected after carbs in everyone - it's just unfortunately my spikes are definitely being packed away into fat cells rather than muscle usage! (and the scales are unfortunately very happily demonstrating this despite eating way less than I ever used to!)

Sounds like you have severe Insulin Resistance. It seems your body is not opening up to allow glucose to be used as prime fuel, and so it is being re packaged into the adipose tissues as fat. So exercise is one way of adressing IR, otherwise a keto diet to empty the liver stores.

There are diabetic meds (Gliflozin meds) that encourage excretion via the kidneys and this might be worth considering with your doctor. If you are overweight then there is a new weight loss treatment (Glutide meds) that could also be a consideration.

You need to empty the excess fat from your liver to reduce hepatic IR which is different from the normal muscle IR. NAFLD is usually when the liver stores lipid fat in the wrong places (ectopic fat) which blocks the normal liver pathways. These fatbergs need to be reduced, and ketosis or ultra low calorie diets are effective in doing this, but it takes a while.

 

[Oldvatr]

Thank you for this!
It does seem from pretty much everything I read at the moment that keto seems to be the best way to tackle both my BG and liver issues.

I think part of my problem is I'm trying to be too restrictive with my diet - keto cuts out all carbs, for my liver (and weight) I'm trying to cut out saturated fats (but taking omega 3 supplements for the 'good fats' to help my liver), but also wanting to help the liver with an anti-inflammatory diet with suggests no diary (at least in the initial stage to give it a good detox) And to top it off I've been veggie for pretty much all my life also so I've got no meat protein sources....
So stuck on what I can bloomin' eat now! Pretty much living off fibrous vegetables (for nutrients/fibre/gut microbiome help) and a few nuts (and even they've got limits on them - like no peanuts for the liver apparently!)...
so so many rules and I'm just so tired!

Have you thought of Meal Replacement? Dr Michael Mosely runs a diet plan that uses MR shakes that are also low carb. The Newcasttle Diet plan uses MR shakes. I am not a major fan of either of these, but it may assist in the liver department since the ND diet especially used MRI scans to demonstrate that it was instrumental in reducing pancreatic (and possibly liver) fat. The shakes will provide the nutrients you need for the short duration of the plan, but the plan is not sustainable in the long term.

 

[Needing help!]

Sounds like you have severe Insulin Resistance. It seems your body is not opening up to allow glucose to be used as prime fuel, and so it is being re packaged into the adipose tissues as fat. So exercise is one way of adressing IR, otherwise a keto diet to empty the liver stores.

There are diabetic meds (Gliflozin meds) that encourage excretion via the kidneys and this might be worth considering with your doctor. If you are overweight then there is a new weight loss treatment (Glutide meds) that could also be a consideration.

You need to empty the excess fat from your liver to reduce hepatic IR which is different from the normal muscle IR. NAFLD is usually when the liver stores lipid fat in the wrong places (ectopic fat) which blocks the normal liver pathways. These fatbergs need to be reduced, and ketosis or ultra low calorie diets are effective in doing this, but it takes a while.

I'm so desperate to get reversing the insulin resistance as soon and quickly as possible - it's hard knowing your fighting against your internal hormones that you can't see/properly measure at all... I'm a scientist so love a good bit of hard data and facts haha!!
The fasting insulin test I find some people use as a measure of insulin sensitivity is a waste of time because they all report how keto decreases IR but that's only because they're taking away the carbs so of course insulin secretion will be lower... doesn't actually show how your body is responding to the insulin that IS there!
After much research I found somewhere that would privately do a GTT with insulin which I think is more accurate as it tests how much is needed after the carb stimulus but you have to pay nearly £600, and frankly - I just cannot do that!

Unfortunately, my doctor is point blank refusing any medication - they claim as my HbA1c isn't raised they will not prescribe any... despite my protestations that its only not raised because I eat once a day and less than 20g of carbs!!! I refuse to put my body through 3 months of constant highs by eating 3x a day just to prove to them I do need medication!

I don't know for sure, but I think the hepatic insulin resistance may have been the primary cause of all this to be honest... my fasting BG was the first to raise rather than my post meal values, and I've read that to be due to poor body response to the early morning liver dump.
Buy yes, I agree - keto/super low cal are going to be the only way to start reducing liver fat (and the BG issues as well)... I'm just hoping it is reversible and I can see actual improvements!

And thank you also for your suggestion about meal replacements shakes - but to be honest, it just goes against absolutely every inch of my being - I understand it helps some people, but I just wouldn't be able to compute how drinking grey gloop a couple of times a day is any better for my body than some spears of asparagus and a dollop of spinach!

I guess I just need to come to terms with the fact this is going to be a very long old slog, but the only way out is having to push through it...

 

[Goonergal]

@Needing help! this Facebook Group might be of interest. The woman who runs it is very knowledgeable: https://www.facebook.com/groups/reversinginsulinresistance/?ref=share