Lchf induced insulin resistance

wizardo

Well-Known Member
Messages
52
It's impossible to completely cut out carbs. But if you are T2 diabetic and want to control your BG adequately you have to radically reduce your carbs in my opinion. I don't think eating even moderate amounts of so-called 'good' unprocessed low GI carbs is enough until the underlying factors in one's diabetes (body fat, fitness, insulin resistance, etc.) have been improved. My aim is to get back to a near normal level of insulin sensitivity and BG control so that I can eat carbs without risk of BG spikes - before I get an avalanche of 'pie in the sky' responses I do accept this is not a given at all but that is what I am aiming for. Even if I do achieve that I certainly won't be eating carbs the way I used to and will continue what many non-diabetics would regard as a low carb diet (small amounts of carb foods fairly occasionally). But compare that to now when I basically don't eat any foods with more than a small level of carbs and I try to limit carbs to 30g a day - around 10x less than I used to eat on average. If you have T2 it does seem to me from what I have read that cutting down on carbs when you are first diagnosed is simply not enough to prevent steady decline in your condition; you need to be much more radical. And you need to improve fitness and shed visceral body fat.

Absolutely spot on. Agree 100%. The only slight difference is that I don't eat any carbs at all and I hit the fitness thing like hell. The diabetic symptoms have all but pretty well gone. I've now throttled back on the exercise but with the no carb diet, my weight is steady and I've put no belly fat on at all. It can be done but it helps to be angry which makes you determined to beat the condition.
 
  • Like
Reactions: 2 people

donnellysdogs

Master
Messages
13,233
Type of diabetes
Type 1
Treatment type
Pump
Dislikes
People that can't listen to other people's opinions.
People that can't say sorry.
Absolutely spot on. Agree 100%. The only slight difference is that I don't eat any carbs at all and I hit the fitness thing like hell. The diabetic symptoms have all but pretty well gone. I've now throttled back on the exercise but with the no carb diet, my weight is steady and I've put no belly fat on at all. It can be done but it helps to be angry which makes you determined to beat the condition.

What do you eat to have no carbs at all? Even a lettuce has carbs?
 

LucySW

Well-Known Member
Messages
1,945
Type of diabetes
LADA
Treatment type
Insulin
@phoenix as ever thanks for the great links ...I do accept that the higher fat or proportionally higher fat in LCHF causes an increase in insulin:carb requirements.

Couple of things.

1) @phoenix, didn't the Wolpert study involve high carb and high fat?

2) Fats - and esp saturated fats. This is a real issue for LCHF-ers, because we need the high fat to feel satisfied, and because so much of that means sat fat. I do think sat fat gorging can be taken too far, mainlining bulletproof coffee and cream for example. I'm one of those people whose LDL cholesterol has increased on LCHF. Triglycerides, HDL and their ratio were very good, so to that extent I've no grounds to worry, but I think sat fat tolerance may vary between people and needs a lot more investigation. I'm certainly going to keep to one butter coffee a day. @donnellysdogs, you were worried about this, weren't you.

Kenneth Sikaris says about this, Hmmm, don't know, you need to watch it. P. Attia says, Hmmm, may need a bit more than attention. I'm quoting him from a blogpost this week.

"some readers may interpret the data I present to mean it’s perfectly safe to consume, say, 25% (or more) of total calories from SFA [saturated fats]. I realize I may have to turn in my keto-club card, but I am convinced that a subset of the population—I don’t know how large or small, because my “N” is too small—are not better served by mainlining SFA, even in the complete absence of carbohydrates (i.e., nutritional ketosis). Let me repeat this point: I have seen enough patients whose biomarkers go to hell in a hand basket when they ingest very high amounts of SFA. This leads me to believe some people are not genetically equipped to thrive in prolonged nutritional ketosis.​

In one particularly interesting case, a patient in self-prescribed nutritional ketosis presented to me with an LDL-P of more than 3500 nmol/L (i.e., more particles than could be measured by the NMR machine so the report simply said “>3,500 nmol/L”) despite feeling, performing, and looking great. Based on his through-the-roof desmosterol and cholanstanol levels, and a curb-side consult from the Godfather I mean Dr. Tom Dayspring, I decided to try an experiment. You see, the logical thing to do in this setting would have been to start two drugs immediately (a potent statin to address the hypersynthesis and ezetimibe to address the hyperabsorption) or tell him to abandon ketosis altogether. But this patient was adamant about staying in ketosis given the other benefits, though obviously worried about the long-term coronary implications. So, we agreed that for a 3 month trial period he would reduce SFA to an average of 25 g/day (vs. about 75 to 100 g/day) and make up the difference with monounsaturated fat (MUFA). Parenthetically, we also reduced his omega-3 PUFA given very high RBC EPA and DHA levels.​

So, on balance, he consumed about the same number of calories and even total quantity of fat, but his distribution of fat intake changed and he heavily swapped out SFA for MUFA.

The result?

His LDL-P fell from >3,500 nmol/L to about 1,300 nmol/L (about 55th percentile), and his CRP fell from 2.9 mg/L to <0.3 mg/L (and for the lipoprotein cognoscenti, both desmosterol and cholanstanol fell).​

Pretty cool, huh? So, my point is this: while I believe the population-based guidelines for SFA are not supported by a standard of science I consider acceptable, it does not imply I believe SFA is uniformly safe at all levels for all individuals.

Some of you may be wondering about me. It turns out I’m in the group (recall: I have no idea how large or small this group is) that seems to do well—at least by the tools we have available to assess risk—with large amounts of SFA in my diet, if and when I elect to. Even when I was in ketosis, eating 4,000 kcal/day (literally getting 40 to 45% of my calories from SFA alone) my biomarkers—cardiovascular, insulin resistance, inflammation—were excellent. Better than they ever were or even are today. Though, my point still stands: there are some people who do not appear able to safely consume massive amounts of SFA.​

One last point I’ll make on this highly charged topic. I realize there is a contingent within the LCHF community who argue that traditional biomarkers of coronary risk—such as LDL-C or its superior cousin LDL-P—“don’t matter” if one is on a low carb or ketogenic diet. Maybe they are right. I guess time will tell. But I am not convinced, at least not yet. As a doctor I can’t look a patient in the eye and tell them a sky-high LDL-P is ok because they don’t eat carbohydrates. So if you’re following such a diet, and your LDL-P goes through the roof, I’d urge you to consider a variation of the diet."
From here.

Any reactions, people?

Lucy
 
  • Like
Reactions: 2 people

phoenix

Expert
Messages
5,671
Type of diabetes
Type 1
Treatment type
Pump
I don't think that there is any doubt that insulin resistance and high levels of circulating fatty acids are related.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169796/
The argument probably hinges more upon the source of those fatty acids.
In the last few years though there seems to be a lot of papers that discuss the mechanisms by which dietary sat fats may increase insulin resistance. They are so specialised that they beyond all but experts Heres a sample diagram http://www.nature.com/nri/journal/v11/n11/fig_tab/nri3071_F1.html

There aren't many people though that are saying to cut out saturated fats and replace them with carbohydrates, most seem to suggest unsaturated fats and recently the emphasis seems to have turned more towards omega 3s and monounsaturated fats. (med diet obviously) but for example
http://www.nature.com/nri/journal/v11/n11/fig_tab/nri3071_F1.html
is very recent so isn't full text http://diabetes.diabetesjournals.org/content/early/2015/02/16/db14-1098.abstract

Actually, even the much lambasted Diabetes UK doesn't say to replace sat fat with carbs.
" Saturated fats (SFA) should be limited and replaced by unsaturated fats,predominantly monounsaturated fats (MUFA).(A)"
 
  • Like
Reactions: 4 people