Another slightly freaked out newbie

Keto is typically touted as being less than 20g per day. That number is used because it’s the amount pretty much guaranteed to get everyone into the state of ketosis whereby you switch from using glucose as the primary source of energy to fats. (Body fat if you need to lose or dietary if not). Some people get there at higher figures. Personally I hit it at about 40g. It is not the same as ketoacidosis in any way.

The advantage of keto is that it takes a lot of the guess work away of how much can you handle. It also means that you jump off the rollercoaster of carbs causing cravings entirely. For me that’s was easier as I’m not good at moderation and find restricted amounts harder than none at all. It’s a slippery slope from one treat to an entire packet or box then onto a day or a week or a month of “just this once”. Also if you start low you get good initial results which are motivating and give the sugar addiction chance to disappear. Then once you have some control you can experiment a bit if you still want to. Tastes may well have changed by then though so what you crave now might be entirely different later.

Oh and bacon is on the menu for sure, as is double cream with a few berries so there are definitely things to look forward to.

Only you will know what method works for you, slow and gradual to acclimate or fast and furious to get the shock over with and jump in with both feet. Only your meter will show what your body copes with. I want to put my body under as little insulin pressure as I can having cane diet for years. I’m hoping treated well it’ll gradually learn to cope better with the few treats I do have. Ie become less insulin resistant.

I knew from years of low carbing that I should lose weight at 50 gm of carbs a day - and it did work for a while, got down to normal readings very quickly - but I stopped losing weight. I dropped down to 40 gm per day maximum but to lose weight now I have to be close to 30 than 35 gm - but then I am no longer young - though I do feel younger than I did.
I would not bother testing high carb foods to start off with - fine tuning your ability to eat various legumes - peas and beans for instance, or even beetroot - bread might be something to try - but only low carb ones. Starting off with things which are most likely to be positives is more encouraging for the long term.

@JulianneG thank you so much for your opening post. It's rich with detail and helped me remember a few things I'd forgotten can happen when beginning to eat the low carb high (healthy) fat diet.

I'm in my 58 now. Had reactive hypoglycemia confirmed by a six hour OGTT test in my 20's. I ate reasonably normally at the time so it was confusing.

(I crossed over to pre-diabetes at age 41, then type 2 diabetes at age 44 because my doctor and endocrinologist didn't tell me about the LCHF diet. [Grrr]. Upon re-diagnosis of type 2 diabetes at age 54 with an A1c of 9.9% (which would be 62.5 in the UK), I like you, discovered the diet, started it within a few days time with guidance from the book, Dr. Bernstein's Diabetes Solution, emptied my pantry of all foods I could no longer eat, bought a glucose meter kit with test strips, started the diet, and on day 5 found my way here for additional support and guidance. And am still here.)

To cope with the reactive hypoglycemia, my doctor instructed me to include protein with all meals and snacks, and to eat every 3-4 hours. Eventually, I learned to carry nuts and an apple or dried fruit with me if I planned to be away from the house for an extended period of time to head off hypos by going no more than 3 1/2 to 4 hours without something to eat, and it worked beautifully. I rarely had problems after that. (Interestingly, a well known dietitian who goes by "Cassie" here in the US encourages her obese clients to initially eat "PFC every 3 hours", that's protein, fat, and carbs, until they're comfortably into ketosis by eating 50 carbs or less, to lose weight, which is similar to the advice my doctor provided all those many years ago.)

But that would be the wrong advise for you because you have type 2 diabetes now, not reactive hypoglycemia.

What you experienced, as HSSS pointed out, was a "false hypo" due to reducing your carb intake. When you lower your carb intake intially, your body thinks your glucose level is too low when you wake up and start moving around. All of a sudden you feel weak and shaky. It's an awful feeling. When this happens, your body releases cortisol to signal the liver to release glucose into the bloodstream to raise your glucose level. After this happened to me a few times, I learned to check my glucose level with my meter and discovered that my glucose level was fine, perhaps a bit lower, but definitely not a hypo. This problem goes away as your body adapts to your new way of eating. But even today, and I've been on the LCHF/Keto diet for more than 4 years now, if I start rushing around a lot in the morning, I can still set off a mild false hypo occasionally, so I've learned to get up a bit earlier so I'm not rushing around.

When I was re-diagnosed with type 2 diabetes in 2015, I declined taking Metformin because I wanted to know how making changes to my diet affected my glucose levels, not how a drug reduced them. I wanted full credit for all my efforts! Happily, and it required a lot of effort, I was able to reduce my A1c from 9.9% (62.5 in the UK) to 5.6% (38 in the UK) in six weeks by reducing my carb intake to 30 - 42 carbs a day, and lots of walking. My doctor was stunned. At my second appointment 3 months later, my A1c had dropped further to 5.4% (36 in the UK), and he was stunned again. I handed him my glucose meter so he could look at the glucose levels I was getting. It was so fun watching him scroll through my numbers! My microalbumin level also was well within the normal range. Then three months later they checked my A1c again, and my status was changed to non-diabetic in my medical record. At the time, I believe he told me he'd only had two other patients who'd had similar success and that both had used the LCHF diet.

Maintaining non-diabetic status is an ongoing process. I haven't been as attentive with my diet for a few years, though still hovering around 50 carbs a day, most days, so had my A1c checked in February. It was 6.3% (45 in the UK). Not good. For the next three months it's bounced around between 5.8% and 6%, so I'm still in the low to mid-prediabetes range, but will get it back into the non-diabetic range soon with the diet and walking. The good news is that all my other lab tests are excellent except my cholesterol because I'm losing weight, 10 pounds so far, and that always causes a rise in cholesterol. And I had my first GGT test, a liver function test, and my result was well within the normal range, in fact, just above the optimal range. All lab tests confirm that my kidneys and liver are happy, very happy. The LCHF/Ketogenic diet has been life changing for me.

All that said, you may not have to do the ketogenic diet. LCHF ranges up to 130 carbs a day so I encourage you to experiment and find what level of carb intake works best for you. Everyone has a different tipping point. I didn't address my diabetes early enough so I have to stay under 75 carbs a day, but under 50 carbs works best for me. But the ketogenic diet works well, not just for diabetes, but for weight loss too.

Looking forward to following your progress. You're off to a great start!

HSSS said:

Keto is typically touted as being less than 20g per day. That number is used because it’s the amount pretty much guaranteed to get everyone into the state of ketosis whereby you switch from using glucose as the primary source of energy to fats. (Body fat if you need to lose or dietary if not). Some people get there at higher figures. Personally I hit it at about 40g. It is not the same as ketoacidosis in any way.

The advantage of keto is that it takes a lot of the guess work away of how much can you handle. It also means that you jump off the rollercoaster of carbs causing cravings entirely. For me that’s was easier as I’m not good at moderation and find restricted amounts harder than none at all. It’s a slippery slope from one treat to an entire packet or box then onto a day or a week or a month of “just this once”. Also if you start low you get good initial results which are motivating and give the sugar addiction chance to disappear. Then once you have some control you can experiment a bit if you still want to. Tastes may well have changed by then though so what you crave now might be entirely different later.

Oh and bacon is on the menu for sure, as is double cream with a few berries so there are definitely things to look forward to.

Only you will know what method works for you, slow and gradual to acclimate or fast and furious to get the shock over with and jump in with both feet. Only your meter will show what your body copes with. I want to put my body under as little insulin pressure as I can having cane diet for years. I’m hoping treated well it’ll gradually learn to cope better with the few treats I do have. Ie become less insulin resistant.

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HSSS, I really enjoy reading you highly informative posts, and understand there's disagreement about carb intake to get into and stay in ketosis, but anything under 50 carbs a day generally works, though it may take a longer.

In 2015, my carb intake was 30 to 42 carbs a day to get into ketosis. I think the "20 carbs a day" originated from the induction phase of Atkins Diet as described in the early 70's, primarily for weight loss. For most people, I feel 20 carbs a day is too great a change unless they're really in really bad shape - (obese, feeling awful, very concerning lab test results, perhaps experiencing the beginnings of diabetic complications) - and feel a strong need to move things along as quickly as possible.

Not sure but I think it took me about a month to get into ketosis. When the change happened, my urine became frothy, then the flow of my urine lessened. I was convinced I'd damaged my kidneys with the diet so immediately went to the doctor's office. They checked for protein in the urine with the dip stick test and assured me I was fine. It's funny now thinking back on that now, but I had so much anxiety at the time because there's so much misinformation about the LCHF/Keto diet on the internet and my doctor was not supportive of me doing the diet initially. Now I know it's one of the most researched diets out there, and it's very safe when done properly with ongoing guidance from people like you on this forum.

Winnie53 said:

HSSS, I really enjoy reading you highly informative posts, and understand there's disagreement about carb intake to get into and stay in ketosis, but anything under 50 carbs a day generally works, though it may take a longer.

In 2015, my carb intake was 30 to 42 carbs a day to get into ketosis. I think the "20 carbs a day" originated from the induction phase of Atkins Diet as described in the early 70's, primarily for weight loss. For most people, I feel 20 carbs a day is too great a change unless they're really in really bad shape - (obese, feeling awful, very concerning lab test results, perhaps experiencing the beginnings of diabetic complications) - and feel a strong need to move things along as quickly as possible.

Not sure but I think it took me about a month to get into ketosis. When the change happened, my urine became frothy, then the flow of my urine lessened. I was convinced I'd damaged my kidneys with the diet so immediately went to the doctor's office. They checked for protein in the urine with the dip stick test and assured me I was fine. It's funny now thinking back on that now, but I had so much anxiety at the time because there's so much misinformation about the LCHF/Keto diet on the internet and my doctor was not supportive of me doing the diet initially. Now I know it's one of the most researched diets out there, and it's very safe when done properly with ongoing guidance from people like you on this forum.

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Ah thanks My post was in responses to the op asking about keto and wanting to share some info about it rather than a recommendation per se

I jumped right in at around 40 a day and when I got pee sticks about 2 weeks in i was definitely in ketosis. I felt no changes whatsoever. No keto flu, no metallic taste, no burst of energy or clarity.

I guess we’re all different in how we respond and what works for each of us. My levels seem to have stuck where they are and I do wonder if I was more lenient if they’d have dropped much at all. It seems for me despite not starting particularly high it was necessary. I fully accept for many people the gradual approach is more achievable and is enough to get the results they want.

Agreed, diabetes is highly individual. I'm still experimenting with trying new things. I can't remember if I had keto flu or not the first time, but have had it from time to time when I was eating low carb for a while then reduced my carbs to go back into ketosis. I had all the problems initally. Started craving corn chips like crazy then realized that was my body telling me I needed more sodium (salt). That resolved that problem. Then I started getting muscle cramps and constipation so I added magnesium citrate to my supplement regimen. That worked, cramps went away and constipation resolved after a couple of weeks. For some, magnesium glycinate is a better choice if vulnerable to loose stools. If I stop the magnesium, the muscle cramps and constipation return, but I've always had problems with leg cramps, since I was a child. Interestingly, some people don't need to supplement magnesium while in ketosis. I eat a lot of vegetables daily so why I need to supplement is a mystery.

Winnie53 said:

Agreed, diabetes is highly individual. I'm still experimenting with trying new things. I can't remember if I had keto flu or not the first time, but have had it from time to time when I was eating low carb for a while then reduced my carbs to go back into ketosis. I had all the problems initally. Started craving corn chips like crazy then realized that was my body telling me I needed more sodium (salt). That resolved that problem. Then I started getting muscle cramps and constipation so I added magnesium citrate to my supplement regimen. That worked, cramps went away and constipation resolved after a couple of weeks. For some, magnesium glycinate is a better choice if vulnerable to loose stools. If I stop the magnesium, the muscle cramps and constipation return, but I've always had problems with leg cramps, since I was a child. Interestingly, some people don't need to supplement magnesium while in ketosis. I eat a lot of vegetables daily so why I need to supplement is a mystery.

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I’ve never supplemented and blood tests show magnesium is fine. Other vitamins eg b12 a different story not keto related - with no explanation either. Not sure if I’m still in ketosis as the pee sticks stop working after a while and I’m not forking out for a more expensive measurement method. but I believe I probably am based on still eating the same way. Maybe I’m kidding myself. A little looseness at first but that was about no gallbladder and fats, then constipation slightly from time to time but that’s usually dehydration.

The longer and more low carb you are the easier it gets to go,longer between fewer snacks etc the better so even if you don’t want to go fully into fasting yet just waiting til you are actually hungry is a good first step. Fasting is beneficial as it allows insulin levels to fully drop between feeds and stored glucose to be drained as it were. All helps towards reducing insulin resistance.

Eating out gets easier as you get more familiar with low carb. First and foremost is ditching the potatoes rice or pasta and getting it swapped out for more salad or veg that appear elsewhere on the menu. Sauces on the side to test sparingly. Build a meal from starters and sides works too sometimes. Any place half decent will work with you if you mention starch or carb intolerant.

JulianneG said:

Is fasting one of those things where your body gets used to it and it's no big deal after a while?

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Absolutely. Although it's really about being "in tune". It's not being in charge of fasting rather it's about listening to hunger. Hunger is like a child - sometimes it's just grizzling and you can ignore it, sometimes it's really upset and you shouldn't ignore it. The problem with carbs is you can get into a relationship where you've got an anxious/whiny child that just won't quit. Note my personal view and not science

JulianneG am continuing to enjoy reading your posts as you follow where the diet and your curiousity takes you.

I'd love for you to continue posting here on this thread over the next month or so. It's amazing how quickly we forget what our experiences were and how our thinking evolved during that first month. Please keep sharing, the good and the bad, also your questions, and what you're learning. Whatever you feel comfortable writing.

copilost said:

Absolutely. Although it's really about being "in tune". It's not being in charge of fasting rather it's about listening to hunger. Hunger is like a child - sometimes it's just grizzling and you can ignore it, sometimes it's really upset and you shouldn't ignore it. The problem with carbs is you can get into a relationship where you've got an anxious/whiny child that just won't quit. Note my personal view and not science

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Loving that analogy...

Once I started 'listening' to the hunger and stopped feeding it...your analogy covered how I felt perfectly.

Nice observation.

JuilanneG your first post rings so many bells with me. I'm recently diagnosed T2 found whilst testing to see what was causing high blood pressure (New drug, as it happens) after years of good control. I also have, or had, reactive hypoglycaemia, which I have had all my adult life I can recall (I'm 60) which was diagnosed by a senior nurse I worked with at the time, oh mabey 15 years ago. My GP never was much bothered about it, but I knew if I had sugary breakfast cereals (say Frosties) I would have the shakes a couple of hours later unless I ate something sweet again, by which time things would settle down.

I hadn't had one for years, as I knew 'what not to do' and lived that way, now perhaps that was T2 sneaking in by the back door. I know my A1C was OK in 2008 the last time it was tested. Now its 6.8%/51 and here I am testing away (bought my own) with BG's from 4.4 to 11 so far this week! Its carbs for sure, bread, rice, potatoes less so, give the spikes so I'm working on my new diet over this last 5 weeks and have also lost 10 pounds (I am overweight but not obese).

I watch this thread with interest as our pathways seem so similar.

Just a couple of tips re. LCHF constipation... Lots of water, exercise, flax seed (whole or meal) and raw cabbage (eg coleslaw) will usually do the trick.

JulianneG said:

I don't know much about fasting and whether my little experiment today will have any actual effect on my body because I'm not intending to do it for a whole day, but this is something I could do more often I think if it's beneficial. Is fasting one of those things where your body gets used to it and it's no big deal after a while? I guess that's today's question One good thing, all the testing practice and I'm getting much better at it, I've learned how big the blood blob has to be to not error on the meter and that it'll get there before the monitor times out. Everything gets better with practice I guess.

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Welcome to the forum. A note about connecting the dots with reactive hypoglycemia and fasting...it has to do with how insulin overshoots and drives down glucose, sending our brain into a panic mode. That is a layman description of what happens.



How is fasting different? When we fast glucose/glycogen gets depleted. Insulin winds down and we start to release fats from our storage reservior... our cheeks, neck etc... you can feel the sensations when you fast. And these fats releases ketones. Hence the term ketogenic diet. These ketones takes over as the primary fuel source except for a few key functions in the brain...

After the first couple of days of fasting, ketones would have ramped up to a level where our brains are adequately fueled. The state of keto bliss, nirvana, enlightenment... so getting over the Metabolic switch phase is critical... low carbs/keto is actually preparation for easier fuel switchover when fasting.

All the best to your journey.

JulianneG said:

So, further musings on my journey. Started taking Metformin, lasted 3 days and felt so utterly awful that I haven't taken anymore and will refuse to do so. Stomach pains, leg pains and I felt so exhausted I was like a 90 year old, I had to keep sitting down to rest. I feel great again now I've stopped taking them and my BG levels don't seem to have noticed, they're still drifting downwards. I haven't had a reading (not even a morning reading) in the 8's for a week, I start at 7 point something, it goes down during the day to 5 point something and then bounces a little after my evening meal, which tends to be the biggest and carbiest meal of the day. My 7 day average is currently 6.9 according to my log, and like I said, I haven't been as 'on it' this last week. I've finished reading Dr Jason Fung's Diabetes Code book and I've stopped experimenting with small fasts for now as I could just be messing up my metabolism and slowing it down. But I'm trying to avoid carbs such as apples for snacks and sticking with more protein based foods such as nuts or cheese. Fasting is definitely something I'm going to look into if the BG downward drift stops, but it needs much more research I think. Anyone here followed his fasting regime? It looks pretty hardcore.

I've done a few experiments with food to see what spikes. Plain porridge really doesn't seem to bother my BG, I'm not seeing spikes so I'm going to continue with that. We had fish and chips as a family yesterday, I had my fish unbattered and only a few chips and I didn't see a bounce there either, so it's the batter that sent it skyhigh last time. It wasn't as yummy but it's doable and I'll get used to that being my new normal. I have noticed that my portion sizes have reduced considerably, I've also noticed the weight is starting to come off, I've lost 6 pounds since I started weighing myself again. Another good downward drift

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I usually skip breakfast and postpone my "brunch" for as long as I feel I can, without feeling icky. I did try the 24-hour fasts with it being broken at dinner, but I couldn't keep them up twice a week. No idea why, it just didn't work for me. I'm one of those very few who gets a gnawing hunger in spite of the "after a while you don't feel hungry anymore" rule. (And before anyone jumps in, no, the many liters of tea I drink don't help at all. Alas. It's not simply thirst disguised as hunger.) Others here have gone a substantial time without food, just doing water fasts... It just is best to start slow and not dive in straight when your body's not used to being in a fasted state. I'd start with 16:8 and go from there. https://www.dietdoctor.com/intermittent-fasting/questions-and-answers#variants You also might get more replies from people who are more "hardcore", if you start a new thread with questions on fasting.