Can you survive long term as low carb but NOT in ketosis?

[Vectian]

My fairly low carb/ low GI diet has been very successful in getting my A1C from 97 to 36 in less than 5 months. I feel that I can sustain that in terms of what I eat and willpower etc. But the big problem I am having is weakness and fatigue, sometimes pretty debilitating. I have investigated if it's a lack of something with no success, so I reckon it's due to a lack of glycogen in the body and muscles. My muscles tire really easily. Obviously if you eat more high GI carbs/sugar the blood sugar goes up.

It seems that your body can adapt to create energy from ketones instead, but presumably you would have to stay in ketosis. I have around 60-80g or so a day, I don't want to do keto and am slim so don't want to lose weight. Is it possible to eat low carb but not at keto levels without feeling tired and weak all the time? If so how do you avoid that?

 

[ianf0ster]

We are all different. some people can experience ketosis on 50gms of carbs per day, but it's only when you get down to under 20gms that practically everyone goes into ketosis.

When I first went Low Carb High Fat, I only tested by Blood Glucose in order to find which foods suited my body. After several weeks, I was persuaded it might be worthwhile measuring ketones, but it may have been too late because I never got a reasonable reading. I since learned that it's often only during a transition to being fuelled primarily by ketones that they can be detected in breath, sweat, urine. When fully 'dual fuel' the ketones are no longer wasted in that way, being used up for fuel instead.

I didn't experience any muscle weakness or tiredness on low carb, in fact the opposite. But my Low Carb is higher in calories than what I ate before. I am/was a slim T2D (TOFI), and took the advice not to cut calories very seriously. I still lost weight, but once I got to a BMI of 22 with Low BG, I increased the amount of fatty meat (pork belly), eggs and cheese I was eating. Sure enough I gained weight without raising my BG and my BMI now fluctuates around 23.

When not fasting, I allow myself what I consider a broad range of carbs per day (anywhere between 20gms and 40gms) and I find that the GI of a food doesn't predict that food's affect on my BG, I know form my days of testing every meal which foods don't suit my body, avoid those ones and ignore the GI's and GL's of all other foods I eat.

 

[Vectian]

We are all different. some people can experience ketosis on 50gms of carbs per day, but it's only when you get down to under 20gms that practically everyone goes into ketosis.

When I first went Low Carb High Fat, I only tested by Blood Glucose in order to find which foods suited my body. After several weeks, I was persuaded it might be worthwhile measuring ketones, but it may have been too late because I never got a reasonable reading. I since learned that it's often only during a transition to being fuelled primarily by ketones that they can be detected in breath, sweat, urine. When fully 'dual fuel' the ketones are no longer wasted in that way, being used up for fuel instead.

I didn't experience any muscle weakness or tiredness on low carb, in fact the opposite. But my Low Carb is higher in calories than what I ate before. I am/was a slim T2D (TOFI), and took the advice not to cut calories very seriously. I still lost weight, but once I got to a BMI of 22 with Low BG, I increased the amount of fatty meat (pork belly), eggs and cheese I was eating. Sure enough I gained weight without raising my BG and my BMI now fluctuates around 23.

When not fasting, I allow myself what I consider a broad range of carbs per day (anywhere between 20gms and 40gms) and I find that the GI of a food doesn't predict that food's affect on my BG, I know form my days of testing every meal which foods don't suit my body, avoid those ones and ignore the GI's and GL's of all other foods I eat.

It seems from what you say that you were in constant ketosis though, where ketones are the primary source if fuel once adapted, so fatigue etc. shouldn't be such an issue. I was wondering if you can be lower carb (like 50-100g) so not in ketosis, but have enough energy to survive. I presume that if you are not in ketosis, the primary source of fuel is still glucose, and if you are eating food which causes smaller rises in glucose then the glycogen stores get depleted and never built up again, hence the problems.

I wear a CGM so can monitor really closely which foods cause spikes which is generally the usual suspects of normal pasta, bread, potatoes, rice etc.

 

[KennyA]

My fairly low carb/ low GI diet has been very successful in getting my A1C from 97 to 36 in less than 5 months. I feel that I can sustain that in terms of what I eat and willpower etc. But the big problem I am having is weakness and fatigue, sometimes pretty debilitating. I have investigated if it's a lack of something with no success, so I reckon it's due to a lack of glycogen in the body and muscles. My muscles tire really easily. Obviously if you eat more high GI carbs/sugar the blood sugar goes up.

It seems that your body can adapt to create energy from ketones instead, but presumably you would have to stay in ketosis. I have around 60-80g or so a day, I don't want to do keto and am slim so don't want to lose weight. Is it possible to eat low carb but not at keto levels without feeling tired and weak all the time? If so how do you avoid that?

Well done on the BG drop. If you're low carb but not in ketosis it follows that you must be getting enough fuel in the form of glucose from what you eat not to trigger ketosis, therefore it is likely that as far as your body's concerned you're getting enough glucose from your current diet. That doesn't mean that you're eating a good diet, just that you're getting enough glucose.

There's about a day's worth of fuel stores in the muscles and liver, so you're unlikely to be depleting them in a couple of hours.

It's also of course possible that weakness and fatigue is coming from something unconnected with your low carb.

I have been in ketosis for almost all of the last five years, and am pretty much done with weight loss. I've been able to slow/stop it by increasing dietary fat - on the basis that I can get enough fuel from that without going into fat stores, and without regaining any bodyfat. So far so good.

 

[Vectian]

Well done on the BG drop. If you're low carb but not in ketosis it follows that you must be getting enough fuel in the form of glucose from what you eat not to trigger ketosis, therefore it is likely that as far as your body's concerned you're getting enough glucose from your current diet. That doesn't mean that you're eating a good diet, just that you're getting enough glucose.

There's about a day's worth of fuel stores in the muscles and liver, so you're unlikely to be depleting them in a couple of hours.

It's also of course possible that weakness and fatigue is coming from something unconnected with your low carb.

I have been in ketosis for almost all of the last five years, and am pretty much done with weight loss. I've been able to slow/stop it by increasing dietary fat - on the basis that I can get enough fuel from that without going into fat stores, and without regaining any bodyfat. So far so good.

The fatigue improves after eating, and I didn't have it like this before changing the diet so I'm pretty sure it's related to that. I have also had numerous blood tests to rule out deficiencies and other things. I have read about the "keto flu" when you start keto, I wonder if I'm constantly on the borderline of ketosis so experiencing those symptoms ongoing as it's too many carbs for ketosis but not enough to be completely clear of it.

Seems to me that the glucose intake is just enough to cope with each day, but not enough to store glycogen. You would have to consume slightly more than you use to store it. Maybe I have to just up the carbs a bit and take the hit on blood sugar numbers, which is annoying as they are all well within non diabetic ranges now.

 

[Jasmin2000]

The fatigue improves after eating, and I didn't have it like this before changing the diet so I'm pretty sure it's related to that. I have also had numerous blood tests to rule out deficiencies and other things. I have read about the "keto flu" when you start keto, I wonder if I'm constantly on the borderline of ketosis so experiencing those symptoms ongoing as it's too many carbs for ketosis but not enough to be completely clear of it.

Seems to me that the glucose intake is just enough to cope with each day, but not enough to store glycogen. You would have to consume slightly more than you use to store it. Maybe I have to just up the carbs a bit and take the hit on blood sugar numbers, which is annoying as they are all well within non diabetic ranges now.

Low carb (<50g/day for the last eight years) but not in ketosis - too much of a risk/hassle for a Type 1. What I noticed very quickly was how easily protein began supplying my glucose and with the right balance of fats, I can work the whole day with very little carb intake. Glycogen will be replenished by protein gluconeogenesis so that's not the cause of tiredness, more likely that your change in diet has lost something like sufficient iron, B12 or folate. I also became tired, but increased meat/fish/egg/liver intake as well as spinach/sprouts, etc, so I got the vitamins and minerals back and tiredness went away.

 

[Vectian]

Low carb (<50g/day for the last eight years) but not in ketosis - too much of a risk/hassle for a Type 1. What I noticed very quickly was how easily protein began supplying my glucose and with the right balance of fats, I can work the whole day with very little carb intake. Glycogen will be replenished by protein gluconeogenesis so that's not the cause of tiredness, more likely that your change in diet has lost something like sufficient iron, B12 or folate. I also became tired, but increased meat/fish/egg/liver intake as well as spinach/sprouts, etc, so I got the vitamins and minerals back and tiredness went away.

I had all the common things tested - B12 fine (I have taken supplements for years), iron on the low side but I take iron supplements now and a little better but not a massive difference. I thought that gluconeogenesis mainly takes place when you are in ketosis i.e. the intake of glucose is very low (or your blood sugar drops too low). It's frustrating because my diet is on paper really good now, it should be super healthy but I struggle to get through the day sometimes because of the fatigue. I don't eat meat so can't increase that (I haven't for 40 years so it's not because of that) consultant said it's because you're not eating enough carbs...

 

[Jasmin2000]

I had all the common things tested - B12 fine (I have taken supplements for years), iron on the low side but I take iron supplements now and a little better but not a massive difference. I thought that gluconeogenesis mainly takes place when you are in ketosis i.e. the intake of glucose is very low (or your blood sugar drops too low). It's frustrating because my diet is on paper really good now, it should be super healthy but I struggle to get through the day sometimes because of the fatigue. I don't eat meat so can't increase that (I haven't for 40 years so it's not because of that) consultant said it's because you're not eating enough carbs...

Gluconeogenesis from fat happens in ketosis, but I eat sufficient protein to avoid ketosis (on purpose) and protein is used in gluconeogenesis to provide glucose for glycogen and fuel for exercise. Try this experiment - eat low carb all day and then for dinner eat a pot of carb-free, high protein yogurt (20-40g like No Sugar Alpro) and watch your BG go up! That's gluconeogenesis happening and your stores are replenished.

Don't know how many carbs you're eating but if your endo is saying it's not enough then maybe your BG is just consistently lowish, which makes most people lethargic. My endo said the same, but when I asked why I should increase carbs if I have a BG of 5.5 throughout the day, they had no response. I think some endos are simply worried about folk who eat low carb - NHS has very little experience of it.

 

[Vectian]

Gluconeogenesis from fat happens in ketosis, but I eat sufficient protein to avoid ketosis (on purpose) and protein is used in gluconeogenesis to provide glucose for glycogen and fuel for exercise. Try this experiment - eat low carb all day and then for dinner eat a pot of carb-free, high protein yogurt (20-40g like No Sugar Alpro) and watch your BG go up! That's gluconeogenesis happening and your stores are replenished.

Don't know how many carbs you're eating but if your endo is saying it's not enough then maybe your BG is just consistently lowish, which makes most people lethargic. My endo said the same, but when I asked why I should increase carbs if I have a BG of 5.5 throughout the day, they had no response. I think some endos are simply worried about folk who eat low carb - NHS has very little experience of it.

It's probably around 60-80g most days, actually the majority of what I eat is carbs - vegetables, beans/lentils etc., nuts, soya but not carbs that raise blood sugar. My average is about 6.2 (A1C of 36) which is right where I want it. I seem to be LADA, but with a good amount of insulin still, so I can keep the blood sugar in non diabetic range with this diet and exercise and no medications. Consultant was very impressed with the numbers, but said that low carb is not sustainable long term due to lack of glycogen. He seems to think that I should just eat whatever high carb rubbish and take insulin to compensate, which I don't want to do. I don't see why I should take a medication I don't need, but that seems to be the NHS approach - dish out medications for symptoms rather than concentrate on getting healthy. I'm sure part of it is to cover themselves. Advice about statins as well is very questionable.

 

[Rachox]

Wow @Vectian huge congrats on your drop in Hba1c! I’m not as scientific as the previous commentators here. All I know is I eat low carb, less than 40g per day, tested for ketones weekly a few years ago and only ever got low readings of 0.6 - 1.2. All I know is under 40g keeps my Hba1c at non diabetic levels and I’ve survived for seven and a half years so far, so I‘ll carry on doing the same!

 

[Vectian]

Wow @Vectian huge congrats on your drop in Hba1c! I’m not as scientific as the previous commentators here. All I know is I eat low carb, less than 40g per day, tested for ketones weekly a few years ago and only ever got low readings of 0.6 - 1.2. All I know is under 40g keeps my Hba1c at non diabetic levels and I’ve survived for seven and a half years so far, so I‘ll carry on doing the same!

Thanks! And that is with no medication at all, just a load of determination and listening to my own body and not to the nurse who wouldn't accept that cases can not fit the standard pattern. Do you every have problems with fatigue and weakness on low carb? It's very frustrating because my diet is really healthy now and numbers all good, just need to figure out what is causing this fatigue.

 

[Rachox]

I was always tired before my type 2 diagnosis, but once diagnosed and eating LC it improved. I’m sorry you are experiencing fatigue and hope with the help of your Dr can get to the bottom of it. How’s your sleep?

 

[Vectian]

I was always tired before my type 2 diagnosis, but once diagnosed and eating LC it improved. I’m sorry you are experiencing fatigue and hope with the help of your Dr can get to the bottom of it. How’s your sleep?

The doctors are pretty useless, even the consultant specialist couldn't answer half of my questions. They just want to give you medications. I have never slept well, but this is definitely food related as it improves after I eat and I didn't have this before I changed the diet.

 

[EllieM]

I seem to be LADA, but with a good amount of insulin still, so I can keep the blood sugar in non diabetic range with this diet and exercise and no medications.

So you've had cpeptide and antibody tests???

I ask because there are other types of diabetes which might need to be checked out.....and might have different issues....

 

[Antje77]

The doctors are pretty useless, even the consultant specialist couldn't answer half of my questions. They just want to give you medications. I have never slept well, but this is definitely food related as it improves after I eat and I didn't have this before I changed the diet.

Maybe a stupid question, but are you eating enough?

 

[Vectian]

So you've had cpeptide and antibody tests???

I ask because there are other types of diabetes which might need to be checked out.....and might have different issues....

Yes, GAD antibody positive, but C peptide completely normal which doesn't make a lot of sense, the consultant wasn't able to explain that.

 

[Vectian]

Maybe a stupid question, but are you eating enough?

I eat more volume of food than before, but as it's often a lot of vegetables probably not so many calories, but then also a lot of nuts to compensate. I'm not really losing weight though (or gaining) which would happen if not eating enough. I do feel hungry often though even not long after eating

 

[Antje77]

I eat more volume of food than before, but as it's often a lot of vegetables probably not so many calories, but then also a lot of nuts to compensate. I'm not really losing weight though (or gaining) which would happen if not eating enough. I do feel hungry often though even not long after eating

Hunger is a natural signal to tell you to eat more.
Fatigue and the likes are very common signals you're not eating enough.
Personally, I eat when I'm hungry (and sometimes a bit more because I enjoy food).

Yes, GAD antibody positive, but C peptide completely normal which doesn't make a lot of sense, the consultant wasn't able to explain that.

From what I understand this is quite common in early T1/LADA.
My C-peptide was just below the low normal threshold even two years after developing diabetes.

 

[MrsA2]

I too think you're not eating enough satiating and nutrient rich protein and fat. The clue is that the fatigue goes away after eating. You just need to eat more to last you for longer. Imho.

 

[Vectian]

Hunger is a natural signal to tell you to eat more.
Fatigue and the likes are very common signals you're not eating enough.
Personally, I eat when I'm hungry (and sometimes a bit more because I enjoy food).

From what I understand this is quite common in early T1/LADA.
My C-peptide was just below the low normal threshold even two years after developing diabetes.

From what I have read most people have low normal at first, but mine was completely normal. How the problem can be insufficient insulin when that shows I produce a normal amount doesn't make any sense to me and the consultant couldn't explain either. I read a meta analysis about the T1 honeymoon period and less than 3% had remission with no medication