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Counting carbs - net or total?

Discussion in 'Reactive Hypoglycemia' started by swttbsy5, Jun 12, 2020.

  1. swttbsy5

    swttbsy5 Reactive hypoglycemia · Active Member

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    Hi All. Just wondering do people count total or net carbs? I've been under 30 grams total per day for maybe a week now and feeling good but it is difficult to stay that low. If I count net then it is a lot less restrictive but just wondering what people's experience is with this?

    Thanks
     
  2. JoKalsbeek

    JoKalsbeek Type 2 (in remission!) · Well-Known Member

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    Where in the world are you? In America, you have to deduct fibre from the total carb count to get to net, but in the rest of the world, fibre is already deducted in nutritional information... So there's no "Net carbs" unless you're in the USA. I count total carbs, and I'm in Europe. Hope that helps.
     
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  3. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    I can understand what you are going through!
    If you want to count carbs, like I did in the first couple of months after starting low carbing, it became an integral part of how much carbs I could tolerate, knowing your limit, will help with how much carbs per meal you can tolerate.
    Until you discover that, then if again like me, you were recording everything else as well, blood levels, which foods, portion size. Counting became less necessary once you have eliminated those foods you cannot tolerate, unless you are experimenting!
    I have a limit depending on which foods, of somewhere between 5% and 10% carbs. Without triggering an episode!
    You now know that you are intolerant to most carbs, it's easier to avoid than count!
    Unless, you are experimenting, I believe just testing your blood levels is enough!
    With everything else going on, it will help not to go over the top with either having one spud or none and having another low carb alternative!

    Keep safe
     
  4. swttbsy5

    swttbsy5 Reactive hypoglycemia · Active Member

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    Ok. What I'm worried about is coming out of ketosis. Even when I have 50g per day my bgl is stable. I'm not eating any foods that raise the bgl. I'm hardly eating any processed foods at all. Just low carb veggies, meat, nuts, cheese, greek yoghurt and some mayonnaise. None of these foods raise my bgl. Maybe I'm being too strict. So let me get this straight - if my bgl stays where it is then the food is ok and it's not about the amount of carbs but more so the type of carbs and if I can tolerate it. The endo said to test ketones in the morning. How does one find out if one has been kicked out of ketosis by a certain amount or type of carb?
     
  5. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Ok, no, your not over thinking this!
    The diet you are following sounds really good and the control you have is brilliant! Staying in normal levels range is the best treatment that I know of!
    You are trying to make sense of all the new things that are happening to you.
    The biggest problem all us hypoglycaemics have is we all have different food that we are intolerant to, my worst are potatoes, then wheat but I'm not gluten intolerant, I'm lactose intolerant too! The amount of refined or complex carbs are important, as is saturated fat of what your right balance of food is. This is why a food diary and a glucometer is the best tools you can use to make sense of how food affects your blood levels.
    You will know if you come out of ketosis, or your blood glucose levels are going out of normal levels, again, I have never used ketones testing, just relied on my glucometer, the way I feel and my health improvements when I was at the same stage of finding out how to get a grip of my blood levels.
    My endocrinologist wasn't bothered if I stayed slightly above normal or just above ketosis, he said that was a more natural state of how the endocrine system works.
    But I just stay in normal levels, because I really believe that is how my body, (not my brain) wants me to.
    It is a lot of things you have to do, and if you do come out of ketosis, then cut out all carbs, if you are like me, a good sleep should put you back into ketosis because of the overnight fast. If you feel a little rough, avoid the worst carbs, or fast, eat little, don't overeat. If fasting doesn't work, then only have a bite or two, cheese is a good option.
    My personal choice it's a ham salad! It's fresh and not processed! The ham is roasted!
    All my meat is not processed!
    Make sure you are getting enough salt. Because you have cut out the processed foods, the amount of salt intake will probably drop a lot.
    The other main thing is drink enough water!
    A good tip if you like your coffee, is a fat bomb. Full fat cream ( because of the good fats and virtually no carbs) in your coffee is a good way to start your day.
    Unless, you are intolerant to caffeine!
    See how this works?
    Potential landmines everywhere!

    Keep asking, keep safe!
     
  6. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    I don't really see where being in or out of ketosis matters - most people swing in and out of using ketones at least once every 24 house. It is natural. If you eat early and late in the day you might go in and out twice. Eat low carb and the drop out might be a mere flicker.
    Your HCP might be concentrating on ketones - but if your 'problem' is carbs then count and control the carbs - surely that is more logical?
     
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  7. swttbsy5

    swttbsy5 Reactive hypoglycemia · Active Member

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    Yeah I'm slowly making sense of all this. Before I went extremely low carb I was doing ok on around 50 grams carbs per day. Is 50 grams considered low? I think it's around 10 percent carbs for me. I'm just not eating any high carb foods at all. I've been adding salt too and also eating halloumi cheese which is pretty salty. Still having 3 meals per day though and a few snacks. The fasting thing doesn't work for me as my glucose starts to drop the longer I go without food. It went to 2.7 the other week. I'm going to do a fasting test soon to check for an insulinoma but the Endo says that's unlikely.
     
  8. Brunneria

    Brunneria Other · Moderator
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    No one ever gets ‘kicked out of ketosis’. That is a total misrepresentation of what happens.we are not dual fuel cars, where the flick of a switch knocks from 0 to 100% to a different fuel.

    Look, I am not getting at you.
    I just find it rather frustrating that the entire internet community seems to have latched on to the phrase and it has now taken on a life of its own.

    The reality is that we humans regularly ease in and out of ketosis on a daily basis, whether we are low carb or not.
    Have a late lie in? A light supper? Skip a meal? Miss breakfast?
    Then you are likely slipping in and out of ketosis.

    As a low carb/ketoer you can flirt in and out of the sliding scale of ketosis and stay fat adapted. Just try and stay on the ketosis side of the line. Depth of ketosis is something body builders boast about, but you will be fine if you stay just this side of the line.

    you asked:
    and while different carbs have a different rate of glucose release (fast or slow and combined with fat, or protein or fibre), portion size and your own personal reaction will also play a part.

    Bottom line: do some self testing, different carbs and different portion sizes, but you are RH, aren’t you? I would urge you to think less in terms of what carbs you can tolerate, and more in terms of keeping your bg low and steady.
     
  9. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    I suspect that the concept is due to people used to constant grazing finding it difficult to escape from using glucose - particularly if they have been eating low fat.
    I'd have been fairly sure of being in ketosis the day after diagnosis, after two meals of just meat, as I started to eat low carb in my early 20s and only abandoned it under protest and the insistence of my GPs. My metabolism is never happier than when not burdened by the carbs it cannot cope with, it is like going from economy to sport mode in my Nissan car.
     
  10. swttbsy5

    swttbsy5 Reactive hypoglycemia · Active Member

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    Haha this does not surprise me. It's sounds like a standard internet thing. Misinformation in a catch phrase. I do have RH and I also need to do a extend fasting test because when i fast, I also hypo. Which could mean insulinoma but apparently that is very rare. The last hypo I had was from skipping breakfast and I treated it when I got to 2.7. Usually the hypo comes after certain foods. A typical morning before I went low carb would be:

    8 am high carb breakfast
    8 30 am bgl around 8 sometimes up to 10 or 11
    9 am bgl 3.4, sometimes lower however hypo symptoms used to start during the crash usually at around the 4.3 bgl mark. It's the sudden rapid crash that used to start the hypo symptoms for me. A bgl of 3.9 is fine while on keto but when I'm at 3.9 after being at 8 or 10 less than half hour previous 3.9 would be very bad.

    Since going low carb my bgl is stable and it was stable before extremely low carb. It was stable on around 60 grams per day of carbs but I thought what the hell I'll try full keto so I went down to less than 26 grams total for a week. Didn't feel all that much better and maybe even a bit worse than when I was on 60 grams per day as my bgl stays around 5 or high 4s. On full keto it stays low 4s high 3s and when I fast it goes hypo. Sorry about all this badly organised information but that's where I'm at! Thanks :)

    Also, I'm a thin guy and I've already lost a lot of weight and very fast on this diet.

    I'm trying to find the upper limit of carbs that I can tolerate without causing the dreaded hypo cycle.
     
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  11. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    I know that you have been diagnosed with RH, It may be Hypoglycaemia of some type, but I do think you need a referral to a specialist endocrinologist who has experience with this type of hypoglycaemia and get the tests to make sure it isn't insulinoma.
    My RH was diagnosed because I didn't go hypo when fasting. I had a fasting test in hospital, to eliminate other conditions such as insulinoma. My specialist told me if I did go hypo when fasting it was not RH! But that doesn't mean you don't have a type of hypoglycaemia that can be controlled by diet!

    Have you seen a specialist endocrinologist or did your GP diagnose you?
    If not, get a referral, get the tests you need.

    Keep safe
     
  12. swttbsy5

    swttbsy5 Reactive hypoglycemia · Active Member

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    I've seen 2 specialist endocrinologists over the last 2 years and they both diagnosed me with idiopathic reactive hypoglycemia. After doing a lot of tests. The first endo tested for insulinoma but the second endo said the test should have been done under fasting conditions and the only way to really find out is a blood test when bgl is below 3.0. She has confirmed the RH diagnoses and suggested a fasting test for insulinoma. She said because I hypo quickly when fasting I don't need to go to hospital for 3 days but to do a fast at home and get someone to drive me to the pathology clinic when my bgl is lower than 3.0 to do the relevant tests. She gave me the forms I need to do that. She said it's to rule out insulinoma and she said it's so rare it's very unlikely to be that. She also said my condition is very unusual and would love to see a study done into RH and keto diet as it is obviously working so well in my case.
     
  13. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Regardless, I would still do it! I would ask your GP to help with the test, if there is no other way! Any tests like this, were the patient is likely to go hypo, should be supervised. A 72 hours fasting test is the final step in diagnosis, and I'm certain, that if you don't go hypo, like I did, then RH is diagnosed. If you do go hypo then further tests are required, to see if it's insulinoma or another pancreatic condition.
    The reason behind RH, is that it is food related, and food will trigger the reaction. Not having food, should not cause a hypo. Unless it is another type of hypoglycaemia or has been said previously.
    You could have something similar to RH with T2, when, you have diabetic numbers fasting and hba1c before the overshoot develops over time.
    The treatment is the same, a ketogenic lifestyle and staying hypo free.
    Insulinoma is rare but it shouldn't be ignored by your specialist.
    Reactive Hypoglycaemia is also very rare, and yes, there is not enough research done, I myself was used as a guinea pig in having a lot of eOGTTs to help my specialist endocrinologist write a paper on how a drug can help with control. It didn't stop hypos and it wasn't a cure, but nevertheless, my specialist did help me understand the condition and how it works, and why!
    Overall, idiopathic should not be used in diagnosis, because if they understood the way food caused the trigger and hypo, it is not unknown. The only reason it could be used is why we have a very weird and rare overshoot, because not many conditions have this, I have been called weird by doctors, especially those who don't understand it!

    Keep safe.
     
  14. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Hi again, have you had your cortisol levels checked?
    I was reviewing some notes I made a few years ago and this stood out and does cause RH and some patients do go hypo when fasting.

    Unless you get the right tests, it's a guessing game!

    Keep safe
     
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