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Fats and Insulin Resistance

Discussion in 'Low-carb Diet Forum' started by Sean_Raymond, Jan 6, 2021.

  1. AloeSvea

    AloeSvea Type 2 · Well-Known Member

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    It is easier for me to do an old-school quote thing then mucking around with deletions in the quote - I hope this is OK for Sean Raymond and readers? These quotes are in a post above from Sean Raymond to me -

    "The ease of access and availability to highly palatable high energy foods continues to increase and it makes sense that as a species which evolved seeking out high calorie foods to survive in an environment where food wasn't guaranteed we will be really attracted to them."

    Talking about calories really doesn't do it for me. And for many I take it, who are trying to be healthy-weighted rather than overweight and fat in today's food environment, that 'eat less, move more' dictum really doesn't work, it seems. This is my understanding at any rate.

    I do believe the theory that ' a calorie is not just a calorie', and that the body deals with different macronutrients in different ways, which is at the base of our current problems with obesity, when our food environment has gotten so -what I would call corrupted - with excess carbs especially in the form of sugar (oh - in everything!), and bad fats that we can't digest properly and do us serious harm in the amount we are eating them. And let us not forget the sugary drinks.

    Yes, insulin plays a big part in fat storage amongst other vital roles. And yes - I brought up the Randle cycle because it is so relevant, of course, when discussing the role of fat and glucose forming food in our diet and insulin resistance.

    I thought the fact that the body deals with proteins, fats, and carbs in different ways especially regarding fat storage was in fact - a fact. And not disputed by nutritonists. Is this not the case?

    Health professionals don't deal with this, in my experience - how to eat to be healthily weighted. They need to do what they are judged on, which is to tell T2D patients they need to lose weight - it is hardly their concern how their patients do it, has been the idea as far as I can see. Doctors send those with diabetes along to - nutritionists! When the patients want direct help. (and are told to exericse more.) Which is why it is so engaging for us to talk with you (you are a nutritionist in the - British ? healthcare system are you not? which healthcare system doesn't really matter. apologies if I have got it wrong - apparently you made this more clear some years ago in a post?) - we don't often get the chance - and what a chance this is. Yes as long as we are civil - quite right!

    It is interesting for me having this exchange with you @Sean_Raymond, as I do not have the opportunity to discuss these things with a professional nutritionist in my present life - not since early in my diagnosis when I engaged most happily on the subject of low-carbing being the first line in combat against insulin-resistance based type two diabetes with those nutrionists I inevitably then came into contact with. I look back fondly on those discussions actually.

    In our species' past, it was not just "where food wasn't guaranteed" (hey - it still isn't! Food insecurity is a really big problem in many advanced countries even) (and this following our Covid year 2020 in particular). but where really sweet fruit, and honey, was not commonplace, or even rare, outside of the tropics. I live in the subtropical part of the south pacific, and the only sweet fruit available before trade with Europeans and the ultimate invasion was a berry that had to be worked on for a very long time to make it barely palatable, and the bees here were not honey bees. I'm talking attraction to sweet (ie very high carb) - which for type two diabetics with a sweet tooth (which having a sweet tooth is after all a common part of our species) is more than just discussing a theory about insulin and body fat. It is no coincidence that a major food staple was the sweet potato - 'kuumara', but I take it was not nearly as sweet back then as the imported varieties are now.

    "Adding this to more sedentary behaviours is for me most likely the main factors driving the obesity epidemic rather than it being because of a particular macronutrient or hormone. "

    Fat storage issues were key to me when I lost a lot of weight after diagnosis, and they are key now in maintaining my normal weight. Fat storage issues are about hormones and macronutrients when it comes to eating, to my mind.

    And the healthiness of physical activity is about how it all works together - food for energy - and ultimately - cardio vascular health isn't it? Which when it comes to our living as long as we can as people with blood glucose system chaos/disruption, is where it is at, isn't it.?..

    When I discuss food and activity with my non-diabetic friends it is this issue that is very interesting to me - as many of them have some level of cardio vascular disease (I am well middle-aged so so are my friends), at the very least high blood pressure, and are on medications for it. I gently tell them that they already have what I am working so hard to avoid. Many unfortunately believe that the medications they take are curing them of cardiovascular disease - not that they are taking them because they have CVD. I find this a health education tragedy. And that there is absolutely a 'follow the money' aspect to it. Which I do see a wrong-minded focus on cholesterol levels to be a part of that. But that is a huge other discussion, but interesting to me that you brought it up so fullsomely in a large paragraph.

    We have not undergone a major genetic shift in just 50 years and I do not believe most people are inherently inflicted with greediness so maybe it is the unconscious aspects of the brain forged in a time of feast and famine that is what drives what are now unhealthy behaviours."


    Hmmm - the word "greediness" does not belong, imho, in a discussion with type two diabetics about dealing with the excesses of the current food environment!

    Do you talk about greediness to your diabetic clients? Mmmm - I hope not!

    We were talking, I thought, about why it is very difficult for folks to not eat high sugared foods and foods that turn into high-glucose in the blood (ie - carbs!) that are cheap and readily available, and that taste delicious to us. My example is usually potato crisps. And "we all scream for ice cream".

    I am very aware that the word 'greed' is not really used in current English unless one is citing the seven deadly sins, of which greed is one of them. The sin 'sloth' absolutely, is also, horribly, used in conjunction with greed to sometimes discuss what is at the bottom of T2D in some people's eyes. Awful. ('Overeating and being sedentary' is the 'nice' way to say the combo, which I believe still, as 'nice' as it is - is wrong, and does insulin resistant diabetics a huge wrong.) 'The Seven Deadly Sins' are part of a particular religious belief and rhetoric which I am not a party to.

    One did not, and does not, need to be experiencing a famine to want to eat as much of sweet food or starchy salty food devised in a food-lab (the crisps) that we are 'hard-wired' to consume a lot of when finding it, indeed because our genes have not had a major shift in the last 50 years. I was not saying that our genes have shifted - I thought I was making it very clear that our food environment has - not our phyical make-up as a species.



     
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  2. AloeSvea

    AloeSvea Type 2 · Well-Known Member

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    Hi @Dark Horse - we have had many exchanges over the years and I appreciate them.

    But the subject of Human Evolutionary Biology is not my personal or "lived experience" per se. Only if you are citing the fact I am a human :). I am stating some very basic Human Evolutionary Biology ideas in my posts and to you - the stuff about my history with not calorie counting was really an aside.

    My 'go to' on type two diabetes and Human Evolutionary Biology is the excellent 'The Story of the Human Body: Evolution, Health, and Disease' by Daniel E. Lieberman. The notes and the data at the back are tremendous.
     
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  3. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    I take it, that you cannot respond to my questions.

    I have took part with full knowledge and consent to verify that a T2 drug is helpful with management of my condition.
    The test was originally to help with first insulin response and increase the insulin so that I would not spike too high, so that I didn't have the overshoot of insulin, so I wouldn't have an episode of hypoglycaemia.
    This is because my specialist endocrinologist was of the opinion that it was necessary for optimum brain function and energy levels.
    It didn't turn out that way. Yes it did increase initial insulin response, but it didn't stop the trigger for the overshoot, there just wasn't me, the tests were done with another diagnosed with the same condition with differentials in symptoms and outcomes.
    The blood glucose monitoring, was very close to each other and the spikes and hypos were slightly different, but the pattern of the monitoring was exactly as predicted, except for the pair of us went hypo, which the specialist was hoping it would not happen.

    It was repeated with a higher dose, same outcome but lower spikes and increased circulating insulin pre test.

    My condition gets rid of excess insulin but it stays in the endocrine system around my system, I have had a NAFL caused by insulin, according to my specialist. Also kidney function and liver function and cholesterol problems.
    From 2001, I was given the dietary advice according to the eat well plate.
    I couldn't understand for over a decade and lots of visits to my surgery that this diet was increasingly putting weight on around my whole body, my average weight until th I s century was around twelve stone. So as I said, the dietary regime I was recommended, was causing me some terrible symptoms, I was misdiagnosed with T2 because, my breakfast caused a huge spike and a reading at the surgery was so high, they gave me all sorts of tablets and put me on a restricted diet, I was around fifteen stone then, in a couple of years, I had put on three stone, I just couldn't understand it.
    Onto 2012, I went to the doctors for a problem with my prescription, and to my surprise, the GP looked at me and gave me a blood finger prick test, it read I think 2.3mmols. In the meantime I had put on another three stone, I was above eighteen stone. I was hardly eating!
    I was referred to a specialist endocrinologist who lucky for me knew about rare metabolic conditions. I had a hypo in front of him on my first appointment, because of my breakfast. Why? How?
    So after taking readings, I was given biscuits to get my blood levels up back into normal levels.
    My breakfast for the past twenty years was porridge, just like the Scots make it, I usually had something akin to baked or new potato for one of my meals and another meat dish probably a roast or similar for dinner, curry, or fish and chips for a treat, whole grain bread, low GI low calories but my weight kept on getting higher.
    So after quite a few tests and starting a food diary, with strict readings of blood levels portion size etc.
    I was told that I was non diabetic and I have a condition called Reactive Hypoglycaemia.
    This means I am carb intolerant, any amount of carbs over a very low percentage, will trigger the overshoot of insulin. I had hyperinsulinaemia, I had insulin resistance, high levels of circulating insulin and when required, I had no effective insulin for the glucose derived from food. The reason why was the excess insulin.
    After going through the dietary recommendations from my specialist endocrinologist, even he accepted that avoiding certain foods, namely carbs and sugar would help me control my levels, all my symptoms I was having was because of fluctuations in blood levels because of my response to carbs, from porridge in the morning to bedtime and through the night, I was going up and down quickly, having spikes and hypos.
    The excess insulin in my blood was killing me slowly, and until I had it explained, researched and talk to my specialist, did I get an idea of what this condition was about.
    I was advised by a dietician that was part of my specialist team and she told me about this website.
    After studying my food diary and reading about how a change in my diet and lifestyle would make a difference in my health which up to this time was really poor.
    I had another good chat with my specialist I persuaded him to back me into going into ketosis. I have all but a small time since diagnosis been on a Keto diet.
    Below 20g of carb a day.
    My final diagnostic test was a 72 hours fasting test, supervised in hospital.
    Because I didn't go hypo all through the test, my blood levels stayed in normal range all through the more than 72hours, my brain function increased, I lost weight, I gained muscle mass, and most importantly my insulin test result was a lot lower than pre test.
    Many T2s have insulin issues and the result of insulin resistance is unused insulin and it must go somewhere.
    This means the pancreas works harder and if I'm not careful with my diet, I will be T2 diabetic.
    It is my experience with my condition, that I know that insulin has to be controlled, having no spikes, no hypos is important that increases my future health.
    Having high circulating insulin levels are bad, having hyperinsulinaemia will kill you.
    T2s are wary of high blood glucose levels and insulin tests are rarely done.
    Constant high blood glucose levels will be fatal and this is why a lot of doctors say it is a disease that will continue to get worse. That is not true if you have the right dietary intake. The balance of protein and fats, with healthy vegetables is a really healthy option for metabolic conditions, because it doesn't raise glucose/insulin, hormones that causes most of the metabolic disorders.
    I finish by saying that I have had a paper published on the drug I was taking.
    And because of the experience of mostly having to find out how my body works, is to stop eating the so called healthy complex carbs like porridge, whole wheat bread, potatoes, too much junk food and essentially any products that have a modicum of carbs, because the effect of triggering an overshoot of insulin will have an adverse effect on your health.
    I am a non diabetic, Late Reactive Hypoglycaemic.

    Stay safe
     
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  4. kokhongw

    kokhongw I reversed my Type 2 · Well-Known Member

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    It would seems to me that the baseline fasting insulin levels were already high for the subjects in both groups... so it would be reasonable that verfeeding on fats when insulin levels are high will lead to more efficient fats storage vs carbs since no conversion is needed...
    upload_2021-1-12_12-3-1.png
    In any case Ludwig's 2018 paper gives a good overview of the Carbs/Insulin model...
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082688/

    And his review on Feeding studies demonstrates his team's understanding of how insulin/ketosis, fat adaption works...
    upload_2021-1-12_12-10-27.png
     
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  5. Sean_Raymond

    Sean_Raymond HCP · Well-Known Member

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  6. Sean_Raymond

    Sean_Raymond HCP · Well-Known Member

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    Hi. Sorry for the late reply. I’ve missed a few posts! And thank you for sharing that experience. Insulin resistance is a very tricky, difficult to understand condition and I think it is brilliant that people here try to understand it. Many Drs struggle mightily with it as do I.

    Yes, I am aware of but not over familiar with your condition. I cannot recall having worked with anyone with it although Bariatric colleagues come across it fairly often after surgery. The cause of it in those cases are understood so aren't comparable. I was just about to ask whether your condition was idiopathic or due to insulin resistance, which is linked to later reactive hypoglycaemia episodes, and you confirm it is due to insulin resistance.

    From a dietary perspective, my first instinct was to look at reducing the insulin response and or rise in blood glucose so carbohydrate reduction as a approach I would consider (it wouldn't just be dietary glucose causing the spike but failure to shut down hepatic glucose production). I see you have adopted a ketogenic diet which has worked for you - once again, I am incredibly pleased to hear this and impressed that you did it outside of expert recommendations. This is such an important lesson here. I’ve used Ketogenic diets for epileptic patients only.

    I’m aware we have a difference of opinion regarding insulin and weight gain/loss and I’m aware my view of this cannot explain the fact you were not eating and insulin resistant yet still gained weight. I find it incredibly frustrating on my part in failing to reconcile this experience with what I’ve seen, experienced and studied. Every time I look to the insulin hypothesis and studies into it I’m sadly also not left with the answer that you reach. Some of this may be linked to inherent genetic differences in some of us that science just hasn’t caught up with to adequately explain. But you found something that works and this is very valuable to me.

    May I ask why do you think insulin resistance is caused by circulating insulin. I am still more persuaded by the idea that accumulation of fat in organs interferes with insulin signalling and insulin release (this can happen in thin people too).

    Similarly, you say that calorie reduction doesn't work for people with T2DM but I have worked with and seen people with T2DM lose weight and greatly improve control of their condition. Many studies support this in both those with T2DM and without. I have trialled low carbohydrate diets and they didn't always work to lose weight and or even markedly reduce blood sugars either. In others, low carb worked well.

    I am aware many have not had success with a purely calorie reducing approach however as was shown by someone who provided a study to show reducing insulin causes weight loss - the study clearly referred to calorie reduction as the cause of the weight loss. I've not seen a concrete study which, with calories controlled, insulin reduction caused weight loss.

    Many here say calorie reduction didn't work for them yet eating more calories and reducing carbohydrate led to weight loss - again, based on what was said I cannot explain that or your experience. I just do not see reduced insulin levels explaining it either.

    Apologies for any typos. I am furiously writing on my phone whilst at work.
     
  7. Sean_Raymond

    Sean_Raymond HCP · Well-Known Member

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    I haven't looked at it in any great detail but I am reasonably familiar with it. If you'd like to state the differences in insulin response to the particular meats then we can discuss it. Fat and protein content of the meat as well as form and digestibility of the meat may impact its insulinaemic response.
     
  8. HSSS

    HSSS Type 2 · Expert

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    My immediate questions would be did the cal reduction also involve a carb reduction and if so how do you differentiate which caused the improvement?

    And how can you be sure of adherence to the low carb prescribed diet? Many have been accused of failing to stick to low cal diets and that is the reason for their failure.

    How can you be sure if was low enough for that person’s insulin resistance? Many find 100g a day adequate for control many find under 20g is required. Expecting a single level to work for all is a flawed plan. Much the same as expecting everyone to respond to a single calorie limit regardless in a traditional low cal diet would be flawed.
     
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  9. Sean_Raymond

    Sean_Raymond HCP · Well-Known Member

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    I will reply and trust you can link what I am discussing to your reply.

    Consuming equal or less calories whilst being active is a pretty solid approach to maintaining/losing weight. I’ve had very good success with people doing this (with or without diabetes). Consuming equal or more energy than your metabolic needs but lowering a particular hormone isn't something I've seen (I have tried it personally and with others).

    A calories is a calorie concept changes after consuming food. Different foods have different thermagenic effects and it is easier to extract energy from some foods than others. Different foods have different effects on satiety and motivation to eat more. Calories in and out is not perfect and is only part of the reason a person may gain unhealthy weight but it is still at its heart the most plausible for me in many cases.

    I do not find the idea that insulin resistance is the cause of weight gain - I'm more convinced at this point that it is more likely a consequence of it. I will change my mind if better research comes out showing otherwise. Yes, a role of Insulin is to signal to the body to stop fat breakdown and promote fat storage but it is a signal which the cell is not obliged to follow - insulin is important in energy metabolism but it is just one of the players involved in the burning or storing of energy.

    Metabolic pathways for fat, carbohydrate and protein are different. I was not referring to the specific digestion or metabolism of them per se (chemical exchanges) but the way fat and carbohydrates are thought to compete for fuel selection. The Randall cycle proposes a theory that describes the flux between fatty acids and glucose for oxidation during fed/fasted states. It isn’t standard to teach it (or at least I wasn’t taught it).

    I think the cycle can be used to put forward an argument that eating fat and carbs together will impair efficient metabolism of a substrate which may have implications for metabolic health but not that it is a reason for why people get fat (fat gets oxidised glucose energy gets stored). It does support the idea that eating fat separate to carbs would mean either one will be more efficiently metabolised. It does link onto the idea that dietary fat acutely impairs glucose metabolism. Fat and sugar together tend to be highly palatable too.

    A big part of a nutritionists and dietitians role is to help people eat healthy and or to achieve a healthy/healthier weight so I am sorry if they were not much help, But I am sure they were interesting discussions. I am more than happy to discuss things with yourself if I feel able to.

    Sweet/fatty foods are indeed particularly attractive but I do not see honey/sweet fruits as particularly problematic. Tribes such as the Hazda eat diets of largely unrefined carbohydrate for periods of the year including berries/honey. Overconsumption of such foods is another matter.

    Hormones are certainly a part of energy homeostasis and fat storage. Some people may be more predisposed to store fat. Similarly some people are more likely to store fat around the viscera but not subcutaneously so they become metabolically unhealthy but do not display any overweight phenotypes.

    Macronutrients may be an issue with how they are packaged i.e carbs consumed in the form of sugar laden fizzy drinks that by pass appetite controls which the body does not compensate for.

    Unfortunately some people view people who are overweight/obese unfairly, assuming they become that way because they are lazy/ willingly overeat - a sterotype of being greedy. I was not suggesting or calling anyone greedy - you may have misunderstood me here. I was making the point that this isn’t the case. That biology and the food environment is against them.

    Regarding genetic shifts, I was making the point within the context of a change in food availability and types of food available and the ease with which these foods are available was a reason behind the obesity epidemic not some physiological change in the general population. I wasn’t suggesting you implied there was any genetic change.
    I agree.

    We are hardwired to seek out high calorie foods which is why eating them can be so rewarding (dopamine release etc).
     
  10. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    The point I was making was that protein that have good fats in general are usually the best for insulinaemic response.
    Through my experience and my food diary, and from my endocrinologist, he told me that certain meats such as chicken, pork and white fish were very good for initial insulin response. And not to trim the fat.
     
  11. lucylocket61

    lucylocket61 Type 2 · Expert

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    I think, as a general point, that the difference in response to various dietary interventions depends on if the person has type 2 diabetes or hypoglycemia etc versus ones with a normal response to carbs. Plus the severity of the impairment of insulin response.

    Perhaps that is not being sufficiently focused on in this thread. It is unhelpful to compare interventions for those without impaired insulin response with those who have an impairment. Like is not being compared to like.

    CICO may well work for the majority of those without an impaired insulin response. However, most of us who are responding on here have a different insulin response, for various reasons, to carbs. Hence our experience being outside 'normal' textbook results for those with healthy insulin responses.

    Further, low carb is usually cited as less than 130g a day of carbs. Due to the varying severity of impairment of insulin response stated by posters on here, such a level is insufficient to overide our impairment, so standard low carbing doesn't help. We have to go much lower. Even 100g a day is too much. This may be why some trials and studies on the effect of low carbing appear to have not helped. The amount of carbs eaten at one time can also affects us, as can the type of carbs
     
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  12. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    I have spoken to many doctors and dieticians, mainly through my last job which was in professional sport. I have also had advice from nutritionists.
    I had a consultant endocrinologist to look at my fatty liver in 2005/6 and why my body was not responding to the dietary regime recommended.
    He did not believe me, when I told him I couldn't drink alcohol, I was only eating what I was advised. He didn't have a clue and dismissed me, because of the reasons that most GPs don't understand it.
    I readily admit I am weird, my system does not work the same as most people or diabetic patients do.
    I produce too much insulin of which the signal does not stop driving my blood levels down, only when the signal is stopped because I need glucose, does the pancreas switch off. It is this unused insulin response that has to go somewhere.
    I am not a trained dietician, I am a person who has battled to get on in life, I have had to depend on my skills and willingness to think logically.
    If you go on the premise that with all the tests I have had, the reason I say that it is insulin is my experience and my food diary, test results, and speaking to my specialist endocrinologist, who is very knowledgeable on rare hypoglycaemic conditions.
    The drug I was tested on and a paper published and used by my endocrinologist was sitagliptin. This is a dpp4 inhibitor. This is useful as I have a very weak initial insulin response. This has been seen in blood taken from a cannula pre test and shortly after and an hour and two hours when I had my first and second eOGTT tests. All my blood panel tests (a lot!) were sent to a private specialised Laboratory down south. I had to wait over a week for the results.
    It is not idiopathic, it is my insulin response that is the key to why.
    The trigger for an overshoot is the rapid glucose derived from carbs, as I said I had too much insulin circulating at the time, which the insulin resistance was a compounded effect, and the cycle of excess insulin, insulin resistance and going high then low into Hypoglycaemia constantly, the basis of being in ketosis is, logical, no spike, no trigger, no overshoot, no hypo.
    And the trigger is caused by carbs. All carbs.
    Calories, I have never counted, I have been on a so called healthy calorie controlled dietary regime but it is carb laden. Calories are not as important as what foods are healthy for you. One T2 is different to other T2s, what works for one won't work for another, that is why you see different results, the cause of T2 is different in most cases and the treatment needs to be individually tailored to the reason for their diabetes. It could be insulin resistance, how do you reduce insulin resistance, by reducing the amount of insulin circulating. A lot of T2s have similar symptoms of reactive hypoglycaemia I do believe that a low carb diet help with reducing insulin to halt the spikes. The right balance for you, is more important. I am lactose intolerant, so I can't get my fats from dairy, I can't eat a lot of vegetables, I have found a balance of protein, fats and vegetables that agree with me and improve my health. I for some reason do not have to use supplements or vitamins, I just need to avoid carbs. I am carb intolerant. I don't need them. I know my brain and body work better without carbs, I am sixty six shortly, I have never been as fit for decades.
    I've left this for last, it is a hypothesis I have discussed with my endocrinologist and came to a conclusion that it is highly likely but no way to prove it.
    One of the causes of Reactive Hypoglycaemia is a bacteria called heliocobacter pylori.
    This bacteria is found in the gut and was always been thought to be the cause of ulcers and stomach problems that are common.
    I had the antibiotics for the bacteria. And it cleared the bacteria. It was no surprise when you research all this that the gut bacteria cured certain issues that I had but it coincided with the severity of symptoms I was experiencing at that time.
    You could say that my stomach issues were cured at the cost of hypoglycaemia.
    Not that I knew about it then.
    I have read and I have wrote that the signal from the brain is what triggers the initial and secondary overshoot of insulin. This signal, I have seen been called the gut brain trigger function, in other words what takes the brain milliseconds to send signals about eating, the gut has a response to what is going in.The signal goes back and forth, because how do you know you are full? No two people have the same gut biotic, and the composition of that bacteria has an effect on how the response to what goes in there. The heliocobacter pylori changed my bacterial balance between good and bad, this altered the signal to other hormonal response including insulin production.
    I am not conversant enough with how and why my body works differently. I just know that I have tried and tested all the foods that I eat and like and it works for me. Having very little carbs and keeping my blood levels in normal range constantly is really beneficial for my health.

    Thanks for responding, I can see that you are learned, I have had life experiences that I know needing to be open minded and resourceful, how much success has been seen with eating the right diet designed for you. The problem with the dietary advice is usually one size fits all, and you should eat five fruit and veg, for example, this is totally illogical if your body cannot cope with five fructose meals every day, similarly having too much of any food is bad. I often tell people because of my fasting regime that I always feel better and have more energy and less tired, and can work for long periods without food. Travelling around the country, I would go without for most of the day, simply because I felt better.
    One of those things that needs to be changed in dietary advice is having three or four meals a day and snacks. I have seen a nutritional paper advising seven times to eat in a day, no one can benefit from that load.

    Thanks for replying.

    Keep safe.
     
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  13. HSSS

    HSSS Type 2 · Expert

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    And how does all this fit with the disordered metabolism of those with type 2 who do not follow a textbook response as I asked earlier.
     
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  14. Sean_Raymond

    Sean_Raymond HCP · Well-Known Member

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    Hi. I've utilised carbohydrate reduction with calorie reduction as well as maintenance diets which were low carbohydrate and just a low carbohydrate diet with no restrictions.

    In terms of compliance, I can personally attest to a strict adherence by myself and partner but with patients/friends/colleagues I would have to rely on their testimony as with anyone else. That'll always be a cofounder.

    How can I be sure it was low enough for that persons insulin resistance? You mean beyond some carbohydrate intolerance threshold? If so, that is a fair point in the sense that in those that low CHO did not work for, was the carb still set too high. I could not say as I did not have the time with those particular people to trial various ratios.

    The diets were designed to provide around 50g of CHO per day and from what I recall were calculated to 10-15% of energy needs. I kept protein to roughly 20% of energy needs. Such diets should have caused a decent drop in insulin (these were not measured) and so not seeing weight loss in those whose diets were matched to their energy needs (I wasn't expecting any - blood sugars were generally better) would need to be explained if the insulin theory (independent of calories) is correct.

    As I say, you make a fair point regarding needing to trial different carb amounts - which my knowledge and experience is lacking in - but surely you'd agree that insulin reduction per se should create at least some weight loss if it is the major driver of weight/fatness?

    You ask how this fits in those with insulin resistance yet I have seen T2DM patients lose weight on low calorie diets frequently and studies that looked at whether insulin resistance affect weight loss found it didn't whilst numerous studies show people losing weight - many low CHO V High CHO studies have shown this
     
  15. Sean_Raymond

    Sean_Raymond HCP · Well-Known Member

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    I've seen weight loss in people with and without type 2 diabetes. This all hinges on insulin doing what many on here say but if increasing or decreasing insulin does not cause fat gain/fat loss then altering insulin isn't going to be the key to weight gain or weight loss. So in the context of a person with T2DM weight loss would be expected to not be greatly impaired by insulin resistance. Studies support this and I've seen this clinically on many occasions....

    BUT then I read the testimonies here where reducing insulin appears to be the only plausible explanation for the result they achieved because many are saying they are eating as much if not more calories prior to reducing/eliminating carbs. Therefore I acknowledged that there are gaps here and some of the questions being asked are forcing me to have to have to re-examine this - I have questions I thought I could answer that I can't. I am going to revisit insulin and try and see if my main sticking point regarding the biochemistry for insulin being the main driver of fat storage can be reconciled with what is being said here. These kinds of questions are very interesting and helpful.
     
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  16. Sean_Raymond

    Sean_Raymond HCP · Well-Known Member

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    This is another very good point. Altered metabolism to carbohydrate is a fair consideration and posts such as these leave me acknowledging that there are gaps here. As I said in the previous post, I must go back and look at this. I genuinely do have a few questions created from experiences shared here and points made by yourselves.

    My understanding is that whilst a person may have issues metabolising carbohydrate why would this interfere with a persons ability to lose weight. The idea for many here rests on this ability of insulin to make someone fat independent of energy - so does insulin do what many on here believe it does? To address the question, weight loss with low calorie diets has been demonstrated many times in people with T2DM, studies show this and I have seen this. How do we make that fit into this insulin hypothesis? Answers on both sides compete - perhaps there isn't a definitive answer here and I appreciate people respond differently to diets.

    This is all deeply thought provoking I must say. I know my colleagues rarely get to have this sort of dialogue so I am very lucky to have these discussions. I agree that peoples tolerance to carbohydrates being different may explain why some people who trial a low carbohydrate diet with no benefit may be because they need to drop the carbs even more rather than it not being a diet that works for them. In this area I need to further my knowledge.
     
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  17. Sean_Raymond

    Sean_Raymond HCP · Well-Known Member

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    Thank you for sharing such details on your experiences, knowledge and views. Such posts make me realise how many gaps there are iin my knowledge and in terms of evidence as what we so far know seems to go out of the window with what has happened to you. This is quite a difficult read as I can only imagine how much difficulty this has caused you in your life, but it is also an interesting read to learn.

    I was going to ask if you had used an incretins. Apologies if you have mentioned it already but can I ask if your insulin resistance and hyperinsulinaemia have been corrected.

    May I also ask, and I ask to understand for my own learning and understanding of your condition. You mentioned your first phase insulin response is weak, I therefore gather that it was in the second phase where your insulin overshoots to cause the hypos. You also said you had no effective insulin to deal with the dietary glucose because of the hyperinusulinaemia - so it was only in the second phase response where over secretion of dietary induced insulin occurred did your body respond to the insulin. Do I have that correct.

    The heliobacter hypothesis is deeply interesting, indeed there could be a role in many metabolic conditions related to the microbiome. I admit I must learn a lot about reactive hypoglycaemia as I haven't really gained any experience of it in my practice. I will certainly look at this hypothesis of yours and maybe knock heads together and see what we find.

    Your comment that "your weird" i.e. your metabolism is just wired differently speaks more to metabolic differences between people and that we are no-where close to understanding it. There are surely many unexplored undiscovered genetic differences and anomalies between people which may affect how we respond to diet. Indeed, we know many such differences to diet exist. This in itself means we have to accept one approach isn't acceptable - a mistake many I know make. Migration and cross pollination of people over thousands of years has probably mixed genes that might have better suited to a more animal based diet and others to higher carbohydrate.

    When we look at when our genome was formed the general agreement is we were in a state of feast and famine (which may explain why fasting appears to be beneficial) but we have still evolved as humans spread around the planet. One such genetic difference exerted by their specific environment is found in Inuit people who eat a largely animal/fat based diet (they do eat some plant foods such as seaweed). Yet they developed a very specific genetic adaptation to prevent them going into ketosis (as non-Inuits would) and continue using glucose as fuel. This discovery has been used to suggest this is an argument against Ketosis being an undesirable physiological state (I am not arguing that here as the protein content of their diet may have stopped them going into ketosis anyway - I am not sure how much carbohydrate they consumed either).

    So. With this in mind and knowing that fat and glucose do compete for fuel useage and impact each others metabolism - possibly because historically fat and carbohydrate were rarely consumed together - and in different ratios- genes adapted for different diets got passed on all over the place which may at least partly explain more than we appreciate the differing of responses to carbohydrate. Maybe this all seems obvious. Or nonsense.

    Many thanks.
     
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    #117 Sean_Raymond, Jan 13, 2021 at 1:50 PM
    Last edited: Jan 13, 2021
  18. lucylocket61

    lucylocket61 Type 2 · Expert

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    To share my personal experience:

    Traditional low calorie dieting, under medical supervision for 10 months when first diagnosed as pre-diabetic over 9 1/2 years ago.

    First 6 months: 1200 Cal's a day. Weight gain of 6lbs total. No change in blood sugar levels.
    Next 4 months: 1000 Cal's a day. Weight stable. Minimal improvement in blood sugar levels. I weighed and measured every morsel of food and drink.

    Then I ditched traditional advice and switched to low carb, medium fats. Not watching calories but estimate around 1800-2000 Cal's a day from looking back at my records.

    I lost 22lbs and within 3 months my blood sugar levels were normal and have continued to be normal in the intervening 8 years.

    My weight stalled at 100g approx of carbs a day. A month ago I reduced my carbs to 50g a day and replaced the calories with fats and proteins. I have lost 10 lbs in the past 4 weeks.

    I am not, and never have been on diabetes meds.

    I hope my lived experience for over 9 years is of use in your musings. Please let me know if you would like further information or clarification.

    My starting weight was 20 stones 8lbs. I am now around 18 stone. I am 5' 2" tall. I am sedentary and have ME.
     
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  19. zand

    zand Type 2 · Expert

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    That's encouraging Lucy. Maybe I need to go lower carb too.

    Edit: I lost weight on 50-80g then it stalled. I don't relish the thought of going lower but will try 30g for a while.
     
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    #119 zand, Jan 13, 2021 at 2:48 PM
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  20. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Hi Sean thanks for your gracious post.
    My medical history started the day I was born. But that is a very long story.
    Poverty covered my school years, hunger was a bad friend.
    I was always told to eat what was put in front of me. But I couldn't.
    The dairy intolerance was evident from childhood, I was ill often with nausea and diahorrea. And butter would have me vomiting, milk would bloat me, it seems that sterilized milk was better than pasteurised. The lactose intolerance is in my family and in my close family, an uncle, an aunty, my niece, my grandson. But all the others are not. I have been told that.it having butter or spread on a sandwich is so unusual, the question is asked, what do you have instead? Nothing!
    Cooked vegetables especially the greens, I couldn't eat, my taste buds wouldn't allow it, so I was often in trouble at school for not eating, cabbage, sprouts, carrots, turnips, cauliflower and spinach, but I could eat the carrots and spinach as pert of a salad with lettuce, toms, cucumber etc. That is how I get my veg micronutrients.
    I enjoyed my junior school, swimming, football, cricket and others who like me, there only real food was school dinners. But home life was hard, not much room, lots of chores because my mum worked but my dad had malaria twice and was only able to do light work, but his health was very poor, heart and low blood pressure.
    Grammar school wasn't any better, like a fish out of water. Yes, I passed my 11+
    But the grammar school was beyond my social class. We were tolerated to some degree but it was really bad. As a school.
    Typically I was a very good sportsman, and I played representative cricket at the age of nine and ten for my local area. I was probably the best cricketer in the school, but because of my class, I didn't get picked until my last year, I never made the football, swimming, rugby team even the chess team was no go.
    You knew what you were and the posh kids told you. The master's were worse.
    So I really had a bad start to life, but it never deterred from bettering myself.
    I got a couple of A levels in history and art, how I don't know. I got o levels in geography, maths, chemistry, English.
    I wanted to be a machine printer, I passed the test and IQ test, to get my apprenticeship but could not find a firm to take me on. So the day I finished school, the next day, I got a job as a do everything that happens in a printing company.
    I was there for two years, before going onto a car manufacturer. I spent 35 years there. Until 2007.
    I was doing shifts, eating or not at stupid o'clock, lots of rubbish, white bread, , and after I married, helping out to feed four kids and yourself, so convenient food and a rubbish diet, I was still quite fit because of walking, on my feet at work and at home.
    I was a team leader and supervision over thirty men at times. My job was stressful but there was so many good times.
    So you could say that I worked my way to a decent job, improved my life and started getting the benefits of a family life with little monetary issues.
    During my last ten years I got abroad through my job and visited plants in Germany, Belgium, France and Spain. I was also down south with engineering on pilot.
    I got interested in electric powered vehicles and worked on a prototype electric vehicle, but it was too heavy to be a production car. The battery life was poor and too big and heavy. The transformation in the last twenty five years has been unbelievable.

    So I retired, and I was already under my doctors due to my issues with my stomach problems, hence the heliocobacter pylori infection was part, that was when my battles with the medical profession started, as described in my last post, they were just following the usual dietary advice. If I had a insulin test instead of the usual blood panel done then, I am convinced that my hypo hell might not have happened.
    But I was getting symptoms akin to a metabolism problem, the doctors never took it seriously, especially after my first endocrinologist dismissed me. The one thing I repeated every time was I'm not eating a lot and I'm working, walking all day, and I'm getting heavier. So because I was down on my medical history as prediabetic, T2, not one of the doctors listened or even thought of getting me an endocrinologist. They were dismissive about my symptoms and didn't believe my intake, no alcohol and my lifestyle. I did get in a bit of a kerfuffal with one of the receptionists. But I had to apologise, to see my doctor again.
    So as my symptoms were increasing, my impatient followed, and a lot of what happened during these years is missing, even some important celebrations, and Christmas. There was quite a few deaths in the family, within five years, I lost my mother (I was on death watch for a total of ten days, she was in a coma) and two brothers, one to cancer and the other to a massive coronary. The wife lost her mother and also two brothers since. I was getting bigger and heavier and my health was going downhill fast.
    I could only work part time and it was a struggle, I had a few incidents that required hospital treatment and even one blood finger prick test read normal. So nothing was said.
    Yes, very tough especially frustrating because I didn't have a clue what was happening to me.
    So since diagnosis and losing all the weight I put on, within two years my health returned, all my organs were good, all my symptoms mainly went away, no insulin resistance and because I wasn't on the hypo rollercoaster, my hyperinsulinaemia cured itself. My NAFL went, my function results were normal. My fasting bloods were normal, my Hba1c levels were normal, my cholesterol came back at around 4 in total.
    For a man of my age and gone through all my troubles, with the family history of heart problems, mine came back normal. Go figure?
    My specialist endocrinologist who always smiled when in consultation and was shocked at my weight loss. This began the drug tests and more glucose tolerance tests.
    So, no incretins, and yes, secondary insulin is the overshoot. So, yes, it is the insulin that drives me into hypo and yes, the only other way to boost glucose levels is to eat, that is why it is recommended to eat every three hours. But that is unnecessary if you don't eat carbs. And because of no carbs it doesn't trigger a spike, and no insulin overshoot, no hypo! And more importantly, not many symptoms. And also the threat of going hypo overnight. Staying in normal range of blood levels works.

    Yes, by a look at reactive hypoglycaemia, there isn't a lot of research especially in this country, I have read papers from the USA and other countries.
    I have scoured the internet, Wikipedia is reasonably accurate and some good information there.
    This is why, I had to find out about how my weird body worked, my new GP in 2013, labelled me so and my specialist endocrinologist confirmed this when having a humorous moment.

    Thanks again, it is a good thing that we learn about others and not fall into the trap of lumping every one into labels of conditions. Every one is different, fingerprints, eyes, gut bacteria, even our response to life, why is there so many different side effects from certain drugs and not everyone?
     
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