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Type 2 On the LCHF diet or LCKD, how does monitoring my ketone levels help me?

Winnie53

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Type of diabetes
Type 2
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Diet only
On the low carbohydrate high fat (LCHF) diet or low carbohydrate ketogenic diet, how does monitoring my ketone levels help me if I'm not trying to improve athletic performance, nor am I trying to lose weight?

To maintain blood glucose and insulin levels within a lower range, is the LCKD advantageous over the LCHF diet? If yes, how?

My understanding is that everyone on the LCHF diet has a different "tipping point", a level of carbohydrate consumption that raises blood glucose levels 2 hours post meal more than desired.

Asked another way, if my "tipping point" is 75 g carbohydrates a day, is eating under 50 g carbohydrates, which would keep me in a ketogenic state, advantageous?
 
If 75 g carb per day keeps your BS where you want it and you are happy with your weight then why change it? I can't personally see any advantage and the extra 25 g per day gives you more variety.
 
You seem to be in the right track as I understand it. Only other thing you may consider is the quality of your carbs (ie low or high GI) and what you eat it with - ie the qty of protein and fat. Sorry, ketone monitoring is not my bag - with LCKD a lot of the literature suggest you have to watch mineral deficiency. Also a higher risk of side effects like constipation, diarrhoea, muscle cramps to name a few. Kidney stones seem to pop up more frequently.
(Way too many conflicting factors to balance - so I survive on a low carb mediterranean style eating).
Cheers
 
fene48 said:
a lot of the literature suggest you have to watch mineral deficiency. Also a higher risk of side effects like constipation, diarrhoea, muscle cramps to name a few. Kidney stones seem to pop up more frequently.
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My understanding is that this is less likely if one is following a well-formulated LCKD rather than the absolutely junky ones that were unfortunately fed to a lot of kids for epilepsy in the early days.

@Winnie53 - my experience of measuring very intermittently is that I have to be very low (under 30g) to consistently show ketones. Like you, I don't find any great benefit to being that low. However, there are a number of health benefits that many people consider worth the effort. The ones I hear talked about most are the mental benefits - both in terms of clarity and mental performance (people like Dom D'Agostino, Tim Ferris and others rave about this "side effect"). There are others with mental health issues who find the diet literally keeps them sane - minimises mood swings, stabilises mood, etc. I've read of a number of people with bipolar getting relief from following the diet. The other people who probably should consider it very seriously are those who wish to avert a recurrence of glucose-dependent cancers or with a very high risk of same.

I guess my advice would be to try it and see if it makes a difference to the way you feel - nothing ventured, nothing gained

If you haven't already seen these blog posts from Tuit Nutrition, you might find them useful:
http://www.tuitnutrition.com/2016/01/dont-be-a-ketard1.html
 

Thank you for commenting fene48. The low carb mediterranean style of eating is similar to how I eat too. It's so great you've found what works for you.

I pop in and out of ketosis regularly, so live in both worlds - (my carbohydrate intake is likely below 50 g a day because I, like you, eat a whole food diet; I eat a small amount of animal protein with each meal, a mix of healthy animal and plant fats, and lots of whole food, plant based foods with every meal; I greatly limit intake of sugar, grains, below ground vegetables, legumes, and fruit. I was able to resolve all issues you mention by supplementing with magnesium for constipation and muscle cramps - (through trial and error I found the right type and dosage, in my case magnesium citrate, 150 mg mornings, 300 mg evenings) - and salt when I don't feel good in general (because I eliminated almost all processed foods that include salt from my diet). Kidney stones take a long time to develop so don't know yet if that will be a problem but I take K2 (MK-7), 180 mcg daily, and its partners cod liver oil, vitamin D3, and magnesium, so hopefully I'll not develop that problem.
 

@Indy51 I just spent time reading the three part series of blog posts that you linked to above. Thank you. Definitely worth the read. I always learn something new from your posts and links within your posts.

It farther reinforces my belief that measuring ketones is for weight loss - (even that's questionable) - and athletic performance and is not useful for managing my diabetes so I'll continue on the LCHF diet/LCKD, walking, and monitoring my blood glucose levels throughout the day. (I had forgotten about the therapeutic benefits of the ketogenic diet for conditions such as Parkinson's, dementia, various mental conditions, seizure disorders, specific types of cancer, etc. Thanks for that reminder.)

I found it encouraging to read that I can be "fat adapted" without being in a "ketogenic state". I go in and out of ketogenesis regularly. The only thing that really changes is I might gain a pound of water weight, but this only lasts for a day or two.

I get so much more information measuring my blood glucose levels in pairs: 1) before bed, upon awakening; 2) pre-meal, 1- to 2-hour post meal; 3) pre-walking, post walking.

I also find periodically monitoring my blood glucose levels pre-meal - (this is expensive) - 30 minutes post meal, and every 15 minutes there after for 2 to 3 hours useful too. By doing so, I learned that my blood glucose peaks (on the LCHF diet/LCKD) 1-hour post meal.

Comparing my "upon awakening" to "pre-breakfast" blood glucose readings tells me how much my blood glucose rises after awakening. Surprisingly, even if my blood glucose level is 110 mg/dL upon awakening, it often will have risen by 10 mg/dL in the half-hour it takes me to prepare breakfast, which is not desired.

I'm still trying to determine when is the best time to walk after a meal. I think it's 90 minutes post meal which 1) gives my body adequate time to digest the food I've eaten and 2) does the best job of knocking my blood glucose levels down so my pancreas doesn't have to keep producing insulin. I may change my opinion on this, but for now it's working well for me. If I have a high post meal blood glucose level, I can knock my blood glucose down by 40 mg/dL walking 1 mile; and up to 80 mg/dL walking 2 to 3 miles. (I should add here that this didn't begin happening until I'd been walking a period of months, perhaps six months or longer, can't remember.)

Another question I've yet to answer is how walking before breakfast or at other times of the day impacts my daily blood glucose levels throughout the day. I think it would be problematic because my blood glucose levels are lowest upon awakening, but I haven't confirmed that.

It feels good to have this much control over my blood glucose levels with diet, walking, and glucose monitoring throughout the day.

If I'm wrong, if there is a benefit to blood ketone monitoring specifically for diabetes, I'd like to hear from you. I really want to do what's best for managing my type 2 diabetes.
 
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Wow, you had a long road to get there and it fabulous that you have the knowledge and ability to fine tune things so well. You have my admiration and best wishes for the future.
 
There's a new interview with Eric Westman, M.D. on DietDoctor.com, Advanced Low-Carb Tips! If you're a member, this link may work...not sure... http://www.dietdoctor.com/member/interviews/westman-lcc/comment-page-1#comment-1439122 If you're not a member, you'll have to sign up as a member. First month is free.

To my surprise, Dr. Westman's obese patients sometimes measure ketone levels, so clearly it has some value for weight loss purposes. He didn't say when or for what period of time though. Also of interest was that many of his obese patients follow a 20 carb LCHF diet for more than two weeks. Not sure where my carb count is, but this is good to know if I decide to lose weight again.

At 28:37 minutes into the interview, Dr. Westman talked a bit about more recent research on ketosis: "If someone is in ketosis and then they eat on meal of carbohydrate it can stop the ketosis in some people up to three weeks. So again it just goes back to the notion that a very small amount may be very damaging in terms of the weight loss and ketosis." "This is the worst case [scenario for insulin resistant people]."
 
Hi Winnie53
Im in ketosis, and I think Im constipated although I drink loads and eat veggies every day like cabbage etc along with protein . Does magnesium supplements help with the constipation. I havent lost weight in three weeks and I think (sorry!) that I am 'bunged up'. Any advice?
 
Hi @Winnie53

I have been mulling this over recently, and I don't think ketosis carries many health benefits really. But being 'in ketosis' can indicate that certain things are going well.

Yes, ketosis is touted as being good for weight loss - but ketones are ketones whether they come from dietary fat or subcutaneous fat, so being in ketosis is no proof that someone is losing weight.

However, (and this is me chuntering without any evidence to back me up!) I think that ketosis is very useful for one thing, and it is a MAJOR thing in my book. It shows that you are fuelled by fat, not carbs, so your insulin levels will be lower than when you were eating carbs.

Unless Our beta cells are dead, we all produce insulin all the time. Background insulin that ticks over 24/7 and insulin that is released after eating (1st and 2nd phase), after liver dumps and dawn phenomenon. In an insulin resistant person the amount of insulin needed can be huge - witness the big doses that some T2 insulin dependents inject, compared with the amount that many T1s do.

We T2s are known for our insulin resistance. So we need more insulin for it to do the same job for a 'non IR person'.
And the more IR we are, the more insulin we need.
But hyperinsulinaemia is what drives metabolic syndrome, it drives weight gain, it contributes to heart disease and strokes, and lethargy, and tiredness and raised blood glucose levels (just watch a few Fat Emperor You Tube Vids and you will know what I mean.

So driving down insulin levels is, to me, even more important than controlling my blood glucose levels. And if you are in ketosis, then you aren't running on glucose, so you don't need much insulin, so your insulin resistance drops.

And checking for ketones is a way of checking whether you are still running on carbs and producing a lot of insulin.

I also speculate that if your (my) body struggles to drop into ketosis, and bounces out of it easily, then that is indicative of high background insulin levels.

(There are 3 main ways to reduce IR; exercise (boo hiss!), low carbing and Fasting. Other things help, including Metformin.)
 
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Yes, do try magnesium. Magnesium citrate works well for me (and the need for it increases on the low carb ketogenic diet). I take 150 mg mornings, 300 mg evenings. Magnesium is a critical mineral because it used for almost 300 processes in the body, so it's very important for your general health too.

@Brunneria I'll read you post late tonight or tomorrow. At work now...
 
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@Brunneria agreed. I'm beginning to think that the savvy type 2 would be better off having their insulin levels checked in place of the A1c. Will write again later...
 
@Brunneria @Winnie53 - Unfortunately, according to Catherine Croft's research studies, fasting insulin may be a good measure for epidemiology but not really that helpful when it comes to individuals as it can vary greatly between individuals and also on an almost minute by minute basis because of the pulsitile nature of its natural release. Back to the drawing board
 
Ah yes, should have said - - I don't trust my fasting bg at all as an indication of IR! It hops about like a pea on a drum.

However, I think that my late afternoon and pre-dinner readings are a much better indication, as evidenced by the fact that they drop significantly when I fast or do sustained steady exercise (boo hiss!).

Also think that physiological insulin resistance needs to be factored in. Because in that situation IR actually rises (a bit) after prolonged low carbing/ketosis. Fortunately, I have found that fasting cuts right through that.
 
Brunneria said:
Fortunately, I have found that fasting cuts right through that.
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Likewise - my fasting levels are normal for the first time since diagnosis (4.5yrs ago) since cutting back to two meals a day/6-8 hours compressed eating window. Came as a very nice surprise
 
Fabulous. Thanks I'll give that a go. x
 
I've been listening to interviews on the Medicinal Supplements Summit this week. Wendy Myers interviewed Jimmy Moore a few days ago. He provided a good overview of the benefits of the low carb/ketogenic diet:

- greater mental clarity; less moodiness, crankiness, and "brain fog"
- improved energy
- cardiovascular benefits - triglycerides below 100, 70 best (these are US numbers, apologies); increased HDL; improved triglyceride/HDL of 1 or less; reduction of small, dense LDL; hsCRP level of 1 or less; reduced insulin levels, a driver of heart disease
- effective treatment for diabetes, metabolic syndrome
- reduction or elimination of high blood pressure, cholesterol, and diabetes medications and insulin
- less or no hunger, cravings
- reduction of inflammation
- improved brain health - useful for everyone, particularly those who have alzheimers, dementia, parkinsons, or traumatic brain injury (TBI)
- used theraputically for cancer treatment
- weight loss
- improved overall health
- increased fuel reserve for athletic performance

Additionally, and this will please you Indy51, Jimmy Moore is coming out with a new book that was co-authored by Jason Fung, M.D.: The Complete Guide To Fasting, (releases October 18th in the US). Still need to read Fung's book, The Obesity Code, also Moore's book, Keto Clarity.

He also talked about monitoring ketones. Ketone test strips" are no longer accurate after the body becomes fat adapted. He uses the Precision Xtra (known as FreeStyle Neo outside US) for an accurate measurement of ketones. He strives to stay within the 1 to 2 range, and said there's little additional benefit above 3. For those who can't afford the $2 to $4 cost per strip (US), the Ketonix Breath Test is an accurate measure of acetone and will give you a yes/no answer, "yes, I am in ketosis, or no I am not". That's probably what I'd use, if I decided to monitor my ketosis status.

They also talked about fasting toward the end of the interview. Wendy fasts 24 hours once every couple of weeks and has noted a reduction of inflammation, as evidence by a reduction of symptoms from her bulging disk. Jimmy recalled an interview in 2009 with Thomas Seyfried in which he stated that you can reduce your cancer risk by fasting for 7 days once a year.
 
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@Indy51, your point about insulin levels is well taken. @Brunneria, perhaps monitoring glucose levels post meal and ketones once or twice daily is a better way to stay on top of insulin levels. I can't afford the Precision Xtra but the Ketonix Breath Test might be doable.

I pop in and out of ketosis quite a bit. Recently, I began drinking meat broth from chicken with sea salt and developed keto flu that lasted more than a week, so I'm now thinking I'm out of ketosis more than I'm in it.

What I find so interesting about this healing journey we're all on is the amount of learning we need to do to restore our health. And I still have far to go. Need to add fermented foods to my diet, and do more fasting. Up until recently, I was doing 12 hour fasts daily. Need to get back to that. Perhaps I could work up to an 16 hour fast. Jimmy Moore is getting good results by eating breakfast, skipping lunch, and eating dinner. He didn't say he was doing this in an 8 hour window, but perhaps he is.

A week long fast once a year is worth considering too.

I'm curious...

What monitoring/lab tests are the two of you doing on a daily, weekly, monthly, quarterly, yearly basis?
 
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