T2 or NAFLD? ...or, a funny thing happened on the way to the surgery

[Chris24Main]

So I have a question...
Short version - under what circumstances should I be expecting to be producing Ketones?

Longer version -

I've been on a roughly alternate day fast for just about 3 months now, fasting glucose level is about 5 mmol/L (morning after a full fast is between 4 & 5). My weight is down to a level that I haven't seen since I hit puberty. My visceral fat is also lower than at any point in my adult life. I've dropped several inches off my waist in terms of clothing - having to buy medium size for pretty much the first time ever.
All of that is on account of the intermittent fasting, and I just outline it to give context; it isn't a big deal really.
Estimated A1c is 41mmol/L

Anyway - I still have some ketone testing strips from when I was initially diagnosed type 1 - so I thought I would put them to use; after all, the main upside to fasting seems to be the benefits that come from ...

... well, here is where it gets more tricky; because much more of what comes after is supposition, theory, and will differ from person to person.

So, my understanding is this (and I offer this mainly to test my understanding against better informed readers - not as an absolute) - after some time, the digestion of the food I've most recently eaten is complete. There will be some left overs working through the small intestines for two or three days, and some of that will make it's way back to the Liver, but all of that will be in the form of digested fat. The liver itself is not dealing with digestion, and therefore doesn't need to be in fat storing mode.

If I'm fasting for ~36 hours, this means that I have about 12 hours of time where the stores of Glycogen are empty - meaning that the liver will have to start producing new products in order to maintain energy levels - Or does it? - one thing I'm not sure about is whether stores of triglicerides in the muscles come into play before the Liver needs to get working..

My main question is - before I break my fast; I should be expecting to see some level of Ketones in my blood. I did this one morning, and sure enough, the level was 1.1 (for context, if you are type 1 and therefore worried about Ketoacidosis, you would be concerned about that, and would be heading to A&E if it was closer to 3).

Now, this morning, I went out paddleboarding early, after a full fast but before breaking it (one of the surprising consequences of daily fasting is that on the days after a fast, I fairly bounce out of bed, full of energy - totally the opposite of what you might think) - and tested my ketones before having anything to eat. This time - 0.2. Nearly nothing - what gives?

I should note that my blood Glucose at this point is 8.5 - as is normal, doing any physical activity drives up the glucose level, particularly in the morning when you get that Cortisol rush.

So - what is going on? is there some other mechanism that is stopping me producing Ketones today, am I actually producing Ketones, but that has been interrupted by the Liver turning on the Glucose pump (figuratively speaking - I realise this would have to be Neoglucogenesis, I just don't know how that interplays with Ketone production)

I cannot have any 'energy producing products' in my blood from eaten food - so it has to be coming from inside my body - I think it can only be from Triglicerides one way or the other, but is that in the form of Ketones or Glucose..?

Can both things be true? - is it one or the other, and even if so, should I care?
There seems to be some confusing advice about doing exercise either at the end of a fast, in order to encourage autophagy, or after eating post fasting in order to encourage muscle growth.

I'm not concerned, only curious - the deeper you go the less you seem to understand...
Any help on this?

 

[Outlier]

I can't offer an answer, but I am very impressed by your research and will be very interested in any explanation.

 

[Chris24Main]

Interesting - I'm taking the lack of reply to mean that for most normal people, the rabbit hole of metabolism is just a place marked 'here be Dragons'

Which I express, fully in the knowledge that even a couple of months ago, I was utterly clueless and disinterested in any such thing, so I shouldn't be in the least bit surprised.

I was saying to my wife only today that I had messed up and eaten an Almond Croissant, thinking 'Almonds' rather than 'Marzipan therefore Sugar' and was surprised to see my blood glucose spiking for the first time in three months.

'but it's ok', she said, with a look inviting me to confirm, 'as long as you're not type 1, then a sugar spike is ok?'

'You really haven't heard a word I've said about this in months'... I thought but very definitely did not utter...

I'm left wondering, actually, what are the things that we - who have had to confront the possibility that the things we have held self-evident like 'fat is bad' and 'breakfast is the most important meal of the day' - may be far from actually good for us... we few who have accepted that habitual lacing of all food with easy to digest carbs is not a good thing... what is it that we collectively feel we know and understand?

And I do say that with an open sense of curiosity. Metabolism is very very complex, and most of us, me included, just switch off at the first hurdle, so it's difficult to really get to a good level of understanding about anything- that's why the Saturated Fat; Heart Health concept is so ingrained, it's so easy to understand - anyone can easily imagine an artery clogged up with the congealed remnants of a Donner Kebab like they had to wipe off their fingers on the way home from a late one in their teens. Everyone can relate to this, and the fact that it's totally, totally not the way that any of this works, makes no difference. We all have that mental image, and we all choose the low-fat option instead, even if it's actually loaded with pea starch that leaps straight from our stomach into our liver into the 'turn immediately into fat' machine and does the very thing we are trying to avoid, even at the same time that we're starting to feel hungry again, because, unlike the full fat version, this hasn't left us feeling full, so we think, 'well, another is fine, after all, it's low fat' - and before you know it, you have two blasts of created fat, and you are still not feeling full.

There is a long list of things I've learned in the last couple of months - to be honest, I'm kind of reaching a plateau myself, I really do not want to sound self-important here -- the amount I understand barely scratches the surface of anything.. but the bottom line is that, as a species, we are so **** complicated, and that's without even thinking about the interplay with our shared Bacteria.

I have this sense that we need an entirely new language to talk about some of this - I truly believe that a big stumbling block for a lot of people is simply the fact that Fat (dietary fat that we cook with and eat) is the same word as Fat (the descriptive term for being overweight).

And I say that, fully in the knowledge that 'being overweight' is a totally loaded phrase in itself, and should be better understood - having a larger storage capability for fatty acids in more adipose cells is a good thing - up to a point of course, but the needle for 'socially acceptable' is not very well calibrated to 'what is good for you'.

I find myself tripping over article after article - there was even one today talking about how processed foods might need to be better labelled to give a better sense of their 'healthiness' - ok, fine; good idea. However, the main issue was that processed foods are still high in fat, salt and sugar.

So - even very well meaning, relatively scholarly articles totally mislead - the issue with over processing is not excess fat, salt and sugar.. it's that they are loaded with simple carbs which slam your liver over and over like a surfer who's getting trashed by one wave after another and is running out of breath.

If we could fix that mental image rather than the 'pipes all clogged up' one, maybe we could make some progress.

Or Jesse Inchauspé with her analogy about how sugar spikes drive all aging processes - the more sugar spikes you have, the quicker you die.

Nice and simple.

or maybe another - Cancer Cells need sugar to develop and grow, if you don't feed them with lots of carbs that become sugar, you make it very difficult for any type of Cancer to thrive.

or - how about - sugar and alcohol are essentially the same in the way that they affect the liver and brain, if you think a bottle of vodka a day is not a good idea, it may be worth questioning your starch intake.

or - 'it's the fat on the inside that will kill you, and it's mainly coming from Pasta, not Bacon and Eggs.'

or - too much sugar in your blood - from carbs - is like walking around a gunpowder factory with a lit match.. You may not see the fires that you're starting, but they will kill you sooner than you think..

How am I doing?

 

[HSSS]

Interesting - I'm taking the lack of reply to mean that for most normal people, the rabbit hole of metabolism is just a place marked 'here be Dragons'

Which I express, fully in the knowledge that even a couple of months ago, I was utterly clueless and disinterested in any such thing, so I shouldn't be in the least bit surprised.

I was saying to my wife only today that I had messed up and eaten an Almond Croissant, thinking 'Almonds' rather than 'Marzipan therefore Sugar' and was surprised to see my blood glucose spiking for the first time in three months.

'but it's ok', she said, with a look inviting me to confirm, 'as long as you're not type 1, then a sugar spike is ok?'

'You really haven't heard a word I've said about this in months'... I thought but very definitely did not utter...

I'm left wondering, actually, what are the things that we - who have had to confront the possibility that the things we have held self-evident like 'fat is bad' and 'breakfast is the most important meal of the day' - may be far from actually good for us... we few who have accepted that habitual lacing of all food with easy to digest carbs is not a good thing... what is it that we collectively feel we know and understand?

And I do say that with an open sense of curiosity. Metabolism is very very complex, and most of us, me included, just switch off at the first hurdle, so it's difficult to really get to a good level of understanding about anything- that's why the Saturated Fat; Heart Health concept is so ingrained, it's so easy to understand - anyone can easily imagine an artery clogged up with the congealed remnants of a Donner Kebab like they had to wipe off their fingers on the way home from a late one in their teens. Everyone can relate to this, and the fact that it's totally, totally not the way that any of this works, makes no difference. We all have that mental image, and we all choose the low-fat option instead, even if it's actually loaded with pea starch that leaps straight from our stomach into our liver into the 'turn immediately into fat' machine and does the very thing we are trying to avoid, even at the same time that we're starting to feel hungry again, because, unlike the full fat version, this hasn't left us feeling full, so we think, 'well, another is fine, after all, it's low fat' - and before you know it, you have two blasts of created fat, and you are still not feeling full.

There is a long list of things I've learned in the last couple of months - to be honest, I'm kind of reaching a plateau myself, I really do not want to sound self-important here -- the amount I understand barely scratches the surface of anything.. but the bottom line is that, as a species, we are so **** complicated, and that's without even thinking about the interplay with our shared Bacteria.

I have this sense that we need an entirely new language to talk about some of this - I truly believe that a big stumbling block for a lot of people is simply the fact that Fat (dietary fat that we cook with and eat) is the same word as Fat (the descriptive term for being overweight).

And I say that, fully in the knowledge that 'being overweight' is a totally loaded phrase in itself, and should be better understood - having a larger storage capability for fatty acids in more adipose cells is a good thing - up to a point of course, but the needle for 'socially acceptable' is not very well calibrated to 'what is good for you'.

I find myself tripping over article after article - there was even one today talking about how processed foods might need to be better labelled to give a better sense of their 'healthiness' - ok, fine; good idea. However, the main issue was that processed foods are still high in fat, salt and sugar.

So - even very well meaning, relatively scholarly articles totally mislead - the issue with over processing is not excess fat, salt and sugar.. it's that they are loaded with simple carbs which slam your liver over and over like a surfer who's getting trashed by one wave after another and is running out of breath.

If we could fix that mental image rather than the 'pipes all clogged up' one, maybe we could make some progress.

Or Jesse Inchauspé with her analogy about how sugar spikes drive all aging processes - the more sugar spikes you have, the quicker you die.

Nice and simple.

or maybe another - Cancer Cells need sugar to develop and grow, if you don't feed them with lots of carbs that become sugar, you make it very difficult for any type of Cancer to thrive.

or - how about - sugar and alcohol are essentially the same in the way that they affect the liver and brain, if you think a bottle of vodka a day is not a good idea, it may be worth questioning your starch intake.

or - 'it's the fat on the inside that will kill you, and it's mainly coming from Pasta, not Bacon and Eggs.'

or - too much sugar in your blood - from carbs - is like walking around a gunpowder factory with a lit match.. You may not see the fires that you're starting, but they will kill you sooner than you think..

How am I doing?

My lack of reply is that 6 yrs in I dont have the fervent energy for digging deeply every day. Sometimes after years of it I need to step away and just try and live my life. I’m not criticising you at all here. I was much the same and some days still am. It’s just that burnout is a thing (especially combined with other life events). I’m sure someone will be along to pick up the conversation soon. It might even be me on a different day.

 

[Chris24Main]

Just in case, because I realise that was a bit 'ranty' - not attacking anyone, any view, or .. really anything.. just venting...
if anyone is left feeling aggrieved or negative in any way, I'm sorry - not my intent.

I'm also not reacting to a lack of replies in a defensive way - I have no right to expect anything - I'm really just riffing, and for sure burnout is a thing...

 

[jpscloud]

So I have a question...
Short version - under what circumstances should I be expecting to be producing Ketones?

Longer version -

I've been on a roughly alternate day fast for just about 3 months now, fasting glucose level is about 5 mmol/L (morning after a full fast is between 4 & 5). My weight is down to a level that I haven't seen since I hit puberty. My visceral fat is also lower than at any point in my adult life. I've dropped several inches off my waist in terms of clothing - having to buy medium size for pretty much the first time ever.
All of that is on account of the intermittent fasting, and I just outline it to give context; it isn't a big deal really.
Estimated A1c is 41mmol/L

Anyway - I still have some ketone testing strips from when I was initially diagnosed type 1 - so I thought I would put them to use; after all, the main upside to fasting seems to be the benefits that come from ...

... well, here is where it gets more tricky; because much more of what comes after is supposition, theory, and will differ from person to person.

So, my understanding is this (and I offer this mainly to test my understanding against better informed readers - not as an absolute) - after some time, the digestion of the food I've most recently eaten is complete. There will be some left overs working through the small intestines for two or three days, and some of that will make it's way back to the Liver, but all of that will be in the form of digested fat. The liver itself is not dealing with digestion, and therefore doesn't need to be in fat storing mode.

If I'm fasting for ~36 hours, this means that I have about 12 hours of time where the stores of Glycogen are empty - meaning that the liver will have to start producing new products in order to maintain energy levels - Or does it? - one thing I'm not sure about is whether stores of triglicerides in the muscles come into play before the Liver needs to get working..

My main question is - before I break my fast; I should be expecting to see some level of Ketones in my blood. I did this one morning, and sure enough, the level was 1.1 (for context, if you are type 1 and therefore worried about Ketoacidosis, you would be concerned about that, and would be heading to A&E if it was closer to 3).

Now, this morning, I went out paddleboarding early, after a full fast but before breaking it (one of the surprising consequences of daily fasting is that on the days after a fast, I fairly bounce out of bed, full of energy - totally the opposite of what you might think) - and tested my ketones before having anything to eat. This time - 0.2. Nearly nothing - what gives?

I should note that my blood Glucose at this point is 8.5 - as is normal, doing any physical activity drives up the glucose level, particularly in the morning when you get that Cortisol rush.

So - what is going on? is there some other mechanism that is stopping me producing Ketones today, am I actually producing Ketones, but that has been interrupted by the Liver turning on the Glucose pump (figuratively speaking - I realise this would have to be Neoglucogenesis, I just don't know how that interplays with Ketone production)

I cannot have any 'energy producing products' in my blood from eaten food - so it has to be coming from inside my body - I think it can only be from Triglicerides one way or the other, but is that in the form of Ketones or Glucose..?

Can both things be true? - is it one or the other, and even if so, should I care?
There seems to be some confusing advice about doing exercise either at the end of a fast, in order to encourage autophagy, or after eating post fasting in order to encourage muscle growth.

I'm not concerned, only curious - the deeper you go the less you seem to understand...
Any help on this?

I'm not sure where I heard it (might even be here in the forums) but someone said ketones are an energy source and perhaps you're using most of what you produce, so you may see lower numbers in your blood. It made sense to me.

 

[HSSS]

I'm not sure where I heard it (might even be here in the forums) but someone said ketones are an energy source and perhaps you're using most of what you produce, so you may see lower numbers in your blood. It made sense to me.

Pretty sure it works that way for urine testing (ie after a while they may stop registering as it shows what’s being unused and wasted). But it was my understanding blood ketone testing shows what’s actually being produced

 

[Chris24Main]

That's my best guess ... I think that a lot of the 'literature' is actually sales product to convince you that if you buy this thing, it will totally tip you into Ketosis in a way that no other thing will...

I'm pretty happy in saying that Ketones are definitely an energy source - along with Glucose, and Creatine, but immediately after that, it gets much more complex, depending on whether you mean energy just to have the cell function, or do muscular work, or if you are talking brain cells..

But I don't think any natural system is like flipping a switch...

 

[Chris24Main]

It could even be that we are used to tracking blood glucose and thinking in terms of levels of this and that ... but that's because we are in an abnormal state .... in theory, the body is totally capable of controlling blood glucose within very fine margins, maybe it's the same for ketones, and that even if you are in 'full' ketosis - in the sense that all your bodies needs are being met from energy from Fat storage, not glucose ... even then, you should not have a great deal in your blood, because you only produce what's needed..

Then, (now I'm speculating) - if you do sudden exercise, or spot a Tiger around the edge of the bush, systems kick in to give you more energy quickly - and your Liver starts kicking out Glucose again..

After all, the Liver is pretty much capable of turning anything into anything, with the exception of fructose / alcohol.