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.

 

[Chris24Main]

So - I had a follow up appointment with the local district hospital diabetes support team yesterday.
For anyone following closely, this was with the same consultant who I had a very tetchy meeting with back in January that tipped my diagnosis from type one to type 2 and really kicked off both this thread, and all the learning that I've undertaken since.
As I made clear to her, I'm eternally grateful to her for forcing the issue about clarifying my diagnosis, because if it wasn't for her, I would still be injecting myself with unneeded insulin, and effectively poisoning myself.

I should also point out that on the basis of the changes that three months of intermittent fasting and low carb diet, she was happy to discharge me from the program, so I'm now totally disconnected from hospital-level diabetic oversight - and that's a really good thing..

All of that said, it was again quite a tetchy meeting - though in the spirit of a Bond spoof, 'we meet again Doctor, but this time I have the advantage'...

not quite as dramatic as that... and the bulk of the meeting was agreeable and positive; however...

We were discussing my diet, two or three days of full day fasting in the week, with high-fat, very low carb and adequate protein diet otherwise. She said - 'just be careful, if you continue with low carb, you could induce a situation where you are creating what are called Ketones, and that could be bad for you'

I said 'hang on, that's exactly what I'm trying to achieve - you're saying that could be bad; I don't understand, and I'm a little surprised'

'yes', she said, 'all your cells need a little glucose and a little fat, so if you continue with a very low carb diet, you could run out of glucose, and induce Ketosis'.

So, I immediately launched into a rant about how we had evolved as a species to deal with periods without food, and that Ketone production was completely normal, and that the body was perfectly capable of controlling it, it was ludicrous to suggest that I could induce an 'out of control' Ketone production situation, and that I did not agree at all with what she was telling me that we need a constant supply of carbs - we don't need carbs at all, and even in the event that I did need carbs for Glucose, the liver was perfectly capable of generating glucose from excess protein.

'No, Protein cannot be turned into Glusose, that's completely wrong' she immediately rebutted.

I was stunned - I thought this was totally uncontroversial, so I ploughed on. I told her again that I was surprised what she was telling me, and that I did not agree, Protein can be converted into Glucose in the event of low carb diet..

'No, no, no, there are the three food groups, and they cannot be converted into each other, this is what I was taught in my second year!' - and she leaned forward and smiled... 'Google it'

I wish I had - I did when I got home, and confirmed that this was right.. more than that, as an engineer, if I was unwilling to accept that anything may have changed from what I was taught in my second year... I'd be a very bad engineer...

So - I decided I was getting nowhere, and changed tack - ok, I said, I'm trying very hard to listen to you... assuming what you say is correct, what are the warning signs if I go into this induced state of producing too many Ketones...?

'you'll feel unwell, and dehydrated..' - ok, I said, so you are describing Ketoacidosis...?

And she was...

so, that was pretty much that.
I did, even in the moment, recall something from one book I had read recently, or video, where a doctor was recalling his second year where he had had a very quick course on nutrition, and how shocked he was to discover that it was almost all just not correct based on what he now knew, and how disappointing it was that the medical profession, his profession, clung to this out-of-date understanding ... but here I was, being hit with that refusal to budge, and again, I was getting some serious pushback vibes.

To her credit, she did then get into a whole thing about how I was a grown-up, and I was able to do my own research, and she could only give me advice, it was up to me what to do with it... but it was pretty clear what she was saying.

I'm coming to a view, that what we are dealing with, as a society, is the power of a story... it is so easy to get behind the idea that eating fat will clog up your arteries.. that the power of this simple but wrong understanding is just so difficult to dislodge, that we now have the medical profession, and the food industry and the Pharma industry - all with best intentions - literally feeding us the wrong stuff until we are dependent on medicine we should not need...

 

[Chris24Main]

So in the spirit of not being stuck in thinking that turns out to be wrong headed - I'd like to humbly retract something I said much earlier about Omega-3 fat.. I think I understand better now the relationship between inflammatory response, and the different types of fat, and having a good balance of Omega-3 and Omega-6 fats in your diet (these being the only types of fat that your body cannot produce by itself) is important.

So - here's an attempt to conjure up a story that makes some sense (following on from that last post, I'm becoming more and more to the opinion that good stories may be the best answer to a bunch of bad stories that we've grown up with)

We all struggle with what fats are, and how they work - we don't like saturated fat.. because ... well, I think because the fear of the word saturated.. it just makes you think of a greasy pan.. that sense of fat saturating your body. Of course, that's not what it means.. it's just about the links between carbon molecules.

So - I grew up in a fishing village on the East Coast of Scotland - in my childhood, there was a working fish market, and the trawlers would come and go every day, and there would be piles of nets along the harbour walls, with nets needing mending.

Now, if you think about your cell membranes like fishing nets, that's an easy thing to imagine... each cell with a wall made up of nets, which in turn are made up of net line, knotted together.. easy, right? Not totally accurate, but good enough. Now, the thing is that all fat is simply strings of carbon atoms, knotted together in various ways - so think of each piece of net line as a carbon string, or fatty acid - I think that's a close enough analogy.

Then - saturated fat, most saturated fat in your body was made in your liver, and the word just means that each bond linking carbon atom to carbon atom is stable - or saturated, but in our net analogy, think of it as being made from new paracord - it's new line and it's not likely to break. That's really all saturated means, it's only a technical chemical term.

Mono-unsaturated fats (think mainly olive oil) mean that one of those bonds is unstable, so in our analogy, maybe the net line is cheaper nylon with a single 'nick' in the line, that could break. Omega-3 (think fish oil) and Omega-6 (think nuts) are special cases, where the nick is in a certain position on the line - position, or carbon atom, 3 and 6.

Poly-unsaturated fats (think seed oils) mean that there are many nicks in the line, as there are many (poly) positions in the line that are nicked (or many unstable links between carbon atoms).

So - if we eat a good balance of fats, our cells will be composed of many different types of fatty acids - or the nets will be made up of mainly good paracord, with some nylon with nicks in them which are likely to break under stress.

OK - so if you're with me so far, the analogy goes like this - Breaks in the line are natural, they are caused by many things (like too much glucose in the blood) and when it happens, the body triggers a repair response. We want that to happen at a certain rate, because the repair team will also look after the system as a whole. To stretch the analogy, there is no point going out fishing with broken nets and not knowing about it; you will starve. You do need something to tell you that the mending is needed.

To go back to the net analogy, every Sunday evening, a group of people would go over the nets, mending as they went. All part of normal business. Later in the evening, they would all go home and the harbour walls were empty during the week.

So - (and this is where it gets really detailed, and my analogy cannot cope, so I'll back off) - different types of fatty acid have different effects on the repair team (immune response to inflammation). Some raise the alarm, and some calm everything down and persuade everyone to go home. (so this is where having the right mix of Omega-3 and 6 is important, we tend to be all 6 - raising the alarm - and no 3 - time to go home).

In other words - out diet (of too much polyunsaturated fats and oils) means that our cell walls are made up of too many pieces of 'breakable net line' that break in a way that sets off the alarms ... all the time... so that the repair team is called out at all hours, night and day, and is exhausted, and no longer able to do the job it should be doing properly..

And that's a story that explains what inflammation is... (and of course this is what drives all the bad health outcomes that we are all aware of)

But - it should also be easy to see that there is nothing in this to make anyone feel that saturated fat is bad...

Sure, if you eat far too much - the harbour walls become totally full of nets and spill over - too much of anything is bad - but within reason, saturated fat itself is really not the bad guy - we need a good balance of all the complex fats you get in real food. (not the abundance of seed oil that you get in overly processed food).

 

[Chris24Main]

By the way - I think I've been able to answer my own question about Ketone production - ie, if I'm fasting and working a near-zero carb diet, why do I still see raises in my blood glucose..

I think the answer is that it just takes longer to get into fat-adaptation, meaning that my body still prefers glucose to fat as an energy source. So, in the event that my body needs more energy, it's creating some glucose... and the good news is that (again, as far as I can tell; this is really what I wanted to know from my consultant, but the very question would have been problematic for her), I only need to keep doing what I'm doing, and my body will become more used to looking to fat for energy - via Ketones rather than Glucose. It will take 3 to 6 months, and I've been at it barely 3, so I can chill.

 

[Melgar]

By the way - I think I've been able to answer my own question about Ketone production - ie, if I'm fasting and working a near-zero carb diet, why do I still see raises in my blood glucose..

I think the answer is that it just takes longer to get into fat-adaptation, meaning that my body still prefers glucose to fat as an energy source. So, in the event that my body needs more energy, it's creating some glucose... and the good news is that (again, as far as I can tell; this is really what I wanted to know from my consultant, but the very question would have been problematic for her), I only need to keep doing what I'm doing, and my body will become more used to looking to fat for energy - via Ketones rather than Glucose. It will take 3 to 6 months, and I've been at it barely 3, so I can chill.

Very interesting post @Chris24Main . I love the analogy. I am going to comment on two points you have raised. Firstly, ketones. My blood sugars are raised and are slowly, slowly rising. I am on meds that have taken 2mmol\ls off my background or natural basal insulin production and whatever off my bolus. I am really into exercise. I test my urine 2-3 times a week. Every time I test I see I am producing 0.5 - 1.5 ketones. I am not on a very low carb diet to induce ketosis. So I worried about this, I worried about ketones in my urine. So I asked my Dr who said as long as I did not have glucose in my urine I was fine. I don't have glucose in my urine. Not satisfied with "it's fine". I went to my goto place, I researched it. I found this, and I quote:

"Ketone bodies are emerging as a significant indicator of metabolic health and recent studies have suggested that the presence of urinary ketones implies the superiority of metabolism, for example, obesity, central obesity, metabolic syndrome, dyslipidemia and type 2 DM."

The Presence of Urinary Ketones according to Metabolic Status and Obesity

Recently, new concepts about obesity and normal weight subtypes with metabolic conditions are rising and ketone bodies are emerging as a significant indicator of metabolic health. This study aimed to find a relationship between ketonuria and those subtypes.The ...

www.ncbi.nlm.nih.gov

The second point 'inflammation" which maybe of interest to you. I have low inflammatory markers, C-Reactive proteins. 1.9 mg/L lab range less than 5 mg/L. I have Osteoarthritis and my joints which often become inflamed, which would cause my CRP's to rise to 1.9. Other general reasons for raised CRP's would be: infection, viruses, autoimmune disorders such as RA and Lupus, obesity and insulin resistance. Insulin resistance will cause raised CRP markers. I quote:

"Our observations among Peruvians suggest that chronic systemic inflammation, as evidenced by elevated CRP, may be of etiologic importance in insulin resistance and diabetes."

Association between insulin resistance and c-reactive protein among Peruvian adults

Insulin resistance (IR), a reduced physiological response of peripheral tissues to the action of insulin, is one of the major causes of type 2 diabetes. We sought to evaluate the relationship between serum C-reactive protein (CRP), a marker of systemic ...

www.ncbi.nlm.nih.gov

"Emerging laboratory and epidemiologic data now link inflammation and hs-CRP to insulin resistance in that hs-CRP levels have been associated with impaired insulin sensitivity and the development of dysglycemic conditions, including the cardiometabolic syndrome and incident type 2 diabetes."

Interrelationships between inflammation, C-reactive protein, and insulin resistance - PubMed

The recognition that inflammation plays a fundamental role in atherothrombosis has led to the measurement of circulating inflammatory biomarkers such as high-sensitivity C-reactive protein (hs-CRP) as a means of improving cardiovascular disease detection and prevention. Clinically, levels of...

pubmed.ncbi.nlm.nih.gov

 

[Chris24Main]

On the first report - not 100% sure what it's about, but I think it's trying to get at the distinction between being 'metabolically healthy' or not, and the distinction between being overweight, or not. The results seem to show that the metabolically healthy and normal weight group are producing more Ketones than any of the other quadrants? - If I have that correct, then I'm not surprised, and my grasping attempt to understand my own condition (which ultimately I'm only really trying to do..) leads me to say that this, and essentially better flexibility between the body wanting to use Ketones for energy and Glucose ... is really the ideal condition for the Human animal, as opposed to the constant Glucose model.

In the end, and I think this is another deliberate oversimplification of the new science around aging - we have evolved the capability to grow in times of plenty, and heal in times of little; constant eating and snacking holds our bodies in the 'growing' state at the detriment of natural healing. At least that's how I understand it.

As it pertains to you... you clearly do lots of exercise; my sense is that you will be burning up much more energy than the rest of us, and that your body will be drawing on energy sources including Ketone production whether or not you are deliberately aiming for that in your diet, and that as a result, there is likely to be some Ketones in your urine. I read the statement to be positive - Ketones are becoming recognised as being a good thing and an indicator of good metabolic health, and positive in terms of the diseases mentioned.

The out-of-date way of thinking that I encountered, is that Ketones indicate Ketoacidosis which is bad and should be discouraged. However that only applies to Type 1 Diabetes where the body (lacking insulin to control glucose) begins creating Ketones as a response to hypoglycaemic episodes, and it goes into an open-loop situation, because the normal hormonal controls are not working..

From the NHS website:
Diabetic ketoacidosis (DKA) is a serious condition that can happen in people with diabetes. It's where a lack of insulin causes harmful substances called ketones to build up in the blood. It can be life threatening and needs urgent treatment in hospital.

Reading that, you can be forgiven for understanding that Ketones should therefore be considered a bad thing in all circumstances, particularly if you are Diabetic.

However, my understanding is that even for Type 1, good control of a keto-supporting diet can drive better metabolic balance, including using Ketones for energy, in a way that can reduce the dosage of insulin needed to control blood glucose, and can therefore significantly improve long term outcomes... but you would never, never draw that conclusion from the wording in the guidelines.

 

[Chris24Main]

On the second study.. on Insulin resistance, my thinking is that this is fundamentally based on shaky science, and that again, the results are really telling us nothing.

From the title: insulin resistance a reduced physiological response of peripheral tissues to the action of insulin

Well, that's stated as a fact, that IR is a form of pathology, and that understanding is at the base of a lot of the treatment for type 2 diabetes - the only trouble is that if it's true, then most of the predictions based on it have not borne out.. and that if you instead, think of insulin resistance like any other form of resistance, resistance to heroin, or caffeine, or exercise, or anything - it's a natural reaction to too much of a thing; then predictions based on that hypothesis give much better results (this is all the work of Jason Fung, and I would point you at him) and make much more sense... the insulin is struggling to pack more glucose into cells because the cells are already too full of insulin, not because of some physiological response of peripheral tissues that has still to be fully explained after many decades..

So - reading the study from that perspective, it's saying that if you are insulin resistant (ie, if you have too much glucose and insulin in your blood) you are likely to have high levels of inflammation - well, yeah..?

 

[Chris24Main]

Much the same for the third.

Inflammation - to go back to my net analogy, is damage to cell wall lining, in the form of breakage to the carbon strings that are the fatty acid chains. At the arterial level (where it's most pertinent to heart disease and plaque formation) its better to think of the endothelial cells as nice, shiny flat tiles on your kitchen floor. They are amazingly complex and they line all of your arteries, and are better thought of as a complete organ - they control all of the transport of molecules from the blood and can communicate with other organs, mainly the liver - I don't pretend to understand even a tiny portion of how it works..

But - inflammation causes these cells to curl up and holler for help from the inflammation response, which piles in to do repair, but also the curling up creates gaps between the cells where nasties can now get stuck, and need to get covered over with a whole bunch of stuff (clotting cascade, which is tremendously complex) finally being capped off with our old friend LDL and Cholesterol..

So - there is a connection between insulin resistance and inflammation - yes, of course there is... it's all about the sugar..

 

[Chris24Main]

But - to be clear @Melgar - I know you are concerned that your blood Glucose levels are rising, and I don't have any answers at all.. I'm pretty sure you are not, but please do not take anything I'm saying as being anywhere near advice...

 

[Melgar]

All very interesting @Chris24Main. I am 100% confident my blood is not acidic due to DKA, but exercise induced nutritional ketosis. It causes me problems because my BS sometimes go very low, my liver fails to correct it, likely because I have expended all my glycogen stores. It took me too long to figure that little pearl out. That being said, I was definitely reassured my metabolism is running at an optimum level. It does, however, boggle my mind that my blood sugars are raised and are rising when I am on meds that force my pancreas to stimulate more insulin - I have low normal insulin production - and I am in exercise induced ketosis, therefore great metabolism, very sensitive to insulin and no insulin resistance It will reveal itself in the end I guess.

The CRP results, for me, ruled out RA. So great news for me. I am also very comfortable with my CRP levels.
There are a number of medical studies that talk about CRP levels and inflammation. You are more knowlegeable than I on inflammation I just wanted to look at what CRP do in the body and what they indicate.

I will have to go, I am at the airport waiting to fly out to the UK!

 

[Chris24Main]

Thanks @Melgar - have a safe flight ...
I was actually popping in to send you this,

I don't consider myself to be particularly knowledgeable about any of this, by the way, just trying to learn; and there really is a huge amount of new research on all of these topics... I suppose I'm just trying to distill all of it into something that makes so much obvious sense that I will believe it myself and continue to believe it (in other words, live by the conclusions) for the rest of my life.

But that video (Dr Robert Cywes, describes himself as the 'carb addiction doc' - I have a book written by him and Malcolm Kendrick among others to delve into next; but I like his no-nonsense approach) gets into the fundamental nature of insulin resistance and therefore the effect of blood glucose in Type 1, Type 2 and what he refers to as Obeso-genic people.

You may not see the connection, but for you with all the exercise you do, and blood glucose still going up, I think there may be some clues...

I suppose, to put my cards firmly on the table, I have some form in this. I consider myself a spiritual but not religious person. I'm fascinated by the need for spirituality we have as a species - that's just an undeniable thing... but any given single form of religion suffers from the comparison with any other single form of religion. So, there is that, but at the same time, most forms of religious practice are very similar in the fundamentals... so, for me... I kind of boil all of that down into.. look, if you focus on the things that all religions share, you end up with something we can all get behind, and you don't need to disregard any individual belief in order to do so... I kind of like the neatness of that way of thinking.

So - I have a systematic way of thinking - it's really what I do for a living as a particular type of engineer. So, over the last 5 years or so, I've been reading up on sleep, how the brain works, then of course, now on metabolism, how stress affects things, what sugar does, and insulin and insulin resistance, and of course the whole Statin question, and inflammation etc... and I'm trying to boil all of that down into something as simple, just because I can't stop myself from thinking that way, like a dog with a bone...

What I'm really curious about is ... is there any appetite for that, or is this just something I should do and keep my mouth shut?

ie, I've been very clear all along, whatever I'm doing here, I'm doing primarily for myself, but if I stepped beyond that; do I just come across as a ...what... know-it-all or worse, some kind of dangerous enthusiast.. or is there any worth in this for anyone else..?
Open question...

 

[Antje77]

What I'm really curious about is ... is there any appetite for that, or is this just something I should do and keep my mouth shut?

ie, I've been very clear all along, whatever I'm doing here, I'm doing primarily for myself, but if I stepped beyond that; do I just come across as a ...what... know-it-all or worse, some kind of dangerous enthusiast.. or is there any worth in this for anyone else..?
Open question...

For what its worth, I enjoy reading your posts!
Sometimes I just glance over them, sometimes I read them closely, depending on mood and subject, but your enthousiasm and friendliness is always enjoyable even with the posts that go mostly over my head.