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Old 07-25-2012, 12:54 AM   #1
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Insulin resistance?

Hey guys . I used to be insulin resistant before I started low carbing. I have a question. What has become of this condition? Is it reduced at all? Thanks guys im really concerned about this.
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Old 07-25-2012, 06:07 AM   #2
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When I first started, I had dark, velvety skin (Acanthosis nigricans) around my neck, between my breasts, and under my armpits, which was one of the signs of insulin resistance. I lost weight, and the dark skin went away completely. So yes, I'd say my condition was reduced.
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Old 07-25-2012, 06:22 AM   #3
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When I first started, I had dark, velvety skin (Acanthosis nigricans) around my neck, between my breasts, and under my armpits, which was one of the signs of insulin resistance. I lost weight, and the dark skin went away completely. So yes, I'd say my condition was reduced.
I have this and never knew what it was till I looked up "dark skin under arms" on the net. I noticed it went away the first time I did Atkins (about 10 years ago), the second I stopped low carb and started chowing down on wheat again it came back. I love what Atkins does for my body even though I very rarely lose weight (my hair grows in nicely and my dark skin patches go away), unfortunatly I turn into super grump, my mood turns bad bad bad when doing strict low carb. I'm doing JUDDD with a low glycemic emphasis (just started the low glycemic) hopefully the marks will go away but havn't so far and have been doing JUDDD for 3 months, I have been eating very high carb though.
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Old 07-25-2012, 08:01 AM   #4
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If you are looking for a way to track this, have you had a doctor check you fasting insulin levels? That can give you a rough idea of your resistance. You could also ask your doc to provide a HOMA (homeostatic model assessment, which uses your fasting glucose and fasting insulin levels in a mathematical formula) or a QUICKI (qualitative insulin check index, which use the same fasting numbers in a slightly different way), which gives you a better estimate. Or you could take your fasting numbers and use some of the online resources to do the calculations and help you interpret them.

If all that seems to be too much or not possible, I would just keep going. By lowering your carbs, you are doing great things in terms of addressing insulin resistance.
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Old 07-25-2012, 09:52 AM   #5
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well, there are two separate issues here. one is, what is your body DOING, since you are low carbing. the other is, what would it do if you were NOT low carbing?

probably you are fine for the first, but the second not so much. no real reason to think insulin resistance would change that way.

I hope you are taking metformin!
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Old 07-25-2012, 11:00 AM   #6
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Originally Posted by Alessandre View Post
If you are looking for a way to track this, have you had a doctor check you fasting insulin levels? That can give you a rough idea of your resistance. You could also ask your doc to provide a HOMA (homeostatic model assessment, which uses your fasting glucose and fasting insulin levels in a mathematical formula) or a QUICKI (qualitative insulin check index, which use the same fasting numbers in a slightly different way), which gives you a better estimate. Or you could take your fasting numbers and use some of the online resources to do the calculations and help you interpret them.

If all that seems to be too much or not possible, I would just keep going. By lowering your carbs, you are doing great things in terms of addressing insulin resistance.
I should probably do some homework about this on the web, but can you elaborate a little more about checking fasting insulin levels, Alessandre? I've only had my fasting blood gloucose checked. I have read about people checking their blood glucose levels before and after meals (and was considering trying it myself), and I know that doctors sometimes order a blood glucose test for a certain number of hours after ingesting glucose or a carby meal ... but I haven't heard anything about checking insulin levels directly. How would that give different/additional information than the blood glucose level tests?
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Old 07-25-2012, 11:27 AM   #7
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I should probably do some homework about this on the web, but can you elaborate a little more about checking fasting insulin levels, Alessandre? I've only had my fasting blood gloucose checked. I have read about people checking their blood glucose levels before and after meals (and was considering trying it myself), and I know that doctors sometimes order a blood glucose test for a certain number of hours after ingesting glucose or a carby meal ... but I haven't heard anything about checking insulin levels directly. How would that give different/additional information than the blood glucose level tests?
I am still trying to wrap my head around this one as well. There appear to be 2 confusing issues for me.

1. If fasting b.g levels are high, one would expect to see high insulin levels in order to deal with the excess b.g.. If b.g. levels are normal but insulin high - that seems to say that the insulin is not being responded to.

2. If someone is on a ketogenic woe, how does this impact the range of 'normal' as it seems that diet would be a big contributor even if fasting is employed.
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Old 07-25-2012, 11:42 AM   #8
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Insulin levels can be measured, but the gold standard for doing so isn't practical for use in most clinical settings. (It is called the "euglycemic clamp" method, with the "eu-" prefix meaning "true", or the "hyperinsulinemic clamp" method). Another way involves an IV or oral glucose challenge. The oral method is often used in diagnosing Type 2 diabetes and insulin resistance. Anyone who was screened for gestational diabetes when pregnant has done the oral challenge. Ah, fond memories!

But there are ways that don't involve purposefully ingesting glucose. These involve taking one's insulin level, which requires a blood draw. The most basic way is to compare insulin levels before and after fasting. Any one blood draw might not be wholly accurate, but if your insulin levels are high after fasting, it is likely due to insulin resistance. Similarly, if your fasting blood glucose doesn't go down much but still remains out of the diabetic range, you are probably insulin resistant. So either fasting blood glucose or blood insulin levels gives you a reference point for looking at your situation.

If you do get a fasting insulin level, there are ways to use that to estimate your insulin resistance. That is the HOMA and QUICKI stuff I mentioned earlier. There are other ways as well. If your doc or the lab won't do any further analysis, you can calculate either the HOMA or QUICKI.

So the tl;dr version: Your fasting blood glucose level is the quickest estimation of insulin resistance, but you can also get a fasting insulin level. That fasting insulin level can either be looked at alone, just like the fasting glucose, or used in some mathematical estimations of insulin resistance. There are more accurate ways to measure insulin levels, but they aren't practical as monitors while LCing.

This is another one of the rabbit holes that we could drop down into, burrow ourselves in journal articles, and never be seen again. None of which is necessary to improve your health. I'll try to stop myself.
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Old 07-25-2012, 12:21 PM   #9
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I am still trying to wrap my head around this one as well. There appear to be 2 confusing issues for me.

1. If fasting b.g levels are high, one would expect to see high insulin levels in order to deal with the excess b.g.. If b.g. levels are normal but insulin high - that seems to say that the insulin is not being responded to.

2. If someone is on a ketogenic woe, how does this impact the range of 'normal' as it seems that diet would be a big contributor even if fasting is employed.
If one's fasting blood glucose levels are high, it is most likely due to insulin resistance (if not frank diabetes), so insulin levels also would be expected to be high.

If one's fasting blood glucose is normal but fasting blood insulin is higher than expected, your body probably is producing more insulin than it needs because of resistance. If you break that fast with glucose (as in a glucose challenge) and you have insulin resistance, the spike in insulin levels will be expected to be greater than in someone without insulin resistance.

But to get more precise about insulin: There are two phases of insulin release. The first phase spikes about 10 minutes after a glucose challenge. The second plateaus in a few hours. It is thought that a person with insulin resistance may a normal first-phase response (or even low if they pancreas is starting to burn out) but then have an increased second-phase insulin response. The expectation/hope for dietary ketogenesis advocates is that it can reverse insulin resistance and thus keep insulin levels low at all times relative to someone eating high-carb. As insulin prompts the body to take up glucose and fatty acids, keeping insulin low should help with weight loss.
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Old 07-25-2012, 01:04 PM   #10
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I am insulin resistant and have pcos. I'm less irritable and tired. Plus I also finally got my first period in 11 months today.
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Old 07-25-2012, 01:13 PM   #11
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If one's fasting blood glucose levels are high, it is most likely due to insulin resistance (if not frank diabetes), so insulin levels also would be expected to be high.

If one's fasting blood glucose is normal but fasting blood insulin is higher than expected, your body probably is producing more insulin than it needs because of resistance. If you break that fast with glucose (as in a glucose challenge) and you have insulin resistance, the spike in insulin levels will be expected to be greater than in someone without insulin resistance.

But to get more precise about insulin: There are two phases of insulin release. The first phase spikes about 10 minutes after a glucose challenge. The second plateaus in a few hours. It is thought that a person with insulin resistance may a normal first-phase response (or even low if they pancreas is starting to burn out) but then have an increased second-phase insulin response. The expectation/hope for dietary ketogenesis advocates is that it can reverse insulin resistance and thus keep insulin levels low at all times relative to someone eating high-carb. As insulin prompts the body to take up glucose and fatty acids, keeping insulin low should help with weight loss.
wow! Some great information! So, if you have a glucose tolerance test and you have a severe drop in glucose 30 minutes to an hour after ingesting the glucose then that could mean insulin resistance also right? or wrong?
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Old 07-25-2012, 02:26 PM   #12
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I am insulin resistant and have pcos. I'm less irritable and tired. Plus I also finally got my first period in 11 months today.
Congratulations, Katy. Good for you for looking after your health by following this woe. I'm glad that you are experiencing some concrete returns for that!
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Old 07-25-2012, 02:54 PM   #13
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wow! Some great information! So, if you have a glucose tolerance test and you have a severe drop in glucose 30 minutes to an hour after ingesting the glucose then that could mean insulin resistance also right? or wrong?
It would be more typical of insulin resistance to not have a severe drop in glucose and instead have higher levels of blood glucose after a challenge.

Part of the problem is that we are talking about points in a pathway, from a totally normal insulin response from a healthy pancreas at the start, to a pancreas that can no longer produce adequate amounts of insulin at the end, which is insulin-dependent diabetes. And we're talking about dynamic processes, so any one blood draw might not be representative (this one reason diabetes is usually not diagnosed based on a single high blood sugar reading).

In discussing glucose and insulin levels, we're also talking about the results of two things: 1) Insulin production and release by the pancreas, and 2) insulin response by muscle, fat, and liver cells (and there are several other substeps here, at the cellular level). For example, a young kid with insulin-dependent diabetes may have big problems with the first part (insulin production and release by the pancreas) but be able to use insulin from shots because the second part is ok.

For someone solely with insulin resistance, early on their problems are at the tissue level: Their pancreas can make and release enough insulin, but the response to insulin by fat, muscle, and liver cells is less than it should be. So the body needs more insulin to get the response it otherwise would have, and glucose and insulin levels will be higher than expected as they are not being utilized efficiently. If this progresses, eventually the pancreas will not be able to produce adequate insulin, leading even higher glucose levels even as insulin levels drop and the person will have diabetes. That progression to diabetes isn't guaranteed, of course; it is just an endpoint in this continuum.
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Old 07-25-2012, 04:59 PM   #14
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The Phinney and Volek book has a good chapter on it. It's not an exact science, so don't feel bad if it's confusing. The "first domino" that causes it might be liver and muscle cells purposefully reducing their number of insulin receptors to defend themselves against the daily onslaught, or it might be a pattern of low-quality cell membranes constructed with omega-6 and trans fats. Regardless of the cause, LC eating seems to be the ideal therapy.
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Old 07-25-2012, 06:31 PM   #15
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It would be more typical of insulin resistance to not have a severe drop in glucose and instead have higher levels of blood glucose after a challenge.

Part of the problem is that we are talking about points in a pathway, from a totally normal insulin response from a healthy pancreas at the start, to a pancreas that can no longer produce adequate amounts of insulin at the end, which is insulin-dependent diabetes. And we're talking about dynamic processes, so any one blood draw might not be representative (this one reason diabetes is usually not diagnosed based on a single high blood sugar reading).

In discussing glucose and insulin levels, we're also talking about the results of two things: 1) Insulin production and release by the pancreas, and 2) insulin response by muscle, fat, and liver cells (and there are several other substeps here, at the cellular level). For example, a young kid with insulin-dependent diabetes may have big problems with the first part (insulin production and release by the pancreas) but be able to use insulin from shots because the second part is ok.

For someone solely with insulin resistance, early on their problems are at the tissue level: Their pancreas can make and release enough insulin, but the response to insulin by fat, muscle, and liver cells is less than it should be. So the body needs more insulin to get the response it otherwise would have, and glucose and insulin levels will be higher than expected as they are not being utilized efficiently. If this progresses, eventually the pancreas will not be able to produce adequate insulin, leading even higher glucose levels even as insulin levels drop and the person will have diabetes. That progression to diabetes isn't guaranteed, of course; it is just an endpoint in this continuum.
Is insulin resistance reversible I wonder? Like if you are on a low carb diet for a long time, could it be that things correct themselves? Or are you looking at a lifetime of following a LC diet?
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Old 07-26-2012, 05:57 AM   #16
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Is insulin resistance reversible I wonder? Like if you are on a low carb diet for a long time, could it be that things correct themselves? Or are you looking at a lifetime of following a LC diet?
Many studies have shown that insulin resistance in some people can be reversed. The conditions in which this has happens vary and include successful bariatric surgery, significant weight loss, adoption of a ketogenic or otherwise LC diet, increased muscle mass, or calorie restriction. And while there's several hypotheses, the underlying mechanisms are not conclusively known.

Phinney and Volek's book, which Picklepete mentions above, examines non-insulin dependent diabetes and concludes that in most cases the diet will have to be maintained to prevent relapse. Investigators who have looked at mechanisms other than LC dieting seem to suggest that insulin resistance can be reversed without a LC diet and thus maintained without one. Examples of this include people who lost a significant amount of weight using a non-LC diet and have been able to keep the pounds off.

You can find some of this in either MedLine or Google Scholar by looking at "insulin resistance reversibility" or "insulin resistance remission" and then refining your search. But it is highly technical stuff and a lot of weeding out of unrelated topics is required.

FWIW, my personal view, applying only to me, is that I need to stay away from a carb-heavy diet for the rest of my life. I don't have diabetes, but I was at great risk for it. I have trouble moderating my carb intake and gain weight easily when I eat too many. I believe the data on the long-term health benefits of LCing, so all of this adds up to limiting carbs as a lifestyle for me.
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Old 07-26-2012, 06:08 AM   #17
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Alessandre, thank you for that succinct explanation on insulin resistance.
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Old 07-26-2012, 06:22 AM   #18
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You're welcome, Clackey. I was aiming for "succinct", but it is hard when discussing such a complex issue without reducing things down to inaccuracy.

I should probably say that this is part of my professional life and then not say too much more about that. But I think I'm a great example of 1) the failure of conventional high-level medical thinking on these issues, as that had been my perspective for years and only changed recently; and 2) the ability to understand the deepest technical issue and still struggle to achieve the results. Talk to me, hopefully, in a year and see what my results are and whether I've walked the talk. In the meantime, I see a lot of people here who present a stronger argument than anything I've read in peer-reviewed journals by sticking with LC, having the health indices improve greatly, losing extra weight, and keeping it off. This place is great, and I find folks - from those who have reached goal and are maintaining to those struggling to just get back on the path once again - a huge inspiration. Thanks, all!
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Old 07-26-2012, 06:35 AM   #19
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Many studies have shown that insulin resistance in some people can be reversed. The conditions in which this has happens vary and include successful bariatric surgery, significant weight loss, adoption of a ketogenic or otherwise LC diet, increased muscle mass, or calorie restriction. And while there's several hypotheses, the underlying mechanisms are not conclusively known.

Phinney and Volek's book, which Picklepete mentions above, examines non-insulin dependent diabetes and concludes that in most cases the diet will have to be maintained to prevent relapse. Investigators who have looked at mechanisms other than LC dieting seem to suggest that insulin resistance can be reversed without a LC diet and thus maintained without one. Examples of this include people who lost a significant amount of weight using a non-LC diet and have been able to keep the pounds off.

You can find some of this in either MedLine or Google Scholar by looking at "insulin resistance reversibility" or "insulin resistance remission" and then refining your search. But it is highly technical stuff and a lot of weeding out of unrelated topics is required.

FWIW, my personal view, applying only to me, is that I need to stay away from a carb-heavy diet for the rest of my life. I don't have diabetes, but I was at great risk for it. I have trouble moderating my carb intake and gain weight easily when I eat too many. I believe the data on the long-term health benefits of LCing, so all of this adds up to limiting carbs as a lifestyle for me.
Thank you so much for sharing your knowledge

I remember a time when I could eat anything and not gain weight. WW and other diets don't work for me unless I follow them doing LC. It has to be LC for me now.

Thanks again!
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Old 07-26-2012, 06:39 AM   #20
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Thank you so much for sharing your knowledge

I remember a time when I could eat anything and not gain weight. WW and other diets don't work for me unless I follow them doing LC. It has to be LC for me now.

Thanks again!
You're welcome. I think my body skipped the "eat anything and not gain weight" part! I do think I had a "look at a cupcake and feel my pants getting tighter" phase, however.
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Old 07-26-2012, 06:40 AM   #21
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You're welcome. I think my body skipped the "eat anything and not gain weight" part! I do think I had a "look at a cupcake and feel my pants getting tighter" phase, however.
I know that feeling!!!!


Hey, do you know if we release insulin from just smelling something carby like bread baking or cookies baking? I've read that somewhere, but I'm wondering if it's true?
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Old 07-26-2012, 06:57 AM   #22
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The earliest physiological response to food is called the cephalic phase. It happens before food enters the stomach and can be triggered by just the thought of food. Looking, smelling, or tasting food can also start this. It sets off a cascade of nerve-based responses to prepare your body to eat. This includes increasing your stomach acid, increasing the movement of your guts (GI motility), and increasing blood insulin. So, yes, just the smell of food can increase your insulin levels. It will be nowhere near what eating a high-glucose meal would be and is variable among individuals, but when it happens it is measurable.

This is why I avoid "food porn" stuff. I think it gets my system going. The increased GI motility can make you feel more hungry or at least raise awareness that your stomach is empty. This response can be altered; I remember reading about how there was a very strong physiological response among a group of obese people to pictures of a cake and that their response lessened over time as they changed their diet and lost weight. I'm too lazy to look it up right now, but I can already tell my psychological responses to high-carb stuff is much less than it was when I was eating a higher-carb diet. I can now pass up nearly all of that without much mental work. I still try not to push it, however.
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Old 07-26-2012, 07:25 AM   #23
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Alessandre, I would be interested on your view on this subject...


Blood Glucose levels
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Old 07-26-2012, 09:03 AM   #24
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Alessandre, I would be interested on your view on this subject...

Blood Glucose levels
I've only looked at this a bit.

I have seen the idea that very low carb diets can raise fasting glucose levels while still keeping them within the standard "normal" range. I have yet to see any good studies that discuss it in detail, however, and one of the often-repeated lines that pops up (that LCing "induces insulin resistance") is inaccurate, IMO. Here's the World Health Organization discussing insulin resistance:

Quote:
From Optimal Cut-off Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) for the Diagnosis of Metabolic Syndrome: Third National Surveillance of Risk Factors of Non-Communicable Diseases in Iran (SuRFNCD-2007), A. Esteghamati and H. Ashraf et al., Nutrition & Metabolism 2010, 7:26:

"[Insulin resistance]... represents a reduced physiological response of the peripheral tissues to the action of the normal levels of insulin..."
I haven't seen anything that shows that peripheral tissue responses to insulin are impaired with ketogenic/very LC diets, which is what that quote implies regarding insulin resistance. Instead, the body's energy utilization and thus insulin response changes. Yes, there is less circulating insulin in ketogenic diets. But that is different than saying, for example, that there is inappropriately low activation of muscle glucose transport (an apparent mechanism for insulin resistance) while LCing, with "inappropriately" being key. IMO, pathological insulin resistance and the physiological changes with nutritional ketosis are two very different states.

I may very well be missing a big piece here and would appreciate any well-sourced info that shows otherwise. If my fasting glucose level goes up but still remains in the normal range and my HbA1c remains low, I'm not going to worry about it - but that is just me.
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Old 07-26-2012, 10:20 AM   #25
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Thanks.

The problem I had was the HbA1c was not normal until 3 months later when I had been out of ketosis for 3-4 months. (5.6 to 4.9)
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Old 07-26-2012, 03:50 PM   #26
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I was put on metformin for insulin resistance and 3 months after i started it my fasting insulin level had actually increased! 3 months after starting LC, my insulin level went from 22 to 12, which is considered in the normal range. I'm still on metformin, but I think that the LC way of eating is what made the difference!
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Old 07-26-2012, 05:25 PM   #27
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Originally Posted by Alessandre View Post
I see a lot of people here who present a stronger argument than anything I've read in peer-reviewed journals by sticking with LC, having the health indices improve greatly, losing extra weight, and keeping it off. This place is great, and I find folks - from those who have reached goal and are maintaining to those struggling to just get back on the path once again - a huge inspiration. Thanks, all!
I hope that some people here who have had success along these lines have shared their experience via The National Weight Control Registry. (Google that phrase and it comes right up.) This is a research database that adults who have lost 30 or more pounds and kept it off for more than 1 year can contribute data to, and is very influential for research on successfully maintaining weight loss. For example, the U.S. government's recommendation that people should exercise at least an hour a day, five or more days a week, to maintain weight loss is based on this being a common practice among people who have shared their experiences through the NWCR.

Here's a quote from the website:
"Recruitment for the Registry is ongoing. If you are at least 18 years of age and have maintained at least a 30 pound weight loss for one year or longer, you may be eligible to join our research study."

This is a credible research study set up by researchers at Brown University and the University of Colorado, has been the basis of many studies published in scholarly journals, and has had results publicized through such high visibility media as USA Today, The Washington Post, and Good Morning America. Contributing data to the NWCR may be a way for you to help increase acceptance of this woe in the medical and research community.
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Old 07-27-2012, 08:36 AM   #28
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Originally Posted by drjlocarb View Post
Alessandre, I would be interested on your view on this subject...


Blood Glucose levels
Similar to the above link..I was concerned when I read this :

Quote:
One caveat here is that very low-carb diets will produce elevated fasting blood glucose levels. Why? Because low-carb diets induce insulin resistance. Restricting carbohydrates produces a natural drop in insulin levels, which in turn activates hormone sensitive lipase. Fat tissue is then broken down, and non-esterified fatty acids (a.k.a. “free fatty acids” or NEFA) are released into the bloodstream. These NEFA are taken up by the muscles, which use them as fuel. And since the muscle’s needs for fuel has been met, it decreases sensitivity to insulin. You can read more about this at Hyperlipid.
Why your “normal” blood sugar isn’t normal (Part 2)

apparently there is more explanation found here


but I don't understand it. Is there anyway to know if I'm creating greater IR in my body by doing strict LC? That scares me....Allesandre, if you could help decipher some of this contrary info, I'd be interested in your comments. I'm sure the others subbing to this thread would be as well.

Last edited by Deb34; 07-27-2012 at 08:42 AM..
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Old 07-28-2012, 07:49 AM   #29
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Originally Posted by Deb34 View Post
Similar to the above link..I was concerned when I read this :

Why your “normal” blood sugar isn’t normal (Part 2)

apparently there is more explanation found here [Hyperlipid]

but I don't understand it. Is there anyway to know if I'm creating greater IR in my body by doing strict LC? That scares me....Allesandre, if you could help decipher some of this contrary info, I'd be interested in your comments. I'm sure the others subbing to this thread would be as well.
I looked at those links earlier, and to me it doesn't say anything solid about an increased risk for persistent insulin resistance with LC. To pick one (the explanation you link to), here's what Hyperlipid says, with most of it edited out for brevity and copyright concerns:

Quote:
From Hyperlipid: Physiological Insulin Resistance

[The author starts by talking about a person who is eating a paleolithic LC diet and has seen his fasting blood glucose levels rise. He then mentions he has seen the same in himself, although his HbA1c has remained in the healthy range.]
...
What is happening? Well, the first thing is that LC eating rapidly induces insulin resistance. This is a completely and utterly normal physiological response to carbohydrate restriction. Carbohydrate restriction drops insulin levels. Low insulin levels activate hormone sensitive lipase. Fatty tissue breaks down and releases non esterified fatty acids. These are mostly taken up by muscle cells as fuel and automatically induce insulin resistance in those muscles.
...
However, while muscles are in "refusal mode" for glucose the least input, from food or gluconeogenesis, will rapidly spike blood glucose out of all proportion. This is fine if you stick to LC in your eating. It also means that if you take an oral glucose tolerance test you will fail and be labelled diabetic. In fact, even a single high fat meal can do this, extending insulin resistance in to the next day.
...
The general opinion in LC circles is that you need 150g of carbohydrate per day for three days before an oral glucose tolerance test.

I did this carb loading thing, then performed my own OGTT. It came out very normal except for mild reactive hypoglycaemia.
....
He is talking about something that ultimately is very different than the insulin resistance people are concerned about here.

When we talk about "insulin resistance" in terms of worries regarding developing diabetes, we are referring to an abnormal response by our bodies to insulin. When the pancreas released insulin in response to glucose, there are problems in the cells in our muscles, liver, and fat. They don't give the full response to the released insulin that they should. This can cause higher levels of glucose in the blood as it doesn't all get fully used. Similarly, it can cause higher levels of insulin in the blood. The pancreas may also start releasing more insulin in an effort for the body to respond fully to glucose. So ultimately these malfunctions in muscle, liver, and fat cells can cause health problems that include diabetes.

But that is not what the author of Hyperlipid, who is a veterinarian, is talking about. And one clue is in his subtitle: "Physiological Insulin Resistance". In biological sciences, you can describe the body's response to anything in one of two ways: It is 1) pathological or 2) it is physiological. If it is "pathological", it is abnormal. The word "pathology" comes from the Greek word "pathos", meaning suffering", and is the study of what makes us suffer, i.e., the study of disease. In contrast, a response may be labeled "physiological". The word "physiology" comes from the Greek word "physis", meaning "nature", and is study of how living things function, i.e., the study of how healthy things work.

So if you are studying how the body responds to, for example, insulin, you can describe that response as either abnormal and unhealthy (pathological) or normal and healthy (physiological). The author of Hyperlipid starts by calling the insulin resistance he is talking about "physiological". Right from the start, he is saying it is a healthy response.

That is a lot of "blah blah Greek blah blah" by me. But this is one of those seemingly small understanding points in which folks without a fairly deep knowledge of this stuff can take a wrong turn. And there's tons of them as this is complex stuff.

Ok, so back to what was said in Hyperlipid: He explicitly says there is no problem with his pancreas or muscles ("normal pancreatic and muscle function", in the 10th paragraph). But his fasting blood glucose is up. He then talks about why he thinks this is so: That while on ketosis his muscles are preferring to use broken-down fat components instead of glucose. But he is clear that this is easily reversible: He will have normal glucose levels in a glucose challenge test if he increases his daily carbs for 3 days. It also doesn't affect his HbA1c (hemoglobin A1c), which is a test of your blood sugar control for the past 3 months. A single fasting blood glucose is like taking a picture of a train as it speeds past: It may not be accurate as there are a lot of factors that may affect that glucose level on that day at that minute. But the HbA1c usually is given more weight due to the longer time period.

This is what I trying to say in a previous post above: That when we talk about the insulin resistance that is a health worry, we are talking about something that happens due to a problem with our bodies. But everything that I have read about insulin resistance increasing with ketogenic diets, they are actually talking about normal, healthy responses by our bodies while in ketosis that easily reverses when we end ketosis. That is why I think it is ultimately misleading to call that "insulin resistance" without addressing this potential confusion. It is not technically incorrect, and I don't mean this as a big criticism of Hyperlipid, which seems thoughtful and solid. But the use of the word "insulin resistance" in a blog that most likely will be read by folks who don't have a deep medical background may be confusing or alarming, even when the author takes pain to say this is healthy and in fact desirable.

Hope that helps, or at least makes sense on a Saturday morning.
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Old 07-28-2012, 10:57 AM   #30
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That does help - quite a bit and thank you for clearing that troubling question up.

Maybe for the sake of clarity we should start to refer to non-ketogenic insulin resistance as 'pathological insulin resistance' and the for diet related, the former!
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