My third three day fast

Did my third three day fast this past week. I find I can do them easily starting Monday after dinner and resume eating on Thursday. I lose around four lbs on the fast but a lb or two returned after the fast. Net seems to be a couple of lbs which is better than they would be if I had not fasted.

One of the better benefits is the dip in Blood Sugar during the fast. By the third day my numbers go from the low 80’s to upper 90’s. Meter shows my averages as 101-103 for the 7 day, 14 day and 30 day. That should be an HbA1C of around the mid 5’s. Still seeing a Dawn Effect every day and a drop by dinner time.

Still doing Intermittent Fasting and LCHF. I eat on a 20 hour fast four hour eating schedule.

My work scale shows I have lost around 46 lbs so my guess is that I am down about 50 lbs in three months.

 

Ketosis Data

From (Ketone body metabolism and cardiovascular disease):

Ketone body oxidation becomes a significant contributor to overall energy metabolism within extrahepatic tissues in numerous physiological states, including the neonatal period, starvation, postexercise, and adherence to low-carbohydrate diets, when circulating ketone body concentrations increase from ∼50 μM in the normal fed state to up to 7 mM. Circulating ketone body concentrations rise to ∼1 mM after 16–20 h of fasting in healthy adult humans but can accumulate to as high as 20 mM in pathological states like diabetic ketoacidosis

Therefore, the metabolism of ketone bodies may influence numerous human disease states relevant to cardiovascular disease, including obesity, diabetes, atherosclerosis, and heart failure.

 

Mexican Food

Had Mexican food last night. Did well. Here’s how I did it.

  1. No chips/salsa.
  2. Ordered fajitas. Forget the name of it (Vallerta Fajitas maybe?). Had chicken, beef, chorizo and shrimp. Very oily/greasy. Included onions, green peppers, cauliflower, broccoli. Tasted good. No chips/salsa.
  3. No rice.
  4. No beans.
  5. No tortillas.

Blood sugar 2 hours later was 95 (pretty much normal for me).

Low Carb and the “Authorities”

From the American Diabetics Association 2008 (Nutrition Recommendations and Interventions for Diabetes):

ENERGY BALANCE, OVERWEIGHT, AND OBESITY

Recommendations

  • In overweight and obese insulin-resistant individuals, modest weight loss has been shown to improve insulin resistance. Thus, weight loss is recommended for all such individuals who have or are at risk for diabetes. (A)

  • For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term (up to 1 year). (A)

  • For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. (E)

Wow. Back when I was a newly diagnosed T2D (in 2003) they were saying LC is bad. Now it is one of the recommended diets for Diabetics. Reading on…

The optimal macronutrient distribution of weight loss diets has not been established. Although low-fat diets have traditionally been promoted for weight loss, two randomized controlled trials found that subjects on low-carbohydrate diets lost more weight at 6 months than subjects on low-fat diets (19,20). Another study of overweight women randomized to one of four diets showed significantly more weight loss at 12 months with the Atkins low-carbohydrate diet than with higher-carbohydrate diets (20a). However, at 1 year, the difference in weight loss between the low-carbohydrate and low-fat diets was not significant and weight loss was modest with both diets. Changes in serum triglyceride and HDL cholesterol were more favorable with the low-carbohydrate diets. In one study, those subjects with type 2 diabetes demonstrated a greater decrease in A1C with a low-carbohydrate diet than with a low-fat diet (20). A recent meta-analysis showed that at 6 months, low-carbohydrate diets were associated with greater improvements in triglyceride and HDL cholesterol concentrations than low-fat diets; however, LDL cholesterol was significantly higher on the low-carbohydrate diets (21).

So everything (except LDL) was better with LC. And they did not differentiate between the various LDL (small particle size vs large).

 

Coffee and Insulin Resistance

Wasn’t too sure about what the title of this article should be. I was tempted to make it Coffee and Blood Sugar but I really need to adjust my thinking since Blood Sugar isn’t the problem, but insulin levels are.

The general concept that lowering Insulin levels also lowers Insulin resistance in the cells makes good sense. The problem is that there’s no available instrument I can use to determine Insulin levels. The only measurement I can do easily is blood sugar levels. Insulin kicks in when blood sugar levels rise. Carbs cause blood sugar to rise and Insulin to kick in. That’s the advantage a Low Carb diet brings to Insulin Resistance.

So why coffee? I have not been a fan of coffee. My preferred drink of choice is Diet Mountain Dew. Lots of caffeine and a taste that I used to like. It now tastes too sweet to me since I have gone LCHF. To replace the caffeine I have taken to drinking coffee. It started innocently enough. Drank some of the horrible coffee at work. Spotted a jar of instant coffee at Trader Joe’s and it was better than the stuff at work. Researched through a friend at work K-cup machine and actually purchased a Bella Single Cup brewstation.

Took this to the next level and actually started adding Ghee to coffee. Not too much, maybe a half teaspoon. I drink 2 mugs (12 oz each) of coffee a day. I’m adding maybe 50 calories to my day during what was previously a fast time. But since those calories are fat rather than carbs it’s not affecting my ketosis.

But all of this begs the question. Have I done myself a favor by trading something I like for something I am just beginning to learn to tolerate? Certainly it’s a more grown up thing to drink coffee but is it a more healthy choice?

By my own testing with my blood sugar meter Diet Mountain Dew really didn’t drive my blood sugar one way or the other. But there’s the question of what it was doing to my Insulin levels.

But, what does coffee do to blood sugar and Insulin? I see a small rise in my blood sugar when I drink my black coffee. And that’s what the literature says happens (Associations between the intake of caffeinated and decaffeinated coffee and measures of insulin sensitivity and beta cell function).

There is some evidence as well that the effect on Insulin Sensitivity is a temporary effect and that the longer term effect of coffee on Insulin Sensitivity is in fact a good effect (Caffeinated Coffee, Decaffeinated Coffee, and Caffeine in Relation to Plasma C-Peptide Levels, a Marker of Insulin Secretion, in U.S. Women):

Intakes of caffeinated and decaffeinated coffee and caffeine in 1990 were each inversely associated with C-peptide concentration in age-adjusted, BMI-adjusted, and multivariable-adjusted analyses. In multivariable analysis, concentrations of C-peptide were 16% less in women who drank >4 cups/day of caffeinated or decaffeinated coffee compared with nondrinkers (P < 0.005 for each). Women in the highest quintile compared with the lowest quintile of caffeine intake had 10% lower C-peptide levels (P = 0.02). We did not find any association between tea and C-peptide. The inverse association between caffeinated coffee and C-peptide was considerably stronger in obese (27% reduction) and overweight women (20% reduction) than in normal weight women (11% reduction) (P = 0.005).

C-peptide is proportional to Insulin although it has a longer half life. It looks as if this may be part of the reason that coffee is a good choice for diabetics. It may raise blood sugar in the short term but lower insulin resistance in the longer term.

 

Blood Sugar Measurements

I’ve noticed that every so often I get a blood sugar reading in the 120’s.  Nothing to be alarmed about but when you’ve gotten used to being in the 90’s mostly it seems out of place. I’ve also started to wash my hands and retest after the number. I’ve noticed that the second reading is quite a bit lower.

For instance, when I woke up at 6:41 I tested and got 122. I then got up washed my hands and retested at 6:52 and my number was 109. Two hours later my number is 93. The 93 may be partly attributable to the Metformin I took when I got up.

 

Status – 2016-10-11

Two status reports in two days! Don’t want to set a record. On vacation from work and kids are in school so I have time to myself.

Bought a new scale

Yah, I know. Should really just ignore the scale entirely but I am a data driven guy. My other scale is a purely mechanical scale and the results were all over the place. The new scale has some fancy features like it measures my body impedance and determines BMI (says I am 34 BMI which is correct), percent body weight as water (shows me at 28% which is pretty low).

The good part is that the weight it shows is consistent but not exactly the same every time I step on. We have one at work that remembers if you stepped on it earlier and lies about it’s own accuracy by telling you the same number. It doesn’t have wireless and the numbers go by pretty fast. I recorded them with my tablet audio and will track them on a spreadsheet. Perhaps every day, perhaps not.

 

Status – 2016-10-10

It has been a while since I last posted a status. Things are going very well. My weight loss is at a slow and steady pace of a lb or two a week. I am down around 40 lbs now from when I started. Remember, a caloric deficit of 500 calories a day will only yield 3500 calories a week or a pound loss per week.

My main goal of getting my Insulin Resistance under control is difficult to measure since there’s no “Home IR kit” out there yet. But I’ve stayed off Insulin and and keeping up the Metformin oral medication.

I was having some problems with cramping (legs mostly) which was due to electrolyte balance. Increased salt, adding a daily multi-vitamin plus Calcium Citrate is working well with no cramping symptoms anymore.

Blood sugar has been steady as a rock. My 30 day average has 100. That translates to an HbA1C of 5.1. Also, I tend to test when I wake up and then two hours later (when the Dawn Syndrome peaks) so the numbers that I get are averages of all of the day’s numbers. My average may be slightly lower than 100. Here are the numbers from my last two weeks.

two-weeks-ending-2016-10-09

Protein and Gluconeogenesis

A dialog in the 2KetoDudes Facebook group has me thinking more deeply about Gluconeogenesis (GNG). One of the folks there challenged my belief that GNG is a culprit with respect to Protein consumption. The person pointed me to a site which had a couple of articles, but this was the key one to represent his POV (Protein, Gluconeogenesis, and Blood Sugar).

It is the contention of the article that for a Keogenic (LCHF) diet the effects of Gluconeogensis from protein consumption are not significant to blood glucose levels. In fact, the article argues GNG and blood glucose levels are negatively correlated.

We haven’t found any solid evidence to support the idea that excess protein is turned into glucose.

Another interesting quote:

On the input side, blood sugar can come from three sources:
– We can eat carbohydrates, and have sugar enter the blood through digestion.
– We can make glucose out of glycogen (the limited amount of glucose stored in persistent form in the liver). This process is called glycogenolysis.
– Thirdly, we can produce new glucose by GNG.

Here’s where it gets even more interesting:

Even on a keto diet, there is still a substantial proportion of glucose production from glycogenolysis. Ultimately, of course, the glycogen in keto dieters also comes from GNG that happened previously.

Here’s a different article (Effect of long-term dietary protein intake on glucose metabolism in humans).

Glucose-stimulated insulin secretion was increased in the high protein group “516  45 pmol/l vs 305  32,p = 0.012) due to reduced glucose threshold of the endocrine beta cells “4.2  0.5 mmol/l vs 4.9  0.3, p = 0.031). Endogeneous glucose output was increased by 12% “p = 0.009) at 40 pmol/l plasma insulin in the high protein group, but not at higher insulin concentration whereas overall glucose disposal was reduced.