Four Day Fast

I did a four day fast from Monday evening through Friday evening this week. Easy breezy. Really easy. Felt strong and like I could have gone on for several more days easily. Think I might try a 7 day fast next.

What happens to me during a four day fast?

My Blood Sugar drops. My afternoon lows on the fourth day were 77. For several readings in the afternoon.  Here is my average of the four days of the fast.

abg-5dayfasting-2016-11-11

My weight drops. Around a pound a day maybe more although by calories count it has to be less than a pound a day. That’s because my expenditure is around 2500 calories a day and a pound is 3500 calories a day. That works out to less than a calorie a day.

I experienced no appreciable hunger and the bit that I did have was transient. Even the box of fresh donuts in the kitchen had no real appeal to me.

Mood was fairly flat which can be a bummer but it’s good to not be fed for flattening out ones mood.

Ordered Dr Jason Fung’s book on Fasting.

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.

 

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.

Food and the Heart

A newly published study (Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries).

The results of our study show that high-glycaemic carbohydrates or a high overall proportion of carbohydrates in the diet are the key ecological correlates of CVD risk. These findings strikingly contradict the traditional ‘saturated fat hypothesis’, but in reality, they are compatible with the evidence accumulated from observational studies that points to both high glycaemic index and high glycaemic load (the amount of consumed carbohydrates × their glycaemic index) as important triggers of CVDs (1, 32–34). The highest glycaemic indices (GI) out of all basic food sources can be found in potatoes and cereal products (Supplementary Table 2), which also have one of the highest food insulin indices (FII) that betray their ability to increase insulin levels.

And…

The role of the high glycaemic index/load can be explained by the hypothesis linking CVD risk to inflammation resulting from the excessive spikes of blood glucose (‘post-prandial hyperglycaemia’) (35). Furthermore, multiple clinical trials have demonstrated that when compared with low-carbohydrate diets, a low-fat diet increases plasma triglyceride levels and decreases total cholesterol and HDL-cholesterol, which generally indicates a higher CVD risk (36, 37). Simultaneously, LDL-cholesterol decreases as well and the number of dense, small LDL particles increases at the expense of less dense, large LDL particles, which also indicates increased CVD risk (27). These findings are mirrored even in the present study because cereals and carbohydrates in general emerge as the strongest correlates of low cholesterol levels.

 

Dr Jason Fung – “The Obesity Code”

From Dr Fung’s excellent book “The Obesity Code” (p 233).

There are five basic steps to weight loss:

1 – Reduce your consumption of added sugars.
2 – Reduce your consumption of refined grains.
3 – Moderate your protein intake.
4 – Increase your consumption of natural fats.
5 – Increase your consumption of fiber and vinegar.

Note this is not the final word in his excellent book.

 

Exercise vs Diet

The common mantra is “get more exercise”. I looked earlier in another post at how much exercise (filter by the tag exercise). My question is whether or not exercise helps in weight loss and if so, how much?

Turns out exercise doesn’t help all that much in weight loss.  This study looked at just how much exercise helped in weight loss (Exercise training versus diet-induced weight-loss on metabolic risk factors and inflammatory markers in obese subjects: a 12-week randomized intervention study).

The study was 12 weeks long and looked at the effects of diet alone, exercise and diet, and exercise alone. Seventy-nine obese subjects were recruited for the study.

Weight loss was virtually identical in the diet only and the diet plus exercise groups. The exercise only group lost significantly less weight.

The key item to note is that both diet and exercise and diet alone both reduced the metabolic syndrome (Insulin Resistance) significantly.

After the intervention, a significant decrease in the number of subjects with the metabolic syndrome was observed in both the DIO group and the DEX group (both P < 0.05; Table 2).

In fact, the Glucose level and Insulin Resistance was more improved in the diet only (DIO) group than in the diet plus exercise (DEX) group.

So you might want to consider the advantages of Diet Only although it looks as if Diet plus Exercise won’t hurt your numbers too badly.

 

Vinegar – Hype or Real?

Real. Vinegar helps with Blood Sugar levels (Vinegar Improves Insulin Sensitivity to a High-Carbohydrate Meal in Subjects With Insulin Resistance or Type 2 Diabetes).

These data indicate that vinegar can significantly improve postprandial insulin sensitivity in insulin-resistant subjects.

The type of Vinegar used was Apple Cider Vinegar. The upper curve is the control. The lower slide is on Apple Cider Vinegar.

Intermittent Fasting – A look at the evidence

This is a great look at the evidence in favor of Intermittent Fasting (Intermittent fasting: a dietary intervention for prevention of diabetes and cardiovascular disease?).

The conclusion is worth reading:

The use of intermittent fasting offers the potential to improve weight loss and enhance the cardiovascular health of overweight and obese individuals with type 2 diabetes and reduces cardiovascular risk. This type of intervention is cost-effective and associated with a low risk of adverse events.

 

One Week Off Insulin

I’ve been off Insulin for a full week now.

So why am I still alive? After all, I needed 100 units a day on the average just one month ago. But here I am. Still Alive!

So did I just decide to ignore my Blood Glucose levels and am I on the edge of dying? Hardly. I’m still checking multiple times a day – mostly now in disbelief at how well my blood sugar is being regulated by my body. My high today was 124 and my low so far today is 109. I never got numbers like that before day after day on Insulin.

For dinner last night I took the kids out to Five Guys Burgers and Fries. I skipped the fries. I ate a bunch of peanuts and more importantly had my burger “bunless”. The choice to replace the bun with lettuce was a good one since it took away about 40 grams of carbs and left about 1 gram. The fat ratio was good and the jalapenos, etc didn’t add much to the carb count but they did add to the flavor.

All of that made my Blood Sugar at 103 around bedtime.

Addendum : Still taking Metformin. Not out of the T2D woods yet.