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).

Why is Keto Better than Low Glycemic?

The Glycemic Index rates food based on their impact on blood glucose levels with white bread coming in at 100. In theory, a system like that sounds like a great deal for Diabetics who need to control their blood sugar levels. If you eat foods which produce smaller increases in your blood sugar you shouldn’t have the excursions into the highs that damage people. And that is true, but is it enough?

As often used, the Glycemic Index puts food into two categories – either good (Low GI),  or bad (High GI). This GI chart breaks it into three categories:

(From here)

In a sense, a Ketogenic diet is the ultimate form of a Low Glycemic index diet. Keto only has food that have very, very low Glycemic Index items. The diet eliminates all of the food on the chart including most Low GI foods. Of course the chart is way out of proportion with actual food usages. Jellybean candy has its own value listed. Some other items, like French Fries, occupy a huge portion of the American diet through fast food.

By way of comparison, Meat has a GI of 0, most nuts have a GI of 10 and vegetables which grow above ground have a GI of 20. You can’t beat that for Low GI.

But why not just eat the Low GI foods? Well, for diabetics they aren’t quite good enough. As the last study listed shows, they do help, but not nearly as well at getting people off T2D medications.

Keto Diet vs Low Glycemic Index Diet

Which is better for T2D subjects, a ketogenic diet or a low glycemic index diet? Both are touted to help diabetics. The last study (on the previous post) showed a modest improvement in HbA1C using the Glycemic Index (about .5).

A 24-week study was done just to answer that question (The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus).

The study subjects were:

Eighty-four community volunteers with obesity and type 2 diabetes

The subjects were randomized and given:

either a low-carbohydrate, ketogenic diet (<20 g of carbohydrate daily; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/day deficit from weight maintenance diet; LGID).

The goal of the study was to determine which group had the best HbA1C control. Once again, the Low Carb (Ketogenic) diet came out on top.

The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p < 0.01).

The Glycemic Index diet subjects had comparable results to the other study with an HbA1C drop of 0.5. More impressively around 50% more of the ketogenic dieters were able to reduce or eliminate diabetic medications.

 

Effects of Eating Protein

From (The Truth About Protein Absorption: How Often You Should Eat Protein to Build Muscle):

When you eat protein, your stomach uses its acid and enzymes to break it down into its building blocks, amino acids. These molecules are transported into the bloodstream by special cells that line the small intestine, and are then delivered to various parts of the body. Your small intestine only has so many transporter cells, which limits the amount of amino acids that can be infused into your blood every hour.

The article goes on to say that different proteins sources are absorbed at different rates.

According to one review, whey clocks in at 8 to 10 grams absorbed per hour, casein at ~6.1 g/hr, soy at ~3.9 g/hr, and cooked egg at ~2.9 g/hr.

Here’s a really interesting point that I didn’t know about:

For instance, the presence of protein in the stomach stimulates the production of a hormone that delays “gastric emptying” (the emptying of the food from the stomach). This slows down intestinal contractions and thus how quickly the food moves through the small intestine, where nutrients are absorbed. This is one of the ways your body “buys the time” it needs to absorb the protein you eat.

That seems to be the mechanism by which protein gets processed by the body. That’s how the area under the curve for protein is so long.

The article goes on to say that:

Carbohydrates and fats can move through your small intestine and be fully absorbed while the protein is still being worked on.

The page then quoted a study (Protein feeding pattern does not affect protein retention in young women) which indicated that it doesn’t matter if the protein is consumed all at one time (Intermittent Fasting style) or over the course of the entire day.

It was higher during the experimental period, but not significantly different in the women fed the spread or the pulse patterns [59 +/- 12 and 36 +/- 8 mg N/(kg fat-free mass. d) respectively]. No significant effects of the protein feeding pattern were detected on either whole-body protein turnover [5.5 +/- 0.2 vs. 6.1 +/- 0.3 g protein/(kg fat-free mass. d) for spread and pulse pattern, respectively] or whole-body protein synthesis and protein breakdown. Thus, in young women, these protein feeding patterns did not have significantly different effects on protein retention.

Interesting…

 

Daily Status – 2016-08-25

Took a blood sugar measurement before dinner last night and measured 80. Wow. Spent most of the day earlier around 100 (a few points above and below). My body is really expecting dinner and is pumping its own insulin in preparation. I may have to shake things up and try skipping dinner one day for a 40+ hour fast – just to confuse my body. If I do it, I will be careful to measure frequently to avoid going too low. LOL. Hard to imagine such a thing “naturally”.

Weight took a unexpected bounce up this morning. I had 5 pcs of bacon and 4 eggs for dinner last night with a lot of cheese. Cooked the eggs in all the bacon fat. My guess is the weight pop was due to the salt in the bacon and the rest of the meal. It’s the really cheap bacon from Sam’s Club. The cheapest out there. I need to upgrade my food sources but it’s tough living in the boonies. Maybe a trip to the big city is in order.

No beer again last night.

Blood sugar when I got out of bed was around 104. Incredible number for me since I’ve never seen numbers like that while I was on Insulin shots. Just measured in the middle of the day and it was 101. My seven day average is at 111. Down from 125 last week and down from 159 last month when I was on Insulin.

Disappointing news on the Blood Glucose meter front. I had switched to the Bayer Contour Next that came with my Insulin pump last year. I liked it since the numbers were higher on that meter than on my OneTouch Ultra meters (they measure close to each other). I also like that it looks like a USB stick and has a USB jack at the one end. Their charting software makes decent graphs.

Problem is my insurance company only allows OneTouch. There’s a USB cable for the OneTouch UltraMini that costs $29.99. If I’m hitting numbers in the 110s and lower I really don’t need to download my numbers. So I guess I am stuck with the OneTouch UltraLink and OneTouch UltraMini meters. Only reason I really need a cable is to make graphs to upload to this BLOG.

The dumb part is that although there is software for the OneTouch meters, the version I have only works in conjunction with the Insulin Pump. The meter sends the value to the pump and the pump can be uploaded to the software. No pump? No uploading.

Alcohol and LC-HF+IF

Lost my taste for alcohol and haven’t wanted one in a couple of days. Haven’t had one either. Wanted to want to have a beer last night and I know that the low calories I had eaten for dinner would leave me hungry so I tried to talk myself into going and getting a beer. Couldn’t do it.

Not sure if it is my desire to keep down carbs or just not enjoying the taste as much when I am on ketosis.

Surprised that it is noon and I am not feeling particularly hungry since my dinner was just a double paddy burger without a bun at Five Guys last night.

Starting to enjoy being in ketosis.

 

Ketosis and Insulin Levels

Noticed this morning that my body was out of ketosis. My detection method is the metallic taste in my mouth when I am in ketosis. Now, 2 hours later I am back in Ketosis. My pump delivers .5 U/hr between 4 AM and 12 PM. The rest of the time I am pumping .25 U/hr.

I am not adding any bolus today so that I can try to understand the effects. I took a Metformin 850 mg when I got up so part of the following effect may be from the Metformin. Numbers were up early on but I am watching the numbers over the day.

  • 7:20 – 130
  • 8:20 – 154
  • 9:20 – 130
  • 10:20 – 116
  • 11:20 – 118
  • 12:30 – 127 (physically active – working in the kitchen)
  • 1:20 – 118
  • 2:20 – 108
  • 3:20 – 111
  • 5:40 – 113

I have gotten pretty much the same response when I used Insulin so why use Insulin?

 

Today 2016-08-14

IF was complicated yesterday which means I broke my fasting window a bit. Knew I was going over to visit family/friends but didn’t want to risk high carb food choices (and there were some but some LC choices as well) so I made a Tex-Mex casserole to bring along. Ate at 5 and got home after 10:30 so I had two beers at the very end and past the end of my window. Blood glucose was 125 at bedtime and I didn’t bolus.

Woke up this morning to a bit of a Blood Glucose high of 141. Not too bad at all considering my total Insulin usage yesterday was 12.1 Units down from 100 units day average before IF+LC-HF.

Didn’t do a single extra bolus yesterday and set the pump to only give out 8 units a day now.

What is the typical Insulin dosage for a T1D? That could help answer the question of how well my own pancreas is now producing Insulin and how much more it is being asked to do not that I am not taking as much Insulin.

According to this site (Calculating Insulin Dose).

The general calculation for the body’s daily insulin requirement is:

 Total Daily Insulin Requirement (in units of insulin)
= Weight in Pounds ÷ 4

So for me, that would be about 70 units of Insulin needed per day. They estimate half being for basal and half being for bolus. That means they are expecting to pump 35 units a day for basal. If you are doing LC-HF the bolus component could be ignored. Yet, I am thriving on 8 units a day and not perfect LC-HF. This implies to me that there’s nothing wrong with my pancreas it’s the overtaxing I’ve done to it over the years that made it not be able to keep up with the demand.

Going to keep a close eye on my Blood Glucose today. I don’t see it likely that it will skyrocket up but this big change downward might be a problem because it’s asking a lot more from my pancreas than it has done in years. Or maybe my pancreas has always been working fine but even added with Insulin the cell resistance has been so profound that neither of them are working all that well.

Pumping Insulin with IF

I have been pumping (using short term insulin) but only doing a basal. My pump has a syringe in it that only holds 300 units of Insulin. My Insulin usage rates have dropped from an average of 100 units a day down to less than 20 a day now. Last time I filled the syringe 5 days ago I took into account the lower Insulin usage and only filled up the pump syringe with 200 units. Problem is now the pump still has 80+ units in it. The infusion sites are supposed to be changed every 3-4 (at the most) days.

Still tastes in my mouth like I am in ketosis but not as much as some mornings. Probably the late night beers.

Am I in fat burning (ketosis)?

Freeing up fat is the goal of any diet.

If your body has burned enough of the fat that you have eaten and it has freed up the easily accessed stores (the fridge in Dr Fung’s analogy) then it starts burning the fat from your cells.

This is called ketosis. From the WebMD site (What Is Ketosis?).

Ketosis is a normal metabolic process, something your body does to keep working. When it doesn’t have enough carbohydrates from food for your cells to burn for energy, it burns fat instead. As part of this process, it makes ketones.

The article continues.

For healthy people who don’t have diabetes and aren’t pregnant, ketosis usually kicks in after 3 or 4 days of eating less than 50 grams of carbohydrates per day. That’s about 3 slices of bread, a cup of low-fat fruit yogurt, or two small bananas. You can start ketosis by fasting, too.

There are ways to detect ketones. The most accurate measurement is a blood test. Another measurement is easier and cheaper, a ketone test strip. The ketone test strip is activated by your urine.

I got a box (with a bottle in it) of 50 Relion Ketone Test Strips at Walmart in the pharmacy for about $7. That’s less then 15 cents a test.

Here’s a good article on using the sticks to measure your state of ketosis (An Overview of Ketone Testing Products).

For me personally, there’s another way. Taste in my mouth. If I am in ketosis my mouth tastes metallic. This site includes that along with other symptoms (What is Ketosis?).

a metallic taste in mouth
strong smelling urine
random bursts of happiness (it’s weird, but it’s true!)
decreased appetite

If you are in doubt use the strips. I am in ketosis even after eating dinner (a LCHF dinner).

When the Strips stop working (Why You Need To Stop Worrying About The Color Of Your Ketostix).