Low-ish Carb Diet and Diabetes

A five week long study was conducted to determine the effect of a non-ketogenic but still low-ish carb diet on blood sugar numbers in diabetes (Diabetes 2004 Sep; 53(9): 2375-2382. Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People With Type 2 Diabetes. Mary C. Gannon and Frank Q. Nuttall).

The study compared diets with two different macros. The carbohydrate:protein:fat ratio of the Low Carb diet was 55:15:30. The test diet ratio was 20:30:50. Again, note this was not ketogenic levels of carbohydrates. The diet was “weight-maintaining”.  Assuming this is a 2000 calories a day diet that would be 2000 * 0.2 = 400 calories or 100 grams of carbohydrates a day.

The subjects were tested and their Plasma and urinary β-hydroxybutyrate were similar on both diets indicating that the lower carb group was not in nutritional ketosis.

The results were favorable for the Low Carb group.

The percentage of glycohemoglobin (HbA1c) was 9.8 ± 0.5 on the control diet and 7.6 ± 0.3 on the Low Carb diet. It was still decreasing at the end of the Low Carb diet. Thus, the final calculated glycohemoglobin was estimated to be ∼6.3–5.4%.

The reason they estimated the final HbA1c numbers would be lower was that:

The mean 24-h integrated serum glucose at the end of the control and LoBAG diets was 198 and 126 mg/dl, respectively.

Carbohydrate Control is the Key to Blood Sugar Control

As the study noted:

Data obtained in our laboratory (1–3) as well as from others (reviewed in 4) indicate that glucose that is absorbed after the digestion of glucose-containing foods (carbohyrates) is largely responsible for the rise in the circulating glucose concentration after ingestion of mixed meals. Dietary proteins, fats, and absorbed fructose and galactose resulting from the digestion of sucrose and lactose, respectively, have little effect on blood glucose concentration.

The study did increase protein by 2x but a previous study had isolated the protein affects on HbA1c:

We previously reported that a diet in which the protein content was increased from 15 to 30% of total food energy, with a corresponding decrease in carbohydrate content, resulted in a moderate but highly statistically significant mean decrease in glycohemoglobin (8.1–7.3%) after 5 weeks on the diet. This was the consequence of smaller postmeal glucose increases. The fasting glucose concentration was unchanged (12).

Thus, the increase in Protein did help the HbA1C due to the decrease in carbohydrates that came along with that increase.

The conclusion was unavoidable given the data:

Thus, the dietary modification that we refer to as the LoBAG diet has the potential for normalizing or nearly normalizing the blood glucose in people with mild to moderately severe type 2 diabetes.

Not as well as the ketogenic diet, but pretty good nevertheless. I did low carb some time back and get my HbA1C to 6.4 (with other meds). But I like my 5.2 number better now.


Protein does not turn into chocolate cake

From (The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 3, 1 March 2001, Pages 1040–1047, Effect of Protein Ingestion on the Glucose Appearance Rate in People with Type 2 Diabetes. M. C. Gannon J. A. Nuttall G. Damberg V. Gupta F. Q. Nuttall.):

Amino acids derived from ingested protein are potential substrates for gluconeogenesis. However, several laboratories have reported that protein ingestion does not result in an increase in the circulating glucose concentration in people with or without type 2 diabetes. The reason for this has remained unclear. In people without diabetes it seems to be due to less glucose being produced and entering the circulation than the calculated theoretical amount. Therefore, we were interested in determining whether this also was the case in people with type 2 diabetes. Ten male subjects with untreated type 2 diabetes were given, in random sequence, 50 g protein in the form of very lean beef or only water at 0800 h and studied over the subsequent 8 h.

Protein ingestion resulted in an increase in circulating insulin, C-peptide, glucagon, α amino and urea nitrogen, and triglycerides; a decrease in nonesterified fatty acids; and a modest increase in respiratory quotient.

The total amount of protein deaminated and the amino groups incorporated into urea was calculated to be ∼20–23 g. The net amount of glucose estimated to be produced, based on the quantity of amino acids deaminated, was ∼11–13 g. However, the amount of glucose appearing in the circulation was only ∼2 g. The peripheral plasma glucose concentration decreased by ∼1 mM after ingestion of either protein or water, confirming that ingested protein does not result in a net increase in glucose concentration, and results in only a modest increase in the rate of glucose disappearance.


Is this Keto?

A very common question for those of us who eat a keto diet is “Is this [whatever] keto?”. Along with it comes comments like “you mean you can’t eat bread [or whatever]”.

It’s down to carbs

In the end, it’s as simple as the number of grams of carbohydrates. There are no hard and fast definitions of what constitutes Low Carb and what constitutes ketogenic. The technical answer is what amount of carbohydrates you can eat in a day/meal that keep you in ketosis.

But that begs the question of what constitutes being in ketosis. There’s also no accepted range of numbers or measurement methods. But the idea is that your body is using ketones for fuel. Even that is not an absolute since everyone uses some mixture of ketones and glucose. If you do an extended fast your body will generate glucose from your liver which converts fat to glucose in a process called Gluconeogenesis (GNG).

The easiest thing to measure and track are carbohydrates using a scale and an app like Cronometer which can show you the total number of carbs in your day.

Measuring Ketones

Ketones can be tested by three methods; blood, urine and breath. Each of these tests measure chemicals produced as a byproduct of ketosis. There’s some correlation between these three measurements but even that is not absolute.

Nutritional Ketosis Measures Blood Ketones

A widely accepted method is to use blood ketones and measure them against a standard. Except that there is no standard. Often cited is Stephen Phinney’s definition of “nutritional ketosis” illustrated below:

This says that blood ketones in the range of 0.5 to 3.0 mmol are optimal for brain and muscles.

Is this Food Keto?

Using this definition any food which you eat over a meal/day that drops your blood ketones below 0.5 mmol is not keto. But there’s no easy mapping of how many carbohydrates it takes to push someone to below that number. A commonly asserted amount is 20 grams of carbohydrates per day will take a person out of nutritional ketosis. For most people this number will be adequate. For others it may be too high and for others it may be too low.

The Only Way to Know is to Measure

The only way to know for sure is to measure the effect of a particular food or activity on your ketone levels. And testing isn’t cheap at around $5 a test strip. I’ve used the Precision Xtra meter for my measurements but I never actually mapped carb amounts to ketone levels. I mostly tracked the ketone levels vs days of fasting.

Cheaper Way to Measure

A cheaper way to measure is urine test strips. They are around $5 for 50 strips. You pee on a strip and compare the color of the strip to a scale. They work well for most people (at least at the beginning) but are affected by urine concentrations (which is a function of your level of hydration). They are also slow to react to diet changes. They can indicate what your level of ketosis was hours ago.

Another Expensive Way to Measure

I also bought a breath ketone measurement device, the ketonix. It is fairly expensive but can be reused.

The trouble is there’s a messy mapping from breath to blood ketones. Here’s the scatter diagram from breath to blood ketones with the best fit curce. Going up from 0.5 mMol to the line shows that that’s something like 2.0 PPM.

The ketonix has a USB interface and the data can be downloaded to your computer. Here’s a screen shot of one capture showing the level at 5.4 ppm which would be around 1 mMol.


In the end, the best way to be in ketosis is to eat a very limited amount of carbohydrates such as less than 20 grams a day.


Strength Gains on Meat Protein vs Ovo-lacto-Vegetarian Protein Sources

Study of vegetarian diets vs meat as protein source diets and muscle gain in older men (Effects of an omnivorous diet compared with a lactoovovegetarian diet on resistance-training-induced changes in body composition and skeletal muscle in older men).

Conclusions: Consumption of a meat-containing diet contributed to greater gains in fat-free mass and skeletal muscle mass with RT in older men than did an LOV diet.

More details:


Maximal strength of the upper- and lower-body muscle groups that were exercised during RT increased by 10-38% (P < 0.001), independent of diet. The RT-induced changes in whole-body composition and skeletal muscle size differed significantly between the mixed- and LOV-diet groups (time-by-group interactions, P < 0. 05). With RT, whole-body density, fat-free mass, and whole-body muscle mass increased in the mixed diet group but decreased in the LOV- diet group. Type II muscle fiber area of the vastus lateralis muscle increased with RT for all men combined (P < 0.01), and the increase tended to be greater in the mixed-diet group (16.2 +/- 4.4 %) than in the LOV diet group (7.3 +/- 5.1%). Type I fiber area was unchanged with RT in both diet groups.

Another study showed favorable results for meat (Effect of protein source and quantity on protein metabolism in elderly women).

With the high-vegetable-protein diet, protein breakdown in the absorptive state was not inhibited to the same extent as during the high-animal-protein diet, resulting in less net protein synthesis during the high-vegetable-protein diet than during the high-animal-protein diet.

Ketone Measurement in Pee Strips

Turns out there’s actual scientific evidence of urine ketone differences between individuals on a low carb diet. And the levels are not a measure of the body’s ability to make use of ketone bodies as some claim.

The evidence comes in the form of a unique scientific experiment done in 1930 on Vilhjalmur Stefansson. Stefansson was an arctic explorer who lived in the arctic for many years and had become accustomed to eating a diet consisting solely of meat (My Life with the Eskimo). The conventional wisdom of the day was that a low carbohydrate, meat-only diet was unhealthy.  A scientific experiment was created to reproduce his meat only diet under metabolic ward conditions. He consisted on the diet for over a year. This was early enough that the conditions of ketosis had not been extensively studied but recent enough that equipment to measure ketones and other blood contents were available.

The experiment is documented (Prolonged Meat Diets with a Study of Kidney Function and Ketosis). One of the many interesting points is the measurement of urine ketone levels. One of the participants had an increase in measured ketones (in urine) and the level stayed high. The other participant on the same diet had a drop in levels over time.

This validates the observation that some individuals on a ketogenic diet continue to have measurable urine ketone levels and others have much lower levels.

Nuts and Inflamation

It’s often said that nuts cause inflammation.

Here is on study (Am J Clin Nutr. 2016 Sep;104(3):722-8. doi: 10.3945/ajcn.116.134205. Epub 2016 Jul 27. Associations between nut consumption and inflammatory biomarkers. Yu Z1, Malik VS2, Keum N2, Hu FB3, Giovannucci EL3, Stampfer MJ3, Willett WC3, Fuchs CS4, Bao Y5.) concluded:

A greater intake of nuts was associated with lower amounts of a subset of inflammatory biomarkers, after adjusting for demographic, medical, dietary, and lifestyle variables. The relative concentrations (ratios) and 95% CIs comparing subjects with nut intake of ≥5 times/wk and those in the categories of never or almost never were as follows: CRP: 0.80 (0.69, 0.90), P-trend = 0.0003; and IL-6: 0.86 (0.77, 0.97), P-trend = 0.006. These associations remained significant after further adjustment for body mass index. No significant association was observed with TNFR2. Substituting 3 servings of nuts/wk for 3 servings of red meat, processed meat, eggs, or refined grains/wk was associated with significantly lower CRP (all P < 0.0001) and IL-6 (P ranges from 0.001 to 0.017).

Here’s another study on the subject of nuts (Medicine (Baltimore). 2016 Nov;95(44):e5165. Impact of different types of tree nut, peanut, and soy nut consumption on serum C-reactive protein (CRP): A systematic review and meta-analysis of randomized controlled clinical trials. Mazidi M1, Rezaie P, Ferns GA, Gao HK.) concluded:

This meta-analysis suggests that nut consumption significantly decrease leptin while have no significant effect on CRP, IL6, adiponectin, IL10, and TNF-α.


Hunter Gatherers and High Protein Diets

JOURNAL OF ANTHROPOLOGICAL ARCHAEOLOGY 2, 1-31 (1983) Energy Source, Protein Metabolism, and Hunter-Gatherer Subsistence Strategies (entire paper as PDF document) JOHN D.

During late winter and spring, hunter-gatherers in temperate, subarctic, and arctic environments often relied on diets that provided marginal or inadequate caloric intakes. During such periods, particularly when stored food supplies dwindled or were used up entirely, lean meat became the principal source of energy. Nutritional problems associated with high-protein, low-energy diets are discussed. These problems include elevated metabolic rates, with correspondingly higher caloric requirements, and deficiencies in essential fatty acids. The relative benefits of adding fat or carbohydrate to a diet of lean meat are evaluated in light of the protein-sparing capacities of these two nutrients. Experimental data indicate that although both enhance high-protein, low-energy diets, carbohydrate is a more effective supplement than fat. Given the nutritional inadequacies of a lean-meat diet, the paper concludes with a discussion of alternative subsistence strategies that increase the availability of carbohydrate or fat at the critical time of year.


PSMF – A Day’s Food/Supplements/Exercise/Biometrics

I’ve completed a day of logging everything with CRON-o-meter. Here’s the data entry part:

Bio-metrics were Weight, Body Fat percentage (from the scale), Body Temperature (used to determine if metabolism has dropped) and Blood Glucose.

Exercise was logged (CrossFit with warm-up and the resistance training portions).

Finally, the food I ate was carefully and completely logged. So how did I do compared to my goals? For overall calories I overshot by 2%. That’s great since I should never go under with PSMF.

The overall breakdown was also pretty good. I went under on my fat and over on my protein which balanced each other out. I did not exceed the carbohydrate number (net grams less than 20). That put me at a net deficit of 1131 calories. That would be about 2 lbs per week of loss.


Thermic Effect of Food and Metabolism of Food

Ever wonder how much energy your body burns while consuming food? There was an experiment to determine the Thermic Effect of Food (TEF) (GlICKMAK, N.; MlTOCHELL, H. H.; LAMBERT, E. H.; KEETON, R. W.; The total specific dynamic action of high-protein and high-carbohydrate diets on human subjects; Journal of Nutrition 1948 Vol.36 pp.41-57).

The conclusions were that:

…the calculated total S.D.A. (Specific Dynamic Action = Thermal Effect of Food) at 16 hr. post prandium represented 17.0 (for Protein) and 9.6 (for carbs) per cent, of these total energy values.

Any diet which runs a calorie deficit will have a reduction in the energy expenditure from TEF. Switching from carb consumption to protein consumption can offset some of this effect.

Protein keeps you warm at night.

BMR and Body Temperature

On a related note, Lyle McDonald says that Base Metabolic Rate (BMR) can be measured with a thermometer (detecting BMR slowdown via body temperature).

Normal morning body temp (=100% predicted BMR) = 96.8-97.2. For every degree below that, assume roughly a 10% reduction.

Seems like a really easy way to determine BMR drops.

This may be based on this study (R. Rising, A. Keys, E. Ravussin, C. Bogardus; Concomitant interindividual variation in body temperature and metabolic rate; American Journal of Physiology – Endocrinology and Metabolism Published 1 October 1992 Vol. 263 no. 4, E730-E734).

…oral temperature correlated with adjusted metabolic rate, and the interindividual differences in body temperature were maintained throughout semistarvation and refeeding. These results suggest that a low body temperature and a low metabolic rate might be two signs of an obesity-prone syndrome in humans.

Here’s a similar result (Effects of infection on energy status):

The regulation of normal body temperature within a narrow range is a complex phenomenon which is altered by the endogenous pyrogenic activity of interleukin-1 that is released by mononuclear leukocytes in response to infection. The resulting fever increases basal metabolic rate (BMR) by 13% for each 1 degree C (DUBOIS, 1937).


Cost of Protein

Attempting to gather the cost of various forms of Protein.

Store Product Unit
Martin’s Boneless
4 26 0.48 3
Walmart Chicken
4 26.64 0.53 19.3
Martin’s Large Eggs 1.99
12 6 0.66 5
GNC Whey
22 50 1.14 1
Walmart Ground
4 28 1.23 1
Walmart Turkey
4 26 1.30 0.5
GNC Casein
27 25 1.30 1.5
Martin’s Cod 5.49
4 23.71 1.45 4.07
Martin’s Ham 4.99
4 18.33 1.70 14.25
Martin’s Shrimp 8.99
5.3 18 2.34 1