Not Losing Weight But Losing Inches

What about people who say that they are not losing weight but they are losing inches? The comment is often something like this:

with the increased protein intake of the keto diet, our bodies produce more muscle mass instead of fat deposits like on a carbohydrate rich diet. Muscle weighs more than fat so that would explain fat disappearing but scale numbers not changing

Maybe… Or maybe not…

Muscle is more dense (lower volume) per pound than fat (article). But gaining muscle mass is very slow. Lyle McDonald say that a young untrained male who begins training can put on as much as two lbs of muscle mass in a month. A woman can put on around half that much. So the rate that people are actually putting on muscle mass is pretty small. And unless someone is exercising pretty hard they won’t put on nearly as much. And older people will put on muscle even slower.

So the if someone is stalled for a couple of days or even weeks it’s not likely that they have put on much muscle mass in that time period. Given months, maybe they have put on some.

But this point can be answered by measuring a person’s body fat percentage.

So, there could be some muscle replacement. Or there could be loss of lean body mass. How do you tell the difference? Take measurements with a tape measure and use a calculator to determine your muscle mass.

And your own body fat percentage goals can be set based on tools like “Visualize Body Fat Percentage“. Make your goal to achieve a body fat percentage not a goal weight. The goal weight can be determined from the goal body fat percentage, etc.

 

Blood Sugar Responses Compared

I asked a friend to be part of an experiment which involved him poking himself with a needle most of the morning. And he agreed. We are both fat adapted (me for 15 months and him for more than 6 months).

We both started fasted from the previous night (no breakfast for myself or my friend). We both ingested 50 g of Whey Protein (IsoPure Zero Carb Protein Powder) at the same time and measured our blood sugar responses over the course of the same morning.

I am a Type 2 Diabetic who has their Blood Sugar “under control” via diet and am no longer on meds. I am 57-years old and do some exercise (CrossFit) five times a week for the past two months.

My fried is a Tri-athlete in his mid-30’s. He’s not a Diabetic and runs frequently.

Here’s the two responses to the same amount of Whey Protein:

 

The results were very interesting.

  1. His fasted (starting) Blood Sugar number was higher than mine. We’ve compared numbers before and noted this same thing. We did not use the same meter since we were looking for relative differences not absolute values.
  2. After ingesting Protein, the Tri-athlete’s blood sugar went down. My blood sugar (the Type 2 Diabetic) went up.
  3. His Blood Sugar returned to normal much more quickly than mine (less than 2 hours. Mine took over three hours to return to normal.

I am not sure if his Blood Sugar went down due to him not having Insulin Resistance. If his Insulin went up in response to the Protein it could have driven his Blood Sugar down. Since I still have some degree of Insulin Resistance my Blood Sugar doesn’t go down nearly as well.

Support for this idea comes from (“Liver Metabolism“):

Overall, gluconeogenesis is stimulated by glucagon and
epinephrine and inhibited by insulin, as observed most
dramatically in insulin-dependent diabetes mellitus, in
which uninhibited gluconeogenesis contributes significantly
to the hyperglycemia.

Insulin favors oxidative decarboxylation of pyruvate and, therefore, also indirectly tends to diminish gluconeogenesis.

Interesting!

 

High Protein Diets are Good for Type 2 Diabetics

High Protein Diets are good at reducing NAFLD (Non-Alcoholic Fatty Liver Disease). From the study (February 2017, Volume 152, Issue 3, Pages 571–585.e8. Isocaloric Diets High in Animal or Plant Protein Reduce Liver Fat and Inflammation in Individuals With Type 2 Diabetes. Mariya Markova, Etc.):

In a prospective study of patients with type 2 diabetes, we found diets high in protein (either animal or plant) significantly reduced liver fat independently of body weight, and reduced markers of insulin resistance and hepatic necroinflammation. The diets appear to mediate these changes via lipolytic and lipogenic pathways in adipose tissue. Negative effects of BCAA or methionine were not detectable. FGF21 level appears to be a marker of metabolic improvement.

And from the conclusions section:

Postprandial levels of BCAAs and methionine were significantly higher in subjects on the AP vs the PP diet. The AP and PP diets each reduced liver fat by 36%−48% within 6 weeks (for AP diet P = .0002; for PP diet P = .001). These reductions were unrelated to change in body weight, but correlated with down-regulation of lipolysis and lipogenic indices. Serum level of FGF21 decreased by 50% in each group (for AP diet P < .0002; for PP diet P < .0002); decrease in FGF21 correlated with loss of hepatic fat. In gene expression analyses of adipose tissue, expression of the FGF21 receptor cofactor β-klotho was associated with reduced expression of genes encoding lipolytic and lipogenic proteins. In patients on each diet, levels of hepatic enzymes and markers of inflammation decreased, insulin sensitivity increased, and serum level of keratin 18 decreased.

 

Are you Insulin Resistant?

The original mission of this BLOG was to find a cure or at least a way of dealing with my own Insulin Resistance. A typical Type 2 Diabetic has Insulin Resistance.  I knew that was what it was called but what is Insulin Resistance and how can someone tell if they have Insulin Resistance?

This paper lays out one way to determine if you have Insulin Resistance (Ann Intern Med. 2003 Nov 18;139(10):802-9. Use of metabolic markers to identify overweight individuals who are insulin resistant. McLaughlin T1, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G.) using the numbers that you typically get when you get your blood work done.

Plasma triglyceride concentration, ratio of triglyceride to high-density lipoprotein cholesterol concentrations, and insulin concentration were the most useful metabolic markers in identifying insulin-resistant individuals. The optimal cut-points were 1.47 mmol/L (130 mg/dL) for triglyceride, 1.8 in SI units (3.0 in traditional units) for the triglyceride-high-density lipoprotein cholesterol ratio, and 109 pmol/L for insulin. Respective sensitivity and specificity for these cut-points were 67%, 64%, and 57% and 71%, 68%, and 85%. Their ability to identify insulin-resistant individuals was similar to the ability of the criteria proposed by the Adult Treatment Panel III to diagnose the metabolic syndrome (sensitivity, 52%, and specificity, 85%).

To summarize (in US units):

  • Triglycerides > 130 mg/dL
  • Triglyceride to HDL ratio > 3.0 (using US units)
  • Insulin > 109 pmol/L

I haven’t ever had my Insulin measured so I don’t know what that number would be but I did have the other numbers done in 2015 and here are my numbers:

  • Triglycerides = 460 mg/dL
  • HDL Cholesterol = 36
  • Ratio = 12.7

Those numbers are well over the numbers that trigger the diagnosis of Insulin Resistance (aka Metabolic Syndrome). Check your own numbers to see where you are.

 

Protein and the Elderly

Here’s a good study/article on Protein and the Elderly (Adv Nutr. 2014 Sep; 5(5): 599S–607S. Published online 2014 Sep 1. doi: 10.3945/an.113.005405
PMCID: PMC4188243. Keeping Older Muscle “Young” through Dietary Protein and Physical Activity. Daniel R. Moore*). One of the points

…35 g (∼0.45 g/kg) of whey protein stimulates mixed muscle protein synthesis in older adults, whereas 10 and 20 g (∼0.13 and ∼0.28 g/kg, respectively) do not.

And:

Individuals who more frequently elicit a maximal stimulation of muscle protein synthesis throughout a daily meal feeding cycle would be more likely to maintain muscle mass and possibly function. This could explain in part the greater retention of lean body mass in older adults who consume more than the current RDA for protein [i.e., ≥1.2 g/(kg ⋅ d)] relative to those who habitually consume a suboptimal amount [i.e., <0.8 g/(kg ⋅ d)]

 

 

Another Protein Experiment

I did a previous Protein Experiment where I compared the response of my Blood Sugar to 50 grams of Whey Protein vs 50 grams of Casein Protein. Since both of those were “pure” Protein with very little fat, I was curious how those results would compare to animal protein which had fat.

For this experiment I chose Chicken Drumsticks. I weighed them amount of mean (total minus bones left at the end) and the nutritional information shows them to have been close to 50g of Protein:

Here is the Blood Glucose numbers (smoothed) over several hours added to the data from the original Whey/Casein test.  The chicken drumsticks are in yellow.

Accounting for Differences

  1. The drumsticks (in yellow) are lower overall because I have been on the PSMF longer and my blood sugar levels have dropped. This is evidence, at least to me, that the PSMF is doing good things for my metabolic health.
  2. There was a dip at the start of the chicken wing experiment which was due to exercise. In this case it was a particularly grueling Saturday morning routine with a lot of lifting and burpees, etc.  That explains the drop from 72 down to 64 at the start.
  3. The highest number was very comparable to the Whey and Casein numbers in terms of rise from the minimum. The max rise in Blood Sugar in all of these cases was no more than 20 units.
  4. The slope down with the animal Protein is longer and slower. That may explain less feelings of hunger as the consumption of the Protein ends.
  5. The curve is longer than either of the “pure” Proteins. The fat may extend that longer than the pure proteins. I’d like to repeat the experiment with low fat chicken breasts and see if it’s the fat or if it is the animal Protein vs Milk Protein of the Whey/Casein choices that makes a difference.

Conclusions

50 grams of Protein is a decent serving size. It is more than enough to stimulate Protein Muscle Synthesis.

All in all, I see nothing to worry about with eating Protein even for Type 2 Diabetics like myself. With all of the “Protein turns into candy bars” fear mongering out there, some sanity needs to be applied to the subject.

Disclaimer

Of course, I would encourage any diabetic to test to see where they are with this same test. At least this way they know what effect Protein would have on their body. If they are a Type 1 Diabetic this information could be helpful to determine what amount of Insulin they should add for Protein.

 

Explanations for Blood Sugar Rise with Protein Consumption

 

Here’s my questions/comments for the KetoGains thread on this subject.

I’ve been trying for a while to wrap my head around this subject. Here’s what I think at the moment. Would welcome any feedback on where I am missing it.

1 – My blood sugar meter shows that my blood sugar goes up 25 points with Protein (50g of whey) for a couple of hours. Not a bad increase since it’s only from 85 to 110 (US units). I have documented this at: http://land-boards.com/T2D/2017/09/26/blood-sugar-response-to-proteins/ .

2 – My blood sugar drops fairly rapidly at the end of the two hours (makes me hungry) which decreases when the blood sugar levels out. As long as I keep that in mind and keep food out of reach in that time frame I am OK. Otherwise, it seems like my body is telling me that it wants is ready to eat more Protein (or just food).
3 – Blood sugar production proceeds at a constant rate which isn’t all that much affected by Protein consumption. I’ve seen enough studies to believe that is probably the case such as //diabetes.diabetesjournals.org/content/62/5/1435. Also, the demand vs supply GNG argument seems strong. This rules out the idea of GNG being increased by the Protein.
4 – In a non-diabetic blood sugar doesn’t rise as much with ingested Protein as it does in a T2 Diabetic. It may not raise at all. I plan on an experiment with a “healthy” friend to confirm this for myself although the studies say it is “minimal”. But is that difference due to broken Insulin Resistance in the T2 Diabetic? As the Insulin goes up to deal with the Protein does that increase the Insulin Resistance of the cells at the same time and block the glucose from being consumed?
5 – The failure for a T2 Diabetic seems to be able to reduce the production of glucose in response to consumption of Protein (or one of the downstream aspects of the consumption). The Glucose (argued above) is getting “backed up” in the process and not being disposed by Insulin since the Insulin is “busy” dealing with the Amino Acids (all in all a very good use of Insulin).

So although arguably Protein doesn’t turn into glucose directly since Protein does lead to a rise in Blood Sugar (in T2 Diabetics) then what difference does it make if it is increased levels of GNG or an inability to reduce the rate of GNG or due to Insulin Resistance? Either way, the result is the same, Blood Sugar goes up (for T2 Diabetics) with protein consumption.

So then the question for me is whether or not Blood Sugar going up by a relatively small amount in a keto dieter who is eating lots of Protein actually a problem? Normally, us diabetics are trained to do things to minimize their blood sugars. This notion is leading a lot of people to eat a lot of fat and less Protein than they probably should.

Put another way, does the advantage of eating more Protein (maintain or growing Lean Body Mass among others) outweigh the disadvantage (marginally higher blood sugars for short periods of time)?

Survey of the Scientific Literature

From an 20 year old article (Diabetes Educ. 1997 Nov-Dec;23(6):643-6, 648, 650-1. Protein: metabolism and effect on blood glucose levels. Franz MJ):

Insulin is required for carbohydrate, fat, and protein to be metabolized. … Protein has a minimal effect on blood glucose levels with adequate insulin. However, with insulin deficiency, gluconeogenesis proceeds rapidly and contributes to an elevated blood glucose level. With adequate insulin, the blood glucose response in persons with diabetes would be expected to be similar to the blood glucose response in persons without diabetes. The reason why protein does not increase blood glucose levels (sic: in a non-diabetic) is unclear. Several possibilities might explain the response: a slow conversion of protein to glucose, less protein being converted to glucose and released than previously thought, glucose from protein being incorporated into hepatic glycogen stores but not increasing the rate of hepatic glucose release, or because the process of gluconeogenesis from protein occurs over a period of hours and glucose can be disposed of if presented for utilization slowly and evenly over a long time period.

Questions raised by this article:

  1. They don’t define “minimum effect” so is a 20 point rise considered to be a “minimum effect”?
  2. Another study indicates that GNG is much more efficient in a Diabetic. Is that because of an Insulin deficiency (the way it is worded above)? Or is that due more to Insulin Resistance?

Here’s a curve from one paper which shows the body’s Insulin response to Protein vs Carbohydrates which shows that the body has a similar response to Protein as it does to Carbohydrates when it comes to Insulin Levels:

This seems to be a reasonable study (Claire Fromentin1,2, Daniel Tomé1,2, Françoise Nau3, Laurent Flet4, Catherine Luengo1,2, Dalila Azzout-Marniche1,2, Pascal Sanders5, Gilles Fromentin1,2 and Claire Gaudichon1,2. Dietary Proteins Contribute Little to Glucose Production, Even Under Optimal Gluconeogenic Conditions in Healthy Humans. Diabetes 2013 May; 62(5): 1435-1442.) which concludes:

We showed that after a normal intake of protein (20–25 g), the contribution of dietary protein to glucose production was small and did not exceed 10% of the total flux during the 8-h postprandial period, contributing the production of 4 g glucose to 50 g of total glucose production.

While that is true in healthy humans (the subject of this study), is it also true of Diabetic persons?

From one of the comments in this thread

Higher protein intake, which needs insulin response to get it where it needs to be, will increase physiological insulin resistance (adaptive glucose sparing) in order to get the protein into where it needs to go without pushing more glucose into the cells. this will result in seeing a higher fasting blood glucose, and lower circulating ketones, as they replace glucose as a fuel for the tissues that previously used more of it.

Here’s the pieces of the puzzle.

  • Body produces a relatively constant level of blood sugar
  • Non diabetics have little to no rise in Blood Sugar when they eat Protein
  • In a diabetic the down regulation of blood sugar in the presence of Insulin is faulty
    1. Eat Protein
    2. Body begins digesting Protein
    3. Pancreas increases Insulin production to push protein into muscle cells
    4. As Insulin goes up so does Insulin Resistance of the muscle cells to Glucose (difference between a diabetic and a non-diabetic)
    5. Because Glucose is not being disposed by the muscle cells as well, the level of Blood Sugar rises temporarily
    6. After the Protein is processed by the body the Blood Glucose drops

So the theory here is that while the blood sugar rises over the short term it is not being pushed into the cells.

 

Ideal Body Fat Percentage

The article (Ideal Body Fat Percentage Chart: How Lean Should You Be?) lists two different idea body fat percentage charts:

And:

Note the references to Jackson, A., & Pollock, M. (1978). Generalized equations for predicting body density of menBritish Journal of Nutrition, 40(3), 497-504. doi:10.1079/BJN19780152 (Full Text).

By age (second chart) my ideal body fat percentage is  20.9%. At a LBM of 144.4 lbs, that’s:

144.4 / (1 – .209) = 182 lbs or about 10 lbs to go to that goal.