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.


Greg Glassman’s Offensive Tweet

CrossFit’s Greg Glassman posted a Tweet which was taken as offensive by some diabetics. Here’s the Tweet:

The criticism came largely from people who were Type 1 Diabetics since this tweet implies that diabetes is a choice of whether or not to drink sugary drinks. And it is true that for Type 1 Diabetes it’s not a lifestyle choice that leads to the Type 1 Diabetes.

But it’s true for both Type 1 and Type 2 diabetics that sugar isn’t their friend.  This is a helpful graphic that makes the point. Which diabetic can take that much sugar without affecting their blood sugar? More importantly what value does that sugar bring to anyone’s life – diabetic or not.

At the risk of offending a Type 1 diabetic sugar is your enemy. Same for a Type 2 Diabetic. Yes, the type 1 diabetic can’t cure their diabetes by eating a low sugar diet. But your diabetes can be controlled much more easily with less sugar. You will take in less Insulin. Even Type 1 Diabetics can become Insulin Resistant.

And I have zero doubt as a former Type 2 Diabetic that the vast majority of Type 2 Diabetics have no business drinking any sugary drink. Yes, those drinks are killing you by raising your blood sugar.

Diabetes professionals know better, though. From (Diabetes Care 2004 Feb; 27(2): 538-546. Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort. Nicola M. McKeown, PHD, James B. Meigs, MD, MPH, Simin Liu, MD, SCD, Edward Saltzman, MD1, Peter W.F. Wilson, MD4 and Paul F. Jacques, SCD)

the prevalence of the metabolic syndrome was significantly higher among individuals in the highest relative to the lowest quintile category of glycemic index (1.41; 1.04–1.91).

And shame on the Diabetic community for not recognizing the role of sugar in both Type 1 and Type 2 diabetes.

Yes, Glassman is right. #SugarKills


Robb Wolf – Split from CrossFit

Eat meat and vegetables, nuts and seeds, some fruit, little starch, and no sugar

–Greg Glassman

I’ve been asked about the CrossFit split from Robb Wolf (Paleo Diet) and how/why CrossFit embraced the Zone Diet. After all they are vastly different approaches to eating. I have opined on the Zone Diet here.

Robb wrote about the split here.

Robb also was in a podcast where he talked about CrossFit:

Here’s another related video where Robb talks about Paleo and training.


Calories In Calories Out – Revisited Again

Here’s some thoughts I have on the Calories In/Calories Out (CICO) model.

The CICO perspective has value but I think where Fung’s contribution worked for me and others was the role of Insulin in weight gain and carbs being the driving force in Insulin Resistance. Combining Low Carb with Intermittent Fasting made for easy compliance. The reduction of Insulin levels over extended periods of time frees the body to release body fat. The release of body fat reduces the need for calories from the diet since part of the fuel that body needs comes from the body rather than meals.

I see Fung’s advice as focused on his patient population which as a kidney doctors is many older diabetic patients. He found that his patients were compliant with Intermittent Fasting and Low Carbohydrate diets. Probably much more so than the standard population because they were seeing a kidney doctor to begin with. Faced with the possibility of failing kidneys or eating OMAD/Low Carb the alternative seems pretty bad.

Also, there are differences in body composition between various diets. Some are more effective than others at shifting the lean mass/fat mass proportions. http://www.ergo-log.com/paleo-diet-makes-fat-cells-lazy.html

I think they do matter but not so much at the start of the diet. Eventually we have to pay attention to them when we stall with lazy keto. But I got from 285 to around 220 with being completely lazy keto. Never would have reached goal weight, though.

Put another way when we have 100 lbs of body fat that’s 3100 calories a day of fat we can easily pull from our fat stores. Easy to do a caloric “deficit” since we have plenty of surplus to draw from in our bodies.

I’ve been looking into the three compartment theory of diabetes and it seems to have legs to me. First our body’s fat cells fill up. Then our liver fills up with fat. Last our pancreas gets choked with fat which keeps us from making enough Insulin. When that happens our fat backs up into our blood in the form of very high triglycerides. When I was Dx with T2D my triglycerides were over 5000. In fact, they couldn’t get an assay on the number since it was too high. Putting someone on Insulin gets them over that by allowing the fat cells to get even fatter. I gained 50 lbs when the doctor put me on Insulin and my diet was not any different.

This has application in this situation since the fat cells stay locked closed due to high Insulin. There are studies which show CICO doesn’t exactly apply in these cases. Diabetics take more Insulin and eat less calories but still gain weight. There’s a strong relationship with Insulin and body fat.

Intermittent fasting and Low Carb break that relationship by lowering basal Insulin levels and allow the liver to begin dumping the fat. That only takes about a week. The pancreas gets less fatty within 2 weeks and the body’s fat cells drop thereafter.

To me the key is the role of Insulin and that’s Fung’s “contribution”. He’s not a researcher but applied what he learned in the clinical setting.

Bottom line is that if someone is Type 2 Diabetic they can get off meds very quickly by following Fung’s approach of Intermittent Fasting and Low Carb. They can learn to count calories/macros later on when they stall if they want to get lower in weight (and some of them may not care about their weight, they just want to be no longer diabetic).

The reason I think CICO matters later on is that our hormones, particularly Insulin, get in order and then the standard model applies.

There are studies which also show CICO is not matched by the data. For example: https://academic.oup.com/jcem/article/88/4/1617/2845298

The mechanism of the enhanced weight loss in the very low carbohydrate diet group relative to the low fat diet group is not clear. Based on dietary records, the reduction in daily caloric intake was similar in the two groups. For the greater weight loss in the very low carbohydrate group to be strictly a result of decreased caloric consumption, they would have had to consume approximately 300 fewer calories/d over the first 3 months relative to the low fat diet group.

I think Protein is the power multiplier between Low Carb and SAD. In part it has something to do with the Thermic Effect of Food with Protein using about 25% of the calories to process and fat and carbs being much less. So Calories in and Calories out need to take into account the source of the calories.

I’m eating about 2800 calories a day now on Carnivore diet with around 280g of Protein a day. Far in excess of my “Needs”. Some of that we just eliminate as Urea – again outside of the CICO model.

Or maybe the CICO model is just really, really complicated compared to what we see on the standard calculators?

My guess is that the standard calculations for BMR and TDEE are inherently based on the SAD macro ratios. They don’t correct for overconsumption of protein nor do they correct for underconsumption of carbohydrates. They don’t take into account hormonal factors either nor medications such as Insulin.

They are good first order approximations. Eat and track macros and by extension calories. Watch the scale. If you are gaining you need to cut back. If you are maintaining then things are set pretty close. If you want to lose you need to cut.

In my case my methodology is:
Less than 20 g of carbs
At least 1 gram of protein per lb of Lean Body Mass
Enough fat to fill the gap between the first 2 and what I want to lose.

Here’s the calculator I wrote to calculate macros.


Carbs After Workouts?

If you are exercising to improve your insulin sensitivity, then Carbs after workouts are bad. Here’s the science (Nutrients. 2018 Jan 25;10(2). pii: E123. PostExercise CarbohydrateEnergy Replacement Attenuates Insulin Sensitivity and Glucose Tolerance the Following Morning in Healthy Adults. Taylor HL, Wu CL, Chen YC, Wang PG, Gonzalez JT, Betts JA.)

In this study they put participants on a 90-minute treadmill at 70% of their VO2max. At the end they gave the participants either a placebo (no carbs) or maltodextrose that matched the caloric expenditure. Researchers then measured the glucose and insulin responses with an Oral Glucose Tolerance Test (OGTT) the following day and found that the participants who had the carbohydrates had reduced Insulin Sensitivity and increased blood glucose levels.

The practical conclusion of this is that to maximize Insulin Sensitivity it is best to both eat low carb and take no carbs after exercise. Decreased Insulin Sensitivity is one of the markers that lead to Diabetes and increasing Insulin Sensitivity is an important part of reversing Diabetes.

This study is the first to show that feeding carbohydrate to replace that utilized during exercise can reduce insulin sensitivity and glucose tolerance the next morning in healthy adults, when compared to a preservation of the exercise-induced carbohydrate deficit. Furthermore, carbohydrate replacement suppresses subsequent postprandial fat utilization. The mechanism through which exercise improves insulin sensitivity and glucose control is therefore (at least partly) dependent on carbohydrate
availability, and so the day-to-day metabolic health benefits of exercise might be best attained by maintaining a carbohydrate deficit overnight.

For those people who are not particularly concerned about their risk of getting Diabetes it’s worth noting that if they refill their Glycogen stores quickly with carbohydrates they are not burning fat. If they let the Glycogen stores be low then their body will burn fat.

Want to burn fat? Work out and don’t eat carbohydrates after working out.


Blood Test Results

I got them back. 2015-09-04 was from before (while I was a diabetic). 2017-07-28 was my 1 year keto anniversary. The new test is about 18 months.

Test Range 2015
WBC 3.4-10.8 11.0 7.7 6.6
Lymphs (Abs) 0.7-3.1 3.8 3.1 2.5
Glucose, Serum 65-99 152 159 103
BUN/Creatinine 9-20 17 31 20
Protein, Tot, Ser 6.0-8.5 6.4 6.6 5.9
A/G Ratio 1.2-2.2 2 2.3 2.5
Total Cholesterol 100-199 159 Did not
Triglycerides 0-149 460 Did not
HDL Cholesterol >39 36 Did not
12.78 2.31
VLDL 5-40 Invalid Did not
LDL Cholesterol 0-99 Invalid Did not
HbA1c 4.8-5.6 7.5 5.8 5.2
Vitamin D 30-100 14.9 Did not
Did not
Testosterone 264-916 Did not
Did not

Interpreting the Results

Looking at the results – overall very good results. Most important of all my goal of hacking my Type 2 Diabetes has been accomplished. My HbA1C number is not even in pre-diabetic range. It is right in the middle of the healthy range.

The Triglyceride number is went from a very unhealthy 460 a couple of years ago to a healthy 118 now. And I was on statins for lipid issues back then. Much healthier now and I am on no statins.

My Testosterone number would be a good number for a young man. Libido from Keto – check…

To see an increase in LDL is not an unusual situation on keto.  The very important ratio is triglycerides to HDL. My ratio went from 12.7 to 2.3 which is a very dramatic drop in risk of heart disease. See (The American Journal of Cardiology Volume 94, Issue 2, 15 July 2004, Pages 219-222. Accuracy of the triglyceride to high-density lipoprotein cholesterol ratio for prediction of the low-density lipoprotein phenotype B. Viktor Hanak MD, Julian Munoz MD MSPH, Joe Teague MD, Alfred Stanley Jr. MD. Vera Bittner MD MSPHc):

A triglyceride/HDL cholesterol ratio of 3.8 divided the distribution of LDL phenotypes with 79% (95% confidence interval [CI] 74 to 83) of phenotype B greater than and 81% (95% CI 77 to 85) of phenotype A less than the ratio of 3.8. The ratio was reliable for identifying LDL phenotype B in men and women.

Studies on the Ketogenic Diet and Blood Biomarkers

There’s a lot of studies which been done on the positive benefits of the Ketogenic Diet on Blood Markers.

More Protein Please

A great study shows an inverse association between Protein intake and body composition (Clin Med Insights Endocrinol Diabetes. 2010; 3: 25–35. Higher Dietary Protein Intake is Associated with Lower Body Fat in the Newfoundland Population. Kristian K. Green, Jennifer L. Shea, Sudesh Vasdev, Edward Randell, Wayne Gulliver, and Guang Sun).

Significant inverse relationships were observed between dietary protein intake (g/kg body weight/day) and weight, waist circumference, waist-to-hip ratio, BMI, %BF, and %TF (P < 0.001). Significant positive relationships were observed with %LM and %TLM (P < 0.001). Additionally, significant differences in weight (12.7 kg in men, 11.4 kg in women), BMI (4.1 BMI units in men, 4.2 units in women), and %BF (7.6% in men, 6.0% in women) were observed between low and high dietary protein consuming groups (P < 0.001). Dietary protein explained 11% of the total variation in %BF in the NL population.

This study provides strong evidence that higher protein intake, even in the absence of energy restriction, is associated with a more favorable body composition in the general population.

Eat more protein, get leaner.


Thoughts on the Zone Diet

The Zone Diet seeks to create a fixed mix of macros by specifying fat, carbs and protein levels. The starting point is:

The numbers are in percentage of calories. On a “standard” 2000 calorie diet that would be:

  • Carbs = 2000 * 0.40 = 800 calories (200 grams)
  • Protein = 2000 * 0.30 = 600 calories (150 grams)
  • Fat = 2000 * 0.30 = 600 calories (67 grams)

Zone vs Standard American Diet (SAD)

According to the CDC (Trends in Intake of Energy and Macronutrients in Adults From 1999-2000 Through 2007-2008):

In 2007-2008 the average energy intake for men was 2,504 kilocalories (kcals) and for women it was 1,771 kcals.

The average carbohydrate intake was 47.9% of total kilocalories (% kcals) for men and 50.5% kcals for women; average protein intake was 15.9% kcals for men and 15.5% kcals for women; average total fat intake was 33.6% kcals for men and 33.5% kcals for women; and average saturated fat intake was 11.0% kcals for men and 11.1% kcals for women.

That means the Zone Diet is lower in carbohydrates, much higher in protein, and a lower fat than the Standard American Diet (SAD).

Macro SAD (Men) SAD (Women) ZONE Difference
Carb 47.9 50.5 40 Zone Lower
Protein 15.9 15.5 30 Zone Much Higher
Fat 33.6 33.5 30 Zone Lower

The main lever of the Zone then appears to be Protein. Doubling someone’s Protein should do some very good things for their health. Added to that is the advantage of the lower number of total calories on the zone.

But would the Zone be a good thing for a Type 2 Diabetic? Certainly it would help some who are diagnosed as pre-diabetic. Anything they do to reduce their carbohydrate consumption will help their pre-diabetes.

Zone vs Ketogenic Diet

The Ketogenic diet has various protein goals depending on you who follow. For a 200 lb male typical numbers would be (using a higher level of protein in this example):

Macro grams kCal/macro Calories % Cals
Carb 20 4 80 4%
Protein 160 4 640 32%
Fat 142 9 1280 64%

Where the two diets differ are their fat and carbohydrate macros.

Macro ZONE Ketogenic
Carb 40% 4%
Protein 30% 32%
Fat 30% 64%

Carbohydrate Effects on a Type 2 Diabetic

Carbohydrates raise blood sugar and therefore Insulin levels much more dramatically in a Diabetic than in a non-Diabetic person. That’s what makes a person an Diabetic. Before I went on the Ketogenic diet I was averaging only 200 grams of carbohydrates per day. I know this since my Insulin pump required me to enter any carbohydrates I ate. And, in spite of being on an average of 100 units of Insulin a day, my blood sugars were all over the place.

My highs were over 200 and my lows never got to 100. Around the start of August I went on the Ketogenic diet. For me, that was going from 100 grams (on the average) of carbohydrates a day to less than 20 grams. I was also not tracking the other macros (fat, protein). Here are my blood sugar numbers from the first three months of the Ketogenic diet.

That chart is the very definition of stable blood sugars. It took being at 20 grams or less of carbs a day to get stable. And before the Ketogenic diet I was nowhere near the Zone Diet carbohydrate levels. I can only imagine how messed up my blood sugar numbers would have been if I had been on the “balanced” zone diet.


Christmas Status Letter


Holidays provide time to reflect on the past year. It’s long overdue to circle back to the purpose of this BLOG. I started this journey of hacking my Type 2 Diabetes almost 18 months ago. In that time, I fixed my Diabetes and so much more.

No More Insulin or Medications

I am on ZERO medications. No diabetes medications. No hypertension medications. I still use a CPAP machine since I am afraid of quitting the machine.

Weight Loss

I have lost over 100 lbs. My starting weight was around 285 and it was 178 this morning. I’ve been in maintenance for a month now and my weight has stayed steady. I wish I had charted better in the beginning.

Added Exercise

After I lost most of my weight (around 80 lbs) I added exercise. I have been doing CrossFit for about four months now. I can lift weights that match the girl’s weights. I usually finish the Workout of the Day (WOD) last but I do finish – even the hard ones. I workout five days a week. The typical CrossFit workout is less than one hour. I take rest days Thursday and Sunday.

Blood Sugar Control

My blood sugar after working out last night was 65 (US units) which is really good. I most often see numbers in the mid 80s. My last HbA1C was taken this summer (before CrossFit) and it was 5.8 (which is at the bottom end of the prediabetes range).

My Macros

My diet consists largely of chicken, nuts and broccoli.

Chicken is a good Protein and different cuts provide different amounts of fat. Kim Chee (from Walmart refrigerated veggie section) is a good probiotic (good for stomach biome). Broccoli is a good veggie and easy to heat in a microwave bag. Finally, nuts fill in the fat numbers in a healthy way.

My Macros

My daily macros are:

My current macros are 1800 calories with 125g of Protein, 20g of Carbohydrates and 136g of Fat. Protein is a minimum. Carbs are a maximum. Fat fills up the remaining calories to meet the limit. If I go over on Protein I will go under on Fat to match. In percentages of daily calories this is 27% Protein, 5% Carbohydrates, and 68% fat.


Here is what I take daily.

Breaking Stalls

I had a long stall this year which lasted for maybe six months. I did some extended fasts which helped a little bit. I then tripped across the idea of doing Protein Sparing Modified Fasting. That broke the fast and gave me a way to make progress with the last 25 lbs that I needed to lose.

My Goals

My goals have shifted over the past 18 months. They started with hacking my Diabetes. I wanted to get off Insulin. That took two weeks.

Since then I have worked at improving my Insulin Sensitivity. For me, the main tool was Intermittent Fasting (IF). One thing that interferes with this is getting in enough Protein. I have added a Protein meal at lunch time. This hasn’t hurt my Blood Sugar numbers.

Another way of improving Insulin Sensitivity is High Intensity Training. I do CrossFit. Training with increasingly heavier weights and intensity will improve Insulin Sensitivity. I hope to keep up this training and there are plenty of goals to reach. I got my first box jump and pullup in the past month.


Healing Diabetic Neuropathy

In diabetic neuropathy, one of the most common forms of peripheral neuropathy, nerve damage occurs in an ascending pattern. The first nerve fibers to malfunction are the ones that travel the furthest from the brain and the spinal cord. Pain and numbness often are felt symmetrically in both feet followed by a gradual progression up both legs. Later, the fingers, hands, and arms may become affected. (Peripheral Neuropathy Fact Sheet).

Is this a permanent condition?

It is a progressive condition which gets worse. The only solution is to reverse the underlying diabetes. That’s where Low Carb comes in. Once the underlying condition gets reversed the body begins to repair/regrow the nerves. Nerves can regrow around 1 mm/day. The growth starts at the spine and goes to the extremities. So neuropathy in the feet or hands can be reversed in around three years or so.