This may seem like a silly question, but what exactly is generalised inflammation? I know inflammation is associated with conditions such as arthritis and such, but what exactly do you mean by inflammation in regards to diabetes? Could you write or have you written an intro on the specific phenomenon of inflammation?
In your view, can eating a low-carb diet result in a level of blood sugar that would spur the secretion of cortisol, thus leading not only to an increased blood glucose level but also a higher-than-usual heart rate and hypertension?
My blood sugars are MUCH better since switching from a VLC to a moderate carb diet. Now, I did start natural thyroid around about the same time, so maybe that is a confounding variable. However, I always felt hungry and craving on VLC no matter how much meat I ate. So, I am thinking that in certain people, ketosis does not reduce appetite (I found it did the opposite for me) and hence the person eats way too much protein and blood sugar rises. Not good.
My current diet of meat, vegetables, fruit, gluten free bread, potatoes and dark chocolate keeps me satiated and my blood sugar is normally in the 95-105 range two hours after eating. I want to get it even lower and your website (along with optimising my potassium levels) is helping me with that. I do feel inflammation is a huge factor for me, so I eagerly await your posts on HOW to reduce inflammation, since I already have the common bases of a gluten free diet and careful carb intake covered.
Finally, can you tell me why my post meal sugars have really improved, but my fasting blood sugar is still in the 90′s? Is the fasting figure the last to improve?
I figured out last winter that I’m something of a cortisol junkie and will invent stress where little or none exists, just to feel “normal”. Your post above about cortisol and blood sugar made my relationship to food make a lot more sense. I’m looking forward to hearing more on the subject.
I don’t check my blood sugar (so far), but I have noticed that like Lynn, I do better on a moderate carb diet compared to a VLC. And for me, the best news about that is that I managed to just accept it as being the best fit for my body (n=1), and not stress over “failing” at VLC. For a cortisol junkie, that’s progress!
Thanks so much for your very helpful posts.
Wow, that explains my skinny grandma who lost her eyesight and legs to T2DM. Thanks Chris!
When I strarted my scientific journey with T2DM more than four years ago I had one idea where I started: “hepatic insulin resistance is a cause for type 2 diabetes.” Fat content of the liver goes hand in hand with the severity of the disease so fat in the liver is related to the problems.
When I looked what causes BG to rise in T2DM I found out that adipose tissue derived lactate might explain atleast part of that. Increased lactate from AT was a result metabolic malfunction of the adipocytes (low mitochondrial oxidation & increased flux of glucose to lactate) which is related to activation of the Randle cycle. Randle cycle activation is caused by increased lipolysis from triglyserides. Then we come back to the question how is lipolysis regulated?
Some studies says that inflammation in the AT will lead to the decreased adipogenesis and perhaps increased FFA avaibility in the visceral deposit:
High sucrose diet or ethanol use will lead to the development fatty liver and T2DM but I’m not sure that it is in causal relation to increased de novo lipogenesis in the liver by fructose or ethanol because happenings in the AT has such a big effect on the liver metabolism. Importance of this is seen studies with PPARg agonists which reverse metabolic dysfunction.
Great article, Chris, thanks.
Stress is really a huge factor today. Nothing in balance, everything in chaos. That´s for sure not healthy. As others before mentioned I also ate tons of fat+protein on keto/VLC and gained sometimes weight, had elevated cortisol levels and low fT3. Now I slowly reintroduced some carbs, first carrots than potatoes. I estimated to regain some weight but it´s still stable. BG is fine with 90 after eating a huge meal of carbs (+fat). Finding is, it´s important to take some things easy. Long ago fat was my biggest enemy now I make peace again with carbs. Everything´s in balance. It´s just food.
Just wanted to say thanks for writing an article that actually mentions us who develop Type 1 as adults – even while lean – it seems we don’t exist in the medical world! I should have the GAD’s tested to confirm – but only needing about 6 units of insulin a day seems to indicate I don’t have much of an insulin sensitivity issue. I also fare much better on a more moderate carb intake than a VLC intake.
Thoroughly enjoying this series, as well as the rest of your blog.
One question I have regarding this series and your writing in general is that dietary carbohydrate intake and glycemic index/load hardly figure in at all. My understanding for a while has been that diabetes and metabolic syndrome in general are at least partially caused by overconsumption of carbohydrates and high GI foods. At the very least, they trigger your body to put on fat, which generally isn’t healthy.
But lately I’ve been reading writing from you and others (like Stephan Guyenet) that high GI carb consumption isn’t really a problem. How can that be? Isn’t it pretty much fact that those things make many people fat, and that many people have lost weight as a result of going on low-carb diets? What am I missing?
Thanks so much for all the work you do, please keep it up.
I am sure Chris will chime in when he gets time but…
Why or how is it pretty much fact?
The idea that diabetes/metabolic syndrome is caused by carbohydrate intake and high GI foods is a gross oversimplification- especially when one does not take into account whether whatever carbohydrate is ingested in processed/refined or not.
Foods are also generally not even in a vacuum like they were for the GI testing – by adding fats and proteins to your meals like you normally would – you get an ENTIRELY different GI response as compared to the GI itself.
…I would say it would be more accurate to say diabetes and metabolic syndrome are more likely caused by a storm of factors that include:
- overconsumption of calories in general combined with lack of movement (note this doesn’t mean exercise or working out; there is a difference between sitting in front of a TV/computer/desk for 10-12 hours/day and simply getting off your butt and MOVING every now and then)
- consumption of processed and franken-foods
- omega 3/6 imbalance
- insulin resistance resulting from an ever disappearing full nights sleep that gets shorter and shorter each decade. It only takes one night of insufficient sleep to induce a 25% increase in insulin resistance. Multiply that effect on a daily basis for an entire career.
- known/unknown enviromental factors – this week a national study was released that linked air pollution and diabetes. I live in Pittsburgh, and the southwest area of PA has a disproportionately large population of folks with diabetes/diabetes complications/metabolic syndrome. We also were the world’s largest steel producer for decades – the smoke stacks are still visible. One wonders how much that has detrimentally effected the local population’s health over the past century – as from talking to friends we also have higher rates of Down’s.
..which as Chris alluded to all induce imflammation – something at that root of just about everything that may ail the human body.
These are just my perspectives as a fitness professional/former competitive athlete diagnosed with diabetes around age 30 – though not type II - who once went through the low-carb honeymoon dropping 30 pounds and 5-6% bodyfat until my health starting turning for the worse - who now enjoys 3-5 pounds of potatoes, rice and other evil foods on a weekly basis and now has much better blood sugar control, mood, and a return of my strength.
No worries Chris, I am in agreement with you. The ROOT is imflammation – I am simply making a non-exhaustive list of the most likely suspects inducing the imflammation.
I should have been more clear about the weight I lost as well. Because of my background – I wasn’t ‘obese’ to begin with, even though I did lose 30 pounds. I went from a bodyweight of 235 @ 16-17% bodyfat (still in the healthy range), to a weight of 205 pounds and bodyfat percentage of 11-12%. So while losing 30 pounds sounds wonderful, it should also be noted almost half of that was LEAN tissue.
My eating habits were not the best - but they were essentially masked by my training. Leaving me to wonder how much local enivromental factors and/or various protein supplements played a role in developing Type I at my age. One silver lining being my wallet is a lot fatter now having realized that all the protein supplements and what not are largely un-necessary; if not completely un-necessary for the majority.
Chris and Russ,
Thanks so much for addressing these questions, I learn almost as much from these comments as I do from the posts.
So one question I have is this — you say that the difference is between refined vs. not refined, but wouldn’t that mean that “whole grains” are a-ok then? I obviously ask that because I’ve read here and elsewhere to the contrary — that all wheat/grains, regardless of refining, are bad.
And besides the diabetes issue, what about general weight/obesity? Management of diet based on GI/GL/Carbs has been a hugely successful strategy for people to lose weight. How does that stack up with your position? Are you recommending that people stop modifying their diets this way, even though it’s been very successful for so many?
Finally, a burning question I’ve had regarding advice against grains/wheat/refined flour:
Cultures throughout the world, especially Europe, have been eating these things for centuries (bread, pasta, etc.). Diabetes/metabolic syndrome/cardiovascular disease are largely modern, 20th century diseases (certainly in terms of prevalence). Why didn’t these problems develop much earlier? Why didn’t we see these rates of disease before now?
I am a thin type 2 diabetic. I am what is called a Ketosis Prone Type 2 diabetic. I don’t particularly disagree with what you are saying. It is more a point of emphasis. KPD’s can be a mix of BMI’s so weight isn’t that grand of an issue. In fact, heavier KPD’s tend to have lower A1c’s then thin ones. KPD’s also tend to be people of color. This is largely due to the fact that darker skinned people tend to live where Malaria is endemic. What we seem to have is a genetic adaptation that gives us some resistance to malaria. Think about it, this adaptation has been around for thousands of years but our susceptibility of going DKA really only becomes an issue in the last fifty.
As I see it, this is an issue purely of diet. What we are eating is at some level poisonous. What those things are, it seems to me are myriad. Rather than pass out more advice on diet, I have rather opted to suggest to people that the one thing they can do is test their blood sugars and see how they are effected by what they eat. This simple bit of advice would have saved me and a lot of KPD’s much suffering.
At 18 went to my GP with indigestion. Every night my sleep was disrupted and I was guzzling antacids. I was checked for ulcers and later Celiacs Disease and the verdicts were both negative.
I lived with this for 35 years and was diagnosed as diabetic when having a standard blood test due to my age.
I have been managing my blood sugar quite well for 5 years now simply with diet. I test my blood sugar level 2 hours after meals and adjust my next meal accordingly.
Now the interesting bit…
During this period I have experimented with various foods and have discovered that my indigestion problem completely disappears when I cut out wheat products. In addition my blood sugar is much easier to control and I can even eat ice-cream and have sugar in my tea and still maintain an HbA1c of 7.
Sounds like you have an issue with gluten. Have you ever tried a 100% gluten free diet?
Also, an A1C equates to an average BS of 170 according to this site: http://www.medicinenet.com/hemoglobin_a1c_test/article.htm
Thanks, I’ll take a look.
A1c of 7 is high ?
My doctor has told me that 7 is the best of all his type 2 patients.
Is he talking rubbish ?
Thanks for that. I’ll see what I can do to reduce further…
Just 1 thing. On my last test it was 6.6. The document from the laboratory also provided it as (IFCC) which was 48.6.
In that document they state that the normal range is (48 – 59) which would put me at the low end, or have I misunderstood something ?
That is not an A1C range then. Double check to see what it was….
Maybe it was a functional range of 4.8 to 5.9? Though a functional range would be more likely to be up to 5.3 or 5.5.
IFCC (International Federation of Clinical Chemistry) is MMOL/MOL whereas the traditional HbA1c in the UK, is a percentage. I understand that from June 2011 the UK is switching to IFCC.
Comments feed for this article