OT - Thanks to Janknitz and DreamStalker (diabetes/diet)

[jnk...]

Thanks to posts by Janknitz, I now have glucose meters.

Thanks to posts and links by DreamStalker, I am now a Dr. Jason Fung fan. I fasted earlier this week and then began a ketogenic approach.

[Janknitz]

How are you feeling and how are your numbers?

[jnk...]

It has been less than a week, but so far I feel great!

My dawn-phenomenon numbers are between 100 and 110, and my numbers during the day are between 80 and 100. But I have only been diagnosed diabetic for about nine months, and I am on 500 mg of metformin er (which I have just decided to take at bedtime, instead of earlier in the evening, in order to work on that dawn effect). My A1c hovers around 6.7.

My doc and diabetes nurse and dietician give me a reasonable amount of leeway in cooperation with my choices in dietary and medical approaches.

Any thoughts or ideas?

[DreamStalker]

Have some potassium citrate and magnesium/calcium blend supplments (preferably orates but citrates will work) available. If you begin having muscle twitch ... they lead up to muscle cramps ... take the K, Mg, and Ca. Drink plenty of water. Have some sea salt by your bed and eat a pinch just before you get out of bed in am. First 2 to 4 days are hardest ... by day 4 or 5 it's easy peasy and you're set to go for a couple of months .... or less (though known world record fast by human is 385 days).

The benefits of ketosis are numerous and still being discovered. We as a species are evolved to be in a state of ketosis more often than being out of it just like the vast portion of vertebrates on the planet ... it's an old paradigm in the animal kingdom ketosis is. So easy a caveman can do it ... just like your typical grass fed cow is normally in ketosis.

Have fun ... Y'all !

[DreamStalker]

Also ... do not fear the low glucose values. I've dipped into mid 50's and can easily maintain low to mid 60's for over several days without I'll effects. Your sustained blood ketone target should be between about 1 and 3 for standard benefits and between 3 and 5 or 6'ish for neurological and/or cancer fighting benefits.

When breaking fast, start with low amounts raw colorful veggies to feed gut flora and re-establish gut enzyme levels before adding back proteins. Following up with cyclic ketogenic diet and 4 to 11 day fasts every other month is a good strategy for optimal health.

I'll post about caprilic oil and ketone salts when my internet connection is back up after tomorrow ... I'm too old for these tiny phone screens.

[Janknitz]

It has been less than a week, but so far I feel great!

My dawn-phenomenon numbers are between 100 and 110, and my numbers during the day are between 80 and 100. But I have only been diagnosed diabetic for about nine months, and I am on 500 mg of metformin er (which I have just decided to take at bedtime, instead of earlier in the evening, in order to work on that dawn effect). My A1c hovers around 6.7.

My doc and diabetes nurse and dietician give me a reasonable amount of leeway in cooperation with my choices in dietary and medical approaches.

Any thoughts or ideas?

Great start! Once you get through "induction flu" it just builds from there. How are your macros? I'm pretty conservative about fine tuning just yet. Just work on getting your macros in line and you are right on target with daytime BG's. Your morning levels are not bad at all.

Metformin won't do much at that dose, but you may not really need it considering how well you are doing. Too early to tell. Don't skimp on salt and stay well hydrated.

[jnk...]

I seem to be especially responsive to the metformin for some reason, even on that starter dose. I tend to respond that way to most medications.

Right now, after the 72-hour water-and-coffee fast (which was easy for me), my macros this first week are averaging around 70 percent fat, 20 percent protein, and 10 percent carb, and I am taking a multivitamin and keeping well hydrated. No electrolyte issues apparent. Feeling oddly clear-headed so far. No induction flu yet.

Admittedly, this is the furthest I've ever strayed from the AMA party line. Feels drastic. But not as drastic as bariatric surgery would be as a diabetes "treatment." And my understanding is that ketosis for liver shrinkage is standard pre-procedure for that (albeit under direct medical supervision). Not sure I'd ever condone it for anyone else, but so far it is feeling right for me in my circumstances at this point in my life.

[jnk...]

. . . I've dipped into mid 50's and can easily maintain low to mid 60's for over several days without I'll effects. . . .

Wow. As I diabetic, I would not be comfortable going below 70, myself, whether I was symptomatic of hypoglycemia or not.

[Madalot]

. . . I've dipped into mid 50's and can easily maintain low to mid 60's for over several days without I'll effects. . . .

Wow. As I diabetic, I would not be comfortable going below 70, myself, whether I was symptomatic of hypoglycemia or not.

I can tell you from experience, that for me, it's bad when I get that low. I can feel it. I feel awful. When I start feeling that way, I check and if I'm running below 75 or so, I get something to eat and quickly. I've dropped to 68 or 69 before and it's not pretty.

[jnk...]

. . . I've dropped to 68 or 69 before and it's not pretty. . . .

Thanks.

I don't think DreamStalker is diabetic, so I can see him being comfortable in the 60s.

I will restart my exercise program later this week. (I had stopped it for the fast and the switch to keto.) Now that I have more than a week's experience using the meters, I'll see later this week what my body does after 30 minutes with my heart rate above 140.

[Janknitz]

It may take a bit of time to get your exercise tolerance back to baseline. Don't overdo. Aerobic exercise is less beneficial than heavy lifting and sprints on keto. Watch your hydration and electrolytes.

I feel really rotten in the 50's but it doesn't happen often. Almost took myself to the ER last time, I felt like I was about to die! It was a really odd incident in the morning while fasted. My BGs are usually fine running from mid-70's to 90's.

That clarity is from ketones. I feel so much better. And when fasting, I feel really calm, too, as long as I'm hydrated.

[jnk...]

It may take a bit of time to get your exercise tolerance back to baseline. Don't overdo. Aerobic exercise is less beneficial than heavy lifting and sprints on keto. Watch your hydration and electrolytes.

I feel really rotten in the 50's but it doesn't happen often. Almost took myself to the ER last time, I felt like I was about to die! It was a really odd incident in the morning while fasted. My BGs are usually fine running from mid-70's to 90's.

That clarity is from ketones. I feel so much better. And when fasting, I feel really calm, too, as long as I'm hydrated.

Thanks VERY much for that. I'll do more lifting this week for now then, and only do a little aerobic to see where I am at. I'll try to ease into it over the weeks to get back to 30 minutes five times a week.

[DreamStalker]

I don't think DreamStalker is diabetic, so I can see him being comfortable in the 60s.

I will restart my exercise program later this week. (I had stopped it for the fast and the switch to keto.) Now that I have more than a week's experience using the meters, I'll see later this week what my body does after 30 minutes with my heart rate above 140.

I am not diabetic though I was diagnosed as pre-diabetic about 6 years ago ... which started me on path to modern paleo diet to my current cycling ketogenic diet (the original "paleo diet").

Of course, anyone who is carb addicted and has not adapted to the ketone energy substrates (acetone and/or beta-hydroxybutyrate) will indeed feel the effects of hypoglycemia due to their homeostasis with elevated glucose levels just as alcoholics will also get withdrawal symptoms. However, the whole point of going into ketosis is to break one’s carb addiction and become ketone adapted. That is what opens up the numerous metabolic pathways that enable the body for cellular maintenance and repair and resetting/rebalance hormonal receptors and sensitivities (set points for insulin, glucagon, ghrelin, leptin, vasopressin, and many other hormones) and all the numerous health benefits. While it does vary from person to person on how long it takes to become ketone adapted -- that is what the meters are for, to determine if you have become ketone adapted … a blood ketone level greater than 0.5 mmol/L is technically a state of ketosis (the lower limit varies between 0.5 and 1.0 depending on how it is defined and so I like to use 1.0 to be sure).

If you are in ketosis with blood ketone levels at or above 1.0 mmol/L, you do not have to fear hypoglycemia (as defined by AMA to be below a 70 mg/dL blood glucose level), because your brain and most of the other cells in your body will use ketones instead of blood glucose. In fact studies have shown that the brain, the heart, the kidneys, and muscle tissue all prefer and are more efficient at using ketones than using glucose. Dr. Richard Veech has in fact shown that the hydraulic efficiency of the heart is increased by 28% using ketones over using glucose … and tri-athletes under ketosis have reported over and over again that they require significantly less oxygen under the same physical stress than while not in ketosis. Dr. Domonic D’Agostino has claimed that he used exogenous ketone esters to purposely drop his blood glucose temporarily into the 30’s (which would normally kill someone who is not in ketosis) without any issue during one of his ketosis courses teaching his class of med students at the University of Miami to prove his point about ketones. Dr. Thomas Seyfried states that during an extended fast, blood glucose will stabilize right at about 60 mg/dL by third or fourth day of fasting (because the liver is genetically programmed to know how to do this to maintain blood glucose, not for the brain, but for the red blood cells which have no mitochondria for the aerobic oxidation of ketones) -- and I have proven his statement to be true for myself with my own fasting experiments with my glucose stabilizing in the low to mid 60’s. What I noticed from my own fasting data is that once my blood glucose drops below 70, I’m pretty much guaranteed to be in ketosis with blood ketones above 1.0 -- although it is also possible for my glucose to spike up into the 90’s when I do eat to end a fast and yet still have ketone levels above 1.0 mmol/L, thus remaining in ketosis even after ending a fast. Again, I’ll post later on the use of caprylic oil and exogenous ketone salts for mitigating the initial ketosis period known as carb flu symptoms and speeding up cellular ketosis adaptation.

Anyway, the human body is very resilient and adaptable for ketosis which is why Dr. Jason Fung, Dr. Daniel Pompa, and others recently jumping onto the ketosis band wagon for treating Type II diabetes have found such amazing success with this approach (Dr. Ron Rosedale actually proposed this method of treating diabetes back in early 1990’s btw). The other thing that D’Agostino has found is that the longer one stays on that border line of ketosis (between 0.5 and 1.5 ketone levels), the easier it becomes to establish the liver enzymes and biochemical transport mechanisms for optimal ketone adaptation to allow people to easily go in and out of ketosis within a matter of hours rather than days … stating that it has an epigenetic effect on DNA.

I do agree 100% that people with Type I diabetes should never attempt any experiments with ketosis at all … though it has been shown that they can benefit with stabilizing glucose fluctuations by limiting their carb intake (according to Dr. Richard Bernstein).

And one last thing, if you plan to do high intensity exercise like weight lifting and/or sprints, you may need to add branched-chain amino supplements to avoid lean muscle mass losses. And also, if you are on hypertension medication, watch your blood pressure closely as you may need to re-titrate those meds lower while in ketosis. I would wait until you are very comfortable with your tweaked optimal state of ketosis ... walking for 30 to 60 minutes daily (with heart rate around 50% to 75% of your max) will do just fine until then since walking actually does a great job of using the largest mitochondrial muscle cells in the body.

[jnk...]

Many thanks, DreamStalker.

I am on no meds besides the metformin and 81-mg aspirin regimen.

It's a good thing my past self isn't here to see me upping fat intake and cutting back on aerobic exercise or he'd be shaking me by the shoulders right now and slapping "sense" into me.

I decided to take some potassium citrate today. Probably a good idea for me anyway, since I passed a calcium oxalate kidney stone a few years back.

[Janknitz]

Low fat and aerobic exercise will still be there if this fails. But it won't.

Do you know what you are likely to see in your lipid panel at first? Be forewarned. Total may go up a lot. LDL will go up some, especially until weight is stable for a while. HDL should go up a lot (a good thing) and trigs should go down precipitously as the carbs go down. Ratios will be significantly improved, especially HDL/trigs which are a far better indicator of CV risk than total or LDL. But expect your doctor to have a cow if he/she only pays attention to statin sales literature.

Over time LDL will come back down.