apod NMR Lipoprofile Results

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Stavia
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Re: apod NMR Lipoprofile Results

Post by Stavia »

GeorgeN wrote:
LAC1965 wrote:
My glucose/insulin situation is just strange. My fasting insulin is really low, often non-detectable, and my fasting glucose, provided I’m in ketosis, is in the high 60s. But I can’t tolerate any rapid acting carbs at all without huge elevations in glucose (similar to the effect that one would see in a type 1 diabetic).
Could be physiologic insulin resistance (which is a good thing and to be expected). It is quite common with those on a VLC diet. In chronic low glucose situations, the muscles don't use the glycogen - it is saved for the brain. Standard advice for those on a VLC before they take an oral glucose tolerance test is to eat at least 150 g/carbs/day for 3 days before testing. These carbs cause to body to reduce or abandon the physiologic IR.
George, you grasp of biochemistry is superb yet again.
Correct - LAC - if you are in ketosis for ages you WILL have a huge spike the first big carb load you ingest as your insulin will be "dormant" and needs to "wake up" again. This is called "physiological insulin resistance". Its not an issue and your response to a carbohydrate load after being in ketosis for ages is not predictive of your true insulin resistance whatsoever.
As George says, you need to re-feed 3 days before you can interpret carbohydrate response.
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Re: apod NMR Lipoprofile Results

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Stavia wrote:This is called "physiological insulin resistance". Its not an issue and your response to a carbohydrate load after being in ketosis for ages is not predictive of your true insulin resistance whatsoever. As George says, you need to re-feed 3 days before you can interpret carbohydrate response.
I think the term was coined by a veterinarian named Peter Dobromylskyj in this Hyperlipid blog post from 2007. It's worth reading that and a lot more if you're interested in HFLC eating as Peter is a smart guy with a lot of interesting things to say.

While it does seem to be a common response to long-term nutritional ketosis, I'm not yet convinced that it is "not an issue". It seems plausible that it's safe and ok for everyone, but to me it also seems possible that it's not. For a detailed discussion, you might check out this thought-provoking post over at FTA. (I hesitate to recommend anything over at FTA as the snarky tone there is anathema to the social environment we try to maintain here. You should picture my holding that link at a distance between thumb and forefinger with head turned and nose wrinkled.)

For an example of someone experiencing more difficulty exiting PIR than the oft-described three days of higher carb eating, I recommend this thread over at Longecity.

Because I am unaware of scientific research on PIR, I tend to think of the ideas floating about regarding PIR as n=1 or folk "science". I think it may be wise to maintain some skepticism on this topic.
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Re: apod NMR Lipoprofile Results

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I believe I read that one should eat a fair amount of carbohydrate in the days before a glucose tolerance test, but it never really registered, probably because I didn’t understand the underlying rationale. Thanks for that information.

I wonder to what extent my very low carb diet has impacted my test results. I absolutely hate glucose tolerance tests. They make me extremely ill, even the ones I did before going ketogenic a number of years ago were tough. My last test was pathetic – blood glucose at about 300 at one hour (fasting 73). I’m afraid of what would happen if I tried to eat 150 carbs a day prior to testing. I have such huge swings in blood sugar, which is why I initially started eating low carb in my early 40s. When I did so I could think clearly for the first time in months, so I stuck with it, with somewhat regular carb splurges. Now (at age 50), I really can’t function mentally if I’m not in full ketosis. Thus, I’m much more consistent in managing my diet and tracking my carbs than I’ve been in prior years. When I slip up I really feel it.
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Re: apod NMR Lipoprofile Results

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merouleau wrote:
Stavia wrote:This is called "physiological insulin resistance". Its not an issue and your response to a carbohydrate load after being in ketosis for ages is not predictive of your true insulin resistance whatsoever. As George says, you need to re-feed 3 days before you can interpret carbohydrate response.
I think the term was coined by a veterinarian named Peter Dobromylskyj in this Hyperlipid blog post from 2007. It's worth reading that and a lot more if you're interested in HFLC eating as Peter is a smart guy with a lot of interesting things to say.

I'm not yet convinced that it is "not an issue". It seems plausible that it's safe and ok for everyone, but to me it also seems possible that it's not. For a detailed discussion, you might check out this thought-provoking post over at FTA.
very interesting!! Thanks for the links.
So much still unknown about mammalian physiology.
And I have the greatest respect for vets. They have a broad and deep education and are super smart (no reference sorry, just my observation).
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Re: apod NMR Lipoprofile Results

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So it looks like PIR results in higher fasting, as well as postprandial, glucose levels (from the links Merouleau provided). With ketone levels under 1.0, I tend to see this, but when my ketone level is around 3.0 or higher, my fasting blood glucose is always low.

I suspect that my situation is atypical (I have a diagnosis of diabetes, type unknown, which I should have mentioned in my earlier post). Interestingly, COQ10 has had a profound impact on my glucose levels. I’m not sure that my fasting glucose in full ketosis would be as low as it is if I wasn’t taking COQ10, which has had many positive effects for me. And on a very high dose of COQ10 I wasn't getting significant spikes in glucose with a moderate carb intake. But I had chronic fasting hypoglycemia, and high blood pressure for the first time ever, so that wasn't something I could maintain.
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Re: apod NMR Lipoprofile Results

Post by Julie G »

Sorry to be so slow to comment, apod. These are actually good results- kudos :D I agree with others- a starting place to further knock down LDL-P, while still preserving "the good stuff," would be to shift some SFA to MUFA. If that doesn't yield you better results, maybe consider doing some of the advanced testing recommended by Dr. Dayspring...
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Re: apod NMR Lipoprofile Results

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merouleau wrote: While it does seem to be a common response to long-term nutritional ketosis, I'm not yet convinced that it is "not an issue". It seems plausible that it's safe and ok for everyone, but to me it also seems possible that it's not. For a detailed discussion, you might check out this thought-provoking post over at FTA. (I hesitate to recommend anything over at FTA as the snarky tone there is anathema to the social environment we try to maintain here. You should picture my holding that link at a distance between thumb and forefinger with head turned and nose wrinkled.)

For an example of someone experiencing more difficulty exiting PIR than the oft-described three days of higher carb eating, I recommend this thread over at Longecity.

Because I am unaware of scientific research on PIR, I tend to think of the ideas floating about regarding PIR as n=1 or folk "science". I think it may be wise to maintain some skepticism on this topic.
I appreciate your writing this, merouleau. I don't find the answers on this as reassuring/compelling as I'd like. I did a couple years slow weight loss on what I thought was a very reasonable low carb diet, and my blood glucose levels after carby meals go a lot higher than I think they ought to, I have diabetes in the family, etc. etc. So since I just heard from multiple friends and family members that they think I am too thin, I am trying to add back a couple pounds and will for the first time do that 3-day carb-heavier thing you describe. I think that considering how much exercise I get, it may be time to go for something more moderate, especially in light of my troubles with blood lipids.

I'm not adding much, though. If this is what it takes to get my blood pressure to stay low, I like that trade. Don't want to be stupid, though. Or obsessive-compulsive, though that may be past praying for.
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Re: apod NMR Lipoprofile Results

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I hope you'll let us know how that process goes for you as I think I am in the same boat. I'm pretty sensitive to high-GI carbs now too, but because I never checked postprandial glucose before becoming fat-adapted, I don't know how much of that sensitivity is due to PIR and how much is just me at 52.

While I'm not sanguine about my FBGs in the 98-103 range, I'm not worried either. I'm just ... paying attention. I haven't been inclined to change much as I feel good every day and am happy with blood pressure, weight, and postprandial glucose in the absence of high-GI carbs.

I need to update my blood lipid tests though as it has been about nine months, and once my head is back out of the sand I'm afraid I'll feel compelled to try something different. Your experience readapting to high-GI carbs may help me decide what to try.
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Re: apod NMR Lipoprofile Results

Post by LanceS »

Thanks merouleau for the additional perspective regarding PIR. Appreciated.

Attia blogged or podcasted about his PIR experiences which were likely on the opposite side of the spectrum from many of our concerns. He hypothesized that because he exercises frequently intensely that his carb stores are in a state of depletion. The carb stores have seemingly given up on getting sugar from blood, but when sugar hits his body, the carb stores seem to come alive and begin rapidly absorbing the blood glucose, leading to a very difficult IR test, whereby the test administrators felt compelled to intervene because of lower blood sugar than he started with.

Anyway, I don't know how relevant his (somewhat scary) experience is, but it does seem that carb stores may play a moderating role for those living the lifestyle. I've certainly had some cake recently that was there and gone so fast, my ketosis didn't know it even happened. As a cautionary tale, just remember that overdoing it (highly depleted carb stores) may possibly lead to some potentially wild the other way blood sugar swings the other way. Sorry I know this leaves more questions than answers, but I think that is reflective of the current state of Attia / E4 PIR knowledge.

Slightly aside: Ivor posted a link to a Insulin guide from Marty Kendall. Looked pretty good to me so here is the link. Haven't tried to read and digest the contents. Sorry if it disappoints.

http://static1.squarespace.com/static/5 ... nsulin.pdf

Further aside, read a bit about where Ivor (Fat Emperor) and Peter from Hyperlipid were starting to dialogue about Familial Hypercholesteremia. I like Ivor alot but he was very into preliminary hypotheses that when cholesterol cannot be absorbed, because of an inefficient receptor mechanism (FH, similar in effect to E4s who hyper absorb / hypo eliminate?) that the cells still need cholesterol. That further the wrong thing to do is statin up and reduce the cholesterol. Naturally these ideas are early stages, and I am reluctant to part with Dayspring cautions, but there should be more evidence, more physiologic insights than many of these papers/discussions/etc. Hoping they find the time to continue cracking that nut as it could lead to insights beneficial (one way or the other, or perhaps unfortunately indeterminate ; ( ) for E4s who have the bountiful LDL-P.
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Re: apod NMR Lipoprofile Results

Post by apod »

I wonder how long I should wait between NMR Lipoprofile tests after adjusting diet? The test runs about $100, so I can't run it that often. I'm anxious to see what a higher carb / lower SFA intake might look like on my numbers (I think I prefer a higher fat diet.)
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