Interesting Dr follow up with LCHF friendly doc for T2
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@albertabeefy, any insights on health hazards attributable strictly to the frequency/intensity of spikes in your BG levels?
(Dr. Bernstein periodically warns folks to limit not only carbs per meal but also total meal size in order to avoid spikes.)
Thanks!0 -
Pretty-much every study I've found on the subject shows that any BG spike of over 140mg/dl (7.8mmol/L) regardless of frequency is going to be harmful. The duration of this elevation combined with the level itself will determine the overall damage that's done. (I know one fellow - not as a patient - who's almost never UNDER 140mg/dl because he's afraid of hypos, and I worry for him greatly.)@albertabeefy, any insights on health hazards attributable strictly to the frequency/intensity of spikes in your BG levels?
Maybe it's just me, but I fail to see how a larger meal would impact one more than a smaller meal if the amount of dietary carbohydrate is the same. Unless one were also hypercaloric and ingesting a large excess of protein.(Dr. Bernstein periodically warns folks to limit not only carbs per meal but also total meal size in order to avoid spikes.)
Thanks!
If I remember correctly a study a couple years ago tested a 2-meal per day regimen vs a 6-meal per day regimen. Both diets were similar in macronutrient composition and isocaloric, and from what I recall the 2-meal per day regimen was slightly-superior (though not hugely statistically significant) for fasting glucose, visceral fat, bodyweight and some lipid markers.
I'd suggest that in many cases "it depends" would be a correct answer. For those of us with diabetes, there's going to be several factors at play that will make results for one vary from another. The best advice I could give people is to experiment with things we know work for some people, do your own glucose testing, and come up with the best treatment/lifestyle plan for you.5 -
@albertabeefy, any insights on health hazards attributable strictly to the frequency/intensity of spikes in your BG levels?
(Dr. Bernstein periodically warns folks to limit not only carbs per meal but also total meal size in order to avoid spikes.)
Thanks!
I don't know that it's meal related, but when I eat higher calories overall for several days in a row my fasting BG tends to be higher, as well as the baseline between meals.
As to frequency/intensity of spikes - I haven't found any good research. Remember - the "weightiest" movers and shakers in diabetes care still believe that 180 within 2 hours is perfectly fine control. We have to get them to "never above 140" before they are even going to think about what damage going above 140 does - let alone taking into account damage done based on the frequency and intensity of those high readings.
Managing blood glucose by carb control (the only effective way to keep BG below 140) is still considered by most doctors a wacko idea. My doctor is supportive, but my spouse - who wouldn't recognize a carb if it came up and shook her hand and initroduced itself - is treated by the same doctor. He has not suggested to her that she follow my lead. My mother limits her occasional sugary treats to 5 grams of sugar - while regularly eating 50 or so grams of carbohydrates. She was agonizing over the 12 gram chocolate covered cherry - even though she'd already had several meals when her carb content was close to 100 grams. Her doctor is happy as long as her A1c is below 7.0.
I think there is growing recognition that an average BG above 140 is harmful, but we're still a long ways away from recognizing that even spikes above that can be harfmul - and exploring how harmful they might be.0 -
Hmm. I'm not sure about the lack of research; Dr. Bernstein seemed to have studies in mind, but he didn't ID them.
One does hear total garbage from health professionals paid to dispense wise counsel. I wouldn't feel comfortable with 180 ever, no matter what any of them might say, but until more chicks have been counted, I won't be ready to accept 140 as a safe high end, even briefly after meals....0 -
I set my own personal limit at 120mg/dl (about 6.65mmol/L) and try to aim for that ... it's attainable most of the time depending on where I start before I eat. If I've fasted a while and my liver decides to dump some into the bloodstream just before I eat though, it doesn't always happen.Hmm. I'm not sure about the lack of research; Dr. Bernstein seemed to have studies in mind, but he didn't ID them.
One does hear total garbage from health professionals paid to dispense wise counsel. I wouldn't be able to feel comfortable with 180 ever, but until more chicks have been counted, I won't be ready to accept 140 as a safe high end, even briefly after meals....
It's just my personal target # where I always feel safe at.2 -
albertabeefy wrote: »
I set my own personal limit at 120mg/dl (about 6.65mmol/L) and try to aim for that ... it's attainable most of the time depending on where I start before I eat. If I've fasted a while and my liver decides to dump some into the bloodstream just before I eat though, it doesn't always happen.Hmm. I'm not sure about the lack of research; Dr. Bernstein seemed to have studies in mind, but he didn't ID them.
One does hear total garbage from health professionals paid to dispense wise counsel. I wouldn't be able to feel comfortable with 180 ever, but until more chicks have been counted, I won't be ready to accept 140 as a safe high end, even briefly after meals....
It's just my personal target # where I always feel safe at.
Thanks. I often wish my liver and I spoke the same language. It would make things easier.
120 is about where my high end is, too. In the absence of a direct line to my liver, I've adopted a couple primitive tricks:
- If BG is over 100, don't eat.
- If close to daily calorie target, only eat if BG is under 90.
- Upon reaching calorie target + 200, start overnight fast (lockdown mode).
(ETA: Assuming min. protein requirement is met.)5 -
albertabeefy wrote: »Pretty-much every study I've found on the subject shows that any BG spike of over 140mg/dl (7.8mmol/L) regardless of frequency is going to be harmful. The duration of this elevation combined with the level itself will determine the overall damage that's done.
My post-exercise readings are regularly in the 145-160 range. Should I be worried?
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MyriiStorm wrote: »albertabeefy wrote: »Pretty-much every study I've found on the subject shows that any BG spike of over 140mg/dl (7.8mmol/L) regardless of frequency is going to be harmful. The duration of this elevation combined with the level itself will determine the overall damage that's done.
My post-exercise readings are regularly in the 145-160 range. Should I be worried?
Going back to the one of the reasons I changed doctors that led to me starting this thread, my former doctor argued with me when I told him the highest readings I get are right after working out which he said was not possible. Doing a simple google search will show it is not that uncommon.
According to my new doctor, it may be that I am overdoing it as part the "stress" that is causing my elevated BG. "Stress" does not necessarily mean what most people think of, but could include lack of adequate or quality sleep, over exertion, etc.
Part of what I am working on is improving my sleep and remembering I'm not as young as I used to be while I am at the gym.1 -
This is one of those oddities where it IS fine, as long as it's only for a little while. Generally, WHILE you're exercising, the liver is constantly pushing out more glucose for use by skeletal muscle, and because it's being used, your levels will remain fine (for most people). However, it's AFTER exercise where - because you've stopped, glucose elevation remains for a bit.MyriiStorm wrote: »albertabeefy wrote: »Pretty-much every study I've found on the subject shows that any BG spike of over 140mg/dl (7.8mmol/L) regardless of frequency is going to be harmful. The duration of this elevation combined with the level itself will determine the overall damage that's done.
My post-exercise readings are regularly in the 145-160 range. Should I be worried?
Also, as @cstehansen mentioned - exercise can raise stress hormones which can also elevate glucose. This is especially true for chronic over-exercisers, of which I have known to be one.
That being said, the overall benefit of regular exercise (for weight-loss, insulin-sensitivity and glycemic control) will always outweigh the temporary elevation you receive after.
I find I can reduce the post-exercise elevation by doing a LONG, gradual cool-down. The more intense the exercise, the longer cool-down I'll do. It may work for you as well.4 -
Thanks for the suggestion @albertabeefy
I was thinking a long cool down might help. My problem is time because i work out before work and am already getting up at 4:45.0 -
Wow, all this has my head spinning. As someone who has never had a BG reading that showed over 121 (and that was a PP, 1 hour reading) on a test, and a fasting that has not been over 92, as far back as 2009 (where my charts track to)...but has an A1C from October, 2016 of 5.4%, and a fasting insulin level at the same test time of 11.3 uIU/mL, I'm concerned...
I am one of those people who has abused my body quite extensively for years upon years unknowingly and unintentionally. I have been formally labeled as insulin resistant, and I am not on any medications currently for any glucose/insulin related issues. However, my condition seems to be more accurately labeled "cellular energy resistant" meaning that even high levels of of ketones create an overload reaction for me causing postprandial somnolence at a certain level. Even during the PPS - I've had readings in the 120 glucose range.
My body has protected me primarily from massively elevated glucose by continually shuttling all the excess off to fat storage before my glucose concentration spikes much. So, on many levels, and only recently, I have begun thanking my body for making me fat (so far) instead of causing glucose related metabolic issues and complications...
But obviously, looking at the A1C of 5.4%, I'm getting elevated spikes at some point, right?
And I really just got super depressed, because the only person remotely close to me on the low carb doc list is a Bariatric Surgeon, and everything on his "clinic's" website seems like his version of Herbalife or whatever (not knocking it for those it helps)... I don't really have the money for dna testing, though my former PCP (still my PCP, but I moved and dread driving 45 minutes to see her) was hoping their clinic system would get it soon (told me 12+ months ago, no updates)...as long as I can reimburse for it (healthcare flex plan at work, as long as medically "ordered" even if not FSA/insurance covered, etc.)...but my income is at poverty level, and I simply can't afford any real out of pocket expenses.
I just don't have anyone who could begin to interpret the results for me.
From the testing I've done, I'm not autoimmune in any way (as far as the tests I've had done - minor ANA number at one point, lowered again, and far below range other minor number, too). I've got formal diagnoses of PCOS, IR, HBP (side effect of hormonal BCP only), hypothyroidism (treating with T4 & T3 in combination, but not NDT)...and some other miscellaneous things. I've treated a number of micronutrient deficiencies, but I still feel like I'm lost in the damned dark... Coritisol is high, but have done suppression and urine tests, and docs were not worried. Liver tests improved lately, but protein/hydration tests getting worse...but still in "range" so no one is worried, per se.
Anyone have any suggestions? Keto stunned my thyroid three separate, measurable times, and anything over keto levels is not sustainable for me in any way that I've found to date without venturing back into carbland without intending to. I don't have a gallbladder, so any fasting over 8 hours or so has me ejecting straight bile, so extending fasting isn't an option.
At this point, I've more or less given up, kind of in a holding pattern, waiting for something to give, but I don't want to regress any further, but every single thing I'm being told, much like @cstehansen, I feel like it isn't right, it isn't helping, and there still has to be something else I'm missing...
Thanks everyone who reads all this mess... I just keep flipping back and forth from hopelessness to apathy, and yes, I know I hide it fairly well from most folks, but man, it just gets old. Sorry to be such a Debbie Downer, but I feel so ... I don't know, clueless? I feel like the more I learn, the less I know... And for now, I'm just done. There has to be something that gives me some information. I hate feeling so...adrift. Nothing makes sense or fits anymore.0 -
KnitOrMiss wrote: »
Thanks everyone who reads all this mess... I just keep flipping back and forth from hopelessness to apathy, and yes, I know I hide it fairly well from most folks, but man, it just gets old. Sorry to be such a Debbie Downer, but I feel so ... I don't know, clueless? I feel like the more I learn, the less I know... And for now, I'm just done. There has to be something that gives me some information. I hate feeling so...adrift. Nothing makes sense or fits anymore.
You know I so feel you.
I cried this morning myself after waking about 7 times to readd eye goops. When I took my handful of supplements (that don't seem to do much of anything) with my water full of other supplements (that don't appear to do much either), I just laughed...the kind of laugh of someone who is on the brink of madness.
All I have to do is wait until Feb 8th for a new dr and pray he actually takes me seriously (HAHAHAHAHAAAAA) and maybe has some sort of innate sense of curiosity. I pray for that anyway. So...frickin...done. *le sigh* But no matter how DONE I am, the earth keeps a spinnin' regardless...Darn physics!!!
Hang in there. 3 -
baconslave wrote: »KnitOrMiss wrote: »
Thanks everyone who reads all this mess... I just keep flipping back and forth from hopelessness to apathy, and yes, I know I hide it fairly well from most folks, but man, it just gets old. Sorry to be such a Debbie Downer, but I feel so ... I don't know, clueless? I feel like the more I learn, the less I know... And for now, I'm just done. There has to be something that gives me some information. I hate feeling so...adrift. Nothing makes sense or fits anymore.
You know I so feel you.
I cried this morning myself after waking about 7 times to readd eye goops. When I took my handful of supplements (that don't seem to do much of anything) with my water full of other supplements (that don't appear to do much either), I just laughed...the kind of laugh of someone who is on the brink of madness.
All I have to do is wait until Feb 8th for a new dr and pray he actually takes me seriously (HAHAHAHAHAAAAA) and maybe has some sort of innate sense of curiosity. I pray for that anyway. So...frickin...done. *le sigh* But no matter how DONE I am, the earth keeps a spinnin' regardless...Darn physics!!!
Hang in there.
Thanks, honey. Tearing up here... I guess it's a little less ... hopeless, to not be hopeless alone? Did you ever try adding the Taurine? It's supposed to help with all the fluid balance stuff...0 -
@KnitOrMiss & @baconslave - this is a marathon and not a sprint. Both of you have been at this longer than me, so I can appreciate the frustration. My wife says I have the patience of Job. In reality, my patience is good with people - like when I am training someone - as long as they are trying and making at least some progress. However, when it comes to anything else, like wanting my A1C to be perfect, I want it and I want it right freaking now!!!!
This process of making a change and needing to wait weeks or months to see if it has a meaningful effect is killer for me.
I guess all I am saying is hang in there. Keep doing your n=1 experimentation to the best of your ability. At least you know more now than you did a few years ago and have made changes that, regardless of whether or not they fix everything, have at least prevented new damage.4 -
cstehansen wrote: »@KnitOrMiss & @baconslave - this is a marathon and not a sprint. Both of you have been at this longer than me, so I can appreciate the frustration. My wife says I have the patience of Job. In reality, my patience is good with people - like when I am training someone - as long as they are trying and making at least some progress. However, when it comes to anything else, like wanting my A1C to be perfect, I want it and I want it right freaking now!!!!
This process of making a change and needing to wait weeks or months to see if it has a meaningful effect is killer for me.
I guess all I am saying is hang in there. Keep doing your n=1 experimentation to the best of your ability. At least you know more now than you did a few years ago and have made changes that, regardless of whether or not they fix everything, have at least prevented new damage.
@cstehansen - I'm just over the experimenting. I know this, too, shall pass, but without just throwing random crap into the mix, I am plum out of ideas. I started losing weight in 2011, I think. Lowest in that time was 2015, before my thyroid tried to die on me. 2 months after going keto. Since then, it's just been a slow climb. Think I finally have my thyroid mostly behaving/functioning, etc., and then everything else stops...
Honestly, the worst thing right now is my perpetual dehydration. Water doesn't help. Sodium doesn't help. Magnesium doesn't help. Potassium doesn't help. I'm just tired of always feeling like I'm on my way to being a prune...a huge one...but one...
And I'm sorry, this is a horrible time for me. I'm not usually this moody/hopeless/down/depressed. I don't know what the trigger is, or I'd put it out of it's misery.
The more I learn, the less I know or understand.0 -
KnitOrMiss wrote: »baconslave wrote: »KnitOrMiss wrote: »
Thanks everyone who reads all this mess... I just keep flipping back and forth from hopelessness to apathy, and yes, I know I hide it fairly well from most folks, but man, it just gets old. Sorry to be such a Debbie Downer, but I feel so ... I don't know, clueless? I feel like the more I learn, the less I know... And for now, I'm just done. There has to be something that gives me some information. I hate feeling so...adrift. Nothing makes sense or fits anymore.
You know I so feel you.
I cried this morning myself after waking about 7 times to readd eye goops. When I took my handful of supplements (that don't seem to do much of anything) with my water full of other supplements (that don't appear to do much either), I just laughed...the kind of laugh of someone who is on the brink of madness.
All I have to do is wait until Feb 8th for a new dr and pray he actually takes me seriously (HAHAHAHAHAAAAA) and maybe has some sort of innate sense of curiosity. I pray for that anyway. So...frickin...done. *le sigh* But no matter how DONE I am, the earth keeps a spinnin' regardless...Darn physics!!!
Hang in there.
Thanks, honey. Tearing up here... I guess it's a little less ... hopeless, to not be hopeless alone? Did you ever try adding the Taurine? It's supposed to help with all the fluid balance stuff...
If you think things are bad now, just wait till we're in retirement homes reminiscing about the dark ages in medicine while getting daily genetically-targeted, personalized morning wellness drinks before we hit the volleyball court...
PS. I think taurine is added to a lot of cat food.
Look at them peepers!
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We already know cats are by nature keto, so maybe there's something to that.
And with the misery that comes with nursing homes, I think I'll just save up some of my non-existent retirement and pay someone to take care of that for me.1 -
It will be nice if/when doctors begin being taught based on research over dogma from the 60's and 70's. It is also good if you can find one who has learned something AFTER finishing med school.2
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Both my PCP and my Endo have helped me on this journey, but it's kind of like they both reached the cliff overlooking Niagara Falls at the same time, the end of their knowledge, and they just helped each other shove me off the cliff - and now I'm in perpectual free fall... If that makes sense.0
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KnitOrMiss wrote: »Both my PCP and my Endo have helped me on this journey, but it's kind of like they both reached the cliff overlooking Niagara Falls at the same time, the end of their knowledge, and they just helped each other shove me off the cliff - and now I'm in perpectual free fall... If that makes sense.
Any chance of getting into a genuine crackerjack immunoligist? Some of these folks are real cryptographers.....0 -
@KnitOrMiss and @baconslave I wish I had some knowledge or insight to impart. All I can do is offer virtual support and hugs. I hope you both can find answers and real help soon!0
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@KnitOrMiss
So sorry that you are having such a challenging time! Do you have access to a university-based hospital/medical center? Such facilities can be the best place to go when you have been unsuccessful getting accurate diagnoses and medical care elsewhere. They typically have the most up-to-date information, testing, etc. available and often have funds to make their services available to the un- or underinsured.1 -
@KnitOrMiss - I was looking for another article, but saw this one and thought I would share it. At the end are links to several others which are related. You have been at this a while, so this might not be new to you, but I figured it wouldn't hurt to pass it along.
https://chriskresser.com/low-t3-syndrome-v-should-it-be-treated-with-thyroid-hormone/
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@cstehansen glad you found the right doc, way to go.0
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KnitOrMiss wrote: »baconslave wrote: »KnitOrMiss wrote: »
Thanks everyone who reads all this mess... I just keep flipping back and forth from hopelessness to apathy, and yes, I know I hide it fairly well from most folks, but man, it just gets old. Sorry to be such a Debbie Downer, but I feel so ... I don't know, clueless? I feel like the more I learn, the less I know... And for now, I'm just done. There has to be something that gives me some information. I hate feeling so...adrift. Nothing makes sense or fits anymore.
You know I so feel you.
I cried this morning myself after waking about 7 times to readd eye goops. When I took my handful of supplements (that don't seem to do much of anything) with my water full of other supplements (that don't appear to do much either), I just laughed...the kind of laugh of someone who is on the brink of madness.
All I have to do is wait until Feb 8th for a new dr and pray he actually takes me seriously (HAHAHAHAHAAAAA) and maybe has some sort of innate sense of curiosity. I pray for that anyway. So...frickin...done. *le sigh* But no matter how DONE I am, the earth keeps a spinnin' regardless...Darn physics!!!
Hang in there.
Thanks, honey. Tearing up here... I guess it's a little less ... hopeless, to not be hopeless alone? Did you ever try adding the Taurine? It's supposed to help with all the fluid balance stuff...
I'll need to make another Amazon order soon, so perhaps taurine will be on the list. But like you, I'm just so tired of experimenting and wasting money and hope.1 -
cstehansen wrote: »@KnitOrMiss - I was looking for another article, but saw this one and thought I would share it. At the end are links to several others which are related. You have been at this a while, so this might not be new to you, but I figured it wouldn't hurt to pass it along.
https://chriskresser.com/low-t3-syndrome-v-should-it-be-treated-with-thyroid-hormone/
@cstehansen - I'll look into that further, but I do take both T4 and T3 (staggered doses)...so looking into why T3 issues may not be thyroid related (I already knew about adrenal stuff being related, should be interesting to see what else can be the trigger) could prove interesting. I've only added T3 medication in the last year, less than the full year, maybe 6 months? But I can feel a marked difference when I take it versus when I don't. However, I also seem to need it less (can drop off a dose, or two) when my sleep is bumped up (like weekends, vacation)...0 -
@cstehansen - In reading this...he talks about...
However, in my clinical practice I frequently see people with low levels of T3 with normal T4 and either low or normal TSH.
My TSH was still high, my T3 was low, and my T4 was low - not normal.... So I'm going to keep reading, but my T3 was the hidden gem so to speak, because the other stuff was and is still messed up too, though definitely improving.0 -
@cstehansen - so in reading through all the pages of that (5 of them?), I'm happy to report that it doesn't seem to fit me at all. My TSH is still higher than optimal. My T4 (free) is still not where it should be, nor was my Free T3. It was improving, but it still wasn't where it should have been. I've had the autoimmune tests done to rule out Hashi's and Graves and RA and Lupus, and none the other factors of the LAH really apply closely, so that puts my mind at least there... But it is still so interesting that there is just so much too it all. There is literally nothing that is straight forward! Even cancer diagnosis can just be where it is found, not where it started or where it is hiding! UGH...0
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KnitOrMiss wrote: »@cstehansen - so in reading through all the pages of that (5 of them?), I'm happy to report that it doesn't seem to fit me at all. My TSH is still higher than optimal. My T4 (free) is still not where it should be, nor was my Free T3. It was improving, but it still wasn't where it should have been. I've had the autoimmune tests done to rule out Hashi's and Graves and RA and Lupus, and none the other factors of the LAH really apply closely, so that puts my mind at least there... But it is still so interesting that there is just so much too it all. There is literally nothing that is straight forward! Even cancer diagnosis can just be where it is found, not where it started or where it is hiding! UGH...
Sorry that wasn't much help. I'm not that knowledgeable about the thyroid, but I know he has had some pretty good insights in other areas so I figured it couldn't hurt to pass this along.0 -
cstehansen wrote: »KnitOrMiss wrote: »@cstehansen - so in reading through all the pages of that (5 of them?), I'm happy to report that it doesn't seem to fit me at all. My TSH is still higher than optimal. My T4 (free) is still not where it should be, nor was my Free T3. It was improving, but it still wasn't where it should have been. I've had the autoimmune tests done to rule out Hashi's and Graves and RA and Lupus, and none the other factors of the LAH really apply closely, so that puts my mind at least there... But it is still so interesting that there is just so much too it all. There is literally nothing that is straight forward! Even cancer diagnosis can just be where it is found, not where it started or where it is hiding! UGH...
Sorry that wasn't much help. I'm not that knowledgeable about the thyroid, but I know he has had some pretty good insights in other areas so I figured it couldn't hurt to pass this along.
@cstehansen - a random tidbit I encountered last night shows that the dry/itchy skin (which I'd attributed to winter) and the itchy/burning combo may actually be related to my thyroid somehow... I've gotta dig in some more...but it sure seemed to make sense.
And I do agree that Chris Kresser has a lot of great knowledge, and if those factors applied to me, it would have helped, but my underlying conversion issues (from T4 to T3, etc.) tie back to low stomach acid and having no gallbladder, etc., as far as I've been able to determine.
Thanks for sharing information, though, too, as I always love learning more!2
This discussion has been closed.