So frustrated and discouraged!

rnjenny8599

So I went to see my physician for follow up and to discuss some issues I was having with trying to exercise. In short, I cant. I have no strength, walking half a block is the best I can do.
I have been strict Keto since january (20 carbs) prior to that I was 60 carbs a day since october.
My fasting blood sugars are consistently 110-120. The more protein I eat, the worse it is. Thru the day, even after eating my blood sugars are 90-100. I can fast effortlessly-24-36 hours and Im not hungry. My urine shows ketones, but I know that doesnt necessarily mean anything.
My calories are set to 1500 a day.
I have lost 22 pounds since october.
My doctor, who I was very angry with, suggested I eat more calories, that was the cause of my weakness, and wants me on a statin-my lipds were devastating. If I saw that in a patient I would freak- total 390, LDL-C 293, trig 203, HDL 38. And he wants me on metformin. we went round and round and I was in tears and disgusted when I left his office. Now I like this guy and he genuinely tries to help me, BUT! he is an internist and thats what they know-pills.
I have read and read and researched and been on here, but how in the world can I still be so insulin resistant and my lipids so horrible after 6 months? And if I am fat adapted, which I am doubting, why on earth is my liver fighting me and making glucose at night?
So between the weakness, the blood sugars, the lipids, I am in doubt that I am fat adapted or even in ketosis. Am I some metabolic train wreck that cant get there? I do NOT want to give up this WOE because its the first time in my life I havent felt controlled by sugar or food. and oh yes, I have weight to lose, currently at 233. He also told me after 25 lbs it was nearly impossible to lose weight! Im just so mad I could scream. Im not here to bash my doctor, he is clearly ignorant, but is he right? am I just some freak that this wont work for?

nvmomketo

Some of us still get higher BG readings in the morning even when we eat everything right. My FBG is still the highest of the day on most days. This morning my FBG was 10 points higher than my BG after dinner. I figure if I keep my BG normal at most times a slight elevation in the morning won't hurt much, and A1C will improve. I've been keto for most of three years.

There are a few things you can try to lower your FBG like exercise (although you are limited right now) and some wine or vinegar at night. Metformin will lower FBG too, and is not always a bad thing, but I am not sure you need it.

Your cholesterol is not ideal but you are losing weight - that will often keep it elevated for a while. Low calories cause elevated triglycerides and lower HDL too. Dave Feldman has done a lot of self experimentation in that area.
http://cholesterolcode.com/

The weakness is a bit worrying. Are you getting adequate electrolytes and calories? That will hurt your energy. How about adequate sleep? Could there be an underlying health issue like hypothyroidism?

rnjenny8599

My A1c didnt budge in 6 months. I managed to bring my HDL up 11 points. According to ketogains, 1600 is a 20 percent deficit. I always check several, but they are about the same. I am supplementing magnesium, I tried broth but gained 6 pds overnite. No more of that. I usually get 3 gms sodium per day plus what I apply to food.

GaleHawkins

rnjenny8599 wrote: »

So I went to see my physician for follow up and to discuss some issues I was having with trying to exercise. In short, I cant. I have no strength, walking half a block is the best I can do.
I have been strict Keto since january (20 carbs) prior to that I was 60 carbs a day since october.
My fasting blood sugars are consistently 110-120. The more protein I eat, the worse it is. Thru the day, even after eating my blood sugars are 90-100. I can fast effortlessly-24-36 hours and Im not hungry. My urine shows ketones, but I know that doesnt necessarily mean anything.
My calories are set to 1500 a day.
I have lost 22 pounds since october.
My doctor, who I was very angry with, suggested I eat more calories, that was the cause of my weakness, and wants me on a statin-my lipds were devastating. If I saw that in a patient I would freak- total 390, LDL-C 293, trig 203, HDL 38. And he wants me on metformin. we went round and round and I was in tears and disgusted when I left his office. Now I like this guy and he genuinely tries to help me, BUT! he is an internist and thats what they know-pills.
I have read and read and researched and been on here, but how in the world can I still be so insulin resistant and my lipids so horrible after 6 months? And if I am fat adapted, which I am doubting, why on earth is my liver fighting me and making glucose at night?
So between the weakness, the blood sugars, the lipids, I am in doubt that I am fat adapted or even in ketosis. Am I some metabolic train wreck that cant get there? I do NOT want to give up this WOE because its the first time in my life I havent felt controlled by sugar or food. and oh yes, I have weight to lose, currently at 233. He also told me after 25 lbs it was nearly impossible to lose weight! Im just so mad I could scream. Im not here to bash my doctor, he is clearly ignorant, but is he right? am I just some freak that this wont work for?

I started out weak and it was one year before I started getting stronger or got Fasting readings down to 100.

Since I took calorie counting/weight loss off the table in Oct 2014 after it did not work out well for the past 40 years but from spot checking a few times a year just to know I am still eating it is in the 2000-3000 calorie range daily with carbs just under 50 grams daily to maintain my 50 pound loss for the past three years. I was eating about the same when I lost the 50 pounds however.

The doctor may have a point that you may be under eating. To learn if this is your case you could eat at 2500 for two weeks and see the results. I have found in my case if I will eat just for better health over time the weight will automatically shift downward.

Not freaking out can be hard I know from personal experience 3-4 years ago. I was aware of no real downside to KETO in my case so I just keep sticking with it and the positive results.

I expect your results will improve in time. Some are two week KETO wonders and some of us are more like TWO YEAR KETO wonders with me being the later.

Dragonwolf

Without before numbers, it's hard gauging your current numbers are in context. In isolation, the lipid numbers are concerning, but the course of action depends on what they were previously.

If they were worse, then they're improving and that's a good thing. If they were better than you might be a hyper-responder, and might be better off getting most of your fats from monounsaturated sources.

Either way, your lipids are fire fighters. If they're that high, something is wrong. That something may be your overall health from before October, which will take time to heal. You didn't gain the weight and health issues overnight, so it's going to take a while to fix them.

The same largely goes for your blood sugar. In my experience, you're kind of borderline for needing metformin and previous numbers might determine which direction you should go.

As for your liver, it's not "fighting you," but it does make glucose. It has to. The body cannot live without glucose at all and it's the liver's job to do so. Keep going with the low carb, maybe add some fasting and exercise, and it'll come down over time.

That said, I'm with your doctor on the weakness part. I deal with a similar issue. If I don't eat enough over a period of time, I start getting depressed and have no energy to do things. You've lost some weight and you've done this for six months now. It might be time to make some adjustments.

You said you can easily fast for 24-36 hours, so it might be worth doing a 5:2 or alternate day fasting protocol. That gives you a deficit for weight loss, but you eat enough on feeding days to sustain energy.

Additionally, exercising will help with the energy levels and enable you to eat more while maintaining the deficit to lose weight. Even more, it will help you build/maintain lean mass that will improve your metabolism and blood sugar.

You don't have to do a ton of exercising. If walking a block is all you can do, then walk a block. Eventually, you'll be able to walk two blocks, then three, then a mile.

rkmeyer41

A coworker recommended bee pollen to increase energy.....any thoughts?

GaleHawkins

Increasing calories would be the first thing to try to increase energy based on my experiences. I have been pretty active from 5-10pm out repairing tractors and a bush hog. I just ate a can of tuna in olive oil and cheese crisps, some coconut, raisins, 100% Cacao and almonds and plan to crash for the evening.

rnjenny8599

previous numbers-A1c 6.4
total chol-279
HDL 27
LDL-203
trig 213
weight 261
I have never dieted in my life. as long as I was active and could do as I pleased I really didnt care. I am a gardener. or was. weeded for a few minutes yesterday=poof, done.
So what if you are a hyper responder-then what?

rnjenny8599

So I have spent the weekend re-reading and re-energizing. Not doing meds. Not. This is crap and Im gonna fix it.

nvmomketo

If you are a hyper responder, your cho,estero, will be a bit higher than most others, that's all. As I understand it, it really does not mean too much.

As Dragonwolf said, your cholesterol is probably showing your past health. It takes time to fix. Keep at it and health does improve, whether it is with high, low or normal cholesterol.

Do consider more sodium. Some low carbers find they need well over 3000 to 5000 mg. some do better with 7000 mg! Low electrolytes can really make you drag so it could be worth trying. If you retain a bit of water, no big deal, right? It's not fat. Just water. It will regulate given a bit of time.

tcunbeliever

Is the physical weakness new, or has this been a long term issue?

I think the higher blood sugars in the morning are known as the dawn phenomenon and it's a known issue for some T2D. Ditto for the insulin response to protein, some T2D have to limit protein as part of controlling their BG levels.

You have lost 22 lbs since October - of course your cholesterol results are sky high, you have to be weight stable for at least 6 months for those tests to even be accurate. So, whatever the test says, it's not real because weight loss skews the results. Your doctor should know this and be aware of the limitations of the test, that's part of his job.

I don't understand any medical professional who says you can't lose more than 25 lbs - that's the dumbest thing I've heard in a while and this whole site is full of people who have lost more than 25 lbs.

Don't give up over one bad doctor appointment - you are in control of your life, not some other person. You are the only one who has to live in your body and you are the only one who gets a vote over what you do with yourself. If you feel better, then your body is healing. Hang in there. It will take time. 22 lbs in 7 months is good progress, it's a nice slow rate of loss that points to fat metabolism rather than water or muscle loss - this is a good marker for improved health. I would also encourage you to take measurements because that can be another good metric for showing improved health. It only takes a few minutes and it can be nice feedback to see the body shrinking.

As for the fatigue - if you are insulin resistant then it's likely your adrenals and thyroid are struggling, they tend to take a beating as part of the IR cycle. Make sure you are getting some magnesium and iodine rich foods to support them nutritionally. Maybe some licorice tea if your blood pressure is normal or low. Licorice can increase BP in some people, so it should be avoided if you already have high BP.

Sunny_Bunny_

Do you supplement sodium? It can explain your weakness at least to some degree. It may even explain a little of the insulin resistance being stubborn.
At the carb level you are eating, you should be getting 5000mg sodium a day. Possibly more.
It makes a huge difference when you correct a low sodium issue.
Low sodium can even affect your mood which doesn’t seem to be as good as it could be with all this going on.
Also, I wouldn’t necessarily be against metformin. Maybe just give the lowest dose possible a try for a bit then work toward dropping it back off later.
If you’re still losing weight or haven’t been weight stable for 6 months or so, that could definitely explain why your lipids are still high. Especially the trigs. Unless you have been cheating, which would also raise trigs.

Read this to understand why sodium is so important.

https://blog.virtahealth.com/sodium-nutritional-ketosis-keto-flu-adrenal-function/

sljohnson1207

To add to what others have said about electrolytes, have you had a full blood work up? Meaning, they've checked your free thyroid hormones, Vitamin D, electrolyte levels, iron level, white blood cell count, etc? If all normal, I don't see any reason for alarm. Focus on what you have achieved already. You have lost weight, lowered triglycerides, increased HDL by a significant amount (YEAH!). Your total cholesterol is higher, but you are dieting, and your liver is responding to the deficit. I don't think they checked your LDL to see if they are fluffy or tiny particles. Many of us have experienced this with our lipid panels. Many doctors are just plain ignorant to the struggles that people face.

Your lack of energy may be too low of calories. You mentioned the more protein you eat, the worse your FBG. What are your macros? Are you getting at least 60% of your calories from healthy fats? Or, are you really low carb, moderate fat, high protein?

Your FBG doesn't even sound that high to me (I am not a doctor), but don't discount Metformin. Many folks take that and are successful with reducing BG levels and even losing weight on it without too much effort.

Is there any chance you are on an antidepressant or other medication well known to trigger weight gain?

The statement your doctor made about only losing 25 lbs is very strange. I can't wrap my head around it at all. I think you sound like a very motivated person, so proving him/her wrong is goal #1, right?

Dragonwolf

rnjenny8599 wrote: »

previous numbers-A1c 6.4
total chol-279
HDL 27
LDL-203
trig 213
weight 261
I have never dieted in my life. as long as I was active and could do as I pleased I really didnt care. I am a gardener. or was. weeded for a few minutes yesterday=poof, done.
So what if you are a hyper responder-then what?

So your HDL improved and your LDL went up rather predictably (smallish change, indicates increased particle size, which is actually improvement, but looks bad on the test). I'd keep an eye on it and maybe check inflammation markers, calcium score, and whatnot (largely due to the fatigue, especially if it doesn't improve with the suggested changes), but so far, that reads as improvement to me. Provided the other tests come back clean, I wouldn't worry about it.

You should see your trigs drop pretty dramatically as time goes on, and over the longer term, your LDL should come down a bit.

If you are a hyper-responder, it pretty much just means you'll want to use more avocado and olive oil and less coconut oil, and maybe eat more fish than land animals.

rnjenny8599

sljohnson1207 wrote: »

To add to what others have said about electrolytes, have you had a full blood work up? Meaning, they've checked your free thyroid hormones, Vitamin D, electrolyte levels, iron level, white blood cell count, etc? If all normal, I don't see any reason for alarm. Focus on what you have achieved already. You have lost weight, lowered triglycerides, increased HDL by a significant amount (YEAH!). Your total cholesterol is higher, but you are dieting, and your liver is responding to the deficit. I don't think they checked your LDL to see if they are fluffy or tiny particles. Many of us have experienced this with our lipid panels. Many doctors are just plain ignorant to the struggles that people face.

Your lack of energy may be too low of calories. You mentioned the more protein you eat, the worse your FBG. What are your macros? Are you getting at least 60% of your calories from healthy fats? Or, are you really low carb, moderate fat, high protein?

Your FBG doesn't even sound that high to me (I am not a doctor), but don't discount Metformin. Many folks take that and are successful with reducing BG levels and even losing weight on it without too much effort.

Is there any chance you are on an antidepressant or other medication well known to trigger weight gain?

The statement your doctor made about only losing 25 lbs is very strange. I can't wrap my head around it at all. I think you sound like a very motivated person, so proving him/her wrong is goal #1, right?

I am on methotrexate and folic acid. new RA. I went to dr worried about thyroid. He totally dissed me. The dang thyroid can cause the lipid issues too. Yes my macros are 60/35/5
I had the fat set higher, but the recommendation was more protein...but it backfires every time. I am adjusting WHEN I eat my protein and avoiding an evening meal with lots of protein to help maybe?
No my FBG isnt that high but I expect better-and it WAS better several months ago. To me it says increasing IR and I dont get it. and oh yeah I intend to prove him wrong.

cricketpower

Are you working nights by any chance?

2t9nty

FWIW, I am down 123 pounds, so loss after the first 25 might not seem very typical for his practice, but it has not been especially hard for me. I have just stuck with the keto. I have a hard limit of 1600 calories a day and a soft goal of 1300. Energy has been good. I was a total freak about sodium initially after a bout with the keto flu though and carefully monitored intake with a goal of 4000 plus liberally adding salt to what I was eating. These days I still track it but don't supplement if it is a little low.

When I was diagnosed T2D, my fasting glucose was over 300. I went on metformin and did not see much change in my numbers. When I started restricting carbs, the numbers fell. After a year of metformin and keto, my A1C was in the 5's. I had my dose reduced, and at my next checkup, the A1C was 5.3. The doctor took me off metformin, and at the next checkup the A1C was 5.9. I don't have another appointment until October, but I am hoping to have brought that 5.9 down by then.

I find my glucose first thing in the morning may be my highest reading of the day. My 7 day average is 110. Morning readings are likely to be 110 - 120.

My total cholesterol went from 225 or so on a statin to 153. I stopped taking the statin and told my doctor I would wait until I reached goal weight and it had been stable for a year before considering taking it again. Total cholesterol was 204 I think at the last appointment. That does not seem so bad.

I can't help much with the lack of energy. It has not been part of my experience.

rnjenny8599

Great job on the weight. I am shooting for about 90 lbs.
Not working nights day time job.

kpk54

I was glad to see this (cut and paste below) in the above referenced article (near the bottom of the article as a modification to the advice of 5000mg):

"People routinely taking NSAID medications like ibuprofen (Motrin, Advil) or (Aleve, Naprosyn) are more ‘sodium sensitive’ because these drugs block salt excretion by the kidneys and raise blood pressure (Zawada 1980)".

I'm an advocate of increased sodium on keto or very low carb but the use of NSAIDs is darn common so people need to be aware...

sljohnson1207

rnjenny8599 wrote: »

sljohnson1207 wrote: »

To add to what others have said about electrolytes, have you had a full blood work up? Meaning, they've checked your free thyroid hormones, Vitamin D, electrolyte levels, iron level, white blood cell count, etc? If all normal, I don't see any reason for alarm. Focus on what you have achieved already. You have lost weight, lowered triglycerides, increased HDL by a significant amount (YEAH!). Your total cholesterol is higher, but you are dieting, and your liver is responding to the deficit. I don't think they checked your LDL to see if they are fluffy or tiny particles. Many of us have experienced this with our lipid panels. Many doctors are just plain ignorant to the struggles that people face.

Your lack of energy may be too low of calories. You mentioned the more protein you eat, the worse your FBG. What are your macros? Are you getting at least 60% of your calories from healthy fats? Or, are you really low carb, moderate fat, high protein?

Your FBG doesn't even sound that high to me (I am not a doctor), but don't discount Metformin. Many folks take that and are successful with reducing BG levels and even losing weight on it without too much effort.

Is there any chance you are on an antidepressant or other medication well known to trigger weight gain?

The statement your doctor made about only losing 25 lbs is very strange. I can't wrap my head around it at all. I think you sound like a very motivated person, so proving him/her wrong is goal #1, right?

I am on methotrexate and folic acid. new RA. I went to dr worried about thyroid. He totally dissed me. The dang thyroid can cause the lipid issues too. Yes my macros are 60/35/5
I had the fat set higher, but the recommendation was more protein...but it backfires every time. I am adjusting WHEN I eat my protein and avoiding an evening meal with lots of protein to help maybe?
No my FBG isnt that high but I expect better-and it WAS better several months ago. To me it says increasing IR and I dont get it. and oh yeah I intend to prove him wrong.

I'd find a new doctor that takes your concerns and either eliminates them or proves them and then helps. Arrogance on his part. That is all I hear when you say he dissed you on that.

Have you seen an improvement in your RA since being keto?

Maybe you need to push your fat higher and protein just a little lower, like 70/25/5. A one month experiment may show some results in the BG department if you feel it's the protein causing it.

It's all just a guess on any of our parts because none of us know your situation better than you do. However. this community is nothing short of amazing for making us think about new angles to research, and providing links to articles and videos from people who have done keto long term.

I wish you the best success in proving that dr. wrong.

rnjenny8599

kpk54 wrote: »

I was glad to see this (cut and paste below) in the above referenced article (near the bottom of the article as a modification to the advice of 5000mg):

"People routinely taking NSAID medications like ibuprofen (Motrin, Advil) or (Aleve, Naprosyn) are more ‘sodium sensitive’ because these drugs block salt excretion by the kidneys and raise blood pressure (Zawada 1980)".

I'm an advocate of increased sodium on keto or very low carb but the use of NSAIDs is darn common so people need to be aware...

relatively certain this is what happened to me with gaining 6 lbs overnight when I tried to up sodium, That approach is not for me. I do about 3-4 gms daily.