Nutritional Ketosis CGM Experiment Day 1

During the last series on using a Freestyle Libre continuous glucose monitor (CGM) I documented the effects of a typical Western high carbohydrate diet on my blood sugars. Many of the meals I ate were obvious treats containing a lot of sugar, but many were just traditional foods, like toast, which still had a significant impact.

In this series I’m going to show the progression into nutritional ketosis (NK), that is, the process by which my body adapts to using ketones from fat breakdown as a major fuel source. The definition of nutritional ketosis is somewhat in flux but it’s generally accepted that NK begins around 0.5 millimolar of ketones as measured in the serum or blood. I will be using my KetoMojo ketone meter every day to show you the results I’m obtaining.

To start off this experiment, I was not particularly careful on my diet over the weekend. I ate quality food, mostly, but not very low carb.

Starting Tuesday, July 30th, I began to follow a ketogenic diet and will continue to strive to keep my carb intake 20 gms per day or less with a maximum of 50-60gms per day for the two week duration. These are recommendations I often give patients with type 2 diabetes and they are very successful in reversing that disease process. My default carb goal is about 75-100 gms per day. I’ve learned over the years that this is the level at which I feel really well and energetic. I focus on my carbs from whole foods such as fruit and sweet potatoes and allow variation from day to day depending on my activity level and taste buds. So a day of hiking might allow for more carbs after returning home while a day of office work I’d try to be more strict.

My diet log for yesterday is pretty simple. I ate three eggs fried in ghee and two pieces of Swaggerty sausage for breakfast along with my multiple cups of black coffee (3 gms of carbs). Lunch was with a friend at Archers BBQ consisting of 1/2 lb of pulled pork and unsweetened tea (0 gms of carbs). I know unsweet tea is sacrilege in the South but there’s a reason diabetes is so prevalent here too. Dinner was two roasted chicken thighs with sauteed onions and mushrooms (5 gms of carbs). My daughter and I then went to work out at VitalSigns which was 40 minutes on the elliptical and 25 minutes of resistance training with machines and body weight exercises. Trying to keep up with a cross country running Freshman during her workouts has left me sore many times this summer. After our work out, I made a protein powder shake about an hour before heading to bed (2 gms of carbs). That’s actually eating later in the night than I really want to, but I felt like the shake was a good idea. Part of the whole purpose of these meters is to allow someone to become more self-aware and be able to respond to their body’s needs instead of just following an regimented program that can’t adapt.

Nutritional profile for the day.
Note: carb count rounded in write up

The nutritional content of my day was very low at about 11 gms of carbs for the whole day. Protein was pretty close to my max goal. From prior personal experience, I don’t feel great when my protein intake gets too far above 160 gms for too long, but that can be dependent on my fat intake. This has been called rabbit starvation by Arctic explores like Vilhjalmur Stefansson due to eating the lean protein of rabbits without enough accompanying fat. However, I don’t want anyone to think that’s a prescriptive level, just my experience with my own diet.

So what was my result after one day of a ketogenic diet, a moderate intensity exercise for about an hour and fasting for 8-9 hours while asleep? Unsurprisingly, it was pretty normal. My ketones were still pretty low.

The human liver makes glucose continuously and can supply all the needs that the body has. Additionally, it stores about 2500 kcals of glucose as glycogen. That would take about 2-3 days of minimal activity to burn through or about 2-3 hours of intense activity. My one day of low carb intake and modest calorie expenditure is not enough to move me into nutritional ketosis. We’ll see what tomorrow holds.

CGM Experiment: What I learned as a non-diabetic from wearing a continuous glucose monitor – Lily Nichols RDN

Here is a great blog post from Lily Nichols, RDN author of Real Food for Pregnancy and Real Food for Gestational Diabetes and presenter at this years Low Carb Denver. Her presentation on low carb nutrition during pregnancy was a solidly scientific and engaging talk.

This post chronicles her time wearing the Freestyle Libre continuous glucose monitor and a good discussion on what ‘normal’ blood sugars should be for the non-diabetic.

I think there is a lot of good information here to consider for those of us who don’t have diabetes but want to understand the stress our body undergoes when we eat certain food.

I’ll be placing a new sensor on next week and blogging about my journey into nutritional ketosis and possibly the effects of fasting on my blood sugars. Stay tuned for that series although, sadly, there will be less cake involved compared to the first series.

Special thanks to my patient who found this article and shared it with me. One of the reasons I love my DPC job is I get to work with incredible people like you all. Patients who are engaged in their own health journey and challenge me too grow, learn, and apply are simply amazing.

Many non diabetics are wearing CGMs to better understand their blood sugar patterns. Here’s what I learned from wearing a continuous glucose monitor.
— Read on lilynicholsrdn.com/cgm-experiment-non-diabetic-continuous-glucose-monitor/

IDM: Women and Fasting: Top Tips for Women Going Through Menopause Part 2

I’ve seen this same observation time and time again. Since using a CGM with most of my patients I’ve begun noticing how often artificial sweeteners cause a reactionary drop in glucose. Presumably this is from the body producing insulin assuming that the sweet taste represents a usable sugar. Since there is no increase in blood stream sugars the net effect is a lowering. So where do sugars go when they leave the blood stream in that manner? They aren’t leaving the body. They aren’t being used as fuel during exercise. They get stored in a cell. It’s hard to lose weight when the body keeps storing glucose in the cells.

Women and Fasting: Top Tips for Women Going Through Menopause Part 2 – Intensive Dietary Management (IDM)
— Read on idmprogram.com/women-and-fasting-top-tips-for-women-going-through-menopause-part-2/

The Truth Behind What Intermittent Fasting Does to Your Body | Inverse

Studies show intermittent fasting can lead to weight loss, stabilized blood sugar, reduced inflammation, improvements in memory and stress resistance, slowed aging, longer lifespan, and blood sugar stabilization — all promising health benefits in return for considerable lifestyle changes.
— Read on www.inverse.com/article/57625-what-intermittent-fasting-actually-does-to-your-body

Decent article on fasting if you ignore the unsupported semi-vegan dietary recommendation. It’s amazing how one can write an entire article on lowering insulin production through fasting and then ignore that very concept when choosing food to eat. Plants are part of a good dietary plan but most plants are mostly carbohydrates. To lower insulin levels all the time, not just when not eating, you have to lower the carb intake. You can’t build your diet on a non-essential macronutrient and expect to stay healthy.

Maybe saturated fat doesn’t cause heart disease

Several recently published meta-analyses of observational studies and randomised controlled trials (RCTs) have found that total saturated fat is not associated with non-communicable diseases including coronary heart disease, cardiovascular disease, and all cause mortality

https://www.bmj.com/content/366/bmj.l4137

A recent report published in the British Medical Journal calls into question the validity of associating saturated fat intake with cardiovascular disease. Maybe the tide is changing.

bmj.l4137.full-1.pdf

CGM Day 9 & 10: Minor detour for ice cream

Did great yesterday until the end of the day when I succumbed to the siren call of ice cream after a very long day. The breakfast spike was due to my infatuation with blueberries.

Today was a new day though. I had my typical Wednesday breakfast at Nick and J’s Cafe of three eggs over well with bacon and black coffee. Then I met a friend for lunch at Dickies for 1/2lb of brisket. We celebrated his amazing success on his low carb/fasting journey which I hope he’ll share on this blog sometime soon.

This afternoon there was a handful of green grapes running out the door to go do yard work at the office.

Glory be to God, tomorrow is always a new day.

CGM Day 8: It takes one day

After last week’s daily deluge of carbs this week I plan to be much more moderate in my intake.

Today, breakfast was just a few scrambled eggs which had no impact. Lunch was a protein shake I like to make from About Time Protein powder with added MCT oil. Again there was no impact.

Dinner was the only meal that showed any increase in my blood sugar. It consisted of roasted chicken, fresh corn on the cob, steamed carrots, and some Colbyjack cheese. The elevation wasn’t enough to push me over 100mg/dL however.

So the lesson I’d like to impart here is that it only takes one day of change to see an impact on your health. Studies show that by the third meal of a low carb nutrition plan there is measurable improvement in someone’s insulin resistance. The time to change is right now.

I heard a proverb one time that said the best time to plant a tree is 20 years ago. The second best time is right now. Make your next meal the first meal of a new way of life. If you need help, call my office. That’s what I do.

CGM 6 & 7: The Coup De Grace

This weekend was my final two days on a high carb, ‘celebration food’, diet. For these days I planned several very high carb meals and they didn’t disappoint in their effect on my body.

On Saturday I worked Trinity’s Walk In Clinic at Fort Sanders West. Usually I bring a breakfast treat for the staff consisting of various low-carb yogurts with fruit and some decently low carb granola options. I decided to try out several of the types of yogurt individually to see their effects.

The first attempt was about 8:30am with Fage’s full fat yogurt. As you can see, one of the individual serving containers had no effect on my blood sugar. Listed as 6gm of carbs the actual amount is much less than that as the process of making yogurt utilizes some of the lactose through fermentation. It might be a good choice in the future for me for a low carb, low impact food.

The second attempt was an hour later with a blackberry Carb Master yogurt from Kroger. At 5gms of carbs and plenty of artificial sweeteners I was hopeful for a small impact. Again, there was no rise to my blood glucose but you can see a dip shortly there after. I’ve come to believe that the artificial sweeteners cause a release of insulin or a failure of glucagon which results in a low to often develop. I’ve seen this in several patients too. I will probably be limiting or avoiding these yogurts down the road. I’d rather have the plain full fat Fage.

Finally I got to the day’s glucose master challenge consisting of two apple fritters which I ate before I headed to Home Depot for some errands. I waited until after clinic was done as I knew it would slow my mental capacity and I didn’t want them to affect my clinical skills. No surprise my glucose spiked and I seriously contemplated laying down in the middle of Home Depot to take a nap. Not wanting to be cited for vagrancy I soldiered on and finished up.

After getting home, I spent several hours working outside in vigorous yard work involving moving rock, shoveling, and digging out a new flower bed. Those bouts of activity were associated with spikes in glucose too. I’ll be interested to see how my glucose responds to exercise when I’m fat adapted later this month. I’ve purposely not exercised in a formal way this past week to keep me as insulin resistance as possible. I’m looking forward to getting back to it.

On my final day, I wanted to go out with a bang so asked the family to go to Mimi’s after church. They were pretty surprised as I never want to go eat there as their low carb selection is very limited. This time that was the point. I had hoped for French Toast but since it contains cream cheese and orange marmalade, two things I really don’t like at all, I decided to try the chicken and waffles. Honestly, I’ve never had this before. I’ve eaten plenty of chicken and plenty of waffles but never on the same plate. I can see the appeal especially after pouring 2 ounces of maple syrup on everything.

The impact was amazing. Again, I felt like taking a nap and found it more difficult to think clearly. The carb count on this meal was incredible. The chicken and waffles is listed as 97 gms of carbs on Mimi’s nutrition website. When the syrup is added it totals 183 gms. Essentially the sugar in 2 oz of maple syrup is the same in all of the chicken and waffles! I couldn’t believe it. The effect lasted hours with multiple spikes. The maximum glucose achieved wasn’t especially high but the duration of effect was over several hours. The area under the curve was very large. That’s when the damage is done.

Later that night, I ate another couple burgers with buns similar to the ones earlier in the week. I wanted to see what affect they would have after such a high sugar load for lunch. Interestingly, it was blunted. Whereas they would typically cause an elevation, it was more restrained.

So as the week has progressed, I’ve learned and experienced many interesting things. I feel more sluggish and less mentally sharp in general and specifically after high carb meals. I’ve gained 3.5lbs of weight (in one week!). I’m more swollen and achy during the day. I don’t think I’m sleeping nearly as well as I usually do.

A single meal has a big impact. That impact is in both directions. A single bad meal causes stress for hours. A single good meal can really help you recover back to normal more quickly. Remember that each day is about each meal. Don’t stress too much ahead of time over the upcoming meals. Fight the battle in front of you and move on. Each day has enough trouble of it’s own.

What’s next? This week will be short as I’m headed out on vacation Saturday but I’ll be turning my attention to a good low carb, whole food recovery plan for the remaining days. I’ll be interested to see how quickly the weight will come off and I start to feel better. After vacation, I’ll use another sensor and document my progression into nutritional ketosis. I’ll be showing my ketone meter readings too.

I’d love to hear feedback from anyone about how this blog series has impacted your decision making process on food or your experiences with blood sugars. Please feel free to email me directly or post a comment publicly as you deem appropriate.

CGM Day 5: Recovery may be boring but boring may be good.

Recovery can be boring but good for you.

Yesterday was day 5 of my CGM experiment with my FreeStyle Libre. It was pretty boring which was a little by design and a little by accident. Interestingly, this blog series has prompted about a dozen of my patients to contact me and acquire a CGM for themselves. I have heard feed back that the lowest price seems to be about $35 per sensor using a GoodRx coupon. Several folks have found that price at Wal-Mart and Walgreens.

I started out the morning still feeling very full and, as you can see from the graph, my glucose numbers were still bouncing around until about 3 am from all the food on July 4th. So, I fasted for breakfast to try and recover. I had planned to have a very low carb lunch of left over plain hamburgers but walked out of the house with them still sitting on the counter. Doh!

I wasn’t able to leave the office at lunch so only ate a small snack and a protein powder shake. In total, it was about 20gms of carbs. That accounts for the small spike and quick recovery. I didn’t end up getting home until 9pm and decided to have leftovers from the July 4th party. That was a pretty high carb meal. As I’ve come to expect, I spiked and dropped after going to sleep. The roller coaster of numbers continued until this morning. One lesson I’m learning is just how detrimental late night eating is. Next week I’m going to eat some moderate to large size dinners of very low carb food and see how much effect that has while I’m asleep. I’m also going to focus on skipping more late night dinner meals if they aren’t a sit down meal with my family.

Overall, the first part of the day was a recovery period which went well. If I had stuck with that process, you can see how a day of appropriate celebration can be accommodated better when surrounded with a few days of self-control and proper eating. We are built for cycles of fasting and feeding. Celebration with rich food can be very appropriate. We just need to limit our celebrations to those days which are in fact a celebration.

CGM Day 4: Did I say cake? I meant cakes.

Celebrating Independence Day, like almost every other American holiday, involves lots of food. Yesterday’s rumor of cake was not unfounded and today was a day marked not by one big meal but by multiple opportunities to eat richly.

Breakfast began with my first cake, four of them to be exact. Paleo Pancakes found at Costco are a lower carb (but not low carb) grain free version of traditional pancakes. They are surprisingly filling for their size and generally you don’t want very many.

Interestingly, these pancakes produced in me a phenomenon I see in many other people and regularly talk about. It’s a clear sign of insulin hypersecretion and dysregulation of the body’s glucose balance mechanism. I developed reactive hypoglycemia after my breakfast meal of four 3 inch diameter pancakes with honey and butter, two fried eggs, and blueberries.

When my CGM read low I double checked it with a finger stick. You can see they correlate well. As my glucose rose, so did my insulin level. It effectively moved my blood stream glucose into the cells of the body and brought the level back down to normal. However, when it hit normal, about 85 mg/dL, the body’s compensatory hormones that help balance the effect of insulin likely failed to appropriately be released. Glucagon is the chief counter-regulatory hormone and signals the body to release its stored glucose from the liver. This slow dripping stream of glucose raises the blood glucose levels just as insulin lowers them. The delicate balance between the two allows for a stable number. Failure of glucagon to release allows insulin to work unchecked thereby continuing to move glucose into body cells and lowering the blood level. Many people feel this occur and Snickers has based an entire ad campaign on this phenomenon. “You’re not yourself when your hungry.” Anyone ever been called h-angry?

Many people try to correct these symptoms by having a carb rich snack or drink. If you must, have a small amount of complex carbs possibly with some protein or fat to slow digestion. Something like a couple ounces of nuts or half an apple and avocado. Ultimately the best fix for this scenario is retrain your body to release hormones appropriately by converting to a low carb, moderate protein, quality fat diet as we’ve been discussing. When done correctly this always corrects the issue as a thoroughly fat adapted individual cannot suffer hypoglycemia.

Of note, I think my hemoglobin and hematocrit are low as a result of the retained fluid from my excessive carb intake this week. Hyperinsulinemia results in retained salt and water which dilutes a stable red blood cell mass. I suspect my blood pressure is running higher than normal too although I haven’t checked it. I have noticed more lower leg and ankle swelling at the end of each day.

After breakfast we began getting ready for our family to come over to cook out. As I started the fire and prepared the outdoor space, my wife made an All-American Angel Food Cake. Her offer of the mostly empty frosting bowl and a spoon was not refused and that promptly spiked my glucose around noon.

Lunch was burgers and hot dogs cooked over the open fire using this awesome campfire grill set up from Wimpy’s. Burgers cooked over a real wood fire really are the best you’ll ever have. They were so good I had the leftovers for dinner. Both lunch and dinner were finished with a piece of cake. You’ll note a small peak between those two meals on the CGM graph. I honestly don’t know what to attribute that to. I don’t think it was food related.

Lastly, what’s Independence Day without a little bowl of ice cream? I think I remember from history class that General Washington celebrated each victory with vanilla bean, or maybe that was Captain America. Either way, it’s definitely American.

So like many holidays, at the end of the day I’d swear I’ll never need to eat again but without fail I do. I think this is a challenge for many of us. Our celebrations are defined by food. We celebrate holidays and get togethers and times with friends and families. I’ve celebrated many an afternoon just making it through the work day. We celebrate Saturday mornings and Sunday lunches. We should celebrate all of these times as life is a celebration of God’s grace and love to us. However, we don’t always have to celebrate with massive meals of carb rich food. Remember the 1/2 lb of brisket I ate the other day? It was delicious and never moved by glucose. I truly believe we can celebrate wonderfully without developing insulin resistance or diabetes. Just think of all the extra celebrations we could have if we lived this out well. Too many lives are cut short by diseases resulting from high insulin levels. We can be a generation that adopts a new normal and changes our own destiny.

I don’t know what tomorrow’s going to be like. It’ll be hard to top today but I’m sure there will be something I can try.