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leosmith

Do low carbohydrate diets reduce cellular insulin sensitivity?

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OldTech

It's a well-known effect and is called physiological insulin resistance. It simply says that your body has gotten use to burning fat and does not quickly adapt to burning glucose. It takes time for the body to switch to burning fat and it likewise takes time to go back to burning glucose. 

 

It is not pathological insulin resistance. What it means is that you will fail a GTT unless you take several day to adapt your body to burning glucose. That is, of course, assuming you are non-diabetic.

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leosmith

It also is a reason why low-carbing isn't quite the straightforward panacea for T1s that T2s assume it must be.

I'm going to show my ignorance here (again). T1's can't produce insulin, right? How would being on low carbs help that situation? Is the theory that if you eat less carbs you'll need to inject less artificial insulin?

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DeusXM

 

 

Is the theory that if you eat less carbs you'll need to inject less artificial insulin?

 

It's the law of small numbers. The idea is that if you eat fewer carbs, you need less insulin and the effect is a bit like steering at low speed. Imagine you're driving a car at 30mph - when you steer, the car moves a little bit and if you're going off the road, it's easy to correct. Drive at 70mph and every steer you make has a magnified effect so you zip all over the road. 

 

It's a fine theory but it doesn't take into account two important things.

 

The carbs you eat are predictable. You eat 30g of carbs, you know you have 30g of carbs going into your blood stream at some stage, and you can probably estimate the digestion curve. That then helps stop your liver pumping out glucose. When your liver is the primary source of glucose going into your blood, you don't know when it's going in, how much is going in, or the speed at which it's going in, which means you will likely spend most of you time bolusing according to incomplete information. Think of it like dawn phenomenon, except it lasts all day.

 

The other thing is the insulin resistance. You know how you're told that if you bolus, you can eat anything and if you dose correctly that you'll be fine? Not if you're low-carbing. Fancy a treat? Awesome, prepare to see your insulin be about as effective as water. Dare to eat a whole slice of bread and then find that your insulin ratio has plunged to something like 1:1 - thus neatly undoing all the work you did to try and reduce your insulin intake overall. There's nothing that sucks more than eating a 'normal' meal and finding you need to take the same amount of bolus insulin that you'd usually take for your basal just to keep your blood sugar under 15mmol/l.

 

Low-carbing is fine for T1s if your liver is entirely predictable and there is no chance of you ever touching a carb again in your life. Otherwise, it can still work but it's a LOT of effort and be prepared for some really bad days too. 

 

Again, I must stress that low-carbing does work for T1s but it's certainly not as straightfoward as the naive 'cut your carbs and you'll be fine' advice many T2s give.

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OldTech

That's a good explanation, Deus. I had not thought about insulin becoming far less useful when the body is changing states when the body is glucose resistant. 

 

However, much the same thing will happen to type 2s. If I suddenly eat a high carb meal my blood glucose will skyrocket and I will be kicked out of ketosis because insulin is not very effective when the cells are not adapted to using glucose. And the effect will last days even if I go back on my keto diet. I can even see this effect if I just eat slightly more carbs than I usually eat. Then I can expect my readings to be higher the next day.

 

While a keto diet will work to gain control of blood glucose it is not without restrictions in what you eat. And if you want to have 'cheat' days it is not a good choice. Cycling in and out ketosis is not something that the body does quickly.

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mbc1963

This is one of my main concerns. I've gotten my BG levels under control (T2) eating LCHF for the last year. But I do worry that by keeping my carbs so low, I'm actually reducing my body's ability to manage carbs when I DO eat them. If I fall off the wagon in the future... will I have a body that's worse off than it was before?

 

Interesting take in the article about the different types of sugars (fructose vs. sucrose vs. glucose). It will be interesting to watch the research play out over the next decades, as we zoom in on what is causing the high rates of T2 diabetes.

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OldTech

This is one of my main concerns. I've gotten my BG levels under control (T2) eating LCHF for the last year. But I do worry that by keeping my carbs so low, I'm actually reducing my body's ability to manage carbs when I DO eat them. If I fall off the wagon in the future... will I have a body that's worse off than it was before?

 

Interesting take in the article about the different types of sugars (fructose vs. sucrose vs. glucose). It will be interesting to watch the research play out over the next decades, as we zoom in on what is causing the high rates of T2 diabetes.

 

Based on general experience with non-diabetics you will not be worse off than before. But it will take awhile for your body to adjust and I would expect it to take longer than for a non-diabetic. However, it is also possible that you still have diabetic damage continuing so you could be more carb intolerant than before, but it's not the LCHF that is the problem - it's your damaged metabolic system. You just won't know until you try.

 

Me? I have no plans to go off keto. It's keto for life. I'm carb intolerant and will stay that way and have no desire to tempt fate. And even if I could go off keto then I am back to eating carbs that are what caused the damage in the first place. No thanks!

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OldTech

I should also reiterate that physiological insulin resistance brought about by low carb is a conditional state and is not pathological.

 

PS a better name for physiological insulin resistance is glucose resistance since your cells are rejecting glucose because they are not ready to utilize glucose. It is the glucose resistance that makes insulin less effective in this case.

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