Physiologic Insulin Resistance
I'm hoping you can give me a simple response to a mess I've apparently created in my own body. I've queried Petro Dobromylskyj, because it was his blog entry of October 2007 (http://high-fat-nutrition.blogspot.com/2007/10/physiological-insuli...) that began to explain to me what was happening to my metabolism. I contacted Dawn Tasher (www.peelingbacktheonionlayers.com) because she was a strongly recommended nutritionist, and she suggested I get in touch with Paul Jaminet, whose work I'd seen on the internet. I've also had no response from him. My own doctor(s) don't seem to have answers. Like Peter, I am a veterinarian so am used to creative problem solving, often making difficult diagnoses on patients who are incapable of giving any history whatsoever on their health condition.
So here's my story. I have been a lacto-vegetarian for 45 years. Added in eggs about ten years ago. About 13 years ago, my husband embarked on the classic Atkins diet - as a vegetarian - to try to lose weight. After two days of eating extremely low carbs, he said he didn't care if he never lost an ounce on the diet because he felt ten years younger and was dedicating himself to living a low carb lifestyle forever. (He did end up losing 35 pounds and keeping it off). "Ten years younger" sounded great to me so I did my homework and joined in. I never needed to lose weight - at 5'4", my weight has fluctuated between 108 and 114 pounds since high school. So - I've been eating VERY low carb (probably less than 40 grams per day), with adequate calories, largely from fats, to maintain my weight for about thirteen years, feeling great, and enjoying what I eat. BUT - my fasting blood sugars have been consistently high (103-107 range) for the past several years when I've had my annual medical check-up. My A1c has always been OK, so my doc always shrugged her shoulders and we both casually figured it had "something to do with" my weird diet. When my A1c was elevated to 6.1 this year, I became concerned. My doc's comments were that if anyone simply looked at my blood work, they would assume that I was a diet-controlled diabetic - which clearly I am not. So the clearest explanation I found of what I've created in this amazing machine called the human body is Peter's explanation of physiologic insulin resistance. Made perfect sense. Several other hits on the web alluded to this same phenomenon, but the conclusions repeatedly run something like, "This is not a problem, a perfectly normal physiologic response, nothing to worry about AS LONG AS YOUR HGBA1C IS NORMAL" - which sadly now mine no longer is. Nobody seemed to have an answer as to what to do if your body has gotten so out of whack that this physiologic insulin resistance has taken you over the edge.
I've hesitated to just blast my system with 150 gms of carbs for three days as has been suggested - not sure how high my blood glucose might get. I'm hoping I might be able to flip my metabolism back to normal by simply adding in some safe starches (more in the range of80-100 gms/day) for a while. I've been checking my blood glucose very frequently throughout the day, and it seems to be all over the place. Same for fasting BG - below 100 about 50% of the time only. I failed miserably a full-blown carb challenge, eating about fifty grams of carbs for breakfast with no accompanying fat and had a one-hour post-prandial BG of 133 and two hours post-prandial of 143. I've been running this little experiment for about two weeks now, playing around with total carbohydrate numbers, different combinations of foods, exercise timing, and different carb sources - i.e. starches vs. lower glycemic fresh fruits. I might be getting somewhere since tonight I had a pre-prandial BG of 93, and a two hour post-full Chinese dinner (including lots of veggies, tofu, sauces, and rice), my two hour post-prandial BG was only 117. But tomorrow may be awful again. This is how it's been.
So - it seems that in an effort to avoid the harmful effects of hyperglycemia, I have created a metabolic environment in which hyperglycemia reigns. What to do? All I know to do is to just keep doing what I'm doing and hope for the best - not a comfortable option for the "double A" type personality that I've been called. Any advice would be greatly appreciated, as I know you must be extremely busy. Hoping this is a simple question for you.
Deeply thankful, in advance.
Most sincerely -
Rai Kaur Khalsa, VMD
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1 Posted by Hilary Fields on 26 Aug, 2014 03:44 AM
I have had a similar experience. Last December I began following Jaminet's Perfect Health Diet and in April had blood work done and was shocked to find the lab report say I had signs of insulin resistance. My A1c was 5.2. I thought it might be due to the relatively high starch intake recommended by Jaminet, a pound of "safe starches" per day. Among the safe starches are white rice and potatoes. So I cut out the starches and went low carb following a diet that could be called paleo. I bought the Rosedale Diet and I think I follow a very similar plan. No sugar, no grains, nothing processed, vegetables, grass fed meat and dairy, etc. In short, I lost about 10 to 15 lbs., look and feel great. 5'6" 132 lbs.
Today, August 25th, I had blood work done again and the numbers from April, when I had it before to now are much worse. My A1c is now 6.1 and the lipids are worse. My leptin dropped from 8 (or 11 depending on which lab number) to 2. My pro insulin to Cpeptide ratio is better but still not good.
I am very lean and I exercise regularly and always have. I am 64 and also have osteoporosis. I am dumbfounded by all of this because I feel like I am a fat burner because I don't get hungry or have cravings and I have never been a sweet or junk food addict.
It is extremely depressing and worrisome because I don't know where to turn. Any help from anyone would be greatly appreciated.
Thank you,
Hilary Fields
2 Posted by hrclint on 13 Aug, 2015 11:24 AM
Wonder if this could be the reason:
HbA1c measures the degree of glycation of your red blood cells’ hemoglobin; this is an indirect measure of how much blood sugar your cells are exposed to over time, since a red blood cell that’s exposed to more sugar in the blood over its life cycle will have more glycation. Thus, A1c seeks to establish the average level of blood sugar circulating through your body over the red blood cell’s life cycle, rather than track blood sugar numbers that rapidly fluctuate through the day, week, and month. It’s a measurement of chronic blood sugar levels, not acute. Sounds like a powerful metric for establishing diabetes risk, right?
It would be if everyone’s red blood cells had identical life cycles, but they don’t. Even though the A1c assumes that every person’s red blood cells live three months — no less, no more — the life cycle of an actual red blood cell differs between and even within individuals.
Ironically, the RBC life cycle depends on how well you control blood sugar. One study found that folks with normal blood sugar had red blood cells that lived up to 146 days and RBCs in folks with high blood sugar had life cycles as low as 81 days. For every 1% rise in blood sugar, red blood cell lifespan fell by 6.9 days. In those with better blood sugar control, RBCs lived longer and thus had more time to accumulate sugar and give a bad HbA1c reading. In people with poorer blood sugar control, red blood cells live shorter lives and have less time to accumulate sugar, potentially giving them “better” HbA1c numbers.
Furthermore, anemia can falsely increase HbA1c by decreasing the number of red blood cells (which need iron to fuel their production). If you have fewer red blood cells in circulation, the ones you do have accumulate more sugar since there are fewer cells “competing” for it. Anemia is a serious health condition, but it doesn’t mean you have diabetes.
HbA1c presupposes that everyone, everywhere has the same number of red blood cells in circulation living identical life cycles. It’s predictive over populations (and in most of the populace, a high HbA1c is cause for alarm), but in individuals it offers less value.
A better use of HbA1c is to track your personal trends. If HbA1c is going up over time, then you can and should worry. But if you have great blood sugar control (which likely prolongs the life cycle of your RBCs and gives them a better chance to accumulate sugar) and a high-ish HbA1c that remains stable, don’t freak out right away. Also, make sure you’re not anemic. And, of course, discuss all this with your doctor.
3 Posted by belanger.g on 18 Nov, 2015 04:29 PM
I'm very interested in hearing from Dr Rosedale about this. More specifically, is this a normal phenomenon when following a VLCHF diet for a very long time (i.e., decades). A simple solution which I can think of (and which I started doing for other reasons: in order to boost IGF-1 while keeping insulin low) is to give yourself a high carb weekend once per month to kind of recalibrate things in there. But my feeling is that there must be something else that is out of whack. For one thing, you don't see this kind of phenomenon in the inuits who basically live on fat for their whole lifetime. Hope Rosedale addresses this soon!