Prednisone, High Ketones, Low Insulin, Low HBA1C...but, Hyperlipidemia and Hypertrilyceridemia
First let me thank Dr. Rosedale for his work. I've learned much from him and enjoyed his talks on Jimmy Moore's podcasts.
I have been low-carb for over a decade. I've had my times of falling off the wagon, but always return, knowing that it's the only truly sustainable nutrition paradigm and lifestyle for optimal health.
In 2012 I found Dr Stephen Phinney's and Dr Jeff Voleck's work and went LCHF. That was a success both nutritionally and in fueling my athletic performance.
This year in May I decided to knuckle down and get completely committed to ketosis. I went hardcore and for the past three months have been eating a diet with a macronutrient ratio of 90/2/8 - fat, carbs,protein. I have also fasted intermittently nearly every day, eating only breakfast and dinner. I have experienced complete satiety, and have had plenty of energy to work in a demanding service job 14 hours a day. During this time I've been recovering from an ankle injury, so there was no athletic element. No "diet and exercise" scheme.
I tested blood ketones and glucose extensively throughout this period. At the beginning I tested as much as 10 times a day. I wanted to discover whatever patterns I could. As the first month came to a close, I began testing less frequently and during the last month only waking in the morning.
I logged all of the test data in spreadsheets on my Google Drive. I am happy to provide a share link to any interested parties.
During my hardcore three months I regularly measured ketones above 5 millimolar, and the highest at 7.2 millimolar. As well, my glucose stabilized to around 85 mg/dL.
Here's the rub:
This week I had blood drawn at Labcorp and worked up for four tests: complete chemistry including lipid profile, HBA1C, C-Reactive Protein, and fasting insulin.
Everything came back smashingly well except for the lipids:
HBA1C: 5.1
C-Reactive Protein: .9 mg/L
Fasting Insulin: 2.3 uIU/mL
Fasting Glucose: 94 mg/dL
Total Cholesterol: 443 mg/dL
HDL: 94 mg/dL
LDL: 309 mg/dL
Triglycerides: 200 mg/dL
This is not the first time I've seen high lipids on my LCHF journey. So there was no shock in most of what I saw. Most of it made sense from my understanding of the science.
What I'm having trouble with are the triglycerides. 200 doesn't fit in my understanding. To me it appears an anomaly.
So that's the purpose of my post. I am reaching out for help to understand why the trigs are so dang high. Please help me connect the dots!
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Support Staff 1 Posted by Ken on 12 Aug, 2016 05:29 PM
Samuel
First off Dr. Rosedale is not a big fan of checking ketones.
Ken/ Rosedale Support Team
2 Posted by Samuel Ashford on 12 Aug, 2016 06:40 PM
Ken,
Thanks for your response.
Ketones aside, my concern are the triglycerides. Nearly everything I read
tells me that my liver is manufacturing excess trigs as a response to how
many carbs I'm consuming. I'm currently eating under 10g a day average, so
I don't see how that explanation makes sense. Again, my fasting insulin is
2.3, which is below normal.
I haven't yet gotten TSH tested, so I haven't ruled out hypothyroidism.
The only other thing I have been able to uncover online is the possibility
of Prednisone. Exactly one week before my scheduled blood draw, my
podiatrist started me on a steroid pack to reduce inflammation due to
posterior tibial tendonitis in my right ankle.
I learned just yesterday that Prednisone can dramatically increase triglycerides. Could that be it?
I don't know how I could know without a subsequent test in a couple of
weeks. Though I didn't finish the pack (because I did uncover Prednisone's
equally significant effect on insulin sensitivity and I tapered more
sharply in time for the draw), I still took a total of 12 - 4 mg doses
prior to the blood work at Labcorp.
Still trying to understand.
Thanks,
Sam
Support Staff 3 Posted by Ken on 12 Aug, 2016 07:27 PM
Sam
I personally do not know about the Prednisone.
Dr. Rosedale would need to exam you to find out what is taking place, however, since he closed his private practice a few years ago, he no longer sees patients nor does any consulting.
Dr. Rosedale is very busy touring globally conducting seminars - teaching his science along with writing new material.
Ken/ Rosedale Support Team
4 Posted by Samuel Ashford on 12 Aug, 2016 07:40 PM
Thanks, I understand
Support Staff 5 Posted by Ken on 12 Aug, 2016 08:33 PM
You are welcome Samuel..
If interested you can be notified, News Sign Up, when Dr. Rosedale's new material becomes available.
Ken/ Rosedale Support Team
Support Staff 6 Posted by Ken on 12 Aug, 2016 08:43 PM
Samuel
I just found out the following and thought I would pass it along..
Prednisone will throw a wrench into any low carbohydrate dieting plans. You would need to retest when you have been off of the corticosteroid for a couple of weeks. You could just get a triglyceride without having to do all the other tests. Triglyceride will get better, as should your fasting glucose.
Ken/ Rosedale Support Team
7 Posted by Samuel Ashford on 12 Aug, 2016 08:58 PM
Yes, that confirms what I found.
Thanks!
Support Staff 8 Posted by Ken on 12 Aug, 2016 09:09 PM
You are welcome Sam ..
The best of health...
Ken/ Rosedale Support Team
9 Posted by Kristin on 18 Aug, 2016 05:32 PM
Hi Sam,
Prednisone can do nasty things. How long are you going to be on them?
Your A1c and glucose levels look great. Keep up the good work.
Your HDL is phenomenal which will also make your total CHO higher. With HDL that high your LDL particals are most likely large and fluffy which are heart protective.
How much saturated fat are you eating ? I found more mono / plant fats lower my CHO favorably. I eat at least o e avocado per day, Evoo, nuts and pumpkin seeds as my main fats. I do eat red meat but try to keep portions small. My macros of fat protein and carbs are 80/15/5. I thrive on a keto diet. Are you getting enough protein? I keep mine around 30 animal/ fish and the rest plant, about 40 but I am not a brick house.
I would wait until your off the steroids until you worry.
10 Posted by Samuel Ashford on 18 Aug, 2016 06:24 PM
Hey Kristin,
Thanks for the response!
For the past 3 months I have been eating a diet of 90% fat, about
two-thirds of which is saturated fat. I ate about an equal portion of
grass-fed butter, coconut oil, extra virgin olive oil, and whatever comes
from the foods - olives, avocados, and the meat.
Yes, I was pleased with several of the markers. But, of course, the Trigs
concerned me.
All that said, the ratios are not too bad. I'd like them to be even better,
though.
There is no question that I am in ketosis. What is concerning about the
Ketone levels, however, is that they are ranging above levels that Dr.
Stephen Phinney, for instance, consider normal. In fact, in his ranges, my
Ketone level is considered starvation. My average over the past three
months is 4 millimolar, and over the past month is averaging 5 millimolar.
There are some things I have under consideration which are liberating me a
little bit from being obsessed about the triglyceride level. I have always
been intrigued that the community of health-conscious people, physicians
and lay people alike, seem to be more concerned about particle numbers,
which are indicators, than focusing energy and effort on the root cause
itself. I have put a tremendous effort myself into following my numbers.
But it can be laborious, and life is much more than data crunching. Very
recently I heard something encouraging it has nothing to do with particle
numbers.
On a Livin la Vida low carb podcast, I heard a talk with Dr Dwight Lundell.
He is a cardiologist who's been around the block more than once. He has
performed over 15,000 surgeries. He says that he has no concern for the
lipid numbers whatsoever. His take on the whole matter focuses on
endothelial damage.
He said something in this podcast I've never heard. He related all of the
damage to the endothelium simply to glucose. He highlighted the fact that
most every cell in the body has insulin receptors, but this is not the case
with the endothelial cell. Therefore, his theory is simply that the glucose
is diabolical to the endothelium. The endothelial cell has no defense, so
it is easily damaged by glucose. So, anyone on a low carbohydrate diet,
should see improvement not simply with lipid numbers, but more importantly,
health of the endothelium, which is where all heart disease begins.
Anyway, I think I'm at the tip of the iceberg studying this. I know there's
a lot more to it than what I've begun to discover. Don't really know where
that will take me.
I have a calcium scoring test coming up 1st of September. That should let
me know where I stand with what's inside the arteries. I also have another
lipid panel and fasting glucose.
As to your original point, I have been giving a lot of thought to dietary
fat intake. After the upcoming screenings, if I don't see any Improvement,
I will probably take your advice and try a period of monounsaturated fats
exclusively. Until the test I think I'll keep my present diet in place so
I'll get an Apples to Apples comparison.
Thanks again for your interest and your help!
Sam
11 Posted by Kristin on 18 Aug, 2016 07:15 PM
I like your stance on apples to apples. Otherwise it only a guess. CHO recommendations are changing all the time so it's hard to know what's right. Personally I believe the ratios are the most important part.
Coco oil is a known offender for many people CHO so I would ditch that first. Of course GF butter is the highest quality ( especially if it's Kerry gold) but still quite high in sat fats.
I became an insulin dependant T 1 diabetic at 50 years old and have been eating a keto diet for 25+ years with a few ' eat healthy grains and fruit' trials that were horrid. I believe having great bs and insulin is the key to longevity. I eat small fatty meals and use the smallest dose possible. By that I mean the smallest dose in the pen. As an example, i take 1/2 unit per meal where loads of diabetics take upwards of 20. Keeping insulin low is almost more important than keeping bs low but of course we need enough insulin to remove excess glucose.
As far as your ketone levels I k ow very little about however being in the starvation range I have to still question your protein. We only need enough for maintenance and repair but we do need a certain amount. Have you seen a reduction in muscle mass? Have you done and use the Rosedale formula? I would think the starvation part might show you could use more protein? Protein and fat are essential to life, carbs not so much.
12 Posted by Samuel Ashford on 18 Aug, 2016 07:41 PM
Well first of all congrats on 25 years in ketosis, and the success you've
experienced.That's very encouraging. Sounds like you have a lot more to
manage than I do!
As far as the protein goes, I got the idea to cut back on it actually from
Dr. Rosedale. It was a talk between him and Jimmy Moore. The talk was on
MTOR and longevity. He just simply recommended that people shouldn't have a
protein intake exceeding one gram of protein for every kilogram of lean
body mass. For me, that comes out to about 60 grams of protein per day. I
am 5 foot 8, and 125 pounds. I am an endurance Runner, and that's about
right for my training weight. My weight at 18, on a very high carbohydrate
diet, when I was in the Army, was 128. For perspective.
In March I had a DXA scan done at a local University. My fat percentage was
9% comma and I don't recall my lean body mass at that time. BMI was on the
low normal side. I've been using a body mass scale daily for some time, due
to the concerns about protein and fat ratios. I don't know how accurate
these things are, but it measures my muscle mass, or rather muscle weight.
This morning as an example, it was a hundred and twelve pounds of lean
mass, and 5% fat. Again, accuracy?
13 Posted by Kristin on 18 Aug, 2016 08:45 PM
Haha. I am 5'8 and 123 pounds. I am not at all a runner unless there's a great sale on handbags. Just kidding. Since diagnosed diabetic 2 years ago exercise is minimal as it's tricky with injected insulin. Too many ups and downs.
I reduced my protein after reading the Rosedale diet and the mTOR pathway as well. I don't eat as much as suggested in animal/ fish but I'm maintaining muscle. More than 3 ounces at a time has a profound effect of raising my bs and is also insulinogenic. My BMI is normal- low as well but the only thing that makes me gain is carbs and obviously not good for bs but my gut doesn't like them either.
Odd you're not gaining weight in prednisone. As far as the body mass scales I wouldn't count on accuracy but perhaps more looking for trends.
Before all this did you have bs issues of any kind? I ask because as I was progressing through different stages of diabetes I could still manage to keep bs low through a VLC diet, moderate protein and exercise. However I had to keep cutting back carbs and protein as my insulin production was getting less and less unbeknownst to me. Finally I start d dropping weight eating more and more fat to try to gain. Didn't happen. At the end, my doctors , yes, plural, mis undiagnosed me and I was down to 94 pounds, near death literally. Roll forward, 2 months on insulin I gained all my weight and especially muscle back. It stopped right where I left off. I still eat the exact same VLC diet I was eating before all that. Point being, I think I saw your fasting insulin was low? I was told it didn't matter what I are or how much, without insulin I was starving in the land of plenty. I don't mean to suggest or scare you but you seem a guy of tests so perhaps ask for a c- peptide test and a GAD. C peptide shows how much insulin you are producing and GAD, glutamic acid decarboxylase will show if it's a autoimmune. Doctors for some reason don't like to run these tests but they are very important and will give you lots of answers. The only reason for the story is low insulin levels and high ketones point there. The type of diabetes I have is called LADA. Latent autoimmune diabetes in adults. Not so uncommon but doctors tend to wait to do those tests until it late. LADA is a slow onset T1 with characteristics of T1 and T 2 eventually leading to insulin. Insulin was the last place I wanted to go but I would fight anyone who would try to take it away. There are other meds like metformin. You can take in the interum to save pancreatic function and prolong things. I may be WAY off but the words low insulin and high ketones as well as starving is indicative. The GAD and c peptide will answer it. Simple blood draw.
I hope I didn't over load you!
14 Posted by Samuel Ashford on 18 Aug, 2016 08:49 PM
Hate to not be tracking with you, but "bs"?
15 Posted by Samuel Ashford on 18 Aug, 2016 08:52 PM
But that's gold to me about the c-peptide test and GAD. Believe me, don't
think diabetes hasn't crossed my mind. I've heard feedback that 2.3 could
be really good or diabetes. I just can't understand how A1C is normal with
diabetes. That's why it's a riddle to me.
16 Posted by Kristin on 18 Aug, 2016 10:55 PM
I'm pretty sure I have been some form of diabetic for many many years. I'm 52 right now. I followed the low fat high carb phase and gained tons of weight, tired, bloated etc. I was about 26 then. Then I found the carbohydrate addicts diet. (VLC). Dropped weight like crazy, energy sky rocketed, lipids great, etc. On to Atkins. Beautiful. Thrived on induction phase of 20 g carbs or less. Been doing this for 25 years but of course the quality of my foods have greatly improved and dropped all grains and starches including 'low carb' grains and all dairy. I used to LOVE to exercise. I was a junky. So full of energy had to keep moving all the time. That being said, I think I was diabetic though knowing nothing about it , I inadvertently kept it in check with a low carb diet and exercise for many years. About 7 years ago I had a nasty virus ( which can cause diabetes) and went to the hospital. That was the 1 st time I heard bs was high. 280. However all I could stomach before the hospital for 3 days was pediolyte for electrolytes and pineapple. I NEVER eat that stuff but couldn't get anything else down. Following recovery, I went back to my VLCHF diet and bs came back down. As time went on I had to reduce carbs even further but still higher than it should be with two handfuls of lettuce. and then found Rosedale and reduces protein as well and things again got better again. All this time my sugars ran around 85. Then started creeping up again. I was goi g to Drs for three years for unexplained weight loss, albeit slow, and rising bs. Of course they said I was fine. I asked for the tests I recommended and they said I didn't need them because bs was good. Well yeah, duh, I'm barely eating any food. Finally my stupid endocrinologist told me to just go out and eat a lot. 2500 cals ( twice what I eat ) so I did and literally overnight my fasting went from 85 to 250 and nothing i ate, didn't eat, exercise etc would bring it down. My pancreas couldn't keep up or catch up. He put me on amaryl, a med that squeezes insulin out of your pancreas. Well I already had failing pancreas no he squeezed it to death, literally. ( I am winning my law suit with him, just starting money negotiations) After 3 months of this nonsense I was in 3 hospitals in one month and finally put on insulin. So....you CAN have a great A1C and fasting bs as well as after meal numbers however, that doesn't mean you don't have bs disregulation by any means. The ONLY way to know is to test bs one and two hours after meals. Fasting bs is the last marker to go. However with your a1c being as it is I doubt you're spiking. BUT if you are more carbs you probably would. You seem very curious. Trot off to Walgreens and get a True To go bs monitor and some strips. ( half price on Amazon for strips) the test kit comes with 10 I think so you can get a general idea. However, the c peptide and GAD would tell you everything. I'm sure your bs is low BE AUSE of your diet, not necessarily because you have good bs regulation. I would NOT advise an oral glucose challenge test either. Just another bit.... Metformin and insulin are by far the two safest drugs. Sulfanase drugs are horrid.
All that being said, your diet and exercise are most likely keeping things at bay. Beg, plead and borrow for those two tests. Again, I'm not saying you are diabetic but I do think it's a distinct possibility. Those tests will give you proof one way or another. They will allow you to be treated correctly if there is issues or will put your mind at rest. There are so many things that cause it other than diet such as viruses, environmental factors , genetics etc. we don't all eat our way there , I know I didn't.
Riddle solved,,, your diet and exercise. Try eating some carbs!!! NO DONT.
Have you been losing weight? That's a big factor in needing more insulin. The high ketones scare me a bit. I'm
17 Posted by Samuel Ashford on 19 Aug, 2016 02:20 AM
Kristin,
Thanks for sharing your story and all the help. I promise this is the last
one I'll shoot you over this stuff.
I didn't really let divulge all the details of my testing the past
messages. I really am the nerd when it comes to tracking my health data.
And finger pricking. Earlier this year before I got back into testing and
hardcore ketosis (previously last marathon training season I was closer to
middle of the road fat than high fat), I went out on the edge and tried
something I probably shouldn't have. There's an endurance runner on the
ultra circuits, Michael Arnstein, who calls himself the "Fruitarian" and
eats only raw fruits and veggies. I read his stuff for a while and thought
I'd be the guinea pig and try it. I was careful to test glucose every hour
on the hour. Well, suffice it to say that after four days, I'd had enough.
I saw major spikes, and though my postprandial was always down 100% after 1
hour and back to normal after 2 hrs, when I saw a 220 right after a meal of
106g of fruit, I threw in the towel - even though 1 hour postprandial was
82 and 2 hour was 62. Most of the post-meal spikes were not that
pronounced. Most were 150s or so, eating a lot of fruit. Anyway, I tell
that tale to make the point that my postprandials, even under the most
extreme sugar loads - recently - have shown that the insulin is in fact
pushing the sugar into the cells where it should be, and out of the blood
where it should not be.
Over the summer during the three months leading up to my panels a couple of
weeks ago, I tested blood glucose and ketones like a madman the first
month. I have spreadsheet data a mile long saved in my Google Drive, and
I'd be happy to provide a share link if you'd like to view it. In some ways
it reads better than an A1C test because it shows precisely what the bs was
on a given hour - random, fasting, or postprandial.
BTW - I looked up the C-Peptide test on Life Extension (where I ordered my
other tests) and they have it. I'll be ordering it tomorrow.
Thanks again,
Sam
18 Posted by Samuel Ashford on 19 Aug, 2016 02:36 AM
Oh. And one last thing. My immediate postprandial at dinner tonight was 90.
Before the meal it was 86. Meal of 19 grams of carbohydrates, 100g fat, 22
g of protein. 1 hour was 93.
19 Posted by Kristin on 19 Aug, 2016 02:50 AM
Excellent! Do your test at two or three hours? That's a boat load of fat in one meal and can deny the spike for hours. Have you heard of the pizza effect? I'm sure you have. If their normal, keep doing what you're doing and get off the steroids as soon as possible! Very nice to see someone concerned with their health! Doesn't happen often enough.
20 Posted by Kristin on 19 Aug, 2016 03:07 AM
I posted a long lost that didn't show up. I'm happy to help and you seem to be on top of everything. Nice chatting with someone like that.
Great on your numbers! That's a LOT of fat in one meal. Do me a favor and take it around 4 or 5 hours later if you can. I'm sure you e heard of the pizza effect.
Try to get off the steroids as soon as you can. They are known to CAUSE diabetes. Maybe you could ask if you could have an injection instead? Much more isolated, doesn't effect the whole system and reduced inflammation faster.
No worries on chatting. Interesting to me. Health is my hobby, sad as it may be ....
I was an emergency medical tech, daughter had horrible stomach issues ( me too) and diabetes.
Just taking a stab in the dark but do you know if your blood type is O?
Support Staff 21 Posted by Ken on 19 Aug, 2016 11:47 AM
Hi Kristin, for some reason your post was flagged as spam - do not know why.
Ken/ Rosedale Support Team
22 Posted by Kristin on 19 Aug, 2016 02:04 PM
Sam, I didn't see your bs question. Stands for blood sugar. Sometimes I call it BS BS when it's not behaving. Yes the other bs is not blood sugar. Lol
I was contemplating the c peptide for you or not. You are obviously producing insulin but then again the question is how much? If you were to eat carbs I would think you would spike. You are coming back down but the spikes are not good. Insulin should keep up with bs and not get a spike. Though normal people do get random spikes. In the SAD diet, 130 carbs is nothing. There is also physiological insulin resistance in some people who eat VLC. If it's not too expensive might just be good info. At this point,moth your diet and exercise no meds should be needed so if you plan on continuing this way you should be fine.
As far as the GAD test, that will show if you have antibodies attacking yiur pancreas and burning out beta cells slowly.
At this point, on steroids, I'm not sure how much I would set things in stone. Since steroids CAN cause diabetes you might get false results. Just something for you to consider.