Ok, so this morning my fasting was only 85! A LOT better than the over 110 it was previous two mornings. Looks like VLC is working MUCH better for ME than mere LC.

Of course you are right about fruit. A large apple has literally more sugar than a caramello candy bar!

Maybe, but based on who is posting about PIR here, I doubt it. I have to say I'm really taken aback by your comment (it reminds me a bit of a doctor who advises a low fat diet for his overweight patient, then assumes he is non-compliant if he fails to lose weight). I can't speak for the others, but I weigh and track every morsel of food that goes in my mouth - for meals I eat at home - and have for 4+ years. I also weigh daily, it's just how I do things. Not that I don't occasionally deviate, but I'm 95+% compliant, and my excursions off plan are slight. Maybe that 5% is enough to undo all the good of eating LC, but I don't think so.

There are plenty of people who believe PIR is an actual phenomenon. Peter at Hyperlipid, a pretty smart guy, devotes no fewer than 10 blogposts to the subject. I think it is simply one of those things that you can't believe is true till it happens to you. And if it hits, it defies all logic.

Peter suggests Dawn Phenomenon may be related and it will affect approximately 55% of diabetics. Perhaps PIR has similar statistics. Enough may escape it to conclude that if it does happen to others, their plan is defective.

I wonder if a higher FBG may be "normal/OK" for those on a ketogenic diet, i.e. the body is raising it on purpose, like in hibernating bears. The medical world's idea of "normal" numbers is based on people eating the SAD. Rather than having a roller-coaster plot of BG on a vLC diet, perhaps the body adapts to a slightly higher base-level BG, which is still probably lower than the roller-coaster average. I.e. it may be adaptive so that cavemen have more energy to run down prey in winter when there are no carbs available.

But of course many do NOT track ANYTHING at all. They simply wing-it, no?

Are you saying that's a totally unreasonable assumption for me to make? If so, we may likely have to agree to disagree on that issue.

I could be wrong, but I strongly suspect that LOTS of people do NOT track, and are rather non-complaint with a true LC lifestyle. More than they really want to admit.

Perhaps not you...perhaps not the esteemed group of folks we have here in this thread...but many.

And I think it's reasonable to try and discover if someone might be "winging it" too much, before going to a lot of time and effort to then start trying to find if there is a medical issue, rather than a simple compliance issue.

I guess my thinking is let's rule-out for certain any possible tracking/complaince issues FIRST. And only then, start going to the effort to track down any possible medical issues or biological idiosyncrasies.

As a personal trainer, I have a great deal of experience which lets me know for 100% certain that MOST people are NOT tracking much of anything. Nor are they very compliant. Despite my constant input and motivational pep talks.

Heck, I even admitted I have not personally been walking the walk like I should have been, which totally explains my crazy high BG's. So I'm really not pointing the finger at anyone but myself.

I have clients all the time admit to me that they've been "off the wagon a bit"...and when I dig deeper they often admit they've been VERY off the wagon.

Of course there are those who, despite excellent tracking and compliance, still get less than stellar results. And I'd hate to accidentally offend such a person, as I seem to have offended you.

Nonetheless, I have found that such people are generally in the minority, and the "issue" usually tends to be too much winging-it. Just like I was doing too much of, and it was making me sick.

I literally "cured" myself of pre-diabetic/diabetic blood sugar levels in TWO DAYS by no longer winging-it and fooling myself about how compliant I was with an LC lifestyle.

And I'd be willing to wager that there are more than just a few folks on this huge forum, who are perhaps also winging it too much, and not getting anywhere near the good results LC could give them if they'd be better trackers and get more complaint with a true LC eating plan.

As for those, like yourself, who really and truly are 95% + compliant, yet still having high FBG's this thread was created for them, no? To discuss WHY they are having this issue despite great compliance.

Heck, as I go longer and longer with a REAL & TRUE LC diet (as opposed to my former "slacker version' of LC), I might also find myself with rising FBG's. Or I might have personal training clients who have this happen, despite near-perfect compliance. So I'd really like to get to the root of this.

Peter at hyperlipid seems to think it's harmless. I do NOT agree with him.

High glucose levels are not EVER good IMO.

Of course I'm not as erudite as Peter, and he could be right.

But I doubt it.

I believe there is something really wrong with people on a true LC diet seeing their BGs go up a little more from year to year.

I'd like to find out why this is happening.

My two main theories at this point are that excess iron and certain saturated fatty acids decrease cellular insulin sensitivity, which can then cause BG's to go up gradually. Even on an LC diet. Just not as bad as on a high cab diet.

But I could be way off base of course. Just a theory really.

I have theorized something similar to what you're saying here. That perhaps the body is trying to create a "glucose buffer" of extra glucose, since it senses virtually none is coming in from food.

But then I have to wonder why it takes YEARS for that to happen to folks on an LC diet? At least according to the anecdotal evidence I've seen.

Seems to me that such a survival adaptation, if one exists, would happen much sooner.

Therefore I have put that theory on the back-burner, but still open to it being possible.

Also open to the possibility that higher than "normal" BG's MIGHT not be so bad within context of low insulin levels. But not convinced of that either. And strongly suspect it's NOT at all ok.

I think the bottom line is that nobody knows why this happens to some.

But I would like to find out just what percentage this actually happens to. Threads like this could kill people's motivation to do an LC diet. A diet that is a LIFE SAVER for so many.

I'd hate to think someone who really needs to be on an LC diet is coming to the conclusion that long-term LC is a de-facto path to pre-diabetic blood sugar levels for anything but a small minority of people.

Frankly, if I want to read this kind of attitude I would spend my time visiting vegan sites, because they know full well that "If what's working for me is not working for you, then you are not doing it right." Jeez.

I fully agree with this.



Suggesting those who have revealed they may suffer from this this problem are non-compliant is not a good way to find out who else may be experiencing it.



This a pretty esoteric topic; I doubt your average person wanting to improve blood sugar by eating low carb is going to be frightened off by it. There are many many more comments to the effect of how good LC is for your blood sugar. It's such an illogical condition that (as I've said a few times now) it is really not sensible to think it might happen to you until it does.

So we've established you are indeed very complaint with LC. So we can rule that out. What's your best gut-instinct on why you have high FBG's? Are you concerned about it? Or do you feel it's perhaps a non-issue within context of LC diet and low insulin levels?

Hi Turtle - Not sure if this was directed at me, but if so, it appears you may have not read what I actually wrote in full. Either that, or I failed to communicate properly.

Having said that, I do find it somewhat perplexing when people get so easily offended if asked about how complaint they are. As if their character is being called into question.

I certainly would not be offended by such a question.

In fact, I find being asked about compliance to be the MOST logical thing in the world. Because only after ruling out the possibility of so-so compliance, can we really justify spending the time and energy to ferret out possible medical issues which may be interfering.

And it is an irrefutable scientific and real-world FACT that MOST people are NOT very complaint with ANY dietary template. Even if heavily supported, let-alone when doing it solo.

For instance, I've had several email exchanges with Dr. Scott Gardner of the A to Z Diet Study, which showed better overall outcomes for the Atkins diet than the Dean Ornish, ZONE, or LEARN eating plans. He says his study, and most every other study done on diet, shows that MOST people are NOT really that compliant with ANY diet for long. At best, just like I admitted I was doing, they follow a rather "lenient" version of whatever diet they're on.

Heck in his A-Z study, they even had intensive help from a dietician to help them follow each of the 4 diets to the letter as best as possible. Even with such help and the "external motivation" of knowing they're in a big study, most of the ladies in the study (311 obese females) simply slacked on their efforts more and more as time went on.

So when myself or someone else brings up the issue of compliance, it is NOT an accusatory finger being pointed in your face, it is simply a statement of FACT.

For many at least.

Perhaps not you. Perhaps not many in this thread. But really no controversy about suggesting MOST are NOT fully complaint with ANY diet long-term.

If anyone has facts to the contrary, I'd love to be enlightened.

I'm not happy about the high FBG, but I'm not particularly worried either as long as my PPs are <140. I believe Jenny Ruhl when she says that is when the damage happens. I should also mention that my FBG is not always that high. Today it was 99. Once I add back IF 2x/week (which I plan to tomorrow), I expect to see it in the mid eighties at least a few times a week.

I guess the explanation that makes the most sense to me is that the body creates insulin resistance in the context of a low carb diet to supply the muscles with glucose when they need it.

Today I added back some cardio and resistance exercise to my routine. I left at 3 pm, 1 hr pp at 110. I came back 2.5 hrs later (actual exercise: 80-85 min) and tested my blood sugar: 108. There is either some serious gluconeogenesis going on or I'm not making insulin at all (not likely, though - I know I have circulating insulin levels in the low normal range).

What makes you think it is caused by iron or sat fats?

I addressed these issues earlier in this thread I believe. I'm too tired right now to post it again. But pretty well accepted that excess iron messes with insulin sensitivity. Which is why even some in LC community advocate giving blood.

Although probably NOT an issue for young woman who still menstruate. Post menopausal it can become an issue.

LC diets tend to supply a lot of iron via red meat.

The sat-fat issue seems to be more controversial, so I'm kinda on the fence about that one. But leaning more towards the belief that SOME sat-fats MIGHT indeed decrease cellular insulin sensitivity. This is an idea that's been around a long time actually, and has not been refuted yet to my knowledge. Whether this happens within context of an LC diet however is even more controversial. It's possible that sat-fats only do this withing context of lots of glucose/insulin.

I think the iron theory is the stronger of the two.

But of course it might be wrong entirely.

Do you sleep well?

Sleep deprivation is well-known to mess with insulin sensitivity. Even just one night of sleep loss makes you somewhat insulin resistant the next day apparently. let alone chronic sleep deprivation.

CoachJeff, love your long explanatory post on BG/compliance/LC. I wondered if you were willing to test your hypothesis (not really a theory which is an explanation of findings and so far you don't seem to have any) with an N=1 experiment. Or if anyone else is willing to join you in this little experiment.

If I am correct, you are hypothesizing that a LC diet leads to (or can lead to) higher iron levels in the blood which may affect fasting BG.

Here is the experiment:

Go to the Red Cross (or any other center) and donate blood.

Mike Eades, in one of his PP books talks about possible iron accumulation from LC. As a result, he and his postmenopausal wife donate blood annually.

Why not try a little blood letting and test you BG before and after--but only after a strictly monitored and compliant LC or ketogenic diet for at least a month. If you notice a result, please post it here. You could even do a one year investigation of this hypothesis.

This year hold to a very strict LC plan, track with a computer program to make sure your carbs remain low and you know what your protein intake is, and donate blood as often as you are allowed during that year. Since you will be tracking your daily BG anyway (I assume) you should have results both after every blood letting and by the end of the year.

Be sure to start with some blood work to see what your tested fasting blood glucose is and your ferrous levels. You might do these fasting blood tests one week after every blood letting. Be sure to end the year with a final fasting BG/ferrous reading.

It's OK to hypothesize, but better to have some facts. That's why I like Westman, Volek, Phinney, and Bernstein. They actually test their hypothesis. And data from a well controlled N=1 experiment is better than speculation.

Liz53, would you be willing to test Jeff's hypothesis too? That way we have a compliant diabetic(?) woman and a not-so-compliant-non-diabetic man's results.

It might even be interesting to set up a challenge on this forum to get as many low carbers (regardless of plan) involved as possible. That way, we are not just speculating and arguing, we might be contributing to the knowledge base on LC.

Compliance with the diet through computer/internet monitoring would be a confounding variable especially for a year long study -- as Gardner found in his study. So reporting on findings could be every 3 months.

What do you think? Are you willing to try?

To CoachJeff on compliance. "I hear you" as we used to say. I agree, many do not monitor or measure at all. Others are more interested in why/why not the diet is working and monitor carefully. I can accept your observations on this. But, remember, most LC books are careful to point out that you don't have to count your carbs--just follow the plan. As a result, many low carbers are loosey goosey about what they eat but think they are following a low carb diet. I have a friend who was explaining to me yesterday why she liked the South Beach Diet. "You can have whole natural foods like bread." She is not a stupid woman. (I am trying to get her to read The big Fat Surprise and NAFNY because she said she needed to lose weight and low carb was what worked for her before.) Was she non-compliant? Did she misread SB? Or did she misunderstand the principle behind LC? Quien sabe?

For those of us who do carefully monitor everything we put in our mouths (whether by computer program or paper and pencil) that has been first weighed and measured, we get quite touchy when people assume we are being non-compliant and that is the cause of our failures. (It's always easy to have 20/20 vision looking at others or re-imagining the past.) There are also people like me who are constitutionally unable to be consistent about anything--including monitoring and following a LC diet. I take breaks, gain some weight and get back on the wagon. But that's just me.

Last, the definition of LC depends upon the program--some are far more liberal than others allowing fruits and vegetables and giving a carb count of below 75 "net" grams/day. That is not my definition of LC but it is theirs. So for any comments about how compliant people are to a LC diet, it is best to know what plan they are on and what amount of what carbs they are allowed on their plan. This forum is a LC forum although it bears the title Atkins. But the variety of plans differ widely on carb counts.

Over all your observations on compliance issues are similar to mine. Love your posts.

The weights thing could go either way, though. When I first started measuring blood glucose, I tested a lot during workouts, etc. I wasn't pushing ketosis like I am now. Fasting blood glucose was generally in the mid-80's to low 90's. Most days, my highest blood glucose level wasn't after a meal--it was during a workout. After a set of deadlifts, it wasn't unusual for my blood glucose to be somewhere in the 120's. Now that I'm eating more ketogenically, it's rare for a set of deadlifts to put my blood sugar past the 90's, and a reading in the 80's isn't uncommon. I figure lower liver glycogen levels are probably behind this--adrenaline/cortisol inducing mobilization of fuel during heavy exertion, and when liver glycogen is relatively high, blood glucose goes up. Exerted muscle will upregulate glucose uptake, but in the short term, the liver can outstrip the muscle's ability to clear glucose, as long as glycogen stores are sufficient.

http://eatingacademy.com/nutrition/...-ketosis-part-i

Peter Attia's blood glucose here went from 77 to 132 doing high-intensity training.



It's a little muddied, because he did take in some very slow carbs and BCAA's. Over the course of the day, I do think using up muscle glycogen will create a sink--competition for glucose storage in muscles vs. liver, and lower liver glycogen probably equals more ketosis, less glucose dumped into the system when stress hormones are elevated, etc.

Also, on a ketogenic diet, carbohydrate metabolism needs to be very efficient. In the extreme of total starvation, it gets to the point where total oxidation of glucose is nearly exclusive to the brain. When glucose is used by other organs/cells/tissues, it's basically fermented to pyruvic or lactic acid, but then makes its way back to the liver or kidney to be made back into glucose. The anaerobic portion of exercise can at least theoretically be satisfied without much loss of carbon from the glucose cycle. If a person on a high carb diet lifts weights, muscle glycogen is broken down and used in both aerobic and anaerobic metabolism, in a well-adapted ketogenic dieter it should be spared for primarily anaerobic metabolism--this efficiency might lose us much of the glucose "sink" that glycolytic exercise would provide to somebody on a moderate or higher-carb diet.