This is Part Three of a series of three Posts. Part One and Part Two covered questions about Type 2 Diabetes. Part Three covers Gestational Diabetes.
What is gestational diabetes?
Gestational diabetes is high blood glucose (sugar) in a pregnant woman who has never had diabetes before, and it only occurs when a woman is pregnant.
The cause of this condition is not completely understood. It is thought that the hormones that are normally present during pregnancy block the effects of insulin in the mother’s body. This leads to a build up of high blood glucose levels. This condition goes away after the baby is delivered and the pregnancy hormones return to normal levels.
Gestational diabetes that is not treated during the pregnancy can cause certain problems for the baby. One of these problems is a condition called macrosomia, which means the baby is born overweight. Babies with macrosomia can suffer from shoulder damage during birth, and they can have problems with their blood sugar and ability to breathe at birth as well. Protecting the baby from these problems is the main reason why diagnosing and treating gestational diabetes during the pregnancy is so important.
Mothers who have gestational diabetes are at risk for developing high blood pressure during the pregnancy. This leads to a higher likelihood of having to undergo a C-section when the baby is born. In addition, the mother is at higher risk of developing type 2 diabetes later on after the baby is born.
What are the symptoms of gestational diabetes?
These symptoms can include feeling thirsty, feeling hungry, having a dry mouth, urinating often, and being tired. Because these symptoms typically occur with pregnancy anyways, the diagnosis of gestational diabetes is usually made by lab work that is routinely performed during pregnancy.
Gestational diabetes usually develops during the sixth month of pregnancy or later, and this is usually when the mother will be tested for this condition. Mothers who are at higher risk of developing gestational diabetes may be tested sooner than that. Typically, a glucose screening test is performed, which consists of drinking a liquid that contains glucose (sugar), and blood is drawn one hour afterwards to assess the blood glucose level. Depending on the results of the blood glucose level, a glucose tolerance test may be performed.
A glucose tolerance test can consist of several steps. First, the mother will be asked to fast (not eat) the night before the test. Then, blood is drawn the next morning while the mother is still fasting. The mother will then drink the liquid glucose again and have labs drawn one hour, two hours, and three hours afterward. The lab measures the blood glucose levels at each of these intervals. The diagnosis of gestational diabetes is confirmed based on the results of these tests.
How do you prevent gestational diabetes?
The best prevention for gestational diabetes is a healthy lifestyle and a normal weight, normal blood pressure, and normal blood glucose levels before becoming pregnant.
Women who are more likely to develop gestational diabetes while pregnant have high blood pressure, high blood glucose levels (but not high enough to be diabetes), and were overweight before becoming pregnant. Also, women who were diagnosed with gestational diabetes during a previous pregnancy are more likely to develop it if they become pregnant again.
How do you treat gestational diabetes?
Lifestyle changes are always recommended to the mother when gestational diabetes is diagnosed, and these include physical activity and dietary changes that are specifically directed by the mother’s physician. The mother’s weight and blood sugar levels will also be closely watched by her physician during the pregnancy as well. The baby’s weight and growth will be carefully watched by ultrasound studies during the pregnancy. In many cases, lifestyle changes are the only treatment needed for gestational diabetes.
If a medication is needed, then insulin is typically used, as it is the safest medication for the baby. Other pill medications can be added to the insulin if the physician feels they are necessary. The medications are usually stopped once the baby is born.
The source of this information is the Virta Health website. Here is the link, please copy and paste it into your address bar
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What are the first warning signs of type 2 diabetes?
The “classic” signs of type 2 diabetes which lead people to see their doctor generally includes excessive thirst, frequent urination, blurred vision, numbness or tingling of extremities, weight gain and fatigue. However, these signs generally show up once someone has already developed diabetes. There are more subtle warning signs that can develop years earlier.
The most common early signs of type 2 diabetes can be fatigue and weight gain, but also surprisingly include symptoms of low blood sugar as well. Signs of low blood sugar generally develop when someone hasn’t eaten for a few hours, and include symptoms like nausea, light-headedness, severe hunger and irritability. This occurs due to a drop in blood sugar between meals, often caused by overproduction of insulin in people who have become insulin resistant. Interestingly, people can experience some of these symptoms, like hypoglycemia and irritability, before they even have a large elevation in their glucose or Hemoglobin A1c. If you are experiencing any of the symptoms listed, you should consider seeing your doctor and getting a blood test for diabetes.
How do I know if I have diabetes?
Type 2 diabetes is diagnosed in a number of ways. These include a fasting glucose of > or = 126 mg/dL, a hemoglobin a1c of 6.5% or greater, or elevated glucose on an oral glucose tolerance test. In addition, a random glucose of >200 is suggestive of diabetes.
However, there are a number of signs and symptoms that suggest type 2 diabetes and should make you consider getting a blood test. These include excessive thirst, frequent urination, blurred vision, numbness or tingling of extremities, weight gain and fatigue. Other possible symptoms include erectile dysfunction in men and irregular periods in women.
What are the symptoms of type 2 diabetes?
Symptoms of type 2 diabetes mellitus are as varied as they are unpleasant. If you notice any of the symptoms mentioned in this post, it would be advisable to seek medical attention.
For example, one might notice an increase in urination. A hallmark feature of type 2 diabetes is an elevated glucose (sugar) level in the blood. When blood glucose levels are high, the kidney struggles to filter the excess glucose out of the urine. The urine thus contains more glucose than it should, and this leads to higher volumes of fluid leaving the body through the urine. This is often accompanied by an increase in thirst.
Additionally, type 2 diabetes makes it difficult for the body’s organs to receive dietary fuel in the form of glucose. And when the body’s organs aren’t getting the energy they need to perform as they should, this can lead to fatigue and hunger.
Type 2 diabetes also makes it harder for the body to heal. This can lead to more frequent infections and slow-healing wounds.
Elevated blood glucose levels from type 2 diabetes can lead to blurry vision. Vision can improve as blood glucose levels decrease.
These particularly worrisome symptoms warrant seeking medical attention immediately:
very severe dehydration and
a significant impairment of one’s ability to think and speak clearly.
What are the symptoms of type 2 diabetes in women?
In general, men and women have similar symptoms of type 2 diabetes. These include excessive thirst, frequent urination, blurred vision, numbness or tingling of extremities, weight gain and fatigue. However, there are some additional symptoms in women that may signal possible type 2 diabetes. These include frequent vaginal yeast infections or urinary tract infections. High blood glucose levels make infections more common and difficult to treat. While there are obviously many possible cause for these infections, patients experiencing recurrent or severe infections should consider evaluation for diabetes.
Another frequent issue seen in women with prediabetes or type 2 diabetes is Polycystic Ovarian Syndrome (PCOS).This syndrome is thought to be connected to insulin resistance, a key component of diabetes, and common symptoms of PCOS include irregular menstrual periods, acne, pelvic pain, and infertility.
In addition, it is important to note that women with a history of gestational diabetes during pregnancy have an increased chance of developing type 2 diabetes in the future. If you have a history of gestational diabetes and have any of the symptoms listed here, it is a good idea to have a blood test for diabetes.
What are the symptoms of type 2 diabetes in men?
In addition to the commonly discussed symptoms for both men and women, another issue discussed less frequently is erectile dysfunction.
How can you prevent type 2 diabetes?
One of the most important first steps one can take to prevent type 2 diabetes mellitus (T2DM) is to reach out to a primary care provider.
A growing body of evidence shows that a well-formulated ketogenic diet can improve and even reverse T2DM. The diet significantly lowers blood sugars. Please see the related post on the best diet for type 2 diabetes.
One medication, metformin, has been shown in multiple studies to be effective at preventing the onset of T2DM. Metformin is both inexpensive and without long-term safety concerns.
There is scientific evidence that suggests that certain foods like refined grains and sugary beverages are associated (that is, they tend to go hand-in-hand) with an increased risk of developing type 2 diabetes mellitus.
There is a strong association between obesity and developing type 2 diabetes, but not all obese people will develop diabetes.
Obesity, like type 2 diabetes, can be caused by any combination of a number of genetic and environmental factors. Diet and exercise can be modified to prevent obesity.
What is the best diet for type 2 diabetes?
The scientific evidence in support of a well-formulated ketogenic diet to improve the health of folks living with type 2 diabetes is so compelling that the American Diabetes Association and the European Association for the Study of Diabetes recently issued a consensus report in which they acknowledge the value of a low-carbohydrate diet to help people living with type 2 diabetes.
Can a ketogenic diet reverse type 2 diabetes?
Insulin resistance is the hallmark of type 2 diabetes and manifests as carbohydrate intolerance. Like other food intolerances, the most logical and effective approach to managing carbohydrate intolerance is to restrict sugars and starches to within the individual’s metabolic tolerance.
A well-formulated ketogenic diet can prevent and slow down progression of type-2 diabetes, and it can actually resolve all the signs and symptoms in many patients, in effect reversing the disease as long as the carbohydrate restriction is maintained.
How do I manage my medications if I make dietary changes to improve my diabetes?
We strongly recommend that patients with type 2 diabetes consult a medical professional before making dietary changes. Changing your diet, particularly changing to the well-formulated ketogenic diet can be incredibly powerful in improving blood sugar and even reversing type 2 diabetes.
However, because of the rapid blood sugar and blood pressure improvements that are seen, it is very important that you have medical supervision while making dietary changes. This is particularly important in patients taking medications like insulin or sulfonylureas, which can cause dangerously low blood glucose.
In addition, newer diabetes medications such as SGLT-2 inhibitors, can lead to a dangerous condition known as “euglycemic diabetic ketoacidosis,” in which patients can have normal blood glucose but dangerous changes in the acidity of their blood.
In addition, due to the rapid improvements that are often seen in blood sugar, it is important to have close monitoring of your biomarkers. This can be difficult for most clinics to provide, but is part of the continuous remote monitoring that is part of the Virta treatment. They sometimes adjust medications multiple times in one day, and often need to be proactive in reducing medications to avoid dangerous low blood sugars.
Does cinnamon help treat type 2 diabetes?
Cinnamon has been extensively studied without showing consistent results.
Diabetic retinopathy can develop when a patient living with type 2 diabetes mellitus (T2DM) has high blood sugars that damage the blood vessels in the retina. Read more at https://blog.virtahealth.com/diabetic-neuropathy/
Can I reverse diabetic neuropathy, nephropathy, or retinopathy with a ketogenic diet?
We have many anecdotes of reversal of neuropathy, retinopathy, and nephropathy in people with T2D following a well-formulated ketogenic diet but there are not objective data (i.e. published peer-reviewed studies) to provide evidence that this is true. Learn more by watching the in this link https://blog.virtahealth.com/reverse-diabetic-neuropathy-nephropathy-retinopathy-keto/
What are diabetic foot problems?
There are many complications (problems) that can happen to the feet when a person is diagnosed with diabetes. These include problems with the nerves, problems with the blood vessels, and problems with healing. Read more at https://blog.virtahealth.com/diabetic-foot/
What is the treatment for diabetic foot problems?
Checking your feet on a daily basis and avoiding injuries to your feet are the best way to prevent diabetic foot problems. Keeping good control of your blood glucose, blood pressure, and cholesterol levels also helps slow the progression of nerve and blood vessel damage that causes diabetic foot problems. It is also best to have your feet checked by your physician or podiatrist (foot doctor) at least once a year
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In this video, Dr Hallberg goes over the underlying causes of type 2 diabetes, how to reverse it through nutritional ketosis, and most importantly, what the research says. What follows is the condensed transcript.
Carbohydrate intolerance and insulin resistance.
What does these terms mean?
To understand, let us start with insulin. Insulin is a hormone our fat storage hormone. You can’t store fat without insulin. Insulin is what helps us dispose of blood sugar from our circulation into the cells where it can be used. When we eat insulin rises different amounts depending on what we eat, to help us dispose of blood sugar.
It’s important to understand what the insulin response is to the different macronutrients and what we see is the same thing that happens with blood sugar, which makes sense because if our blood sugar is rising, our insulin is going to need to go up as well to dispose of that blood sugar, pushing it into the cells.
So what we see is that with carbohydrate consumption insulin goes up a lot. Peaks quickly and drops fast. With protein it gets a lot better. Look at what happens when we consume fat – nothing there’s not an insulin response. That’s going to be important as we make our food choices – what actually happens with insulin and blood sugar when we eat.
The first thing that I think we need to start with, is understanding how much sugar is actually in our blood or our circulation at any given time. The average adult has five liters of blood running through their circulation at all times. If you think of a two-liter of soda I mean this is a lot of blood and in that blood their sugar. But actually the amount of sugar is a lot less than most people think.
An average blood sugar – most people realize a good one would be less than a hundred but less than a hundred what?What does that mean in a context that we can wrap our head around? If you do the math on this what that means is five grams of sugar dissolved in five litres of blood. Not much, especially when you realize five grams actually is just a teaspoon. What’s supposed to happen after we eat is when blood sugar starts to rise, insulin rises and helps us dispose of sugar into cells where it can be used. But remember I said that’s what’s supposed to happen in a system that’s functioning normally.
But now let’s get into insulin resistanceand the food choices that we make. Now most of you realize that a soda is not a good food choice. Right. We can all accept that. A can of sugared soda is not gonna be healthy for us. We know it’s gonna cause our blood sugars to rise. Why? It’s full of sugar.
Other carbohydrate food choices that we sometimes think are healthy for us are full of just as much sugar. If we compare a can of soda to a cup of brown rice, the brown rice has more sugar than the can of soda. More. It’s amazing.
Let’s take a look at what happens if we eat a cup of brown rice. You might have thought that was a good choice for two reasons, Number one it’s low fat, number two it’s actually pretty low calorie. A cup of rice only has about 200 calories.
Foods that we think are healthy for us, we’ve been told are healthy for us, if we have insulin resistance they’re still not a good food choice.
So for someone who consumes a cup of brown rice but is insulin resistant, here’s what we found – a cup of brown rice contains 45 grams of carbohydrates. That’s 9 teaspoons of sugar. You remember, in our system there’s one teaspoon. What is our system to do with nine teaspoons rushing in from a supposedly healthy food? What our body does is insulin levels rise and as insulin levels rise it helps push the sugar into the cells, so that our body can keep the 1 teaspoon at a teaspoon.
That’s what’s supposed to happen but in someone who is insulin resistant insulin isn’t doing its job.So as those 45 grams come rushing into our circulation, we’re unable to dispose of them as we should. So our body’s response to that it’s just make more and more insulin.
Our insulin levels, they rise and they rise. We’re carbohydrate intolerant. So we have to be very cautious here and not presume that some of these healthy carbs are actually just that. Because when the carbohydrates are high and we are insulin resistant. They’re gonna cause a problem either way. They haven’t gotten high enough and we can dispose of the sugar for a while. But years, maybe even decades later our system can’t keep up any longer and our blood sugars start to rise. That’s now diabetes.
Let’s talk about carbohydrate tolerance vs. carbohydrate intolerance.Some people have a high carbohydrate tolerance. What does that mean? When they consume foods, specifically carbohydrates their insulin levels will rise, they need to, to dispose of the sugar coming in into the cells. But they don’t need that much insulin because their carbohydrate tolerance is high.
Now, for people who have a low carbohydrate tolerance who are carbohydrate intolerant, if they consume the exact same food, let’s say a cup of brown rice. What’s gonna happen with their insulin levels? They’re gonna go up dramatically, because their body is resistant to the insulin and therefore they need a lot more of it, a lot more insulin, a lot more of our fat storage hormone to dispose of the same amount of carbohydrates. So what we see here two very different things – high carbohydrate tolerance, low carbohydrate tolerance.
With low carbohydrate tolerance this is driven by insulin resistance causing our body to need to make much more insulin, much more fat storage hormone.What does that do? It puts us into a vicious cycle. So for someone who has a low carbohydrate tolerance if they eat carbohydrates over their tolerance, what happens is they need more insulin. So our body releases more insulin and this actually leads to the insulin resistance getting worse.And around and around we go. People get stuck in this, they get stuck in this vicious cycle when they have a low carbohydrate tolerance driven by insulin resistance.
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Type 2 diabetes (T2D) has long been thought of as a progressive, incurable chronic disease, largely because traditional means of treatment have had limited potential to reverse the disease.
Newer research suggests reversal is possible through three methods: bariatric surgery, low calorie diets (LCDs), very low calorie diets (VLCDs) and carbohydrate restriction.
Sarah Hallberg, DO, MS of Virta Health recently published a review of 99 original articles examining the evidence for type 2 diabetes reversal using each of the three reversal methods. We have included the advantages and limitations of each summarized below.
Defining diabetes reversal. We have defined reversal as maintaining an HbA1c below 6.5% without the use of glycemic control medications. Metformin was excluded from this criteria because it is not specific to diabetes.
Diabetes reversal intervention 1: Bariatric surgery: The most commonly performed bariatric surgeries in the U.S. include laparoscopic and robotic Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG). Anatomically, they both decrease the size of the stomach with RYGB also diverting the small intestine. Bariatric surgery has also been shown to cause alterations in GI hormone releases that may impact eating, hunger, and satiety as well as affect gut microbiota populations.
Advantages of bariatric surgery:
Unilateral improvement in glycemia following operation
High rates of T2D remission compared to the non-surgical groups
Three-year remission rates of up to 68.7% after RYGB
Rapid blood glucose improvements (within hours to days), which likely represents the enteroendocrine responses to altered flow of intestinal contents (i.e., bile acid signaling and changes in microbiota and their metabolome).
Disadvantages of bariatric surgery:
Surgery of any type can be associated with complications leading to morbidity or mortality. Complication rates have been stated to be as high as 13% and 21% for SG and RYGB, respectively.
Significant financial costs of an average of $14,389US.
Increased likelihood of long-term adverse events.Major adverse events included medication intolerance, need for reoperation, infection, anastomotic leakage, and venous and thromboembolic events.
Diabetes reversal intervention 2: Low calorie diets (LCDs). Several studies have reported successful weight loss with decreased insulin resistance and medication use following a LCD or a VLCD. Total calories per day in studies for VLCDs range from 400-800kcal. LCDs range from 825-1800 kcal per day and the higher range has been shown to be significantly less effective. Research suggests that LCDs are effective in reversing diabetes in the short term (up to two years), especially in patients with a more recent diabetes diagnosis.
Advantages of LCDs:
Quick improvements in glycemic control.A low-calorie diet of 900 kcal, including 115 g of protein, led to significant improvement in glycemic control attributed to improvements in insulin sensitivity.
Effective in the short term.A VLCD and gastric bypass surgery were equally effective in achieving weight loss and improving glucose and HbA1c levels in obese patients with T2D in the short term. DiRECT (Diabetes Remission Clinical Trial), a community-based cluster-randomized clinical trial with 306 relatively healthy participants with T2D (given an 825 kcal/day formula for 3-5 months) found that at one year, 46% of patients met the study criteria of diabetes remission (HbA1c <6.5% without antiglycemic medications). This dropped to 36% at two-years.
Disadvantages of LCDs and VLCDs:
Overall difficult to sustain.In one study, weight loss persisted in the diet-treated patients only for the first three months, indicating difficulties with long-term maintenance. Other studies also reported similar pattern of early blood glucose normalization without medication use, but the improvements were not sustained long-term. One study showed that while a VLCD normalized glucose levels within a week; however at 12 weeks over a quarter of the patients had an early recurrence of diabetes with an average weight regain of 20%.
Requires substantial caloric restriction. A substantial level of calorie restriction is needed to generate enough weight loss to reverse diabetes. Short-term interventions with moderate energy restriction with metformin (which led to modest weight loss) were less effective in reversing diabetes than standard diabetes care.
Severe energy restriction may have negative long-term effects.Studies have suggested that the body undergoes physiological and metabolic adaptation in response to caloric restriction, and this may shift one’s energy balance and hormonal regulation of weight toward weight regain after weight loss.
Diabetes reversal intervention 3: Carbohydrate restriction: Before insulin was discovered in 1921, low carbohydrate (LC) diets were the standard of care for diabetes. With the emergence of exogenous insulin, the goal became to maintain blood sugar control through the use of medications instead of preventing elevations in blood glucose by restricting carbohydrates in the diet. In response to recent studies, the idea of preventing blood sugar elevations with carbohydrate restriction has found its way back into the mainstream standard of care.
A low carbohydrate diet typically restricts carbs to less than 130 grams per day, and a ketogenic diet to 20-50 grams per day.
Advantages of carbohydrate restriction:
Highly effective.In our published trial providing significant support through the use of a continuous care intervention (CCI), we examined using a low carbohydrate diet in patients with T2D, compared with usual care T2D patients. At one year, the HbA1c decreased by 1.3% in the CCI, with 60% of completers achieving a HbA1c below 6.5% without hypoglycemic medication (excluding metformin). Insulin was reduced or eliminated in 94% of users. Most cardiovascular risk factors showed significant improvement. Improvements were not observed in the usual care patients. Another 34-week trial found that a ketogenic diet intervention (20–50 g net carbs per day) resulted in HbA1c below the threshold for diabetes in 55% of the patients, compared to 0% of patients in the low-fat group.
Does not require calorie restriction.Patients are instructed to carefully restrict dietary carbohydrates, eat protein in moderation, and consume dietary fats to satiety.
Sustainable with support. The one-year retention rate in our continuous care intervention was 83%, indicating that a non-calorie-restricted, low carbohydrate intervention can be sustained.
More cost-effective than bariatric surgery.
More effective than restricting overall calories.A study comparing a non-calorie restricted, very low carbohydrate (<20g total) diet to an energy-restricted low-glycemic diet in patients with T2D found a greater reduction in HbA1c, weight, and insulin levels in the low carbohydrate group. 95% of participants in the low carbohydrate group reduced or eliminated glycemic control medications, compared to 62% in the low glycemic index group at 24 weeks.A small (34 participants) one-year study of an eat to satiety on a very low carbohydrate diet compared to a calorie-restricted moderate carbohydrate diet found a significant reduction in HbA1c between groups, favoring the low carbohydrate group.
Disadvantages of carbohydrate restriction:
Often requires support. Many of these trials included an educational component, and determining the appropriate method of support may be key to the overall success with disease reversal.
Results are promising, but longer-term follow-up studies are needed. Follow up studies have shown sustainability at two years, so longer-term studies are needed to determine the sustainability beyond that.
This Post has been condensed from Reversing Type 2 Diabetes with Bariatric Surgery, Very Low Calorie Diets, and Carbohydrate Restriction: A Review of the Evidence
I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.
I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.
To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.
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Nutritional ketosis is a natural metabolic state in which your body adapts to burning fat rather than carbohydrates. It is clinically proven to directly reduce blood sugar (HbA1c), improve insulin sensitivity (HOMA-IR) and reduce inflammation (as measured by white blood cell count and CRP).
Dr. Phinney answers viewer’s questions:
Q: I am interested in reversing type 2 diabetes – is a ketogenic diet recommended?? Thx! —Susie T.
Dr. Phinney’s Answer: Insulin resistance is the hallmark of type 2 diabetes and manifests as carbohydrate intolerance. Like other food intolerances, the most logical and effective approach to managing carbohydrate intolerance is to restrict sugars and starches to within the individual’s metabolic tolerance. A well-formulated ketogenic diet can not only prevent and slow down progression of type 2 diabetes, it can actually resolve all the signs and symptoms in many patients, in effect reversing the disease as long as the carbohydrate restriction is maintained.
For complete answers to this and the other questions please copy and paste this link into your address bar
Q: Appreciated your article on the concerns about prolonged fasting. Could you comment on the utility and safety of shorter durations of fasting (i.e. 16 hrs of fasting/8 hrs of eating or 20 hrs of fasting/4 hrs of eating over a period of 1 day)? —Anonymous
Q: Can you achieve this on a vegetarian diet too? A lot of people I know from India, including my wife, are vegetarian and prediabetic or T2D. I am a T1 and now on keto diet, but I am not able to convince the vegetarians to eat meat. —Anonymous
Q: Does the amount of fat I eat in a ketogenic diet interfere with my ability to burn body fat? —Marcos C.
Q: Why are blood ketone values lower in the morning than in the afternoon/evening? —Nikola S.
Q: When I started my cholesterol was fine. Now my glucose has dropped 40%, but my cholesterol is 241. Should I be worried? —Kerry J.
Q: Since families often (and should!) eat together, is there any concern about children who are eating high fat diets at breakfast and dinner with their ketogenic parents, but higher carb foods at lunch/snacks at school? —Tera N.
Q: What are your inflammation biomarkers? —Tekla B.
Q: Can long-term keto diet contribute to hypothyroidism? —Sonia Z.
Q: Why some people’s LDL goes sky high on keto diet? —Sonia Z.
Dr. Phinney: The changes we see in total and LDL cholesterol levels are much less predictable than the changes in triglycerides and HDL cholesterol. For the full answer click the link below.
Q: There is a lot of concern about protein intake and gluconeogenesis kicking people out of ketosis. As stated in your book, moderate protein is .6-1 gram/pound of lean body mass. As long as you stay within that protein range is GNG something to be concerned about? —James F.
Q: Does Diazoxide helps in the ketone production? Thanks a lot for sharing your knowledge. Your influence is bigger than you think. —Salomon J.
Q: Does athlete fat oxidation rate vary continuously with carb intake? Or is keto the only way to get it above 0.5g/min?—Norman T.
Q: My daughter has high uric acid on KD, we don’t know if she did before KD, have you seen this before?—Justine L.
Dr. Phinney: Yes, blood levels of uric acid usually double in the first week of a ketogenic diet or with fasting. This is because there is a competition between ketones and uric acid for excretion by the kidneys early in adaptation. As the adaptation process proceeds over a few months, the uric acid level comes down to normal levels even as nutritional ketosis continues, Thus this is a process of clearance (i.e., excretion), not over-production from dietary protein, and this temporary elevation in uric acid is usually harmless unless one is prone to gout. That said, the precursors of uric acid are pretty high in organ meats like liver and kidney, so if these are part of one’s diet, they should be eaten in moderation. You can learn more about keto-adaptation here.
Q: Thoughts on patients suffering from depression and/or hypothyroidism and keto diets? Also, interested in your thoughts on “The Fast Metabolism Diet” by Haylie Pomroy, which encourages a 5x/day eating plan, which includes a couple days of a keto-like diet after some carb and protein-heavy days each week over the course of a month. Thank you for what you do, sir. Appreciate your work. —Tyler S.
Q: Love your and Dr. Volek’s low carb performance book – amongst the ‘good’ fats you talk about high-oleic safflower being acceptable (better PUFA ratio). Are high-oleic SUNflower oils OK and can you cook with them? —Chris B.
Q: Could blood ketones, along with blood sugars, be used to fine-tune insulin dosing? Too little insulin with someone with type 1 and we get DKA. With too little insulin ketones disappear. Could we use ketone levels are consistently below 0.3mmol/L as a signal that we have too much basal insulin? —Marty K.
Q: Does Virta know the benefit of whey protein for diabetes? Not sure in the context specifically of DM, but it is a very high quality protein source – BCAA, immunoglobulins —Salomon J.
Q: Why NOT eat certain oils, such as safflower and sunflower oil? Do these oils impact ketosis or is it for other reasons? —India K.
Q: Can you please explain hair loss on Keto? —Jessy G.
Q: Thanks for all you do!! There are groups that advocate the potassium to sodium ratio at 4 grams to 1 gram per day. Does that fit into your view of those two. Also, is 400 milligrams of Magnesium appropriate? Thank you! My ketone level ranges from .3 to 1.2. —Mark K.
Q: Are you looking at Cardiac Calcium Score? —Lincoln C.
Q: Hi Dr. Phinney. I have chronic pain and take a lot of medications. Also have controlled type 2 diabetes. Do you think taking 4400mg of gabapentin a day could be why I am not losing weight that easily. I am eating under 30 grams of carbs a day and I don’t eat a lot of fat. I eat just twice a day, and only around 950-975 calories. Thank You! —Teresa R.
Q: While someone pursuing a therapeutic ketogenic diet for the management of cancer, epilepsy, Alzheimer’s or dementia may want to reduce protein to achieve elevated ketone levels, do you think someone trying to manage diabetes or lose weight needs to consciously worry about “too much protein” or can they just follow their appetite when it comes to protein intake? —Marty K.
Q: If you are trying to reduce saturated fat but maintain ketosis, what fat sources do you recommend? —Gail K.
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As always, I am interested in your thoughts on these topics.
2HealthyHabits 