High Blood Sugar In Ketogenic Dieters! Plus A Special Surprise (Hint: Genotypes And Metabolism)!

A while ago Michael and I were discussing future article topics. There are truly a plethora of avenues to go down in this area of research and there is no lack of things to research and comment on. But even though I have a couple of pretty cool MCT articles sitting around on my desk, I want an interesting topic. I want something new. Something challenging. Besides, everyone is drinking the MCT koolaid these days. It’s become passe. (Also, it upsets my stomach and I have a personal vendetta against it. So there.)

What’s new? There has to be something new!

Michael pointed me to one of his old articles on physiological insulin resistance as an idea. I brushed it off at first. Dismissed it as a quirk.

But then I thought about it. WHY does blood glucose rise in response to a low carb diet? It truly is an interesting question. What does it say about low carb diets if they induce an almost diabetic effect on circulating glucose?

Thus my research began. This short abstract  confirmed that it is normal for people on low carb diets to experience a rise in blood glucose levels. Because it’s a non-open journal (shame!), there’s a one-sentence explanation given:

A decrease in first-phase insulin secretion may partially contribute to the short-term LC/HFD-induced increase in postprandial plasma glucose levels.

First phase insulin secretion? There’s a first phase? So… There’s more than one phase to insulin secretion? I had no idea. Call me ignorant but I had no idea until this point that there was more than one phase to insulin secretion.

This article delves deeper into the signaling involved in (what I learned is called) biphasic insulin secretion. The first phase of insulin secretion lasts approximately 10 minutes, and the second phase of insulin secretion picks up after the first and lasts for several hours. This is initiated by the influx of glucose into the beta cells of the pancreas, leading to an eventual depolarization and activation of calcium channels that regulate insulin release.

Type 2 diabetes is associated with a shift from biphasic, to monophasic insulin release, and it is therefore important to establish the cell biology of insulin release kinetics.

O rly? This is where I become instantly hooked… Their experiment involved a particular calcium channel and studying a mouse knockout version of it, which was heavily responsible for the second phase of insulin release. The first and second phases are related, yet separate processes, it turns out.

The conclusion we can now make in low carb dieters: a similar process is happening. People become monophasic in their insulin releasing, like diabetics. Let’s tease out the particulars now…

When sugar is ingested, there are two very important proteins that are released: GIP and GLP-2. These two work in a similar manner, acting on the beta cells to release insulin. I would like to add now that GIP is also released in response to fat intake. We’ll come back to that point.

While infusions of GLP-1 seem to increase the insulin release in diabetics significantly (source), Lewis et al. argue that the rise in GIP levels following glucose is greater in magnitude and appears to be more insulinotropic than GLP-1 (source).

Indeed, it has recently been suggested that the primary physiological role of GLP-1 may be inhibition of upper gastrointestinal motor and digestive functions rather then potentiation of meal-induced insulin secretion.

I will let Ehses and Lewis duel that battle out. At any rate, the article goes on to find that GIP is very important to a rapid beta cell response to glucose, and it increases absorption of glucose in the intestines. Interestingly enough, neither acute nor chronic impairment of GIP seems to alter fasting plasma glucose levels, but in mice with disrupted GLP-1 receptors, they are often accompanied by fasting hyperglycemia. Even the null mutation in the GLP-1 receptor will exhibit high blood glucose levels.

Therefore, while GIP appears to act as an acute insulinotropic hormone in order that β-cells may anticipate the absorption of glucose from the gut, GLP-1 signaling appears to be additionally important for the maintenance of normoglycemia, irrespective of the site of glucose entry into the circulation. This ability to promote glucose disposal makes GLP-1 a candidate therapeutic for the treatment of the abnormal glucose homeostasis associated with diabetes mellitus.

Follow me here for a little bit: If low carb dieters are not intaking glucose (for the very purpose of reducing an insulin response!) and not activating GIP accordingly, possibly not activating a second phase insulin response (depending on the genetic variant), then according to science, the absolute natural reaction of the body would be to have higher blood sugar levels. While diabetics and ketogenic dieters have the same symptom, one is a purposeful manipulation of the chemical signaling in the body, and the other is a distinct disregulation caused by a complicated clusterfuck of issues (diabetes).

So that solves that question! Now to return to GIP, because I stumbled across something truly fascinating here: GIP is released from glucose…but also from fat consumption. Ah hah! Interesting!

In this article (http://ajcn.nutrition.org/content/95/2/506.short) the researchers examine the relationship between genetic variants of the GIP receptor in response to different diets (low carb, low fat, and low/high protein). If you have ever hated someone for their ability to lose weight on a low fat diet, if you have ever wondered why such huge gaps in beliefs and attitudes exist towards low fat and low carb diets, here’s why: different people respond (metabolically) differently to different diets.

Sometimes in papers, the graphs are worth a million words. Essentially if you have a certain allele (also depending on if you’re heterozygote or homozygote), it can dramatically shift weight loss, fasting glucose, fasting insulin, and insulin resistance (HOAM-IR) in response to fat and carbohydrate metabolism.

So in conclusion, having higher blood sugar levels on a low carb diet is a consequence of killing the insulin response, which looks similar to diabetics but is actually far, far different.

Also, there are some people who can eat nothing but oatmeal and potatoes and lose lots of weight, and it’s not their fault that they’re mutants. I’m quite sure there will be many more future studies showing other genotypes that affect fat and carbohydrate metabolism, but we can now all agree there is no one best diet for everyone.


51 Responses to “High Blood Sugar In Ketogenic Dieters! Plus A Special Surprise (Hint: Genotypes And Metabolism)!”

  1. Hello there and thanks for interesting the post. I follow a paleo ketogenic diet that also involves one single low carb high fat meal a day taken in the evening with no other foods consumed at all except water. To my knowledge the hyperglycaemia experienced when one switches gradually to a LCHF diet is a temporary event and should be so until ketosis is well established. I am assuming temporary here to mean short term and not temporary in the sense that sugar goes up at every meal even in a ketotic state.
    Also the paper your refer to that finds association between diet variants and weight loss the so called high fat diets are hardly that at only 40% (USDA has 30%). A ketogenic diet should go well above 65% preferably 80% and they may not be isocaloric with the lower fat higher carb variants. I ahve printed the paper and shall look a bit more closely at the experimental set up.
    Was not aware of the itnerplay between GIP and GLP and will look more into it. Thanks for

    • For the hyperglycaemia argument, Micheal has told me he’s consistently seen his blood glucose elevated on the diet- as well as lots of n=1 comments around the internet and on the article I linked at the beginning. Maybe he can further comment on this.

      You’re right, the diet variations article’s version of high fat is also fairly moderate carb. Not ideal ratios. However despite that what makes it truly fascinating to me is that it still showed a tremendous difference in weight loss and other factors. I wish they would have made it more low carb but I imagine they would have had more attrition from the study as well.

      • Indeed, my blood glucose has inched up year over year. I’m not seeing the dive that many others report, and out of concern for this, I started looking into it.

        It appears that I am not alone in this regard. :)

        • THis is really intriguing…do you consume dairy and specifically milk?
          I ahve not had my blood gluose measured and do not own one of those as I feel so stable and well…Somepeople say that high level of glucose=low ketones. What are you ketone levels and do they change with blood glucose? COuld it be that in some people gluconeogensis takes over? I am baffled and intrigued. I look a bit more into the muscle specific insulin resistance and that also whlould be a temporary event to prevent protein loss from muscle for gluconeogenesis whilst the ketones accumulate. I shall continue on this interesting trail…..

          • It IS fascinating, isn’t it?

            To answer your question: No milk. I do eat cheese. Use full cream for some things. No milk though.

            I don’t have a blood ketone meter, and I stopped measuring the urine ketones some time ago. Yes, I was consistently in ketosis…no, I def. noticed the reduction in urine ketones after about 6 months (guesstimating here…it was a long time). Phinney and Volek suggest that this is a natural transition…your body just gets better at not making _excess_ ketones. In theory, my serum ketones should still show the full story.

            Alas, at $5.00 a ketone test strip, I’m not likely to start measuring them soon.

  2. Ehi thanks for your reply. I am intrigued as I genuinely did not know about this and I am always try to maintain ketosis through diet and fasting practices so i would not wish to have glucose spikes and I msut say I feel remarkably stable through the day even adding to the fact that I go to the gym three times a week in the evening usually well within 19-20 hours of water only fasting. Yet I exercise vigourosly including resistance with not adverse effects and no immediate urge to eat. When i do eat is fat/protien. So I have always assumed my blood glucose is stable by now (have been on this regime for 6 months now).
    Thanks again very mind opening and will look at comments on previous post and do some research of my own. Report back if I find anything of interest.

  3. Report back if I find anything of interest.

    Much obliged. I’m fascinated by this topic. I had assumed my fasting glucose would have lowered as well, which is why I was surprised when it went up year over year.

    From my reading: this is not something that everyone experiences. I wouldn’t be alarmed if I were in your shoes and had no reason to suggest otherwise.

    Physiological insulin resistance may provide a helpful explanation for others who are seeing their readings go the wrong direction.

  4. Please re-read the Japanese abstract within your blog above. The High fat (low-carb) diet did NOT decrease GLP-1 (You said “If low carb dieters are not intaking glucose (for the very purpose of reducing an insulin response!) and not activating GLP-1”). Instead, it increased GLP-1 activities compared to Low fat diet.

    Which means good.

    Your long term (fasting) glucose tolerance (glucose control ability) becomes better if you follow low carb., because your GLP-1, -2 and other various incretin and gastrointestinal hormones become active than ever.

    Only when you change from HFD to HCD suddenly (which is usually unnatural because they don’t change their eating patten easily), the glucose level goes-up.

    But, anyway, the extreme HFD could have also some stress to the body of glucose metabolism slowly and/or suddenly, especially to the people, you mentioned, of genetic weakness.

    So be careful, everybody. We could be different from Inuit people or HFD prone gene.

  5. If you follow HFD couple of week, the GIP hormonal activity decrease (body adaptation to new enviro.), because it is strongly related with carcohydrate digestion and initial glucose (peak) response than fat digestion and hormonal signal (fat and/or protein digestion are more related with GLP-1 instead).

    The 2nd phase (long running and also the most important) insulin secretion induced by GLPs and other GI hormones after becomes dominant for blood sugar control and be looked to be monophasal insulin secretion. This is completely different from diebetic monophase of strong GIP (which is usually no good).

    In this new adaped body condition, if you take glucose test and check the value, the answer is clear. Oh.

    The surgical stomach by-pass treatment of diebetic patient is the same hormonal technique. The weaked GLP-1 activity is stimulated, because it is secreted at below (not upper) intestine. If the GLP secretion is activated than ever, the satiety hormonal pathway is also activated. The glucose answer then? Clear.

    Bye and cheers.

    • katkinsk

      Actually I agree completely with you, which is why I was stumped for the last hour figuring out where I went wrong. Oh I used the wrong hormone, that’s why! I wrote and edited this post in several different parts of the weekend- thus why that sentence made no sense. I fixed it for you: “Follow me here for a little bit: If low carb dieters are not intaking glucose (for the very purpose of reducing an insulin response!) and not activating GIP accordingly, possibly not activating a second phase insulin response (depending on the genetic variant), then according to science, the absolute natural reaction of the body would be to have higher blood sugar levels.”

      I’m sorry to have made you write out such an elegant comment for such a base mistake.

  6. Geoff Smith

    Having just been to ER for what turned out to be a a bladder stone I was shocked to find out my BS was 12.6 because I have been very low carb for 6 years.
    So by explanation “consequence of killing the insulin response, which looks similar to diabetics but is actually far, far different.”
    But high blood sugar has detrimental affects we are told does it matter the cause?

  7. Steven Fussner

    I’m not sure if anyone else has pointed this out yet. But in the paper looking at different genotypes for the snp rs2287019 that you got all the graphs from is not at all applicable to a ketogenic diet. If you look at the methods section for the paper and the macro-nutrient breakdown, you’ll see that there is no way any of the subjects were in ketosis. There were two “Low Fat” diets. The first was, (20% fat, 15% protein, and 65% carbs). The second “Low Fat” diet consisted of (20% fat, 25% protein, and 55% carbs). The “High Fat” diets consisted of (40% fat, 15% protein and 45% carbs) for the first and (40% fat, 25% protein, and 35% carbs) for the second. All four diets were caloric restriction diets which explains the weight loss. If you want to compare a “Low Fat” diet to a true ketogenic diet it needs to be “High fat, low carb” with carbohydrate composition of around 10% or less.

    Here is an article looking at exactly that. A “high fat, low carb” ketogenic diet has been shown to be more efficacious for weight loss than a low-fat diet and improved other serum markers such as a greater decrease in triglycerides and an greater increase in HDL cholesterol.

  8. Teresa Mallory

    I would love a follow-up, as this is complicated – Volek & Phinney’s book says that between 30-60% total fat calories, there is a reduction in insulin resistance. That’s a very easy range to fall into if you’re not counting – is it likely many keto-dieters who are experiencing raised blood sugar might be responding to this range?

  9. Teresa Mallory

    Oops, error on last comment, I meant to say reduction in insulin SENSITIVITY (not resistance).

  10. Geoff Smith

    Yes Teresa it says that but goes on to say above 50 it gets better “What we do know is that, pretty consistently, as dietary fat percent is increased from 30% to 60% in animals and in humans, insulin sensitivity does get worse. But once above 60% of energy as fat, which typically translates to less than 20% of energy as carbohydrates (assuming 1 5-20% from protein) , insulin resistance turns around and starts to improve.
    I’m thinking that we are looking at this physio insulin resistance out of it’s correct context. We tend to have people that are office bound or for a large majority of their life or athletes who are performing their exercise or not. We are not looking at from the hunter gather aspect of how their day would play out, all day every day.

  11. I’m not a medical nor science person, just a diabetic, type 2. I’ve begun a ketogenic diet, less than 20 gr carbs, about 25-30 gr protein, which leaves fat at 65-70%. I take 40 pen units of Lantus Solostar daily in the morning, 850 mg Metformin 3x a day. Before I started the diet 2 weeks or so ago I only took the most Glipizide I took was 2.5 mg and now I take 5 to 7.5 mg of Glipizide daily because my bsl’s won’t drop. I get up in the morning and the bsl’s are around 200, take all the meds and if I’m lucky, at bedtime they’re around 135. Then I take another 2.5 mg of Glipizide hoping they’ll drop overnight. I don’t know if I’m eating to much protein. my cells are completely locked, my pancreas can’t make any insulin (the Glipizide doesn’t seem to be working as well, same for Metformin) or ?. I’ve talked to my doctor but no help there, nor the last two doctors. Have I not waited long enough? Does anyone have any idea what is at play here, I would be very grateful. I need to lose about 40 lbs as I gained 20 just by being on insulin. Thank you in advance.

    • Geoff Smith

      Rita I would think that the first issue is the stress to your body. It depends on how much carbs you were ingesting and how quickly you switched to low carb. Most people will get something called Keto flu or low carb flu as your body switches from burning glucose to using ketones as fuel. This can take easily 2 weeks sometimes longer.
      Are your grams of fat/protein/carbs per per meal? On the Ketogenic Diabetics Facebook page we do get people coming off the ADA diet thinking per meal. I try to stay at 10-15 grams per day of carbs and have for just over 3 years.
      Once you get into ketosis it will take some time to become fully keto adapted and then it will take some time for your body to reset sort to speak. During that time numbers will get progressively better but there will be some weird spikes off and on.
      I would say give yourself 3 months to see numbers really getting good. Weight however should start to melt off now.

      • Art De Vany

        Rita, exercise and intermittently fast, particularly overnight. Note that the keto diet caused an elevation in glucagon, which releases glucose from the liver. What goes in may not be what comes out. Being a diabetic means that your liver is locked into a FOXO stress response, making glucose and fatty acids and packaging them into chylomicrons to be transported into your blood vessels. IR makes your brain and liver think you are starving and, thus, the strange activities of simultaneously producing glucose and fatty acids, as would be the case if you truly were starving. Nothing seems to “follow the rules” when you are insulin resistant. Exercise to elevate insulin sensitivity and to cut the inflammation that is messing up your metabolism. Eat moderate fat only, move a bit to protein, at least a gram per pound of lean tissue and fast over night.

    • I to was slowly gaining weight over the course of the last 4 years and I was not eating anything carby, I gave up the dairy and my numbers went from fastings over 100 to way down, upper 60’s lower 70’s. Not really sure what it was, since I was eating cream, high fat yogurt ect… But I lost 18 pounds withing the course of 2 months so it came off fast once I could convince myself to quit. I actually think it is the whey protein that caused my high numbers, but I am not sure, it is not calories since I eat over 3,000 a day and I am still able to lose. Just maybe something to try, I struggled for years trying to get my numbers down and listening to most forums they say to eat cheese and yogurt and it is good for you, but in my case that is not true.

      • Did you cut grass fed butter too? What are your main foods you eat or your daily diet? I just started trying the keto diet again, but in the past I have high BS with it and struggle losing weight on it without at least some non-startchy vegetables in my diet(y.squash, cabbage)

    • When my mother takes too much insulin at night she wakes up with really high blood sugars above 200, on the dose her doc prescribed but when she cutd that in half she would wake up on the 130s maybe your taking too much insulin at night and it’s causing your blood sugar to drop too low. When its too low your liver pumps out some glucose, but being a type 2 on insulin your own body cannot bring it back down. You wake high and stay highish, then you repeat the cycle.

  12. Mumsie

    I have a puzzle and I am hoping someone here can shed a little light on things for me so I will list everything that I can think of in order to present a more complete picture so please bear with me.

    I have been following Dr. Bernstein’s diabetic dietary guidelines of 6+12+12 carbs for breakfast, lunch, dinner respectively, 4-8 oz protein per meal (he recommends using the protein to improve satiety at whatever level you determine works and then to keep it consistent for the same meal time daily) and no limits on fat. No sugar; I am using xylitol or erythritol for any cooking and some splenda syrup for my coffee. The only dairy I have is full cream in the coffee. I have been refining this since the first of the year to get to those levels. Supplements that I have begun experimenting with include: Amla, Curcumin, fiber as inulin or psyllium, cinnamon, apple cider vinegar. Fats I am consuming other than saturated animal are coconut oil or olive oil. I am grain free and consume flax, nuts and no fruit unless a few random blueberries in a flax muffin. I drink about a gallon of water a day atm. I am also usually seeing small amounts of ketone activity on ketostix daily.
    At first I saw an improvement in my glucose levels but lately they have been inching up slightly. I have yet to see numbers like he says are possible but my A1c has dropped from 7.9 to 6.5 as of March (most current result) which puts them squarely back to previous levels (before events listed below occurred). I want much better numbers so I keep plugging away at this. I am trying to figure out what the culprit might be and here are some possibilities:
    1. A year ago March I had a thyroid attack out of the blue with a reading of 102 so basically no thyroid at that point. The doctor put me on 50mcg levothyroxine then cut that in half then dropped it completely after I became hyperthyroid. After that my readings have been all in the normal range as they have always been. The doctor couldn’t explain it and said it was the first time in 25 years of practice that a patient recovered like that without being permanently hypothyroid. My thyroid might be messing around or it might not. I am not noticing any symptoms of being hypo like before.
    2. Last September one of my brothers died suddenly and this caused a lot of familial stress, of course. His 54th birthday falls tomorrow on Mother’s Day and I have had him on my mind a lot lately and also my 85 year old mother to whom I am quite close. I am worrying about her. This could also be a culprit but I feel like I am just worrying not really stressed. My 85 year old dad is having some health issues but nothing major-mostly not taking proper care of himself despite all of my mother’s efforts.
    3. I may be experiencing an increase for reasons I have yet to determine related to the diet and maybe I’m not doing something right.
    4. Since starting this in January, I have lost a total of 20 lbs with a plateau that began about 3-4 weeks ago. That caused me to be even more particular about my dietary numbers in an effort to get things going again and this is when I started to notice the small uptick. What confuses me there is that even with the lost weight my A1c is only back to where it was prior to the thyroid attack and losing my brother. I was hoping for better numbers after losing that much weight so far. I am working on being a daily exerciser with walking, dumbbells and rebounding being the most common activities for me for now but I have not been as consistent as I need to be to date.
    Any suggestions?

    • Geoff Smith

      First worry is stress so can affect hormone levels.
      I find his carb levels too high. I stay at 15g or less a day. Watch the nuts they can cause carb creep. I put min in a 1/4 measuring cup to eat and have that only once a day.
      I’m not sure why your dairy free but butter has good nutrients and is a great fat to add.
      I have been in ketosis for just over 3 years and stopped seeing anything on a ketostik after about 4 months of being keto adapted since I was burning them. HOWEVER after 2 years I saw my numbers creep up a bit and doing research found out about “physiological insulin resistance” . There are many articles about it and one is right here on Ketopia http://ketopia.com/physiological-insulin-resistance/
      What I am not happy about is how high can the blood sugar go from this AND does is elevated glucose level without the presence of insulin make it less destructive to the body

      • Mumsie

        Thanks Geoff for your reply. I will correct my “dairy free” to mean only milk products as I do regularly consume organic grass fed butter and some cheese. My mother is from Ireland so I would be disowned if I didn’t love my butter and cream, lol. I have cut the nuts back to a 1/4 cup serving just this week as I was overindulging I think. I soak then dehydrate them and consume them raw. I am hoping that you are right in that the stress is playing a big factor here but only time will tell if the holiday/birthday stress is the culprit. I find all of this much more difficult being female than my other brother or my dad due to the hormone nonsense. All of my health issues all of my life have been hormonally connected. I read the physiological insulin resistance article on here that you referred to and that is quite interesting. I also want the same answer to your last concern. To me any elevated glucose is not good unless someone can prove otherwise but then try and convince a doctor of that when they still tell you that 6.5 A1c is your miracle goal number. I will try skimming off some more carbs and see if that helps, too. Again, thanks!

        • Geoff Smith

          Once I was under 15g a day and mostly around 10 My numbers settled right down to where I saw no peaks from a small carb meal like a slice of pizza. It took a year and a half that low to get there but everyone’s pancreas will be different. Some may need longer to recover, some less time.
          From our ancestors point of view having a elevated glucose level may have been very normal. They had to get up in the morning and hunt down breakfast.
          It is so hard to know what is the correct way for the body to be since most of the studies have been on higher carb feed people. For me even 50g a day now seems high so look at what is being studied in the general population.
          The other issue is activity level. I don’t think our bodies were designed for the kind of workout we get in the gym. We are endurance animals. LOL

    • rdzins

      I quit the dairy and lost 25 pounds. My fasting insulin went from over 100 to 75.(I am going on month 2.5 of no dairy and the numbers just came down to the 70’s) I don’t know what it was the cream in the coffee and I ate full fat yogurt also. Even when I tried the low carb shakes my numbers creepup again, the shakes have whey in them which is a dairy product so no dairy for me. I saw results within the first week and the 25 pounds came off really fast within the first 6 weeks. I don’t know if it is the casein in the dairy or what it is, I now only use butter and nothing else. I think at least for me dairy causes a insulin reaction, I don’t really know but cutting it out was really hard but it made all the difference for me. I try to stick to a high fat diet for the satiety part, but unfortunately it no longer includes dairy, maybe you could try it for two weeks and see if it makes a difference.

    • Michael g

      Restrict carbs to no more than 30grams. Eat no sugar.drink no sugar.restrict alcohol. Eat higher amounts of saturated fats in animal fat,eat butter,eat coconut oil, eat moderate protein say 6oz max no more than 3 servings. Keep the fat coming, don’t count calories.begin walking once or preferably twice daily. You will get into ketosis within 3 days, it will improve blood sugars over time as you keto adapt. Insulin is your enemy, the only way off it is to eliminate the carbs and sugar and to lose fat weight around your mid section and this takes time. But once in ketosis fat starts to melt off your body. People successfully lose 100 lbs or more in a year on this diet all whilst eating more calories due to the high fat content. Another side effect of the diet is lab results usually improve for ketogenic minded people. GOOD LUCK.

  13. Mumsie

    Hi Geoff, I am going to trim the carbs further for awhile and see what happens. I think it might just help and I am hoping that after some time that I can add a few back. I actually am quite happy on 15-30 a day so a little more won’t really matter much to me. Mostly it is my veggies that I want. Do you have any experience or opinons on the erythritol or xylitol affecting glucose levels? Bernstein is not a fan but I don’t think that they are an issue for me. Just curious.

    • Geoff Smith

      Mumsie the best thing to do is eat to your meter. If having something new test at one hour and then again at two hours. Some things take longer to digest and can cause a huge spike but not until the second hour. Most people seem to experience a rise from the alcohol’s but some do not. I have no problem with Splenda but some people do so it only safe to test to determine.

  14. thanks for this article! My type 2 husband went vlc Jan 2014 and his March check up showed fbs 176 and hga1c 8.2, never happened in 15 years of control by diet, doctor panics, I find that this happens to vlc, we have been on wheatbelly diet, but cheating on it and not having enough fat, his numbers came down to normal for 2 months after we quit stevia in the raw and splenda, they they crept back up July, am so glad for your website, I am hoping we can do this, don’t want to go back, also found his iron pills had elevated iron in blood which antagonizes Insulin, found research in Finland and Spain, cuttting out the iron pills, avoiding liver, he was on iron for severe anemia when he got type 2 and the iron pills were just ongoing, but I think getting off gluten let the pills absorb and his ferritin was 88, never been over 30 in 15 years, thanks for the talk on GLP-1, etc, I found out about them and found they have seperate power from Insulin itself, we haven’t checked glucose at all, taking olive oil and coconut oil with us to lunch, looking for fet, just got new book today, The Big Fat Surprise at B and N, can’t remember how to spell author name, I think it will be the scriptures for putting fat back, my spouse was raised on lard, butter, whole milk, pork, on a family farm, I think they were ok until they left, Western diet caused 2 older brothers to pass, age 55 and 72, 2 sisters have type 2, also, no family history, love ketopia. thanks!

  15. Thanks for the article; it is very thought provoking. I have tried ketogenic diets several times and they simply do not work for me. I have held closely to the macronutrient guidelines of 80/15/5 and have tried various food restrictions, e.g. – no nuts, or no dairy, etc, and various lifestyle variants, e.g. – exercise, no exercise, raising calories, lowering calories, etc.

    I have noticed some very interesting things during these experiments. The first thing that I notice is that I do not get “keto flu”, regardless of how fast I switch from high carb to keto. Considering that other people have described it as feeling “as though they are dying” (yes… I do know some drama queens), I found it very strange that I was asymptomatic with good energy levels.

    The second thing of note was the rise in blood glucose, despite taking 1000mg of metformin per day. Fasting glucose is elevated, as well as postprandial.

    The third thing is no significant production of ketones according to the blood ketone monitor.

    Lastly – no weight loss. I have actually gained weight on a ketogenic diet.

    My ketogenic diet attempts varied in duration from 5 days to 3 months.

    I have been in touch via email with some of the “keto gurus” (Moore, Wortman, Westman), and all stated that they have never seen anything such as this.

    But after reading this, I am beginning to think that my body is producing sugar from fat. This would explain the lack of keto flu, lack of ketones in the blood, rise in BG and the failure to lose weight. Surely it would be considered unusual to be on a diet of 80/15/5 (paleo… no processed foods, so no sneaky carbs) for 3 months with no results.

    Currently, I am following Dr. Bernstein’s carb recommendations of 6/12/12, with moderate amounts of fat and protein and am having much better blood sugars and am seeing some weight loss.

    Anyones else experience something similar?

  16. Folks who do not know, when TAGs are hydrolyzed they are broken down into fatty acids which travel into the serum being carried by different proteins and glycerol which is the backbone of the previous TAG. Glycerol, as Geoff mentioned, and as seen in quite a few papers…can contributed to gluconeogenesis.

  17. Do you know of any data showing high fasting blood sugar in ketogenic dieters? The only published data I am familiar with has shown ~10% lower fasting blood sugar in ketogenic dieters compared to normal dieters.

  18. Your whole article is based on a false premise, you missed the phrase “short term increase”. This means when the person or animal goes into full ketosis there is no more rise in blood glucose and the reason for that is the glycogen stores are drasticly lower in the liver.

  19. And low carb is not equal to ketosis. Ketosis is when all you eat is pure protien and pure fat and chloryphyll (which is a protien). If you are eating any carbs at all you are not in full true ketosis which is required to have very small glycogen stores.

  20. THANK YOU THANK YOU THANK YOU. I did labs the other day and was in the diabetic range and it really freaked me out, to say the least! I eat zero sugar, so I was struggling. I SOOOO needed to have this information. Not that I could explain this to another, thus I pinned it to my pinterest account for future info and to take to the Dr to read.

  21. I went from taking 100-150 units of insulin a day to 40 units. Went from 355lbs to 320 in 2 weeks. All by limiting to only 30g of carbs. My blood sugar went form almost 300 14day average to 142. But then when I woke up and throughout the day, till I went to bet it was always over 200, high as 400. I went back up to giving 100+ units of insulin to keep the my blood sugar down. It didnt work. I even dropped to 10g carbs a day. Nothing

    This is very fucking frustrating. Even gained some weight back. Still under 30g carbs, still crazy high insulin for everything. I am about to give up and just accept an early death.

    • Geoff Smith

      John how long were you at 10g of carbs a day?
      First thing to remember you did not get to where you are today in a short period of time and it will not be a short period of time to get back to healthy.
      Congratulations on the los of weight. 35 lbs in 2 weeks is not the norm at all so I can not say why that would happen but doubt it was solely due to low carb.
      SO action to take going forward. Carbs 10-15g a day. Protein low…. very low. Don’t care about what any charts say they are based on a non diabetic carb eating human. You must keep your protein to no more then 4oz per meal. Your body WANTS to burn glucose and is going to fight to keep that way. Any excess protein will be converted to glucose and mess with your numbers.
      Now the good news. Eat as much fat as you like. Coconut oil, butter, lard, bacon fat, avocados. I eat about 1.5 lbs of butter a week by the spoon, can’t be bothered to put it in my coffee.
      You want to get into ketosis. Once you are your burning your fat. Now the simplest way to lose the weight and control the blood sugar is go on a water fast. I have been on one for 56 days. I have a physical job and I do 2 sessions of HITT for 30 mins twice a day as well. If you are in ketosis when you start it will be easier and no hunger issues.

  22. I’m new to this and am trying to follow along. Sorry for the basic question… When you say “high” fasting blood sugar, are you talking about numbers that are considered “normal” for people not on keto too? So “high” fasting would be anything over 100? I feel like I’m “high” fasting BS when I’m over 80. The last few days I’ve been in the 90s, but my ketones are still 1+. Is that OK? Not sure why BS is up, but sometimes it is in the 70s. Need to read more to understand, but just don’t want to be hurting myself in these early stages.

  23. Hi, I have been following a HFLC life style for the last 3 weeks and initially my blood sugar was in the normal range. I stick very strictly to a 5% carbs, 20% protein and 75% fat. I also do intermittent fasting, Skipping breakfast as i’m not hungry and eating lunch and light dinner. I lost 2kg in the first week and 1.5 in the second week. This week my weight seems to have stalled and my BG was 6,1 this morning?!! Where did this come from? How do I fix this and get the weight loss started again? I need some advice.

    • Geoff Smith

      The first thing I would say is cut the protein and increase the fat. 80 percent at least, if your diabetic lowering the protein in very important.
      Second anytime you get stuck one of the tricks you can try is a fat fast to rev up the metabolism. Honestly I am not sure why you would be losing so slowly.
      Another good way to melt the weight is add in coconut oil. Making fat bombs is a good way to get butter and coconut into your diet.
      3 weeks is not very long and depending on how you ate previously to this your body needs to go through some big changes to be keto adapted… burning ketones for fuel. At this point your body maybe trying to continue using glucose for fuel and to do so breaks down some muscle protein. The morning high can be from the liver dump that happens in humans to get us moving in the morning. It still thinks we have to get up and hunt for our meal. LOL

  24. I have been on Keto diet for over a year since I was diagnosed as pre-diabetic. But now my glucose has moved UP into the diabetic range!!!! Am I understanding this article correctly that this is temporary? Should I be doing anything different?

  25. I see a few people struggling with this issue and thank the commenters for the different ideas. That dairy protein can be the trigger in some cases seems likely as exorphins can interfere with paracrine signalling, and at the level of signalling on a keto or low carb diet this may be more obvious.
    Also the idea about glycerol spilling out during weight loss or high-fat feeding; how is GNG from this regulated? Glycerol and aminos are the source of excess sugar in uncompensated/unmedicated diabetes.
    As for the harm the high BG does – it’s high because it’s not getting into cells, and it’s in the cells that it does harm. There’s no reason to think that glycation of hemoglobin is harmful in itself. Hb is replaced regularly and – critically – RBCs have no mitochondria. What about kidneys? Has anyone seen glycosuria with this phenomenon?
    People who have a genetic defect that prevents them from metabolising glucose normally (I forget what this is) run high HbA1cs with no complications. Is this the right model for what we are seeing with LCHF in some people?
    The strategies we can use to lower this BG include IF, vinegar before meals, HIT. Maybe coconut oil.
    Also, first phase insulin response is harmed by excess omega 6 and inadequate omega 3. If this is going on, then a fish-and-coconut diet (limit omega 6 – no nuts, no olive oil, use coconut and tallow, butter, but plenty of fatty fish) might be needed for a time to flush out the omega-6 stored in the body from previous diet.

  26. I’ve read this post and all the replies, and unless I’m missing something, I haven’t heard anyone mention what happens to their BG following a bit of carbs 2 hrs post meal. I started seeing these elevated PPBG numbers when I finally started monitoring my BG after LCHF for the past 3+ months. I’ve been in ketosis this whole time save for the early days when I first started out. I’m a 40 yo former highly competitive road cyclist who can’t exercise like that even for fun due to chronic fatigue which is due to damage to the hypothalamus. My waking BG has been high and climbing to the point it was 138 this morning despite getting super strict with my carbs and taking fat bombs in my tea in the form of coconut and Irish butter. I know I’m keto because the meter tells me so and my thinking is only clear when I am in keto. The funny thing is I’m not IR. A few nights ago the wife an I had a dinner out and along with my fatty beef ribs and small salad I decided to eat the lil scoop of white rice on the plate to see what would happen. About 2 hours later when we got home I tested my BG…80! I can’t remember the last time I was that low while keto. So my insulin response works. But here’s the rub…no weight lost since day one 3+ months ago. I am able to do very light exercise not exceeding 65% of HRM without pushing myself over the fatigue cliff for weeks. I figure the rice may have pushed me out of ketosis but I fat bombed my way back in quickly. My question is like most, what’s up with the PPBG and why can’t I drop weight?


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