Diabetes: I realise this is the weight-loss... - Weight Loss NHS

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Diabetes

I realise this is the weight-loss forum, but diabetes and obesity are inextricably linked, and we seem to have had quite a few posts on the subject lately. I was unable to respond to lucigret's tag on a closed thread, so herewith a few thoughts on the subject.

1) Back when my mum was a ward sister, diabetes was almost unheard-of. Those few cases who did appear were Type 1. Type 2 was such an obscure condition that, if a case turned up, all the medics would cluster around and prod and question the poor patient.

So let's be clear about this: T2D is not just "one of those things" that strikes at random. It has a very specific dietary cause: synthetic foods which our bodies have never encountered before, stuffed full of easily-digestible carbohydrates and lacking fats - often because the fat has been artificially removed. If you stop eating in that specific way, your chances of acquiring T2D drop dramatically.

2) Diabetes is not caused by obesity. We know this because about 30% of cases present with a more-or-less normal BMI. Obesity and diabetes are both a consequence of a body failing to adapt to repeated and excessive doses of glucose-based energy (carbs and sugar). Your body can adapt to virtually any diet that doesn't cause this scenario ... as is very apparent by looking at the wide variety of healthy diets consumed worldwide, or historically.

3) If you already have T2D, it can be painlessly and quickly reversed with what is inaccurately called a "low-carb high-fat" diet. This name is actually a pejorative, invented by vested interests in order to imply that it's unhealthy. The correct term should be "moderate carb adequate fat", or something along those lines.

Nevertheless, I'll keep using the term "LCHF" here, mainly because that's the name of the HU group associated with this way of eating.

4) LCHF has been repeatedly shown to be the most effective way of reversing T2D, and the NHS Diabetes Prevention Programme is endorsing it in certain areas. It's main benefit is that it is sustainable in the long term. The food is tasty and you can eat until you're full: essentially, it involves eating good old meat and veg, as humans have done for millennia. Your appetite quickly adapts to it, and you stop wanting bad food.

5) The competing therapy is known as the Newcastle Diet, which is an ultra-low-calorie diet based around food substitutes. It has a broadly similar success rate (~60% complete remission) but it is very unpleasant, and in fact it works in exactly the same way as a standard LCHF protocol: it reduces the carbohydrate load on your body. The difference is that it also reduces protein and fat, without any theoretical justification for doing so. The long-term efficacy of the ND is unproven, but since the patient is not told why his condition occurred in the first place, and what he can do to prevent it, relapse seems inevitable.

The TL;DR version: Diabetes Type 2 is easily reversible, and if you do it right, it stays reversed. It is not a progressive, permanent condition. If anyone feels it might be the right course for them, the LCHF group is a welcoming place with lots of knowledgeable people - including a few who have successfully reversed diabetes or prediabetes.

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Thank you TAT for taking the time to post this information here 😊

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Thank you for posting TAT 😊. I especially like this sentence “The correct term should be "moderate carb adequate fat". . . This is my belief, just proper food in sensible amounts.

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Indeed. I get very frustrated with the idea that there's one single "healthy diet". There really isn't. Humans are incredibly adaptable - they'll thrive on pretty much anything from pure vegan to pure carnivore (although personally I don't think those extremes are particularly sensible). There's only one diet that they can't adapt to, and that's the one that's full of "engineered food" - products that look like food, but actually aren't.

Once you've got diabetes, or prediabetes, your best option is dial your carbohydrates right back as far as practically possible to allow your body to recover, but a normal human body can consume historically ordinary food and do just fine.

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Eloquently put TheAwfulToad.

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I love the alternative MCAF too - it would save me having to explain to people that I’m not cutting out ALL carbs or gorging on deep fried chicken.

I have an acquaintance (I stress that, as not a close friend) severely struggling with T2D, very obese, mobility now minimal. I did deliberately raise T2D in conversation so I could mention that LCHF could help. I was worried that I could come across as preaching or interfering but we seemed to have a good conversation without offence being taken by them. Months later they have deteriorated and don’t appear to have wanted to make any changes. It upsets me to watch them struggling, but I don’t know them well enough to know whether I should try again. Obviously no one else reading this will be able to tell me either! But I just wondered whether anyone else ever feels a sort of guilt when they see people, even strangers, obviously suffering, when you feel within yourself that you’ve found a way out of the downward spiral?

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It's very tough. I've had conversations (and failures) like that myself. There are all kinds of reasons why people don't want to try it, but I suspect a very big factor is the antipathy of the medical profession. That in itself I do not understand: you would think doctors, of all people, would be able to grasp the logic behind LCHF. Yet apparently they do not. Diabetics (and people with other metabolic diseases) are often browbeaten and shamed into following the party line. You have a disease. You can't change it. Now take your pills, do as your told, and be quiet.

Unfortunately people have ultimate control over their own lives, and there's often little you can do to stop human suffering even when you know the solution from personal experience. People either find their own way out ... or they don't.

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Thanks for replying TheAwfulToad. I suppose it’s the old adage - you can lead a horse to water but you can’t make it drink. You’re right again - I got the impression that “You have a disease. You can't change it. Now take your pills,” was exactly what they’ve been told by GP. My own GP told me last year that I needed to go on a low fat diet (again!) wanting to prescribe Orlistat, which I didn’t accept.

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Well done for refusing Orlistat. Out of all of today's solutions-looking-for-a-problem, Orlistat must be the poster child for pointless drugs that doctors prescribe simply because it exists.

They must surely know that dietary fat has nothing to do with weight gain, diabetes, or all the rest of it ... unless they were asleep or hungover during Physiology 101.

How are you doing so far by ignoring everything they tell you? :)

But yeah ... leading a horse to water. I occasionally show up in the Diabetes forum urging people to give LCHF a try. I think I'll been doing that for about a year. Not one person has been interested in at least considering it, and I've had one or two "how dare you suggest such a thing" responses. I can't help wondering if there is a psychological component to T2D - something along the lines of those tendencies that lead to self-harm, or possibly a state of learned helplessness ( en.wikipedia.org/wiki/Learn... ). There's also a strange phenomenon where people kind of "grow into" chronic diseases - the disease becomes part of their identity, and they're loath to give it up.

I've pretty much given up on that. It's just too demoralising watching people slide down the slope of drug therapy, unstoppable obesity, depression, and all the rest.

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I’m doing really well on LCHF (or rather MCAF 😀) I started unwillingly as all previous diets had been followed by increased weight gain and I didn’t want to get even bigger - but I was told I couldn’t go on waiting list for hernia op unless I did lose weight. Within 6 months I’d lost best part of 3 stone, applied to go on waiting list for op, to be told that I no longer had the hernia. Double win. I feel so much healthier and happier now and this feels more like a way of life than a short term diet, so hopefully this time things will be different long term.

Re T2D I wonder whether people would rather be under the doctor for a medical condition that requires professional help than hear “you can take responsibility and try fixing this yourself” .

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Thank you for this post. Because it’s been called low carb, high fat, I’ve tended to not read in any detail as my body reacts horribly to lots of high fat and I do need some carbs. I’ve also been worried about the descriptions of the body going into ketosis, but your description here sounds very measured and sensible and I will start to read more about this approach. Thanking for taking the time to post this

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What happens when you eat fat? Do you have any known metabolic disease that might cause a problem here? Are you taking any medications that might be causing this?

I'm aware that there are certain diseases that can affect fat metabolism, but they're quite rare. If you do have an issue like this, you can still do a low-GI diet without going full-blown LCHF. It's not quite as effective, but it should be more sustainable for you.

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I get chronic diarrhoea....which is always identified as IBS (!). I’ll look into the low GI approach and I’ll see how I respond to that. Thankyou so much for your help, it’s much appreciated.

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I agree H61g, I don’t like any ‘diet’ that is LOW (or high) anything ☹️ But I’ve gradually changed how I eat, and reduced carbohydrates in particular as I’m currently not moving very much. I keep a close eye on the numbers using MFP agree with TAT about it being more “moderate carb, adequate fat” 😊

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This is great TAT thank you for the info. my dad became type 2 diabetic while my mum was fighting cancer 9 years ago, he never really addressed his eating or exercise at this time as he was more concerned about my mum's battle with cancer. After she sadly lost the fight he was broken and turned to comfort eating and slowly over the years he has gone from diet regulated to tablet regulated and is now injecting insulin daily.

He attends the diabetic clinic regularly "for the nurse to tell him off again" as he puts it, as his numbers are always much higher than they should be, he's happy if they stay in the teens and dont rocket into the 20's but the nurse wants them much lower understandably.

I have a very close relationship with my dad and we can and do talk about his diabetes I've bought him various books to help him understand the condition and make healthy informed eating choices.

when we're together we only eat healthy whole foods. I'm following the LCHF eating plan and I've told him all about it and how it can reverse T2D.

I've asked him to mention this on his next visit to the diabetic clinic so hopefully they will support him and help monitor him too.

He has always struggled with his weight and now living alone he is free to eat whatever he wants and does not always make the best decision.

I'm planning on printing out an easy guide of LCHF eating plan with ...

things to eat lots of

Things to eat occasionally

And things to avoid

To help him make healthy informed eating choices

I'm still early days with the LCHF eating plan myself but I think it could help him and I do want him around for many more years to come.

Any suggestions to help point him in the right direction would be greatly appreciated

XxX

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Hopefully, your example will lead him down the right path. LCHF is really very straightforward, so your list of 'eat this, don't eat that' should be more than adequate ... if he really wants to do it. But you're right, he absolutely needs the support from the clinic on this because he will need to adjust his insulin and medications. If he goes full-blown keto, the effects can be very rapid (a matter of hours) which means he'll need close monitoring and careful adjustment of (or complete cessation of) insulin injections. I really, really hope you can get them onside.

It's very hard to raise a parent, isn't it :)

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Ah yes it's not easy.

I will print him off a guide and give him lots of encouragement and advice on ketosis and the dangers for diabetics.

I don't want him to go at it all gung ho!

I really just want him to eat the foods that will keep his blood sugars at a good level.

XxX

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welll ... the only way to maintain blood sugars at the right level is to allow your body to do so, and that means reducing your carb level to a point where your endogenous insulin can dispose of it properly, and you can drop the insulin injections.

Unless you know for certain that he has no pancreatic function and no chance of regaining any (in which case he's effectively Type 1), there's no halfway-house here. He's failing to reduce his carbs under his own steam because of the insulin injections, which cause aggressive blood sugar dips. He probably feels overwhelming urges to "top up", for the same reason overweight people do - his body is incapable of burning fat for energy (and also incapable of burning carbs, which is a horrible position to be in!).

If he's only recently started on insulin, there is some modest possibility of a full recovery, or at least going back to pills only. But he will need to go "keto" initially, under a doctor's supervision. Ketosis is not the same thing as ketoacidosis - the latter is typically triggered by excessive carbs with inadequate insulin (ie., a hyperglycemic event). It really only happens to Type 1 diabetics who have absolutely zero pancreatic output. This is why Type 1's do have to eat a certain amount of carbs: the insulin injections are essential, but it's impossible to calibrate the dose accurately, so dietary carbs are added to maintain blood sugar. It's a weird balancing act that doesn't apply to Type 2.

Ketosis resulting from a low-carb high-fat meal should be self-regulating as long as his pancreas is still basically working, but this is why he needs a doctor's supervision. Once they've confirmed that, yes, his pancreas does have adequate output to regulate ketosis (insulin/glucagon perform this function) everything will be fine. A T2D body adapts to LCHF in essentially the same way as a "normal" person - the initial adaptations occur within a matter of hours, and optimisations occur over the next couple of weeks.

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Thank you so much for this explanation, I think I should print this (with your permission) and give it to him to take to his doctor. This is just the kind of info that the doctors need to know too.

Many thanks

XxX

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I would like to think they know it already :)

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I would like to think that too

😁😆

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Is there a Diabetes Awareness course near you? Ive heard good things about them, talking a lot of sense 😊

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I'm not sure if there is a course, i will look into it and see if he will come along with me.

XxX

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That's a good idea. I get the feeling they're a bit hit-and-miss, depending on who's running it, but it can't hurt to try.

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Hi, TheAwfulToad

Keto is similar to LCHF but more extreme an even more effective?

...and LCHF or Keto work best in combination with (Intermittent) Fasting? See:

healthunlocked.com/fasting-...

and:

healthunlocked.com/fasting-...

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Much prefer the term “moderate carb adequate fat”. Some LCHF fans appear to me to be almost obsessive, especially on the LC side. Indeed LCHF seems to have become The Diet of the moment. Pity we can’t adopt MCAF, far more sustainable! 😊

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I totes agree. The caveat is what we use as a measure of moderation. Most people will use their family, their friends, their neighbours, celebrations, the Eatwell Guide... and the focus for the past 50 years has been on lowering saturated fat (nationally we eat 1% above the recommendations, and I'm eating someone else's), with carbohydrate being touted as a 'healthy' alternative. My point is that our perception is completely skewed.

Normal, in today's society, is far from moderate.

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It drives me mad how TPTB have redefined the word "balanced" to mean "mountains of starch and little else". That would have given Orwell something to smile about.

You're right of course that our perception has been skewed by this relentless redefinition of words, such that we now view anything other than "lots and lots of carbs" as "low", and anything higher than "zero fat" as "high".

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Doesn’t quite have the same ring to it does it? But it will be my mantra from now on 😊

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My views on low-carb have evolved a lot over the years as I've done more research and gained some experience. A long time ago I probably would have been one of those fanatics, although I've never subscribed to the "all carbs are poison" viewpoint - that's as simplistic and unfounded as "saturated fat will give you heart disease". Clearly, humans can eat carbs without harm. Plenty of societies do. But there is a breaking-point where it all goes downhill fast.

The whole debate about carbs vs. fats is really a red herring. I'd quite like to see LCHF redefined as "low crap high food". The point is that people don't eat carbs and fat; they eat potatoes and steaks and bananas and burgers. The "packaging" matters. The big picture matters. LCHF is really just about getting back to proper food, and discarding bizarre manufactured products like margarine, skimmed milk, chemically-extracted vegetable oils, breakfast cereals , suspiciously-squishy bread and cakes, diet shakes, and low-fat "yogurt" made from modified starches.

These things have become so commonplace that we accept them as normal. A lot of them even carry government-approved "healthy eating" stamps. But they're not even food, nevermind healthy.

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Haha love that! Low crap high food is a much better definition. Proper food and no snacking between meals (you’ll spoil your dinner), and sweets a treat on Friday night only - that was the way I was brought up in the 50’s and 60’s, and I didn’t know a single fat person back then. It all went downhill in the 70’s with the advent of both fast foods and so-called diet products. And we all know the rest of the story!

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“Low Crap High Food” love it 😊

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I’m all in for low crap high food.........brilliant!

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I did not call it MCAF, but that is what I have been doing!

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Great thread - thanks TAD!

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I've added this to my resources list. It should really be a pinned post and compulsory reading (esp with the replies!)

healthunlocked.com/nhsweigh...

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Moderate carbs, adequate fat sounds good, particularly if sugar, starchy carbs and unhealthy fats are excluded. In this sense I reckon the Mediterranean diet is a good option for a healthy way of eating and living.

I think the Newcastle Diet was develop to help severely obese people to lose weight rapidly and reverse type 2 diabetes. From what I have read, in this study they did the meal replacement shakes and soups for 8 weeks and then the participants started to eat real food. They were also provided with behavioural support throughout. It is obviously an extreme diet, so you wouldn't do it unless you have to lose half of your body weight I suppose. Definitely not something to do if you want to lose a pound or two.

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As you say, the Newcastle approach depended on great, ongoing support. I think it would be hard to make the transition from shakes/soups to real food without that support.

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Dear not remotely awful Toad

As you seem very informed, have you ever heard of my symptoms? No GP has & there’s nothing on the internet. I get frequent & dramatic low blood sugar - shakes, can’t speak coherently, can’t safely drive or use a sharp knife, sweats, hugely stressed & confused. It’s much worse with sugar & refined carbs, so They have not been eaten part of my diet for 20 years. I eat very healthily (protein, vegetables, Greek yogurt, nuts, ancient grains). I have put on weight partly because I have eaten too much of this, because I am so hungry / afraid of low blood sugar episodes (also a sleep disorder, mirrazapine & suddenly sedentary job - other stories). If i eat a big healthy breakfast, when other people are thinking it would be nice to have lunch, I am ready to stab someone if only I could hold a knife steady. I deduce, not medically trained myself, that there is something lazy about my hormone that releases glycogen to glucose, but it can triggered by eating. I am ok again 5 minutes of eating cashew nuts - but they can’t possibly be in my blood stream that quickly. It is perfectly possible that I do not have low blood sugar & for some reason my brain is mimicking the symptoms but I need help for that as well as I cannot function as a responsible adult during one of these episodes. NB I definitely do not have diabetes, I have had a lot of tests. The NHS website says that low blood sugar is only caused by the insulin overdoses, but this obviously is not the case for me. If you don’t know anything about this, do you have any idea who might?

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Without knowing precisely what you're eating day-to-day and seeing the results of your tests (and the conditions under which they were conducted) I can only hazard a few guesses.

Have you ever had a blood test during one of these episodes indicating that this really is low blood sugar?

A handful of cashew nuts (which are quite 'carby') could well have an effect after only five minutes: because you're chewing them, you'll get some amylase activity and some glucose absorption through the mucous membranes of your mouth. If you experience similar relief with a teaspoonful of HFCS, then most likely it's genuine hypoglycemia.

If we assume for now that these are hypoglycemic episodes, I wonder if you have a glucagon malfunction? Crudely speaking, glucagon is responsible for boosting blood sugar when none is arriving from the products of digestion. Although everyone talks about insulin, glucagon and insulin carry a complex-valued control signal (complex in the mathematical sense : en.wikipedia.org/wiki/Compl... ). If one axis of that signal is "missing", the control loop will not function as it should. Alpha-cell failure to respond to low blood glucose could cause the symptoms you describe.

I'm only speculating here, of course! I guess you could test the hypothesis - if your doctor is interested in giving it a go - by carrying a low-dose glucagon pen (autoinjector) around with you. If you use it and experience immediate relief, it'll be a strong indication that that's where the problem lies. I'm not suggesting this is critically important, but if you enjoy experimenting on yourself it might be enlightening.

"Diabetes" is very narrowly defined as HbA1c or single-point glucose measurements beyond the normal range, but IMO that's not a good metric. The defining factor in diabetes (that might consequently show up as a high HbA1c reading) is control-loop instability, characterized by very low and very high excursions of blood glucose accompanied by similarly extreme (or completely unregulated) output of both glucagon and insulin.

I guess what I'm saying is that you might have an unusual presentation of diabetes that isn't detected via the standard tests - or more plausibly, pre-diabetes. Have you ever attempted to go "keto"? Doing this almost completely bypasses your carbohydrate-based energy pathway. Most of your body's organs will start to adapt to running either on fatty acids or ketones, dramatically lowering your average requirement for glucose. At worst, you should experience some symptomatic relief. At best, you may find that whatever-it-is that's malfunctioning will recalibrate itself.

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Thank you so much. I will process all that you have said & do some more investigating. My current diet for last 6 weeks is Keto-ish, limited carbs - a small serving twice a week. I have fewer low blood sugar crises now, or rather it’s longer before they arrive, but they have not gone altogether. I will weigh my food & step up fat rather than protein.

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Since your present diet has produced some measurable improvement, I would attempt to just go all-in. For most people it really is a leap of faith (given all that we've been told about the "essential" role of carbs in the diet) but even those two small weekly servings may prevent fat adaptation. Clinical experience is very clear: you have to go very low-carb to trigger ketogenic adaptations; if you don't, your body will limp along trying to run on carb-based energy which just isn't available in adequate amounts. 25g net carbs per day (or lower) seems to be the magic number. Nobody knows why, as far as as I'm aware. But it is what it is.

You don't need to do it for very long - a couple of weeks will suffice - but the idea is to remain consistently low-carb during that period so that your body has literally no other option but to switch over to Alternate Power. You can then come out of keto (increasing your carbs to a more practical, but still modest level) and it'll carry on with a definite preference for fat-based energy. After that initial hard switchover, fat adaptation continues as a slower process over a period of weeks and months.

It's not necessary to weigh your food - in fact you absolutely should not attempt to limit the size of your meals. As long as you pick very-low-carb ingredients, you can eat as much as you like (within reason!) confident that your appetite will say "that's enough" at the correct point:

dietdoctor.com/low-carb/vis...

But yes, you do need to introduce sufficient fat (from whatever sources you like) to make up for the missing carbs.

If you have some irreparable failure in pancreatic function, going low-carb won't entirely solve the problem. But it should get much, much better in time.

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I’ve been thinking about this today & I won’t go all in Keto - I’ve had stress / anxiety related constipation & needed surgery to help this. There is also family history of bowel cancer. So I shall continue to eat lentils & other pulses, but will make some low carb switches - such as cashew nuts for pecan nuts, and always choose broccoli over peas.

I’d also like to understand the medical evidence for why our bodies don’t know how to use fat reserves when they need them. There’s no one fat in Ethiopian famines, because they’ve been eating rice lately & their bodies have forgotten how to use fat. While I feel pretty dreadful without food & having a low blood sugar crisis, i’ve never gone into a coma - so somehow my body must know what to do! I have More research to do. Toad can you tell me what sort of a medical specialism this is? Is it endocrinology?

Thanks again SO much.

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I notice most people fear doing the keto phase, but invariably remark afterwards: "I wish I'd tried this years ago". There are endless scare stories in the press about how dreadful it is (I suppose it's a sure-fire way to fill a few spare column-inches in the heath supplement pages) but there's no reason to believe a couple of weeks of ketosis would cause anxiety or cancer :)

I'm not pushing you into something you're not ready for, but you may come to a point where you think it's worth a go, and I'm just trying to reassure you that it's not painful, stressful, unpleasant, or dangerous. You may even find that your general mood improves: low-carb diets do have (positive) neurological effects on some people. For example we've had two posters on the LCHF group who found their migraines stopped, which is a massive result as far as I can see.

>> I’d also like to understand the medical evidence for why our bodies don’t know how to use fat reserves when they need them

I was oversimplifying a bit. The point is that the definition of "need" depends on context. If you literally stop eating then of course fat will be mobilized. If you have insufficient food for a period of months, fat will be burned. However muscle will be burned preferentially, especially in the context of a dietary carbohydrate bias: that's why kwashiorkor is common in famines. I was referring to the state (common in Western dieters) where people are eating ~600-1000kCal/day as carbs, but insufficient total calories (ie., low fat and low/moderate protein). In that scenario your body can stay more-or-less carb-fuelled by drastically dialling down its metabolic rate. The precise mechanism behind this is anybody's guess, but I think anybody who has done a low-fat low-calorie diet can confirm the empirical reality. It certainly happened that way for me. My personal theory is that it is an optimal solution for survival during a famine. Maintaining a high metabolic rate while burning through fat reserves would be the fastest possible method of dying, so bodies that adopted that strategy were weeded out of the gene pool millennia ago.

Only type 1 diabetics are at risk of hypoglycemic coma, and only then if they're injecting insulin. Your body is extraordinarily sensitive to low blood sugar: what you experience subjectively as a crisis is actually a very modest drop in absolute terms. That's why a few cashew nuts sorts it out.

Everyone else - including Type 2 diabetics - can manage their blood sugar automatically to some degree. But the control system for that is adaptive: it can observe its own performance and adjust its own loop parameters, and it can do this on multiple levels. It's actually a distributed, nonlinear, adaptive control system, which is impossible to describe in anything except handwaving terms. What seems to happen in Type 2 diabetes is that, when your body observes that it can't sink dietary glucose fast enough (extreme insulin resistance plus a very-high-carb diet), its only option is to relax the tight constraint on blood sugar excursions. There is literally no other mathematical solution. In some cases, it will recalibrate to normal operation when the carbohydrate overload is dialled back a bit: that's what Dr David Unwin is seeing with his modestly-low-carb programme. In other cases, it seems to get stuck. I suspect this is because the control loop has been shoved so hard against its limit stops that the information required for loop adaption is being "lost".

Yes, it's endocrinology, but if you're interested in going down the rabbithole, I recommend you also read up on dynamic systems theory and control systems. Few (if any) researchers in this field know anything about it, which is unforgivable IMO. Almost all of your body's critical systems implement some sort of control loop, and the behaviour of such systems is complicated and non-intuitive.

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Thank you very much. I am hugely grateful for you taking the time to explain all this. I should say that I am not reacting to scare stories in the press, I just know what happens to my body, when I have not had enough fibre. I don’t believe Keto would make me anxious (my childhood did that), but rather anxiety slows my digestive tract to a crawl. I also have to take massive iron doses to prevent periodic limb movement disorder (yes my body is frankly a bit crap all round), which also causes a spot of constipation. And there is a lot of evidence that insufficient fibre contributes to bowel cancer & I suspect I may be more likely to get it than the average person. So, I love the idea of Keto, but I would need to be sure I was not swapping one medical issue for another by reducing fibre and increasing fat. I would also be massively surprised if I had type 2 diabetes - perhaps you aren’t saying that. When I first started experiencing this low blood sugar thing 25 years ago, I was underweight, but.... I had been messing around eating just apples & dirt coke - which obviously was terrible for my blood sugar levels. As I said before, I have now not eaten refined carbs for years - would lentils and quinoa give me type 2 diabetes? I think the answer for me now is to gradually reduce my carbs still further - no more peas, cashew nuts & quinoa - and keep an eye on my digestion.

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I'm really just navel-gazing here. What's happening in your (admittedly very strange) scenario is hard to guess! It's possible, I suppose, that you did some lasting damage in your younger days? I'm just throwing out some testable hypotheses so you can (possibly) nail it down.

Keto is very high in fibre because it's based largely on low-carb vegetables. In fact it's probably higher in fibre than the official starch-based diet, although it might have a different distribution of fibre types. The "high" in "high fat" is relative to the low-fat standard (ie., virtually zero fat). I've never attempted to calculate it accurately, but I doubt I eat much more than 150g of fat per day. That's a maintenance level, of course - keto might be closer to 200g - but you'd be surprised how easy it is to work that into a more-or-less normal meal routine.

Are you diabetic? Well ... it depends how you define diabetic. Diabetes is a dynamic failure, but doctors diagnose it with steady-state tests. Presumably you're not dumping glucose into your hemoglobin (which is pretty much where doctors say, yep, you're diabetic) but the blood sugar undershoot suggests poor control loop tuning - which is exactly how prediabetes presents. You won't feel hyperglycemic overshoot, but it's a safe bet they're occurring. What label should be applied is a moot point: the solution is to re-calibrate. Your proposed course of action should work. It does work for most people in a similar situation. But if it doesn't, there's always keto!

The alternative hypotheses (as I see it) are:

- Your blood sugar control is basically normal, but you have an unusually strong reaction to very small changes in blood sugar. I gather you already considered this as a possibility.

- Your pancreas is damaged, and it cannot react as it should due to physical limitations.

Keto would have a definite positive effect in either of those two scenarios, whereas a carb reduction might not.

It's a different conversation, but as far as I can tell the evidence on fibre as it relates to bowel cancer is highly equivocal; there are some who suggest that the abrasive effect of excessive fibre, in the context of inflammation caused by the modern high-refined-carbs diet, could even be a factor in causing bowel cancer. Personally, I'm not sure what to think. I've done a lot less research on that than I have on carbohydrate metabolism! It certainly seems to be more complicated than "more fibre = less cancer".

Just a thought: you're not on a very-low-salt diet, are you? This can cause all sorts of "crap all round" symptoms.

Anyway, do let us know how it goes with your experiments. This is all very intriguing :)

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Thanks thanks thanks! No - I eat salt: bacon & ham in my salads, & cheese. May I ask? Is endocrinology your profession in some way, or have you done a lot of research for personal reasons (with a knowledge of the human body to make it make sense?)

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Nah, I started out in life as a psychologist, but I was disillusioned by what I saw as professional dishonesty (ie., the fact that most clinical psychologists and psychiatrists were just winging it, with little hard evidence to support the treatments offered). Things have changed quite a lot since then, though - it's a much more respectable career these days. I suppose I wanted to be a medic like my mum and dad (I can remember reading their medical textbooks for entertainment when I was a kid), but I wasn't keen on the blood and guts aspect!

Basic endocrinology is a mandatory component of a psychology degree.

Anyway, I rapidly lost interest in clinical practice and ended up in engineering instead. I firmly believe more doctors need to know about engineering, since they're basically dealing with an incredibly complicated machine. They're floundering around trying to understand things that were worked out decades ago in other disciplines, and they end up either re-inventing the wheel or getting completely the wrong end of the stick. I took a big interest in obesity and diabetes about 10 years ago (a few years after being very successful with low-carb eating) and read all the research I could find. I discovered that the theoretical framework and math that I learned in control systems engineering is an invaluable aid to understanding how carbohydrate metabolism works ... and how it goes wrong.

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