Sugar to stop gluconeogenesis?

tittiger

Hi!
I have asked similar questions on the forum before only to discover that people that know much about ketosis don't seem to frequent this forum at all. That being said let me begin:

I have had unexplained high blood sugars (Not being under stress and having high cortisol) during outright water fasts and now on what Dr. Mercola has coined a "Ketofast". A diet of half of my normal calories, half of the protein, and carbs under 20 net grams.

This morning after a low carb, and low protein, 800 calorie day yesterday I had a BS of 106.
(BHB was .03 which is higher [0.4} than when I went to sleep last night.)
I have had the same thing happen 5 days into a fast with BHB levels of 7!!!

Anyhow I took a teaspoon of sugar (7g of carbs) an hour ago and my blood sugars did not go down as Mercola states in 2 of his books (but neglects to give any specific or useful directions)

My questions are:

1.) Was I really using gluconeogenesis on this ketofast and how do you tell with some certainly? (I certainly had to be on the water fast)

2.) Is 7g an appropriate amount of carbs? Should I have used more or less?

3.) Should I continue checking BS every 30 minutes and see what happens?

FWIW I am very frustrated at the lack of resources to resolve issues like this.
This has been going on for well over year and after multiple attempts to get answers, I have decided that most people really don't have a clue, even about the basics such as this.

I am hoping that I am wrong and someone can authoritatively make some observations.
For everything that CM has done for Mercola, and the lacking discussion of this in both "Fat for Fuel" and in "KetoFast", it seems like he should be in this forum and helping people out.

Regards
Joe

BRBWaffles

Any time carbohydrate intakes go that low, you will be breaking down either skeletal muscle or protein from your food for gluconeogenesis. Your body will convert certain gluconeogenic amino acids to glucose to a sum total of about 80-130g of glucose per day.

Ketosis and gluconeogenesis are compensatory mechanisms to support energy metabolism during carbohydrate deprivation or fasting. The mechanism that initiates ketosis is glycogen depletion, primarily in the liver. When you run out of pyruvate you run out of oxaloacetate. When that happens you have to use amino acids to keep the Kreb's Cycle going. So, the elevated blood glucose probably doesn't have anything to do with glucagon liberating glycogen.

Gluconeogenesis is also tightly controlled. Your body doesn't like doing it unless it has to. I doubt you're generating so much glucose from gluconeogenesis that you're spiking your blood glucose. I think the problem is that ketosis directly impairs glucose disposal. A recent one-year trial overseeing hundreds of patients using ketogenic diets to manage type II diabetes found that ketosis need not reduce blood glucose, and for some it can increase it by diminishing insulin sensitivity. This is because overall energy status is typically king at determining glycemic status.

Personally I think the best diet for glucose control long term would be a hypocaloric high carbohydrate low fat diet with adequate protein. Say 50% carbs, 20% fat, and 30% protein. High carb diets maximally increase glucose disposal, and being hypocaloric means that blood glucose doesn't have an opportunity to stay remarkably high, provided a healthy fat mass.

It should also be noted that high blood glucose in the diabetic phenotype is mostly coming from the Cori Cycle in the liver due to increased anaerobic glycolysis and lactate production in peripheral tissues. If you are anywhere on the diabetic spectrum, this alone could explain your blood glucose issues. This is also something controlled by overall energy status.

tittiger

Thanks for the feedback BRB. I am very familiar with what you go into but strongly disagree that high carb is a way to control blood sugars. The only way I know to regain insulin sensitivity and thus solve the high blood sugar issue is to limit carbs and desensitize your insulin receptors to insulin.

I have fasted and had blood sugars in the range of 70 mmol/L or lower and had plenty of energy.

During this most recent fast, my blood sugars were 120 mmol/L As HIGH as when I am not fasting!

According to Mercola, the problem I was likley encountering is that insulin is the main hormone that inhibits gluconeogenesis. SO if during fasting your insulin drops very low, the inhibiting effect on gluconeogenesis in the liver is removed and it goes full throttle making glucose. For some reason this does NOT raise insulin to the degree that the feedback loop works and gluconeogenesis is again inhibited.

Again according to Mercola the way to fix this failure of the feedback loop is to ingest carbs (he gives no real details which is frustrating) and for some reason the carbs raise you insulin, fixing the broken feedback loop (while for some reason the liver produced glucose does not raise insulin to the level of fixing the feedback loop)
(which I can not understand and wish Mercola had elaborated)

Anyhow I have no other explanation for the high blood sugars. Mercola's fix did not work for me. The 7g of carbs that I took, shot my BS to 140 mmol/L and they came back down to the same (high) 120 mmol/L in about 3 hours. It did not bring my blood sugars back down to what I would expect during a multi day fast. (say below 90 mmol/L)

Am I missing something? I think Mercola is on the right track. I am just missing something here it seems.

BRBWaffles

"The only way I know to regain insulin sensitivity and thus solve the high blood sugar issue is to limit carbs and desensitize your insulin receptors to insulin."

Carbohydrate restriction reduces insulin sensitivity by driving up cytosolic citrate and inhibiting the insulin receptor substrate's communication with GLUT4, the insulin-dependent glucose transporter. There are two ways to drive up cytosolic citrate to this effect. Either you use fatty acids as fuel or you eat in a calorie surplus. Ketosis literally causes insulin resistance. It actually cannot work any other way, physiologically.

"According to Mercola, the problem I was likley encountering is that insulin is the main hormone that inhibits gluconeogenesis."

Actually, just having enough carbohydrates to keep PDH (pyruvate dehydrogenase) active and the Kreb's Cycle running without needing to use amino acids to get oxaloacetate is what inhibits gluconeogenesis. It literally comes down to carbohydrate availability, not insulin. You actually don't need insulin to inhibit gluconeogenesis. You could just ingest pure fructose, bypass the pancreas entirely, and inhibit gluconeogenesis in the liver that way. You don't need insulin to inhibit it.

I think Mercola doesn't know what he's talking about, personally. It wouldn't be the first time.

tittiger

Thanks for taking the time to clarify.

I agree that he has been wrong in the past. In this past book there are inconsistencies and just very unpolished thought processes. That being said I think that there is a lot of good though provoking info in the books of his that I have read.

Your explanation interests me but for the moment is above my pay grade. :-)
I tend to stay on the surface with things chemical, especially biochemical in nature and try to rely on "experts" such as yourself or Mercola. It saves a ton of time (decades) to "stand on the shoulders of giants".

OK to the meat of things. If sugar is the main way that gluconeogenesis is regulated in the liver, that still does not explain to me why fasting one time I have BS of 70 and the next time they are 110. Something is just not adding up.

I am wondering how stress and adrenaline may playing into all of this?

So many variables, such as -- since I was feasting 2 days prior, I likely had full glycogen stores to begin with. Which may explain my BHB of 0.3. during the second day of the following ketofast? Perhaps if I kept up the ketofast for a few more days I could be sure that my glycogen stores are empty....

I have to stop and absorb all of this intotallity before my head explodes! I do not do this for a living so a lot of it doesn't come naturally from everyday use.

Thanks again for pointing me in the right direction and would like to hear any further insights into this.

Joe

Susan_RD_101

@BRBWaffles did an incredible job of summarizing this!

tittiger

I have a little bit of insight on this matter...
I have read several accounts of how when in ketosis for long periods that the body rebels with high blood sugars. Regardless of physiological causes, it is an observable thing according to my sources. Diet variation is the answer I think. i.e. diet variation and coming out of ketosis every now and then. (this is not my current problem as I have trouble staying in ketosis when I am eating)

My high glucose when fasting may be less of an issue when fasting if I look that GKI rather than glucose and BHB separately.

https://keto-mojo.com/pages/glucose-ketone-index-gki

For instance my numbers were just glucose 98 mg/Dl, and BHB 3.2 mmo/dL

A respectable GKI of 1.7.

Shallimar

Please check out ketogenicforums.com for all your keto questions and needs. It is THE place for keto info and community IMHO. FYI, Your body will not break down skeletal muscle while in ketosis, as someone stated, unless you have a dangerously low body fat percentage in the neighbourhood of 4%. As for high BG while fasting, don't freak out. This also happens to me. I have perfectly normal BG on lab testing 5.0 and also a perfectly normal A1c 4.9 (Canadian values), yet this morning on 40 hours fasted my BG was 6.4 i.e. considered diabetic range. Here is a great article from a reliable source that explains what may be happening to you. Dietdoctor and Dr. Fung's IDM (intensive dietary management) sites are also excellent keto and fasting resources. Of note, Dr. Fung is a practicing licenced physician who sees real patients, not just an internet personality.
https://www.dietdoctor.com/low-carb/fasting-blood-glucose-higher

BRBWaffles

@Shallimar

Your body will not break down skeletal muscle while in ketosis, as someone stated, unless you have a dangerously low body fat percentage in the neighbourhood of 4%

This is just not true. While you're in ketosis, you NEED to use amino acids to support at least some proportion of GNG. Up to 50% can come from the Cori cycle (this is dependent on total, whole body energy status). Up to 15% can come from glycerol. A small fraction can come from fat through the conversion of small aldehydes. But the rest comes from amino acids. Some are dietary and some are from skeletal muscle.

MANY people using CBGMs on low carb diets report strange BG surges in the middle of the night. This is cortisol reacting to liver glycogen depletion. When you're sleeping, you're fasting, even if you ate before bed. If your liver glycogen is low (ergo you're in ketosis), you need to break down your lean tissue to maintain euglycemia. That's just the way it works.

As for high BG while fasting, don't freak out. This also happens to me. I have perfectly normal BG on lab testing 5.0 and also a perfectly normal A1c 4.9 (Canadian values), yet this morning on 40 hours fasted my BG was 6.4

Case in point. During ketosis, cortisol is used to maintain euglycemia. When the liver runs low in glycogen, cortisol signals to skeletal muscle to donate amino acids to the liver. The liver will use them to surge glucose into the blood (especially at night or post-exercise). Waking up with higher blood glucose demonstrates the basic physiology I'm discussing.

Dietdoctor and Dr. Fung's IDM (intensive dietary management) sites are also excellent keto and fasting resources. Of note, Dr. Fung is a practicing licenced physician who sees real patients, not just an internet personality.

They're also quacks. Just saying.

tittiger

Not to address anyone in particular but as is often the case those that are trained by the government often are most hopelessly stuck in the past.

For example my computer science degree illustrated this to me in spades - I knew less after graduating than before and I was years behind what was curent. I don't have the time to debate all of these points but appreciate your time.

My daughter the MD is another example of state imposed ignorance. An AMA trained MD is the last place I would look for health advice as evidenced by the average lifespan of an MD being about 59 years and also my daughters self imposed poor health.

Here is a book for you if you wish to investigate this further as it is not IMHO the dreadful muscle wasting condition that is often painted. There is a ton of evidence to the contrary in this book and also in my extensive personal experience:

The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable

****HOW DO HYPERLINKS WORK HERE? Unlike any editor that i have used recently. ****

tittiger

Have you gone down the autophagy rabbit hole? A large number of amino acids are recycled when autophagy by the AMPK pathway is invoked. The body has all sorts of protein sparing mechanisms the least of which are the stem cells that develop after 4 or 5 days of fasting that will rebuild healthy better than the old ones. muscle cells.

Anyhow I think that much of the "alarms" that traditionally trained people raise about ketosis are mostly bunk. There are plenty of uber intelligent people that are fooled by their myopic bottom up training and come to bad conclusions. One needs to look no further than AMA trained medical professionals to see evidence of this fact. It is well established that MD's in the US die at an average age of about 59. They are obviously doing something majorly wrong and I would question anything that comes out of their mouths.....especially concerning the effects of being in ketosis.

Reagards
Joe