Category Archives: what should my blood glucose be in ketosis

optimal ketone and blood sugar levels for ketosis

  • A reduced carbohydrate diet will help reduce your blood sugars and increase your blood ketone levels.
  • Blood glucose control and improved metabolic health will help to reduce your risk of many of the diseases of modern civilisation such as diabetes, heart disease, stroke, cancer, Parkinson’s and Alzheimer’s.
  • We become ‘insulin resistant’ when our fat cells get full and can’t store any more energy.  Once our adipose tissue becomes insulin resistant, excess energy is stored in the liver, pancreas, heart, brain, eyes and other organs that are more insulin sensitive.  We also see increased levels of energy in our blood in the form of glucose, ketones and triglycerides.
  • Endogenous ketosis occurs when we eat less food than we need.  Our insulin and blood sugar levels decrease and ketones rise to supply the energy we need.  Exogenous ketosis occurs when we eat high levels of fat and/or take exogenous ketones.    While a low carb or ketogenic diet helps to stabilise blood sugars, most of the good things associated with ketosis occur due to endogenous ketosis  
  • If your goal is blood sugar control, longevity or weight loss then endogenous ketosis with lower blood sugars and lower ketones is likely a better place to be than driving high blood ketones with exogenous ketosis.
  • This article reviews blood ketone (BHB), breath ketone (acetone) and blood sugar data from a large number of people on a ketogenic diet to understand what “normal” and “optimal” ketone levels might look like.

low carb diets reduce blood glucose levels

Many people start a low carb diet to manage their blood glucose levels, insulin resistance or diabetes.  As shown in the chart below, foods that contain less carbohydrate cause a smaller rise in our blood sugar levels.[1] [2] [3]

carbs vs gluocose score.png

If you are insulin resistant, have prediabetes, diabetes (Type 1 or Type 2) it makes sense to reduce the carbohydrates in your diet to the point where you can achieve the blood glucose levels of a metabolically healthy person.

If you cannot produce enough insulin to maintain your blood sugars it makes sense to reduce the insulin load of your diet to the point that your pancreas can keep up.

What are optimal blood sugar levels?

According to mainstream medical definitions:

  • “normal” blood sugar regulation is defined as having an HbA1c of less than 6.0%,
  • Prediabetes is diagnosed when you have an HbA1c between 6.0 and 6.4%, and
  • Type 2 diabetes is diagnosed when you have an HbA1c of greater than 6.4%.

However, as shown in the charts below, the mainstream definition of “normal” is far from optimal.

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HbA1c vs cancer incidence

By the time you have “pre-diabetes”, you are at risk of many of the most common western diseases of ageing and causes of death such as heart disease, stroke, Parkinson’s, Alzheimer’s and cancer.[4] [5]

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However, if you’re interested in optimal rather than what passes for normal, the table below shows some suggested HbA1c and average blood sugar targets.

risk level

HbA1c

average blood sugar

(%)

(mmol/L)

(mg/dL)

optimal

4.5

4.6

83

excellent

< 5.0

< 5.4

< 97

good

< 5.4

< 6.0

< 108

danger

> 6.5

> 7.8

> 140

In this video, diabetes pioneer Dr Richard Bernstein tells how he refined his understanding of optimal blood sugar levels by asking healthy your sale reps to demonstrate their blood sugar metres on themselves.   They always seemed to come out at about 83 mg/dL (or 4.6mmol/L).  This correlates well with the level at which we see the lowest level of risk of various common diseases.  Today, people with Type 1 who follow Dr Bernstein’s recommendations balance their food and insulin to maintain a blood sugar of around 83 mg/dL or 4.6 mmol/L.

ketosis vs. hyperinsulinemia

While high glucose levels are bad news (due to glucose toxicity and excessive glycation) they typically go hand in hand with high insulin levels.[6] [7] [8]

A metabolically healthy person will store excess energy in their fat cells, ready for easy access when required later.  But if we continue to fill our fat cells with the excess energy they get to the point where they cannot continue to expand to absorb the excess energy.  It is at this point that our adipose tissue becomes insulin resistant.

Ted Naiman does an excellent job explaining insulin resistance in this video.  If you want to dig into the subtitles of this topic you should also check out:

The “good news” is that becoming insulin resistant will slow the expansion of your fat cells.  Unfortunately, the bad news is that once our fat cells become insulin resistant the excess energy will be re-directed to the parts of our body that are more insulin sensitive such as our liver, pancreas, heart, brain and other vital organs.

Our pancreas works overtime, secreting more insulin to try to keep the energy in the liver and fat cells in storages while we use up the glucose in our bloodstream.   High insulin levels mean that we will find it harder to release energy from our fat stores when we go without food.[9]

Without easy access to our body fat stores, we will be driven by our appetite to eat again sooner.  Without easy access to their fat stores, someone who is insulin resistant may be driven to eat more often.

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Fasting insulin levels in healthy populations tend to range between 2 to 6 mIU/L.[10] [11] [12]  The average insulin levels in western populations are 8.6 mIU/L.   Meanwhile, the official reference range for “normal” fasting insulin is less than 25 mIU/L.[13] [14]  

Given that the western world is going through a crisis of metabolic health, it is safe to say that this cut off for ‘normal’ is also far from optimal.

how to manage your dietary insulin load

The good news is that you can tailor the insulin load of your diet to suit your current level of insulin resistance.   As shown in the chart below, the insulin generated by our pancreas is proportional the net carbs in our diet plus about half the protein it contains.

food insulin index vs carbohydrates fibre and protein.png

Reducing the insulin load of your diet can help to reduce your insulin and blood sugar levels to the point where your pancreas (and any insulin resistance you may have) can keep up and maintain normal blood sugars.  With lower insulin levels, we can access our body fat for fuel, either from our body or our food.

A person with type 1 diabetes is not able to produce enough insulin to keep energy tucked away in their liver, fat stores and even muscle tissue.  Without exogenous insulin, people with type 1 diabetes see both their blood glucose and blood ketones rise to very high levels.  This is called ketoacidosis which is dangerous and requires exogenous insulin as soon as possible.

As shown in the image below of JL, one of the first children with type 1 diabetes to receive insulin, people with type 1 diabetes quickly regain weight with exogenous insulin administration.

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Rather than minimising insulin, it’s important to find the optimal dose of insulin.  Too much insulin can slow the release of fat from your body to be used for fuel.  Too little insulin and we effectively disintegrate.

People who switch to a low carb diet often find that their blood glucose and insulin levels drop and they are not hungry.  However, the problem with a very low insulin load dietary approach is that it may not contain enough of the vitamins and minerals that you need to help you avoid nutrient cravings in the long term.

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High-fat foods have a high energy density which can make it hard for some people to manage their satiety.  This can be problematic if their goal is weight loss.  Very high-fat foods also tend to be less nutrient dense and are less satiating than high fibre or high protein foods.

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The most ketogenic foods also contain lower levels of protein which is critical to managing satiety.

We need to find the right balance between a lower insulin load diet that will stabilise our blood sugar while still getting the essential nutrients that our mitochondria need to thrive and produce energy efficiently.

If you need help with the process of balancing your blood sugars and nutrient density, the Nutrient Optimiser is a tool to help you refine your diet to stabilised your blood sugar and insulin levels while also maximising nutrient density as much as possible.

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blood glucose and ketones in fasting

When we go without food, our blood glucose levels decrease as the glucose in our bloodstream and liver (glycogen) are used up.  With less glucose available our body turns to our body fat stores.  Our liver converts our body fat to ketones for use in the brain rather than glucose.

This process is termed “endogenous ketosis” (endogenous = originating from within an organism).

2017-12-29 (4).png

As explained by Dr  Sinclair in this video, there are many of beneficial things that occur during endogenous ketosis such as autophagy, mitogenesis, mitophagy, upregulation of SIRT1 and increase of NAD+).  The body effectively goes into repair mode so it can make it through to reproduce in the next time of plenty.

The chart below shows my blood sugar and blood ketone (BHB) levels during a seven day fast.  As glucose levels decrease ketone levels rise to compensate for the lack of energy.

image

The sum of glucose and ketones continues to increase during fasting.  The sum of glucose and ketones can be thought of as the “total energy” (i.e. glucose + ketones).

Often in fasting, the body will let the total energy in the blood go quite high.  This high-energy state enables you to be at a very high state of alertness and be ready to find food to survive.

Exogenous ketosis vs endogenous ketosis

The mental clarity after a few days of fasting great!  But in practice, it’s hard to mimic all the benefits of going without food by forcing higher ketones with a very high-fat diet.

I think it’s important however to understand the difference between exogenous ketosis and endogenous ketosis.  

  • Endogenous ketosis is when we eat less and our body is forced to use some of our body fat to make up the difference. 
  • Exogenous ketosis occurs when we eat lots of fat (or take exogenous ketones), and we see blood ketones (beta-hydroxybutyrate) build up in the blood.  

2017-12-29 (5).png

Higher levels of ketones can build up in the blood when you are eating more fat than you are burning.  As a general rule, higher blood ketones are not a cause for concern as long as your blood glucose levels are also low (i.e. low total energy).

You will always be somewhere on the spectrum between exogenous and endogenous ketosis.  We need to ingest enough energy to not fade away and while building and repairing our organs and muscles.  

Keep in mind that most of the good things we attribute to ketosis and the ketogenic diet occurs due to endogenous ketosis when fat is coming from our body (e.g. autophagy, increase in SIRT1, increase in NAD+).  

What should your blood sugars and ketone levels be in ketosis?

Our understanding of the ketogenic diet is still evolving.  Keto Clarity co-author Eric Westman recently admitted that there is still a lack of clarity ideal ketone levels.[15]

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The image below shows the ‘optimal ketone zone’ from Volek and Phinney’s Art and Science of Low Carb Living. which has unfortunately led to a lot of confusion.

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In reality, it’s hard for most people to achieve “optimal ketone levels” (i.e. 1.5 to 3.0mmol/L) without fasting for a number of days or eating a LOT of additional dietary fat (which may be counterproductive if your goal is weight loss).

Recently, I had the privilege of having Steve Phinney (pictured below in our kitchen making his famous blue cheese dressing) stay with us when he spoke at a Low Carb Down Under event in Brisbane.

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I quizzed Steve about the background to this optimal ketosis chart.  He said it was based on the blood ketone levels of participants in two studies.  One was with cyclists who had adapted to ketosis over a period of six weeks and another ketogenic weight loss study.  In both cases these ‘optimal ketone levels’ (i.e. between 1.5 to 3.0mmol/L) were observed in people who had recently transitioned into a state of nutritional ketosis (Capacity for moderate exercise in obese subjects after adaptation to a hypocaloric, ketogenic diet, Phinney, 1980).

Since the publication of this chart in the Art and Science books, Phinney has noted that well-trained athletes who are long-term fat adapted (e.g. the athletes in the FASTER study) actually show lower levels of ketones than might be expected.

Over time, many people, particularly metabolically healthy athletes, move beyond the ‘keto adoption’ phase and are able to utilise fat as fuel even more efficiently and their ketone levels reduce further.

Urine ketone strips are often considered to be of limited usefulness because the body stops excreting ketones as it learns to use them.

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As our blood glucose levels decrease, our ketones increase to make up for the lack of fuel.   When we have less glucose available our insulin levels go down, more fat is burned, and blood ketone levels rise.  But it seems that over a longer period of time as our body learns to use blood ketones more effectively.

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As discussed in this post, BHB ketones enable our body to store and transport ketones around the body before they are converted back to acetoacetate to be burned in the mitochondria.  Similar to high blood glucose levels, chronically high ketone levels are not necessarily a desirable thing.  As you will see below, a healthy metabolism tends to operate with less fuel mobilised in the bloodstream whether that be in the form of glucose, ketones or free fatty acids.

Crowdsourced ketone and glucose values

In late 2015 I pooled a range of data from myself and a number of people on the Optimal Ketogenic Living (OKL)  Facebook group.  After sharing this data initially, a number of other people sent me their data.  Later, Michel Lundell from Ketonix agreed to share an extensive set of anonymised data for me to analyse.

I hope that this crowd-sourced data will help to provide more clarity about optimal ketone levels in a similar way to Dr Bernstein surveying the glucose metre sales reps helped to provide a better understanding of what normal ketone values are.

The chart below shows the sum of the blood glucose and ketones (i.e. total energy) from nearly three thousand data points from a broad range of people following a low carb or ketogenic dietary approach.

image24.png

On the right-hand side of the chart, we have a high energy situation from both glucose and ketones. While not as extreme, high energy situation is similar to someone with Type 1 diabetes with high glucose and high ketone levels due to inadequate insulin.  High levels of energy in the blood causes the pancreas to secrete insulin to hold the glycogen back in the liver and stop lipolysis (i.e. the release of fat from storage) until the energy in the bloodstream is used up.

On the left-hand side of the chart, we have a low energy situation.  These people do not have too much energy floating around in their bloodstream.  They are also likely insulin sensitive and can easily access their body fat stores for fuel.

As shown in my fasting ketone data above, we may see high blood ketone levels when we go without food for an extended period.  However, trying to replicate high ketone levels with high levels of exogenous ketones or an oversupply of dietary fat will not provide the same positive benefits as endogenous ketosis.

Based on this crowd-sourced data it seems the body tries to maintain a blood glucose level of around 4.9mmol/L and a blood ketone level (BHB) of around 1.5mmol/L.  The table below shows this data in terms of average as well as the 25th percentile and 75th percentile points.

 

ketones (mmol/L)

BG (mmol/L)

BG (mg/dL)

HbA1c

GKI

BrAc

total energy (mmol/L)

25th

0.6

4.2

76

4.3

1.8

46

3.4

average

1.5

4.9

89

4.7

7.3

56

6.4

75th

2.1

5.6

101

5.1

14

66

12.9

blood glucose and ketone levels during exogenous ketosis

Some people come to low carb or keto for therapeutic purposes (i.e. to manage chronic conditions such as cancer, epilepsy, traumatic brain injury or dementia).  These people can benefit from higher ketone levels to fuel the brain when glucose cannot be processed due to high levels of insulin resistance.  If you are trying to avoid cancer cachexia or trying to feed a child with epipepsy then an energy dense diet can be an advantage.  However, most people do not require this degree of therapeutic ketosis, particularly if weight loss or reversing insulin resistance is the priority.

People following a therapeutic ketogenic diet may be fuelling up with MCT oils to achieve high ketone levels and low glucose:ketone index values (GKI) value for therapeutic purposes.  Others will target high levels of ketones for brain performance.  Others will load up on exogenous ketones and glucose to ‘dual fuel’ the system for athletic performance.

One of the benefits of a low carb or keto diet is that it tends to eliminate a lot of hyper-palatable processed foods.  Stabilising blood sugar and insulin levels can also help normalise appetite and cause people to eat less.

The danger, however, with trying to drive high levels of ketones primarily through exogenous ketosis is that it will lead to an energy excess which will drive insulin and slow the use of fat and glucose stores until the energy in the bloodstream is used up.

Even though we are getting most of our energy from fat rather than carbs, the body will still work to bring maintain lower levels of energy in the bloodstream using insulin, and stop the release of stored glycogen and body fat until you have used up the energy in your blood from your food.  This is why Thomas Seyfried and Dominic D’Agostino talk specifically about the benefits of a calorie restricted ketogenic diet. [16] [17] [18]

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blood glucose and ketone levels for weight loss and endogenous ketosis

Many people embark on a ketogenic dietary approach to manage their diabetes and achieve long-term weight loss.  They want lower insulin levels to enable them to burn more body fat for long-term insulin sensitivity and health.

On the left-hand side of the total energy chart below, we have a situation where we are generating endogenous ketosis, meaning that our own body fat is being burned for fuel.

With lower levels of energy in our blood, our body needs to draw on fat from our body fat stores as well as use excess stored fat and old proteins in our liver, pancreas, brain and other organs (i.e. autophagy).

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To understand what all this means, the chart below shows the data divided into three thousand data points into five quintiles, from lowest to highest total energy.  For each quintile, I have calculated the average, 25th percentile and 75th percentile blood ketone (BHB) value.  Half of the ketone values fit between the 25th and 75th percentile values.

optimal ketosis

quintile

average BG (mmol/L)

BG (mg/dL)

ketones (mmol/L)

total energy (mmol/L)

25th

average

75th

1

4.5

80

0.3

0.6

0.7

5.0

2

4.9

88

0.4

0.8

1.1

5.7

3

5.1

92

0.6

1.1

1.5

6.2

4

5.1

92

1.2

1.8

2.3

6.9

5

5.1

92 2.2

3.2

4.0

8.3

In the discussion above we see that the lowest risk of the modern diseases of ageing and metabolic health occurs when we have an HbA1c of less than 5%.   It seems that as a general rule (other than when we are fasting or aiming for therapeutic ketosis) being somewhere to the left of this chart is (in the first or second quintile) with blood glucose levels less than 5.0mmol/L (or 90mg/dL) is optimal.

In summary, it appears that the lowest blood sugar levels are associated with lower ketone levels and a lower total energy overall.  Or to put it another way, higher ketones are not an indicator of improved metabolic health.

Virta study ketone values

The crowd-sourced data above seems to also align well with ketone data from the Virta study (Phinney et al., 2017).

In this study, they aimed to get their patients into nutritional ketosis (which was defined as blood ketone levels between 0.5 and 3.0mmol/L as per the optimal ketone zone chart above) using a ketogenic diet.

The distribution of BHB levels is shown in the chart below.  The average blood ketone levels over the first 10 weeks of the study were 0.6mmol/L, with a standard deviation of 0.6mmol/L.  The chart below shows the distribution of blood ketone levels.

2017-12-29 (6).png

In spite of consuming a ketogenic diet under the supervision of Steve Phinney and the Virta team, many of the study participants did not achieve ketone levels that qualified as nutritional ketosis.  Although the ketone values were reasonably low, the reduction in HbA1c was still substantial.

Virta HbA1c.png

Many of the people on insulin were able to reduce or eliminate their insulin requirements.  Also, most of the participants lost a significant amount of weight.

2017-12-29 (10).png

Do ketone values change after long-term adaption?

Anecdotally it seems that people who are very physically fit may find they have lower blood ketone levels as well as lower blood sugar levels.

In fact, unless you are managing a chronic condition that benefits from high ketone levels (e.g. Alzheimer’s, Parkinson, dementia or epilepsy) you could save your money on testing ketones and focus on making sure your blood sugars are closer to optimal.

Anything ‘keto’ is very trendy at the moment, as discussed in this article, ketones

 

 

Is it the ketones or NAD+ that is really doing the good stuff?

A smart friend of mine, Robert Miller, has been challenging my thinking recently around ketones recently.   Robert’s theory is that the benefits that people attribute to ketones are actually mainly due to an increase in nicotinamide adenine dinucleotide (NAD+).[19] [20]

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Adequate levels of NAD are critical to moving energy around our body, from our food to our mitochondria.[21]  NAD+ declines with age, increases in fasting, during a ketogenic diet or in response to exercise.  When NAD+ rises, SIRT1 helps our body to repair and improve our insulin resistance.[22]

Our NAD+/NADH balance is critical to controlling our appetite and telling the body whether we need more fuel, or if it’s time to tap into our body fat stores.

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We can increase our circulating levels of NAD+ by eating a nutrient dense diet, particularly with adequate niacin (vitamin B3).[23]  There is a range of NAD+ supplements that seem to have positive benefits.

Nicotinamide Riboside is a close precursor to NAD+ which can be helpful for people who struggle to make NAD+ directly from food.

Image result for niacel

However, Nicotinic Acid (i.e. full flush niacin) is a much cheaper supplement that will work just as well for most people.

NAD+ metabolism is a fascinating rabbit hole if you want to do some research, but for now, let’s say that it’s essential to have adequate NAD+ to enable your mitochondria to convert the food you eat to energy rather than having it back up in your body.

What about breath ketones (acetone)?

You will likely be aware that three separate types of ketone bodies:

  1. acetone (breath ketones),
  2. acetoacetic acid, and
  3. beta-hydroxybutyric acid (BHB in the blood).

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Fatty acids come to the liver either from our food or lipolysis (mobilisation of fat from our body) and converted to acetoacetate.   Unfortunately, we have no way to directly measure acetoacetate, only BHB in the blood and acetone in the breath.

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The Ketonix is a device that you blow into that measures the acetone which is akin to exhaust that is released when you burn acetoacetate.

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Blood ketones (BHB) are the most well-known form of ketone bodies.  There is some relationship between blood ketones and breath ketones, but it is not direct.  The chart below is Measuring Breath Acetone for Monitoring Fat Loss: Review (Anderson, 2015)[24] which states

“Endogenous acetone production is a by-product of the fat metabolism process… Breath acetone concentration (BrAc) has been shown to correlate with the rate of fat loss in healthy individuals…  A strong correlation exists between increased BrAce and the rate of fat loss.”  

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The data below provided by Michele Lundell from Ketonix data shows a similar relationship between breath ketones and blood ketones but with a lot of scatter!

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Breath acetone is likely a stronger marker of burning ketones for fuel, not just buffering energy in the blood.  A higher NAD+:NADH ratio means that less AcAc is stored as BHB and is available to be oxidised, at which point we see more breath acetone.

What I’m trying to illustrate with the dodgy clip art in the chart above is that having high blood ketones and low levels of breath acetone appear to be a sign that you are not burning the fat you’re eating.

By contrast, a high level of breath acetone with a low level of blood ketones (BHB) and low blood glucose may be a sign that you are very efficiently burning the fat you eat.

If you had a choice, I think it’s better to have high breath acetone (BrAce) and lower blood ketones (BHB) (which would suggest that you were efficient at burning fat) than high BHB and low BrAc (which would indicate that you were good at eating fat but not necessarily burning fat).

The figure below shows BHB vs BrAce for the different purposes that people nominate for using the Ketonix.  What we see is that people with diabetes (red trend line) have both higher blood glucose and higher blood ketone (BHB) levels (i.e. higher total energy).   Fuelling the mitochondria with the right nutrients that increase NAD+ will both help to burn off the excess energy and manage appetite through the NAD+: NADH ratio.

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The second law of thermodynamics states that the total entropy (chaos) of an isolated system can only increase over time.  It seems that an organism that is ageing will decay and not be able it’s energy packed in storage, but instead, we will see increasing levels of energy floating around in the bloodstream (e.g. diabetes).

What can we use blood ketones for?

Blood glucose levels are likely more useful than worrying about blood ketones, I think tracking BHB can still be helpful in diabetes management.

You will remember that people with uncontrolled type 1 diabetes will have blood glucose and blood ketones that are sky high.  This is called ketoacidosis.

The mainstream approach to treating diabetes is by ramping up the insulin to suppress both blood glucose and blood ketones.  Unfortunately, without modification of diet to reduce the insulin load, excessive amounts of exogenous insulin will just slow fat burning as well as suppressing blood glucose levels.

Having low blood glucose and very low ketone levels (say less than 0.4 mmol/L) can just be a sign that you are taking too much exogenous insulin and need to back off the exogenous insulin dosing.  If you are taking exogenous insulin, this would be worth checking periodically to make sure you’re not overdoing the insulin.

summary

  • Metabolic related diseases such as heart disease, cancer, stroke, diabetes, Alzheimer’s disease, kidney disease are the leading causes of death.
  • People with the best metabolic health (i.e. low HbA1c, insulin and blood sugar levels) have the lowest risk of dying from these common western diseases of ageing.
  • Keeping your processed and starchy carbohydrates low will help to keep your blood glucose and insulin levels and reduce your risk of obesity.
  • When we fast, our glucose levels decrease, and ketones increase to maintain our energy levels.
  • People who are metabolically healthy and insulin sensitive typically have a lower level of total energy (i.e. glucose + ketones) in their bloodstream.
  • We can mimic the rise in ketones with added fats or exogenous ketones that we see during fasting. However, the real benefits occur when the body is forced to draw on its own stored energy, and we experience autophagy, upregulation of SIRT1, and a rise in NAD+.
  • The benefits that we often attribute to ketones may also be due to increased NAD+ levels which occur in fasting and/or with a nutrient-dense diet.
  • We can only measure beta-hydroxybutyrate (in the blood) and acetone (in the breath). We can think the BHB as a buffer ready for use, and acetone as the exhaust showing that the ketones have been burned for fuel.  Higher levels of fat burning with a lower need for buffering is a better place to be than a large buffer in the blood and minimal fat burning.

references

[1] https://optimisingnutrition.com/2015/06/29/trends-outliers-insulin-and-protein/

[2] https://www.researchgate.net/profile/Peter_Petocz/publication/13872119_Holt_SHA_Brand_Miller_JC_Petocz_P_An_insulin_index_of_foods_the_insulin_demand_generated_by_1000-kJ_portions_of_common_foods_Am_J_Clin_Nutr_66_1264-1276/links/00b495189da41714fa000000.pdf/download?version=vs

[3] http://ses.library.usyd.edu.au/handle/2123/11945

[4] http://www.cardiab.com/content/12/1/164

[5] http://www.nejm.org/medicine-and-society-data-watch

[6] https://intensivedietarymanagement.com/tag/hormonal-obesity-theory/

[7] http://carbsanity.blogspot.com.au/2011/09/24hr-profiles-insulin-secretion.html

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC329588/

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC329589/

[10] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[11] https://www.ncbi.nlm.nih.gov/pubmed/11994907

[12] https://www.ncbi.nlm.nih.gov/pubmed/10535381

[13] http://emedicine.medscape.com/article/2089224-overview

[14] http://www.newhealthadvisor.com/Normal-Insulin-Levels.html

[15] https://www.facebook.com/AdaptYourLife/videos/vb.1608140252761871/1899686180273942/?type=2&theater

[16] http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0115147

[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/

[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/

[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852209/

[21] http://www.ketoisland.com/blog/all-aboard-nad/

[22] https://selfhacked.com/2015/09/06/nad-and-sirt1-their-role-in-chronic-health-issues/

[23] http://mitofuel.co.za/mitofuel/

[24] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737348/

[25] https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0009-2

[26] http://care.diabetesjournals.org/content/24/2/362

[27] https://en.wikipedia.org/wiki/Homeostatic_model_assessment

[28] http://www.thebloodcode.com/homa-ir-calculator/

 

post last updated October 2017