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paulgfoster

Carbohydrayes , sleep and glucose control

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I have practiced Cr intermittently over the last few years sometimes for a year or two then slipping off the wagon.

I notice two things and cannot really understand either, When not on a cr regime  and when i eat simple carbohydrates, all the awful stuff like biscuits and refined bread i sleep really well and have better glucose control.

I have just gone back onto Cr and cut all refined carbs out of my diet and consequently i toss and turn all night?  Any ideas or can anyone relate to this?

Secondly i just had a glucose tolerance test and was told to eats lots carbs for three days prior, my fasting blood sugar was excellent, 4.4 mmol/l and results normal, however now i am going back to Cr and some complex carbs , my fasting bsls in the morning are borderline prediabetic,  and my response to  foods more marked.   Ie in mmol/l  on the sad diet my bsl never rose more than 6.5 ...after the 75 gram glucose loading with the Gtt........yet on the carb reduced diet a banana will send it up to the high 7's.

I have read a lot of paleo guys on lo carb also have high fasting bsls.

Although not of worry to most people it concerns me as i have just been diagnosed with peripheral neuropathy.(ideopathic but from reading maybe linked to metabolic syndrome)

The peripheral Neuropathy hit me with full force two years ago when i had been on an optimal cr diet and no simple carbs for over a year. All my markers were great except Fasting bsl and i achieved my optimal weight and diet.   Confused and not knowing what to do to prevent further nerve damage. The doctors here dont seem to follow any of this, or have a clue

 

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Since no one else responded I'll take a stab at it.  I believe the suggestion to consume carbs for 3 days before an OGTT is that there are aspects of carbohydrate metabolism such as enzymes that are down regulated without sufficient carbohydrate intake.  Low carb diets have been shown to improve insulin sensitivity and boost glucose tolerance, but a reintroduction of more carbs can be needed to achieve a good test result.

 

As for all of the other issues, perhaps the best you can do is track your blood glucose more frequently and see in detail your post prandial response to various foods under various dietary regimes.  Eventually I expect continuous blood glucose monitoring tech will become affordable for the masses but for now I think the consumer blood test strips are the most practical option.

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Re: disturbed and desultory sleep.

 

When I go to sleep fasting or on an empty stomach reason would suggest that I sleep deeply and peacefully. It has never been so. When fasting, my sleep is even more desultory. It is already desultory by itself. I absolutely don't know the reason but the fact that some dietary restriction makes sleep less restful is not a unique experience evidently.

 

Re carbs: in my very brief recent stint on a low carb diet, I had the undesired effect of a pronounced weight loss, so much so that I had to stop such restriction.

I realized that, barring chronic conditions like T2D, metabolyc disfuntion, overweight and so on, low carb may not necessarily healtier. MAybe for those who are insuline sensitive, decreasing the insuline signal too much and too abruptly may cause a cascade of metabolic reactions with an overall unfavourable outcome. Should I try that again, I'd do it much more gradually, giving time to the system to adapt.

 

In the case of paulgfoster's  one suggestion might be to resume eating simple carbs but the heathy ones, like fresh fruit, a little honey and dried fruit and healt food store cakes, and very  very gradually decrease their amount, in a stepwise fashion as to ensure system adaptation, that may be an intersting experiment to pursue. A successful  adaptation might require many months or a few years.

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All:

I'm sorry not to have weighed in on this earlier: I figured someone else would nail it quickly:
 

I have practiced Cr intermittently over the last few years sometimes for a year or two then slipping off the wagon.
I notice two things and cannot really understand either, When not on a cr regime  and when i eat simple carbohydrates, all the awful stuff like biscuits and refined bread i sleep really well and have better glucose control.
I have just gone back onto Cr and cut all refined carbs out of my diet and consequently i toss and turn all night?  Any ideas or can anyone relate to this?
Secondly i just had a glucose tolerance test and was told to eats lots carbs for three days prior, my fasting blood sugar was excellent, 4.4 mmol/l and results normal, however now i am going back to Cr and some complex carbs, my fasting bsls in the morning are borderline prediabetic,  and my response to  foods more marked.   Ie in mmol/l  on the sad diet my bsl never rose more than 6.5 ...after the 75 gram glucose loading with the Gtt........yet on the carb reduced diet a banana will send it up to the high 7's.


So the most obvious explanation here is that you either have a variation of either the Dawn Phenomenon or the Somogyi Effect:
 

The dawn phenomenon and the Somogyi effect cause high blood sugar levels, especially in the morning before breakfast, in people who have diabetes.

Dawn phenomenon
The dawn phenomenon is a normal rise in blood sugar as a person's body prepares to wake up. [Nondiabetics have this too: it just doesn't push them into the diabetic range -MR].

  • In the early morning hours, hormones (growth hormone, cortisol, and catecholamines) cause the liver to release large amounts of sugar into the bloodstream. For most people, the body produces insulin to control the rise in blood sugar.
  • If the body doesn't produce enough insulin, [or amylin, or GLP-1, or if you have hepatic insulin resistance and therefore don't suppress glucagon release -MR], blood sugar levels can rise. This may cause high blood sugar in the morning (before eating).
Somogyi effect
If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning. An example of the Somogyi effect is:
  • A person who takes insulin doesn't eat a regular bedtime snack, and the person's blood sugar level drops during the night.
  • The person's body responds to the low blood sugar by releasing hormones that raise the blood sugar level. This may cause a high blood sugar level in the early morning.
How can you tell the difference?
The Somogyi effect can occur any time you or your child has extra insulin in the body. To sort out whether an early morning high blood sugar level is caused by the dawn phenomenon or Somogyi effect, check blood sugar levels at bedtime, around 2 a.m. to 3 a.m., and at your normal wake-up time for several nights. A continuous glucose monitor could also be used throughout the night.
  • If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect.
  • If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon.  

 

See more on dawn phenomenon and the Somogyi effect here.

The usual advice for people who are not Type I diabetics who have the Dawn Phenomenon is to avoid carbs before bed, to avoid adding background blood glucose to the unopposed counterregulatory response. The usual advice for people who are not Type I diabetics who have the Somogyi Effect is to eat carbs before bed, to avoid the initial dangerously-low levels that cause the overreactive counterregulatory response that leads to the spike.
 
Based on your account of your experience, you may have a version of the latter: it's even more likely if you frequently wake up sweating or with headaches. I can easily see this happening in a person on severe and/or low-carb CR, due to depleted glycogen stores and low basal fasting glucose. I think I may have occasionally encountered this myself during wintertimes when I was at my most severe levels of CR, though I have no blood sugar data (I can't get enough blood to take fingerstick glucose readings): I would just wake up prematurely, often in a sweat, with what felt like a large cortisol surge.
 
You may also conceivably have a variant of dawn effect if you're not churning out enough insulin, either because of adaptation to a lower-carb, lower-glycemic diet (see below) or for more worrisome reasons.
 

I have read a lot of paleo guys on lo carb also have high fasting bsls.


... consistent with my Somogyi effect suggestion above.
 
Your high postprandial glucose response to a banana may actually be a quite normal adaptation to low-carb dieting, as I've discussed before:
 

 

 

In the LC circle, it is well-know that you need to "carb" up 2-3days before doing a OGTT to avoid IGT result. Their usual explanation is that LC increase insulin resistance in the muscle, an utterly normal physiological response to carbohydrate restriction.


In my book, when CR folks start to exhibit the metabolic profile of low carbers and start to use their same excuses for what is clearly impaired metabolic health (i.e. "benign starvation diabetes"), I say that's the time to start worrying.

in this case I think there's strong biological plausibility to what they're saying about the OGTT. Acutely, in response to a meal with a non-trivial amount of carb, the body releases insulin and the peripheral tissues respond to suck the glucose up. But during normal daily overnight fasting — and more dramatically in extended fasting (so-called "starvation diabetes"(3,4) which Blagoskonny thinks is informative on the effects of rapamycin), counterregulatory hormones are up to facilitate release of stored glucagon, enable ketosis and gluconeogenesis, and the liver and muscles are in a state of metabolic insulin resistance as part of normal mitochondrial fuel-switching; all of this helps shield the brain's glucose supply. This situation is completely reversible after break-fast on a daily basis, and after a short period of refeeding in "starvation diabetes".

It would be surprising if a similar situation did not reign (on both fronts) for nutritional ketosis on a very-low-carb diet, and such a phenomenon is anecdotally reported (concerning OGTTs that can be normalized by a few days' return to a non-ketogenic carb intake — which is what's recommended anyway). However, I'm not aware of a formal study to document this.

Cf. the notion of type II diabetes secondary to chronic energy excess being the result of chronically overloading both systems at once, leading to loss of mitochondrial and metabolic capacity for fuel-switching,(1) and Denise Minger's similar notion of the "macronutrient swampland."

Finally, much of the metabolic profile of low carbers is really quite favorable, and resembles people on CR (super-low TG, high HDL, generally good fasting glycemia and HbA1c), etc. Of course, much of this is itself likely the result of energy restriction ...

 


The fact that (if I'm understanding you correctly) you've had your high postprandial glucose go away when going off CR suggests to me a reversible effect of this nature, rather than some kind of damage to your system. If you want to check this, try (as suggested) a few days' return to a non-ketogenic carb intake — which is what's recommended for an OGTT), and see what happens after a banana or OGTT.
 

Although not of worry to most people it concerns me as i have just been diagnosed with peripheral neuropathy.(ideopathic but from reading maybe linked to metabolic syndrome)
The peripheral Neuropathy hit me with full force two years ago when i had been on an optimal cr diet and no simple carbs for over a year. All my markers were great except Fasting bsl and i achieved my optimal weight and diet.   Confused and not knowing what to do to prevent further nerve damage. The doctors here dont seem to follow any of this, or have a clue

 
That does sound worrisome ... but does it reverse when you go off of CR? If so, is it possible that you actually have Raynaud's syndrome, not diabetic-type neuropathy? I would expect that a CR-induced reduction in body temperature would exacerbate this, both directly and by causing peripheral vascoconstriction, and would coincide with your CR-induced glucose changes on a purely coincidental basis.
 
Reference
1: Muoio DM. Metabolic inflexibility: when mitochondrial indecision leads to metabolic gridlock. Cell. 2014 Dec 4;159(6):1253-62. doi: 10.1016/j.cell.2014.11.034. PubMed PMID: 25480291; PubMed Central PMCID: PMC4765362.

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