Jenny Ruhl reports her ketosis experiences

Jenny Ruhl has just posted another update – at the mid-point of her planned 2 week journey back into nutritional ketosis.  Jenny is very experienced in sustained ketosis, having spent 5 years maintaining nutritional ketosis in the recent past, plus years at a low carbohydrate intake above the point of significant ketosis  This unusual degree of personal experience, plus her extensive communication with others following low carb lifestyles and her broad knowledge of the research and the science, makes her reports especially valuable and insightful.

Her report is particularly important because she is one of those who don’t thrive when in ketosis, particularly over an extended period.  Individual differences in metabolism are very real.

Her post.

More on her history with nutritional ketosis, part of her discussions with Jimmy Moore on his Ask the Low Carb Experts podcast from September 20, 2012.  web page

Addendum Oct 15, 2012

Jenny posted about the outcome of her 2 week trial.  I commented on her trial and provide the link to her post in this excerpt taken from Part 4 of my Ketosis series -

Jenny Ruhl’s recent experience – You have to scroll down to the comments section below her post to see where she reports that she did test positive for urine ketones throughout the trial 2 weeks, after the first couple of days. I include it here for some balance.  Also, it reflects some other people’s experiences that I have read about in the past months where the person has done blood testing for ketones and not had substantial weight loss when eating to satiety.  Note – in Jenny’s trial she did lose weight, but she remained hungry as she kept to a calorie cap.

What you eat is only part of the whole picture when it comes to what is determining your body weight (unless being in semi-starvation or putting up with chronic hunger, neither of which are tenable long-term).

Jenny is an extremely happy camper when it comes to a “to the meter” individually targeted lowering of carbohydrate intake as an essential aspect of controlling diabetes and glucose intolerance (see her other web site, facebook and books).

Impact of high blood glucose on vascular events and death

This study is just published.  When looking at this study, there are four key factors to consider:

  • This is a study that looks at correlation, it does not specifically test cause. People who had evidence of sustained exposure to higher blood glucose levels had worse outcomes, for whatever mix of reasons.
  • This study did not look at micro-vascular disease (such as nerve damage, kidney damage or eye damage) or rate of deterioration of glucose control, so the study does not say that there might not be health benefit from achieving a HgA1c of less than 6.5%
  • I’ll have to wait to see the full text of the study (and consider input from others who will doubtless publish commentary) to consider what further might be said of this study. For example, the fact that the results of the study did not suggest a protective effect from having HgA1C below 6.5% could be related to low numbers of the study group reaching such a relatively good level of control – although this was probably accounted for. Only further examination of the full study report will tell.
  • Also, HgA1C is only one way of looking at blood glucose levels.  It does not give information about aspects of blood glucose that vary between people, such as the degree of elevation of fasting glucose versus glucose spikes after meals.
Diabetologia. 2012 May 26.

Relationship between HbA(1c) levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes.

Department of Cardiology, Gentofte University Hospital of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark, ca@heart.dk.

Abstract

AIMS/HYPOTHESIS:

The optimal HbA(1c) concentration for prevention of macrovascular complications and deaths in obese cardiovascular high-risk patients with type 2 diabetes remains to be established and was therefore studied in this post hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial, which enrolled overweight and obese patients with type 2 diabetes and/or cardiovascular disease.

METHODS:

HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality were analysed using Cox regression models.

RESULTS:

Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA(1c) available at baseline (i.e. study randomisation). Median age was 62 years (range 51-86 years), median BMI was 34.0 kg/m(2) (24.8-65.1 kg/m(2)) and 44% were women. The median HbA(1c) concentration was 7.2% (3.8-15.9%) (55 mmol/l [18-150 mmol/l]) and median diabetes duration was 7 years (0-57 years). For each 1 percentage point HbA(1c) increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p = 0.12 for interaction). In contrast, the risk of all-cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA(1c) increase (p = 0.02 for interaction). There was no evidence of increased risk associated with HbA(1c) ≤6.4% (≤46 mmol/l). Glucose-lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations.

CONCLUSIONS/INTERPRETATION:

In overweight, cardiovascular high-risk patients with type 2 diabetes, increasing HbA(1c) concentrations were associated with increasing risks of cardiovascular adverse outcomes and all-cause mortality.

PMID: 22638548

Do you know where your blood sugar climbs after eating?  BloodSugar101.com

A Sunday Morning in June

When “normal” blood sugar is not normal:

A great day to save life and limb …

On a Sunday morning, some reading that is all about taking charge of your health, getting results and protecting your future.

This is the introduction to the BloodSugar101.com website, it will open in a new window.

“A Very Brief Summary”

The focus of this particular article is controlling blood sugars when you have diabetes.

In her new book, Diet 101, Jenny provides the reasons why every person should be aware of their blood sugar health, even if they do not meet the lab test cut-off values that are used in the diagnosis of diabetes or pre-diabetes. She covers how to understand your blood glucose (“sugar”) test results and then what you can do to claim your health.

To encourage you to linger a while and learn about this vital aspect of protecting your health, here is some music to go along with your reading:

Michael Hedges, Aerial Boundaries

Diabetes – Not Just Type 1 and Type 2 Anymore

English: Diagram shows insulin release from th...

English: Diagram shows insulin release from the Pancreas and how this lowers blood sugar levels. (Photo credit: Wikipedia)

Need for Wider Recognition of Non-Classic Forms of Diabetes

Almost all discussion of diabetes revolves around what are called Type 1 diabetes and Type 2 diabetes.  Type 1 diabetes is the term used when there is a very low or absent production of insulin, due to destruction of the type of cells in the pancreas that make insulin.  Classically, this onsets in childhood and is the result of an immune attack on those cells.  The term is also used when those cells are destroyed by other processes.  An example would be repeated or severe bouts of pancreatitis (inflammation of the pancreas), which may bring a great deal of pancreatic tissue destruction.

Type 2 diabetes is the term used when the amount of insulin being produced is as much (or more) as would normally be needed to do its job, but the blood glucose is high because the signal of the insulin is not being recognised properly at the level of the cells – most prominently, in terms of blood sugar levels, the muscle cells and the liver.  The cells are “resistant to insulin”, and the person has “insulin resistance”.  The insulin production is higher than normal, but not high enough to keep blood glucose in the normal range, die to cells not responding properly to the insulin.

These two types can also get mixed up together.  A person with Type 1 diabetes (not able to produce enough or any insulin) can also becomes resistant to insulin, which would mean that they need higher amounts of insulin to keep their blood sugar controlled.  Someone with Type 2 diabetes can, over time, have a gradual destruction of their ability to make insulin, becoming more like a Type 1 diabetic.

It turns out there is more to the story.  There is also MODY and LADA.  It turns out that these need to be included more in our awareness.  The term “MODY” is an acronym for “Maturity Onset Diabetes of the Young” and “LADA” is an acronym for “Latent Autoimmune Diabetes of Adults”.

For an explanation of these, I refer you to Jenny Ruhl’s site, BloodSugar101.com.

Keep in mind as you read these two articles that our present understanding of both LADA and MODY is not well developed. More research will fill in gaps in our knowledge, so it is to be expected that the known facts and the concepts will develop over time.

From Diabetes in Control comes an article discussing new findings about LADA:

AACE: Latent Autoimmune Diabetes in Adults often Misdiagnosed

Almost half of nonobese adult with poorly controlled diabetes have latent autoimmune diabetes that has been misdiagnosed as type 2 diabetes….

Ankit Shrivastav, MD, from the Institute of Postgraduate Medical Education and Research in Kolkata, India, said that, “Young, nonobese, adult-onset diabetic patients with a negative family history, a rapid deterioration of glycemic control, and a rapid onset of complications should be screened for autoantibodies.”

Here is a recent article about MODY:

“Systematic Assessment of Etiology in Adults With a Clinical Diagnosis of Young-Onset Type 2 Diabetes Is a Successful Strategy for Identifying Maturity-Onset Diabetes of the Young”

It is time for these two other forms of diabetes, which had been thought of as uncommon, to be included more generally in our thinking and our approach.

Short Link for this article http://wp.me/p2jTRh-9Z

Normal Weight but At Risk

High Blood Sugar, Diabetes and High Blood Pressure in People of Normal Weight

Dr. Mark Hyman has written well on this topic in his new post “Skinny Fat People: Why Being Skinny Doesn’t Protect Us Against Diabetes and Death”.

In this article, he incorporates findings from the research paper below.  I had re-tweeted (from Emily Deans MD) about this study a few days ago and was just about to write a post on it, but Dr. Hyman has this covered.  This is the link to the free full text of the research paper.

Pediatrics. 2012 May 21. [Epub ahead of print]

Prevalence of Cardiovascular Disease Risk Factors Among US Adolescents, 1999-2008.

Source

aDivisions of Nutrition, Physical Activity and Obesity and.

Abstract

OBJECTIVE:

Overweight and obesity during adolescence are associated with an increased risk for cardiovascular disease (CVD) risk factors. The objective of this study was to examine the recent trends in the prevalence of selected biological CVD risk factors and the prevalence of these risk factors by overweight/obesity status among US adolescents.

METHODS:

The NHANES is a cross-sectional, stratified, multistage probability sample survey of the US civilian, noninstitutionalized population. The study sample included 3383 participants aged 12 to 19 years from the 1999 through 2008 NHANES.

RESULTS:

Among the US adolescents aged 12 to 19 years, the overall prevalence was 14% for prehypertension/hypertension, 22% for borderline-high/high low-density lipoprotein cholesterol, 6% for low high-density lipoprotein cholesterol (<35 mg/dL), and 15% for prediabetes/diabetes during the survey period from 1999 to 2008. No significant change in the prevalence of prehypertension/hypertension (17% and 13%) and borderline-high/high low-density lipoprotein cholesterol (23% and 19%) was observed from 1999-2000 to 2007-2008, but the prevalence of prediabetes/diabetes increased from 9% to 23%. A consistent dose-response increase in the prevalence of each of these CVD risk factors was observed by weight categories: the estimated 37%, 49%, and 61% of the overweight, obese, and normal-weight adolescents, respectively, had at least 1 of these CVD risk factors during the 1999 through 2008 study period.

CONCLUSIONS:

The results of this national study indicate that US adolescents carry a substantial burden of CVD risk factors, especially those youth who are overweight or obese.   PMID: 22614778  (added emphasis mine)

It is very telling to read the full report.  In there you will find a chart of the results.  This chart includes important results that are not clearly expressed anywhere in the written report. That is, some of the numbers are only reported in visual form on the chart.

From this chart, one can see that 13% of the children who were classed as normal body weight had pre-diabetes or diabetes! (That is about 1 in every 8.)

OK, let me repeat that 10 times! (Or, I can just hope you might pretend I did.)

Imagine how many kids this would have been if Jenny Ruhl’s criteria for non-damaging blood sugar levels had been used (not a snowball’s chance on that).

Mark Hyman goes on to report:

A surgeon friend of mine recently told me that even in people of normal weight, he found belly’s full of fat – caked around their colon, liver, kidneys, and draped over all their organs.  This is caused by our industrial diet full of high fructose corn syrup, added sugars, trans-fats, flour and processed food.

Dr. Hyman’s full post includes much more than this and is well worth the read.

Short link for this post http://wp.me/p2jTRh-7o

Review: Diet 101 by Jenny Ruhl

Diet 101: The Truth About Low Carb Diets (Kindle Edition)
This book is a natural continuation on from the author’s on-line interactions and blogging that led to her remarkable contribution Blood Sugar 101. There has been a perception that the main value of choosing to change the amount or type of carbohydrates (sugars and starches) in your diet is as a weight loss diet. Also, there has been a perception that this strategy is only valuable if applied very strictly – and this strict application then means that many people find it too difficult to keep up over time.

In Diet 101, Jenny Ruhl emphasises the fact that the greatest value from controlling carbs is in keeping blood sugars within the normal, non-damaging range. What if you’re not diabetic? Many people who do not meet the cut-off blood sugar test levels to be diagnosed with diabetes have blood sugar levels, at least for parts of the day, that are associated with slowly-accumulating harm to health. This problem is very widespread in our society.

What to do? This damage can be avoided, or at least lessened, by changing your intake of carbohydrate foods – by just as much as you need to and/or are able to. Even changes less than targeting perfection can bring benefits you might really value.

Jenny Ruhl explains all this in her new book in a clear, easy to understand manner, with all the back-up science also available for those who are interested. Also, she ties the excess swings in blood sugar to excess hunger drive and the tendency to gain weight. To be useful, this needs to be practical day-to-day, which is an important goal and strength of the book.

My review on Amazon of Jenny Ruhl’s new book.

Update: Please see my blog “Carpe Your Blood Sugar” inspired by the work of Jenny Ruhl and Dr. Richard K. Bernstein.  Links on the Resources page there to 3 interviews with Jenny.  www.carpeyourbloodsugar.com

(This post short link http://wp.me/p2jTRh-6F).

Sunday Stories

Sunday is a good day for stories of hope and inspiration.

Personal stories of benefit from low-carb/controlled-carb nutrition:

Jenny Ruhl, diagnosed with diabetes in 1998

Personal stories on Dr. Andreas Eenfeldt’s blog

Dr. Jay Wortman’s personal story

If you would like to inspire others with your personal story, but don’t want to do this on a blog, Tumblr, etc, a good option is Ancestral Weight Loss Registry (listed under LINKS).

A comment by Dr. Richard Feinman on another site, quoted in full:

RIchard Feinman · Professor of Cell Biology (Biochemistry) at State University of New York Downstate Medical Center

“People need to do what works for them.”  How do you find out what works best for you. Diabetes is a disease of carbohydrate restriction. The first thing to try is to keep carbohydrates as low as possible. If that doesn’t work, you might want to try something else but it is always good to start with the science. As Dr. Eric Westman put it: At the end of our clinic day, we go home thinking, “The clinical improvements are so large and obvious, why don’t other doctors understand?” Carbohydrate restriction is easily grasped by patients: because carbohydrates in the diet raise the blood glucose, and as diabetes is defined by high blood glucose, it makes sense to lower the carbohydrate in the diet. By reducing the carbohydrate in the diet, we have been able to taper patients off as much as 150 units of insulin per day in 8 days, with marked improvement in glycemic control-even normalization of glycemic parameters. Read more at http://www.inquisitr.com/193759/diabetes-a-growing-threat-with-no-single-dietary-answer/#Hk7Sl0wpw3xtP5Eh.99.
(I believe he meant to say “Diabetes is a disease of carbohydrate intolerance”).