January 11

Low-carb diets improve type II diabetes

34  comments

I just read an article in the Family Practice News that shows once again that the low-carb diet is the Rodney Dangerfield of diets: it gets no respect. Especially not from the press.
The Family Practice News (FPN) is one of the so-called throw-away journals that are sent to physicians free of charge. The FPN is also one of the few of the zillions of these things that I get that I actually don’t throw away until after I’ve read it. Reporters working for the FPN seem to haunt the types of medical meetings I would attend if I could afford the time to attend every one I wanted to. Their reporting is pretty sharp and concise and for the most part honestly portrays the research it reports.
The December 1 issue contains an article on a poster presentation at the NAASO meeting a couple of months ago that I found interesting on a number of levels and wanted to pass along.
To set the stage, let’s go over a couple of things. First, NAASO stands for the North American Association for the Study of Obesity, which now goes by the name The Obesity Society. NAASO is the academic obesity research society. It’s members are primarily scientists working in academia on obesity research. But not all are academic researchers. They let me in. I have been a member since the mid 1980s and have attended numerous meetings.
Second, a few months ago I posted on a presentation from the last meeting of the American Heart Association (AHA) that received huge press coverage. This was the so-called study (it was actually a poster presentation just like the NAASO one I’m going to write about here shortly) that seem to indicate that the Atkins diet caused blood vessel damage. The findings of this ‘study’ were presented by the press in wide, wide coverage as an indictment of low-carb diets. As my analysis showed this wasn’t really a study, and the diet wasn’t really the Atkins diet. In fact, it wasn’t even really a low-carb diet.
In October 2007 (at about the same time the AHA meeting was taking place) NAASO had its national meeting in New Orleans. MD and I go to as many of these as we can, but we had a scheduling conflict that made us miss this one. Unlike the AHA, NAASO doesn’t publish an online compilation of the abstracts of all the presentations. You get a hard copy at the meeting, but no online resource. So, unless you’re there, you don’t really know what got presented.
A group from Duke presented a poster showing the results of their ongoing research comparing the effects of two different dietary regimens for weight loss. One of the groups of subjects were randomized to a low-carb dietary protocol – the other to a low-fat diet plus the drug orlistat (Xenecal or in OTC form called Alli).

The study, which is planned to last 48 weeks, includes 146 outpatients from the Durham Veterans Affairs Medical Center. All have a body mass index 27 kg/m2 or greater, and 46 of the patients also have type 2 diabetes. Their mean age is 56 years (range, 48–64 years); the majority are male, and roughly half are black.
In the 6 months that the trial has been ongoing, weight loss with both regimens has been similar (10–12 kg) and so has the reduction in waist circumference.

So, we’ve got patients on two radically different diets who have lost about the same amount of weight and, presumably, from the same areas. Yet the subgroup of these patients who have type II diabetes did radically better on the low-carb diet.

After 24 weeks, the mean HbA1c among the 22 type 2 diabetes patients in the low- carb arm dropped from 7.5% to 6.8%, a significant reduction. The HbA1c in the 24 type 2 diabetes patients in the orlistat arm went from 7.6 to 7.4, and did not fall significantly from baseline.

And more of the patients on the low-carb diet were able to get completely off their diabetic meds.
These are pretty impressive statistics when you consider that all the changes can be attributed to the diet composition and not simply the weight loss since both groups lost the same weight.
Is it just me or do you also find it interesting that this study wasn’t picked up by the press and disseminated everywhere as the Atkins diet study was? I wonder why not? It was the same type of presentation – a poster – at a major scientific meeting attended by hordes of reporters. Yet this study never made prime time news – only a throw-away medical journal.
Type II diabetes has reached staggering epidemic proportions in this country, and even kids are now starting to get what used to be called Adult Onset Diabetes (type II). It seems like the results of this study would be big news to those fighting the disease. Could it be that the press has an anti-low-carb bias? It certainly makes one wonder.


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  1. According to an article in this week’s Lancet, low carb diets still get no respect especially when it comes to diabetes. Instead, the preferred treatment option still appears to be a high carb diet supplemented with statins. This suggests that high carb diets cause a statin deficiency in diabetics. Or perhaps, more accurately stated, statins enrich diabetics who hold stock in pharmaceuticals. Once again, science has been subverted for financial gain. Perhaps the spelling should be changed to $cience.
    “Statin Therapy Should Be Considered For Most Diabetes Patients
    Article Date: 10 Jan 2008
    No matter how old diabetes patients are, whether or not they have cardiovascular disease, irrespective of whether they are male or female, statin therapy reduces the risk of major vascular events, such as heart attack, stroke, or coronary revascularization (the need for an operation to bypass or unblock the coronary arteries). This is according to an Article in The Lancet, this week’s issue.”
    Apparently just having diabetes, well controlled or not, is sufficient reason for MDs to prescribe statins!
    Hi David–
    It’s truly pitiful when a drug such as the statins are recommended for a broad range of patients without substantial evidence that such drugs will do much other than lighten the patients’ wallets.
    Best–
    MRE

  2. The mainstream bias against low carb nutrition is aggravating, to put it mildly.
    My FBS last December was 339, my weight in the 240s, I think; after a year of low carbing, I now weigh 150 pounds, and have not needed meds in months. Yesterday’s FBS was 79.
    Hi Daryl–
    Congrats on a great job? It sounds easy, but I know from years of professional experience that it’s not. You’ve accomplished a great deal, now work on maintaining what you’ve got.
    Best–
    MRE

  3. The work is a step in the right direction. But why didn’t they include a protocol eliminating harmful fats and adding omega-3, which many consider critical to cure the disease?
    Does the medical profession really want a cure or do they want only to manage the condition with treatment?
    As a pre-diabetic whose parents both died from diabetic complications, you can be sure a cure is of utmost importance to me. Treatment is fine, but it didn’t save my mom from three amputations, the last of which caused a debilitating stroke.
    BTW, thanks for mentioning your book Protein Power Lifeplan in your reply to my comment on the flaxseed article blog. I hadn’t heard of it. I got a copy, read it through and found it even better than Protein Power. Thank you very much for writing it. The information is excellent, and spot on based on my personal experience. I’ve added Mg to my diet and will lower my 330 ng/ml ferritin level over the next few months. The rest of your advice had already been followed.
    Dave M.
    Hi Dave–
    I don’t have a clue as to why they didn’t eliminate harmful fats and add omega-3. It was probably because it would confound the results since they weren’t looking for a cure, but instead just a comparison between a standard low-carb diet and a low-fat diet plus orlistat.
    Cheers–
    MRE

  4. Hi Mike,
    You would think that an improvement of ‘only’ 7.5 to 6.8 A1c would indicate some compliance issues for the low carb group? – albeit far superior to the alternative and not as a result of the weight loss as the ADA would have you believe.
    My favourite paper in this area is this one (and I would love to get my hands on the full text);
    http://www.ncbi.nlm.nih.gov/pubmed/6617408?dopt=Abstract
    Note both the date, and the speed at which insulin dependant type 2s were weaned off medication (average 1.9 days!!) and the very impressive continuing diet managed success over the longer term for the majority of test subjects.
    Cheers,
    Malcolm
    PS Having some difficulty posting comments from my Mozilla browser just now (not sure if it is you or me) – either comes up with a spam message or just disappears into the ether – this comment from Explorer – anyway I apologise if there have been any duplications.
    Hey Malcolm–
    I agree with you about the minimal reduction in HgbA1c. In practice I saw a much greater reduction than that all the time. But I didn’t get a look at the data, only the summary as presented in the paper. What wasn’t mentioned was whether the researchers were using the odious intention to treat analysis. If so, that could have buggered up the outcome quite a bit.
    Cheers–
    MRE

  5. Hello Dr. Eades,
    I came across this interesting article about some diabetes research in Canada:
    http://www.nationalpost.com/news/story.html?id=a042812e-492c-4f07-8245-8a598ab5d1bf&k=63970&p=1
    Could it be that excessive sugar in the blood interferes with the production of the neuropeptides they mention? Or the blood sugar causes the inflammation which affects the nerves? I would be interested to hear your take on it.
    Thanks for your work,
    Zack Sloan
    Hi Zack–
    I read about this study when it was first published. It’s really fascinating, and it will be interesting to see if the findings can be reproduced in other labs. And in other mammals. Especially humans.
    Type I diabetes is typically caused by an immune attack against the beta cells, not really be excess glucose as in type II diabetes. I suspect that somehow the firing of the neurons reinvigorate the damaged beta cells and get them producing and releasing insulin again. At least that would be my bet.
    Cheers–
    MRE

  6. Maybe the press is controlled by the same people who control the FDA and the government; the pharmaceutical lobby whose goal is to increase use of insulin, statins, and all of the other medications lining their coffers.
    I wouldn’t be at all surprised. Or maybe their just stupid.
    Cheers–
    MRE

  7. Dr. Mike: Even though important info like this is not being picked up by the MSM the way it should, it is getting out there, thanks to your blog and others.
    Here’s something else that I think is a bit encouraging from Daniel Carlat, and it’s about time:
    * * *
    http://carlatpsychiatry.blogspot.com/
    Friday, January 11, 2008
    Macy Foundation Bombshell: Industry-Funded CME Must End
    The clock is ticking for industry-funded medical education. The latest body blow comes in the form of a report on medical education issued by the influential Josiah Macy, Jr. Foundation. Read it here. The report was the product of a conference attended by many of the brightest minds in medicine, including Catherine DeAngelis, editor-in-chief of JAMA, Harvey Fineberg, president of the Institute of Medicine, and David Leach, recent executive director of the Accreditation Council for Graduate Medical Education.
    The Macy Foundation couldn’t be clearer: commercial support of CME has got to go.
    * * * *
    Best,
    W
    Hey Wil–
    Interesting report. Everyone with a brain knows that commercial (read: drug company) support of CME is a bad thing. But will it ever change? I think it’s doubtful.
    If pharmaceutical support were withdrawn the conference fees would several thousand dollars per meeting instead of the $300-$500 they are now, and many docs wouldn’t attend.
    It’s too bad, but that’s the reality.
    Cheers–
    MRE

  8. It makes good sense to me that if there is less carbohydrate going into the system the HbA1c will be lower, just as I’d expect it to be lower if someone was having good blood sugar control with metformin, but does this actually mean the diabetes has improved? Presumably if the patient went off the diet the underlying mechanism behind his diabetes would still be there, wouldn’t it? Not quibbling about the good news, just curious as a non-diabetic who fortunately hasn’t had to think about this before.
    If one has the propensity to develop type II diabetes while on a lousy diet, that propensity remains even if the signs and symptoms of diabetes vanish after adopting a proper diet. It’s the same with obesity. If the propensity to obesity is there yet kept in check with a good diet, going back to the improper diet will bring back the obesity.
    Hope this answers your question.
    Cheers–
    MRE

  9. I can add another health improvement credited to the low carb diet. Since beginning low carb in 2001 my vision has improved, dramatically. I went from 20/300 vision, needing corrective lenses at a dioptre of -3.75 to the present, where I now have 20/60 vision, needing only a dioptre of -1.75. Recent research on studies comparing hunter-gatherers eating a traditional diet vs. those eating a modern western diet has led me to believe improved glucose metabolism is responsible for this dramatic change. Myopia is almost nonexistent among hunter gatherers (between 0 and 2%) however when they’re introduced to refined carbohydrates the rates reach, and often surpass, western numbers – upward of 25%.
    I wonder if anyone else has noticed this kind of reversal of myopia?
    Nat
    Hi Nat–
    I’ve heard the same story you related from several other people over the years. I really can’t say what has happened, but I’m certainly glad that it has. I would bet that the increased swelling as a function of higher sugar levels in the lens or other ocular structures is a root cause. When the swelling decreases as sugar levels fall, vision improves.
    Cheers–
    MRE

  10. On AOL news I saw an article by Alex Berenson of the NYT about whether Fibromyalgia is a valid ‘disease.’ (“Drug Approved. Is Disease Real?”). Apparently, many doctors, including one of the first to try to define fibromyalgia, say that the disease doesn’t really exist. Of course, the pharmaceutical companies beg to differ, and it’s hard to tell someone who is experiencing pain that it’s ‘not real.’
    Of course it ends this way: “Still, Dr. Wolfe expects the drugs will be widely used. The companies, he said, are “going to make a fortune.””
    Now if we could view all of the drugs to treat cholesterol with the same skepticism.
    Indeed. And one has to ask, is an elevated cholesterol a disease or a lab finding? I would opt for the latter. But you can’t prescribe and get reimbursed for a lab finding, so it’s imperative that the lab finding be converted to the disease of hyperlipidemia. Sad, sad, sad.
    Best–
    MRE

  11. I was just talking to a friend of mine who is a very overweight type II diabetic. i’ve been trying to get her to do the low-carb thing but she has been very resistant. She told me that she was sent to the nutritionist by her doctor and that the nutritionist was putting her on South Beach. She said that when she asked about Atkins or other version of the VLCHF diet she was told that South Beach was a better choice, but she said that the nutritionist did add that all of the endocrinologists themselves were on the low carb diet. You would think that that would tell them something! Go figure.
    Hey Felicia–
    It beggars belief.
    Cheers–
    M

  12. Interesting new research just published on insulin resistance.

    “Scientists Identify New Mechanism of Insulin Resistance
    Resistance to insulin that precedes type 2 diabetes may stem from a “metabolic traffic jam” that blocks the body’s ability to switch between glucose and fat as energy sources, say researchers at Duke University Medical Center.”
    “Normally, the body switches fuel sources during the day, says Muoio, a phenomenon known as “metabolic flexibility.”
    “For example, overnight and during periods of fasting or exercise, muscles and other organs in the body burn fat as fuel. That’s because there is usually more fat available at that time. But during the day, and especially after a meal, mitochondria switch to glucose,” she says.”

    Comment: The authors should have stated “after meal containing carbohydrate” and further that the body only switches to burning glucose because it has to get rid out it.

    “This makes sense, because food makes more glucose available and healthy individuals increase glucose use when it’s on hand. But there’s the hitch: If the diet is consistently too rich in fat and calories, the switchover does not occur. The mitochondria just keep working harder and harder to burn all the fat, and the effort eventually fails.

    Comment: Things really start to fall apart in the above statement. It appears as if the authors don’t understand physiology 101. A diet rich in carbs (the average American consumes about 500 grams a day) is also rich, very rich in the worst kind of fat resulting from the conversion of excess glucose derived from carbs. And the high insulin levels (I know the readers know this) shut down fat burning. So in reality this research is a further indictment of high the carb diet as the underlying cause of type II diabetes. This perpetrator deserves capital punishment.

    “This is what leads to a “metabolic traffic jam,” – a mitochondrial gridlock where fat accumulates and blocks the use, or metabolism, of glucose. Muoio believes that chronically stressed mitochondria send out a distress signal that prevents insulin from doing its job, allowing sugar to build up in the blood. “

    Comment: Now, the author’s conclusion. Drum roll please:

    “There are two very easy ways to prevent insulin resistance: Exercise more – you’ll help mitochondria burn fat more effectively, or eat less fat in your diet. That’s always easier said than done, of course.”

    Comment: Huh? if you reduce fat, you will eat more carbs which will be converted to excess fat which will cause and/or increase insulin resistance. This is a joke….right?
    I guess no one ever taught these people to think critically.
    Cheers–
    MRE

  13. I just saw another Alex Berenson article online from the NYT about Zetia having been found to be ineffective in studies that ended in early 2006. The BIGGER news in that article, and the question that’s being asked, is why it took nearly 2 years (And some prompting from Congress, apparently) before the drug companies would release the data.
    Not that I want the government any more involved than is necessary, but several doctors interviewed were also appalled.
    The spokesperson for Schering said that they themselves didn’t now the full results until 2 weeks ago. I don’t doubt that. I also don’t doubt that they knew what the results would show over a year and a half ago, and put the project on the back burner so they’d have ‘plausible deniability’ when they were finally forced to finish and report their analysis.
    If the Macy Foundation mentioned in a previous post is really serious, this article should be a hanging curve ball right in their wheelhouse…
    Hi Bob–
    See today’s post.
    Cheers–
    MRE

  14. Several years before changing my diet, I had substantial hypoglycemic symptoms. Blood tests always came back negative but my symptoms remained. Diabetes runs in my family, initiated by my mom. I don’t understand why my symptoms were not investigated further. But anyway, my symptoms all vanished once I began low carbing. Not only were my symptoms ignored but so was the “cure”. Migraines,itchy skin, insulin spikes have vanished. My blood tests are near perfect but my ability to take care of myself is the result, not medecation.
    In reference to Nat’s post, my eyes did not improve but for the past 3 years, I have not needed to change my prescription. This is the first time in all my glass-wearing life that I have not need to get stronger lenses. And you know what else? I have less gray hair on my head. I have heard of others who experienced this on another web-site. Also with low carbing, I can go longer without food. Going for longer than 6 hours isn’t insane to me anymore.
    After reading the Canadian study, I was wondering and I am so afraid to ask this…is it possible that glucose imbalance can be the culprit behind some forms of dystonia? I don’t mean to grasp at straws but this really makes me wonder. After reading that it can help MS among other things. Capsacin, used to treat the islets, seems a lot more safer then botox, me thinks. It sure makes me wonder. I would like to delve deeper into this.
    Thanks Dr. Eades,
    Mary
    Hi Mary–
    Don’t know if a glucose imbalance could be a driving force behind the development of dystonia. If a low-carb diet helps the condition, I would attribute it (and this is only speculation on my part) on the increase in ketones feeding the brain. This is a question you might want to address to Dr. McCleary on his blog because he knows much, much more about these sorts of disorders than do I.
    Best–
    MRE

  15. Dr. Mike:
    Found this one cute. Probably one for the “haven’t we just been saying that for years” file.
    JAMA. 2007 Sep 26;298(12):1420-8. Links
    Omega-3 polyunsaturated fatty acid intake and islet autoimmunity in children at increased risk for type 1 diabetes.
    (Although one wonders if it is mostly the Vitamin D in the cod liver oil.)
    Hey anne–
    I’ve had this paper sitting in my pile for several months now, but haven’t yet gotten around to reading it critically. Maybe this will be my inspiration.
    And it could well be the vitamin D.
    Cheers–
    MRE

  16. I read that the ADA in Dec. 07 finally has acknowledged the low Carb diet as an option for physicians as an alternative for weight loss in diabetics, but has stopped short of saying anything about the (bigger) impact of the low carb diet on improving blood glucose control because of lack of conclusive evidence.
    Pretty sad really. I now know how much hard evidence there was to support the current high carb/ low fat ADA diet and glybluride combination for 3 years that drove me into the type-2 that I am living with now.
    Most people believe their doctors without question. I used to. I am afraid that I am way too cynical about doctors and researchers now … shouldn’t be that way.

  17. I read that the ADA in Dec. 07 finally has acknowledged the low Carb diet as an option for physicians as an alternative for weight loss in diabetics, but has stopped short of saying anything about the (bigger and more easily demonstrated) impact of the low carb diet on improving blood glucose control because of lack of conclusive evidence.
    Pretty sad really. I now know how much hard evidence there was to support the current high carb/ low fat ADA diet and glybluride combination for 3 years that drove me into the type-2 that I am living with now.
    Most people believe their doctors without question. I used to. I am afraid that I am way too cynical about doctors and researchers now … shouldn’t be that way.
    Hi Guru–
    It really is too bad that you can’t trust your doctor on health issues, when he/she should be the go-to person for this information. But as long as Big Pharma controls the supply of information, I fear things won’t change any time soon.
    Cheers–
    MRE

  18. When a study came out alleging that a vegan diet was good for diabetics, I first read about it in the Washington Post. In reality, the vegan diet did better than the ADA diet (no suprise there), but neither diet reduced A1C below 7%.
    Yet you had the typical hype. Some were proclaiming that a vegan diet beat Atkins, even though it wasn’t tested against Atkins. Yet true success on low carb is minimized. Now the ADA recognizes that low carb may be good for weight loss (up to a year), but still recommends low fat for those with type 2. Rodney Dangerfield has it right.

  19. I’m new here but I’m learning a lot. Thank you for the information. Here is a video of Gary Taubes on Charlie Rose I thought your readers might like to view. I got upset watching Barbara Howard from the American Heart Association, she does not have clue. Does a high carbohydrate diet cause that fatty heart Dr. OZ demonstrates?
    http://www.charlierose.com/shows/2002/07/26/1/an-hour-about-obesity-in-america-with-guest-host-dr-mehmet-oz
    This was an appearance Gary made before he wrote his latest book. I got so steamed watching it that I couldn’t bring myself to see it through. I don’t know what kind of fatty heart Oz demonstrated because I never got that far.

  20. Hi,
    About 3 minutes and 30 seconds into the video, Dr. Oz pulls a heart covered with fat out of a bucket. The heart is from a patient during a transplant. Just wondering what caused the fat on that heart. Thank you.
    http://www.youtube.com/watch?v=JPyme62niYM
    I hung in there despite the lag between the film and the sound to see what you were talking about. The heart he pulled out is obviously a diseased heart if it was removed during a transplant procedure. But it is normal for there to be some fat around the heart. I don’t know that the heart shown was all that abnormal in appearance. It’s just that most people don’t know what a heart looks like. Go to a butcher shop and ask to look at a cow’s heart. It will look the same and it will be from a cow that consumed very little saturated fat in its diet and ate a totally plant-based diet. And didn’t live very long – a couple of years at most. Yet it will still have some fat on it. Fat that goes into the mouth doesn’t necessarily end up around the heart or in the arteries.

  21. I wonder if there is a difference between a grass fed cow’s heart and a grain fed cow’s heart.
    I’ve never compared them, so I can’t say. Maybe others can.

  22. Dear Dr. Eades,
    I am from India (Bangalore) and am at the threshold! of type2 diabetes (fasting blood sugar
    in the range of 110 – 150 mg/dl from last 4 years). Struggled hard to reduce weight and blood sugar levels with high complex carb.+low fat regime with little success. Recently started Glycomet 250 mg twice daily on Doctor’s advice. Now, I have discovered your wonderful book ‘Protein Power’, and as expected, a couple of doctors with whom I discussed it did not
    show any enthusiasm (FAT IS BAD!). Since I am so convinced with your book, I ignored that advice and started on your diet plan last week. It is working like a charm on my weight problem and energy levels. Will check the sugar level may be after a couple of weeks. I would like to thank you for such a great job. Request you to keep up the good work.
    Just need a piece of advise. Should I stop Glycomet right away or wait for a while
    for the blood sugar to stabilize?
    Regards,
    Subbu
    44 years old male, 10% overweight, Ovolactoveg., strong family history of Type 2 diabetes.
    Fasting blood sugar before starting PP = 150 mg/dl
    Hi Subbu–
    Glycomet is metformin, which is a blood-sugar-lowering medicine that can be taken with a low-carb diet without lowering sugars too much. It’s okay if you stay on it while on the diet, but work with your physician to get you weaned off as your blood sugar stabilizes at the lower level.
    I’m glad to hear you’re doing so well.
    MRE

  23. How do you explain the radical vegans’ assertion that a low fat, high carb, vegan diet can reverse diabetes as well? See: http://www.pcrm.org/magazine/gm06autumn/diabetes.html
    The radical vegan diet hardly reversed diabetes. In fact, the minimal reduction in HbA1c over 22 weeks isn’t particularly remarkable.
    Take a look at this study that lasted for 22 months. These subjects were on a low-carb diet and had much greater reduction of HbA1c. If any diet ‘reversed’ diabetes it would certainly be the low-carb diet, not the vegan one.

  24. hello my name is Jess I am almost 16.
    i have been overweight most of my life and have recently been undergoing blood work for a couple of months. my doctor says that i may have the pre signs of type 2 diabetes. I was told that if i lose weight there is a chance that i could save myself from actually having type 2 diabetes. i was wondering if you knew any good diets that i could try to help me in the process.
    please and thank you
    Jess
    Hi Jess–
    Grab a copy of Protein Power or the 30-Day Low-Carb Diet Solution. These books should tell you everything you need to know.
    Good luck.
    MRE

  25. Hi Dr Mike,
    I was wondering if you knew of any studies done on type 1 diabetics and carb restricted diets. I remember reading one a few years back but can’t find it anywhere now. I think it was a Swedish study.
    Clint
    Although the low-carbohydrate diet was the mainstay of treatment for type I DM before the discovery of insulin, there haven’t been a lot of studies in modern times. Here is a link to one. You can find others by going to PubMed and putting ‘low carbohydrate diet AND type 1 diabetes mellitus’ in the search function. You can also find out more info by reading Dr. Richard Bernstein’s book.

  26. Hi
    I have been struggling to lose weight for a long time.Now my doctor tells me to start with glycomet 500mg as i have developed insulin resistance.But my blood sugar levels are normal.Is it advisable to take glycomet for weightloss.
    Many doctors prescribe glycomet (the generic of Metformin) for weight loss. Give it a whirl. It should affect your blood sugar levels much, if at all, if they are normal.

  27. Hello –
    I am a 6′ 175 lb male in good shape – I strength train in the Arthur Jones / high intensity style. I eat low carb all the time (sometimes I use the ‘Anabolic Diet’ which consists of carb consumption one day per week while eating <30 grms / day all other days). My fasting blood sugar is ALWAYS above 100. sometimes it’s 102, sometimes it’s 110, etc. I am convinced that my liver must be churning out blood sugar via gluconeogenesis. My HbA1c is around 5.2, which isn’t bad, but I’d like it to be lower. I’m a bit confused about a couple of things –
    1 – wouldn’t being in the glucagon dominant phase create glucagon insensitivity in the same way that Insulin dominance produces insulin insensitivity? also, wouldn’t the cells that produce glucagon get worn out the same way that the beta cells get worn out churning out insulin?
    2 – if I eat virtually no carbohydrate and am in glucagon dominance, how does blood sugar ever get lowered? If gluconeogenesis is rampant, how will I ever lower my blood sugar, since I have very little insulin circulating due to the low carbohydrate diet?
    Sometimes I think I need to eat something that stimulates a lot of insulin just to get my blood sugar down. I’m sure I’m confused about these things, so maybe you could help enlighten me.
    Thanks Doc,
    Peter
    The short answer is: Don’t worry about it.
    Insulin is so much more dominant than glucagon that you’re not going to get in trouble with excess glucagon or runaway gluconeogenesis. If glucagon were to drive the gluconeogenic pathways to produce an excess amount of glucose, that little bit extra would stimulate the release of insulin, which would then shut down gluconeogenesis.
    Excess blood sugar – whether it originates from the diet or from gluconeogenesis – stimulates the production and release of insulin, which then decreases the blood sugar. If you have normally functioning beta cells, i.e., you’re not a type I diabetic, you won’t run your sugar too high by gluconeogenesis.

  28. Dr. Mike –
    Thanks for the response – but wouldn’t you think fasting blood sugar of 102 – 110 is high? My normal doctor was a bit concerned that I may be borderline diabetic. I’ve been thin all my life and have been avoiding sugar and simple carbs since I was 15 (I’m now 47). I’ve been doing low carb constantly since 2002. Whaddaya think? (also – don’t some type II diabetics have a problem with abnormally high fasting blood sugar from gluconeogenesis – I thought that’s one of the things Metformin was supposed to help?)
    Thanks,
    Peter
    But are you a type II diabetic? I wouldn’t just look at fasting blood sugar levels by themselves. You need to consider HgbA1c levels as well. HgbA1c levels represent an average of blog sugars over a couple of month period, and are a more accurate measure of what’s going on overall blood sugar-wise than is a single fasting blood sugar.

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