An insulin assay is done when fasting, prandial and postprandial insulin levels are checked. It is a very difficult test to perform, as it's only done in a clinical setting. But, you do not have to have this type of test to know if you are hyperinsulinemic.
The only insulin test that you need to have done is your fasting insulin. Though there are abnormalities in insulin release, postprandially, in the obese and people who are at risk for developing diabetes, your fasting insulin levels tell you everything you need to know about how insulin is impacting your metabolic health. A fasting insulin test is easily obtainable and if your doctor refuses to order you one, you can still have it done inexpensively, without a doctor's order, at certain walk-in or online labs.
When you're fasting, there is no need to have excess insulin circulating in the bloodstream. Fasting is when insulin levels should be as low as possible, so that fasting blood glucose is not impacted and you minimize insulin expression at the fat mass. It doesn't matter what your levels are prandially or postprandially, as long as insulin returns to very low levels during fasting. Low fasting insulin levels means that your prandial and postprandial blood glucose levels did not become abnormally elevated and excess insulin had to be released in order to lower it.
Insulin levels should be:
- Temporarily below 3 µIU/mL for maximum weight loss.
- Between 3-6 µIU/mL for weight loss maintenance and preservation of lean muscle mass.
2. I read in "keto" groups that "the lower my blood glucose, the better". This low blood glucose means I have been "cured".
The main anomaly seen in metabolic disease are large disparities in blood glucose levels, not simply high blood glucose. These disparities can cause abnormally low fasting blood glucose and abnormally high postprandial blood glucose. So keeping blood glucose low chronically does not solve this problem and it certainly does not mean you are "cured".
Low blood glucose can potentially worsen your condition because it's the lows in blood glucose that make the rule. The lower blood glucose drops, the higher and more persistent the highs become. This is in essence, what diabetes is. A high blood glucose set point which was determined by its lows.
Fasting blood glucose should preferably be around 83 mg/dL. Once blood glucose starts dropping down into the 60s mg/dL, it is no longer normal.
This low blood glucose can be caused by an inability of the counter regulatory system to release adequate stored glucose and/or high insulin levels continuing to lower blood glucose through fasting times. Whatever the reason, low blood glucose should be checked out by a doctor. Do not assume that it is okay, because you are making up for it with ketones. The goal of ketosis is to release fatty acids for fuel, not to drive blood glucose down to abnormally low levels.
Fasting blood glucose should preferably be around 83 mg/dL. Once blood glucose starts dropping down into the 60s mg/dL, it is no longer normal.
This low blood glucose can be caused by an inability of the counter regulatory system to release adequate stored glucose and/or high insulin levels continuing to lower blood glucose through fasting times. Whatever the reason, low blood glucose should be checked out by a doctor. Do not assume that it is okay, because you are making up for it with ketones. The goal of ketosis is to release fatty acids for fuel, not to drive blood glucose down to abnormally low levels.
3. Is eating dark chocolate the same as adding sugar to my coffee, if I use an equal amount of grams?
People become obsessed with numbers, but the body doesn't care about human made numbers. The grams make 0 difference. It's all about blood glucose. The only thing the body sees, is blood glucose going up or down and at what rate.
The sugar added to a 90% or more chocolate bar is to mitigate the bitterness of the chocolate. The chocolate bar is still bitter and the small amount of sugar in it, is not detectable as sweet. The purpose of adding sugar to coffee, or any other food, is to make it sweet. The taste of sweet makes all the difference in the world, between these two foods, that may contain the same grams of sugar.
The body is stimulated to release insulin in multiple ways, including incretin hormones activated during the process of tasting and chewing food. This means that there is a big difference between eating a 90% chocolate bar, which still tastes bitter, and a sweetened coffee.
4. Will artificial sweeteners allow me to enjoy desserts without paying the price?
The insulin release effect mentioned above is what has caused a failure in curbing obesity through the use of artificial sweeteners. As long as the food is sweet, the body will release copious amounts of insulin in preparation for a glucose tsunami. When that tsunami does not come, insulin still remains high and will drop your fasting blood glucose too low instead. Not to mention that this excess release of insulin will also have a prolonged expression at the fat mass, making you even fatter. I haven't even touched on the obesogenic hypothalamic effect of sweet taste which only complicates matters further.
That is why you can still remain fat on a ketogenic diet that includes artificial sweeteners. You're eating nothing but fat, while still unable to control your blood glucose because of the effects of excess insulin release/expression.
5. I think fasting is the best way to resolve dietary problems. I can just apply fasting to any diet and succeed.
False. That makes a great marketing pitch but it has 0 basis on reality. First, the only metric for metabolic health lies in proper blood glucose regulation and fasting effects blood glucose just as much as eating.
People become obsessed with numbers, but the body doesn't care about human made numbers. The grams make 0 difference. It's all about blood glucose. The only thing the body sees, is blood glucose going up or down and at what rate.
The sugar added to a 90% or more chocolate bar is to mitigate the bitterness of the chocolate. The chocolate bar is still bitter and the small amount of sugar in it, is not detectable as sweet. The purpose of adding sugar to coffee, or any other food, is to make it sweet. The taste of sweet makes all the difference in the world, between these two foods, that may contain the same grams of sugar.
The body is stimulated to release insulin in multiple ways, including incretin hormones activated during the process of tasting and chewing food. This means that there is a big difference between eating a 90% chocolate bar, which still tastes bitter, and a sweetened coffee.
4. Will artificial sweeteners allow me to enjoy desserts without paying the price?
The insulin release effect mentioned above is what has caused a failure in curbing obesity through the use of artificial sweeteners. As long as the food is sweet, the body will release copious amounts of insulin in preparation for a glucose tsunami. When that tsunami does not come, insulin still remains high and will drop your fasting blood glucose too low instead. Not to mention that this excess release of insulin will also have a prolonged expression at the fat mass, making you even fatter. I haven't even touched on the obesogenic hypothalamic effect of sweet taste which only complicates matters further.
That is why you can still remain fat on a ketogenic diet that includes artificial sweeteners. You're eating nothing but fat, while still unable to control your blood glucose because of the effects of excess insulin release/expression.
5. I think fasting is the best way to resolve dietary problems. I can just apply fasting to any diet and succeed.
False. That makes a great marketing pitch but it has 0 basis on reality. First, the only metric for metabolic health lies in proper blood glucose regulation and fasting effects blood glucose just as much as eating.
Fasting may be the easiest way for some people to restrict carbohydrates, by simply restricting ALL macronutrients, but it is not going to solve dietary problems. You can not fast forever, but you must eat forever. For this reason, the long term solution to dietary problems is by addressing diet. Avoidance (fasting) is not going to do this for you. Anyone can fast, but knowing how to eat is a much more complex problem and until it is resolved, no amount of fasting will fix the long term problem of obesity. The long term solution is dietary.
6. Gluconeogenesis needs to be avoided at all times, so I can gloat about my low blood glucose and high ketone levels while still remaining insulin resistant.
Gluconeogenesis (the making of new glucose) is a demand driven, not supply driven, process that does not just use amino acids in protein, but can also use glycerol in triglycerides (fat) or lactate in the muscles. This process occurs to everyone. It is completely normal. It is only exaggerated in people with metabolic syndrome, because of insulin resistance of the cells that make glucagon. This causes glucagon to not work properly.
Glucagon is the counter regulatory hormone to insulin. It regulates glucose levels by mitigating the effects of insulin to prevent hypoglycemia. These two hormones work together to produce anabolic or catabolic states, through a series of complicated feedback loops, which also involve other metabolic hormones like leptin. But, when there is insulin resistance, it prevents proper feedback signaling to occur between metabolic hormones, causing several abnormalities. Hyperglucagonemia is one of them.
Blood glucose rises with protein intake, from glucagon releasing your own excess liver glucose, in an exaggerated way. This does not occur in metabolically healthy individuals because, for them, glucagon is properly regulated by leptin. You are not making all this glucose from the protein you just ate. It's not primarily "new glucose", it's primarily old glucose and it's your own insulin resistance, causing this poor glucagon/leptin/insulin feedback, not the intake of protein. Restricting protein only hides this anomaly, it does not cure it.
6. Gluconeogenesis needs to be avoided at all times, so I can gloat about my low blood glucose and high ketone levels while still remaining insulin resistant.
Gluconeogenesis (the making of new glucose) is a demand driven, not supply driven, process that does not just use amino acids in protein, but can also use glycerol in triglycerides (fat) or lactate in the muscles. This process occurs to everyone. It is completely normal. It is only exaggerated in people with metabolic syndrome, because of insulin resistance of the cells that make glucagon. This causes glucagon to not work properly.
Glucagon is the counter regulatory hormone to insulin. It regulates glucose levels by mitigating the effects of insulin to prevent hypoglycemia. These two hormones work together to produce anabolic or catabolic states, through a series of complicated feedback loops, which also involve other metabolic hormones like leptin. But, when there is insulin resistance, it prevents proper feedback signaling to occur between metabolic hormones, causing several abnormalities. Hyperglucagonemia is one of them.
Blood glucose rises with protein intake, from glucagon releasing your own excess liver glucose, in an exaggerated way. This does not occur in metabolically healthy individuals because, for them, glucagon is properly regulated by leptin. You are not making all this glucose from the protein you just ate. It's not primarily "new glucose", it's primarily old glucose and it's your own insulin resistance, causing this poor glucagon/leptin/insulin feedback, not the intake of protein. Restricting protein only hides this anomaly, it does not cure it.
When you eat carbohydrates, the process is the same. Most of the high blood glucose you measure, after eating potatoes, is coming from your own liver, not the potatoes. The reason that you restrict potatoes, and not the steak, is because potatoes add even more glucose to the mix and the steak won't.
Though this exaggerated postprandial glucose release can cause high blood glucose, and should be monitored carefully if you are a Type II diabetic, it is not a pathological process like it is for Type I diabetics. In the context of a carbohydrate restricted diet, slightly elevated blood glucose can be a positive sign. It usually occurs during active weight loss, as the liver increases gluconeogenesis in order to use stored energy. It is an indication that insulin is reducing and allowing the body to release stored energy for use or elimination. This slight elevation also prevents blood glucose from lowering too much, increasing hunger and fatigue.
Reversal of insulin resistance is what resolves this condition. The only way to reverse insulin resistance is to obtain proper blood glucose regulation. Restriction of protein will not achieve this. You can control your blood glucose after eating protein by dividing your daily protein intake into three meals a day. This prevents you from consuming all your protein, at once. Dr. Bernstein's recommendation is as follows:
Though this exaggerated postprandial glucose release can cause high blood glucose, and should be monitored carefully if you are a Type II diabetic, it is not a pathological process like it is for Type I diabetics. In the context of a carbohydrate restricted diet, slightly elevated blood glucose can be a positive sign. It usually occurs during active weight loss, as the liver increases gluconeogenesis in order to use stored energy. It is an indication that insulin is reducing and allowing the body to release stored energy for use or elimination. This slight elevation also prevents blood glucose from lowering too much, increasing hunger and fatigue.
Reversal of insulin resistance is what resolves this condition. The only way to reverse insulin resistance is to obtain proper blood glucose regulation. Restriction of protein will not achieve this. You can control your blood glucose after eating protein by dividing your daily protein intake into three meals a day. This prevents you from consuming all your protein, at once. Dr. Bernstein's recommendation is as follows:
- Breakfast: 6 grams carbohydrate, 3 ounces protein
- Lunch: 12 grams carbohydrate, 4 ounces protein
- Dinner: 12 grams carbohydrate, 5 ounces protein
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