1. Low carb people told me I could "fix" my fatty liver disease in a few weeks, but I still have had no improvement with my liver in more than a year of following low carb.
You'd be surprised what some people claim is low carb. There are folks who believe coconut sugar and cassava flour is "low carb". For this reason, I don't know what you mean by "low carb" so I cannot address your diet as you did not detail your protocol. I can only address the claims being made online by low carb advocates which bamboozled you into following a diet, that is obviously not working for your particular problem, and you have wasted valuable time.
Always take any claim of this sort with a grain of salt because you simply don't know what your individual outcome will be. The only intervention that has ever reversed fatty liver disease, in about two weeks, has been the elimination of all sugar from the diet. This has been done with a ketogenic style protocol. The same effect has also been seen by simply removing soda and other sugared beverages from the diet but mostly in children. Of course, these approaches are only true if the fatty liver disease was caused by excess sugar consumption to begin with.
So when you read about the "reversal of fatty liver disease" in a low carb platform, it is usually in the context that sugar was the culprit for the disease. If you take away the sugar, then the disease is cured, but fatty liver disease is not solely caused by sugar intake.
Aside from excess carbohydrate consumption in the form of sugar, fatty liver disease can also be caused by excess alcohol intake, viral infections, certain drug treatments and consumption of high dietary fat, particularly from vegetable oils. This means that if you don't follow low carb correctly and you begin consuming abnormal amounts of dietary fat, you will contribute to your disease progression and will see no improvement in it.
This is because abnormal lipid metabolism leads to ectopic liver fat accumulation. Trying to metabolize an extraordinary amount of dietary fat is abnormal lipid metabolism. In other words, you have too much energy stored in your liver and you are trying to add more. That's why swapping one high energy diet, like a high carb diet, for another high energy diet, like a high fat diet, will not work to improve your condition. So if this is the case, you have to address it immediately. Stop following charlatans and get on a true low carbohydrate protocol.
Aside from this, disorders in genes involved in fatty acid uptake, hepatic triacylglycerol secretion, choline deficiency and fatty acid oxidation also lead to fatty liver disease. The pathogenesis of fatty liver disease involves multiple pathways, including fatty acid uptake, de novo lipogenesis, mitochondrial fatty acid oxidation and lipoprotein secretion. So if you have genetic issues, in any of these pathways, you can develop fatty liver disease and if it's not addressed, the disease will progress and not improve. As you can see, there are multiple ways of acquiring fatty liver disease and multiple things that will contribute to it.
I know that your doctor will not give your fatty liver disease a second thought as conventional medicine believes that fat accumulation in the liver is benign until inflammation or scarring occurs. The problem with this is that inflammation and scaring is the end stage of fatty liver disease and that's when irreparable damage to the liver occurs. For this reason, it is up to you to figure out what is causing your fatty liver disease and address it. You have to force your doctor to not sleep on this and find out what is causing it through a proper investigation.
You also need to stop waiting for a low carb miracle to occur because you are wasting valuable time that could be spent finding a way to properly treat this problem rather than waiting for low carb to finally "kick in" and "cure" it for you. It's obviously not happening.
2. Blood glucose rises with exercise.
This is caused by an exaggerated stress response, which is typical of people with full diabetes. Blood glucose rises with any injury or illness for these people as well.
As metabolic health improves, this effect tends to disappear. The length of time that takes depends on many factors, so it's highly individualized. You just have to focus on continuing what you have to do in order for things to improve with time. Do not do strenuous or prolonged exercises and never exercise fasted. That might help in the interim.
3. Even when consistently following "clean keto" for 2 years, my HbA1C has been creeping up.
You are still having blood glucose regulation issues. Like I have said many times before - "keto" and low carb are only palliative treatments for metabolic conditions. That means that they treat symptoms, not the actual condition itself. The actual condition is the result of poor blood glucose regulation. The canary in the coalmine, which signals this is the case, is not necessarily your increasing HbA1C but how much body fat you still have. As long as "keto" and low carb doesn't cause you to lose weight, specifically body fat, you will continue to be at the threshold of metabolic dysfunction.
When you first start "keto"/low carb, you lose some body fat because your blood glucose regulation improves. This in turn helps lower your blood glucose, HbA1C and insulin levels. You feel as though you have found the cure to your ailments but because you never fully correct your blood glucose regulation, you never lose enough body fat. The problem continues and not only do you not lose enough body fat, but you also begin piling more on and your metabolic numbers begin to rise. For some people this happens sooner and for others later, depending on their overall lifestyle but it will happen. As long as you are overweight/obese, it will happen again. You are simply moving the goal post further away but you're headed right to it.
This is why these diets have to be accompanied by lifestyle changes that are anti obesogenic. The diet alone will only get you so far.
4. Calories don't count if you are carnivore, unless you're diabetic and need to lose weight.
It depends on where the calories are coming from. Excess protein calories only build lean muscle mass. Excess fat calories only build fat mass. So, instead of tracking all of your calories, make sure that you track your fat calories instead. Everything else is irrelevant and this goes for both diabetics and non diabetics.
Fat and protein macros are individualized but the rule of thumb for fat grams is to always stay between 50 - 150 grams a day. The more body fat you have to lose, the more you should lean towards 50 grams.
5. I have transitioned to "keto" but feel hypoglycemic.
"Feeling" hypoglycemic and being hypoglycemic are two different things. The clinical definition for hypoglycemia is:
- A blood sugar level below 70 mg/dL (3.9 mmol/L) is too low and can cause harm.
- A blood sugar level below 54 mg/dL (3.0 mmol/L) is a cause for immediate action.
Lower blood glucose does not equal better in this blog. The goal is to obtain and maintain normal blood glucose regulation, not lower blood glucose. Lower blood glucose does not solve the complicated pathology of metabolic syndrome.
If your blood glucose is higher than 70 mg/dL then you are not clinically hypoglycemic and so your symptoms are being caused by "pseudo hypoglycemia". This is actually very common, especially in people who aren't full diabetics yet but are on their way there. Pseudo hypoglycemia is a state where the body actively tries to elevate blood glucose, even if it's at a normal level, by causing you symptoms that will make you eat or rev up the body's stress response. Ignore this. It will go away with time. Feeding into it will only cause for you to never get off this merry go round. Allow the body to learn how to regulate its blood glucose on its own, without your intervention.
If your blood glucose is lower than 70 mg/dL then you have to reformulate your diet so that this does not occur. If this means switching from "keto" to moderate low carb, do so. You want to keep your blood glucose steady. Unsteady blood glucose will deteriorate your counter glucoregulatory response further and soon you will be dumping out incredible amounts of glucose to prevent any lowering of it to normal.
If your blood glucose is lower than 70 mg/dL without symptoms, then you have a very big problem and you need to address it with a healthcare provider as some diabetics do not experience any symptoms when their blood glucose reaches clinical definitions of hypoglycemia. This is a problem with the autonomic nervous system causing a failure of the counter glucoregulatory response. It can be life threatening as your blood glucose can drop low enough to put you in a coma without you being none the wiser to it.
So anytime you have symptoms of hypoglycemia, check your blood glucose to determine what's really going on and then act accordingly.
6. If you are on "keto". you should reduce the units of insulin you are currently on.
You need to talk with your healthcare provider. We cannot advise you on how to reduce injected insulin or any other type of prescription medication. Even if I could advise on this, I wouldn't because the internet is not a surrogate for proper healthcare. Any low carb advocate that allows this type of advice to be shared on their platform is immoral.
Altering your prescription medication, either on your own or with the advice of some fool online, is very dangerous and irresponsible. Monitor your blood glucose and discuss changes with your doctor so they can help you reduce or eliminate any medications you might be currently on.
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