Don’t forget your checkups on LCHF!


Do you need to go in for your checkups if you, as a diabetic, eat LCHF and have improved your blood sugar dramatically?

I received an e-mail from a physician about this:

The E-mail


I’m a fellow doctor reading your website with interest, and am myself following an LCHF diet.

Many success stories about type 2 diabetes where it really can do wonders.

But – I do wish that you’d point out a little more that one doesn’t get completely healthy. People should be encouraged to their annual checkups to monitor HbA1c and blood pressure. Many of these patients are on insulin and were already hit by renal damage and hypertension. And then maybe the orthodoxy fades with time and they get sloppy with the diet.

LCHF may get discredited if people go under-treated without checkups, and suffer complications that we otherwise usually don’t see.

You are really doing a great job and now it seems the old bastions are starting to fall!


Ingrid Sandhall


True – it is important for diabetics to go in for checkups. Far from all type 2 diabetics manage without medication; this applies foremost to people who start eating LCHF early in the progression of the disease.

People who have had type 2 diabetes for a long time are usually able to decrease their medication and show greatly improved health markers on LCHF, but often some Metformin is still needed, and perhaps a blood pressure tablet to make it all look perfect.

People with type 1 diabetes will of course normally always need insulin injections, but in substantially lower doses – and perhaps less frequently – on LCHF.

As Ingrid Sandhall writes, it’s not unusual that a few more carbohydrates sneak into the diet without you really noticing, and then it’s a good idea to monitor health markers, and perhaps increase motivation.

What do you think?

Do  you have diabetes and follow an LCHF diet? What does you doctor or diabetes nurse say when you come in for you checkup?


Ingrid was happy to share her e-mail with the readers.


The Doctor: “Have You Started an LCHF Diet, Or Something?

“Hello LCHF – Goodbye Type 2 Diabetes”

One Year on an LCHF Diet with Type 1 Diabetes

How to Normalize Your Blood Sugar

LCHF for Beginners


  1. Lynne
    This is a useful reminder, thanks. I started LCHF a few weeks after being told I was diabetic (HbA1c was 6.9). Good glycemic control almost immediately, but Total Cholesterol up to 8.2!

    Have had 2 annual diabetic checks since, plus retinopathy.

    Doctor lets me monitor my own BP, am on 2 meds and seems to work. He never checks it. Tries to persuade me to have a statin, I always say no. Tells me I need carbs 'for energy'. Basically he seems happy enough but has no interest in LCHF or how I get lowish HbA. Does not measure HDL or Triglycerides any more, NICE guidelines say Total Cholesterol is enough.

    I get far more support from this website and similar sites than I do at the surgery.

  2. Howard Lee Harkness
    I actually caught my abnormal blood sugars and corrected them long before my VA "doctor" could detect the problem. But I'll tell you what she *does* say:

    1) Saturated fat is bad for you; you need to reduce dietary saturated fat.
    2) Red meat is bad for you; you need to reduce the amount of red meat you eat.
    3) Your cholesterol (an imaginary number "calculated" using the discredited Friedewald equation) is 210, you need to be on a statin. Even though your HDL is over 100, and your triglycerides are under 40. (A condition which is known to damned near everyone *not* in the "medical" profession to cause the Friedewald equation to be off by as much as 100%)

    The last two appointments that the VA made for me, I simply cancelled. I am certain that I'm labeled in my records there as "non-compliant."

    The "medical professionals" at the VAMC can probably handle acute injuries. But for anything less than an immediate life threat, they are a bit like the mechanics at Pep Boys (a chain auto parts & repair shop in the US), e.g. if you tell them to replace a hose, they can do that. But if you don't know what is wrong with your car, they probably don't either.

    I do have an elevated blood pressure, which I have succeeded in reducing a bit, and I will experiment until I find something that works. My "doctor" wants to put me on pills for that, too -- and more pills for the side-effect of aching joints caused by the amlodipine besylate. I'm not going down that path, regardless of being labeled non-compliant. The worst part is *not* that she has no clue about what might be causing my high blood pressure, but that she doesn't really give a shit.

    To her, it's 1) symptom -> pill, 2) side-effect -> another pill, 3) more side-effects -> more pills. She has not done a single thing for me in 3 years that could not be accomplished equally poorly by a bus-driver with a checklist.

    I will continue to access my own health as best I can, because I think I'm better at it than my VA "doctor."

    Reply: #11
  3. Ekaterina
    I have been managing my sons Type 1 diabetes with LCHF diet. I did not know about this diet 4 years ago when he was diagnosed at the age of 6. As a result of reduced carb, gluten free diet (he does not have allergy on gluten), he has been almost insulin independent for the first 3 years and now he requires very little insulin. He is almost never experiences low or very high BG.

    Here is a link to our recent interview, which you are very welcome to share.

    Kind regards,
    Ekaterina Lochoshvili-Griffin

  4. LarryB
    I've been doing LCHF for about 18 mos. A1c is down from 7ish to 5.3, and has been for over a year. I'm off of all medications and have perfect blood pressure (which never was high) and good cholesterol. That one's normal by the old standard, and a bit high by the new one, but with good ratios. I'm also 75 lbs (34 kg) lighter.

    My doctor wants me to come in every 6 months for an exam and blood work, and I don't see that as a problem, considering that I used to do that every 3 months.

  5. Frances
    Thank you for posting this. I want to learn more on what to reasonably expect (the process, timeframe markers for the process of recovery) as one moves towards recovery for T2DM.

    So far, my T2DM partner has reduced his blood sugar average from 10.1 to 8.4, due to LCHF and increasing the intensity and regularity of physical activity (based upon my insistence that we guided by research findings in preference to "the limited personal opinions of prescription monkeys").

    When diagnosed 8 years ago, my partners average BG was 16. He asked the Dr. at the outset "Can this be managed through diet and exercise?" Answer: "No, without medication you will die!" This curt response came as a complete shock, considering a close friend had achieved this already. This person is fit and well... and most definitely alive!

    Before I entered the picture (with my curious mind) my partner had been on Metformin/Janumet oral for years, with gradually declining health. He was, as one might expect, emotionally addicted to the daily habit of ingesting these pills, out of perceived distress. Now he is taking control of his own recovery, witnessing positive results, better educated to be able to stand his ground (his desire is to manage it himself)... he is looking forward to being in the position of reducing his meds. His Dr. wants his BG averaging 7, which is consistent with my viewpoint that this be our next target.

    At the same review (just a few days ago) my partner was informed his cholesterol is too high... another hurdle to overcome. Mmmm, is this so? I query. Dr. proports (again) that this recent development can only be treated by meds. Fortunately, Dr. says he doesn't want to introduce these in addition to what he is already taking, which buys me time to research this, in relation to the cholesterol readings, so we can stay "one step ahead" of the Dr's prescription pad.

    My instincts query whether more meds are valid, necessary, beneficial. Will these meds lead him towards full recovery? Or away from this? Is this just another possible addiction? Or another "hook"... a "loyalty" card to keep him as a fearful forever sick patient to be treated endlessly with inadequate potions that empty his hip pocket.

    Our attitude towards the Dr. is: We will only hire your services if you lead my partner towards a fully realized real recovery. We are not interested in anything else you might offer. So far, LCHF and my research has been the only source of progress. I am presently looking for a more well educated Dr. (who is up-to-date on research) to replace this one.

  6. dave riley
    I'm doing the LCHF and since then have gone off meds and usually stay within normal range -- under 6.7 mmol.

    I don't much discuss it with my doc as everything I've done -- lifestyle, exercise, diet -- has been DIY built on my own research.I still have elevated BP. Lost 10 kgm. But after veering ketogenic I now consume some starches at most meals.

    I had started off 'low carb' but it didn't make all that much sense in that if you cut back on your vegetative matter, what do you replace it with?

    I think the LCHF is the most reasonable approach -- a great baseline for existence.

    Nonetheless, I always like to take my own blood's measure -- just to see what's a'happening.

    I got a lot from the Swedes: especially in regard to respect for fats and dairy products which confirmed my own experiments.

    Just so long as we aren't forced to eat, or sit downwind from, Surströmming -- its' all good.

  7. Daniel Ferreira
    My doctor calls me a genetic freak bc I used to eat 20 whole eggs a day for 2yrs, and my cholesterol was beyond perfect.

    Not going to try to convice anyone about Low carb, as everytime I do, they dont believe it, and if I show them my results of my blood work every 6 months, they just say "genetics" or "you are young"

    Reply: #8
  8. JD
    You can always retort by pointing to a case study about an 88 year old man who ate 25 eggs a day for at least 15 years and had normal cholesterol levels. It's kind of funny to read how they concluded back then (this was in 1991) that he must be a genetic freak with super human bile, or something.

    My doctor calls me a genetic freak bc I used to eat 20 whole eggs a day for 2yrs, and my cholesterol was beyond perfect.Not going to try to convice anyone about Low carb, as everytime I do, they dont believe it, and if I show them my results of my blood work every 6 months, they just say "genetics" or "you are young"

  9. François
    I fully agree with the suggestion to continue getting regular check-ups. This should prove to anyone doing it that LCHF is really working and decreasing blood sugar, HbA1C (essential to measure in anyone who is slightly plump with a BMI of 25 or more, especially in females (higher diabetes risk) and in Asians, South-East Asians and Pacific Islanders because of the much higher incidence of diabetes at lower BMI's in these people. Blood glucose may be normal, at the expense of a very high circulating insulin which promotes severe chronic inflammation.When blood sugar rises, HbA1C and insulin have been high for years before, creating severe inflammation.

    You have to ask for it as most physicians will not ask for a HbA1C if the blood glucose is normal. I also recommend checking for another marker of inflammation, the C reactive protein. Triglycerides are also the most important piece of the puzzle to interpret the cholesterol profile. A high total cholesterol alone is meaningless. A high total cholesterol with a high triglyceride level (raised by carbs and alcohol) means trouble, as the LDL particles are then small, dense and atherogenic. But a high total cholesterol with a low triglyceride level (usually associated with a high HDL - not "good" but rather a marker that you are doing something right) means the LDL particles are big, fluffy and harmless.

    The new cholesterol guidelines seem to be unfortunately there to stay, as by following them physicians will dramatically increase their prescription of statin drugs. And since the experts who came up with this nonsense admitted that the LDL goals of the previous recommendations had been pulled out of thin air, they decided to keep it simple and came up with a "statin by age" guideline, with total cholesterol the only marker. That way, a high number is much more scary.

    And since in many states, as a physician, you'd better abide by the guidelines or else, we will unfortunately still see a lot of this crap. I fear it will only get worse.

    My suggestion for a basic blood work.
    CBC and differential. Sedimentation rate. C reactive protein
    Creatinine and BUN (for kidney function)
    Creatinine clearance if creainine elevated
    AST, ALT, GGT for liver function. (interesting to follow when there is a symptomatic fatty liver)
    Fasting blood glucose, HbA1C level
    Total cholesterol, triglycerides, HDL-C and LDL-C - no need for particle size measurement - just look at the triglycerides)
    Any other test your physician may see fit.

    And I suggest to look for a "primal doc". Just google it and you'll get a listing by state and country. These physicians eat either a paleo or primal diet and are familiar with the LCHF concept. You'll get a more interesting exchange with one of them. Yoy may also want to take a look at Kris Gunnar's interesting blog entry: You'll find a ton of important info on these blogs.

    I strongly suggest googling also Dr Jason Fung, a nephrologist who treats diabetes with LCHF to prevent kidney failure. He has great videos on his site.

    Good luck!

  10. Bonny
    I have been diagnosed with insulin resistance and type 2 diabetes in 2001. I started LCHF beginning May 2013. Apart from losing 17 kg gradually while nothing else worked, I stopped my medication in August 2013. I have no problems whatsoever (even if I do a small cheat once a month). My cholesterol also never spiked and my blood pressure actually went down after losing some weight. I have tried many diets and this is for sure a way of life for me.
  11. murray
    Howard, for blood pressure you might try some dietary and other non-medical measures directed toward healthy, relaxed blood vessels. Watch for any research report you can find on endothelial health.

    To relax blood vessels, anything that stimulates NO (nitrous oxide) relaxes blood vessels (assuming those metabolic pathways are working properly, which is not always the case). Foods good for stimulating NO production are spinach and celery, which have nitrates, and supplementing with arginine (an amino acid).

    Other foods good for endothelial health in various studies include dark chocolate (every day I have 100% with no added sugar) and blueberries. (I prefer wild blueberries.)

    Blood sugar peaks are of course bad because of glycation damage to the blood vessel lining, especially if there is sheer stress damage.

    Avoid chronic cardio or any activity that significantly increases blood pressure and flow (which causes some degree sheer stress damage to arteries) without adequate rest and recovery between sessions to heal sheer stress damage. On the other hand, periodic sessions of fairly intense cardio are helpful to enhance the flexibility and elasticity of blood vessels. Like any training, over-training is bad. Some of the worst cases of atherosclerosis are in athletes who continually over-train. In theory, sheer stress damage results in a healing, inflammatory response. This requires delivery of cell-building cholesterol from LDL particles. To the extent there are small dense LDL among the LDL particles, there is a higher chance there is oxidized lipid in the LDL particles, which particles get tagged for destruction. Macrophages in the inflamed sheer stress damage area consume the oxy-LDL particles, but if there is too much oxy-LDL the white cells begin to accumulate and inflammation persists rather than abating once the sheer stress damage heals properly (and its not aggravated by more intense exercise or glycation, smoking, the presence of advanced glycation endproducts (AGE) from eating sugary foods or food cooked at high temperatures, more oxidized lipids from consuming vegetable oil especially if used in cooking, environmental toxins, etc.) . The chronic inflammation results in calcification. (There is greater calcium attraction where endothelial cell types have changed in proportion as a result of consuming vegetable oils, as demonstrated by Fred Kummerow's research. See Interaction between sphingomyelin and oxysterols contributes to atherosclerosis and sudden death, The overall process results in thickening of the artery wall and narrowing of the vessel and reduction in the flexibility and elasticity of the blood vessel, none of which helpful for reducing blood pressure.

    For reversing calcification, consume adequate K2 (distinct from K1), retinol (distinct from beta carotene) and D3. Most people are K2 deficient. K2 is highest in certain fermented cheeses (such as gouda, brie) and in the fat, organs and eggs of grass-feeding animals (such as grass-fed cattle, pasture chickens). K2 (in conjunction with retinol and D3) activates an enzyme to reduce calcification in soft tissues of the body.

    Stretching increases the flexibility and elasticity of blood vessels.

    I developed slightly elevated blood pressure in my late twenties. I started exercising a lot and lost over 15 pounds and really watched salt intake. My blood pressure remained absolutely unchanged at 130/90. After going LCHF and following some of the above, my blood pressure dropped to around 95/65 (sometimes 100/70, sometimes 90/60, usually in between). (I learned about K2 after my blood pressure had already dropped.)

  12. NS
    "I strongly suggest googling also Dr Jason Fung, a nephrologist who treats diabetes with LCHF to prevent kidney failure. He has great videos on his site."

    That is not entirely true.

    Dr. Fung offers his patients several different protocols to lower insulin. A high fat regimen is just one of them. Others which he emphasizes (perhaps even more) include eating lots of fiber rich foods from fruits, vegetables, and whole grains; while he recognizes the contribution of Taubes and paleo, he also recommends plant-based whole food approaches, such as Mark Hyman's Blood Sugar Solution. These are hardly LCHF regimens. And, yet, despite these carbs, his patients seem to be doing exceedingly well.

    There are many routes to lower insulin, reduce inflammation, diabetes reversal. LCHF is only one among the available options.

    Reply: #18
  13. Galina L.
    I asked my doctor to put the information that I am on a LC diet into my medical records. I want to be the part of statistics with my N=1 without going to the national weight registry road mostly because my health improved more dramatically than weight. I lost only 30 lbs, but I don't need prescriptions for asthma any longer, diuretic for low legs edema, antibiotic once a year for a seasonal flu not clearing up on its own, prescription for yeast infection because OTC things stopped working, migraines are well managed now. My cardiovascular markers were always good, probably due to my exercise routine and a generally healthy life-style.
  14. eddy
    Replies: #16, #17
  15. Eric Anderson
    I would like to see the collection of data on Fasting Insulin, Glucose, Ketones an THEN the gut microbiota via stool and about 5,000 metabolites in the blood to see the before and after effct as well as comparedwith SAD and or vegetarians of the same ages. Why not

    I think LCHF offers a lot of health and aging benifits we should know more about. Eric

  16. Paul the rat
    "..I checked in with my doctor…"

    You did? - good for you !. However I have contact with patients and they all improve in all forms of intestinal diseases (and not only) when we, as the first step, ask them to significantly reduce or eliminate your healthy multi grains from their diet eddy. Are you going to say that our group and our patients are all delusional?. Next time I will show a patient your article you provided link to and say that he or she should be no better, really.

  17. Murray
    The link is a nice philosophical set-up discussion but fails to deal with any of the research. One would have thought Fassano 2011 and the effect of gliadin on zonulin would be just the starting point of scientific discussion. The blog doesn't get to that starting point.

    My wife was dumbfounded by the abruptness of her improvement going off gluten with respect to headaches and migraines. She had gone years with a headache almost every day and increasing frequency of migraines, to almost weekly. She had been seeing the leading headache specialist in the country. Then, after I hounded her after reading Wheat Belly, she stopped wheat, etc. and did not have a headache a day later and went clear for 45 days (at 47 years old, by far the longest as an adult) until the day after she ate a couple of cookies the kids baked. Since then it is fairly predictable when she gets a headache--the day after she his a dessert "to die for". Given that the headaches go away avoiding gluten and recur reliably when gluten is consumed, plainly gluten has some causal role. My wife is not celiac. She does, however, have partial North American aboriginal ancestry, so she may lack genes for grain tolerance that Europeans have.

    Curiously, Fassano lists indications that MS and brain cancer appear linked to gluten and zonulin. My wife's mother had both MS and, later, brain cancer. Her mom's sister also got brain cancer. Since learning about these associations with gluten, there are fewer flour-containing desserts she finds are "to die for."

  18. François
    It is absolutely true that there are many ways to decrease blood insulin (this is paramount in treating and reversing diabetes) and Jason Fung uses quite a few, which he offers to his patients. I had an interesting online discussion with him. One of the most important ways he does decrease circulating insulin is by intermittent fasting, which he achieves by having patients skip breakfast, this being combined with different dietary approaches. And overall, all approaches that work do decrease the carb load: as both carbs and high doses of protein do stimulate insulin production, high carbs and high protein are to be avoided. The only macronutrient that does not stimulate insulin is fat.

    It is certainly possible to achieve some degree of success in treating diabetes with a few dietary approaches, but it is essential to decrease the total daily carbs. Please see Yoshifumi Y, Uchida J et al., A non-calorie-restricted Low-carbohydrate Diet is Effective as an alternative therapy for patients with Type 2 Diabetes. Intern Med 53: 13-19, 2014.

    The advantage of a LCHF diet over other approaches is that people are not hungry and stick more easily to the regimen. But again, LCHF is not the only approach. But it's a darn good one.

  19. NS
    Thank you for the response.

    My apologies but I am lacking the time at the moment to reply properly but in the meantime you may be interested in the below study as one example of "other (non-LCHF/LFHC) routes" that work in T2D reversal:

    Replies: #20, #21
  20. Paul the rat
    we discussed this paper few months ago at
  21. François
    As Paul noted, we discussed this paper. MA-Pi macrobiotics is a very unbalanced diet (see the author's own conclusions as far as the dietqary deficits they noted in their subjects). This "diet" is an attempt to combine a dietary ideology with some fuzzy Eastern philosophical principles.

    I do not recall Jason Fung telling me he ever used this "diet". Of course, it works as it decreases tremendously the carb load. But personnally, I feel that the price to pay (deficiencies in iron, in B12 and vitamin D are not worth it. Nor is being hungry all the time.

  22. NS

    First point: I have never mentioned this paper on any diet blog before. Perhaps Paul is confusing me with another poster.

    Second point: I am not privy to personal discussions with Dr. Fung so I can't speculate as to what he tells people in conversations or thinks privately. I can only judge according to what is publicly available. From his online presentations, it is clear that he does not support LCHF ~as an exclusive tool~ to remedy obesity. Fiber, along with other elements such as IF, play a critical role in his model on how to reverse, insulin resistance, T2D, and obesity, as can be seen here:

    He speculates and emphasizes that it is the fiber that goes a long way in explaining the Japanese/Asian paradox (despite the rice). Incidentally, I find telling the new fondness for "resistant starch" among LCHFers. The Ma-Pi macrobiotic is extremely close to what poor Asians would have eaten historically and what many still eat today. In many parts of China, some people live almost exclusively on noodles,yet no diabetes. When they add in signifacant amounts of meat and fat, the story changes. But I agree with you that iron, b12 - and zinc - deficiencies on such a regimen is problematic. My solution is to add a little fish and meat rather than use "butter, bacon, and brie" as my foundation foods. In any case, while a traditional macrobiotic diet does decrease the modern processed "carb-load," the diet is still north of 80% carbs. Moreover, if diabetes resolves itself on this regimen - AND - they are eating carbs while doing so (in the form of brown rice, tubers, legumes, fruit, and vegetables), don't you think that's a rather compelling reason to give pause to the adamant argument that "carbs cause diabetes"?

    Dr. Fung emphasizes the huge insulin spikes from animal protein in his talks. I think this is an under-recognized issue in LCHF/LC circles. In Asia, (unlike in the west) the norm is for people to regard animal proteins and fat as fattening, not (unprocessed) carbs. I think this has merit and truth given their contexts. We cannot separate the truths we come to from our contexts so we always have to be mindful of how they may not allow us to see things differently that are also true as well. It seems carbs on a whole foods diet are not a problem if one's protein and fat are moderate enough.

    I also don't understand your "hunger" argument. On a macrobiotic diet, one can eat virtually unlimited whole fruits, vegetables, and significant amounts of grains, legmes, tubers, etc... It seems pretty satiating... I would think more so than one based on butter and other fats.

    Lastly, there are no - not that I'm familiar with - societies that we know of that ate LCHF or LC long term besides the Inuit or Masai. Does anyone have any literature that points to those tribes' longevity or state of health in their later years? Can it compare those of the Blue Zones?

    FWIW: I completely reversed my own T2D on a high raw regimen which included plenty of apples and grapefruit. I maintain an A1C in the high 4s/low 5s, even with the occasional cheat meal and no meds or special supplements, besides a multivitamin/mineral.

    Replies: #23, #24, #25, #30
  23. JD

    I also don't understand your "hunger" argument. On a macrobiotic diet, one can eat virtually unlimited whole fruits, vegetables, and significant amounts of grains, legmes, tubers, etc... It seems pretty satiating... I would think more so than one based on butter and other fats.

    I spent a week as a vegan. I didn't calorie restrict myself at all. I ended up what seemed like buckets full of food, but was hungry all the time. I spent most of my day eating, shopping for food, preparing food, and thinking about food. It's fair to say I was obsessed with food. Contrast that to when I eat LCHF. If I miss a meal it's no big deal. If I get too busy I can even go a whole day without eating anything, I just eat more whenever I do eat (letting my hunger be my guide). From being obsessed with food to not caring is extremely liberating, not to mention improve health markers, skin, ect. This is not an uncommon experience. It's great if the macrobiotic diet works for you or anyone else, but the LCHF diet works for a boatload of people too.

  24. Paul the rat
    I did not say that you posted this link before here or somewhere else in the Universe, I said that we discussed this paper already at dietdoctor (posted by some other vego-vegetarian).
  25. erdoke
    I believe that the others referred to an extensive discussion of the study at this site. Nobody mentioned that you were involved.

    "diabetes resolves itself on this regimen"
    "The Ma-Pi diet 2 significantly reduced glycemia, serum lipids, uremia and cardiovascular risk in adults with T2DM. These results suggest that the Ma-Pi 2 diet could be a valid alternative treatment for patients with T2DM and point to the need for further clinical studies."

    There seems to be a big gap between your conclusion and the conclusion of the (21-day) study...

  26. NS

    The macrobiotic regimen mentioned above is not a vegan diet. Please see the reference link.

  27. NS
    As is seen here -

    - after three months, results included a drop in HbA1C from 8.35 to 5.67 - on a high carb regimen - in addition to better cholesterol, triglyceride, weight, and BMI numbers.

    That's pretty significant.

    See this as well:

    Reply: #28
  28. erdoke
    Please forgive me if I am skeptic about any 'effect of diet on health' type studies lasting for just 21 days. Sure, most of the 3 months results shown at your link still represent a nice improvement, but isn't it strange that blood pressure, triglycerides, LDL cholesterol and the ratio of these latter two to HDL all increased from 21 days to 3 months? It would be interesting to see 6 and 12 months follow up data to see longer term trends.

    Just a kind reminder: LCHF is not a high protein diet. I found it useful to induce my body with a combination of 30-35 % protein + 55-65 % fat, but then gradually went down to as low as 15-18 % protein. At the same time the majority of the carbs comes from vegetables and to a lesser extent from nuts and fruits, so I do agree that fibers are important. Even the hypothesis about the negative effect of low level acidosis is acceptable. On the other hand why not leave out barley and add eggs instead to a healthy diet?

  29. Galina L.
    Charles Grashow brought links to the study in comments on the blog-post "Poor, misunderstood calorie" run by Bill Ladacos where he discussed "A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes (Saslow et al., 2014)".

    Here are the links provided by Charles

    It was not a vegan, but a vegetarian diet. My point was that they had to have special cooks trained in a macrobiotic diet preparations to train participants in order to decrease glycemic response of consumed foods. Who could argue that the quality of food could be influenced by cooking? The research was done mostly in the third-world countries, like Cuba (Italy was the exception). They didn't developed D2 because they were eating too much of Western Foods. The population in Cuba experiences food shortages now, not overabundance of industrially made foods and drinks. Macrobiotic cooks taught 21 Cuban diabetics to make what was available in their country more healthy.I think it was very useful for the people who could not get any amount of eggs, butter and vegetables they wanted to buy. Does it mean that it was a better way to eat than a low-carbohydrates diet? Of course,LCarbing is not the only way to stabilize blood sugar for diabetics. The Newcastle diet is promoted as the possible cure "Newcastle Study Claims Possible Cure" The catch - it is only 600 - 800 calories a day consumed in the form of meal-replacing shakes + 200 calories in the form of not starchy veggies.
    I see the important advantage of LCarbing .in the high satiety and high hedonistic quality of foods, plus, no special cook are need to decrease the glycemic index of foods. The food enjoyment is a very important feature for a diet which is supposed to last you for years. Meat consumption rises insulin, but not blood sugar for the reasons discussed to death previously basically everywhere.


  30. murray
    "Dr. Fung emphasizes the huge insulin spikes from animal protein in his talks. I think this is an under-recognized issue in LCHF/LC circles."

    "Huge" insulin spikes? The insulin index charts I have seen do not show huge spikes. High glycemic carbs or large quantities of lower glycemic carbs cause much larger insulin spikes. That said, it has been repeatedly pointed on this blog that eating a lot of protein elevates insulin.

    "In Asia, (unlike in the west) the norm is for people to regard animal proteins and fat as fattening, not (unprocessed) carbs. I think this has merit and truth given their contexts. We cannot separate the truths we come to from our contexts so we always have to be mindful of how they may not allow us to see things differently that are also true as well."

    Could you translate that?

    I take your general point is that a manageable metabolic homeostasis can be achieved by eating foods that in a particular gut biome context have a manageable blood sugar challenge, by virtue of being difficult to digest quickly. In effect, this is a trickle approach to sugar, so that the glycogen buffer can manage sugar influx to allow more or less continual trickle of sugar burning without resorting to much fat-burning. So eating much protein or fat would be fattening because the metabolism is too busy burning sugar all the time.

    So yes, I can see how in principle it could work and apparently does. But then you elevate an existence argument into conclusions that make no sense. Plainly excess carbs are required to cause type II diabetes, but what you have described is a hack to keep a high-carb diet from being a metabolic challenge, through trickle absorption and protein-fat shunning, but it does not show that anything other than a high-carb diet causes type-II diabetes.

    Also, how does your existence argument (that a benign high-carb diet is possible) in any way undermine LCHF? There are lots of way to hack the body. Peter at Hyperlipid had an excellent post on how to hack metabolic pathways to lose weight eating loads of mashed potatoes.

    Personally, I much prefer eating fat to starches or fruits and enjoy the benefits of ketone metabolism. Chacun à son goût. Mine has brie, hollandaise and duck confit over grapefruit and apples.

  31. murray
    As an addendum, based on recent commentary on resistant starch (and possessing the general open-minded predisposition of being a member of the LCHF community), I have been experimenting with potato starch over a few weeks. I haven't noticed any difference in anything. No improvement, no ill effect. Ketone and blood sugar ranges remain comparable, with exercise duration and intensity the day before and quantity of food the previous day (especially later in the day) seeming to affect morning measurements of blood sugar and ketones more than anything else. My carbs are consistently low, coming from starchless vegetables, modest portions of berries and nuts.
  32. NS
    I'm not sure what you're looking at. The numbers I see show improvements in all bloodwork, including BP, TGs, LDL/HDL. These results were reported for those who stayed on the regimen for 6 months. See above links. As far as health is concerned, I don't think you can argue against the fact that the thinnest, longest lived people on the planet eat high carb diets.

    Thank you for the links and the always essential comments. The issue of protein and insulin... sure, meat/fish do not raise glucose levels much but perhaps there is another mechanism where the insulin rises that do occur are detrimental in other ways. Dr. Fung highlights studies where patients who kept tight control of their glucose with insulin ended up having ~far worse~ actual outcomes than those who used less insulin and consequently had less favorable glucose levels, i.e insulin increases were highly associated with earlier deaths. I also wonder whether this insulin makes the difference between the very thin Asians I know who don't eat much meat or fish or what we might consider "suffcient" animal protein and the relativerly chubbier ones who do.

    Well then, that's some hack I guess! Wouldn't you say? It has ostensibly allowed the Asians to be among the fittest, healthiest, and longest lived people on the planet. If you have any links regarding the outcomes/longevity of animal protein/fat consuming tribes/areas, I'd love to see them. Hack or not, we are all looking for the best "hacks," the best methods. That's why we spend time on blogs searching. With respect to LCHF, for the more prudent-minded, it may be better if they so choose to proceed with caution and take advantage of other less potentially damaging insulin reducing methods such as those outlined by Dr. Fung. The LCHF regimen as a long term movement trend is largely a new phenomenon. Just because people are not having health issues yet, doesn't mean that that will continue to be the case in the future. Absence of evidence is not at all equal to evidence of absence.

    Replies: #33, #34
  33. murray
    "less potentially damaging insulin reducing methods " - really?

    I would have been content, like Touchstone in As You Like It, to say "I cut it to please myself" and leave it at that. We both apparently agree processed sugar and starches are bad and health improves by eliminating them. But now you suggest (with no evidence) that LCHF is damaging. Also, you make assertions about LCHF in traditional cultures that have zero basis in fact. Some readers here might actually believe this. So let's look at some facts.

    A few years ago in Sweden, a complaint was brought to medical regulators by a disgruntled dietician concerning a physician who had treated her own insulin resistance successfully by going LCHF and was successfully treating patients with the diet. Being a serious charge, two years was spent reviewing over 16,000 scientific studies and the conclusion was that LCHF was safe and effective. Please identify what scientific evidence they overlooked.

    The great Swedish biologist Carl Linnaeus, came to much the same conclusion after studying the aboriginal Sami people in 1726. The aboriginal Swedish Sami population has been eating a low carb (est. 20% energy from carbs) for millenia, including reindeer milk. This is consistent with observations about the aboriginal Cree and Salish in Canada. The Salish learned to render the fat of candlefish (oolichan) to remove most of the polyunsaturated fat to make oolichan butter. This was used like Hollandaise sauce to enhance meals of fish, etc.. Oolichan butter alone accounted for 30% of calories. Oolichan butter was so prized it was traded inland some 300 km through mountainous terrain over what were known as oolichan trails. The first European explorers followed oolichan trails to find their way to the Pacific coast. Drs. Phinney and Wortman analyzed oolichan butter for fatty acid composition and, remarkably, found it was the closest match to stored human fat ever recorded by scientific analysis. It is unsurprising that the human body would be well adapted to processing the type of fat it uses when it uses energy from the fat stored in its own cells.

    Perhaps I hung around with too many anthropologists in graduate school (they were the most interesting I found), but through them I heard of countless cultures with LCHF regimes. Indeed, it seems almost all (if not all) hunter-gatherer (non-agrarian) cultures were 40% carbs or less. One friend was especially fascinated with the Kalahari bushmen, who derived a large portion of their calories from eating mungongo nuts. They are known as consummate pursuit hunters. Dr. Tim Noakes in his book Waterlogged, reviews the remarkable evolutionary adaptations in the physiology and metabolics of hominids-humans to become pursuit hunters. Humans have a large advantage hunting under the noon-day sun (along with a few mad dogs and Englishmen). We are upright, hairless, sweat, retain salt and so forth. A furry four-legged animal who can't sweat with its entire back exposed to noon-day sun will fade. I tested this on my dog one summer day (when he was being playfully unruly and would not allow me to leash him up at the park to go home). It works. Eventually he just laid down, eventually, breathing quickly with a massive tongue hanging out. I could easily have brained him with a rock (I resisted).

    Hominids lost the genes to produce fructase enzyme after migrating out of the jungle into the savannah and could no longer directly metabolize fructose for energy. The reason is obvious: fruit was not a part of the diet long enough for the gene to disappear. Lots of evidence hominids ate brains, based on stone tool markings on ruminant skulls in midden sites. A colleague was just in the Serengeti in April and reported that, indeed, when lions kill and eat ruminants they leave the skull intact. Ripe pickings for early stone-using hominids to get ample fat and, especially, DHA to fuel brain evolution. the evidence suggests a very LCHF diet for well over a million years. Wrangham (Catching Fire) marshalls evidence of cooking being used beginning some time between 100,000 and 1 million years ago. This allowed detoxificaton of plants and made fibrous foods more digestible, expanding diet to include, for example, tubers.

    Dr. Weston Price's valuable survey work of culture and diet before Western starch and sugar is very instructive. He did careful analysis of the dental health, jaw and air passage development and general health of cultures from six continents. Significantly, the two healthiest peoples he studied (bearing in mind he did not study every culture in the world), were the Masai (who ate largely milk, meat and blood) and remote Swiss villagers, who ate mostly cheese. A typical meal of the Swiss, for instance, was a slice of bread made from grain that had been ground the day before, and a piece of cheese the same volume. Volume, not weight. So figure it out--that is quite LCHF. And plenty of dairy and saturated fat. they did eat meat (nose to tail) but not a large amount compared to other groups.

    The dairy is significant because analysis of the human genome has shown the most strongly selected uniquely human gene has been the gene on chromosome 2 for adult lactose tolerance. It emerged independently in African and in Eurasian groups. Interestingly, a huge advantage the Mongols had in warfare was LCHF and dairy. They conquered territory vaster than the Roman empire, covering the entire steppes across Asia. Their armies took with them cattle that grazed on the grassland and provided dairy (yoghurt) and meat. The cavalry men rode with a fatty jerky under the saddle, which tenderized the meat. (Ingenious.) More interesting, the LCHF allowed them to master siegecraft and gave them an endurance advantage in battle, defeating the grain-eating Jurchen Chinese who could not last without continual meals, developing "low-carb flu" and eventually being defeated.

    So the suggestion that LCHF is new and potentially damaging is not grounded in fact, scientific, anthropological or evolutionary. Indeed, one has to be careful comparing a high-carb culture. Other apes and most humans have only two alleles of the gene to produce amylase to digest starches. Many people from long-standing grain and rice cultures, by contrast, have up to 30 alleles. Recent science has shown they have much higher metabolic tolerance for starch. So a hack that works in one culture might not work in another. An Asian with a suite of genes to tolerate starch but no gene for adult lactose tolerance, might do poorly in a remote Swiss valley eating fermented cheese made from the raw milk of cows on alpine grass---and vice versa. One thing that becomes apparent reading Dr. Price's book is that every culture developed rituals that embedded dietary practices to hack their metabolism and deal with health issues that arose.


  34. Paul the rat
    "...The LCHF regimen as a long term movement trend is largely a new phenomenon. …"

    Really? - in addition to Murray list do some reading on Aborigines of Australia

  35. Galina L.
    Thank you, NS for kind words.
    Unfortunately, people can measure only blood sugar easily nowadays, but not their insulin levels which could be different for different individuals with the same BS, unless they are diabetics type 1 who know how much they injected. I measured my fasting insulin once out of curiosity - it was in the low range of normal.
    When it comes to the study, I personally doubt that the diet which consisted predominantly from carbohydrates ( "Total volume of the Ma-Pi 2 diet consisted of 40–50% whole grains (rice, millet, and barley), 40–50% vegetables (carrots, kale, cabbage, broccoli, chicory, onions, red and white radish, and parsley), and 8–10% legumes (adzuki beans, chickpeas, lentils, and black beans)") could require less insulin production from a human body on a daily basis than a diet with 30 - 50 gram of carbs and 60 - 70 grams of protein. Also, many LCarbers have not more than 2 meals a day which suppose to decrease the area under the curve of insulin production and provides other benefits of IF. There are the people who live mostly on stakes, consume protein shakes, but I do believe they are a tiny minority.
  36. Kris
    I was looking for an opinion from you all. Having been type2 diabetic for 16 years now, currently doing LCHF for six months now with great results- six months ago had to inject 65 units of insulin twice a day, now only injecting 11 units twice a day, blood sugar levels daily between 85 and 95 before and after meals, and in the morning. Should I ask my MD to let me try Metformin? Or just keep on using insulin? - while my body continued to heal itself? Appreciate any comments- thanks!
  37. Galina L.
    I said it before, may be more than one time, so, excuse me for being repetitive. We could do our best to imitate any ancient way to eat and get more healthy than the people who eat the Standard American Diet. I am sure cooking all my food all my life served me well, even though I found out later that a LC version of it was better.
    We have to understand that de-industrialization of the modern food production is a very unlikely event , we face now the problem how not to be too sick and fat because there is too much food around us. My guess is that the industrial LC food consumed to satiety is the better choice than the Standard Western Diet for many people who are too busy, don't know how to cook, got used to artificial flavors too much since being babies. I wish they would test their Macrobiotic diet against LCarbing, it was not the case.
  38. Dr. Richard Maurer
    Thanks very much for your posts and information. In the U.S., I am disappointed by the regular visits to doctors. Once someone has the Dx of T2DM, the knee jerk reaction is simvastatin 10-20 mg, lisinopril 5mg (regardless of HBP), aspirin and then a program of W&W for Metformin time.
    I use different degrees of LCHF diet for all those who fall into the Insulin resistance categories (I spelled this out in the book, The Blood Code.

    People need to make sure they get copies of their own blood tests and track the improvement and progress - their doctor needs to be in the passenger seat, helping navigate the road ahead. Recovery from T2DM (and hypothyroid too) requires a very self-empowered patient. The doctor's visit should help empower and motivate - find the right doc!

    Thanks again Diet Doctor. Yours, Dr. Richard Maurer,

  39. Lynda B
    Not sure how to comment on a specific posting but wanted to do so re Lynne's on 22/5. Have been T2 diabetic for almost 20 years and have tried many approaches including Macrobiotics, alternate day fasting (both for about 7 months and I was 100% fanatical with it), low GI and always had pretty good control. But had big rebound to Macrobiotics and ADF and put on lots of weight again.
    April last year Hba1 was 6.6, TC 6.9 (266.8), HDL 1.9 (73.47), LDL 4.6, Triglycerides .81. That was just after I started to give up ADF. I then gained almost 42lbs.

    Just before Xmas started using Myfitnesspal for calories counting (always healthy, non processed foods etc), then in Feb started 'eating to my meter' and testing BS after meals which I had never done (no doctor ever suggested it!), and then at end Feb discovered LCHF and moved to that. Not really difficult in that most of the time didn't eat high carb food anyway - though now don't at all - and love being able to eat butter, bacon fat etc! I find it suits me and my fasting levels started being regularly in the low 5s and 4s.
    When I started LCHF I had already lost 22lbs and have since lost another 22. Slowed down but still coming off. I also do quite a mix of exercise. (Have been in ketosis whole time).

    HOWEVER!! Had my blood test last week.HbA1 5.8. Good, HDL 2. Good. But like Lynne my TC had shot up to highest ever in the 20 years it's been tested. 8.6. And LDL up to 6. Even that wouldn't have felt too bad but Triglycerides also up to 1.22 which surprised me.

    So of course the surgery called me in - not to congratulate me of course but to talk about my cholesterol which means to give me the same scary You have to take statins lecture they have been giving me for years. So I refused to go in. And I've read all that stuff about small LDL particles etc but am finding it hard not to worry at such a big jump. I have a small cholesterol 'bump' on right eyebrow which I believe may indicate familial high cholesterol and I wonder if that makes any difference to how concerned I should be. Should I cut back on saturated fats. Give up my once a day 'fat coffee' etc.

    But am also wondering about Lynne's last two blood test as she doesn't mention the results. Sorry this got so long. Sometimes it does feel rather scary doing all his on my own rather than having a doctor to work with. Maybe that's easier in the US where you pay them and if you don't like how they are you to go elsewhere? But national health doctors in the UK not so open to this.
    Thank you anyone who has hung in this far!

  40. Terry
    I'd like to know if there are any guidelines around for Doctors and Nurses to know when to reduce or completely eliminate Metformin as a LCHF dieter progresses with success in their diet.

    Is there a guideline? What clear and precise markers should they be looking for to help make these types of decisions?

    I believe all doctors and nurses have the best intentions, but as LCHF takes a foot hold, such matters become more prominent and therefore guidelines need to be put in place.

    Does such a resource even exist?

    Reply: #41
  41. Zepp
    Im no doctor nor an expert.. but I belive that it is the glucose levels that predict if one can try to lower Metformin.

    Fasting levels, postprandial levels but mostly A1c!

    Reply: #42
  42. Terry
    yes, that makes perfect sense!

    Hence the necessity for regular checkups for anybody on a LCHF diet and ideally a doctor supportive of it.

    You say your 'no doctor nor an expert'… but your depth of knowledge and insight makes me wonder if you ought to be Zepp!

    Thanks again.

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