How to Diagnose, Prevent and Treat Insulin Resistance [Infographic]

What You Need to Know about Sugar and Insulin Resistance

In today’s post our fructose journey comes to a sweet conclusion, with answers to the questions that really matter:

Earlier in this series we discovered that fructose is not scarier than glucose. In fact, consuming too much glucose is even riskier than consuming too much fructose because glucose is a more powerful trigger forinsulin resistance.” It is excess glucose that raises blood sugar and insulin levels, turns off fat burning, shifts fat and cholesterol production into overdrive, feeds cancer cells, and sets the stage for inflammation throughout the body.1)Park MH et al 2014 Arch Pharm Res; 37:1507-1514 People with insulin resistance are at high risk for developing type 2 diabetes in the future, so insulin resistance is often referred to as “pre-diabetes.”

So, should you focus on reducing the amount of glucose-y food you eat and lean towards fructose-y foods instead?

Good luck with that…people talk about fructose as though it’s a separate sugar from glucose, but practically speaking, it’s not. In real foods, fructose never exists alone—wherever fructose is, glucose is right there beside it, so it’s not easy to separate them in your diet. Even the vast majority of manufactured foods and beverages contain a mixture of fructose and glucose, as you’ll see in the infographic later in this post.

Luckily, it doesn’t matter. All sugars and starches ultimately break down into glucose and/or fructose in your body, and your body turns a lot of the fructose you eat into glucose anyway (see article one: Has Fructose Been Framed?). This means that overeating ANY kind of sugar jeopardizes your good health. Too much sugar of any kind can cause insulin resistance, sending you on a path to chronic diseases, including: obesity, cancer, heart disease, erectile dysfunction2)Yao F et al 2013 Clin Res Cardiol 102(9): 645-651fatty liver disease, polycystic ovarian syndrome (PCOS), type 2 diabetes, gout, and Alzheimer’s Disease.3)Willette AA et al JAMA Neurology published online July 27, 2015

Who wants any of those? Nobody.

It may seem sweet and innocent, but sugar is actually your worst nightmare.

That is why, no matter what type of diet you eat, how healthy you are right now, or how much you weigh, it is extremely important to take control of your sugar intake! I’m sorry to tell you that counting calories, exercising, and eating more vegetables will NOT save you from the insulin resistance, inflammation, and chronic disease caused by excess sugar.

How much sugar is too much?

It depends on who you are, and what kind of sugar we’re talking about.

Eating sugar is a game of Russian roulette—risk varies from person to person. There’s no way to know for sure what the safe threshold is or which diseases you will get if you overdo it. However, we do know that some people can get away with more sugar than others.

There are two types of people in the world: INSULIN SENSITIVE and INSULIN RESISTANT. 

There are two types of carbohydrates in the world: NATURALLY-OCCURRING SUGARS AND STARCHES and REFINED CARBOHYDRATES.

Let’s break ’em down…

Insulin sensitive people

These lucky dogs have what is commonly referred to as “good metabolism.” Most can usually get away with eating to their satisfaction without gaining weight or losing control over appetite. Generally speaking, if you are physically and mentally healthy, you feel good, and your body weight is naturally normal and stable, you probably fall into this category. If so, you can probably eat naturally-occurring carbohydrates such as fruits and starchy vegetables relatively safely, just like our healthy ancestors did, without worrying about how many carbohydrate grams you eat per day. However, you could still easily become insulin resistant if you eat refined carbohydrates, especially as you get older. Carbohydrate metabolism tends to worsen with age. To protect yourself from insulin-resistant conditions down the road, stick to whole foods and hopefully you won’t lose your ability to process carbohydrates later on. I wish I’d known this when I was a teenager!

Insulin resistant people

We are the unlucky, growing majority—most of us gain weight by simply thinking about a muffin, and if we actually give in to our cravings and consume the afore-mentioned muffin, we then cannot stop thinking about…another muffin. Mmmm…muffin…muffin…muffin…If you have insulin resistance, then your carbohydrate metabolism is badly damaged. I’ll show you lots of ways to figure out whether you have insulin resistance shortly. For those of us who are insulin-resistant, the sad truth is that we need to limit ALL types of carbohydrate, including fruits, starchy vegetables, grains and beans, not just added sugar and refined carbohydrates. The happy truth is that since carbohydrates lie at the root of most of our problems, we have the power to change the course of our future simply by changing our diet!

Naturally-occurring sugars and starches

Fruits: All fruits contain sugar (a mixture of fructose and glucose), so they can raise blood sugar and contribute to problems in insulin-resistant people. However, fruits also contain water and fiber, making them more filling than other sweet treats. They also contain fructose and sugar alcohols, which can result in a laxative effect or other uncomfortable symptoms if you overeat them. These ingredients are nature’s built-in stop signs. It’s a LOT harder to overdose on sugar eating whole fruit than it is to overdose on sugar by eating candy, cookies, cake, or by guzzling fruit juice or soda. The sweeter a fruit is, the more dramatically it can raise your blood sugar. Examples of low-sugar fruits are strawberries, blackberries, raspberries, apricots, and papayas. Examples of high-sugar fruits are grapes, pineapples, watermelons, mangoes, and figs.

Vegetables: Most above-ground vegetables that don’t taste sweet (such as lettuce, broccoli, and spinach) are very low in sugar and are safe for everyone’s metabolism. However, any vegetable that tastes sweet contains some sugar (think beets, carrots, acorn/butternut squash),4)technically squashes are fruits because they contain seeds, but most people think of them as vegetables, and most root vegetables (potatoes, yams, turnips, etc) are full of starch, which breaks down quickly into pure glucose and can spike blood sugar. Insulin-resistant people should minimize sweet and starchy vegetables.

Grains and Legumes: Grains (wheat, corn, rice, oats, etc) and legumes (beans, peas, soy, lentils, etc) are very high in starch, most of which breaks down into glucose in our bodies. If you eat these foods whole, their outer bran coating slows down their digestion, so they raise blood sugar more slowly than if you eat them in their more refined forms (ground up into flours or powders). If you have insulin resistance, you should stay away from all legumes and grains, even whole grains. Luckily, grains and legumes aren’t good for people anyway, so it’s wise to avoid them regardless of your insulin sensitivity status.

Refined Carbohydrates

These include all processed and pure sugars, whether they come from a natural source or not: white sugar, high-fructose corn syrup, glucose syrup, agave syrup, molasses, honey, maple syrup, brown rice syrup, fruit juice concentrates, etc.

Contrary to popular belief:

  • Honey is not healthier than other forms of sugar. In fact, it contains more grams of sugar per teaspoon than any other sweetener (see infographic below).
  • “High-fructose” corn syrup is not worse than other forms of sugar. White sugar contains 50% fructose and high-fructose corn syrup contains 55% fructose. Numerous studies have confirmed that there is no difference between white sugar (sucrose) and HFCS -55 when it comes to your health.5)Moeller SM et al, Council on Science and Public Health, American Medical Association 2009. The effects of high fructose syrup. J Am Coll Nutr 28(6):619-26 6) http://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm324856.htm
  • Agave syrup is not a natural sweetener. It is manufactured by adding enzymes to inulin, the indigestible starch found in agave roots. Agave syrups contain in the neighborhood of 70% to 90% fructose, making agave syrup the mother of all high-fructose syrups. 7)http://www.international-organics.com/info-files/Intl_Organics_Organic_Agave_Info.pdf

Flours and purified/processed starches such as corn starch are also considered refined carbohydrates because they don’t exist in nature and can cause sharp blood sugar spikes. Because flours and refined starches break down rapidly into glucose, most cereals and baked goods are high in sugar, even if they have no sugar added or don’t taste sweet. Examples include bread, pasta, crackers, white rice, and non-sugary cereals like Special K®, Corn Flakes®, and Rice Krispies®.

How much refined carbohydrate can you eat? 

Everyone should avoid refined carbohydrates. They are bad for all of us, whether we are insulin-resistant or not. The less you eat of these the better.

The World Health Organization (WHO) officially recommends in its new 2015 guideline8)Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015 http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf?ua=1 that people of all ages should limit sugar to less than 5% of total daily calories. So, if you eat 2,000 calories per day, the WHO says that no more than 100 calories should come from added sugars, including “sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.” That amounts to 26 grams of sugar per day, which is just over 2 tablespoons of sugar per day, maximum.

The WHO guidelines were created with healthy people in mind, not people with insulin resistance.

So… How do you know if you are insulin resistant?

Are you on the road to diabetes? For starters, you can take my quick quiz How Carbohydrate Sensitive Are You? to see if you have common signs and symptoms of insulin resistance.

If you already have type 2 diabetes, you definitely already have insulin resistance. Type 2 diabetes is the body’s way of saying you can’t process carbohydrate anymore. 

If you have any of the following health problems, you are likely to have insulin resistance:

  • Central obesity (too much belly fat, shaped like an apple instead of a pear)*
  • Fatty Liver Disease
  • Gout
  • High blood pressure
  • Heart Disease
  • Polycystic Ovarian Syndrome (PCOS)
  • Erectile Dysfunction
  • Acne (to learn how diet causes acne, read my post The Complexion Connection)
  • Alzheimer’s Disease (read my article on Psychology Today about how insulin resistance causes Alzheimer’s: “Preventing Alzheimer’s Disease Is Easier Than You Think“)

*While being overweight or having an “apple shape” increase the chances that you have insulin resistance, there are some normal weight “pears” (and even a few underweight folks) out there who have insulin resistance, so don’t go by weight and shape alone.

Medical Tests for Insulin Resistance

There is no simple direct test for insulin resistance on the market, so most health care providers use a combination of tests along with other information about you to determine how insulin resistant you are. Some of the most useful tests are listed below:

  • Fasting insulin
  • Fasting blood glucose
  • Fasting triglycerides (fat in the blood)
  • HDL (so-called “good cholesterol”)
  • HsCRP aka highly-sensitive C-reactive protein (a marker of inflammation)
  • Uric Acid (for more about insulin resistance and uric acid levels, read Is Fructose Bad for You?).

I’ve put together a downloadable PDF of these insulin resistance tests with their target ranges9)which vary among clinicians, scientists, and laboratories so you can see how your numbers compare to healthy values. You may want to take the PDF to your next medical appointment and discuss it with your health care provider. Also included is a new quick and dirty formula you can use to estimate your own insulin resistance by plugging in your fasting blood glucose and your triglyceride results.

What to do if you have Insulin Resistance

If your current numbers don’t look good, or if you already have an insulin-resistant condition such as diabetes or fatty liver, it is extremely important to take action as soon as possible, or your health will continue to decline. But take heart: your fate is NOT sealed! You have SO much more control over your health than you may realize. Want to reverse insulin resistance and all the diseases that come with it? Resist those carbs! Here’s a wonderful TED talk by obesity specialist Sarah Hallberg M.D. about how to treat insulin resistance and Type 2 diabetes with low-carbohydrate diets.

While the cutoff values vary from person to person, most enlightened experts recommend that people with insulin resistance lower their total NET carbohydrate intake to 60 grams per day or less in order to improve metabolism [net carbs = total grams of carbohydrate minus total grams of fiber]. Everyone has a different threshold (mine happens to be about 30 grams per day), so you’ll have to see for yourself. In most cases, carbohydrate cravings will go away within a number of days once you get your carbohydrate intake down low enough. It’s important to avoid refined and high glycemic index carbohydrates, and not to eat all of your daily carbohydrate in one sitting, so aim for no more than 15-20 grams of net carbohydrate from whole foods per meal. It’s perfectly safe to eat no carbohydrate at all, so you don’t have to worry about going too low, only about going too high for your particular metabolism. You’ll know if you’re over your personal limit if your lab tests or health problems are not improving (or are getting worse), you have carbohydrate cravings, or you are gaining weight. It only takes a few weeks to see improvements in appetite, weight, and even most blood tests!

How to Find Your Sweet Spot

How to begin depends on your personality. If you’re an all-or-nothing person who prefers cold-turkey approaches, start by removing almost all carbohydrates for a couple of weeks by eating only meat/seafood/poultry/eggs, healthy fats (olive/palm fruit/avocado/coconut/saturated animal fats), and non-starchy, non-sweet vegetables. [In fact, if you want to start with zero carbs, it’s even simpler to remove all plant foods and just eat meat, poultry, and/or seafood as your first step if you’d like. Meat-based diets are surprisingly safe and healthy.] Then, if you wish, you can gradually add back healthy whole food sources of carbohydrates until you find your personal limit. If you’re a one-step-at-a-time person, start with your usual diet and gradually remove carbohydrate until you find your personal limit. If you go this route, remove the refined and high glycemic index carbs first, as these are the most powerful triggers for insulin resistance. For detailed step-by-step instructions on how to gradually reduce your carbohydrate intake and find your personal “sweet spot”, please see my post Carbohydrate Sensitivity Diet Options.

One helpful way to track your progress is to invest in a blood glucose monitor so you can check your own blood sugar at home. The most important time of day to check is first thing in the morning, before breakfast (“fasting”). Your goal should be to get your fasting blood sugar down into the 80s. There are many glucometers on the market, and they vary widely in price and accuracy. I own two myself that I can personally vouch for, but there are less expensive systems available. The cost of the meters themselves is usually not the issue, it’s the blood test strips that run into money, so compare strip prices when shopping. The ones I own are the OneTouch UltraMini, which measures blood sugar only, and the Precision Xtra Blood Glucose and Ketone Monitor, which can measure blood sugar and blood ketones (separate strips required). [Ketones and ketogenic diets are topics covered elsewhere on my site, but long-story short, because the body can turn excess protein into sugar, some people need to limit protein as well as carbohydrate in order to achieve their health goals.]

Many doctors still advise people with insulin resistance, even people with full-blown type 2 diabetes, to continue to eat large amounts of carbohydrate per day. Often these physicians will prescribe blood sugar lowering medicines or even insulin to control your blood sugar, instead of advising you to remove sugar from your diet. They may tell you that your problem is due to too much fat in your diet, or not enough exercise. This advice is outdated, illogical, and misguided. Where does high blood sugar come from in the first place? FOOD. If you are confused about whether to follow your doctor’s advice or the advice you’re reading here on this site or on the many other excellent sites that recommend a low-carbohydrate approach to diseases like diabetes, don’t take anyone else’s word for it—do your own experiments and see what works best for you. I am confident you will discover for yourself that removing sugar from your diet is a lot more effective in helping you reach your health goals than other approaches.

If lowering your carbohydrate alone is not enough to see results, there are additional tips in the infographic below.

Preventing and Fighting Insulin Resistance

Whether you have insulin resistance or not, if you care about your health, want to cut your medical bills, avoid or get off medications, stay out of the hospital, and greatly increase your chances of living a long, disease-free life, the single most important thing you can do for yourself is to eat as little sugar as you possibly can. If you need support and ideas about sticking to your health goals, including strategies I personally use to keep myself on track, please see my post 20 Tips for Staying Low-Carb Healthy During the Holidays (and all year long!)

The infographic below includes simple steps you can take to remove hidden sources of sugar in your diet before it does any more damage to your health, along with additional strategies to control your blood sugar and insulin levels. I hope you find it useful, and if you do, please pass it along to others. 

infographic with 10 tips to cut your sugar intake, boost your metabolism and improve insulin resistance

If you are unable to view this image, click here.

Share this infographic on your own site using this embed code:

Still hungry for more information about carbohydrates?

Learn how carbohydrates cause high cholesterol on the Cholesterol page.

Read about how carbohydrates impact your mental health in these posts: Bipolar Disorder and Low-Carbohydrate Diets and Sugar and ADHD.

In case you haven’t already, take the How Carbohydrate Sensitive Are You? quiz, and check out the Carbohydrate Sensitivity Diet Options page for a step-by step-approach to reducing the level of carbohydrates in your diet.

For wonderful information and inspiration, I highly recommend Dr. Andreas Eenfeldt’s website about LCHF (low-carb, high-fat) diets: www.dietdoctor.com

What’s Your Experience?

Do you have any tips or tricks to share with others here about how to cut down on sugar? What have you personally found useful in improving insulin resistance and the diseases associated with it? Any questions for me? I would love to hear from you in the comments section below

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References   [ + ]

  • Ella Daly

    Hi. I downloaded the pdf and see insulin resistance formula as fasting blood glucose (mg/dl) x fasting trigs (mg/dl) divided by 2. I got FBG 82.8mg/dl* Trig 150.62mg/dl being 12,471/2 being 6235. “Men with values over 8.82 and women with
    values over 8.73 are most likely to be insulin
    resistant …..” Have I missed something in the formula?

    Great info which I am hoping teenage carb addicted sons will at least read.

    • Dear Ella
      Thank you so much for noticing this important problem with the formula; I just checked and the log function is missing! I am having the formula on the PDF corrected right now, but here is the formula for you, and I’ve calculated your result:

      ln (or natural log of) [FBS X TG (both in mg/dl)/2]

      The “ln” or “natural log” is taken after you’ve plugged everything else in, so first multiply the triglycerides by the blood sugar, next divide by 2, then hit the “ln” button on your calculator to get the result. If you’re using an iphone, you have to turn the iphone sideways to see the ln button. Do not use the “log” button, because that will give you a completely different answer.

      Plugging in your numbers:

      82.8 X 150.62 = 12,471
      12,471 divided by 2 = 6,235
      ln (natural log) of 6,235 = 8.74

      Thanks again for letting me know and good luck with your young men. In my experience it is usually not challenging to get young people to understand and agree with the logic about healthy diets, but it is another thing entirely to convince them to change how they eat. Change is hard…and young people often feel invincible…

      • Paul

        Dr. Ede,
        Thanks for sharing this formula, I tried looking up the reference (#7 in the PDF) and couldn’t find it. I noticed that reference #2 had the same info as reference #7. Could you post the correct reference?
        Thanks.

  • Carole

    Do you recommend counting TOTAL or NET carbs?

    • Hi Carole
      Great question: I go by net carbs, which is total carbs minus fiber. Thanks for asking! I’ll edit the post to clarify.

  • Bonnie

    Hi! I do enjoy reading your research! I would like to mention that you noted choosing unsweetened tea or coffee… but these beverages have an effect on insulin levels also.
    I think the combination of having coffee and sugars/ carbs.. might be causing trouble for many people.

    Perhaps you can write about this connection?

    I know that (perhaps the caffeine) of coffee & tea.. causes a lot of trouble for people and I have to think that it has to do with insulin levels also. ( examples… Gut rot, faintness, appetite suppressant, anxiety, shakiness, headaches, diuretic etc.)

    I believe that the “caffeine – high carb” connection might have a lot to do with causing diabetic issues. ( I myself do not have diabetes)
    I know for sure that having brewed coffee on an empty stomache makes me very unwell & low blood sugar has been a big factor in my chronic migraine issue.
    Migraines need carbs to improve. A salad with protein would be totally indigestible during a migraine.

    I know that’s a wide variety of info!,, but I wanted to keep this short & hopefully something useful 🙂

    It is good of you to do all this Research! Cheers! 🙂 Bonnie D.
    PS.. I also loved your talk about the dangers of vegetables! Excellent! Thank you!

    • Hi Bonnie

      Yes, you are absolutely right about caffeine having an effect on carbohydrate metabolism! Caffeine raises stress hormone levels, which prolongs blood sugar elevations to a modest degree. Most people who follow a strict low-carbohydrate diet can get away with unsweetened caffeinated beverages, but In people who don’t notice enough improvement in their metabolism simply by eating a very low-carbohydrate diet, removing caffeine is one of the things they can try to see if they can get better results. Other potential culprits include dairy (often added to coffee/tea), sugar substitutes (sugar alcohols, Splenda, etc) and excessive protein intake. For people who need to remove caffeine in order to correct their metabolism, but miss the taste of coffee or tea, they could substitute herbal iced teas and decaffeinated coffees.

      In addition to caffeine, coffee contains all kinds of other ingredients that can be irritating to the body, the stomach in particular, but to test whether it is the caffeine or some other culprit within the coffee that is bothering you, you’d have to compare decaf to regular, which you may have already done. I know a lot of people with migraines find caffeine very helpful when they are in the midst of a painful headache. I used to have migraines and would drink coffee to help nip them in the bud. I haven’t had any migraines since changing to a ketogenic diet (low carbohydrate, moderate protein, high fat), but this is a challenging diet for most people to stick to.

      Other migraine triggers include nightshades http://www.diagnosisdiet.com/nightshades/ and biogenic amines http://www.diagnosisdiet.com/histamine-intolerance/ , which can be found in aged and fermented foods.

      I don’t know what kind of diet you currently follow, but if your migraines are related to low blood sugar, you might find my next post, coming in a week or two, helpful, as it will focus on hypoglycemia and stress hormones. Additional information about caffeine will be included! One of the best ways to treat hypoglycemia, surprisingly enough, is to eat a low-carbohydrate diet.

      Thanks for the great questions and for your interest in the information on the site!

      • Marcd

        Paul Jaminet author of “The Perfect Health Diet” encourages consumption of “healthy” starches such as potatoes. He says that when eaten along with fat and an acid, like vinegar, they don’t spike your blood sugar very much. Right or wrong?

        It also seems to be true that starchy tubers are “Paleo”, that is, we are very well adapted to eating them. It doesnt seem plausible that a hunter gatherer would ever walk past a supply of tubers.

        • Dear Marcd

          Great questions.

          1. Yes, I agree, the glycemic index of sweet and starchy foods varies depending on what they are eaten with (fats, fiber, protein, etc). So yes, you can lower the glycemic index of a starchy food by mixing it with other foods. That doesn’t necessarily make foods like white potatoes completely safe for you if you have insulin resistance, but it may make them safER? You’d have to check your own blood sugar responses to these kinds of foods, because each of us responds differently to foods depending on our metabolism. The glycemic index of foods actually varies from person to person. Please see my page about this for more info if interested: http://www.diagnosisdiet.com/diet/low-glycemic-index-diets/

          2. Yes, I agree. No doubt our prehistoric ancestors included whole food sources of carbohydrates such as fruits and starchy roots in their diets, depending on where they lived and time of year (hard to find many carbs in the winter in some areas of the world). However, there was virtually no access to refined carbohydrates back then, so I think it’s safe to imagine that they had healthy carbohydrate metabolism. If so, then they probably handled whole food carbohydrates relatively safely, as people today without insulin resistance should be able to, as well. However, if you have insulin resistance, it’s important in my view to limit even “safe” starches to no more than 60 grams per day (and perhaps fewer, depending on your metabolism).

  • Dear twitchyfirefly

    Thanks for your kind words about the site; I’m so glad you find it useful! 5 years on very low carb–congratulations! Isn’t it amazing how well it works to prevent common ailments like colds?

    Interesting! In the link you posted to Hyperlipid, the scientific logic behind physiological insulin resistance makes sense to me. I currently eat a ketogenic diet (about 4 months in this time around) and have been measuring my ketones religiously every morning, but haven’t been measuring my blood sugar. I will begin to track this and report back soon. However, last time around, my blood sugars were in a very healthy range, so I wonder if it varies from person to person, or as suggested in the Hyperlipid blog, it gradually rises over years? I suppose, as Peter states in his article, as long as everything else looks ok, maybe not to worry…

    As for dairy, yes, would be great if you could check it to make sure it’s not throwing you off too much, but if you’re feeling well on your current regimen, and you love dairy as part of it, maybe worth it in the grand scheme of things–one must choose one’s battles:)

  • John

    Dr. Ede…

    So if one dumps out all the carbs except those of whole fruits and lower starch veggies, in order to get adequate calories each day one has to dump quite a bit of overt fat onto whatever food they eat (assuming every meal doesn’t come with a super fatty cut of meat). Is this reasonable? I mean on one hand I feel like somehow some way there is always a cure, so if we have the capacity for mass IR then we also have the mass production of overt fats available to counteract and go on a high-fat diet once we screw ourselves up with carbs. However, can’t it be dangerous to be sucking down so much fat? Is there a point where we just overload our ability for bile production? I know the story of the Inuits and I’m somewhat familiar with the Ketogenic diet, but somehow it just seems to me that such an excessively fatty diet would have it’s own hazards.

    Also, it seems to me, via my own current experience after nearly destroying myself with heavy carbs and the demineralizers such as phytic acid, that IR and/or carb intolerance can be greatly aggravated and prolonged by lack of adequate mineral intake and/or absorption, perhaps most notably magnesium and zinc. Dangerous as it can become, my body screams for sugar when I’m not getting adequate magnesium, and without what seems to me as being zinc I have little blood-sugar regulation–like I have to eat HFLC or HCLF or I have major immediate issues–there’s no in between. And these issues of course then get better or worse depending upon mineral adequacy. Said another way, the blood-sugar related issues will NOT go away no matter what I do without adequate mineral support. Thoughts?

    Thank you for this series of articles.

    • Dear John,

      Happily, most people can easily handle a high-fat diet. Fat is the macronutrient that is gentlest on our metabolic machinery (mitochondria). Healthy fats are non-irritating and 100% absorbed from our gastrointestinal tract. Fat adds flavor and texture to food and is very satisfying. Fat is required for the absorption and storage of a variety of key vitamins and therefore needs to be eaten with every meal.

      You are correct that there are some people who can’t process too much fat–people who have had certain kinds of intestinal surgery, for example, especially those who have had their gallbladders removed. And some people are sensitive to certain types of fats (dairy fat comes to mind). But if you had to pick one macronutrient to “overeat”, this is by far the safest one. There is a wonderful new book by investigative journalist Nina Teicholz called The Big Fat Surprise: http://www.amazon.com/dp/1451624433/?tag=diagdiet-20, which tells the story of how fat has been unjustly accused of causing health problems. There is no scientific evidence that diets high in natural fats are harmful.

      I haven’t researched mineral metabolism myself yet, so I can’t say much that’s intelligent about that question, only to listen to your body and supplement with minerals if that’s what feels best to you. I do know that low-carbohydrate diets change the way water and minerals are handled by the body, and that people eating a ketogenic diet often find supplementing with magnesium helpful. As for zinc, meat is an excellent source of zinc, and as you point out, phytates from foods like grains and beans interfere with zinc absorption, so they are best avoided entirely.

      • John

        Dr. Ede,

        I just finished reading The Big Fat Surprise. Thank you so much for the recommendation! The book is outstanding. It’s such an awesome time we’re living in that ages of garbage “science” is being revealed and being put in the landfill where it should have been sent outright… Now please pass me that bacon-wrapped lard! 😉

  • John

    Dear Dr. Ede,
    Just signed up for your blog. Information is valuable and straight forward. I clearly am insulin resistant and have been limiting carbs for over a month. Having read your blog, there is clearly more that I can do. I am also going to follow up on the tests you recommend. The most important gift you have given me is dispelling my confusion about food and nutrition, that is not only incorrect but often contradictory. Thank you very much. John G

    • Dear John,

      Welcome! I’m so glad you are finding the information helpful. Clearing up confusion is my favorite thing to (try to) do here, so thank you for your kind words. Congratulations on lowering the carbs and keep up the good work!

  • Pauline

    Dear Dr Eade
    Many thanks for all your hard work; this information is vital for everyone, and for our animal friends also.

    I would just like to mention that blood glucose tests on home glucometers can give alarmingly high results if vitamin C is taken regularly as it seems these simple testing machines can’t tell the difference between glucose and the molecularly similar vitamin C.

    Having spent months fretting about my ‘high’ fasting BG on what I thought was a very low carb diet, I finally discovered the anomaly was in the machine. For example my fasting BG is usually below 90 but if I take vitamin C it can hover around 105. Apparently the more sophisticated equipment in testing laboratories is accurate, it’s just the home models that cannot differentiate and I have not yet found a home model that can.

    Best wishes, Pauline

    • Dear Pauline

      I wasn’t aware of this, so thank you so much for this important feedback! I did a literature search and found this article: http://care.diabetesjournals.org/content/37/5/e93.full.pdf+html which explains that some strips (such as those that come with OneTouch meters) contain the enzyme glucose oxidase (abbreviated GO or GOD), which can’t tell the difference between viamint C and glucose, and other strips (such as those that come with Bayer Contour meters) contain glucose dehydrogenase flavin adenine dinucleotide (GDH-FAD), which work well even if you take vitamin C. Fascinating.

      I also found an FDA warning about a completely different test strip chemical (GDH-PDQ) that can’t tell the difference between glucose and certain other sugars found in special medications: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PatientAlerts/ucm177189.htm

      Turns out there are 4 different kinds of test strips: GO/GOD, GDH-FAD, GDH-NAD, and GDH-PDQ.

      I also found a great list of glucose meters that tells you which chemical each meter uses: http://www.glucosesafety.com/us/pdf/countryspecific_glucose_list.pdf The list was last updated in 2013, so before you purchase a new meter, double check about which chemical the test strip uses with the manufacturer.

      Here’s a very detailed article about test strip interactions with substances other than glucose that can cause inaccurate blood sugar results: http://www.medscape.org/viewarticle/714742

      As far as I can tell, most test strip errors occur with unusual medications or medications that are only used in a hospital setting, but there are a few common exceptions: VITAMIN C, ACETAMINOPHEN (Tylenol) and URIC ACID (uric acid levels can be high in some people, especially people with gout). This means that, depending on which strips you use, your blood sugar readings could be inaccurate if you take Vitamin C supplements, Tylenol, or your blood level of uric acid fluctuates a lot.

      Wow. Who knew? Thanks again Pauline!

      • Pauline

        Thank you very much Dr Ede for all the additional info – now I can go hunting here in Australia for a meter that won’t give me nightmares!
        Best wishes, Pauline

      • Conservitus

        Dr. E and Pauline you are both amazing for raising and researching this issue. I too was drivin crazy while on a ketogenic diet trying to figure out why 8 am fasting sugars were all over the place. Some days 78 some day 105. Yet urinary ketones were always moderate to high in the morning. So naturally I blamed the protein.

        Well yours truly has always routinely taken 2-3 grams of Vitamin C every morning in my bullet proof coffee. Voila I did not take it for 3 days, after I read this post and my am fastings were 77,84,81. Same protein level (1gram/KG body weight), net carbs around 30 grams, rest fat calories.

        My meter is a OneTouch ultra too. So a humongous virtual hug and thanks to the both of you for guiding this ketogenic traveller back to the path of sanity.

        • Hooray for finding the solution! Very happy for you:)

  • Sylvain Martel

    Hi Dr. Eade,
    I am really impressed by the quality and the clarity of your blog posts. Congratulations!

    I have tried the insulin resistance formula to see if between my two last blood tests, after going Low Carb High Fat (LCHF) and Intermittent Fasting (IF), there is improvement in my insulin resistance. On may 25th, my BG was 385,2 and my TRI were 44,64. On july the 20th my BG was 90 and my TRI were 25,74.

    If i am correct this shows that my IR went from 9,06 to 7,05. As we can see, my numbers improved a lot and are now in the normal range. But I doubt that my IR really improved, because, if I eat carbs, my BS are still raising wich is a sign of IR.

    So my first question is, are my calculations correct and my second one if so, did my insulin resistance really improved?

    Thank you for you great work, and helping for a better understanding of what we are all in.

    Sylvain M
    Val-d’Or, Québec, Canada

    • Bonjour, Sylvain!

      Wow, congratulations on your amazing accomplishment–those are very impressive results! I hope that other readers will be inspired by seeing how much you can improve your blood tests in only two short months!

      Yes, by my calculations you went from an IR score of 9.05 to 7.05–wonderful!

      Your question about insulin resistance is excellent. When people with insulin resistance like you and me remove sugar from our diet and replace it with fat, our total health improves–susceptibility to inflammation, fat/cholesterol processing, appetite control, energy level, weight control, mood, etc. And yes, our insulin sensitivity also improves tremendously. But there is a big difference between insulin sensitivity and carbohydrate sensitivity. Unfortunately, you are correct that our carbohydrate sensitivity does not improve. Once carbohydrate metabolism is broken, it tends to stay broken. This is why changing how we eat needs to be thought of as a new way of life, rather than a short-term diet.

      So what does improved insulin sensitivity mean? It means that our cells can now respond to insulin properly. Too much sugar hijacks insulin’s attention, taking it away from other important jobs. Insulin is not just a blood sugar regulator. In fact, that’s the least important of its duties. Insulin is actually a powerful growth hormone; it’s main job is to tell cells what to do with the food they receive–should it be stored as fat? Burned for energy? Used to build new cells? Insulin is supposed to be listening to all kinds of other important, subtle signals from the body–listening to other hormones–figuring out what our cells need, not constantly receiving emergency signals to lower our blood sugar.

      When our insulin sensitivity is corrected by a low-carbohydrate diet, our bodies can function normally again. But sadly, we never get back our ability to tolerate sugar:(

      • Sylvain Martel

        Well, merci beaucoup Dr Ede!

        Your explanations are very sharp and easy to understand. Crystal clear, to me!

        Does your last phrase “But sadly, we never get back our ability to tolerate sugar” means that even a repetitive cycle of extended Intermittent Fasting (IF) periods combined with a Low Carb Healthy Fat (LCHF) diet, cannot bring back some of our sugar and or carb tolerance?

        I like to think that it is possible that some of our cells who have received too much stress from too much sugar can retrieve their functionality?

        Sylvain M

        • Dear Sylvain,

          I guess it depends on what we mean by sugar tolerance; I don’t believe that we can ever go back to getting away with eating carbohydrates on a regular basis without negative consequences, but perhaps some people can go back to being able to eat some carbohydrates of some types sometimes? I suppose there is always hope, but I’m really not sure. I belong to a network of clinicians who study and prescribe low-carbohydrate diets, so let me ask them and see what they have to say. If I find anything worth sharing, I will let you know. And thank you again for generously sharing your story.

          • Sylvain Martel

            Well thank you very much Dr. Ede!

            My personal research and readings, suggest me that a big fallacy we encounter in this diagnosis-cure of “sugar-carb-starch” intolerance is that we consider them and or glucose as our primary source of energy.

            What would happen if we would consider Fat+Proteins=Ketones F+P=K as the right equation? Thinking that way, would probably make it easier to consider “refined carbs” just as an alternative unhealthy source of energy rather than the main.

            Did we as human beings become “TOO” intelligent to put first things first and appreciate them from the “WRONG” side?

            As carbs is the only macronutrient that is not essential to our survival, maybe, we could rephrase the question that could be addressed to your network of clinicians?

            Is it possible to retrieve close to 100% of our tolerance to natural carbs and sugars?

            Thank you very much, Dr Ede and have a nice and wonderful time helping all of us heal in getting away from the root cause of many of the chronic disease we encounter all around the world.

          • Interesting idea that we are too intelligent for our own good–we are the only animals (I think…) that manipulate our natural food supply to create new, unnatural (albeit tasty) foods that our bodies can’t safely handle, and then use our big brains to justify eating them:)

            Yes, I agree. I consider meat (meaning poultry, seafood, red meat) to be the best food for humans, and agree with Dr. Ron Rosedale, who often says that our cells are healthiest if we burn fat instead of carbohydrates for energy. Therefore, the less carbohydrate we all eat, the better. I don’t believe it’s possible to retrieve 100% of our tolerance to natural sugars and starches. However, if we adhere to a pre-agricultural whole foods diet (animal foods, vegetables, fruits) from childhood forward, and protect our carbohydrate metabolism from damage, we seem to do fine eating carbohydrates from fruits and vegetables (rather than from sugar and flour); there are many examples of traditional peoples who lived this way who have shown us that this is true.

            For people interested in reading more about how modern diets containing sugar and flour predictably damage human health:

            Nutrition and Physical Degeneration by Weston Price: http://www.amazon.com/dp/0916764206/?tag=diagdiet-20

            Good Calories Bad Calories by Gary Taubes: http://www.amazon.com/dp/1400033462/?tag=diagdiet-20

            Food and Western Disease by Staffan Lindberg:
            http://www.amazon.com/dp/1405197714/?tag=diagdiet-20

      • DaWanda

        So true! This is a very educational and informative article. I have attended many diabetic seminars and your blog has helped me to understand more about carbs than any of them!

        • Hi DaWanda,

          I’m so glad you found this article helpful–thank you for letting me know!

  • Eugenia L. Zanone

    Hi, Dr. Ede,
    Just want to thank you for all the info & encouragement you give! A 25-year struggle with obesity and diabetes is being reversed by the ketogenic diet–50 pounds down in a year! Too much protein was the other key for me; always stalled on other diets. Why did it take so long to discover the truth? Thanks for putting this info out there!

    • Dear Eugenia

      Wow, 50 pounds, congratulations! Your story is sure to inspire other readers, so thanks for sharing it here. I completely agree that some of us need to limit protein as well as carbs to achieve our health goals; I know for myself that limiting carbs worked when I was younger, but not anymore–the KD is the only diet that works for me at this point in my life. Luckily, as I’m sure you know, it’s a very comfortable diet to stay on long-term once you get the hang of it. Keep up the good work, and thanks for writing!

  • laguna

    “beans and grains aren’t healthy anyway”–you claim?
    I labeled you a ‘quack’ as soon as i read that.

  • Emaho

    Wow, what a great site! Simple, clear explanations of so many illnesses and diet issues. All in one place. And as an added benefit, your commenters are excellent.

    Awhile ago, thanks to the Diet Doctor, I found the sites of Dr. Fung and nutritionist Amy Berger. I’m slowly and happily going through them. Now, I’ve added your site to my list. As the gray days of Oregon are now upon me, I’ve got plenty of reading to get me through.

    BTW, I’m an eleven year veteran of the LCHF diet. I’m a live today and not totally blind (yeah that complication makes me passionate), because I read Dr. Bernstein’s Diabetes Solution back in 2004. I’ve been T1D for 50 years and I’ve probably been pre-T2D for many years. I mean I cut my insulin dosages by half back in 2004. So all of those years of eating HCLF meals must of had an effect.

    Of course for my treatment routines, being T1D or both T1 & T2D does not really matter. But still I’m curious. Do you happen to know what a healthy range of insulin would be for various people?
    Thanks again!

    • Dear Emaho,

      Welcome! So glad you find the site helpful, and so glad you discovered LCHF 11 years ago. Eating low-carb absolutely reduces insulin requirements, and that has clearly been a very important protective factor for your health.

      As for your question about a healthy range of insulin, I’m assuming you are asking about a healthy range of insulin dosages for people with diabetes. If I’ve got that right, the best answer I can give you is: the lower the better. The less insulin you have to administer, the better off you’ll be when it comes to your overall health and protection from advancing insulin resistance (pre-T2D, as you correctly point out).

      Some people with type I DM who continue to struggle to some extent with blood sugar control and high insulin requirements are leaving LCHF behind and embarking on ketogenic diets (which limit protein intake as well as carbohydrate intake), because excess protein can turn into blood sugar and raise insulin requirements, although not nearly to the same degree that carbohydrate can. If you are curious to learn more, I would recommend a book called The Ketogenic Diet for Type I Diabetes written by a Ellen Davis, a nutritionist, and Keith Runyon MD, a physician with type I DM: http://www.ketogenic-diet-resource.com/treatment-for-diabetes.html

      Have a great day!

  • MICHAEL PANICCIA

    Hi Dr. Ede

    I am A newbie here and will briefly describe how I came to this point in my life

    I am hoping you can help me understand, I am very scared and worried

    3 months ago on a yearly blood test exam my fasting blood was 6.1 first time ever

    My doctor told me i am pre diabetic
    I went a month later follow up AIC test and it was 5.1
    so my average he said was 5.5
    he has now told me i was now only at risk for pre diabetic

    It seems he makes up his diagnosis per individual test

    I have been testing my own now for 3 months and went on a low carb diet
    It does seem when i have too many carbs i can go up to 9 or even 10 sometimes

    So I decided to try a 3 hour high intake carb test on my own
    I ate 80 or more of carbs my numbers and test times are shown below
    My 2 hour was i believe over the 140 max but 2 1/4 seemed under the mark

    Can you tell me what you see in my numbers because doctor told me he does not care about my own home testing

    High carb ingested = 122 carbs or more
    2 Quaker instant oatmeal packages 25 carbs each = 50 carbs
    1/2 of a large bag of regular frito lay potato chips = probably more than = 80 carbs

    Total ingested over 130 carbs

    pre meal = 5.2

    1-hour = 11

    1/30-hour = 11.2

    1/75-hour = 10.9

    2-hour = 8.8

    2/15-hour = 7.7

    2/30-hour = 7.7

    2/75-hour = 6.8

    3-hour = 5.1

    Your help and thoughts and advice would be greatly appreciated

    • Hello, Michael

      I am a big believer in home testing, as it gives you excellent real-time everyday results about how what you’re eating affects your blood sugar, so I think it’s fantastic that you are seeing for yourself what your numbers look like. The A1C test is not nearly as helpful as the other tests listed in the PDF I included in the post above. It’s just an average of your blood sugars over the past 3 months. In your case, you are clearly having a high blood sugar response to a carbohydrate-rich meal, which over time is not healthy. In mg/dl, the units I’m accustomed to using, your blood sugar is surging from a not-bad 92 to a very unhealthy 202. This is a clear sign of glucose intolerance and likely insulin resistance, as your body is not able to use insulin to keep your blood sugar from spiking far too high. I am so glad you are trying a low-carbohydrate diet, as this should protect you from such steep spikes in blood sugar! It’s best to aim for a morning fasting blood glucose of between 4 and 5 (see conversion chart here: http://www.diabeteschart.org/mgmmol.html)

      • MICHAEL PANICCIA

        Hi Dr Ede

        Thank you very much for a very informative response you clearly understood and responded with good information for me to help deal with my insulin resistance.

        I do have a few follow up questions though

        Can insulin .resistance or glucose intolerance contribute significantly to the development of diabetes

        do you think from what i have told you so far that I may actually have pre diabetes right now

        And last of all I have been on low carb diet for 3 months now
        And i can not seem to get my blood readings lower than 5.5
        Sometimes i can get 5.1 but usually around 5.5
        Are these 5.5 readings cause for concern

        Could it be dawn phenomenon or my 40 grams of crestor i take for high cholesterol. I heard some where sometimes cholesterol raises your blood sugar although i do not know if they mean fasting blood sugars

        Thank you in advance

        • Hi Michael

          Yes, insulin resistance over time, if not managed with diet, will typically lead to diabetes, so eating a low-carb diet is the best way I know of to prevent that from happening. If not managed with diet, insulin resistance will usually gradually worsen and then diabetes develops as the final stage of the process. You probably already have pre-diabetes but as long as you keep to your low-carb diet, you will probably never develop full-blown diabetes. I wouldn’t worry about readings in the low 5’s; ideal morning blood sugars are in the mid to high 4’s, but low 5’s are pretty good! If you want to try to get them lower, you might need to eat a little less protein, increase exercise, or try removing dairy.

        • Ari

          Statins have diabetes (T2) as a side-effect. Read the warnings in the package leaflet.

  • Christina Morrison

    hi dr ede,

    thanks for all your amazing info. i have been doing an elimination diet for a month (no grains, dairy, nuts, legumes… mostly healthy fats, meat and non starchy vegs) to repair my gut. i was feeling fine and then for the past two days i had a great increase in anxiety, my heart beating loudly and more quickly, and couldn’t sleep well….. all unusual experiences for me (at least in recent times). i was not craving starches or sweet but decided to see what would happen if i ate a sweet potato. about 2 hours after i ate it everything calmed down…. anxiety went away, heart normalized and i slept for 10 hours. now i don’t know if carbs are good for me or not. what do you think? btw, i scored a 2 on your carb questionnaire.

    • Dear Christina

      That is very interesting, thank you for your question. That happened to me at certain points along the way, too, and has happened to others who first embark on a very low carbohydrate diet. In some cases it is due to inadequate calories, protein, and/or fat in the diet, leading to unstable blood sugar (falling levels). In some cases it is due to electrolyte imbalances that can occur when adjusting to a very low carbohydrate diet, because low carbohydrate diets change the way the body handles salt and water. Most people who experience electrolyte imbalances do well by taking magnesium and potassium supplements and being sure to eat enough salt (sodium). If you are concerned primarily with gut repair (as opposed to insulin resistance related issues such as overweight, diabetes, etc), you may do fine by leaving starchy roots in your diet if your metabolism feels best when you eat them, as grains/beans/nuts/seeds are the most important carbohydrate-containing culprits in gut problems.

      • Christina Morrison

        hi dr ede,

        thanks so much for your helpful reply. great to know that this is a common response. i am sticking with the diet and have not had any more problems with anxiety or heart. i am continuing to eat starchy roots, but far less carb than i used to eat. perhaps my body was also adjusting to being able to burn fat vs carb.

        i am interested in the electrolyte imbalance you mentioned: can you recommend an article or book in that regard?

        i have another question regarding the acid/alkaline balance. how is it possible to eat so much meat and fat without becoming too acid? i am still eating quite a bit of vegs, so am not too worried about it, but for people who eat only meat, would this be a concern? also, how do you get vit c if only eating meat or meat and cooked vegs?

        thanks so much for your time and wisdom.

  • paradigm shifter

    It’s not true that you can be healthy without eating any carbohydrates. That was the initial problem with the Atkins diet until he modified it and increased the carbs.

    • lele23

      The longest-lived, healthiest populations on Earth, the “Blue Zones,” eat traditional diets based on complex carbohydrates (grains, beans, and vegetables) and are virtually free of diabetes 2 and other “diseases of affluence.” So yes, carbohydrates are indeed necessary.

      • Lorrianna Thomas

        There is no such thing as an essential carbohydrate

        • lele23

          Cute but meaningless catchphrase. If you believe vegetables are essential for good health, then you believe carbohydrates are essential, because vegetables are packed with them. Diets high in unprocessed carbohydrates have been shown time and time again to be ideal for long term human health. The Tsimane of Bolivia have recently been shown to have the healthiest hearts in the world. Their diet is 78% carbohydrate.

          • Lorrianna Thomas

            It’s not a “catchphrase” just stating a fact. Our bodies will produce all the glucose that we need. We don’t need to get it from carbohydrates. Therefore it is not essential that our body have carbs. The carbs are not the essential part of the veggies.

          • lele23

            Even if you could get by without consuming carbs, why on earth would you? They have been the basis of the human diet throughout our evolution, and they are the bulk (no pun intended) of the diets of the most disease-free, longest-lived communities on earth (the “Blue Zones”). And speaking of “bulk,” fiber is 100% carbohydrate. Most people consume too little of that as it is. The Academy of Nutrition and Dietetics states that consuming a MINIMUM of 130 mg of carbohydrates a day is necessary to keep body and brain functioning normally. Now I I’ll go and enjoy my delicious, carb-heavy dinner of a sweet potato with spicy lentils and collards. And then a couple raw dates for dessert.

          • Lorrianna Thomas

            Lol you do that. And I’ll keep my glucose levels stable and prevent diabetes, heart disease, and more by keeping my glucose low and stable without ups and downs. Oh and it works great to get rid of inflammation in the body too.

          • lele23

            I’m 56 years old, and I’ve been eating whole-foods, 100% plant-based for thirteen years. My glucose levels are perfect, cholesterol is way down, and inflammation is gone. In fact, the inflammation factor is why so many world-class endurance athletes, including Scott Jurek, Rich Roll, and octogenarian Ruth Heidrich, swear by a plant-based (vegan) diet.

  • Alison

    Hi Dr., I’m curious what you think about the research that suggests some carbohydrates are need to support normal thyroid and hormone function, especially for those who may be borderline hypothyroid. I’ve read several sources that suggest carbs in moderation including sweet potatoes <75-100 g carbs / day) are actually better for women with potential thyroid issues and for women with PCOS. Any thoughts? Thanks, Alison

  • Melissa Hayden DeLong

    Good morning,

    I am not new to low carb dieting, or any diet for that matter. I am over weight and have been for 15 years, since my pregnancies. I know I messed my metabolism up from yo-yo dieting all those years. Right now I am eating meat, seafood, eggs, fat and I little dairy in the form of cream in my coffee and butter to cook my eggs. I lost 5 pounds right away and have been going up and down 1 or 2 pounds ever since. It’s been about a month. Also, I usually have a glass of red wine in the late afternoons. I’m on vacation this week and I plan to stop the wine in a few days after I get home. I have never eaten in such a way that is so liberating. This is easy for me. I’m not hungry and I have no cravings. I used to be obsessed with food and I’m just not anymore. I never want to go back and I never am tempted to cheat. At the moment I’m not very active, but I want to change that as well. It’s difficult to bend and move with fat getting in the way.

    My question is since I carry a lot of fat, should I reduce my fat intake in order for my body to burn its own fat? If so, where should my fat intake cap off?

    I log my food intake on my fitness pal so I know I’m not over eating. This is a great way to eat and I believe all my research that it is healthy and I’m not doing my body any harm. But my friends and family don’t like that I quit eating fruits and vegetables. The problem for me is that when I eat fruits and vegetables I crave refined foods that do not serve my health. I become obsessed and it’s a miserable way to live.

    Thank you for all of your sound research and sharing it on your blog. You give me hope.

    • Hi Melissa

      Congratulations on your newfound success! Sounds like you have made a fundamental shift in the way you approach food and dieting, which is fantastic. There are many who struggle with weight plateaus on low-carb, high-fat diets, myself included. Some potential culprits for those of us with more stubborn metabolism are:

      caffeine
      low-cal/no-cal sweeteners
      dairy
      eating too much protein for your metabolism
      alcohol

      Despite what some low-carb experts say, eating too much protein, or eating too many calories in general, can matter for some of us, especially for women.

      Fat is the nutrient to look at LAST. All of the things on the above list can raise insulin levels or destabilize blood sugar in sensitive people. To figure your protein requirements, divide your body weight by 2.2 to get an estimate of how many protein grams your body needs per day. It varies from person to person but this will give you a ballpark figure. If alcohol or the other things on the list aren’t your culprits, it’s well worth looking at protein. If all else fails, you can try lowering your fat intake, but most people don’t need to worry about fat.

      Hope that gives you even more hope–keep up the great work!

    • Bailey Gros

      Melissa, your story sounds just like mine. When I start a ketogenic diet I lose 4 or 5 lbs. then the weight loss stops & goes up a pound or two & doesn’t want to budge after that. So frustrating.

  • Umer Aziz

    Hi Dr. Ede

    Thank you for the wonderful insights. One thing I’d like to ask though: I am a chronic patient of high uric acid, i.e. I have had high uric acid levels since the age of 22/23, and I guess (from what I remember) it was triggered by the Atkins diet. My uric acid levels are usually in the range of 8.5 – 9.0). I have always been obese for as long as I remember, and recently (at the age of 36) been diagnosed with diabetes. My question is that: is the LCHF diet safe for people with high uric acid?

    • Dear Umer,

      Yes, the LCHF diet is safe for the majority of people with high uric acid levels. In fact, high-carbohydrate diets are one of the driving forces of high uric acid, so it is likely that a LCHF diet would lower your uric acid. If you have never tried it, it is well worth a try. You don’t mention whether or not you have gout associated with your high uric acid levels, but if you do, cutting carbs can be very helpful for that as well in many cases. Here are a couple of other posts I wrote about this topic:

      http://www.diagnosisdiet.com/is-fructose-bad-for-you-a-summary-of-the-research/

      http://www.diagnosisdiet.com/got-gout-but-love-meat/

      • Umer Aziz

        Thank you Dr. Ede. Yes, my uric acid has caused me atleast 4 gout attacks in the last 15 years. I will give this diet a shot and report my progress. Many thanks !

  • S.T.

    I encountered your blog today (via DietDoctor), and the usefulness and detailed content of your articles really hits the spot. (In particular, for a friend, I’ve been looking for a good explanation of the rationale for low-carb for cancer, without political polemics, and yours is it — thanks.) Also, unlike so many blogs, the comments and your reponses are as contentful as your main articles, and well worth reading (such as the comments about vitamin/drug causes of elevated blood sugar readings, and the links you added about other things which interfere — that topic would be worth a posting on its own.)

    The insulin resistance formula in the linked pdf, as well as the carb sensitivity quiz, is something I’ve been seeking for a long time, in order to help quantify my own health, thank you. [I’ve been concerned that my fasting blood glucose is generally 111, with A1c of 5.7, so it was reassuring that IR number is under the cutoff — triglycerides are low, perhaps due to LCHF]. Also, are you aware of a formula for estimating one’s insulin level based on other data from blood tests?

    I would like to read the article cited for the formula, but am unable to track down the reference — perhaps there is a copy-paste error? Would it be possible for you double-check citation number 7 on the pdf (“Lee SH et al 2015 The American Journal of Medicine 121: 519-524”) That is, looking under that journal title, I can’t find it under the first author, and looking at page 519 of the 2015 volume yields an article about osteoporosis, and looking at page 519 of volume 121 yields a different 2008 article about diabetes.

    Thanks again for your very informative and useful posts.

  • Staci Leupp

    I’m vegan…Any advice.o

    • lele23

      Whole foods, plant-based is the healthiest diet for humans. Stay away from refined, processed products, and consume whole grains, legumes, veggies, fruits, nuts, and seeds. Diabetes and other “diseases of affluence” are virtually nonexistent among people who eat this way. Check out the documentary Forks Over Knives. Best regards.

  • Joanna Hibberd

    Is damage to the hippocampus reversable?

  • elisabeth

    Thank you SO much for your quality, referenced information. There is so much misinformation out there, all over the web, and people are confused about what makes a good diet. I’m concerned for our next generation especially, as they’ve been fed so much wrong information about fats, meats, sugars, etc. What you are doing is so important, and you’re doing it well. My mom is in the later stages of Alzheimer’s and my dad suffers from other psychotic depression. I completely believe that insulin resistance and inflammation has played a significant role in these mental illnesses and is the root cause in most degenerative disease. Please keep doing what you do!

  • kdbm

    Excellent information!

  • A road travelled

    Dr. Ede, your site is wonderful. I have ready many of your blog posts and find them clear and well researched. Thank you for all the work you do!

    I am one of those with a thyroid problem – Hashimoto’s. Last year my thyroid tests revealed subclinical hypothyroidism. As I was gaining weight and was no longer the petite girl who could eat anything, I was glad to try thyroid hormone to address this. My body (perhaps fortunately) doesn’t respond well to usual treatment. My body did it’s usual thing and fought it. My blood pressure spiked and I felt terrible even on a small amount. And so began the research…

    I am quite certain that I have a measure of Insulin Resistance due to my weight gain – especially around my abdomen. However I don’t do well on a very low carbohydrate diet. On a low carb diet I don’t recover from exercise well, get dizzy and feel foggy. I generally eat a paleo diet with higher carbs. I *try* to keep my carbs at around 100 grams per day which is a challenge as I don’t eat any grains or starchy veggies at all so rely on squash and low glycemic fruit.

    The result of this diet on my thyroid has been good – my numbers are now considered ‘normal’ (although still too high for my liking).
    However, I am still concerned about Insulin Resistance. My mother has Alzheimer’s Disease and it is prevalent on that side of the family. But I am concerned about protecting my thyroid and do know that I feel best on higher carbs. Any words of wisdom?!

    Thank you kindly,
    Lana

  • Danae Thalassa

    I have excluded carbohydrates from my diet completely: no refined carbohydrates, no grains, not starchy vegetables, no carbohydrates from fruits. I have increased as well the fat content: olive oil, coconut oil, fish oil, and some butter, as well as I have increased the amount of green vegetables that I consume. The benefits for me are tremendous ! cognitive clarity, no brain fog, high energy levels, good quality of sleep, substantial weight loss, elimination of bloating symptoms, and complete absence of premenstrual symptoms. while I had to take painkillers on a monthly basis, I now go with 0 use of painkillers. I could never imagine that would be possible. so I am a testament of how increasing fat, and eliminating carbohydrates can be very beneficial. the question that I have is what about carrots, and beetroots, and healthy bean and lentil stews (no potatoes there), and other fruits. Can they be incorporated in a healthy diet? these are things that I am craving sometimes and I miss them. Could I have a carrot and beetroot salad, or a white bean stew or lentil stew with tomatoes as a guilty pleasure once per week? I understand you might not be able to reply to this specific question. But if you do, I want to thank you in advance!!

  • Danae Thalassa

    and also for everyone who would ever like to minimize sugar but is afraid that its not possible, I would say to add fish oil in their diets, and increase good fats. after a while they will not be hungry, and will have absolutely no cravings for refined carbs or sugar. I want to sent my very best wishes to everyone who want to change their eating habits and increase their quality of life and health! it is possible, its realistic and you are going to feel so good!

  • Lorrianna Thomas

    Did you know that hormonal imbalance can cause high fasting glucose levels? ! And too much caffeine can wreak havoc on the endocrine system and the adrenals, which create your hormones. So basically too much coffee can effect glucose levels by effecting your hormones. Ive been eating low carb for over 3 years now and had high fasting blood glucose levels. I was also a heavy coffee drinker. I’ve since weened off the coffee and I’m hoping that will help my hormones balance themselves. Perimenopausal as well.

  • deborah

    (I posted this at the quiz link, but it was meant for here. Thank you for your work!)
    I’d been on a low fiber diet since I had an intestinal blockage 2 years ago, which finally threw my A1C levels into full diabetes. I’d always had gestational diabetes and knew to watch sugars — especially fructose which (yes!) gave me gout — and I also ate plenty of fiber. But the blocked gut wrecked this plan.

    Glad to say LCHF, which I started last summer, helped me to easily lose 25 # and reverse my diabetes.

    Yet LCHF combined with low fiber also gave me huge constipation problems, and a not so successful heavy but necessary reliance on magnesium citrate. I’ve had gut problems all my life, a rupture of the ascending colon at 23 and a sigmoidectomy at 50. In Feb, after 10 years of calm using ALIGN probiotic to heal my gut, I developed serious diverticulitis. Went to the ER, was admitted. To treat it we cultured my blood and used non-dextrose antibiotics and ringers solution IVs, no food for 3 days, and then a clear diet returning home. The docs and staff were interested to see how easily I maintained the fast, blood sugars running in the 80s and 90s, not hungry (keto adaptation rules!), and they really supported me. I also have a great surgeon following me, and he felt with my history, I needed a colectomy. But after I was healed enough, a colonoscopy showed my gut was only inflamed at the distal end, though I had, as I had at 23, diverticuli throughout the entire length. Just something I was born with.

    After this I returned to low fiber LCHF. Alas, two more bouts of infection followed — which may have to do with the ventral hernia repair I needed after so many surgeries (one for kidney cancer, bladder repair after birthing injury, C-sec, hysterectomy…) and I have mesh implanted below the muscles, goretex variety. So a complicated picture.

    Research has helped me understand the importance of soluble fiber in healing and maintaining the colon. So I continued LCHF and added inulin to my diet. I’m having really good results. Also adding MCF’s to the mix — plain coconut oil didn’t sit well with me. I wondered if you have any opinion on inulin. I’ve been using it for months now. I feel great. Last blood work was fabulous. These articles make me hopeful this will last:

    https://www.ncbi.nlm.nih.gov/pubmed/28596023

    http://jn.nutrition.org/content/129/7/1402S.full