Tuesday, August 19, 2014

WHY NEVER HAVE AN "OGTT" (oral glucose tolerance test) DONE WHILE ON ZERO CARB


We already know doing Zero Carb may be sometimes socially difficult, why add more problems?

What I will talk about is not well known by ‘common medical doctors” but any practitioner with common sense and some knowledge of nutrition will be able to understand the principle behind the point I want to make here.

I would say that in the last 5 years, I have read many times on different website supported by renowned LC doctors, that there is 2 lab reports that may come up with abnormal readings and create great confusion for anyone doing a reduced carb diet. Luckily, we know any LC eating plan will improve seriously a lot of blood tests including lowering triglycerides, normalizing cholesterol profile, getting glycated hemoglobin in normal range, not forgetting good (low) blood insulin level, low leptin levels and, of course, good blood sugar readings.

Except…

Except that we have seen some folks on LC getting light abnormality on their morning fasting blood sugar results and also bad results on an OGTT (oral glucose tolerance test) test.

The OGTT is usually done to identify a possible “carbohydrate metabolism defect” or, as doctors call it, any sign of ‘insulin resistance”. I do not like the words “insulin resistance” because so many think this leads to diabetes type 2-B. But, as you will see, “insulin resistance” is not always a bad thing; it is often a “switch” to move from burning glucose to burning fat and should be called “physiologic insulin resistance”

The OGTT test is often ordered when someone has a “little increase” of his fasting blood, not enough to diagnose a full-bloomed diabetes, but to identify those in the pre-diabetes phase. I will not give “normal numbers” because different countries have different “measuring systems” and very different “references”. And as we have a very international audience on this blog, I do not want to create confusion. But just to say, numbers to be “considered diabetic” in the USA are absolutely not the same as in Europe…

So when a doctor order an OGTT test, the patient will get an appointment in the morning while fasting and be given an oral dose of liquid glucose. Then, usually, blood samples will be done every 30 minutes for 3 hours to see how the body of the said patient will react to a fix dose of glucose. Sometimes, some lab will go up to 5 hours of testing.

Someone having problems metabolizing carbohydrate should have high numbers, as the pancreas will not produce enough insulin to clear up the blood of excess glucose by “moving it” into all the cells of the body with insulin receptors.

Sometimes, some folks will show a sign of hypoglycemia while doing the test, which means they are in the phase of “hyperinsulinism”, the basic pathology that will lead eventually to “pathologic insulin resistance” and diabetes 2B.

So what will happen to anyone doing a LC, an especially a Zero Carb diet, while doing an OGTT test?

Well two things may happen but to understand them, one must first get some specific knowledge.

When doing a LC diet, which normally means doing a high fat diet, the body will adapt to burning fat for energy. As there will be minimal circulating glucose, the body will do everything possible to preserve it for the few cells that only work on glucose (red blood cells) and it will do this by “closing up” the cells receptors to insulin, which should, as I already said, called “physiologic insulin resistance”.

This is why, on a LC diet, when fasting during the night, gluconeogenesis becomes an important process to provide the said glucose AND it is not rare to see SLIGHTY elevated FASTING blood glucose in the morning for folks on such diets.

All this being said, the “slightly elevated fasting glucose” is absolutely normal on LC diet and should never be considered as significant.

So what can you do if “trapped” in doing a OGTT?

First, after doing everything you can to explain you cannot do the test because you are on a “high fat low carb diet”, the way out is to “reactivate” the insulin receptors on your body cells. To do this, you must, sadly, get back into eating carbohydrates for at least 3 days, nothing less.

And why do I am passing this information? Because, and I repeat it, it may happen that folks on any modified carb diet get a “slightly elevated” fasting blood glucose and doctors will automatically think “pre-diabetes”….

Of course, instead of a OGTT, you can also ask your doctor to do a “glycated hemoglobin” which will show that your overall blood sugar was absolutely normal in the last 2 months (which is usually the outcome on LC diet).

Another reliable test is to simply measure your blood sugar 1 or 2 hours after any LC meals (if you follow a serious LC diet since at least 3 months). This will prove your body can metabolize any carbohydrate or excess protein that may be turned into glucose.

Of course, I cannot finish without talking about the effect of “excess protein” on blood sugar. Studies have documented between 50 to 60% of proteins can be turned into glucose after a meal, “IF NEEDED” or “IF PROTEIN ARE EATEN IN EXCESS”. So this is why, on Zero Carb, we should look into eating an adequate quantity of protein AND PROBABLY A LITTLE MORE, as we will transform some of it into glucose to answer our needs.

But the problem here is to decide what is an “adequate” quantity. There are some rules such as “1 g per kilo weight per day” but this is good for a “carby” diet and if you are a moderately or a very active person, you will need much more because you will burn very fast any glucose your body will make up from protein.

The best way to know is still to measure your blood sugar after meals and see how your body deals with any excess meat protein. But, and I repeat myself again, do not rely on morning fasting glucose measurements because “gluconeogenis after a meal” is controlled by a totally different process from “gluconeogenesis after a night of fasting”.

Denis










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