After 17 hours fast, only mild ketosis

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Tincup
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Re: After 17 hours fast, only mild ketosis

Post by Tincup »

ShepR wrote: Sat Jul 02, 2022 2:06 pm Mike, can I upload any photos on this platform?
Yes, when you've quoted someone, or are in Full editor/preview mode, there is are two tabs below the text input box: Options and Attachments. When you click on the Attachments tab, you can either drag & drop a file(s) into the text box (something I didn't realize you could do & have never done) or click Add Files, which will bring up your file manager and let you navigate and select files. Then you can click "Place Inline" and a link to the uploaded file will be added in the text box.
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Re: After 17 hours fast, only mild ketosis

Post by mike »

ShepR wrote: Sat Jul 02, 2022 2:06 pm Mike, can I upload any photos on this platform? I have a full month with notes, of her CGM data. More recently, on 6/30/22, I gave us Whole Foods clam chowder, and big salad for dinner. The clam chowder had few potatoes, and I also gave her about 4 saltine crackers with butter. Yes, I know this is heavy carbs, but I was experimenting to see what the effect of bergamot and berberine may provide. Prescription was to take 2caps each half hour before big meal. I did not get a baseline before dinner (you may assume 111-117), but 1 hour exactly after meal, her glu was 180. 2 hours after meal was 189, 3 hours after meal was 111. Sleeping glucose levels are around 100, at rest daytime levels without food are between 96-117, but ANY carbs cause a spike. The spike is within 1 hour to hour and half after dinner and range from 187 to 252. And it sometimes takes 2 hours to settle back to 111-117.
Sorry to hear about your housing situation - real gut punch.

If you click on Full Edit Mode on the bottom, it allows you to do a number of things - including to add photos. Did you say what her HbA1c has been? It seems like her spikes are too high, but also need to see where she started from. And is she really getting down to pre-food level after? If she is having a lot of variability, it is hard on the brain. When you are at the upper ranges, there is too much glucose and neurons can basically burn out. To protect itself, the blood brain barrier (BBB) will become desensitized to glucose by lowering the density of glucose transporters. This is a slow process, and so when glucose swings back down, there is not enough fuel getting into the brain. Ketones can help make up for this if you have them. Ketone Esters may as well (go slow to start). Too long without enough fuel and you get neuron problems as well. On my CGM there is a target zone of between 70 and 180, and that is where you want to stay. The closer you are to 100% in that range the better. What you describe sounds more like she is on the path to losing glucose control. If you can switch carbs to fat until she is 100% in that zone for a few weeks, you might also see her blood glucose averages drop. CSF glucose levels are a percent of blood glucose levels, depending on the density of glucose transporters in the BBB. More transporters mean CSF glucose is closer to blood glucose and blood glucose does not have to be as high to supply needed fuel.
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Re: After 17 hours fast, only mild ketosis

Post by ShepR »

Tincup wrote: Sat Jul 02, 2022 2:35 pm
ShepR wrote: Sat Jul 02, 2022 2:06 pm Mike, can I upload any photos on this platform?
Yes, when you've quoted someone, or are in Full editor/preview mode, there is are two tabs below the text input box: Options and Attachments. When you click on the Attachments tab, you can either drag & drop a file(s) into the text box (something I didn't realize you could do & have never done) or click Add Files, which will bring up your file manager and let you navigate and select files. Then you can click "Place Inline" and a link to the uploaded file will be added in the text box.
Tincup, thanks! I will try this and upload some CGM data for Mike.
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Re: After 17 hours fast, only mild ketosis

Post by ShepR »

mike wrote: Sat Jul 02, 2022 3:14 pm
ShepR wrote: Sat Jul 02, 2022 2:06 pm Mike, can I upload any photos on this platform? I have a full month with notes, of her CGM data. More recently, on 6/30/22, I gave us Whole Foods clam chowder, and big salad for dinner. The clam chowder had few potatoes, and I also gave her about 4 saltine crackers with butter. Yes, I know this is heavy carbs, but I was experimenting to see what the effect of bergamot and berberine may provide. Prescription was to take 2caps each half hour before big meal. I did not get a baseline before dinner (you may assume 111-117), but 1 hour exactly after meal, her glu was 180. 2 hours after meal was 189, 3 hours after meal was 111. Sleeping glucose levels are around 100, at rest daytime levels without food are between 96-117, but ANY carbs cause a spike. The spike is within 1 hour to hour and half after dinner and range from 187 to 252. And it sometimes takes 2 hours to settle back to 111-117.
Sorry to hear about your housing situation - real gut punch.

If you click on Full Edit Mode on the bottom, it allows you to do a number of things - including to add photos. Did you say what her HbA1c has been? It seems like her spikes are too high, but also need to see where she started from. And is she really getting down to pre-food level after? If she is having a lot of variability, it is hard on the brain. When you are at the upper ranges, there is too much glucose and neurons can basically burn out. To protect itself, the blood brain barrier (BBB) will become desensitized to glucose by lowering the density of glucose transporters. This is a slow process, and so when glucose swings back down, there is not enough fuel getting into the brain. Ketones can help make up for this if you have them. Ketone Esters may as well (go slow to start). Too long without enough fuel and you get neuron problems as well. On my CGM there is a target zone of between 70 and 180, and that is where you want to stay. The closer you are to 100% in that range the better. What you describe sounds more like she is on the path to losing glucose control. If you can switch carbs to fat until she is 100% in that zone for a few weeks, you might also see her blood glucose averages drop. CSF glucose levels are a percent of blood glucose levels, depending on the density of glucose transporters in the BBB. More transporters mean CSF glucose is closer to blood glucose and blood glucose does not have to be as high to supply needed fuel.
Mike, I just put 2 hours into composing a reply to you on this. When I hit "Submit", had to log in again, and all my work was lost! Sorry, I am through for tonight.

Here's part of it:
Hemoglobin A1c
Jan 2020 - 5.5
Oct 2020 - 5.2
Mar 2021 - 5.4
Jan 2022 - 5.4
Mar 2022 - 5.5
April 14, 2022aa.jpg
Daily Pattern - 29 of 30 days - April 5-July 3, 2022.jpg
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ShepR
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Re: After 17 hours fast, only mild ketosis

Post by ShepR »

Tincup wrote: Sat Jul 02, 2022 2:35 pm
ShepR wrote: Sat Jul 02, 2022 2:06 pm Mike, can I upload any photos on this platform?
Yes, when you've quoted someone, or are in Full editor/preview mode, there is are two tabs below the text input box: Options and Attachments. When you click on the Attachments tab, you can either drag & drop a file(s) into the text box (something I didn't realize you could do & have never done) or click Add Files, which will bring up your file manager and let you navigate and select files. Then you can click "Place Inline" and a link to the uploaded file will be added in the text box.
Tincup. Thanks for the "Place Inline" tip. I would have missed it!
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Re: After 17 hours fast, only mild ketosis

Post by mike »

ShepR wrote: Sat Jul 02, 2022 11:00 pm Mike, I just put 2 hours into composing a reply to you on this. When I hit "Submit", had to log in again, and all my work was lost! Sorry, I am through for tonight.
Ouch. Couple of suggestions for the future for long posts - 1. create outside and then copy/paste. or 2. Hit submit after a bit to save, with maybe a note that it is in progress, then hit the Edit button on your post and go back in and add some more.

As to what you did put, I would say her sugars are in general fine. Her patterns show that she is within the Target Range for the most part (I believe the lightest band goes to 90%, so 10% is above or below). The only part to improve would be the evening meal - that is where she is having the most variation and often higher peaks. This is not well understood in regards to how the BBB regulates Glucose Transporter density. It could be that it is allowing full glucose into the brain since she is only highish for short periods. It could also be that that is enough for the BBB to de-sensitize to an extent. To be safe, I would still switch carbs to fat in that evening meal - try to get the peaks lower. Particularly any fast carbs. Add extra fat here and there to try to build up her calories and ketones.

Also, I would investigate ALZ-801 trials
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Re: After 17 hours fast, only mild ketosis

Post by SusanJ »

ShepR wrote:RE: can we squeeze some more improvement in thyroid? I don't know.
I'm not a thyroid expert by any means, but the numbers don't look too bad. Bredesen does set TSH as < 2.0.

I do know that high cortisol can affect thyroid function. Perhaps being low in weight / nutrition is causing some extra cortisol to be released to kickstart gluconeogenesis. Maybe you'll see thyroid improvement as a side effect if you can succeed in the weight gain arena.

I second Mike's suggestion to have fewer carbs and more fats at night. Plenty of research out there that says we humans have some pretty strong circadian rhythms when it comes to calorie source: primarily carbohydrate-catabolic mode earlier in the day and primarily lipid-catabolic mode later in the day.
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Re: After 17 hours fast, only mild ketosis

Post by ShepR »

SusanJ wrote: Sun Jul 03, 2022 11:45 am
ShepR wrote:RE: can we squeeze some more improvement in thyroid? I don't know.
I'm not a thyroid expert by any means, but the numbers don't look too bad. Bredesen does set TSH as < 2.0.

I do know that high cortisol can affect thyroid function. Perhaps being low in weight / nutrition is causing some extra cortisol to be released to kickstart gluconeogenesis. Maybe you'll see thyroid improvement as a side effect if you can succeed in the weight gain arena.
Thanks for input SusanJ. I agree and I am going to start implementing fewer carbs, more fats.
Not confident how to get more fats into her diet, as she is only eating 2 meals a day. 1st meal consists of smoothie which has some good fats in the form of Coconut Manna. and 2nd meal, I tend to go towards good protein, and green veg. I am thinking about making fat bombs and have her eat one square at each meal. That would be added fat.

You said: "I second Mike's suggestion to have fewer carbs and more fats at night. Plenty of research out there that says we humans have some pretty strong circadian rhythms when it comes to calorie source: primarily carbohydrate-catabolic mode earlier in the day and primarily lipid-catabolic mode later in the day."

I really don't get the significance or even the meaning of this. Please expand on it a little? Thank you.
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Re: After 17 hours fast, only mild ketosis

Post by ShepR »

mike wrote: Sun Jul 03, 2022 10:12 am
ShepR wrote: Sat Jul 02, 2022 11:00 pm Mike, I just put 2 hours into composing a reply to you on this. When I hit "Submit", had to log in again, and all my work was lost! Sorry, I am through for tonight.
Ouch. Couple of suggestions for the future for long posts - 1. create outside and then copy/paste. or 2. Hit submit after a bit to save, with maybe a note that it is in progress, then hit the Edit button on your post and go back in and add some more.

As to what you did put, I would say her sugars are in general fine. Her patterns show that she is within the Target Range for the most part (I believe the lightest band goes to 90%, so 10% is above or below). The only part to improve would be the evening meal - that is where she is having the most variation and often higher peaks. This is not well understood in regards to how the BBB regulates Glucose Transporter density. It could be that it is allowing full glucose into the brain since she is only highish for short periods. It could also be that that is enough for the BBB to de-sensitize to an extent. To be safe, I would still switch carbs to fat in that evening meal - try to get the peaks lower. Particularly any fast carbs. Add extra fat here and there to try to build up her calories and ketones.

Also, I would investigate ALZ-801 trials
Hi Mike, and thanks for following up. I will take care now as I understand the system kicks me out frequently, and anything I wrote while being kicked out, may get deleted when I log back in.

Please say what is the BBB you refer to. Thanks. [how the BBB regulates Glucose Transporter density.]

I will take your advice, and implement more fat, and try and get the carbs down. A lot depends on what she is willing to eat. Some time back I made fat bombs. They are refrigerated after mixing, then cut into squares. I could add a fat bomb to each of her 2 meals / day, while eliminating fast carbs, and only occasional complex carbs. Yes, build up calories and ketones. Sadly, I have to focus on downsize and move in 60 days. It will mean less attention to diet for that 2 months.
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Re: After 17 hours fast, only mild ketosis

Post by ShepR »

Tincup wrote: Sat Jul 02, 2022 2:35 pm
ShepR wrote: Sat Jul 02, 2022 2:06 pm Mike, can I upload any photos on this platform?
Yes, when you've quoted someone, or are in Full editor/preview mode, there is are two tabs below the text input box: Options and Attachments. When you click on the Attachments tab, you can either drag & drop a file(s) into the text box (something I didn't realize you could do & have never done) or click Add Files, which will bring up your file manager and let you navigate and select files. Then you can click "Place Inline" and a link to the uploaded file will be added in the text box.
Thanks Tincup. I was able to upload photos of CGM data to Mike. The "Inline" button I would have missed had you not pointed it out. Big thanks!
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