Low insulin pathway to dementia?

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joesmith
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Low insulin pathway to dementia?

Post by joesmith »

Hi!

I've followed Ketogenic diet since a year before my dementia diagnosis. My metabolic biomarkers have seemed very good. Except that the lab marks my fasting insulin as "too low" at 0.9, half the lower reference range value.

I now read (to me) shocking research that low insulin levels, as well as high ones, are associated with markedly increased incidence of dementia. This hypothesized to be related to insulin's neurotrophic properties:

https://www.ncbi.nlm.nih.gov/pmc/articl ... morbidity.

Is there discussion of this as it impacts Bredesen protocol? Should people not at risk from metabolic syndrome strive to maintain a moderate insulin level?

Thanks!
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Re: Low insulin pathway to dementia?

Post by Tincup »

joesmith wrote:Hi!
I've followed Ketogenic diet since a year before my dementia diagnosis. My metabolic biomarkers have seemed very good. Except that the lab marks my fasting insulin as "too low" at 0.9, half the lower reference range value.

Is there discussion of this as it impacts Bredesen protocol? Should people not at risk from metabolic syndrome strive to maintain a moderate insulin level?
Hi Joe,

What is your glucose reading taken at the same time as your insulin?

I know fasting insulin is very pulsatile. My main concern would be that your body makes enough insulin, when it needs it. A Kraft test (oral glucose tolerance test with insulin readings taken at the same times as glucose reading) might be useful. However people on a keto diet can have a low response unless they carb up for a while, at least 3 days at 150 g/day prior to taking the test.

What kind of a daily carb intake do you have? I've been keto adapted since Oct 2009, so have experience, but still eat a fair amount of carbs for someone on keto (80=180g/day). I also do extended fasts (7 day), in fact in 2017, I did a series of 5 day fasts out of every 14 days for 19 cycles over about 8 months. I probably have a 0.8 reading in there somewhere, but typically I'm in the 2-4 range. The labs Dr. Gundry uses don't do decimals, but I do have some LabCorp ones where they are presented in decimals.
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Re: Low insulin pathway to dementia?

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Thanks for your swift and helpful reply! I'll try to get a Kraft test

My glucose was 82. I must eat at least 60 or 70g of carbs a day, to stay between 0.6 and 2.4 mmol.

Something that surprises me - the study I mention seems to me huge news in terms of its implications for understanding the neuroprotective effects (or otherwise!) of very low carb diets. It looks like solid research - 1000+ participants in a longitudinal study. But it has only been cited 6 times since 2018... Is this a fringe finding, or have other people heard about this...?
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Re: Low insulin pathway to dementia?

Post by msdorney »

joesmith wrote:Hi!

I've followed Ketogenic diet since a year before my dementia diagnosis. My metabolic biomarkers have seemed very good. Except that the lab marks my fasting insulin as "too low" at 0.9, half the lower reference range value.

I now read (to me) shocking research that low insulin levels, as well as high ones, are associated with markedly increased incidence of dementia. This hypothesized to be related to insulin's neurotrophic properties:

https://www.ncbi.nlm.nih.gov/pmc/articl ... morbidity.

Is there discussion of this as it impacts Bredesen protocol? Should people not at risk from metabolic syndrome strive to maintain a moderate insulin level?

Thanks!
Welcome joesmith! You've found a wonderful community of people committed to helping with information and inspiration, as you can see from the previous response from Tincup. There are lots of great resources and many terrific members here at ApoE4.info. One such resource is the Primer written by a doctor who is herself, ApoE 4/4. You may have taken a look at this already but it is PACKED with valuable information. Also, the How-To Guide can help you navigate the ApoE4.info website. I wish you continued success on your journey.
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Re: Low insulin pathway to dementia?

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In this population-based study of middle-aged women free of diabetes mellitus at baseline, the 34-year risk of dementia was more than doubled in women with initially low fasting serum insulin compared to women with medium insulin values.
It appears that insulin was checked at the beginning of the study only, if I'm reading the paper correctly. How useful is that?
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Re: Low insulin pathway to dementia?

Post by Tincup »

I'd hazard a
joesmith wrote:Thanks for your swift and helpful reply! I'll try to get a Kraft test

My glucose was 82. I must eat at least 60 or 70g of carbs a day, to stay between 0.6 and 2.4 mmol.

Something that surprises me - the study I mention seems to me huge news in terms of its implications for understanding the neuroprotective effects (or otherwise!) of very low carb diets. It looks like solid research - 1000+ participants in a longitudinal study. But it has only been cited 6 times since 2018... Is this a fringe finding, or have other people heard about this...?
I'm guessing very few of those subjects were on a low carb diet. If your glucose was 82 with insulin of 0.9, with 60-70g carbs/day that indicates very good glucose disposal to me. HOMA IR is 0.2

I'm guessing your insulin would look fine if you tested insulin (and glucose) exactly two hours after your carbiest meal of the day. This is from Catherine Croft's PhD thesis using Kraft's data. If <30, then excellent, between 30&50 need more info and >50 bad. From my non-medical opinion, I'd like to know your body will make insulin when needed. With a glucose of 82, your body didn't need much insulin to dispose of it.

As Slacker notes, only testing the insulin once is not that useful. As mentioned previously, fasting insulin is very pulsatile. Using one value to project over decades!

First thing you might do is just retest insulin/glucose.
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Re: Low insulin pathway to dementia?

Post by Tincup »

Wondered about insulin in the carnivore space. Pulled up this commentary on Dr. Shawn Baker's labs.

HbA1c: 6.3
Fasting Glucose: 126 mg/dL
Fasting Insulin: 2.6 mIU/L

Your labs look much better to me.
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Re: Low insulin pathway to dementia?

Post by MarcR »

Joe, I agree with Tincup that you don't seem insulin resistant. Do you continue to meet the criteria for a positive dementia diagnosis today? If so, I wonder if you have something else going on. Are you familiar with Dale Bredesen's Type 3 Alzheimer's classification?
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Re: Low insulin pathway to dementia?

Post by Julie G »

Is there discussion of this as it impacts Bredesen protocol? Should people not at risk from metabolic syndrome strive to maintain a moderate insulin level?
Great question. From the most recent book, Dr. Bredesen suggests that optimal fasting insulin is 3.0–5.0 μlU/mL, with a caveat that confirms Tincup's perspective. He says that for those who are insulin sensitive, with fasting glucose <90 mg/dL, fasting insulin of <3.0 is still in a healthy range. That said, given that some insulin is necessary for glucose metabolism in the brain, my guess is that you wouldn't want to go lower.
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Re: Low insulin pathway to dementia?

Post by joesmith »

Hi Everyone

Wow - I only joined the forum yesterday and am blown away to have had such supportive and informed comment already. Thank you very much! I will follow up your suggestions.

I'm especially grateful since I'm living in Thailand - while care is in some respects very good, it is not reflective of recent research. My primary neurologist hadn't heard of Bredesen, for example, and recommends a Mediterranean diet over a ketogenic diet on grounds of greater data on the former

MarcR kindly asked: "Do you meet the criteria for a positive dementia diagnosis today? If so I wonder if something else is going on" My diagnosis on basis of MRI and PET is of mild posterior cortical atrophy, especially in the parietal lobes (but not frontal or hippocampus), giving doctor to suspect early-onset atypical Alzheimers, but lumbar puncture came back negative. Neuropsychological test results still pending. Subjectively I feel I meet the DSM functional criteria for dementia, But in terms of cause we seem to have reached a dead end (Doc says, unhelpfullly,, that I "have a pathology whose cause we don't know and can't know with today's technology".) When I ask him about factors mentioned by Bredesen in Type 3 diabetes, he says (echoing Bredesen), but we'd expect your degeneration to be global. I've done almost all of the tests recommended by Bredesen 2020. So something else going on, seems plausible. But what?

Thanks again!
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