What exactly is "clean eating"

[DragonBits]

Where is your body fat sitting at right now? Do you have access to an accurate measurement? Seems like almost any man with high bf% (above 25%) is somewhat insulin resistant and the higher the bf the worse the resistance.

No doubt it's because I am overweight. Which is good, because I can lose weight, and I haven't been paying a lot of attention to what I eat. Like once in a while I would have a bowl of macaroni at 2:00 Am. On TRT it's a lot easier to change all that.

Right now, probably around 25% BF, when I took the test nearly a month ago, 28%. Just a guess based on tanita weight scale done in a clinic several times around my current weight and other higher weights but in 2013-2016.

I have lost maybe 7 lbs of fat over the last 6 weeks.

But I have never gotten any sort of really accurate BF%, not even with calipers.

Currently I am 162, 5-4 and wear 32 inch jeans. In the avatar pic I was 150lbs.

In 2009 I was 190 lbs and wearing 36 in jeans.

It is interesting to compare pics from before TRT in 2009, after 5 years of TRT then after 2.5 years off of TRT.

When I used to run 5 miles and was ~38 years old, I got down to 133lbs and could easily wear 29 inch jeans.

 

[Nashtide]

No doubt it's because I am overweight. Which is good, because I can lose weight, and I haven't been paying a lot of attention to what I eat. Like once in a while I would have a bowl of macaroni at 2:00 Am. On TRT it's a lot easier to change all that.

Right now, probably around 25% BF, when I took the test nearly a month ago, 28%. Just a guess based on tanita weight scale done in a clinic several times around my current weight and other higher weights but in 2013-2016.

I have lost maybe 7 lbs of fat over the last 6 weeks.

But I have never gotten any sort of really accurate BF%, not even with calipers.

Currently I am 162, 5-4 and wear 32 inch jeans. In the avatar pic I was 150lbs.

In 2009 I was 190 lbs and wearing 36 in jeans.

It is interesting to compare pics from before TRT in 2009, after 5 years of TRT then after 2.5 years off of TRT.

When I used to run 5 miles and was ~38 years old, I got down to 133lbs and could easily wear 29 inch jeans.

Body fat percentage and insulin resistance is interesting. When I was 25% bf, everything I ate became fat. Now that I'm under 15%, I can't gain weight! I've been eating an extra 300 calories a day for three months and I've gained 3.5 lbs!

 

[dnfuss]

Seems like almost any man with high bf% (above 25%) is somewhat insulin resistant and the higher the bf the worse the resistance.

The evidence simply doesn't support that. Many of those who are insulin-resistant are obese. That is consistent with the notion that poor blood sugar control promotes obesity. However, the converse is not the case, i.e., the majority of the obese are not insulin resistant. Or at least they don't present with high blood sugars. A HOMA-IR, which relates only to basal glucose control and is therefore only indicative and not diagnostic of insulin resistance, is not usually done. It's even rarer to run a hyperinsulinemic euglycemic clamp during OGTT, which is much more definitive.

 

[Nashtide]

How do we know that the majority of the obese are not insulin resistant?

 

[Nashtide]

I don't think insulin resistance and high blood glucose are the same thing. I see insulin resistance as the inability to funnel carbs into muscles and liver and instead the carbs get converted to fat and stored.

 

[dnfuss]

How do we know that the majority of the obese are not insulin resistant?

You are right. Technically we don't know that (basically because insulin resistance is rarely tested for, per se). But we do know that the majority of the obese do not present with high blood sugars. It is true that more Type 2 diabetics are fat than are thin. And more of the obese have diabetes than the general population. But the majority of the obese don't have diabetes. This points at diabetes being the driver of obesity; not the other way around. Those who propose obesity as the driver of diabetes inevitably state somewhere that they do not truly understand the etiology. I think that speaks volumes.

 

[dnfuss]

I don't think insulin resistance and high blood glucose are the same thing. I see insulin resistance as the inability to funnel carbs into muscles and liver and instead the carbs get converted to fat and stored.

They aren't the same thing, but your definition doesn't go far enough. Insulin resistance in those with the wrong genetic makeup results in some portion of carbs being converted to glucose and neither being stored as glycogen in the liver/muscles or as triglycerides in fat tissue, but instead being released as glucose into the bloodstream in excess of the body's normal homeostatic levels (i.e., diabetes).

Insulin resistance is a necessary condition for Type 2 diabetes (many, maybe most, Type 1 diabetics are not insulin resistant; that is almost unheard of in Type 2). Obesity is not a necessary condition for Type 2 (there is a significant minority of Type 2 diabetics who are thin). A percentage of the obese, higher than among those of normal weight, are diabetic, but the majority are not.

 

[Nashtide]

I understand what you are saying, but I think in the broad understanding of insulin resistance isn't only present in diabetics. Most folks with insulin resistance are not diabetics yet. Elevated blood glucose is not the issue, portioning of carbs is the issue. My understanding is that folks with insulin resistance can have normal blood glucose. You obviously know more about this subject and I'm enjoying learning from you. Perhaps insulin resistance is the wrong term for the what I'm describing? Maybe obese people simply are insulin inefficient?

 

[dnfuss]

Of course, it's a far more complicated picture biochemically than either one of us is describing, and you are correct on several points. But my essential point is that the direction of causality seems much more likely to be that high blood sugar/diabetes is responsible for obesity in diabetics (for which there are good biochemical explanations) rather than obesity causing high blood sugar/diabetes (for which most scientists seem to offer only conclusory statements and a dearth of plausible biochemical explanations). You can have insulin resistance (although, again, it's usually presumed rather than clinically diagnosed) and weight gain without high blood sugar/diabetes, although it's almost never the case that you have Type 2 diabetes without insulin resistance. It's a Venn diagram. Nearly all Type 2 diabetics are insulin resistant and most (not all) of them are overweight/obese. But obese Type 2 diabetics are only a (minority) subset of the obese. That's where I've been attempting to go in this thread: to the extent Type 2 diabetics are fat (and not all are), it's the diabetes disease process (including insulin resistance) that's making them diabetic and obese, not their obesity that's making them diabetic.

If you're fat and naturally have truly normal blood sugars (i.e., adults with fasting blood sugar generally in the mid-80s, 100 or below one hour after almost any meal, and return to fasting blood sugar or nearly so by two hours), then you have nothing to worry about right now as far as diabetes (and if you're fat and insulin resistant, the prescription is basically the same as for diabetics: cut carbs). The problem is that the ADA takes the official view that blood sugars significantly above these levels but below the thresholds for clinical diabetes diagnosis represent "pre-diabetes," which they imply is harmless and about which they say nothing can be done. They tell pre-diabetics (and their doctors) to simply monitor glucose levels. And while it is true that the majority of pre-diabetics do not progress to diabetes, about 35-40% will do so. Pre-diabetes is not a benign condition. Pre-diabetics, e.g., experience serious cardiovascular events (stroke and heart attacks) at significantly higher rates than those with truly normal blood sugars. Pre-diabetes is really more properly viewed as mild diabetes, which may or may not progress to moderate or severe diabetes. And the blood sugars of pre-diabetics can be normalized, just as those of diabetics can, if one is willing to do what it takes to manage them.

 

[dnfuss]

I don't have time to respond to all of your post, but the key here is "consistent" and "routine".

My levels are neither, I gave the worst case levels. I have seen fasting BG at 98 and post-prandial levels in the 120-130s.

My own diagnosis is that i am insulin resistant and pre-diabetic. I do agree these are not levels seen in healthy non-diabetics.

 

[dnfuss]

I don't have time to respond to all of your post, but the key here is "consistent" and "routine".

My levels are neither, I gave the worst case levels. I have seen fasting BG at 98 and post-prandial levels in the 120-130s.

My own diagnosis is that i am insulin resistant and pre-diabetic. I do agree these are not levels seen in healthy non-diabetics.

If the lowest fasting glucose you observe is 98 mg/dl and the lowest post-prandial levels (at one hour or two?) are 120s/130s, then yes, you are certainly at least pre-diabetic (mild diabetes). As noted above, that is not a benign condition. Pre-diabetics experience serious cardiovascular events at significantly higher rates than do those with truly normal blood sugars.

But it is also possible that your diabetes is more advanced than that. What you have shared of your history (over 65, overweight, several immediate family members diagnosed with diabetes, several fasting glucose tests over 100 mg/dl) would suggest that you consider having an
Oral Glucose Tolerance Test (see Glucose tolerance test - Mayo Clinic). You can try this at home if you want an approximation of the OGTT: https://bit.ly/2Iixe87, although it's not as definitive.

 

[madman]

I understand what you are saying, but I think in the broad understanding of insulin resistance isn't only present in diabetics. Most folks with insulin resistance are not diabetics yet. Elevated blood glucose is not the issue, portioning of carbs is the issue. My understanding is that folks with insulin resistance can have normal blood glucose. You obviously know more about this subject and I'm enjoying learning from you. Perhaps insulin resistance is the wrong term for the what I'm describing? Maybe obese people simply are insulin inefficient?

 

[dnfuss]

Quite so.

 

[DragonBits]

If the lowest fasting glucose you observe is 98 mg/dl and the lowest post-prandial levels (at one hour or two?) are 120s/130s, then yes, you are certainly at least pre-diabetic (mild diabetes). As noted above, that is not a benign condition. Pre-diabetics experience serious cardiovascular events at significantly higher rates than do those with truly normal blood sugars.

But it is also possible that your diabetes is more advanced than that. What you have shared of your history (over 65, overweight, several immediate family members diagnosed with diabetes, several fasting glucose tests over 100 mg/dl) would suggest that you consider having an
Oral Glucose Tolerance Test (see Glucose tolerance test - Mayo Clinic). You can try this at home if you want an approximation of the OGTT: https://bit.ly/2Iixe87, although it's not as definitive.

I would be more interested in the Glucose Tolerance Test with Insulin (8 specimens). Measuring insulin at the same time would be interesting. (Fasting, 1,2,3 hours later.)

I calculated a HOMA-IR score, it was 3.0, significant insulin resistance. But I already knew that and likely that was the worst it has been, though I had never tested insulin levels in the past.

Out of curiosity, this morning my fasting BG at 6:31 was 96, at 7:40 I ate a ham/egg on white toast with small apple, at 8:48 BG was 120, at 9:16 108.

It was interesting to read on your link that if you don't have a lot of carbs then eat a big carb meal, you will over react. That was the feeling I get. A lot of times I won't eat anything but coffee and 20 grams of protein, then go bike for 2 hours.

If I have a deep dish pizza after that, it can really soar my BG for longer than 2 hours and make me sleepy /crave sweets. (typical). No doubt the fat slowing down digestion and triglycerides hitting the liver causes the longer elevated BG.

I give myself about 5 more months to "fix" this, I have only been focusing on BG since Sept 9th. I get it's not really a permanent fix, I couldn't go back to eating Pasta Alfredo, white rice, Chinese food, Fruit smoothies, French fries, trail mix, all things my wife likes to eat.

But hopefully my BG will be a lot better.

If I were to do a home OGTT test, I think 75 ml of dark karo syrup would be very similar to the glucose they give you in the lab test.

I wonder about metformin. If I take metformin, then stop taking it after a few months, how long before my BG returns to "normal" non-drugged levels? Does anyone know this?

 

[dnfuss]

I would be more interested in the Glucose Tolerance Test with Insulin (8 specimens). Measuring insulin at the same time would be interesting. (Fasting, 1,2,3 hours later.)

Good for you. If you can afford it (or if insurance will pay), go for it.

Out of curiosity, this morning my fasting BG at 6:31 was 96, at 7:40 I ate a ham/egg on white toast with small apple, at 8:48 BG was 120, at 9:16 108.

Clearly pre-diabetic levels. What was much more concerning were your post-prandials of 156 and 177. Those are more typical of diabetes.

It was interesting to read on your link that if you don't have a lot of carbs then eat a big carb meal, you will over react. That was the feeling I get. A lot of times I won't eat anything but coffee and 20 grams of protein, then go bike for 2 hours.

That consideration really applies to those who have been on a diet for some time (not just a day here and there) of less than 75g of carbohydrate a day (the Standard American Diet generally provides carbohydrates in three times or more that amount). I don't know for sure, but it sounds from your posts that that is not the case for you. But if you suspect that may apply to you, just make sure you consume at least 150g of carbohydrates per day for at least three days in a row through the day before the test date (you fast on the test date and usually take the test first thing in the morning).

If I have a deep dish pizza after that, it can really soar my BG for longer than 2 hours and make me sleepy /crave sweets. (typical). No doubt the fat slowing down digestion and triglycerides hitting the liver causes the longer elevated BG.

Doubt it's the triglycerides; that's not really been demonstrated. Simpler explanation is that it's probably just that a huge carbohydrate load that's digesting over an extended period. From a blood sugar perspective, pizza is really just a giant piece of bread with toppings on it.

I give myself about 5 more months to "fix" this, I have only been focusing on BG since Sept 9th. I get it's not really a permanent fix, I couldn't go back to eating Pasta Alfredo, white rice, Chinese food, Fruit smoothies, French fries, trail mix, all things my wife likes to eat.

See my earlier posts regarding Dr. Bernstein's book "Diabetes Solution." It has a tremendous amount of information regarding the normalization of high blood sugars. Don't set arbitrary limits on yourself for improvement. Like TRT, normalizing blood sugars is a marathon, not a sprint.

If I were to do a home OGTT test, I think 75 ml of dark karo syrup would be very similar to the glucose they give you in the lab test.

Sort of, but not really. Karo syrup also has fructose and water in it. If you want to get just a general indication that can be obtained by home testing, you already have it. Now you need to have an OGTT in a doctor's office or lab using the standardized medium and measuring glucose (and perhaps insulin, as you've mentioned) using venipuncture (the standard against which home plasma meters are measured). Using Karo syrup and your home meter will not be definitive. If your doctor follows the ADA party line he will dismiss your concern as premature, refusing to do anything until you demonstrate clearly full-blown diabetes (by which time you may have been developing diabetic complications for years). If that happens you might want to consider finding a new doctor. And even if your doctor is more aggressive in treating elevated blood sugars (few are), he will still insist on an OGTT before he'll treat you.

I wonder about metformin. If I take metformin, then stop taking it after a few months, how long before my BG returns to "normal" non-drugged levels? Does anyone know this?

Plasma half-life of metformin was often stated as being 6.2 hours, with all traces gone after 24 hours. However, the experience of those on metformin, and subsequent studies (see, e.g., Unexpectedly long half-life of metformin elimination in cases of metformin accumulation. - PubMed - NCBI) indicate that a week to 10 days is really the median for systemic clearance. I would say that, to account for individual variations, after two weeks off of metformin there should be no traces of the drug remaining in your system.

 

[DragonBits]

Sort of, but not really. Karo syrup also has fructose and water in it. If you want to get just a general indication that can be obtained by home testing, you already have it. Now you need to have an OGTT in a doctor's office or lab using the standardized medium and measuring glucose (and perhaps insulin, as you've mentioned) using venipuncture (the standard against which home plasma meters are measured). Using Karo syrup and your home meter will not be definitive. If your doctor follows the ADA party line he will dismiss your concern as premature, refusing to do anything until you demonstrate clearly full-blown diabetes (by which time you may have been developing diabetic complications for years). If that happens you might want to consider finding a new doctor. And even if your doctor is more aggressive in treating elevated blood sugars (few are), he will still insist on an OGTT before he'll treat you.

Why get a doctor involved in this and what value does a doctor provide? When I think of getting a doctor involved in my health, I think it’s for one of a couple of reasons.

• Doctors can write prescriptions that you need for insurance to pay for things.
• Doctors can write prescriptions that you might need to get drugs that are difficult to buy without a prescription.
• Doctors might have specialized knowledge that would help direct health care.
• Doctors have skills like performing surgery or doing an ultrasound guided cortisone injection that are beyond the ability of home health care.
• MRI’s, x-rays and other procedures can’t be ordered by private individuals and you need a technician / doctor to interpret the results. (Though the doctor seems to depend a lot on the MRI technician to tell them what an MRI is indicating. X-ray, mri, calcium scan, etc.)

I can order an OGTT test myself, if I don’t meet the insurance requirements (ADA party line?) that suggests I need diabetic care, then a doctor’s prescription can still be filled but won’t be paid for by insurance.

I can get metformin from a Defy doctor or can order it without a script over the internet.

I would tell my doctor what I was doing, maybe he would add some useful advice and I think it's good to keep him informed, but I wasn’t looking for him to be overly involved. If I was formally classified as a diabetic, it would be more clear to me that a doctor would add value.

So at this point I don’t think I need a doctor unless you can tell me what value they would bring to this?

 

[dnfuss]

Why get a doctor involved in this and what value does a doctor provide? When I think of getting a doctor involved in my health, I think it’s for one of a couple of reasons.

• Doctors can write prescriptions that you need for insurance to pay for things.
• Doctors can write prescriptions that you might need to get drugs that are difficult to buy without a prescription.
• Doctors might have specialized knowledge that would help direct health care.
• Doctors have skills like performing surgery or doing an ultrasound guided cortisone injection that are beyond the ability of home health care.
• MRI’s, x-rays and other procedures can’t be ordered by private individuals and you need a technician / doctor to interpret the results. (Though the doctor seems to depend a lot on the MRI technician to tell them what an MRI is indicating. X-ray, mri, calcium scan, etc.)

I can order an OGTT test myself, if I don’t meet the insurance requirements (ADA party line?) that suggests I need diabetic care, then a doctor’s prescription can still be filled but won’t be paid for by insurance.

I can get metformin from a Defy doctor or can order it without a script over the internet.

I would tell my doctor what I was doing, maybe he would add some useful advice and I think it's good to keep him informed, but I wasn’t looking for him to be overly involved. If I was formally classified as a diabetic, it would be more clear to me that a doctor would add value.

So at this point I don’t think I need a doctor unless you can tell me what value they would bring to this?

I had just assumed you might have a doctor who you were seeing on a regular basis. If you can order an OGTT on your own, that's fine. A metformin prescription probably would be covered by insurance even without a diagnosis of diabetes (my insurance has done so), but generic metformin is so cheap that it's not a big deal if it's not covered. Other diabetes meds are another story. Many types of insulin, e.g., are very pricey without good insurance coverage.

With good information you can certainly direct your own care. I would again strongly recommend to you the book "Diabetes Solution" by Dr. Richard Bernstein. Some parts of the book pertain more to Type 1 diabetics who are on insulin, but there is still a wealth of knowledge there.

Don't get too hung up on the concept of "formally classified as a diabetic." Once one starts to exhibit other than truly normal blood sugars it is only prudent to take steps to bring them under control, however you want to classify yourself. The ADA's implicit position that pre-diabetes is benign and that nothing can/should be done to treat it is unfortunate. Pre-diabetes is better thought of as simply "mild diabetes."

Once you have your OGTT results, you can decide what if anything you want to do about them. If you have questions, I'd be more than happy to offer help if it's wanted, but again definitely suggest you take a look at Dr. Bernstein's book.

 

[DragonBits]

Doubt it's the triglycerides; that's not really been demonstrated. Simpler explanation is that it's probably just that a huge carbohydrate load that's digesting over an extended period. From a blood sugar perspective, pizza is really just a giant piece of bread with toppings on it.

Got the book, it’s good, a little overly focused on those with really high BG over 200-400 and those taking insulin. Huge focus on carbohydrates. Not so much on people like myself with FBG of around 100 (+/- 9).

On page 42 of the book by Dr. Bernstein.
“(Transient insulin resistance can be created in laboratory animals by injection triglyceride-fat-directly into the liver’s blood supply.)”

Also, even small amounts of alcohol seem to cause big spikes in triglyceride levels. I did have a beer with the pizza. Double the trouble?

I had just assumed you might have a doctor who you were seeing on a regular basis.

I do have a doctor, I will likely see him on a regular basis, but you should know better not to use such vague language.

I intend to see this doc once a year for a physical / blood test, or if I think I have a more immediate problem like a persistent sinus infection I had, I make an appointment.

I have had this current doctor since Dec 2017, and so far I like him and will try and keep him. But no doubt you mean more frequent visits. The doctor before this was last seen in Aug 2016. He changed insurance groups, changed office location, my insurance at the time was not compatible, now that I am on Medicare I could go to him, but I wasn’t that impressed with him in the first place.

I self-directed my medical care like ordering blood tests and being on TRT for ~15 years with no insurance, so I got accustomed to it.

Don't get too hung up on the concept of "formally classified as a diabetic." Once one starts to exhibit other than truly normal blood sugars it is only prudent to take steps to bring them under control, however you want to classify yourself. The ADA's implicit position that pre-diabetes is benign and that nothing can/should be done to treat it is unfortunate. Pre-diabetes is better thought of as simply "mild diabetes."

I don’t get hung up on it, but insurance companies and most doctors do tend to get hung up on formal classifications. I haven’t talked to my current doc, but my guess is he would be concerned as he is kind a holistic doctor and wanted me to keep a food diary for him. Though my FBG was 99 on 1-5-2018 he was more concerned with lipid profile (triglycerides ) and c-reactive protein, he has yet to see my recent blood tests.

Another thing missing from Bernstein’s book, he talks about doing the c-peptide test but NOT about doing an insulin test. For me, an insulin test is more appropriated since I don’t inject insulin.

I was surprised on page 149 of Dr. Bernstein’s book a list of acceptable sweeteners included saccharin, sucralose, and aspartame. True they are don’t contain carbs, but this concerned me.
=============================================================
Segal and Elinav added saccharin, sucralose, or aspartame to the drinking water of mice and found that their blood sugar levels were higher than those of mice who drank sugar water -- no matter whether the animals were on a normal diet or a high-fat diet.

Finally, the researchers recruited seven volunteers, five men and two women, who normally didn’t eat or drink products with artificial sweeteners and followed them for a week, tracking their blood sugar levels. The volunteers were given the FDA’s maximum acceptable daily intake of saccharin from day two through day seven. By the end of the week, blood sugar levels had risen in four of the seven people. Transfers of feces from people whose blood sugar rose increased blood sugar in mice, more evidence that the artificial sweetener had changed the gut bacteria.

“It’s small,” Obin said of the seven-person study, “but it’s very, very profound.”

https://www.webmd.com/diet/news/20140917/artificial-sweeteners-blood-sugar#1

 

[dnfuss]

Got the book, it’s good, a little overly focused on those with really high BG over 200-400 and those taking insulin. Huge focus on carbohydrates. Not so much on people like myself with FBG of around 100 (+/- 9).

Lots of focus on insulin use because it's tough to manage and critical to those who need it (many Type 2s and all Type 1s). The rest of the book applies to those like yourself, especially the focus on carbohydrates. No one with blood sugar control issues will ever achieve truly normal blood sugars without limiting carbohydrates.

On page 42 of the book by Dr. Bernstein.
“(Transient insulin resistance can be created in laboratory animals by injection triglyceride-fat-directly into the liver’s blood supply.)”

Also, even small amounts of alcohol seem to cause big spikes in triglyceride levels. I did have a beer with the pizza. Double the trouble?

High carbohydrate intake and alcohol can raise triglycerides. Fats alone do not. Triglycerides are part of the chain of hepatic blood sugar production, but the beginning of the process is carbohydrates, not fats.

I do have a doctor, I will likely see him on a regular basis, but you should know better not to use such vague language.

I just said I assumed you had a doctor, lots of people do, pretty reasonable assumption. If you don't have one involved, that's fine, too, as long as you can get any desired insurance coverage, etc. I made a reasonable but, as it turns out, incorrect assumption, but don't see where I used vague language.

I self-directed my medical care like ordering blood tests and being on TRT for ~15 years with no insurance, so I got accustomed to it.

If that works for you, great.

I don’t get hung up on it, but insurance companies and most doctors do tend to get hung up on formal classifications. I haven’t talked to my current doc, but my guess is he would be concerned as he is kind a holistic doctor and wanted me to keep a food diary for him. Though my FBG was 99 on 1-5-2018 he was more concerned with lipid profile (triglycerides ) and c-reactive protein, he has yet to see my recent blood tests.

So if you do want to work with him, discuss your observations and see if he'll order an OGTT and go from there. C-reactive protein is a marker. There are no studies indicating that reducing it per se has any positive effect on actual health outcomes (as opposed to other markers). There is, however, tremendous clinical evidence that normalizing blood sugars will prevent diabetic complications. The two main things that reduce triglycerides are lowering carbohydrate intake and reducing/eliminating alcohol consumption.

Another thing missing from Bernstein’s book, he talks about doing the c-peptide test but NOT about doing an insulin test. For me, an insulin test is more appropriated since I don’t inject insulin.

Yes, C-peptide is valuable for Type 1s and very advanced Type 2s in gauging how much insulin their bodies may or may not be making, in effect trying to see how much beta cell function is left. I agree that it probably isn't indicated for you. He doesn't discuss testing insulin because it doesn't really tell you anything actionable. I.e., so you find your insulin level is "x," how would that change your treatment?

I was surprised on page 149 of Dr. Bernstein’s book a list of acceptable sweeteners included saccharin, sucralose, and aspartame. True they are don’t contain carbs, but this concerned me.
=============================================================
Segal and Elinav added saccharin, sucralose, or aspartame to the drinking water of mice and found that their blood sugar levels were higher than those of mice who drank sugar water -- no matter whether the animals were on a normal diet or a high-fat diet.

Finally, the researchers recruited seven volunteers, five men and two women, who normally didn’t eat or drink products with artificial sweeteners and followed them for a week, tracking their blood sugar levels. The volunteers were given the FDA’s maximum acceptable daily intake of saccharin from day two through day seven. By the end of the week, blood sugar levels had risen in four of the seven people. Transfers of feces from people whose blood sugar rose increased blood sugar in mice, more evidence that the artificial sweetener had changed the gut bacteria.

“It’s small,” Obin said of the seven-person study, “but it’s very, very profound.”

https://www.webmd.com/diet/news/20140917/artificial-sweeteners-blood-sugar#1

Sigh. I read the paper (couldn't see the raw data because it's only available in the online version of the journal which costs $200 to access). The primary study subjects were mice, with the human portion as an adjunct, and was focused on changes to the gut microbiota. You can't know what the rise in blood sugar was without access to the raw data, but I doubt it was meaningful (and don't know composition of artificial sweetener matrix used, see caveat in following paragraph). The sample size (seven subjects) was way too small to be useful. And Obin, quoted in the last line of text, had no connection to the study whatsoever, he just read it. I wouldn't attach any significance to this study, and to my knowledge its conclusions regarding human blood glucose response to artificial sweeteners has not been reproduced.

But if you're concerned, do what millions of diabetics do every day, drink a beverage containing artificial sweetener and see what it does to your blood sugar in contrast to what drinking one without sweetener does. The overwhelming consensus from diabetics who do this is that artificial sweeteners do not raise their blood sugars. But you have to be careful. Look more closely at Dr. Bernstein's book. As he points out, most of the artificial sweeteners you see in packets actually contain some dextrose (sugar)! Less than in a sugar packet, but not none. It is not an amount that matters to those with normal blood sugars, but it matters to diabetics. If you are trying to manage your blood sugars and use artificial sweeteners, read Dr. Bernstein's book regarding how to do so. I don't use sweeteners in my coffee, etc., so I haven't had to pay close attention to this.

 

[DragonBits]

dnfuss

Rather than quote everything, I am just going to give a generate reply since you are the only one I am chatting about this subject.

Artificial sweetener:

The problem with drink a beverage containing artificial sweetener and then testing BG, it's a stupid test.

I can readily see it will not affect BG. Even if the theory is 100% correct about them affecting the microbiota.

Because it takes weeks for your gut microbiota to change, it isn't an immediate response. (And some take probiotics, who know if this counters the problem?)

I get concerned because I do drink a lot of diet soda, and it has never seemed to really help me lose weight. At best it's just a lot of chemicals that hopefully isn't harmful used to deliver caffeine. (But it's hard to stop.)

On testing Insulin levels:

One thing I wanted to know about testing insulin, how much insulin am I producing? Is my BG high because of lack of insulin or insulin resistance? The one time I did test fasting insulin levels it was 12.1 uIU/dl, which is high for fasting insulin levels. So one can deduce I am insulin resistant, though the OGTT w/insulin test would give more precise numbers and any possible variation.

If I am insulin resistant, then losing weight should help a lot, if I don't produce enough insulin then it's a different and more serious problem. (or some combination of the two)

Lower carb diet:

I am fully convinced lowering carbs will lower BG, but how much do I need to lower carbs in my situation? I don't want to go to a 30 gram per day total unless I absolutely have to.

Last night I ate 12 bugger king chicken nuggets and a small couple of oz piece of apple strudel, probably about 85-90 grams of carbohydrates total for that one meal, an hour later my BG was 126, I took a short walk for 15 min, BG was 114 after that, when I woke up it was 89. That seems reasonable to me.

I just baked the apple strudel because I had it frozen and my mother likes it and I was curious how it would affect my BG.

alcohol:

I don't drink enough alcohol to really affect anything longer term, at most 2 beers a week or a margarita with mexican food, sometimes nothing at all for weeks.

Future:

Next I have to eat a large buffet dinner to see how that affects my BG Or rather how high it gets.

The good news for me, I am down from 168 > 162, all fat maybe added in a few lbs of muscle. My first pass goal is ~150 lbs.