28 Days of Keto for High Fasting Blood Sugar: My First Update, Revisited

2017-07-31

This was the first one. It wasn't meant as a channel. It was a Facebook Live for friends who were curious about the "weird diet" I'd started, and it shows: no script, and me stopping mid-sentence to say hi to people joining the live.

In this video

[0:00] What keto is (very low carb, high fat) and why I started: my fasting blood glucose was running high for me, and reading led me to low-carb, high-fat eating.
[1:00] Fasting readings had come down from the 120s and 130s to around 100, almost 20 points (video 9Hk0jRb_9Es). I wanted to get consistently under 100. Weight down about 12 pounds, most of it water by my own account.
[1:30] The glycogen-and-water explanation for early weight loss, and my keto flu: energy crashes and poor sleep, no cramps, about 28 days in.
[2:30] Fat bombs (not a fan) and bulletproof coffee (not a believer), though I use heavy cream in coffee.
[3:30] Why keto has to be high fat: I argued there's a ceiling on protein, so the rest of the calories must come from fat.
[4:00] A short case that insulin resistance comes from carb-heavy eating, long eating windows and weight.
[5:00] What I was eating: avocado, tuna salad, chuck roast, London broil with butter, bacon, onion and garlic. No barbecue sauce.
[5:30] Cravings felt psychological (potato chips), not like hunger.
[6:00] Goals: mainly blood sugar, plus getting near 200 lb for an amateur MMA fight.
[6:30] What I liked (alertness, steady energy) and what I missed (potatoes, carrots, bananas).
[7:00] The big one: I was often coming in 800 to 1,000 calories under what my app allowed, without wanting more.

The line that holds up: "I've never been on a diet where I didn't feel hungry"

Looking back, the part of this video that matters most is the last two minutes. Not the glucose numbers, not the food list. The part where I said I was finishing days hundreds of calories short and didn't even want to cook (video 9Hk0jRb_9Es).

I still read it the same way. I didn't say calories stopped mattering. I said (going by the auto-caption) that you theoretically have to restrict calories, but that the studies say appetite works differently on low carb, so you eat less without forcing it (video 9Hk0jRb_9Es). That's the "deficit, not restriction" idea I kept coming back to in the MyFitnessPal video and the realistic-goals video.

The evidence pages don't have a trial on "low carb makes you less hungry" specifically. The closest is on protein: when protein went from 15% to 30% of energy with carbs held constant, people eating as much as they wanted took in 441 fewer calories a day and lost 4.9 kg over 12 weeks (Weigle 2005). That's 19 adults, and it's protein, not carb restriction. So the honest version is: I reported what happened to me, and there's some support for the appetite effect of higher protein. More in why you might not be hungry on keto and the hunger chapter.

On blood sugar, the reason I started: the American Diabetes Association's consensus report says cutting total carbohydrate has the most evidence for improving glycaemia (Evert 2019). If your fasting glucose is high and you're on any glucose-lowering medication, that's exactly why your doctor needs to know before you cut carbs. The drop I was happy about can go too far when a drug is also pushing it down.

The claim worth unpacking: the "protein ceiling"

At [3:30] I explained "high fat" this way: about 220 grams of protein is all you can handle in a day, past that you head toward toxicity your liver and kidneys can't process, so protein tops out near 880 calories and fat has to fill the rest (video 9Hk0jRb_9Es). The arithmetic in the auto-caption gets tangled right after that, so don't try to follow it.

Here's what the evidence pages say, and it doesn't line up with how confidently I said it:

The US reference intake treats protein at 10 to 35% of energy as an acceptable range for adults (IOM 2005).
The European Food Safety Authority describes intakes up to about twice its reference value as regularly eaten and considered safe (EFSA 2012).
A meta-analysis of 28 studies (1,358 people) found higher protein intakes (1.5 g/kg/day or more, or 100 g/day or more) did not change kidney filtration differently in adults without kidney disease (Devries 2018).

So I stated a hard toxicity limit as if it were settled, and none of these sources gives one. What I had right was the shape of it: keto is low carb, protein is moderate, and fat is what's left. Where the kidney part is real is for people who already have kidney disease, and that's a conversation with your doctor, not a forum thread. See too much protein and protein and kidneys.

Then vs now: fat

In this video I called fat bombs gross and a daily 400 to 500 calorie bulletproof coffee "empty calories" (video 9Hk0jRb_9Es). That part never changed; I made a whole video on it days later.

What did change was how much fat I told people to eat. Here, fat is the default that fills the plate. A few weeks later I was telling people to stop eating too much fat (video NUJNFG6lLWw), and by 2018 I described fat as the variable you raise or lower depending on the phase you're in (video UygKGoP_BtA). Same idea as the protein ceiling, really: fat fills in, but it doesn't have to fill everything.

Key points

I started keto for high fasting blood glucose; fasting readings dropped almost 20 points in about four weeks (video 9Hk0jRb_9Es).
About 12 pounds in the first month, most of it water, which is normal early on. See water weight.
My keto flu was energy dips and bad sleep, no cramps. See keto flu.
The best result was not being hungry, and eating under my calorie target without trying.
My "220 g protein ceiling" isn't backed by the evidence pages; healthy kidneys handled higher protein in the trials reviewed. Kidney disease is a different story.
On diabetes or blood pressure medication? Talk to your doctor before cutting carbs.