2

votes

Advanced Glycation Endproducts & fasting hyperglycemia on the Paleo Diet

Answered on August 19, 2014
Created January 23, 2011 at 2:17 AM

Hi All,

Because the amount of AGE is proportional to serum glucose, and those on prolonged 'low-carb' diets experience some insulin resistance, shouldn't one worry about increased AGE's, like HbA1c, on a low-carb Paleo diet? Although weight loss would temporarily trump this effect, shouldn't the prolonged hyperglycemia be a concern for those who are long-term paleo? Has anyone on it, say, for 5 years after reaching their desired weight had their HbA1c checked?

Thanks for your input,
Mike

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 24, 2011
at 05:59 PM

@Eva & malac: Although one can find a study to support anything, I give the following articles (free on PubMed) to demonstrate that beef stripped of fat and chicken liver can induce insulin secretion. The rule of thumb I remember from medical school is that for every 50 g of dextrose serum insulin doubles. So, these increase are comparable to that of 250g of dextrose assuming a starting insulin level of ~ 5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC292827/?page=3 (gives the insulin increase after protein)

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 24, 2011
at 05:47 PM

@malac: You may be right that I misunderstand Eva's argument. But, you raise an interesting point that I'd like to comment on. Why is it impossible to have high (according to Westerns medicine's tables) glucose on a VLC diet? I understand that, as Kurt Harris says, insulinogenic isn't hyperglycemic. Even so, insulinogenic compounds can be hyperglycemic because they make the sugar stick around longer in the blood. Slower exit can promote the accumulation we would pick up as hyperglycemia. That being said, I think what I just outlined is hypothetical enough to be a subtle chronic effect at best.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 24, 2011
at 05:43 PM

@malac: So if periods of elevated glucose periods do exist, then there could be more AGEs on a low carb diet. Yet, many people's HbA1c goes down on those diets. So, will it start to creep back up, or maybe there are other AGEs that are better to use as proxies.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 24, 2011
at 05:42 PM

@malac: That is the blood glucose is increased after fasting or a low enough carb diet (which as dicsussed on here mimics fasting). You are right that a low-carber could have an exaggerated response to a high-GI meal. But, I'm trying to get a handle on the chronic effect of following a low-carb diet in good faith.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 24, 2011
at 05:39 PM

@malac: In response to your comment on the link I provived, I'm sorry that I didn't indicate where to look. If you scroll down to right above the comments, you will see Stephan speculate that low-carb diets may no necessarily pathologically raise fasting blood glucose. (Bear with me because I know that's not a strong statement.) He links to Chris Kresser http://thehealthyskeptic.org/when-your-%E2%80%9Cnormal%E2%80%9D-blood-sugar-isn%E2%80%99t-normal-part-2 who, a bit before the HbA1C heading postulates the mechanism VLC- > Insulin Resistance -> Hyperglyecmia.

62ed65f3596aa2f62fa1d58a0c09f8c3

(20807)

on January 24, 2011
at 04:22 AM

Individual response to protein and carb intake vary greatly. However, I have yet to see even one incidence of someone eating fat and protein and lowcarb and developing higher than normal blood sugar. I think it's simply a case of the body responding to protein differently than to carb. That is not to say that protein does not stimulate some insulin response, but the majority of studies I have seen have shown that response to be overall well below response to carb. Also, it's just plain hard to eat giant hoards of protein. You get full, but not so with carb.

30fd031cc07a0d7dee7f1cad57f48a0c

(443)

on January 23, 2011
at 04:36 PM

fasting levels for bgc on paleo for most people are 60-70.

30fd031cc07a0d7dee7f1cad57f48a0c

(443)

on January 23, 2011
at 04:35 PM

@mac389 link on robb wolfs site about my wife during our pregnancy (i wrote into his podcast...i had this almost exact argument with a fetal nutritional md and our midwife....the research ( with robb's help) I gave them actually altered their recommendations for nutrition for pregnant women. dont put your cart ahead of the horse... http://robbwolf.com/2010/09/06/gestational-diabetes-what-constitutes-low-blood-sugar/

30fd031cc07a0d7dee7f1cad57f48a0c

(443)

on January 23, 2011
at 04:28 PM

@mac389 I think you misunderstand Eva's post. Protein being insulinogenic does not increase hyperglycemia. By your own response you are stating that tribes that consume pure protein and fat diets would have high blood glucose? this is simply impossible.

30fd031cc07a0d7dee7f1cad57f48a0c

(443)

on January 23, 2011
at 04:26 PM

@mac389 This is a great discussion. That aside, the link you provide (nor does any other information I have ever read or studied) show an association between lowcarb and hyperglycemia. If a low carb-er was to consume a meal of mostly high carb/high GL food then yes...because of the insulin resistance your body will try to hold on to that sugar for a longer time. But during a period of normal low carb eating (which should be most of our diets on paleo) then no elevated glucose periods exist...which essentially dont cause any AGE type products.

30fd031cc07a0d7dee7f1cad57f48a0c

(443)

on January 23, 2011
at 04:25 PM

@mac389 This is a great discussion. That aside, the link you provide (nor does any other information I have ever read or studied) show an association between lowcarb and hyperglycemia. If a low carberer was to consume a meal of mostly high carb/high GL food then yes...because of the insulin resistance your body will try to hold on to that sugar for a longer time. But during a period of normal low carb eating (which should be most of our diets on paleo) then no elevated glucose periods exist...which essentially dont cause any AGE type products.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:55 AM

@malac: I provided link in response to you and James right under my initial question. I'm glad that you are a counterexample to the scenario my question implies. AGEs are good for no-one! I mean to say that hyperglycemia can arise from and be a symptom of insulin resistance. Certainly there are other ways for either to happen.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:53 AM

@PaleoGran: Thanks for the pointer. Peter's thoughts on AGE actually sparked this question. However, I will certainly re-read the posts to make sure that my recall bias isn't skewing this question.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:52 AM

I focus on AGEs because they seem to explain many problems not only in diabetes but also in the 'diseases of civilization' for example, hypertension. They are also incredibly inflammatory especially as the core of atherosclerotic plaques. (Macrophages love sugar.) But, AGEs, like HbA1c, seem to be a function just of average serum glucose level. So, it could cause major problems even if other things are 'dialed in'.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:48 AM

@Eva: Thanks for the detailed answer. Perhaps I worded it poorly, but I wasn't considering diabetes. I was using hyperglycemia just to mean elevated bood glucose. It's also not true that glycemic load needs to decrease on a low-carb diet because some commonly consumed types of protein are as insulinogenic (and prolonged insulin secretion usually leads to insulin insensitivity and hyperglycemia) as high glycemic carbs. (I think this is part of the motivation for Peter's approach.) In any case, my question is that wouldn't someone on a chronic low-carb diet also have hyperglycemia -> AGEs?

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:42 AM

@malac: I meant fasting (as in waking up or after an IF) hyperglycemia that is worse while on a low-carb vs. higher-diet. (By higher carb I mean those like the ones Stephan mentions here- http://wholehealthsource.blogspot.com/2010/11/glucose-tolerance-in-non-industrial.html.)

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:36 AM

@James: Perhaps both too many & too few carbs can cause insulin resistance. Peter at Hyperlipid discussed this (link = http://high-fat-nutrition.blogspot.com/2007/10/physiological-insulin-resistance.html).

30fd031cc07a0d7dee7f1cad57f48a0c

(443)

on January 23, 2011
at 06:50 AM

I have read several sources showing insulin resistance and low carb (its the reason prior to an oral glucose toletance test if you are low carb you must eat high carb for several days prior to testing).....but ive never heard of low carb causing hyperglycemia.

5e36f73c3f95eb4ea13a009f4936449f

(8280)

on January 23, 2011
at 03:59 AM

I've not seen references saying that low carb diets cause insulin resistance. It's the other way around, high carb diets cause insulin resistance. Where are you getting that from?

  • 4e40d2b9e1a762949a25b958762aa10d

    asked by

    (762)
  • Views
    2.7K
  • Last Activity
    1433D AGO
Frontpage book

Get FREE instant access to our Paleo For Beginners Guide & 15 FREE Recipes!

3 Answers

5
62ed65f3596aa2f62fa1d58a0c09f8c3

(20807)

on January 23, 2011
at 07:48 AM

Very low carb does lead to insulin resistance in many people. When glucose intake is low, much of the body's cells convert to fat burning and become more insulin resistant and less ready to take on glucose. THis preserves available glucose for those few cells that require glucose for fuel. This is a natural process and is not the same thing is diabetes/hyperglycemia for several reasons. The first is that it is quickly reversable within a few days by increasing carb intake. Your glucose processing system is still fully adaptable to various conditions the same as any healthy person. It's just that when glucose intake is low, it naturally adapts, but if glucose intake were to rise again, it quickly adapts again.

The other issue is that with true diabetes, your blood glucose is out of control and gets dangerously high. That does not happen with the insulin resistance brought about by very low carb eating because you are not eating large amounts of carbs and your body is adapted to the carb you do eat. So your blood glucose should remain stable and not spike after eating. The exception would be if you surprised the heck out of your body by suddenly pounding down a load of sugar all at once. Because your body had adapted to very low carb, the sudden sugar intake would catch the body flat footed and it would take a few days to fully readapt to higher carb intake.

However, for some few poeple, it does seem that very low carb results in kind of high resting blood glucose numbers, but still, there should be no post meal spikes so peak blood glucose should never pass the normal range. I guess in some people, theoretically this could lead to slightly higher overall blood sugar levels, but only assuming that the person had higher fasting blood glucose but post meal glucose was not lower than previously. However, this would still not be a pathological condition like in true diabetes and the overall blood glucose scores would still be in the healthful.

Fasting blood glucose and response to a sudden glucose load is only part of the condition. THey use those markers as potential warning signs for a person that may have seriously too high blood glucose on a day to day basis. But those with adaptive insulin resistance would not have too high blood glucose on a day to day basis, just maybe slightly higher resting blood glucose. And their blood sugar control mechanisms would still be fully functional according to prevailing conditions.

With very low carb diets, insulin resistance is merely an adaptive mechanism to preserve glucose, whereas with diabetes, it is a breakdown of the system due to overload of glucose. It's like if a truck were sitting idle in the driveway, is it sitting there doing nothing because it has no load to carry and all the work is done, or is it sitting there because the truck is broken and so the load cannot be delivered? The symptom is the same in both situations and so to really understand the true situation, you have to look at the larger picture.

62ed65f3596aa2f62fa1d58a0c09f8c3

(20807)

on January 24, 2011
at 04:22 AM

Individual response to protein and carb intake vary greatly. However, I have yet to see even one incidence of someone eating fat and protein and lowcarb and developing higher than normal blood sugar. I think it's simply a case of the body responding to protein differently than to carb. That is not to say that protein does not stimulate some insulin response, but the majority of studies I have seen have shown that response to be overall well below response to carb. Also, it's just plain hard to eat giant hoards of protein. You get full, but not so with carb.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:48 AM

@Eva: Thanks for the detailed answer. Perhaps I worded it poorly, but I wasn't considering diabetes. I was using hyperglycemia just to mean elevated bood glucose. It's also not true that glycemic load needs to decrease on a low-carb diet because some commonly consumed types of protein are as insulinogenic (and prolonged insulin secretion usually leads to insulin insensitivity and hyperglycemia) as high glycemic carbs. (I think this is part of the motivation for Peter's approach.) In any case, my question is that wouldn't someone on a chronic low-carb diet also have hyperglycemia -> AGEs?

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:52 AM

I focus on AGEs because they seem to explain many problems not only in diabetes but also in the 'diseases of civilization' for example, hypertension. They are also incredibly inflammatory especially as the core of atherosclerotic plaques. (Macrophages love sugar.) But, AGEs, like HbA1c, seem to be a function just of average serum glucose level. So, it could cause major problems even if other things are 'dialed in'.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 24, 2011
at 05:47 PM

@malac: You may be right that I misunderstand Eva's argument. But, you raise an interesting point that I'd like to comment on. Why is it impossible to have high (according to Westerns medicine's tables) glucose on a VLC diet? I understand that, as Kurt Harris says, insulinogenic isn't hyperglycemic. Even so, insulinogenic compounds can be hyperglycemic because they make the sugar stick around longer in the blood. Slower exit can promote the accumulation we would pick up as hyperglycemia. That being said, I think what I just outlined is hypothetical enough to be a subtle chronic effect at best.

30fd031cc07a0d7dee7f1cad57f48a0c

(443)

on January 23, 2011
at 04:28 PM

@mac389 I think you misunderstand Eva's post. Protein being insulinogenic does not increase hyperglycemia. By your own response you are stating that tribes that consume pure protein and fat diets would have high blood glucose? this is simply impossible.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 24, 2011
at 05:59 PM

@Eva & malac: Although one can find a study to support anything, I give the following articles (free on PubMed) to demonstrate that beef stripped of fat and chicken liver can induce insulin secretion. The rule of thumb I remember from medical school is that for every 50 g of dextrose serum insulin doubles. So, these increase are comparable to that of 250g of dextrose assuming a starting insulin level of ~ 5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC292827/?page=3 (gives the insulin increase after protein)

2
D31a2a2d43191b15ca4a1c7ec7d03038

on January 23, 2011
at 02:24 AM

I don't know the answer to your question, but Peter Dobromylskyj discusses such things at his blog, Hyperlipid.

http://high-fat-nutrition.blogspot.com/

He has done a series on AGE. If what you are looking for isn't in the posts, it may be in the comments.

For those not familiar with Peter's writing. He is brilliant, funny, and delightful.

Hope this helps a bit.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:53 AM

@PaleoGran: Thanks for the pointer. Peter's thoughts on AGE actually sparked this question. However, I will certainly re-read the posts to make sure that my recall bias isn't skewing this question.

0
30fd031cc07a0d7dee7f1cad57f48a0c

(443)

on January 23, 2011
at 03:44 AM

Can you provide some links that support your theory that low carb leads to hyperglycemia? I check my BGC on a regular basis (not diabetic just curious) 1 hour after a meal and never find it above 90. I was under the impression that AGE happen somewhere around levels in excess of 120. I am pretty adherent to the paleo diet for the last 3 years and my a1c was 5.2 last month. I think you might be off by stating that insulin resistance is linked to hyperglycemia. You become insulin resistant secondary to your body (CNS) wanting to hold on to the little glucose that you generate via gluconeogenesis on a low carb diet.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 23, 2011
at 11:55 AM

@malac: I provided link in response to you and James right under my initial question. I'm glad that you are a counterexample to the scenario my question implies. AGEs are good for no-one! I mean to say that hyperglycemia can arise from and be a symptom of insulin resistance. Certainly there are other ways for either to happen.

Answer Question


Get FREE instant access to our
Paleo For Beginners Guide & 15 FREE Recipes!