Can type 2 diabetes return if you add carbs back in? Do you need to take supplements on a low-carb diet? And do you need to have high ketone readings to lose weight?
Get the answers to these questions in this week's Q&A with me.
Please note that these answers do not constitute medical advice, and no doctor-patient relationship is established. These answers are for general information purposes, and you should discuss any changes with your healthcare provider.
Can type 2 diabetes return?
I'm a 45-year-old male with a sedentary lifestyle. In June this year, I'd had type 2 diabetes for four years, with a hemoglobin A1c (HbA1c) of 12.5%, elevated liver enzymes, total cholesterol of 270 mg/dl (7 mmol/L), high blood pressure with an average reading of 140/90, and weighed 212 pounds (96 kilos) at the height of 5 feet 9 inches (175 centimeters).To improve my health, I started fasting, completely stopped all sorts of sugars and salt and started taking Metformin 500 milligrams once a day. No change in my sedentary lifestyle, though.
Today, in November 2020, I weigh 150 pounds (68 kilos), my HbA1c is 4.7%, my total cholesterol is 160 mg/dl (4.1 mmol/L), my LDL cholesterol is 117 mg/dl (3 mmol/L), my liver enzymes are normal, and my hypertension is gone and averaging 120/80. I feel younger and am full of energy.
However, I notice that occasionally my fasting sugar (after about 12 hours of fasting) is 101-103 mg/dl (5.7 mmol/L). Why is that so? Am I still pre-diabetic?
Secondly, I'm worried that once I start moving to a normal carb diet, my type 2 diabetes will return!
I'm still taking Metformin 500 milligrams once a day. Shall I continue or leave it?
Hi Syed.
I think you are correct to be concerned about having a recurrence of diabetes if you go back to a high-carb diet. Your body has already proven that it is prone to developing type 2 diabetes on a high-carb diet, so why would it be different now?
This is part of the controversy of whether we should say we "reversed" type 2 diabetes or put it in "remission." Whatever term we use, I think the key is that it's not a forever cure. But if someone continues to follow a low-carb diet, it is unlikely that it will ever return.
Best,
Dr. Bret Scher
Should I take supplements when following a low-carb diet?
There are many opinions on whether a person should supplement with vitamins, minerals, fish oil, etc., in the low-carb/keto/carnivore community. Some say we're routinely deficient in vitamins K2, D3, magnesium, and omega 3's in our diet. Others, like Dr. Ted Naiman, say they don't take any supplements. Those trying to slow/reverse CAC scores seem to be advised to take the cocktail of supplements I mentioned above. How should we think about this?Hi Michael.
I think you worded that very well: "There are many opinions..."
Unfortunately, that's what it comes down to, opinions, not scientific evidence. That makes it very hard to know what is "correct."
Much of it will have to do with your version of a keto diet. Do you include veggies? How much? Do you include seafood? How much? What type of eggs do you eat and how much? All of those play into deciding if you would potentially benefit from supplements. A simple rule is that the more restrictive a diet is, the more likely you may benefit from supplements. But if someone is eating a variety of above-ground veggies, nuts, seeds, fish, dairy, eggs, and meat, then the need for supplements is much less than if someone is vegan, or only eats muscle meat or someone who doesn't eat any fish.
Best,
Dr. Bret Scher
How can I increase my ketone reading?
Hi,I've been following a keto diet for seven months to lose weight. I'm restricting carbs to 20 grams per day. Despite this, my ketone reading - using the Keto-Mojo ketone meter - rarely exceeds 1.0 mmol/L. My weight loss has also slowed down, and over the last two months, I have only lost 2 pounds (0.85 kilos) per month despite my calorie intake and activity staying the same. Am I right in believing that a higher level of ketosis would translate into more weight loss? If this is right, how can I deepen my ketosis?
Hi Pia.
That is a great question and a common misunderstanding. There is no evidence to suggest that higher ketone readings mean "better" ketosis or that higher readings are better for weight loss. It is true that anecdotally some people notice better weight loss with higher ketones, but that is far from consistent and is not supported by scientific evidence.
Here is a guide on breaking a weight loss stall, and here is one that describes the concept of "optimal ketosis" is more detail.
I hope that helps!
Best,
Dr. Bret Scher
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