I am currently "researching", learning all this stuff. So I guess take it with lots of caution?
Since you asked, this is headlines of most of what I figured out:
* Your main goals should be achieving metabolic flexibility, eliminating most of the "bad" stuff (sugars, processed oils, most carbs, etc.), supplying your body with mitochondrial decouplers daily and doing low level aerobic exercise, consistently.
* If you feel hungry at any time you are doing something wrong.
* If you feel cold due to lower basal metabolic rate at any time you are doing something wrong (most likely restricting calories in an improper way).
* Metabolic flexibility means you can can easily get into and out of fasting. You are not driven by hunger and can easily continue your life (work, exercise, etc.) with or without meals, without detriment. This is typically achieved by periods of ample food as well as periods of fasting (calorie restriction is not fasting). On a daily basis you can restrict your eating window to 4-6 hours. On longer scale it is useful to do periodic changes to your diet (for example intermittent fasting with restricted carbs and calories for 2 months, then follow with 2 weeks of higher calories and carbs).
* Bad stuff are sugars and almost everything that is highly processed, refined, enriched, etc. Meat from unhealthy, stressed animals. Getting rid of all or almost all carbs is desirable as long as some carbs are in the diet from time to time to exercise your insulin.
* Mitochondrial decouplers are substances that cause your mitochondria to waste energy. Wasted energy is heat. For example (I think...) by supplying myself with mitochondrial decouplers I have shifted my temperature comfort level by about 5C. I can now walk, run, sleep, work at about 5C lower that I did before at the same comfort level. What are mitochondrial decouplers -- polyphenols, medium chain triglycerides, caffeine, ketone bodies, etc.
* Low intensity training (I started running about 30 minutes daily at conversational pace) causes your body to develop more mitochondria. More mitochondria present better opportunity for the body to waste heat as well as host of other useful adaptations. You don't have to be running -- taking a brisk walk after your last meal of the day is a fantastic way of getting some activity as well as efficiently clearing blood sugar and improving effective insulin sensitivity (insulin sensitivity is your ability to clear blood sugars, exercise does not improve insulin sensitivity directly but helps clear the sugar making it as if insulin was more effective).
* Exposing body to cold. You don't need to start getting cold therapies -- if you live in colder climate like me it is enough to just not avoid cold at all cost. I am running daily regardless of weather and I am wearing clothes just enough to get mostly comfortable after say 15 minutes of running in -2C but maybe a little cold at the start.
* Consistently good night of sleep is a must.
* High stress can cause blood sugar and insulin resistance. Body reacts to stress by releasing sugar (to prepare you for effort). But chronic stress causes chronic blood sugar causes chronic insulin causes you getting fat and unhealthy.
* Carbs cause insulin (duh) which causes:
** fat in your fat stores being unavailable to your body as an energy resource,
** when the fat stored in your body is unavailable to your body you will be hungry even in the presence of hundreds of thousands of calories on you (which is crazy if you think about it),
** your brain is built to seek more carbs when you get hungry.
* Fats don't make you fat. People on keto diets quit keto when they finish losing weight because they find they are unable to eat so many calories as fats and they consistently undereat or change their diets unwittingly.
* If you have to eat carbs, make effort to reduce their impact. Never eat "naked" carbs -- preceding carbs with fats and/or protein can significantly lower glycemic index. Preceding fats with acids deactivates enzymes in your saliva that cause about 40% of carb digestion in your stomach -- effectively lowering glycemic index (sushi has only 40% of glycemic index of same portion of plain rice -- due to rice vinegar added to the sushi rice). Taking a walk right after carb meal helps body clear blood sugar faster (for example 20 minute brisk walk right after a meal can shorten aftereffects of the meal from 5 to 3 hours).
> (insulin sensitivity is your ability to clear blood sugars, exercise does not improve insulin sensitivity directly but helps clear the sugar making it as if insulin was more effective).
Can you elaborate? As far as I'm aware exercise (even moderate) does indeed increase insulin sensitivity. I was told so by my doctor and as type 1 diabetic with 24/7 glucose monitoring sensor I can "see" this. A day long hike (not intense, just long) does incredibly things to my required insulin dosage. It can go down to mere 10% the amount of insulin per carbs that I usually use. Now of course some of this is due to the exercise itself and the muscles taking in some of that energy. But some should be due to a reduced insulin sensitivity.
Regardless of the type of diabetes you have, your body needs to clear sugar from bloodstream. It really does not matter how this happens, exactly. Insulin performs other functions in your body... but ability to clear sugar is the absolutely most vital concern.
If you can do things that either prevent or clear blood sugar levels from your bloodstream you can technically live without the need for insulin at all.
With a proper diet and discipline you can theoretically even dispense with continuous monitor. What this would require is observing yourself with a monitor while you test your lifestyle choices to validate you are not making mistakes and then stop using it when you trust what you are doing is effective.
Please, do not misconstrue this as an actual medical advice (I am a software developer and definitely no medical education). But if I was type 1 diabetic I would probably try to ensure correct levels of sugar without external insulin. The problem with external insulin is that the dosage is always delayed, it is a point in time and is never perfect. This is not perfect for your health, it is just the best we can.
Now, I would never recommend this to a person I don't know they can be responsible and disciplined enough not to endanger themselves this way. I think this is critical and I also think that unfortunately most people who have diabetes are not fit mentally to do this.
But lowering your blood sugar without insulin would lead to much better results because you would avoid the spikes altogether and you would not risk getting sensitive to insulin from overdosing it.
FYI when I am on keto diet my blood sugar levels are staying consistently low regardless of how much I eat. I have lower blood sugar levels right after a large meal than most people have before the meal(~85mg/dL or 4.7mmol/L after a meal with ~75mg/dL or around 3.9mmol/L before the meal).
I do not plan to stay on keto all the time, I am using it as a tool to build metabolic flexibility. But if I was diabetic I would probably consider keto very seriously to improve my prospects and break dependency on external insulin, constant blood sugar monitoring and every day decisions on what and how much to eat.
I'm afraid but this is a very simplistic view and not how it actually works.
You cannot keep your blood sugar stable by eliminating intake of carbohydrate. Something every diabetic who goes into weight lifting learns really quickly (and is well established in literature and known by doctors): protein will increase your blood sugar. It is a very delayed response (3-5h+) and its amplitude is low but it will happen. The process is called gluconeogenesis. Your body has multiple metabolic pathways to create glucose out of nearly any kind of protein found in your body (figuratively speaking) and will do so even in the presence of enough calories (i.e., this is not a response to malnutrition or under-eating).
And then there are all the hormone-based reactions. The classic obvious culprit for raising blood sugar out of nowhere is of course adrenaline but even many others can do so. Stress reactions and others will do this. The glucose in this case comes from your liver which stores it as glucagon. Note that your liver will store glucagon even when you have no carbohydrate intake. As mentioned above, your body will metabolize it eventually.
Your advice about keto is downright harmful. Type 1 diabetics should not go on a keto diet. This is actively advised against and will lead to coma and death. The reason keto works for healthy people is that they actually do not go 0 on carbohydrate and, therefore, still have some amount of insulin in their blood (also for other reasons). Even vegetables contain small amounts of digestible carbohydrates that will trigger trace amounts of insulin and protein, through the pathway illustrated above, will do so as well.
Please understand that diabetes is an old and very well researched condition. Modern medicine has a trove of long-term detailed data and statistics telling us what works well and will lead to a side-condition-free life in old age and what will lead to long term damage. This is well understood. Contrary to what you suggested, modern diabetes management does not advise to reduce insulin need as much as possible through dietary means for type 1 diabetics.
Edit:
Please note that blood sugar is not a "lower means better" metric. A low blood sugar has risks associated just as high blood sugar has. The "band" of good values is well understood and the headroom "upwards" (i.e., higher than normal values that still won't cause damage) is a lot larger than the headroom "downwards". In fact, standard therapy for diabetics keeps them a little higher than the normal person just for safety reasons. Personally, I stay in a "normal person" range but I also have the luxury of fewer trouble managing my values than others.
> Something every diabetic who goes into weight lifting learns really quickly (and is well established in literature and known by doctors): protein will increase your blood sugar.
It is true that EXCESS protein will be converted to sugars. As long as you limit your protein intake it will be used exclusively for housekeeping. That's why keto diet is not only carb elimination, it is carb elimination WHILE restricting protein to about 30% of your calorie intake.
It is exactly this reason why keto diet is so hard to maintain -- because you have to fill the rest with fat and this is a hard thing to do.
> Please understand that diabetes is an old and very well researched condition.
It is funny that you mention it, because do you know what was the actual first treatment for diabetes? Before they were able to produce insulin?
It was actually eliminating carbs from the diet. Yes, in the past, keto diet was the main (and the only) way to treat diabetes.
>It was actually eliminating carbs from the diet. Yes, in the past, keto diet was the main (and the only) way to treat diabetes.
Except it didn't work. People died. Meanwhile, today, we have a very good understanding about the secondary diseases, long-term damages, and how to prevent those with therapy. And a keto diet is no part of that.
Edit:
>It is true that EXCESS protein will be converted to sugars. As long as you limit your protein intake it will be used exclusively for housekeeping. That's why keto diet is not only carb elimination, it is carb elimination WHILE restricting protein to about 30% of your calorie intake.
While excess protein is indeed converted that way, it will also happen to small amounts of "non-excess" protein. Protein in your body is in a constant flux. Your muscles are not static but undergo constant breakdown and build-up.
While gluconeogenesis can be strongly reduced with dietary restrictions, it cannot be completely stopped. In fact, an important inhibitor to gluconeogenesis is insulin and thus, for a healthy person, consumption of carbohydrates.
This is an awesome list. I listened to an audiobook called "why we get sick" and every known health condition was linked to 'insulin resistance'. I knew eating carbs was bad but it blew my mind.
He even linked prostate cancer to insulin resistence. But unfortunately i checked the references the book and the linked papers didn't really support the case. Even after you get prostate cancer, IGF 1 inhibitors don't seem to do much to slow it down( some small sample studies seem inconclusive https://www.nature.com/articles/s41416-020-0774-1)
As far as I understand there is couple of ways cancers are linked to insulin. Not necessarily insulin resistance but think in terms of things that cause insulin resistance also help cancer grow.
For me the most compelling connection is that people who are likely to develop insulin resistance are also people who are very likely to have relatively little autophagy. Autophagy is a process where your body consumes protein that already exists in your organism. It will consume all sorts of stuff and what is really important is that it will break down abnormal protein like protein that got misfolded.
Autophagy is promoted when you fast for at least 14-18 hours -- but people who are constantly eating when they don't sleep don't ever reach fasting this long.
It is crazy to take a look at how different people look after losing a lot of weight depending on what kind of route they chose. People who lost weight due to intermittent fasting rather than calorie restriction tend too look much better and have much less loose skin. What happens is, due to IF regime their bodies were regularly undergoing autophagy while they were on IF and during autophay they were essentially "eating" their own protein like unnecessary connective tissue, skin, etc.
Without autophagy to periodically clean garbage from your body various unnecessary things just lie there and cause all sorts of mayhem and inflammation. Misfolded protein is potentially carcinogenic because defects in those protein are pretty much random and if a protein gets broken just right it might be causing damage to pretty much anything else. It increases your chance that a random damage can start cancer going somewhere.
Another way insulin might be linked to cancer is that insulin is a growth hormone and cancer is a tissue with abnormal growth. I don't know the details and I know enough to say that insulin does not necessarily cause growth of everything (how fun it would be to get your ABS just by overeating...) But it seems really possible that if cancer is sugar-loving tissue that needs lots of it to grow and insulin tells your cells to take as much sugar from bloodstream as they can then cancer might "be loving it". And also there are some cancer treatments that rely on starving or at least slowing cancer growth with a high ketone and low sugar levels.
Since you asked, this is headlines of most of what I figured out:
* Your main goals should be achieving metabolic flexibility, eliminating most of the "bad" stuff (sugars, processed oils, most carbs, etc.), supplying your body with mitochondrial decouplers daily and doing low level aerobic exercise, consistently.
* If you feel hungry at any time you are doing something wrong.
* If you feel cold due to lower basal metabolic rate at any time you are doing something wrong (most likely restricting calories in an improper way).
* Metabolic flexibility means you can can easily get into and out of fasting. You are not driven by hunger and can easily continue your life (work, exercise, etc.) with or without meals, without detriment. This is typically achieved by periods of ample food as well as periods of fasting (calorie restriction is not fasting). On a daily basis you can restrict your eating window to 4-6 hours. On longer scale it is useful to do periodic changes to your diet (for example intermittent fasting with restricted carbs and calories for 2 months, then follow with 2 weeks of higher calories and carbs).
* Bad stuff are sugars and almost everything that is highly processed, refined, enriched, etc. Meat from unhealthy, stressed animals. Getting rid of all or almost all carbs is desirable as long as some carbs are in the diet from time to time to exercise your insulin.
* Mitochondrial decouplers are substances that cause your mitochondria to waste energy. Wasted energy is heat. For example (I think...) by supplying myself with mitochondrial decouplers I have shifted my temperature comfort level by about 5C. I can now walk, run, sleep, work at about 5C lower that I did before at the same comfort level. What are mitochondrial decouplers -- polyphenols, medium chain triglycerides, caffeine, ketone bodies, etc.
* Low intensity training (I started running about 30 minutes daily at conversational pace) causes your body to develop more mitochondria. More mitochondria present better opportunity for the body to waste heat as well as host of other useful adaptations. You don't have to be running -- taking a brisk walk after your last meal of the day is a fantastic way of getting some activity as well as efficiently clearing blood sugar and improving effective insulin sensitivity (insulin sensitivity is your ability to clear blood sugars, exercise does not improve insulin sensitivity directly but helps clear the sugar making it as if insulin was more effective).
* Exposing body to cold. You don't need to start getting cold therapies -- if you live in colder climate like me it is enough to just not avoid cold at all cost. I am running daily regardless of weather and I am wearing clothes just enough to get mostly comfortable after say 15 minutes of running in -2C but maybe a little cold at the start.
* Consistently good night of sleep is a must.
* High stress can cause blood sugar and insulin resistance. Body reacts to stress by releasing sugar (to prepare you for effort). But chronic stress causes chronic blood sugar causes chronic insulin causes you getting fat and unhealthy.
* Carbs cause insulin (duh) which causes:
** fat in your fat stores being unavailable to your body as an energy resource,
** when the fat stored in your body is unavailable to your body you will be hungry even in the presence of hundreds of thousands of calories on you (which is crazy if you think about it),
** your brain is built to seek more carbs when you get hungry.
* Fats don't make you fat. People on keto diets quit keto when they finish losing weight because they find they are unable to eat so many calories as fats and they consistently undereat or change their diets unwittingly.
* If you have to eat carbs, make effort to reduce their impact. Never eat "naked" carbs -- preceding carbs with fats and/or protein can significantly lower glycemic index. Preceding fats with acids deactivates enzymes in your saliva that cause about 40% of carb digestion in your stomach -- effectively lowering glycemic index (sushi has only 40% of glycemic index of same portion of plain rice -- due to rice vinegar added to the sushi rice). Taking a walk right after carb meal helps body clear blood sugar faster (for example 20 minute brisk walk right after a meal can shorten aftereffects of the meal from 5 to 3 hours).