Addendum, Addendum

So, a brief addendum to my addendum. 

I purposely steered clear of insulin in the rundown of hormones related to hunger, as this hobbyhorse has kind of been ridden to death over the years.  However, while searching for the links on my last post I came across a new (to me) blogger, Butter Bob, with some very interesting information about abnormal insulin response.  Bob Briggs has made an incredible journey (he lost 150 pound in a little over a years time) and is sharing some great information.  Here is the post, 'Why Are Fat People Hungry?'.

What particularly caught my attention is about midway down the blog post, in the discussion and graphs of observations by Dr. Joseph Kraft regarding abnormal insulin response.  While most of us are familiar with the idea of chronic elevated insulin, insulin resistance and it's contribution to metabolic syndrome, the graphs of normal vs. elevated insulin response are fascinating.  Dr. Kraft's profiles of abnormal insulin response help us begin to see part of the framework for why some people seem to be more sensitive to carbohydrates in their diet, and find it so difficult to tap into the stored energy in fat cells, leading to 'unusually' elevated hunger between meals.  This may also explain why some people find a low carb/high fat diet to be particularly beneficial.

To quote:  "Two people sit down to eat a meal, one might have a normal insulin response to that meal that will leave them back to normal fasting insulin levels in 3 hours. And they won’t get a very high insulin level even after they eat.  The other one might have higher insulin levels BEFORE they even start eating and after they eat, their insulin numbers might be as high as three times the amount as their normal eating partner and they might not be back at normal fasting levels for 5 hours or more. Some of them, because they remain hungry even after eating because of this high insulin response, will snack, these people will almost never be at normal fasting insulin levels.  One important note, Dr. Kraft tested the low carbohydrate diet and found that it can change these abnormally high insulin patterns to a normal insulin pattern within a years time."

The blog post is actually a transcript of his YouTube video, which I've embedded below.  No doubt I will be referencing his videos/blog posts in the future. . .

 

Future posts:  I've been working intermittently (heh!) on a post about intermittent fasting (as a weight loss tool and as a tool to reduce inflammation), as well as a post about the role of nutritional ketosis in exercise and how ketosis has worked for me in regards exercise/mountain biking this summer (hint, the post title is "Nutritional Ketosis = Jet Fuel").

 

 

My Blood Work

Edited to correct HDL reference range and add footnotes found in my blood work results - apparently someone was too impatient to get out and mountain bike and forgot to check their work :)

So, in my last post I mentioned the 'helpful' email I received from my insurance company *rolls eyes*; they are so 'helpful' that they are now requiring you to meet their health standards score to save money on your insurance premiums.  You are scored based on your blood pressure, LDL cholesterol, glucose, triglycerides and tobacco use status; if you do not meet a minimum target score, or improve your score next year, your premiums go up.  My indignation over this Big Brother approach and whether it is reasonable, is fodder for another time; I thought some might be interested my blood work as a real life long term paleo/low-carber (sorry, I've only got the last two years on hand). . . 

 

For context - my diet has been 'paleo' for over seven years now, low carb-ish without carb counting; I've entered my diet into FitDay randomly over the years to see where all the values were falling out, but my diet is pretty consistent, so I don't track day-to-day.  Last fall (again, for context after my 2014 blood work) I made some minor changes in my diet to shift into nutritional ketosis, confirmed via urine test strips - or, as I saw in a comment the other day, measuring my peetones - heh!  Slightly less protein and slightly more fats, primarily from avocado, macadamias, coconut oil and butter; no significant changes in my produce consumption, as I was already fairly low-carb. 

 

As for exercise, at the same time that I started a paleo diet, I started weight lifting again.  My experience is that weight lifting is VERY beneficial for my rheumatoid arthritis - likely every bit as crucial as diet; in a future post, I'll discuss more. . .  I started out with pretty low weights, but seven years later, I am lifting literally three times as much weight as I was in the beginning (woot!); lifting sessions are typically 20-30 minutes in duration.  I also started mountain biking again about four years ago.  I ride or lift, on average, four to five days a week.  In the deep winter, when the local trails are trashed due to weather, I mostly lift with an occasional ride here and there when the ground is frozen solid.  In the summer, I mostly ride, with one or two weight lifting sessions a week.    Also, I'd like to note for anyone interested, in shifting my diet toward nutritional ketosis I did not experience any noticeable difference in my exercise performance. 

 

On to the numbers! 

 

Total Cholesterol

2014        2015          Reference Range

186          198            100-199

 

LDL

2014        2015           RR

87            108             0-99

 

VLDL

2014        2015           RR

17            11                5-40

 

HDL

2014       2015            RR

82           79                greater than 59

 

T. Chol./HDL Ratio

2014       2015           RR

2.3          2.5              0.0-4.4
 

Triglycerides

2014        2015         RR

86            54             0-149

 

Glucose

2014        2015         RR

101          103           65-99

 

Hemoglobin A1c

2014        2015         RR

5.4           5.5            4.8-5.6

Footnotes found in my blood work:

**According to ATP-III Guidelines, HDL-C greater than 59 mg/dL is considered a negative risk factor for CHD (coronary heart disease).

**T.Chol./HDL Ratio
    CHD Risk
    1/2 Average Risk    Men-3.4   Women-3.3
          Average Risk    Men-5.0   Women-4.4
    2X Average Risk    Men-9.6   Women-7.1

**Hemoglobin A1c
    Increased risk for diabetes:  5.7 - 6.4

    Diabetes:  greater than 6.4
 

So, I'm thrilled with the lower triglyceride and VLDL numbers.  HDL is still nicely in the very high numbers, keeping my Total Cholesterol/HDL ratio low.  The LDL is outside of the lab reference range, but still below the lower target number of 130 used by the insurance company, so I wasn't penalized for that; it's a shame that they don't include HDL or the Total Cholesterol/HDL ratio in their scoring.  I was penalized for having high blood glucose.  I'm not terribly thrilled with the glucose number, although such numbers are not unusual for those who are very low carb (VLC) and/or in nutritional ketosis.  Peter, Mark and Robb have all blogged about this phenomena. 

It is my understanding that this can be 'fixed' by eating a more moderate carbohydrate diet for a short period, which could be a strategy for next year's blood work to ensure I stay within the insurance company's target score and don't end up getting nailed with higher premiums.  I'm well within the overall target score this year, so there's that. . . On the other hand, I would have expected the A1c number to be a bit lower, and the elevated blood glucose still gives me the willies. . . I know Dr. Terry Wahls advocates a ketogenic diet for a variety of reasons - time to reread that section of her book and confirm whether I want to continue with nutritional ketosis or drop back to my 'normal' low-carb paleo diet. 

In any case, Happy Spring all!  The local trails are finally in good shape and although the weather isn't quite so warm as last weekend, the sun is out - I'm off to ride!