Carbohydrates and hidden insulin resistance

• The Carb Crisis broadens Why We Get Sick by prioritizing carbohydrate effects beyond calories, including insulin, hunger, and chronic disease. [1][2]
• Prediabetes is diabetes in slow motion. Normal fasting glucose can coexist with elevated insulin until insulin-resistant muscle and liver cannot maintain glucose control even with high insulin.
• The order in which muscle and liver become insulin resistant is unresolved, with no convincing human or animal evidence establishing a fixed sequence.
• High blood glucose triggers insulin-mediated tissue uptake and urinary excretion through the kidneys, unlike high circulating fats or amino acids. Blood glucose is potentially toxic at excessive levels.

Glucose swings, hunger, and GLP-1

• The comparison of 200 calories of cereal with 200 calories of eggs illustrates how a carbohydrate-driven glucose peak and subsequent fall can provoke hunger about 90 minutes later.
• A large glucose rise drives insulin secretion and can cause an overshoot in insulin resistance. Glucose can fall below baseline while insulin suppresses ketone production.
• The brain has high energy requirements and little capacity to store fuel. Low available glucose and ketones generate hunger and cravings despite large body-fat reserves.
• Giving sugar tablets during a hypoglycemic episode can perpetuate a repeating cycle of glucose rises and subsequent falls.
• GLP-1 is a satiety hormone. In a 1996 study, women with obesity had little or no three-hour GLP-1 increase after a carbohydrate meal, although their fat-meal response was similar to that of lean women. [3]
• Identical pasta meals can yield very different fullness in two women; elevated insulin and weak GLP-1 signaling can jointly impair weight control.
• Weight loss from a low-carbohydrate intervention depends on continuation of its supporting habits; returning to previous habits can restore previous weight.

How far to restrict carbohydrate

• Active, muscular people can tolerate more carbohydrates than many people with insulin resistance. Carbohydrate reduction is the initial measure, with 50 g/day an achievable starting target. [1]
• A daily limit of 50 g does not ensure ketosis because insulin responses and metabolic goals vary. A 20 g/day limit can be relevant with low glucose tolerance or neurological goals requiring ketones.
• Bikman’s carbohydrate cutoffs include extrapolation beyond definitive human trials, are not universal, and do not require universal ketosis.
• Bosworth’s patients often have severe insulin resistance and prior unsuccessful diets. Her initial limit is 20 g/day or less of total carbohydrate to support ketone generation; Bikman’s net-versus-total distinction remains unspecified.

Using CGM to judge glucose tolerance

• Continuous glucose monitoring can capture changes missed by fasting glucose. A customary meal with roughly 50–70 g carbohydrate can be evaluated by the peak rise and recovery time.
• A 40–60 mg/dL rise remaining elevated after two hours indicates poor tolerance; a 20 mg/dL rise returning to baseline within two hours indicates moderate tolerance; a 10 mg/dL rise returning within an hour indicates high tolerance.
• High glucose tolerance commonly accompanies substantial muscle and physical activity. Muscle functions as a glucose sink, taking up about 80% of glucose cleared after a carbohydrate-heavy meal in an average person.
• During disease reversal, Bosworth avoids foods that increase glucose more than about 30 mg/dL in the first half-hour, including when levels normalize within two hours. Age, stress, sleep, and illness influence the response.

Protein, dietary fat, and protein sparing

• About 1 g protein per pound of ideal body weight is Bikman’s target for maintaining or building muscle, linked to Stuart Phillips’s human protein work; it does not require forced consumption of protein powders.
• Whole-food protein with natural fat supports digestion. Fat stimulates bile-acid release for both fat and protein digestion; very lean or powdered protein can interfere with the desired hormonal pattern.
• Bikman participated in analysis supporting newer US Dietary Guidelines and disagrees with persistent concerns over dietary fat and continuing saturated-fat limits. [4]
• A documented 382-day fast in a Scottish man illustrates reliance on body-fat reserves and ketogenesis as the distinction between prolonged fasting and starvation. [5]
• Dietary logging misses internal protein recycling through autophagy. Human beta-hydroxybutyrate evidence indicates reduced muscle proteolysis and possible flexibility below the protein target during ketosis.

Ketones for the brain

• Human therapeutic findings involving ketones include seizures, migraines, bipolar disorder, schizophrenia, and Alzheimer’s disease, placing brain health at the center of ketogenic use.
• Concussion can induce brain insulin resistance and reduced fuel availability; ketones supply energy during recovery.
• Ketosis is not universally necessary, but neurological illness is a reason to maintain a supply of ketones.

Reversal, remission, and cravings

• Insulin resistance can reverse on fasting-insulin and HOMA measurements, and type 2 diabetes can improve enough to permit medication discontinuation.
• Reversal depends on continued habits and is not a permanent cure. A return to previous behaviors can rapidly restore insulin resistance, consistent with remission.
• A waist circumference less than half of height corresponds to a waist-to-height ratio below 0.5. Normalizing glucose, HbA1c, CRP, or liver enzymes alone is insufficient to establish recovered carbohydrate tolerance.
• Improved glucose tolerance does not necessarily remove carbohydrate addiction. For some people, carbohydrate exposure can restart cravings and abstinence is easier than perfect moderation; others can eat carbohydrates occasionally without relapse.

Questions after Bikman leaves

• In a mostly carnivore viewer, fasting glucose declined from the low 100s into the 90s and into the 80s after an evening protein snack. Morning ketones and whether the snack is whole food or powder help distinguish greater insulin secretion from improved metabolism.
• Ketogenic eating is Bosworth’s first-line dietary approach for type 2 diabetes, hypertension, gout, and arthritis, with joint pain and swelling improving in four to five weeks.
• Dementia care centers on measurable ketosis beyond low-carbohydrate eating. A published case of a 40-year-old woman with Down syndrome and Alzheimer’s involved cognitive improvement on a ketogenic diet, interpreted by Bosworth as reversal of dementia. [6]
• The liver continues producing bile without a gallbladder. Three successive days of sardines serve as an example of adapting to fatty foods; abrupt high fat intake can cause belching or fatty diarrhea.
• A non-ketogenic chemist took a half dose of exogenous ketones in a single-person demonstration, and his blood ketone meter exceeded its measurement range after 12 minutes.
• Bosworth gained approximately 20 lb over three and a half years despite weekly fasts lasting 60–72 hours. Following a hurricane, earlier meal cessation around 2–3 p.m. and exogenous ketones for hunger accompanied a 20 lb loss over six months.
• Higher morning ketones, lower hunger, better dietary restraint, and increased basal energy expenditure accompanied the change. Exogenous ketones also signal the liver to increase endogenous ketone production without shutting it off.
• A proposed self-experiment uses exogenous ketones at 8 a.m. and noon for 10 days, unchanged other habits, daily morning fasting-ketone measurements, and cessation to test persistence of higher baseline ketones, alongside continued carbohydrate restriction and meal discipline.

References

1. [00:02] The Carb Crisis — https://benbellabooks.com/shop/the-carb-crisis/
2. [00:02] Why We Get Sick — https://benbellabooks.com/shop/why-we-get-sick/
3. [00:13] Attenuated GLP-1 secretion in obesity: cause or consequence? — https://doi.org/10.1136/gut.38.6.916
4. [00:30] Dietary Guidelines for Americans, 2025–2030 — https://cdn.realfood.gov/DGA_508.pdf
5. [00:32] Features of a successful therapeutic fast of 382 days’ duration — https://doi.org/10.1136/pgmj.49.569.203
6. [00:50] Case report: Ketogenic diet acutely improves cognitive function in patient with Down syndrome and Alzheimer’s disease — https://doi.org/10.3389/fpsyt.2022.1085512