People following a low-carb nutritional protocol have reported better results then slgt2/glp1 inhibitors alone, especially when considering muscle wasting (a ketogenic intervention usually gains muscle)
The muscle loss is thought to be due to nutritional deficits rather then the drugs themselves. Since you said your eating a balanced diet - does that mean your getting 2g per kg of ideal body weight complete (ASF or high DIAAS) protein per day?
CICO is technically true, but not clinically relevant - the carbohydrate model of obesity has more clinical impact. I can send over the paper if you want the details but if the bodies hormones are allowed to operate normally (without elevated insulin) the normal hunger and satisfaction signals are sufficient to get healthy.
Are you measuring your muscle over time? With a inbody scale, or dexa scan? That can be helpful
As far as I’m aware a low carbohydrate diet can be combined with the drugs
Update
Sauna use has been associated with muscle retention in people who don’t exercise, this is wild speculation on my part, but the slgt2/glp1 drug muscle loss may be attenuated by frequent sauna use - if you have it available
People following a low-carb nutritional protocol have reported better results then slgt2/glp1 inhibitors alone, especially when considering muscle wasting (a ketogenic intervention usually gains muscle)
I agree that carbs aren’t great, but they do have their place and can be vital to overcoming diabetes in some patients.
The muscle loss is thought to be due to nutritional deficits rather then the drugs themselves. Since you said your eating a balanced diet - does that mean your getting 2g per kg of ideal body weight complete (ASF or high DIAAS) protein per day?
Probably not to be honest. I’m struggling to get enough protein.
the carbohydrate model of obesity has more clinical impact.
What is this?
I can send over the paper if you want the details
Please do
Are you measuring your muscle over time? With a inbody scale, or dexa scan? That can be helpful
I haven’t. I’ve never even heard of a dexa scale.
As far as I’m aware a low carbohydrate diet can be combined with the drugs
I think, especially in a cooler climate such as the UK, low carbs makes sense as your body doesn’t have the sun to burn through the carbs (and starch) as efficiently.
Sauna use has been associated with muscle retention in people who don’t exercise, this is wild speculation on my part, but the slgt2/glp1 drug muscle loss may be attenuated by frequent sauna use - if you have it available
I’ve actually been thinking about visiting a sauna, so this is timely advice, thank you.
I agree that carbs aren’t great, but they do have their place and can be vital to overcoming diabetes in some patients.
I’m aware of the Randel cycle (not a cycle) and how the potato/mcdougal/rice diets can help some people reduce their insulin resistance. However, I don’t think there is any necessity for a carbohydrate in human nutrition, at least not published in literature. In so far as some low glycemic carbohydrates can help a patient displace more glycemic carbohydrates I would agree it is a valid tool. If we look at type 2 diabetes as a state of carbohydrate intolerance (which it really is because of blood glucose being driven directly by carbohydrate consumption) then it is not advisable for any type 2 diabetic to incorporate carbohydrates in their protocol.
I really need to move my notes off of lemm.ee this weekend. TLDR on the paper insulin is the driver of obesity, reducing insulin is the solution to obesity (allowing the body to enact its amazing homeostasis capabilites)
I haven’t. I’ve never even heard of a dexa scale.
You can use any capacitive scale that estimates muscle mass to give you a broad indicator of progression or retention. Inbody scanners are fairly common at gyms, some places have dexa body composition scanners which are even more complete, but any measurement from any system is good enough here to milestone progression. It could even be weekly hand grip strength measurements.
I think, especially in a cooler climate such as the UK, low carbs makes sense as your body doesn’t have the sun to burn through the carbs (and starch) as efficiently.
I’m not familiar with any mechanism between sunlight and carbohydrate mobilization. Perhaps just warmer climates make being outside nicer so people are more active?
I’ve actually been thinking about visiting a sauna, so this is timely advice, thank you.
Start slow! and enjoy it (make sure not to take your glasses into the sauna, I melted mine).
Happy to talk at length and get into the details about any of the above.
TLDR: DKA and Ketosis are distinct biological states, and eating carbohydrates does not provide a benefit in avoiding DKA. i.e. DKA is resolved with insulin and not injecting/consuming glucose.
Update - Above you said your on a SLGT2 inhibitor, which does decrease insulin levels, so there is a DKA risk with that medication by itself, with your KPD condition I agree its probably not great to combine SLGT2i medication and a strict ketogenic diet
3.5.2.2.2 Medications that increase ketoacidosis risk - SGLT2 inhibitors: These medications carry a risk of euglycaemic ketoacidosis. TCR alone cannot cause ketoacidosis, but it may enhance the risk posed by SGLT2i by lowering insulin concentrations because insulin inhibits ketone formation. SGLT2i-induced ketoacidosis may occur with normal BG concentrations, and this heightens the risk of ketoacidosis going unrecognised. It is worth noting that a VLCD (typically less than 50 g of carbohydrate a day) can produce a physiologically normal state of
ketosis, that should not be confused with the pathological state of diabetic ketoacidosis. Despite recent literature supporting slight cardiovascular risk reduction and renal protection of SGLT2i, it is recommended that SGLT2i are used with caution in those adhering to a low carbohydrate eating plan. It is appropriate to stop SGLT2i in many cases, particularly in those adhering to a VLCD (30–50 g/day). A GLP-1 agonist is a safer choice as a second-line agent after metformin. See Murray et al. [299] for an excellent review of the physiology of an LCD mimicking many effects of SGLT2i - From Ketogenic :
The Science of Therapeutic Carbohydrate Restriction in Human Health
Full disclosure I run the !ketogenic@dubvee.org and !carnivore@dubvee.org communities, so I have quite the bias.
People following a low-carb nutritional protocol have reported better results then slgt2/glp1 inhibitors alone, especially when considering muscle wasting (a ketogenic intervention usually gains muscle)
The muscle loss is thought to be due to nutritional deficits rather then the drugs themselves. Since you said your eating a balanced diet - does that mean your getting 2g per kg of ideal body weight complete (ASF or high DIAAS) protein per day?
CICO is technically true, but not clinically relevant - the carbohydrate model of obesity has more clinical impact. I can send over the paper if you want the details but if the bodies hormones are allowed to operate normally (without elevated insulin) the normal hunger and satisfaction signals are sufficient to get healthy.
Are you measuring your muscle over time? With a inbody scale, or dexa scan? That can be helpful
As far as I’m aware a low carbohydrate diet can be combined with the drugs
Update
I agree that carbs aren’t great, but they do have their place and can be vital to overcoming diabetes in some patients.
Probably not to be honest. I’m struggling to get enough protein.
What is this?
Please do
I haven’t. I’ve never even heard of a dexa scale.
I think, especially in a cooler climate such as the UK, low carbs makes sense as your body doesn’t have the sun to burn through the carbs (and starch) as efficiently.
I’ve actually been thinking about visiting a sauna, so this is timely advice, thank you.
I’m aware of the Randel cycle (not a cycle) and how the potato/mcdougal/rice diets can help some people reduce their insulin resistance. However, I don’t think there is any necessity for a carbohydrate in human nutrition, at least not published in literature. In so far as some low glycemic carbohydrates can help a patient displace more glycemic carbohydrates I would agree it is a valid tool. If we look at type 2 diabetes as a state of carbohydrate intolerance (which it really is because of blood glucose being driven directly by carbohydrate consumption) then it is not advisable for any type 2 diabetic to incorporate carbohydrates in their protocol.
This is a interesting paper (and my notes) on the absolute requirements of carbohydrates in human nutrition: Paper - Confronting myths: relative and absolute requirements of dietary carbohydrates and glucose as metabolic fuels. - 2024
Fight fight!
Paper - The Carbohydrate-Insulin Model of Obesity - Beyond “Calories In, Calories Out” - 2018
I really need to move my notes off of lemm.ee this weekend. TLDR on the paper insulin is the driver of obesity, reducing insulin is the solution to obesity (allowing the body to enact its amazing homeostasis capabilites)
You can use any capacitive scale that estimates muscle mass to give you a broad indicator of progression or retention. Inbody scanners are fairly common at gyms, some places have dexa body composition scanners which are even more complete, but any measurement from any system is good enough here to milestone progression. It could even be weekly hand grip strength measurements.
I’m not familiar with any mechanism between sunlight and carbohydrate mobilization. Perhaps just warmer climates make being outside nicer so people are more active?
Start slow! and enjoy it (make sure not to take your glasses into the sauna, I melted mine).
Happy to talk at length and get into the details about any of the above.
This is interesting, thanks for sharing. Sadly a keto diet is beyond me as I suffer from KPD.
Always happy to share! I’m genuinely happy you read what i wrote!
KPD https://en.wikipedia.org/wiki/Ketosis-prone_diabetes ?
You might find this interesting Ketosis, ketoacidosis and very-low-calorie diets: putting the record straight - 2011
TLDR: DKA and Ketosis are distinct biological states, and eating carbohydrates does not provide a benefit in avoiding DKA. i.e. DKA is resolved with insulin and not injecting/consuming glucose.
Update - Above you said your on a SLGT2 inhibitor, which does decrease insulin levels, so there is a DKA risk with that medication by itself, with your KPD condition I agree its probably not great to combine SLGT2i medication and a strict ketogenic diet