@Timothy - blood pH is buffered and is essentially unchanged for individuals in nutritional ketosis.
Individuals who follow a low-carbohydrate diet will also develop ketosis. This induced ketosis is sometimes called nutritional ketosis, but the level of ketone body concentrations are on the order of 0.5–5 mM/L whereas the pathological ketoacidosis is 15–25 mM/L.
Hi David,
I hear you and am having a similar issue. I’m going in and out of ketosis, exercising daily, and taking Metformin and ozempic. I’ve had success with a recent A1C reading of 4.8, and am really wanting to drop or reduce meds. I also worry about kidneys.
My doc is quite traditional and wants me to stay on meds. I feel my numbers are due more to ketosis and walking.
I don’t have any advice other than you’re not alone with not knowing! My instinct is saying to skip or reduce Metformin and see how it goes. We can always ramp bank up again, right?
I wish Atlanta had a Jason Fung or a guy with similar knowledge to The Diet Doctor. Speaking of the diet doctor one of his podcast episodes discusses higher BG readings during ketosis.
Best,
Julie
Dear Julie, thank you for sharing your information. I have in fact reduced my Metformin down to one 500 mg tablet a day. I take that only to please my doctor, as my A1Cs are normal. Most doctors have experience only with people in glycolysis, since most people eat the carbs that are the primary food that is sold in stores today.
Given that the people they know about are abnormal with respect to diet, no wonder they see type 2 diabetes as one of the most common diseases, and see medicines as the most important of treatments for that disease. It is a rare patient who does enough research on their own to learn enough about ketosis.
And, and just speaking for myself, if it weren’t for all the delicious artificially sweetened food products now available to those with diabetes, I would probably be on the usual type 2 diabetes roller coaster of increasing my medications steadily all the way down to death, since I cannot live without my sweets.
David, I’m curious if you have seen an improvement in your eGFR on keto. There are some studies on it.
jack16, I’m not really pursuing tests for kidney function. Still discouraged after my cancer treatments left me with 50% kidney function. I doubt that this will be restored by ketosis, as I can’t see any medical rationale for this.
I’d keep reading. it’s not hard to include kidney function in a blood test.
https://scholar.google.com.au/scholar?q=kidney+disease++ketogenic&hl=en&as_sdt=0&as_vis=1&oi=scholart
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0018604
Dear jack16, Of course I get creatinine and BUN tests about twice a year. But I’m lucky if they don’t show a decrease in kidney function. They certainly do not show an increase in kidney function due to my ketogenic diet.
Thank you for this interesting paper. As to my peripheral neuropathy, I initially had numbness in both feet as a result of a high carbohydrate, low fat diet. This is what initially brought me to medications. The numbness has gradually improved as a result of my ketogenic diet, but it has plateaued at its current level, which is an anount of numbness that is not distracting and not a problem for me.
My cancer treatments two years ago also caused peripheral neuropathy, mostly in my hands with sensations of pins and needles, and that has almost entirely disappeared since, as it does for many cancer patients.
As with so many human effects, good statistics are usually necessary to discover what interventions actually help, and to what degree.
Some interventions are so effective as to allow generalizations, such as that a ketogenic diet will usually get type 2 diabetes and insulin resistance under good control without the need for medications in just few months. This generalization is confirmed by each new study done, and only disputed by studies with questionable experimental design.
The generalizations you have made so far do not fall within that same category. We cannot say that a ketogenic diet, in general, will improve kidney function or eliminate neuropathy. Such effects are only seen statistically, not in everyone.
Thanks for the feedback, I’m glad your neuropathy has settled and the kidneys aren’t getting worse. They might do a full human study one day. It’s hard getting funding, when there is nothing to sell.
Amen.
I thought Metformin was supposed to lower blood sugars and reduced insulin resistance?
From my own experience and my reading, I would say that the effects of Metformin depend on the patient. Also, that it has fewer unwanted side effects than most medicines. If a patient has recently been diagnosed with type 2 diabetes, they are most likely not demonstrating very much insulin resistance and a small amount of Metformin should produce a good effect.
However, with a “regular” American diet, high in carbohydrates, protein, and fats, insulin resistance will most likely increase with time, requiring higher doses of Metformin to keep the blood glucose in the normal range. Think of carbs as poisonous in such cases.
Eventually other medicines will have to be added, and finally the patient will require ever-increasing amounts of insulin, due to the increasing insulin resistance.
There can be a plateau where medications can stabilize, otherwise the end result can be loss of feet and vision due to reduced circulation or neuropathy, and eventually an early death. This is why a ketogenic diet is so exciting and important for public health.
The statements made in this posting are my opinions, not medical advice. See a knowledgeable doctor for accurate information. Do not start this or any diet or other major life change without informing your doctor.
Always work with a doctor if you wish to try a ketogenic diet, and make sure you take good vitamin and other supplementation when you change your metabolism type from glycolysis to ketosis.