Post-Low-Carb Meal 5-Hour Glucose Tolerance Test Produces Rather Odd Results

My arm had so much blood sucked out of it for these tests

I just returned late on Thursday from my 3-hour trip up I-85 North to Durham, North Carolina to spend some time with the Triangle (and Beyond) Low-Carb Meetup group there as well as seeing a great low-carb doctor from Duke University named Dr. Eric Westman to conduct some tests and talk about my recent blood sugar woes and pesky 30-pound weight gain in 2008 that won't come back down again no matter what I do. It was a good time away although I missed blogging and updating you about the healthy low-carb lifestyle. And I'll be leaving again on Tuesday to go see my brother Kevin in Pensacola, Florida for at least a week where I will have ZERO Internet access besides my iPhone (and, no offense, but I ain't up for blogging on that thing with the hunt and peck typing!), so I'll be trying to squeeze in as many posts as I can before then. It's gonna stay busy for me the next couple of months.

But so many of you have been wondering about how my visit with Dr. Westman went that I wanted to make sure I provided an update, especially with the results from my five-hour glucose tolerance test (GTT) following a low-carb meal which was conducted on Monday. If you thought my home testing of my blood sugars was interesting enough, just wait until I tell you what happened during the GTT. Unbelievably crazy! I'll share more about that in a moment.

First, let's look at the bazillion other tests Dr. Westman ran for me to see if there are other culprits going on with my health. A few of these I requested done because Dr. Keith Berkowitz (who I will be sharing a special two-part follow-up podcast interview with the first week in August about this answering your questions), who espouses the "reactive hypoglycemia" theory for long-term low-carbers, suggested I have them run.

Here were the results:

Vitamin B-12--529 (normal)
Cortisol--8.9 (surprisingly normal)
Homocysteine--6.7 (normal)
25-Hydroxyvitamin D3--42 (normal)
HbA1c--5.0 (a little low, but normal)
LDL particle number--1453 (borderline high)
Small LDL particle number--30 (low is less than 600!)

By all accounts of these tests, I'm one extremely healthy guy! My thyroid function was all fine and so was my liver function. So it's good we can rule those out as culprits. I was quite frankly shocked to see my cortisol levels in the good range considering all the stress I've experienced lately, but this just confirms my body handles it all very well apparently. The A1c number was also encouraging since it is so spectacular and out of the diabetic range completely (although Dr. Berkowitz thinks it is a little low--a sign of the reactive hypglycemia according to him).

My LDL and total cholesterol are higher than normal as I've previously blogged, but look at the particle number of the dangerous "small" LDL--a measly little 30! That's just 0.02 percent of my total LDL particle number...in other words, quite negligible and protective considering over 95 percent of my LDL particle size is the large, fluffy kind. :D I'm not at all worried about my lipid profile with my HDL at 65 and triglycerides at 77. That's an HDL/triglycerides ratio I'd put up against anybody else's every day of the week.

Alright, so what the heck is going on with my blood sugars? And, more importantly, what is happening with my insulin levels when my blood sugar drops even after a low-carb meal? Inquiring minds, myself included, sincerely want to know. Here are the results of my GTT after eating a low-carb breakfast consisting of eggs and cheese with a chicken breast from Chick-Fil-A:

TIME--GLUCOSE--INSULIN
FASTING--87--4.4
30 MIN--89--13.7
1 HOUR--78--11.1
2 HOUR--78--9.0
3 HOUR--89--5.1
4 HOUR--87--5.0
5 HOUR--89--4.7

Fascinating test, huh? And it's just about what I expected was happening. My fasting glucose and insulin levels are perfect, but within a half hour of eating even a low-carb meal I'm seeing a TRIPLING in my insulin levels to keep my blood sugars in check. This would be a typical response if my insulin then came back down again within the first hour or two, but it doesn't.

As you can see, the insulin sustains at that higher level for two hours lingering at 13.7 then slowly dropping to 11.1 and then hitting 9.0 before dropping back down significantly in the third hour to get closer to baseline. During this time of elevated insulin, my blood sugar falls below fasting down about 10 points before rising back to where it started once the insulin comes down again. A normal response would show blood sugars going up quickly and then falling quickly, but not for Jimmy Moore. Lucky me, eh?

So what am I to make of this and what plan of action does Dr. Westman and his colleagues suggest I implement to limit this insulin response so that maybe I can get my recent weight gain to come back down again? I wish I could tell you it's a pretty cut and dry "do this and all will be well" solution, but it's not. The reality is I need to tweak this slowly by only changing one thing at a time. That one thing for me will include eating LESS protein than I have been and watching my specific portions of protein and overall intake just to see if it makes a difference.

Yes, I know cutting portions and even counting calories is almost taboo to talk about within low-carb circles and I'm not interested in that debate right now because I'm not fully convinced of it. Only time will tell. I haven't once counted calories or measured out my portion sizes in the past four and a half years of livin' la vida low-carb, so this is a tough sell for me. But I'm certainly game for doing something different to get my weight to come back down again, especially that little bit that has come back to my midsection.

Interestingly, Dr. Westman suggested I cut back on the amount of protein I have been consuming because it is possible that my body through gluconeogenesis is converting much of the dietary protein I have been consuming into glucose/sugar/carbs which COULD be the reason why I haven't been able to get my weight back down again. And this theory certainly has some merit since I consciously increased my protein intake when I started lifting weights for the first time in December 2007 shortly before my weight gain.

Sure, I also took creatine in the first six weeks and that may have had some impact on the weight gain. But consuming more protein-based foods in an effort to help with my muscle growth could have sabotaged my weight maintenance efforts somewhat. Although I have experienced quite an increase in the amount of muscle on my body after six months of training, it's not implausible that upwards of half of that weight gain is indeed muscle mass. The rest of the 15 or so pounds of weight I have put on over this period of time may be the result of excess glucose from protein.

Beginning yesterday, I started adding in more fat and deliberately trying to eat less total protein (not as a percentage, but overall) to see if it makes a difference. One way I'm doing this is to make sure any protein source I am eating is offset by an addition of more fat. For example, if I'm eating a chicken breast that is basically all protein and little fat, I'll slather it in butter and add cheese on top. Cheese in the form of brie or other fatty ones as a meal will also be a way to increase my fat while decreasing my protein. Cooking eggs in butter and adding cheese also will help with this. Nuts, coconut oil, heavy cream, and other high-fat foods will become more and more prevalent in my low-carb menus.

Since I already eat most of those foods anyway, this shouldn't be difficult to implement. Simply cutting back on protein could be as simple as eating half a steak or only one burger patty or chicken breast. Making sure I contribute fat and fiber to my meals will keep that ratio of fat to protein at the 3-1 ratio I am hoping to attain. Carbs, of course, will remain reduced to basically non-starchy, green leafy veggies.

What do you think about all of this? I'd love to know what you think about the results of my GTT. I'm also frightened to think what would happen if I did a traditional GTT with a glass of sugar water--EEEK! My insulin would go even MORE berserk! Your thoughts as always are welcomed. :)