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. :)

An Enigmatic Quandary About Having An IVF/ICSI Baby

It's been a little more than a week since I've updated you on where my wife Christine and I are in our decision about what to do regarding having a baby. With terms like infertility, IVF, and donor sperm becoming a natural part of our lexicon these days, the exceptional response that so many of you have offered us has been tremendous. THANK YOU to everyone who has offered your opinions and we appreciate the incredible feedback.

Here's what has happened since the last update:

I went back to the reproductive endocrinologist for another semen analysis to see if there was ANY WAY POSSIBLE to have a baby using my sperm. The prospects were grim according to the two previous test results which yielded 4% and 0% quality sperm respectively. So I wasn't holding out much hope.

But imagine my surprise when the doctor said they found 8% motility (sperm that moved) which statistically is not that much different from the 4% since we are talking about MILLIONS of sperm. They like to see 50% motility for sperm to naturally do their thing and make babies naturally. While statistically it is possible since there are a little less than a million sperm that are motile, the likelihood of that happening is about as good as getting struck by lightning.

And yet there is GOOD NEWS in this now--the numbers are at least high enough that I can have MY BABY with Christine! Well, maybe. It will depend on that process called in vitro fertilization (IVF) and another specialized procedure called intracytoplasmic sperm injection (ICSI) (where the good sperm is injected into the middle of the egg to see if an embryo can be created from a fertilized egg). Since my quality sperm is so severely low, this is the ONLY way outside of that very small chance that one of my swimmers will find a way to reach Christine's eggs. While physically possible, it is probably unlikely. So IVF/ICSI is basically our primary pathway for having a baby produced by both of us.

We've had all the tests done which include an infectious diseases panel, the Anti-Mullerian Hormone (AMH) test (important blood test for measuring the follicles in the ovaries to determine if a woman can make babies--high AMH levels indicate a condition known as polycystic ovarian sydrome, aka PCOS, something livin' la vida low-carb has been known to help with), general hormone testing for Christine, semen analysis for me, a sonohysterogram to see Christine's ovaries on an ultrasound, and probably a few other one I just don't remember at this point. Each of these tests have been adding up the costs into the thousands of dollars already.

Now we face an enigmatic quandary about having an IVF/ICSI baby and WE WANT YOUR HELP. You've been such an amazing resource for us so far and we are facing a fast-approaching deadline for our decision (coming no later than November 14th!). If you have been through an IVF and/or ICSI cycle, whether you were successful or not, and would be willing to have us call you to talk about it, then please e-mail me your name and phone number at livinlowcarbman@charter.net. We have some very difficult issues to work through that only someone who has gone through before could possibly understand (it's back to that "shared human experience" thing again!).

The major issue right now is money. I know, it shouldn't be a concern when you are talking about the process of having your baby, but I'm trying to separate myself emotionally from this right now. It's easy to see how people get sucked into this without really thinking it through first. I don't have anything against reproductive endocrinologists who do what they do, but it's easy to manipulate helpless couples into making choices they probably shouldn't make.

With that said, the fact is this IVF/ICSI procedure is going to be VERY expensive. Because this is a specialized procedure and involves some highly sophisticated technologies, just doing this alone costs $12,000-15,000. That doesn't count all the drugs they put you on, these tests we've been doing, and then all the pre-natal care leading up to the birth that is quite costly, too. It's a lot to think about.

Worst of all, the money is due in full BEFORE they will even begin the process. I understand the reasoning for doing that because they want to make sure they get paid since there's no turning back once that wheel starts rolling since you can't take the baby away once it starts growing inside the mother. The doctor has to take care of his own best interests and that is completely understandable.

Our particular reproductive endocrinologist has something called an IVF Refund plan that we are considering as a possible option. You receive 3 IVF cycles and 3 Frozen Embryo Tranfers (FET) to try to get pregnant. They push this one hard to couples who are desperate for a child, but have been unable to do so yet. It is supposed to give you "peace of mind" about the decision, but I'm not convinced yet of that personally (so much for the "peace of mind" part).

Supposedly it gives you a 90% refund if you are not "pregnant" after those three attempts which is an incredible marketing tool for them. You know they HOPE you get pregnant on the first try so they can get more money out of you. I hate feeling this way, but I'm just naturally skeptical about these kind of things. The cost of the "guarantee" is more than double what one cycle would be--in excess of $25,000. So, basically, you pay for two IVF cycles and get one free if the first two don't work.

Then, my concern about this "guarantee" is in their definition of "pregnant?" It is quite possible that Christine could be pregnant by their legal standards, but then never have the baby itself. I asked our doctor about the number of successful IVF cycles that resulted in a baby at his office over the past year (the only REAL measure of success in my eyes) and he said it's about 50%. Our prospect for having a baby with this method is about as good as it is not. Is it worth taking out the equivalent of a luxury car payment loan to MAYBE have our baby?

The worst case scenario with doing this in my mind is getting stuck with a $600-700 monthly payment for the next five years for...nothing. No baby. No return on that investment. Nothing but heartache and more pain. And the vision of some doctor getting rich off the hopes and dreams of a couple who just wants to have a child of their own to hold, love, and cherish. The guy's probably a good man, but you can't help but think these kind of things.

By the way, why is this process so freakin' expensive anyway? What do all those thousands of dollars go towards paying? Where do people with modest to lower incomes go when they want to have a child, too? The answer is they don't have that opportunity. And our doctor's office says most health insurance companies won't pay a dime for it either! Sheez! This royally sucks!

On the other hand, the best case scenario is we have a beautiful baby (or multiple babies!) of our own and gladly pay that monthly payment for a child we can love and raise (we even started looking at names over the weekend). Christine and I have talked about the "cheaper" options like donor sperm and she is dead set against it since it is physically possible for us to have OUR baby.

So the only real decision we have on the table right now is this: Do we take the chance that we will have a baby using this method with the risk that we may not and be stuck with a monthly reminder into our 40's that we couldn't have a baby?

Again, it is very difficult for me to remove myself from this emotionally which I have tried to do as much as possible. But we earnestly want to hear from anyone who has been through this decision-making process to give us your wisdom and knowledge before we make our decision. Ultimately we will do what is right for us, but I trust and appreciate anyone who wishes to help us. Send us your phone number if we can speak with you sometime this week. This decision needs to happen no later than Friday, so time is of the essence.

Here are some more e-mails I received from my readers about our situation:

Jimmy,

I just read your blog post about the problems you and Christine are having with conceiving. I truly, in my heart, believe that there is a reason for everything we encounter in life. I am not good at putting into words how I feel about something but, here goes.

When I was 13 days old, my life began. I had been put up for adoption by my biological parents and that is the day my "real" parents took me home. Both of my sisters and I were adopted from the same place, The Edna Gladney Home in Ft. Worth, Texas. I believe today it is just called Gladney.

Had God not known what good, loving people my parents were, he would not have lead them down that path. It takes special people to take a child into their home that is not their biological child, and love that child as if they were their own. Many, many children living with their biological parents today do not experience that kind of unconditional love and sadly never will.

I know who my biological parents are. I know where they live, I know their phone numbers. I have not and will not make the call to either one of them. I am one of the seemingly few adoptees in today's society that honestly isn't even curious about them. God gave me the parents I had. The best parents that ever walked the face of the earth. The most loving, caring, attentive, willing to do what ever it took to give us a good life, people He could find for us. How special is that!? Even now, 16 years after the death of my father and 1 year after the death of my mother, I have no intention of making those phone calls.

I don't know you and Christine personally, but from what I have seen and read in the short time I have been introduced to the work you have done, you and Christine are cut from the same cloth as my parents. Your love of life, Christian beliefs and obvious love for each other flows outward from each and every post, pod cast, blog post and video you make.

If you cannot have children of your own, please don't forget that possibly God has other plans for you and Christine. There may be a child somewhere that desperately needs you to love them, care for them, teach them, grow with them and just be there for them. A child whose biological parents can not or will not. A child like I was.

God Bless you and be with you during this difficult time.
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I was adopted at birth and want to make a good case for adoption. I was adopted by people who wanted me very badly and they gave me the best life they could. Though I found my natural family when I was 29 and I became close to my natural mother and brother and sister (my father could never bring himself to meet with me), my adoptive parents will always be mom and dad to me.

Jimmy, knowing you to the extent that I do, I'm sure you would love an adopted child as your own blood. So you may consider adoption as one alternative. The difficulty is that adoption isn't as easy as it was in 1949, and you may have to accept a child that doesn't come from the same socioeconomic background as you and Christine, or a child of a different race, indeed from a foreign country.

I think it is very wise, Jimmy, not to rush into anything, and particularly not out of any sense of desperation. Try to keep in mind and heart, as I try to and don't always succeed, that you and Christine are each complete, as you are, with or without children.

A little more on the matter of being adopted: I didn't mention that being an adopted child, as loved as I was, was not without its odd feelings of insecurity and curiosity from time to time. But kids have such feelings for any number of reasons. I was not athletic, whereas my adopted father was, for example.

Incidentally, I later found out that my natural parents were too young to keep me, had conceived me out of wedlock, but I believe that they wanted me, but my father's parents who insisted that I be given up. How ironic since after I was born and given up, they pushed my father and mother into getting married, whence I have a full blood sister and brother from that union. It was absolutely stunning to meet them when I was 29.
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Many of my ‘infertile’ clients have conceived using the protocol listed below:

1) coenzyme Q10, which protects against reactive oxygen species in the spermatic membranes, significantly increases motility in infertile men, improves fertilization rates, and increases sperm count and motility; 600mg per day in divided doses

2) Arginine, a precursor of several compounds thought to play a role in sperm motility 3000mg (3 grams) per day in divided doses on an empty stomach

High dietary levels of arginine and/or ornithine may cause reactivation of latent herpes viruses in a few susceptible individuals. If this occurs, discontinue use. Herpes Viruses are also ‘cold sores’ that occur in and your mouth. So if you get these often, arginine is not recommended.

3) Carnitine, which plays several roles in the development of healthy spermatozoa and has been shown to increase sperm count and motility. 1500 mg (1.5 grams)per day in divided doses on an empty stomach

All of these will greatly increase sperm mobility and count.
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Hi, Jimmy--

I have read your online book and am a low-carber. I am also an IVF nurse. After reading thru your blog I felt like I needed to respond.

First, let me say that I know how difficult the journey is, I live it with people everyday. Second, please know that there is a huge variation of advise and techniques available depending on what clinic you go to. Our clinic, for instance has a national/internaitonal reputation and we see patients from around the country and the world. Many have been treated elsewhere unsuccessfully before they reach us.

This is really not a sales pitch for my clinic. But as another writer observed, most men only need a relative few sperm of their own to be able to father a child using the latest techniques of recovery and fertilization but not all labs have the tools or the personnel.

I am not anti-adoption by any means, and it is a good choice for some people. But it is difficult choice to give up your own biology. Maybe you're not quite at the point where you have to give that up.
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Dear Jimmy,

I recently discovered your blog from the writings of Dana Carpender. I am a long term low carber, been at it since 2002. I remember well the hoopla there was when Gary Taubes first wrote 'What's if it's all been a big fat lie'?; I remember waiting at my computer hoping that Dr. Atkins would recover from his ultimately fatal fall and I remember the low carb marketing mania of 2004. However unbelievably I just discovered you :)! I love your writing style and am in the process of trying to get through all your backdated blogs.

I was saddened to read about you and your wife's battle with infertility. I have PCOS and endometriosis so know what it's like to battle with an unwilling body. I am not currently trying to conceive but I chart my cycles. From this I can see that conceiving may not be the easiest for me.

As well as being a low carb diet fan I am also a big fan of alternative remedies and have found them to be very helpful for my own ailments. I found this website that features a doctor who is well known in the U.K. and Ireland and has had great success getting people pregnant by giving them megadoses of vitamins and overhauling their diet. She's more of a moderate carb, low saturated fat type but I do agree with her policies re: soy, caffeine, alcohol, organics and omega 3's.

Anyway I hope that things look up for you guys. I am from Ireland by the way and adore your Southern accent. It's my favourite accent in the world!

Keep the comments coming and God bless you guys for your loving support. We appreciate you more than we could ever tell you. :)