I'm late to the party here, but have to say that this makes complete sense to me. I've been a strict carnivore for a little over two years and I dropped 60 lbs the first year. However I've been on a plateau for the better part of a year. I've recently cut down on the amount of food I'm eating, but not enough to feel deprived. I've also, cautiously, incorporated carbs, in the form of green veggies, into meals, a couple of times a week. I've started losing weight again. I'm definitely going to make a grocery trip for more vegs.

For everyone worried about the Randle Cycle and mitochondrial damage, raw dairy seems to tick every box. You get the slight carb kick, calcium, some protein & fat, and it’s slowly absorbed in such a way that the Randle Cycle isn’t remotely as bad. Have some raw milk.

Another fantastic piece of the metabolic puzzle. Excellent. Dawns on me that if one was needing to "normalize" upcoming bloodwork for the traditionally minded doctor (or insurance application, etc) one could incorporate reasonable carb dosing leading up to the appointment. This way one's exceptional health will not be penalized by the 3d MD practitioner. Keep up the great work!!

This is an evolving situation and I am so glad someone like you that is so intelligent keeps up with the latest info of keto, carnivore, low carb, etc. and how we can tweak the way we eat to have good health. I eat OMAD and have some carbs and my blood sugar can go to 160 but usually I go from 100 to maybe 130 and then back down in a couple hours so I think this is kind of what I am doing. Not a lot, but I definitely trigger insulin and then it comes down like it should. I sensed that we didn't have to aim for no raise of insulin. It will be tricky for each person to find his/her sweet spot. I don't eat a lot of fat either, as I think that can become another extreme that might not do us any favors. I use some cream in my coffee, some butter on my food etc but do not add stuff like fat bombs or on purpose add a lot of fat.

When I first started keto 3 years ago. I read all about how the high carb low fat diet was causing so many problems years after it was introduced. My concern was how do I know that this won’t cause problems years from now. It seemed to me that there could be a pendulum like effect where using fat for fuel could have its own set of problems. So many folks were saying that there is a need to be metabolically flexible but were in a panic if their bs was 130 after a meal. I think using strict keto helps heal a lot of chronic illnesses then adding some form of carbohydrates will assist to being truly metabolically flexible. this video has answered a lot of my questions. Thanks

Thank you for this, Doc! A few years ago my PCP checked my fasting insulin and it was 1.6. Triglycerides 46, HDL 108 and total cholesterol in the high 300's. I was eating about 60g carbs/day and at a normal weight, 130. Life happened, and I ate more carbs and gained about 15 lbs over several years. Now, trying to lose the weight & returning to low carb, I find I can't sleep through the night. I did some research & found that insulin helps regulate serotonin and melatonin and without enough insulin, it screws up your sleep. Tried a self experiment & ate a carb snack after dinner and sleep just fine. Withhold that and I'm lucky to get 5 hours sleep. I never understood all the effects of insulin, so thank you for this video. I'd love to hear your thoughts on how insulin affects hormones that affect sleep which, of course, is also important to good health.

I few years ago I found out that I was insulin resistance and was not feeling good. I started intermittent fasting and clean strict higher fat keto diet. Within a week I was feeling better and in about 3 months I had reversed my insulin resistance and my blood work was back to normal and I was feeling better than ever ! After a year I started adding a few carbs (yams, 92% dark chocolate, berries, organic whole milk in coffee) not all of them every day but maybe 2 or 3 in once a day to maintain metabolic flexibility and it has worked great for me. HDLs up to 80, Triglycerides about 82, LDLs 220, VLDLs about 13 on last blood test. Excellent HDL to Triglycerides ratio. Fasting glucose about 76 to 80, and after a meal with some carbs about 110 to 120 than right back down.

Thank you for this deep dive into insulin, dr. Cywes! This deserves a part 2 if I may be so bold. :) I’ve improved so much on the keto carnivore diet, I have debilitating “incurable” disease so this is my life raft. So I’m very protective of it. I’m still pretty ill but I have improved so much and slowly continue showing improvements 3 years in. But thank you for explaining how insulin is not only an inflammatory hormone. I’ve watched your videos for years and I think I thought insulin was bad because you said so. But it was on the context of obesity meaning hyperinsulinimia (did I get that right?Probably not lol)! Of course insulin is bad when your levels are through the roof. I misunderstood what you have said. And I’m so glad you continue to do videos like this for us. I learn a lot from you. PS: Something on the back of my head always thought dr. Nathasha McBride wasn’t wrong! She was on the carnivore diet before almost everyone and she is for whole milk, yogurt and kefir even for her strictest diet. I am trying yogurt right now and was concerned for my insulin which before the yogurt experiment was 3. Now I have your experience and knowledge to give me more peace of mind. I still have to keep a watchful eye on my ketosis because of my health issue but I am less anxious right now. I deeply appreciate your work and devotion. Thank you. Andrea.

I started readding a bit of potatoes back into my carnivore diet of 11 months because i was starting to feel a bit off, and i noticed that as soon as i started doing this one or twice a week in general i felt much better, and have never had any negative repercussions of adding back in that starch. I had suspicions about this just based on what was happening to me and how i felt on a daily basis. Very informative, thank you Cywes, much love.

This is great, thank you. I adopted a low- to very-low-carb way of eating nearly 7 years ago and now am close to your 95% carnivore diet. I'm a thin female of menopause age (ugh!) and over the last couple of years I noticed some reactive hypoglycemia, where I would get lightheaded after the occasional higher-carb item, such as when celebrating someone's birthday and I partake in a small piece of cake or something (rare). I had the same thought -- I wonder if I should eat slightly more carbs to prevent this. But then something interesting happened. I traveled to a work conference last month at a wonderful hotel. The conference fed us amazing food, and I ate a LOT more artisanal bread, potatoes and fancy dessert than normal, for 3+ days. I was SURE I would gain a few pounds from that, but the opposite occurred - I didn't gain anything and actually dropped a small amount of weight that has stayed off. There was a bit of bloating and gas that I didn't enjoy, though (unpleasant reminders of my past high-carb life) and for general health reasons I feel best when I don't eat that way regularly. I had heard other people say that triggering insulin release occasionally is a good thing. I've been a financial supporter of Dave Feldman for several years and I am very interested in his work, and while I was close to meeting the LMHR criteria for his ongoing study, my LDL wasn't high enough. I now feel pretty good about that, and I have my own n=1 evidence that staying low-carb most of the time, but not all the time, works well for me.

We believed BG elevation triggered insulin telease. But Need to block glucagon to raise insulin. This requires GLP1 from consumed carbs

Great information, as usual, Dr. Cywes. Thank God I'm in your capable hands for when I get to that stage in my journey. Much love & respect.

Being on Keto (70 % Fat, 20 % Protein, 10 % Carbohydrate) and now at my desired weight. I just use 15% creme in my afternoon coffee instead of 35 % like in the morning . A few adjustments to keep the insulin paradox happy. Thank you very much for this important input . Maybe I could add a good glass of South African Red wine as well. Or a good Cabernet Sauvignon White very cold.

That's a great video Doctor Cywes. Leaves me pondering though how adding 100-130 grams of carbs fits into a carb-addiction model.

Thank you for this video. This topic is spot on for me. While on the low carb cruise (May 2022), I asked you a question about being a lean mass hyper responders because I suspected I might be in that category. Three months prior to the low carb cruise, I had a lipid panel which resulted in my doctor suggesting I start a statin. I requested an additional panel be completed in three months so that I could test your answer to my question. After three months of increasing my total carbs from approximately 0-5 per day to 10-20 per day, I improved my lipid panels….however, not sufficient enough for my doctor as he still wanted to prescribe a statin. When the doctor’s office called about picking up the prescription, I indicated that I wanted to discuss the matter with him prior to taking the statin. I have not heard back from him, nor I have even picked up the prescription. Unless you disagree, I believe adding even an additional 10 carbs will improve my panel yet again.

Okay, let's talk about it. It does make me think. I'm 5'4" male, 135 to 137 pounds. Very low carb, keto, carnivore for a good two years. Only whole foods. Last C-Peptide was 1.4. A1C is 5.8. Usually .4 or .5 ketones in the morning. Daily blood sugar about 115. Do I need to eat carbs to arouse insulin to wake up and bring down my A1C? A glass of raw kefir every morning? How about refried beans with my lamb shank? Butter on my sweet potato? I just pray we all don't wind up back on the Good O''l Standard American Diet!

Turned up LMHR added 100-150 g carbs BOOM INSTANT MUSCLE GROWTH!

It took me a couple of listens to understand the nature of concern. I hear that in a somewhat undefined way insulin is a key component of the lipid energy cycle/process that is important to LMHRs. I would think that most would consider this an important item of interest that has been mostly be left out of the discussion. That said...this seems a bifurcation of concerns of high ApoB levels in the bloodstream. 1) The lipid energy model is pointing out that high LDL/ApoB levels is primarily due to a higher fat energy utilization (transport) by the body. The model, from what I can see, is agnostic to the source of the energy or for that matter, the source of ApoB to build the transporters. So a higher burn rate would mean more transporters and a higher measure of ApoB particles. In converse, If ApoB is not available or suppressed, then one would expect some downstream effects, say lack of willful energy. 2) High ApoB/LDL levels could be due to blockage. Receptors are not available or lipoproteins are not able to engage in lipid exchange. If the energy production process keeps pumping out ApoB48 and ApoB100 transporters, then, yeap, we would have a problem....energy toxicity in the bloodstream. And low levels of insulin would exacerbate this problem. But I am not seeing a direct relationship between an increase in lipid energy utilization (and the subsequent increase in ApoB/LDL) and the ability of insulin to effect amino acid use. You seem to be saying the carbohydrates are essential to health 😉😉

Great Video! Thank you so much. I am 74, have always had High cholesterol. Have been carnivore for a year and Keto for 2 yrs. before. Recent blood test (TC 951, Trig 239, HDL 70, VLDL 82, LDL 799 and A1C 5.3.). HOW AM I ALIVE?

This is me to a T. I am 58 and was on a strict carnivore diet w/o any cheating and noticed my energy went from normal to in the trash about 6 months into the carnivore diet. Looks like I need to get my blood work sent to you for analysis. I have introduced a small amount of carbs into my diet in the meantime and do see some improvements, but worried about my liver function/s and how that could be affecting my overall health. I want to personally thank you for your efforts and sharing this so hyper responder people like myself have a chance at improving their longevity.

My triglycerides were 5000. Kidneys failing. T2d. BP 200/110. 1 month later after listening to your program my BP was 120/60 and I had to quit BP meds and stop insulin. 4 months on program now. Down 50 pounds. Ill update on triglycerides as I have appointment soon but I got a good feeling about it. Thanks doc. Your a life saver

Best video on insulin I have seen. T1D for 22 years

This makes so much sense. At the time I was eating a stir fry for one meal and a salad for the second, each with meat, I really lost weight. Since I went pure carnivore, I am carrying fat that just won't go. On the positive side, on pure carnivore my blood pressure is sigifiantly lower and my meds are one quarter. Maybe my penchant for Chinese stir fries are too high in salt. I have been craving a Greek salad. I will reintroduce low arbs. This info could be life saving. Going from fad to knowledge is such a relief. Thank you Dr. Cywes!

That makes so much sense. I love your logical brain and your explanations!

I wish you would address the LMHR and the effect of insulin suppression on glucose and A1C. I've been on keto for two years limiting my total carbs/day to 20 or less. Seven months ago my cholesterol was 530 and LDL 450. I also had my fasting insulin checked. It was 2.6 and my C-peptide, serum was 1.4. So, I elected to start eating more carbs. I went from around 20 total carbs/day to 40-45 total carbs/day. In my recent bloodwork my total cholesterol dropped to 272 and my LDL to 194. However, and this is what doesn't make sense to me, my glucose readings at home are now consistently 98-107. Seven months ago My A1C was 5.1 having fallen from 5.4 a year earlier. Now it's up to 5.43. Why are my glucose levels 98-107 on 40-45 total carbs/day? Why is my A1C rising? I don't feel comfortable with the trend. Any thoughts would be appreciated. Thanks.

I started keto 4 years ago and it got me into the habit of just eating natural wholesome food. It has kind of morphed into eating healthy but still not eating any processed foods, grains or empty carbs. I started adding a little more carrots, potatoes and limited fruit especially since I’ve started powerlifting so I’m feeling great, stronger and my bloodwork is still in line. My 55 year old body/mind is still obedient to a base keto diet but adding just a few more carbs seems quite healthy. I’ve also found that it is ok to have an alcoholic drink from time to time without overdoing it. Thanks Doc!

This just happened to me after being on very low carb keto for 2 years.

As in everything in life, too much or too little is a problem. There’s a sweet spot somewhere in the middle, and only time and experience will help us discover where it is located.

I was wodering what are the other consequences of insulin supression apart from high lipids... Excellent talk

Hi, I do not think insulin suppression increases Chloesterol absorption as the main mechanism. I did an experiment on myself 6 months ago I did a water fast for 11 days, ie no dietary cholesterol intake True and as expected, my insulin went down to 1.2 However, my choesterol and LDL went through the roof but my HDL remain very stable through I lost about 300gm to 500gm a day so autophagy could be one major contributing factor, but I cannot imagine that to be the case entirely. I believe there are other factors at play that requires further discovery

You addressed this to those who have been on the Keto or Carnivore diet for some time. At what point should those who are just starting on the Keto/Carnivore lifestyle take this into consideration? I can't imagine those who are trying to get their numbers under control would want o spike their insilin during these early stages of the diet.

Consumption of sufficient protein should trigger appropriate amount of insulin. Once the body is insulin sensitive, the insulin required is lower but still get sufficient response from the lower circulating insulin. If your theory about too low level of insulin affects muscle growth, then what explains these muscular strict carnivor such as Dr. Shawn Baker, Dr. Anthony Cheiffey ( spelling ?) I am ketovore and close to carnivor 90% of the time, just to see my muscles growth is very good. I don't buy this paradox!

Hi Dr. : For what I understand in this video, insulin suppression is a problem because of high cholesterol , but that is not an issue unless you want to get a new health insurance. IT is simply a matter of numbers in the blood work with no real implication for health.

This makes perfect sense, insulin is necessary--not too little, not too much. God's design is perfect--thank you so much for this info. Dr. Cywes!!

Love your work Doc 🙂 ..love the way you wave you're arms about reminding me of Scotty Kilmer the master of vehicle video's on KZfaq 👍

Excellent! I have been looking for an explanation of this phenomenon. You seem to be describing me to a T. But it also raises practical questions that I would love to see you address in a future video. I think I understand the concept but am unclear about how to monitor this balancing act. How do I know when I need to add carbs back into my ketogenic diet and by how much? Will fasting insulin tests tell me? How do I in practice balance the need to produce insulin by eating carbs while remaining low carb in order to reduce my blood glucose? I think this is very important and would be the subject of a future video that I would value.

my understanding is that High protein levels Will trigger insulin to sufficient levels.

Thank you, Doc, for this wonderful piece. You've been talking about this for a long time now, but every new piece of data you find helps reinforce the message. I've been 13 months into keto/carnivore. I didn't measure my insulin 13 months ago, but my A1c was 5.5%, with a fasting blood glucose of 5.6. 6 months in, my A1c had come down to 5.3%, did not measure fasting blood glucose at the time, but I did measure insulin; and that was less than 1.6 (undetectable). 13 months in, my A1c is still 5.3%, but my fasting blood sugar averages 4.0 - 4.9. My insulin is still less than 1.6 and my C-Peptide is 0.59. But I am not sure I am too worried because my fasting ketones are at 0.9 (which tells me insulin is keeping that under control). While I have lost some 13kg of body fat, I have also put on 2kg of lean muscle in the same 13-month period, which further tells me that insulin is working enough to support muscle protein synthesis. Prior to keto, I was, essentially, pre-diabetic. I was suffering nerve damage (story for another day), despite looking slim (it's easy to hide belly fat when you're tall). I think I am what the good Doc calls a "diabesogenic", where I, genetically, can't make sufficient insulin to gain weight to protect me against hyperglycemia (my mom was the same - she became a full-on Type 2 diabetic while looking skinny and healthy). So I could be wrong, but specifically to me, this tells me that I may not require the presence of significant amounts of insulin in my blood for me to function optimally and healthily, and that despite having insulin blood work of less than 1.6, I am not exhibiting signs or side effects of insulin suppression... well, not in the past year, anyway. That said, I will keep monitoring it with blood work every 6 months, to see whether my very low insulin and C-Peptide is able to maintain or lower my A1c, and keep my fasting glucose well within the 4.0 - 4.9 range, as it's currently doing. I've also done a GAD65 and IA2 Ab test - to check for possible anti bodies that could lead to Type 1 Diabetes, and that came out negative. Suffice it to say, I am an LMHR, with Triglycerides of 0.7, HDL of 2.6 and LDL of 7.4.

How did humans do this before all the sweet foods (20.000 years ago)? All vegetables and fruits we eat have been sugar enhanced compared to their natural equivalents.

you need to invite your carnivore type professional peers to debate this with you. For it's obvious that you're going to have different opinions in that debate. And only then from a well run discussion can everyone learn from each other. To simply lecture to us, mostly a group of non MD's ( even though many here are well read ), WE don't have enough knowledge or experience to really know if what you are professing is valid or not. Open yourself up, ask for other's input, let us see you test the waters of other professionals like yourself. For I can think of a dozen medically trained carnivore types that would love to chime in and sort this out. But, that would take some guts.

I have an appointment with you in January, 2023 and looking forward to it. My blood work looks like a LMHR. My cholesterol is now over 300 and HDL over 100 and they both keep increasing along with LDL too. Triglyceride is below 40. I’m neither keto nor carnivore. I eat more paleo-ish if I had to call it something. I’m very intrigued to learn more about the insulin connection.

I agree. I had this happen in year 2 carnivore so I added dairy that has carbs and it helped. Things like high fat yogurt, cheese, and for kids whole milk.

N=1: Eating an animal-based diet but incorporating small amounts of favorable carbs into it, makes me feel much better than no-carb, physically and mentally. By a mile. In fact, eating this way guarantees my success in eating animal-based.

I’ve been listening … and making sure I spike my insulin some …

Nice to see a proper discussion of insulin. Too many just demonise it. Carnivore is fantastic for healing but long term we need to make some adjustments.

You say around 10:10 that because Lean Mass Hyperresponders have suppressed insulin they don't have good protein synthesis or autophagy. But didn't you say before that insulin blocks autophagy? And isn't low insulin mimicking fasting, thereby enhancing autophagy?

just when we think we know it all!! thank you for your due diligence!

I think this theory needs more study to determine what is happening in Cywes’ observation. Consumption of meat generates insulin production. Ketogenic diets make one insulin sensitive. It is well known that protein raises insulin. We call it gluconeogenesis when too much protein inhibits ketosis, bec the body is turning that protein into fuel. An "Insulin Index of Foods" was published in 1997 which listed 38 foods that produced higher insulin levels. This study and subsequent studies showed that any type of meat (beef, chicken, and pork) produced substantial insulin secretion. "In fact meat protein causes as much insulin release as pure sugar." Meat raised insulin levels higher than a large apple, a cup of oatmeal, a cup and a half of white flour pasta. * Some of protein-rich foods (beef, cheese, eggs) have larger insulin responses per gram than did many of the foods consisting predominately of carbohydrate." * "Carbohydrate is not the only stimulus for insulin secretion." Protein-rich foods can also stimulate insulin secretion without increasing blood glucose concentrations. "A low-fat diet based on less-refined, carbohydrate-rich foods with relatively low insulin scores may help enhance satiety and aid weight loss as well as improve blood glucose and lipid control * "Pasta, oatmeal porridge and All-Bran cereal produced relatively low insulin responses despite their high carbohydrate contents. * Some protein and fat-rich foods (eggs, beef, fish, cheese, cake and doughnuts) induced as much insulin secretion as did some carbohydrate-rich foods. Beef was equal to brown rice and fish was equal to whole grain bread.)"

We secrete amylase, which breaks down starch into glucose, into our saliva because starch was a regular part of the human diet at some point in the past. We have more amylase in our saliva than chimpanzees. Some amount of starch based carbohydrate in the diet seems like a part of our natural diet.

Wow,wow wow!! What an eye opener! Been OMAD for a year, reversed T2D and majorly lowered triglycerides but have instinctively thought I need to have some carbs after trying carnivore and trying to go zero carb

Ahh, that makes a lot of sense. Thank you, Dr. Cywes. I've found that I handle protein and fat a lot better if I stick to at least 75-125 grs of carbs per day.

In complete agreement! I also think an extra point: large fluffy cholesterol particles need more LDL than the same number of small dense. In my experience, and I look at a ton of NMRs, I see this over and over again: LMHR with large LDL count have very large cholesterol particles. Since all LDL is the same size, by definition, fewer LDL is needed for a person with small dense unhealthy cholesterol particles than if the person has large fluffy healthy ones. So larger LDL (in light of low triglycerides and high HDL) represent large fluffy healthy cholesterol particles. I usually move an insulin suppressed person from carnivore to hypercarnivore--just a couple of plant carbs a day triggers enough insulin to "restart" the system.

I have to listen more times. This was hard for me to comprehend!

The issue with the blunted insulin response is chronic elevation of tge AMPK pathways in the islet cells. The research supporting this is there. People even med professionals seem to want to classify various pathways into hard rigid boxs. The issue is most all pathways in tge body act with modulation. It's enviornment and stimuli dictate there action. Take AMPK. It acts differently depending if there is a positive or negative nutrient and energy balance. Further its effects change between if the pathways are activated in a pulstal or chronic way. Same is true of MTORC and most other metabolic pathways. The issue is the eventual effect on islet mitochondria. The beta cells need that regular modulation between Ampk and MTorc pathways and pulstal bolus release as seen from gluc9se stimulated response. In the most basic sense it's a if you do not use it you r e use its capacity eventually to tge minimum ne essay for its constant enviornment. The human physiology developed to handle and thrive in wildly varying enviornments. It's why we are overly skewed to enzymatic based responses in response to environmental and nutritional changes. All macros induce insulin release. How many times have you heard pure fat has no insulin effect? Wrong. Mono poly and mct fats all illicit a insulin release. As do numerous amino acids i.e. protein. Leucine, Isoeucine are two that directly stimulate insulin release. Then you have your glucogenic aminos. These are converted via hepatic gluconeogensis, such as, glutamine, alanine, glycine. So let's summarize. Fats cause a insulin response, amino acids which make up proteins illicit insulin responses thru multiple pathways, of course all sugars produce a insulin response. All one has to understand is insulin is THE most powerful and abundant nutrient partitioned and transport in the body. Fat carb protein it Hasan effect on its transport. Now for fat many thought it was not true in vivo as insulin changes in systemic blood was not found. But this was b3cause the liver was absorbing the vast amount of it. This was found doing liver cirrhosis research. Where a shunt was placed on the portal vein. By blocking tge main circulatory pathway from the pancreas to the liver (portal vein) peripheral insulin concentrations increased in response to fatty acid and then became consistent w I th what was seen when directly flushing islet beta cells in viva. If you do not believe amino acids such as isoleucine or leucine directly stimulate insulin release vs thru conversion to glucose as with other aminos try this. Order some L-leucine or isoleucine supplement powder. Fasted take a large single dose of say 15-30 grams. Basically 300mg/kg bw. 100kg bw = 30grams of either amino acid. First check glucose. Take the dose of amino acid. Then after 30 minutes recheck your blood glucose. You will find it has dropped. Obviously directly checking plasma insulin concentrations is the direct way but requires lab access vs a simple at home monitor.

Ben bikman does not espouse that ketogenic diets are harmful long term.

This happened lately and had never happened before. Being a LMHR by the book I ate chili sausages which I rarely do. Got horrible battery acid diarrhea lasting 7 days. I felt burned every 30min at the toilet and did not sleep for a week. And what stopped it? In 2 hours? Sugar in the form of strong Danish salt licorice and German vegan labled gummy bears. Now I know better as those were the first sugars or sweet ingredients in my diet this year 2022!!! Usually I eat more liver but had not done so for a while. There are enough of carbs to keep the carnivore bugs operating when having liver a few times a week but not too much. I also had cut down on my 100% cocoa powder and cheese due to an Oxalate dumping experiment. Causation or correlation? Will never know. I will do it again and hope the candy works and saves me again. Thanks from a n=1 healthminer and LMHR bage of honor 55y male.

I have wondered about this for a while. Thank you

Great video. I would love for you to do a deep dive into CAC Scores. I think a lot of folks with chronically high LDL who have had this test done would also love to get info on what it really means

Helpful

Excellent video! Thanks Dr. Cywes

Think this is the category I fell into. My April bloodwork showed Triglyceride .92 mmol/L Cholesterol 10.92 mmol/L HDL 2.37 mmol/L LDL 8.13 mmol/L And my Dr freaked out and immediately suggested statins. I said I would work on my diet. At that time I was zero carb for almost two years (been low carb/keto/carnivore/back to keto and now low carb since 2001). Next round of bloodwork is in October, so we'll see if that has made any difference. Carbs now anywhere between 40-80g, mostly from berries & low glycemic vegetables. But this WOE for me is a non-negotiable. Have lost 110lbs, "fixed" PCOS, controlled type 2 (no medication needed). I'm all for some tweaks and evolving, I'll never go back to a SAD (pun intended!) way of eating

Thank you very much for that important Information because I was so scared that my total Cholesterol went up to 323 and therefore started to take statins(advised by my doctor) But as I stoped all sugars ,cakes,ice cream, milk and bread and lost mire then 20 pounds I could not understand it.

I'm a sugar addict. I can't consume 130-150 grams of carbs without it triggering me. Even vegetables trigger me. When it comes to sugar there is no moderation, that's why I'm carnivore.

So, my latest lipid panel showed that I am a LMHR. LDL: 287, Triglycerides: 60, HDL: 85. I am starting to introduce more carbs in my diet. This is largely a result of watching a similar video that Dr. Cywes posted some time ago. I am happy to know that my lipid panel is not that far off from that of the good doctor. I am awaiting the results from Dave Feldman on LMHR to see if I should really be worried about being LMHR. Yeah, life gets more complicated as one gets older. 😒

My problem is sleep due to this. Adding back carbs more on the keto side now.

Someone suggested thiamine deficiency as it relates to insulin synthesis and glucose metabolism in cells. So, I am trying Thiamax...will let u all know if it changes anything.

So , Dr. Paul Saladino is very right then .

Thanks Doc! We all must learn new things as We go on this Journey of Good Health. One thing I have learned on my journey to loose weight and lower my Blood Pressure is... Eat less carbs and sugar, Exercise daily and every once in a while have a day off eat carbs, eat sugar all in moderation, And Enjoy life!

I wish he wouldn’t go off like this without much more research.

Ok Doc, this explains my question of why I still have not only high cholesterol but also high blood sugar, 200 fasting. I’ve eaten a very low, under 20 total grams of carbs diet now for 2 years and 4 months. Have lost and maintained a 50lb weight loss. I’m 5’5” and weigh 135 lbs. 66 years old. I understand about the physiological insulin resistance as explained by Dave Feldman. I’ve been tested recently for LADA and I don’t have it, C Peptide is fine. Been type 2 diabetic for 24 years, 4 of them on insulin before going low carb. So here I am a hyper responder that’s been racking my brain for the last couple of years trying to figure out what the hell was wrong with me. When I can afford it I’m going to make an appointment with you for a consultation because I’m not sure if the high blood sugars are causing damage because of insulin suppression and I’m not quite sure how many carbs I should be consuming. The last 3 months I’ve upped my total carb intake from around 10-20 to 30-40 but still my fasting blood sugar remains in the low 200’s. It comes down in the afternoon to around 140 but I’m always high in the morning. I should say that I eat 2 meals a day with an average IF of 16-18 hours. Anyway, I feel like I could be the poster child for being a lean mass hyper responder. I’d just like to stop worrying about it, my brain is getting tired. By the way I’m Kim Leon-Guerrero from Guam, one of the people that interviewed you for a local keto show my husband Ken and I did last year. My best to you and the family and thank you for all you share here on your channel. 🌴❤️🤗❤️🌴

I'm an ApoE4/4 LMHR with lifelong reactive hypoglycemia that got so bad that I had to go zero carb. On zero carb my total cholesterol measured 435. After six months, I added berries to my diet, and my cholesterol dropped to 330. In further experimenting, I figured out it is only starch that I need to avoid. I can eat as much fruit as I want. Just to test it out, I once ate one quarter of a full size watermelon as my meal and felt completely fine. The last time I had about 30 grams of starch, I had 4 hours of hypoglycemic, simultaneous nausea + voracious hunger. Even with fruit in my diet, my fasting insulin measured only 3.8. People with ApoE4 have sluggish LDL receptors, and LDL tends to stay in circulation, where it oxidizes. Even though there is no junk in my diet, my OxLDL is high, and my functional medicine doctor wanted me to lower my cholesterol to lower my OxLDL, which I did with zetia and lowered sat-fat intake. Got it down to 215. OxLDL much better. But, my libido vanished, and I couldn't sleep; Dr tested my testosterone, and it was low. It all returned to normal after ditching the pills and resuming my regular diet. I seem to feel better the higher my cholesterol is. On zero carb, my libido was out of control. My LDL is in the 200's and my ApoB is 150, but I'd rather feel like I do now, so if my elevated lipids are going to kill me, so be it. Last summer, at age 60, my CAC was zero, and a CIMT showed no blockages, so I'm not too worried.

Dietary cholesterol is not a predominent source for body cholesterol

You should not be eating pure fat. As Ben Bikman says: don't fear fat, eat the fat that comes with the protein, protein and fat are meant to be consumed together. - with protein, you have an insulin response. Problem solved.

Interesting. I have taken note and will add a bit more carb to my diet :)

Doc, I think you baffle me with too much of the theory. I am on insulin , 78 years old in remission from cancer. On low Carb diet thanks to you and your experience with patients. I have reduced insulin use. ie Base line long lasting from 40mmol(?) to 30 per day, Fast acting pre meal from 30 to 24 per day. Maintaining from initial at start of diet of about 8-9 mmol fasting to sugar to 6-6.5, through out the day. So all good advice applied,thank you. This Paradox thing is confusing me

Tell it like it is! Information = freedom

At 4:30 - Dr Boz has a great 10 min video on this topic - "LDL Cholesterol is NOT what you think! Understanding LDL Cholesterol".

I agree that this LMHR thing is off track. Dr Kraft always said normal insulin is 5 fasting and not over 60 (international microunits or whatever) after eating (actually during a glucose/Kraft test). Otherwise you have "diabetes in situ". I dont think you can drive your insulin too low with diet. I dont think we will show Kraft pattern V. I didnt. If the body needs insulin for other purposes, I imagine it will make it. As long as you trigger that 60 units once a day with protein, you are probably good. Heck, just test that. Add carbs if needed. I think its more that an insulin resistant person winds up with dietary fat in the liver. I have this issue. I get excessive gluconeogenesis, TG a bit high and 10 lbs belly fat, pattern B LDL-p. Like a mini metabolic syndrome. It clears up if I cut out dairy and I eat PSMF. ie. Eat less fat.

Thank you that was super clear I am LMHR and I have near black out with a little alcohol, so I’m trying to figure out WTF is going on. I will read through comments before I ask about Randle cycle and how to use some carbs

Enjoyed that, Doc!

Something like that may be happening to me. I’m working with a supportive doc here in Australia I’ll try to get to the bottom of this with him. Thanks as always. I’ll be 4 years keto carnivore next month.

Interesting conversation. Have you ever spoken with Dave Feldman?

I don't understand the problem. "Big particle" LDL and high total cholesterol is supposedly harmless as long as the Trigs are low and HDL is high which is what we get with the very low carb diet. Your suggestion of 100 carbs per day would put me back on fattening injected insulin

Love your work

YES, this is perfect and correct. All humans must have Periodization in their eating patterns. infant, toddler, adolescent, young adult, mid life adult, older adult. Death the eating stops. All the periodization patterns with meat / eggs base. Meat being any meat from birds, land animals to fish / seafood. Eggs being any and all eggs. Quantity of food, food timing will depend on your: age, race, activity levels, sleep patterns, goals, lifestyle, past health history, present health status. No one size fits all. Roughly there are humans very short to very tall. From baby weight to 600lbs+, from couch potatos to ultra marathon runners, from office worker to 380lbs+ strongman competitors.... Now mix in genetic variations and other factors. Of course no one size fits all.

Thank you for all the info Doc

So I recently had several weeks of eating around 70-130g carbs daily, and I also added some exercise. Funny thing is, my HbA1c actually went DOWN a tiny bit from 30 mmol/mol to 27 mmol/mol, whereas being strict carni/keto I never managed to get it that low, even while exercising like an athlete at the time. My trigs also tend to be super low when I have more carbs, from around 0.72 mmol/L on strict VLCD to around 0.51 mmol/L with more carbs. My LDL-C did go down slightly by like 2-3 mmol/L, but still quite high at around 7-8 mmol/L, and my HDL went up as well but I chalk that up to exercise since it's always high when I have regular daily exercise, even if it is just walking. Problem is that I end up triggering my carb addiction, so not sure how to solve that part.. I do love rice and can somewhat moderate it, but still not enough. I should look into some starchy veggies, though, see how that works out, since I haven't tried that, yet.

Cant wait for part 2!!!

Hi Rob - Just a couple of questions I hope you can help with in relation to your video 1) What % of the population would you assert is LMHR and/or capable of being "Insulin suppressed"? I raise this because unfortunately as you can see from the comments, many people use this educational video of yours and the LMHR as an excuse to reintroduce carbs (a slippery slope) to their diet without getting the bloodwork as you always suggest. If you are not a LMHR, then the correction is not an overcorrection and you dont need any carbs as you still spike insulin enough without? 2) You express how the mechanism works clearly and concisely but you don't really express why this whole scenario is a problem? You only say "The concern though is.. That you dont have insulin so your protein synthesis your autophagy all of those things are failing and become problematic when you dont have insulin". 2a) "Autophagy is failing" - Based on what you said earlier, insulin blocks autophagy not support it so there shouldnt be a problem with autophagy it all in this scenario? 2b) "Protein synthesis failing" - Is insulin a requirement for protein synthesis or can protein synthesis still take place via other supporting mechanisms without much insulin? I make this comment as a big fan not to seem like im picking at the video on purpose. Infact its quite the opposite, its such an interesting area/topic and has such huge potential impact that I think its important to be very clear on exactly why we are saying this is a problem? Thanks for all your hard work putting out such great information

Thank you Dr Cywes!

What I take from this video is that carnivore long term is a no-no, and HFLC; well check your carbs. I'm currently on 10% carbs which gives me around 50g of carbs per day (2000 cal "budget"), and I am persisting with this to assist my liver and gallbladder (especially) to produce more bile. It seems to be working, gut health doing very well. But I will move towards 100g of carbs, at least 2/3 per week then, methinks.

Great video information! I've (actually the cardiologist I see) been concerned about my cholesterol #s. But the overall are not dissimilar to yours: 260 Total Chol; 89 HDL; 57 Trigs. The ratios (trig/HDL < 1 and Total/HDL< 3.5) are good. My Hba1c now is 5.5% and Fasting Insulin is 5.6. This does not seem too low, where 4.0 is insulin sensitive? The LDL is at upper limit for normal. My numbers seem reasonable and I resist meds, even herbal ones (that contain maltitol!). I am 65 years-old female, was diabetic, was on Metformin for 9 years - stopped 2.5 years ago. Been low-carb or < 30 total carbs 2 1/2 years. The positive health results seem too good to be true - I expect some sort of backlash from my body, so I get spooked whenever I hear something like this. I do eat slightly higher carbs 2 meals a week (between 30-50gr) - always whole foods or wine - just higher carbs. Something you said once about Pancreas "forgetting" how to produce insulin, or the muscles in the body ignoring glucose in favor of waiting for ketones? I'm obviously no Dr and this is mightily confusing. But I try. I am healthier than I've been in decades, so there's that.

Doc, I do enjoy your videos. You are very unbiased, to the extent of being contararian at times.👍🏽 I am mostly carnivore.. but do have fruit, or coffee with milk and cream as dessert occassionally. Also ice cream at times 😉. I think of all this as indulgence. I have 2 questions.. 1. Is the protein in a carnivorous diet not sufficient to trigger insulin? 2. What is the range to classify it as insulin supression and what is the serious downside to it?

Invaluable. Thank you

120 gms a day would find me on rdrugs for prediabetes. Tris are 99. I need to find a balance and get the weight off.

Hmmm.... this is interesting. There is probably some sense to this. When I went on Keto in the beginning I did not know that somethings had carbs, like honey and cottage cheese and milk etc. I was losing weight fast and my lipid panel was not off the chart high. LDL-C went from 104 to 225, HDL-C went from 40 to 60. TG dropped from 225 to 57 But when I pushed it and became more strict, LDL-C jumped to 350 within hardly 2 months. HDL-C went to 75 and TG to 49. From what he is saying I will include some carbs to bring shit down, nothing wrong with some carbs, just no need to get stupid and eat every junk in the book as it was the case before all this. Yea I paid for it alright.

If you become a hyper responder, then you simply add a few carbs. Not enough to gain weight on. Just enough to kick in your pancreas, to produce a little insulin to place your glucose where it needs to go. Like the old saying..."if you don't use it, you lose it" lol we still need insulin, even when low carb. But some think that less insulin released, the better. This can be true, but, we NEED an insulin release every now and then to get that sugar out of the bloodstream.

Great info Dr. C! Thank you so much!!! Would you suggest getting these carbs from vegetables? Especially for us who are dairy sensitive.

your videos are extremely informative, I need a note pad lol thanks for sharing

You talk só well. Slow, pause. Easy to follow you vs other presenters. Well done.