When your “normal” blood sugar isn’t normal (part 1), In the next two articles we’re going to discuss the concept of “normal” blood sugar. The Rosedale Diet is the most scientifically advanced diet in the world, that has been shown to mimic the amazing effects of caloric restriction on health and life extension, without having to even think about restricting calories. I believe, quite simply, that all sugars, and foods that convert into sugar, will have a detrimental effect if eaten, and therefore the fewer non-fiber carbohydrates that a person has, the better, and that the difference should be made up by consuming more beneficial fats and oils.  Besides that, our diets are fairly similar in that they are both, compared with a standard diet, higher in fat and lower in carbohydrates. There are three major reasons why I believe it is very important to carry this discussion forward as far as possible. The third reason is less philosophical and more basic scientifically.  I believe that many venues of science, from basic physiology to the biology and genetics of aging point to a simple, but very powerful statement concerning health, that I have stated for many years and has yet to be disproven. This brings us back to that bowl of rice that is the basis of the difference of Paul’s and my diet.
There appears to me to be, not a point of diminishing returns by further reducing carbohydrate consumption (without increasing protein consumption, but by increasing beneficial fats and oils), but a point of accelerating returns the lower one goes below that 100 g of glucose consumption.
Jaminet continues, “Two basic matters are at issue: (1) What blood glucose level is best for health? I have said often that we must get to the root of a problem, and that would certainly pertain to this discussion. I give a summary and conclusion near the end of this article that answers this very important question that is critical to determining an optimal diet. Dr Rosedale seemed to feel that this was the weakest point in my argument, and directed his fire here. It is true that the word “detectable” carries a lot of weight when it comes to health risk. However, as one looks deeper to detect adverse effects from raising insulin, leptin, or glycation, then yes, there would be detectable levels of health risk from even a single glucose excursion.
This view makes sense as a matter of molecular chemistry: the number of glycation reactions may be proportional to the concentration of glucose, and if glycation products are health damaging toxins then toxicity may be proportional to glucose levels.
The trouble with this is that it doesn’t really get at what we want to know: what blood glucose level optimizes human health?
Actually, what we really want to know is what level of glucose consumption optimizes human health.
I believe, that there is a very important clarification that needs to be made here, at least as it concerns this current post. However, when one is looking only at glucose, one is looking only at the tip of an iceberg.
My [Jaminet] interpretation: I would say that this study demonstrates that mortality is a U-shaped function of blood glucose levels, but it doesn’t tell us the shape of the bottom of the U. This study used glycated hemoglobin, HbA1c, which can serve as a measure of average blood glucose over the preceding ~3 weeks.
This supports the “blood sugar should be as low as possible” thesis, since lower HbA1c levels were associated with lower mortality. Let’s finish our examination of this issue with a quick look at Dr Rosedale’s third cite.  (Does this mean that Paul is OK with the other 17 or so studies that I had cited previously showing a detriment of glucose at levels well below those that Jaminet had proposed were safe? This study looked at blood glucose levels 2 hours after swallowing 50 grams of glucose, and then followed the men for 38 years to observe mortality rates. Though this is known among clinicians in the field, without having clinical experience, CarbSane would not know this. This is not indicated in any of these studies, or the many studies that I cited previously … It is possible, but so then is any speculation of impaired health.
But suppose Dr Rosedale is right, and that low blood glucose levels are most desirable for at least some persons. If the key to health is achieving below-normal blood glucose levels, then low-carb diets are in trouble. In general, very low-carb diets tend to raise fasting blood glucose and 2-hr glucose levels in response to an oral glucose tolerance test. A high protein diet that many, if not most in the paleo community adopt by substituting protein for carbohydrates, is not healthy. The general opinion in LC circles is that you need 150g of carbohydrate per day for three days before an oral glucose tolerance test. Not in the low carb circles that I have kept; in the low carb circles of those of us who helped found the field, or in those circles of clinicians who have regularly treated patients with glucose problems.
Although I did show many studies showing the correlation of glucose on aspects of health and even mortality, it was done to disprove the notion that only glucose above 140 is detrimental, which they did, including in context of studies pertaining to insulin and leptin. This is at the high end of the 20% to 30% of energy (400 to 600 calories on a 2000 calorie diet) that is the Perfect Health Diet recommendation for carbs.
I have consistently heard those in the Paleo, higher carbohydrate camp refer to the Kitavans as an example of a population eating a high carbohydrate diet and supposedly being much healthier, and the conclusion is drawn that the high carbohydrate diet is causing the improved health. Trying to draw conclusions from population groups is extremely difficult and can lead to very poor science. All one can say is that Kitavans with their diet of far less junk food, lower protein, higher (cellulose) vegetables, high MCTs, that may help result in short and lean stature, with their less stressed lifestyle gives them low rates of heart disease and diabetes but with an approximately average lifespan with few centenarians. I would not hang my hat on Kitavans as a reason to eat carbohydrates, as the hatrack is not secure. Studies confirm that high-carb diets tend to lower fasting glucose and to lower the blood glucose response to a glucose challenge.
I will spend a bit of time going over this and the next study cited by CarbSane and presented here, as they are excellent examples of really bad science (if that word should even be used at all) that are very misleading, and they in no way support the position that increasing carbohydrate intake is healthy… at best perhaps only somewhat less unhealthy than worse diets. This study compared a standard high fat, high carb, low fiber diet to a diet much higher in fiber. Again, what I have said for decades is that lowering glucose by raising insulin is trading one evil for an even worse one.
Furthermore, in these studies, the low-carb group was not well adapted, and necessary nutrient supplementation was not given. Once again, what those two studies merely show is that eating carbs and fat (as pure corn oil !) together is very bad, that eating large amounts of pure glucose will rapidly spike blood glucose and therefore insulin that (at least for a while before insulin resistance kicks in) is known to rapidly lower the blood glucose, that force feeding copious amounts of corn oil to maintain high calorie intake might have deleterious effects, especially in conjunction with improper implementation and without proper supplementation of at least magnesium, potassium, and omega 3 oils. The proper very low carbohydrate (higher beneficial fat, moderate only protein) diet, a few very simple precautions, and a little bit of time is necessary before significant benefits are realized,,,and they will be realized if this diet is properly implemented.
Medical and nutrition studies are now often (usually?) undertaken, not to discover some underlying truth, but rather designed to obtain a predetermined and biased outcome as part of a marketing effort. Both of the previously cited studies, one from 1973, and the other from 1990, were authored by James Anderson, whom I am quite familiar with. Furthermore, these studies are irrelevant to our discussion that ought to be comparing, as much as possible, a very low carb, high (healthy, not corn) fat and moderate protein diet in which the participants had enough time to become adapted, to a higher carb diet. This last study did not report fasting glucose, but did track blood glucose for 4 hours after the glucose challenge. The 20% carb diet lines up pretty well with the mortality minimum, and both high-carb and very low-carb diets wind up at bins with slightly elevated mortality.
Now, I don’t believe we can infer from data on high-carb dieters what the relationship between blood glucose levels and mortality will be in low-carb dieters.
Well, if we all have diabetes, more or less, then I guess I have to consider whether our regular diet – which recommends about 20% of energy (400 calories) as carbs – is healthy for diabetics. Now, before I begin this discussion, let me say that I don’t claim that this is optimal for diabetics. The low-carb diet was a little higher in protein and lower in fat than we would recommend, but very close overall to our recommendations and spot-on in carbs. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. So the big benefit, in terms of glycemic control for diabetics, comes from reducing carbs from 55% to 20%. I am happy that Jaminet said that, since reducing glucose spikes may be even more important than reducing fasting glucose. I am a type II diabetic and a Perfect Health Diet follower, so I want to chime in with my experience….


For dinner tonight, I had a fatty pork rib, green beans, and a small baked potato with butter and sour cream.
So not only am I losing weight on the Perfect Health Diet, my blood glucose levels have actually improved, thanks to the increased carbs counteracting the dawn phenomenon, just as Dr. To repeat: I’m not claiming that our regular diet, providing 20% of energy from “safe starches,” is optimal for diabetics. Why does this magic number, which happens to be the Perfect Health Diet recommendation for carb intake, do so well?
Actually, glucose utilization can vary tremendously depending on the activity of many hormone levels, including insulin, leptin and their level of sensitivity, cortisol, thyroid, growth hormone. That rice consumption spread throughout the day may, at least for a significant part of that day, prevent one from burning fat. That glucose can be toxic is very well known, however it is the effect of glucose on hormonal signals that is the most important. I believe that the issues stated above are not the root issues that I have frequently referred to in the prior posts. This is particularly true with biological illness, but also happens with any form of communication, including written. My statement was a description of what the scientific literature shows, and the adjective “detectable” carries a lot of weight here. The consumption of glucose causes a much wider range of effects than just affecting baseline, fasting blood glucose.
So the impact of a toxin on health will not rise linearly, but non-linearly with a steeper slope as one moves to the right. As Ron himself says, having too little blood glucose is “incompatible with life.” So low blood glucose – depriving us of the benefits of normal levels of this nutrient – is a catastrophic negative for health. But the precise numbers don’t matter much; the point is that there is a U-shape, and somewhere in that U is a bottom where health is optimized. Fasting glucose, and therefore this graph, will be pertinent in showing perhaps a correlation between fasting glucose and health, and perhaps more importantly if changing fasting glucose levels changes that correlation.
Most studies relating blood glucose levels to health have been done on diabetics eating high-carb diets. In fact, that likely will not happen in anyone all of the time given the variability in environmental circumstances such as daily stress and sleep. Diabetics have poor glycemic control, and episodes of hypoglycemia as well as hyperglycemia, so HbA1c levels (which represent average blood sugar levels) may be a poor proxy for the levels of glycemic toxicity.
Effectively there were only three cohorts, since the highest HbA1c cohort had only 2% of the sample; the other three cohorts contained 27%, 36%, and 36% of the study population respectively.
CarbSane makes an important observation: this study used whole blood rather than plasma to assay blood glucose. There have been considerable advances in the measurement of glucose since then, such that the differences are less, though still present. Furthermore, anyone checking glucose using a home monitor (other than perhaps some newer ones calculating serum glucose), is using whole blood.
Using the conversion factor that Jaminet indicates would translate to a blood monitor level of 101. It could be due to that portion of the day in which people were in car accidents as they were texting on their phone… in other words, since other variables were not measured, we can speculate about any other cause other than the most likely and that all the studies cited here and in my last post point to; that elevations in glucose above baseline are not healthy. I have never seen this in people following my diet; only in those perhaps who were following a high protein diet. Mark, posting as iwilsmar, asked about his gradual yet progressively rising fasting blood glucose (FBG) level over a 10 year period of paleolithic LC eating. I have noticed higher BG from higher protein diets many times, compared to my recommended higher (beneficial fat) diet with lower protein.
The conclusion based on the totality of those studies was that detriments of glucose on various aspects of health are seen well below values that Jaminet claims are safe. There are far too many variables to fully account for, and the best one can do is associate a particular variables such as a high carbohydrate diet with health. This is very high in medium chain triglycerides that have been shown to have numerous and powerful metabolic advantages. Kitavans eat less protein than in western societies, most of which is concentrated in 1 meal, further reducing IGF and mTOR, both of which have been shown to extend longevity.
I don’t know about you, but I am striving for better health than revealed by the Kitavans. I have stated innumerable times that the typical diet is so bad that making any changes to it leads to improvement. Jaminet is attributing their poor relative results to their low carb intake that is, by the way, 20% glucose = 600 cal.
Spikes in glucose may even be worse than a high but steady BG (see studies below), and spikes in glucose and insulin may, and I believe do, bring about insulin and leptin resistance, and therefore a whole new realm of metabolic devastation. It is well known that those people who are not adapted to a low carbohydrate diet may not fare well in the first few weeks following the initiation of this, especially if they have not supplemented with potassium and magnesium that will be lost as excess fluid is excreted in urine as insulin is reduced. The studies by CarbSane and Jaminet are like comparing a fat 40-year-old to a fat 50-year-old in the 100 yard dash, and assuming that the winner is fit for the Olympics.
I think it is still an open question what the optimal diet for diabetics is, and different diabetics may experience a different optimum.
I am quite familiar with Jeff and his work through Eric Westman who has collaborated with Jeff often and me previously; he is a co-author on my paper cited here.
Postprandial insulin responses immediately after the fat-rich meal were significantly lower after the VLCKD. This blood glucose level would have been maintained throughout most of the day, with the postprandial peaks and troughs flattening. I believe that I was the first person to use a low carbohydrate, relatively high-fat diet to treat diabetics and taught most of the others in one way or another who are doing this today, And I will emphatically say that lowering carbohydrates as much as possible, without the consumption of excess protein, is by far the best way to lower glucose and insulin (and leptin), i.e. There are in fact quite a few articles that are now showing that spikes in glucose are worse than steady high glucose.
I have been eating rice, potatoes, bananas, and other safe starches ever since, as well as fermented dairy products, such as plain, whole milk yogurt. Note that since following the Perfect Health Diet, my fasting blood glucose reading has gone down. I don’t know what the optimal diabetes diet is, and it may be different for different diabetics. Jaminet’s diet is certainly not a bad diet, and I hope that I have never given the impression that it is.
This has been shown to me over the last 2 decades of patient experience, the continual outpouring of supporting science, first pertaining to insulin, then leptin, then mTOR and the now very robust science over the last decade pertaining to the biology of aging…and also by the numerous well known low carb diets that have ultimately modified their original programs to try to morph into mine. When one eats glucose there will be glucose spikes of varying amplitude, and as shown above, this is particularly detrimental. The issue does not have much to do with blood glucose levels per se, but much more to do with the effects of glucose on nutrient signaling, in particular leptin and insulin. Obviously, this cannot feasibly be shown, so one has to use the best science available to extrapolate most accurately.
The point of the studies that I cited previously pertaining to glucose levels was to show that there is no specific threshold for glucose above baseline that determines health or not, as Jaminet believes. If it was only blood sugar, than the initial graph would still hold, showing an increase in glycation correlating with an increase in glucose. Also, diabetics are usually on blood-glucose lowering medication, which may distort the blood sugar – mortality relationship. Whole blood has more volume (due to inclusion of cells) but the same glucose, and so less glucose per deciliter. That brings us to the second issue: which diet will produce these low blood glucose levels? I have treated many dozens of people, diabetics and otherwise, who have supposedly been on other low carbohydrate diets, and lowered their blood sugars considerably when I put them on my diet, that generally entailed reducing protein while increasing fat.


At the least, an insulin level measured concurrently with each glucose is necessary for any meaningful results pertaining to health. What’s more important is that it did so concurrent with lowering insulin, thus improving insulin sensitivity. However, association does not mean cause, as I have talked so often about pertaining to cholesterol studies. They do not have a higher number than average of centenarians (if any) and do not have higher than (even post 50 year old to account for high infant death rate) average lifespans. The worst diet to be on is a high fat, high carbohydrate diet, as the (non-fiber) carbs prevents the fats from being burned. James Anderson happens to be the chairman of the National Fiber Council, an organization that is funded by HCF [High Carbohydrates and Fiber] Nutrition Research Foundation (a nonprofit foundation reputedly funded by large carbohydrate containing food corporations and whose chairman happens to be Dr.
They appear designed to fit the following graph, based loosely on a couple of old and highly controversial studies and a couple of anecdotal reports. What the overwhelming preponderance of evidence had shown, and what the conclusions by the authors themselves had shown, is that there is no specific threshold for glucose below which is healthy.
I have often said that diabetics may benefit from going lower carb (and possibly higher protein) than our regular dietary recommendations. It is extremely unlikely that Jeff (or Eric) would agree with that statement or Jaminet’s conclusions about a very low carbohydrate diet raising blood glucose. Previously, I was suffering from the “dawn phenomenon.” My blood glucose levels overall were well below 140 one hour after a meal and 120 two hours after a meal.
But I think there is plentiful evidence that even for diabetics, our “regular” diet is not a bad diet. I hope that no offense is taken, and that the effort at education for both the audience and myself is what shines through.
It rightfully acknowledges that glucose will cause some degree of damage at virtually any level, as I had previously maintained, and now puts the onus of health on the repair of that damage. All human studies pertaining to health and longevity are inferences and not proofs as, I’m sure Jaminet will agree, it is not feasible to carry these experiments out lifelong in people.
It effects nutrient signals that are perhaps the most powerful hormones in the body that detect nutrient levels, and have an extremely powerful effect on energy use and storage and genetic expression of health (or not), as I discuss more later. I do not believe, nor might Jaminet, that fasting blood glucose is the sine qua non for health, and it should not be used as such. Low average glucose can occur with adrenal insufficiency such that cortisol levels are inadequate, or growth hormone deficiency, etc.
The high carb diet also kept blood glucose low, and if this is all that was looked at, there would be little to conclude. In this case the high fat, high non-fiber carb diet was being compared to a low fat, very high fiber high carb diet. It is very possible that the very rapid and large spike in glucose secondary to eating carbs with a glycemic index of 100, caused an equally rapid spike in insulin that rapidly reduced the blood glucose. One cannot come to any conclusions, let alone what Paul is calling plausible, from those studies.
However, Dr Rosedale is here saying that even a healthy non-diabetic should eat a diet that is appropriate for diabetics.
Only my fasting BG reading was out of whack, usually between 120 and 130, first thing in the morning.
Therefore, what a person eats can turn up repair, or lower it, and this arguably is the most important impact of diet on health and longevity, and must be primary when recommending a diet to promote health and longevity. Certainly, just like with the thyroid studies that he has pointed out below and that I believe are misunderstood, the detrimental effects of lowering glucose would be determined by how and why it is being done; as part of illness, or as part of a physiological and “purposeful” regulation to extend longevity.
They are a disease of improper signals being given to glucose, especially those coming from insulin and leptin.
However the real and big story is that the high carb diet kept the BG down at the expense of raising insulin significantly, and thus worsening insulin resistance, and this is a very detrimental effect to overall health, risk of virtually all chronic diseases of aging, and confers a high risk to shortened lifespan.
There are a multitude of studies easily found that show the opposite; that eating a high carbohydrate diet is associated with raising fasting and post prandial glucose. I do believe that if Paul were to treat diabetics and compare results, his ideas would be quite different.
Using a more accurate conversion, it would be 118; still very unhealthy and considered impaired glucose tolerant.
It should be looked upon as we view a piece of chocolate cream pie; unhealthy, but we want it now anyway, and not that we are biologically better off for having eaten it. I have no qualms about saying that what I’m doing and teaching to be healthy is quite unnatural, as it is the quest to be able to live a long, happy, and youthful life after making babies. I will emphasize again; only measuring blood glucose without knowing what insulin and leptin are doing gives very incomplete and often misleading information when it comes to effects of any intervention such as diet.
Furthermore the inadequacy of testing may have covered up the rapid, and detrimental spikes in glucose (that Jaminet also alluded to earlier) and insulin that may have likely occurred, especially with the higher glucose diets. More than that is speculation from using studies (a 65% corn oil diet?!) that I doubt Jaminet has faith in either.
Regardless, no one is really recommending a 0 carbohydrate diet, as this would have to be laboratory fabricated. It is extremely unfortunate that this is being touted as healthy by Newell himself, who will have to suffer the consequences of being misinformed. The point is that there is no such thing as a glucose deficiency or a healthy need to eat starches.
What this study once again shows is an incremental increase in mortality far below a glucose level that Paul has said is healthy. They effect many other, even more significant aspects of health, such as a massive shift in genetic expression.
If Jaminet really believed in these studies, then why is he not recommending very high sugar diets? Regardless, there are way too many studies that show the opposite; that eating glucose and glucose forming foods impair glucose tolerance and insulin sensitivity, and worsens diabetes, if not being a major etiologic factor, to draw opposing conclusions. However, what my experience has been with my VLC (very low carb) and higher fat diet, is that fasting and post prandial glucose become further improved, into completely healthy, non-diabetic, non impaired glucose tolerant ranges. This concern of nature and evolution began with the beginning of life to include single-celled organisms…like the 15 or so trillion cells that make you up.
Though a mistake to focus on fasting blood glucose only as an index of  diabetes or health as is conventionally being done, I must say that it is my experience that fasting glucose is uniformly reduced on my diet… as are insulin and leptin levels. This is also why the standard of current medical care for diabetics generally makes them worse. I do not and have not disputed that Paul’s diet may lead to (much) better results than the french fries (whoops, potatoes allowed by Paul) and coke diet that the average person may eat. I drive occasionally without a seatbelt, but I do not want anyone telling me that this is safe.  If there is some unbelievably great bread at a restaurant, I might have a small bit, and savor it, not because I am deluded into thinking it is healthy, but because I am willing to take the risk. As I have stated so often; lowering glucose at the expense of raising insulin is doing someone no favors. Many studies are now showing a correlation between glucose and insulin levels and cancer risk. Newell may be doing better than bad on the surface (only in-so-far as blood glucose levels go), but I consider it a failure if a type II diabetic of mine is not completely reversed, such that healthy blood sugars are obtained without medication and associated with lower insulin. It is so important, that I have to keep repeating it; diabetes is not a disease of blood glucose, but a disease of the signals being given to glucose. One of the best ways to improve fertility is to improve leptin signaling that my diet has been shown to do.



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