Laura Schoenfeld: I feel like I’ve said this before, but I have so many different avenues that I share information in that it’s possible I haven’t mentioned it here. People on a very-low-carb diet, in almost like an ironic twist, tend to have elevated fasting glucose—not to the point of diabetes. Obviously if it’s 105 to 125, you’re not in the diabetic fasting glucose range, which is 126 or higher, but people who are on low-carb Paleo tend to have higher fasting glucose and then lower postprandial glucose, and glucose during the day tends to go down after they’ve eaten some food. Also their hemoglobin A1c tends to be lower than someone who would be prediabetic or diabetic. So maybe their hemoglobin A1c is between 5 and 5.7, whereas someone who’s prediabetic is going to have an A1c that’s 5.8 and higher.
With 105 to 125, I can almost guarantee if he was eating more carbs, you’d see that drop into the 85 or 95 range. I’d be curious if he is overweight, if he has any history of insulin resistance, what his glucose levels were before he went low-carb Paleo, what his activity levels are like, how he’s sleeping, how much total food he’s eating. All these things can affect your insulin sensitivity. If it’s a female, I’d want to know if she has any sort of PCOS or any high testosterone, which can affect insulin sensitivity, but generally, on a low-carb diet you’re going to see fasting blood sugar in the high 90s and even to the low 100s. Basically what happens is you get a little bit of insulin resistance that’s happening to make sure that the glucose that they’re eating goes to their brain. It’s going to need glucose. You can’t not have any glucose. You would die if your blood sugar dropped below a certain level. Your body wants to conserve any glucose you’re eating to go to your brain and also your red blood cells, and so the rest of your body becomes somewhat insulin resistant so it doesn’t suck up the glucose from the blood stream. And when you start to eat more carbs, you become slightly more insulin sensitive, as long as, obviously, you don’t go in the opposite direction and overeat carbs and then possibly become insulin resistant again. But you get rid of that systemic insulin resistance that comes in low carb, and then your body is using glucose more effectively and it’s not necessarily trying to conserve it for the brain.
For that person, honestly, I’d want to know why they’re eating very low carb, do they have any history of insulin resistance, and would adding a little bit of carbs, especially at dinnertime, potentially bring that fasting blood sugar down into, like I said, the mid 80s, maybe low 90s.