While we're on the topic of carb restriction, I wanted to go over with you some of the things people see when they cut back on carbs a lot, and this involves another thing that we may need to pay attention to while doing so.
I've spoken about dietary fat as being the most interesting of the three macronutrients, and that's saying something given the role that dietary carbs plays in diabetes, but we tend to focus our attention almost exclusively on glucotoxicity even though we know that in diabetes, lipotoxicity, poisoning by too much fat, is an even bigger deal.
So some people might read this and then say, aha, I told you that fat in the diet is bad for you, better listen to us and go low fat and high carb. Well if you are worried about fat, as you definitely should be, that's the absolute worst thing you could do.
The problem is that excess carbs get turned to fat in the liver, through a process known as de novo lipogenesis, basically turning carbs into fat, and as it turns out, this is by far the most unhealthy fat you could ever have. It's no secret that eating too many carbs makes you fat, and cutting back makes you less fat, and this should tell you something right there.
Dietary fat is actually more transitory, the fat from the liver is made specifically for storage, not for immediate energy, while fat in the diet can be used for immediate energy, although this is where it gets a little complicated.
High levels of insulin is what drives fat storage, and high levels of insulin is also what causes too much fat to be stored from carbs, along with too much of the raw material, carbs. Now as type 2 diabetics we tend to have way too much insulin, just because our blood sugar is high doesn't mean that this is not the case by the way, our cells may be insulin resistant and require these higher levels but insulin does a lot more than just regulate blood sugar, storing fat is actually its primary function.
People who are on very low carb diets tend to get most of their energy from fat though, and therefore can tolerate pretty much any amount of fat and tolerate it very well, as they have switched over their energy metabolisms to a large degree to burn fat for energy instead of glucose.
In order to pull this off though, a few things need to happen. People tend to only focus on one of them and with non diabetics there really is only one element here, and that's carb restriction, although you can further this process by also restricting protein as well, although it's not necessary, but to be in full nutritional ketosis it is to some degree.
The other things that need to happen here, which happen with non diabetics but don't always happen with diabetics, is that insulin levels need to be driven down, as well as blood sugar levels. So if your insulin levels and your blood sugar levels are not both on the lower side, and we're actually taking a bit below normal here, this isn't going to work so well.
High insulin levels by the way not only increase fat storage, they inhibit fat burning, and when you're looking to burn fat for energy, well that's going to be a problem of course.
If both your insulin levels and your blood sugar levels are high though, this isn't going to work so well at all. There's no way you are going to use fat primarily for energy with high blood sugar, the body will always use glucose first if it is available and the only way to force it to use fat instead primarily is to deprive it of glucose, and when you have high blood sugar well that's as far from depriving your body of glucose as you can get.
Higher insulin levels also tend to mess this up as well and low carb is supposed to reduce them below normal but with a lot of glucose being dumped from your liver, both blood sugar and insulin will be elevated here.
So what happens when you go high fat under these conditions? Well hardly anyone talks about this and some people will even look at you as a freak if you have high blood sugar on low carb, it's not supposed to be high, maybe you should hang with this longer, I hung with it for a lot longer than I should have though and my blood sugar remained very high the whole time.
A high fat diet will obviously increase the amount of fat in your blood, and in particular increase free fatty acids, which are severely implicated in insulin resistance, and you're not really using this for energy as the keto people do, so you do have to exercise at least some restraint here.
This isn't unlike the effect of high carb and high fat being worse for your diabetes than high carb low fat, and although in this case you may actually be eating a low carb diet, it's as if you are eating a high carb diet as far as your blood sugar is concerned, you're just getting the high carb from your liver instead of from digestion.
Now this doesn't mean you want to go low fat either, but it's not necessarily just a fat free for all for all of us where we can just eat all the fat we want and the more the better.
As it turns out, we instead may need to pay attention to our intakes of both, and some of us may do better actually increasing carbs and protein a bit and cutting fat a bit, in a way that we are choosing between evils, and both of these macros can influence diabetes a lot in excess, and it's therefore a matter of finding the right balance.
I eat a fairly high fat diet simply because I'm limited to how many carbs I can eat without messing up my blood sugar too much, but it gets worse when I replace some of the carbs I eat with fat instead, and it also gets worse when I replace some of the fat I eat with carbs, so it's a matter of finding the right balance here for you and we certainly don't want to just ignore fat intake.