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When I was pregnant for the first of 3 I was diagnosed with gestational diabetes after badly failing the glucose tolerance test. Within a week I was on insulin shots. (I have no family history of type I or type II diabetes, I'm caucasian, was underweight when I got pregnant and was only 32 ->no risk factors) I was told that since I was insulin dependant that there was a 50% chance that I would become a Type II diabetic within 5 years. That was 7 years ago. I had gestational diabetes for my other two pregnancies but was diet controlled because by that time I had learned what worked for me and what did not. Since then I have kept an eye on my blood sugars. Just over a year ago I felt terrible. I had a list of complaints longer than my arm. I felt like crap. I went paleo December of 2010. Within two weeks most of those issues had resolved. I was sold. I went lower and lower carb and lost nearly 30 lbs. I am guessing that I am usually under 30 carbs a day although I haven't figured it out in a while. I am at my goal weight right now. I am female, 40yo, 5' 3.5" and 103 lbs. The body fat scale says I am skinny fat at 20%BF (yes I know those scales can be inaccurate but the number is the same when I do the measurements). I don't excersise other than just being a busy mom of 3 young kids. I just had my yearly physical and had my cholesterol run but we forgot to add a HbA1c to the mix but I wasn't concerned enough to go back and have it done. It was 4.9% last year before going low carb so it shouldn't be a problem, right? I am pretty strict with my diet because I find I quickly feel like shit if I eat poorly. So I would say I am 95% on target. My lab values were as follows: Total: 227 LDL calculated: 170 HDL: 47 TG: 44 Vitamin D level: 76 (I supplement) STSH: 1.57

I was a bit freaked out at that high LDL and the DR called me back to her office to "counsel" me on it. I suppose I could get a VAP but I figured those LDL are probably the large fluffy type since I have no family history of heart disease and my TG/HDL ratio is great. Am I wrong? Should I be worried? Anyway so this brings me to my bigger concern. About a month ago I was out to dinner with my family and instead of having salad like I usually do I decided to throw caution to the wind and I had GF pizza. It was awesome. However less than an hour later I felt like I was dying. I know my blood sugar was high, real high but I didn't have my meter with me. I felt like I was surrounded in molasses, every step was an effort, my thinking was foggy, brain dead actually, lethargic, thirsty etc. It sucked. It took the rest of the afternoon to recover. Then earlier this week I was out with the kids. I picked up pizza for them. I was starving so ate the left overs which was only 3 very small slices of very thin crust pizza. About an hour and a half later I noticed that I was really thirsty so checked my blood sugar. It was 181!!! Even more concerning to me was that other than the thirst I was asymptomatic. So how high was it last month when I felt like I was dying??!! I checked my fasting BS this morning and it was a stunning 96. I am flipped out. Am I now diabetic?

I feel great when I eat well. The only other concern I have is with hair loss. It is coming out by the hand full and it is looking thin now. Is that a result of a LC diet? Should I be getting my thyroid checked out? I know that the TSH I had done tells me almost nothing.

So my concern is this. Has my low carb diet caused a carb intolerance? Is the low carb diet messing with my thyroid causing hair loss? I feel like I may need to up my carbs to stop from going bald but if I increase my carbs are my blood sugars going to soar? Rock and hard place situation here.

I would greatly appreciate any insight you brilliant people could offer me! Thanks so much.

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D3 is high. How is your A and K2? – Dean Nov 16 2011 at 23:47
Dean, on what grounds are you asking "how her A is"? The k2 is legit, but as many questions and blogs show, we don't know about A. – Chase Nov 17 2011 at 2:38
A and k2 were never drawn. Can you explain why I need them checked? – Blueberry Nov 17 2011 at 3:42
They work synergistically. If one is out of balance, it's easier to develop vitamin deficiency or toxicity. That doesn't mean they have to be tested - if you eat enough liver, A is probably covered and if you don't supplement, there's a very good chance K2 isn't. You're moving in uncertain grounds with that D3 level. – Dean Nov 17 2011 at 11:21

11 Answers

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Sounds like you should just avoid pizza....Seriously though, you're not dying and you don't have diabetes. The cholesterol levels are normal, especially if you eat a lot of dairy fat from butter and cream.

As for the blood sugar issue, by eating low carb you develop insulin resistance in your muscles (not the same as hepatic and later adipose insulin resistance that is associated with obesity/diabetes). This is so that glucose can be spared for the brain when it finally does arrive. When you ingest a large amount of rapidly digesting carbohydrates when you're otherwise LC, you should experience a spike like you describe.

Low carb is known to decrease thyroid function, so that may be your hair loss issue. If your waking body temperature is really low (like 96.*) then your thyroid is probably being told by the hypothalamus to not work very hard.

Most of your issues would probably be solved with more carbohydrates (smallish amounts throughout the day) and more exercise so that you have a healthy number of mitochondria to process the glucose when it arrives.

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 Ugh, excercise. It is so hard to find the time to do something you don't enjoy doing. – Blueberry Nov 16 2011 at 19:14
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 If you have no emotional investment in what you eat, it's because you haven't had a health problem to correct. If you had, you might have an experience to gain insight from instead of just speculation. – Ambimorph Nov 19 2011 at 0:27
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 I consider reactive hypoglycemia to be a health problem that I have corrected, but if someone cites some studies that say that what I've done to correct it is actually possibly unhealthy, I would thank them for the information and see what I might be able to alter rather than vociferously defending my diet and trying to squelch the truth from getting out. – Travis Culp♦ Nov 19 2011 at 0:48
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 I'm not squelching truth, I'm squelching fear-mongering mythology based on half-truths. – Ambimorph Nov 19 2011 at 0:56
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 Yes, Ambimorph, don't you know there's a veritable low-carb holocaust going on out there? And all those poor epileptic children -- CHILDREN!!!! -- on ketogenic diets. My god, have you no decency? – Rose Nov 20 2011 at 0:56
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Low carb & insulin resistance go hand-in-hand.

This may be helpful for the blood sugar question: http://robbwolf.com/2010/09/06/gestational-diabetes-what-constitutes-low-blood-sugar/

Adding carbs may help with your hair loss. If you add them, do it slowly.

Are you getting enough nutrients? Really important that you eat the "whole animal" when eating LC/VLC.

Sufficient D?

Eggs?

Eating liver & bone broth or gelatin?

Oysters for zinc?

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 I think I am good on my D as my level was 76. I do eat a ton of eggs. I have 16 laying hens so I always have lots on hand. Yes to the liver and bone broth. I dislike beef liver but I have found a way to make chicken liver pate that I love. Made some last night. Yes to oysters too. Although I can't imagine it would hurt to increase those things. – Blueberry Nov 16 2011 at 19:09
Blueberry, can you share your chicken liver pate recipe? I'm also a hard sell on liver, but I'm game to try again... syrahna at g mail dot com – syrahna Jan 18 2012 at 17:50
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You are not skinny fat at 20% body fat. 20% puts you in the "athletic" category for women according to the American Council on Exercise. If you want to see a visual of bodyfat percentages, see Tim Fenriss (4-Hour Body) or Leigh Peele.

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 Awesome links! I do have a body image issues. I still look in the mirror and see fat, jiggle and loose skin. Those pictures are really helpful. There is just no way I could ever look at myself as is and see "athletic" tho. :) – Blueberry Nov 16 2011 at 19:35
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 Ya know, fat, jiggle, and loose skin are perfectly normal at any weight other than those crazy body builder competition stuff. – Marnee Dec 12 2011 at 0:50
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Elevated fasting BG is normal, since your system is adapted to de novo gluconeogenesis, and not dependent on the carb rush/carb crash cycle to stay regulated. Chances are that if you increase your carb level, your fasting BG will actually go down, and you will be better adapted to cheat days.

However...

Chances are VERY good that eating things that are carby but not pizza-crust-carby will have a much different effect than what you're describing. I can't eat GF pizza crust; it wrecks my digestive system. Normal pizza makes me feel pretty heavy. Maybe you could experiment with potato/sweet potato and see if it does something different.

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GF pizza crust wrecks your digestive system? In what way? I will experiment with less processed carbs and check my BS to see how I respond. – Blueberry Nov 16 2011 at 19:13
A feeling like my colon was processing sand, and an unpleasant change in stool consistency. Anyway, I just mean to avoid grains and legumes when trying to ascertain what effect straight starches, oligosaccharides, and sugars have on your BG, because wheat, soy, and other grains may cause other side effects which give you that ill, run-down feeling irrespective of BG changes. – air_hadoken Nov 16 2011 at 20:41
I think air hadoken is on to something. Since I cut my carbs, my tolerance for grains went in the toilet - and I've been GF for three years, and happily eating gluten free grains on a daily basis until 6 months ago. Just last week, I ate a big bowl of popcorn in a week moment, and I felt like dying. GF pizza crust also sits incredibly heavy now. And I've never had a "delicate" system. I think it's just the simple carbs. – syrahna Jan 18 2012 at 17:52
Sundownv, how is your tolerance to potatoes and sweet potatoes? The primary starches in wheat and corn (amylose and amylopectin) are also the same starches in roots and tubers. I would look more at the proteins than the starches from grains, even GF grains, if roots and tubers don't give you problems. – air_hadoken Jan 18 2012 at 21:48
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Hi Kimi,

I don't think you are going bald from paleo or vlc. I think you are likely experiencing tellogen effluvium which is a very common hair shedding that follows significant weight loss (30 pounds is significant on your petite frame.) Fat loss also equals estrogen loss and this is especially true at your age so again, this fluctuation could cause a temporary hair shed like telogen effluvium. Rest assured, if that is the cause, it is temporary. Google it and/or check out: http://www.webmd.com/skin-problems-and-treatments/hair-loss/effluviums

VLC has natural diuretic effect and you could be peeing out your b vites. Try 5 mg of biotin even if you are eating sevearl eggs per day -- excellent for hair. If you take a lipoic acid supplement, it can cause interference with body's use of biotin -- so always supplement with biotin if you take alpha lipoic or r-lipoic acid supplements. Note that telogen effluvium can occur after other stresses to the body such as surgery or any other severe or chronic period of stress. The shedding typically occurs several months after the period of stress is resolved and therefore those who experience it have difficulty seeing cause and effect until they realize the length of hair follicle growth and resting phases.

At your petite size, I see no reason why you need to add 50 or 75 grams of carbs unless you want to. VLC is not making you bald unless the natural appetite suppressant effect is causing you to skip meals due to lack of hunger. Your body could perceive meal skipping as a stress. Hair is made of protein and since you are vlc, I assume you eat adequate protein. One other thought is anemia -- this too could cause a shedding issue. Also, get a full thyroid panel (free t3, free t4, antibodies) and don't be satisfied with just a TSH to rule out thyroid issues. At 40, your body is not going to react to significant changes such as your excellent weight loss without a few bumps here and there on the road.

Congrats on your weightloss succcess and I don't think you have diabetes based on the pizza incident. Your body wasn't used to handling the carb onslaught of the pizza so your glucose went higher than it normally does and you understandably felt crappy. Follow your fasting and A1C to look for meaningful trends if you are really worried. But you had an unusual meal and so a blood sugar deviation is not so unusual. One last thing, lack of restorative sleep absolutely raises blood sugar and impairs glucose tolerance even in the young and healthy. (Sleep deprived college students who had been cramming for exams tested pre-diabetic but normalized after getting back on normal sleep schedules.) Also skipping meals and especially breakfast can raise blood sugar and impair glucose tolerance and insulin sensitivity in some people. Hope this helps.

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Lots of great stuff here. I hope you are right and that it is temporary. I do supplement with biotin 10 mg twice daily. You bring up a good point about meal skipping. Maybe I should check into fitday again because lack of appetite is definitely an issue some days. Honestly I like that about a LC diet. It's nice to not feel hungry. That said, I would rather feel hunger than be balding. I need to look at my protein intake as well as looking into my iodine intake. I think that may be a problem. Thanks for the alternate ideas. – Blueberry Nov 17 2011 at 3:55
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Yes...you were diabetic. Are you still? Get a BS meter from WalMart...Relion...100 strips 38$ and check your BS after any food you suspect. If you go over 140...dont eat it. Have your HBA1c checked (3 month avg. BS), get your Insulin/Leptin and C Reactive protein checked.(inflammation) C Peptide checked to see where your beta cells are as far as their health. Lastly, protect your children. Because of the gestational diabetes, they are much more at risk to develop diabetes. HOWEVER...they never have too. If you educate yourself and educate them on the way to eat to keep BS and Insulin and Leptin low...they will not become diabetic.

Just one of many studies on this. http://www.sciencedaily.com/releases/2011/05/110526064633.htm Look at the Gestational as a warning. It is your canary in the coal mine. Take it seriously and understand that you can prevent this. Good luck.

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Yes, your VLC diet can cause you to not handle insulin very well. I'm a paleo nutritionist. I would suggest you up your carbs to 50 - 75 grams per day through roots and tubers and get to a gym to get some more muscle tone. A VLC diet of under 30g is not that great in the long term. Diana

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I have to admit, I have become a bit carb phobic. I fear weight gain and fear feeling poorly and both of those things seem to accompany increasing carb intake. That said going bald isn't very appealing either. I had a kidney stone this summer so I also try to avoid high oxalate foods so that would eliminate sweet potatoes, white potatoes, carrots... I will check my list to see what starchy veggies I can have. I am assuming you are suggesting roots and tubers and not fruit due to fructose content of fruit??? – Blueberry Nov 16 2011 at 19:12
Berries are fine, and even some fruit as long as it's not 100% fructose. You shouldn't fear carbs - they can do a lot of good, especially by reducing cortisol. I would have some bloodwork and an ASI test to see what your levels are, and slowly introduce carbs. the goal is to be able to eat some carbs and not to have a huge reaction either way to carbs - you want your body to be able to handle them. If you are having this large of a reaction, you are not metabolically working properly. – Diana Rodgers Nov 21 2011 at 15:59
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 Diana, do you have an arguement to back up "A VLC diet of under 30g is not that great in the long term." I would like to see it please. Especially when giving out this info with authority to pre diabetics, diabetics.etc. "Bring out your dead"....."Bring out your dead..." – Andre Chimene Dec 6 2011 at 8:49
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Re Exercise:

This is a super quick morning routine from Tim Ferris. He uses it to prevent fat storage but it's a great little AM routine. I wake up and after some back/neck stretching and hip rotations, I do Ferris' 3 exercises : 3 sets of air squats, 3 sets of exercise band pulls and 3 sets of wall pushups. This is a super quick morning routine . Scroll to middle of page of this link and it shows videos of the exercises: http://fitnessblackbook.com/diet-tips/gone-in-60-seconds-one-minute-of-activity-to-avoid-storing-calories-of-a-meal-as-body-fat/

This seriously takes just minutes and builds functional strength. If you feel like it, add a plank for 60 seconds or more.

Also, make meditation and deep breathing a part of your life.

Woops -- forgot to add -- eat breakfast before the exercise above. The link speaks of doing them before a meal to avoid fat storage but doesn't apply to you. Read Quilt's blog today -- especially about light and meal timing and exercise timing. Great stuff.

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That does sound doable. I have just started doing yoga and that feels good. I just need to be consistent. Thanks for the link. – Blueberry Nov 17 2011 at 3:56
Hi Kimi, I think the yoga would be excellent as it would serve the dual purpose of lowering stress levels. I think less (but wise less) is more re exercise. For what it's worth, I asked my athletic hubby his thoughts and he said "She's a busy mom with 3 children -- that is the ultimate workout!" He has kids from prior marriage -- I don't. – Alexandra Nov 17 2011 at 17:13
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check out dannyroddy.com

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Check for celiac. Because of the no risk factors for GD.

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Tested negative. I am gluten intolerant tho and avoid it 100%. My husband and 2 of 3 kids have CD so we are all gluten free. – Blueberry Nov 17 2011 at 3:45
Negative gut biopsy or blood? Did you do the enterolabs test? I skipped the biopsy but the enterolab test was pretty eye opening. At that point, I was definitely malnourished and yet quite overweight. – syrahna Jan 18 2012 at 17:54
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One more new study on the subject. Please keep an eye on BS/Insulin/Leptin/Inflammation... http://www.medscape.com/viewarticle/754734?src=nl_topic

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