Using The Glucose Tolerance Test To Prove Fructose Intake Is Safe For Diabetics

yerrag

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Ray has talked and written about fructose being different from glucose in the body's response to them, especially with regard to diabetics. The cause for hyperglycemia is the abundance of free fatty acids in the blood stream, of the polyunsaturated variety, called PUFAs for short.

The presence of PUFAs inhibit the body's tissues from metabolizing glucose, and without the tissues using up glucose being supplied through blood, the blood sugar levels will rise. PUFAs can over time destroy the beta cells in the pancreas, which would render it incapable of producing insulin. Not being able to produce insulin would make it difficult for blood sugar to come down, for which insulin medication is needed.

For individuals who still retain the ability to produce insulin, the increase in blood sugar from glucose intake is followed by an insulin reaction, which causes blood sugar to drop as the blood sugar is converted to fats by the liver. The blood sugar level can be quickly lowered by the insulin response, and this would lead to low blood sugar levels, a condition called hypoglycemia.

Whether a person suffers from hyperglycemia or hypoglycemia, it still points to an inability to hold blood sugar levels within a normal range. This ability affects our health in many ways, as it reflects on our ability to metabolize sugar for energy, which we need for our daily energy needs, as well as for our immunity.

Conventional wisdom has it that fructose is not a healthful to take. We hear of Mercola saying that fructose intake leads to increase in uric acid, and equates that to a bad thing, forgetting to mention that uric acid is an antioxidant. It associates uric acid with arthritis and with gout, but neglecting to mention that people with cancer often have very low uric acid levels.

Ray Peat has nothing but good things to say about fructose. He says that fructose, unlike glucose, can readily be metabolized by the body, even for people whose blood contains plenty of PUFAs. He also says that regular intake of fructose can restore the beta cells in the pancreas that produce insulin.

Yet how many of us has brought this knowledge to use in the real world? For ourselves, and for the people around us who are afflicted with problems of blood sugar control? I was once hypoglycemic, but did not realize I was. I would get fever and flu often, and wonder why I was so weak inspite of the many Shaklee vitamins I was taking. When I don't eat for 3 hours, I would feel sleepy, or my nose would begin to run, or I would have a cough. Taking a piece of candy would only make things worse. It was only when I read a book on hypoglycemia that I took more notice. And when I convinced my primary care physician to let me take a glucose tolerance test (GTT), the 5hr variety, I realized from the graph of the results that I was hypoglycemic. I made that conclusion, by the way, as my doctor looked at the data and told me I was normal, being "within range."

The GTT holds a special place in my heart, as it was this test that put me on my way to health. Yet few people have heard of it. Few use it at all. People just rely on the FBS (fasting blood sugar), but it does little in showing the true state of how well we maintain our blood sugar.

The GTT is done in a diagnostics lab, much in the same place where we have our blood tests taken. It involves taking a preset amount of glucose (75g is what I remember), and taking blood sugar values every hour for 5 hours, starting at 0 hour. A curve is plotted with the x-axis for blood sugar, and the y-axis for time. Based on the shape of the curve, a person can be easily diagnosed as being diabetic, normal, or hypoglycemic, in varying degrees.

It is a very simple test though, and anybody can do it himself. All he needs is to fast for a good 8-9 hours before the test, and take 75 grams of glucose, and use a blood sugar meter (Terumo is one brand) to take his blood sugar level every hour, staring from 0 hr, for 5 hours. Plotting the curve is simple. And interpreting it is as easy as long as you can see. If one is too scared to do it, getting a nurse would help.

I would like to use this test to prove what Ray has been saying about fructose. If what he says is true, that fructose is readily metabolized regardless of a person's ability to metabolize glucose, the GTT curve from fructose intake should come out to be closer to looking like the curve of a person with normal, or healthy blood sugar control.

I would need three subjects (a diabetic, a hypoglycemic, and a person with healthy blood sugar control) to take 2 GTT's each. One test involving glucose, and another test involving fructose.

The GTT curves of each subject would be put side by side and compared, and it would hopefully prove that indeed fructose intake, instead of glucose intake, would be beneficial to persons with blood sugar control issues.

But there is one catch so far. We don't have access to pure fructose. So we would need to do another set of tests for the diabetic and the hypoglycemic. This time, instead of fructose, we would be using real honey, cane sugar, orange juice, and pineapple juice. Honey and cane sugar are half fructose, and pineapple juice has more fructose content that orange juice.

This set of GTT tests would serve to determine whether intake of these substances would be advisable, in terms of whether they will produce more stable blood sugar control in people. Depending on the results of these tests, one could determine whether it would be better to substitute rice intake with intake of say, cane sugar on a caloric equivalent basis.

I go back now to my question of whether you have really applied Ray's thoughts on fructose to heart, to yourself and to the people whom you can help, blood sugar control-wise. If you are able to see the results of such tests, will you be convinced to shift your carb intake to intake of fructose-rich substances? Would you be able to convince family and friends to make the shift? And would it be possible to see some diabetics regain the ability to produce insulin and improve the quality of their life?
 
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yerrag

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Testing My Understanding Of Starches

Look at post #9 for an example of a glucose tolerance chart. It is actually my GTT from 18 years ago. It reveals a sharp drop in my blood glucose from the first hour to the third hour, from 110 to 65. It explains why I needed to eat again after 3 hours, as my blood sugar had dropped so much that at that point I would start to feel sleepy, and often I would begin to sneeze, or my nose would start to drip, and at times, my throat would start to get soar, and I would end up with a fever later.

The blood sugar would go back p at the fourth and fifth hour. I think this is the result of glycogen from the liverbeing converted to glucose. This is well and good, but it's better to avoid having blood sugar at those low levels. It impairs my immunity. I also think it makes me more susceptible to allergies.

I don't think my GTT curve looks like that now. I imagine if I did my GTT now, I would have have start off with a blood sugar level of 85 at 0 hour, then 90 at 1 hour, and it would level off at 85 at the third hour, and stay constant till the fifth hour. This is a curve of a person with healthy blood sugar control. Keeping the blood sugar level consistently within safe range, to me than would be 80-100, would be a sign that we are metabolizing sugar well. Not having the presence of free fatty acids in the blood to interfere with sugar metabolism, I think, would be associated with such a GTT curve, or profile.
 
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yerrag

yerrag

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I'm really convinced the GTT does more than a simple fasting blood sugar (FBS) test in giving us the state of our blood sugar health. Without the GTT, I wouldn't have known that I was hypoglycemic. Without knowing I was hypoglycemic, I would not have know to address my condition then. Substituting my meals with brown rice over white rice did the trick then, at least as far as managing my hypoglycemic condition, so that I avoid episodes of low blood sugar. When I avoided these low blood sugar episodes, I didn't get sick as much anymore.

Before I learned of Ray Peat, I had decided not to use PUFAs anymore, even avoiding the fish oils I have been taking. I had listened to Brian Peskin on "It's Rainmaking Time," and it seemed to make sense to avoid PUFAs. It must have been four years since I ditched PUFAs, and since then I've read of Peat and read his articles, and I decided to see if I can do better now eating white rice. I switched back to white rice, and I realized I no longer need to white brown rice, and it felt as if I don't get those blood sugar lows I had before on white rice. What changed? My body probably had gotten rid of the PUFAs in my system (from 4 years of being PUFA-free), and my body was metabolizing glucose well, such that my blood sugar wasn't spiking up anymore, and I wasn't releasing insulin anymore to deal with the high blood sugar, as my blood sugar wasn't getting that high anymore after a meal. True enough, Peat was right, the PUFAs were keeping my body tissues from metabolizing glucose, and the PUFAs were causing my blood sugar to go up, to a point where insulin was released, and which would cause my blood sugar to go down to low levels.

I'm now going to be the healthy test subject. I'll do a series of GTT on myself. I have a blood glucose meter to take blood glucose readings. I'll use different kinds of sugar - a) 75 grams of glucose, b) 75 grams of fructose, c) 75 grams of cane sugar, d) 75 grams of honey, e) 75 grams of orange juice, and f) 75 grams of pineapple juice.

I have to know where to get glucose and fructose though.

From these tests, I would get an idea of how different forms of sugar and fruit juices would affect my blood sugar. This would serve as a template for testing people with blood sugar problems, such as diabetics, and hypoglycemics. It would be interesting to show the effect of fructose on the blood sugar on diabetics and hypoglycemics. If diabetics and hypoglycemics could really metabolize fructose, then it begs the question of why people aren't doing this to manage diabetes and hypoglycemia. Perhaps if I could show that intake of fruit juice also has positive effects, then diabetics and hypogycemics could start drinking fruit juice as part of their meal, replacing starch such as rice and potatoes in their meals.

But you may be saying this study is not for you since you're not diabetic. But are you sure you aren't hypoglycemic? If you are hypoglycemic and you don't know it, you owe it to yourself to know. Hypoglycemia is very much undiagnosed by mainstream doctors. Not much attention either is paid to it by naturopathic doctors. Having a healthy blood sugar level throughout the day and night has important implications for your health, far more than you give it credit. I hope I can show you how easy it is to diagnose it yourself.

Remember, a problem identified is a problem half-solved.
 

Ulysses

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You guys are talking about reactive hypoglycemia, right?
 
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yerrag

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You guys are talking about reactive hypoglycemia, right?
I'm not sure what reactive hypoglycemia is. But is it hypoglycemia induced by insulin reaction to hyperglycemia?
 

Ulysses

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I'm not sure what reactive hypoglycemia is. But is it hypoglycemia induced by insulin reaction to hyperglycemia?
Yes, I read your post more closely and that's what it is. I have it too; I actually passed out in the waiting room during my GTT.
 
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yerrag

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Yes, I read your post more closely and that's what it is. I have it too; I actually passed out in the waiting room during my GTT.
That was really bad. How low did your blood glucose get before you passed out? How long did it take before you passed out?
 

Ulysses

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That was really bad. How low did your blood glucose get before you passed out? How long did it take before you passed out?
Less than an hour. I have no idea how low my glucose was because, you know, they only take it hourly. Even at the hour mark I was low. 55 mg/dL.
 
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yerrag

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Less than an hour. I have no idea how low my glucose was because, you know, they only take it hourly. Even at the hour mark I was low. 55 mg/dL.
It's that bad then. How are you dealing with? How are you improving your blood sugar condition?
 

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My wife is T1D since age 28, now she is 48. I have given her pure fructose when she has hypo and it spikes blood sugar just the same if not even more! But again she might not be the perfect test subject as she is on thyroid medication and her liver is not in good condition (not converting T4 to T3) , and liver is in charge of putting fructose in use. I want her to make FTT but she cant stay 5hrs only on 75g of fructose, i guess after 3hrs she needs to eat again. Btw i think no big difference between honey and cane sugar, both are 50/50 glucose/fructose.
 
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yerrag

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@Ulysses and @kondevantoni thank you for your comments and observations. It gives me pause now to consider the safety implications to undergoing this test without supervision. That may be a reason it is done in clinics and not as a DIY procedure. There are some gotchas that we can be unprepared for at home. Perhaps it would be advisable to bring a nurse in to do the test, as well as have a plan laid out to deal with situations such as fainting. Now I get what @tara was saying in another thread about this being unsafe, as she had experienced discomfort taking this test.

Nevertheless, I feel that the test is useful as it reveals the extent of our blood sugar control disorder. If you are fainting like Ulysses did even during the first hour, it shows how bad the blood sugar condition is. It could also reflect on the heavy presence of PUFA free fatty acids, as well as poor glycogen storage, or adrenal insufficiency. But without knowing how bad the blood sugar control situation is, we aren't equipped to deal with the situation. I look at my situation and now realize how much better off I was in being able to make it throgh a 4 hour GTT, and I feel blessed that I saw my condition and took corrective steps. Those corrective steps led me to a much, much better state of health. I would say I was on the way to becoming diabetic, since hypoglycemia would easily turn into diabetes once the pancreas' beta cells die and cease producing insulin. It would be a matter of time when that happens since my condition was caused by PUFAs, and constant PUFA exposure would lead to the death of the beta cells.

kondevantoni, perhaps your wife was still able to metabolize the fructose, but it's just that it was being metabolized at a slower pace due to her compromised liver condition. Otherwise, why would she need to eat again after 3 hours? In that condition, it would seem she isn't metabolizing fructose initially, as her blood sugar would shoot up.

One thing I failed to consider is whether the blood glucose meter would be able to measure fructose, is fructose were used instead of glucose. Does anybody have an answer to that?
 

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One thing I failed to consider is whether the blood glucose meter would be able to measure fructose, is fructose were used instead of glucose. Does anybody have an answer to that?
I guess fructose is metabolized in the liver and then enters bloodstream as glucose so you can measure it.
 

kondevantoni

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Otherwise, why would she need to eat again after 3 hours?
Not necessarily, but her blood glucose will probably go too low for that amount of time, usually she eats every 2-3hrs and makes sure blood glucose is highish before bed.
 

Ulysses

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It's that bad then. How are you dealing with? How are you improving your blood sugar condition?
Well, for one thing, when I had that test done I was MASSIVELY overtraining, like, 40 minute cardio workouts above lactate threshold on a daily basis (I know) and had been for a couple of weeks. So, I don’t know what influence that had on the results - I have since backed way off on the exercise. Other than that, Peating, using different strategies to enhance insulin sensitivity, avoiding PUFA, trying to get plenty of very low intensity exercise.

The test was two years ago now and I feel that my condition has greatly improved during that time - it would be interesting to take it again now.

But yeah, I agree, it should be supervised. Nobody at the lab noticed that I was unconscious. Luckily, I wasn’t unconscious for long - just a few minutes, I think. The lab people are just technicians, though; the person I feel irritated with is the endocrinologist who ordered it. He should have been able to foresee this possibility.
 
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yerrag

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@kondevantoni ,

From Glucose and sucrose for diabetes. :

One of the points at which fatty acids suppress the use of glucose is at the point at which it is converted into fructose, in the process of glycolysis. When fructose is available, it can by-pass this barrier to the use of glucose, and continue to provide pyruvic acid for continuing oxidative metabolism, and if the mitochondria themselves aren't providing sufficient energy, it can leave the cell as lactate, allowing continuing glycolytic energy production.

Many people lately have been told, as part of a campaign to explain the high incidence of fatty liver degeneration in the US, supposedly resulting from eating too much sugar, that fructose can be metabolized only by the liver. The liver does have the highest capacity for metabolizing fructose, but the other organs do metabolize it.
 
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kondevantoni

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@kondevantoni ,

From Glucose and sucrose for diabetes. :

One of the points at which fatty acids suppress the use of glucose is at the point at which it is converted into fructose, in the process of glycolysis. When fructose is available, it can by-pass this barrier to the use of glucose, and continue to provide pyruvic acid for continuing oxidative metabolism, and if the mitochondria themselves aren't providing sufficient energy, it can leave the cell as lactate, allowing continuing glycolytic energy production.

Many people lately have been told, as part of a campaign to explain the high incidence of fatty liver degeneration in the US, supposedly resulting from eating too much sugar, that fructose can be metabolized only by the liver. The liver does have the highest capacity for metabolizing fructose, but the other organs do metabolize it.

Thanks yerrang, thats good news i did not know that other organs can metabolize fructose.

This morning i did the GTT with honey, but couldn`t keep it longer than 2hrs, got so hungry and had to eat. As you can see from the numbers BG went too low!
Woke up 8.30- BG=5.2 mmol/l
8.45 ingested 75g of honey
9.15 BG=7.0 mmol/l
9.45 BG=3.8 mmol/l
10.15 BG=4.8 mmol/l
10.45 BG=4.1 mmol/l

In a few day will do the fructose version and post.
I am 50 yo male, 2 years since RP, before that 5 years paleo, healthy, BMI=24, no medications, RP diet and suplements.
 

tara

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One thing I failed to consider is whether the blood glucose meter would be able to measure fructose, is fructose were used instead of glucose. Does anybody have an answer to that?
I'm not sure that it does. I think it might only measure glucose, and not fructose or lactose or other sugars.

Refractometer measures all the sugars (or is it all the dissolved solids, which is mostly sugars?).
 
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yerrag

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Thanks yerrang, thats good news i did not know that other organs can metabolize fructose.

This morning i did the GTT with honey, but couldn`t keep it longer than 2hrs, got so hungry and had to eat. As you can see from the numbers BG went too low!
Woke up 8.30- BG=5.2 mmol/l
8.45 ingested 75g of honey
9.15 BG=7.0 mmol/l
9.45 BG=3.8 mmol/l
10.15 BG=4.8 mmol/l
10.45 BG=4.1 mmol/l

In a few day will do the fructose version and post.
I am 50 yo male, 2 years since RP, before that 5 years paleo, healthy, BMI=24, no medications, RP diet and suplements.

Sorry took a while to respond. I wasn't so used to mmol/L. But now able to correlate to mg/dl values.

That still seemed to show a very fast insulin response. Would be interesting to see the response to fructose. If the fructose is well received and metabolized, and it doesn't trigger an insulin response (due to because it isn't glucose, or due to the fructose didn't go high enough to trigger an insulin response, assuming it does trigger an insulin response), those numbers would just play out within a safe range for blood glucose.

I should do my own test, just don't have a source for fructose and glucose yet. Haven't been looking though.

Incidentally, I find my response to honey good. When I'm hungry and take a tablespoon of honey, I feel good. I'd like to see how that plays out in a GTT. For now, I'll just take 75g of honey to see how that feels. After one hour, I still feel good.
 
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yerrag

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I'm not sure that it does. I think it might only measure glucose, and not fructose or lactose or other sugars.

Refractometer measures all the sugars (or is it all the dissolved solids, which is mostly sugars?).
Probably won't matter as much, as long as blood glucose levels are accurately reflected, assuming that it is glucose that determines the insulin response and it is glucose that determines the body's responses to high and low blood sugar.

I only have salinity refractometers. Would have to check if there are refractometers that are low-cost that can be used for determining fructose levels.
 
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