Lawrence Tam says, "I keep waking up in the middle of the night and keep awoken for hours
before I give up and get off my bed.
Would low-carb, say 50 grams, make it worse?
My blood glucose was 6 three days ago, which was too high.
I like to try low-carb," and he clarifies that that's 100 milligrams per deciliter.
"I keep waking up in the middle of the night and stay awake for hours.
Would low carb make it worse?"
Lawrence, if you are in the chat, can you just clarify whether you are already on the
low-carb diet of 50 grams per day?
So, yeah, it definitely could.
So, look, if you're on a ketogenic diet—okay, first, let's say you're not on a ketogenic
diet.
Your brain will consume 120 grams of carbohydrate every day, just your brain.
There's got to be another 30 grams or so that would be used no matter what obligately by
red blood cells, certain cells in the testes, and the kidney, and the lens of the eye.
And then the rest of your body, if you're eating not a ketogenic diet, the rest of your
body is not really trying to be a fat burner, so it's going to burn through carbohydrate
that could have been replaced by fat, but it wasn't because you had carbohydrate there.
And so, your liver stores about 90 grams of carbohydrate to be able to stabilize your
blood sugar between meals, and overnight is the biggest time where it has to do that because
overnight is the longest period of time that you go without meals.
You add that up, you're looking at like 250 grams of carbohydrate a day—we haven't gotten
to high-intensity exercise yet.
You're looking at, if you want to keep your glycogen stores replete, you're probably looking
at 250 grams of carbs a day.
Now, if you go on a ketogenic diet, what happens?
Well, your brain glucose consumption goes down from 120 grams a day to like 30 or 35
grams a day.
You cannot and will not ever, ever, ever, ever, ever go to zero.
That's one thing.
You still have another 20, 30 grams of carbohydrate that you're burning through by cells that
cannot burn anything else, like red blood cells, certain cells in the kidneys, certain
cells in the testes, certain cells in the lens of the eye.
So, you still have a minimum probably 60 or 70 grams of carbs per day that you need, even
when you're maximally keto-adapted.
I'm not saying you need to eat those carbs.
You'll make them through gluconeogenesis if you don't eat them.
But the rest of the body where the needs were flexible has mostly shifted to burning fat
for fuel on a long-term ketogenic diet.
So, the real big problem is if you're not low-carb enough to be keto, but you're way
under 200, 250 grams of carbs a day.
Like, probably 100 grams of carbs a day is like, if it works for you, great, but if you
have symptoms of low blood sugar at night, you shouldn't be spending a lot of time guessing
why because you're in this gray area where you are not keto-adapted, your brain is still
burning through 120 grams a day, your liver still stores 90 grams a day, and the rest
of your body still probably is preferentially burning carbs for energy instead of storing
them for the most part because the carbs are there.
So, your body is not deliberately, intensively reorganizing to conserve the carbohydrate
in that gray area.
On 50 grams, I don't know.
How keto are you?
It's more interesting to me whether you've had sustained like 2, 3, 4, 5 millimoles per
liter ketones in your blood than how many grams of carbs you're eating.
Because if you do have sustained full-on ketogenesis, you're probably, over many weeks, you'll be
very keto-adapted, but if you don't, like if you cycle between 0.5 and 1, I don't think
you're going to be super keto-adapted.
And so, I think you're probably in that gray area.
Or if you're 50 grams of carbs a day and you don't have ketones, you're definitely in that
gray area.
So, waking up in the middle of the night and staying up for hours, yeah, if you're on low-carb,
look at the carbs, definitely.
Lawrence adds, "I'm not on the ketogenic diet."
Well, you might not be deliberately keto, but unless you test your ketones, we don't
really know how ketogenic you are, so that's the big issue there.
But again, you may have this problem on keto, but keto is way safer than being in this,
what Denise Minger calls, the macronutrient swampland, where you're like kind of low-carb,
kind of high-fat, but you're not really optimized for one or the other.
I think that's probably the worst place to be from this perspective.
And I'm not saying there's not other causes of waking up in the middle of the night.
I'm not saying that if you do have 50-100 grams of carbs, you will be in this place.
I'm just saying, if you are eating 50 or 100 grams of carbs, and you are in this place,
then you absolutely should connect the two and see if increasing your carbs helps.
Your blood glucose is a little high.
Low-carb is not the best solution to high fasting glucose.
There's a lot of people on low-carb who have high fasting glucose.
There's a ton of people who go low-carb and develop high fasting glucose.
So, low-carb helps you—if you are glucose-intolerant, you absolutely will not get high postprandial
glucose spikes when you don't eat carbs because you didn't eat the carbs, but your morning
fasting glucose is like, only if your glucose tolerance is ridiculously bad is that glucose
left over from the carbs you ate last night.
In most cases, it's hormonally controlled, and there's nothing about low-carb that modulates
the hormones in the way that prevents that.
Low-carb modulates the hormones in the way that spikes that because the hormones that
raise your fasting glucose in the morning are number one, glucagon, and then number
two, compounded by adrenal hormones.
And both of those are the early- and late-stage adaptations to low glucose supply.
You know what raises your morning fasting glucose very acutely?
Not sleeping well.
Okay, so the case you're making is one for forgetting about the glucose and fixing your
sleep, and what you're reporting says to me, definitely look at the carbs first in fixing
the sleep.