Low Carb 4000+ Calorie Diet?.....Please Help

Diet and Nutrition
1

So my doctor recently told me two things I never wanted to here: 1. I have bad cholesterol and 2. I am in danger of developing Stage 2 diabetes. These were not the things I wanted to hear because I am only 20 and am desperately trying to put on weight.

I am 74 inches tall and only 150 pounds: Skinny I know. I have been lifting awhile but lately I have not been only because of how screwed up my diet has been and how slammed packed I have been with school (I know not a real excuse); I just have no idea where to start.

Normally I eat around 3000+ calories and that usually kept me around 155-160 but I had carbs in my diet. My goal weight is 215 eventually but right now I would like to try and hit 180. The highest I ever got was 170 but I was eating over 300g of quality carbs and eventually got the flu and never was able to gain it all back.

Can anyone help with a good 4000+ calorie diet that is low (less than 50 grams) of carbs? Is it healthy to consume 300g+ each of fat and protein regardless if they are considered healthy? From everything I have read 4000-4,500 calories would keep me gaining until I hit around 180 to 185 pounds, of course weight training would be part of it too not just eating.

-Side note: I have to do cardio at least twice a week due to the program I am in.
Thank you everyone for your help, it is greatly appreciated!

PS: Doctor said stay away from anything with high amounts of bad fats (whole eggs, creams, bacon, etc) especially if I planed on eating it every day. Also starchy carbs and most fruit (bananas and anything with the word melon in it) are a no go too.

PSS: Just to give you a perspective on how my body is if I eat under 3000 calories and run say 1.5 miles and workout that day too; I would lose on average of 2 pounds a day. Also when I had the flu I lost 20 pounds in a week easily.

2

Your doctor’s idea of “bad fats” is out of date. Which, sadly, is not surprising.

For the time being, I would quit worrying about reaching 215 pounds and just focus on slowly gaining good, clean weight. Not all of us are meant to be mass monsters, and if you have potential T2DM brewing I would strongly advise keeping that at bay vs forcing yourself to gain extra weight just because. You might look very, very good at a lean 175 anyway

Two medical questions:

  1. what exactly prompted your doctor to say you’re on the edge of developing T2DM? A fasting glucose result? An HbA1c test? If so, what was the result?

(Note: I am not an MD, but I’m a cardiovascular disease epidemiologist and have published a handful of articles in the medical journal Diabetes Care. So while I’m not licensed to practice medicine, I’m a bit more knowledgable than a layperson and might be able to help you understand your test results)

  1. what was your cholesterol panel actually like? Most docs are a little behind the times on interpretig this stuff as well. Total cholesterol number means little, and high LDL isn’t always as bad as docs think it is.

As for your question re: what to eat, I want to hear the answered to these questions first, but I’ll repeat that your doc’s idea of "bad fats is straight from the oh-whoops-we-fucked-up dietary guidelines of the 1980’s and 1990’s that GAVE everyone type 2 diabetes. I would recommend fatty cuts of meat (duck, lamb, goose, chicken with the skin on) plus things like coconut oil, butter, heavy cream, avocado, and some nuts here and there.

3

I know quite a few people who have gained some quality LBM the proper way, but I don’t know anyone who has done so on a long-term diet with carbs consistently at <50g/day - not a single person. I won’t say it’s impossible, but you should research the role of carbs being used as a proper anabolic nutrient. I used to be carb phobic, and while I lost fat, it got me nowhere LBM wise.

If you are dead set on living a very low carb lifestyle long-term and that’s just how it’s going to be, yet you also want to have success with adding quality LBM and weight training, the only middle ground I know of is something like the anabolic diet or the cyclical ketogenic diet (you can Google those terms and do some reading).

You might check out the thread I posted a week ago, being in a similar situation with some higher than normal fasting blood glucose levels. There were some great responses with article links that you might find very helpful: http://tnation.T-Nation.com/free_online_forum/diet_performance_nutrition_supplements/diagnosed_as_prediabetic

4

[quote]Mxdamien wrote:
So my doctor recently told me two things I never wanted to here: 1. I have bad cholesterol and 2. I am in danger of developing Stage 2 diabetes. [/quote]

What is “Stage 2 diabetes”?

5

If you have trouble maintaining weight on 3000 cals at 150 pounds then it is probably due to a high degree of insulin insensitivity already, if not type 2 diabetes.

The main problems that diabetes doctors “have” with fat is that a) they believe it makes you gain fat and become less insulin sensitive and b) they believe that saturated fat is atherogenic and c) to a lesser degree they believe that eating fat reduces your insulin sensitivity for that meal.

a) does not have to be true. You do not need to gain fat eating more fat, but they just assume that the more fat the average American eats, the more calories and fat they are accumulating. Also more bodyfat DOES push you closer to diabetes. (If you have trouble gaining weight on 3000 cals you likely have hit the beginning of type 2 diabetes anyway).

b) The sum of research does not show dietary saturated fat as atherogenic. When the effects of high carbs that people who eat high saturated fat usually eat are remove, the higher saturated fat diet is probably anti-atherogenic.

c) It does reduce insulin sensitivity during a given meal, if you take x carbs and y fat and add 50% fat your acute sensitivity does go down, but if you replace carbs with fat and keep cals the same your insulin demands are LESS and your insulin sensitivity long term also stay higher which can keep you from going to the final stage of type 2 which is a dead pancreas.

Going below 100 grams of carbs a day has been shown to possibly raise blood sugar, and the lower you go the more erratic it can become because it upramps gluconeogenesis to provide glucose for the brain. You become LESS insulin sensitive at under 100 grams. Also stress hormone induced blood sugar spikes tend to be greater on a very low carb diet than on a 100 gram carb diet because on the 100 gram carb diet your not relying on a constant basal glucagon release to maintain brain glucose, and again that tends to lower insulin sensitivity.

In my honest opinion, a prediabetic will have the best chance at reversal if they get 100-150 grams of carbs then if they go under 100 grams because their body becomes insulin insensitive to preserve glucose for the brain at under about 100 grams a day.

Also, a low animal fat diet can further reduce insulin sensitivity by creating a choline deficiency.

Omega 6s (linoleic acid) has to be removed. Also, among MUFAs, Canola, even with low erucic acid lowers lifespan in rats.

Omega 6s cause inflammation chronically which reduces insulin sensitivity CHRONICALLY and elevates blood sugar chronically.

You can follow your doctor’s advice and your consolation will be an apology 20 years from now.

6

[quote]EyeDentist wrote:

[quote]Mxdamien wrote:
So my doctor recently told me two things I never wanted to here: 1. I have bad cholesterol and 2. I am in danger of developing Stage 2 diabetes. [/quote]

What is “Stage 2 diabetes”?[/quote]

I assume he means Type 2 and is just unfamiliar with the terminology.

Which is understandable. I’m quite well-versed in this now but as a first year grad student I didn’t even know the difference betwee T1DM and T2DM. That’s why I like OP to give us a little detail about exactly what his physician said when telling him that he’s on the verge of developing DM. I can think of a couple things that might be misleading.

7

[quote]ActivitiesGuy wrote:

[quote]EyeDentist wrote:

[quote]Mxdamien wrote:
So my doctor recently told me two things I never wanted to here: 1. I have bad cholesterol and 2. I am in danger of developing Stage 2 diabetes. [/quote]

What is “Stage 2 diabetes”?[/quote]

I assume he means Type 2 and is just unfamiliar with the terminology.

Which is understandable. I’m quite well-versed in this now but as a first year grad student I didn’t even know the difference betwee T1DM and T2DM. That’s why I like OP to give us a little detail about exactly what his physician said when telling him that he’s on the verge of developing DM. I can think of a couple things that might be misleading.[/quote]

You may be right. That said, how many 150# @6’2", never-been-fat/can’t-gain-weight 20 y.o. with metabolic syndrome have you heard of? Because I’ve been a doctor a reasonably long time, and it’s a first for me.

8

[quote]EyeDentist wrote:

[quote]ActivitiesGuy wrote:

[quote]EyeDentist wrote:

[quote]Mxdamien wrote:
So my doctor recently told me two things I never wanted to here: 1. I have bad cholesterol and 2. I am in danger of developing Stage 2 diabetes. [/quote]

What is “Stage 2 diabetes”?[/quote]

I assume he means Type 2 and is just unfamiliar with the terminology.

Which is understandable. I’m quite well-versed in this now but as a first year grad student I didn’t even know the difference betwee T1DM and T2DM. That’s why I like OP to give us a little detail about exactly what his physician said when telling him that he’s on the verge of developing DM. I can think of a couple things that might be misleading.[/quote]

You may be right. That said, how many 150# @6’2", never-been-fat/can’t-gain-weight 20 y.o. with metabolic syndrome have you heard of? Because I’ve been a doctor a reasonably long time, and it’s a first for me.[/quote]

We definitely need to know why his doctor considers him to be at risk of develping type 2 diabetes. New research shows it to be autoimmune mediated and its actually MORE genetically predisposed than type 1 because the propensity for insulin sensitivity is more directly related to specific genes than what leads to type 1.

9

And also what bad cholesterol means.

10

Well I was pretty much in the same condition when I started lifting 3 years ago, high cholesterol skinny/never gained weight…

What’s wierd is that your doc’s advices are partly off, telling you not to eat whole eggs or fruits is dumb imo

Good sources of fat you can pile on : whole eggs, avocadoes, dark chocolate, coconut milk, all sources of Omegas3 - moderately : some oils, some nuts as long as you avoid omegas6
About carbs, maybe try to avoid them for most of the day, I’d still keep some fruits here and there (breakfast, snacks), and a good dose around workout. Avoiding starch : yes, since it might also mean avoiding gluten, wheat, and so on

If you had a screwed diet anyway, you were bound to stay skinny. You need vitamins, minerals, alcaline, non inflammatory foods to grow. That might mean less total calories than what you believe you need

11

[quote]EyeDentist wrote:

[quote]ActivitiesGuy wrote:

[quote]EyeDentist wrote:

[quote]Mxdamien wrote:
So my doctor recently told me two things I never wanted to here: 1. I have bad cholesterol and 2. I am in danger of developing Stage 2 diabetes. [/quote]

What is “Stage 2 diabetes”?[/quote]

I assume he means Type 2 and is just unfamiliar with the terminology.

Which is understandable. I’m quite well-versed in this now but as a first year grad student I didn’t even know the difference betwee T1DM and T2DM. That’s why I like OP to give us a little detail about exactly what his physician said when telling him that he’s on the verge of developing DM. I can think of a couple things that might be misleading.[/quote]

You may be right. That said, how many 150# @6’2", never-been-fat/can’t-gain-weight 20 y.o. with metabolic syndrome have you heard of? Because I’ve been a doctor a reasonably long time, and it’s a first for me.[/quote]

Oh, I agree. That’s why I’d like to know what his test results were or what prompted his doc to tell him that he’s on the verge of DM.

I can imagine a couple of errors/misunderstandings, on both the patient and physician side, that might end up in a confused patient.

  • did the physician make this assessment based on a single glucose measurement? If so, was it a fasting glucose? If it was interpreted by the physician as a fasting glucose, was the OP actually fasting?

  • was it something more sophisticated like a GTT or an A1c?

  • whatever the test was, did OP follow pretest instructions properly?

  • has OP considered getting a retest to confirm that this isn’t a lab error or fluky one-day reading caused by non fasting and/or stressful state / poor sleep (there’s evidence that poor sleep → higher fasting glucose), etc.

Basically, like I said, I want to know if the doc has made this diagnosis based on a single test and, if so, I want to know if that test can be trusted or if there’s some unseen source of error here

I also suspect, given the doc’s lackluster (from what OP has told us) diet advice, that the doc may not be much of a nutrition expert (and that’s not meant as a knock on the doc; there’s a reason we have specialists for these things).

12

Just to be clear as well, I had a doctor tell me I was borderline with a morning fasting blood sugar of 95 and 99. And this was not my “fasting” blood sugar. My real fasting blood sugar is 80, but when I first wake up, my morning cortisol kicked it up to the mid to upper 90s.

So if the doctor is interpreting a 95 fasting blood sugar as borderline he is falling into a particular camp. Now a 95 fasting blood sugar may be more PREDICTIVE of future diabetes than an 80, but its not healther and there are many normal explanations.

If the doc is seeing a 120 he’d be prescribing something already. That leaves HbA1C and glucose tolerance test.
And if you have a fasting blood sugar of 101, you pretty much get an HbA1C as standard protocol. Now if that were say 6.0-6.4 I’d say he is in danger.

As for cholesterol, I’d rather be at 240 than 140, that’s for sure. I’d rather be at 220 than 170. Lower is not better and there is nothing wrong with a 220 cholesterol. I know a 75 year old lady who was put on a statin because here cholesterol is 170, which is LOW LOW LOW TOO LOW for a 75 year old lady, but since she has moderately high blood sugar which is under control with meds, and over 170 she fits some new standard of 2 borderline characteristics.

13

I am having a hard time visualizing the doctor’s appointment. Doc “well, your in danger of developing type 2 diabetes…see ya next year”

It doesn’t make sense.

Maybe you already have type 2 diabetes, but it is still reversible?

14

An aspect which seems addressed insufficiently often is that the microbiological status of the GI tract can have a great deal to do with development of metabolic syndrome or Type II diabetes, and it can be missing important things to view diet only in terms of effect on body once absorbed rather than also effect on the gut microbiome or receptor activation in the GI tract. Also, far too often more than one variable changes at a time, and effects get attributed to the wrong variable.

So, all kinds of nutrient effects get (IMO) misevaluated by many nutritionists, doctors, and study authors.

An indirect effect of increased fat consumption is increased bile production, which can greatly affect the relative proportions of different bacterial types in the GI tract. As an incomplete example of effect of such changes, increase in some of the gram-positive bacterial types can increase lipoteichoic acid production, which is an inflammatory activator of TLR2 which likely promotes development of Type II diabetes. In contrast, some other bacteria produce a TLR2 inhibitor. It’s a definite fact that the balance of bacteria makes a difference.

A direct effect though not of “fat” itself but specifically at least palmitic acid is activating this same TLR2 receptor. Some activation is normal and fine and is not going to promote development of Type II diabetes or metabolic syndrome. But, all things in balance is as good as philosophy here as anywhere.

I don’t think it’s likely for most individuals (Not to say it might not be true for a given individual) that progression towards Type II diabetes is advanced by a healthy diet with moderate consumption of complex carbs relative to a particularly low-carb diet. And I especially don’t think it likely that aiming for high fat (for example over 200 g to hit this caloric goal on low carbs) is going to be better in this regard. It will probably be worse. The reasons for modern increase in prevalence of Type II diabetes is for other reasons than presence of reasonable carb intake.

15

Hey guys sorry for all the confusion, let me clear some stuff up:

The main reason why I sought out a doctor to begin with was over the past 6 months something just didn’t feel right. Before the appointment I was eating my normal carbs and protein, steadily increasing weight. The main thing I noticed was I was getting very tired. I didn’t think much of it so I got a blood test and here is the stuff that came back that were an intermediate or high risk:

Cholesterol:
Apo B (mg/dl) - 67 Noted as a Intermediate Risk
LDL-P (nmol/L) - 1273 Noted as a Intermediate Risk
Inflammation Oxidation:
Lp - PLA2 (ng/mL) - 262 Noted as a High Risk
Metabolic:
25-hydroxy-Vitamin D (ng/mL) - 17 Noted as a Intermediate Risk
Glycemic Control:
Fructosamine (umol/L) - 342 Noted as a Intermediate Risk
Insulin Resistance:
a-hydroxybutyrate (ug/mL) - 5.6 Noted as a Intermediate Risk
Beta Cell Function:
Proinsulin (pmol/L) - 15 Noted as a Intermediate Risk
Proinsulin:C-peptide Ratio - 7.8 Noted as High Risk

Basically what he told me was I had some evidence of Beta cell dysfunction and that the elevated Proinsulin to c-peptide ratio has been associated with the beta cell failure and beta cell dysfunction. He also said I reason for me feeling like garbage after I eat is that my body is making too much insulin per gram of carb. He told me I am in early stages and I could reverse it but I have to start now. He also said there was some evidence of adipose tissue insulin resistance.

16

Ah. So the concern is Type 1 DM.

As for the OP having “Stage 2” diabetes…Turns out, there is a push among DM researchers/clinicians to develop a three-stage model of Type 1 DM:

http://www.healthline.com/diabetesmine/defining-those-early-stages-of-type-1-diabetes#1

17

[quote]EyeDentist wrote:
Ah. So the concern is Type 1 DM.

As for the OP having “Stage 2” diabetes…Turns out, there is a push among DM researchers/clinicians to develop a three-stage model of Type 1 DM:

http://www.healthline.com/diabetesmine/defining-those-early-stages-of-type-1-diabetes#1[/quote]

I am not sure. I thought that first, but then thought that it seems like the doctor ordered the c-peptide and proinsulin tests because the patient was becoming hypoglycemic after eating carbs, and OVERsecreting insulin because he has reduced adipose sensitiviy to carbs, so when he is inactive he gets an overresponse of insulin, but then if he becomes active the muscles respond very fast to the excessive insulin and push his blood sugar low.

My take is that the doctor called for the tests to see if there was tumor induced pancreatic hyperinsulinemia, but found a ratio of c-pep to proinsulin that correlates to future onset of type 2.

type 1s are not insensitive to insulin. They may be VERY sensitive to insulin, and the test to ID them is autoantibodies. beta destruction occurs in both types, and is probably autoimmune mediated in both types.

But I am interested in the 3 stage model of type 1. There is a two stage model of type 2 though, basically insulin resistance, and beta cell loss, and the beta cell loss itself has really 2 stages, glucotoxic mediated, and immune mediated beta cell destruction.

But late onset type 1 is possible. If the doctor is saying to stay away from bad fats like eggs and cream, for someone with a BMI of what 19?, then I question that. Those fats HAVE been shown to increase total LDL in some cases…but BY enlarging the VLDLs to larger, less harmful LDLs! total LDL goes up but ApoB doesn’t.

Those tests though, the CPep and proinsulin are done in people already diagnosed with Type 1 diabetes, stage 1 for example. In fact they are rarely ever done for someone who is not type 1 in “stage” 1.

18

I forgot to ask the OP for a typical diet, what kinds of foods have you typically eaten over the 6 months or so leading up to this?

19

Leading up to the tests I was eating a good amount of carbs around 300g or so a day with things such as angel hair, brown rice, sweet potatoes, wheat breads, leafy greens with the occasional pizza. Also dabbled in weight gainers for some time like Serious Mass and another nutrishop low sugar brand.

20

See this E.D.

so its pretty clear that the tests were ordered for hyperinsulinemia, which may lead to type II diabetes because of hyperinsulinemia which is both the cause and effect of insulin resistance (nothing to do with Type I Diabetes).

http://care.diabetesjournals.org/content/31/Supplement_2/S262.full

Once again it looks like hyperinsulinemia makes fat cells particularly resistant. This makes the hyperinsulinic response to carbs even greater, causing a spiral.
The hypos that the OP felt were due to lots of insulin, but fat cells being unable to respond due to their IR. Muscles and liver then will end up being exposed to all of that insulin, but they are more sensitive, especially when glycogen gets low, or muscles are used, and the hyperinsulinic levels drive hypos.

So gaining muscle and losing fat may prevent the development of T2D, although I am interested in the diet because it may also cause hepatic insulin resistance which may also be reversible with dietary changes, although these changes tend to be a little different than the ones that could reverse adipocyte resistance. (dietary fat alone can raise adipocyte insulin resistance, but reduce hepatic and muscular insulin resistance).