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Lowering blood glucose and increasing ketone levels can be difficult even when following a strict ketogenic diet. Here are some points to consider if you are having trouble getting baseline blood glucose levels to drop. My thanks to Miriam Kalamian for her assistance and expertise in troubleshooting: Physical stress: Cancer is a metabolic source of stress. Tumors may create metabolic waste products which can be converted to glucose. In addition, extensive liver metastases can interfere with the liver’s ability to generate ketones. Mental stress: Excess emotional stress can increase levels of cortisol, a hormone which can increase blood glucose. Find ways to decrease emotional and mental stress: try yoga, prayer, meditation, art projects, or doing something that you love that absorbs your attention and takes your mind off of your health. Chemotherapy and radiation: Your body reacts to these treatments like they would any injury or illness. Blood glucose is increased, however, be aware that a ketogenic diet blunts this effect. So, your blood sugar will be lower than it would be if you were eating a standard high carb diet. Dehydration: Dr. Mike Eades (author of Protein Power and a physician expert on ketogenic diets) says, “In my experience, I've found many people on long-term low-carb diets are chronically dehydrated. Chronic dehydration can increase the concentration of sugar in the blood. I've had lowcarb patients who have developed elevated glucose levels drink 16 ounces of water each morning and at least a couple of glasses of water throughout the day. In each case in which I've used this strategy, blood sugar has fallen into the normal range within a week.” Medications: Steroids and other drugs can increase blood sugar, but may be necessary for your treatment protocol. Talk to your primary care physician about equally effective drugs without this side effect. Protein consumption: It is very easy to “overeat” protein if food intake is not tracked via a food scale and log. At each meal, most people only need a serving of meat about two thirds the size of a deck of playing cards. Try lowering daily protein intake by 10 grams (in other words, eat about 1.25 ounces less protein). Hidden carbs: Read labels and count every carb in food, drinks and supplements. sugar alcohols and excess fiber can cause blood sugar spikes and interfere with ketosis for some people. Carbohydrate intake on food labels: Food labels do not provide accurate measures of carbohydrate. Food manufacturers can list zero carbs for up to 0.5 carbs per serving. Vitamins, herbal supplements, toothpaste, lip balm and other cosmetic products: These can have added sugars. Again, check labels. You may have to eliminate your supplements for several days while monitoring blood sugar. Then reintroduce them one at a time to determine which might be the source of hidden sugars. Caffeine intake: Drinking caffeinated coffee or sugar free cocoa or eating dark chocolate and other caffeine containing foods can drive up blood sugar. Caloric intake: Use the Customizing Your Ketogenic Diet steps in Chapter 6 to find the recommended caloric intake for your ideal weight and adjust your caloric intake to match. If you are losing weight you don’t want to lose, eat more calories as too low of a caloric intake can also be a stressor that results in elevated blood sugar. Exercise: Moderate exercise can elevate blood sugar for a short time right after the exercise is stopped. However, it reduces baseline blood glucose and insulin levels in the long run. In contrast, vigorous exercise can raise blood glucose for longer periods due to a stress response. Intravenous Vitamin C: higher blood sugar levels can result from intravenous C as it is metabolized like a carbohydrate. Low thyroid function: Check with your doctor on thyroid status. Dr. Datis Kharrazian has an excellent book on this subject. Miriam Kalamian recommends that people with low thyroid function ease into the ketogenic diet, one meal at a time. She suggests adding a quarter cup of cooked legumes or increasing the amounts of non-starchy vegetables at two meals until you adjust to a ketogenic diet plan. Micronutrients: Deficiencies of micronutrients can be detrimental to blood sugar control. Taking at least a baseline multi-vitamin/multi-mineral is recommended. Vitamin D levels should also be checked and optimized. See supplement recommendations in Appendix A. Systemic body inflammation: inflammation can cause blood sugar to rise, so take steps to reduce it. Eat salmon, tuna or other oily fish more often or take fish or krill oil to increase omega 3 fatty acid intake. Herbs such as turmeric, ginger, garlic, cloves, cardamom and others are anti-inflammatory. Google anti-inflammatory herbs for more information. Colds, flu and other illnesses: Fighting off virus or bacterial infections will result in elevated blood sugars. Insulin resistance: As we age, most of us eating a standard high carb diet develop some sort of insulin resistance, a systemic body reaction to chronically high glucose and insulin levels. It takes time for this condition to reverse itself once a ketogenic diet is started. Age in general: Younger people will generally respond better to dietary changes with faster drops in blood glucose and higher ketones, often within days of starting the diet. Older people will find this process takes longer. Gender: Women can experience higher blood sugars during menstruation. Blood measurement variations: Home monitor readings will be higher than a venous blood draw at your doctor’s office. Miriam Kalamian writes “ALL home monitors are merely screening tools developed for people with diabetes. That's why these "generous" variations are considered acceptable. I took our meter to several of Raffi's blood draws and found that his venous draw analyzed at the lab was ALWAYS lower than the meter, so I factored that in when testing at home. Also, I advise people to take a second reading anytime the measurement looks either too high or too low.” This document is shared courtesy of Ellen Davis from her “Fight Cancer with a Ketogenic Diet” ebook. The complete book is available at http://www.ketogenic-diet-resource.com/cancer-diet.html