Question: "I keep waking up in the middle of the night and stay awake for hours. Would low carb make it worse?"
It definitely could.
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, the kidney, and the lens of the eye. Then the rest of your body — if you're eating not a ketogenic diet, the rest of your body is not really trying to burn fat, so it's going to burn through carbohydrate.
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.
If you add that up, you're looking at like 250 grams of carbohydrate a day — and remember we haven't gotten to high-intensity exercise yet.
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. 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.
==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.
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. That's because a low carb diet alters the hormonal environment in two main ways:
1.) Increases the morning glucagon response.
2.) Increases adrenal hormones.
Both of these are early and late-stage adaptations to low glucose supply.
This Q&A can also be found as part of a much longer episode, here:https://chrismasterjohnphd.com/podcast/2019/02/09/ask-anything-nutrition-feb-1-2019/
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Chris Masterjohn, PhD, is the Founder and Scientific Director of the mitochondria test Mitome.