FUDiabetes

Low Carb Nutrition Change

keto
low-carb

#1

If you have not watched the Australian documentary " The Magic Pill" yet on Netflix, get to it asap. I was thinking about a Keto diet for some time now, and this documentary added the necessary kick to it with how native tribes ate and what has changed for them.
The premise of the documentary is basically that us human beings over 5,000 generations have become the most fearsome adapt predator on the planet due to physical strength and intelligence and what has changed since the beginning of the Industrial Revolution?
The one thing that has changed is our nutrition, our diet. And the information we are given about it of what is good and what is bad.
Anyhow, do yourself the favor, watch the movie, read about it, think about it. And keep an open mind that our food pyramid as we know it, might be upside down.

I started on Monday, not so much as a Keto-diet but eliminating carbs and turning my food pyramid upside down, anything that has a glycemic index, and replacing it with fat and protein, fewer fruit, more vegetables. No grains, no bread. Replace with nuts. Almond flower breads. No potatoes, no rice, no pasta. Replace with cauliflower mash, zucchini gratin, zucchini spirals. Whole milk out, in comes the heavy cream. In comes the avocado. Blueberries, as often promoted in Keto diets, actually have a higher glycemic Index than apples, pears, and plums with about 38 and cherries, 22, and grapefruit with 25 being the lowest. I will not say “no” to those but reserve them for very light snacks and emergencies when and if running low. And a fair warning: It appears that “the industry” has already gotten a hand on that “Glycemic Index” and there is a lot of misleading info out there. Best example: skim milk, whole milk, heavy cream. The higher the fat the better since you are replacing carbs with fat. Personal example so far: replacing whole milk with heavy cream in coffee = bolus reduction by 50%, resulting in a steady level while whole milk has a spike even though the bolus is 50% higher.

Results for Monday with keeping the Basal as is and being very careful with the Bolus, I ended up with an 121 average, deviation of 28, 100% TiR set at 60-180 and most importantly no sharp spikes. All very gradual soft changes. Food intake was Coffee w/ heavy cream instead of whole milk with normal Bolus = slight drop instead of steady. Egg w/cheese and chives, no Bolus = steady. Big dinner with roasted chicken and roasted veggies, all low glycemic, no potatoes. Romaine with normal Bolus = no spike but extremely steady level all night long. I expected somewhat of a drop in the middle of the night and tried to cover with some nuts, pecan and almonds, which led to a slow and steady rise to Tuesday morning of a 178 reading. Lesson learned!
Continuation on Tuesday with extremely steady level results with an average of 119, deviation of 37, and TiR of 91%. 9% of TiR was low between 55-60 because of a touch too big of a bolus to correct.
I will not go into food details anymore but that I try to eat extremely low glycemic, not to be hungry, still having a glass of wine. I struggled a bit with no rise after dinner with a reduced Bolus and a slight drop below 60. Lesson applied from what I learned the previous day about the nuts and spend all night between 91-94, no spikes, a complete flat line. It is now Wednesday morning, almost 10am, with a reduced Bolus around 7am and Coffee w/ heavy cream there are no changes. From midnight, and before, until now between 91-95.
Take away from the first 48 hours, actually 60 hours: extremely steady levels, no sharp spikes, really easy to control with some adjustments. Slight reduction in Insulin intake. The Basal seems to work just fine in the background.
Off to eat something, eggs and bacon, no bread, no Bolus. Let’s see how that works? 60 minutes later after 3 eggs and 2 slices of bacon = 108, an increase from 95, still sipping the last bit of coffee. Kind of disgusting by now with being 3 hours old. Another 60 minutes and it is creeping up to 122 now, doing an ever so light Bolus.

As a disclosure, the results from last year, which I was very proud off: 122 mg/dl Average Glucose (CGM), 48 mg/dl Standard deviation (CGM), Low Hypoglycemia risk, 85% TiR, 3% Low, 2% Very low, 10% high with settings between 60-180/24 hours.
So far, in the last 48 hours, I am beating those numbers by a good margin: 120, 33, n/a, 96% TiR, 4%low, n/a very low.


#2

@John, great to read your detailed discussion and to see your early success!

In fact, even Harvard Medical School has some good things to say about the keto diet:

At the same time, for the sake of scientific integrity, I do need to mention that there is grave doubt over the authenticity of the keto diet :slight_smile: Many researchers believe that the percentage of meat in the diet of hunter-gatherer societies is quite low, and that carbs were actually much more significant. Here is an example of such studies:

https://www.jstor.org/stable/10.1086/682587

[EDIT] Here is an interesting article that is, I think reasonably balanced (except for the title…):


#3

My bad. As I tried to distance myself a bit from the “Keto diet” to differentiate more to as how we potentially ate some 1000 years ago, I involuntarily said “eliminating carbs”. Carbs have obviously always been part of any nutrition at any given time and I am pretty sure that Caveman John would not have said no to that delicious sweet fruit on a tree, or that carb rich vegetable which might have been easier to get to as that fatty nut high up in the tree or that protein that bites back. Neither does this John today will say no to carbs but just try to keep the glycemic count down as much as I can s it might have been way back when.
Another important point in this whole nutritional awareness should always be what we all know of how important it is that the carbs we eat are “complex carbohydrates”. Nothing refined that enters your bloodstream as it enters your mouth but sugars like organic cane sugar, that might take up to 8 hours to be broken down by your body to enter that bloodstream. Some alcohol carbs have that effect too. Beer for example always shows up late in my readings, up to 4 hours after consumption.


Diabetic beer olympics: advice on alcohol use?
#4

A quick update, about 80hours in.

The really amazing thing is how steady overnight levels are with this “low carb”. Before I always had little peaks, going up and down about 20 ticks. Now it is a steady line with a max variation of below 10.

Pretty much the same with a slightly higher deviation during the day. But it follows the pattern of very slow, gradual changes.

Strangely enough, as of this point, I do run the same Basal dosage but reduced Bolus by about 30%. I am sure there will be the point, there always is when the Basal is catching up on being too high.

And still no grain in the diet but a Bourbon last night with no effects to report, I took my dear time with it.

Even though I am kind of burned out “counting” food and just follow experience to control T1, it looks that I probably will have to get back into that to find out the exact percentages and the amount of carbs to get more details of what to expect in weight loss, associated insulin reduction and such. Right now I am just marveling at my “flat-line” with no spikes.


#5

I have noticed the same effect in my BGs when I switched from half and half to heavy cream in my coffee, too. A long period of 4-5 hours of gradual rise. I didn’t have to reduce my bolus though. My breakfast is yoghurt with berries, Apple, kiwi, banana and chia, flax, hemp seeds, a quarter cup of each food category. I bolus 2U for that. Sometimes I go low briefly and then spike a bit so I tried the heavy cream. It has a significant effect on BGs just with that one change! I don’t actually want a long steady rise though so I no longer use the heavy cream. I’d like a brief, small rise! :slight_smile: Maybe a smaller amount of heavy cream will do the trick?:slight_smile:


#6

another quick update: Basal is beginning to act up. I am having a very difficult time to get above 60 to silence that Dexcom and I am stuffed.
This morning: Basal still running regular dosage on Omnipod. Dexcom is going off since 5am demanding food but running steady just below 60 even with a handful of Blueberries. No rise. Bolus reduced by 50% for coffee w/heavy cream. No bolus for 2 slices of low carb almond bread with poached egg and 2 slices of bacon, no bolus for handful of blackberries w/ Stevia and cream. Dexcom is getting annoying now with running in the mid-50’s. Time to reduce basal. It is around 11:30am.
Up to this point: average carb per day 29grams. Zero grains. Slight increase in average glucose, significant drop in deviation, and with that obviously an improved TiR. All de-and increases in bloodsugar levels are very gradual, no spikes. Basal insulin reduction: n/a to this point, reducing by 20% from here on forward. Bolus insulin reduction: 30%
And a slight rethinking of the goal even that there was none but a change in nutrition: insulin level reduction is becoming the main goal, weight loss as the means to reduce insulin levels is a welcome bonus. Ketosis might be something unavoidable, even though that I am having a difficult time to accept those Ketone-enemies in my bloodstream as welcome friends.


#7

@John, I find your reports on your keto diet tryout extremely valuable, and unique on the web in the analysis and the level of detail you provide.

I really look forward to your next posts. Your thread can become a great resource to others in the D community. Thank you!


#8

@John: lots of positive results so far! Thanks for keeping this log.


#9

Could you provide some baseline info (sorry, you may have already stated some of this elsewhere but useful to have here since you’re trying to document a radical diet change here).

How long ago were you diagnosed as T1, and what was your age when diagnosed? Were you ever diagnosed as T2 or insulin resistant? What was your BMI at diagnosis and now? Are you trying to go into ketosis or just trying to eat lower glycemic index meals? How much exercise do you get, either at work or additional activity? As you lose weight your TDD insulin requirements will almost certainly go down, so making note of that could be interesting too.

If you are calling this keto diet (and I don’t think you are) then it takes some time for a body to go into ketosis and it is important to closely monitor your ketone level with ketone blood strips and meter. Also important to keep track of your total daily carb consumption, whether fast or slow carbs, including any carb corrections you take. That could be interesting regardless of whether you are going keto, so maybe it would be helpful to also let us know what your diet looked like before you started changing it. How much carb and sugar, vegetable and fruit were you eating before? Macronutrient breakdown before and after?

I’m also curious whether your lower carb lower glycemic index meals will change the way you bolus since single fast acting bolus may not work as well.

I’ll be interested to see how it goes, keep us posted.


#10

Thanks for sharing this information! It’s so interesting! I’ve seen the documentary you’ve mentioned (although I can never remember the title) and it was really fascinating!

A few things about your experience had me wondering…

Do you trust the Dexcom with your diet change? Have you backed it up with a finger stick? I have no data on that at all - it’s just a curiosity about whether or not the Dexcom would remain accurate in the face of the lower BG numbers you’ve been experiencing.

I’m wondering what that means for T1Ds out there. I have an understanding of the “Keto Diet” for the pancreas normal person. But I don’t really understand the ketosis situation for T1 and if there are any differences. I stumbled across the following trying to answer my own question. The first one is a longer read but packed full of what seems like very practical advice for those curious about the how-tos of a Keto diet:

This article seems to clear up what to actually eat:

Also, in doing a little googling about “Keto diet type 1 diabetes” be aware the first few results were bunk. One of them described T1 as “juvenile diabetes” which was ridiculous to me and I let them know.

I’m guessing @John has an understanding of ketones and Ketosis, but I didn’t! Hopefully this helps someone. :slight_smile:


#11

You really want me to work, do you?
Diagnosed as T1, or as the called it back then “juvenile diabetes”, 1988 after a bad cold. My regular weight back then was around 78kg (172#'s),when diagnosed I had dropped down to 68kg (150#'s) at a height of 180cm (5’11").
After I had started with Insulin I was still traveling the “Hippie Trail” on a shoe-string for a few years before settling in the USA. Up until about 2005 there were no noticeable changes in weight, even though activity levels were going down. But if I would look at my medical check-ups, there probably would show a steady incline.
Up until 2005 I also had a slightly more relaxed attitude towards my results, doing probably on todays terms, medium to bad with A1C’s of 7.5-8.1 hanging on to very small shots of Humalog (Bolus) and Lantus (Basal) of 10-20 units each/daily.
From 2005 on I increased Insulin levels steadily to meet the demands of lower A1C’s. Those got consistently better with results between 6.8-7.4 from 2005-2015, to todays numbers of 6.4-6.6 since about 2015. At the same time my weight and BMI crept up and reached 30 by 2013 in an ever increasing curve to 39.1.
Exercise is still normal with dog walks of about 90 minutes total, swimming twice a week of 90 minutes, and Tennis of about 2 hours once or twice, depending on time and weather.
Food intake up until the “change” was normal to low. Since the weight gain did not go unnoticed for obvious reason I got curious and tracked calories and activities through 2016 and part of 2017. The results were demoralizing. I had an average calorie intake of below 2,000 calories and I was gaining weight. And the food was always with a sharp eye on complex Carbohydrates and of what we considered a very balanced nutrition with almost zero intake of highly processed foods.
The very first thing after realizing this, was a switch in medication. The "statins"were the first to go. Lantus followed shortly thereafter and got replaced by Humalog with the Omnipod. At this point it is Humalog with a dosage before the nutrition change of 60units basal/60units bolus.
The only other medication, and this might be an additional diabetic risk factor, is Cabergoline 0.5 (1 twice a week) to control Prolactin levels after a benign tumor on the pituitary gland was discovered and removed in 2015. A close friend of mine, with a very similar T1 history, was just diagnosed with a Prolactinoma in a slightly worst spot and might loose her hearing in one ear with the removal. My suspicion at this point is over-dosage of Insulin to stay “in control” no matter what.

With that my approach began as weight-loss with using the Keto-diet but has developed into the main goal of Insulin-reduction. The first week already shows good numbers with posting excellent results with a 114 average, 16 deviation on day 6 with a reduction of Humalog units by 23% Basal on day 4, and Bolus % by 25%.
I do not think that I am in Ketosis but don’t really want to focus on that at this point since I am focusing mainly on my bgl’s and insulin intake. If there is a weight loss, I appreciate it and take the resulting reduction in Insulin units first and then the weight loss since the higher levels of Insulin might be the main reason for the weight in the first place. There is where the intention and direction of this might change over time. But since my partner and I doing it together, she counts and goes with a net carb intake of 14grams. I might be significantly higher since I indulge in my glass of wine, bourbon and probably am relaxed a bit more with fruit the few times I dropped below 60. But we both have had zero grams in grains.


#12

Very interesting. So I agree completely that Dr. Bernstein’s approach results in very good control, with the caveat being that not everyone can do well on so low carb of an approach.

My son has better control with low carb, but because he is still growing rapidly and working out heavily 6-7 days a week, we have never gone lower than 75 carbs a day, and most days he is eating four full meals for a total of 90-120 carbs. This supports his weight lifting gains as he tries to bulk up before baseball season. With that said, if 30 carbs a day works for you, that is great.

I hope you get your basal worked out, otherwise you will end up feeding the low with more carbs than you want.


#13

I trust the Dexcom with providing a lot of data but would not bet my life on it. If I can and something seems off to my personal, internal meter I double-check. At this point for the last week I am at 4.6 calibrations per day. I had a very discerning issue with the Dexcom last year while on an fundraiser long distance swim I had to stop because of “low” warnings. I had no back-up meter in the support boat and found myself eating in the support boat against the warning untilI got to shore to measure above 300. I was pissed to miss this event we worked so long and hard for with a reading that should not be possible under any circumstances.

BTW, when I was diagnosed in 1988,T1 was widely called “juvenile diabetes” to differentiate to the old folks with “sugar”. In all reality I almost want to guarantee you that a large percentage of people in the medical field today, cannot accurately describe a T1 and T2, the difference and the treatment. That is why you have a sight like this with the real experts and people with knowledge who are seeking even more knowledge.

With those Ketones I cannot get rid of those schoolings that are stuck in my head that you have a high Ketone count in your bloodstream when uncontrolled high sugar levels are there. Those Ketones are supposedly, or so they said, destroying your filters in the kidneys and liver as the main organs to filter out harmful things in your bloodstream. Basically Ketoacidosis where the presence of Ketones wit high glucose levels lead to highly acidic state of your blood
But now you are looking at a state of Ketosis which is not harmful since those ketones are the chemical your body produces to burn stored fat.
Here my own personal logical thought process hits a wall. As an uncontrolled T1, one of the signs that you are one, is rapid weight loss due to the fact that your body needs energy and cannot get it from you since you are not producing Insulin. So, it takes with the help of the Ketones your body fat and turns it into energy. “It occurs when there are dangerously high levels of ketones and blood sugar present at the same time.” That was the leading cause of death for T1’s some hundred years ago, dying as starved skeletons.
Now with Ketosis it “refers to the presence of ketones in the blood. Because a person in ketosis does not experience high glucose levels at the same time as they do with ketoacidosis”.
I cant understand logically that Ketones behave one way in our body and in the presence of high glucose levels differently. It is chemistry 101 with the amount of Ketones in your blood and a controlled pH level. But weren’t those Ketones produced by those high glucose levels? Somehow there is one step too much in this equation for me that my brain cannot handle. No wonder that I am not a chemist or mathematician?


#14

@John, the level of ketones is different in normal ketosis (normal in a keto diet) and in DKA, that is a major difference. If you check this article for instance, there is a dual set of good tables that shows the difference in levels for urine and blood keto meters between ketosis and ketoacidosis levels:


#15

I absolutely agree, this is highly dependent on every person. I do not believe that any human being at any given time in our time line as humanity went carb-less. But the amounts and ratio of carbs to fats to protein has changed.

As a T1 pre- and past puberty the needs are obviously very different and a higher carb diet is needed compared to grown ups and elderly.
There will be a moment in my opinion when there is the tipping point and I am sure it will be something on a very gradual unnoticeable change. We, as the T1’sare somewhat lucky with having such close insight at our bodies. As long as your sons A1C’s are good, as long as his overall control is good, as long is weight and weight gains are within normal levels, question any change and increase in insulin dosage. The one quantifiable change in our bodies. Fight tooth and nails against dosage increases with trying anything else, including carb reduction.
And it might be an overall healthier approach to sports with weight classes to reduce or gain the weight needed for a certain class instead of dehydrating yourself, starving yourself when it can be done and maintain the lower weight with your regular diet and the experience of a T1.


#16

Thx, those tables are very helpful to get a good visual on those levels to get rid of preconceived knowledge and to relearn.


#17

i was on a HPHFLC diet for years. i was a waif of a person for lack of carbs, despite my fat intake.

i am someone who MUST bolus for protein and fat. eggs, fish, meat, cheese, nuts, etc. so i was still requiring insulin as if i were eating carbs.

i found that once i was dx with gastropareses, i could no longer maintain this diet without feeling terribly ill and very uncomfortable in my stomach. also, when i began my swimming, i HAD to add carbs to my diet just to stay afloat in the water.

so i am guessing, as we are all different, IMHO, that what works well for some, wont work at all for others. but isnt that the nature of this disease anyway? :rofl:

i deffinately can appreciate the well controlled BGs. but i am fortunate enough to have excellent control by managing my basal rates and my ICRs. also, i found that as long as i eat a protein with a carbs, i do not spike, whereas, if i only eat carbs alone, my BG will rise noticeably.


#18

update on basic results after 1 week:

  • 48 hours: TiR% 0/93/5/1%, Average mg/dl 105
  • 7 days (start): TiR% 1/91/6/2%, Average mg/dl 108
  • 14 days: TiR% 2/91/5/3%, Average mg/dl 110
  • 30 days: TiR% 6/86/4/3%, Average mg/dl 114

TiR = 60-180, high/in range/low/very low %

Insulin reduction: Basal -25%, Bolus -25%
Weight loss: 2 pounds (wife: 3.5 pounds)
edit: she is most likely in Ketosis, I am most likely not. I will get a cheap breathalyzer and add Ketones next week for the basic update.

Breakfasts:

  • coffee w/ heavy cream
  • eggs/bacon
  • poached eggs/prosciutto
  • yoghurt/berries/crushed nuts

Lunches:

  • all kind of salads w/ leftover meat, hardboiled eggs, cheeses, salamis, ham

Dinner:

  • Roasted chicken w/ roasted vegetables (onions, garlic, carrots, rutabaga, turnip, fennel, shishito peppers), Romaine salad w/ Avocado oil and balsamic vinegar
  • Steak, zucchini gratin, green beans, tomato/cucumber salad with red onion
  • Porkloin roast, cauliflower mash, brussel sprouts, Caesar’s salad
  • Shrimp with onion and garlic, curry bayshrimp salad(mayo, bay shrimp, curry powder, touch of ketchup in avocado (2 halves)
  • Scallops wrapped in bacon, asparagus roasted in avocado oil, endive salad
  • Lamb chops, tomato/cucumber/red onion/olives/sliced fresh mozarella
  • Shrimp Scampi, Schnitzel(w/ breading), tomato/cucumber/red peppers

All dressings are home-made and super easy, do not ever buy those pre-made ones.

Snacks:

  • Nuts
  • Berries
  • Veggie slices and radishes w/ cheeses and cold-cuts, salamis

Drinks:

  • plenty of water and carbonated water like Pellegrino, for electrolytes
  • wine, bourbon, vodka, pastis (one of my favorites) with dinner, pre-dinner, or after-dinner of what we consider “normal amounts” like a second glass of wine is ok, a third might be a party. If you are in Ketosis, be careful if you use a cheap breathalyzer. Ketones and alcohol are the same thing on your breath.

One remarkable thing: the Dexcom line has no spikes what so ever, every change is very gradual, no spikes up and down of 10.


#19

Is the breathalyzer better or cheaper than the ketone urine strips that are available?

Also, it looks like you are cooking all of your meals which has many benefits just in itself. As a note, we really like 1/2 an avocado covered with salsa as part of our breakfast when you are looking for ideas. Also, since this thread has strayed into another pretty interesting area, i.e. your personal Keto experience reports, would you be open to me splitting some of these posts and giving it a different title?


#20

Thank you for the clear and in-depth history you added. It makes your results much easier to make sense of.

Don’t bother, these are so unreliable as to be useless. Only a blood meter with strips will give usable results.

As I’m sure you know, these can have sufficient carb to keep you out of ketosis. 30g carb per day really severely limits what you can eat. Bernstein says no berries or tomato and limits other vegetables and nuts saying they have too much carb.