Low Carb Nutrition Change

Food & Diet Low Carb
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Monday, February 4, 2019

weight: +1.8#’s :face_with_symbols_over_mouth: frustrating but the insulin reduction and results are still encouraging enough to overcome that frustration.
comment: could be water retention? Strange since there was no alcohol the entire week except the beer on Friday? Will stick to wine or cocktails this week, if even, to compare to next week.
Bolus: unchanged
Basal: unchanged
comment: showing some low levels the early morning hours, might drop another .1 unit in the next couple days
Ketones: 0.0

Results are holding up, Nutrition info (these are serious logs, nothing omitted or whitewashed), and a fantastic 48 hour reading
image

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Great news John. I wouldn’t worry about the weight gain, the body is a very good buffer on weight. One of the reasons we have lasted as long as we have during food shortages.

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I can’t make out too much from the image, but how is your calorie count compared to your old diet? You can gain just as much weight eating low carb as you can eating high carb if your calorie count is too high.

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For what it’s worth I am still utterly amazed how easy it is to maintain a steady glucose level. I had that under decent control for some time now but this nutrition change puts a whole new level of control on it.

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@John. Not to be contradictory, but to demonstrate how individual this is, I eat very differently than you do and have similar control.

I eat about 110g carbs ( no GI calculation, but I eat ice cream, donuts, candy) and my current A1c is 5.8 with an SD of 30, and TIR (70-140) is 90%. I do sometimes spike, but it is only usually for very short times, but this happens with normals too.

I am not against the occasional pizza or pastrami sandwich. I am 67 yo, have been T1 for almost 48 years, am healthy as a horse with no complications. I enjoy life, and food is a big part of it.

I don’t present this to brag, only to suggest that to be so adamant about food choice ignores the variability in our disease.

As always YDMV. If it works well for you, that’s great! But what works for me is also pretty great.

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oh, bummer, I thought you could open the pictures individually to see the data more clearly?
A few years back I figured out with excessive counting of calories that I was maintaining weight with a calorie count of below 2,000 and gaining weight with going over. This carb manager, I am using now, puts me at 1,942 calories to loose about 6 pound per month. It is just suggesting a different distribution of Net Carbs, Fat and Protein. But the proven knowledge holds true that I seem to gain with even slightly under 2,000 calories. No matter low carb or not. The benefit is just the much easier glucose level control and it might be easier to force yourself into that low net carb ketosis state to loose weight. We will see?

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Yeah, I’ve found that eating low carb, I still need to monitor and restrict calories to lose any significant amount of weight; it’s just easier to restrict calories (to a safe level, just below what I’d normally eat) and feel full when eating LCHF than if I’m not. Otherwise I end up hungry all the time.

That said, my body (like most people’s) seems to have a set point, below which it does not want to stay. When my weight has creeped above that, watching my calories brings it back down pretty easily and it stays there with low effort; past that point, and loss is extremely hard fought and hard to maintain. I think if I drastically altered both my activity level and diet and maintained those changes permanently, it might shift, but anything short of that seems unlikely to have much effect.

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Grats to you to your results and your health. I think we all know how frustrating individual T1 is and that nothing works the same for the next person. Nothing to contradict on that one. I had pretty good control before this nutrition change as well, doing the exact same thing you are doing and was enjoying life.

But somehow I was intrigued by this documentary “The Magic Pill” and it provided that kickstart to challenge my curiosity. Of course there was some hope to loose weight, and the idea of reducing insulin intake, with the challenge of changing eating habits of a lifetime. With me there is always that underlying challenge to see if I can overcome “addiction”, any addiction and leave those engrained eating habits behind. But that is another story, probably more appropriate for close family.

The one thing that struck me with this nutrition change immediately is that extremely level glucose line with no little, minimal spikes up and down. It was so noticeable even with decent control before that it keeps my curiosity fanned.

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And again, curiosity got a hold on me and I split all info up into %, Grams, Calories of Net Carbs, Fat, Protein and total calories into a spread sheet. First thing that stuck out was obviously the percentage and how that relates to the calorie intake. You might think that you are eating low carb, but you actually might have reduced your total calorie intake so much that the percentage is higher than recommended. It appears that the percentage ratio is the key to get into the stage of Ketosis. For example: day “x” with 1125 calories of 1942 recommended, 14 grams of Net Carbs of 24 recommended. All well below but the % Net Carb is exactly at 5%. Day “y” with 1449 calories and 19 gram Net Carbs puts me at actually 7% of net Carbs. 2% above the recommendation with all other results below the recommendation.
Doing that spread sheet seems so far to point to one mistake. And of course, everyone else already knew that. Too much protein! Seven (7) “average” numbers of 10 sets of data are showing lower averages than recommended. Three “averages” showing higher than recommended. “%Protein” 32% of 25%, “Grams Protein” 122.08g of 121g, and “Calories Protein” 488.78 of 484.

In other news: this is really weird. After experiencing enough mild lows, dropping just below 60 in the timeframe between 3am-6am, I adjusted the basal rate by the lowest margin possible, 0.05 units, and promptly climbed above 150 during that timeframe. Reverted back to the 0.05 units higher rate and promptly dropped below 60 again. A 90 point swing with a 2.15 vs 2.2 per hour. Don’t we just love our bodies?

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Tomorrow it is going to be 5 weeks/1 month into this nutrition change to a low carb diet. Time for some conclusions.

Perimeters: Before this change, we ate pretty healthy for todays standards. That means no heavily refined fast food or prepared meals. Approximately 50% Carbohydrates, 25 % Fats, 25% Protein of 2,000 calories daily.
We changed to a 5% Net Carbs (deduct the fiber), 70% Fat, 25% Protein

Observations:
No to little carbs equals insulin reduction. This is pretty obvious since you re not consuming any food that requires insulin to be broken down into energy. Do not try this if you are having trouble with hypo’s to begin with and a difficult time to control those. If you are having trouble bringing hyperglycemic results down and do not want to use more insulin, this might be a good approach.
For me the insulin reduction was: basal -25%, bolus -65%.

If you are well in control, let’s say below a 7.0 A1C, you still will see some improvements. I would guess with higher A1C’s the improvements will become more dramatic.

Weight loss: I lost almost 7 pounds in 4 weeks. This is a pretty good amount in my eyes but definitely not the “Magic Pill” over any other diet as a lot of “Keto-diets” will promise you. Even though I was consistently below the recommended Net-Carbs of 24 grams and constantly below the recommended calorie level of 1,942 cal with an average of 1,564 cal, I never entered that “magic” state of Ketosis, constantly reading “zero”. I technically should have been in that starving mode but I was not as far as I can tell. My wife reached ketosis frequently, mostly in the afternoons, between 0.9 -1.7 on a breathalyzer. She dropped some weight but percentage wise not as much as me, even with being in Ketosis.

This leads to my last observation and a brand-new question and my conclusion to that question. It might challenge the bio-chemists and hopefully we might get some understanding which I can not readily find to that question. We T-1’s can obviously synthesize large amounts of ketones with uncontrolled high blood sugar levels which will lead to ketoacedosis.

Can T-1 diabetics synthesize ketones with controlled blood sugar levels?

The Synthesis and Utilization of Ketone bodies

“Ketone body synthesis occurs normally under all conditions. However, the formation of ketone bodies increases dramatically during starvation. This seems to be due to a combination of factors. Prolonged low levels of insulin result in both increased fatty acid release from adipose tissue, and increased amounts of the enzymes required to synthesize and utilize ketone bodies. In addition, in the liver, increased demand for gluconeogenesis results in depletion of oxaloacetate, and therefore in decreased capacity for the TCA cycle. This causes a rise in the levels of acetyl-CoA, the substrate for ketone body production.”

A non-diabetic will meet the requirements for ketone body synthesis with automatically having low levels of insulin resulting in higher amounts of fatty acid and enzymes required to synthesize and utilize ketone bodies when being on a low carb diet.
What does this mean for a Type-1 diabetic on an insulin pump? How do you achieve “prolonged low levels of insulin” without raising your glucose levels and going into ketoacedosis instead of ketosis? This would only be possible in a “starvation-diet” with zero carbs and no insulin administration. But with that situation ”no level of insulin” since you are not administering artificially insulin is different to “low levels of insulin” your body would produce in that starvation-mode?
Or do you go on a fine balancing act of lowering your insulin as much as you can without going above a certain glucose level? But that is what we are doing already, otherwise we would go hypo.

Conclusion: A type-1 diabetic on an insulin pump will never be able to meet the requirement of “low levels of insulin” unless he stops treatment. Stopping treatment will lead to high glucose levels even with a very low carb diet. This will lead to ketoacedosis. It appears that another trigger for the liver to synthesize ketones is missing with the absence of Islets of Langerhans, or at least the beta cells in those islets. I am thinking that all the differences between reactions of T-1’s to anything could depend on the individuals extent of the damage to those Islets “about which little known”.

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I disagree, A T1 certainly should be able to go into ketosis while taking the right amount of insulin to keep their BG well controlled. The problem, I suspect, is that you are eating either too much carb, too much protein, or both.

Carb: net carb is a sales tool for the keto diet industry. Bernstein and others do not talk about net carb; they talk about total carb. Unless the fiber you are eating is sawdust, it will largely be digested, so it should not be subtracted from carb intake when computing your intake. Stay away from any packaged foods from the “keto diet” industry that push the number of net carbs; they are not being truthful.

Protein: The human body normally gets a substantial proportion of calories from carb, and uses the carb to make glycogen which is essential for your brain and important for your muscles. If you eat keto, your body still needs to store glycogen in your liver and muscles, so it breaks down protein. Extracting glucose from protein is not quite as efficient as breaking down carb, but it is not difficult and your body will definitely do so. This is one of the major problems with the real keto diet (as opposed to the pretend keto diet that the diet industry is pushing) - you need to severely restrict not just carb but also protein if you want to go ketogenic. Unfortunately if you eat too much protein you go out of ketosis, but if you eat too little you start to break down your muscle cells (which is clearly not a good thing). There are calculators to figure out how much protein you are allowed to eat, which you should look up if you really want to try to go into ketosis.

P.s. it is typical to produce ketones when fasting, so ketones can be present in the morning or other fasting time periods even when not in ketosis (I’m guessing this is what your wife is seeing). That is why it is important to get ketone blood strips, to distinguish between small amounts of ketones from short-term fasting from higher levels of ketones from being in ketosis. Your breathalyzer is not a valid test instrument for ketosis.

So my take on it, is that you are eating a healthy diet (assuming you are still eating a large amount of vegetables, nuts and fruit all of which contain carb), but it is not a keto diet. Personally I think that is to the better.

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the point was that per “carb manager” I am actually well below a “recommended carb”, net carb or + fiber, level. Also the recommended protein and fat levels are very close to the recommended levels to actually get me into “ketosis”. In our little "test group of myself and my wife as a non-diabetic, she actually got the ketone-readings while I did not. We did set up with the same goals with obvious different body measurements.
This obviously points to the one main difference. T-1, no ketone readings and non-diabetic, with ketone readings, while eating at the same time, the same food at the same prescribed ratios, and testing for ketones at the same time.
It was also pretty clear from the get-go that there is no big difference to Nestle and Monsanto and the “Keto”- industry but size. But that is a whole different discussion by itself of to what kind of mis-information that leads.

Here is the question again, probably better asked in a very direct form to begin with:

Is there any T-1 diabetic out there who managed, with well-controlled blood sugar levels under 7.0 A1C, to synthesize ketones between 0.1 - 6.0 with a low-carb diet?

Strangely enough, I could not find a clear cut answer to that on the Internet but that with a low-carb or “ketogenic” diet you are burning fatty acids for your muscle demands. Your brain cannot use that as energy. A side-effect of that is the production of ketones. That is why we are producing ketones in the first place to feed the energy need of the brain in the case of lack of carbs. And of course, if a T-1 is not capable of producing ketones on such diet, that creates a ton of danger coming along with that diet as starving your brain of energy.
Besides the obvious short-comings of all tests for ketones, urine, blood and breath all being either cost prohibitive or give such different readings that those numbers invalidate each other.

But it still leaves this one question in our little test-group:

**

> Why did the non-diabetic get ketone readings and the T-1 did not?

**

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Well that is the million dollar question. I wonder if you were to lower your carb intake further if you would produce ketones? Seems worthy of an experiment. Also, I suspect each person is different, so no matter what the calculator tells you, there is a bit of individual difference going on.

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Talking about a “million dollar question” and some real $$$. The “Ketone” in easy gel-form, extra-strength liquids, chewables or caplets as the “magic weight loss supplement”.:rofl:

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@John These conversations might be of interest to you:

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One question is answered today under extremely strange circumstances.

Last evening I had to "warm-up"the Dexcom sensor, a fairly new one that just went through its 1st week. I checked blood sugar before I went into the 2-hour warm-up and actually verified on the Omnipod with being at 94. At that time I was kind of looking forward to set a “new record” with going 48 hours between 80-120.This is around 6pm. I started to make dinner, lamb chops grilled with a Greek salad, cucumbers, tomatoes, red onion, olives and feta cheese. By 7:15 I set the Omnipod for a small bolus since it was a very low carb load with no balsamic vinegar used but apple cider vinegar. By 8pm dinner was done and the Dexcom demanded its 2 calibrations for the “new sensor”. Both calibrations came back at 42 and 44 and another 3rd in disbelief of 42 and I did not feel a thing. It took me about 2 hours to climb back out of that low and I have no idea how that even happened?
The last bolus before that dinner bolus was around 12:30 for lunch, no exercise any different to any other day. The dinner bolus at 7:15 with food and a drop of 50 within 2 hours. The only difference was that I felt kind of tired just running on auto-pilot walking the dog and making dinner which was also the reason that I double checked my glucose levels before “warm-up”.
And here is the kicker. The morning after, running a bit high with 171 of over correcting that scary low, I read ketones for the first time with a solid amount on the breathalyzer of 2.17.

That answers the question if there is any T-1 out there who has synthesized Ketones on a low-carb diet? Yes, I did myself! But how? Somehow it did not go the way I would have expected it but rather in almost a way of an emergency reaction by my body to get energy to the brain via ketones.

Now I am really wondering how to understand the bio chemistry of our metabolism and the role ketones play?

  1. Are Ketones just “byproducts of the breakdown of fatty acids”?
  2. Or do we need ketones, synthesized by the liver, to break down those fatty acids when there is a lack of carbohydrates?
  3. What else is needed to synthesize those ketones and what are the triggers for the liver to do this?
  4. Do we understand the same thing under the word “byproduct” that it is just an incidental or secondary product devoid of any other function? Ketones seem quiet a bit more than “byproducts”?
  5. Do we even understand the same things under the word “ketone”? As some use it as another word for “superior fuel source for the brain” as energy for the brain while others see it as a way of bringing the energy derived from fatty acids across the “blood-brain barrier” if there is a lack of glucose, the preferred energy source for the brain?
  6. Is it just ignorance or is it dangerously stupid to tout those ketones as “superior fuel source for the brain” in order to promote a ketogenic diet?

And a Dexcom related observation: if your Dexcom is stuck in giving you "low"readings, double check and input calibration numbers even if those are low. You might have to do that a couple of times to re-calibrate that sensor.

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Wow, quite the night. I will let someone else chime in about biochemistry, because with my inorganic background I just remember that you can dissolve everything biologic in the right acid mixture…

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In a normal diet, the brain primarily uses glucose. Almost nothing but glucose. It only uses ketones during times of starvation (or lack of carbs).

If ketones were the ideal fuel source, wouldn’t the brain be designed to use them all the time? Why would it not use them all the time?

If you are out in a boat, and you run out of gas, the oars are certainly an ideal way of getting back to shore! But certainly not when you have sufficient fuel in the boat.

Ketones are a great emergency fuel source for the brain. It can keep someone alive when they are in starvation conditions. But that does not mean they are ideal.

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ketones are definitely not the brain’s “preferred” fuel source. It’s a tacked-on, backdoor hack the body uses when glucose is not available. You can see that’s the case because the chemical reaction to produce energy while generating ketones only occurs when other byproducts needed for the normal carb-driven aerobic respiration pathway are depleted.

Even polar bears and big cats, who are obligate carnivores, are not routinely entering ketosis as their primary metabolic pathway. They require higher protein levels and then convert that protein into glucose. (Inuit are also not entering ketosis, by the way, because they eat parts of animals, such as the liver, that contain just enough carbs to keep them out of it.)

That said, it’s very likely that humans in the past had frequent periods of starvation (either hours, days or even lean months when food was scarce) and so one could argue potentially that entering ketosis regularly might actually be good for the human body somehow, just as intermittent fasting is now thought to offer some benefits. And you can certainly argue that in type 1 diabetes (or epilepsy, or potentially other conditions), something is very messed up with the primary metabolic pathway, so the backup might be a good alternative because it may not suffer from the same defect.

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This is more and more the way I look at it. From my personal experience now, not only just eating a low carb diet but actually having followed the Keto percentages I would say Keto is a “trend” and a lot of people are jumping on the bandwagon without having a clue.

For regular non-diabetics it is just another diet to lose weight. It largely depends if you actually hit those percentages of carbs/protein/fats exactly and some other requirements to trick your body into producing those Ketones.
For T-1’s it is of course a great way to reduce insulin-dosage. The lower your carbs, the lower the dosage. We all know that.
I would think that it would need a larger study to really find out what the insane recommended carb-load for healthy nutrition of 45-60% really does to a human body? Someone could argue that the onsets of all kinds of diseases, including t-2, epilepsy are related to this recommended food pyramid, but answering that with an equally unproven diet/nutrition as Keto is just masquerading as the “healthy” version of bad food and their manufacturers.

And here is the scary part. I was just kicked out of a facebook forum of “keto for diabetics” which is non-distinct between t-1 and t-2 for questioning why so many on this forum have the same question “how do you handle those low blood-sugars when on keto?” After answering faithfully that as a T-1 you would lower your insulin dosage, I actually created a post trying to figure out what those doctor/patient relationships are and how they in particular for T-1’s or any insulin dependent T-2 determine the amount of dosage with an ever changing nutrition? The general consent was that you have to get permission from your Dr to change your insulin dosage. When I questioned that with that you would have to get permission of what to eat from your Dr as well or you would have to post a warning-note on every “Keto” - site or forum for potentially endangering yourself with eating low-carb and your prescribed insulin dosage, I got "kicked"or "banned"without any explanation. If that is really the case for newly diagnosed diabetics, we have more than a health crisis on our hands. We do have a serious educational crisis not teaching any longer the necessary things any diabetic will need for the rest of their lives.

I somehow took it for granted that pretty much every one here on this site, actually adjusts their insulin dosage as needed on a daily base for the bolus, and after trends develop for the basal as well without consulting with their Endo-s first? Of course I will pass that info at my next check-up, but even though my Endo is super responsive to emails I would feel kind of silly asking for “permission”. You would not ask for permission to eat that ice-cream either. Just let me know if I am wrong with that?

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