Type 1 diabetes, endurance sport and the LCHF approach: Lewis’ story.

I first met Lewis about a year ago when he came in to see me for a consultation. He will explain his story below, but the crux of it was that he wanted to ensure he was on the right track with his food intake as he started on a low carbohydrate, high fat (LCHF) diet to help his blood sugar control and his endurance sport. In reality, I merely confirmed what Lewis was already doing. Lewis had some trouble finding a lot of information for people with type 1 diabetes who undertake endurance sport, so felt the more he could share his experience, the better it will be for others looking to transition to a low carbohydrate, high fat diet for their blood sugar control. Despite what you may believe, it is not dangerous to follow an LCHF approach to diet if you have diabetes (type 1 or type 2). In fact, it’s quite the opposite. Thanks, Lewis, and over to you.

I was diagnosed with Type 1 diabetes 30 years ago, aged 9 years. I have always been a well-controlled diabetic, (according to the ‘diabetes guidelines’). About 3 years ago, I started training daily. It started out being just gym, then moved on to training for triathlons. Doing exercise is a vital part of a control plan for someone with type 1 diabetes, but it isn’t always easy to balance the amount of sugar, exercise and insulin. It is this balance between the amount of sugar, exercise and insulin that they call the ‘three legs of a stool’. They all are vital, and without any one of them, the chair will fall over. I try and keep my sugar levels above 4 and below 8 mmol/L, what is considered ‘normal’ and is typically controlled by the body’s natural hormonal processes in a person without diabetes.

What I found as I was training was that I was having to supplement large amounts of glucose whilst exercising to stop my sugar dropping. Then, after the exercise, my sugar levels would sky rocket to 15 mmol/L or higher. I would have to take extra insulin to counter the extra high blood sugar, and that would drive my sugar right down low again. It is this extreme roller-coaster of sugar levels that I interpreted as being necessary if one wanted to participate in endurance training. I would typically require a Gu gel every 20 – 30 minutes to stop my sugar dropping. On a four hour bike ride, that would be a massive (and expensive) 8 Gu gels, taking in approximately 160g of carbs. My sugars would be ok during the ride but then would skyrocket afterward.

Also, I had no confidence what my sugar level at any one time would be. If it was in the “good” range, was it only temporary? Was it on its way up, or on its way down? After having diabetes for 25 years, I still had no idea at all. I was thin, muscular, getting fitter and fitter. But my sugar levels were extremely erratic. I was pre-occupied with food, and was always hungry.

Then, a number of things happened all in the same month, October 2013:

  1. I heard Grant Schofield speak about LCHF diets
  2. I watched a Youtube clip of Dr Troy Stapleton, an Australian doctor who developed diabetes and eats LCHF. He said his inspiration was Dr Richard Bernstein’s Diabetes Solution.
  3. I read that book, and it pretty much changed my life. Dr Bernstein is an engineer who was diagnosed with Diabetes in the 1950s. He was the first person to do “home glucose monitoring” and turned the industry on its head, saying patients needn’t go to hospital to check their blood sugar. He later became a doctor (in his 40’s) to specialise in diabetes, and further the cause for good blood control.

He was, and remains, and engineer at heart. His basis for blood sugar control is one only an engineer could come up with. In a nutshell, you can’t predict what your sugar level will do. You can’t get the balance right between sugar and insulin. You will always be wrong. If you happen to be right, it is only by accident. He was describing me, and my rollercoaster sugar control. He explains that if you don’t eat carbs, then you don’t need as much insulin. If you don’t take as much insulin, then you don’t need as much carbs. I switched to LCHF in October 2013, and did my first Half Ironman in Jan 2014. I had submitted a detailed race report to Grant about this race.  Fast forward a year later and I have never looked back.

In terms of the food, eating becomes easier and easier. I do the cooking at home, which is quite useful!

My typical breakfasts now comprise an omelette with 3 eggs, chopped mushroom and chopped tomato. Alternatively, I soft boil 3 eggs, and have them with an avo and tomato salad.

My typical lunch would comprise a green salad with left-overs from the night before. I take care to make enough supper to leave something for lunch the next day.

Typical suppers in our house are below; it is all organic, whole food and high in fat.

  • Spaghetti bolognaise with low carb mung bean pasta (less than 5g net carbs for a big bowl of pasta). covered with olive oil and cheese.
  • Pizza on pizza base made from 1 cup almond flour, 1 egg, 1tbs olive oil, 1 tsp salt. (makes enough for 2 pizzas. very filling)
  • Hamburger on a bread roll made from 1/3 cup almond flour, 1/3 cup ground linseed, 1tsp baking powder, 1 egg, 1tbsp olive oil, 1tbsp cream, 1/2tsp salt. Baked in a mini-round tin, comes out like perfect soft bread roll.
  • Creamed mushroom soup (lots of mushrooms, cream, soup stock) served with Almond bread toasted slices. I make a large almond and linseed loaf once a week, slice it and freeze the slices for ready toast.
  • Bangers and mash (using cauliflower mash)
  • Fried chicken thighs (fatty and juicy) served with a green salad laden with olives and cheese
  • Fish fingers and “chips”. The fish finger batter is coconut flour and seasoning. Fried in Coconut oil. The chips are the same recipe as the pizza base but rolled thinner. Baked until brown and crispy. Add salt and the kids love it.
  • Butter chicken and rice (using cauliflower rice)
  • Taco night where it’s all the Mexican trimmings on either cauliflower tortillas, or large fresh crisp iceberg lettuce pieces as tortillas.

I try keep the level of protein at every single meal the same. Approximately the size of a deck of cards.

With regard to my sugar control and insulin levels during the year…

There is a test called HbA1c, which measures the average blood sugar over the last 3 months. The traditional diabetes practitioners (such as where I go at North Shore Hospital) have this range up, and the red oval shows where the practitioners try to have you aim your sugar levels.

hba1c

A non-diabetic is supposed to be 5%. The reason the practitioners want us diabetics to be at an average of 8-10. (which is too high, as the non-diabetic body wants to be at 5%, is that (as a diabetic) when you eat regular carbs, you blood sugar will always rise after a meal. It can rise to 10 or 12, and then come back down again. This is “normal”. So, if your sugars are always rising to 10-12 after a meal, and your average is sitting at 5, it can only mean one thing. You have many many dangerous low blood sugar hypos.

I take 2 different insulin types. I take a long acting insulin called Lantis, which processes the natural sugars the body creates. (nothing to do with food). I also take a short-acting insulin (purpose made to handle carbs in food) each time I eat. My long acting Lantis dose has not really changed since going LCHF.

Now, when I was eating my traditionally healthy high carb low fat diet, I was taking between 10 and 12 units of short-acting Humalog each meal. My sugar would absolutely rise after the meal, then I would more likely than not correct it, then it would fall too low. Hence the terrible roller coaster. I assumed, as does the Diabetes Clinic, that to achieve non-diabetic levels of blood sugar control, it required a lot of low blood sugar hypos. I would have had to correct my low blood sugars hypos 3 – 4 times a day.

Nowadays, eating LCHF, I would typically take 1-2 units per meal. This is only for the hidden carbs in vegetables etc. If I was stricter in my eating, I could reduce that dose even further. I have since had to buy a “paediatric” insulin pen, which allows me to dose in half units. Which is quite something. My sugar never rises after a meal. Then, because I am taking very small insulin doses, it doesn’t drop down low either.

My last HbA1c reading was 5.6 and then 3 months later 5.3. A cause for celebration really, as this is approaching non-diabetic levels. The Diabetes Clinic sister on duty was extremely unhappy, and had to call a supervisor. They were not happy letting me drive home. They could only deduce that for my levels to be so low, I must have been having many many dangerous hypos.

I took it upon myself to explain diabetes to them. “If I take no carbs, then my sugar won’t go up. If take no insulin then my sugar won’t come down”. I can manage my sugar in a very accurate range. I have very few hypos, and when I do, their intensity to slight (ie, not powerful caused by large over-doses of insulin). And that by following their protocols, I would have many more.

lewis

Lewis completing the Auckland Marathon last weekend (November 2nd, 2014). Note the glucose monitor on his left arm.

Susan’s ketogenic experiment

Now for something different: Susan came to me this week wanting some support as she embarked on a ketogenic diet. As a woman who is both an avid consumer of information and investigative, she’s done a lot of reading about it but hadn’t come across a much information on the effects of a ketogenic diet on a woman of her age.  So she’s undertaking an n=1, and wanted to document it. She will undoubtedly start her own blog but right now, she’s starting the journey here.

I’m Susan, a 50 year old woman and 1.53m tall, originally from the US, married to an awesome man (but sadly childless), an ‘enthusiastic participant’ of most all things outdoors and lifting weights. I was really lucky to have been raised in a very loving family, working class, suburban, incredibly ‘normal’. My mum certainly did her best where food was concerned, or at least to the understanding she had at the time – iceberg lettuce salad with dressing to start, things like meatloaf or pork chops, spaghetti and meat sauce, tinned veg, and ice cream for dessert. We normally had fast food as a treat maybe once a week – McDonalds, KFC, Fish & Chips. We were normal suburban kids, out on our bikes or in the cul-de-sac until dark, running around, walking to school, and I reckon I was normal weight until…the microwave oven!!!!!!

Both my parents worked, and when the microwave arrived, so did the easy, processed, and addictive after school treats. Hot Dogs! Burritos! Pizza! Hot Pockets! Basically, we’d get home from school and have another complete meal. Still, until I was 16, my weight was pretty much fine. I was never an athlete, but I loved my tramping and my outdoor pursuits, and was an avid girl guide. I lived my last year of high school on Grape Nuts Cereal and Diet Coke. And Snickers. And voila, the spiral into something I never imagined, not just for myself, but never imagined existed. A metabolic nightmare that ensued for the next ten years. By the time I was 19, I had gone from a regular menstrual cycle to having maybe 3 or 4 per year. I went looking for help, and what was the doctor’s solution? You got it, birth control.

When I was 21 I met the man who was to be my first husband, I remember that preparing for the wedding, when I was 23, I went on a crash diet which involved 2 shakes per day and not a lot else, and I managed to get down to about 53kg, which was the lowest I’d been since I was 15 years old. Slowly the weight crept back up, but by then I felt like I had all of the tools to understand what it took to keep me in a relatively small state (mainly, don’t eat!). I also went off birth control, as we wanted to have a child. I did manage to fall pregnant quite quickly, only to miscarry at 12 weeks. Following that, once again my periods pretty much stopped, and eventually I went to another doctor to try to figure out why. I had massively polycystic ovaries (PCOS). The doctor was emphatic that the only solution was a ‘wedgectomy’ and massive doses of clomiphene to force ovulation. I declined.

Fast forward 5 or 6 years, I’m out of my first marriage and in bliss with my current partner and living in the UK. I was still having irregular periods and turned to IVF – which involved three unsuccessful attempts, and difficult recoveries from each. About this time I started having some major anxiety issues. Looking back on it, this was really the turning point for me and my health. It was suggested that acupuncture might help, and thanks to an amazing 5-element practitioner, I was brought back to some semblance of physical and emotional balance. This experience led me to start reading and exploring alternative approaches to health and well being. Some worked for me, the acupuncture and cranio-sacral therapy, and some didn’t and felt like a waste of money, like reflexology and kinesiology. I was  OK with that – I felt that it was OK to try things even if there is a chance that they won’t work .

My weight was not good. My lovely man is (was) a vegetarian when we met, and naturally I joined him. Lots of pasta, rice, soy, bread. You can guess what happened. Then we went on the macrobiotic diet, and that made things worse, especially for me with mood swings and ‘hanger’… By the millennium, I weighed 68kg. Technically obese for my frame. But why? Wasn’t I doing all the right things? Eating purely? Being aware? Clearly not, but then, another voila moment.

My cousin’s daughter had been diagnosed with PCOS, and prescribed a drug called Metformin. My ears pricked up – there is another treatment besides a wedgectomy??? I went straight to the doctor, who kindly but firmly explained that in the UK he couldn’t possibly prescribe Metformin for anything other than Type II Diabetes. However, the universe (and science) had turned. Literally a few weeks after that I read in the Sunday Times about a doctor in Harley Street, London, who had been successfully treating women with PCOS. I make a booking immediately.

When I walked out of his clinic an hour after I’d walked in, my life had changed forever. Dr. Carey knew about the connection of insulin to PCOS, the condition of hyperinsulinanemia, and was fairly confident that changing my diet to exclude wheat and processed sugar, and 1/2 hour of light walking in the morning would work wonders. I can still see the little graph he showed me about what happened to my blood sugar when I ate carbs, how my metabolism had become broken so that regardless of the amount of insulin I secreted it wasn’t effective at clearing the glucose, and that my PCOS was a manifestation of those elevated levels of insulin.

I got my period the next month. And I have had one EVERY MONTH SINCE. And the weight started to melt off. I accelerated this through buying Dr. Robert Atkins book, and adopting the low carb principles. Throughout the week I would eat low-carb bars, nuts and protein.   On the weekend I would eat ice cream and drink red wine. I spent my last few years in the UK quite happily hovering at between 60-62kg. Not lean, but certainly nowhere near obese. We emigrated to Aotearoa in 2003. Joined the gym, took up snowboarding in the winter, kitesurfing in the summer and tramping regularly; we’d found our ‘place’ for sure.

At the start of 2007, I had started getting serious about my weight lifting and potentially body building.  I decided to find a trainer who ‘got me’ and I wound up working under the tutelage of a Sydney based body building enthusiast (female) for the next 4 years. Over those years, I broke innumerate personal records for lifting heavy things, for testing myself beyond my wildest imagination. That was the good part. The not so good part was the dieting! For those 4 years and beyond, I weighed and measured every morsel that went into my mouth. Within 15 months I went from 60kg and 27% body fat to 52kg and 13% body fat (tested in hydrostatic tank) I looked amazing, but my wonderful husband nearly left me! There is a very, very thin line between commitment and obsession.

Without knowing it, those 4 years set me up for another, even worse metabolic nightmare, but again, one that no one could have predicted or imagined. I was fit, lean (a little bit miserable) and seemingly unstoppable.

Then the earth moved.

I was in Southern Cross Hospital on Bealey Avenue at 12:51 on 22nd February. I was getting ready to be prepped for my procedure, when I was thrown out of my chair and watched the building twist and shift. As anybody who was there knows, that was just the beginning.

Everyone had a different emotional and physical reaction to the earthquakes – some left, some got ill straight away, some got depressed. I just went harder. Action, movement, gotta keep going, gotta help, can’t stop. By July I noticed that I was losing whole chunks of time – it was like I’d suddenly ‘snap back’ to reality, having no idea where I was, what I was doing. This was particularly scary when it happened whilst driving! Then one fateful day I was going hard in Bottle Lake Forest on my mountain bike, and my legs stopped working. I wish I could adequately describe the sensation – it wasn’t cardiovascular in nature, but literally, I could not push my legs around on those pedals. I have no idea how I got home.

I had been avoiding going to the doctor for the other symptoms quite simply because I didn’t have a doctor, as mine was tragically killed in the CTV Building. But I now knew I had to do something, so I contacted a wonderful doctor at the Helios Integrative Medical Centre. Thanks to her, I managed to bring myself back to health over the next 18 months through supplementation (including whole thyroid), relaxed, intuitive eating, and much, much less exercise. My physical journey back to health was celebrated by completing the Oxfam 100km in April 2012.

Post Traumatic Stress is a very real thing, whether or not you label it adrenal collapse. I think that through my experience I had instinctively begun to recognise the power of food as medicine, or at least much more powerful than we give it credit for. It sounds obvious now, but I hadn’t really thought of food as anything but pleasure or fuel. What about as true, deep nourishment?

My real food journey included finding the work of Weston A. Price, and the wonderfulness of Raw Milk. We joined a herd share and started our own fermentation bench – whole milk kefir and yogurt – yum! Having been wheat and gluten free (also corn, which is actually the worst for me) since 2000, I made the further step to becoming grain free in November 2012. I will have sushi as a treat, or the occasional slice of gluten free bread with eggs bennie for brunch out, but overall eliminating grains have been super easy for me.

For the past 18-months or so, my focus has been on real food. I made another discovery – I love lambs liver! I’d never had liver of any description, but now we eat it once a week. I buy organic meat or from the butcher whenever possible, and have so enjoyed the nourishment that meat brings to our bodies. I also make bone broth, kombucha and sauerkraut.

I feel great, healthy, balanced, calm, focused, and as an avid consumer of information I have come across the ketogenic diet but cannot find a lot of information out there for the peri-menopausal woman. Hence, I’m enlisting Mikki’s help for my own great Ketogenic experiment. Given where my health is at now (i.e. not a metabolic mess) it is a good time to try it. (Ketogenic: 80% calories coming from fat; 10-15% protein, 5-10% carbohydrate).

I have just received  a Ketonix electronic breath ketone-measuring device from Sweden to measure ketones (a sign that you are burning fat as your prefential fuel, and not glucose), and my overall goals are:

  • To be in ketosis for these 30 days, as measured by my Ketonix, noting anything and everything about the state and its effect on mood, sleep, energy, etc.
  • To be confident enough at the end of these 30 days to STOP weighing/measuring (the most difficult part of this experiment has been getting my head round going back to that practice)
  • To not lose strength in the gym
  • To become metabolically flexible enough to complete a 4-5 hour endurance training session for a multsport race I’m doing, with no carbs and no ill effects (this is the long term goal; and it isn’t ‘no fuel’ it is ‘no carbs’ – this is a long term goal)

I have not weighed myself at the beginning of this month, but I do have a ‘number’ in mind that I would like to see at the end of it, and I’m really interested to see what happens to my blood cholesterol levels (which were tested in June and will be retested in 8 weeks’ time).

Thanks for reading, and I’d love it if you would follow me on this journey. Mikki will be posting updates regularly on my progress.