A little over a year ago I was bored. I was working in an office environment and not able to get out climbing. I wanted to try something to shake up my routine despite the obvious constraints. I decided to do an experiment with a vegan diet, which ultimately led me to try the complete opposite–a ketogenic diet. This bit of skylarking wound up taking off and got this humble blog ranked #1 in Google for the search terms “type 1 diabetes and the ketogenic diet”. This happy accident has brought many of you here no doubt although it’s left me with a burden of continuing to write about a topic that I feel has been wrapped up (at least in my life). The notable exception is the modified Ketogenic diet which I am currently following.

There is one loose end, however–and that is the issue of high cholesterol. I also have the dubious honor of ranking very highly in Google searches for ketogenic diet and high cholesterol–a pleasure that I’d prefer to postpone indefinitely. I am still working on sorting out the details on my high cholesterol and what it means for my adherence to a low carb, high fat ketogenic diet. There is a dearth of information available that gives simple, clear insight into the topic of cholesterol–and much less still when you add type 1 diabetes into the mix. Half of the discussion resembles this: “Cholesterol is not a problem! Eat more butter and stop listening to the man!” The other half resembles this: “Cholesterol is a HUGE problem! Eating that butter is going to kill you!” I would like to believe that a modified ketogenic diet could win the middle ground between these two viewpoints.

The ketogenic diet stabilizes and controls my blood sugar without technology. This fact alone makes it an asset that could revolutionize the impact of diabetes if given the chance–especially significant for the millions of people who can’t afford higher tech solutions. It gives me the simplicity and freedom that allows me to live out from under the burden of diabetes about 90% of the time. Still, living with the cholesterol monkey on my back is a concern.

I feel as though I can choose to either optimize cholesterol or blood sugar–but not both.

I choose to optimize blood sugar because there is no lack of conclusive clinical evidence showing what uncontrolled blood sugar does. There is also no shortage of anecdotal evidence showing how much harder it is to be active, creative, happy and productive while riding the glucoaster. Without getting all morose, let me just say that I have chosen my priority. It’s not an easy choice and it gives me a lot of stress and grief–but it’s the best I know to do and I am prepared to live or die with the consequences.

Welcome to my life with diabetes and climbing. These types of decisions are par for the course.

What I have learned with the help of my doctor (he is an amazing endocrinologist who is supporting my blood sugar management despite its unorthodox approach) is that I am most likely a hyper-responder to saturated fat. This is a genetic anomaly that causes my body to produce exponentially more cholesterol in the presence of saturated fats. The detriment of that cholesterol is still undetermined–along with the possibility or being able to reduce it.

Thanks, genes! The diabetes was a sweet offer–but wait, there’s more…

In light of this hypothesis, I am not abandoning a low carb, high fat diet but I am following a modified ketogenic diet. I believe that most people have to modify whatever diet they follow in order to accommodate their specific needs. A modified ketogenic diet can, of course, mean many different things–it is not imply any one specific modification. I am trying to add more unsaturated fats in place of saturated fats. In simplest terms that means that I am eating more olive oil, macadamia nuts and fish. I am eating less red meat, eggs and coconut oil. In a lot of ways it’s closer to hybrid mediterranean diet. It’s really hard to sell this approach since it doesn’t fit with the self congratulatory memes of the vegan “path” nor the devil-may-care tropes of the ketogenic community. Oh well.

My cheese intake is still predictably unaltered. I will be buried with my block of Coastal Cheddar and a paring knife if need be. Nuff said there.

I recently started swapping out olive oil in my coffee rather than coconut oil. Before you gag and click away, I have to tell you that it’s actually delicious if you put it in a blender. I’m still putting heavy cream in my coffee with the olive oil. Additionally I am eating more leafy greens and cruciferous vegetables (red cabbage, brussel sprouts) as vehicles for more olive oil and more fiber. I’ve cut out a lot of red meat–not to complete exclusion but I’ll eat a steak or some lamb once a week rather than twice or three times weekly. Meat ends and deli meats which I love–have been largely replaced with macadamia and Brazil nuts. I am also increasing fiber intake through the vegetables and adding chia seeds to just about everything I can.

I’m not on statins currently–but I am taking fish oil, vitamin D and Berberine as part of my normal supplement routine of magnesium and potassium.

I don’t have any solid numbers yet to indicate the effectiveness of the modified ketogenic diet on my cholesterol. In terms of its impact on my blood sugar and energy, I feel like it takes a little more olive oil to get into ketosis. It’s lower caliber–but it still seems to be getting the job done. I’ve been taking more insulin recently–but I am not sure if this is because I am back living in Massachusetts or because of the dietary modifications. I have always found a dramatic decrease in my insulin dosage when I am out west (10-15% consistently). On the flip side, I have more time and space to focus on my diet and supplementation here than I did when we were living on the road.