Why I chose a Ketogenic diet to manage my diabetes

I feel like one thing that has been missing from my discussion of diets in the last few months of experimentation is my personal story with food. In fact, you should subscribe to the AdventureRx Podcast because that is going to be the next story I am going to tell in episode 28! There is a reason that I arrived at a place with my diabetes where I feel comfortable going to “extremes” and it didn’t happen over night or because someone berated me into doing it. It all came from a desire to be able to climb more confidently. I don’t necessarily mean climb “harder” because I am not the best climber out there by a long way. I mean being able to place less focus on my blood sugar and more focus on my climbing.

The vertical world has always been a drop-test for my diabetes and it has taught me much of what I know. Conversely, when people ask ‘how do you treat lows on a climb?’ or ‘don’t you worry about going low?’ my response always goes back to what I have learned about eating. In short, when I need to focus on something beyond my diabetes, food is my first tool to implement that fix.

I have always eaten a diet that’s relatively low in carbs. To me that was just “eating food” until about two years ago when I started to hear terms like “Paleo” and “Keto” floating around. Honestly, when I was diagnosed with diabetes I realized early on that the greatest limitation I was facing came from blood glucose variability. I think that this is true for many others as well-eating the same things from one day to the next but not knowing how blood sugar will respond is frustrating and in some cases frightening. At 16 years old I decided that I would eat foods that required the least amount of insulin possible-because more insulin on board generally meant greater chaos in my experience.

I didn’t make that decision from reading a blog-or writing one. I didn’t get to that conclusion from a YouTube video. That was 1999 and there was barely email back then. I noticed what did and did not make me feel good and which foods always required correction after eating. Honestly it wasn’t hard for me to cut out the heavy carbs since I was able to fill up on proteins and fats and low carb vegetables. It was a dietary shift-but not a sacrifice from my standpoint. I can’t say that a dietary transition like what I am about to describe would be as easy for someone who had a sweet tooth or couldn’t live without pasta. I grew up on meat and cheese and fish and vegetables so it felt less traumatic to restrict carbs.

After living with type 1 for a few years I began accepting the label of “Low Carb”-I remember my college roomates commenting on the lack of nutritional balance on my food tray when I’d be at the dining hall. I got pretty decent control (mid-low 6s A1C but with at least one high over 200 and at least one low in the 60s each week) I figured, ‘That’s all there is-this is as good as it gets’. I basically stopped looking for new approaches until 2010 when I was working as a rock climbing and canyoneering guide in Utah. Being in a community of people who were very in tune with “clean eating” while working a job with significant daily energy demands made this a perfect time to try new strategies.

I decided to try a raw vegan diet which definitely had a lot of benefits in terms of energy but it required a lot more in terms of food volume. If I was out climbing or hiking, that was no problem because I could eat relatively low-carb vegan meals without additional insulin. The tricky part was breakfast-before I’d head out to adventure-my sugar would regularly be in the 200’s because I needed more carbs for energy but couldn’t afford to take too much insulin up front, knowing full-well that I would plummet once I started hiking.

Over all, I felt that the benefits outweighed the costs and that highs in the mornings would just have to be a price I paid. I hoped that my other efforts to be fit and healthy would somehow make up for any shortcomings in my blood sugar control. Once I stopped guiding, I was able to set my own schedule again and I found that smaller carbs over a longer period worked better on my blood sugar and that ultimately there was no substitute for feeling full after a meal. The foods that I could always safely fill up on? Meat, cheese, fish, eggs…and so I decided to go back to a generally low carb diet. This is how I ate until this past summer when I finally got fed up with the lack of energy that I felt on this type of diet.

I had made the mistake of thinking that I was on a Ketogenic diet in this blog post and so I renounced that way of eating and decided to re-approach the vegan diet. You can read about how it worked and how I struggled with it and ultimately returned to the old reliable low carb diet.

Here’s the thing though; I had been on a low-carb diet for years but never on a Ketogenic diet. Our bodies basically have two options for fuel: fat or glucose. A low carb diet that cuts the glucose without actually shifting the energy source fails to address the bigger issue-and this is seen very clearly in the “failure” and lack of energy that I had felt when I really pushed my body. I was low-carb enough to help lower my blood sugar but there was nothing there to replace glucose as a fuel source.

I feel that it’s fair to point out that I am not a researcher or a scientist. I know there has been a lot of scholarly debate about what diet is best and which macronutrients are worst. If that invalidates my experience in your eyes, then that is perfectly reasonable-I only share to encourage other in experimenting for themselves. Having said that, I know that about 90% of the things my endocrinologist used to tell me-were right out of the textbook but I rejected them because I knew what worked for me based on performance, experience and blood sugar averages. In other words, I prefer to do what works based on my own experience-especially when that experience paints a very clear picture.

Recently my experience has shown that a Ketogenic diet suits my needs very well. I have energy in abundance, blood sugar stability that I have never before experienced (even during exercise) and I don’t feel hungry throughout the day. So what changed? How is this any different than before?

Fat. More fat. I started replacing the carbs in my diet with fat and moderate protein and you can read exactly what I eat here. Looking back, I had always thought that protein was the obvious to replace carbs. Once I began increasing coconut oil and macadamia nuts as part of my diet I began to feel the shift in energy levels that come with entering a state of ketosis-where your body effectively adapts to burning fat as its primary fuel source-not sugar. In order for that adaptation to occur, it can take up to two weeks of eating less than 50 (ideally under 30) grams of carbs in a day and replacing the majority of those calories with fat.

A Ketogenic dietary approach may be largely untested in the long term. It is certainly not as simple as a single blog post from an enthusiastic self-experimenter might make it seem. Here is what I do know. I know my body fat is down. I know my blood sugars are lower overall. I know my blood glucose is stable enough that I can go for a 3 mile run (starting at about 130 mg/dl) without having to eat anything to correct a low. I know that I feel energetic and my head feels clear. I also know that I’d be missing out on these benefits if I didn’t take the initiative to try a lot of different things and invest the time in figuring out how my body runs best through a lot of trial and error!

LivingVertical thrives because of YOU. I (Steve) personally appreciate the fact that you are part of our growing community of active and adventurous people with diabetes. I will be offering diabetes coaching services beginning October 1st-and I have space for 5 people who are looking to improve their lifestyle, diabetes control, goal setting and adapt their management to unique, active pursuits. Email me for more info [email protected]!