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.

[…] Why I’m trying a modified Ketogenic diet – I decided to do an experiment with a vegan diet, which ultimately led me to try the complete … I am not abandoning a low carb, high fat diet but I am following a modified ketogenic diet. I … […]
Interesting mods Steve. I recently found out that the digestive issues I’ve had with Keto was due to pancreatic enzyme insufficiency. Yes thank you pancreas for the one more “here you go try this one on for size”! I had to actually stop Keto completely for about 4 months while we figured all this out. It was making me physically very sick. So now that we have it figured out I have been modifying my Keto/low carb diet to find the right fit for me also. I cut out all red meat except for the very rare small steak (I do pay for it but it’s so worth it) and increased my fish and vegetable intake. I also had to increase my chicken intake as I’m not much for pork, but I’m learning to dress it up differently. I’ve greatly increased my unsaturated fat and lowered my saturated fat. I’ve had a hard time staying in ketosis, but I feel so much better with the mods and new enzyme meds they have me on. I’m still getting relatively decent glucose control so I will take what I can get at this point and keep trying different combos. Doctor wants me to give up cheese and dairy in general, but that’s NEVER going to happen : )
This is very interesting-sounds like we have very similar mods going on-for different reasons but with similar results. Cutting the coconut oil has definitely made ketosis less intense but if it can make the BG control and the cholesterol align I won’t complain.
[…] Why I’m trying a modified Ketogenic diet – 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 … a little more olive oil to … […]
[…] Why I’m trying a modified Ketogenic diet – … 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 … […]
Thank you for posting about this. I have T1 D and have recently started a ketogenic diet, and the main thing about it that makes me nervous is the possibility that my cholesterol may go up. Maybe it won’t since the high cholesterol levels associated with diabetes are usually parallel with poor glucose control, and my control has only gotten better since going ketogenic… But it’s still something I’m going to ask my endocrinologist to test a little more often. A lot of the mods you’ve made are ones that had already crossed my mind, should my cholesterol go up, but I hadn’t started thinking about supplimentation. It’s really helpful to see what someone else has worked out.
Thanks for sharing this! I think that modification is always a part of the process. Some of us drew the short straw on the lipids and others of us find no impact or even an improvement of lipids when on keto. I’m glad that you seem to be a “long straw” person! I’ll keep posting up about how these mods are working!
I very much appreciate finding your blog; especially on this topic. I switched to a keto diet to lower my blood sugar, which of course, it did. And, my cholesterol numbers skyrocketed. However, my triglycerides came way down. I am curious why you replaced coconut oil with olive oil. I believe coconut oil is really good for us from what I have read. Also, you are taking fish oil and I have also read quite a few articles that these supplements most often have rancid oil in them. I supplement instead with fresh organic hemp seeds along with chia seeds. Also, isn’t full fat coconut milk better than heavy cream? You probably have addressed this all before but I am brand new to your site; Would really appreciate as I feel kinda lost out there combining different ways of eating. Most people like to ‘choose a side’ but I am doing what’s best for my body.
Cholesterol measurements are more complex than cholesterol levels-particle size and density seem to play a role as well. The fact that your trigs have gone down seems encouraging as trigs are more highly correlated with CVD mortality than cholesterol itself, but you will most likely have to follow up on this. I replaced coconut oil with olive oil because coconut oil is almost entirely saturated fat which is not objectively bad-but when I have a reaction to saturated fat, it’s my hypothesis that I will improve my cholesterol by avoiding inordinately high doses of saturated fat. I eat both hemp and chia seeds too, along with fish oil. I don’t know about the rancid fish oil but I have not seen anything in my research suggesting that it would contribute to dramatic cholesterol increases. In terms of heavy cream v coco cream, again it comes down to saturated fat. I am optimizing away from sat fat. I don’t think the ‘better or worse’ paradigm really applies here-it’s more about appropriate for the needs/nuances of the particular situation, like you say.
[…] Why I’m trying a modified Ketogenic diet – 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 … […]
[…] Why I’m trying a modified Ketogenic diet – … 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 … […]
[…] Why I’m trying a modified Ketogenic diet – 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 … I am not abandoning a low carb, high fat diet but I am following a modified … […]
I hope this works out for you- I have had excellent results; I have been doing a modified keto diet for a while and my cholesterol remains within a healthy range. I just don’t feel good with saturated fats and instinctually avoid them. I have watched my blood sugars level out and stabilize with mod-keto so that my CBGM looks like a gentle prairie horizon. I love it! I have never been a big meat eater; a stint experimenting with paleo seemed to increase gluconeogenesis significantly, so I eat limited protein amounts and this works for me.
I’m still trying to perfect the morning coffee- MCT and coconut cream are good but after a couple of weeks they start to feel very heavy. Maybe a rotating recipe- can’t wait to try the olive oil tomorrow and thanks for the tip! Being over 40 I am constantly urged by the doctors to take a statin even though my cholesterol is perfect. I tried it once in an attempt to qualify for pump supply finding and had wretched GI upset. Never again.
I have had Type 1 for 43 years and remain free of complications. My TDD is less than 20 and I feel awesome. I presently bike an hour each way to work and it’s the best part of my day. I never thought I would be this healthy for so long. It has taken alot of experimentation over the years and alot of renegade approaches. By far modified keto has been the most successful. I’m rooting for you!!
Thank you so much for sharing this Helen! It’s super inspiring to hear your story, first of all-and second it’s great to hear that you are getting great results on modified keto. I feel like I am in much the same boat-the only question on my end is in regards to the “intangibles” of cholesterol. I am keen to see how my inflammation markers turn up-and my particle size. I will keep you updated!
I have started doing the olive oil whipped up in my coffee in the morning and it’s actually pretty good. Thanks Steve for the tip. Helen’s story is inspiring and I believe from what I am reading now that modified keto is the best way to go. Steve, I am anxious to hear about your cholesterol numbers as I have the exact same particle size (and they’re sticky too) issue. It makes saturated fat in meat a real negative. I just found out about it last year by taking the Boston Heart Test but that’s a whole other story.
Thanks for sharing this update Beth! I am actually going to get my bloodwork done tomorrow…fingers crossed! I have no idea about particle size or anything else yet-hopefully this test will reveal something about that. In other news, I hate fasting! 🙂
Thank you very much for sharing your experience! I also follow the keto diet and I’m T1. But I eat red meat quite often. And I’ve got a question - what do you eat then in order to feel full? I noticed that fish is not that filling for me as meat…
I eat a lot of eggs and cheese-also greens with fat (olive oil) and nuts. I have a hard time eating a full three meals a day as I feel full very rapidly.
Thank you very much for sharing your experience! I also follow the keto diet and I’m T1. But I eat red meat quite often. And I’ve got a question - what do you eat then in order to feel full? I noticed that fish is not that filling for me as meat…
Hi Anna! I do know that strange hunger of which you speak!
There are different kinds of ‘not feeling full’ and different remedies. I’ll just share some of mine here in hopes of offering a good starting point for you to do your own investigations. We T1s are all our own lab rats, aren’t we?
If I am feeling a bit lower energy and meals leave me still feeling hungry for something, I start doing wheatgrass shots. Wheatgrass is very low carb at 2g per ounce (trust me, 2 oz is as much as you want) and you can throw a bit of ginger and lemon in to make it more palatable. I work in a busy emerg department and I started doing wheat grass when I just didnt have tome to chew veggies in a workday. I find it gives me a feeling of satiety body-wise, possibly because it’s so full of nutrients and happy enzymes.
If you have just plain belly hunger after meals, I would suggest making a batch of something like ‘ultimate keto bagels or sesame buns’; recipe here: http://thenourishedcaveman.com/keto-bagel/ . These transport well, are much better toasted and will fill you with fiber that can take that edge off the end-of-meal feeling of being missing something.
Another post-meal hunger comes from just not enough food, or going too long between meals, although many keto advisors will tell you that two meals a day are sufficient. Again, my crazy busy workdays inspired this remedy. I always carry a small jar of coconut butter/manna, almond butter, and mct oil. In the past I have added a touch of xylitol just for kicks, but it’s just fine plain. I make it at home in batches and put in in small 125 ml jars. During the day or even before a meal, I will eat spoonfulls of this and find it very helpful for energy sustenance. When I am out and about all day on my bike and sometimes just don’t want to lock up and forage for food, this will get me through. It’s funny, I recall the unpredictable days of higher carb and never ever leaving home without Skittles for the inevitable blood sugar lows. Now I don’t leave home without what I think of as this ‘keto pemmican’, and don’t worry at all about lows.
These are just a few suggestions. Consider them a starting point for investigations into possible answers to your query. The reality for Type 1s is that we are all uncontrolled experiments of one. I believe that we all thrive best on modified versions of any regimen, because that’s part of personalizing the pancreas.
Hello to everyone! Helen, thank you soo much for your advice. I will try Wheatgrass shots, this is something absolutely new for me:) As for Multi Seed Bagels I made something like these but with hazel nuts, sunflower seeds, almonds, eggs and some berries. Verryy tasty and easily transportable. The only disadvantage - it needs time to cook them and they are so delicious that it’s hard not to eat all of them at once:) And do you eat vegetables? Like cabbage, broccoli, carrot, tomatos etc.? And how much?
Hi Steve, I’m in very similar boat as you with my keto & cholesterol numbers, so I was very happy to find your blog. I’m going to be trying to modify my keto diet as well, and was curious why you’re saying you will be eating more macadamia nuts - it seems like they’re still pretty high in saturated fat? Very curious on your thoughts since I don’t want to give them up, but if trying to lower sat fat intake, seems like we should cut them down? Thanks!
I’m not eliminating saturated fat-just trying to back off some of the direct sources like coconut oil. Macadamias do have some saturated fat in them but they have a LOT of monounsaturated fats (same as avocado and olive oil) unlike coconut oil which is all saturated. I am modifying to see if the increase in MUFA improves my profile moreso than just avoiding the saturated fat-think offense more than defense. I have no idea if this will work-but I don’t anticipate giving up keto regardless.
Hello to everyone! Helen, thank you soo much for your advice. I will try Wheatgrass shots, this is something absolutely new for me:) As for Multi Seed Bagels I made something like these but with hazel nuts, sunflower seeds, almonds, eggs and some berries. Verryy tasty and easily transportable. The only disadvantage - it needs time to cook them and they are so delicious that it’s hard not to eat all of them at once:) And do you eat vegetables? Like cabbage, broccoli, carrot, tomatos etc.? And how much?
You need to stop worrying about your cholesterol and listen to this guy. https://www.youtube.com/watch?v=8ls9HWRxvMo
I’ve heard all of that before. I am not looking at cholesterol as the single failure point in my health-but ignoring it altogether is foolhardy. If Dr Attia who is the most knowledgeable and professional advocates of low carb eating reserves his judgement on the complete irrelevance of cholesterol to CVD then I think it’s worth considering as significant albeit not the only factor worthy of management. In any case, thanks for telling me what I need to do. I spend a lot of time wondering about that.
[…] what I would recommend for him! Moderation and the mediterranean diet; he’s currently trying a modified ketogenic diet or really a modified mediterranean diet. Brilliant and exactly what we all should be […]