Thursday, March 31, 2011

low carb diet & forcing ketosis

hi all!

today i wanted to talk about something really controversial - forcing a ketotic state through living a very low carb lifestyle.

i received a comment on my recent NJA post about the primal diet. it was an anonymous comment, but it was so good a question i felt it needed answering! here it is:

i am also a type 1 diabetic. were you advised to follow a low carb diet, or was it a personal choice?  diabetes today shouldn't hinder your ability to eat nearly anything! the advice is to eat as you would regularly and match your insulin to that.

i know for myself i rely on carbohydrates, be they low GI, and do not forbid myself from having a few squares of chocolate or a apple crumble made with sugar or some icecream, etc.

i just wonder whether low carb is really good for anyone? ESPECIALLY a diabetic?

this comment left me annoyed that i hadn't fully explained where i stand on low carb, and what the phrase 'low carb' really means to me in a practical way. so here is my best attempt at an answer...

it has been a personal choice for me to go low carb. when i've seen a nutrionist throughout my years of diabetes care i've only ever been advised to follow a 'balanced' diet, with a good proportion of everything, including wholegrain carbs. i've generally been praised for looking after myself well, all the while maintaining a high hbA1c of 7.6 + (normal is less than 5.5%).

i used to think that i could eat anything, and i didn't let my diabetes stop me from eating whatever i liked, although it was always within reason (minus a few Ben & Jerry's sessions at uni when i ate a whole tub). i was frequently eating about 40-60g carbs at a meal, and then more if i was out, at someone else's house or celebrating a special occasion.

i reached a cracking point this february 2011 - i had a severe hypoglycaemic attack in the night, i had my retinal screening test when they found more burst capillaries, i was taking several days a month off from work from high sugar levels, i had some very expensive dental work done (and i'm only 23!) and i became an auntie for the first time!

i went on the tudiabetes forums for answers - and i found lots of people talking about how going 'low carb' was helping them manage their diabetes better and acheive better hbA1c's. my mum bought me the diabetes solution by dr bernstein, which i promptly read, and was very impressed with (review to come soon). so i thought i'd give it a go, it wasn't a drastic difference to my eating habits then - so it wasn't going to be too difficult, and if after two weeks i noticed a positive difference to my blood glucose control, then i told myself i would stick with it....

and of course, after two weeks i noticed a massive improvement in my control and sensitivity to insulin. so, there has been no turning back since then ♥

so how low carb is 'low carb'?
i guess that the thing with a low-carb diet is just how low carb you go... do you go as low carb as bernstein suggests (the 6, 12, 12 principle?) or do you just reduce the carbs you eat to way below the average, to something your own body can handle and use efficiently?

i think the danger with low carb, and the reason we don't associate that phrase with anything healthy, has to do with forced ketosis. there's a theory that people like Atkin's have concluded, celebrated and advocated through a low carb lifestyle - that by going on this diet you'll force your body into ketosis, where it burns fat for energy, instead of carbs.

atkins seems to think that going into a ketotic state is a good thing, because it shows that you are losing weight. but if you don't need to lose weight then what then? and aren't ketones really bad for your system?

i asked myself this after my second week on the diet when i was feeling a bit groggy. i decided to use a ketostix to measure where is was at, and found i had ketones in my system. then followed a frantic search for answers all over the net: to which i concluded that i'd eaten too much fat and not enough carbs in proportion to the amount of exercise i was having. and that although there were ketones, this was a sign of non-PWD's ketosis rather than a PWD's ketoacidosis (i had had perfect sugar levels that day, all under 7mmol's, so i was very confused). anyhow, with a little adjusting, i have not had one more positive ketone test, and i now check each evening - and will do until i am settled on this new lifestyle.

so, i would never recommend a ketogenic diet, because i don't think it's a positive thing to do to your body, and can give you permanent damage to your kidney/liver/gallbladder. something worth keeping in mind, especially when a PWD's body is more at risk of these things anyway.

i eat about 50-100gr carbs a day, and those are mostly at breakfast time and as snacks before and after exercise. i hardly eat any carbs at dinner, it's usually a big salad, and i eat a small amount at lunch with by large protein portion for the day. i found this post at marks daily apple very helpful in understanding how many carbs i ought to be eating. but i also think that it's different every day, and that you also need to listen to your own body's demands, and account for the amount of exercise your getting with your carb intake.

the other thing to mention is that, with my insulin pump, and having managed my diabetes for 12 years, i was able to take charge of lowering my basal insulin rates, and adjust for fewer carbs with my meal boluses. if you want to go lower carb, but aren't sure how then speak to your local GP or endocrinologist about it - my local practice have been very supportive of my change in diet, because they know i won't do anything TOO crazy, and they know it WILL help improve my health.

anyway, that's all for now. and in the meantime, tell me your experience with reducing your carb intake, or your thoughts on ketosis?


MevsDiabetes said...

I've also been reading Bernstein's book and I started following a fairly strict low carb diet about a month ago. I can't deny the results - balanced blood sugars, a straight line most of the time on my CGM, and less worry about going low or high. Dr. Bernstein basically says what no diabetic wants to hear, but what I believe most diabetics deep down are aware of but don't want to admit, that WE SHOULD NOT BE EATING WHATEVER WE WANT. Sure, we "can" eat it, we can put it into our mouths and swallow, but that doesn't mean it's not going to hurt us, either in the long run or in the short term with more highs and lows. Injecting insulin, whether through shots or a pump, cannot mimic a working pancreas to the extent that we are free to eat whatever we choose. There is obviously two schools of thought on this, the low carb advocates like Dr. Bernstein and the ADA's position of "Do whatever works best for you." To me, the results I'm seeing are undeniable and only make sense. The less carbs you eat (including trying to avoid carb laden foods like breads, pasta, cakes, etc), the easier it will be to manage blood sugars and the more feasible it is to keep yourself within a normal range.

diabetesgirl said...

Great post! And wow- 50-100 gr carb per day - I bow to you!

I too try to follow a low carb / primal style diet but don't always do so well... I find as a T1 PWD MDI, keeping my carb intake under 135 grams per day is working for me.

While it is theoretically true that a PWD can eat whatever they want with the appropriate insulin injections I find the reality of it is not so simple...

Daisy said...

This post was really helpful! I've had diabetes for 14 years, yet my blood sugar levels have been everything but balanced most of the time. I have now started to put a low-carb diet into practise and have found that, not only are my levels better, but I also feel much more alive!
Thank you for suggesting it to others x

Victoria said...

I am a new diagnosed type 1 diabetic. Once I got over the shock of learning I had this condition, I had to face my doctor and diabetes nurse insisting that I eat carbs at every meal. I went along with what they said at first but I was most unhappy. I then read about Dr Berstein and put my foot down! Since going on a strict low carb diet, my blood sugar levels have been fantastic. And I have never eaten so healthily - lots of salmon, nuts, eggs, vegetables etc. BUT the problem I am having is that I have high ketones in my blood. My doctor had said this is not good and that I must eat carbs. It is a nightmare!

Tonight, I did a ketone test and got a reading of 3.3 (I am told that it should be no higher than 0.6). I took fright and so scoffed down some crackers and took some insulin. Yes, my ketones when down to 1.2 a little while later but my blood sugars went up to 9 (they haven't been higher than 6.2 for two weeks).

I am so frustrated. I want to follow Berstein's advice but I don't seem to be able to do it without producing ketones and thereby risking damage to my kidneys. Has anyone please got any advice for me?

By the way, I have been a diabetic for only four weeks; 40 years of age; taking only a small amount of insulin (because of the low carbs and also due to the fact that my doctor thinks I am still in the 'honeymoon' phase).