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?

Tuesday, March 22, 2011

getting in the groceries

ever wondered what other type 1 diabetics purchase at the grocery store or supermarket? well, here's a chance to find out... the following video is just me showing you the things i've bought this week to cook and eat. 

i think it's a pretty accurate reflection therefore of the sort of diet i'm eating at the moment, and what sort of things we eat day to day. yes, it's a lot of vegetables, but there are also a few slightly unusual storecupboard items that i discuss...

i hope this is of use to you type 1's out there who are stuck in a food rut, and i hope that it inspires you to try some new things. 

i also think it is quite interesting to see what is available in other countries and supermarkets - it's definitely an eye opener (last time i made a grocery haul video, people were shocked at the amount of plastic UK supermarkets use to package their foods).

ps. ever heard about the primal or paleo diet? well, it's another 'low-carb' diet that has a huge following on the internet - there's loads of really good recipes for diabetics (because it's grain and bean free) and so it's a fantastic place to find new resources and nutrition info.

if you are interested in finding out more, i wrote an article on not just apples all about the paleo diet and primal nutrition, with a bunch of links and resources too, so do check it out. it's been very helpful in getting my sugar levels straightened out...

Tuesday, March 15, 2011

living with type 1 diabetes

thanks to the great response to my last cooking video, i am now launching a channel for diabetic recipes and information! i am really excited about this new project, and i hope it can help out lots of you living with diabetes or caring for a diabetic child or relative...

so here's an introductory video for you all:

as always, any requests or questions are most welcome - i am here to help!

please subscribe to my new channel  (it's free!) to show your support and to receive regular updates...

Monday, March 14, 2011

the 'sunday roast dinner effect'

whilst reading the section in bernstein's book about the 'chinese restaurant effect' i was confused. i continued being confused for a short while every time it was mentioned in the book, until i suddenly hit upon a more accurate metaphor for my understanding... the sunday roast dinner effect!

the idea behind the metaphor is that when you eat so much (even though it is low carb!) and get SO full your body cannot process everything in it's normal way. instead of requiring an immediate insulin response, then a second long lasting response, there is also a third response of insulin required to help counteract the glucagon the body releases (which the body does because the intestines are stretching to compensate for all that food you just ate!)

so basically, if you eat a whole bag of lettuce even though it's basically full of water and has no carbs, you will still need to inject insulin to cover it because of the quantity you ate.

this only started making sense to me when it helped to explain the reason behind my post-sunday-roast high blood sugar. a sunday roast doesn't potentially contain that many carbs, meat, veggies, gravy... i always assumed it was the amount of fat i was consuming that caused the rise in blood sugar, but however much i injected (more on that later) it didn't seem to help my levels on a sunday afternoon.

but, as we all know (especially in the uk) sunday roasts are an opportunity to eat LOADS, and get stuffed - in fact, it's almost rude in our family to be sensible with your portion sizes when it comes to this meal. traditionally we all spend the afternoon sat immobile or asleep for an hour to allow our bodies to digest the hefty quantities we just downed.

sometimes we do go for a sunday walk afterwards, which helps a little with the quantity of fat consumed, but will do nothing much to help the 'overeating effect' that creates the rise in blood sugar.

it's the same with Christmas - gluttony is a key aspect to many family holidays and traditions, it would seem.

anyway, so now i understand why this happens i can eat a bit less on these occasions, and learn to manage portion control. if eating so much requires me to have more than 6 units of insulin bolused then it's WAY too much - and the amount I will need will rise exponentially the more and more I stuff myself. so i might end up needing 8 units to cover 50g of carbs, just because i ate so much.

and then you see if i injected that sort of quantity i will build up resistance to the insulin and it will become far less effective in my body. and i also run the risk of going substantially lower later on in the day when the insulin finally works it's way to being absorbed.

ok, so what do we learn? overeating is never a good thing, ever. however 'satisfied' it makes you feel, or how much a part of tradition it is, or however much you just want to politely finish what is put on your plate - it's not worth it!

Monday, March 07, 2011

pancakes for breakfast - low carb and perfect for diabetics!

hi everyone! i hope the sun is shining as brightly with you as it is with me :)

i recently created a video on my youtube channel, a pancake recipe that is just so delicious and low in carbohydrates that i couldn't not share it with you all. they are full of good protein and fat, and are just brilliant for diabetics in the morning - especially kids with a healthy appetite!

if you have any other video requests, please do let me know... i'm quite happy to talk about anything to do with diabetes, or insulin pumping, or diet. and if you haven't yet visited my channel, then do, because there's a healthy living series on there worth checking out ♥