My Diabetic Ketogenic Journey

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My On-Going Diabetic, Ketogenic Journey

By: Todd Gamel, RN

Original Article: January 9, 2017

Revised: June 23, 2018

On September 13th, two days before my 54th birthday, I came to the realization that I needed to do something about my health and welfare. Diagnosed as a type 2 diabetic back in 2013, I quickly went on the oral diabetic metformin and slowly over time the dosage was increased in an attempt to get my blood sugars and my hemoglobin A1C under control. While I did not engage in any consistent exercise routines, I attempted to follow the recommended diabetic diet as proposed by the American Diabetic Association (ADA). At the time, for a guy my size 5’9” 248 pounds that was an 1800 calorie diet. The ADA interactive ‘Create A Plate’ tool on their website suggested that I eat a diet that consisted of 25% protein, 25% grains and starchy foods, and 50% non-starchy vegetables, plus a serving of diary and fruit or both as your meal plan allowed.

I attempted to cut almost all sugar intake, we stopped purchasing sodas, and started making all of our tea with Splenda low calorie sweetener, I counted calories to keep my caloric intake below 2000 calories a day, with the occasional cheat day. I will admit, I often strayed because I simply felt hungry all the time, even on 2000 calories a day. As a registered nurse, I have to admit, I trusted all the information that I read from The ADA, after all they are medical professionals right? Surely something must be wrong with me if I cannot seem to make any headway with my blood sugar control and my weight. I kept looking for what I was doing wrong, until I discovered the low carbohydrate high fat (LCHF)lifestyle as proposed by a Swedish physician Dr. Andreas Eenfeldt. In this article I will attempt to explain to you while the dietary guidelines as proposed by the ADA are simply wrong, and why they are simply unhealthy.

 

Because Results Matter (Our Progress)

Because I want to encourage your to continue to read this article and do your own research, I am going to share with you my results of eating a LCHF or Ketogenic (Keto) eating program up front. I have been following a strict LCHF eating plan (less than 20 carbohydrates per day) for four months, my wife eats about 20 – 30 carbs a day. My wife and I started this new lifestyle as I mentioned previously two days before my 54th birthday on September 13, 2016. Below are our individual results.

My Result’s (Diabetic)

Weight Loss: 70+ lbs

Waist: Originally 46 inches, now down to 32 inches.

Hgb A1C: Prior to Keto (7.3), June 13, 2018 (5.2)

My Wife’s Results (Non-Diabetic)

Weight Loss: 30+ lbs

Waist: Dropped 2 pants sizes.

What is amazing about these results is that while I have lost more than 70lbs, my wife has lost more 30lbs without having to do any additional exercise. What I am saying is that she made no other changes to her lifestyle other than choosing to eat LCHF. While I exercise, ride my bike for 40 minutes every other day, then perform strength training for an hour every other day (alternate between riding and lifting weights) before I go to work, my wife is unable to do so because of her arthritis. My point is, that eating a LCHF or Keto diet will change your life for the better. If you are a diabetic, it will help you not only improve your Hgb A1C, but help you lose weight, and the best part is you will never be hungry.

 

Carbohydrates and Blood Sugar

It’s funny that the ADA stated in their position statement ‘Nutrition, Recommendations and Interventions for Diabetes‘ back in 2008 “The amount of carbohydrate ingested is usually the primary determinant of postprandial response.” In layman’s terms eating carbohydrates is the primary factor to increases in your blood sugars, therefore, the more carbs you eat, the higher your blood sugars. Yet, they still recommend that a good diabetic meal consist of 25 to 50% carbohydrates (25% grains and starchy foods, 25% non-starchy vegetables and a serving of fruit and or dairy at each meal). I say 50%, because non-starchy vegetables still contain some carbohydrates. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) on their website state: “Experts suggest that carbohydrate intake for most people should be between 45 and 65 percent of total calories”.

In fact, the ADA recommends that a diabetic male should consume somewhere between 45 – 75 carbs per meal, and 15 – 30 carbs per snack each day. For women their recommendation is 30 to 60 grams of carbs with each meal and 15 – 30 carbs with each snack. So even if we use the low end of the spectrum that’s 165 carbs per day for a man (45×3 = 135, two snacks per day 15×2 = 30), and 120 carbs per day for a woman (30×3 = 90, two snacks per day 15×2 = 30).

So why are the ADA dietary guideline for consuming these amount of carbohydrates a problem? In order to better understand the problem, we have to look at how carbohydrates increase the insulin response in our bodies. In order to do so we need to examine the following chart that indicates how 1 gram of carbohydrate raises your blood sugar.

Weight In Pounds (Kg)         1 Gram Of Carbohydrate Raises Blood Sugar

< 60 (>28)                                       6-10mg/dL (.33-.55 mmol/L)

60 – 100 (29 – 47)                             5 mg/dL (.28 mmol/L)

101 – 160 (48 – 76)                          4 mg/dL (.22 mmol/L)

161 – 220 (77 – 105)                        3 mg/dL (.17 mmol/L)

> 220 (> 105)                                  1 – 2 (.05 – .11 mmol/L)

A quick examination of this data indicates that 1 gram of carbohydrates increases your post prandal blood sugar anywhere from 1 to 6 points per carbohydrate consumed. The lower your weight, the more of an impact that it has on your blood sugar. For most people who are diabetic and obese (greater than 220lbs) for each carbohydrate you consume your blood sugar increases by 1 to 2 points after a meal. That’s 45 to 90 points if you eat the least number of carbohydrates as recommended by the ADA. Unfortunately eating like this will cause you to live a life in which your are dependent on oral diabetic medications and possibly insulin for the rest of your life. So what is the solution? Actually, It’s pretty simple. By restricting your carbohydrate intake you can make great strides in controlling not only your diabetes, but your weight as well.

 

Fueling Your Body (Carbohydrates, Fats, and Proteins)

The human body is an amazing biological adaptive machine that can run on a variety of fuels. All things being equal, your body will first burn carbohydrates for fuel, when there are not enough carbohydrates available to support your bodies needs, it will adapt or change it’s fuel source to burn stored fat, once those fat stores are depleted and there is not enough carbohydrates or fats to support life, then it adapts again to burn protein (muscle mass). Reducing your carbohydrate intake to less than 20 carbohydrates a day, does two things. First, it forces your body to adapt to burn the next widely available energy source which is fat. Second, reducing the number of carbohydrates decreases your overall blood sugar and insulin levels (extremely important for those of us who are diabetic).

Once your body becomes adapted to burning fat, then you will see a significant amount of body fat reduction as well as weight loss. What that means is that if we are not feeding our body carbohydrates for fuel, eventually you will run out of fat stores and your body will begin to burn lean muscle mass, and that is something we want to avoid at all costs. The solution is fueling your body with the necessary fats via a low carbohydrate high fat diet.

 

Low Carbohydrate High Fat (LCHF) Diets

While there are slightly different levels of LCHF diets, when I speak of LCHF I am referring to strict LCHF recommendations of keeping your overall carbohydrate count to less than 20 carbohydrates per day. This restriction in carbohydrates causes your body to eventually change it’s fuel source to burn stored fat as opposed to burning carbohydrates. By restricting our carbohydrate intake, we are placing our body in a state of nutritional ketosis, hence the term ‘Ketogenic Diet’.

Typically a person on a LCHF or Keto diet regimen should get their calories from the following: 5% from carbohydrates, 25% from proteins, and 70% from fats. Quite a bit different from the ADA recommended guidelines for diabetics. I guarantee you that if you are reading this type of information for the first time you are simply floored by the thought of getting 70% of your carbohydrates from fat. I know I was when I first started looking into the LCHF and Keto lifestyle. After all, both your doctor and the FDA have been telling us for years that fats are bad for you, right?

Some fats are not good for you that is correct, mainly trans-fats. However the fat intake while you are eating a LCHF and Ketogenic diets relies on the healthy saturated and monosaturated fats (for more information on fats see my article ‘The Skinny On Fats’). These healthy fats encourage your body to stay in a state of nutritional ketosis which makes your body a fat burning machine which promotes weight loss. In addition to making your body a fat burning machine, LCHF and Keto eating plans will do one thing for you that no other diet can, they will keep you from being hungry, something we will discuss in the next section of this article.

LCHF or Ketogenic Diet

Carbohydrates: 5% (includes non-starchy vegetables)

Protein: 25%

Fats: 70%

ADA Recommend Diet

Carbohydrates: 25%

Protein: 25%

Fats: 0%

Non-Starchy Vegetables: 50%

 

The Satiety Of Fats

The biggest obstacle that most of us have when we embark on a low fat diet regimen (because your doctor and the FDA says it is the healthiest choice for you) was the constant hunger pangs. It is not that we do not want to eat better or make significant changes to our health, it is simply that a low fat diet leaves you feeling hungry all the time. If you are reading this article, then you know I speak the truth. It is this constant state of hunger that causes many people to give up their health goals to lose weight and better manage their diabetes. So let’s look at why a high fat diet works were other’s fail.

Despite what many studies have shown in the past, our personal experience as well as many who follow the LCHF or Ketogenic diet have found that a high fat diet helps you to feel more satisfied than a high carbohydrate or high protein diet. Hundreds of thousands of people have changed to a LCHF or Keto lifestyle and the one thing they all mention (us as well) is how they do not feel hungry when eating this way. On the contrary, they all remark about how they always felt hungry when on a low-fat or fat restricted diet.

Here is just one of my personal experiences as an example. Before I started eating a LCHF diet, I would eat a homemade breakfast burrito once I got to work at 0630 in the morning that contained the following: 2 eggs, 1 slice American cheese, 1/8 pound of beef sausage with one tablespoon of green salsa verde (Calories – 471, protein 23.5 grams, fat 21.9 grams, carbs 39 grams). By 0930, I was hungry again, and looking for a snack, which often contained a lot of carbs (cheese crackers or saltines and peanut butter). Now, every morning I eat three scrambled eggs cooked in two tablespoons of butter with one tablespoon of heavy cream, and three pieces of bacon (Calories – 655, protein 31 grams, fat 57 grams, carbohydrates 1 gram). So now I am eating almost three times the fat, as before, and I am never hungry, even 6 hours later. And BTW, that is after walking on the treadmill for 35 minutes before I go to work.

My point is that I am eating three times the fat than I was before, and I am not hungry. Why? Despite what many studies say, good, healthy fats help to satiate you making you feel full, thereby curbing your hunger pangs. Simply put, we have never been hungry eating LCHF foods like we were on previous diets. The great thing is that our results are typical and experienced by almost everyone who engages in a LCHF or Keto lifestyle. The Bottom line, a high fat diet helps to keep you from feeling hungry.

 

Glucose Control

While weight loss is an added benefit, the primary reason we embarked on a LCHF eating regimen was to help control my blood glucose levels. I am a diabetic, and diabetes runs in my family, my grandmother was a type 1 diabetic (insulin dependent), like many Americans, I am a type 2 diabetic (insulin resistant). When I followed the ADA dietary recommendations for diabetics, I could never get my blood sugars under control. In fact, before I began this LCHF journey my last Hgb A1c was 7.3. The last straw for me was my my endocrinologist put me on 20 unit of lantus insulin. I had tried to avoid this for as long as possible, but two weeks into taking insulin shots, I knew there had to be a better way to control my blood sugars.

That’s when I began to research the LCHF as proposed by Dr. Andreas Eenfeldt after watching a video on YouTube on low carb fat lifestyles. From there I have researched many different ketogenic and paleo eating plans. Two weeks after embarking on a LCHF eating plan, my fasting blood sugars had decreased by 30 points, and my blood sugar was less than 100 before I went to bed. I was able to stop taking my lantus insulin at this time, although I am still on oral diabetic medication metformin (500mg twice a day) I am taking half of my previous dose. My fasting blood sugar this morning was 96, my Hgb A1c this morning, four months after being on a LCHF eating program my Hgb A1c was down to 5.5, almost two years later (June 2018) it is currently 5.2. According to the ADA, a normal non-diabetic person has a Hgb A1c of around 5. So I am close to normal. While I have discussed with my endocrinologist the options of stopping my metformin altogether, I have decided to stay on this reduced dose (500mg twice a day) at this time.

 

Better Blood Pressure Control (Reducing Anti-hypertensives)

Two months on the LCHF / Keto lifestyle I was able to decrease my blood pressure medication to half of the original prescribed amount. I was previously on a dose of lisinopril 40mg once a day, six moths after starting this ketogenic way of eating I am off all of my blood pressure medications. This morning my blood pressure was 122/72, with a heart rate of 64 with no blood pressure or diuretic medications. When I started eating LCHF my blood pressure was 126/84, with a heart rate of 84, and I was taking 40mg of lisinopril once a day. All I can say is that eating a LCHF / Keto lifestyle works.

 

Conclusion

So what does this all mean? If you are a diabetic and or are morbidly obese, then you need to seriously look at the LCHF and or Ketogenic lifestyle. I am not going to lie to you, it does take some mental discipline to change your entire way of eating an thinking about nutrition. There will be many people who will want to discourage your from meeting your goals and possibly chastise you for making these changes to your lifestyle, but you have to take control of both your diabetes and your weight before you suffer severe medical complications that you cannot recover from. Uncontrolled blood sugars in diabetic patients increase their likelihood of having a stroke by 2 – 4 times according the the National Stroke Association (NSA). While I can find no specific numbers, all of the medical journals indicate that diabetics are at a greater risk for myocardial infarction (heart attack) and complications after a myocardial infarction than non-diabetic patients.

I am not a doctor, and this article should not be misconstrued as medical advice. I am simply sharing with you the changes that both myself and my wife have made to make us not only healthier, but happier. It should be noted that before you embark on any change in dietary habits you should consult with your physician regarding your current state of health and any medications that you are currently taking. He or she may want to discourage your from this lifestyle, but ultimately you have to decide what is best for you and your body. As always, I hope that you have found this article informative and beneficial for you and your family, if so please take the time to share it with your friends so that they can benefit as well. Until next time, stay keto strong my friends.

References:

Carbohydrate Counting & Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, accessed January, 7, 2017.

Low Carb For Beginners – Diet Doctor, Accessed September 2016.

Diabetes & Stroke, National Stroke Association, Accessed January 1, 2017.

Nutrition, Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association, Diabetes Care, volume 31, Supplement 1, January 2008.

Scheiner, Gary, MS,CDE, Treating Hypoglycemia: One-Size Does NOT Fit All!: Thinking LikeA Pancrease, diaTribe, Making Sense Of Diabetes. 6/13/13.

Mawer, Rudy, Msc,CISSN, The Ketogenic Diet 101: A Detailed Beginner’s Guide. AuthorityNutrition, Accessed September 2016.

Phinney, Stephen,MD, Very Low-Car Diet Beats ADA Diet in Type 2 Diabetes According toNew Study, May 4, 2014

The Skinny On Fats, November 3, 1016

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