Ketogenic Diet: Day 3

First, here are the cold, hard facts:

Keytones?
Yes - tested positive for Light to Moderate this morning and tonight. :-)

Weight:
Is down by 3 lbs since I started this diet.

Blood sugars have been:
Breakfast: 114
Lunch: 139
Dinner: 137

Food:
- Breakfast was my favorite sweet and savory omelette again, along with coffee (with ghee and coconut oil -- this made me feel a little ill today).
- Lunch was (what I could find from a quick run over to Trader Joe's because I didn't have time to pack one today) Miso ginger soup, baby spinach and greens, bleu cheese, candied pecans, and cranberries with a raspberry vinaigrette dressing (which I only used half of to keep the carbs down).

- Dinner was Low Carb Ham and Black Bean Soup I made to use up leftovers.

Now for the thoughts and feelings about this....

What I am feeling in one word: calm.

Here's some elaboration on that. I am surprisingly not craving carbs like I used to. My mind is not crazy with this constant need for fuel. It has been a very calming feeling for me. Very zen-like. My mind and body seem to steadily have the nutrition/fuel they need throughout the day. I am not always thinking about my next snack or next meal because I feel full, satisfied, and nourished. Even on the 40 carbs per meal plan I was doing, I constantly felt the need to eat (carbs) for energy. It was weirdly kind of stressful.

On this plan, the main thing that stresses me out is what my doctor said to be careful about: limit animal products. Because apparently when you eat higher on the food chain you are exposed to more toxins that get stored in fat cells. So I have been trying very hard to make about 75% of my diet vegetables and only 25% meat/eggs/dairy.

Ketogenic Diet: Day 2

When I woke up this morning I used some Ketostix to test if I have ketones in my urine. Sure enough, I had Light to Moderate! Score!

Here was breakfast - 1.5 slices of bacon, coffee with ghee and coconut oil, and one of my favorites! "Sweet and Savory Omelette" recipe from the Buzzfeed Clean Eating Challenge:

SWEET AND SAVORY APPLE OMELET

Makes 1 serving

Ingredients

• 1 tablespoon olive oil
• 1 medium apple, thinly sliced
• 2 large eggs for women; 3 large eggs for men
• 1⁄4 teaspoon vanilla extract
• 1⁄8 teaspoon kosher salt

Procedure

Heat olive oil in a medium nonstick skillet over medium heat, then add the apple slices and cook until soft, about 4 minutes. Meanwhile, crack the eggs into a small mixing bowl with kosher salt and 1⁄2 teaspoon water, and beat with a fork until thoroughly combined. Spread the apples evenly on the bottom of the non­stick skillet, then add the eggs. Turn the heat to low and cook 3 minutes, until the bottom of the omelet is set and the top is only slightly liquidy. Carefully flip the omelet and cook 1 minute. Serve omelet with the other half of the apple, sliced. (I did not do this - I only had the half of an apple in my omelet to keep my carbs down)

347 calories, 23.6 g fat (5.2 g saturated fat), 22.8 g carbohydrate (5 g fiber, 16.4 g sugars), 13.6g protein, 421 mg sodium, 372 mg cholesterol

Yum!!

Then I had a lunch meeting for work, but fortunately it included all things I could eat: lots of veggies and some meat!

What you see above is: Caesar salad, squash vegetable medley, Greek salad (cucumbers, tomatoes, feta, chickpeas), and chicken. Also, iced tea with lemon. It was delicious!

My blood sugars have been pretty stable it seems, although I don't quite have my insulin doses worked out yet since I am trying to be conservative, so it was 142 at breakfast, 169 at lunch, and 174 at dinner.

Dinner was at a friend's house, and fortunately I was able to put together a ~17g carb dinner of spaghetti squash (1 cup), tomato sauce (1/2 cup), and lil smokies.

Ketogenic Diet: Day 1

I couldn't stop thinking about this new diet, so I decided to start it today.

Here's my approximate calorie/protein/carb/fat breakdown to maintain my current weight:

• 2,150 calories
• 109-183 grams of protein per day (15%)
• 30-50 grams of carbohydrate per day (5%)
• 191 grams of fat per day (80% or 1,720 calories)

BREAKFAST:

• 1/2 mason jar of homemade chicken/bone/veggie broth
• Spinach salad with a few strawberries, pecans, and raspberry vinaigrette
• Coffee with 2 tsp ghee (clarified butter), 1 tsp coconut oil

Blood sugar:

My blood sugar was 209. Normally I would take 2.5 units of Humalog to lower it (1 unit H for every 40 mg/dL over 83 mg/dL), but I was instructed not to do this initially so I didn't.

Insulin:

I took 3 units of Humalog to cover breakfast. I also lowered my Lantus to 8 units instead of 9 this morning. 

MID-MORNING SNACK:

Breakfast tided me over til 9:45am when I got hungry and ate a package of seaweed (good source of iodine and only 1 carb!). At 10:30 I ate a handful of (about 1/2 cup) peanuts. Even though these aren't Paleo, they are fairly low carb (10g) and satiating (14g of protein, 28g of fat).

Blood Sugar:

I tested my blood sugar and it was 204.

Insulin:

I took an additional 2 units of Humalog to bring my blood sugar down.

LUNCH:

• Spring greens
• 4 strawberries
• Handful of walnuts
• 1/2 cucumber
• 6 snap peas
• Raspberry vinaigrette dressing
• Ham (leftover from Easter...)

Blood Sugar:

At 12:40pm I tested my blood sugar and it was 193.

Insulin:

I took 2.5 H to bring it down and 2.5 H to cover lunch carbs.

So that about puts me at my 50g carb limit for the day! I will need to have absolutely no carbs at dinner to stay under...

I am feeling pretty good.

Trying a Ketogenic Diet

I have started reading the book "Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High Fat Diet" by Jimmy Moore and Eric Westman, MD.

...and it has been amazing.

My spouse told me yesterday, "Why do you need to read another book about nutrition/low carb diets? They all say the same thing. Surely, you can't learn anything from another book like this."

While there are many similarities between books like this, I actually do learn new things from each nutrition book I read. This book especially brought a piece to the puzzle I needed to learn so badly: my 50-120 grams of carbohydrate diet I've been trying to do for the past year is actually not ideal.

Here's why:

In the article, "Debate: how low can you go? The low down on the low carbohydrate debate in type 1 diabetes nutrition" the following question is answered:

"Can a nutritional regimen based on low carbohydrate intake provide safe and more effective glycaemic control for healthy type 1 diabetes glycaemic management?"

Fraziska Spritzler, a Registered Dietition and Certified Diabetes Educator, who contributed to the Keto Clarity book, gave the "YES" response. And Carolyn Robertson, another expert, gave the "NO" response.

To summarize, here is what I learned:

1. Human bodies can function on fat or carbohydrates as a primary fuel source. This has helped our species survive. Sometimes people need to use primarily fat for fuel (i.e. the Inuit tribe), and sometimes people need to use primarily carbs for fuel. There are pros and cons to each kind of fuel source. Surviving primarily on fat does not always give you an optimal amount of micronutrients or antioxidants (which you typically get from fruits and veggies). Surviving primarily on carbs can be hard on your heart, brain, and liver since it takes some work for your body to keep your blood glucose in balance. Also insulin (which is required for the digestion of carbs) creates inflammation in your body, and can lead to weight gain.
2. Ultra low carbohydrate diets (less than 50g of carbohydrates per day) can be very effective, but must be well planned out to get an optimal amount of nutrients each day. This is the diet that Dr. Richard K. Bernstein (a type 1 diabetic himself, and endocrinologist) recommends for achieving normal blood sugars. They can be hard to stick to due to social situations often involving carbohydrate-laden eating/drinking. Also, many of Dr. Bernstein's recipe suggestions in his book involve milk/cheese/yogurt/sour cream, which I cannot eat. There is a fantastic interview between Jimmy Moore (of Livin' La Vida Low Carb) and Dr. Richard K. Bernstein at this link: http://www.thelivinlowcarbshow.com/shownotes/288/dr-richard-bernstein-on-the-low-carb-diabetes-cure-ep-254/
3. Semi low carb diets (50-120g of carbs per day) make blood glucose erratic/unpredictable for type 1 diabetics. This is because the body derives fuel from both carbs AND/OR fat. And you don't necessarily know what your body (your liver) will decide to do that day. So this type of diet makes managing your blood sugars much more difficult. To quote Robertson: "A low carbohydrate plan is not a good strategy for people with type 1 diabetes largely because they lack effective biological feedback, or the capacity to recognize a change in the liver’s rate of glucose secretion."
4. Higher carbohydrate diets (120+ grams of carbs per day) can be harder on your heart, brain and liver due to greater fluctuation in blood glucose throughout the day and night. It is much easier to stick to because it is so flexible, cheap, and the type of diet that most Americans adhere to. It is the diet I've been doing for most of my life.

Since I have never actually given the ULTRA low carb diet (under 50g per day) I am going to try to do this during the month of May and see how it goes.

When I wrote to my diabetes team about this they did say, "I do have to say this is not a diet we recommend for people with Type 1 diabetes but for 1 month you should be ok as long as you monitor your ketones and blood sugar often."

So what about ketones/diabetic ketoacidosis?

Diabetic ketoacidosis, or DKA for short, is a very serious condition that I may need to be careful about when doing an ultra low carb diet.

Keith Runyan, MD, is a type 1 diabetic and says that those with DM1 do not need to worry about going into diabetic ketoacidosis (DKA) when following a ketogenic diet. Here is a quote (below), and a link to where he talks about this: http://drkrunyan.com/About.html

"In summary, DKA is a serious potentially life-threatening complication of either T1DM or T2DM caused by acute illness in a person with diabetes, undiagnosed diabetes, or noncompliance with insulin therapy in an insulin-dependent diabetic. Persons with diabetes should understand that utilizing a well-formulated ketogenic diet in the treatment of diabetes does NOT increase the risk of developing DKA. Nutritional ketosis is a normal consequence of the fat and keto-adapted individual who is restricting dietary carbohydrates to between 20 – 50 grams/day. The table below shows the various levels of ketone concentrations in the body to help differentiate between ketosis and ketoacidosis:

Body Condition	Quantity of Ketones Being Produced
After a meal	0.1 mmol/L
Overnight fast	0.3 mmol/L
Ketogenic Diet (Nutritional Ketosis)	0.5 - 6 mmol/L
> 20 days of fasting	5 - 10 mmol/L
Diabetic Ketoacidosis	15 - 30 mmol/L

So, my goal will be to make sure my ketones are between 0.5-6 mmol/L (Nutritional Ketosis) while on this diet.

From looking at a conversion calculator online, 0.5-6 mmol/L = 9-108 mg/dL.

How will I figure out what to eat?

Jimmy Moore has some good recipes at this link: http://www.livinlowcarbmealplan.com/recipes/

How will I need to modify my medication?

These are the recommendations my diabetes care team gave me:

1. Start by only taking the amount of insulin needed for the # of carbs I eat. Don't take any insulin for correcting blood glucose at the start (and see how this goes).
2. Reduce basal insulin by 1 unit at AM and PM (so 2 units total reduction) to start. 
3. If my blood sugar drops at night, I need to reduce my PM basal insulin by 1 unit every 2 days until no more low blood sugars at night.
4. If I have low blood sugar during the day, I need to reduce my AM basal insulin.
5. If I start to lose weight, I will need to reduce my basal insulin even further.
6. Monitor keytones daily.
7. If I eat large amounts of protein at a meal I will need additional insulin, as protein forms into glucose if there are no carbs available - it just takes longer.
8. Have glucagon handy in case I go low.

Here I go....!!!