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....!!!