Half-Marathon 3: Keto and Mental Attitude

A flat course along quiet lanes with part of the run done in a private estate It is an impressive country house owned by the National Trust, with equally impressive gardens. Before you read further, please go back to the menu and read the warning if you haven’t done so already.

I had only 3 weeks in which to train and one of these was a recovery week. Circumstances were such that I did only 3, 6-mile runs over consecutive days with an hour’s road biking somewhere in the middle. The last run was exhausting and was clearly over-training for my fitness level, so I decided to give the rest of the week a miss and ‘wing it’. Winging it has been my modus operandi of life and has worked so far. So, wing-it it was. The last half-marathon was the second half-marathon in 2 months that I had done. That  was already new ground for me, so this third one was completely uncharted territory. My main concern now was not a worry about cramping up or any injury like that. I was more concerned that I might have a heart attack or something. Us diabetics are prone to heart attacks and all things related to blood vessel disease. I had 20 years of damage in the ‘clockwork’ by doing things in the wrong way, so things could blow up at any time.  Steady running seems OK, except for a nagging ache on the left side on some occasions. I reckon that it might be spasm of the gullet or something as it comes and goes and is no worse really than a couple of years ago. It might be heart. But I don’t think it is. I have never had a heart attack but this did not feel like it might be. All this talk of uncharted territory and the like  is a mental thing, I guess. In reality this half-marathon is a completely manageable couple of hours running just a week slightly earlier than I wanted. And nothing more. I guess we are all limited by our own sense of what is possible. If we think 10K then that is probably us. I have some fridge magnets all with inspirational messages. They talk about our own sense of limitation. Try this from Sir Edmund Hillary ‘It’s not the mountain that we conquer but ourselves’. Or T.S.Eliot ‘ Only those who risk going too far can possibly find out how far one can go’. And of course, challenging oneself in the end is exciting. I have done my fair share of risky things in adventure sorts over the years. The dare, the apprehension, the decision to commit and the adrenaline rush are addictive.  In adventure sports, other brave people have ‘been there’ before and have learned from mistakes to improve safety. All I have to do  is to do what I am told by my instructor, and be taught how to assess the risk. Then do it. In this series of experiments with diabetes, I am constantly warned that what I am attempting to do is against all scientific consensus. In it’s own way, stepping outside the norm of medical practice is just as daunting as risk sports. If not more so. There are of course pioneers in the field of keto who have laid the groundwork. And I am keen to reinforce that work in my own way.  I feel sure that my  guideline diet of high carbohydrate and low fat has brought me to the brink of a personal health disaster. So, where with risk sports you make a positive decision to take the risk, in these experiments I am making a positive decision to reduce the risk. The short-term experiments like this series of runs are a challenge. But I am pretty sure I have a sound knowledge of the biochemistry, and it will work. Risky, possibly, but I am sure that the gains will be found in the longer term.  The experts will tell you that it is risky. There is little evidence for the benefits of keto in the longer term.  But the biggest risk I take is doing the same thing as I have for 20 years. I am just declining in health by doing that. Ironically there is plenty of good evidence to say that decline in health will happen!  Doing the same thing over and over and expecting different results  seems doomed to fail. Ask Einstein. He defined insanity like that.
So, from now on, I have determined to see beyond what I currently think of as normal. I will make more progress that way. My new normal will be what I previously thought as not possible.  Otherwise I might become a 10K man forever.
Now that I am doing longer training runs I can concentrate more on posture and how my body is tense in some areas. I can work on that slight ache in the chest. The hips can also get achy until I fix my mind on relaxing them, and my upper arms and shoulders seem to be quite fixed. I am learning to rotate my arms from side to side which seems to help. It seems to give forward momentum. Carrying my glucose monitor in the left hand might make it worse, I cannot tell. And the increased effort of breathing when tired, I am discovering is just tightness in the neck muscles. It is quite interesting actually discovering all of these things. Honestly, who would have thought running was such a palaver?  We just got up and did it when we were kids. I guess years of bad habits such as sitting in a car for half an hour on the way to work , then sitting at a desk for 8 hours, then back in the car takes its toll. So, now that I am less concerned about race timings, and more on experiments with diet and insulin, I can concentrate on that. And I can also practice shifting posture and see what feels good.
This was a run to get out of the way before my holiday. It was one of only 4 organised runs in the UK that day. The most local one was fully subscribed so it was a 2 hour trip to the venue the night before. This was the closest one. I could have simply just churn out the miles of my local half marathon route alone.  But I needed a medal!
It was to be a club-type run. Minimal facilities but functional. Plenty of serious club runners, polite but not humorous. Not a Fun-Run atmosphere and not much chatting en-route. But that was OK. It was just perfect for my needs. I was only here for the business of running. And it was flat. I needed flat.

Preparation.
After the last run which required quite a lot of carbohydrate during the run itself, I felt that a bit more preparation was needed. Waking up  with a glucose of 4.5mmol/l was encouraging but I had no dawn phenomenon again.  However, I knew that my glucose levels would go up when I started the run. I knew it from experience. But I was caught out last time and wary of a repeat of that. I decided to go for 2 eggs and streaky bacon 4 rashers one and a half hours pre-run. 500 calories including creamy coffee. That left a 600 calorie deficit. 9 calories per gram of fat this was equivalent to only 66g of fat ( 2.4oz) I had that available on board round my waist to give up. I still have a thin spare tyre. More a racing bike these days, but it is there. So I decided to donate some of that. Isn’t that what it is for after all? I injected the usual basal insulin, 10 units, on getting up, and decided not to inject any rapid acting insulin at that time. A glucose of 4.5 with no intake of carbs would be very risky indeed. I would see how things went closer to the run. My breakfast included an 20g protein load, some of which might convert to glucose, which I had to bear in mind.
40 minutes to go and glucose was 6.7 and rising. That was the protein, possibly some cortisol and adrenaline. What to do? I could have waited and saw what happened in the subsequent hour or so. If I did this I would take my insulin pen with me on the half-marathon. There was room in my running belt for insulin which I could take mid-run if needed to bring the glucose down to normal after the run. In the event, with 30 minutes to go I decided though to go for a 4 unit rapid acting . Why? I thought it was likely from experience that the glucose would go up more. And high glucose is not good. Because of the way my insulin worked for me I knew it would be a couple of 2 hours before it kicked in. The time delay before action is reducing and I hope this is due to insulin resistance decreasing. So, if I injected 4 units, that amount of insulin would lower my glucose by 8.8 mmol/lit ( roughly 2.2 mmol/l per unit in someone of my size according to Richard Bernstein in his book Diabetes Solution ). By 2 hours that 4 units of rapid-acting insulin would have kicked in. Through experience I know that the rate of action of rapid-acting insulin (not including a potential 30% variability in absorption!), is to bring the glucose down by  6 mmol/l/hour for me personally. So, if my glucose was 7mmols/l 30 mins before the start, it would have likely stayed there until half and hour to go and then would fall at 6mmol/l/h. So, by the time it kicked in, that final 30 mins would reduce the glucose by 3 mmol/l and it would then be 4mmol/lit at the end. Safe enough and covered with continuous monitoring. So I gave it a go. When I finished, I would be able to sort any low out at leisure with glucose tablets. The great thing though about continuous monitoring is the luxury of sorting out on the go so this was less of a big deal than if I were to use a standard glucometer. I am lucky to have one.

The Run.
A nice gentle start in cloudy but warmish conditions, perfect for running perhaps slightly too warm. Working on the fluid formula of 400-800 mls per hour from research done by Tim Noakes, I reckoned 500mls of water would do it per hour. So I took 300ml  pre-run  and topped up twice on the way round. At half way, feeling good. I was on for 1 hour 50, way too quick. Ridiculous. And it was to prove to be the case. I finished outside 2 hours. Slightly disappointing but realistic. And my best time in this series. I got the usual light-headedness and ache in the chest, but put this down to tension. I could feel that I was tensing up. My pulse was regular so I assumed the heart was OK. I did some in-run relaxation. It seemed to help. I had to walk a couple of times to settle a sense of exhaustion, but did manage to speed up at the end.  At the one hour mark, so about half way, my blood glucose peaked at a way too high 13mmol/l.  Then it started to fall at a predictable rapid insulin rate of 6mmol/l per hour. So, I reckoned that, with one hour left to run I would finish at a glucose of 7 or so. That was the theory and that is what happened. I took slightly longer to run the distance and the final glucose was just under this. But it all worked out. These small insulin doses are great. You just feel so safe. At less than half way into a run I could totally relax and ignore my diabetes! Think about something else. What a luxury that is. If you have Type 1 you will connect with this. It can be difficult to remember forgetting diabetes.

What did I learn from this?
I was pleased to have completed this half-marathon in the way I did. Carb free and with reasonable control. I now know that the practice of injecting insulin and not covering with carbs can be done. I am loving the keto! There is still much to learn, but I reckon that less protein and more fat will be the way to go on the next run. I have got into splitting up protein in equal amounts throughout the day. It smooths out control on a normal day, and it has become a habit. But I think I can get better control when running if I cut out the pre-race protein. Just go with the fat. I think it will be less complicated and make preparation easier. I will do that in my next run in 5 weeks time. But first a holiday. I am looking forward to my Italian holiday and 2 weeks running in the lovely scenery of Tuscany. It will be very hot and that will be a challenge in itself. I am beginning to find out that I can safely cut the carbs, just as I had predicted at the start of all this. I reckon that with nine Half-Marathons to go, that I can perfect my glucose control and have time to experiment more radically on a few of the runs. I will try omitting the pre-run meal completely and just keep burning the fat. Perhaps a longer fasting period??  And, if can bear to, I might also try a ‘heritage’, DAFNE-style run. Fully carbed-up and injecting to suit. It makes me shudder just to think of it.

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