We need to shake things up a bit if these runs are to have any meaning. I have done 3 runs on high fat and protein, each meal totalling around 500 calories, and relying on body fat to provide the deficit. I am reasonably happy but need to refine because of the glucose spikes in the run. I am sure that I will be able to get the balance right by adjusting timings of insulin and the blend of fat and protein in the meal. But more of the same and fiddling about at the edges is for another time. I need to press on with testing the ketogenic diet and have some ideas based on the past runs. Today’s run has no challenges as far as the route is concerned. It is relatively flat on quiet tarmac roads. No hills, no rough trails underfoot. I can concentrate on experimenting with diabetes. As usual, please read the warning section.
My training has been more dedicated and I feel a bit fitter generally but not yet feeling fully-fit. I can put in a bit of a sprint at the end. But stamina for hills is not there. I still think a lot of it is mental, but the engine is a bit lacking I think. What to do to increase stamina without becoming completely obsessed about it? I have been reading about high intensity training (HIT), where you train in intensive bursts rather than prolonged aerobic exercise. A lot of personal trainers I have met do that. It seems to be the ‘latest thing’, the must-have answer to fitness for the next few years. I have bought the programme to give it a go, but it is hard to find the motivation to do it. To be honest I find it a bit boring. But the time has come to discipline myself to do this if I am going to improve my times. I will start HIT after this run.
For today the pre-run diet will explore energy just from fat. I think Richard Bernstein’s approach to take regular protein loads throughout the day to help improve control is sound and I will go back to that. But I need to sort out that unacceptable morning glucose peak. So, out with the protein today.
But how much fat will I go with? A half–marathon is just 1200 calories of energy in addition to my usual daily requirements . I am keto-adapted so am fat-burning anyway. I could just do the run and use some on-board reserves. I will, but another time. But I want to run on a fat-burn today. People obsess about saturated fat and cholesterol. They even talk about fat and cholesterol as if these are the same entities . Of course they are totally different compounds, their only common characteristics are their solubility in a fatty environment. They hang around together because that is the most efficient way for the body to move them around. In fact they also associate with vitamins A,D, E and K , because these are fatty substances as well. And of course the media-cuddly omega fats snuggle up with cholesterol on their ride through the blood stream. But none of these fatty substances are unhealthy components of the diet. Despite just about every recent statement from guideline bodies saying that saturated fat and cholesterol in the diet do not affect heart disease, this is the official advice we are still given. It of course makes little sense if you know the biology. Mainstream Medical Science really does need to catch up!
Our liver makes most of our cholesterol and this is partly regulated by insulin. A quarter of our total body cholesterol is found in the brain and acts to facilitate nerve function. More cholesterol is produced at night when we are asleep. Is that a coincidence or is it serving a vital maintenance function?
We are fat-burning naturally a lot of the time. Resting muscle thrives on it and so does intestine. And our body produces glucose in enough quantity for crucial tissue needs. We know that we do not need to eat glucose to get that energy as we make it from other metabolites and also from proteins, in the kidney, liver and intestine. And of course, insulin ensures a normal glucose level in the blood. Any excess glucose is parked away so that blood glucose levels can remain stable. It is parked away as fat. Excess carbohydrate in a meal will lead to the production of fat under the control of insulin. This is saturated fat as we know. Saturated fat is a very efficient fuel and the end-product of fat metabolism is ketones, which are themselves fuel, perhaps better fuel than fat. It seems then, that the body just needs us to eat the correct nutrients and then it can look after it’s own needs. It can convert everything to everything else if you see what I mean. But an incorrect blend of nutrients might direct that metabolism into an unhealthy state. Feeding myself carbohydrate when my metabolism cannot process it has led to all sorts of problems. I am pleased to have stopped it when I realised. It seems that fat and protein suit my defective carbohydrate metabolism.
So, on this run what type of fat will I take? Well, clearly something from a healthy source, so that will be fat from pasture grazed animals, or oil processed by pressing with no industrial processes such as dissolving in hexane, and washing out ‘impurities’, (that means nutrients to me and you) in caustic soda(*). That is important. Industrially processed fats have little nutrient value and contain trans fats. And will I eat saturated fat or unsaturated fat? Most will know that few foods are pure saturated fat or unsaturated fat. Olive oil has 10% saturated fat, but is mostly mono-unsaturated, pork has 25% mono-unsaturated fat but twice as much saturated fat. I am not too worried about omega fats today. Sure they have anti-inflammatory effects, but I just want to simplify it to fats that provide energy. Oily fish is a good source of omega fat but it has protein as well and I want to avoid the protein today. I have decided that I will go with coconut oil and unsalted butter. I have found a recipe you see for Bulletproof Coffee. Well a derivative of that. Double strength coffee, 30g coconut oil and 20g of butter whisked up. Coconut oil is 100% sat fat. Coconut oil has 850 cals/100g. And butter 734cals/100g, 82% fat 52% of which is saturated, 0.6% carb and protein. That makes a total of 430Cals all as fat. It seems to be the ideal fuel package today. I will reserve the right to add some fibre if I feel sick! I will allow my body to provide the other energy, which is only 88grams (3.1 oz) of body fat. I can give that up okay.
It was to be an early start and a 40 minute drive to the venue. I woke up tired after a short sleep of only 6 hours. I was out until late but took care with alcohol, consuming only one glass of red wine. I woke with a glucose approaching 7mmol/l and allowed just one unit of insulin rapid-acting to nudge the glucose down a couple of mmol/l. Remember that one unit of insulin in someone of my weight 75kg reduces glucose by 2.2mmol/l. I used the same amount of long acting insulin, 10 units. That is my reliable dose. And took a glass of 300ml plain water.
We arrived 1 hour pre-run so brewed up the coffee in the car park and blended it with the pre-weighed 30g coconut oil and 20 g butter. A vigorous shake and it was done. A creamy,greasy, black mix. I think I had done a reasonable job. Not too much of the separation that this drink is supposed to be prone to. It tasted quite reasonable. Oily on the palate but the coffee and coconut came through strongly with notes of butter following. And another 250 ml fluid as coffee. So I have had half of my allowance already. I work on 4-500ml/hr in normal conditions in this country.
My blood glucose level was 6.3mmol/l in the 20 minutes before the run. At the half way point it was approaching 7mmol. This was looking really good and bang on the glucose prediction. Exciting, and to boot I had yet another good time at 7 miles. But predictably this tailed off mile after mile towards the end. There were plenty of hills which I had not expected and a nasty one at 11 miles. But the thing was, I was not needing to walk on the hills. That was progress indeed. Ok, I was being overtaken by walkers, but I was doing what would be recognised as running, however slow.
The glucometer sensor fell off at the 8 mile mark with a glucose of 7.3mmol/l. But I felt good. I could stop worrying about a hypo. One unit of rapid acting was not going to do much. The main concern now was, had I injected enough insulin? Because if I was insulin-deficient then my glucose levels would start to rise. It has happened to me before when exercising. One of the functions of insulin is to remove glucose from the blood into the cells of the tissues where it can be used as energy. Even if you are burning fat though, you are still making glucose and using it for energy. The body makes it by converting other substances, notably protein, but also by reversing biochemical pathways if necessary. Red blood cells for example can only use glucose as fuel and they work hard in exercise. So, there is a need to make glucose. If I had not injected enough insulin, there would be no way to reduce the levels of glucose made by the body. The glucose would not be able to get into the cells, because that process is largely insulin driven. If the cells could not access glucose because there was no insulin to enable that to happen, the glucose in the blood would rise, and the cells would then take their energy from fat and ketones. Ketones are just the natural end-product of fat breakdown but they can then be used as well to provide energy. If you have insulin in sufficient amount, then fat burning and producing ketones is not a problem at all as the glucose levels will be controlled. Insulin pretty well orchestrates metabolism and fat burning will also be controlled in a precise way. But if there is no insulin then fat burning also gets out of control and therefore so do the levels of ketones. Very high, unregulated levels of ketones make the blood more acidic. High levels of ketones, high levels of glucose, and increased acidity in the blood equal ketoacidosis. And all that glucose in the blood makes you pee so much that you become severely dehydrated. So if I had injected insufficient insulin, I could be at risk of the dreaded ketoacidosis. And worse, with no insulin in the body, potassium levels build up in the blood. That can lead to heart rhythm problems. High glucose, high potassium, acidic blood and dehydration are a potentially fatal combination. So it was a worry. That is why if you have gastroenteritis it is still important to take insulin. It is vital if you are going to avoid ketoacidosis. But with enough insulin, everything is fine. Regulated fat burning, normal, healthy levels of ketones and business as usual with normal glucose levels. The ketogenic diet is safe in type 1 therefore if one injects sufficient insulin. Ketosis in a ketogenic diet is not related to keto acidosis in any way apart from the letters k-e-t-o and o-s-i-s.
And that is what it turned out to be. A glucose of 3.9mmol/l just after the run. It was vindication of the theory that you can inject insulin and not need carbs if you plan it right.
What Have I learned?
I have managed to demonstrate that basal insulin is sufficient to meet the metabolic needs of the body during a 2 hour period of moderate intensity exercise when no carbohydrate is eaten. And beyond as well. Because after the run it was completely stable between 4mmol/l and 7mmol/l into the night.
So, there you have it. If you don’t eat carbs you don’t need extra insulin. What I had thought all along. I feel good about this but not bullish. To be honest, I knew what should happen and it did. But I had a nagging doubt for an hour that I could be getting into early ketoacidosis. Very early admittedly and easily managed, but not safe enough to make it routine practice. So I am going to do this again. Probably twice more. It is so important to me that I cannot rely on one run to make that judgement. But that was exciting. The hard work of research is paying off. But I want to keep exploring the boundaries even further. This run was all about whether fat alone could provide the energy. It did. But logically there is no reason why some of that fat has to come from the diet an hour or so before exercise. My body can provide it possibly, I am fat burning after all. I have relied on fat from the body for the second half of the last 2 runs and that has been okay with respect to glucose. But my performance has tailed off. Is that cause and effect? Well, we shall see another time. I think I might do a run on body fat alone with just black coffee for breakfast. That seems like a fair challenge.