Having HbA1c in the non- diabetic range is the norm. It is a gift so late-on in my life with diabetes that I am eternally grateful for the moment that I discovered keto.
I have become pretty slick at using a keto diet over the months. If I do get high glucose levels it is usually my own fault. Occasionally genuine error reading the labels, but mostly, laziness and indulgence.
Imagine my surprise, then,when I became aware of the Paleolithic Ketogenic Diet. (PKD). I had sent some of my work on keto for a review by Csaba Toth, a Doctor in Budapest who understands low carb diets. He works with a biologist, Zsofia Clemens and they run a clinic called Paleomedicina. Csaba was an intensive care doctor when he discovered that autoimmune diseases such as T1 might be triggered by food in the gut breaking through into the blood stream. The idea is that certain foods that we were not genetically set up to eat, can cause irritation in the gut. In turn this opens up the cell walls lining the gut to allow food particles to get into the blood stream. This then sets up an immune reaction by the body. The antibodies produced sometimes then mistake parts of the body as ‘foreign’ for example the pancreatic cells that make insulin and attack and destroy them to create a chronic disease such as type 1 diabetes.
The assumption is that humans are not genetically programmed to cope with many foods we now see as parts of a normal, health diet. We were genetically made to eat meat and fat, with modest amounts of vegetables. Csaba and Zsofia have treated people in the early stages of type 1 diabetes and have written up some scientific papers to share their results. Some would take this as evidence for their methods, others would find alternative explanations for their results. Have a look and see what you think www.paleomedicina.com https://www.researchgate.net/profile/Csaba_Toth9
In any event, it was an intriguing idea. It would be easy to dismiss as a fringe idea. But if Richard Bernstein had gone with orthodoxy, where would I be now? (And him?!). There is not a lot of point becoming dogmatic about LCHF for it’s own sake. My interest was piqued. I needed to take a look.
So, off I went to Hungary. A 3 hour drive west is the small town of Zalaszentgrot where Paleomedicina run a residential week to teach PKD. They provide all of the food and do personal consultations alongside communal teaching.
To be fair, I wasn’t expecting much personally. I am so far down the line of autoimmune disease that my insides must be pretty furred up. Just running diabetic range blood sugars all those years must have stuck everything together inside. The years and years of high glucose levels must have bonded sugar to just about every tissue. If there was added inflammation from the diet also, along the lines of leaky gut, well, just multiply all of that by a factor of n. If I were a kettle I would have been replaced years ago as furred up beyond use. But I am still having fun and feel vital every day. Living in the now is everything and I have a second chance. So, I am going to take a look and see what happens.
It was not to be the best start in trying to be scientific about it, unfortunately. I was going to get some pre diet bloods done at the clinic. But I happened to turn up on a National holiday, so this was not possible. Getting them arranged privately in the UK via the local hospital lab when I got home was a lot hassle and delay. I gave up in the end. And also I had by then been on the PKD diet for too long for the tests to have any real meaning. It was shame as it would have been good to experiment. All manner of tests less familiar to the routine NHS monitoring of diabetes.were planned. GAD antibodies ( newly diagnosed can get them, not me, too far gone), ditto C-peptide. Vitamin D? Ditto. Etc etc. Magnesium is another intriguing test in diabetes. I wasn’t aware that this metal was vital to proper functioning of cell energy pathways. There also a direct test of leaky gut where you drink a clear liquid containing small indigestible beads of a plastic substance called polyethylene glycol. These beads are sized so that they will not pass through a healthy gut. But if the gut is inflamed and leaking then they will get into the body. They can then be measured in the urine a few hours later.
For someone just diagnosed. I’m sure these would be fascinating to do.
What was the diet like? Well, it consists of fat from animals, 4 legs preferred, fish, less acceptable in small amounts. Eggs okay, raw veg, such as saurkraut, turnip, cabbage, swede, mainly. Ideally the animals would be pasture fed. Offal was encouraged. The ratio of fat to protein was 2 grams of fat to 1 gram of protein. So, that was a hefty protein hike for me. Water only.
In reality it was a more than acceptable diet. The meals prepared in the hotel were superb. Surprisingly the fat was manageable without veg to help to eat it. I have now eaten my first brain,and tasty it was too. Bone broth was also excellent and prepared with a few root vegetables.
Two meals a day were recommended with no snacks if possible. This was easy for me as I do that anyway. And of course I had already cut out carbs. Out went dairy, nuts, nightshade foods ( peppers, aubergines, tomatoes potatoes). Out too went spices other than salt and pepper, alcohol, and too much leafy veg ( because of insecticides, herbicides etc ). Coffee and tea were out too.
But I felt well on it. I found more difficult to adapt to the diet when I got home and my usual routine. Boredom somehow makes me want to switch on the kettle. Getting home late from work makes me go straight for the fridge, having fasted all day. A bad habit. But that aside, I found that getting enough fat and moderating the protein was a big ask. I frequently went into double figures because of the protein which I was overestimating. So, for me personally it a mixed result. I started to crave carbs for some reason for the first time in 2 years but was able to resist. I did 6 weeks as intended. I weakened on the coffee, and the occasional alcohol. But overall I managed it. Because of the problems with blood tests this time I will never really know how effective it was. But it was a good experience and one I might revisit in the future. Instinctively I felt better off dairy, and continue that. Vegetables are back but those from the nightshade family are still out. So I have actually made some significant dietary adjustments as a result of learning about PKD. My glucose levels are now back on track.
I now think about glucose control in the context of inflammation in addition to carb restriction. I never thought about it like that before. No inflammation and normal glucose, excellent. Inflammation and high glucose, not good and what current dietary guidelines in diabetes are not addressing. And everything inbetween. It is a fascinating idea.
I did my month 11 half-marathon 2 weeks later. This one involved a few laps of a wood with some uphill sections. My dietary preparation was fasted as usual. I just took long acting but it was slightly different. You see I had changed to a so called ‘designer insulin’. It has an ultra long action over 30 hours. I think it is designed with Type 2 in mind. Fire-and-forget with a steady state insulin level that would be good in insulin resistance. I am not a huge fan of insulin in T2 as in the main I don’t believe the model. Most people don’t run out of insulin because the pancreas dies of exhaustion through overwork. I was at a professional meeting the other day and heard this very thing. How then I asked, does the pancreas miraculously recover just days after bypass surgery in obese people with diabetes to enable them to stop using insulin? Of course it doesn’t and the insulin producing cells never died off in the first place. Insulin resistance is a simple response to poisoning with carbs. It is biochemistry and physiology pure and simple. You don’t need to invent theories based on a disease model to explain this. Just stop the poison. Which, in diabetes, is carbohydrate. Then you don’t need the insulin in the vast majority of cases. Good for the person, but a potential disaster for the manufacturer.
This designer insulin seems okay at this early stage. I use slightly less overall than my previous long acting insulin and if I am strict with the meter can go up to 30 hours between doses. I know that I must try to inject the correct dose of insulin for me and it is not good if I use less. I risk high glucose and ketoacidosis if I go down that route. I will always need insulin. But I am anxious not to have too much on board. I am keen to get just the right amount. There are some chilling graphs of insulin levels in relatively well controlled T1’s where the levels are well above normal. As I have mentioned before, that is creating conditions for resistance. So, any reduction to optimal is good. I am still striving to control T1 without the insulin resistance of T2. If I can do that I will be very happy indeed.
The first 6 miles were a breeze and I felt good, the last 6 were ones to forget. It was a total wipeout on the hills and feeling tired on the flat. I just ran out of stamina. My finishing time was 8 mins above average. Glucose levels were good throughout maxing at 9, troughing to 4. I think that a change to PKD was not the problem. But I do think I am just a bad runner because I am not preparing like a runner. I am still preparing like a diabetic. Diabetes has dominated my exercise for so long that it has taken 2 years of keto for me to start thinking about non-diabetic preparation! I have now proven what I set out to do with respect to insulin and carbs. I have shown conclusively that if the insulin dose is correct that carbs are not needed. In fact, that is so obvious to me that it always surprises me that health care professionals still send me letters at work which clearly show that they take the opposite view. So, it is now time for me to move on.
I have been running with little thought for muscle building, and more concern with fat burning. This particular run was a routine run based on what I have found to work. Basically, fast , inject, and run. But, looking back, my past 3 runs have not been good. Have my fasts made me slow? ( sorry). I think I am just wearing myself out . Just pounding the trails hour after hour with no thought for doing any other sort of training to vary it a bit. I still cycle when I can but that is the same sort of thing. Aerobic, cardio type training.
But I mentioned several months ago that I needed to get some more thorough preparation with a varied exercise regimen beyond just running. I have decided to get a trainer and sort myself out. I will get no fitter just by running alone. I hate the gym but it is time to act. I need to know what exercises will suit me best. The internet is awash with exercise plans, but I have no clue which might help me. I need to know more about increasing my overall fitness in a progressive way and not just trying to heave weights at random. That is the way to a rupture, and I don’t want that, thank you very much. I have tinkered with internet fitness programmes with no success.. So, about 6 months after I thought about it, I have decided to act. With me, being slow to act is the way it is. I can only change when I am ready. Slow learner? Maybe. But I think it is more a case of doing the work to get to this point. I cannot now improve by just doing more of the same. Change will not happen unless I put some effort in to make that change happen. And it is not just physical. I might also now try to optimise my diet by increasing my pre-run protein. I often need a few grams of glucose supplement towards the end of a run, so the delayed glucose rise with a protein meal might be the perfect solution. I will never be taking carbs again unless I need to rescue a hypo, but I will be looking at diet from an athlete’s perspective. Time also to get Stephen Phinney’s book on althletic performance on keto. This journey just gets more intriguing!