Type 1 Keto

Summer Running. 730 miles in 5 weeks.

In the summer of 2018, when I was 59 years old, I took the step of committing to a long run.

I have had Diabetes Type 1 for 23 years. For the first 20 years, I was controlling it by conventional management, which is high carbohydrate meals, with insulin calculated to cover those carbs. I am a GP, and, at the time, I believed that the guideline recommendations for diet were the best option. But after 20 years of struggling with balancing the insulin with carbs, I took the risk of breaking from convention and going on a low carb, high-fat diet.  And over the past three years, I have personally had great success. I can manage my Diabetes well. For the first time ever, I have had near-normal blood glucose levels, not just for the odd day or week, but 24/7/365. And with less planning.  It has been transformational in my life with increased energy, improved clarity of thought, and reduction of aches and pains.  I use basal: bolus injections only and have never used a pump. But I do have the luxury of a continuous glucose meter (CGM). 

Last year I set about exploring low carb in physical activity by running 13 half marathons in a year (one every four weeks) on a low carb diet. I found that I could quite happily not eat before runs. I would be perfectly well-controlled through a run as I was confident that, because I was using fat for energy through dietary choice, I would not disturb my insulin-carbohydrate metabolism. That proved to be the case. 

So, I became more ambitious and set a challenge to run long distances daily to see what would happen. It was more of a personal challenge to celebrate my new lease of life that low carb had offered me. I had no idea what 20 miles of daily running might do to me physically or metabolically but wanted to give it a try. In the past, when I was on high carbs, I remember having to pull out of some short distance running events because of mainly calf injuries. Whether this was cause and effect, I will never know, but it is rare nowadays. 

Dreaming of Wild Camping 

In addition to the personal challenge, I thought that I might take a look at how my low-carb lifestyle would react to long periods of physical activity. So, I decided to monitor a few things: calories, carbs, protein, fat ketones, and glucose. Since I already had a continuous glucose meter, I could track my glucose every 5 minutes. I am lucky to be able to self-fund, but I feel all people with Type 1 should be made aware of the option of a low-carb lifestyle and be provided with a CGM. It is a safer method than finger prick testing, the learning curve is rapid, and there is the potential to improve long-term control almost to normal levels with the reduction in complications that accompanies this. I think that is very short-sighted of decision-makers to base decisions purely on device costs based on current methods of management. The evidence for the effectiveness of low carb in Type 1 is out there; it is just not being used to inform decisions.

Tasty Low Carb Food in Moffat 

I thought that I would measure ketone levels daily and at the end of a run. Ketones are nothing more than very versatile energy molecules that are the end-result of burning fat. They are used by nearly all tissues for energy, and the brain is particularly partial to the odd ketone. If they build up to high levels, they can be converted to acetone, another ketone that is very easy for the body to excrete. So, they are self-regulating if there is sufficient insulin in the body. This can be a concern in diabetes management if you badly miscalculate the dose of insulin to manage carbs. Or if you have other conditions such as infection that often need to be actively managed in Type 1.  I calculated that my ketone levels would be highest after finishing running for the day.  I would then be at peak potential dehydration, and end-dosing of insulin (so most vulnerable to diabetic ketoacidosis). So, taking a finger prick test at that time would give an idea of ketoacidosis risk.   For some peculiar reason, some diabetes specialists are concerned about low carb as a risk factor for ketoacidosis. This is not the case. It doesn’t make any sense when you look at metabolism.  Indeed, high carbohydrate diets are more likely to increase the risk of diabetic ketoacidosis. That does make sense. And in fact, reduced risk on low-carb has been shown to be the case in a recent study by David Ludwig in Boston, USA, who reviewed the data from the low-carb Type 1 predominantly children’s community. In that study, people on low -carb diets had a lower rate of diabetic ketoacidosis.  

I kept a food diary using www. myfitnesspal.com, which would be able to monitor my macronutrient intake, fat, protein, and carbs. 

I planned to start at John O’ Groats, one of the most northerly points in Scotland, and head towards Lands’ End, the longest recognised long-distance path in the UK, around 900 miles.

John O’ Groats 

I decided that I would run this alone and unsupported as that would give me the more significant challenge of both day to day management of Diabetes and the potential for getting into trouble. But even though that sounds irresponsible, I knew from experience that this risk was minimal indeed on low carb. I would probably not even have attempted it in this way if I were on higher carb conventional management. In that case, I would feel less confident about balancing carbs and insulin to keep me safe. In my experience, hypos on a traditional diet can arrive unannounced and need rapid attention to manage.  In the north of Scotland, I was going to run through unpopulated areas and need to camp in the wild, source my fluids from local natural sources and carry enough food supplies to reach the next shop. I would be 40 hours in the wild at one point but, of course, had the option of seeking emergency help from local traffic if needed.

Lifesaver Community Shop Tomatin, near Inverness 

I had no idea how this would go. Whether even if I would survive a week. I would take it day by day. If I made Lands’ End, it would be a bonus. My first target was simply to get to Bettyshill. It was a village on the north coast of Scotland but 50 miles west of John O, Groats. Then I would be able to turn left and head south. That would be a psychological boost.  On other occasions, my target was a few days ahead. On others, just getting through the day was the goal, and on a couple of days, just getting to the next step was a huge achievement. It was a roller coaster journey, certainly in the first two weeks.  I kept a diary of the trip and might make this available elsewhere. This article is more for the interest of Type 1 and their friends, family. It might also be of interest to Health Care Practitioners who need insights into the low-carb Type 1 diabetes mindset. 

Data from the Run 

Distance 730 miles. John O’Groats to Bristol 

(Knee pain curtailed the journey. It was quadriceps bursitis, and at one point, I was unable even to walk. I rested for a week, but as there was not sufficient progress with healing, I decided to stop. Leaving too large a gap between stages renders the total distance meaningless. I had already acquired the data I needed). 

Time 35 days. 

Hypos. I estimated these from the graphs and my diary at 1.4 per week (average in typical diabetes population 2.9 per week). Disabling hypos nil. Hypos requiring cessation of running were just 2. Hypos were not a problem. 

Miles per day, 20 average. (12-32) 

Average calories per day 2748 (The daily calorie intake increased gradually through the weeks as I adopted eat when hungry strategy. It was getting on for 4000 in the last two weeks)

HbA1c reading after the run: 39mmol/mol

The average carbs were 56g per day 

The average percentage of carbs in the diet was 9%.  

HbA1c at the end of the run 39 mmol/mol. (this is an indicator of longer-term control (3 months) and an indicator of the likelihood of getting complications. The standard, non-diabetic upper limit is less than 42, the diabetes threshold is 48) 

The average percentage of fat in the diet was 69% 

The average percentage of protein in the diet was  22% 

Ketones were typically between 1 and 2mmol/lit.  The level of ketones did not correlate with glucose. Some of my higher ketones (a level above 3), were associated with normal glucose levels. 

Daily ketones tended to settle into the low end of the ketosis range. Sufficient ketones for the activity? In this case more does not equal better. Why would the body produce more ketones than necessary if the insulin is normal? Answer it doesn’t need to. More glucose does not equal better control; neither do more ketones equal better ketosis. 

Weight loss 8lb at week 4, 9lb at week 5. So, I had reached my natural weight for this activity by week 4.  

If I were to rely on carbs to provide my energy, I would not have got halfway to Inverness, not to mention Bristol. Proof that you don’t need to carb up. 

Fluid balance 

I have always gone with ultra-marathon runner and low-carb campaigner Tim Noakes’ rough guide of 400-800mls per hour running when calculating fluids.  Having experience of running 1-2-hour duration runs, I am comfortable with drinking when thirsty. So, I never planned a rehydration strategy. I elected to drink only water (plus coffee twice a day and zero sugar drink around once a day for a taste change). 

Lovely water from the River Tay at Dunkeld 

Roughly my intake was between 2 and 5 litres a day for the run depending on the heat. Carrying excess fluid in a rucksack adds weight, so I used a filter water bottle mostly in streams occasionally puddles if needed.

extreme situation 

Top survival tip: Cemeteries are a reliable watering hole 

Calorie Balance 

I was concerned about maintaining the correct calorie intake. Of course, I had body fat stores; 20,000 calories are widely quoted. It sounds a lot compared to the relatively puny 1,800 calories of glycogen, which carb-loaded athletes rely on for energy. When that runs out, they hit’ the wall’ Being a fat-burner, I never get this problem. There is plenty of evidence now that moderate-intensity prolonged physical activity is very good at drawing on fat as the preferred energy source. But everyone is different and needs to find their personal optimum.   I calculated that if I did not eat sufficient calories, my fat stores would be used up in a couple of weeks, and I might struggle. I had no idea about this. So, I tried to force the calories in the first two weeks. The result was poor glucose control with high levels resistant to bolus insulin. Nausea was a constant companion, and I vomited once after a large intake of tinned oily fish.

Hearty, Low-carb camping breakfast. With added butter. Nausea inducing at the start. 

Then it finally dawned on me.  Trying to maintain my existing weight was not necessarily the best thing to do. That weight was set by long hours sitting at a desk, with bouts of relatively short duration exercise of up to an hour a few times a week.  Things would change when I reduced my inactivity and increased my activity. So, my new ‘normal’ weight ought to stabilise to suit my lifestyle. That was the plan. 

In the same way that I was drinking to the body’s demands, I would eat similarly. Listen to the body. In the event, it worked for me. After that, I got better glucose control, my nausea settled, and I noticed that as the weeks ticked by that my calorie intake gradually increased naturally. At last, I had started to listen to what the body needed. 

I never felt weak or exhausted beyond what I would typically expect from such an activity. In fact, it never occurred to me to take a weight check until four weeks had elapsed. It showed that I had lost 8 lbs. One week later, at five weeks, another pound had come off. But the thing was that I felt good, and my friends who I met at stages throughout the run commented on how well I looked compared to their expectations of how I might look. 

So, what to make of all of this science of rehydration drinks, isotonic fluids, energy bars bla, bla, bla?  I think that while it might have an application at the pinnacle of sporting achievement, it would be entirely unnecessary for me, along with most people. I stick with water and fresh, healthy food. If I need glucose, it will be in a tablet form, or a jelly baby.  You cannot take the sports science of Olympic gold medallists and apply it to a park run environment. For the majority of these sports-orientated products with cheap ingredients and high prices, we are being taken for fools by immoral marketing execs. Type 1’s who low-carb should treat it with the contempt it deserves. 

Leave these on the shelf

As I got into the run, I was starting to think that this long-distance running lifestyle is, in fact, a healthy state. We begin by assuming that the sedentary lifestyle is the default normal. Presumably, because everyone does it, we believe it is normal. And, because physical activity requires effort, it is considered more stressful on the body. But I think that a sedentary lifestyle is an unhealthy state. There is nothing healthy about forcing your lower limb joints into 90-degree angles for hours at a time while sitting at a desk.  Perhaps if everyone became more active for long periods, not a lot of work would get done, but a paradigm shift in how we think about health might be needed. It is not merely the absence of disease. It is more nuanced than that. 

 Nutrient Balance 

So, now we come to the controversial bit. The way Type 1 is managed at the moment is through selective application of the NICE guideline NG17. While there is provision for individualised care, Type 1 health care practitioners will usually recommend a DAFNE style approach to management. DAFNE means Dose Adjustment for Normal Eating. It is an educational programme for Type 1’s. It teaches a basal-bolus approach to insulin management and uses the current high-carb guidelines for the diet. So, if you go to the majority of diabetes clinics, you will be advised to eat at least 70g of carbohydrate per meal so that you can buffer the effects of the insulin you are going to use. And also, because the guidelines suggest this number of carbs per meal.  

As we all know, insulin reduces blood glucose, so that makes people vulnerable to hypos. And hypos, of course, require urgent carbs in the form of glucose to rescue the situation. Better to have enough carbs and prevent that from happening in the first place goes the thinking. But, apart from dealing with low blood glucose, (when you will want pure glucose anyway), using carbs to add a safety margin because of potential for hypos with insulin is not necessary. It is necessary, however, to inject enough insulin to cover the body’s metabolic needs. That is, of course, crucial in Type 1.  But adding extra insulin to cover dietary needs to the level we do under the current guidelines is not required. Carbohydrates are non-essential foods for humans, so we can safely remove them from the diet. There is no science at all behind the current recommendation for such a high carb intake.  

Pork scratchings and cheese and chive dip high fat, high-calorie lunch 

 Insulin in higher doses than the body needs to optimise its metabolism will lead, over the years, to increased insulin resistance. This causes worsening glucose control, gain in weight, and high blood pressure. In addition to Type 1, these higher- than-needed doses of insulin will lead to Type 2 diabetes. Double Diabetes just in case you thought a single type was bad enough. There is plenty of evidence that this is the case. After all, we Type 1’s die of exactly the same diseases as those with Type 2, even though we start with a completely different condition.  Type 1 is due to the body being unable to produce insulin.  Type 2 is when the body is unable to utilise insulin. We tend to need increasing doses of insulin with time, and our weight goes up because insulin makes the body store carbs as fat. And insulin also causes the body to retain salt, so the blood pressure goes up. Better then to take the correct amount of insulin and low carbs. That is why I use low carbs. I will never come off insulin because my own body does not make any but am getting better control with about half of the previous dose.   

Faces only a mother could love, and the only glucose you need. These few jelly babies will typically cover 2 or 3 low-carb hypos. 

I certainly did not intend to eat anything like the guideline mealtime recommendation of 70g of carbs per meal.  50g per day would be more than enough. 

Richard Bernstein had worked this out over 30 years ago. Being an Engineer with Type 1 diabetes, he had none of the conventional medical indoctrination to hinder him. He worked out that he could improve his diabetes control by removing carbs from his diet. This had many benefits. He needed less insulin so that he had less risk of hypos; he achieved excellent glucose control, his blood pressure reduced, as did all of the other markers that would indicate worsening of his Diabetes. And crucially, his complications resolved. He has given hope to tens of thousands of Type 1’s, so it disappoints me that most Health Care Professionals have not heard of him, or if they have, most seem to ignore his method. 

Richard Bernstein. Famous Low Carb Pioneer 84 years old, Type 1 72 years, still practicing as a doctor. 

When I finally discovered what Richard Bernstein had achieved, I had lived with Type 1 for over 20 years. After then reading Ellen Davis and Keith Runyan, two more USA clinicians promoting low carb diets, I tried it myself with transformative results. Gone were the glucose excursions from day one. Gone, also, were those ominous soft side-effects confirming that Diabetes was getting hold of my body and wrecking it. These were dizziness on standing ( this was crippling and represented Diabetes destroying the background regulatory nervous system), joint aches, and general stiffness, suggesting that sugar was attaching itself to my muscles and tendons. It does this to blood cells, and we can measure it as HbA1c. That is because blood is easy to access. But glucose sticks to other tissues as well. The fogginess of thought also resolved. I think this is a general symptom of too much sugar, as many non-diabetics who go low carb are impressed on their improved clarity of thought. Tiredness and visual blurring at times due to glucose excursions. They all resolved in a few weeks.  

My energy levels were so good that I took up regular running again and was able to run half -marathons regularly last year. A half -marathon every month, something I would never have even contemplated more than yearly before I went low-carb. 

So, I have been on low-carb, in fact, very-low-carb diets for three years. Also, my marker of longer-term control, the HbA1c, over that period has been in the non -diabetes range, which is below 48 mmol/mol. And in the last 18 months, four of the previous five home-tests have been in the normal range that is less than 42 mmol/mol. This compares with 50-70mmol/mol in the 20 years of conventional management. 

Bear in mind that only 3% of Type 1’s achieves an HbA1c in the NICE guideline range, which recommends aiming for the lowest level that defines Diabetes, 48 mmol/mol.  Though widely quoted, the DAFNE evidence for improvement in diabetes control is inferior, indeed compared to a low-carb diet. Other educational aspects of this course are useful, though.  

I measured my food intake by using myfitnesspal.com. My average carbs per day were 9% throughout the run. Once I got into the rhythm, I was getting to 7% in the last two weeks. Sometimes carbs were needed to correct non-serious hypos, and this accounted for most of the higher carb days. I talk about that later in this article.  On other days though, my glucose management wasn’t the best, and I was just caught out through poor food choice. All Type 1’s will understand this.  For example, I was served with Coke rather than a Diet Coke at one pub. I usually always make absolutely sure the bar staff has understood, but, on this occasion, I obviously did not make myself clear.  I was able to correct the resulting high glucose with a calculated insulin dose during a run and did not get a hypo. Thank goodness I was using a CGM. Otherwise, I might have been high for hours, possibly increasing my risk of ketoacidosis.

If you are going to have Diet Coke in a pub, make sure that the bar staff understands. I was pleased with the correcting-dose calculation, and it did not affect my running. If I had not had that Coke, I could have posted my pic with a flat trace on social media! 

 On other occasions, it never dawned on me that some foods were higher in carbs.   Iced Latte is nearly 19g carbs! I would never have thought that. Some branded dips have far more carbs than other brands of otherwise the same product. You just have to check every brand. Shopping routinely in the same supermarket can cause complacency.  On one occasion, when I was at rock bottom both physically and psychologically, I had food and drink, knowing they were higher carb. That’s being human for you. I had had no sleep the night before because I was attempting a bivvy night out and bought a bivvy bag that morning.  But it was so uncomfortable that I was up at dawn and getting on with it. 

Bivvy bag, not for me, I discovered. 

It was a hot day, and I was exhausted with  12 miles to go. I had to walk while being nearly asleep. And my legs hurt. All over. Mandy, a kind Dog Walker who had given me directions earlier, passed me on her way home and offered a lift for the last few miles. I declined as I felt close enough to the goal. And I would have to find my way back to that point to restart the next day.  It was a kind gesture. There were many kind people on this trip, and that was heart-warming.  On arriving at my B and B after 31 miles, I fell asleep for 16 hours with no food or insulin. Luckily, my glucose levels were okay if slightly high the next morning. So, the next day I had an indulgent morning of self-pity and bought that half-pound of cherries in the market and a beer in a restaurant.  But the average carb intake, even when I include poor food choice, indulging, and hypo-correction was 56g per day. I thought that was good at nearly 3000 calories per day. I had no way of planning meals as I was unable to carry much food with me, so I was having to eat out and use shops. As I moved into more populated areas, the choice became better. One thing is sure. The world at large is still a high carb, low-fat one. 

typical breakfast fayre at most BandB 

One has only to look at the choices on offer in bed and breakfast accommodation to confirm this. I tended to eat out at nights, so I was vulnerable to carb additives in sauces, but overall, I was good at this through experience.  

Foraging for berries was a joy. A handful of berries once a day was a pleasure to look forward to. 

Foraging once a day was something to look forward to 

I drank almost no alcohol. What I did take was in the form of wine, but I lost my taste for it as I did mayonnaise, chocolate, and strong cheeses. 

Glucose Control 

Good average with an HbA1c of 39mmol/mol. One for Twitter. 

For a week or so, my control was poor. I know that for me, overeating of even low carb foods raises my glucose levels, and they stay there because of insulin resistance. I know this because I can inject a bolus of insulin without food cover, and the levels will stubbornly remain high. It seems that my glucagon (which raises blood glucose) has free rein when my liver is processing too much food, and the insulin stops working. That is why I choose to have fasting periods during my day usually and extend my mealtimes to give things a chance to settle. 

Also, I know that my insulin resistance is higher in the mornings, so I usually tend to skip breakfast but still inject a tiny bolus of insulin. Caffeine makes all this worse, as does stress. But on this trip, I had to have breakfast for practical reasons. I could not guarantee that I would find anywhere suitable and timely in the early weeks. In the first week in Scotland, I occasionally indulged in black pudding to get energy and to take part in the culture. They were also good sponges for extra butter. But it seems that, like sausages, their carb amount can vary. So, when I decided to take energy as-needed rather than forcing it in, I was able to reject these, with improvement. 

Overall, I was pleased with control, but on some days, it was less tight than I would have liked, especially at the beginning when I was trying to work it all out.  But I felt that I was getting better as the weeks went on, and the successive CGM traces show this. And the averaged graph above seems to show a reasonable profile.  

WEEK 1; forcing calories in the early weeks not getting good results 

WEEK 2; nuts do not metabolise well in me. I was using these for forcing energy as they did not cause nausea. Plus, too many black puddings 

WEEK 3; beginning to settle by eating to the body’s needs 

WEEK 4; Finally getting to grips with it. 

WEEK 5. Finally, into a routine 

I was never in any trouble with hypos. Yes, I did drift into the low range and, on a few occasions, had to supplement with glucose. The glucose increased my overall carb intake, but I can honestly say that the hypos were more of an irritant rather than a significant worry. I could generally pick them up ahead of the CGM as these devices always lag. A hypo when I am running usually makes me feel more tired than I would expect. I would then feel the need to stop running and only manage a couple of minutes more running on the restart before becoming tired again. I am good at picking that up.  However, 10-15g carbs would sort out the problem with minimal interruption to routine. On just one occasion, I needed almost 30g of carbs to get a correction. In the absence of bolus insulin, I can only think that this was due to Lantus (long-acting insulin) stacking. Too much the night before and that morning. A new one for me. 

I had the usual inexplicable periods of insulin resistance and improved insulin sensitivity, when the same food, the same insulin dose and the same level of physical activity gave completely different glucose results.   I can only think it would be hormonal—stress hormones, most likely. There is so much to learn. If only Type 1 was simply about balancing carbs and insulin! 

Running Strategy 

I thought I might at some point try to run the full daily 20 miles in one go, or even do a marathon distance. However, as this was all new to me, and I had done little dedicated training beforehand, I decided to work within the limits of what I knew possible. I am not a fast runner; indeed, I do not consider myself to be a real runner. 

At school, I always came around 20th out of 100 or so in the annual cross-country. My best half-marathon was 1 hour, 40 minutes when I was a student. Lately, it is just over 2 hours. I am a jogger, a plodder. But I like the activity. I rarely go out ‘wired up’ with GPS, heart monitors, calorie monitors, distance, cadence, auditory stimulation, and all of the gear that the marketing people push as required props for one of the most basic human activities. I just run for enjoyment nowadays but have used them in the past. Such monitors can be useful training and motivation aids, and I do use them from time to time.  I also pay for the occasional half -marathon for the fun of running en -masse, but my favourite running now is just letting the miles flow away while my mind is wandering. I used a running watch on this occasion to simply record the distance. Oh, and a CGM to record glucose.  

It doesn’t get better than this

this… 

Or this… 

Or this. Loch Shin 

 

Heavy rain all day. Not all easy going 

I never used headphones. I wanted to de-clutter. Letting the mind wander can be boring at times. And during periods of tiredness with a lack of self-motivation, boredom can set in, and it can be demoralising. But most of the time, it was the right thing.  Random things would just pop into my consciousness and liven up my internal conversation.  I did not want to be transported back to some other point of my life by music, nor did I want some TED talk person to add new ideas. They are on a different journey to me. I would pick up their ideas another time. Concentrate on, well, nothing in particular. 

I was often running on cycle routes, but it occurred to me as I was soaking up the miles, especially on those long undulating roads where the uphill seems forever, that the difference between running and cycling is that there is no freewheeling with running. Muscles are used to power up hills, and then they are used to control the descent on the way down. There is no freewheeling down hills when running. Even walking is not the same as freewheeling. Lucky cyclists. 

I elected to try to get at least 12 miles under my belt as soon as practically possible after a bacon and egg breakfast. Then have a long lunch and enjoy the rest of the day, running a bit, stopping, walking if I felt like it. Or being forced to walk on some hills.  Perhaps a cafe somewhere when I finished.  It was gratifying, and I managed to immerse myself in the trip as a pleasurable adventure as well as a running challenge. On one day only was I was forced to walk the whole time. This was when I acquired a knee injury. I covered 15 miles, could barely stagger but hoped that, as with all my other aches and pains, I would work it off. But I discovered that walking is so different from running. The mindset is different. There is time to look around and see more. The miles tick away oh so slowly on roads built to run on, and with 20 miles a day, this was torture because I was in a running frame of mind.  The whole day had to be spent walking, rather than having mid-afternoon finishes and long lunches.  I did not want to walk at this particular time. But I can imagine it would be great on another occasion.   If it was not running, then walking was not an acceptable substitute for this journey.  

Equipment 

Starting with a towed buggy for a week 

the solar panel worked well in charging everything up 

I started with a child buggy intended to be towed behind a cycle. I had adapted it to be used with a sled pulling harness as used in the polar regions for towing sleds across the snow. I was helped with this by Rosie Swale-Pope, who incredibly managed to run 10,000 miles over five years using buggies. 

The buggy I intended to use had not arrived on time, so I had to source a heavier one and hastily adapt it. I managed a huge 4 miles of testing before setting off! My kit included a stove, tent, sleeping bag, bedroll, and clothes. Luxuries were a cafetière and pepper mill. Food would be bought en-route, but I had enough room for supplies that would last the 48 hours I would need when camping out in some remote regions of Scotland. I was hoping to use the buggy as an advertising platform for two charities. The Public Health Collaboration, which I am a founder member of, promoting a real food lifestyle. And Pasture for Life who are doing work to make agriculture sustainable. Sustainable agriculture requires grazing animals for fertiliser, whether we decide to eat the animals or not. The soil structure and health of the soil is dependent on microbes. The microbes that nourish the soil do this by almost exactly the same methods as in humans. Humans have billions of gut microbes, and these are important in maintaining our health. Destroying the soil will end up destroying its ability to provide crops. If we are going to eat real food, it is best if it comes from real farming practices.  

Andy Rumming in Cirencester is passionate about nurturing the cows, the pasture, and the health of the soil. He supplied me with some dry-cured beef for my trip. 

It became apparent on day three that this buggy-towing thing was not going to work. Sure, I was experiencing the ‘bedding in’ aches and pains of a new adventure and adapting to suit. But unexpectedly, I could not establish a rhythm with the towing. My running action, especially on upward inclines, meant that the buggy was fighting me with every step, and there was a constant tugging back sensation. I was literally hauling this thing around. And entirely unexpectedly, the shoulder harness was causing acid reflux. I already had nausea from overeating, and reflux on top of that was quite uncomfortable. 

My kit weighed 36 kg, plus whatever food and drink I needed to add, just under half of my body weight. Furthermore, it was getting in the way of traffic on the narrow roads, and I was continually stopping to allow traffic to pass. I could not get into a running rhythm. I had to rethink what I was trying to achieve. Rethinking my plans became a regular habit on this trip. 

End of that Part of the project! 

The whole point, I concluded, was to try a long run on low carb, not to have a camping adventure. I needed the buggy for the first week because of the isolated route I had chosen. But it was not essential after I reached Inverness. I was lucky in that my friend, Ian, was passing through Inverness, and we met up so that he could take the buggy and other non-essentials to his home near Stirling.  I would meet him there and post stuff home. I decided then to run with a rucksack, carry minimal supplies, and use local accommodation en-route. I picked up a cheap 20 litre rucksack from the middle aisle of a Lidl in the lovely market town of Tain, north of Inverness, and decided to carry the following items. 2 short-sleeved tops, one long sleeve, two pairs of shorts, three pairs of socks, trousers, lightweight fleece, insulin and paraphernalia surrounding Diabetes, charging cables, power supply, spare running watch, hat, wallet, charcoal filter water bottle, knife, plastic fork, basic toiletries, sunscreen, sunglasses, notebook and pen, and lightweight waterproof running jacket. I later posted this jacket back home and bought a shirt for looking reasonable in the evenings. And that was it. It came in at just under 5 kg. There were a waist and chest strap, so I was able to get a good fit. 

 

My running shoes were Innov8 Roclite 315.  They had about 100 miles use, so were perfectly run in, excuse the pun. These shoes have a minimal heel but suit me perfectly. They lasted most of the distance I finally achieved. I also bought the best socks I could. Nike LG Dri-fit. These proved excellent for me, and I was blister-free for the whole trip. Because they are highly absorbent, they also take a long time to dry! The rest of the running kit was straight out of the drawer.  

ready for replacement at 700 miles 

To work out a Route, I started with Royston Wood’s excellent Lands’ End to John O’ Groats Safe Cycling Route. He had worked out a reasonably direct route avoiding busy roads and tried to choose cycle paths, canal towpaths, quiet off-road and where necessary, short often protected distances of main-road. It was the right choice as it turned out, but he was a 100-mile-a-day cyclist, and I found some of the roads that he chose were quite busy. However, I thought that selecting cycling routes would suit a runner. They are relatively smooth underfoot, and the gradients are not unduly steep either way. Plus, I did not want to be going miles along gnarly, uneven footpaths, often with missing signage. I combined this guide with Google Maps, which was installed on my phone. It took different routes on occasions, but the mapping here is not sensitive enough to follow paths and lanes. These two sources led me down some real suicide roads—parts of the A9 A34 and A6. The A6 from Penrith to Kendal stands out as THE road that no pedestrian should ever set foot on.         

Just round the bend, the barely recognisable footpath beyond this 100-meter new path on a junction ended. This was a Google recommended walking route in Staffordshire. The other side of the junction was a grass verge—tokenism at its best. 

An impassable neglected footpath on the A6. No option but to use the narrow road 

Often narrow and twisting with narrow, uneven verges. I would have thought it was no place for a slow cyclist either. On the day I used the A6, there were many heavy lorries in addition to cars.  One could hear the menace of a vehicle approaching from behind, the roar of the engine, and the force of the wind being pushed into my path. Some vehicles barely altered speed or direction to get around me.  It was horrible. I constantly had to jump onto the verge to get out of the way. By the end of the day, I was mentally exhausted, almost in a panic with each passing vehicle.  After that, I took great care with Google Maps to use their satellite images to check the path provision on each route. So, if you are planning to do the same, please bear that in mind. At this point, I discovered Komoot, which is more suited to running. The distances calculated were longer but more realistic than Google, and this site did seem to find the quiet routes along cycle paths and canals. But it did meander, occasionally onto footpaths. Some parts of the route were so complicated that the time spent navigating became so high that it was inefficient. Several times I missed a turn and ended up some distance off-course. But I did get an unexpected glimpse of the Jodrell Bank radio telescope in Cheshire, when on a wild goose chase along the wrong road, light years away from my intended route. The National Cycle Network was also good at showing quiet lanes. However, one needs to know where the route numbers go. Some paths overlap or cross each other. Plus, everyone in every council in the country is planning cycle routes such that some signs become very confusing, often with several local routes competing for space on the signposts with the national cycle paths.  Also, they do tend to meander to find quieter roads, and when running rather than cycling, this can be costly in miles.

I met a lovely couple near Lairg, in North Scotland. They had cycled from Hamburg and were towing their 10-month-old son in a buggy. They were cycling the North Sea Cycle Route, which I happened to have done some four years earlier by bike.  We got talking about our common interest, and about navigating parts of the UK. We agreed that it is necessary to use common sense and adapt the official route to make it practical.  It was funny that they mentioned Ipswich. On arriving there, the main road into the town routes the official North Sea Cycle Route in a convoluted circuit round housing areas for about 2 miles only to reappear literally 100 metres further down the main road. We remembered it well. But minor aberrations aside, overall, the National Cycle Network is a great resource when used wisely. I love it. 

I developed a strategy of spending time in the evenings to plot the next day’s route. I used a hybrid of all these sources. But my absolute favourite paths were on the canal towpaths. Fast, often smooth, no navigation required, and plenty of interest on the way. No cars, often no people out of the population areas. I fell in love with towpaths. I am already imagining another trip running the canal network in stages. 

Pretty Canal at Worsley, Manchester 

Bridgewater Canal 

Gloucester to Sharpness canal 

Injuries 

It was an injury that ended this project. It was knee bursitis from the quads tendon. The terrible thing was that I was well into my stride, 700 miles completed in five weeks, and with less than two weeks to go. It caught me by surprise as I had been running pain-free for nearly two weeks. It started as a niggle, just after I had tackled the only significant hypo of the trip. (stress? running badly?) I had just that morning revised my trip and added 4 miles to it, but it was only 21 miles in total, so it should have been do-able.  I was running over some slightly rough ground on a poorly maintained path. There was no drama, just a slightly worsening pain. By the end of the day, I was hobbling. The next day there was no improvement. I did get into a run of sorts, but the pain was significant, and I was not relaxed, with a lot of tension in the upper body. 

End of the adventure 

 The next day I could only walk, and running was out of the question. By the evening, I could barely do that. The following day, I could only get around by grabbing onto furniture. The pain in the left knee was okay on standing but excruciating when I tried to put weight on it.  I elected to go home at that point as I was only an hour away.   I knew that this was a serious problem. I was sure that it was nothing more than bursitis, but boy, it was painful. 

I had been lucky otherwise. For three weeks near the start of the run, I had a pain in the right outside lower leg. This was tendon, possibly brought out by the fact that my right hip rotates outwards slightly. It took 5 minutes or so to warm up in the day, but I could run with it and control the pain mentally. It became sore to touch, and there was some swelling. But it finally resolved entirely after one day’s rest when I had to attend a meeting. It never came back. 

In the first two days, I had piriformis pain on the right hip. It was deep buttock pain. Charlie Babb of CB Fitness in Bath was on hand to give me advice on this as he did for most of my injuries.  

Shortly after I had dealt with the piriformis, I acquired a quite painful left lower hamstring tendon pain. It could radiate to the thigh and also down the leg. It was a significant pain for a few days, but I was able to get into a run after going through a painful minute or so, and the pain was no worse with running. But after about three days, the pain was intense. There were short pulse electric shock sensations behind the knee and into the foot for about an hour. After this, an hour of limping and a short rest, it all resolved and never returned. 

There were minor aches in the mornings from the prominent hip bursas on the bony part of the upper outer thigh. These just wore off after about half an hour and a bit of stretching beforehand. Similarly, there were some pains under the kneecaps on both sides in the mornings, which worked off with running. 

Occasionally especially in the early days, there was tightness in the lower leg muscles. 

Remarkably I never developed any joint pains. They were always free moving and never swollen. 

I never had cramps on this run either. I am lucky in this respect as I never use supplements. I never took painkillers or muscle rubs until the last day.  And then I concluded that they were not very useful for this injury anyway.  

I did develop a painful abrasion on the back when I started using the rucksack. I discovered this was due to poor packing practice. It went when I attended to this.  

On one occasion only, at about three weeks into the run, I ran over a short dry twig which I felt under the toes of the right foot. Beyond thinking that I must take care of where I step and feeling lucky that this was not slightly further back, which might have caused a stress fracture, I thought no more of it. That night the area felt bruised and remained vulnerable for ten days. But it never blistered. A ‘Compeed’ plaster and time did the trick. 

I became fascinated by relaxation in running. I would become aware of an ache in the leg and be able to relax into a fluid gait to resolve the problem. I was amazed by how when trying to run when in pain, I became aware that my back and shoulder muscles became fixed. 

relaxing into the trip 

A significant breakthrough came when I remembered to run ‘through my core.’ I was aware of this after I did some exercises with personal trainer Dave Marsh in Stroud. It transformed my running. When under stress, I tend to tip forwards and use the calves and quads more. Getting back to the core, instantly improves the posture, by getting the pelvis flatter, the large muscles then power the running, the stomach pulls in, the head goes up, and the shoulders go back…The Zen of running. It was a daily pleasure to concentrate on getting into a relaxed running posture. Any niggles could be sorted by adjusting the position. I usually found it to be the pelvis, mid to low back, and upper body that sorted any aches in the legs. Peculiar to me but well known to physios.  

In Conclusion 

I had a fantastic summer adventure. I am slightly disappointed to have failed to reach my ultimate goal, but on the other hand, there were plenty of positives. 

I know that my preferred method of controlling Diabetes through very low carb is safe. 

Throughout a physically intense few weeks, I have had overall good glucose control and no safety issues around my Diabetes. I have markers of long-term control that are likely to reduce my risk of developing complications.  My measure of long-term control, HbA1c, was in the normal range after this run. I cannot extrapolate my experience to other fellow Type 1’s as my Diabetes is unique to me. Everyone has their personal exercise strategy.  But this account might give some insights on management using low carb that might be of use. 

 Low carb is a safe and effective practice in Type 1 diabetes. This is a story of just one person, but thousands of Type 1’s around the world do the same, all with the same results.   In my view, the resistance of government bodies to provide even the information, not to mention provide the expertise for implementation, is proving costly. Mainly in the unnecessary daily distress caused by the near-impossible demands of current practice, and the sense of failure that this gives to those Type 1’s who try so hard and of whom only 3% will get anywhere near to target.  But also, the completely unnecessary long-term complications that are so costly to quality of life, and longevity. And also, expensive to public expenditure.  

I have also confirmed to myself that my limitations are primarily in my mind. The fact that I did not reach my ultimate goal is not that important.  Failure of this project would have been not starting it in the first place. I could have found plenty of legitimate excuses. But in the end, it is the old cliché of this being the journey and not the destination, etc., which is so well put across in the poem Ithaka by CP Cavafy. 

   There are plenty of Health Care Professionals who would find a 59 yr old male with long-term Diabetes, opting to run 20 miles a day for up to 2 months, solo and unsupported a clinical challenge. But I have shown to myself that anything is possible if the will is there, and that one is prepared to adapt to situations. 

And finally, the sage thoughts from the empty mind of a runner. 

Physical fitness is a gift. If you have it, do all in your power to nurture it. 

Muscles can be both engines and brakes. 

The world at large is travelling at the pace of vehicles and not humans. 

Humans are becoming voluntarily incapacitated in the longer term by opting to replace their legs with powered wheels. 

Low carb for the general population is nowhere near even approaching the norm.  

 ‘If you think you can or if you think you can’t, you are probably right.’ (credited to Henry Ford) 

One adventure ends, many more to come, hopefully 

The nightly stopover towns on the route.  John O’ Groats – Thurso-Bettyshill-Loch Shin(Altnaharra)-Lairg-Eddington-Cromarty-Inverness-Carrbridge-Dalwhinnie-Pitlochry-Stanley-Kinross(bivvy night)-Livingston-Carnwarth-Abington-Moffat-Ecclesfechan-Carlisle-Penrith-Kendal-Lancaster-Bamber Bridge-Eccles-Alderley Edge-Alsager-Eccleshall-Wolverhampton-Stourport-Upton upon Severn-Hardwicke-Berkeley-Almondsbury I took tow rest days: day 15, when I was exhausted after a night of no sleep (trying to bivvy). Day 26 was to attend a meeting.