Another T1 DM Using the Paleo Lifestyle to Manage Blood Sugars

photoI had the pleasure to connect with Shelby Hughes, a fellow type 1 diabetic, to talk about the great use of a paleo lifestyle to gain health, and more so find more ease in controlling blood sugars. Have a look at our conversation and please share if you have found similar things in your diet transition.

How long have you had diabetes? I was diagnosed with Type 1 diabetes in 2008 at age 39 years old. Originally I was diagnosed with Type 2, but after changing my diet, taking oral medication and performing daily exercise wasn’t helping my blood sugars, I had additional lab work that confirmed I had the antibodies for Type 1.

What eating regime have you found to be most helpful in managing stable blood sugars and how did you come to find this diet? When I was first diagnosed with diabetes, I researched online and found that many diabetics (both Type 1 and 2) had been successful following a low carb diet. When I switched to this type of diet, I did see improvement in my blood sugars. However, I was not able to maintain a low-carb lifestyle for a long period of time. Eventually I “fell off the low-carb wagon” and started eating a Standard American Diet again. My blood sugars were always on a rollercoaster!  In January 2013, after hearing about the Paleo and Primal lifestyle from an online friend with diabetes, I decided I would try a Paleo framework for eating. Initially I was going to do it for just two weeks. After two weeks, I noticed that my blood sugars were AMAZINGLY stable. I didn’t have lows, I didn’t have highs. I never looked back!

What main improvements in your health have you observed, diabetic-related or not? Besides having very stable blood sugars (I can literally count on one hand the number BOTH lows and highs I’ve had since starting eating within the Primal/Paleo framework. My sleep has improved (I was having terrible issues with insomnia last fall, before changing my diet). I have lost weight, but I think that’s mainly because I’m staying within or just below my caloric requirements and I’ve increased my exercise. But I do have tons of energy. I was never a runner, EVER, but I completed my first 5K in March and I’m training now for a 10K. In fact, I never liked exercising at all, but now it’s like I HAVE to move my body or I feel like I’m going to crawl out of my skin! Other changes I’ve noticed are that my skin breaks out less and I don’t get mouth ulcers (I was getting them weekly before I made the changes).

Do you find the diet realistic and something to maintain long term? Would you recommend it to others managing their diabetes? I honestly believe this is a lifestyle I can manage long term. There are so many good Paleo substitutes for my favorite “comfort foods” that I just don’t feel like I’m missing out. I make cauliflower crust for my pizza, I make muffins with almond and coconut flour, I make “pasta” with spaghetti squash or zucchini “noodles”. Many people think that Paleo or Primal means “low carb” but it doesn’t have to! I eat tons of fruit and starchy vegetables like butternut squash and sweet potatoes. I am definitely eating carbs! And it’s funny…I’ve noticed that fruit and starchy veggies don’t spike my blood sugar like grains do. I won’t say that I’ll never eat another grain in my life…there may be a special occasion that warrants it! But since I love how I feel and love how stable my blood sugar is, it’s just not worth it to me to change back to eating a Standard American Diet.

What does a typical day of food look like to you? I’m a creature of habit, so I like to eat the same thing a lot of times.

Breakfast:  Green smoothie with fruits and veggies, a hardboiled egg, and bacon.

Lunch: a big (I mean big!) salad with grilled chicken, avocado, artichoke hearts, eggs, bacon, tomatoes, raisins, nuts, seeds, mushrooms, cucumbers, balsamic and olive oil dressing, and a nut flour muffin and fresh fruit.

Dinner: some kind of meat (pork, chicken, shellfish, beef), some kind of green vegetable (leafy greens or Brussels sprouts – usually whatever is fresh from the farmer’s market or available from our CSA bag) and some kind of starchy veggie or “grain-like” food – roasted butternut squash, acorn squash “fritters”, sweet potatoes, or maybe cauliflower “breadsticks.” I’m not really a “dessert” person, but I do drink a glass or two of red wine before dinner each night.

What is the best thing about the diet? One of the best things is that you can pretty much eat anywhere and get something that falls within the framework. When I first started, I had to go out of town for work and stay at a hotel. Of course that means eating out every meal. But you can get a big salad pretty much anywhere, and you can always ask that your “burger” or whatever be served without a bun. Of course now when I travel I plan ahead and pack snacks that can be meals: hardboiled eggs, homemade beef jerky, kale chips, homemade “larabars”, fruit, nuts, seeds, etc.

Any tips for someone getting started on this type of diet? Before I started, I bought the cookbook “Practical Paleo” by Diane Sanfilippo.  It has the most beautiful full page pictures of food and some great recipes. I bought the book and decided I would make something from it each week. Next thing I knew I had tried several new foods that my husband and I both loved, and it was easy to transition to the next step of eliminating grains. I also used many blogs on the internet – you can google any food and add the keywords “paleo” or “primal” and get tons of great recipes. Mark’s Daily Apple is another great resource for people wanting more information.

Anything in addition you’d like to say? I think some people get the wrong idea about the Paleo or Primal framework because like with all things, there are extremists out in the land of the internet. Also, depending on the source, different people have different ideas about what is “paleo” and what is not. I think that there is no black and white answer…it’s not about “what the cavemen ate,” it’s about nourishing your body with foods that you love and that help your body perform at its very best.

Thanks for sharing your insight Shelby! Perhaps your story will inspire others to seek change and gain health.

Cheers to you and good health,


Taco Time

Have you ever looked at the ingredient list on pre-made taco seasoning? If you have, you are aware of the unnecessary fillers such as corn starch and wheat. And these are the ingredients we can pronounce! My point being, is instead of buying a taco seasoning packet, simply use your spice rack for the Mexican dinner. This is what I do for my family.

Clean Eating Tacos:

  • 1 pound of grassfed beef (or very lean ground beef)
  • Optional – 1/2 onion and/or bell pepper
  • 1 1/2 Tbsp chili powder
  • 1 tsp smoked paprika 
  • 3 tsp cumin
  • 2 tsp garlic powder
  • 1/4 tsp crushed red pepper
  • 1/4 tsp fresh oregano (dried if frsh isn’t handy) 
  • 1/2 tsp sea salt or himalayan salt
  • 1/2 tsp ground pepper


Heat ground meat (and onion or some fresh diced bell pepper) on high.  Cook, stirring frequently to break up the meat, until fully cooked, about 8 minutes.
Add spices to beef.  If the meat appears dry, add 1-2 Tbsp of water. Stir to fully incorporate.
Turn temperature down to medium and cook another 10-12 minutes, stirring occasionally. I often stir in some salsa at the very end to add more moisture and flavor.


We usually eat our tacos w romaine lettuce leaves and homemade guacamole  Oh! And I can’t forget to mention, save the leftovers for a killer taco omelette in the morning.


FREE Clean Eating Workshop – Chicago – Saturday, February 2nd – 12noon

Have any plans this Saturday? How about you join me at Fit Girl Studio in Lincoln Park for a FREE Clean Eating workshop! During the workshop you will be able to fully understand and appreciate the concept of clean eating. By the end you will be asking yourself how there is any other way to live.

This is a must event at an awesome workout studio! Feel free to enroll in a 1 week trial at Fit Girl Studio for $20 too. Their classes are epic, diverse and keep me wanting to come back for more.

Hope to see you Saturday!

To make a reservation please contact the studio at or call 773-899-6525.

Cheers to you and good health!



Sunday Session: Sausage Stew, Breakfast Bacon muffins, Spaghetti Squash, Chopped Veggies

With today’s freezing weather I found it to be a great time to spend some time in the kitchen. This is what I’ve made for the week.

Veggie Sausage Stew:

  • 1/2 lb farmer’s market ground sausage
  • 1 green pepper diced
  • 1 onion diced
  • 3 cups celery diced
  • 1 medium to large zuchini cubed
  • 7 tomatoes cubed
  • 2 cups sliced mushrooms
  • 1/2 teaspoon pepper
  • 1 1/2 teaspoon basil
  • 1 tsp apple cider vinegar
  • 1 tsp of roasemary
  • 1/2 cup parsley, freshly chopped
  • Crushed red pepper flakes, to your liking
  • salt to taste

Method: Brown sausage, combine all ingredients in a slow cooker, and allow it to cook on low for several hours. Batch half the meal in a freezer safe container and store half in the refrigerator for the week. *I doubled this recipe by just multiplying the ingredients by 2, but you may want to also increase the amount of spice. This stew was also good with some spaghetti squash. Provided a more comfort food craving. 

Paleo Infused Breakfast Muffins – Bacon:

  • Uncured bacon, strips (I did some with leftover proscuitto too)
  • Framer’s market eggs, or I like Trader Joe’s free range
  • Spices – crushed red pepper, pepper, coriander.

Method: Heat oven to 375F, using a cupcake baking pan, line the cups with the bacon, allowing for none of the pan to show, crack open an egg in each cup and add spices. Cook for about 20-25 minutes, pull out of the oven, allow it to cool, and store for the week.

Spaghetti Squash

  • 1 squash, cut length-wise

Method: Preheat oven to 375 degrees F. Once the squash is cut length-wise, remove the seeds and strings with a spoon. Place a sheet of foil on a baking sheet, place the 2 squash halves faced down. Bake for 45-50 minutes. Pull out of the oven, allow to cool until you are able to touch, and fork the squash to create angel-hair like pasta. Store in the refrigerator up to a week and season with a variety of spices and ingredients. A few ideas include olive oil, lemon and basil, marinara sauce, coconut oil with cinnamon, ginger and raisins or it’s great just plain!


I chopped raw veggies to have on hand for quick snacks and as a side for lunch. If I don’t have my vegetables cut, in a clear container, I am less likely to eat them.

I also had a nice stash of hard boiled eggs in the fridge from last week

I have plenty of raw fruit on my table including clementines, apples, oranges and bananas. Sometimes having a fruit bowl makes me happier than a bouquet of flowers. The fruit is colorful and purposeful!

Have a good week team!

Client’s Paleo Transition – Becky Schlageter

Please paint a picture of who you are:

Becky is an Ohio native who moved to Chicago 6 years ago. She has always been passionate about health and wellness. She graduated from Ohio University with a degree in Exercise Physiology and Pre-Physical Therapy. After college she worked in the corporate world for several years, but is now back doing what she loves! She received her NASM Personal Training Certification last year and is now spending most of her time helping others achieve their fitness goals with one-on-one personal training. As well, Becky most recently partnered with Kelly Schmidt, RD, LDN on some health programs/bootcamps. Stay tuned.

What inspired you want to do Paleo?

I was in a rut and bored with my eating habits. I had also read a lot of literature on this diet and many positive reviews, and thought it was worth trying first-hand. So I put myself on Kelly’s Paleo Infused Nutrition Pledge food challenge to see if I could stick the program for 4 weeks; I did! I also wanted to speak intelligently about intuitive nutrition and more easily empathize with my clients who were participating in other food challenges, diets or cleanses.

What is your health goal/objective?

I want to improve digestion and nutrient absorption, as I now know good digestion equals good health. I have always been a healthy eater, but never really noticed my energy levels or regularity being where they should be. I didn’t feel my healthy eating efforts were paying off either. I am always interested in learning more about nutrition and food labels. Lastly, I wanted to drop those 5 lbs clinging to my thighs, which have fallen off eating a real food diet. Success!

What was the most challenging thing in following a paleo diet? How did you overcome this challenge; if you did?

At first, eliminating dairy was the biggest challenge for me. I had been eating greek yogurt, cheese and ice cream regularly for the past few years. First and foremost, I got rid of all the dairy products in my fridge. This helped me stay on track and avoid any temptations. I also did some research and came up with some “dairy alternatives”. I am now borderline obsessed with coconut milk and can’t image going back to drinking regular milk. I also was able to make an amazing non-dairy cheesecake that left me just as satisfied as if I were eating the real thing. My second biggest challenge was not drinking beer. I am an avid beer drinker and love hoppy, craft beers. I was able to completely eliminate beer for the entire month. However, there are some tasty gluten free beer options that I have recently discovered. They don’t leave you feeling as bloated and full. For you Chicagoans-Binny’s, Trader Joe’s and Whole Foods as well as lots of restaurants have a decent gluten free selection.

What was your overall impression of the diet? Do you still follow it?

I honestly loved the diet. I learned a ton about nutrition and how misleading some food labels can be. I also felt better (increased energy, better digestion and healthy skin). Experimenting with all the different recipes was also really fun. If anyone needs any recipes-I have a ton I’ve collected over the past few months. is also an awesome resource for great recipes and fun commentary.

Since completing the challenge, my motto has been “80/20”. I try and stick with it 80% of the time and I give myself a little wiggle room with the other 20%. For example, I was just home for Christmas and there was NO WAY I was not going to have JUST ONE piece of my mom’s homemade fudge. I also think the “80/20” mindset is very healthy. You don’t feel totally defeated if you cheat one day…so be it, just get yourself back on track!

What changes did you see after doing one of Kelly’s Paleo Infused Nutrition Pledges?

As I mentioned above, my digestion, energy and skin were better than before. I also slept better. And, lost those stubborn 5 lbs on my thighs. My awareness of all the crappy food options out there is also worth noting. Every time I go to the store or go out to eat I find myself really scrutinizing the labels and menus. I deem this as a really positive thing and really believe “you are what you eat”.

What advice would you tell someone considering the Pledge?

I would highly recommend the pledge. Go into the pledge and challenge yourself to stick to it 100% for the 4 weeks. Thereafter, you can decide if it’s right for you. I would also recommend anyone considering the pledge to plan ahead. Researching recipes and literature surrounding the premise of the pledge ahead of time will really help you mentally prepare for what lies ahead, ultimately leading to a successful pledge.

What were/are your favorite snacks and meals?

I loved making sweet potato fries. Super cheap and easy. I also made egg “muffins” as a fun breakfast alternative (basically eggs with whatever fixings you want, baked in muffin tins). Homemade nut butter was also a god send. I would eat this along with carrots, celery or an apple for a snack. Beware though-it’s addicting! I also made a lot of smoothies for lunch with fresh fruit and veggies. Adding an avocado to the smoothies gives it an awesome creamy flavor. Spaghetti squash with homemade marinara and chicken sausage, butternut squash with bacon and onions…the list goes on and on.

Any other comments?

Just try it! You have nothing to lose….besides 10 lbs, better sleep and better skin!


Becky Schlageter is an excellent Certified Personal Trainer and is passionate about her client’s success. Email Becky at [email protected] if you are in the Chicago area and want some fitness coaching. 

Best Paleo Chili Ever

Chili is so perfect for winter. It is hearty, nutritious and uber easy to make. This December I made one of my best batches yet. Here is what I did:


  • 2 lbs of grassfed beef, ground
  • 2 6 oz. cans organic tomato paste (Trader Joe’s)
  • 1 14.5 oz can diced organic tomatoes (Trader Joe’s)
  • 3 bell peppers, varying colors
  • 10 carrot sticks, organic, about 8 in. long (Trader Joe’s; 1 bag)
  • 2 cups of spinach
  • 1/2 medium yellow onion
  • Spices – 3 T cumin, 2 T chili powder, 1 tsp salt, 1 T pepper, 1/2 T crushed red peppers, 1 T oregano, 1 T paprika – all measurements depend on your taste.
  • 1/2 cup Franks Red Hot sauce (yes, you read that right)


Place slow cooker on high. Once warm throw in the half diced yellow onion, followed by the can of diced tomatoes. Add in the meat. Let cook for about 30 minutes.

During the 30 minutes, chop the bell peppers and all but 3 stalks of carrots into 1 inch pieces. Turn the slow cooker to low and add the bell peppers, carrots, tomato paste, spices and hot sauce. Stir until spices and tomato paste are evenly distributed.

Let the chili cook for 8-10 hours on low, stirring occasionally. Once you get to the end of the process, turn off the heat, add 3 stalks of chopped carrots and the spinach.

I like the variable (crunchy) texture and that is why I add more carrots at the end of the cooking process. As well, adding the spinach provides a more nutrient-dense punch to the meal. Vitamin C can easily be damaged with heat and that is why it is added at the end.

Once cool store half of the chili in your refrigerator and the other half in your freezer, so you have something healthy to eat next month when your time is tight.

Cheers to you and good health,


Let’s Talk New Year’s Resolutions

Do you have one? I have a few in mind, and while my yearly goals do not always last the 12 months, they are still good to have.

Come 2013 I will be embarking on an auto-immune diet protocol during my January Paleo Infused Nutrition Pledge. I am doing this because it will be a good challenge that will bottom-line improve my health. Most recently my thyroid has been showing some variation (signs of hashimoto’s) and ensuring my gut integrity is optimal for my well-being and defense in thyroid problems.

If I suggested this resolution to be last year or the year before, I would have set myself up for failure. It will (hopefully) work for me for this year coming, because I have a clear understanding of what I need to do, and my food intake is already rather restrictive, and more than half way in meeting the auto-immune protocol guidelines.

Overall though, the Paleo Infused Nutrition Pledge is not about restriction. It is a Pledge you come up with that aims to improve your health. You make a commitment/goal to yourself and to me your dietitian. And through the 4 week Pledge I help you stay on-top of your health game and propose some guidelines of being your healthiest you. So if you are interested, just let me know. It’s nothing to be scared of, it’s an opportunity to learn a whole new way of looking at food. Best part, you don’t have to spend time commuting to appointments, etc. The Pledge is an online private forum, where you have a dietitian, me, at your fingertips for questions and/or to voice your successes and struggles. Who wants to join?!

If you want something more hands out, I can also offer a Clean Eating Bootcamp developed by myself and an excellent Personal Trainer, Becky Schlageter, here in Chicago. Our Bootcamp is composed of 6 sessions, giving the client personal attention to their diet and fitness program. This Bootcamp will start the second Monday of every month. Who wants to join?

As a health professional, I make it my duty to create programs that are appealing, yet attainable for consumers. If neither of the above attract you, let me know what does. Nonetheless, aim to be your best person this year. Because you deserve good health, and the quality of life that goes with it.

Cheers to you and good health,.

Happy Holidays,


Top 10 Reasons to See a Paleo Registered Dietitian

The Academy of Nutrition and Dietetics posted an article, “Top 10 Reasons to Visit an RD,” and it inspired me to repost similar content but outline why a Paleo Registered Dietitian can suit your needs.

A trusted health care professional can serve as an integral liaison in helping you make change for a healthy lifestyle. See how consulting with a Paleo RD can benefit you.

  1. Diabetes: You have prediabetes or any other form of diabetes – T1, T2, Gestational and you want to gain control. A Paleo RD can change your life and your relationship with food by teaching you holistic, real-food approaches in eating a nutrient-dense diet, low to moderate carbohydrates and avoiding pro-inflammatory foods to help you best control your blood sugars.
  2. Community: Your community has high levels of obesity. A Paleo RD can work with local leaders, including doing presentations to schools, teachers and parents, to create wellness programs that promote healthy eating, sourcing high quality food locally and physical, natural movement for everyone.
  3. Media: You are a marketing manager for a food company/restaurant and know consumers’ preference for good-tasting food that is healthy. A Paleo RD can make the connection and work with your media campaign to develop new messages that will be successful in the marketplace.
  4. Performance: You want to improve your performance in sports. A Paleo RD can transition you to be fat-adapted, enhancing your ability to perform longer and better. Whether you’re running a marathon, skiing or jogging with your dog, you deserve to properly fuel your body with the right foods at the right amounts.
  5. Special Diets: More than 15 million people in the US have a food allergy and this does not even address food sensitivities  A Paleo RD dietitian will work with you to develop an eating plan for your new needs and even help uncover food sensitivities.
  6. Family Nutrition: A Paleo RD an help you take care of your family, from parents growing older and at risk for Alzheimer’s  dementia,  etc, to newborns and eventually starting on solids. A Paleo RD who has special culinary skills can teach you how to cook in a simple, convenient way as well as educate you on what foods to choose.
  7. Food Relationships: Perhaps you or your teenager has issues with food and eating healthfully. A Paleo RD can address the impact certain anti-nutrients have on our mental health. Please note if a condition such as anorexia, etc, can be addressed by a Paleo RD, yet, a RD who specializes in eating disorders should be your first attempt. I will plug the book Primal Body, Primal Mind as a go-to resource as well.
  8. Locavore: Your community wants more local foods to be available. A Paleo RD can inform you of some great options in how to connect with a nearby farmer, as well as, provide advice on how to grow your own produce or herbs.
  9. Time: You and your husband/wife have just started a family, perhaps you have moved, started a new job or hobby and time is just not there. A Paleo RD can help you get through and not put your health in the back burner
  10. Supplements: While all health professionals can agree, food first is the best approach in getting your needed nutrient intake, however, a Paleo RD can help you source the best needed supplements or food substitutes. Perhaps liver and onions are a thing of the past, but the nutritional bang for your buck you can get with this ancestral meal or a homemade bone broth may need to be revisited.
Regardless of the niche a health professional has, everyone needs some sort of coaching. From a personal trainer, to a running coach, a business mentor, to a Registered Dietitian. Treat yourself and see what a coach can offer you.
Cheers to you and good health,


Sildorf SM, er al. Remission without insulin therapy on gluten-free diet in a 6-year old boy with type 1 diabetes mellitus. BMJ Case Rep. June 21, 2012.

Jonsson, T, et al. Beneficial effects os a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc. Diabetol. 2009; 8: 35.

Cordain L. The Nutritional Characteristics of a Contemporary Diet Based Upon Paleolithic Food GroupsJANA. 2002; 5(3): 15-24.

Wolf, R. The Paleo Solution – The Original Human Diet. 2010.

Rosebud O. Robertsa, Lewis A. Roberts, Yonas E. Geda, Ruth H. Cha, V. Shane Pankratz, Helen M. O’Connor, David S. Knopman and Ronald C. Petersen, Relative Intake of Macronutrients Impacts Risk of Mild Cognitive Impairment or Dementia, Journal of Alzheimer’s Disease, 2012 

Wangen W. Healthier Without Wheat – A New Understanding of Wheat Allergies, Celiac Disease, and Non-Celiac Gluten Intolerance. 2009.

Paleo Infused Nutrition Pledge – 4 Week Clean Eating Food & Fitness Challenge

Do you feel like you have tried everything to shed those lingering stubborn pounds? Or are you frustrated with a sensitive digestive system? How about your blood sugar? Do you get irritable when it’s been 2-3 hours without eating? Perhaps you too have diabetes and want to improve your A1C. Or are you trying to conceive and it’s been taking longer than desired? Do you fight sugar and carbohydrate cravings daily? Perhaps you have been eating a primal diet for awhile, but some neolithic foods have been showing up more than you want.

If you have said yes to any of the above, perhaps a Paleo Infused Nutrition Pledge/Clean Eating Food & Fitness Challange is what you need. Starting the first of every month, join a small community-based team to reach your health goals and pledge to eat clean. 

Overall, this is a commitment you make to yourself and RD, Kelly Schmidt, with set health and diet-related objectives.

  • RD will help coach you to eat foods clean of sugar, gluten, lectins and processed foods for 4 weeks.
  • RD will provide nutrition guidelines for the pledge
  • Certified Personal Trainer will suggest workouts and excercise motivation
  • Provide daily motivation and tips
  • Support via a team forum with other people on a similar journey
  • Q&A sessions
  • Meal plan guidance.

This is a great way to reprogram your epigenetics, strengthen your immune system, detox naturally and optimize your body composition. Most clients find this is a great way to get them back on track and incorporate new healthy habits.

Expectations during this 4 week program include:

Better sleep, decreased inflammation, better (performance) recovery, diminished anxiety, weight loss, higher energy, increased fertility, better blood sugar control, better digestion and more. This program can help educate you on how to amend your lifestyle to be your best person now and beyond the 28 days of the pledge.

Depending on where you are coming from, Kelly will help you get started on the right nutrition plan. A realistic goal is the best goal to start with, and there is no sense in setting yourself up for something that is not attainable.

Kelly’s mission is to inspire and motivate you to find your own healthy balance through proper nutrition leaving you to feel empowered to embrace all that life has to offer. Please select which plan is ideal for you and contact Kelly at [email protected]. A $15 discount is implemented for those who sign-up by the 15th of each month. List price is $50. 

Type 1 Diabetes Paired With a Paleo Diet

I have three main purposes for my website and one is to help educate consumers on the connection between nutrition and health, secondly to describe the philosophy of my counseling services to potential patients to distinguish it from other dietitians/nutritionists and thirdly, to act as a portal for people with type 1 diabetes and those interested in the care for type 1 diabetes to connect, communicate and learn.

That said, I am honored to share the experiences from Keith R. Runyan, MD, a physician in Florida, about his journey with type 1 diabetes.

So often I can write how the paleo diet has changed my life (diabetes), yet, when I see another fellow T1 experiencing similar things, I am inspired to share the story with my audience. Thank you Dr Runyan for allowing me to post this information and keep up the great work with your diabetes and helping your patients.

Dr. Runyan’s story goes something like this…

In medical school, I learned a tremendous amount of information about anatomy, histology, embryology, physiology, biochemistry, cell biology, and genetics, as well as most of the pathologic conditions that affect mankind.  Interestingly, the topic of how nutrition influences or causes disease was lacking.  Of course, we learned about vitamin, mineral, fatty acid, and protein deficiencies and their clinical presentations, but the idea that a diet which deviates from that on which humans evolved to thrive can cause numerous major chronic diseases was not covered or adequately emphasized.  So, over most of the past 20 years, I have been treating these diseases with medications and advice to see a dietitian, thinking that the dietician would be dispensing correct information about what my patients should be eating.

In 1996, I gradually became ill with weight loss initially, then later fatigue, polyuria (excessive urination), polydipsia (excessive thirst), and diarrhea.  Through the powers of denial, of which mine were strong, I was able to ignore these symptoms and continue working.  Even though my wife, other physicians, and nurses noticed the weight loss, I continued to believe the problem would go away on its own.  Eventually, in 1998, having lost 40 lbs. from my originally normal body weight, I could no longer deny I had a problem.  I saw a physician and had some tests run.  My blood sugar was 489 mg/dL, and obviously I had diabetes mellitus, type 1 in my case.  I started on insulin that same day with resolution over the next 2 weeks of the fatigue, polyuria, and polydipsia, but the diarrhea which turned out to be caused by diabetic autonomic neuropathy involving the intestinal tract would take another two and a half years to resolve.  With treatment of the diabetes with insulin and improved blood sugar control came the onset of severe and diffuse peripheral neuropathy with pain and numbness over most of my body.  I could not decide which was worse, the whole body pain or the diarrhea up to 20 times per day.  Fortunately, I did not have eye, vascular, or kidney involvement and that remains the case today.  The neuropathic pain gradually resolved over the next year, and the neuropathic numbness gradually went away after 2-3 years.  But, I did want to discuss the difficulty I had with controlling blood sugars while following the recommendations of the ADA (American Diabetes Association).  Ever since I was diagnosed with type 1 diabetes mellitus in 1998, the ADA has recommended a low fat diet in line with the dietary fat-heart disease hypothesis since heart and vascular disease is the most common cause of death of the diabetic patient.  Specifically, a dietary intake of 50 – 60% of calories from carbohydrates (carbs) has been recommended, some of which may be simple sugars.  In theory, I thought this seemed plausible, since the ADA recommended counting carbohydrate grams in the diet to be balanced with insulin, in my case, or other diabetes medications (for those with type 2 diabetes).  However, after 2 years of weighing my food or otherwise calculating the grams of carbohydrates eaten with each meal, there was no significant improvement in blood sugar control and no improvement in the number or severity of hypoglycemic episodes (low blood sugars).  So, I abandoned the carb counting and just tried to keep the intake of carbs constant with each meal.  At some point along this journey, I heard about the book “Dr Richard Bernstein’s Diabetes Solution”.  I did not read the book at the time, but found out about the “drastic” reduction in carbohydrates in the diet as the main feature of his approach.  The thought of giving up so many foods that I liked did not appeal to me.  I thought the fluctuations in blood sugar, hypoglycemic episodes, and my HgbA1c values of 5.6 to 6.9% were an inevitable part of having diabetes.  In addition, I assumed that if his approach was scientifically based and clinically effective, that the medical authorities (including the ADA – American Diabetes Association) would have also embraced this approach.  But the fact that they did not, added to my reluctance.  Well, I should have looked into that more at the time and actually read his book.  In 2008, the ADA for the first time acknowledged the use of a low carbohydrate approach for the purpose of weight loss in diabetics for up to one year, based on a recent study published in the medical literature.  They did not, and have not, embraced the low carbohydrate diet for all diabetics long term.

In 2007, my wife trained for and did her first triathlon.  I watched her first triathlon race and saw how she and so many others appeared to enjoy it.  I had not exercised on any regular basis since high school and since I had a chronic disease that might be helped with exercise, I decided to give triathlon a try.  I enjoyed the exercise and having a goal to work toward gave me the motivation I needed.  After a few years of increasing the distance of the triathlon events, I contemplated doing the full ironman distance triathlon.  I started looking into how to keep my body fueled and blood sugars near normal for the 12+ hours it might take me to do such a race particularly since sugar is the primary, if not sole, fuel used by athletes during a long distance triathlon.  This is what motivated me to discover the dietary change that I am currently enjoying.

In 2011, I reexamined my diet and studied the Paleo Diet (Loren Cordain, PhD), the low carbohydrate ketogenic diet for diabetes (Richard Bernstein, MD), and the low carbohydrate ketogenic diet for athletes (Stephen Phinney, MD, PhD, Jeff Volek, PhD, RD and Eric Westman, MD).  I have combined portions of both of these diets for myself.  The essence of the low carbohydrate ketogenic approach for diabetes is as follows.  Diabetes is a disease of carbohydrate intolerance.  Carbohydrates in the diet are not essential to the diet, only protein and fat are essential.  Near elimination of carbohydrates from the diet will maximally improve diabetes control, reduce insulin doses needed to control blood sugars in type 1 or insulin dependent type 2 diabetes, and in the case of pre-diabetes or early type 2 diabetes can normalize blood sugars without medications.  See Athletes page for more details.

I transitioned to this low carbohydrate ketogenic diet to address both of my issues, namely diabetes control and fueling endurance exercise with excellent results.  My blood sugars are better controlled and hypoglycemia is quite unusual.  I have had several blood sugar readings in the range of 46 to 60 mg/dl without any symptoms of hypoglycemia.  Readings this low prior to the ketogenic diet would have caused symptoms of hypoglycemia.  On the ketogenic diet, however, these symptoms are absent presumably due to the use of ketones by the body and brain.  I am able to exercise with no apparent loss of energy or power while consuming relatively little sugar during exercise to prevent hypoglycemia.  I measure my blood sugar while exercising usually every 60 – 90 mins or if I feel my blood sugar might be low.  My blood tests have improved in the typical pattern seen on a ketogenic diet. Triglycerides decreased from an average of 76 to 65 mg/dL, HDL cholesterol increased from an average of 61 to 90 mg/dL, the triglyceride/HDL ratio decreased from 1.31 to 0.72, the calculated LDL cholesterol increased from an average of 103 to 162 mg/dL.  The hsCRP (high sensitivity C-reactive protein, a marker of inflammation) decreased from 3.2 to 0.7 mg/L.  Of note, in my case, exercise did not result in a significant change in any of these lipid values, nor did niaspan or pravastatin (taken during different time frames).  The niaspan was discontinued 16 months prior to and the pravastatin was discontinued 4.5 months prior to these latest results.  Seeing that this diet actually worked for me and the scientifically proven health benefits of a well formulated low carbohydrate diet for treatment of obesity and numerous chronic diseases, I decided to add nutritional therapy to my medical practice.  In addition to review of books and literature, I am using the resources of the ASBP (American Society of Bariatric Physicians) in preparation for the board certification examination in obesity medicine (by the American Board of Obesity Medicine) in Nov. 2012.

What Does Dr Runyan Eat?
1.  Macronutrient Composition
Protein – about 0.7 grams protein per pound of body weight per day, currently 163 lbs X 0.7 = 114 grams per day.  This is close to what I ate prior to starting a ketogenic low carb diet.  This is in the range recommended for athletes (0.6 to 1.0 grams per pound of body weight per day).  I chose the lower end of this recommended range for two reasons.  First, I am doing endurance exercise rather than body building exercise and therefore need less protein.  Second, too much protein in the diet can interfere with maintaining nutritional ketosis since protein in excess of the body’s needs for production of enzymes, hormones, structural components, etc. can be converted to glucose which in turn would require more injected insulin and suppress fat burning and ketone production.  The protein in my diet comes from grass-fed beef, lamb, and pork (which is higher in omega-3 fatty acids than grain-fed), range-fed chicken, omega-3 enriched eggs (currently not range-fed), cheese (extra sharp cheddar, feta, and cream cheese primarily), fish (primarily wild caught Alaska salmon, but other varieties as well) and shrimp, plain Greek yogurt (10% milk fat), and nuts (primarily macadamia and pistachio).

Carbohydrates – about 40 – 50 grams carbohydrate per day.  I aim for about 30 – 40 grams from my diet, and during long exercise sessions (> 2 hrs) which generally occurs 2 days/week, I may take up to 24 grams of carbohydrate per hour while exercising to prevent hypoglycemia.  Carbohydrates in my diet come from vegetables (kale, collard greens, yellow squash, zucchini squash, brussels sprouts, lettuce, etc), and the small amount of carbohydrates contained in cheese, yogurt, nuts, cream, and 2 tbls lemon juice for salads.  I avoid all grains and foods made from grains, fruits (except tomato and avocado), potatoes, and legumes.  I take sugar (glucose) only to treat hypoglycemia or prevent it during exercise.

Fats – about 230 grams fat per day (about 100 grams saturated fat, 100 grams monounsaturated fat, 30 grams polyunsaturated fat, 6600 mg of omega-3 fatty acids, omega-6/omega-3 ratio of 3.6 to 1, and 600 mg of cholesterol).  Fat in my diet primarily comes from meat, tallow, eggs, fish, cheese, nuts, butter, heavy whipping cream, coconut oil, olives and olive oil.

Totals Calories = (114 grams protein x 4) + (45 grams carbohydrate x 4) + (230 grams fat x 9) = 2700 calories.  From a caloric perspective, 17% of calories come from protein, 7% from carbohydrates, and 76% from fat.

2.  Micronutrient Composition
I used the USDA nutrition data tables primarily to calculate the micronutrient content of my diet.  Using the Recommended Dietary Intake (RDI) values for my sex and age, I compared them to my daily intake.  My diet met or exceeded the RDI values.

3.  Fiber
My daily dietary fiber intake is about 18 grams/day, which is less than the recommended 30 grams/day.  This recommended figure is based on the belief that dietary fiber will prevent colon cancer.  I believe that colon cancer is not causally related to dietary fiber, but more related to a carbohydrate predominate diet since colon cancer is one of the many diseases of Western civilization.

In summary, I have combined most of the tenets from the Paleo Diet as outlined by Loren Cordain, PhD (except for the use of some dairy products, inclusion of more fat, exclusion of fruit) with a ketogenic low carbohydrate approach as detailed by Richard Bernstein, MD which I believe is optimal for those with diabetes.  This lifestyle has resulted in the best control of my diabetes to date and has the potential to minimize the many complications of diabetes.

Keith R. Runyan, MD
6499 38th Ave N., Suite C-1
St. Petersburg, FL   33706
Phone (727)345-3908