‘Hands Down’ the Paleo Diet is the Best Solution for this Case of Diabetes

Thanks to social media I was able to connect with yet another fellow health advocate, using the paleo diet to control his type one diabetes. The below interview was held with the writer of Intrepid Pioneer, a site about modern homesteading principals.

Perhaps, you as the reader, can connect with this interview and maybe find yourself inspired to optimize your diet. Feedback is welcomed.

Cheers to you and good health,

Kelly

How long have you had diabetes?

I was diagnosed May 2011 during my routine annual physical. At that time my blood sugars were up around 360 and my AC1’s ran around 12.3. At first I was treated as if I was a Type 2 with Metformin. The medicine only helped to control my blood sugars down to around 250 or so. At that time my endocrinologist informed me that I probably have LADA or Latent Autoimmune Diabetes, which basically has been coined type 1.5 Meaning I developed adult on-set Type 1. My father has had Type 1 all his life and was diagnosed as a child.

What eating regime have you found to be most helpful in managing stable blood sugars and how did you come to find this diet?

Paleo, hands down, without a question. It took me some time to get there. I had tried Weight Watchers, and measure portions, etc. but I still just felt that each time I checked my glucose it was a crap shoot. I eventually did the Advocare 10 day cleanse and my blood sugars stabilized. Next I started researching Paleo and ultimately I ended up taking on the Whole 30 challenge. That was it and I’ve been keeping a food/exercise journal since Jan. 2013 and am now able to completely understand how my body metabolism it’s sugars. Sometimes my glucose is a surprise to me and when that happens I can look back through my food journal to see just what I ate or did for that number (good or bad).

What main improvements in your health have you observed, diabetic-related or not? 

I’ve lost about 15bls and I am exercising on a more regular basis and enjoying it. Whereas I used to say the only time I ran was when I was being chased and now I’ve let a buddy talk me into running a Rock and Roll half-marathon in 2014. Plus, I’ve started doing Crossfit and I love strength training, lifting weights and the intensity that Crossfit brings as well as the community of likeminded no-bullshit real people.

Do you find the diet realistic and something to maintain long term? Would you recommend it to others managing their diabetes? 

Yes, not only do I feel better, and have tighter control over my diabetes, I absolutely recommend it to anyone. Here’s the deal too that I like about Paleo – it can be as strict as they want or modify it to fit their lifestyle. For example, I am a home brewer and I love beer AND I love cheese. Those two delicious pieces of goodness I will never give up, so instead I gave up hot, fresh, warm bread and pasta. It’s all about choices.

What does a typical day of food look like to you? 

Easy. Take today for example:

6:30a – BG 82mg/dl
20oz black coffee and 1 banana (it was a rough morning, sometimes I eat eggs or I’ll make a protein shake)

8:30a – 103 mg/dl
another 20oz Black coffee

9:35a
1 apple and 1/3c raw almonds

11:15 – BG post snack 125 mg/dl

12p
1 salad (bib lettuce from my garden), with radishes, scallions, cucumbers and 1/3c raw sunflower seeds, a little goat cheese and rice vinegar dressing. 1 large avocado and a 12oz can of seltzer water.

1:15 BG post lunch – 97 mg/dl

2:45p
1 string cheese and an organic raspberry yogurt.

7:50p 237 Pre dinner (went out to a pub for Guinness and ate happy hour bar food)

9:45p 155 post dinner (took 8u fast acting w/dinner since I was so high from the bar food)

Here’s another example:

6:05a 138 fasting

6:30a 2 eggs over medium + 1 banana

8:45a 160 post breakfast

9a 20 oz black coffee

10 a 1/3c raw almonds and an Asian pear/apple

11:15a Turkey burger with mustard 2 slices whole wheat and cheddar) not paleo I know 🙂 Wanted the carbs for my workout.

11:30 2 servings of my C4 pre-workout drink

12 Crossfit during lunch

1p 2 servings whey protein shake post w/o

3p 127 post shake

7:15p Paleo Chicken in Mushroom coconut sauce over quinoe and garnished w/scallions + 1 glass red wine

9:05p 106 post dinner

Pick any day of the week and or specific day (this year) and I can tell you what I ate and when. I realize today might be the best example of a day.

What is the best thing about the diet? 

If I fall of the wagon for some reason and eat some chips or red vines (my kryptonite) I don’t feel guilty, like I did in the past when I tried Weight Watchers. I still mark it down in my journal, take it as head nod and move forward. You can make what you want of eating Paleo, be strict, or give yourself a cheat day. I love eating real food, that’s not prepackaged crap, I feel healthier and have more energy each day.

Any tips for someone getting started on this type of diet? 

Plan. For me that is the most essential thing. I found that when I didn’t plan, I fell off the wagon and I only had me to blame. It’s easy to do, but to stay focused you just have to plan. When you know what your meals are for the week, you can get home from work and then get at it in the kitchen. No excuses.

Anything in addition you’d like to say? 

Since eating the Paleo lifestyle, and I hate it when one calls it a diet because then it feels temporary, I’ve pretty much stop taking my fast acting mealtime insulin. Meaning I only inject fast acting when I know I’m having Pizza for dinner as a treat, or for a thanksgiving meal, etc. My long acting insulin has reduced by over 10 units since starting this diet. All of that said, Paleo is great and it all tastes so good because it’s real food, but I have found that I also need to exercise, eating Paleo combined with exercise has yielded dynamic results. My endocrinologist was blown away by all that I had done, reduced my insulin injections and basically had my A1C’s in check — my last appointment I was 7.3. Still a bit more to go but the last time I was pushing 9 just six months before.

Lastly, some may say that eating Paleo is expensive, I would then ask, which is more expensive paying for real, quality food, or paying a doctor/insurance company for advice and then paying for an prescription? It’s all just choices.

 

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,

Kel

Input from Crossfit Owner, Low Carber Managing his Type 1 Diabetes – @Type1CrossFit

I had the pleasure in the last year to cross paths with Eric Pelletier, thanks to social media, and am thankful to see someone also living with type 1 diabetes and not being afraid to push their themselves physically and mentally to be in the best care of their ability. Today’s post captures an interview with Eric, and can be helpful to many others looking for inspiration and understanding on adapting to a healthy lifestyle for stable blood sugars and an optimal quality of life. Thank you for your time Eric!

Please tell us a little about yourself. From your social media updates, I see you are eating rather low carb and perhaps playing with some intermittent fasting (IF)?

You are correct I am still dabbling in IF and trying to maintain ketosis regularly. I also own Type 1 CrossFit in Wheeling, IL so it makes for a badass platform!

A little bit about me? Well I was diagnosed with Type 1 Diabetes at 28 days old. I am 26 now. For most of my life I was spoon fed a traditional diet (Food Pyramid) and put on an insulin sliding scales to maintain blood sugar levels. As a kid and through high school I was not very athletic; bowling. I was always afraid of what would happen if I went to hard and did not know how to manage my blood sugar levels.

Fast forward a few years, I began working at Naval Station Great Lakes in the Fitness Center and in this location I was introduced to CrossFit. When I heard about it I went home and read What Is Fitness and Foundations and it was like a light bulb clicked on. I was hooked as what I was reading made so much sense. Low carbohydrate diets, coupled with high skill movements, performed in a fashion that maximized results. Yep. I was hooked. 4 years later I am currently located at 9 Huntington Lane, Wheeling, Il, 60090 with Type 1 CrossFit.

What diets or food plans have you tried to control you blood sugar, and what has been the easiest and most successful? Why?

The easiest and most successful program sits beautifully inside my Diabetes management brainchild, but it is a diet void of food allergies or sensitivities, a diet that ensures maximum insulin sensitivity, and optimizes nutrient intake. If I remove things that cause problems in blood glucose levels/are inflammatory, minimize insulin needs, and eat vitamin and mineral rich foods, I don’t see how ANY case of diabetes is hard to manage. Think about this.

You only get one or a zero. Do you eat vegetables at every meal? Do you eat protein at every meal? Do you eat fat at every meal? Do you limit carbohydrates to post workout, primarily? Have you eliminated potentially problematic foods to see what happens? If you said no to any of these things, you are not doing what you could to optimize your health.

Personally I have also played with intermittent fasting as I find it quite fun, and very good at returning insulin sensitivity after maybe a tough training cycle or a bad eating day.

When you do intense workouts, such as Crossfit, how do you stabilize your blood sugar. Do you eat before/after and what do you do with your insulin dosages?

In my gym I always have juice on hand and insulin around. For me, as long as my blood sugar is in a good range, depending on what the workout is will depend on how I take care of it. Very short couplets get a nasty spike, so I bolus pre workout. Longer (15+) get a spike and then a drop so I will pace at about 80% and make sure to test immediately after to ensure I don’t drop too bad. Strength and skill pieces cause a drop due to the lack of “balls to the wall intensity.”

When you eat or have eaten a ketogenic-like diet, how is your insulin sensitivity affected?

Eating a ketogenic diet or IF, my insulin sensitivity is amazing! Here is a beautiful analogy! Spray perfume in a room and at first you smell it really strong right? After a few minutes you lose the sensitivity to smell it. In order to re-sensitize you have to either spray MORE or leave the room. In the case of the diabetic, MORE means more insulin which leads to fat gain, heart issues, and potentially many more issues. The other option is the remove the need to produce or TAKE insulin. Absence makes the heart grow fonder, and in this case, growing fonder means increasing sensitivity  Your body doesn’t realized the potency of what it had (good or bad) until it’s gone.

Before anyone else that has type 1 diabetes attempts a ketogenic diet, what do you first recommend before jumping in? For example, move to a moderately low-carb diet, and then tinker into ketosis, etc?

Be aware, your basal needs will drop DRAMATICALLY! Your body is at a baseline requirement level in relation to the current diet you have and what you are doing. If you make a dramatic change, it only stands to reason that your insulin needs need to change as well. I notice in online communities that this idea is overlooked. If your baseline levels are running lower (hypo), doesn’t it make sense to reduces your baseline insulin? Yes. My recommendation is to first and foremost, remove some potentially problematic foods. Wheat or dairy at first, and if you are eating sugar as a regular part of your diet, and not as a requirement to maintain a normal blood sugar, address that too. Remove one thing, adjust insulin, and repeat.

Kelly: As a dietitian working with many other patients with diabetes, changes need to be adapted slowly. It’s too hard to generalize what to do on a website, as we are all coming from different places. Work with a healthcare professional when making such changes. And of course, I am always happy to help. 

As for food groups or ingredients, are there any certain things you avoid, such as gluten, soy, dairy, etc? How does the avoidance or inclusion of certain foods help manage your blood sugars?

Gluten is terrible. End of story. Dairy, even with no carbs in it (cheese) causes a huge spike. I also find that if I have a big meal with virtually no carbohydrates (save veggies) I have an automatic increase in insulin sensitivity, and by default, lower blood sugars.

Kelly: I want to also add, in case anyone with type 1 diabetes is reading this post, overall this is general information. When eating a low carb diet, which may not include many carbs per meal, you still need to cover your meal for protein can convert into sugar. Please work with your team, myself included, to assess what the best protocol is for you.

How have your labs changed since adjusting your diet to low-carb?

My labs have improved greatly. At one point in my life I have hit 11 on my A1C. Recently I was at 6.5. not too bad for a lifer with this!

Some final thoughts:

Fix your food first. Do not fall victim to the idea that exercise will fix it all. If you eat poorly so as to induce inflammation, insulin insensitivity, and lack vital nutrients, you do not need to exercise. It may actually make it all SO MUCH WORSE.

Ask yourself this, why are you eating so many carbohydrates when the result is the need for insulin. Insulin managements and blood glucose management are the hallmark of BOTH cases of Diabetes. Why would you eat in a way that induces complications to that maintenance  That’s like being allergic to bees and kicking a bee hive. Not only is it crazy to do, but it does NOTHING to improve your health.

Where to find Eric:
@Type1Eric
@Type1CrossFit
www.facebook.com/crossfitovercome (soon to be /type1crossfit)
Email: [email protected]

As If We Are Scientiest

Ever since I was diagnosed with type 1 diabetes at the age of 8 years old in 1992 I began to learn and understand that my activity, food choices, and mental health all had an impact on my diabetes, or what we check multiple times a day, my blood sugar. Can it get frustrating? Yes; I’m preaching to the choir. But it’s interesting. This situation (as in no one day is the same) allows me to understand my body in a way that others aren’t able to do (is this the silver lining??). I can truly assess how certain foods make me feel (energy, mood, mental clarity, blood sugar response, etc) and affect my insulin sensitivity.

Overall, I feel like a scientist when learning how to manage my diabetes and through the last 21 years I have most importantly learned, “There is no such thing as failure. It’s simply feedback. Assess, roll with the punches and carry-on.”

Sure it is easy to get down on myself when I slip up on diet, dismiss exercise and have a sub-optimal blood sugar reading to show for it, but what is that going to do for me? Nothing, and certainly nothing good. The right thing to do is to understand why a blood sugar is high or low (which sometimes can’t be pin-pointed) and think of a way how in the future, I can prevent the situation.

Having type 1 diabetes for 21 years and counseling others with type 1, type 2 and gestational diabetes I have learned:

  • what macronutrient ratio (number of carbohydrates, verse fat verse protein) work best to have at each meal. For example, I do far better on a low carb diet where the margin of error is less when matching my insulin to my meal/carbohydrate content. Thanks to Dr. Bernstein’s book, Diabetes Solution, I truly grew to appreciate this concept. 
  • Firstly realizing this with myself, I do not thrive on gluten containing grains. Indeed, when I would eat whole grain bread my blood sugars were tougher to control (I did not fully realize this until 2009 when I did a 4 week gluten free diet; and I have been tested twice for celiac with negative results). Furthermore, looking at the data I am not the only person with diabetes finding this relationship. Research suggests that 10% of those with type 1 diabetes has celiac disease and this does not even encompass those with gluten sensitivity. Adding to this foreseen correlation a recent study just came out last year showing that a gluten free diet put a newly diagnosed 5 year old boy’s type 1 diabetes into remission. 
  • Supplements can have a place for people with diabetes. Especially real food supplements (I do not advocate synthetic supplements). I think the topline most important supplements are those that help strengthen our gut integrity and immunity. This can include fermented cod liver oil, vitamin D and a probiotic. Additional supplements can be of use, including chromium picolinate, gymnema sylvestre and magnesium.  
  • Sleep is crucial. If you have diabetes have you ever noticed an increase in insulin resistance with little sleep? When my sleep is rough, I can easily see an increase of 30 mg/dl+ in my readings. This starts in the morning and throughout the day I will notice an increase in cravings as well. talk about a lose-lose situation. 
  • Stress can act like a spoonful of sugar sometimes too. Can you relate with what I am saying? Even good stress can make my blood sugar go up. For example, I do a lot of public speaking and with this event, I am excited to present but have some nervous nerves and if I don’t give a small bolus I end-up with hyperglycemia. Managing stress is just as important in making smart choices of what to put on our plates. 
  • Exercise is so important (as if you already didn’t know). But this month, along with numerous other studies, a study published in Diabetes Care found that people with type 2 diabetes had better blood glucose control and an improvement in body composition. Besides this current study exercise (including walking, swimming, playing, tennis, you name it) can help your release stress, sleep better, have a more positive outlook on life and more. 
The underlying message here is that diabetes does bear a challenge, but it also gives us insight on what works for us. My diabetes is a daily reminder to not only count my blessings, but to push myself to be the healthiest I can be. We have to take the good with the bad and when our diabetes act up, we need to remind ourselves to take our emotions out of the equation and absorb the information as feedback. It’s as if we are our own scientist working on a daily experiment of optimal health.
Cheers to you and good health,
Kelly (Registered Dietitian Nutritionist)

Clean, REAL Food Desserts

I wish I could claim these awesome, paleo and diabetic-friendly desserts, but they were both basically spoon-fed to me and I could not get enough. Enjoy. Gobble, gobble.

Pumpkin “Ice-Cream”

  • 2 Bananas, frozen
  • 1/2 c. Pumpkin purée (good on you if you roast and puree your own. However, we realize that is not always realistic)
  • 1/4 c. Almond milk, coconut milk, or milk of choice
  • 1/4 tsp. Pumpkin pie spice mix
  • Honey, raw, to taste

Throw in a foods processor and enjoy.

 

Chocolate, Almond Pudding

  • Coconut milk, 1 can
  • Almond butter, crunchy, half to 3/4 of jar
  • Hershey’s cocoa, to taste (~1/2 cup)

Mix all together and die in chocolate goodness. As well, you can vary the measurements of the listed ingredients to adjust the texture.

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…

Background
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

 

5 Ways to Enjoy Pumpkin

If you have been following my tweets you may well know my recent love for pumpkin. It. Is.Amazing. Certainly satisfies any taste and easy on the blood sugars. A few ideas for pumpkin include:

1.Pumpkin Soup  – First peel an pumpkin, cube and then roast in the oven. Once tender blend together ingredients such as cinnamon, nutmeg, coconut milk, onion, pepper, sea salt and a touch of honey.

2. Pumpkin Porridge – On a Sunday I will roast a whole pumpkin or throw a diced pumpkin in the slow cooker to have on hand during the week. This comes in handy, especially early mornings when I am pinched for time. My pumpkin porridge includes 2 eggs, 1/4 cup to 1/2 cup of pumpkin, cinnamon, sea salt pecans/macadamia nuts all mixed together and microwaved in a coffee mug. Viola.

3. Roasted Pumpkin – As simple as it sounds, I reheat pumpkin and add some spice to my liking. Paprika and pumpkin marry well and go nicely with 2 poached eggs or grilled fish.

4. Pumpkin Dessert – I reheat pumpkin again with a concoction of coconut milk or flakes, cocoa nibs and cinnamon. If I have a really bog sweet tooth, I will drizzle some honey on-top.

5. Pumpkin Salad – Pumpkin over some fresh greens, pine nuts and homemade balsamic dressing is an easy and go-to dinner for me this season. The fiber keeps me full and the pine nuts have the perfect taste. If I want a little sweetness to my salad, I will also throw in some raisins.

As you can see pumpkin is so versatile. Do you have a favorite way to eat it? One thing is for sure – while it’s easy to buy pumpkin in a can (especially in the US), it is much better to buy and roast one, eliminating the preservatives and package contamination. Good health, often takes an extra step but is always worth it.

Cheers to you and good health,
Kel

An Image of Health

I will never forget when my good friend’s mom approached me (two plus years ago) at her wedding shower and said, “Kelly you are just the image of health.”

Me, in my mind thinking, “really, do you know what my A1C looks like?!” But instead, replied to such a compliment with pleasure. It was really nice and has clearly stuck with me over the years.

So what do I think? Am I an image of health?? First begs the question, what is health?

  • I am an ideal body weight, even though I wrestle with 5 or so pounds year-round.
  • I work out a fair bit, but not too much. Maybe a pilates, spinning or yoga class a week. A session on the stair-climber with weight lighting, more weight lifting and walking (of course). I LOVE walking when time allows.
  • I do not drink my calories. My liquids usually include tea, water, more tea, long blacks (but trying to cut back because I want better sleep) and occasional diet cola. Oh, a fair share of red wine too. Can you blame me?
  • I avoid grains like the plague.
  • I try to not take life too seriously.
  • I skip legumes in my diet, well except a bluemoon craving for peanut butter.
  • I motivate others to be an advocate for their health.
  • I believe in taking risks.
  • I seek adventure (I am wearing the blue helmet).

And as far as diabetes goes:

  • I visit my Endo 3-4 times a year, as well as my dentist, ophthalmologist, optometrist and Women’s Health doc,
  • I use an insulin pump, but I do not change the infusion set every 3 days as I should. I likely change it when I get an alarm telling me the volume of insulin is low.
  • I have no idea when the last time was I changed my lancet.
  • Yet, I do test my blood sugar 6-10 times a day. Have you seen my fingers?
  • But that A1C, which is supposed to be 6 or below, is an ongoing battle, or can I say, experiment.

Thankfully for a paleo-like diet, I know what I need to do to keep a stable blood sugar. Instead of consuming grains, legumes, corn, soy, vegetable oils and dairy, I resort to high quality meats, eggs, nuts, fish, vegetables, olive oil, butter, coconut, fruit, potatoes (sweet) and white rice. The latter gives me such amazing energy and when I am diligent with my food choices, I feel great.

So going back to question, “Am I an image of health?”

Yes. Yes I am and you can be too. I am nutrient seeker, I am happy, I work hard on my diet and well-being, I count my blessings and I am passionate about helping others optimize their food choices.

Put your best foot forward today by taking care of yourself. If you need any help, that is what I am here for.

Cheers to you and good health,
Kel

Positive results from first human clinical trials of a first-generation artificial pancreas system

WEST CHESTER, Pa., June 11, 2012 – Results from the first feasibility study of an advanced first-generation artificial pancreas system were presented today at the 72nd Annual American Diabetes Association Meeting in Philadelphia. Findings from the study indicated that the Hypoglycemia-Hyperglycemia Minimizer (HHM) System was able to automatically predict a rise and fall in blood glucose and correspondingly increase and/or decrease insulin delivery safely. The HHM System included a continuous, subcutaneous insulin pump, a continuous glucose monitor (CGM) and special software used to predict changes in blood glucose. The study was conducted by Animas Corporation in collaboration with JDRF as part of an ongoing partnership to advance the development of a closed-loop artificial pancreas system for patients with Type 1 diabetes.

“The successful completion of this study using the HHM System in a human clinical trial setting is a significant step forward in the development of an advanced first-generation artificial pancreas system,” said Dr. Henry Anhalt, Animas Chief Medical Officer and Medical Director of the Artificial Pancreas Program. “It lays the foundation for subsequent clinical trials, bringing us one step closer to making the dream of an artificial pancreas a reality for millions of people living with Type 1 diabetes.”

In June 2011, Animas received Investigational Device Exemption (IDE) approval from the U.S. Food and Drug Administration (FDA) to proceed with human clinical feasibility studies for the development of a closed-loop artificial pancreas system. The company partnered with the JDRF in January 2010 to begin developing such an automated system to help people living with Type 1 diabetes better control their disease.

“We are encouraged by the results of the first human trials in this partnership with Animas,” said Aaron Kowalski, Ph.D., Assistant Vice President of Research at JDRF. “An artificial pancreas system that can not only detect, but can predict high and low blood sugar levels and make automatic adjustments to insulin delivery would be a major advance for people with Type 1 diabetes. Such a system could alleviate a huge burden of managing this disease.”

About the Studies
The trial was a non-randomized, uncontrolled feasibility study of 13 participants with Type 1 diabetes at one trial site in the United States. The investigational Hypoglycemia-Hyperglycemia Minimizer (HHM) system was studied for approximately 24 hours for each study participant during periods of open and closed loop control via a model predictive control algorithm with a safety module run from a laptop platform. Insulin and food variables were manipulated throughout the study time period to challenge and assess the system.

The primary endpoint was to evaluate the ability of the algorithm to predict a rise and fall in glucose above or below set thresholds and to command the pump to increase, decrease, suspend and/or resume insulin infusion accordingly. The secondary endpoint was to understand the HHM system’s ability to safely keep glucose levels within a target range and to provide guidance for future system development. The study also examined the relationship between CGM trends and the control model’s algorithm for insulin delivery.

Source: Tonic Life Communications