#9: My Ketogenic Low Carbohydrate High Fat Paleo Diet

This post describes what I eat with an update on my BG control for type 1 diabetes (T1D) at the end. I call it my ketogenic low carbohydrate high fat (KLCHF) Paleo diet (technically not 100% Paleo, but close enough). Often people view the term “diet” to mean something that is temporary for a specific purpose, usually weight loss. For me, it is a permanent way of eating now, and if I need to make a tweak here and there, that’s okay, but it will always be low in total carbohydrate and absent refined carbohydrates and processed foods. Carbohydrate is the macronutrient that raises blood glucose (BG) the most, so keeping them low is the primary goal. Of next importance is using whole foods which naturally have the necessary micronutrients and enough complete proteins to support my exercise. I had to add fat to my meals to replace calories from the omitted carbohydrates. My protein intake did not change after starting KLCHF. This way of eating has resulted in a significant improvement in my BG control for T1D and supplies my body with the energy, substrates, and nutrients to allow daily resistance and aerobic exercise.

To stay in continuous nutritional ketosis, I keep the total carbohydrate content at about 50 grams/day. I have counted it only a few times, but I am fully aware of carbohydrate content of foods and doubt it varies much from day to day. By monitoring urine ketones, blood ketones, and breath ketones (Ketonix), I have confirmed nearly continuous nutritional ketosis. Protein content is about 1.4 grams/kg body weight/day, so for my 5’8″ height and 166 lb. weight, that’s about 105 grams of protein/day. Fat content is fairly high as a percentage of calorie intake (about 75%), but the quantity of dietary fat (about 209 grams/day) is just enough to feel energetic and maintain a lean body composition.

Hunger has never been a problem for me, but has become even less noticeable since starting my KLCHF diet. I eat breakfast (8 am) and dinner (6 pm) at about the same time each day. I started skipping lunch (thus eating two meals a day) in 2001 to avoid taking insulin with lunch to decrease the likelihood of hypoglycemia while at work. Eating at regular times is not absolutely necessary with T1D treated with insulin analogs, but I prefer a regular schedule because I do think my insulin sensitivity changes throughout the day particularly after exercise and this affects the mealtime insulin doses needed.

What I Cook & Eat

  • Beef, grass-fed, including skeletal muscle (65% lean), heart, liver, and kidney
  • Fish, mainly wild Alaskan salmon
  • Pork sausage and bacon (both uncured)
  • Lamb occasionally
  • Chicken & Turkey occasionally
  • Eggs (chicken)
  • Non-starchy vegetables (about 5% carbohydrate content by weight)
    • Cabbage (Red, Green, Napa), Kale, Collard Greens, Spinach, Bell Peppers, Carrots, Leeks, Onions, Mushrooms, Brussels sprouts, Home-made Sauerkraut from Red Cabbage, Bok-Choy, Broccoli, Cauliflower, Yellow Squash, Zucchini, Cucumber, Lettuce (Iceberg & Romaine), Turnip Root, others I’m not recalling.
  • Fruit – Avocado, Tomatoes, Olives, Strawberries, Blueberries, Blackberries, lemon juice on fish and salads
  • Nuts & Seeds – Pepitas, Macadamia, Brazil, Pecan, Walnut, Pistachio, Cashew
  • Fat – Butter, Coconut & Olive Oils often, Cheese rarely (all these added fats are admittedly processed)
  • Note: I developed an intolerance to milk prior to my diagnosis of T1D. I did try heavy whipping cream after starting my KLCHF diet, but am also intolerant of it.

What I Drink

Water (filtered by reverse osmosis), Unsweetened Tea & Coffee

What I Don’t Eat

  • Grains – Wheat, Corn, Rice, Oats (there are many more) or anything made from them, which is too numerous to list here. Gluten is a protein present in a number of grains (all varieties of wheat including spelt, kamut, and triticale as well as barley and rye.) which can cause a number of medical problems for a significant portion of the population with gluten sensitivity or celiac disease. In my case, I avoid them due to their carbohydrate content.
  • Starchy vegetables – potatoes, sweet potatoes, yams, most root vegetables (turnip root okay), peas
  • Legumes – peas, beans, lentils, peanuts, soybeans
  • High sugar fruits – includes most fruits except berries, see above.
  • Sugar and the fifty other names given to sugar.
  • Vegetable Oils (really seed oils) – Canola, Corn, Soybean, Peanut, Sunflower, Safflower, Cottonseed, Grape seed, Margarine & Butter substitutes, Shortening.
  • All Processed Food-like Substances (except as listed above) i.e., most of what is in the grocery store.
  • I avoid restaurants except when traveling, and then order fish or steak with plain steamed non-starchy vegetables (no gravy or sauces that typically contain sugar, cornstarch, or flour).

What I Don’t Drink

  • Colas (both sweetened and unsweetened).
  • Fruit Juice except small amounts of lemon juice.
  • Alcohol (can cause hyperglycemia or hypoglycemia in persons with diabetes).
  • No artificial sweeteners, don’t need or like them.

Simple but Effective for Managing T1D

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Breakfast – Wild Alaskan Salmon, Home-made Sauerkraut, olives, coffee

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Dinner – burger, cabbage, collard greens, turnip root, butter

There are additional images of my meals on twitter @KeithRunyanMD

Below are the actual blood glucose results and insulin doses for the previous 4 weeks.

Last 4 weeks ending 11:28:15

Below are the distribution of BG values in the ranges shown on the x axis for the past 4 weeks. The percentage of values <51 mg/dl was higher than usual and is not intentional. None were symptomatic which is good if that is due to brain utilization of ketones, but potentially dangerous if due to hypoglycemia unawareness (this was discussed in a previous blog post). Of the BG values < 51 mg/dl, 38% occurred before dinner due to my afternoon exercise, and 44% occurred after dinner due to my mealtime insulin dose being too high in light of the exercise. I don’t normally have this much hypoglycemia related to exercise, which indicates my basal insulin dose is too high at this point in time. I’ll be decreasing it from 22 IU/day to 20-21 IU/day to reduce the frequency of hypoglycemia.

 

Last 4 weeks BG freq

In the next post, I discuss blood glucose variability in T1D and post my results before and after starting the LCHF diet.

Till next time….

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13 comments

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