Tag Archives: low carb diets

Interview with Nathan Shackelford about Eating Low Carb

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I like interviewing different people who strive for glucose numbers as close to normal as possible because if that’s what non-diabetics have then that’s what I feel I should work towards (taking in consideration all kinds of factors, of course).  I’m not saying it’s the right decision for everyone, I’m just in the process of figuring out the best diet for me and I know others are on the same wavelength.  I think it’s important that we keep dialogue open about this and by talking with those who feel they’ve made a great decision for themselves we can keep the learning and exchange alive.

Nathan Shackelford is an art teacher, husband, father of three kids, and has had type 1 diabetes for about 26 years.  He also writes a great diabetes blog you can follow here.  Nathan has been eating low carb for some time and I wanted to hear his perspective about it and see what we could learn.

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Nathan, how long have you had type 1 diabetes?

I have been Type 1 since the summer of 1985, so it’s been about 26 years.

And how long have you been eating low carb?

I was motivated to qualify for life insurance in 2003, and going low-carb was one of the things that helped me to get my A1C under 7 so that I could be considered “healthy”. It worked.  Besides better A1Cs I’ve also benefitted from feeling better and getting healthier overall. It’s surprising how many aspects of your life can be affected by poor blood sugar control.

How low carb do you go? About how many grams of carbs do you take in a day?

I go pretty low. My only carbs are usually things like almonds and avocados, and green vegetables. I’d guess that I consume 20-30 grams of carb a day. At this level, carb counting doesn’t have as much of an impact. I find that meals with more protein are the ones that require the most insulin.

Why do you think low carb is the right way to go for you, personally?

I’ve done it both ways, and haven’t been able to get good results with even moderate carb levels. I’ve experimented to see if I can include more carbs and use more insulin and the results always have me back with higher A1Cs. In the day to day, I don’t really see major differences, but the average control over time shows that it doesn’t work as well. For instance, this past summer I took a trip to Europe with a student travel program. I didn’t want to work too hard at getting special food items for myself at hotels with the language barrier, etc. so I ate some of the starchy carbs that came my way and used more insulin. When I got back from my trip I realized that my glucose control was off for most of my trip, and I had picked up a few extra pounds as well. My A1C for summer was up significantly.

What’s a typical meal look like?

I usually have eggs for breakfast, sometimes on top of a pile of arugula. My favorite lunches are tuna salad or chicken salad with greens. Dinners are usually chicken, beef or fish with broccoli or cauliflower and salad. We do a lot of ethnic foods at home, so those look pretty different.

Why do you think so many people with type 1 diabetes choose not to try going low carb?

I think many of us think of eating “normally” as the measure for living a normal life with diabetes. I think if we start defining living normally as having normal blood sugars, we will make changes to make it happen. Carbs are kind of addictive, and most people don’t realize that if you can go for 4-7 days without them, you can leave them behind.

Some people forget to point out that for people who eat low carb, many eat loads of vegetables, which technically, are high in carbohydrate. Are you one of these people who eats a lot of low impact veggies?

My diet doesn’t look vegetarian at all. The protein and fat are the main source of energy and the vegetables are there because I love them. The ones I eat, though, are the types that have small impacts on my glucose levels. If I eat 2 cups of steamed broccoli it would have a pretty noticeable impact on my blood sugars just by quantity in my stomach. If I keep it at ½- 1 cup, it’s fine.

What do you think about the paleo or primal diet?

The Paleo/Primal diets have resonated with me because they are fantastic for diabetics. My sister is also a Type 1 diabetic and she and her family eat Paleo and it has solved many health issues for all of them. I have read the Paleo and Primal literature and think it’s a great thing for people to pursue for better health. I’m already living gluten-free because I don’t consume any grains. I still use cream in my coffee, but that’s the only dairy I typically use regularly. I don’t have any issues with dairy, so I’m not interested in eliminating it. I used to brew beer at home regularly, and that was one place where I was consuming gluten. I found out, almost by accident, that my body responds better to cider than beer. So, I’ve been making my own hard cider at home and haven’t brewed beer in several months.

Does your family eat like you?

My way of eating has impacted the family to some degree. We have less junk food around the house and our typical family meals are centered around protein. My son and my youngest daughter are starting to naturally eat the way that I do. It just appeals to them, and they are thriving. We still have potatoes or tortillas on the table with some meals, but they are not the focus of the meal. I think we have all become healthier since I started pursuing my health goals. People keep asking my wife what she’s doing to get so slim.

ShackelfordFamily

Where would Carmen San Diego be if she had diabetes?

I don’t know her very well, but, I think she’d be at her local farmer’s market geeking out on all the fabulous produce.

What’s the hardest thing about eating low carb?

I’m a pretty easy-going person, so I don’t like anyone to feel obligated to do anything special for me. I try not to put any special attention on what I do or don’t eat, but sometimes you realize that there’s not much in a meal that you can go after… like a spaghetti dinner with garlic bread. I can’t even just eat a polite portion of that. It’s not that I wouldn’t love that stuff… I guess trying to balance between “not being a pain in the neck” with taking the impact of daily food seriously.

You seem to be really optimistic about life with type 1 diabetes. Why is that and have you always been this way?

I’ve always been pretty upbeat about diabetes, despite the seriousness of the disease. My dad is a Type 1 diabetic and he always has had a good attitude about. He lives a rather normal life and views his glucose control as a puzzle to sort out, rather than a drag. You’ll often find him going for an 30 minute walk to get glucose levels back to normal. I find that curiosity about it keeps me motivated to know as much as I can and master it. Instead of accepting the idea that it’s going to derail my life and control it, I plan to be in control. Attitude has a lot to do with that, and I plan to win.

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I really appreciate hearing how someone fits this way of eating into their life and the reasons behind doing so.  I think the reasons for finding foods that lower insulin needs are compelling enough to consider very seriously.  Thanks so much for answering those questions, Nathan!

Remember to check out his blog: Edibles…(the diabetic edition)

The Case for Lowering Carbs, Part 2

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So continuing from The Case for Lowering Carbs, Part 1

I often hear/read people remark that so many diabetics have lived decades with 7% and 8% A1c levels and they’re fine. That’s all well and inspiring but I can’t count on that being what will happen to me. How many people with 7% A1c averages are no longer with us because of heart disease? How many people are dealing with complications of diabetes after only two decades with it? Two decades is nothing. To a person diagnosed as a child, a few decades means that their prime of life is going to be rudely interrupted.  Maybe that is why now that I’m done with the high carb needs part of my life that all young people go through, I feel like I really need to buckle down and get blood sugars as close to “normal” as possible.

Growing up people said to me, “I bet the toughest part of having diabetes is the needles isn’t it?” Or they’d substitute “needles” for “testing” or “counting carbs” or “feeling different”. I always felt misunderstood because my biggest issue with diabetes is that you can manage it really well and still suffer bodily damage. I may not have much for complications after 17 years with diabetes but I have other issues that doctors directly attribute to my having diabetes. All of these issues are a big deal to me.  Recently, a conversation with some ladies who’ve had type 1 for several decades made me realize that I’m realistic to expect more challenges or complications from here on out.

I’ve been thinking about how badly I really want to avoid complications. I’ve decided I want this badly. And if that means eating fewer carbs than I’d like in order to keep a low A1c without risking too many dangerous lows, I may have to suck it up for my ultimate desire of being healthy in 50 years. I don’t want to sit around regretting my actions or wishing I’d done different. The truth is that a healthy body makes me happier than just about anything else because of all that leads me to. But that’s just me.

Of course, maybe a lowered carb diet will be the thing to do me in. However, my thoughts return to the fact I have always understood about diabetes: that high blood sugars are extremely damaging to the body, especially in the long term. So I know I’m gambling, but I’m doing it in faith alongside all the hours of research I’ve put in and personalized knowledge of myself. I’m going to be lowering my carbs again and trying to see how that works. I won’t be going as low carb as Dr. Bernstein recommends, but a little lower than I am now. I will also try to eat only healthy fats and keep those to a minimum.  Sounds like I’ll be restricting calories a lot doesn’t it?  Low carb…low fat…well that’s possible.

If your belief or decision is different from mine, I don’t judge or blame you one bit. Everyone longs to live a happy and wonderful life on their own terms. That is as it should be.  Though I do consider taking good care of myself part of my citizen duties since my health or lack thereof does affect others.

I’ll keep you posted on how this goes.

The Case for Lowering Carbs, Part 1

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My brain is scrambled.

With much reluctance, I often ask myself this question:

What’s more damaging to one’s health?  A low carb diet or blood sugars higher than that of a non-diabetic?

The answer to this question is complicated because there are different things to consider:

  • Is a low A1c the healthiest A1c?  For example, is a 4.8 A1c better than a 6.2 providing there is a low standard deviation?  (it seems up for debate?)
  • Do I want to risk having a heart attack or stroke in 30 years and enjoy eating what I like in the meantime?
  • Do I want to endure a strict and limited diet in favor of more easily managed blood sugars?
  • What health issues can arise from low carb?  What health issues can arise from decades of higher than normal blood sugars?
  • Personally, heart disease and metabolic syndrome runs on both sides of my family.
  • I’m Hispanic, so a minority, and more susceptible to heart disease and stroke.

If you’re thinking, “low carb doesn’t mean well managed blood sugars”, well that is true.  However,  assuming you’re not struggling with the basics like the ins and outs of testing, giving insulin, and carb counting, in my experience is does mean well managed blood sugars.  (Key words: my experience)Because of The Law of Small Numbers, low carb really helps me avoid sharp blood sugar peaks and valleys.  The time I tried low carb, my A1c was a 4.6 and 4.7 and I’ve never felt so healthy in my entire life.  Right after that I got pregnant with twins so obviously I had to up my carbs for that.  Though, I still didn’t consume more than 120 carbs per day, even at 8 months pregnant.

But what about too many lows when striving for such a low A1c?  The thing is, if you have type 1 diabetes, low blood sugars occur from too much insulin and low carb means giving very little amounts of insulin, which typically makes it to where one doesn’t experience many lows or at least not many harsh lows.  (Again, assuming everything else is in place)  Low or lower carb helps me avoid more instances where I might get close to passing out from a quickly moving low and for me that’s like buckling up every time I get in my car to drive.

The danger with lows is always explained like this:  “The lower your average blood sugar, the increased likelihood that you will suffer from dangerous lows.”  This statement leaves out an important variable, which is the quantity of insulin given.  I’m not going to drop super low all the time if I’m giving a unit or two of insulin for a meal and have the correct basal rate.  And if I do go low, it won’t often be the type of low that requires assistance.  The times I’ve had wicked lows are the times I’ve had to give a lot of insulin to cover a high carb meal or to bring down a major high blood sugar.

If you’re striving for a low A1c and eat a diet relatively high in carbs, well then yes, you are risking too many dangerous lows.  My diet has lately consisted of more carbs and the extra amount of insulin I have to give is driving me nuts and driving me to eat less carbs.  I don’t want to just give more insulin because then I gain weight and deal with more ups and downs.  Right now, I’m a full time mom of twin toddlers, full time house wife, three meal a day chef, and a part time writer and blogger.  I don’t have the time or energy to tackle these blood sugars.  It’s overwhelming me.  But I also can’t use my current lifestyle as an excuse to have higher blood sugars.  That won’t make me feel better later when I’m dealing with the consequences.

By the way, my last A1c was 5.4 but my hematocrit was 39.7, slightly below 40 which I’ve understood lowers one’s A1c somewhat.  My meter tells me my A1c is more of a 6%.  I thought that was important to clarify at some point.

Anyway, as you see, I’m quite torn.  Torn indeed.  I know it’s not the right decision for everyone considering the multitude of variables involved but in this post I’m simply wondering if it’s the right thing for me, personally.  I will keep thinking on this…

Help me out.  What do you think?  Do you eat low carb or lower carb?  Why or why not?

Ketosis versus Ketoacidosis

Courtesy of Master Isolated Images

Courtesy of Master Isolated Images

 

I hear over and over again that low carb dieting can lead to ketoacidosis.  It’s confusing to me because of the people out there who thrive on very little carbohydrates.  How do they avoid diabetic ketoacidosis?  How have I in the past?  I looked it up and learned that: (and correct me if I’m wrong)

Ketones are organic compounds that result when body fat is broken down for energy.  If you lose, say, a pound of fat you will make ketones.

Ketosis is the presence of excess ketones in the body.  It is the continuous state of fat metabolism.

Diabetic Ketoacidosis (DKA) is a state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism.  The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes.

Ketones resulting from low carb dieting or from fat loss measure around 5 to 20 mg/dl while the quantity of ketones associated with DKA is quite higher.  The warning to diabetics is if one low carb diets and then has elevated blood sugars, they are perhaps more likely to reach a point of ketoacidosis sooner than if they had no trace or small amount of ketones in their system to begin with.

What I’m understanding is that low carb dieting in diabetics should only be done with very tightly managed blood sugars. 

I could be wrong.  But it seems people might confuse the two because I’ve heard people say that they wouldn’t limit carbs because they don’t want to go into DKA.  These people I’m referring to don’t have diabetes of any kind so that is where my confusion stemmed.  If you don’t have diabetes and you limit carbs for some reason, then the ketosis in the body is not going to lead you to DKA-it just means you’re a constant fat burning machine?

Any thoughts on this?

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