Lately, people seem very curious about how I’m fuelling my swim training using a low-carbohydrate approach. I get lots of incredulous questions– ‘You eat only THIRTY GRAMS of carbohydrates a DAY?’, and people often seem mystified by my food choices. So let’s go there. Let’s talk why, and how, and what on earth I eat on a low-carbohydrate diet that keeps me full, fuelled for long distance marathon swimming, and achieving awesome diabetes control and a stellar HbA1c of 5.1%.
Here’s the story:
I have eaten a low-carbohydrate diet since about a year post-diagnosis, so since early 2002. I have pretty much eliminated grain-based foods (bread, pasta, rice, cereals), processed foods and most fruits in favour of non-starchy vegetables, meat, fish, eggs and nuts, berries, and full fat dairy products. These days, you’d probably call it somewhere between a ‘paleo’ diet and a LCHF (Low Carb High Healthy Fat) diet. Back when I started eating this way it was not sexy or fashionable, it was just a bit weird. Now it’s kind of in vogue, which is nice because it makes navigating social situations easier and I feel the need to explain (or defend) the way I eat far less often. That said, it’s not that controversial – I’m just eating real food!
Why do I eat low-carb?
To me, it is totally illogical to tell a person who cannot metabolise carbohydrate to eat it constantly. And yet, this is the advice I received on diagnosis: eat according to the Australian Guide to Healthy Eating. This meant eating 8-12 serves of grain-based foods, high sugar fruits, and starchy veges every day, and taking industrial doses of insulin to cover the food. I dutifully ate according to the advice: cereal and toast for breakfast, sandwiches and fruit for lunch, pasta for dinner. My sugar surged high after every meal, because synthetic insulin is a woefully blunt tool – it is simply unable to work as fast or as sensitively as the non-diabetic insulin response. No matter how accurately I counted my carbs, or how carefully I calculated my doses, the insulin could not effectively deal with the tsunamis of glucose charging into my system, so I rode high, and then swung low, after nearly every meal. It was a crazy rollercoaster ride. I couldn’t exercise – all the insulin constantly circulating sent me crashing low. I even feared sleep because of my volatile levels.
Eight months in to my life with type 1, I remember thinking to myself: this is unacceptable. I have had enough. And I am not prepared to do this for the rest of my life.
So at eighteen years old, I took control; I went searching for a solution. I had read about a low-carb diabetes doctor online called Dr Berstein. Bernstein is an interesting cat: an engineer-turned-endocrinologist who lives with type 1 and for a long time was the sole, heretical voice taking on the establishment and speaking to the benefits and logic of a low-carb approach to managing diabetes. He now has a powerful following of people with type 1 who are changing the diabetes nutrition paradigm through a dynamic online community called TYPEONEGRIT. I ordered Bernstein’s seminal text ‘Dr Bernstein’s Diabetes Solution’ from the USA, saving up my $11 an hour wage from the video store I worked in to send away for it. It took six weeks to come, and when it arrived, everything changed.
Loosely following Bernstein’s protocol, I dropped carbohydrate back significantly and almost overnight life changed for the better. My glucose levels stabilised, I dialled back my massive doses of insulin to 25% of my previous total, the error margins in my calculations were vastly reduced, I stopped having wild highs and crazy lows, I stopped gaining weight, and I could contemplate exercise again. I could do things I could not have done if I’d remained on the rollercoaster: sleep through the night without fear, go for a run confidently on my own. It took commitment, creativity and a bit a discipline, but it was worth it a thousand times over.
Fast forward sixteen years and here I am, taking low-carbohydrate eating for type 1 management to the next level: becoming a fat-adapted athlete.
I started looking into fat-adaptation about four years ago when I was contemplating a long distance mountain bike race. Previously, when racing, I’d broken with my low-carb approach and thrown myself on the mercy of accepted sports nutrition advice: carb-loading to force glycogen into muscles, and relying on gel shots throughout races to fuel performance. I was fuelling with glucose, because that’s what athletes were advised to do and I thought it was the only way I would be able to perform.
It was a total diabetes nightmare. I remember starting an Olympic distance triathlon in Mooloolaba with a blood glucose of 17 after a standard-issue breakfast of oats and banana, having had to reduce my bolus so as not to go low while racing, but enduring two hours on the start line of thirst, anxiety, extreme fatigue – and then a crampy, terrible race trying to run my BG down. This happened over and over, race after race.
Then, a book by an exercise physiologist and a doctor (Volek and Phinney) called ‘The Art and Science of Low Carbohydrate Performance’ arrived on my radar. It wasn’t anything to do with diabetes, but it fitted with my food paradigm and it offered up some mind-blowing thinking: instead of relying on glucose to fuel activity, it is possible to eat in such a way that trains the body to burn fat preferentially to glucose. It made total sense. Stored glucose offers up about 2000 calories of energy, totally depleted in a mere couple of hours – whereas utilising body fat provides an almost endless supply of energy, allowing for consistent fuel for performance. The added bonus for me as a type 1 diabetic was obvious: I could fat-adapt, exercise relentlessly, and still achieve stable glucose levels. The holy grail.
I had to try it. It took about four weeks to properly ‘adapt’ by eating according to a modified macronutrient ratio: higher fat, moderate protein, and very low carbs. I upped my fat intake signifcantly, mainly relying on healthy sources of monounsaturated fat like olive oil, avocadoes, macadamias and walnuts – and also slightly increasing saturated fats like butter and coconut oil, satisfied that the heart health/sat fat connection has been roundly destroyed in recent research. I dropped my carbs to less than 30 grams per day, sourced mainly from non-starchy veges. Protein remained pretty steady – protein makes me feel full, and so is pretty self-limiting.
It worked. I remember racing for hours and hours around that mountain bike course, smiling the whole way, with a perfectly stable BG. I watched the others in the race gulp gels and chocolate and sports drinks but I didn’t need to refuel once. I had energy to burn. I smashed that race and I’ve not looked back.
Since then, I’ve used fat adaptation to fuel races, hikes, rides, swims – and life. I know I can confidently take on long exercise sessions without fearing BG fluctuations when I’m fuelled this way. And this way of eating has 100% enabled me to approach a massive challenge like swimming to Rottnest Island.
You want evidence?
A few weeks ago I did an 8km swim. I only had my long acting overnight insulin, Levemir, onboard (I try never to swim with a meal bolus in my system – it is a recipe for a hypo). I made a Bulletproof coffee so I had some fats in my system to use. I checked my ketones (which signal the extent to which my body is burning fat) and they were sitting at 1.1mmol/L – healthy, and showing I was already burning fat after an overnight fast.
My BG was 5.8 when I started the swim, and when I emerged from the water three hours later it was 5.7. A flat, beautiful line. Again, energy to burn. Ketones running in the 2s at the end, showing my body had bypassed glucose and gone for fat to fuel my swim. The stoke was next level.
Pre and post-swim levels:
So – what do I eat?
I keep it pretty simple. I don’t make complicated food, I am an intuitive cook and I am hopeless at following recipes. I genuinely don’t find my way of eating difficult to cook for or stick to. Here are some examples of easy meals I make a lot:
Breakfast: Eggs, a bowl of ricotta with tomatoes and basil, low carb bread (from The Protein Bread Co for example) with avo, low carb pancakes (again from The Protein Bread Co) with blueberries and greek yoghurt.
Lunch: Some type of protein (tuna, chicken, hard boiled eggs, ricotta cheese) with a giant salad or if I’ve been organised, cooked veges from the night before. Olive oil and nuts are usually mixed through.
Dinner: In summer, generally bbq veges – zucchini, peppers, eggplant – with chicken, fish or meat. I make high fat sauces with tahini, olive oil, yoghurt and lemon juice and use lots of spices. Salads also feature a lot, I make lasagne using eggplant instead of pasta, spiralise zucchini often to have with bolognaise, and find subs and swaps for nearly every high carb meal to make it work – even pizza!
I don’t snack a lot but if I do, I reach for olives, tuna, greek yoghurt, cheese, veges and dips, and nuts.
Training food? Nut/protein balls (home made) and 90% dark chocolate.
Easy. Simple. Fresh. Fast. Satisfying. Natural. Delicious.
This way of eating has supported both my health and my sanity. I run an A1C in the low 5s, and I feel I can take on any physical challenge and figure out type 1 to make it work. It’s empowering to feel this in charge of my disease.
Type 1 will always throw me curveballs, but I feel that choosing to eat this way can help me minimise their impact, while fuelling my body in a way that enables me to smash my goals.
Kilometres this week: 30