REAL LIFE: WHY I QUIT KETO!

Exercise physiologist and diabetes educator Drew Harrisberg shares his experience of managing his type 1 diabetes with the keto diet

I decided to try out the keto diet to see what all the hype was about. People claim it is the ultimate fat-loss diet, others say it can reverse type 2 diabetes. I had to put it to the test to see if it would help me manage my type 1 diabetes.

My keto experience

The thing that makes this experiment so eye-opening is, as someone living with type 1, I get to see objective insights every day into my BGLs and insulin requirements. I also have two university degrees. First, I completed a Bachelor of Science (exercise and sport) and went on to become an accredited exercise physiologist. Then, after being diagnosed with type 1 diabetes at age 22, I went back to university and completed a post-grad certificate in diabetes education and management. After two months on a ketogenic diet, I was very lean, fit, had great focus and concentration, could go many hours without eating, had flatline BGLs, and achieved my lowest-ever insulin requirements. At that point, it seemed like keto was indeed a magic bullet and I was a huge proponent of that way of eating. Fast forward another

two months, everything took a turn for the worse.

I noticed that every time

I ate foods containing carbohydrates, my blood glucose went very high and that frustrated me. I also noticed my cholesterol went up to 6.4 mmol/L. Sure, I was very efficient at burning fat and ketones for energy, but my tolerance for foods containing carbohydrate went down noticeably, even after exercise, when I’m usually my most insulin sensitive. Not only could I no longer eat the smallest amount of carbs (a banana) without a large blood glucose spike, I noticed that I needed more and more insulin in order to bring my BGLs back down into the normal range.

It would have been easy to demonise carbs as the culprit for the glucose spike, but that would have been a case of mistaken identity.

Here’s why: even if I didn’t eat anything and my own body produced glucose endogenously (as in, the liver dumped glucose into my bloodstream via a process called gluconeogenesis), I couldn’t fix my high BGLs because I was resistant to the insulin I injected. It felt like I was on my way to developing type 2 (type 1 is more than enough, thank you!). It was a frightening reality and a huge wake-up call.

The keto diet does not cure insulin resistance and type 2 diabetes

Just because keto can lead to stable BGLs and low insulin levels, and patients can come off their medications, does not necessarily mean it reverses type 2. It may seem like they’ve reversed their diabetes, but really, they’re just managing symptoms, and the minute they eat a carbrich meal their BGLs can go very high. It’s like a coeliac patient removing gluten from their diet and seeing symptoms disappear. Does that mean they’re cured? Of course not, they just removed the trigger that leads to symptoms without addressing the cause of the disease. As soon as they eat gluten, the symptoms return.

The ketogenic diet is a shortterm, band-aid solution to minimise BGL fluctuations, but does not reverse the underlying condition of insulin resistance. In fact, evidence-based research shows eating a low-carbohydrate diet actually worsens insulin resistance. ➤

By almost completely removing carbs from the diet, you’re simply removing the trigger that leads to symptoms (hyperglycaemia) without addressing the actual cause. Then, when you add carbs back in, your body can’t tolerate them, which makes it seem like carbs are ‘bad’ for you but really, carbs are the victim of somebody else’s crime.

After spending hours and hours down a rabbit hole of research, it turns out the real culprit is the very high levels of saturated fat found in meat, bacon, eggs, butter, coconut oil etc... which can lead to a build-up of fat inside the liver and muscle (called intrahepatic and intramyocellular lipids). When lipids accumulate in tissues where they don’t belong, it can cause the cells to become dysfunctional, leading to insulin resistance and impaired glucose tolerance. Sure, the human body can convert excess glucose to fat, but the conversion of glucose to lipids via ‘de novo lipogenesis’ happens to a very small degree and those new lipids make up a very small percentage of intramyocellular lipids.

Furthermore, insulin has been wrongfully demonised as a ‘fat storage hormone’. Yes, one of the physiological properties of insulin is lipogenesis (fat storage), but when you minimise your intake of dietary fat, the impact is minimal. The reality is, insulin levels in the normal physiological range are required for survival. Insulin is not the enemy that many low-carb advocates claim.

Insulin resistance is a silent disease. Most people don’t know they have it because they don’t need to monitor their BGLs or inject insulin on a daily basis, but I do. As someone living with type 1, I get objective insights every single day. I see first-hand the effects of different lifestyle variables on my insulin and

BGL control. Everyone is different, so don’t just take my word for it. Look it up for yourself. The science is out there (and has been for decades). High-fat diets have been shown to induce insulin resistance and reduce glucose tolerance. The evidence is eye-opening.

Insulin resistance can affect anyone and everyone diabetic or not. It doesn’t discriminate.

Low-carb diets work, but…

There’s no denying a low-carb approach can lead to weight loss, stable BGLs, reduced HbA1c, low total insulin requirements and overall improved diabetes management. In fact, I couldn’t agree more! I followed a low-carb approach for eight years with great results. I achieved a 70 per cent reduction in total insulin requirements and very stable blood glucose control. But my point is, those biomarkers say nothing about one’s insulin sensitivity and carbohydrate tolerance. When you become primarily fat-adapted you lose metabolic flexibility and can’t tolerate even small amounts of carbs. To me, that doesn’t sound optimal when some of the healthiest foods known to humans are avoided on keto.

Some say the mechanism is insulin resistance, others say it’s enzymatic regardless of the mechanisms, one thing we all agree on is carbohydrate tolerance goes down. I’ve even seen worldleading keto experts admit the keto diet induces a state of temporary “insulin resistance” or “glucose intolerance”. I’m not aware of specific evidence proving a keto diet causes type 2, but that doesn’t mean it isn’t on the horizon, especially because keto is such a new health craze with limited long-term research.

However, the evidence clearly shows a high-fat diet impairs glucose tolerance and induces a state of insulin resistance. So my concern is if someone goes on a long-term high-fat diet, and then ends up over-consuming calories, gaining weight, leading

As someone living with type 1, I get objective insights

every single day

a sedentary lifestyle and reintroducing carbs, but doesn’t reduce their fat intake, then their risk for developing type 2 will likely increase.

I don’t have a problem with the physiological state of ketosis. You can achieve ketosis by fasting, following Bernstein’s approach (low-carb, high-protein keto approach) or even doing a plant-based keto diet. I have concerns with the modern keto diet because it’s very high in saturated fat and I don’t think bacon, eggs, butter and coconut oil should make up the bulk of your daily calories, especially when they’re replacing known healthy foods such as fibre-rich, nutrient-dense and antioxidantrich fruit, legumes and starchy vegetables.

The solution

Having made the connection between poor health outcomes and saturated fats, I knew I had to make a change. So, I decided to embark on a journey to see if removing those foods altogether and eating more carb-rich, plantbased foods would reverse the metabolic damage I had caused. I immediately embarked on a strictly whole-food, plant-based journey with guidance from world-leading plant-based diabetes experts Robby Barbaro and Dr Cyrus Khambatta at Mastering Diabetes (masteringdiabetes.org). They have helped dozens of people successfully reverse their insulin resistance and type 2 with a low-fat, whole-food, plant-based diet. It is different to a vegan diet because on a vegan diet you can technically eat refined, processed foods that fit under the vegan umbrella. A whole-food, plantbased diet means you eat food in its original form, making the diet low in calories (particularly calories from fat) and high in fibre, nutrients and antioxidants.

I dropped my fat intake from 75 per cent of daily energy intake to between 15-20 per cent. I removed all animal foods and oils from my diet. I focused on eating healthy fats from avocados, nuts and seeds. I also added whole grains and legumes back into my diet (both of which I hadn’t eaten in nearly seven years since following a paleo approach), and an abundance of all types of fruits and vegetables.

Within 48 hours my insulin sensitivity started to return to normal. Within 1-2 weeks my carbohydrate intake was the highest it had been since being diagnosed with diabetes and my insulin use dropped dramatically.

As I write this article, I’ve been strictly plant-based for four months and the results have been astonishing. I’ve achieved my best ever insulin-to-carb ratio and it feels like I’ve regained control of my health. What started as a plant-based journey towards personal development and health has turned into something so much bigger.

The positive impact I’m having on myself, the people around me, environmental sustainability and animal welfare gives me so much fulfilment and joy. I cannot wait to see where this journey takes me over the long-term.