In 1998, at the age of 38, I was diagnosed with type 1 diabetes, and in my case more specifically I had type 1.5 diabetes or latent autoimmune diabetes in adults (LADA). Once the diagnosis was made, I treated my diabetes with multiple insulin injections and frequent blood-sugar monitoring with the advice of endocrinologists along the way. Neither I nor my endocrinologists gave any thought to a change in diet since I was already following a “healthy” dietary regimen as recommended by the American Diabetes Association (ADA). Initially, I was pleased that my glycated hemoglobin A1c (HbA1c) tests were ranging between 6.5% and 7% most of the time. HbA1c is a blood test that is proportional to one's average blood sugar over the previous 2-3 months. Although these HbA1c values were in the ADA-recommended range, they were certainly not in the normal range for nondiabetics (which is something closer to 4.2%–5.6%). With those values, there was no assurance that I would not develop long-term diabetic complications at some point.
More distressingly, I was having two to five hypoglycemic (low blood sugar) episodes each week, which I thought were just part of having fairly well-controlled diabetes. My hypoglycemic symptoms ranged from clothes-soaking sweats, rapid and pounding heartbeats, blurred or double vision, transient numbness of skin, and many other symptoms that varied from episode to episode. The most bothersome were the mental symptoms of hypoglycemia. These included an inability to recognize that I was hypoglycemic. Therefore, I was not aware that I needed to treat it. Sometimes I was argumentative with my family when they told me to take sugar because I was not aware I was hypoglycemic.
Hypoglycemia was an embarrassing event since it meant a lack of control, and it was worsened by the fact that I am a physician and should have all the resources and knowledge to avoid it. More importantly, hypoglycemia can be life-threatening, and although I never lost consciousness, had a seizure, needed assistance, or had to be hospitalized, there was no assurance that any of those things would not happen while I was treating my diabetes using conventional therapy.
I was constantly thinking about how I was feeling and if how I felt could be yet another symptom of hypoglycemia. While lying down to sleep, I wondered whether I would wake up in the night in a sweat from yet another episode of low blood sugar—or not wake up at all! There was a three- to four-month period when my glucose meter was unknowingly reading falsely high. This caused me to consistently overdose insulin, which resulted in an increased frequency of hypoglycemia and nightmarish hypoglycemic episodes so severe that I felt I might die. Fortunately, I was able to manage them myself without needing assistance. I finally purchased a new glucose meter, which put an end to the death-defying episodes. After those experiences, I checked the meter reading against laboratory glucose results, purchased new meters on a more regular basis, and sought out the most accurate meters to purchase. I currently use the Freestyle Freedom Lite Meter which is very accurate.
What I didn’t know then was that controlling diabetes with the ADA’s high-carbohydrate diet without having recurrent hypoglycemia is impossible. After all, who would have imagined that respected diabetes experts would recommend an impossible task? Having recurrent symptomatic hypoglycemia is certainly not a good way to go through life, especially since it can be avoided!
In August 2007, at the age of 47, I decided to start exercising. I knew I had a chronic disease that might be helped by regular exercise. I decided to start training regularly to complete a sprint triathlon: a 0.9-mile swim, a 10-mile bike, and a 3.1-mile run. Having a goal provided additional motivation for me. I completed my first sprint-distance triathlon in December 2007. 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 my blood sugars near normal for the duration of the event, particularly since sugar is the primary fuel used by most athletes during a long-distance triathlon. I was consuming sugar in order to prevent hypoglycemia to the point that I was having hyperglycemia (high blood sugars) more often than not. My HbA1c had increased to as high as 7.9% as a result and I feared that it would reverse any benefit of exercise.
In 2011, I signed up to enter an ironman distance triathlon the following year that consisted of a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile marathon run. Due to my frequent hyperglycemia while consuming sugar, and the constant threat of hypoglycemia, I felt I needed a new approach. That same year, I was listening to a triathlon podcast, IM Talk, hosted by John Newsom and Bevan James Eyles, in which they interviewed Loren Cordain, PhD. That interview introduced me to the concept of diseases of Western civilization. Briefly stated, people who have never been exposed to foods created by agriculture and food-refining technology (mainly highly refined sugars and starches, including sweets, flour, white rice, and fruit preserves) rarely develop chronic diseases like dental caries, diabetes, hypertension, heart disease, obesity, dementia, cancer, appendicitis, and peptic ulcers. As a physician, this came as quite a shock to me. One would think that physicians who spend their entire careers treating these chronic diseases would have been taught this in medical school. Soon after, I heard Jimmy Moore’s Livin’ la Vida Low Carb podcast interview with Dr. Richard K. Bernstein, a diabetes specialist in New York who also had type 1 diabetes. After obtaining one of the first blood-glucose meters available, he discovered by trial and error that carbohydrates had the greatest influence on his blood sugars and that a low carb diet containing less than 30 grams carbohydrate per day normalized his blood-sugar levels with a much-reduced insulin dosage.
From the tenets of The Paleo Diet, as described by Dr. Cordain, I placed more emphasis on using real whole foods and paid more attention to the source of foods. I had already added grass-fed beef, free-range, pastured chicken, and pork to my diet in 2004, but I added liverwurst (liver, heart, kidney) and wild salmon to my diet in 2011 as well. One can have success with conventionally sourced foods, but I appreciated some of the significant differences that grass-fed and pastured foods had to offer.
Still skeptical that conventional medicine could possibly be so wrong, I was on a mission to both verify what Dr. Cordain was saying and to learn more about how nutrition affects health and disease. I read Gary Taubes’s book Good Calories, Bad Calories on the history of diseases of Western civilization, the origin of the low-fat diet, lipid-heart and carbohydrate hypotheses, and the evidence supporting the role of dietary refined carbohydrates and sugar in the causation of chronic diseases. I read Dr. Bernstein’s Diabetes Solution, which described his method of using the low carb diet to treat diabetes, and many other books and articles. I wanted to make sure that the information I was obtaining was accurate since I was changing my own treatment in opposition to current medical convention.
I also utilized information from The Art and Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance by Stephen Phinney, MD, PhD, and Jeff Volek, PhD, RD. When I learned that all of the above authors' information was consistent and supported by the medical literature, I was annoyed with myself. Why had I not taken the initiative to find this out for myself sooner? Why didn’t the world’s leading diabetes experts and organizations find this out or mention it as an option? Why didn’t the research-funding organizations support studies to test the carbohydrate hypothesis? How could so many scientists and physicians come to believe that a diet with six to eleven daily servings of bread, cereal, rice, and pasta was a “healthy” diet. And why did the ADA embrace a high-carbohydrate diet for persons with diabetes? After all, those are the people who are the most intolerant of high-carbohydrate foods. In addition, the practice of consuming large amounts of refined foods never existed on the planet until a few hundred years ago. How could humans adapt to them in such a short time on the evolutionary time scale?
So, on February 8, 2012, I started my new lifestyle: a ketogenic diet added to the resistance training, swimming, biking, and running that I had started in 2007. From what I learned reading The Paleo Diet, I had already eliminated milk, grains, sugar, starchy legumes, and all processed foods in November 2011. Following The Paleo Diet plan led to a 45% reduction in my meal-time insulin dose, but no improvement in my average blood sugar (about 125 mg/dl), nor any reduction in hypoglycemic episodes. I needed carbohydrate restriction added to the mix. In order to reduce my carbohydrate intake to 25 to 35 grams per day, I eliminated potatoes and fruit. To replace calories from the carbohydrates that I eliminated, I increased my dietary fat using nuts and seeds. I simultaneously reduced my insulin doses (primarily short-acting insulin, but also long-acting somewhat) from about 54 units a day to about 35 units a day over the few months. Today, I continue to adjust my insulin doses based on my blood-sugar readings which you can see in my blog.
Once I adapted to the low carb ketogenic diet, I was able to increase my training distances without needing to eat significant amounts of sugar. I developed the habit of carrying both insulin and glucose tablets with me, just in case, but I rarely needed either of them. I no longer feared hypoglycemia either while sleeping or exercising and my hyperglycemia improved markedly.
On October 20th, 2012, I completed the Great Floridian Triathlon, an ironman distance event, in 15.5 hours with no need for any glucose, sugar, or food, using only my body-fat reserves for energy. I had no hypoglycemia, but I did have mild hyperglycemia that I did not treat with insulin because I was expecting my blood sugar to fall at some point during the event. My blood sugar at the end of the event was 156 mg/dl.
My HbA1c improved gradually from 6.5% on average before the low carb ketogenic diet to 5.6% in the first year. In 2013, it remained at 5.6% and, in 2014, came down to 5.1% with an average blood glucose of 85 mg/dl. This resulted in more hypoglycemia, albeit without symptoms (more on that later); and subsequently I have sought an average blood glucose of 96 mg/dl in exchange for fewer hypoglycemic episodes.
The variables I track include insulin doses, exercise type, duration, and frequency. Since I keep my dietary protein, carbs, and fat constant from day to day, I do not track them anymore. My dietary protein is about 1.8 grams/kg body weight/day (140 grams), carbohydrate is about 40 grams/day, and fat that primary comes from animal products, nuts and seeds totals about 200 grams/day.
My blood tests improved in the manner typically seen on a low carb 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; and the calculated LDL cholesterol increased from an average of 103 to 162 mg/dl, but later came down to 132 mg/dl. The hs-CRP (high-sensitivity C-reactive protein, a marker of inflammation) decreased from 3.2 to 0.7 mg/l. Today, I have no complications from diabetes and with my improved glycemic control and marked reduction in hypoglycemic episodes, my quality of and outlook on life has improved dramatically.
I hope it is clear from my story why I am compelled to pass this life-changing information on to others who have had similar problems managing health problems that could be dramatically improved with simple changes in lifestyle. This is why I decided to create this website. I hope that you can take this information to your physician and that you can benefit as well.
Keith Runyan, MD - My Medical Training and Credentials
College: Emory University, Bachelor of Science in Chemistry, 1982.
Graduate School: Emory University, Master of Science in Physical Chemistry, 1982.
Medical School: Emory University School of Medicine, 1986.
Internship / Residency: Internal Medicine, Emory University Affiliated Hospitals Program, 1989.
Both books are available as a PDF ebook and as a print book from Amazon. Note: Clicking on the links above will take you to the website of Ellen Davis, MS, my coauthor. Her website is ketogenic-diet-resource.com.
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