Keto: Week one

In my last post, The Story So Far, I summarised my path from diagnosis with type 2 diabetes in December 2020, to the present day and my experiment with keto. In this post, I talk about my first week on keto as a type 2 diabetic: blood glucose numbers, weight loss, side effects, and reflections.

What is keto?

Keto is a low carb, moderate protein, high fat diet.

It gets its name from the mechanism it relies on for energy. There are three sources of energy for the body:

Carbohydrate: turned into glucose.
Protein: also be turned into glucose.
Fat: turned into ketones, in a process called ketosis.

If you eat a very low carb diet, and make sure your protein isn't excessive, your body has to burn fat for energy. When you're doing this, you're 'in ketosis'.

Getting into ketosis takes time. Your body usually has about 24hrs of glycogen stored, which can be released and turned back into glucose. So on the first day of eating a keto diet, you're still actually running on glucose.

After the glycogen stores are gone, your body has to start burning fat to produce ketones. It can take time to adapt to this: especially for the first few days you may experience keto flu (symptoms include headaches, lethargy, brain fog, irritability, and just generally feeling off). However, many of the symptoms of keto flu can be reduced or avoided by making sure you get enough electrolytes. Read more in r/keto | adapting to a low carb lifestyle. Note that it can take weeks to fully adapt.

Potential benefits of keto

There are many benefits claimed for keto, including:

Blood sugar control: inevitably, if you're eating very little carb, you're unlikely to have high blood glucose.
Weight loss: the diet is filling, and it forces your body to fully adapt to burning fat, making it easier to maintain a calorie deficit. But do note the calorie deficit: keto isn't magic, if you eat more calories than you burn, you will still gain weight.
Avoiding energy crashes: you steadily burn fat as needed, avoiding blood sugar spikes, and the subsequent crash.
It is used to treat some conditions. It was originally developed to treat epilepsy. However, medical/therapeutic keto is a little different from the looser version practiced by most people. I won't cover it here: it's not the program I'm on, or something I've researched.

And some more subjective ones:

Some people experience increased energy, and/or better mental clarity.
There are experiments ongoing using keto to tackle a range of mental health problems.
Some people seem to find it effective as a way to control binge eating.

As with any diet, exercise caution: if you look hard enough, you'll find someone claiming keto cured any condition you care to name.

Why keto for type 2 diabetes?

As mentioned above, keto has (at least) two benefits for type 2 diabetics:

Improved blood sugar control.
Weight loss: losing weight improves insulin resistance, and may even put your diabetes into remission. For details on the mechanisms behind weight and type 2 diabetes, I strongly recommend Life Without Diabetes: The definitive guide to understanding and reversing your type 2 diabetes by Prof. Roy Taylor.

Virta Health | Reversing Type 2 Diabetes is a good, short, simple guide on this topic.

My keto

I'm doing a strict version: aiming for 20g of carb. I'm vegetarian, so that's an additional restriction. To begin with I'm keeping it simple: quick easy meals, and focusing on adapting to keto rather than worrying about calorie deficit. Although I have ended up in deficit every day: I'm just not hungry enough to eat more.

I'm using Cronometer to track my diet. Exercise isn't really a thing right now. Although I'm feeling pretty good on the diet, I don't want to push it, and I don't feel completely 100%.

As for side effects: it's been interesting. Days 1-3 my body decided to sample a different side effect each day. Day 1, my hands, feet, and ankles swelled up, presumably with water retention. This isn't something I usually get, and was very random. Day 2 the swelling cleared, but my stomach decided to protest the new diet pretty emphatically. Day 3 my stomach was fine, but I had a headache.

Other than those slightly odd and short-lived effects, there was some fatigue. Day 2 it hit hard, but it was also a draining day regardless of diet. I checked my electrolytes and got better control of supplementing them, which may have helped, as I gradually improved. I still feel a bit tired in the evenings, and not at 100% strength, but overall I feel good: my energy has been incredibly stable, and my focus has been excellent.

The stats

After a week on keto:

Fasting blood sugars: 4.0 mmol/L.
Weight: 5lbs down (246 -> 241).
Waist: 2 inches down (49 -> 47).

The fasting sugars feels nothing short of miraculous. That's not just a good number for a diabetic, it's a healthy number for a normal person. I have never seen a 4 on the glucose metre since I was diagnosed, even during periods of excellent control.

I did a spread of tests one day during the week: fasting, 30mins after eating, 2hrs after eating. I was 4.8 on waking, and steadily in the 5s through the day. No spikes, and never out of a perfectly healthy range. This feels incredible.

Not everyone sees such quick results. I had a bit of a headstart: I went straight onto keto after three weeks attempting a very low calorie diet, meaning I had already been eating quite low carb, and lost some weight. So some of the work to clear the fat in my liver and start bringing my numbers down was already in progress. Also, although I've had some bad HbA1C results, they've never been truly horrifying: my highest-ever was 68 mmol/mol. So the speed of your results will depend on your condition going into keto.

Final thoughts

I'm publishing this on day 9 of keto. I'm slightly tired, but I've found the energy and focus to do a lot of writing, as well as clear a lot of housework. I am loving the absence of energy crashes, the massively reduced cravings, and above all, the amazing blood sugar numbers. I'm really hopeful that this could actually work for me.