In today’s interview I get to speak with US board-certified orthopaedic spinal surgeon and a thriving type 1 diabetic, Dr Carrie Diulus, about how she uses the vegan ketogenic diet, along with specialised insulin strategies, to manage her diabetes and feel better overall.
Carrie is very passionate about using a multifaceted approach which takes into consideration a numerous factors effecting health, to achieve amazing results, both in her own life, and with her patients.
In today’s interview we get a chance to talk about traditional approaches to type 1 diabetes, why she chose to go vegan keto and how she made the low carb diet work for her.
If you know someone with type 1 diabetes, or anyone on a vegan/vegetarian diet, who is interested in learning more about how they can go low carb/keto, this interview is for them.
I enjoyed this interview as we often tend to think of low carb/keto diets as needing meat and animal fats, but after speaking with Carrie, I have a better understanding of how the low-carb diet can be adapted to suit individual dietary needs if a person wishes to be on a plant based diet that is vegetarian or vegan.
Whether you are trying to manage diabetes or simply have a preference for a specific diet, be that vegan, vegetarian or carnivorous, (with a few tweaks) you can still try the ketogenic diet and see if it works for you.
Special thanks to Carrie for joining me on the show. Enjoy the episode!
Show Notes with Timestamp Links
Highlights of what we talk about during the interview:
Click on one of the timestamp links in the brackets to jump to that point in the interview audio.[00:19] – Introducing Dr Carrie Diulus, a US board-certified orthopaedic spinal surgeon who practices “patient-centered” medicine, rather than the traditional “disease-centered” model. She was featured in the documentary “Fat, Sick and Nearly Dead 2” and is a thriving type 1 diabetic who uses a low-carb, vegan, keto diet with specialized insulin strategies to manage her diabetes. [01:24] – Carrie explains the difference between type 1 and type 2 diabetes. Type 1 diabetes most commonly being an autoimmune disease where the pancreatic beta cells are damaged and can’t produce sufficient insulin. Type 2 diabetes is related to insulin resistance and an overproduction of insulin by the pancreatic beta cells to compensate. She also explains how studies have shown that raised blood sugar, independent of diabetes, leads to advanced glycation end (AGE) products and can contribute to spinal degeneration. [03:50] – We often think of type 1 diabetes as a juvenile condition that gets diagnosed in youth and type 2 as a condition that develops in adulthood, but Carrie explains why this is not always the case. She was diagnosed as a type 1 diabetic as an adult and, while they still don’t have a definitive answer to explain what triggers this, there are genetic factors at play as well as other factors such as sleep, diet and stress that can play a significant role in disease manifestation. For type 1 diabetes there is no diet that can manage the condition on its own, insulin is always necessary. [09:29] – The symptoms of type 1 and type 2 diabetes are fairly similar. Commonly, people don’t feel well and experience frequent urination, increased thirst, and rapid weight loss. For type 1 diabetes, diabetic ketoacidosis (DKA) also occurs; DKA presents as a really bad flu and is a medical emergency. Carrie explains how she was diagnosed when her physical revealed that her HbA1c levels were elevated. [12:25] – Home glucose tests are readily available and can be a useful tool for keeping track of how our body is handling carbohydrates. Studies have shown that individuals react differently to different carbohydrates. While we shouldn’t obsess over the numbers all the time; it can be a good guide to use periodically and can help us be aware of how factors, such as, stress and sleep, are affecting our blood sugar levels. The goal is to have fasting blood glucose levels below 90mg/dl (5mmol/L), however, Carrie explains that we can have normal fasting blood sugar levels and still have elevated insulin levels. Checking HbA1c is a better way to check for arising problems. Other ways to test for this are testing fasting insulin levels, testing glucose tolerance with insulin levels, or, if we want to check for type 1 diabetes, the C peptide test is the most appropriate. (Listen to Dr Benjman Bikman talk more about the importance of testing insulin levels) [18:12] – The traditional approach for management and treatment of type 1 diabetes includes using two types of insulin along with a certain amount of carbohydrates. However, it can be hard to determine how much insulin is necessary with this approach and eating carbohydrates makes the issue even more complicated. Dr Stephen Ponder’s concept of Sugar Surfing by continually monitoring blood sugar levels using devices, such as the continuous glucose monitor FreeStyle Libre or Dexcom, can help with extreme swings in blood sugar levels like the ones Carrie herself experienced. She decided to go low carb instead; by not eating carbs the blood sugar stays at a steady level and it is easier to manage how much insulin is needed. [24:06] – The brain doesn’t need glucose in order to function and will be fine using ketones. The concern for type 1 diabetes is the DKA. Carrie explains that ketones themselves are not a problem, they are a measurable marker that presents with the metabolic collapse happening during DKA. For a healthy individual low-level ketones are fine, however, for type 1 diabetes elevated ketones are a serious concern. (Top tip: 3 easy ways to measure ketone levels) [29:29] – So could type 1 diabetics drink exogenous ketone ester drinks like the HVMN ketone ester drink that Dr Brianna Stubbs along with Geoffery Woo worked on? Carrie believes that there is a role for exogenous ketones, but she has concerns for anyone with elevated blood sugar levels taking these. She uses ketones in patients to stabilise things from a neurological stand point as well for anti-inflammatory benefits. There is less need for pain medication and increases recovery post-surgery for people on ketogenic diets. It can help people feel better. [33:11] – Changing our diets and eating more non-starchy vegetables and less processed carb-loaded foods, can result in numerous benefits. Because most of the benefits we are seeing from ketones are anecdotal we need more research to get solid answers in terms of how high therapeutic levels need to be. [35:36] – What tools does Carrie utilise when she treats her patients? She explains there is still a place for traditional treatments and how she uses these along with diet to effect positive changes and calm inflammation in her patients. We still need to better understand how diet impacts the muscular, skeletal and neurological systems and funding more research in this area is needed. [37:19] – Why does Carrie use a vegan ketogenic diet to manage her type 1 diabetes? She explains that even though she gave up meat when she was 12 years old her diet wasn’t ideal, and nutritional optimisation is an important factor in a good diet. After her diagnosis she followed the ADA guidelines initially and ate a pescatarian, paleo diet. Eventually, she decreased the amount of carbohydrates she ate and reintroduced animal proteins to her diet. The high protein diet recommended by Dr Bernstein worked well in terms of lowering her blood sugar levels, but Carrie found she didn’t feel well on the animal protein diet. After a virus left her with gastroparesis she further experimented with her diet and found plant-based proteins were the easiest for her to digest and gave her the best results. (Listen to orthopaedic surgeon Dr Shawn Bakers’ carnivore diet as a complete opposite to Carries’ diet) [43:22] – Keto vegan diets can be tricky to some extent. Carrie explains how most plant-based sources of protein tend to be low in lysine, which is one of the essential amino-acids and recommends some good plant-based sources. Another recommendation Carrie gives her patients is to always add a fat with non-starchy vegetables and vice versa. [45:55] – One of the more common reasons people chose a vegan diet is due to ethical reasons, but for Carrie it was more down to how she responded to animal protein and the taste factor. Our bodies are adaptable and can perform well with different diets, the trick is finding out what is the best one for your body at this particular point in time. [48:36] – How to get enough fat on vegan diet? There are lots of good plant-based sources of fat including avocado oil, olive oil, coconut oil/butter, raw cacao, nut butters, chia seeds. Carrie also eats avocados every day. Virta recently shared a recipe for vegan butter on their blog. (Listen to our interview with Dr James McCarter from Virta Health to find out how their online type 2 diabetes reversal treatment works). [51:57] – Carrie explains why the Nutrient Optimiser is a great tool that gives you an idea of how well you are doing in terms of getting the nutrients you need. Chronometer and MyFitnessPal are some other tools people can use to measure protein, fat and carbohydrate. Getting enough B12 can often be challenging on vegan diets. Some of the supplements Carrie recommends include a nutritional yeast with B12 supplement, Omega 3 from algae oil supplement, as well as vitamins D3 and K2, which can both be plant-based. [54:04] – Carrie believes we can all benefit from certain supplements depending on which diet we are on. We need to be dialled in to how we feel and if we see something isn’t working for us anymore, be willing to adapt to something new. Feeling good and having good lab work are good signs we are doing well. On the other hand, flaky skin, tiredness, not sleeping well, hair falling out, gaining weight are all signs something needs to change. [55:55] – Carbohydrate content of fruit and vegetables matters for people on vegan keto diets and diabetics especially. For Carrie bananas, chickpeas, peas, potatoes and corn are foods she avoids as they will raise her blood sugar levels significantly. She give us some great examples of food she eats instead. [59:10] – Carrie explains how to change the metabolic syndrome in someone with insulin resistance we can change the primary fuel at either end of the spectrum; we can go low fat or low carb. There are no long-term studies on what it means to be low carb as diabetic, what we do have is anecdotal evidence of people feeling better and day-to-day lab measurements which look good. [1:00:36] – It’s interesting how people can use continuous glucose monitors such as Dexcom or FreeStyle Libre to get data that shows them how they are responding to different food. Knowing your specific response can be incredibly useful for optimising risk factors. [1:02:17] – There are not many mentors for people doing vegan ketogenic diets, but there is a growing Facebook group called Vegan Keto Made Simple where people share recipes and information. As with any diet, the concern is that people are getting optimal nutrients and currently there is no great guide out there for people on how to eat vegan keto. Carrie talks ensuring leucine levels are high enough, lifting weights and supplementing with branch chain amino acids, the benefits of cycling mTOR and minimising the effects of sarcopenia. (Listen to Dr Stuart Phillips on how to avoid sarcopenia) [1:06:28] – Carrie explains there are strategies she uses in managing her weight training and high intensity interval training, both of which result in blood sugar to spike. She also explains how slow long-distance running doesn’t result in a dramatic drop for her that most diabetics experience because she is keto adapted. She emphasises how even though, Dr Bernstein’s book is a great resource we still need more research on type 1 diabetes and low carb diets. [1:09:24] – Do people on vegan keto diets also experience changes in cholesterol levels like the hyper-responders Dave Feldman talks about. Some people see numbers rise initially and then stabilise again. The question is what is the impact of that and what these markers mean in terms of true risk? The inflammation seems to be more problematic. For Carrie personally, all the traditionally used markers look better on this diet, however, she wonders if we are using these markers in the right way? [1:14:37] – To follow Carrie and find out more find her on Facebook, twitter and Instagram accounts.
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