Monday, April 15, 2019

Retrospective #59: The VLCKD: What I Eat and Why

I eat a Very Low Carbohydrate Ketogenic Diet (VLCKD) because I want to lose weight. And I want to do it in a healthy way, and because I want it to be easy (of course) and not involve hunger. I also want to eat in a way that achieves good blood glucose control (I’ve been a Type 2 diabetic for 33 years), and I want to continue to maintain the huge improvements in blood lipids (cholesterol), and blood pressure, and inflammation that I’ve seen since before I lost 170 pounds.
When I started to eat Very Low Carb, I didn’t know that I had a medical condition called Metabolic Syndrome. I had all five indications: central obesity, T2DM (or pre-diabetes), hypertension, elevated triglycerides and low HDL. After a period of time on the VLCKD, all five of these indications were mediated by this diet.
I know I have sufficiently restricted my carbohydrate intake to be in ketosis by testing my blood glucose in a fasting state (before eating breakfast). My body always has a little glucose available for energy, either in the form of glycogen in the liver or muscle cells, or from amino acids stored in the liver from eating too much protein. The liver will make glucose from these glucogenic amino acids through a process called gluconeogenesis. Since I am a Type 2 diabetic with impaired glucose tolerance and insulin resistance, if I eat too many carbohydrates, my fasting blood sugars will rise above ‘normal’ for me. When I return to dietary ketosis, my fasting blood glucose drops to the mid- 80s, with Metformin. That’s me. Your Mileage May Vary. We’re all different.
My pancreatic function and other aspects of my metabolism are broken and have been for many years. Like many Type 2s and even pre-diabetics (diagnosed and undiagnosed!), to maintain healthy blood sugar levels, I cannot tolerate more than very small amounts of carbs, low GI or otherwise. I must accept that I will never be able to do so without blood glucose “excursions” (dangerously high levels of “sugar” circulating in my system. Inevitably, that will lead either to diabetic complications (eye, nerve or kidney disease), or one of the Macrovascular complications that are strongly associated with Type 2 diabetes, such as cardiovascular disease, hypertension, and various cancers. So, what do I need to eat to remain continuously in a mild state of ketosis?
Breakfast and lunch are easy for me because, as Richard K. Bernstein, MD, recommends in his book, “The Diabetes Solution,” I eat the same thing every day. Breakfast is two fried eggs, two strips of bacon and 12 oz of coffee with 1 ½ oz of heavy whipping cream and 1g of pure stevia powder. K:G ratio = 1.88:1.
For lunch, (when I remember to eat it – I’m really not hungry, so I’m not “reminded”), I eat a can of Mediterranean style Brisling sardines in olive oil. I drink the oil in the can too (about 1 Tbs). Lunch K:G ratio = 2.93:1. I sometimes wash it down with diet iced tea (sweetened with liquid stevia). Of course, water would be a better choice.
For dinner, we eat a medium portion of protein (with skin and/or fat on) and a portion of vegetables with melted butter or olive oil. Sometimes, with salmon for example, we use a sauce made with crème fraiche. We like roasted meats, including chicken, spare ribs, lamb chops, short ribs or a petite filet (with a single 8oz filet shared by the 2 of us). We also like to rub our cuts of meat with herbs and olive oil before roasting. We sometimes roast the vegetables too, after tossing them in olive oil and sea salt. Cauliflower, Brussels sprouts and asparagus are especially good this way. We avoid the sugary vegetables (carrots, peas, beets and corn) and of course all the starchy root vegetables. And we do not eat bread at home. (I sometimes cheat with bread in a restaurant.)
This menu usually adds up to about 1,200 calories a day, which is at least 1,000 less that I probably use. The balance of energy comes from my fat stores, as long as I am in dietary ketosis and my blood insulin level is low. That only occurs because my carbohydrate intake is very low, and protein moderate, allowing my dietary and body fat to break down for fuel. This diet is about 5% carb, 20% protein and 75% fat. The K:G ratio of most meals is >1.5. This is a Very Low Carb Ketogenic Diet (VLCKD).                   

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