Low Carb (Vegan Keto) Diet Results for Type 1 Diabetes • Dr Carrie Diulus

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[Music]
hello everyone and welcome to biohackers
lab I'm your host Gary Cohen and on
today's episode I have dr. Carrie
Diaries dr. Dee Ulis is a
board-certified orthopedic spinal
surgeon practicing near Cleveland Ohio
she enjoys practicing patient-centered
medicine rather than the traditional
disease centered model she was featured
in the documentary called fat sick and
nearly dead too dr. Degutis is also a
thriving type one diabetic who uses a
low carb vegan keto diet with
specialized insulin strategies to manage
her diabetes Carrie thank you so much
for coming on today thank you for having
me I really appreciate the opportunity
yeah we've got so much to talk about
because I mean just with your intro
there I think people can understand that
you so you're a practicing surgeon you
are a type 1 diabetic but you also
follow the low-carb community the keto
community and the vegan community and
and you know on your website too I see
that you do sort of lifestyle medicine
so you talk about sleep stress
management there's so many good things
we can talk about today so I'm really
glad I got you one oh absolutely I'm
happy to be here thank you so to begin
with I think for listeners because
you're my first type one diabetic
patient who's been on the show so could
you just explain to people what is the
difference between type 1 and type 2
diabetes yes
so type 1 diabetes is an autoimmune
condition most of the time where the
body attacks the beta cells so the
pancreas is the organ that creates
insulin and beta cells are the cells
that create insulin and in type 1
diabetes there's an autoimmune reaction
that happens and the beta cells get
destroyed and damaged and the body loses
the ability to produce enough insulin
and sometimes entirely can't produce any
insulin at all type 2 diabetes on the
other hand is related to insulin
resistance of the muscle cells and the
liver and the fat cells and so the beta
cells in the beginning
are still able to produce enough insulin
in fact they start to produce a lot of
insulin so that they can overcome this
insulin resistance so you know we always
describe it as insulin resistance is
where the key doesn't fit in to the lock
and so the body sort of bombards it with
a lot of keys trying to find you know a
way to get glucose into the cells
because excess glucose which is sugar
around in the blood is sticky I always
describe it to patients as what happens
when you give a toddler a sucker you get
sticky everywhere and the same sort of
thing happens in our bodies where that
we get these advanced glycation
end-products which are what happens when
there's elevated blood sugars and even
in the spine world we've had this these
recent studies that have shown that
elevated blood sugars independent of
diabetes and obesity lead to advanced
glycation end-products which lead to
spine degeneration so you know these
abnormal blood sugars which can happen
anytime we eat a large carbohydrate load
until the body can deal with it
can actually play a role in even spinal
degeneration so for a type-2 diabetic
most type 2 diabetics have some sort of
obesity going along with it although
there are thinner type 2 diabetics and
originally we used to think that type 1
diabetes was a juvenile condition and
type 2 diabetes was you know as we got
older but we're starting to see now more
and more kids that are type 2 diabetics
and I was actually diagnosed type 1 as
an adult and there's more studies that
are indicating that actually the
incidence of type 1 can occur throughout
life and there are probably quite a few
type twos that it's assumed that there
are type 2 but they may actually be a
type one because they rapidly need to be
on insulin and then it gets even more
complicated in that a type one can
become a type 1 and a type 2 if they
develop insulin
later in life and type 2 when their
pancreas stops being able to produce
enough insulin or any insulin it starts
to gradually go down as the beta cells
start to sort of get exhausted for you
know lack of a better term they sort of
become type 2 type ones without the
autoimmune component so well effectively
I have an autoimmune condition my
pancreas doesn't produce insulin anymore
so I have to give myself insulin and you
know there are some strategies to to
deal with it deal with that but you know
there's no diet at this stage that we've
seen or found that are going to change
the fact that my pancreas doesn't work
and I have to give myself insulin so I
mean you should already such good
information there and that was going to
be one of my questions was when were you
diagnosed and as you said it was only
when you were an adult because that is
something I have come across because
when I you know when I was learning
physiology it was the same thing you
always think type 1 is a juvenile
condition like a child's condition so
that's when it's picked up in childhood
but it seems strange like wow so you
could see you only get diagnosed as an
adult and that's incredible to think you
could go that long and then only get a
type one so what do you think happens
there I as a child you didn't have
diabetes or did you have diabetes or is
it that it's suddenly it's when you had
that autoimmune like when your body
attacked your own pancreas there's but
these beta cells beta cells that um
that's when it triggered the type 1
diabetic condition yeah and we don't
fully understand all the triggers I mean
there's research on you know gut factors
and dietary factors and viral factors
and you know there are about 10% of type
1 diabetics are what we call antibody
negative meaning you know there are a
number of antibodies that we can measure
in people GAD being the most common one
that
we think is associated with the you know
type 1 diabetes but as far as what the
trigger is we don't know I have a family
history of it it starting later in life
and I have the genetics for it and I
also have celiac disease I was diagnosed
with celiac disease in my 20s although I
you know probably experienced it
throughout my life as a child you know
my brother and my sister my brothers
about a foot taller than I am and my
sister is like six inches so that I am
so you know celiacs played a role and
there's a core there's a fairly
substantial cross over with Ely accent
type 1 diabetes sharing similar genetics
so yeah and also that autoimmune
response like why you're you know put
the celiac component there I'm guessing
there's probably like an immune response
stresses may play a role I mean I would
say you know I was my story's a little
complicated I was overweight in college
um and about a hundred pounds overweight
from where I am um and ended up losing
all the weight and did a lot of
competitions and you know did long bike
races and long multi sport races and
maybe some of that you know had benefit
but there's also some oxidative stress
that happens there and then as a
surgical resident I was a pathology
resident during all that competition
stuff as a surgical resident you know
basically I didn't sleep for seven years
and you know so you know and then it
became a mom and then you don't sleep
then so you know all of those things and
my husband was in the military and was
you know deployed overseas during my
cheap year so stresses sleep you know
all of those things are huge factors and
I think you know we see it with patients
but I seen it really in my own life that
if you
try and fix one thing without looking at
the big picture it's sort of you know
like plugging up a dam that's rupturing
without you know solidifying all of the
holes and it becomes important so you
know my own ability I always sort of
joke that you know it sometimes feels
like my genetics are not compatible with
life after 35 you know I have to make
sure to be on top of all of these things
if I want to you know live this super
stressful lights that I have is this
fine surgeon and keep it and check and
be able to be at the top of my game okay
and that's again why I got you on
because you're a classic N equals one
you know you're self testing and you get
to buy a hack and do all these cool
things and learn about yourself your own
physiology and how to make your life
best so before we get into some of those
cool things to just so people can
already hear okay so you could have type
type on diabetes when you get all them
for multitude of reasons but then what
are some of the symptoms they should
watch out for that would make you think
you're type 1 versus a type 2 so you
know diabetes in and of itself the
symptoms are fairly similar in that you
know as your blood sugars are getting
elevated the common is you don't feel
well you're urinating a lot you're
thirsty all the time
you're losing weight rapidly and even a
type 2 if they get to that critical
stage will start to lose weight so those
are the symptoms and then of course for
type 1 there's the presentation of decay
which you know which is diabetic
ketoacidosis which is where the body the
blood sugars have gotten elevated and
the ketones have gotten really elevated
you know from a ketose standpoint we can
talk about all that and the bodies in a
metabolic acidosis and that frequently
presents like a really bad flu I mean
there's abdominal pain and nausea and
vomiting and feeling awful and in fact
it can be mistaken as being the flu and
so that's sort of a medical emergency to
you know be treated if it truly is decay
which is how a lot of times type one
presents although we you know there's
more studies indicating that type one
actually is somewhat phasic in that you
know you can catch it at earlier stages
potentially and that for me was sort of
how it happened I went for an executive
physical and I was out actually talking
about how to use diet and lifestyle to
manage type two and obese orthopedic
patients and they did my labs and they
said here and once he is elevated I was
like well that's not possible and they
said well you know statistically you're
probably a type two and it ended up long
story short it just didn't really fit
and then my body declared itself as you
know a type one Wow okay so it was just
by chance doing executive medical
getting that hba1c number back and being
it way too high and going hey what's up
on this one and I sort of tried to fix
it with diet because I didn't want to
use you know medications at that time
and you know I was kind of in that
honeymoon phase so I was able to manage
it somewhat and then as happens with
type one the wheels kind of came off in
it became clear that it wasn't
lieutenant I just didn't fit I have no
family history of type two so like the
pieces just didn't fit the puzzle okay
and so if someone doesn't have access to
hba1c kind of lab tests quit just a
simple home glucose test check yes a
simple way also to see if it's getting
towards those kind of levels would you
say Lukas testing which is readily
available for everyone is a great way
for anyone to have an idea of how their
body is handling carbohydrates and so
you know it's not something that
you know it's not harmful although some
people get a little too obsessive with
their numbers but it gives you an idea
if you you know there's the study
studies that Israel would show that
different people have different
reactions to different carbohydrate
loads when combined as Whole Foods and
so you know it can give you an idea of
what it is your relative carbohydrate
tolerance and what foods send your blood
sugar too high even as somebody who's
you know not a diabetic I think it can
be helpful to have that we know that
fasting blood sugars those studies that
show that fasting blood Sugar's over 90
start to indicate an increase in
cardiovascular risk so you know the goal
ideally is to have a fasting blood sugar
be below 90 um and you know there are
other things sleep can affect that
stress can affect that so you know even
if people have a diet that seems to be
tune in if they're not getting good
sleep or not getting you know they're
overly stressed because of cortisol
reactions it can be a good guide for
them that hey I need to pay attention to
this my blood Sugar's are elevating but
on the other side of it we don't if you
know I have to check my blood sugars all
throughout the day I don't think it's
something that you know everyone should
focus on all the time but it's certainly
for periods of time can be very useful
information especially if you're trying
to lose weight or you're trying to sort
of figure out metabolically where you're
at hmm and also I'm just thinking if
someone is maybe a little bit more rural
or remote who's listening to this and as
you said the symptoms could come across
as a cold or a flu and if you're
thinking oh as me you know as a simple
home check just doing a glucose check if
you have that access going oh well okay
yeah my sugars are way too high here and
I feel bad so I need to definitely call
someone yeah I mean ultimately if you
feel bad it's worth be seen by a
physician even you know but yes I mean
we wanna you know the it's a
double-edged sword
risk of you know a lot of home testing
and I say this fully realizing that I do
a lot of crazy things myself that make
other you know physicians nervous and I
would never recommend them for patients
just because I'm trying to sort out on
my own like okay I'm feeling my way in
the dark here but certainly elevated
blood sugars are concerned for anyone
and it makes you more susceptible to
illness and injury and harder to get
over an illness or injury if you you
know you're seeing numbers that are
substantially elevated I think everybody
I mean the issue is when we check
fasting blood sugar as physicians if you
go in for your annual physical and if
the doctor checks up just a fasting
blood sugar rather than a hemoglobin a1c
you miss people that are actually moving
into an area of metabolic concern
because in fact you can see
paradoxically low blood sugars and
people who have fasted overnight if your
insulin levels are high so you know if
you're a snacker and you're snacking all
the time and your insulin levels are
already high and then you do you know an
overnight fast and go get your blood
drawn because your insulin levels are
high your blood sugar may actually be
paradoxically lower than it typically is
so a hemoglobin a1c is an inexpensive
test and is available in any lab and is
something that you know or you can go
there are ways of ordering these online
to check yourself for relatively
inexpensive if your doctor's not willing
but most are and then even to take it
one step further
you know fasting insulin levels or even
you know glucose tolerance test with
insulin levels really give you an idea
metabolically of you know are your
insulin levels too high hmm and are you
moving into the direction of type 2 even
if your blood sugars are totally normal
because we know that there's you know
pathology associated with that yeah I
had dr. Ben Beckman on and he you know
talking all about insulin and insulin
resistance and yeah probably the biggest
takeaway on that was why not just order
in
that test just to see if it's it's not
in it's not expensive and it doesn't
seem complicated so it would you know
having the the glucose level the sugar
level and the insulin level those two
numbers would probably I guess be very
very useful to understand what's going
on yes and in a type 1 or if you're
trying to see if the pancreas is burned
out then a c-peptide is the most
appropriate test because it's a little
protein that comes off of the insulin
sort of again not to get technical into
the science of it but you can measure
that and it gives you an idea relative
to what the blood sugar is is the body
producing enough insulin or again that's
great information for people who may
think of MI or anti so it's the sugar
levels the insulin and requesting the
c-peptide number to see if if maybe you
are fantastic so just like a quick
little summary before we get into your
cool things that you do to manage it on
all your strategies what is the
traditional approach then for a type 1
diabetic once you're diagnosed like them
the management and the treatment versus
because I'm going to use that
information to then compare to like what
you've found and why do you do so
traditionally the traditional guidelines
in the American Diabetes Association are
that you give insulin so there's basal
insulin which is a long-acting insulin
this is injectables injectable yeah and
then there's bolus insulin which is the
insulin that you give in response to
elevated blood sugars or carbohydrates
or protein ingestion although they don't
typically recommend it for protein
ingestion because you're counting carbs
so the traditional recommendation is a
it varies a little bit but it's you know
to have about 30 grams of carbohydrate
or more per meal so that you can give
insulin
to balance out the to keep you know
ketones low and um part of where the
history of that was is we've gotten
better with being able to micro bolus
insulin through the different pumps but
insulin is really powerful in small
amounts it's hard to draw up teeny teeny
amounts so it ends up being within a
syringe you can only there's a limit to
how small an amount you can draw and if
you give more insulin than either your
blood sugar dictates or the carbohydrate
thee you've eaten dictates you're going
to go low and a hypoglycemic event can
be fatal
and so with the you know traditional
insulin strategies you had to eat a
certain amount of carbohydrate because
you had to take insulin so that you
could cover your basic metabolic needs
but the issue with that ends up being is
it's hard to balance that out I mean I
you know have
I worked in my undergraduate my degrees
in biology chemistry and I worked in a
biochemistry lab and you know there was
a pathologist after medical school and I
can't figure out exactly how much
insulin to give for an apple and so you
know because it matters what you're
eating how much insulin resistance that
you have is a woman we have different
cycles throughout the month and that
impacts all of it and so initially when
I was diagnosed I sort of called it
pescetarian paleo which was you know
what I was eating at that time
and started decreasing and decreasing
and decreasing my carbohydrates and then
I was diagnosed in went on insulin and I
initially followed the ABA guidelines
which resulted in I was you know four
hundred one minute and forty the next
and you feel bad at both extremes hmm
you know being elevated for a long
period of time does damage to the body
it takes longer to see that damage
happen a you know really low blood sugar
as I said you know can be potentially
fatal so after a few weeks of doing that
I was like okay this is not working and
carbohydrates are the issue so it just
makes sense to me that if I just limit
the carbohydrates that I take then I
limit the amount of insulin that I need
to give and then I'm not gonna have
these big excursions so what so Kerry
just so I can summarize a little bit
there what I'm hearing is that the
problem you and other type 1 diabetics
had is that insulin is so powerful but
we can't give it in such a small enough
a dose to give to make sure that you
know we don't give you too much in one
way you have to take a little bit too
much and because you have to take too
much insulin you have to give you the
recommendation is to eat more
carbohydrate to balance out the issue
from taking too much insulin is that
sort of like what I'm hearing yes so
with the old syringes that was for sure
the case as far as being able to give
the small amounts now with the newer
pumps you can give very very then the
issue becomes how fast does it absorb
how much of it absorbs is there like
there are ton of factors in you know
it's it's not a simple you eat 40 grams
of carbs and you give this many units of
insulin because it's all gonna absorb
and the carbohydrates may absorb slower
or faster and it ends up being hard to
balance now there are some strategies
Steve ponder doctor ponder is a
pediatric endocrinologist who is type on
himself and he's created this sugar
surfing I mean you can do it where you
watch your continuous glucose monitor so
I
have a device that puts a little chat
that are under my skin and it's able to
go to my phone and tell me what my blood
sugar is that's let the Leafs lifestyle
leave style yes sweet non bite but yes
and so you can watch what your CGM graph
is doing and you can react to that and
give small doses of insulin or small
doses of carbohydrates to do that and
that works the issue that I have is I'm
really busy treating patients and doing
surgery all day and I don't have time to
micromanage my diabetes all the time so
by not eating substantial amounts of
carbs my blood sugar stays relatively
flat and much easier to manage so when I
do give insulin I give small amounts so
it's much less likely to drive me very
very low plus I'm on a ketogenic diet so
I have small amounts of ketones all the
time and we used to think that the brain
needed ketones in order that the brain
needed glucose in order to function
that's not true the only cells in the
body that actually need glucose to
function or red blood cells and so the
brain will function just fine on ketones
there's concern again as a type one
diabetic because gja
can be a fatal condition yeah what you
were talking earlier about the
ketoacidosis that's going to be one of
my questions like being on a ketogenic
diet you know you're trying to make
these healthy ketones but if you get too
many ketones then you go into
ketoacidosis which and so that's so
interesting being a type 1 diabetic that
those ketone levels to be in health
range not ketoacidosis danger range so
walking around on a daily basis and I
mean I operate so I operate in the
fasted State in fact I find that I'm
better you know my brain is functioning
and you know I don't eat breakfast I
have black coffee in the morning um if
it's a day when I'm in clinic I'll have
lunch but a lot of times I just wait and
eat you know when I'm done with my day
so I'm able to keep my blood sugar again
because it's not you know I'm not
putting carbohydrate source in and
have to worry about I have my basil ants
and so I have a pump at this point so my
pump
I have basil insulin and it's set at
different amounts at different times of
the day
um and then I have different Basil's for
different times of the month as a woman
because yeah but the hormones here yeah
with the hormones so um a person who's
just walking around living their life
healthy even as a type 1 diabetic unless
you take a massive dose of so first of
all let me say ketones are not the
problem
ketones are a symptom or non symptoms
ketones are something that are
measurable that go along with the
metabolic collapse that's happening with
dk okay so if we're healthy and we're
doing well and our bodies aren't under
excessive amount of stress and we're not
dehydrated
some low-level ketones are perfectly
fine just like for everybody else
illness as a type one diabetic even as a
low carb type one diabetic is no job you
know you still have to really pay
attention and that's where you know
again with illness if you can't eat if
you're dehydrated
so ketoacidosis can actually happen in
somebody who's not a type one diabetic
under it's called starvation
ketoacidosis or there are these newer
diabetes medications that can cause a
type two to go into what's called u
glycemic DJA but it's a bigger metabolic
thing than just your body's burning fat
for fuel it's the whole metabolic
collapse that's happening and it takes a
substantial trigger you know so there
are reports of starvation ketosis where
people have not eaten for extended
periods of time their ketone levels got
incredibly high and they went into a
metabolic acidosis with that in a type 1
it typically ends up being related to an
illness that's caused significant stress
cortisol levels are elevated glucagon is
going up insulin is not able to suppress
the ketones being produced dehydration
is usually a factor so it's a complex
saying that's happening and we all as
type ones have to watch for mm-hmm you
don't want to downplay that at all okay
yeah that was good that was good
information there so yeah you don't want
stress sickness and being dehydrated
being type one diabetic because that's
that's time to cause you you towards a
bad issue there and ketones are just a
piece of that and we happen to be able
to measure those ketones so you know on
a daily basis my ketones may range
anywhere from on the blood monitor from
five millimole to you know one point
five or two
it's when we start to see it in much
higher levels that me you know is
looking boring but it depends on what's
going on with the whole picture as to
whether it's you know there are non-diet
there are non type ones who we've seen
in the blogosphere showing you know
ketone levels of five and six and seven
as a type one diabetic that makes me
nervous because we metabolically are
different and we can launch very quickly
if we let things get that high but it's
not again it's not walking around living
your life doing things there's other
things that are usually going on your
insulin delivery got shut off so if your
pump isn't giving you insulin because
there's a malfunction with it you can
slip into DKA without stress or that
just because you're not getting enough
insulin so it's really about making sure
that you're getting enough insulin to
help keep the metabolic milieu in check
so here's an interesting question you
just got me thinking about you know
there's a head doctor Briana Stubbs from
human in San Francisco who makes the the
ketone ester drink would you ever drink
that so I the type one diabetic I have
please no one else out there I warned
you this to play with it I can say that
again from a metabolic standpoint I
think it's starting it makes us all
nervous we don't know the answer but the
reality of it is you know as a type one
diabetic I wear a fatal dose of insulin
on my body at all times right and we
give it in small amounts but you know
type 1 diabetes is work we're acting
like in Oregon and so I think there is a
role for exogenous ketones I have
concerns about anyone taking exogenous
ketones with elevated blood sugars
because to my knowledge there's not a
normal state that the human body is in
where blood sugars are elevated and
ketones are also elevated so I'm paying
close attention to those studies
I took them you know before they were
palatable and sort of tasted like jet
fuel and so I just I don't recommend it
um so you just get the same sort of
cognitive benefits and some of the other
things just because of the way your body
metabolizes potentially as it is how
high do your ketones need to get to have
the cognitive benefits right so if you
take a ketone drink and your ketones you
know go to the 7 which I've seen you
know some of the studies showing I feel
like I have the cognitive benefits if
I'm above point 5 for my patients
neurologically you know I use ketogenic
diets in my patients because ketones so
beta-hydroxybutyrate is you know we all
know of anti-inflammatories like a leave
an advil and all of those those are Cox
inhibitors and so beta-hydroxybutyrate
is a cox-2 inhibitor so in Wow I don't
actually know that it also inhibits this
nlrp3 inflammasome which starts the
inflammatory pathway and then it
modulates ampk so ketones I use it in
patients because it helps
sort of stabilize things from a
neurologic standpoint but it also is you
know anti-inflammatory I use it in all
of my surgical patients and we're seeing
you know again this is anecdotal you
don't have all the data but anecdotally
I'm seeing people use dramatically less
pain medication after surgery wounds are
healing faster people are getting back
into activities faster and a lot of my
patients are obese and type 2 so we're
using it to sort of stabilize them
metabolically but even non obese non
type-2 diabetic patients are seeing
benefit from a pain standpoint I'm
affect my husband always jokes that I
should give people the ketogenic diet
after surgery because we've had quite a
few people cancel surgery we got better
with a diet but that's all really a
great tip for people listening if they
you know back pain so common in this
world and people may be at that stage
where they're consulting someone like
yourself for potential surgical care and
as a simple thing to try it's like yeah
your diet can impact your back health
and your pain levels so what it's worth
a go right and it's you know it's
changing what you eat which you know we
can argue that you know I've heard
people say that changing someone's
religion is easier than changing their
diet but we do it every day and you know
I'm in a busy surgical practice and we
you know sort of have it down where I
explained just enough of the science and
say here try this and it's amazing the
number of people you know I mean we're
getting people in an orthopedic practice
off of their type two diabetes
medications and a lot of them there it's
cleaning up their diet so much and you
know we're going to talk about this but
I'm plant-based so for a lot of people
it's actually you know they're eating
more plants although I don't typically
put my patients on a plant-based
ketogenic diet but they're eating more
non starchy vegetables and they've eaten
in their lives and so there's benefit to
that too that we can't tease out from
this so they're not eating you know the
process carbohydrate foods and not
having the blood sugar levels but so so
ketones have benefit if I'm using it
from a neurologic
and poignant again this is all anecdotal
I can't you know
qualify it I feel like we have to get
people at least in the initial stages
where they're beta-hydroxybutyrate is
above 1.5 to start to see true
neurologic changes and there's more of
that research that's solid in the
epilepsy community um and there's you
know I just tweeted about a study this
past week that came out about using the
the ketogenic diet in to prevent damage
from a stroke and so we're seeing these
new things happen and what level you
need to get your beta hydroxy butyrate
to or even your acetone to so there's
some additional data that the acetone
may be a factor as well in controlling
these neurologic conditions so we don't
have the answers as to how high you need
to get them but you are it's I think
it's quite nice to hear that you are
finding some benefit for patients again
so something out there people might be
or may have heard of it's like sciatica
like a trapped nerve a pinched nerve and
again a part of the treatment paradigm
to help get a situation is what it is
again potentially even raising your
ketone levels could help the pain levels
and then and nerve itself because it is
a nerve function better so I think
that's really cool you know treatment
wise I inject you know powerful steroids
are you know in the epidural space
around the nerve roots to substantially
calm inflammation and so from my
standpoint I always talk about the
toolbox with patients where you know we
utilize all of these things together
often so you know there is still a role
for traditional treatments but for sure
dietary changes can make a such a huge
difference for patients and then they
come in like my back means better but so
are my hands over my shoulder so are my
knees so you know we really do need to
better understand how diet really
impacts the musculoskeletal neurologic
sense you know
systems but it's funny because it's sort
of like heresy to say that your diet
impacts your musculoskeletal health and
yet you know and we know that for
example in knee if you lose one pound
that's four pounds off of your knees and
we're so we're really good at the
biomechanics of it but we really need to
pay more attention to the biochemistry
of it all and how diet impacts that yeah
and I think you know at that point there
because we put people who are carrying a
bit extra weight they always told you
know get the weight off and then that
will make your joints feel better but
you can have people who are more petite
or thinner but they can still be sore
and have hip a can me ache and is
because they're inflamed so yeah what I
tell my patients in clinic is that you
know this diet is is potentially
anti-inflammatory and you may have
benefit from it and weight loss is a
side effect that can happen and I
haven't yet had anybody complain about
that side so let's let's come back to
your personal story a bit now with the
type one diabetes and the management
style so we've we've discussed how the
traditional management is and you said
that you were on that like the type of
the paleo type diet to begin with so how
did you end up as you mentioned a more
plant-based diet and even now as I
believe it's a vegan ketogenic diet if
you could just guide us along that
pathway yeah it's a really circuitous
pathway but uh you know I gave up me
for varying reasons when I was 12 and
for the better part of 20 years I was
plant-based and to a certain extent at
work it really didn't there were issues
with that and I didn't do it perfect and
you know nutritional optimization is an
important you know factor and sort of
dialing it in so then in orth you know I
ended up getting the diagnosis of type 1
diabetes and I followed the ATA
guidelines and at that point like I said
I was mostly pescetarian paleo and then
as I was trying to manage it on my own I
started decreasing my carbs decreasing
my carbs and that's when I introduced
animal proteins back in and I it from a
blood sugar standpoint it worked well
and so then I was diagnosed so that's
when I ended up so the timeline wise it
was pescetarian paleo and then really
low carb couldn't get my blood Sugar's
under control and I was eating like
almost zero carbs so I was almost on the
total polar opposite of sort of a
carnivore type diet although I've never
done well with eggs or dairy um
and so then I went to insulin went back
to the ATA and it wasn't working and so
then I went you know more traditional
ketogenic diet and it was after that you
know I was into it for quite a bit
before I found you know dr. Bernstein's
work in his book and type 1 grid and
that whole group of type 1 diabetics
that are managing it with a low-carb
approach and that was working well
although there are some subtle things
that you know at times you know dr.
Bernstein's approach is more low carb
higher protein um I am an individual and
this is where it gets individualistic I
don't do as well on higher protein and
I've just found that out through my own
biohacking and I gave it a shot you know
I mean I tried the full out again even
once I was on insulin super low carb and
I just
my blood Sugar's were great I didn't
feel great and so I'd increased it a
little bit more with a little more non
starchy vegetables and then I got a
really bad virus that resulted in a post
viral gastroparesis so what that is is
after the virus was gone my stomach
didn't work right because why not right
I didn't have enough going on in my life
and so now I get can't eat and I
couldn't you know when I would eat it
wouldn't move through and so I had to
try and work really hard to get
nutrients in and honestly it was truly a
blessing because I was able to start I
we did testing on you know as my
nutrition status was getting worse we
were testing actual amino acid levels in
addition to you know protein levels and
all those things and I had to learn how
to get nutrients in or you know if I
continued on that trajectory end up with
a feeding tube which was just not
anything I was interested in so I was
able to start with um like amino acids
themselves that I ordered from a special
lab and put them into a smoothie and I
was able to kind of get that in and then
to cut it short plant-based proteins
were easier along the way for me to
digest again I tried whey protein I
tried egg protein and I just don't
tolerate those at all I probably you
know have some autoimmune reaction to
those and so you know I tried adding a
little bit of fish back in and I just am
NOT a huge fan and honestly like the
reason that I gave up me when I was 12
is I just don't really like it hmm and
so instead of but I had in my brain I
was like I have to be keto and keto
involves me I just said why am i pushing
this let me just do this vegan keto and
do it and it worked really really well
for me now can I say that I'm gonna be
vegan keto from here to eternity
absolutely I can't say that because if I
objective data that you know I need to
add animal protein back in or if I
develop a taste for it I would consider
it but at this point my inflammatory
markers are lower than they've ever been
my insulin requirements everyday are
lower than they've been my a 1c is 4.8
the last time I checked it you know so
high sensitivity CRP is a marker of
inflammation I could never get it below
1.2 and now it's like 0.3 I mean it's
ridiculously well um I'm in my mid-40s
and my sex hormones you know estrogen
progesterone all of that are better you
know I was going into sort of early
menopause and now it Those have
recovered completely um whether it'll
stay that way or you know once I am
menopausal if it needs to change then
I'll change it for right now
I'm doing so well I don't have to worry
about weight um that there's no reason
for me not to continue this and it's
been an interesting thing because it's
certainly not the 100 level course like
doing Keo vegan is so some extent easier
but it's trickier at the same time so
some people try and avoid soy I found
that I do very well with soy and I
wasn't doing so initially the issue with
that is the other sources of protein
that are plant-based tend to be lower in
lysine so hemp seeds chia seeds um you
know things along those are the nuts and
the seeds I use such in Chi seeds and
borrow nuts and things like that they
tend to not have significant lysine and
I will say we've never actually like
there are very few documented cases of
individual amino acid deficiencies but
lysine is one of the essential amino
acids so P protein has lysine in it and
there are a large you know number of P
protein things that are available out
there I try and keep my diet to be as
whole food based as possible so I use
black soybeans just the same way anyone
would you
black beans and they're very low in
carbohydrate I will use Latini beans
which the brining process that's in them
they have almost zero net carbs and I
test that out because carbs can't hide
from a type one diabetic um and like
those bars and stuff that you know I try
and avoid the bars because I found too
many of those things you know they say
they have zero net carbs and then you
know Myra might come 180 what is going
on with this that's not what should
happen so I'm doing really really well
with this and it turns out there's a
whole community and there's a lot of
people who say you can't do a ketogenic
diet and be vegan and the reality is you
can you just swap out you know the the
protein source for a plant-based source
and I eat a lot of non starchy
vegetables and I whenever I sort of tell
my patients whenever you eat a non
starchy vegetable put a fat with it when
you ever you eat a fat put a non starchy
vegetable with it know me there are some
benefits to the phytochemicals and that
that are in vegetables so yeah I mean
that for me that's that's fascinating to
hear that journey that you went on and
as you said you know you you're doing
measurements and you found that that you
know this approach was giving you the
right numbers and you were subjectively
feeling better so this is taking me
objective data plus the subjective
feeling of how you want to feel and
putting them together and going like
this this is how I want to be and what
it's also interesting to hear because I
was wondering why you want to be vegan
if it was more from like an ethical
point of view that you probably like
animal preservation which seems to be
the the main reason most people choose
it but as you said you just felt you did
it's like a taste factor and you didn't
perform well on it so and you know if
you're you're gonna do whatever makes
you feel best so I think that's good
good for people to hear - yeah and from
the ethical side I mean you know I'm we
have three big dogs in a cat you know
and yeah those things are all factors
but I think the ethical side of it gets
trickier in the sense that you know mono
crop farming is a prob
and you know our whole sort of food
agricultural system needs to be shifted
over yeah that's a whole whole big talk
just the whole other discussion on to
how do you optimize that and yes there
are people who want to do keto vegan for
the purely ethical reasons and maybe you
know and you can there's arguments on
both side of it for me it's just about I
was never a huge fan of me you know if I
don't need to eat it why eat it and I
mean this is one of the things that
because I live in this weird world why I
have friends who are you know really
outward the you know delivering the
message in the Quito community but also
ones who are in the vegan community and
the reality of it is they're not both
wrong you know there are people who do
well although I do have concerns about
people long term from a neurologic
standpoint long term on a low fat like a
less than ten percent fat vegan diet but
the human species is incredibly
resilient and we can you know our bodies
can adapt and adjust to the environment
we can thrive I think really the the the
true art of it is figuring out what at
this moment in time because it may
change works best for your body and in
conversation even with some of the
protein scientists you know there's
concerns are you getting all of the
amino acids that you need and there's
some new research coming out looking at
the gut microbiome and how that plays a
role in why is it that the human species
is as adaptable as it is that it's
really complex physiology and you know
it's not as simple as you know I don't
the more I learned the more I realize
like Occam's razor just doesn't apply so
I want to get a little bit more into the
Nitty Gritty of awesome with your
testing and what you found so you
mentioned cuz I you know I I follow you
on Twitter and you do share some good
stuff in there and what I love about
your approach is you just you kind of
it's the way I like to think to you
you just you're looking at all different
points of view and you know it's sort of
fanatic on either spectrum of anything
anywhere so you just want to look at you
what works best for you and so I I did
see that some people kept asking you the
questions like so how do you get enough
fat because you know they would think
but I come from a ketogenic world where
you have to eat like lard and butter and
things like that but like if you're
vegan you don't get to eat butter so
it's immediately like how do you get
just enough fat so I was kind of oil um
uh olive oil um you know coconut oil and
you know there some people the coconut
oil is a whole sort of separate
discussion and the fats that are in it I
think you know there's the medium chain
fats and then there's lauric acid which
is handled differently in the body I
mean that was one of the fascinating
things that I learned by having the
gastroparesis was with gastric emptying
and how does our body handle these
different chain length fats and whether
they're poly unsaturated or
monounsaturated um so there's avocado
oil there's olive oil um you know
coconut butter uh you know rock cacao
and you know I mean there's fat in
plants so avocados I eat an avocado
every single day in fact I travel tsa
and I have gotten to know each other
very well over my avocados in my luggage
um they actually leave my insulin pump
like that doesn't throw them it's you
know they've started testing food and
avocados so you know I carry with me nut
butters and things like that um and like
I said avocados and I there's I I
haven't had any issue with getting
enough fats I like salad dressing on my
salad so I'll have a big leafy green
salad with a bunch of you know
vegetables on it shaved Brussels sprouts
in it or great broccoli is fantastic
cauliflower I mean sort of whether
you're vegan keto or not it sort of
feels like we all worship at the you
know altar of cauliflower sometimes
because we make one Tom flower oh and
then you put a fat with it so I actually
you know Berta
they had a recipe recently for
a vegan butter that uses a little bit of
almond flour and coconut oil and some
turmeric and some salt and it's you know
I don't really miss butter but that you
know spreading it on I have a chia bread
that I make that's you know made the
chia seeds and chia seeds have fat in
them so you know there's lots of
different plant-based sources of bats
yeah so so someone who is coming from
that side they make you know okay you
can actually get enough dietary fat to
qualify as like a ketogenic diet point
of view the macros are exactly the same
I mean and no then it just becomes are
you somebody who's low carb that does
better on high protein or is it moderate
protein you know where is it optimal for
you and you just plug in the foods I
think um you know and there are
different tools out there I don't know
um if you've seen the nutrient optimizer
I mean that's a great tool that that um
what is the nutrient optimal you know
has a program that you can plug in what
you eat and it goes through and you know
sort of gives you a score or how well
you're doing from a nutritional
standpoint the ones that are readily
available that are easier like
cronometer or MyFitnessPal where you can
plug all of that in and what you want
your protein carbohydrate fat to be but
I also argue that you want to optimize
nutrients so yes there's an issue with
getting enough b12 on a vegan diet no
question about it nobody can argue about
it I have because of course why not
an MTHFR Berrien as well so you know i
think again i should not be alive um I
take a methyl fully you know um and a
methylcobalamin supplement but
nutritional yeast the one that I use
that I like I put it on my food because
it gives it a flavor that I like has you
know it's supplemented with b12 so
you know the argument always ends up
being yes so yes I've heard can you get
enough fat b12 is an issue I supplement
most of my patients because of some
research that's out there on omega-3
fatty acids because people don't tend to
get enough of that I use alkyl um I
would probably be fine with fish oil but
again I'm sort of trying to hold this
space and say can you be completely
vegan and there are you know vitamin d3
plus t2 is something that I also
supplement my patients with there are
plant-based d3 and k2 as well so
Japanese natto which is a fermented soy
bean
um and I may be saying it wrong but I
like it it's people say it's an acquired
taste but if I put mustard you know soy
sauce or coconut aminos with it I really
like it so that's another way to get k2
so there are supplements I think even
under the best circumstances people
struggle to get all of the nutrients in
I worry about some of the people who are
doing the pure you know carnivore type
diet in that they're not getting enough
of the nutrients that you need from the
organ meats and so I think we can all
benefit you know there there's something
to be said for a shift in your diet will
make you feel different sometimes better
sometimes worse and then the question
just becomes where do you come into that
diet from a nutritional standpoint when
you start it and do nutritional
deficiencies develop down the road and
for me the real key is paying and being
dialed in to that and the simplest thing
is how you feel and if you feel really
great on it then it's working if you and
if your labs look good and it can be
simple absent any doc can check if
you're tired and your skin is flaky and
you're not sleeping well and your hair
is falling out all places that I've been
or you're gaining weight and you feel
like you're not eating much at all like
those are all signs that something needs
to change
yeah and that's again by hacking N
equals one test yourself learn about
yourself find out what works for your
physiology so not get married to it if
it's working now it doesn't necessarily
mean that you don't need to you know
adapt and exactly what you were saying
to and that's why I love you know
speaking to people like you because I I
feel the same you know it you know you
your life changes as your well our
hormones change as we age - so lean
muscle mass and a whole bunch of factors
or environmental where we are monetary
so many things happen in life you know
so you don't feel stuck in one sense you
you know go over the flow just learn
what works best for you I would also be
interested to know so with with you
having access to all your testing that
you're doing
are there certain vegetables or fruits
that are just you would say no no if
you're a vegan keto just it's probably
going to cause you a problem I mean the
carbohydrate content of them matters so
you know fiber are to a certain extent
and it gets into the nitty-gritty of net
carbs and you know there's two kinds of
there's soluble fiber and insoluble
fiber and if we're really truly dialing
it in you know you can subtract some of
that from the carbs that are in the food
that you're eating but
you know in my diet it depends on what
my whole day looks like I'll have you
know the low glycemic index berries I'm
in the low carb area so there's glycemic
index and then there's slicing the globe
so as a type one diabetic I would have
to save the glycemic index matters some
but it really is truly the glycemic load
and so um for somebody is a type one
diabetic the carbs matter end of story
you have to cover them with insulin and
so any fruit that has substantial amount
of carbs you're gonna have to cover with
insulin and that just starts the whole
up down rollercoaster if you don't match
it accurately so yes or no so you know
I'm gonna bring it up because I do
notice it quite a few people in the
vegan community seem to bring up bananas
a lot for some reason and I was just
thinking but yeah a very ripe or sweet
banana it does influence your glucose
level and you would be able to measure
that right there's not because it's
gonna send me high it's just a roller
coaster that I don't want to be on right
and it kicks you out of ketosis and
there's benefits of being in ketosis so
anything that has a substantial provide
rate look like I love chickpeas I I
would eat chickpeas over a stage and
like my whole life
chickpeas will send my blood sugar
through the roof even though I'm begin
at this point I don't eat them because I
just don't want to deal with that yeah
um so low you know blackberries
strawberries raspberries I'll have a
small amount of those and it doesn't you
know sort of set things out of whack as
far as vegetables you know most of the
non starchy vegetables asparagus
Brussels sprouts broccoli cauliflower
kale you know those things are fine
cucumbers olives love olives I eat
olives every single day um the black
ones or the green ones what's that the
black ones are the green ones bring it
on doesn't matter I've yet to meet an
olive that I don't like and so are there
any vegetables you would say that so any
starchy vegetables like those carrots
I mean I'll eat a small amount of
carrots but peas peas are really alike
Ewing but we corn which is not really a
vegetable to grain but you know so any
of those starchy ones I don't need again
because I'm you know not wanting to be
on that roller coaster and you know
there are you know those who find that a
super low fat I mean if we're talking
about changing metabolic syndrome with
somebody who has insulin resistance you
can change the primary fuel at either
end of the spectrum so there is you know
if you eat incredibly low fat you the
body will you know utilize the available
fuel and so there's you know some data
there to indicate that yes you can
improve metabolic syndrome with that
sort of diet again I have some concerns
with that and the other side of it is we
don't have long-term studies you know
this is one of the pieces I know that my
day to day feels better my inflammatory
markers are lower my brain functions
really well I can operate for hours and
hours on end and not get tired or hungry
or any of the things that happened when
I was you know low-fat plant base
um but we don't have long-term studies
on okay what does it mean to be you know
low-carb as a type one diabetic you just
you don't have that data so to be able
to put my science hat on and say hey
this is great there's you know we have
to have sort of hedge what we say about
that but I can tell you my day-to-day
measurements look like I'm minimizing
known risk factors and I saw a tweet
from someone who I believe is a type 1
diabetic part of that grid that you
mentioned it earlier and it was
fascinating because that freestyle Libre
that you were talking about whether you
the continuous glucose monitor and there
was okay yeah so the Dexcom them one one
but I don't which one it was but anyway
they I guess in your in the community
it's always talking about appreciating
your lines or respecting your lines and
so that she was just showing a picture
of someone who is non-diabetic I guess
was wearing it just to sort of assess
their day which I found fascinating and
they could see like they ate a jacket
potato or like a white potato and what
it did to their body we saw the spike
the lion that lion spike and I thought
yeah the kind of data that you get
access to it must be so fascinating
because someone whose nan died but it
doesn't wear that device but I think I
would learn so much about myself if I
was wearing one just and I just ain't my
normal diet for seven days and went okay
what did my lines do look yeah any
knowledge is power
um and it's different right so again
that I talked about it before but the
research that's coming out of Israel and
you know what is the response to
somebody for a banana versus ice cream
and they saw that people had different
responses to those so you know one
person it the banana made them hide the
ice cream didn't and the other it was
vice versa and so you know there's
there's variability in that and that's
where you know again from a biohacking
standpoint knowing how these things
impact your body is so powerful as far
as optimizing your risk factors so do
you have any mentors or people in
vegan ketogenic diets world's because
you know I'm sure there's enough yeah
because that's why I got you on thinking
you know you could be a great example if
anyone is considering that if they
because it's because there are extra
nuances and things to consider like how
they get it get that information that's
why we're doing the interview today so
so there is a really large growing
Facebook group I mean it's amazing how
many people have been in it and people
post recipes and things like that and
the admins for the group so it's called
vegan keto made simple and there's a lot
of great information there and the
number of people I mean I think the
group's been around for about a year and
the last I checked which is a month or
two ago I think there were over 26,000
members in that group yes so it's the
the interest is there I mean I do have
concerns again about people making sure
with any diet getting you know optimal
nutrients with it and so there's not
again that's one of the things that you
know there's not a great guide out there
yet at this point for how do you do low
carb vegan which is why I try and post
like it drives my mom crazy she's like
why are you posting what you eat on your
Instagram you're a spine surgeon and
it's because you know people want to
know those things to give them ideas and
you know I'm fairly lazy and eat sort of
the same things on a regular basis so
sometimes I have to force myself to come
up with something new just to have
something to post and we're talking
about doing cookbooks and things like
that to give people ideas but um you
know the guidelines are effectively the
same as far as the macros and dialing
that in like I said before it's just
learning how to use these plant sources
of protein you know when there's
benefits so you know then the question
becomes from an mTOR standpoint do you
want to make sure that your leucine
levels are high enough in an individual
meal so the way I eat is I'll have
at least one meal a day where my protein
load is more than 30 grams and my
leucine levels are over that sort of 2.5
threshold looking at the data that's out
there I I lift weights and I will use a
branched chain amino acid supplement
once a week when I do that do we know
for sure all of these answers that this
is the best way to be doing it no but
I'm learning you know so what I'm doing
now may be completely different a year
from now but at least for now it seems
to be working and I think there's
benefit to cycling mTOR you know not
leaving it on all the time not all the
time
based on the longevity data so you know
again if you're sort of trickling
protein along all day and you're doing
it from a plant-based way you may not be
triggering that mTOR um and sarcopenia
of aging which is you know the muscle
wasting that happens as a result of
aging from uh spine and musculoskeletal
standpoint is something that we want to
try and minimize so you know that's
where it's interesting to me the
research that's coming out on okay how
do we use you know meals in order to
minimize that and then weight lifting
strategies and things like that to sort
of maximize the to be fibers which are
the super fast twitch fibers that help
prevent us from falling and breaking our
hips when we get older mm-hmm and that's
why again like I said earlier all the
way when we started the podcast was you
look at so many other factors and the
type of exercise weight lifting to
stimulate yeah there could be so many
more good factors we could talk about
for type one diabetes management what
you found
you know like weight lifting sleep my
own I might need to get you on again
carry is it that's but weight and sleep
I mean if I do a heavy leg day or if I
do a high-intensity interval training my
blood sugar goes up and I have to give
insulin for that but it's a different
amount of insulin that I give I would
have a food spike with that so there are
strategies around all of that because
insulin is necessary to build muscle and
there's a cortisol reaction that happens
with that long
of distance you know then it's more a
matter of you know I'm cheeto adapted at
this point so if I do long slow distance
I don't see the dramatic drop that a lot
of diabetics see because my body my
muscle is preferentially at this point
it would seem and again I follow under
the shoulders with that statement of you
know dr. Bullock and dr. Finney and the
work that they've done as far as you
know doing athletic sports
Kito adapted and it's not different for
a type one okay it is possible oh for
sure yeah I mean I you know I'm not
doing a lot of long-distance running
right now um most of my work is
high-intensity interval training and
weightlifting but you know I have on
this diet and you know there's you can
which is a sort of slow early starch
supplement I don't actually like the
taste of it to me it tastes like
wallpaper paste but I could use
something like that or nothing and go
out and do a long run and you know I
bring a couple glucose tabs along with
me but not nearly the crashes you know
when you've got high levels of insulin
on board and you go exercise it's like
you know turning an amplifier on a
speaker and that's when you start to
crash and that's where a lot of type
ones feel like they have to have
carbohydrate available all the time for
exercise and again when you become keto
who adapted the science changes and
that's where you know a lot of this
stuff some of us we're still sort of
feeling in the dark with this and we're
relying on the experience of dr.
Bernstein and he his book is great and
type one grit is great um there are
things that you know not everybody
follows the same exact prescriptive
things and so learning where the
pitfalls are learning where those
problems are we need more funding so
that research studies can be done so
that we can actually know where do
people get themselves in trouble as a
type-1 trying to follow this and you
know there's not good research studies
on it because even at this point it's
still super controversial to say a type
one is doing low carb
yeah well in your case you're type 1
vegan and ketogenic you know so each one
on itself is massive study surf and you
combine all three into one she's unique
yes another quick question would be
cholesterol levels do they also you know
so when people to a lot of people in the
ketogenic community when they when they
go that route they may get as they
ailments as a hyper responder response
yep does that happen on a vegan keto
diet two word changes in cholesterol
levels have you seen anything so it can
I mean um yes I don't have enough I've
seen people say wow my numbers went up
really high and again if we look at in
the epilepsy community some of the
studies show that there's an initial
increase and then you know it sort of
normalizes out and then the whole
question becomes what is an elevated
cholesterol what is an elevated LDL mean
I have never personally had issues that
are substantial with I'll be on
cholesterol but of course again to be
unique I have a really high lipoprotein
little a
and so what does all of that mean and
how do we you know mitigate any impact
with that so for short fats will raise
the cholesterol and again it's you know
live and plump those fats yeah they're
so fast yeah so it can raise it the
question becomes what is the impact of
that and you know we there's there's
zero studies out there on what a vegan
keto diet means for longevity doesn't
exist there is one study out of Canada
that showed that um compared to a than I
don't want to put this wrong with
compared to a low-fat my based diet and
more adkins type plant-based diet had
benefits um lower triglycerides higher
HDL you know um so it gets nuanced and
then the question becomes for me it's
more picture of what's going on with
inflammation if there's a lot of
inflammation in the body that's
problematic um and you know again it's a
really exciting time to look at what do
these different markers of lipids in the
blood actually mean when we're talking
about true risk so I really didn't
answer your question no you like you
said you haven't noticed a change I was
just I think it would be interesting for
myself and listen sit here like in that
community because I'm not in the
Facebook group just do do people talk
about having the same issue compared to
someone who may be on a ketogenic diet
that does contain animal animal products
even someone who's on a plant-based
ketogenic diet they they deal with the
same issues so to a certain extent I can
say yes people do see um
at least transient increases but just as
many people are posting you know again
this is all anecdotal and N equals one
amazing lab results I can tell you
whether this is the right thing or not a
preventative cardiologist with my
lipoprotein little a being as high as it
is said you know minimize your LD
like they suggested a statin and I said
thank you anymore but um the I what I
personally have found is plant-based
ketogenic versus omnivore ketogenic
there is nobody that would put me on a
statin because my LDL is low my HDL is
high my triglycerides are always lower
than regardless of what I'm on my
triglycerides are always lower than my
HDL I mean my total cholesterol number
is low you know I ran stuff through Dave
Feldman's program looking at remnant
particles and I was in the lowest you
know percentage group with that um on
the the vegan keto diet so for me I can
say that yes from if we look at the
traditional markers and the traditional
recommendations my numbers all look
better compared to omnivore keto but
then the question becomes do we are we
really using those markers in the right
way yeah that's the clinical
interpretation that we're always
learning and that's what science is
trying to figure out and Dave Feldman
cool well I mean it's amazing like I
think it's fantastic to have all of
these you know engineers that are
weighing in on all this because it's a
different perspective and you know it's
sort of you know I like the analogy of
the you know the blind men feeling the
elephant and describing what they're
feeling we're you know we in traditional
medical training and allopathic medicine
Western medicine have this sort of focus
that's been passed down over time and we
have a way of looking at things and
having people with outside perspectives
and different patterns of thinking is
amazing and like branching all of this
open in such a fascinating way that you
know we're gonna learn a lot from this
and anybody who pushes back from paying
attention to that you know is kind needs
to open their minds a little bit more
and at least learn and pay attention to
what you know these different
perspectives on you know thinking
patterns are around all this
well I've definitely enjoyed listening
to your thinking patterns today they're
being fascinating how can anyone keep in
touch with you follow what you're doing
you mentioned some accounts if you just
want to mention those again so I can put
them in the show notes yeah so I have a
Facebook account
it's querida Ulis MD a Twitter account I
sort of differentially post different
things on those trying to reach
different audiences and then my
Instagram is is carried a Ulis MB where
you know I'll post a lot of recipes and
things like that
and those are you know most of my social
media I try there's that busy surgical
practice thing that sometimes I get
really quiet for a while and then so
yeah a command patient is my doctor just
Instagram again never Instagram
inappropriate times carefully my
Instagram about a patient that when I
post maybe it's usually weeks later like
I as I'm going through my day I'll take
a picture of something um and you know
I'm a posted three months later because
I'm like I haven't posted anything a
while I need to post something and I'm
trying you know to be a very diligent
student of my teenage daughter and learn
social media you know I'm her as far as
all of that goes good they can just take
fit like selfies and be perfect every
time and I take a selfie and I look like
ah yeah there's a school for that long
arm I am not a topper I'm small so long
arms don't work okay I just want to say
thank you so much for sharing your
personal story and such great
information I mean we've talked about
the journey of what causes type 1
diabetes symptoms of diabetes testing
nuances you know ketogenic diet even
diet protein there's there's been so
much information in this episode which I
just want to say thank you for sharing
that and again I know there's so much
more I could probably pull out but I'm
going to try keep them keep this just
under an hour and a half now so
anyone still listening to this thank you
so much for getting to the end too but
carry it yeah I probably get some more
ideas and so I probably want to maybe
get you on for another episode if you're
willing to do that yeah absolutely I
mean I'm thank you so much I'm honored
that you would have me on and you know
get to talk about all of these you know
fascinating things and well yeah and
it's groundbreaking and exactly what you
said you know your cutting edge and your
having to test things because there's
there's nothing out there and you need
to figure it out and this is why I love
this community because this is how we
learn you know we we learn from each
other case studies and then from that we
get that pattern recognition going on
okay so there's get this pattern and
sometimes it's here sometimes there and
that's what we need to listen to these
kind of stories yeah and every time
somebody pushes back against something
that I say which I actually love it
because then I go down that rabbit hole
of
all right what is their validity into
this and that's how I learn things so
you know we don't really learn from our
successes we learn from our failures and
so I welcome people criticizing what I'm
doing as much as you know being
interested by it because that's how I
keep asking questions more and more
questions so it keeps like fun well
again thank you so much doing this and
making this opportunity available so how
these solutions no problems
you

Listen to Dr Carrie Diulus, US board-certified orthopaedic spinal surgeon and a thriving type 1 diabetic explain how she uses the vegan ketogenic diet and insulin strategies to manage her diabetes. 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. ✅ Check out the episode including all the extra show note links here: https://www.biohackerslab.com/ep48-dr-carrie-diulus/ ✅ Listen to the interview on iTunes here: https://itunes.apple.com/us/podcast/ep48-low-carb-vegan-keto-diet-results-for-type-1-diabetes/id1228136261?i=1000410682160&mt=2 ✅ Link to this Youtube Video: https://www.youtube.com/watch?v=477plfExP3w ✅ Follow us on Twitter: https://twitter.com/biohackerslab ✅ Follow us on Facebook: https://www.facebook.com/BiohackersLab ✅ Follow us on Instagram: https://www.instagram.com/biohackers.lab/

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