Ironman triathlon on LCHF with Type 1 diabetes

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Introducing Lewis Civin. Lewis is a 38 year old Type 1 diabetic. He has a great story of what is possible doing Ironman triathlons on a LCHF diet.
His persistence and  learning experiences leading into and from the recent Auckland Ironman 70.3 on a low carb high fat diet tells us loads about human physiology and fat burning. Lewis’ story has some great insights about how both carbs and protein affect his blood sugar and insulin requirements. Lewis’ race data from the 70.3 event in Auckland.
If you are a Type 1, or know a Type 1, then this will be really interesting.  If you are an endurance athlete it’s interesting for seeing what is possible on fat burning alone.

Before we begin properly, here’s Lewis’ coach Stephen Farrell.  Steve is a good friend of mine – we’ve known each other 25 years since he and I were professional triathletes – he always used to beat me. He’s now a professional triathlon coach and has been the Director of Triathlon NZ’s Olympic medal wining program in Beijing.

Steve ……

While Lewis’ story is about conquering diabetes, the lesson for all of us is that there is a solution to any barrier that gets in the way of our life goals.  All it takes is persistence and the right support team.

 I hope you find his race report inspiring.  For me, it was one of those golden coaching moments where someone smashes through the glass ceiling and finds a whole new world of exciting challenges.  Seriously, I’ve seen people win Olympic gold medals and not be as excited as Lewis was on Sunday.  I caught up with him immediately after the race and he didn’t stop talking for about 10 minutes! It was awesome!!!  He’s already entered next year’s race!

Over to Lewis….

I have had diabetes since age 9. I have always been reasonably well controlled, HBA1c between 7 and 8. Healthy weight. I would have typically taken 22 units of lantis (long acting insulin) at night and 8 – 12 units of humalog (fast acting insulin) before each meal.
I have been serious about managing my diabetes (hard working and frequent measuring) and that’s been recognised with “good control” of blood sugars –  at least in the traditional view of it.  I would still end up with about three “hypos” (low blood sugar) a day and thought that was just part of the cost of having good glucose control

Health kick

About 2 years ago, I started to exercise daily. I’m calling this my “health rebirth”. I was getting older, I have a family – the usual stuff.
As a consequence. I began to eat a traditionally healthy low fat high carb diet. No fats at all, lots of fruit, lots of wholewheat starches. 6 small meals a day. I was drinking black coffee to avoid any chance of extra fats!
I was always hungry, but otherwise thought I was a model of good health. I did lose weight as a result of my restricted calorie diet.
As a result of my lower calories and daily training, my insulin did decrease substantially. I was on 12 units of lantis at night and 6-7 units of humlag a meal. My HbA1C was around 7%.
My blood sugars were “stable”, but required a huge huge amount of effort. I would have low blood sugars 3 or 4 times a day, and would constantly be adjusting up and down. I just assumed this is the “cost” of having lower average blood sugars.

Triathlon kick

When I started doing daily exercise, weights, etc, it seemed to me the pinnacle would be to achieve a triathlon. I did my first 3-5-3 tri in the Barfoot & Thompson ITU in October 2012.
I could never ever swim a length. I have no natural swim-ability. I hate running.

My swimming remains really awful. In fact, on this 70.3, I actually stopped kicking, and swam as if I had a pull-bouy. I shockingly smashed my expected time. I was hoping to come in just under a hour, but I came in 44 mins. It’s like I have an anti-kick!

I realise now that it’s really fun to push myself in different disciplines.

Enter LCHF

In October 2013, as I took my triathlons more seriously, I researched LCHF. It ended badly.
I tried the diet, and it fit like a glove. I loved the foods, I loved the tastes, and more importantly, I was never hungry. Ever. I used to live my life obsessing about my next snack. My blood sugars were very very stable and I got down to taking 12 units lantis at night and 2-3 units humalog a meal.
All was well, for about 5 days and then I became very ill, and tested my ketones. I was waiting for ketosis to start, but instead, I had sky-rocketed straight into ketoacidosis.
Naturally, I FREAKED out, and took a huge amount of insulin to kill the ketones, and basically put myself back on my traditional low fat high carb eating plan.
I talked to my endocrinologist, who was upset and wondering why on earth I would even consider LCHF.
My take on it was that on the LCHF diet, there was just not enough insulin floating around my body and that was causing my body to enter this extremely dangerous condition called ketoacidosis. Since this is life threatening, I was taking it very seriously. LCHF was not for me.
But I missed the feeling of satiety that the high fat brought. My coach Stephen Farrell encouraged me to give it another go.  So I went back, but included a small carb with each meal. 1 apple or 1 slice of low GI bread. A type of hybrid. This worked ok.
Then I heard about Dr Bernstein and his book The Diabetes Solution. I started reading that and found that he had almost written the book for me.
I am now fully on a LCHF diet, no exceptions. I tried an experiment with my Lantis (long acting insulin). I thought that if Lantis should be enough insulin to prevent ketoacidosis, then perhaps I was one of the few patients in whom lantis did not last 24 hours. Grant: maybe it’s the extra physiological output and demand of the training that moves everything through the system faster?
I am now on 8 units Lantis in the morning and 8 at night, and my blood sugars are exceptionally stable.
One important thing I have found on LCHF is that over-eating protein seriously affects my blood sugar. I’ve taken the advice of Dr Bernstein about only eating a serve of protein around the size of a deck of cards, but doing so with every meal.  This advice has really helped me so much.  I think I have tended to overeat protein and suffer the consequences of higher blood sugar. If I over consume protein I need to get more insulin on board or walk around with seriously high blood sugars”
Grant’s comment – that’s interesting and I think can help us understand why everyone on a LCHF diet might need to think about this principle of protein consumption. The “deck of cards” principle might mean a protein intake of 30-40 g of available protein per meal (90-120 g/day).  What we know about protein and LCHF:
  • Protein is essential for healthy living.  We need around 0.8 to 1.2 g protein available per kg body weight per day. Maybe a little more if you are exercising a lot.
  • Once intake exceeds that need, protein will be converted to glucose by the liver.  That glucose will need insulin to move it into cells.
  • A problem we often see in stalled weight loss or dropping in and out of ketosis in LCHF diet is the overconsumption of protein. As above, that extra protein eventually invokes an insulin response, turning off fat burning and promoting fat storage.

So Lewis shows us here how excess protein can affect insulin requirements. That’s true for diabetics and non-diabetics. Bottom line: Eat a moderate amount with each meal. Add extra fat rather than protein to fill you up if you are still hungry.

How does this effect the Ironman?

So, when I would usually (pre LCHF) go on a long training ride, say 3 hours, I would need to take 1 Gu gel every 20-30 mins to keep my blood sugars from dropping. I would literally take 10 gels with me, and come home with only 2 or 3 left.

Grant: this is pretty typical of any triathlete on a high carb diet. It’s costly, but also burning exclusively carbs probably causes way more oxidative stress (damage) and reactive oxygen species in the body. Net result: slower recovery, more immune problems, more tiredness, faster ageing.

After the ride, my sugars would eventually sky rocket, as the cumulative effect of the sugars eventually would come home to roost.
Dr Bernstein recommends small glucose tablets, such as Dextro tabs, to adjust sugars in a much smaller way (each Gu gel has 25g of Carb, and each Dextro tab has approx 2g of Carb).
The Auckland 70.3 this weekend was my first real test of a big event whilst on LCHF. I decided I wasn’t going to pre-emptively raise my sugars, but rather test throughout the event, and take dextro tabs when needed.
Here’s how it panned out:
Grant: Normal blood glucose is around 5 mmol/l, most diabetics would run a bit higher than this to avoid low blood sugar. High blood sugars damage the body in the long run.
 
Breakfast was high fat yoghurt with cream, and a lchf cereal recipe I found online at the Dietdoctor.
  • Coconut flakes
  • Walnuts
  • Hazelnuts
  • Almonds
  • Flaxseed
  • Sunflower seeds
  • Pumpkin seeds
I took 2 units of Humalog for breakfast.
  • 5:56 (just before the swim) [glucose] 7.1 mmol/L. I took 1 Gu gel, as that is what I always have done.
  • 7:35 (at the start of the ride) 9.0 mmol/L. It was a little high, which is good, and I took a Gu gel to set me up for the ride. (Remember, I would take a Gu Gel every 20 – 30 mins)
  • 7:58 (an hour into the ride) 10.3 mmol/L. I did not take anything waiting for my sugars to drop.
  • 8:18 – 14.3 mmol/L. A bit too high and freaking me out, any higher and I would need to take insulin. I didn’t have it with me and I would have to try and arrange with someone to bring some insulin en route.
  • 8:40 – 11.3 mmol/L. Thank god it started to come down. Still not taken any Carbs since the gel at the start.
  • 9:00 – 11.8 mmol/L.
  • 9:18 – 11.6 mmol/L. Still no carbs after more than 2 hours on the bike. I actually thought my tester had broken, giving me identical readings over such a long period. So I stopped at an ambulance on duty and asked if they could test my sugar for me. That was at about 9:30am. Their reading was 9.1 mmol/L
So I took nothing more on the ride. One gel and thats it.
Then at 10:02 in transition for the run, my sugar was 6.8 mmol/L.
I took 1 glucose tab (1 10th of a gel). I took no more glucose on the 2 hr run, and I also didn’t test, as my sugar were feeling fine. Every 2nd water stop I took half a banana, and perhaps 2 sips of coke.
I was super strong on the run. I ran with an even, almost negative split, and I reckon I could have kept going.
So, the total carb inload for a 2 hour run was a single 2g dexto tab, and perhaps 1.5 bananas and perhaps half a cup of coke. In my old plan, this would have required 4 – 6 gels.
 I took no carbs at the end of race.  I was feeling great, still do.
My blood sugar an hour after the event at 1:49pm was 3.4 mmol/L, which is more than manageable. My sugars didn’t rise obviously after as there were no sugars.
This whole experience is still bewildering for me, as it now appears that my body is somehow generating its own glucose.
Kind regards Lewis Civin
Grant, final comment: This really is a great story Lewis, so thanks for sharing it. What it shows us more than anything isn’t that you are generating more glucose – maybe there is a bit of that.  But that you can use fat as a fuel source almost exclusively across a major event and be fine.  Not only fine, but strong the whole way.  He’s had great recovery too.
For the more detailed account of his diabetes. Lewis now has amazing control with an HbA1C of <6%. His blood sugars are very stable in the 5 mmol/L region most of the time. He feels great and he isn’t hungry all the time.  From deprivation to satisfaction. That’s what we like! Well done Lewis.

13 comments

  1. Rich Kerr · · Reply

    Hi Grant

    Really interesting and thought provoking post, and well done Lewis!

    A question that I have as a non diabetic employing LCHF is “what do you fuel up on prior to and during?”

    (1) training e.g a 45 min -1 hour swim session or a 45 – 1 hour run, or

    (2)1 – 2 1/2 hour events like olympic triathlons or multisport event or long ocean swims

    Should carbs like Gu’s or banana’s be employed prior to & during?… or should fat be the fuel?

    Thanks

    Rich

    ________________________________

    1. Rich, my opinion – carbs will always help you go faster in a triathlon, but being a fat burner as well is great. Ironman type events using this combinaiton mean you spare more glucose and can make the distance faster too. The trade off is health and recovery though. MOre glucose burned is more ffree radicals and the harder on your body that is

    2. Lewis Civin · · Reply

      Hi Rich

      I am NO expert, but my blood sugar levels tend to give an indication of fueling requirements. Only an indication.

      I did a 60 min hard run this week, with no fueling before, during and after. My blood sugars remained constant throughout, but did start dipping slowly toward the end.

      This morning we did a reasonably hard 60 min sea swim. Again, no fueling before and during. Blood sugar was reasonably low after. Meaning I would need to start fueling after 60 mins, but not during and not before.

      Also, my energy levels were 100% throughout. I did not feel weak or sluggish.

      I am doing a 3 hour ride this weekend, and I will report on how much “external” fuel I will need to add.

      It seems to me that my body is seeming to “autofuel” on LCHF, certainly in shorter distances.

  2. I really should take heart from this. I’ve been type 1 over 40 years, diagnosed at age 9 as well. I suspect that eating too much protein is my problem too. I’ve cut my insulin doses almost in half since going LCHF a few years ago but still take 15 units Lantus a night and bolus shots of regular or Humalog before meals of 20 units or more. It doesn’t help that I’m fairly sedentary and weigh 115kg or so…

  3. Very interesting article. Thank you.

  4. […] Carb, Moderate Protein, High Fat approach makes more and more sense. Read Grant’s interview with Lewis Civin for more on LCHF for Type 1 […]

  5. Tonja · · Reply

    Lewis, that is amazing! I am also 38, Type 1 Diabetic, diagnosed at age 8. I have been training for my first Tri this July, and find your story very inspirational! I have been eating LCHF with a Paleo template for a while and find that it is the only way to keep my blood glucose stable. I also have much more energy for training than I use to have eating high carb since I would just end up chasing the carbs with insulin and exercise. Great job!!!

  6. […] I switched to LCHF in October 2013, and did my first Half Ironman in Jan 2014. I had submitted a detailed race report to Grant about this race.  Fast forward a year later and I have never looked […]

  7. I’m a type 1 diabetic who started eating LCHF about 8 weeks ago. I’m used to riding 500-600 miles per month but since starting LCHF ive really struggled. My av. Speed is dramatically down and I suffer from tunnel vision, weak legs and a ‘hollow chest’. (In other words classic ‘bonking’ symptoms for a carb loaded athlete) from pretty much mile 1.

    I’m taking on board lots of water throughout the day and adding electrolytes but I’m still feeling awful on the bike.

    Any suggestions?

    Thanks in advance.

    1. Two important things to consider – first are you having enough salt – this is a common issue when getting adapted to LCHF.
      Second – too much protein – this puts you in a metabolic grey zone with too many carbs for getting fat adapted (extra protein goes into glucose in the liver). YOU END UP TIRED BUT NOT GETTING KETO ADAPTED.

      1. Thanks for the reply. I own a ketone meter and have been testing my Levels since week two. My first reading was 4.0 which freaked me out a little as I wasn’t expecting to be in ketosis that soon. My last reading 4 days ago was 2.4 (well within the day adaption range).

  8. Hi Lewis
    Very inspirational and interesting! I’m type 1 and have signed up for my first tri next year and like you prior to lchf kind of rely on regular carb intake during training etc. I’m now on the verge of changing to a lchf diet so would be interested to see an example of what and when you eat on a daily basis. Thanks in advance and we’ll done!

    Rich

  9. Great I wanted to find out if adding carbs consistently while running long distance would take you out of ketosis if you do this on a daily routine when u have type one diabetes

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