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Little_Wonder

Newbie
Dear all,

I am pretty much confused with my results and afraid what to do next.

Briefly, I am Type1 for 22 years, 34y old, athlete (endurance sports). Considering I never found a formula for glucose management, I decided to cut out carbs maximally. So, from after this last Christmas, the whole January I was on a low carb diet (mostly fats, moderate proteins). My glucose levels NEVER EVER were so straight. A flat line (I couldn't believe it). Even with lower ranges I felt the glucose is down, but my hands were not shaking.
However, I started to have proteins in urine (along with ketones) and my Endo is horrified, saying it is from muscle breakdown and it will not be good if I continue. So I listened and started to have around 200g carbs per day (that was 10 days ago). Now I am back to higher ranges of blood glucose and not handling them effectively. Waking up at night and couldn't get back to sleep is only one issue. The blood sample 10 days ago (30 days of keto) showed elevated ranges of Cholesterol, LDL, Triglycerides. However, HbA1c was noticeably better result than 3 months before (January affected this outcome).

Now, on the one hand I've had great levels of blood glucose (keto diet) and proteins in urine (along with ketones), on the other hand BG far from great and High Triglycerides. I understand LCHF regime will cause high Cholesterol ranges. According to Dr. Andreas Eenfeldt, the level of overall Cholesterol shouldn't be taken for granted, but keep an eye on ratio between overall Cholesterol and HDL (in my case, I am on the right track here). Also, Low Tryglicerides along with high HDL shows that LDL particles are harmless, but I have LDL high/er (3,9). So now I really don't know what step to take....

Bernstein however, doesn't like the term LCHF, but moderate protein intake (which I think is fine, because there is no evidence that larger amounts of protein intake (especially for athletes) are affecting renal functions). Just if wondering, my training is endurance sports ranging from 7-20 hours per week. Currently I am on the far lower spectrum of this equation though.

Logically, I tend to have carbs around my training sessions (just before, during and after), which combined with relevant protein intake shouldn't cause muscle catabolism in the way it shows proteins in urine. But, once I introduce the carbs into the diet all together (mentioned above), protein ranges in urine are gone.

Also, I see that AST levels went up.

What do you think about all of this?
- I would like to take on low carb principles but cannot get rid of proteins in urine
- carbs along with relevant hydration shows negative urine samples in any case

Thank you in advance for your thoughts and understanding.
p.s. this long/er story couldn't be shorter, sorry...
 
Sounds like a dramatic reaction to a dramatic change in diet. Maybe you should of eased into it a little slower? Gradually worked your way down until you found an acceptable ratio of carb intake for your endurance sport. This could allow your system to adjust with the change in diet.

AST went up... from what to what? Elevated levels are fairly common in diabetics. It may just be a little up due to the change in diet and its impact on various other levels on your blood test.

If you are losing muscle mass it's most likely due to not eating enough protein to maintain it. Remembering you have just changed your diet.
 
All I can tell you is I've always eaten high protein. I prefered mackerel in a tin to boiled sweets as a child. Now I believe Iwas type2 at 6yr old so that may have something to do with carb cravings or not as my case may have been.
I have excellent kidney function.
Now. Since starting lchf I've had inflammation from increasing carbs for a treat/xmas etc. I have heart disease now too, I guess from animal fats. However lchf is excellent for getting rid of fatty liver.
All pros and cons.
Ketones in your urine on lchf means the hf part is working effectively. That is what the lchf diet does.
However if your lclf you wouldnt get ketones, I'm led to believe. I'll tag @Brunneria for more guidance on lchf ketones. I hope this helps!
 
@Little_Wonder I'm curious as to what a typical breakfast, lunch, dinner, and any snacks consisted of when you were low carbing, also how many carbs were you eating a day during the month of January.

Here's three of low carbohydrate ketogenic diet researcher Stephen Phinney's most recent lectures... https://www.youtube.com/user/lowcarbdownunder Scrolling through these lectures, there's also two titled "Low Carb for Type 1 Diabetes" presented by two parents of a type 1 on the LCKD. In the USA there's a Facebook page titled Type One Grit, also focused on younger type 1's... https://www.facebook.com/Type1Grit/ Perhaps someone here is familiar with a website focused on athletes who use the LCKD to manage their type 1 diabetes.

Perhaps you'll learn something there that will be helpful from Phinney. In one of the lectures he stated that 10% of their study participants got worse not better on the LCKD, that they tolerate a higher carbohydrate diet well.

I've been on the LCKD for two years with great results, but am not an athlete. It would be so great if an athlete who competes using the LCKD could respond to you.

One other thought is that Mark Sisson came out with a new book in 2016: Primal Endurance: Escape Chronic Cardio and Carbohydrate Dependency and Become A Fat Burning Beast! but he doesn't have type 1 diabetes... https://www.amazon.com/Primal-Endur...F8&qid=1486537064&sr=8-4&keywords=mark+sisson
 
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Okay, perhaps this will be helpful - (he has type 1 diabetes and has been using low carb for more than 5 years)...

Jason Lonergan - 'Running A Marathon LCHF as a Diabetic & Coeliac'


This one too...

Low-Carb Performance, 11:40 minutes - (interview with Stephen Phinney, M.D., Ph.D.)


Prof. Jeff Volek - 'Nutrition for Optimising Athletic Performance', 41:51 minutes

 
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Hi,
Have you read Voleck and Phinneys Art and Science Endurance book? It accompanies their Living book.

I'm afraid I can't help about the proteins in urine. I had slightly elevated albumin last set of blood tests, and have reduced protein in diet, but my googling has been pretty useless on the subject, for both kidney recovery information and causes other than high blood pressure that seem relevant to me.

I did find one study that found vit b1 was helpful to the kidneys.

Perhaps @tim2000s has more info? I recall some useful protein comments in the past, Tim :)
 
Little_Wonder said:
Dear all,

I am pretty much confused with my results and afraid what to do next.

Briefly, I am Type1 for 22 years, 34y old, athlete (endurance sports). Considering I never found a formula for glucose management, I decided to cut out carbs maximally. So, from after this last Christmas, the whole January I was on a low carb diet (mostly fats, moderate proteins). My glucose levels NEVER EVER were so straight. A flat line (I couldn't believe it). Even with lower ranges I felt the glucose is down, but my hands were not shaking.
However, I started to have proteins in urine (along with ketones) and my Endo is horrified, saying it is from muscle breakdown and it will not be good if I continue. So I listened and started to have around 200g carbs per day (that was 10 days ago). Now I am back to higher ranges of blood glucose and not handling them effectively. Waking up at night and couldn't get back to sleep is only one issue. The blood sample 10 days ago (30 days of keto) showed elevated ranges of Cholesterol, LDL, Triglycerides. However, HbA1c was noticeably better result than 3 months before (January affected this outcome).

Now, on the one hand I've had great levels of blood glucose (keto diet) and proteins in urine (along with ketones), on the other hand BG far from great and High Triglycerides. I understand LCHF regime will cause high Cholesterol ranges. According to Dr. Andreas Eenfeldt, the level of overall Cholesterol shouldn't be taken for granted, but keep an eye on ratio between overall Cholesterol and HDL (in my case, I am on the right track here). Also, Low Tryglicerides along with high HDL shows that LDL particles are harmless, but I have LDL high/er (3,9). So now I really don't know what step to take....

Bernstein however, doesn't like the term LCHF, but moderate protein intake (which I think is fine, because there is no evidence that larger amounts of protein intake (especially for athletes) are affecting renal functions). Just if wondering, my training is endurance sports ranging from 7-20 hours per week. Currently I am on the far lower spectrum of this equation though.

Logically, I tend to have carbs around my training sessions (just before, during and after), which combined with relevant protein intake shouldn't cause muscle catabolism in the way it shows proteins in urine. But, once I introduce the carbs into the diet all together (mentioned above), protein ranges in urine are gone.

Also, I see that AST levels went up.

What do you think about all of this?
- I would like to take on low carb principles but cannot get rid of proteins in urine
- carbs along with relevant hydration shows negative urine samples in any case

Thank you in advance for your thoughts and understanding.
p.s. this long/er story couldn't be shorter, sorry...
Click to expand...

Hi @Little_Wonder,

I have noticed that this is your first message on the forum. So, please be welcomed to this forum. There are lots of helpful and knowledgeable people around.

Incidentally, I have just read the following article by David Ludwig on dietdoctor.com.

I wonder if some of the info in this article might help you with your question. In this article, Ludwig looks at a study, which put women on a ketogenic diet. The researchers observed that on a ketogenic diet, protein breakdown initially increases, but returns to normal by week four (see excerpt below).

THIRD (above): Women with obesity were given a calorie-restricted ketogenic diet compared to a non-ketogenic diet, both with the same protein. For 3 weeks, the break-down of lean tissue like muscle (i.e, nitrogen balance, see bottom panel) was greater on the ketogenic diet compared to the non-ketogenic diet, but this difference was completely abolished by week 4.
​
Here is the link the the full article: https://medium.com/@davidludwigmd/adapting-to-fat-on-a-low-carb-diet-bfd0cd314e4e#.bbut58ioa

I am certainly no expert on this -- but might this not suggest that muscle breakdown might decrease if you are on this diet for a bit longer than one month?
 
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Hi @Little_Wonder My experience of microalbuminuria was that it was dependent on the amount of protein I was eating and I had a very clear threshold above which I saw protein in my urine (I was testing because I wanted to be clear).

My eGFR and Creatinine numbers are generally in the normal ranges, but when eating a high protein diet (which I was for roughly four weeks), and by that I mean 850+ calories a day from Protein, I saw protein in my urine because it wasn't being handled by my body. At the same time, my creatinine levels went up. When I reduced the protein amounts back down again, this stopped.

If you search the web, there's a decent amount of evidence that discusses protein amounts in the diet and kidney health. If your kidneys are healthy, then there are very few issues at all with high protein intake.

So what would my advice be? Firstly, get your blood tests done and ask for eGFR, if possible GFR and Creatinine levels. These should be done fasted and on a normal diet. This will indicate whether you have any kidney issues.

If these come back okay, you need to determine what your threshold level of protein is. If you're not able to use it all, then there's no point in eating it and having it come out in urine.

Cholesterol has been answered here already, and AST can indicate a number of things. These include liver issues and muscle damage, and as an endurance athlete, I can understand how muscle damage might influence your AST level.

Hope that helps.
 
Thank you folks for your responses. Yes, that was my first post...I kept an eye for the Forum for some time, but did not find an answer anywhere so decided to sign up. I am very much aware of the experience and knowledge of the people here. Together it is easier to make some sort of logical conclusion. I could go on and on about lack of knowledge in Nutrition the specialists have in general, but let's stop there....

@Tophat1900 Dramatic reaction to a dramatic change in diet is a possibility, of course. AST went up to 51. I can see your point.

@ickihun by inflammation what do you mean exactly? As far as research is concerned, there are no evidence (not to my knowledge) that too much animal fats (cholesterol) alone result in heart disease. If combined regularly with unhealthy carbs, well that's another story, but carbs are the ones to blame as they are full of modified genetics and processed ingredients. I am aware of ketones in urine, I understand the reason and their production from fats.

@Winnie53
Keto:
BREAKFAST: Eggs ommelete along with bacon, salt, coconut oil, sezame seeds, coffee with milk (10-15g CH). Topped with olive oil.
LUNCH/DINNER: Fish and vegetables, meat (mostly chicken). Tend to have snacks in between with various outcomes, mostly with nuts. It seems like caloric deficiency by looking at this, but it is not present, believe me...Breakfast is pretty much the same, but I tend to have cooked green vegetables on a daily basis.
As far as non-keto nutrition, put in brown rice, bulgur, fruits (different kinds), muesli with these meals (oats also with eggs, but no olive oil on the topping), and bars and gels, isotonic drinks and honey during training sessions. This all results in lousy management. While training no problem (great), but the rest of the day not good.

@Brunneria – keeping an eye on literature of course. I understand Voleck and Phinney suggestions about calculating protein requirements

@ziggy_w Thank you for the link, I ve read it. Tend to question if there is really a muscle breakdown going on here or maybe something wrong with kidneys (22y after all with not so good regulation)? Hopefully it is muscle breakdown, because logically looking at it, just increase proteins and you should be fine, right? Really don't know what is it. If kidnyes are damaged, you should not drink too much liquids, avoid potassium foods etc. My sweat rate is 1 – 1.4 litres per hour during training, I mean common...
On the other hand, once I introduce carbs, along with proper hydration, they tend to go away, but ketones also vanish, as carbs are the no 1 fuel then. So, it could be that kidneys are not yet affected generally. Because 1-2 days of carbs and the proteins in urine are gone.

@tim2000s What was your treshold and (if not a secret) what is your BMI, height, weight? It all affects the usage of protein dosage and calories theoretically. How did your conclusion went in relation to theoretical approaches? By muscle damage affecting AST levels, you mean out of improper recovery post workout (up to let's say 48h after) or something else? Your advice seems pretty sound, my Endo's advice is not that I'm not using it all, but rather that I break it from the muscle tissue because I lack more than I bring in...

NOVEMBER (JANUARY – keto)
- Cholesterol – 4.2 (6.6) mmol/L
- Hdl – 1.7 (1.8) mmol/L
- LDL – 2.3 (3.9) mmol/L
- Triglycerides – 0.5 (1.9) mmol/L
- e GFR – 104 (110) mL/min/1,73m2
- AST – 29 (51) U/L

The answer I am looking for is why are the proteins there (in my case). Other than atrophy which my Endo says, it could be unproper recovery from training sessions in general, which is also acceptable. You find a formula for that with trial and error and act accordingly.
 
@Little_Wonder in the presentation above, Jason Lonergan - 'Running A Marathon LCHF as a Diabetic & Coeliac', it looks like his carb intake is 120 to 150 carbs a day.

Thanks for sharing with me what you're eating. It's good you're including plant foods in all your meals. Maintaining the health of our gut flora is equally important too. I don't have any answers. I hope you'll keep us informed as you sort this out.

I heard Mark Sisson interviewed last night. He also is/was an endurance athlete. Now in his 60's, in the interview, and I assume the book, he talks about carbohydrate loading, weight gain, over training earlier in his life, the toll it took on his body, and how he eats, exercises and remains physically active and healthy today. I haven't read the book, but it's been well received here in the USA. I'll be most interested hearing what you discover about yourself healthwise over this next year. :)
 
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