Practising as a Stroud GP for most of his career, Dr Ian Lake was diagnosed with Type 1 diabetes at the age of 35. Twenty-seven years on, he enjoys long-distance running and campaigns for lifestyle health. Simon Hacker discovers his secret.
Diagnosed with life-changing Type 1 diabetes at 35, Dr Ian Lake resolved to simply get on with life. But a potentially fatal low blood sugar episode while alone in the wilds of Norway led him to question conventional current wisdom for combatting the disease.
Years on from a diagnosis that affects the lives on nearly half a million people in the UK, Ian fronts type1keto.com which calls for a major shift in the way we combat a health challenge that’s growing by about four per cent each year – the climb increasing to five per cent among children under five.
“After 20 years of Type 1 diabetes, I started to develop some very early complications. I also had a severe hypo when camping alone in Norway in the wild, which was certainly a wake-up call,” says Ian, who practised for most of his career as a GP in Regent Street, Stonehouse.
“I had read about cutting down carbs in the management of Type 1 diabetes a year earlier, but as this was not the type of routine NHS care I was used to, I ignored it. Developing retinal complications and having the scare in Norway made me revisit low carb.”
Trialling a very low-carb or ketogenic diet from the start, Ian says the results were immediate: “I had some encouraging levels of blood sugar control from day one. So successful has it been, my mild retinopathy has resolved. It shows how nurturing near to ‘normal’ conditions in the body can make a big difference and hopefully minimise the chances of long-term complications.
One of the undoubted benefits of a very low carbohydrate lifestyle is what Ian calls the normalisation of day-to-day life. “Whereas before, even something as simple as a walk to the shops required planning around insulin injections and glucose tablets, nowadays I feel free to do pretty much as I please. For example, an hour-long run requires little preparation – I know it won’t be a problem.”
“I always carry glucose tablets and monitoring, though the evidence shows people on a very low carbohydrate lifestyle have around five times fewer hypos. For anyone reading this who has Type 1, they will know this is enormously significant.”
Perceiving that this message is slow to get out, Ian embarked on a national campaign. At its heart, he says, is the premise that encouraging the body to burn fat as its fuel source, rather than sugar, is not starvation.
“Carbohydrates are not an essential part of the diet. So, eating carbs in a condition where the body can’t handle them, and this includes all types of diabetes, surely makes little sense.”
Could this be a message that might benefit us all?
“A very low carb diet is not deficient in calories, but because people burn fat, weight does drop off to a normal level for any individual. The pleasant side effect of fat burning with regular calories is that people tend to lose weight if they need to – and with no hunger. The body tends to stabilise at its preferred weight. Energy molecules, called ketone bodies, are produced as a result of fat burning. So that is why this is called a ketogenic diet. It is a natural process.”
To put his trainers where his mouth is, last year Ian organised eight people, including another person with Type 1, to run 100 miles over five days – with zero calories. Olympic rower and healthy lifestyle campaigner James Cracknell joined the exercise.
“The aim was to that we could show how natural this all was. Yes, zero calories, water only! It was a project designed to answer the common concerns around keto diets. We conclusively showed you do not need sugar for energy as you have a fat store ready to go. In an average weight person, the fat store has at least 100,000 calories, which is 50 times more than the equivalent natural sugar stores, which are called glycogen stores.
“The body can make all of the sugar needed by converting fat and protein, such that no sugar needs to be eaten. We managed to convince double Olympic rower James Cracknell to take part and convert his body to fat burning, which he did, with no problems. At the pinnacle of the sport, such as when James was rowing at an Olympic level, sugar is possibly beneficial, but for the 99.9% of us who are not performing at that level, fat burning is more than acceptable. I’d argue it’s the body’s preferred fuel.”
While low-carb lies at the centre of Ian’s approach to managing T1, he says it is part of a broader strategy to combat this disease through lifestyle. “We are getting better at covering lifestyle in managing disease in the NHS,” he says, “and the same applies to all forms of diabetes. Physical activity, stress management and sleep are all part of good management.”
With conventional medical training focussing on using carbohydrates in Type 1 diabetes because we need to inject insulin, blood sugar levels can drop due to insulin injections. “Carbs are consequently encouraged to ensure the margin of safety is more significant. But we have shown that, unless they need to rescue a hypo, it is not the case that people with Type 1 need glucose for energy when following a keto lifestyle.”
Ketones can be a major concern for diabetes clinicians – but they need not worry about the ketogenic diet. Some circumstances that are unrelated to a low carb diet might lead to diabetic ketoacidosis, But the thinking on Type 1 management is at a point of change, and we need to provide the information so that patients can choose from the options available to them. That is why I call this a very low carb lifestyle, to include diet, physical activity, stress management and sleep. ”
So what’s a typical dietary day? “I usually have an Americano-style coffee for breakfast, with my first meal at lunchtime, after hopefully an 18-hour fast. Often it is 16 hours. Fasting is a good practice as it helps the body become sensitive to insulin, and this also applies to people with any type of diabetes. It also stimulates the body’s repair processes so that you are more likely to stay healthy. If I feel any hunger, which is more likely to be due to stress, I will have some fizzy water, which mostly takes away the desire to eat. I break my fast with something like an omelette with cheese or mushrooms or full-fat Greek yoghurt with some berries. I don’t snack as a rule, but if I do it will be a small handful of nuts or some 85% or higher dark chocolate. Hard cheeses are okay as well. An evening meal will be finished by 8pm, if possible. After this hour, the body needs to prepare for sleep. Processing food after late meals leads to poor sugar control, not just in people with Type 1.”
Proportionally, Ian bases meals around protein and fat with as few carbs as possible, aiming for 30g of carbs a day – which is around 90% less than current government guidelines.
“It’s not difficult; after a short time you get used to it and enjoy it for the benefits it brings. I rarely feel hungry. If I eat meat, I choose the fattest of cuts, including organ meats such as the liver, as the most nutritionally complete and affordable options. I will have this with loads of green leafy veg or a salad with plenty of olive oil.”
Any sweet dish, he adds, would be very low carb. “There are many recipes online for satisfying meals that have next to no carbs. In most cases, you’d find it hard to tell the difference.
“Nowadays I don’t see carbs as either desirable or necessary. I’m lucky that I don’t have a sugar addiction, but for those who do, the first thing is to recognise it. There is help available. Sugar addiction affects more people than we’d imagine.”
Despite saying he’s ‘semi-retired,’ Ian radiates energy as an ambassador for a very low-carb lifestyle. “My mission now is to promote and teach this lifestyle in Type 1 diabetes so that all healthcare practitioners can offer it as an option for management and support their patients in this,” he says.
A survey carried out by type1keto.com showed that 90% of people are now obtaining their information through the internet. “We need more education, so that information about very low carb diets is available on the NHS. Habits are hard to change, but the benefits to Type 1’s are so profound that some emphasis must be given to low carb lifestyles.”
Ian came to Stroud more than 30 years ago to raise his family – and says the topography of the five valleys was magnetic. “We just loved the beautiful landscape. I grew up in Lincolnshire’s fens where anything over about fifty feet was a hill and stood out for miles and was likely a tourist destination!
“Above all, I just love the commons, and the countryside is perfect for what I do. Stroud has such a lovely vibe, and I have many good friends here. I can’t imagine living anywhere else now, with the possible exception of the Alps, which are effectively the Stroud Valleys on steroids!”
For relaxation, he loves anything outdoors. “I do find steady running or running and walking very meditative. But my favourite dietary indulgence is a no-brainer: a coffee, out in the morning with friends. Having spent a career grabbing a mid-morning drink on the hoof in a GP clinic, often drinking it cold, it’s still a novelty. I’ve also put my old camping stove to good use and often sit out on one of the commons and have a brew up!”
Find out more
Follow Ian on Twitter @idlake. The site www.type1keto.com has access to information on low carb in type 1 diabetes plus courses and recipes. And see www.zerofive100.com for the inside story of the five-day 100-mile run.