In mid-sentence, Nicole shot up from the couch and raced for the bathroom.

“Oh oh,” said our 7-year old son, Jonah. “There goes Mamma again.”

“It’s so hard to talk to her these days,” I said. “At least she’s getting lots of exercise.”

Over the previous six months my wife had started to experience frequent diarrhea. Soon after eating she’d suffer diarrhea that could last 12 hours or longer. Her blood sugars would remain low, indicating it wasn’t caused by an infection.

Because of the diarrhea, Nicole would not eat during days she had to go out of the house. She’d often not see a meal until 6pm at night. In August we went to a water park and she had to fast the entire day.

As the situation worsened she also suffered from bloating and nausea. The scale showed she had lost a few pounds. Her energy was down. Libido was gone. Frequent nocturnal trips to the bathroom resulted in sleep deprivation.

The Gastroparesis Strikes Back

December brought the final blow: Her gastroparesis flared up like never before. This is a diabetic complication where the stomach doesn’t empty after eating. Normally a cooked meal will hit her bloodstream within 45 minutes of eating. By December it was taking up to 12 hours.

And when it did finally find it’s way into her intestines… it didn’t stay there long.

The delayed stomach emptying caused very bad episodes of hypoglycemia. Nicole would take her meal bolus but the meal wouldn’t get into her bloodstream (just the insulin). She spent many nights with a 1.7mmol/L blood sugar because there was no way to get sugar into her bloodstream.

Fortunately, she produces a lot of ketones and does okay with such a low blood sugar.We had to temporary abandon meal boluses. Instead she would take a correction every four hours with Humalog.

Seeking a Solution to Chronic Diarrhea

We tested numerous approaches to dealing with diarrhea. None of them made any difference. We upped probitiocs, lowered probitoics, removed fibre, experimented with anti-fungals, tried to constipate her with dairy… nothing helped. Many things only made the situation worse.

Nicole suffers from kidney failure. Hence, we speculated her body may have adapted to remove waste usually expelled via urine through her bowels.

The other thought was that the GAPS program she has been following may be cleaning out pathogens or heavy metals from her gut.

In the end, the answer was much simpler. We found a dietary tweak that eliminated the diarrhea overnight. Before I explain this course adjustment, let me sum up what we we’ve been experimenting with in 2013.

The Sunny Side of Low-Carb

Since March of 2013 my wife, Nicole, has been following the low-carb diet outlined in Dr. Bernstein’s Diabetes Solution (in combination with the GAPS Nutritional Protocol). The diet allows for 6g of carb at breakfast, 12g at lunch and 12g at dinner.

Following this diet, in less than nine months, Nicole’s A1C went from 7.0% to 4.5%. And that’s with her already suffering from kidney failure, neuropathy, gastroparesis, anemia, hypothyroidism and tachycardia.

Also, when Nicole began eating low-carb she saw immediate improvements in her sleep, energy level, libido, hair, skin, breathing, water retention, blood pressure and mood.

So when her health started to deteriorate we didn’t even suspect it was caused by a deficiency in carbohydrates. As we continued to research, however, we discovered many other people suffering similar symptoms when following an extremely low carbohydrate diet.

Finally at the end of December 2013 we decided to experiment with adding some high-carb, non-starchy vegetables (like carrots and onions). Hardly a high-carb diet. No more than 50g of carb a day (often, more like 30g).

Within 24 hours her nausea lessened, the diarrhea diminished and her overall feeling of well-being improved. A month later, she doesn’t suffer from any diarrhea, her energy is better and her appetite is back. The gastroparesis still remains.

Why Wasn’t 20g of Carb a Day Enough?

Obviously she needed more carbohydrates in her diet. Not much. Merely adding 20-30g a day seems to have corrected the problem. But why did she react so badly to extreme carbohydrate restriction? After all, it did produce a 4.5% HgA1C (almost unheard of amongst type-1 diabetics). It reportedly works for Dr. Bernstein and his patients.

I have a few theories as to why Nicole needs more carbs in her diet than Dr. Bernstein. These are just ideas to consider:

• Nicole’s gastroparesis has always effected her ability to stomach protein-rich foods. In order to survive on a near zero-carb diet one needs extra protein. Excess protein is converted into glucose by the liver, thus meeting carbohydrates needs. Nicole simply may not have been able to eat (or digest) enough protein.
• The diarrhea would always get worse during her period. I’ve heard from many women following low-carb diets that they need slightly more carbohydrates prior to their period.
• The most common theory is that cortisol (a stress hormone) is required for the conversion of protein into glucose. Nicole’s complex health condition may not have been able to handle the extra stress. Though keto-researcher  L. Amber Wilcox-O’Hearn provides evidence in this article suggesting that cortisol is only involved if blood sugars are lower than 3 mmol/L (55 mg/dL).
• Genetics may play a factor. If your ancestors had access to an abundance of carbohydrates, then an ultra-low carbohydrate diet may be too extreme for your DNA. Nicole has some Greek blood in her, for example. The Greeks consumed more carbohydrates than the people of Northern Europe. She’s mainly Irish, though, so it’s a weak point.

If you have another theory, please email us and let us know.

The Zig-Zag Path to Better Blood Sugars

A big lesson for us here was not to abandon Dr. Bernstein’s low-carb diet. Nicole has never had better blood sugar control. The diet brought her HgA1C from 7.0% to 4.5% in nine months and showed great promise.

The negative side-effects could have easily justified Nicole snapping back to eating pasta and ice cream. Instead, we just upped the carbs slightly (except on her birthday, where “slightly” involved an entire slice of strawberry chocolate cake made with coconut flour and honey). A small adjustment. That was all that was needed to still benefit from the tighter blood sugar control a low-carb diet delivers. Also the addition of carrots, onions, beets and squash are all permitted on the GAP Nutritional Protocol.

At this point we see little other option. What use is good blood sugar control if your gut is falling apart as a result? She would have ended up starving to death with the way the diarrhea and gastroparesis was going.

How Will the Extra Carbs Effect her HgA1C?

Her last HgA1C, however, has already risen to 5.0% (from 4.5%). I think we’d be happy enough if it could stay at 5.0% (better than many “non-diabetics”).

Right now, the combination of more carb and gastroparesis is not ideal. Nicole can’t take insulin with her meals. She ate a dinner of meatball soup (beef, carrots and low-carb vegetables) and it took until 2am to finish “dumping.” So she has to let her blood sugar rise and counter it with humalog corrections every four hours. This has resulted in her blood sugar peaking at 8 mmol/L for short periods.

If the gastroparesis corrects itself we are hoping the addition of 30g a day will still allow for tight blood sugar management. It will require more insulin which increases the margin for error, but it’s still better than eating mashed potatoes for dinner. We’ll continue to measure her food, repeat the same recipes, and fine-tune the insulin dosages for each meal.

And, of course, we are still hopeful that the GAPS nutritional protocol will put an end to the destruction of her beta-cells. While the GAPS program doesn’t specify tight blood sugar control as a prerequisite, I’d imagine that the less inflammation in the body the better the chances of seeing a cure for type-1 diabetes.

We’ll continue with the 50g-of-carb-a-day version of GAPS and see how her A1C does. We’ll also keep a close eye on her gastroparesis. If she can return to dumping food in a timely manner, we’ll be in a much better position to control her blood sugars with meal boluses.

By no means do I think everybody needs to consume 50g of carb a day. If you are type-1 diabetic I’d recommend trying 20g a day as Dr. Bernstein suggests. The less carb you have to deal with the easier it is to manage the blood sugar. We’ve seen this first hand. I know many people (even non-diabetics) who do just fine on less than 5g of carb a day.