Treating Type 1 Diabetes and Depression with a Ketogenic Diet | Lisa La Nasa’s Journey

Lisa: 
My sense of self-efficacy or confidence in being able to do something positive for my health and be in control of blood sugar levels, that was something that I had never experienced in my 14 years of diabetes management. I didn’t know that was something that I would ever feel.

Bret: 
Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a nonprofit initiative of Baszucki Group where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

Lisa La Nasa, founder of diaVerge Diabetes, lives with type 1 diabetes. Now, she lives with type 1 diabetes. Before she really suffered from type 1 diabetes. Despite doing quote unquote everything her doctor said, her blood sugars were going from 40 to 400, and she was experiencing severe mental health challenges from the blood sugar and from just the lack of control.

But when she found the way you eat dramatically impacts your blood sugar, and by adopting therapeutic carbohydrate reduction, she changed her life and now is using that information to change the lives of hundreds. So, let’s hear from Lisa and her amazing experience.

Lisa, thank you so much for joining me today at Metabolic Minds. 

Lisa: 
Hi, Bret. Thanks so much. Nice to meet you. 

Bret: 
Yeah, so we were connected through, Andrew Koutnik, who has been on Metabolic Mind before, and an amazing diabetes researcher and just an amazing human being living with type 1 diabetes. And as soon as he met you and heard your story, he’s like we have to connect.

We have to connect and get you to share your story. So, start from the background. Give us a couple minutes on your background and why you got here. 

Lisa: 
Sure, thanks so much for having me. I have a history of type 1 diabetes, and I come from a family of type 1s. So, my mom and my brother were both diagnosed when I was very young.

I grew up with type 1 diabetes around me, and I was diagnosed in my early twenties, which is considered somewhat of an unusual age to be diagnosed with type 1 diabetes. So, I followed what my doctors were telling me to do. At that point, I ate my normal diet. I dosed insulin for it like they were telling me, and my health started to deteriorate somewhat quickly.

Within the first probably seven, eight years, I was having digestive issues. My urine protein levels were coming back elevated, which is a sign of kidney damage. And I had actually suffered from clinical depression for years, actually even before my type 1 diagnosis.

And now looking back on that, I’m quite sure that was because of blood sugar dysregulation at that point, but I struggled. I struggled for what felt like an eternity, and it was cognitive dissonance because I was doing everything my doctors were telling me to do. I was following all of the recommendations. And they kept telling me that, oh, you’re not doing good enough, you’re not doing well enough.

You need to do X, Y, and Z. And I’m saying, but I’m doing everything you’re telling me to, and I’m still not getting the results that you’re telling me I should get. So, it it was really hard to try to figure out what the next steps were. And at that point, I was suffering from severe depression, and I was actually suicidal for a time. And I couldn’t figure out my way out of this mess because it just didn’t make any sense to me how come type 1 diabetes management should be so hard.

And my blood sugar levels were swinging from 40 to 400 every single day. it was just a roller coaster, and honestly, a nightmare. And so I started searching online because that was my only hope.

You know, this was 2014. 

Bret: 
Yeah, so I want to, sorry, I’m going to interrupt you for one second. 

Lisa: 
Go ahead. 

Bret: 
Just to emphasize this, and you’re not someone, you’re not someone out there with no medical care, going from 40 to 400 and severe depression. You are being cared for by your doctors. You’re doing what they say.

You’re part of the medical system. And yet, in order to get well, you had to go out on your own, out of the medical system and research your own. I just, I find that so frustrating, but also encouraging and amazing that you’re able to do it. So, once you did this and you went on your own journey. Sorry, I interrupted you because I thought it was such a important point.

So, take it from there. 

Lisa: 
And that’s a really important point because it seems like people, if you are going to have success with diabetes management, you have to find the methods on your own. But I’ll come back to that. So, I started searching online. And in one of the standard diabetes management Facebook groups, excuse me, one of the standard diabetes management Facebook groups, somebody had posted a beautiful continuous glucose monitor graph.

It was of no blood sugar fluctuation. It was just little tiny movements here and there. My blood sugars are going zooming up to the four hundreds down to the forties. They were nuts, and I didn’t even know that more steady blood sugar level was even possible.

And so I started asking some questions. How did you get this? How can I get this? This looked amazing. I couldn’t believe it. And this person said that she had read a certain book called Dr. Bernstein’s Diabetes Solution. And I thought this must be some miracle cure because I had never seen anything like this before. So, I was living in the middle of Argentina at the time.

I got the book on Kindle and started reading it. Read through it pretty quickly, and i, to be perfectly honest, I hated it. I said this could probably work for other people, but it’s too strict for me. It’s too strict for me. I’m not somebody who’s going to track every single blood sugar level and watch everything I eat.

And that might be for other people who are maybe more scientific minded or medically minded, that’s not for me. And so I put it on the shelf for a whole year, and tried a whole bunch of other things during that year, including a vegan cleanse, including paleo diet, including a Whole30, and nothing made the difference that Dr. Bernstein’s program claimed it would.

So, it was actually New Year’s 2015 that I said, okay, I’ve tried everything else. I really, at this point, have nothing to lose. So, I’m going to give it a week. And within that week, I was absolutely sold. My insulin levels were coming down. I needed less insulin.

My blood sugar levels were a lot steadier. I felt better. And I said, wow, okay, if this is just after a week, imagine what would happen if I give it a month. And the improvements just kept getting better. So, within a month, I said, okay, this is how it is, this is my future. This is what I’m going to do.

And then shortly thereafter, my husband encouraged me to start writing about what I had done. And so that’s really how my outreach and my company began. 

Bret: 
Yeah, so it sounds like you had some dramatic improvements. And so tell us what was going on with your depression and your mood as you noticed your blood sugar stabilizing, and you started this new diet and lifestyle.

Lisa: 
Yeah, my overall sense of well-being and mental health improved dramatically, and I attribute that to a few different things. One is stabilizing blood sugar levels because I know with hypo and hyperglycemia, mental health is affected by that. That is something that has been studied. So, it is partially that I’m sure. But then also my sense of self-efficacy or confidence in being able to do something positive for my health and be in control of blood sugar levels, that was something that I had never experienced in my 14 years of diabetes management. I didn’t know that was something that I would ever feel.

So just being able to have that personal sense of control that I was able to really create my own future and steer my health in the direction that I wanted it to go. That I think was so incredibly substantial. 

Bret: 
Yeah. So that’s, that’s an amazing personal story, and I guess I’m jumping ahead.

We’ll get into your coaching business. So, from there, you got into coaching just numbers and numbers of people with both type 1 and type 2 diabetes. But is that something that you see commonly among the people you work with and now that your coaches work with type 1 diabetes? That feeling of, I don’t know, they have no agency, they have no advocacy for themselves? That they are feeling depression because of their lack of ability to control things? Is that pretty widespread? 

Lisa: 
Yes, yes. I, personally, see a lot of trauma and a lot of burnout in the type 1 diabetes community. in particular, because type 1 is what we have traditionally worked with, but particularly with a type 1 diagnosis comes that sense that you don’t have control over your future. You have this chronic lifetime illness. You have this huge daily burden. Being able to manage or not manage this condition, sole responsibility is on you. And there’s generally a lot of shame and blame attached to that if you can’t control your blood sugar levels.

So, just within the diabetes community as a whole, I see trauma, burnout, shame, lack of confidence, lack of believing that they deserve anything better. 

Bret: 
Yeah, and that’s sums it up very well, but it’s just so sad to hear that. And that’s like with the best care, right? That’s with people getting standard medical care. But with simple, or maybe not so simple, dietary lifestyle changes ,all that can turn around.

So, actually I do want to be mindful for people who don’t know of Dr. Bernstein’s book. Tell us what the diet is, but also I want to hear why you felt it was too difficult to do and what you noticed once you started it in terms of its difficulty.

Lisa: 
Yes, so Dr. Bernstein’s Diabetes Solution book is all about therapeutic carbohydrate reduction for the control of blood sugar levels in both type 1 and type 2 diabetes. So, with that, it’s reducing your carbohydrate intake, which also then will reduce the amount of insulin that you need to cover those carbs and reduce any blood sugar excursions that happen because of any dosing errors or carb counting errors.

So, it’s really very small movements. You’re controlling your inputs in order to control your blood sugar level, your inputs being food, insulin, even exercise, et cetera. So, first of all, I do have to say Dr. Bernstein is a, he’s still alive, still practicing. He’s a fantastic role model for the diabetes community.

But he was originally trained as an engineer, and became a medical doctor in his forties. And much of his program really focuses on the engineering aspect of creating your own health. And I think that’s maybe what I pushed back against because it is very, I don’t want to say rigid, because once you get into the details, it’s very flexible, actually.

But it comes across as being very regimented, very controlled. And I said, look, I’m a creative. I don’t buy into any of that. I don’t think that I could eat such a rigid, strict plan because he recommends less than 30 grams of carbohydrates per day. So, I thought, I love my scones. I love my pasta. I love my bread.

Nobody’s going to take that away from me. But yet, I also knew that what I was doing wasn’t working. 

Bret: 
Yeah, so then once you started on the carbohydrate restriction though, did you still say oh, this is really hard, I miss my scones? Or did all, or did things change right away? What was your transition period, and I guess, how do you coach individuals when they are starting low carb, both from your experience as an individual doing it and as a coach?

Lisa: 
Yes, great question. When I first started, the first few days, I have to say were somewhat hard because we’re creatures of habit. And so I would just be reaching for whatever I would normally reach for and go, oh, I can’t have that or, oh, I’m not eating that anymore. And so it was a lot of kind of recommitting every single day, pulling myself back from the things that I might want to grab and recommitting to what I needed to eat to actually give this a good shot.

And after the first few days, it became a little bit more natural. Within the first two weeks, I’d say I was really able to find things that I love to eat that would also support my blood sugar levels. And I think that’s the key. So, we’re not just saying that this is a one-size-fits-all diet. We’re saying that we have to find the foods that we love to eat, that bring us personal satisfaction, make us feel full, but that also support our goals of steady blood sugar levels.

Bret: 
Yeah, I think that’s such a great point, too. Because if someone loves Italian or Indian or Mexican or whatever the case may be, to try and say everybody needs to eat steak and broccoli may not work. And same thing, that’s the problem we’ve gotten into for 50 years saying everybody needs to eat low-fat.

For one, it just doesn’t work because it makes you hungry, but people just don’t enjoy it. And if you don’t enjoy it, you’re not going to stick with it. And that’s been a hard lesson learned. So, I like to hear you say that there. And we say this all the time, ketosis is a physiologic state.

It’s not one diet, and there are many different diets that can fit it. So, when you talk, when actually, maybe I’m confusing things here? So, there’s carbohydrate reduction and there’s ketosis. So, do those have to be the same thing to achieve success in type 1 diabetes management? 

Lisa: 
We don’t actively seek ketones in our diet.

Most of the people who follow Dr. Bernstein’s plan, or who we work with, do not check ketones unless say they are running high blood sugar levels, they’re dehydrated, they have some sort of illness that could push them to diabetic ketoacidosis. So, that is a completely different thing than nutritional ketosis.

And that is a very severe and life-threatening condition that needs medical attention. So, we use our ketone meters as a safety measure, not necessarily to measure a nutritional ketosis. 

Bret: 
Yeah, and I think that’s an important point because if your standard endocrinologist or primary care doctor hears about keto and type 1 diabetes, they immediately think danger, ketoacidosis. 

Lisa: 
Yes. 

Bret: 
And it’s so refreshing to hear you say no, we don’t need to worry about that, except in these extreme circumstances, and then we can test ketone. So, it’s not, it’s not a dangerous thing. So, let’s catch up here. Oh yeah, go ahead.

Lisa: 
Can I just interject one thing? 

Bret: 
Please. 

Lisa: 
I did want to say that for the most part, people who are following this plan do show some ketones. But like I said, it’s just not one of the therapeutic goals of ours. And I would be really interested to see if people were to track it more frequently, what sorts of levels we would be running at.

Because generally, we might be eating two or one or two meals a day. We have long fasting times, and of course, the low carbohydrate intake too. I’d be very curious to see what a general ketone level would be within our community. 

Bret: 
I want to see the study of the American Diabetes Association Diet versus Dr. Bernstein-style diet and someone with type 1 with a CGM, with a continuous ketone monitor, CKM, and follow them for three months, six months, whatever the case may be. That would be a fascinating study. Alright, we’ll talk offline with Andrew Koutnik to see how we’re going to make this study happen. 

Lisa: 
Would love to. 

Bret: 
Yeah. But now let’s catch up on your whole coaching business that you started. You took this from a personal journey to writing to sharing about it to now creating a whole coaching business for people using insulin and people with diabetes. And so how many people are you, how many coaches do you have?

How many people are you coaching? And what are some of the insights you’ve gained so far from this? 

Lisa: 
We are always working on building our community. Right now, we have three coaches and a few adjunct employees that are working for us. We work in English, Spanish, and Portuguese, and we are really trying to get the word out about this option for diabetes management.

We’re trying to show that this is possible. This can help reduce the burden of diabetes management. And in fact, we’re all living it. All of the people that I employ are also living with type 1 diabetes. So, we are personal examples of what this can do. And it’s interesting, too, that we all came to Dr. Bernstein’s plan individually and through our own research and our own searching, searching for answers. 

Bret: 
Yeah, I love that they’ve all, they all have type 1 diabetes and came to this way of eating on their own and now can use their personal experience plus the training they’ve received to help others.

And you mentioned earlier that in order to really, I’m going to put words in your mouth because it’s not exactly how you said it, in order to succeed and really thrive, you have to seek out treatment on your own. And that’s just disappointing for the medical community for to say something like that.

But expand upon that, and tell us why you think that is. 

Lisa: 
I think there are many different facets to why people have to seek out answers on their own. First of all, of course, we have the American Diabetes Association, which is recommending to people on one hand, that they follow a personalized diet plan that is created with their dietician. But then on the other hand, they recommend 45 grams of carbs per meal, plus snacks. And and so we have that trickles down to the doctors who then say, okay, that’s the law. That’s what we have to recommend. The doctor, endocrinologists and dieticians just regurgitate that and and keep people in that cycle. Plus, a lot of diabetes education organizations that have been associated with hospitals have been shut down recently. Those aren’t considered money makers.

So, you have the people who might know a little bit more about diabetes education and actually living every day with type 1 or type 2 diabetes, and the education isn’t getting out to the people. So, now that really also leaves a gap that people with type 1 diabetes aren’t feeling supported.

They don’t feel like they have a team around them. They don’t feel like they necessarily have the specific strategies to be able to address some of these issues that they’re encountering. And so, I think it just, it’s a really unfortunate situation that people have to go online and find their communities online.

They have to, like we said earlier, seek out the answers for themselves because the ADA, their endocrinologists, their dieticians aren’t helping to support them. And even when people go to those professionals and say, hey, I want to follow a ketogenic diet, like you had said, they often hear the word ketogenic, and it’s a knee jerk reaction.

They don’t want to have anything to do with that. And they will say, no, it’s going to kill you. So it’s, we’re getting pushed back at every turn. It’s a real disservice to the people with type 1 diabetes. 

Bret: 
Yeah, and as we’ve talked about through this interview, a disservice medically with blood sugar swings, and also mentally with the just with the disenfranchisement and feeling like you have no agency and depression that can go along with that.

But thank goodness these communities are popping up and exist. And what are some of the best communities or best places for people to go if they want to learn more? 

Lisa: 
TypeOneGrit on Facebook is, was really one of the first groups for Dr. Bernstein’s program. And actually, Allison Herschede, who is the lead diabetes educator at my company, she was one of the co-founders for TypeOneGrit back in 2014, I believe.

So, there are Dr. Bernstein-specific Facebook groups. In particular, Dr. Bernstein has a great website with information from his book. There’s also Diabetes University on YouTube, which has many years worth of archives of videos from Dr. Bernstein. And our company is diaVerge Diabetes. And so we have a website, Facebook group, Instagram, and we’re always working to get more information out to the people who need it. 

Bret: 
Wonderful. I really appreciate your advocacy and just how involved you are in this space and really helping spread the knowledge to people who can benefit so much from it as you have and all your clients have and you’ve seen it.

And I think it’s one of those areas of medicine where we really aren’t helping people nearly as much as we can. So, I appreciate all your efforts, and thank you for joining us today to spread the word. 

Lisa: 
Thank you so much, Bret. I appreciate your time. 

Bret: 
Thanks for listening to the Metabolic Mind Podcast.

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