Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
25 Oct

What About Type 1 Diabetes?

You hear a lot about type 2 diabetes on this and other sites in the community. It’s easy to see why: type 2 diabetes is the “lifestyle” diabetes, the preventable one, the one that “doesn’t have to happen” and that you can “fix if you just dial in the food.” All true, for the most part. Whether you’re in the camp that thinks it’s red meat or egg yolks causing it, or fatty liver from excess PUFAs and fructose, the point is that people commonly accept the idea that T2D is preventable and manageable with the right diet and lifestyle. But what about type 1 diabetes? Why don’t we hear so much about it?

First of all, it’s rarer than T2D. For better or for worse, there simply isn’t as large an audience for stuff about type 1 diabetes. Second, type 1 diabetes (T1D) is an autoimmune disease. In T1D, the pancreatic beta cells that produce insulin in the body are destroyed by an autoimmune attack. Left untreated without exogenous infusions of insulin, T1D results in severely elevated blood sugar and, eventually, death. Autoimmune diseases are confusing, tricky, and hard to manage. I mean, your body is attacking itself and preventing a completely necessary physiological function – insulin release! It’s not something you want to mess around with. It’s not a subject you can tackle lightly.

And I think that’s why people have steered clear of making any absolute recommendations regarding T1D and Primal or paleo. That said, we can make some general recommendations, I think, that won’t cause many problems and can even help solve some of them (with a doctor’s approval and assistance, of course).

I find the standard issue protocol a little odd: let people eat all the carbs they want and supplement with, as Dr. Kurt Harris once put it, “massive doses of insulin required to compensate for 6 times a day tsunamis of glucose arriving from the gut to keep the glucose from putting you in a coma.” Sure, it “works” in that it doesn’t kill you outright, but it’s an imperfect solution. It’s trying to replace an innate, finely-tuned physiological function (insulin release in response to glucose) with the blundering inexactitude of exogenous insulin administration by human hand.

Are there any other options?

Low carb diets certainly work. Richard Bernstein, an MD with T1D himself, wrote The Diabetes Solution, a popular book that prescribes an essentially ketogenic diet for diabetics. It’s the diet he used to manage his own condition, and it’s apparently helped a huge number of people (the latest 2011 edition of the book has 45 5-star reviews on Amazon).

Indeed, several studies support the use of low carb diets in the treatment or management of T1D:

A low carbohydrate diet in type 1 diabetes: clinical experience–a brief report. – After three months on an isocaloric low-carb diet (70-90 grams per day, with extra fat and protein to make up the missing calories), the weekly rate of hypoglycemic incidents in T1D patients dropped from 2.9 to 0.2 and requirements for insulin after meals dropped from 21.1 IUs to 12.7 IUs. After a full year, insulin requirements were even lower at 12.4 IUs per day. Total and HDL cholesterol remained the same, while triglycerides dropped.

Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit. – Researchers tracked long-term diet compliance and HbA1c levels in T1D attendees of an educational course recommending lowered carbohydrate consumption. Those who complied with the recommendations saw their HbA1c drop from 7.7 to 6.4 after four years, while those who did not comply saw their HbA1c move from 7.5 to 7.4 (no change) after four years.

Effects of carbohydrate counting on glucose control and quality of life over 24 weeks in adult patients with type 1 diabetes on continuous subcutaneous insulin infusion: a randomized, prospective clinical trial (GIOCAR). – Among adult patients with T1D, carb-counting improved quality of life, reduced waist circumference and BMI, and reduced HbA1c levels.

Does low carb “cure” T1D? No. The pancreatic beta cells remain damaged and unable to produce insulin, but the amount of exogenous insulin required for proper physiological function is lower when you’re not eating so many carbs. This improves quality of life (not so many needles), it improves metabolic risk factors, and it improves body weight (not so many needles full of insulin). By all accounts, low carb seems to help T1D, and it definitely doesn’t hurt it. So that’s something.

What about going Primal? And not just the food recommendations – can the kind of lifestyle changes I encourage have any affect on T1D?

Well, as I always like to do, let’s talk about epigenetics and gene expression. Most people think of T1D as a “genetic disease,” as in you “just get it” if you have the genes associated with T1D. But, as my astute readers undoubtedly know, genes do not represent our destiny. Genes – particularly the ones associated with disease – require an epigenetic trigger before they’re expressed and become active. For genotype to give rise to phenotype, you need an environmental stimulus. This is true of numerous diseases, and type 1 diabetes is no different. And sure enough, among monozygotic twins (same genotype) with the genes for T1D, there is just a 30-50% concordance rate for the trait. That means though they have the same genes, if one of the twins has T1D the probability that the other twin will have T1D is only 30-50%. In other words, there’s something more at work than genes (otherwise there would be a 100% concordance rate). And, it’s shown that when people move from a low-T1D incidence area to a high-T1D incidence area, T1D goes up. The genetics aren’t changing; the environment is changing.

If I know my readers, you’re now wondering about these epigenetic triggers. Right? Let’s take a look at several candidates (you may be familiar with them):

Vitamin D – The further away you are from the equator and the less UV rays you’re exposed to, the greater the incidence of T1D.

Breastfeeding – There is a strong association between protection from type 1 diabetes and having been breastfed as a baby.

Gluten – 7% of type 1 diabetics also have celiac disease, which by some measures affects just 0.7% of the general population in the United States. Babies with early exposure to gluten often display evidence of T1D-related antibodies.

Omega-3s – In one study of children at (genetic) risk for developing T1D, omega-3 intake was inversely associated with the disease.

Sound familiar to anyone?

Interesting, but what about once you already have T1D? Well, if you catch it early enough, there’s a chance you can restore or halt the destruction of beta cell function, just like the 6-year old Danish boy who enjoyed total remission of type 1 diabetes (complete with cessation of insulin therapy) upon adopting a gluten-free diet. Most people don’t catch it early enough, though. For them, the folks with full-blown type 1 diabetes, the same Primal prescriptions are going to be helpful.

Avoid gluten. Studies suggest that avoiding gluten can improve type 1 diabetes, particularly in those with celiac disease. It can also reduce type 1 diabetes-related antibodies and reduce intestinal inflammation in type 1 diabetics. I suspect it’s helpful for diabetics with “mere” gluten sensitivity, too (which is probably a ton of them!).

Get sun or take vitamin D. Although you can’t go back in time to prevent the development of T1D, you can make sure your vitamin D levels are adequate. Plus, folks with T1D are at a higher risk for having low bone mineral density, with which vitamin D can assist.

Get your sleep. Sleep isn’t just helpful, it’s especially helpful in T1D. Altered sleep patterns disrupts circadian rhythms, which disrupts insulin sensitivity in type 1 diabetic youths. Same goes for adults with T1D, who suffer impaired peripheral insulin sensitivity after just a single night of bad sleep.

Exercise intelligently. “Vigorous” exercise can exacerbate blood glucose levels, with some researchers even proposing an intense 10 second sprint as an effective way to boost blood glucose levels in type 1 diabetics experiencing a hypoglycemic episode. Lift weights, walk a lot, and sprint occasionally – but be careful about how often and how intensely you do it.

Keep the carbs low. The fewer carbs you eat, the less insulin you’ll need to administer.

Overall, I don’t think going Primal is just helpful for type 1 diabetics who want to reduce their reliance on exogenous insulin; it looks almost essential. At any rate, I see nothing inherent to the Primal Blueprint that would preclude a type 1 diabetic from adopting it.

When you do approach your doctor, you don’t even have to mention the grains, legumes, sugar, and vegetable oils you won’t be eating, the sun you’ll be getting, the sprints you’ll be occasionally sprinting, the quality and quantity of sleep you’ll be focusing on. Just say you’re thinking of trying “low-carb,” which your doctor will no doubt be familiar with and (hopefully) open to trying.

Tomorrow, I will feature a success story from someone who’s using a Primal approach to effectively manage his type 1 diabetes, so stay tuned for that!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Autoimmune diseases remind me of lesch-nyhan syndrome, an interesting disorder. It can cause people to harm and mutilate themselves.

    Animanarchy wrote on October 25th, 2012
  2. I’ll be honest, my brain starts to shut down when Mark’s articles get a bit more scientific, but I still found this fairly easy to understand and accessible. Maybe someday, I’ll convince my refined-carb-loving Boyfriend to cut back on the refined foods a bit, since both his father and paternal grandfather have diabetes (T2, I think). Due to his Native American ancestry, he is also probably less tolerant of refined foods than a lot of other Westerners, but his good genetics seem to be keeping him healthy so far, thankfully!

    Tasha wrote on October 25th, 2012
    • I am the opposite, I love when Mark posts technical articles. As an engineer I love learning how our body interacts and what hormones are causing what.

      Wayne wrote on October 25th, 2012
  3. yes i agree and thank you Mark! I am a current T1D and very active- the ketogenic diet of primal life and that depicted by has helped my BS so much – i first began insulin when i was 15 and have never had good BS until MDA- I am hoping to be a friday success story someday – glad somebody is breaking the waters on the discussion of T1D as you always hear about T2D – one thing Dr. Attia and Gary T. showed me through some infor is where you inject your insulin is a huge thing- I always injected into my “spare tire” (i wear a pump) and i could never diet/workout enough to fix the extra abdominal fat- well now i inject into my thighs and my tire is a couple times smaller now (which helps prevent so many other issues)

    lockard wrote on October 25th, 2012
    • I have NEVER heard that injecting insulin into the abdominal area contributes to the “spare tire”. I am a T1D and have been for 15 years. Never had anything extra on my stomach until I had my kids. I also switched to a pump instead of syringes at that time (endocrinologist’s recommendation), was told never to place the infusion set anywhere other than the stomach and haven’t gone back to doing it any other way. I’m totally going to try switching to thighs and see if it helps as I am working on losing that extra bit.

      Thanks for the tip!

      Sarah wrote on April 24th, 2013
  4. As someone healing from a different autoimmune disease, I would love it if we stopped describing it as the body attacking itself. I don’t think that’s what’s happening at all. The body is in a high alarm state and trying its best to help, but it’s gotten confused. It’s goal is always to heal. I liken it to a house that’s on fire. Conventional medicine simply turns off the smoke alarms. Primal living attempts to put out the fire.

    Eileen wrote on October 25th, 2012
    • That’s probably the best analogy I’ve every heard for an autoimmune disease.

      Charlayna wrote on October 25th, 2012
      • ever heard, not every heard…

        Charlayna wrote on October 25th, 2012
    • It’s also good to keep in mind that it’s still unproven that type-1 diabetes is an autoimmune condition. While there is evidence to suggest this is true and it does look very likely… it could be something else.

      John C. A. Manley wrote on November 8th, 2013
  5. Art de Vany speaks about caring for his son and first wife with type 1 diabetes in his book and it was this experience over a 25 year period that helped him develop his Evolutionary diet principles.

    Kelda wrote on October 25th, 2012
  6. My son has an autoimmune disease (chronic hives), but no longer suffers from it. He was on adult level medication (steroids, etc.) to keep it in check about a year ago. The doctors said that they didn’t know what caused it, or how to cure it. They said we were lucky, as they had some patients with the same problem that had much more extreme treatments.

    My wife and I had already been following the Primal Blueprint but our son was not a strict adherent. After reading some of Mark’s earlier articles about autoimmune problems and how a Primal lifestyle could help, we made our son go strict on the diet. It cured him.

    To let you know how well this worked, you need a little background. About a year before we had found the Primal Blueprint (so about 2 years ago) he broke out in terrible hives, ones that even started to cause inflammation in his longs and trouble breathing. After going to the emergency room he went to allergist that diagnosed him and started treatment. We tried various things to keep it under control. We started to scale back on the medication, experimenting to see what was the minimum we needed to keep his condition under control. When the hives came back we knew that we needed to keep on giving that medication (this experimentation was prescribed by the doctor, to try to minimize his suffering). So we had a pretty good idea on what we could get away with and what we couldn’t. After getting this under control for about 8 months the wife and I just happened to start following the Primal lifestyle. We didn’t force our son into it, he ate our dinners and such, but we still had separate snacks for him such as crackers, cookies, etc.

    After reading some of Mark’s earlier articles about autoimmune disorders I proposed that we have him go strict. It would just be a continuation of our experimentation. So we had him go strict for about a month, and at the end of the month we tried cutting back his medication. No hives. We kept at this for a few days. No hives. Just to see if we could verify his triggers we allowed him to snack on some gluten filled foods (bread, crackers, etc.). Hives were back within an hour. We gave him some of his medication, they went away.

    So now we know the cause and cure for this problem the allergist said that they didn’t really know what the cause was or what could cure it. We’ve shared our discovery with them, not sure how they are using it, but hopefully they are using it with their patients. For us at least, we know it helps with our little patient, and that we are setting him up for a healthy life. I guess it is a bit of a blessing, as without his problem he may not adhere as tightly as others. But it will still benefit him in so many other ways.

    It’s also hilarious to here him get all indignant about the grains that they keep on pushing at school and he’s not shy about telling his friends and teachers about how bad they are for you and can make you sick!

    Aaron wrote on October 25th, 2012
    • Great story and one I often see with my patients. Gut health and grain intolerance upregulate your immune system leading to inflammation we as physicians call “autoimmune reaction.” It’s awesome to see a person discover their own cure.

      William wrote on October 29th, 2012
  7. I also think it’s interesting that ketogenic diets greatly improve neorological diseases – like epilepsy, which I had as a kid. I think keto diets need to be explored further for their therapeutic benefits. Very interesting read!

    Dani wrote on October 25th, 2012
  8. I have a friend who has adult onset Type-I diabetes. I didn’t even know such a thing existed. He was a healthy, thin, active person and was surprised by it. The recommendation for him was to eat lots of carbohydrates, monitor his blood sugar and take insulin. It’s so unfortunate this is standard procedure, but I suppose taking more insulin is better for profits.

    Diane wrote on October 25th, 2012
    • Mass zombification.

      Animanarchy wrote on October 25th, 2012
    • Aye….. I was told to do the same. Type 1 since before I was 1 year old. High carb, more insulin….. 230+lbs later and declining health at only 25.
      I switched to a low carb diet and a more paleo one (without realizing that classification at the time).
      I’m at a steady 170 now, have atleast defined abs, a A1C better than most typical americans, and feel better than I ever have in my life.
      Don’t believe all the ADA’s hype about what’s “good” for you.

      Richard wrote on October 25th, 2012
      • The ADA should be ashamed of themselves. They recommend that patients with diabetes NEVER go below 130 grams of carbohydrate/day, as this is “unhealthy.” Last I heard, they almost insisted you HAVE to eat whole grains as a significant part of these carbs. 130 is admittedly better than the typical SAD, however, for some diabetics, 130 really is still too high.

        It is amazing that the ADA and other conventional medical organizations are so fearful of low carb diets, when there is so little evidence to back up these fears.

        Fritzy wrote on October 27th, 2012
    • Better for profits in two ways: 1) They sell more insulin. 2) They sell more drugs to deal with the complications of chronically high blood sugars resulting from taking so much insulin and eating so much carbs.

      Win-win for the drug company. And an easy sell as long as they don’t spell out the complications.

      John C. A. Manley wrote on November 8th, 2013
  9. My son is a type one diabetic diagnosed at three years of age. Sadly it runs in my family. My sister has it and also two of my uncles and an aunt. We went paleo about two and a half years ago now after having been low carb for about eight months before that. The effect on my son’s sugars (he’s 12 now) has been nothing short of miraculous. He uses half the insulin he used to and we have very few lows, in fact the one we had this week (71) was the first in more than two months. His average BG moves up and down (depending on the occasional treat) but is usually in the low to mid hundreds. His endocrinologist didn’t approve at first but has relented given our results (and his excellent blood work). I don’t get the feeling she’s recommending it to her other patients though.

    It really has changed our lives. As Mark mentions above… having shown sensitivity to gluten myself (I have diagnosed asthma that I used to be on advare for that goes away as long as I don’t eat or drink gluten), I wish we had known this earlier, that it was more available back when our little guy was diagnosed we might have been able to reverse it. Now the best we can do is feed our other non diabetic son as primally as possible and hope that someone comes up with an effective immune therapy to turn off the destruction (such as Dr. Faustman’s interesting treatment protocol).


    Tim wrote on October 25th, 2012
    • Tim, that’s fantastic what you are doing for your son. Still, I wouldn’t trust your docs. My research (as well as Dr. Bernstein’s book) show that an average blood sugar in the low to mid-100s is still too high. Studies show that this will still lead — long-term — to cardiovascular and brain damage.

      My wife is type-1 diabetic. The only way we could get her down to 83-90mg/DL was by following Bernstein’s program — basically quasi-no carb. The problem with type-1 diabetes is that blood sugar will rise enough simply from eating protein and fiber. Other than a few grams of carb — it’s too difficult to manage the blood sugar using injected insulin.

      John C. A. Manley wrote on November 8th, 2013
  10. I know a guy I used to play hockey with. He is T1D. I have debated contacting him to let him know about how paleo/primal could help him but I’m not sure if it would be too weird. I haven’t seen the guy in like 10 years and we were only friendly acquentances, not friends. Do you guys think I should forward him this article?

    Wayne wrote on October 25th, 2012
    • Of course you should do that and also recommend Dr Bernstein book Diabetes Solution

      Liv wrote on October 25th, 2012
    • I think you should! I think he would be very happy to see it, I would be.

      Sarah A. wrote on October 26th, 2012
    • I find it’s usually better to ask something like: “Would you be interested in some resources I’ve found for avoiding the complications of type-1 diabetes?”

      If he’s not interested, why waste your time and be perceived as a bother? Other people and causes that need and want your help.

      Most type-1 diabetics are in denial about the disease and it’s side effects, I think. Their doctors program that way. Just take insulin and you’ll be okay. My wife did that for three decades and ended up with kidney failure, heart attack, stroke…

      John C. A. Manley wrote on November 8th, 2013
  11. “(with a doctor’s approval and assistance, of course)”
    Nice one. ; )

    Animanarchy wrote on October 25th, 2012
    • I know Mark needs to include that to keep from getting sued, but my recommendation is to try it even without a doctor’s approval. Most doctor’s go by CW and won’t approve. A good amount will let you do what you want as long as you are careful and report back your results. Very few are in on this Primal eating and what it can do for you.

      Experiment for yourself. It’s not like anything that is being recommended is totally crazy. If you are super paranoid just make small changes at first. Ease yourself into it.

      Aaron wrote on October 25th, 2012
      • when i told my doctor that I was ketogenic he was concerned but said as long as the good Blood Sugars continued he would support it- but your right doc’s are so very sold on grains are good eat them a lot and then use insulin (which just promotes insulin resistance and fat growth)

        lockard wrote on October 25th, 2012
      • I agree with this. I am t1 and I told my doc/nurse that i was trying out eating low carb earlier this year and she told me I needed to go to the dietitian right away and this was a stupid thing to do. 6 weeks later I was also diagnosed with celiacs disease and then she sent me to the dietitian again who told me I NEEDED to eat rice/gluten free bread etc or I was have no energy. Such bull.

        I think that most t1’s know that they know more about their condition than the doc’s… I mean they are the ones living with it and a paleo/primal diet makes absolute perfect sense I don’t see why after discovering it a T1 would not convert even against their doc’s wishes. Also reccomend bernstein’s book, although with my life style at the moment I find his super strict diet hard to stick to, I really like his ideas and use them both with most of the paleo/primal ideas and I have MUCH more control than I used to. I would love to send in a success story one day also and can’t wait to read the one 2moro!!! :)

        Sarah wrote on October 25th, 2012
      • Exactly, he only says that to prevent a lawsuit for giving out medical advice. I think the problem with a lot of this modern society is NOT taking their health into their own hands and listening to doctors with outdated/lobbyist inspired information.

        Sarah A. wrote on October 26th, 2012
    • True. My doctor tells me to stay away from doctors. They don’t know anything about paleo diets or nutrition. Just test and treat with medications.

      Nice&Slow wrote on October 25th, 2012
    • It might not even be enough of a disclaimer, depending on whether California law is as bad as North Carolina:

      Charles wrote on October 25th, 2012
      • FYI: That website came up with a virus warning. :(

        Jase wrote on October 31st, 2012
  12. I’m a Type 1 Diabetic and have been since I was 19, I’m 38 now. As you state Mark, people think it’s all genes, but there is no history of Type 1 diabetes in my family (at least none that we know of), so I believe 100% that mine is not genetic and was somehow triggered by my environment, but hard to say for sure.

    I’ve always been active and actively managed my diabetes with moderate to good success. Over time, as I’ve gotten older and led a slightly more sedentary life (I’m a software developer, so not moving a lot during the work day), it just got harder to manage. I had a roller coaster of highs and lows everyday. Eventually I got a pump and that made things so much better, but still highs and lows were common. Ultimately that comes down to counting carbs which is largely a fools game. Even if you can count them perfectly with every meal, your body reacts to them differently ever day based on all kinds of factors (sleep, stress, exercise or lack thereof, probably a million other little internal biological things, etc). The other bit here is that, at least for me, if I take in a lot of carbs in one sitting, say over 100, my body does not process those 100 carbs at the same rate that the insulin does which makes it nearly impossible to dose insulin for that amount of carbs. The pump helps some, but in my experience, if I eat that many carbs all at once, I’m bound to have high, even uncontrollable highs, 3-6 hours after I eat and getting them under control at that point is extremely frustrating and difficult.

    I discovered Mark’s site and the Primal/Paleo lifestyle about 2 years ago when I was looking to make some lifestyle changes for the better and start getting back into shape. It’s been life changing for me. Period. Since that time I’ve lost about 30 pounds and am now building muscle instead of fat (I use a book called ‘You are Your Own Gym’ by Mark Lauren which fits really, really well with the Primal life). I went from taking in over 200 carbs a day to right around 100 now. I went from over 50 units of insulin a day to right around 30, which is more than 50% basal. My A1C’s are consistently between 6.0 and 6.2, low enough that my doctor always asks about my low blood sugar incidents. He’s surprised when I tell him I have none (or very close to none). It’s simply a result of eating less carbs and getting off the carb roller coaster. I don’t have a lot of lows but I no longer have a lot of highs either and that’s the big difference. All these benefits in addition to feeling better every day, sleeping better at night and increased energy (to keep up with my 5 and 7 year olds)!

    Bottom line, if you are a Type 1 Diabetic, I would really, really encourage you to look at the Primal/Paleo lifestyle. It will change your life for the better. One last tip for you diabetics is that you don’t have to go all in – I’m not 100% primal/paleo, but I’m most of the way there. It’s hard to go all in right away, but the more you do it, the more you’ll get it and want to. It’s much easier to stop eating the bad carbs (breads, cereals, pastas, etc.) than I ever thought it would be.

    Thanks for all the good info Mark, keep it coming and keep spreading the word – I am.

    James wrote on October 25th, 2012
    • Ditto, James, and thank you, Mark. It’s so easy for those of us in the T1 camp to feel forgotten … or lumped in with T2 diabetes, or cavalierly dismissed. I appreciate the intelligence and thoughtfulness and empathy that went into this post.

      T1 for 25 years / VLC primal for about 4 months … still some tweaking to do; it hasn’t been an easy transition, but I’m sensing the roadblocks and experiments are going to be worth it.

      Heather wrote on October 25th, 2012
    • Inspiring story! I don’t have T1D (for which I am very thankful!) but just wanted to sound a note of support for “You are Your Own Gym” — just discovered this book too and LOVE it! There’s a also a great app that will guide you thru his somewhat complicated workout protocol with no brainpower required. I love that I can do it anywhere, no more gym membership and great results!(Beware the Bulgarian Split Squats, tho, I hurt my knee trying these last night)

      MissJelic wrote on October 25th, 2012
      • What is the name of the app?

        meghan wrote on October 26th, 2012
      • I just looked up You Are Your Own Gym on Amazon and see there is a version for women. Did you ladies read that one, or the original? I always wonder if reading fitness books aimed at women is really necessary, or if they are just written for women who think that they need a separate book for them. What say you?

        Sarah A. wrote on October 26th, 2012
        • Personally I think it would be better to buy the book for woman. Even though I haven’t read it, fact is a man’s body is created differently than a woman’s body. For example, a woman can put their elbows together and move them up to do a back exercise but most men find it difficult to do because they had broad shoulders. Still I think you’re good for the majority of moves and when it comes to cardio, I dont think gender matters.

          Dania wrote on February 26th, 2014
    • Great scouting in finding Mark, James. Primal is surefire way to go to get your BS under control. Please do pick up Dr Bernstein’s Diabetes Solution. I have been Pre Diabetic/Type 2/Now Type. I burned out my own Betas following CW while working for an Endo. The end result for a lot of Type 2s is to burn out their betas and become Type 2. Had I read Bernstein, Had I read Dr Rosedale, had Mark’s Daily Apple been around 14 years ago…I would still be just a hypo glycemic gym rat and I could have had the knowledge to keep it that way. Mark’s breakdowns of the info are the most readable. Dr Bernstein will teach you to bring your carbs down to 30 per day and you will reduce your insulin. Dr. Rosedale will teach you why high insulin is just as dangerous as high blood sugars. Between the 3 of them, you won’t have to ask anyone’s permission how to be and how to achieve great health.

      andre Chimene wrote on October 25th, 2012
    • That’s awesome about you A1C’s! I’m 31 and have was diagnosed with T1 when I was 3. Paleo/primal has helped so much. My last A1C was 6.4 and it’s improving everytime I have it checked!
      I didn’t have any history of T1 in my family either.

      Samantha wrote on October 25th, 2012
    • Fantastic post, James! Thank you for explaining your ‘journey’ so well. I’ve got Type 1 diabetes too and I was slightly nervous about going primal, but reading what you wrote has inspired me.

      And thank you too, Mark – it’s great to see Type 1 being covered here as so many people only seem to concentrate on Type 2. I’m sure we can ALL benefit from going primal :)

      Em wrote on October 27th, 2012
    • That is such good advice. I have a child(only four) is type 1, do you think it appropriate for me to give them less carbs/grains, even though so young? Also, what are you eating instead of say pasta, just lots of eggs,nuts,fish,meat?
      Thanks again.

      Eleanor wrote on April 16th, 2013
  13. These days they actually have Islet cell transplants which is really cool and promising for people suffering from the autoimmune disease Type-1 Diabetes. Look into it if you are interested.

    Wayland wrote on October 25th, 2012
    • Currently the need for ongoing immunosuppression (and all of its collateral complications) makes islet transplants less appealing than they might at first sound. I applied to the program several years ago and ultimately decided not to pursue it.

      Heather wrote on October 25th, 2012
    • I haven’t read much about the islet transplants. But, from what I’ve read about other transplants I don’t see a huge benefit for the Type 1. You exchange one thing you have to take for life(insulin) for another (anti-rejection drugs). Don’t know about Obamacare coverage of the procedure or AR drugs either. Seems insulin and paleo/primal is a lot cheaper and gives a freer lifestyle.

      Leo wrote on April 8th, 2014
  14. Has anyone else wondered what primal man did to fortify his O3 count if he lived in a mountainous and/or landlocked region? Sure, there’s the incidence of pond and lake fish, but without such a wide variety available, I struggle to understand how they would have handled such a pressing nutritional concern. Maybe wild poultry was their source….

    bigmyc wrote on October 25th, 2012
    • Brains!!!! No, seriously, organ meats are a good source of omega-3.

      Kitty =^..^= wrote on October 25th, 2012
    • Omega 3’s are PLANT OILS EXCLUSIVELY, even the fish that O’3’s are commonly derived from DO NOT MAKE THEM, they accumulate from the food chain of smaller prey that eat SEA ALGAE which is an aquatic PLANT that synthesizes them via photosynthesis, which is why O-3’s are in grassland plants & therefore the tissues of land dwelling herbivore animals. Flax seed oil is just one land plant that contains O-3’s. For confirmation check the Wikipedia pages re omega 3’s and the concept of Homeoviscoous Adaptation.

      cancerclasses wrote on October 25th, 2012
      • Oops, just one O in Homeoviscous.

        cancerclasses wrote on October 25th, 2012
      • Oops, it’s in the wiki article on micro algae, here’s the quote:

        “While fish oil has become famous for its omega-3 fatty acid content, fish don’t actually produce omega-3s, instead accumulating their omega-3 reserves by consuming microalgae. These omega-3 fatty acids can be obtained in the human diet directly from the microalgae that produce them.” And also from almost all land grasses & plants.

        cancerclasses wrote on October 26th, 2012
    • Kale is a great source of Omega 3’s, but purslane, a wild green, has more than twice the amount and tastes great. You can get your vitamin d by going out to look for it. It can be canned, pickled, sauteed, wilted, stir fried, added to any dish cooked or raw. It grows in most places and is easily identifiable. It’s my new favorite veggie.

      TruckerLady wrote on October 25th, 2012
  15. Diagnosed as hypoglycemic at 9 years old my parents ‘treated me by having sugar available at all times. EVERYONE in my family is diabetic. At 18 I felt horrible & the writing was on the wall. I figured since I’d probably end up diabetic I’d cut all sugar out now. Well 28 years later I am healthy, trim & active. No signs of diabetes. I’ve been officially paleo 8 mos., but close to it for 5 years. My family thinks I should just relax & eat cake, but I say nay nay.

    momupthecreek wrote on October 25th, 2012
    • Fantastic! Inspiring! Keep ignoring the eat-cake people. I don’t know what makes them do that…

      Carol wrote on October 25th, 2012
      • Genes. Diabetics crave more carbs, and with them so readily available….. the outcome isn’t so sweet. (Pun intended)

        Richard wrote on October 25th, 2012
  16. Thanks Mark. Great article and great comment section. My daughter has T1D and we are moving to a paleo diet. We all take vitamin D3, and Omega 3 krill. Try to stay high fat, low carbs and are doing well. Have any of your readers stated to supplement with cayenne pepper or probiotics for digestion and gut health? We hope this will all level her A1C’s.

    Anon wrote on October 25th, 2012
    • ** started to supplement **

      Anon wrote on October 25th, 2012
      • Be careful with cayenne, it can be pro-inflammatory for some people. For me, I found pro-biotics (in pill form) to be a waste of money. But I do drink raw milk kefir and eat kimchi and sauerkraut, not which you meant…

        Kate wrote on October 26th, 2012
        • I had good luck in the short term with cayenne, and really bad luck in the long run. I got severe stomach cramps and burning and started to have GERD like symptoms, which I otherwise never have. I think cayenne is fine short term, or in food to taste tolerance. Pills in the long run not so much. I was taking cayenne because it inhibits substance P, and it did help reduce pain for a while.

          Rachael wrote on October 27th, 2012
  17. Great article, though I’m surprised you didn’t include dairy consumption as one of the factors that is linked to the development of type 1 diabetes. It’s a connection that has been in the literature for a while, with evidence suggesting that in some, there is a casein/insulin auto-antibody issue- specifically an A1 casein connection.

    High quality (and high fat) dairy may be Primal (and delicious), but it may not be advantageous for those with type 1 diabetes.

    Victoria wrote on October 25th, 2012
    • I think gluten has been more closely linked to the development of t1 in more recent times. I remember about 8 years ago my parents were researching t1 after my brother and I both developed it at age 12 (no-one else in the family has it) and this theory was all the rage back then.

      Sarah wrote on October 25th, 2012
  18. Thanks for featuring this topic- a have adult onset type 1 and am always looking for type 1 related research, stats, and articles, but pickings are slim. the thought of eating tons of glucose and carbs and counteracting it with tons of exogenous insulin sounds pretty bogus to me. i’d love to see more of your findings on this subject!

    GFG wrote on October 25th, 2012
    • Iz u CrAzY? There’s 160 articles on Dr. Bernstein’s site alone, just go to and click on the articles button.

      cancerclasses wrote on October 26th, 2012
  19. Good read mark. Will be passing this on to a friend with a diabetic son. In Robb Wolfs book he goes into detail how grains and digestive tract health could actually trigger the autoimmune response that damages the beta cells. Pretty interesting.

    Luke DePron wrote on October 25th, 2012
  20. There is recent animal research into type 1 diabetes which shows that neuroendocrine cells in the gut will produce insulin on a ketogenic diet, and that this can keep these animals alive.

    Anon wrote on October 25th, 2012
  21. I’m also surprised you didn’t mention dairy. To my knowledge, there are many different factors of autoimmune disease, but one of them involves something called molecular mimicry. Basically, this is where something you inject mimics structures in your body, and as your body starts to attack the ingested material, it simultaneously attacks that part of your body that this food mimics. For type I diabetes since it is the beta cells that are being destroyed, it is hypothesized that the beta casein molecule in dairy products cause a molecular mimicry action in the body that attacks the beta cells of the pancreas.

    Vincent wrote on October 25th, 2012
    • @ vincent

      i dont understand everything you just said but i drank milk like crazy growing up (family of 6 and we would go through a gallon of milk each day) now T1D

      lockard wrote on October 25th, 2012
      • The idea is that your body decides that certain amino acids (the beta casein in milk in your case) are bad so your immune system starts destroying them. However, there are essential amino acids that your body produces that your immune system can’t tell apart from these “bad” amino acids, so it starts attacking them as well, thus you end up with an autoimmune disorder. This seems to go hand in hand with leaky gut syndrome, which is where your intestines start to become more permeable and certain substances that either need to be further digested or not digested at all enter your bloodstream. Following this line of reasoning, it isn’t necessarily just the milk’s fault; there could have been other foods in your diet that caused your body to process foods in a way that it made your immune system think that the milk you drank was a microbial invader.

        Charles wrote on October 25th, 2012
  22. ‘with a doctors approval’…I wouldn’t(and don’t) wait for a dr’s approval!! my dr “recommended” 300+ carbs/day and to eat whatever i wanted when i was dx’ed last year with T1D. Good old conventional wisdom-it frustrates me every time i think about it. People need to educate themselves and learn how their bodies respond to different foods and make their own decisions…there is no reason for T1D’s to settle for any less control over BS than a normal person!! After going primal and extensive self-education, my BS levels are better than most non-diabetics.

    Shawn wrote on October 25th, 2012
  23. I think anyone suffering from an autoimmune condition should try the paleo “autoimmune protocol” for several months, not necessarily with a hope of reversing T1 diabetes, but for better overall health and identifying possible triggers for underlying conditions.

    Paula B wrote on October 25th, 2012
    • I couldn’t agree more. I don’t think I would have ever discovered my celiac disease if I hadn’t gone full paleo 2 yrs ago. My symptoms were atypical enough and scattered enough that no doc had been able to piece together the puzzle. Neuro issues were blamed on my MS, weight issues on my thyroid, and my morning “smoker’s cough” was just post-nasal drip (caused by WHAT??????) Digestion issues were…. well, that’s just the way things are for some people, right?

      This diet hasn’t been a cure for everything, but I know I will live longer and stronger because of it.

      Kate wrote on October 26th, 2012
  24. I’ve been a type one since the age of 12, I’m now 30. I have two healthy boys (2,4) and wonder about if I should exclude dairy and gluten. When pregnant I was very very good friends with Vitamin D. I can vouch for Dr. Bernstein’s LC (30g of CHO/day) or something similar to a VLC way of eating. I have made my doc aware that I would be attempting to significantly lower my carbs and like some of the comments on here, it wasn’t exactly encouraged. I am constantly being pushed to start taking a statin. I will admit eating this way is difficult for me but the results speak for themselves–when I can have near perfect postprandial bs and know that the “fire within” is being put down with healthy proteins, fats, no gluten, etc, I have no other reason to not do this. Thanks Mark for writing about Type 1’s as our situation is quite different from Type 2’s (who can benefit even more from this type of lifestyle). Cheers!

    pylgram wrote on October 25th, 2012
  25. Type 2 diabetes may also be an autoimmune disorder too.

    Of course the researchers are looking into immune suppressing or vaccine treatment. No money in diet.

    Anne wrote on October 25th, 2012
  26. I was diagnosed with T1 at age 3. I didn’t take to breastfeeding as a newborn so I was given soy formula… eww! I was also a colic baby which I’ve heard has to do with tummy troubles… possibly signs of leaky gut? There is no history of T1 in my family that I’ve been able to trace.
    I’ve been on an insulin pump for 2 years now. My A1C’s pre-pump days were no lower than 8.5! After a year on the pump my Ac1 was down to 7.3. After 8 months of paleo/primal my A1C is down to a 6.4!!!
    Excuding gluten, grains and suagary foods has helped sooo much!
    I would reccommend this way of eating to ANYONE especially people with type 1 diabetes! :)

    Samantha wrote on October 25th, 2012
    • One more thing… I would recommend to any T1 to have their thyroid checked before eating VLC. I had to find out the hard way. But the good thing is that only after a week of upping my carbs to 90-130 (depending on activity level) I am feeling much better :)

      Samantha wrote on October 25th, 2012
    • Hey Samantha,

      I had colic as a baby too and no history of t1 in the family. My brother and I were both diagnoised as type 1 diabetics!

      I have also recently changed to a pump and my control has improved so much (lowest hba1c pre-pump was 7.0 and I was constantly going low, it was so hard to achieve!!), I also went paleo/low carb around the same time and also helped so much too!

      Could not reccomend a pump + paleo/primal/low-carb eating more to t1’s especially those who are having trouble with control.

      Sarah wrote on October 25th, 2012
      • That’s great Sarah! I can’t believe I’m just now starting to make all the connections between the soy formula, colic and such.

        Samantha wrote on October 26th, 2012
  27. A few theories of why people develop type 1 diabetes have been missed.
    In Australia and New Zealand, there is a lot of discussion as to whether A1 proteins in milk are to blame. A1 milk proteins are mainly found in Friesan cows which were once in the minority amongst milking cattle. Most Jersey cattle produce milk that contains the safer A2 protein. Genetic testing can be done and in Australia we have A2 milk available in the supermarket. It is thought to be better for a raft of medical conditions.

    Another aspect of epigenetics or hereditary disease. The mother’s immune system can be damaged by something for example pesticides. And as the foetus’ immune system is educated in utero, the foetus of a damaged mother is likely to develop the same autoimmune conditions as the mother.

    My immunologists example, my mother grew up in Malaya and was exposed to excessive amounts of DDT. She went on to develop Hashimoto’s autoimmune hypothyroidism in her 50’s. I developed it in my 30’s as did one of my sisters.

    So prevention of autoimmune conditions may require avoidance of milk with the A1 protein and avoidance of pesticides and herbicides in this generation is required to prevent autoimmune conditions in future generations.

    I also strongly agree with everything else Mark has listed.

    Mary wrote on October 25th, 2012
  28. I am beyond thrilled that you wrote this article and can’t thank you enough! It’s such important information and I appreciate all the studies you linked up as well! Many thanks!

    lydia wrote on October 25th, 2012
  29. Great post and responses. Looking forward to tomorrow’s info. My son’s a diabetic and it’s tough.

    Linda A. Lavid wrote on October 25th, 2012
  30. When we sometimes buy regular commercial meats it may be wise to select the lowest-fat cuts: e.g. flank steak in place of fatty sirloin. If the undesirable omega 6:3 balance is located in the fat instead of in the lean protein then the bad effects of grain-fed beef are minimised by this choice. Marinating in an acceptable mix such as spiced lemon/onion soup tenderizes and moisturizes such tough, lean cuts. This doesn’t correct all of the defects of feedlot finished beef but should go a long way toward minimizing omega 6 overloading.

    phusisphilo wrote on October 25th, 2012
    • I think the EFAs are in the meat, the dripping is more saturated?

      Anon wrote on October 25th, 2012
  31. Good timing, I just read an interesting diabetes blog entry from Scott Hanselman, a technologist from Microsoft with T1D. He mentioned he eats mostly paleo. He also gives some good insight on what living with T1D is really like, especially in relation to the current state of technology.

    Mark L wrote on October 25th, 2012
  32. Hi, interesting article. I was wondering if you have any other references of studies on the association of vigorous exercise and impact on blood sugar. The cited article states that a short burst of vigorous exercise (10 seconds sprinting) after about 20 minutes of moderate activity maintained glycemia, but did not boost it, as the article indicates.

    Exercise causes cells to take up glucose, thereby lowering blood sugar. This is one reason exercise is very beneficial to individuals with DM. I haven’t seen any indications of exercise actually raising blood sugar. I think this is an important distinction as it could affect insulin requirements in T1DM patients (who need less insulin with exercise). Normal insulin dose plus exercise is known to cause hypoglycemia.

    K. Schuette wrote on October 25th, 2012
    • I am T1D, and if i do a short sprint session it will raise by blood sugar significantly. It is my understanding that this is caused by adrenaline, the ‘fight or flight’ natural response that releases glucose into the blood stream to give your muscles a quick burst of energy, except T1Ds don’t produce insulin to counteract the adrenaline, hence the brief BS raise. That is also why i give myself a small bolus right before or after a workout session. Any prolonged exercise(>1 hr), then my BS starts to drop

      Shawn wrote on October 25th, 2012
      • Thanks for the quick reply! That makes a lot of sense and is also really interesting! I’m really glad you got back to me on this and I will look into it more.

        K. Schuette wrote on October 26th, 2012
    • I have been T1D since 15 (now 27) and if i do really intense stuff my BS will jump (high school wrestling was a funny thing practice, long and 75% made me go long and i would have to eat to maintain, but when i had a match, short and intense i would have to give insulin) now days long slow runs drop insulin (if i have not been ketogenic) and CrossFit will make me jump

      lockard wrote on October 26th, 2012
      • “long and 75% made me go long”
        * make me “go low” not “go long”

        lockard wrote on October 26th, 2012
  33. Wow. I’ve been a T1 diabetic for 39 years with very few complications. I only recently went on the Paleo diet (2 months ago) due to a flare up of rheumatoid arthritis (didn’t know I had it). My A1Cs have been lowered from 7 to 6.4 and I expect they will get even lower next time. I am elated! But I am also extremely angry at the USFDA and the American Diabetes Association for not recommending a low carb lifestlye for diabetics. I feel better than I have ever felt and have lost weight without even trying. I weigh less than I have in over 20 years. I talk to everyone I know about the Paleo diet. It is the way to live!!

    Diana wrote on October 25th, 2012
    • I am a t1d. can you please give me ideas of what you eat on a daily basis? would love to make the switch

      Charlene wrote on October 25th, 2012
    • I’m also a T1 who has just gone to Paleo and I like you can’t believe I wasn’t told about this. The results so far have been nothing short of amazing to me!

      My BG’s are within range for the first time in years.

      Tim wrote on January 10th, 2013
  34. I find this article to be very timely – the take home point in my therapeutic diets lecture this morning was “low carb diets are not recommended for type 1 diabetics!” In that same class, I am working on a T1D Meal Plan assignment for a fictional overweight couch potato male with a slowly healing foot wound. The ‘correct’ answers are to allow this man to consume over 400g per day – seems very therapeutic, right? Thank you for killing my curiosity with this post, Mark!

    Carly wrote on October 25th, 2012
  35. I’ve been type 1 since 1970, and only in the past three years or so have I had blood sugar control anywhere near what I’d like — since I’ve sharply reduced how much carbohydrate I eat. The board-certified endocrinologist I’d been seeing for over ten years was thrilled at my improvement until I told him I was aiming for under thirty grams of carbohydrates a day. He assured me that my brain cannot run on so little carbohydrate (I suppose that fat people forced to go without food for a couple weeks die of brain failure, then). My hemoglobin A1c is still too high (near 8 all too often, but before that it was invariably over 10) and I probably eat so much protein that much of it ends up converted to glucose — there’s room for improvement, but until I stopped eating much carbohydrate, nothing else I tried had much effect. I was on Symlin for a while, which slows digestion and carbohydrate metabolism and can leave one feeling nauseated every waking moment — it’s better just not to eat the carbohydrates in the first place.

    Mark. wrote on October 25th, 2012
  36. Sigh. I know a T1D who is such a committed vegan that she’ll never consider making a primal change, even though she very often has low BS fainting episodes (one recently while driving – wrecked a car but no one hurt thankfully). Her love for animals is commendable in many ways, but it is also keeping her from being as healthy as a T1D can be.

    I was diagnosed 3 years ago with severely low Vitamin D levels, so I started taking D3 that was sourced from lanolin (the oil in sheep’s wool); she said she’d rather die than do what I was doing. Thing is, my levels were so low that dying was a possibility!

    Thanks to going primal less than 2 months ago, the migraines I’ve had for decades are gone and a recent screening blood test (finger-stick, so not as accurate as a blood draw) showed a huge improvement in triglycerides and HDL. I’m excited to see what they’ll be when I do my annual ‘real’ blood test in a few months. Feeling so much better makes ignoring the commonly available crap food easy to ignore!

    KitC wrote on October 25th, 2012
    • I also love animals. Especially the tender, juicy ones.

      Animanarchy wrote on October 26th, 2012
  37. Just want to say thanks so much for this article mark. I have been reading your blog for a couple of months now and have been experimenting with lower carb eating since the beginning of the year. My t1 is under a lot better control than it was and i really agree with everything you have said. I hope it will help other type1’s too!! =)

    Sarah wrote on October 25th, 2012
  38. Just been reading the Whole30 book and realise there are other foods that cause or create a poor hormonal response, Milk is one, ( other than the ones mentioned hear grains etc ) it could also be useful to remove milk from the diet and only use heavy cream or reduce insulin..and insulin like growth factors..

    BPT wrote on October 25th, 2012

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