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!