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. Hey guys I’m a newly diagnosed type 1 diabetic, 24 years old. I’ve just started the ketogenic diet against docs orders.

    Basically I’m sick of going low all the time so I decided to cut out carbs and see how my lows would go if I started fueling my body with ketones.

    So far? I haven’t had a single low or needed to eat any sugar to boost my levels. When I drop to 4ish my sugars correct themselves. Not a single high. The highest I’ve had is under 7 I think?

    I have one question though as I can’t find my answer on the Internet or through my educators as they do not know of or promote anything to do with low carb because it’s not in the Australian management guidelines.

    QUESTION; how high can your blood ketones be before it’s dangerous? I’ve been told by doc that over 0.6 is bad! I have however read that anywhere from 0.3 – 3.0 is ok for dietary ketosis ? I am at 1.3 and am now panicking as they told me it was really bad?

    I did my research and I was convinced that I was in the right so can anyone tell me who’s correct ? Or is I’m going to Die? Lol

    Aaron

    Aaron wrote on January 2nd, 2014
    • Hi Aaron
      Which aussie city do you live in?
      I would watch the following youtube link from Troy Stapleton, a Dr who is also managing his type 1 Diabetes with ketosis, and of course you could contact him for advice as he has done plenty of research. the link is below

      http://www.youtube.com/watch?v=TR8rc_AF6XU&list=PLrVWtWmYRR2Aev7gkUTEHXuRa4HDjMp2u

      best wishes for your self management against pressure of CW, you will do much better travelling the road you have taken!

      Corey wrote on January 2nd, 2014
  2. Paleo is definitely beneficial for type 1’s. My child is living proof of this. I would encourage all diabetics to embark on this lifestyle.

    Amelia wrote on February 22nd, 2014
  3. I haven’t gotten through all the comments, but I will. I started my husband on paleo-“ish” diet back in Dec, he is TD1, has diabetic retinopathy and also his urine tests keep showing too high levels of protein. He became diabetic when he was 13yr olds, he is now 36yrs, and used to be on shot insulin and when we first were married they even had him on the wrong type of insulin which was causing too many highs and lows. We couldn’t control it! He had an a1c of no lower than 10-11 for many years. Finally after begging and hunting for doctors we were able to get him on the pump which was so good for him! He is pretty heavy and needs to loose weight, which is one reason I put him paleo-ish, as nothing else has worked. He has been able to virtually get rid of his inhaler for asthma…although we will see what happens come allergy season. I know he has to exercise more, but time is such an issue. We have been able to get his a1c down to 7-8, still needs to get lower.
    I am still learning all about this new way of thinking, the way the Drs don’t tell you about. I have a question on the exercise comment and bring up the sugars. When he exercises his blood sugar falls and he ends up with a low and needs to eat to bring it back up. What are we doing wrong. The way his endo explained it that when he goes low his liver will eventually output stored sugar, but that eventually the liver will run out and one day he may not recoup from a low.

    Any thoughts.

    Shari wrote on February 25th, 2014
  4. I have been type 1 since 1985. In the 8-weeks I’ve been eating <30 carbs/day my A1C has dropped from 8.6% in March 2014 to 6.5% in July 2014. The Dr. thinks 5.7% at next visit. It is such a relief to finally have results after trying without success for 29 years to manage this disease by doctors orders – I was the perfect patient but still never had success.

    I've started to document my food intake (all macros), insulin and bloodsugar cgm at http://facebook.com/Type1Drop and http://twitter.com/MarshallEmsley if you'd like to see the data and results. I also feel very grateful to Dr Bernstein for his book the Diabetes Solution. Thanks for a great blog Mark Sisson!

    Marshall wrote on July 30th, 2014
  5. Great info, Mark, and thank you for taking time to address type-1 diabetes! I have had type-1 for 8 years now and it’s wonderful when I find new information to manage it.

    One thing to note: 10 second sprints were not used to combat a hypoglycemic incident in progress. They were used to combat the likelihood of post-exercise low from glucose uptake. During the study you mentioned, the sprints were initiated when BG was around 200 mg/dl (11 mmo/l) So, I personally wouldn’t go doing sprints if I found my BG at 60 😉

    One question for you: Is there a bike-only form of sprinting? Would it be as effective to go all-out max on a bike for a sprint duration as compared to running? My feet are not fond of running and I try to avoid putting too much stress on them.

    Thanks again for the great work.
    Jason

    Jason LeCount wrote on September 14th, 2014
  6. An outstanding share! I have just forwarded this onto a co-worker who has been conducting a little homework on this.
    And he in fact bought me lunch due to the fact that I found
    it for him… lol. So allow me to reword this….
    Thank YOU for the meal!! But yeah, thanks for spending the time
    to talk about this subject here on your website.

    Transoean wrote on October 15th, 2014
  7. If you are a type 1 diabetic and you eat ZERO carbohydrates, will you still need to use insulin?

    Peter wrote on January 28th, 2015
    • Yes, you will still need insulin. Your liver can turn some of the protein into glucose – gluconeogenesis. There are some cells that require glucose such as red blood cells. I highly recommend Dr. Richard K Bernstein’s book Diabetes Solution. He recommends only 30 G carbs/day from low carb veggies.

      Anne wrote on January 29th, 2015
  8. I have a good friend with type 1 diabetes. All day long, he chases insulin with fruit juice and honey, and then again more insulin, in the attempt to keep his blood sugar stable. Needless to say, it’s not working well at all, but he’s surrendered to the idea that lots of highs and lows are just a part of life for a type 1 diabetic. He has a great attitude and eats mostly paleo friendly food, just way too many carbohydrates. He’s starting to have metabolic issues, visceral fat, has been put on statins, etc. For such a strong, handsome man just hitting 50 this year, it’s painful to watch. He should have so many years of good health ahead of him.

    I’ve been talking to him a lot lately about reducing his carbohydrates. Recently he cut his carbs down and had hypo episodes 3 days in a row, because apparently he hadn’t cut back enough on the insulin. I felt terrible that this was a result of listening to my advice! I realize that going low carb has to be part of an overall strategy involving reduction of insulin, but the question is, how does one make the transition safely? Do you keep basal insulin the same and reduce mealtime insulin? Or do you reduce basal as well? Anyone have experience here?

    Another semi-related question: Is it possible for type 1s to do intermittent fasting? Nothing crazy, but maybe not eating until 1pm. If any type 1s have experience with this, I’m curious how it works with the timing of basal insulin administration.

    Would love to get some advice here!

    Robin H wrote on May 7th, 2015
  9. I stumbled across this site after searching “paleo type 1 diabetes”.
    A friend of a friend on Facebook was ranting because an article she had read mentioned that Type1 diabetes could be controlled and or prevented using holistic means. She obviously disagreed with this and was probably emotional because she didn’t want to even consider the possibility.

    I don’t have diabetes but reading the article on this site and some of your comments reminds me of my own experiences with allergies. I had allergies for 30 years. I cannot tell you how many thousands (probably in the hundreds of thousands) of dollars were spent trying to control my allergies. Drugs, immunization shots, ER visits, etc. Never would I have believed that there was a “cure” for my allergies. I was always told that allergies were not cured, they were just managed. I was/am allergic to pretty much everything: pollen, dander, dust, mold, etc, etc…

    We went strict paleo a few years back. 3 months after that was spring time. I was fully expecting my allergies to hit off. They didn’t. It took me another few allergy-free months to even begin to think that my new diet might possibly have anything to do with my lack of allergies. That holiday season, I cheated on my diet and my allergies came back. WITH A VENGEANCE. Another month of being “clean” and they were gone. I have had several other instances where my allergies have been brought back (noone to blame but myself lol) and again, “cured”. I know now exactly how to trigger them and how to get rid of them. For me: Grains are out. Dairy sparingly.

    I tell anybody who will listen about my experience and am surprised at how many folks say “I’m not giving up bread”. My response is always “ok, but YOU are CHOOSING to be miserable.”

    Anyway, glad to hear that folks with Type1 Diabetes are learning that they can control if not “cure” their diabetes. Really stoked that there are folks out there with level heads figuring this stuff out.

    chris wrote on February 3rd, 2016

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