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!

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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157 thoughts on “What About Type 1 Diabetes?”

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

  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!

    1. 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.

  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 TheEatingAcademy.com 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)

    1. 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!

      1. My daughter was diagnosed with T1D 4 years and 8 months ago. In case it matters, she was double-diagnosed with Celiac disease the same month. She was 13 years of age. You could have bounced a quarter on her abdomen prior to the dx of T1D. She never used a pump (an issue of financial inability for us us). Due to low body fat, she had few choices as to where to inject even the tiniest needle. The abdomen became the preferred region. No more than a year and 1/2 later, she had a very saggy abdomen. Nothing changes that. Her abs @ 17 years of age look like mine after birthing six kids! Being the skeptic that I am and the body makeup that my daughter is, I’m not convinced that this is belly fat. It is the result of pinching her abdomen several times a day for many months on end. Just as stretching the flesh for birth weakened it, I surmise that pinching is liken to stretching. I’m not surprised that using a pump resulted in firmer flesh around your gut.

      2. oh man my spare tire is bad, ive been type 1 for about a year and a half and it is definitely a thing. espeically since my body is insulin resistant as well… it sucks and i cant get rid of it!

  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.

    1. 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.

  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.

  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!

    1. 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.

  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!

  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.

    1. 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.

      1. 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.

    2. 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.

  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).


    1. 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.

  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?

    1. Of course you should do that and also recommend Dr Bernstein book Diabetes Solution

    2. I think you should! I think he would be very happy to see it, I would be.

    3. 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…

  11. “(with a doctor’s approval and assistance, of course)”
    Nice one. ; )

    1. 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.

      1. 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)

      2. 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!!! 🙂

      3. 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.

    2. 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.

  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.

    1. 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.

    2. 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)

      1. 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?

        1. 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.

    3. 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.

    4. 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.

    5. 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 🙂

    6. 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.

  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.

    1. 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.

    2. 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.

  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….

    1. Brains!!!! No, seriously, organ meats are a good source of omega-3.

    2. 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.

      1. 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.

    3. 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.

  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.

    1. Fantastic! Inspiring! Keep ignoring the eat-cake people. I don’t know what makes them do that…

      1. Genes. Diabetics crave more carbs, and with them so readily available….. the outcome isn’t so sweet. (Pun intended)

  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.

      1. 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…

        1. 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.

  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.

    1. 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.

  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!

    1. Iz u CrAzY? There’s 160 articles on Dr. Bernstein’s site alone, just go to diabetes-book.com and click on the articles button.

  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.

  20. 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.

    1. @ 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

      1. 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.

  21. ‘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.

  22. 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.

    1. 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.

  23. 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!

  24. 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! 🙂

    1. 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 🙂

    2. 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.

      1. 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.

  25. 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.

  26. 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!

  27. 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.

  28. 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.

  29. 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.

    1. 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

      1. 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.

    2. 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

      1. “long and 75% made me go long”
        * make me “go low” not “go long”

  30. 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!!

    1. I am a t1d. can you please give me ideas of what you eat on a daily basis? would love to make the switch

    2. 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.

  31. 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!

  32. 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.

  33. 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!

  34. 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!! =)

  35. 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 ghee..to reduce insulin..and insulin like growth factors..

  36. I am T1D and went primal on May 1st with my wife. I grew up in a spanish family with all meal consisting of wither rice or pasta. I thought I would never be able to give them up but I was wrong. A friend turned me on to the site and when reading about some of the lifestyle choices people make it was all the stuff I did.I was 282 lbs and eating between 325-400 grams of carbs a day, using 125-130 units of insulin a day and just out of shape and always tired. I’ve now lost 23 lbs, avarage about 150 grams of carbs a day and I’m only using 75-80 units of insulin on average per day now! I’m about to get my first A1C taken next week since starting and I’m sure it will be better than the last 9.6. All I can say is Primal works great and I’m still not where I want to be on weight or amount of carbs but i’m getting there. I still get tired in the afternoons but nothing like before and I’m testing different things to try and get that under control. My wife and I are going to PrimalCon in April and can’t wait to get even more insight’s on the best thing to happen to our healt n a long time. I need to also be more diligent about exercise which is something that is still missing. Overall it’s been great and there have been some big changes but still working on being more primal!

    1. With excercise James i personally do nothing but body weight work and some sprinting. I dont need (or want) to go to a gym, when its good weather (about 1 week of the year in UK) i work out outside. Im talking working at 1 arm push ups, 50 consectuive 1 leg/pistol squats, handstand push ups. I could barely do 5 stanrard push ups last August and prior to didnt excercise. O got into a routine and now i love to workout. I’d recommend ‘you are your own gym’ and ‘convict conditioning’. The excercise will make real diference to your a1c. My last a1c was 6.5, i’m aiming, and will acheive, 4.6 within a year. I keep recommending on here but Dr Bernsteins the diabetes soltuion is a must read for diabetics, combined with primal it’s made amassive difference to my blood sugar within the last 4 weeks. I wish it hadnt take me 23 years of diabetes before i read it.

  37. Fantastic, information, Can any one tell me how precise the blood test is that determines, the Beta Islet destruction?? etc

  38. Thanks for sharing this great article! That is very interesting I love reading and I am always searching for informative information like this.

  39. I also would like to chime in as a T1D and say switching to primal/paleo/eating REAL food has changed the way I manage my diabetes for the better and after 16 years with this disease feel better and look better than I ever have!

    1. Oh yeah and – my doctor and dietician think I’m crazy eating this way, but I’ve decided it’s because they have been taught according to the SAD protocol and cannot legally recommend any other way!

      1. Yep i think from a legal perspective even if they are open minded they get stuck. Epecially in the US where health is insurance based.
        In the UK i get 20 mins with my Dr (although rarely the same one) every 6 months, ”you’re not dead, thats good, see you in 6 months.”

      2. Yeah, I’m a dietetics student and I’m interested in studying diets like paleo for diabetes management, and how that might work, but it’s not really ever brought up in class. If I hypothetically recommended paleo IRL and the person wasn’t super compliant and got sick I would be in SO MUCH trouble! I’m looking forward to more research on this topic as time goes on.

  40. It’s nice that a post dedicated to type 1 has been written as those type 2 hog the diabetes lime light! 😉 . I’ve been type 1 for 23 years (35yo) and started the primal journey about august 2011 and I can say that type 1 is pain in arse, literal and figurative.

    Last month i read Dr Bernsteins book and realised i was (still) consuming too many carbs and the reality is i shouldn’t be eating sweet potatoes, potatoes, canned tomatoes and several other foods that primal peeps take for granted. Within a week i saw my bloodsugars start to normalise, and I mean normal, like non diabetic range. They improved greatly on primal but this berstein/sisson hybrid has taken them to a new level. Bernstein advocates the use of sweeteners and whole load of processed foods but i’m doing the diabetes solution with a primal lead, so no processed, just meat veg fat, the good shizzle. It helps that I’m a rather good cook, blow my own trumpet. But if wasn’t for Mark and this website my diabetes wouldn’t have improved so much and my knowledge wouldn’t have improved and I wouldn’t have got to know about Bernstein through my process of going from link to link, researching, not understanding, understanding, experimenting. BTW my GF had no choice but to follow primal, she loves it now, she lost 30 lbs in the last year, looks amazing. Now she near enough preaches it to anyone who’ll listen.
    One thing i’d disagree with in the article (i’m nit picking here) is ”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)”. I still have the same amount of injections (needles) each day, i just don’t inject as much insulin with each injection.
    One thing that i’ve noticed over recent years that’s converse to the widely reported kids getting type 2 is adults getting type 1 (aka juvenile diabetes) without them first having type 2. For me that definitely points to environmental factors. But there’s still a big role gene’s play when it comes to autoimmune. My mums side of the family have 3 celiacs, 1 of who is also type1 (that sucks), there’s 3 or 4 type 1’s, there’s a lupus, then my mum and some of her sisters have rheumatoid arthritis. Our immune systems are cold blooded killers. I also recently introduced my sister to primal and shortly after (couple of months ago) Mark did an article on gluten intolerance, almost like celiac but much less severe and she realised she had that. Obviously primal sorted that out within a couple of weeks. Voila!

    For any type 1 diabetic out there i would endorse the primal approach coupled with the bernstein approach (I personally find all out sprinting has no effect on raising my blood sugar). I would agree with Bernstein in that diabetes (1 and 2) is probably the largest cause of death in the USA, it’s just not reported as diabetes on the death certificate because it the symptom that kills you. Got diabetes then had a heart attack? Guess whats on the death certificate? Heart attack. Guess what caused the cause of the heart attack, diabetes. Cancer? Yep. Caused by the diabetes. The list goes on. The advice handed out by the ADA and BritishDA (I’m from the UK) is criminal, it’s killing millions. Eat a shit load of carbs, pasta, bread, cereal. In fact why don’t you base 60% of your calorie intake on this crap and then inject insulin. Ah, the food pyramid, you’ll be mummified and entombed if you go anywhere near that particular pyramid ( Mark, that should be quote of week!). Injected insulin doesn’t work anything like your non-diabetic insulin. Your insulin is chauffeured Bentley, give it instruction it’ll carry it out as instructed, even when you abuse it. injected insulin is the old ass bus that has no heating, should have turned up 60 minutes ago when it’s zero degrees outside and you need to pee for the 3rd time in the last hour. It sucks at it’s job. Call me a conspiracy theorist but big pharma is quite happy for more insulin to be injected to cover huge carb intake thats promoted by the ADA, BDA etc. Unfortunately these ‘ charities’ are in bed (to what degree you can argue) with the big pharma. Think there will ever be a cure for diabetes, no chance. Cures don’t make profit. Blood testing strips, insulin, insurance does.

    Anyhoo I’m writing this whilst at work and my big ass sald is staring at me and I’m hungry so rant over.

    1. Just to add to the above, as if it wasnt long enough, is that i also do Intermittent Fasting. I eat my first meal between midday and 1pm and my 3rd and last meal between 8pm and 9pm. Every day. If you’ve read IF aint for diabetics, tell them i sent ya, and they’re wrong.
      This approach isnt advocated by Bernstein but it works for me at least.

      1. I’m on day 5 of IF now and going well, sometimes just struggling to get it all in! 🙂 What method are you following?

        1. Hi. Cool, stick with it. It’s a great tool.
          I’m going with the Martin Berkhan Lean gains style, just 16 off 8 hours on. I’ll occasionally do a 4 or 5 hour eating window, first meal about 4-5pm, but I’ve never done a 24 hour one although I’d give it a go. IF gets easier with time. My girlfriend thought she’d never be able to go without eating breakfast (pre primal days she was pathetic if she didn’t eat every 3 hours!!) but now finds IF easy and regularly doesn’t eat til 2pm, plus she eats less and says she feels less hungry since she started it. She had weight loss plateau and this really kick started the weight loss again. I think once a non diabetic can happily do IF without complaining of low blood sugar (they should try diabetic hypoglycaemia!!) they are fat adapted.
          Personally I like it for several reasons. Helps burn fat, gives my digestive system a rest and it also means that for 14 hours out of 24 my blood sugar can stay pretty much untouched as long as I get my long acting insulin dose on the money.

    2. That pyramid quote is a good quip.
      I think it might be a good idea to have quotes of the week. Maybe 3 or so.
      It’s a good medium for entertainment and sharing ideas and encourages more care to be put into comment writing so why not expand it?

    3. Hey Greg. I’m also type 1 in UK. Novice with Primal. Struggling abit. Bernstein on my book shelf but not got round to reading it yet. Shame there is not more interest in UK with primal. Wrote to Diabetes Uk and Balance mag suggesting they do a feature on it but they wouldnt contemplate it

  41. Thanks so much for addressing T1. While I’m somewhere in between T1 and T2 (gestational diabetes that didn’t go away after giving birth at age 27 and needed insulin immediately), I’ve always considered myself more T1. Most people don’t understand it at all because it’s T1. My husband is mostly Paleo and I’m certain our whole family will be shortly after reading this. Thanks Mark!

  42. I’m a 60 year old who was diagnosed type 1 20 years ago. A year ago, I had my sleep apnea diagnosed, went on a CPAP machine, learned how to count carbs and tailor my insulin dose to my intake and bg level. I cut out all wheat and grains. I learned about primal diet here, and with the help of the New Atkins Diet book, have greatly improved.

    My daily insulin dose has gone from 140 units to 0, I use Metformin now. My endo has said each blood test has indicated that I making more insulin. I”ve lost over 60lbs and feel in control of my health for the first time in many years. My allergies have disappeared, no more chronic sinus infections, athma is totally gone.

    I’d say this is a very beneficial program for Type 1’s.

    1. Thats totally amazing! Thats a success story right there.
      I would highly, highly recommend you read the diabetes solution by Dr Bernstein, lots of good info in there.

      1. Thanks Greg, I have read the Bernstein book and found it immensely useful. I only wish I had found it sooner.

    2. I have to say, you story sounds like T2 not T1. A daily intake of 140 units is huge for typical T1. Being able to reduce to zero injected insulin and get by on metformin only is another indicator that your are T2. A T1’s body produces no insulin.

  43. I have had t1D for 44 years- was diagnosed just before my 7th bday. I was stubborn for a very long time and stupid in college to the point of ketoacidosis and near death and a coma for 3 days- I straightened up for awhile after that, got married and pregnant snd behaved pretty well through pregnancy and had a healthy baby. 🙂 started working out (crossfit) and went paleo 2 years ago and I have NEVER felt better! My A1C’s were always in the 11-13 range and after going paleo for 3 months , my A1C was 8.5- my doctor did cartwheels. I rarely ask permission to do something so she didn’t have a chance to approve or disapprove but she loved the results! I also lost 30 pounds over the first year and a half. I have no food allergies or intestinal probe so that is not a factor I just know that I feel great- so I am sticking with this. 🙂

  44. I am also an adult-onset Type I, with ZERO family history of the disease. My diabetes was discovered during my pregnancy with my son @ age 28. In hindsight, I can see symptoms originating all the way back to age 18. I have been 70/30 or 80/20 (more recently) Primal since May. My A1c is down from 6.9 at diagnosis to 5.4 at my last checkup in August. Based on my meter readings and overall health, I feel that it will be even lower at my next appointment. I have lowered my basal insulin from 18 units to 15 so far, but am still tweaking because I have been experiencing minor lows. My bolus ratio has been reduced from 1:15 to now 1:20, and also still tweaking. I have gone from a size 16 to a size 8, and I feel like a different person.

    My endo says this is just my “honeymoon phase” and not to get excited. I guess we will see. But in the meantime, I will keep going Primal, and am considering full on Paleo if I can sacrifice the cream in my coffee and occasional cheese/cream based dips for my veggies. I realize dairy has been implicated in T1D almost as much as gluten, so I know I need to add this into my experiment.

    As for other carbs in my diet, I am certain gluten is the main cause of my problems. When I venture into safe starches or even cheat with a little brown rice or white potato, my blood sugar recovers quickly with proper insulin dosage. Early on, when I would have a gluten cheat, my blood sugar stayed out of whack for days. I have never been tested for celiac, or even gluten sensitivity. As a Type 1, I just take it for granted that I have gluten issues and now avoid it like the plague. I would definitely advise other Type 1s to do the same.

  45. I’m type 1 (for 35 years, since age 3) and I do believe that eating fewer and healthier carbs helps with bloodsugar control. But please don’t offer people the hope that they can reverse type 1 diabetes. 24 hours without insulin and I’m in the ICU … probably dead within a week.

  46. This is all well and good. I have been diabetic for over 45 years. I have been told that I am diabetic because of a virus. I want to be healthy, I want to eat healthy, but almost every day I have cravings or just plain don’t want to eat what is good for me. Does this go away once you start on any of these alternate diets?

    1. I would definitely say those cravings start to go away after 2-3 weeks of Paleo/Primal, and it only gets easier from there. People ask me all the time if it’s hard, if I have cravings, or “how can you just sit there drinking water and eating nuts while we all eat cake?” And I honestly just tell them that I have no desire for it. And it’s TRUE. If you read “Wheat Belly”, he theorizes that gluten acts on opiate receptors in the brain. I have heard likewise that sugar acts like cocaine in the brain. Those two together pack a powerful punch. But like a drug addict who goes through the initial detox (not too fun, mind you), those cravings DO go away, get manageable, and you become healthier.

  47. I work in healthcare. I spoke to a dietician I used to work with about my patients out-of-control blood sugars and the amount of carbs (mostly refined garbage) on their meal trays. She informed me that they could actually receive MORE carbs than that, according to ADA guidelines; they could have up to 4 exchanges per meal (60 grams!) Add snacks to this, and most patients were consuming over 200 grams a day (and certainly not in the form of “safe starches.”) I know she is required to follow certain guidelines if she wants to hold onto her job, however, in the mean time, her patients with diabetes (both type 1 and 2) were regularly enjoying pre-prandial blood sugars in the 200-300s!

    Finally, she admitted that it came down to cost. And there, I think is the crux of the whole thing–carbs are cheap, and the ADA is not going to make recommendations that don’t jive with the typical hospitals food budget. I know this sounds cynical, but they certainly aren’t basing their recommendations on sound science.

    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. I wont even get into their view on the evils of fat.

  48. As a T1, I really appreciate this article. When I decided to try (still getting there) primal eating I had immediate success but didn’t really know how to manage my changed insulin requirements at first.

    So I started by halving all my insulin. This became my new measure. I eventually had to slowly increase my doses to find the right amount. It’s better to run slightly higher and increase insulin, than to have too much insulin, and stuff yourself on carbs because of a hypo.

    The hardest thing about the primal diet is getting access to clean meat and vegetables. Organic meat is great but costs a fortune. It’s incredibly frustrating, knowing you need to change for your health, but you cannot afford to eat like your grandparents did.

    So as much success as I’ve enjoyed on primal, I am often forced to eat more carbs than I want to (more fruit) simply because it’s what I can afford.

  49. Thank you so much, Mark for writing this article. Type 1’s always feel so left out, being lumped in with type 2’s, which is a completely different disease. I was diagnosed at age 16, which is 41 years ago! I followed Dr. Bernstein’s diet for 7 years 1996-2003, which saved my life. But went on Raw food vegen diet to try and cure type 1 . IT DIDN’T Work. I started paleo Jan 1 2010. Then after researching ketogenic diets, I went even lower carb. I eat about 20 gm carbs a day. My diet is now 80% fat, 15% protein and 5% carbs. I am doing very well on these percentages. I believe the only reason some people have trouble with very low carb is because they are afraid to eat enough fat. I really have to eat enough fat to keep me satisfied throughout the day. I actually eat very low amounts of protein, because protein will turn to glucose if you eat too much. 2-3 eggs abd bacon for breakfast, 4 oz grassfed meat and sauteed vegies at lunch and grassfed raw butter, colostrum and a few Brazil nuts for supper. This works very well for me, keeps me satsified, so I can stay on the diet. My last A1c was 5.1, I was very happy with that. It is so wonderful to communicate with so many T1D who are taking charge of their health and lives. I recommend staying far away from regular allopathic doctors, I check in with an alternative nurse practitioner if I need to. (for syringe prescriptions) I take regular insulin and NPH because I don’t need prescriptions for those! I still think there is a way to regenerate our beta cells and heal.

  50. Very nice post also getting good responses. My mother in low is also having diabetes and I will follow this for her.

    Thank you very much.

  51. I’m a Type 1 Diabetic and have been for 12 years. I have struggled with my BG readings and A1C readings for years. I just couldn’t understand other T1’s that had good control. (and I’m on a pump).

    I have always taken my Diabetes seriously but have never figured out why my BG spike even with say a very low gi cereal (last A1C was in the 9’s). I am now on my 5th day of Paleo and all I can say is WOW! So far my BG have normalized and I am within range for the first time in years. The biggest plus is that I am not worried about big swings to the low BG side so I have good control (will live longer) and have more confidence not having to worry so much about lows. Yes it’s early days but the principal will remain the same on my BG, I have no doubt.

    Thought I would share here.

    I can see how it will take time for the medical community to look at a simple change like this due to mostly out-dated info on Cholesterol / Fats etc but hey I’m treating myself and taking control.

    Can’t wait for my next A1C 🙂

  52. Tim, Funny you should post. Last night I watched a series of youtube vids with Richard Bernstein, the author and Type 1 diabetic, of The Diabetes Solution, mentioned here at MDA. Dr. Bernstein is awesome. Anyway my son has Type 1 and, at age 29, he has been struggling. I sent along Dr. Bernstein’s book and for the first time in fourteen years, he (my son) has gotten his head around what he needs to do, no thanks to his doctor who just keeps upping insulin levels. Continued to success to you and thanks to Mark and Richard for lighting the way.

    1. I also just found Dr Bernstein only last month, and as a result of his book and trying out Paleo am now managing my blood sugars well for the first time. Great book!

  53. Interesting Blog. I thought i would share my experience as a Type 1 Diabetic.

    Having been a Type 1 Diabetic for 6 years. I have dabbled in this before without much planning and after 4 weeks found I didn’t need half the size of my regular insulin. I lost about 7 pounds and felt great. The only problem was working away and lack of available ingredients forced me to go astray.

    That was a year ago and my weight came back and insulin getting out of control. I am now back on the paleo lifestyle (not diet as i don’t want to think of it as short-term) and I am better prepared this time with lots of paleo ingredients in the kitchen, loads more recipes available since last year.
    I am four weeks in and 10 pounds lighter, insulin jabs are down to virtually nothing, I am monitoring levels all the time and finding the opposite, the sugar levels too low without having insulin. The food cravings have disappeared, no stomach rumbles as I have paleo granola bars, at the ready.
    Hoping it continues, I think i may reintroduce some dairy once I get to my ideal weight as it seems i could be missing a few essential nutrients. the almond milk takes a little getting used to.

    Bottom line is thumbs up for Paleo from me.

    Hope this helps any other T1D thinking of trying the lifestyle.

  54. Searching for Paleo eating for my friend who was just diagnosed with gestational diabetes…I happen to have type 1, so I am looking to support her. Here’s another bravo for this article & fab conversation. I have lived 36 of my 40 years with iddm and can’t wait for my cells to heal themselves (one way or another!?) – but in the meantime, I am re-amping my vlc Paleo/primal lifestyle, as it’s served me well in the past. Also, I have a healthy 3 year old dd and would love another, even at my “advanced maternal age”!!

  55. I am a type 1 diabetic, and I know I am late to the party but wanted to say that having recently discovered paleo through a friend, and cut carbs out of my diet, I am now experiencing the first phase of my life when I feel like I actually have control over my blood sugar.

    The results for me have been incredible. Before cutting them out I diligently followed the advice I was given about matching insulin to carbs, but was always chasing my tail. Now my blood sugar has stabilised and HbA1C is right down. I couldn’t recommend it enough!

  56. Thanks for this article. I knew about the evils of gluten in other auto-immune disorders, but not with Type 1 Diabetes.
    I am a nurse, and thanks to my anatomy courses and even my nutrition courses, I have always known the food pyramid didn’t match up with reality.
    My daughter, my mother, and myself have been low-carb (around 100g a day) and gluten free for a year now, with only my father refusing to come along. I have had asthma since I was 8 and Hashimoto’s Thyroiditis since 13. My mother has Hashimoto’s and celiacs, and was diagnosed as T2D with Fatty Liver Disease last year. This was when she finally gave in to my years of begging her to change her diet. (Her brother has T1D, as does her father, who also has Hashimoto’s, so I knew she was a diabetes candidate) I can’t help but think that if we had known about Primal Lifestyle years ago, none of us would have the health problems we have now.
    I had not even heard of Paleo until a year or so ago, and didn’t start doing any research until recently, when a friend of mine went Paleo. I wish I had found this page sooner! I’m going to direct my uncle and grandparents toward the book, and try to sell my father, just this week diagnosed as T2D, on Primal. My current A1c is 4.0, and I’d like to keep it this way. The evidence speaks for itself. This is not just a fad diet, this is a lifestyle change based on sound medical/scientific evidence.
    I’d also like to add for the record that not all doctors are bad. Our dr encourages his diabetic patients to go low carb, and try to get off meds. He also encourages low carb and discourages lap band and gastric bypass to those who want to lose weight.

  57. Serena, better late than never. Also the body can have amazing recuperative powers. Continued success for your entire family.

  58. Hi, I just had a read over your article, and the attached study, just a note, in your article you speak of “equirements for insulin after meals dropped from 21.1 IUs to 12.7 IUs.” which is correct however insulin is administered prior to meals, based almost entirely on the amount of carbohydrate you are about to ingest – the only time you would really need to dose after a meal is if you miscalculated – which happens quite often as pre prepared meals often have hidden carbs – like corn syrup or thickeners.

    Other than that, this article is why I am giving the’ 21 day total body transformation’ a try.


  59. I have been Primal for three months and am also a T1 Diabetic. This diet has helped control the disease greatly, by making my BS easier to control. There have been two challenges though: One, I at times eat too low carb of a diet and feel Hypoglycemia slowly over coming me and on a primal diet it is hard to deal with that as there are few foods that hit the bloodstream quickly and don’t spike. Second: even when I keep the carbs very low, strangely after periods of intense exercise or work I have sudden sharp increases in my BS once spiking to 35 mm/ol (healthy is 4-8). In this instance I had not eaten any carbs for 24 hours and even then it was just a veggie stirfry. Why would I have such spikes? is the fat I’m losing releasing some dormant stored sugar?

  60. Hi, I’ve been a T1 for 19 yrs now (I was 11 when first diagnosed) and recently became aware of the Paleo diet. My a1cs are very high and I need to take control of my diabetes. The regular system and diet are not working. And for a little while there I kinda given up. I even had a pump for 4 years and did better but not as good as the result many have obtained with Paleo.

    As I read about the Paleo, I like the idea; however, I have one concern: how hard is it on kidney health? Thanks to the heavens, I have no complications yet; however, as I’ve been researching diet options like Atkins and Paleo have raised the concern of increased protein and kidney disease with long term applications. Has any of you that have been on Paleo for couple years or more had any renal changes/tests? What has been your experience? Please advise me, thanks.

  61. My son has type 1 diabetes, and I use the paleo diet for the whole family. I recommend this lifestyle and eating plan for diabetics. If he strictly adheres to low carb eating, his blood glucose levels remain in the non diabetic range. As soon as he eats any processed foods, rice, potatoes, ice cream, his blood shoots up high. I believe that wheat gluten is responsible for initiating the autoimmune response, and so wheat and all grains are forbidden in our house. In addition to the food choices, I encourage exercise and sun exposure.

    High carb and low fat is promoted as the correct way of eating for diabetics in my country. But, I did my own research and this website definitely saved my son’s life. His HbA1c blood tests are around 5.5, which apparently is rare amongst diabetics. And yes, Dr Bernstein is the guru of diabetes management and his books should be read by all diabetics. The dietary requirement for carbohydrate is zero, but nobody in diabetes healthcare seems to know this.

  62. I am mom of a T1D 3 year old who was dx when he was 2. He was also breastfed for 2 years and weaned right before he was dx. The important thing to note is that while a LC or VLC diet works wonders for adult T1Ds it is not healthy for growing children. Children are using carbs to grow and are much more active than adults. They need the carbs!

  63. 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


  64. 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.

  65. 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.

  66. 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 https://facebook.com/Type1Drop and https://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!

  67. 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.

  68. 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.

  69. If you are a type 1 diabetic and you eat ZERO carbohydrates, will you still need to use insulin?

    1. 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.

  70. 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!

  71. 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.

  72. Great article. Obviously 8 years since you wrote this we know so much more. I am a T1 since i was 28 and am now 42. Someone recommended Primal blueprint 4 years ago and it changed my life. I’ve been Primal ever since. I take half the insulin I used to take and work out half as much and look ripped and in great shape and feel so so much better. Thank you Mark