Type 1 Diabetes and Low carb
I met a guy called Ralph Norris a few months ago. He is one of New Zealand’s more successful businessmen and corporate CEOs. He’s had roles as CEO of Air New Zealand, ASBank, and Commonwealth Bank Australia (CBA). He’s on the board of New Zealand’s biggest company Fonterra, and the Treasury board, and is fit and healthy looking. He’s a peak performer in every aspect of his life; even in his mid-sixties he still looks good and is sharper than anyone I know.
Oh yeah, it’s Sir Ralph Norris too!
I was showing him around our labs at AUT’s Millennium Institute where my research centre is. I was explaining the work we do with both athletes and the general public to try to understand and encourage them to burn fat as a primary fuel source and how we often achieved that through low carbohydrate high fat (LCHF) diets. We talked about resetting the metabolism, lowering insulin, and dealing with Type 2 diabetes.
He immediately became engaged and explained how he had been working on his own diabetes (Type 1) for 20 years with a LCHF diet. He described his glucose control as “the best his specialist had ever seen”.
This leads me to a question I am often asked about – are Type 1 diabetics safe to use a LCHF diet?
I think the first thing to remember is that Type 1 diabetics have no insulin. As such, they cannot move glucose into the cells. Before synthetic insulin was invented, the disease was untreatable and sufferers would literally starve to death because fuel couldn’t move into the cells. Either that or ketoacidosis would get them. This is a dangerous condition where the body produces so many ketone bodies that you end up with life endangering acid blood. Either way it was bad news.
Enter insulin. Now diabetics had the missing substance and could live a healthy life – almost.
The same thing applies to every human – high blood sugar and subsequent high insulin to deal with that sugar will directly and indirectly damage tissues and organs all around the body. These effects, through vascular and tissue damage are well documented in the scientific literature.
So how about we help the Type 1 diabetic by reducing and restricting the amount of carbohydrate they eat?
Sounds good to me, but when I asked others in the field about this they looked at me sternly and told me that I was simply out of line and WRONG. Restricting carbs for Type 1 diabetics is dangerous they say.
How I ask?
Ketoacidosis and other complications they reply.
Really – damn – well I think THEY are just plain wrong and the research both mechanistic and experimental would support this.
Here’s a 2012 study by Nielsen et al in Diabetology and Metabolic Syndrome showing safety and great outcomes.
Reduction of dietary carbohydrates and corresponding insulin doses stabilizes and lowers mean blood glucose in individuals with type 1 diabetes within days. The long-term adherence for persons who have learned this technique is unknown. To assess adherence over 4 years in such a group the present audit was done retrospectively by record analysis for individuals who have attended an educational course. Adherence was assessed from HbA1c changes and individuals’ own reports.
Altogether 48 persons with diabetes duration of 24 ± 12 years and HbA1c > = 6.1% (Mono-S; DCCT = 7.1%) attended the course. Mean HbA1c for all attendees was at start, at 3 months and 4 years 7.6% ± 1.0%, 6.3 ± 0.7%, 6.9 ± 1.0% respectively. The number of non-adherent persons was 25 (52%). HbA1c in this group was at start, at 3 months and 4 years: 7.5 ±1.1%, 6.5 ± 0.8%, 7.4 ± 0.9%. In the group of 23 (48%) adherent persons mean HbA1c was at start, at 3 months and 4 years 7.7 ± 1.0%, 6.4 ± 0.9%, 6.4 ± 0.8%.
Attending an educational course on dietary carbohydrate reduction and corresponding insulin reduction in type 1 diabetes gave lasting improvement. About half of the individuals adhered to the program after 4 years. The method may be useful in informed and motivated persons with type 1 diabetes. The number needed to treat to have lasting effect in 1 was 2.
Even more interesting is a recent interview conducted by Dr Norman Swan on the ABC’s Radio National programme ‘Health Report’. Dr Swan is an excellent health journalist and just picked up on the whole low carb thing. I highly recommend listening to this if you are a Type 1 diabetic, or you know one.
Check the response by endocrinologist Dr Kemp on ABC Radio National to the diabetes story. Dr Kemp, who is a senior endocrinologist and past president of Diabetes Australia, is out to lunch and completely misses the point. Here is a great example when he says why he wouldn’t point patients with diabetes to a low carb diet….“So what we attempt to do is actually allow people to continue to live their life the way they wish, eat the way they wish.”
The listeners however – and those who have made comments on the Radio National www site – get it. These are lay public afflicted by diabetes. Will the medical profession be the last to understand the problem they are charged with treating? Here’s an example comment
So this expert agrees that low carb diets control blood sugar and reduce the need for insulin (which is incredibly good for everyones health) but he wouldnt recommend that diabetics eat a low carb diet because it would be too difficult for them to stick to…I think that is a condescending and ridiculous thing to say. Is it easier for those people to have their feet amputated, get vascular disease, go blind and need dialysis? I know what it does represent – diabetics who continue to eat a high carb diet will need prescription medication and a raft of medical interventions for the rest of their lives – very prosperous for some. There is no money in dietary interventions – especially nutrient dense fresh wholefoods. I feel very sad for all the people out there who rely on this experts advice for their health and their lives.
Footnote: Another Vanuatu story. I have written previously about some of my experiences doing diabetes prevention work in Vanuatu and other places around the Pacific. I now recall a very sad story of a beautiful 19 year old girl in Southern Vanuatu. I was testing fasting blood glucose and hers came out at 26 mmol/l (normal = less than 5). Straight way I knew she had Type 1 diabetes recently developed. I sent her away and tested her again the next day, same thing, and again the next day, same again. What breaks my heart here is that there is simply no insulin on those islands and virtually no chance of getting any. So she was just going to be left to slowly die with Type 1 diabetes, something we treat everyday in New Zealand. It’s hard to go away from there and feel good about anything…..