Type 1 Diabetes and Low carb

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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.

BACKGROUND
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.
FINDINGS
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%.
CONCLUSION
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…..

23 comments

  1. Grant, glad you raised this issue. Dr Bernstein is the authority on low-carb DM1, he himself is type 1 and has lived LCHF for 30-40 years.
    http://en.wikipedia.org/wiki/Richard_K._Bernstein

    “As of 2006, Bernstein had an HDL cholesterol of 118, LDL of 53, Triglycerides of 45, and average blood sugar of 83mg/dl.[3] By 2008, at 74 years of age, Bernstein had surpassed the life expectancy of type 1 diabetics. He attributed his longevity to the low-carbohydrate dietary approach and lifestyle changes he had developed for diabetics.”

  2. Hello Grant, or greetings from Sweden. Having a Kiwi mom (living in Sweden) I took a trip to NZ some 19 years ago to visit some relatives. I noticed something even then: everyone in my family was on a Wheatabix (I believe the “thing” is called that) diet. Of course they also had their bacon lettuce tomato sandwiches on white bread (not whole grain). It struck me how most in my family was severly fat despite the low fat eating regime. My grandpa died of colon cancer and was chewing on those freekin’ Wheatabix as soon as he woke up. Dr’s orders of course. One wonders if the high processed carb diet is to blame…

    Anyway. I have been thinking about NZ and the food habits and am glad to see that you are picking up the fight against the conventional, unproven dietary guidelines. After all, you have so many open grass fields to raise good cattle and sheep on. So good meet should be around in abundance.

    With regards.
    Glen

  3. I’ve been type 1 since 1970 and my initial diabetic diet was relatively low-carb — at least compared with what in the Eighties was conventional wisdom. I spent decades eating cereal with skimmed milk and pasta with marinara sauce and being told by board-certified endocrinologists that I just needed more exercise and more insulin to get my hemoglobin A1c under 10.5 or so. The culmination was Symlin, an expensive synthetic relative of amylin that left me nauseated every waking moment but helped a little, partly by slowing digestion and partly by making me too nauseated to eat much. About five years ago I went low-carb and when I belatedly saw my endocrinologist he was pleased that my A1c was around 8 but insisted that the human brain cannot function on under 100g of dietary carbs a day. Now my A1c runs around 6.5 and I’m still overweight but my complications are getting no worse. My hatred for the American Diabetes Association is boundless.

  4. Speaking from the coal face of General Practice, using a lower carb “real food” approach is incredibly successful in controlling type I DM. Done right, most end up on a smallish dose of long-acting insulin at night, with very little or no need for any short-acting boluses during the day. Great Hba1c, low triglycerides, high HDL. The only problem is the patient having to nod along to their endocrinologist and specialist nurse, and casually omit informing them of what they’re really doing. Sad state of affairs.

    1. Sad I agree, we have to change this!

      1. Indeed. My boy’s a type 1.. When he was diagnosed, we felt so thankful that we happened to live near one of the top child diabetes centers in the world (Denver, CO). The advice there sounds exactly like the advise/philosophy of Dr. Kemp above.. “no need to change your life!!! Just count the carbs and inject the necessary amount of insulin and you’re good to go on with your life!!!”

        4 years of trying that… I mean obsessing, measuring, counting, doing math, tweaking, adjusting…. Bullshit! It’s Impossible to normalize blood sugars that way. They may as well be saying, “Meh, enjoy yourself and just accept that fact that you’re gonna lose a foot or two, go blind and be on dialysis later on in life. Luckily a massive stroke will probably take you out of you misery before things get TOO bad!”

        That wasn’t acceptable to me.

        Took my boy for his 3 month checkup today after having read Dr. Berstein’s book and adopted his low carb program. His a1c was down 1.1 to 7.6, so we still have a way to go, but what an improvement. His Dr. was pleased with the awesome improvement in control but turned around and told us that we need to get his carb/meal up to 40-50g.. That we were dangerously low..

        No support at all out there for a well formulated LCHFMP type 1 lifestyle to normalize blood sugar.

        Sad. I had to sit there and nod..

      2. The thing is that a good LCHF diet can likely help a Type 1 have a healthy normal lofespan. Instead we treat them as if that is not possible. Hang in there, keep the goo fight up!

    2. I hope that I’ll end up there. One small shot of long-acting insulin analogue (Lantus) at bedtime, bolus shots before meals that are still a bit large. I wonder whether more Lantus would keep the bolus shots smaller. Also I worry that with too much Lantus my fat cells won’t lose fat readily. Still, doing pretty well already. Occasionally tempted to pig out on carbs.

  5. MargaretRC · · Reply

    My son is type 1 and his doctor totally endorses his LCHF lifestyle, as do I (wholeheartedly!) Wish there were more doctors out there like him.

  6. Surely we can do something to help that type 1 diabetic girl… can I sponsor her insulin somehow? I’ve been a Type 1 diabetic since I was 10, and NO ONE should have to live without insulin… and I can’t just hear that story and not try to do something :/

  7. I am really struggling to find a nutritionist/dietician who can support me with going LCHF Im type 1.5 diabetic (look it up) extremely overweight and on an insulin pump. Joined gym in Dec. if i eat the way they suggest at my gym small and often frequently ‘good’ carbs i struggle.. Cant do small and often with insulin .. Always end up hypo … Any my point of emailing you is how do I get seen by you or one of your staff that could help me sort this all out? Thanks

    1. Yes I agree good ones are hard to find. Our two staff are Dr CAryn Zinn and Dr Mikki Williden both awesome and very LCHF friendly. Google them and drop either a line

  8. My husband has been type 1 diabetic since he was 19, he is now 41 and has always been told to use carbs to stabilise his blood sugar levels. I have recently started to change the way I eat and have been trying to eat LCHF. Since starting to look into diet more I am convinced that LCHF will definitely help him stabilise his levels which have been up and down lately. Googling ‘type 1 diabetes and LCHF’ brought me to this page. I am excited to know that it does work and more excited that my husband is willing to give it a go. Thanks for the great article!

    1. Love it. I also recommend Dr Bernnstien’s type 1 diabetes book – available of amazon

      1. Hi, I’ve had type 1 for over 20 years & been following LCHF for just over 1 week. My diabetes is great, but I’ve had mild -moderate ketones (approx 1.5-2.5). My sugars aren’t high, but just worried this may damage my kidneys etc?

      2. No real evidence for that – sugar will certainly damage your kidneys – fat doesn’t – excess protein might but I want you to eat just moderate protein.

  9. I know this is an old post, but I hope you see this Grant. Try contacting a group called “INSULIN FOR LIFE” they take donations of insulin and distribute it globally to people who otherwise would not have access – such as this poor girl you mentioned.

    1. Yes thanks I have since meet Ron Rab who is doing this great work

  10. Laura Atkinson · · Reply

    Hello, I have been type 1 diabetic for 41 years, since the age of seven. I was never able to even nearly get my diabetes under reasonable control, no matter whether I tried hard to be “good” or not. I started lchf about three months ago, and my latest HbA1c was 6.1%. By the grace of God I am still well after 41 years of diabetes, but also by lchf will I continue to be healthy. I feel like a death sentence has been lifted from me.

  11. I have been a Type 1 diabetic since November 2014 and was encouraged to go low carb. To make up for the low carb, I went high fat — like 110 grams a day of foods like coconut oil, grass fed butter, almonds, avocados, etc — in a 2,000 calorie a day diet. Upon doing this, my insulin needs (both Humalog and Lantus) started to rise. Do you think this is possibly the result of glycoglucogenesis occurring in my liver — where fat is is converted to glucose — as well as the fat making my cells temporarily more insulin resistent? If so, this suggests that LCHF should really be low carb “moderate” fat, at least for me.

    1. Possibly – I’d also check your salt intake and make sure thats high enough?

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