LCHF for Type 1 Diabetes

posted in: Food, Health and Nutrition, Insulin | 64

I spend a great deal of time in my clinic dealing with the problems of type 2 diabetes. But occasionally, people ask about type 1 diabetes (T1D) as well. The reason why it is so rare for me is that I treat adult patients where T2D outnumbers T1D by at least 9:1. I was looking at a fascinating study that my friend, Ivor Cummins (The Fat Emperor) had alerted me to a few months ago.RichardBernstein

Dr. Richard Bernstein is a fascinating character. He had developed T1D as a child of twelve and began to have complications by his 30s.  He eventually went to medical school in order to learn better how to treat his own disease. Eventually he decided that the proper treatment was a low carb diet. This was in direct contradiction to the prevailing wisdom of the time (1990s), which included treating patients with insulin and a diet high in carbs.

Dr. Bernstein opened up a controversial clinic to treat T1D with a low carb diet and also wrote several best selling books discussing the same topic. Over the years, it has proven to be a safe treatment for T1D. While there are few long-term studies, Dr. Bernstein himself is living proof of the low carb T1D paradigm.

In many ways, T1D and T2D are exact opposites of each other. T1D typically affects children who are usually quite skinny. T2D typically affects adults who are usually quite obese. This is not absolute, and we are seeing much more T2D in children as their weights have increased. There are also cases of normal or even underweight patients with T2D. But in general, that is the case. T1D is the severe deficiency of insulin where as T2D is the severe excess of insulin.

Nevertheless, people often treat both types of diabetes in the same manner. Both are treated with medications or insulin to keep blood glucose in acceptable levels.

Wait, you might think. You must be off your rocker. How can you treat two disease which are essentially opposites with the same treatment? Isn’t that like treating anemia (too little blood) the same way as treating polycythemia (too much blood)? Or like treating vitamin D deficiency the same as vitamin D toxicity? Well, yes. For many reasons, I believe that the current treatment of diabetes is entirely incorrect.

Since T2D is a disease of too much insulin, then it is easy to see why you would treat it with a low carbohydrate, high fat (LCHF) diet. Since refined carbs increase insulin the most, and natural fats the least, you should eat more fat and less carbs. That makes perfect sense. But why would you want to treat T1D the same way?

If T1D patients have too little insulin, then why would you need to limit carbohydrates? You could simply give more insulin to cover the glucose raising effect of the carbs. For decades, and even today, T1Ds were told to eat a high carb, low fat diet. Why?

The main reasoning was this. Most T1D patients eventually develop heart disease and die of complications related to heart disease. The conventional ‘healthy heart’ diet was a very low fat diet. If you ate lots of fat, it would clog up you arteries and cause heart attacks. Therefore, the ‘best’ diet would be very low in fat, which meant a high carbohydrate diet. This high carb diet would mean that more insulin would need to be injected to control blood sugars, but that wasn’t so bad. Was it?

There were two main problems with this reasoning, and it has literally killed thousands of people. First, diets high in cholesterol and saturated fat turned out to have minimal impact on serum cholesterol or heart disease. Zoë Harcombe, obesity researcher and best selling author recently published an article in the British Medical Journal pointing out that there was no evidence to support the low fat diet. The Academy of Nutrition and Dietetics recently reversed its position on saturated fats and recognizes that they do not contribute significantly to heart disease.

However, it is still not obvious why a Low Carb diet should be so beneficial. The second great mistake was to assume that high doses of insulin are not harmful to the body. This turned out not to be true at all. Persistent high levels of insulin over many years leads to insulin resistance. That’s the crux of the problem. Not gluco-toxicity but Insulin Toxicity.

Let’s look at the EuroDiab Study. This was a prospective cohort of T1D patients from Europe. Compared to normal people, T1D have a 3 or 4 fold higher risk of dying. This is not especially controversial. But what was the reason? Most doctors believe that it is due to gluco-toxicity (toxicity of the high blood sugar).  The high blood sugar causes damage to proteins (AGE or Advanced Glycation End-Products), which then raise the risk of dying. If that was true, then very tight blood sugar control would be essential and also reverse the excess mortality.

In this study, a multi-variate analysis showed that there were several factors associated with this excess mortality. Gluco-toxicity in fact, did have a small effect as A1C was associated with a small higher risk (standardized hazard ratio of 1.18).  However, this was much smaller than the risk associated with the Waist-Hip Ratio (WHR), a standard measure of visceral fat.

This is the usually found in metabolic syndrome, which is insulin excess, not insulin deficiency. In other words – this is more typical of type 2 diabetes, not type 1. What is going on?T1D Survival

The ‘Golden Years Cohort‘ studied 400 T1D patients who lived over 50 years managing their disease. These were people who had obviously beaten the odds and survived. What was their secret?

The average HgBA1C was 7.6% – well above the normal of 6.0% and well over the target level of 7.0%. Some patients had A1C’s of 8.5-9.0% and still lived a long life. So, clearly, glucotoxicity was not the major player here. These people had ‘sub-optimal’ sugar control and it didn’t seem to matter.

Another paper “Why do some patients with type 1 diabetes live so long?” reviews some of the contradictory evidence. While some studies have shown benefit to low blood glucose, others have not. In reviewing the evidence, it appears that reasonable, but not necessarily ideal blood sugar control is needed. While glucotoxicity is a player, it is not a major player. What was the major factor in survival?

Low daily insulin requirements are significantly correlated with survival. This is fascinating. I have argued that high insulin levels leads to insulin resistance (type 2 diabetes). If this is true, let’s think about what is happening here.

In T1D, the conventional dietary advice is to eat a low fat high carb diet in the mistaken belief that dietary fat is bad for heart disease. The result is that more insulin is required to deal with the higher blood sugars (the dietary strategy of carb up and shoot up). This excessive insulin intake over years (persistent high levels) actually leads to insulin resistance, just as what happens in T2D in the normal population.

Over the decades of high insulin, type 2 diabetes develops in these patients with type 1 diabetes!  In fact, these patients have double diabetes, which is why factors like cholesterol, high blood pressure and high WHR all become increasingly important for T1D.

The cure for T1D led directly to T2D! It was the disastrous advice to eat a high carb, low fat diet. Instead, what would happen if you followed Dr. Richard Bernstein’s LCHF diet? You would dramatically reduce refined carbohydrates, which leads to much lower need for insulin. Blood sugars are controlled, but don’t need to be perfect.

Marty Kendall Optimising Nutrition
Marty Kendall
Optimising Nutrition

In other words, there are two toxicities to be aware of. The first, and less important is gluco-toxicity. The more important is the insulin-toxicity. It is the insulin itself, in high doses that is leading directly to insulin resistance and type 2 diabetes.

While T1D patients will never be completely off of their insulin, they would still be wise to listen to Dr. Bernstein and follow a LCHF diet to minimize the insulin-toxicity. Their life, very literally depends upon it.

One of the best online resources I’ve ever seen was written by Marty Kendall who details specific foods and their insulin effect. He has written an absolutely fantastic series of post on insulinogenic effect of foods, and well worth a look. It’s absolutely terrific stuff.

Interestingly, like Dr. Bernstein, Marty is also an engineer, who developed a specific interest in foods for type 1 diabetes because his wife suffers from this disease. By changing her diet to a low insulin diet, her health has dramatically improved with better control of sugars, improved energy and mood. Look at happy couple! So sweet, I could throw up. Excuse me…

The key here is the focus on eating foods that lower insulin requirements. This takes into account the carbohydrate content, protein, and fibre content of foods. This is a far more comprehensive measure of insulin requirements than a simple carb count, and therefore much more closely approximates the truth.

64 Responses

  1. Wow. Thanks Jason! Feeling humbled to be mentioned in the same post as the mighty Dr B!

    Your blog and video series have helped join the dots and sent me down the insulin index rabbit hole! Exciting times!.

  2. Hi Dr. Fung,

    I can’t believe you wrote this post and talk about Dr. Bernstein! …I just bought his book, “Dr. Bernstein’s Diabetes Solution” (4th Edition), a week and a half ago. One girl said on her blog that she would recommend that every diabetic read his book. I couldn’t agree more. As a Type II diabetic, I have learned so much and have never been taught most of what I have been reading.

    I do have a question since I seem to be losing quite a bit of weight quite rapidly on the LCHF diet. I’ve only been on LCHF for two weeks and have dropped 8 lbs. Already my skirts (and even my underwear!) are falling off of me.

    I actually am very concerned about this rapid weight loss, as I have always been told that a person shouldn’t lose more than two pounds a week.

    And I am wondering if this rapid weight loss will leave me with loose skin hanging from my body. I have seen pictures where people lose a lot of weight and they have a lot of skin hanging down from their arms after they lose the weight.

    In Dr. Bernstein’s chapter on “Treatment” (page 203), he talked about increased thrombotic activity during weight loss. He said that it could increase the risk of heart attack or stroke. (Yikes, that is the reason I want to lose weight–to avoid these very complications that you can get with having excess weight! I had no idea that a person could get these complications by losing weight!) Dr. Bernstein did recommend taking 80 mg chewable aspirin once daily during a meal or to use omega-3 fish oil capsules.

    Dr. Fung, you mentioned in your youtube video that people often lose weight rapidly when they fast. Do you have any such concerns (or even other concerns) with respect to rapid weight loss with fasting patients?

    • Most people would be envious of the rapid weight loss Marie. Sounds like the reduced insulin levels are working for you. If you’re eating to satiety you shouldn’t lose too much weight.

      See https://optimisingnutrition.wordpress.com/2015/04/02/carbs-protein-type-1s-and-canaries/

      • Hi Marty,

        I know that most people would be envious of a quick weight loss, but I really am concerned that it is too much too fast. I realize that a person will often lose more weight when they first start a diet, and then it will slow down and level out. My concern is complications from losing weight too quickly.

        I am actually a strict eater (even when I was on the Diabetic Diet) and I do eat to satiety. The only thing is with LCHF diet I find I am ravenous from 3:00 p.m. till I go to bed. It is quite embarrassing when I am out in public and my stomach talks louder than I do! 😉 LOL I honestly was wondering if I have a tape worm.

        I do have snacks and enjoy eating fruit in the evening (and whatever fruit that I want, not just berries). The interesting thing is that I can’t have just any fruit during the day, because it raises my blood sugar level. Just the other day, I had half a grapefruit with my eggs for my morning breakfast (as I was trying to cut the fat taste). My fasting blood sugar levels have been between 5-7 two hours after my meals, since starting LCHF. (My numbers were so beautiful that I would actually kiss my logbook! 😉 ) But when I had the morning grapefruit my blood sugar went up to 8.3. Since the range is between 5-10, I am still well within range. It is just that after having years of not being able to get my blood sugar in control, to see an 8.3 pop up made me nervous and want to go back to eating berries (blueberries, strawberries, raspberries, etc.) during the day.

        Marty, does a weight loss mean that I am reducing my insulin resistance and not just lowering my blood sugar levels? I really want to reduce my insulin resistance, but I thought I had to fast to accomplish that. I am also wanting to reverse my fatty liver. According to Dr. Fung’s video presentation, a person can also have fatty pancreas. (…I was shocked. I couldn’t believe it. A couple of days ago, I was telling a dialysis nurse about the fatty pancreas and even she didn’t know that could happen.) Can a person reverse fatty liver and fatty pancreas just through dieting?

        Marty, I want to thank you for compiling that list of optimal foods that diabetics can eat. I found your website a while back and your list really helped me to understand what I should and shouldn’t eat. It has been very helpful, as my husband was initially very frustrated in not knowing what I could and couldn’t eat and told me to find a list.
        https://optimisingnutrition.wordpress.com/2015/03/22/cheat-sheets/

        • Many people lose water weight in the first few weeks but nearly 2kg a week is pretty quick. Dr B recommends increasing protein to increase weight.

          Dr Fung is the guru, but it seems that the low insulin / fasting approach allows the fatty liver and fatty pancreas along with the body fat to reverse.

          So glad you found the cheat sheets and you’re getting great results. That’s so exciting to hear! 🙂

        • Hi Marty,

          Yes, I did notice in Dr. Bernstein’s book that he recommended increasing protein to increase weight. However, I am unable to do that. I am maxed out on protein and fat!

          Interestingly, before I started the LCHF diet, I had a lot of trouble eating meat. I couldn’t even tolerate the smell of it. (That is why it had been easy for me to try the vegetarian and vegan diets, as it seemed I had been headed that way anyway. However, I got so sick on them, that I could not maintain them.) I do find it fascinating that when I cut out all carbs and sugar, that I was able to eat some meat–and even enjoy it.

          I am also taking homemade meat broth daily. (I don’t know if this counts for protein serving.)

          Yesterday, I was despairing not knowing what I could do to slow down this weight loss. (One thing I know for sure is that I cannot go back to any carbs or grains. It is very clear to me now that carbs and grains are a poison to my body.) I thought that maybe I could have cream whipped up with some fruit to try to gain weight; however, given my experience with LCHF I think I would probably lose even more weight.

          I’ll keep searching for an answer. My goal is a slower weight loss. I would like 2 pounds a week.

          • Georgette

            Hi Marie, have you considered the possibility that you actually need insulin injections, if you are not injecting insulin? Or, if you are taking insulin injections, you are not using enough, which I suspect by the blood sugar results you mentioned. Dr. Bernstein has talked about this in some of his free, monthly web casts.

            I haven’t read all of your posts so I don’t know if you are a diabetic, or which type. The blood sugar you listed above would indicate your are an uncontrolled diabetic. Normal range is 4.2 -5 mmol, not the 5-10 mentioned in your post. Normal A1c is 4.2 to 4.6.

            To try to debunk the typical ADA recommendations is too much for me to write here. I encourage you to carefully read Dr. Bernstein’s book, Diabetes Solution, and also check out Dr. Bernstein’s Diabetes University channel in YouTube.

            It’s too bad we can’t talk privately. I would like to talk with you more.

          • Monica

            Mary,
            I’m on the same boat…onces my BS improved my weight and mostly size/volume went down to the point that I feel I’m thin in extreme. I was not overweight to begin with but, now it is hard for me to find clothes that fit me.I’m 1.64m, 53kg with 21% body fat. I have tried to eat a bit more but, I’m not hungry and feel full yet after meals so cannot eat more.
            Our bodies are wise enough to set our healthy weight on their own so, I trust mine. I’m providing it with loads of nutrients then let’s keep trusting. 😉

          • Marie

            Hi BobM,

            WOW! Body set points… I never even would have thought of that, but it makes sense.

            I woke up late yesterday morning and thought it was too late for breakfast, so I thought I would make it an “Intermittent Fasting” day. Now I did take my meds and supplements, thinking that my number would be a little lower. To my surprise, my number was higher — 8.8! (Still within the 5-10 range though.) But I don’t want my number to be that high, so I concluded that at this time my body needs three meals (plus snacks) per day.

            I will consider intermittent fasting again when I stop losing weight.

            Thanks so much for sharing!

          • Marie

            Hi Monica,

            Yes, I will listen to my body! 🙂

        • I think it’s complex as to whether losing weight means you’re less insulin resistant. I think to some degree, it does. But I lost about 20 pounds on LCHF, but then got stuck. I started doing research on how I could lower my insulin resistance, and that’s how I found intermittent fasting. With intermittent fasting, I’ve really restarted weight loss. Did I reduce my insulin resistance by my LCHF diet to a new set point and the IF (intermittent fasting) has allowed me to go to a new, lower set point? It’s a good question. I’m not sure how you’d even test whether that was true.

          Personally, I cannot eat much fruit: only a few blueberries or strawberries. Anything else causes too much of a blood sugar rise.

          • Marie

            Hi BobM,

            Sorry, I messed up and my message is above! …I seem to have such problems with computers! 😉

        • Hi Georgette,

          Your numbers are so different than what the specialists who I have seen have told me. I really have to do more research on this. …maybe I’m not doing as good as I thought. Thanks for the heads-up.

    • No, I don’t worry about too-rapid weight loss. I think it reflects mostly water loss, which I consider a good thing

  3. I’ve been reading Jenny Ruhl Diabetes 101 blog recently, and she seems favour a LCHF diet but also taking insulin, unless I have misunderstood, to minimise beta damage from T2 complications. The best advice from Dr B for me was the taking of low dose naltrexone in evenings to help with cravings/overeating. This med has been a life changer for me.

  4. Wow, great post! I just got my brain shifted. Insulin toxicity is major problem not glucose toxicity. Man, I hope that is right.

    As I remember Dr. B’s story, he went to medical school in his late 40’s mainly because he was frustrated by trying to tell the ADA about the wonders of LCHF for diabetics, which he had discovered on his own by self-testing his blood sugar and noting what he had eaten. Those logical engineers, really! The ADA would not listen to him because he was not a doctor. Unfortunately, even with his MD, they still don’t listen.

    (The ADA may not get it, but maybe those in Los Angles have. I recently saw three short You Tube comic routines where eating carbs was considered the worst sin in LA. Amy Schumer was one of the comics.)

    • Nate. I think Jason would say that both insulin toxicity and glucose toxicity are both issues that can be managed through diet rather than just piling on the insulin to try to suppress the blood sugars. Dr B is very big on people achieving normal blood sugars as well as manipulating the diet to avoid “industrial doses” of insulin and the roller coaster of blood sugars that comes with that. See https://optimisingnutrition.wordpress.com/2015/03/22/diabetes-102/ for some thoughts on the advantages of achieving ‘normal’ blood sugars.

      • Dikeman

        Dr. Bernstein prescribes insulin to virtually all of his patients to achieve normal blood sugars. Combined with a low carb diet, these small physiologic doses of insulin are harmless. Dr. Bernstein would disagree with allowing patients to run sky high blood sugars for the sake of pronouncing them cured. Diabetics deserve normal blood sugars.

    • Georgette

      Yes, Nate is correct. Dr. Bernstein was frustrated because no one would give him or his data the time of day. He thought if he became a doctor, the medical establishment would listen to him, but sadly, that wasn’t the case. Dr. Bernstein was the first to ever suggest home blood sugar monitoring, which was met with disdain. In any event, every diabetic who uses a home blood sugar meter can thank Dr. Bernstein.

  5. Hello All!

    Dr. Fung,
    This is again a great post! Also great to know about Marty. I can’t wait to read his blog to continue learning on insulin and sugar.
    I have a question and really hope someone could have insight on it.
    I got insulin resistance about two years ago and was dealing with it until about two months ago that I discovered Dr. Fung and started IF. I was on low carb diet yet but, fasting blood sugar was still a problem until I started fasting for 12h a day and 24h once per week. That was when my FBG went down to ideal levels around 75, that is what I thought but, I had found recently that if I measure my FBG right after waking up I get like 95-100 and as soon as I start moving or after 15-20 walking around it goes down to 75-80.
    Is that normal? What does that mean? Have any of you experienced the same?
    Thanks a lot in advance
    Mónica

    • Upon waking your liver will dump a bunch of glucagon into the blood stream to get ready for the day and your blood sugars will rise. It sounds like your overall average blood sugar across the day would be OK. See https://optimisingnutrition.wordpress.com/2015/03/22/diabetes-102/ for details on ideal blood sugars based on a range of metrics. Sorry Jason for spamming your blog! 🙂

      • Marty I also like your blog and your manifesto should be more widely known; thanks to Dr Fung for sharing. I find the insulin index very strange, as in some foods, fish and onions from memory have a large insulin index . There were some others that were strange as well, although the avoc/salmon/olives having a low index is pretty much in line with what we thought.

        • Thanks JW. The surprising thing for me was the effect that protein has on insulin demand, even though it typically doesn’t raise blood sugar as much. See https://optimisingnutrition.wordpress.com/2015/03/23/most-ketogenic-diet-foods/

          • That surprised me, too. Realizing that I’m insulin resistant caused be to try IF and to decrease my protein (on the vast majority of days, anyway) while increasing my fat content. I also limit yoghurt and other dairy products, which I did not do before. (I don’t eat much dairy anyway, but I’m eating even less now.)

          • ccavanaugh66

            It makes sense if you think of insulin as the storage hormone, and protein as something the body really likes and needs to store. Vegetables, not so much.

      • Marty,

        Thank you so much for your comments. I feel better now :). I was concerned about the morning rise. You are right, my blood sugars during the day are fine, after meals the highest I go is around 110 and by 1-2h, depending on what I ate, I’m back to 90-100.
        I’m a big fan of your blog yet! Great job!!
        Cheers
        M

  6. Love your work; I have thoroughly researched the topics related to fats, carbs, and diet at my website (visit http://healthfully.org/rh/). I lover your desire to change behavior through educating your audience; and the quality of your lectures. One minor slip on your part, Dr. Fung: “In many ways, T1D and T2D are exact opposites of each other.” T1D typically affects children who are usually quite skinny. T2D typically affects adults who are usually quite obese.”

    However in your lectures on YouTube, they are not “exact opposites”: those who are prediabetic and thus are insulin resistant, they over produce insulin to manage their glucose. But upon developing a fatty pancreas, their insulin product drop significantly in a few months; thus their serum glucose rises to become symptomatic.

    This failure of beta cells to produce adequate insulin in T2D is similar to T1D. Those with T1D produces some insulin since typically not all their beta cells are destroyed by their immune system.

  7. I would like Dr. Fung’s opinion on what a normal A1C level is? Is it the 6.0% mentioned in this article, or is that for T1Ds? Thanks!

    Dr. Jason Fung: Less than 6.0% is defined as normal, although the lower you get, the better. However, this only applies if you are using diet rather than medications.

    • Hi Dr. Fung,

      Okay, so if you are using diet and are on medications, what is your A1C level supposed to be? Thanks!

      Dr Jason Fung: Taking medications will lower your A1C, but it will not make your diabetes any better. It will only make your blood sugars better, not your diabetes (high insulin resistance). Ideally, you should aim to get of meds and have a normal A1C.

    • Okay. Thank you very much, Dr!

    • Definitely Jason!

  8. I have just discovered that Dr. Bernstein is on YouTube with a series that he calls “Dr. Bernstein’s Diabetes University.”

    Here is his first video where he gives his own testimony and even shows his first blood sugar meter.

    https://www.youtube.com/watch?v=WFNGdKSXx64
    (Just follow the links after you view the first video session.)

    I have already had so many of my own questions answered and would highly recommend this video series to everyone.

  9. Jennifer

    Dr Fung, are there any possible drawbacks/negative aspects you know of to fast 24h-48h a couple of times a week and eat LCHF for a non-diabetic normal-weight (65kg, 170cm) healthy person (and I am not insulin resistant that I know of)? I have a couple of ‘comfy kilos’ that I call them that i am trying to get rid of and like fasting as a method but my husband insists I need to find out any possible drawbacks of fasting. Thank you!

    Dr. Jason Fung: I see nothing wrong with it.

  10. Hi

    I have been doing intermittent fasting on and off for a couple of years, today i typically have an eating window of 8-12 hours, it varies. I also haven’t been eating refined carbs for years, but I do eat lots of low GI carbs. I am 180 cm, 34 years old, weighing roughly 155, with ca 8% body fat. I recently had my bloodwork done, i do this 3 times a year because I like to keep an tab on my values, especially since I was diagnosed with Iga nephropathy, but I seemingly reversed the condition some years ago. In regards to my recent bloodwork it showed my c-peptide levels to be 167 pmol/l, which is pretty far below the reference level, 270-1290, but my B-HbA1c was 5,1%, and most recently 4,9%. My doctor is talking about it Diabetes type 1, and because of my history with autoimmunity, (ref: Iga Nephropahty) off course i worry about this, but could my c-peptide levels be at this level because of my diet, fasting and overall lifestyle(exercising, meditating etc)? I am scheduled to have a glucose toleranse test in a few days.

    Appretiate any answer

    Dr. Jason Fung: An A1C of 5.1% is far below the range considered pre-diabetes (6.0%)

  11. I am a physician also with Type 1 diabetes and I manage it with low dose insulin and LCHF diet. I have great success with it for my patients as well, but it is still a highly controversial topic. I do find issues with the microbiome effects in some people in LCHF but there are a few effective strategies I use to help optimize a healthy gut. Thanks for doing the work that you are doing! The ADA guidelines just lead to a roller coaster of highs and hypos. I amputated far to many legs in my career and treated way to many postoperative complications as the result of diabetes that isn’t tightly controlled. I am speaking about this at the North American Spine Society Meeting this fall. Hopefully more of is can get the message out that it is safe and effective.

    • Dr Diulus, I’ve been trying to find good material on this question and haven’t. Could you point us towards a good source or two on LCHF and gut biome? I’ve only found quite politicised, i.e. anti LCHF prejuduced, sources.

      Thank you,

      Lucy

  12. Hi Dr. Diulus,

    Thank you for sharing this with us. What exactly are the microbiome effects that you find? What strategies do you use to optimize a healthy gut?

    I am very interested in this, as I have recently come across some YouTube interviews with Dr. Natasha Campbell-McBride.
    https://www.youtube.com/watch?v=Z_0NvcJZwa8

    Also, have you seen any of the diabetic complications reverse in your patients who are on the LCHF diet? If so, which ones?

  13. […] [email protected] /* */ (LucySW) Guys, here’s an article Jason Fung recently posted (linked from Diet Doctor) about low carb and Type 1. It all seems quite fine and dandy, and then […]

  14. I haven’t been doing a low-to-moderate carb diet for very long, but find it seems to be sustainable for me, even with some above-average athletic performance requirements.

    That said, as much as I (really) enjoy my fats, I’m wondering if the studies that show that ingesting fat with sugar impacts PP BG curves quite dramatically vs. just ingesting the exact same sugar alone (with no fat).

    The 100g mentioned in this study seem to be quite high for normal folks (vs. the routine 600+ grams of carbs during training), but the difference in curves is striking. Thoughts? Perhaps this sort of curve is only possible at very high glucose levels and would not be the same for a 30g glucose + 3g fat (holding the 10% ratio)?

    Ultimately, I think keeping carbs low avoids a bunch of this, but I was wondering if the “fat blocking insulin receptors” science is factor vs. a distraction.

  15. Sorry, forgot the link to that Doctor’s paper: http://postimg.org/image/dgkq45ecv

  16. […] såg hos Kostdoktorn en länk till ett bra blogginlägg av Jason Fung: LCHF for type 1 diabetes.Där visar Jason på att det är höga insulindoser som är mest kopplade till sjukdom och död […]

  17. Jason, I compiled this list of some of the people with type 1 diabetes who have inspirations to us and the ‘secrets to their success’. I hope people find it helpful. http://wp.me/p5VAQF-QQ

  18. And here’s another post ‘Balancing Diet and Diabetes Medications’ that tries to join the dots to help people with diabetes navigate between the apparent extremes of fasting and diabetes medications. http://wp.me/p5VAQF-S4

  19. […] פוסט זה מוגש כשרות לאנשים שלא יכולים ואו קשה להם לקרוא באנגלית. הזכויות על התוכן שייכות לכותב של הפוסט המקורי. את הפוסט המקורי ניתן למצוא בכתובת הזאת. […]

  20. […] Since my previous article in this series, I have had several queries in regards to Type I diabetes, and I wanted to find more information for those of you with Clients and/or relatives with such questions. This site has brilliant information about Type I Diabetes & Low-Carb High-Fat Diets. […]

  21. What a fantastic post. I’ve been type 1 for 14 years, diagnosed at age 29. I have been able to keep my A1 C at 5.2 eating LCHF. Here’s my question: which is more harmful, a brief BG of 200 mg/dL or a brief BG of 45 mg/dL. Both are clearly undesireable, but mistakes happen.

  22. It’s all very well talking about fasting and losing weight, but what if you only weigh 60 kilos (140 lbs)? I certainly cannot afford to lose more weight!!! Any ideas anybody?
    Tom

  23. Thank for Sharing.

  24. Jim Ingram

    This post is amazing to me as I was just thinking about the same issues this morning. I am a Family Physician, recently eating a Ketogenic Diet and reading everything I can get my hands on about the same. I am entirely in agreement with the idea that the standard dietary advice offered for T2DM is actually toxic, ultimately causing the disease to progress through worsening of the Insulin resistance underlying the disease. Now that I’m getting my mind around that idea, my mind is getting blown pondering how beneficial it would be for T1DM patients to lower insulin need by lowering carbs, even to the point of being in nutritional Ketosis without being in Ketoacidosis. The concepts are fascinating, though my practice sees only rarely type 1 diabetics. Thanks for all of the great information and leadership in this important area!

  25. Hi Marty. I’ve not come across my question/an answer anywhere and am hoping you can give me your opinion. T1 for 50 years. Healthy. I’m one of those referred to in the article: regularly over 7 HbA1c and struggle to achieve normal BS. Exercised/exercise cardio all my life. Weight? Awful. Gained about 10 lbs/decade and insulin increased 10 units/decade. For “no” reason. Came across Dr. Fung’s mind-shattering info in June and my IR. Changed my ways of thinking and behavior, daily insulin requirements decreased from average of 50’ish units/day down to 35’ish immediately. Weight hasn’t budged since June. Still slightly over 200. IS THERE HOPE FOR ME LONG TERM T1 with my weight? Maybe it’ll just take longer due to the length of time on insulin? Maybe regular IF will help? I’m in control of BS with pump testing approx 10 times/day. Any thoughts? I thank you for your great work and I thank you in advance…

  26. Dr. Richard Bernstein,

    My Grand-daughter (13 yrs old) has type 1 diabetes, and still in her honeymoon phase. Would like your thoughts on getting her into LCHF diet to reduce stress on her pancreas, and maybe making her life more normal.

    She has doctor here in Anchorage who would work with another knowledgeable doctor – I believe.

    One thing, she is very very thin, as went into coma from starving before discovered that she was type 1 diabetic.

    Please respond if you can assist or you know someone who can. We are happy to take her to any doctor anywhere for help.

    Alan

  27. Lucy Eileen

    Hello Jason, Marty, et al,
    Thank you for all the information about T1D after referencing Dr. Bernstein. I’ve not seen some of the problems I’ve had with T1D addressed so well as on this blog. It explained to me possibly why I’m still alive after more than 50 years on insulin as T1D. I’ve had T1 for almost 55 years and was diagnosed in 1962. Insulin has never worked well for me but I’ve managed to use it daily since 1962. I’ve got the complication of gastroparesis (along with retinopathy and some neuropathy). Also I’m on a lot of thyroid medication, levothyroxine and armour thyroid– Thyroid and A1C are tested every 3-4 months and tsh result goes up and down; endocrinologist just shrugged last time. I studied the Bernstein book but could not stick with it for more than 5 days even though it made total sense to me. I’m thin due to the metabolic problem of T1; have trouble with snacking too much. Jason, I’m quite inspired by your How to Reverse T2D Naturally youtube! I’m going to try intermittent fasting and hope to help the gastroparesis, lower my A1C, which was 7.8 last time and 8.0 the whole year before that. I’m hoping something gets resolved also with thyroid but I’m clueless about meds and thyroid. If anyone has tried intermittent fasting as T1D, please write. Thank you again.

  28. Torey Severino

    Wow! This is such an important read and information that *EVERY* diabetic should take note and read over and over again! Thank you Dr. B for writing this blog and I hope that many will read this and realize how poorly educated and poorly managed some Endocrinologist are at treating and helping T1D maintain a healthy lifestyle! I have had T1D for 37 of my 41 years alive. The early years through my mid to late teens I remember the massive roller coaster my HA1C and my daily fingersticks would produce such highs and so many lows. The mood swings, minor depression, and physical issues with my GI system and eyes-never once was it attributed to the massive amounts of insulin I was taking. It wasn’t a big deal because I thought I was indestructible when I was working out 2-3 hours a day, playing HS football and basketball and constantly on the move! My metabolism would burn all the high carbs I was eating! My sugars would sky rocket but then I would continue to use my pen needle to take more insulin, thus dropping my sugar levels and just fill up again on carbs and sugar. Into my early to mid 20’s when the playing career was over and the excessive workouts had lessoned, I started to gain weight but have major eye complications. I’ve had over 15 very extensive and painful proliferative retinopathy laser treatments. Into my early 30’s I was at my highest weight and was considered morbidly obese. I never assumed or questioned this was due to the amount of insulin I was injecting. When my wife and I had our baby girl, my world needed to change. I was so concerned that had I done nothing, I wouldn’t be around long enough to walk her down the isle. I was forced to try other remedies, even against my doctors recommendations. They were so focused on the HA1C and not the weight. In the last 4 years I have lost over 30 lbs and kept it off! I have reduced my insulin levels by close to 50% and and take an average of 30-40 units per day versus close the 70-80 units a day I used to take. I have even experimented with Invokana and Jardiance to help lesson the insulin needed. I recently came across the Ketogenic diet and am excited about implementing this into my food regime. I look forward to living a very long and healthy lifestyle now that I have taken control of my disease and not allowing it to take control of me! I want to say thank you for validating my concerns and speaking the truth about the real problems effecting T1D’s and how to safely and properly manage this terrible disease! Thank you Dr. B and especially Jason for writing and posting this blog! !

  29. Mary Cameron

    Thank you for this interesting article. I have given this link to a friend of mine who has type 1 diabetes, and hopefully she will read and note any useful information. My own mother had serious T2D, and died of its complications.
    I have always been watchful of Insulin “Resistance” and my weight. When I was 50 I lost the battle with weight and gained 35 lb in short order and it took 4 years to get if off (plus another 10 lb). I used LCHF to do it. Christine Cronau has a great webpage, and facebook page for this way of eating.
    I have taken to eating Kefir and drinking Kombucha to see if those make any difference to weight/blood sugar/insulin control. I am the proud owner of an Optium meter and measure glucose and ketones most days.

    I feel lucky to have lost the weight, and not starve

  30. hi my husband has Type 1 and has been on this lchf diet for nrly 3 weeks . levels are good but no weight loss. most frustrating. can u help?

    • First, let me say I am not giving medical advise, I am not a doctor and if you want to try anything I have been doing please do some of your own research. There are a so many great videos on Youtube by MD’s, PHD’s, Engineers and other really smart folks that you can tap into for ways to lower your blood sugar without insulin.

      I am also type one and have issues with losing weight, and shot up 40lbs when I was first diagnosed and started on insulin. I was already not eating carbs and taking only 14 Lantus a day and a minor amount of rapid as needed. When I asked my Endo about the weight gain he said “eat less” and walked out of the room. That was the last time I went to that quack.

      I tried a variety of LCHF diets without being able to get into ketosis. Over the last year I have dropped 40lbs (zero exercise), still 40lbs to go, once I switched to an all organic, grass fed meat Ketogenic diet.

      To put it simply, insulin makes you store fat, so the more you inject, the more fat will be stored or at least it will stop you from having the ability to use your own fat. Personally, I am not concerned with losing weight as much as I am with making changes to improve my health and the weight lose is just a bonus.

      Currently, I am fully keto, eating only real food, trying variety fasts of various lengths with taking alpha-lipoic-acid and a few other blood sugar lowing supplements. If I can take a supplement to lower blood sugar, I will need less insulin, thus helping my body use my fat for energy. Not sure how the supplements will work, but they seem to be, just need to find the right dose.

      Last, anytime I am making changes to my diet, like fasting or supplementation I check my blood sugars hourly and record them in a spreadsheet. Most of us would probably not go low, when I fasted three days my blood sugar was between 7-10. I was still drinking organic bulletproof coffee (grass fed butter, ran out of mct oil), organic green tea and I had one 12oz cup of homemade organic chicken broth on day two.

      Hourly checking is worth while as the last thing you ever want to experience is Ketoacidosis. This happened before I had been diagnosed and it really sucked, oh and I almost died from it (when I was first admitted my blood sugar was 23.5). Not to point blame, but an allergy doctor had put me on a high carb, no fat elimination diet and within a week I was in the hospital with Ketoacidosis. That is when I was first diagnosed as a diabetic.

      There are no easy answers as for many years, care of diabetics has been controlled by the companies who produce insulin and diabetic drugs. I can only say thank god there are healthcare professionals like Dr. Atkins, Dr. Bernstien, Dr. Phinney, Dr. Volek, Dr. Noakes and most recently Dr. Fung who refused to accept the status quo. There are so many more but if you need some common sense health advise, what these doctors have to say would be a great start on your road to better health.

      I do not have a website or am in any way affiliated with any doctor or company. In no way am I funded or getting paid by any entity; I only spend my time doing research for myself and to help others, period.

      Thanks for reading and have a great day.

  31. Dr. Fung,

    Thank you for this article. I’ve recently adapted a keto way if eating and will be starting IF soon. I have type 2 diabetes (off meds since VSG last year). In doing all the research, I’ve wondered about how it would work for type 1 diabetes. My 16 year old son was diagnosed at age 5. His insulin requirements have gotten pretty high (1 unit per 4 carbs at some meals). My belief is that he suffers from insulin resistance like me (as well as many people in my family). Recently he was sick and hasn’t had much appetite and I’ve had to adjust his insulin to 1/6 from 1/4. We’ve also had to reduce his lantus. All this made me start thinking of LCHF diet for him and IF. Basically, he does IF naturally. He usually doesn’t want to eat breakfast and won’t eat until 2 or 3 in the afternoon. So long as his sugars aren’t low I let him listen to his body. I’m hoping he’ll get on board with a LCHF diet with me so we can finally see a decent a1c, but even more so to correct the damage years of excess insulin has done.

    Thank you for all your hard work and research and for so willingly sharing your knowledge. I’m in the process of reading The Obesity Code and plan to read your book on fasting, too.

  32. I’ve been a Type 1 diabetic for over 20 years. Have been LCHF on and off for the past 5 years. I’m not concerned about weight loss, but about the effects of ketones. My endocrinologist warned me against cutting out carbs completely because of the effect of accumulated ketones in the brain. I haven’t researched this at all, but maybe you all can answer this concern. I have had high average blood sugars recently, and feel foggy when I improve my blood sugars to a more normal range. But I don’t think this is due to increased ketogenic activity.

    • Hi Bethany, Not to go over what I just wrote in a response Annie’s query from January 31st 2017. Check it out, do some research for yourself & maybe consider doing a search for a new endo in your area. Don’t be afraid to change your endo, I did and am far better off for it. Clearly any medical professional telling a diabetic to eat carbs is a quack. Not to offend people in the medical community, but frankly if I have offended your egos, sorry-not really; I am really offended by all of the people being mistreated leading to numerous complications, huge increases in metabolic diseases and death. So really who should be more offended, the medical community or the general public?

  33. First, many thanks to Dr. Fung for looking beyond his medical school education in an effort to truly help, not only his patients, but all of us who he reaches through this site, his books and his many Youtube videos.

    I tried to write a comment explaining how I got to be a type one and it ended up being pages long. So just a question for Dr. Fung or anyone who may be in the same situation and know the answer to my query. I have added a brief history for some context.

    I have done every diet ever invented, even some weird all sugar diet from the late 60’s early 70’s. Hey don’t judge when you are 420lbs at 20 years old you are willing to try anything. From my mid 20’s I followed Atkins on and off, with some success (330lbs in 2014 and now 220lbs). I do not eat processed food and and follow a real food diet. A mix of grass fed meat/game meat, organic heavy cream, coconut oil, grass fed butter and only above ground organic vegetables for carbs. Some supplements including MCT oil.

    Recently I tried a three day fast. My issue is, I was keeping my blood sugar at 4-6 (28 Lantus and maybe 8 Nova rapid/day) previous to the fast and decided why would I need insulin if I was fasting. I was testing hourly to make sure it did not go too high as I am keto adapted and I had in the past went into Ketoacidosis due to bad medical advice from an allergy doctor. Hospitalized for a week and that is when they told me I had diabetes(two and a half years ago). When I was fasting my blood sugars were from 8-10.

    First, with all the additional benefits of fasting, I want to do it, so do I need to be concerned about the elevated blood sugar levels?

    Second, if I take insulin and fast will I still get the benefits?

    I am not concerned about the weight loss from fasting, more the cleaning out of damaged cells and generation of stem cells and HGH. Thanks again to Dr. Fung for all his hard work, it is never easy to swim against dogma and to anyone who can give me some help with implementing fasting into my routine.

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