Keto Diet and Type 1 Diabetes

Keto Diet and Type 1 Diabetes

For thousands of years, something has been sneaking up on children and robbing them of their ability to control their blood sugar levels. The culprit is an autoimmune condition called Type 1 Diabetes, and its incidence has been increasing in both the United States and in other western countries.

But there is no need to worry. This sneaky disease has left us with enough clues to diagnose it, manage it, and potentially reverse it.

How to Know If It Is Type 1 Diabetes

Type 1 diabetes is most commonly diagnosed in children between the ages of 10 and 14, although many children can present with symptoms at ages as young as two years old. The incidence is approximately 1.5 times higher in American non-Hispanic white people compared with African American or Hispanic individuals.

Risk Factors for Type 1 Diabetes

The three most well-researched risk factors for type 1 diabetes include:

  • Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition.
  • Genetics. Specific genes can increase the risk of developing type 1 diabetes.
  • Age. Although type 1 diabetes can appear at any age, it is diagnosed in two prominent peaks. The first peak occurs in children between 4 and 7 years old, and the second is in children between 10 and 14 years old.

However, these aren’t the only three risk factors. Recent research has found that type 1 diabetics tend to have a different balance of bacteria in their microbiome then non-susceptible individuals. Vitamin D deficiency, gut health issues, and dairy intolerance are also linked to a greater risk of type 1 diabetes as well.

Having all of these risk factors, however, does not mean that you will have type 1 diabetes. Its symptoms will provide us with a clearer picture.

Symptoms of Type 1 Diabetes

Type 1 diabetes signs and symptoms can appear relatively suddenly and may include:

  • Increased thirst
  • Frequent urination
  • Bed-wetting in children who previously didn’t wet
  • Extreme hunger
  • Unintended weight loss
  • Irritability and other mood changes
  • Fatigue and weakness
  • Blurred vision

If you see any of the above symptoms in you or your child, then consult your doctor right away. If not, symptoms may progress to diabetic ketoacidosis — the most common cause of death in children who have type 1 diabetes.

How to Confirm If Its Type 1 Diabetes

At your doctor’s appointment,  they will run some blood tests to get more clues as to what is going on.

These blood tests may include:

Glycated Hemoglobin (A1C) Test

This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to the hemoglobin (the oxygen-carrying protein in red blood cells).

The higher your blood sugar levels, the more glycated hemoglobin you will accumulate. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.

Random Blood Sugar Test

Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes. This blood sugar level is especially suggestive of diabetes when coupled with any of the signs and symptoms of the condition, such as frequent urination and extreme thirst.

Fasting Blood Sugar Test

A blood sample taken after an overnight fast is a fasting blood sugar test. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is a pre-diabetic level. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, then you have diabetes.

Autoantibody Testing

If you’re diagnosed with diabetes, your doctor may also run blood tests to check for autoantibodies that are common in type 1 diabetes. These tests help your doctor distinguish between type 1 and type 2 diabetes when the diagnosis is uncertain.

The Difference Between Type 2 and Type 1 Diabetes

The difference between type 2 and type 1 diabetes

Let’s clear up any questions you may have regarding type 1 and type 2 diabetes.

The type of diabetes we are focusing on for this article is type 1 diabetes. It accounts for about 5–10% of all cases of diabetes. Being an autoimmune disease, it turns the body’s immune system — which normally fights harmful bacteria and viruses — against the insulin-producing cells in the pancreas. Eventually, the immune system destroys the pancreas’s ability to produce insulin. The result is blood sugar levels that are out of control and wreak havoc on the body.

Type 2 diabetes, on the other hand, is a result of insulin resistance rather than insulin deficiency. Insulin resistance occurs when the cells no longer respond to insulin signaling. The pancreas responds by secreting more insulin, which increases insulin resistance in the cells. This vicious cycle creates chronically high blood sugar levels.

Type 2 diabetes is commonly caused by overfeeding on calories and carbohydrates (the macronutrient that stimulates the most insulin secretion) and inactivity, not by an autoimmune issue. However, both type 1 and type 2 diabetes have many similarities including their symptoms, long-term complications, and the diet that helps best with their treatment.

The Long-Term Complications of Diabetes

When left unmanaged, both type 1 and type 2 diabetes can affect major organs in your body, including heart, blood vessels, nerves, eyes, and kidneys. Eventually, diabetes complications may be disabling or even life-threatening.

The most common long-term complications of diabetes are:

  • Cardiovascular disease
  • Nerve damage (neuropathy)
  • Kidney damage (nephropathy)
  • Eye damage
  • Foot damage
  • Skin and mouth conditions
  • Pregnancy complications

Although both type 1 and type 2 diabetes can be catastrophic, these long-term complications can easily be avoided. Substantial research evidence suggests that diabetic complications are decreased as a result of improved glycemic control.

In other words, if you control your blood sugar levels, they won’t control you.

How to Treat Type 1 Diabetes

How to Treat Type 1 Diabetes

When you improve your blood sugar levels (indicated by lower A1C and better blood sugar numbers), you will improve your health and be able to live a normal life with type 1 diabetes.

To improve blood sugar control, people with type 1 diabetes must:

  • Take insulin and follow the treatment plan prescribed by the doctor
  • Track carbohydrate, fat and protein intake
  • Frequently monitor blood sugar with a blood sugar monitor
  • Eat healthy foods
  • Exercise regularly
  • Maintain a healthy weight

This is what many doctors and researchers suggest, but “eat healthy foods” and “track carbohydrate, fat, and protein intake” are vague suggestions. Is there a specific diet plan that people with type 1 diabetes can follow?

The Type 1 Diabetes Diet

A 2008 article in the Pediatrics in Review contains all the recommendations for working with children with type 1 diabetes, including the ideal diet. What do they suggest?

The recommended diet usually contains 50% to 55% carbohydrate calories, 20% protein, and approximately 30% fat. Most carbohydrate calories should be complex carbohydrates, and the fat portion should emphasize low amounts of cholesterol and saturated fats.

However, studies on how this kind of diet affects patients with type 1 diabetes are nonexistent. Interestingly, the research suggests that there may be a better diet. In fact, it is the same diet that has been found to help reverse type 2 diabetes — the ketogenic diet.

The Evidence Points to The Ketogenic Diet for Type 1 Diabetes

The evidence points to a ketogenic diet for type 1 diabetes.

The first line of evidence for an ideal type 1 diabetes diet is a pair of case studies: one with a young girl and another with an adolescent male.

The young girl in the first case study had epilepsy and type 1 diabetes, which is more prevalent in children with epilepsy. Researchers sought after an effective diet for this complicated case, so they put the girl on a classic ketogenic diet (about 5% daily calories from carbs and 75% from fat) for 15 months.

The results were promising. Since the start of the ketogenic diet, no clinically overt seizures were reported. The girl was even being much more active and reaching significant developmental achievements that she wasn’t reaching before the ketogenic diet.

The researchers also tracked the girl’s A1C levels and glycemic control, the two most important measures for type 1 diabetics. Both of them improved significantly without any adverse side effects. These results indicate that the ketogenic diet may help manage type 1 diabetes and epilepsy simultaneously.

The results of the other case study were even more incredible. In the study, a 19-year-old male with newly diagnosed type 1 diabetes was put on a special type of ketogenic diet for 6.5 months. During this period, he was able to discontinue insulin use and restore some of the insulin production in his pancreas.

The researchers went on to conclude that:

…an intervention with the paleolithic ketogenic diet in an early stage of the disease with residual insulin secretion may halt or reverse type 1 diabetes mellitus. Follow-up at sixth month in the case of our patient is relatively short and the positive results may appear as a honeymoon effect.

The honeymoon effect is the period of time when the pancreas is still producing enough insulin to aid blood glucose control. Because of the honeymoon effect, it is much more likely that the paleolithic ketogenic diet didn’t halt or reverse type 1 diabetes. However, the possibility that this diet is responsible for this patient’s incredible recovery still remains.

To get a more definitive understanding of these results, I reached out to the authors of the case study for an update on their patient’s condition. One of the researchers responded promptly with this:

No, it was not a honeymoon period. But he decided to stop the diet and therefore had to go back to insulin. Another patient with a much longer follow-up: Case Study

Although this indicates that type 1 diabetes was not reversed (in both cases), these results are still impressive — and the paleolithic ketogenic diet is the primary reason why.

But what exactly do the researchers mean by a “paleolithic ketogenic diet”?

Here’s how they described it:

His diet consisted of meat, organ meat, fat, and eggs. In his diet, red and fat meats dominated over lean meats. He was eating vegetables in insignificant amounts. His diet had a ketogenic ratio (fat:protein + carbohydrate) of at least 2:1. No oil of plant origin or artificial sweeteners were allowed.

He also took 5,000 IU of vitamin D3 and excluded all milk and dairy from his diet [two important dietary strategies that we will address later].

The best part is that it didn’t take six months for the combination of the paleolithic ketogenic diet with vitamin D supplementation to produce results. In fact, the tapering of insulin was done promptly. Researchers stated that “following the first paleolithic-ketogenic meal glucose level was only 86 mg/dL thus there was no need for external insulin.”

However, there is some bad news. These case studies only reflect what happened to one young girl and one adolescent male on a ketogenic type diet. This means that these results may not apply to other type 1 diabetics. We need some evidence from larger studies as well. Luckily, there are two.

In one study consisting of twenty-two patients with type 1 diabetes, carbohydrate restriction was put to the test. While they were on a diet that limited them to 70-90 g carbs per day, participants had significantly less hypoglycemic (low blood sugar) episodes, lower A1C levels, and required less insulin after three months of carbohydrate restriction.

A similar result was found in another study on 48 people who had type 1 diabetes for 12 years or longer. They were simply educated on how to reduce carbohydrate consumption and lower their insulin dosages. Twenty-three of the participants were adherent to the “diet” and experienced a significant decrease in A1C after three months and four years.

Even without a strict ketogenic diet protocol, carbohydrate restriction helped type 1 diabetic. This suggests that carbohydrate restriction is highly effective in improving type 1 diabetes management.

But what about reversing type 1 diabetes? It is highly unlikely that this is possible. According to the current evidence, the most that a diet can do for a patient with type 1 diabetes is halt disease progression and reduce their insulin needs. In cases where the patient is still able to produce some insulin, it is possible for them to be taken off of insulin medication completely with the help of the right diet and healthcare professional.

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