When most people think of “diabetes,” they think of Type 2 Diabetes – that’s the kind that you (usually) get as an adult after a lifetime of eating junk food and sitting on the couch. Type 2 is the “diabetes” that goes along with the rest of the metabolic syndrome (obesity, high blood pressure, and high cholesterol).
Type 1 Diabetes is a completely different problem. It’s related to diet (more on this below), but it’s not a “lifestyle disease” and it’s not caused by a poor diet the way Type 2 is. In Type 1, an autoimmune attack on the pancreas prevents them from producing the hormone insulin. Insulin is necessary for metabolizing carbs and protein (more on insulin here), so people with Type 1 Diabetes have to inject insulin every time they eat a meal.
|Type 1 Diabetes||Type 2 Diabetes|
|NOT part of the metabolic syndrome; patients with Type 1 Diabetes are often thin.||Part of the metabolic syndrome; closely connected to obesity (although not all people with Type 2 are obese).|
|Not enough (if any) insulin is produced, so your body can’t metabolize carbohydrates or protein on its own.||Insulin is being produced (too much of it, actually), but your body is “deaf” to the insulin signal so it doesn’t work properly.|
|Common in children||Rare in children; usually develops in adults after a lifetime of bad eating.|
|Not caused by eating junk food and not exercising.||Can be caused by eating junk food and not exercising.|
|Autoimmune disease||May have an autoimmune component, but is not primarily an autoimmune disease.|
It’s easy to see how a Paleo approach to diet and lifestyle could be safe and effective for Type 2 Diabetes – if a disease is caused by eating too much junk food and not exercising, then eating real food and taking up a gym habit can only be helpful. But what about Type 1? Here, we’ll explore some research suggesting how Paleo could be helpful for people with Type 1 Diabetes.
Paleo is not a magic cure for Type 1 Diabetes or anything else. People with Type 1 Diabetes need to work closely with a doctor to manage their insulin levels – this is all just information that you can bring up with your doctor to help you find a diet that works best for you.
Low-Carb Diets for Type 1 Diabetes?
The standard advice for Type 2 Diabetes is very slowly inching toward a low-carb diet, but for Type 1, it’s not so obvious how that would help – after all, even if you’re eating almost no carbs, you’d still need some insulin because you need it for protein, too. It’s not like Type 2, where lowering carbs can actually treat the underlying problem. Low-carb diets won’t prevent the autoimmune assault on your pancreas or restore normal insulin function, so what’s the point?
That line of reasoning has led to the typical recommendation for Type 1 Diabetes: keep eating a standard “healthy” (high-carb, low-fat) diet but supplement with enough insulin to make up for what your body isn’t producing. As anyone with Type 1 Diabetes can tell you, this requires a constant juggling act of counting carbs and responding with insulin.
It’s true that even a low-carb diet would still require someone with Type 1 to take some insulin, and it’s true that low-carb doesn’t fix the fundamental problem, but actually some evidence shows that it can be helpful. A couple studies (like this one, for example) have shown that lower-carb diets with a matching reduction in insulin dosage can improve glycemic control in Type 1 diabetics (at least, as long as people stick with them). This makes a lot of intuitive sense: without as many carbs in the diet, the range of potential blood sugar spikes isn’t as high, and there’s a lot less seesawing around.
Paleo tends to be lower in carbs than a typical “healthy” diet even if you aren’t intentionally restricting safe Paleo starches like potatoes and sweet potatoes. So in that respect, it might be helpful, if it’s coupled with an adjustment in insulin to match the reduction in carbs. Of course, you could also try for a high-carb, low-fat version of Paleo (you'd have to really like potatoes, but it would be doable), if that's what works for you.
Paleo and Type 1 Diabetes: Other Interesting Aspects
Autoimmunity and Gluten
One of the most interesting aspects of Type 1 Diabetes from a Paleo perspective is the Celiac connection. Celiac disease is between 5 and 10 times as common in people with Type 1 Diabetes as it is in the general population. And most Type 1 Diabetics with Celiac Disease are asymptomatic: they don’t get any GI symptoms even though the disease is still damaging their body in other ways (osteoporosis is one big example).
The treatment for Celiac Disease is a gluten-free diet – so could Type 1 Diabetics also see an improvement in their diabetes symptoms from avoiding gluten?
This study reviews the evidence for the T1D-Celiac connection. So far, evidence is inconsistent regarding the effects of a gluten-free diet on diabetes symptoms, but there just hasn’t been a lot of research into it. There are a handful of case studies, and a few larger studies with conflicting results – some show an improvement in blood sugar control with a gluten-free diet, and other show the opposite. The researchers are currently in the middle of a study that should clarify some of that, particularly in people with asymptomatic Celiac Disease.
This is interesting evidence that could potentially support a Paleo diet for people with Type 1 Diabetes (since Paleo eliminates gluten grains along with other grains), but so far, it’s not clear whether or not there’s really a benefit.
Autoimmunity and the Gut Microbiome
Another interesting point is the role of the gut microbiome in Type 1 Diabetes. Gut microbiota may have one answer to the burning question of Type 1: if it isn’t caused by diet and lifestyle, then where does it come from?
Part of it is genetic, but genetics can’t tell the whole story, and especially not the rapidly increasing rate of the disease. This study lays out the case for a strong influence of gut flora on Type 1 Diabetes:
- Gut flora are a very important part of the immune system. Specifically, they control the permeability of the intestinal lining, which is involved in the development of many different autoimmune diseases, including Type 1 Diabetes.
- Many things that affect the gut flora, like method of delivery and use of antibiotics, also affect the risk of developing Type 1 Diabetes. Interestingly, early childhood introduction to grains and cow’s milk may also be a risk factor.
- People with Type 1 Diabetes have measurably different gut flora than healthy controls.
That all points to a role for the gut flora in influencing Type 1 Diabetes. Unfortunately, nobody has actually done a study to see what kinds of probiotics would improve gut health in ways that affected diabetes symptoms. It’s not clear what a “healthy” pattern of gut flora looks like from a diabetes point of view, or what kinds of probiotic therapy would be best for restoring it. It’s interesting to think about – and it’s rarely a bad idea to take simple steps to keep your gut happy – but there’s no evidence for a definitive recommendation like “eat __________, in ________ amount.”
Summing it Up
Paleo is not a miracle cure for Type 1 Diabetes (or anything else, for that matter). None of this is medical advice for treating or preventing diabetes – it’s all just information that you can use or ignore, or discuss with your doctor to see how it might apply to your specific case. But there’s no evidence that Paleo would be unsafe for Type 1 Diabetics, as long as insulin dosage is adjusted accordingly. And there’s some suggestion that eliminating gluten and restoring a healthy pattern of gut flora may be beneficial. Hopefully the surge of interest into the gut flora lately will help fuel more research and possibly even uncover some specific potential foods or supplements that might help.