2

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Type I diabetes

Answered on August 19, 2014
Created March 29, 2012 at 5:27 PM

My 20 yr-old son has had Type I diabetes since he was 14. Ketosis is a dangerous physical state for him. I'm still reading more on the diet, but does it recommend (as did Atkins) to be in a state of ketosis or not. I don't think this is safe for an insulin dependent diabetic and I'm not too keen on it for anyone. Seems like enough fruits and veggies would help avoid this?

Db4ad76f6f307a6f577e175710049172

(2297)

on March 30, 2012
at 07:03 AM

Glad I could help. For me, if I ever became diabetic, type I or II, I#d pretty much go keto right away. To me it makes sense that if the body can't control blood sugar from carbs effectively, then it would be best to just avoid them. But that's me.

53ba4017f8db7f5ebe4af165a3acda93

(30)

on March 30, 2012
at 12:53 AM

Thanks, Samantha, sounds like we both got positive answers from reliable sources. I would be interested in more information from you. I'm on Twitter (@eSCKWID), so if you follow me and I follow you back I can DM you my email address.

53ba4017f8db7f5ebe4af165a3acda93

(30)

on March 30, 2012
at 12:51 AM

Made the call to endocrinologist, read up some more, looks like mild ketosis (as from a ketogenic diet) hasn't turned up any serious problems for Type 1 diabetes, so I will definitely give this serious consideration for my son. Thanks for all the responses!

53ba4017f8db7f5ebe4af165a3acda93

(30)

on March 30, 2012
at 12:44 AM

I have a BSc degree in dietetics & MSc in bio, I know the difference between ketosis and ketoacidosis. Ketoacidosis results from severe uncontrolled ketosis & my son spent four days in the ICU because of it when his stupid PMP was ignoring me about suspecting he was diabetic.He still has to monitor his ketones as well as glucose. I will check out Bernstein's book and also speak to his endocrinologist from when we lived in Boston (before retirement, he was head of Endocrinology Dept. at Harvard Medical School) to find out if he knows of any research on this diet and Type I's.

145d4b0f988af15acc6b26eccc1f4895

(1932)

on March 29, 2012
at 06:51 PM

Yes it's all about the difference between ketosis and ketoacidosis. NOT the same thing! Get the definition of these conditions clear, eSCKWID, and you will see the difference. (But you are totally correct to be concerned until you understand it, as Type 1 is not something to play with!)

A968087cc1dd66d480749c02e4619ef4

(20436)

on March 29, 2012
at 05:53 PM

Ditto on the Bernstein book. He's low carb, but not paleo. Paleo does not specify macronutrient ratios - it can be low, moderate or high carb, depending on a person's needs or goals. Paleo is really about eating wholesome, nutritious food. But it's probably better for a T1 diabetic to lower carbs to a point where less insulin is required. Insulin is a powerful hormone that has both positive and negative effects.

3aea514b680d01bfd7573d74517946a7

(11996)

on March 29, 2012
at 05:45 PM

If you haven't read it, Dr. Bernstein's book is terrific. He's a Type I and has controlled his diabetes for years using a low-carb keto approach. Certainly you want to watch out for ketoacidosis, and constant monitoring is a must. http://www.diabetes-book.com/

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6 Answers

3
05ba9ff83ed938fe751764aae9d84eff

on March 29, 2012
at 07:14 PM

Hi! My name's Samantha, I'm 22 and I've had Type 1 diabetes for 18 years. When I first found out about Paleo/Primal nutrition about 2 years ago, I was intrigued. After doing a lot of research, reading many books, and even speaking directly with Robb Wolfe, I decided to try it. I immediately saw great results. My a1c went from mid-9's to a 7.0. I effortlessly lost nearly 30 lbs (put on after years of being a collegiate rower and eating tons of carbs each day). While my body was first adjusting to this vast change in dietary habits, I was producing ketones, although my bg's were always below 200 (and often 80-140). My Endocrinologist (Director of Endocrinology at Georgetown University Hospital) agreed that this was a safe and natural process. (He was wary of the lack of grains in my diet and the high amounts of protein, but I decided to follow the paleo tenets and ended up with great results). As mentioned above, ketosis and ketoacisosis are two very different things (just as Type 1 and Type 2 diabetes are two very different, yet similar-sounding conditions). The biggest challenge for me was determining how much insulin to take for very low-carb, high fat/protein meals!

If you or your son would like to speak further, I'd be happy to give you my email address and/or recommend some resources. I've done a lot of community outreach/counseling through JDRF, so I'd gladly discuss. I wish I had more resources for T1's when I first started Paleo!

53ba4017f8db7f5ebe4af165a3acda93

(30)

on March 30, 2012
at 12:53 AM

Thanks, Samantha, sounds like we both got positive answers from reliable sources. I would be interested in more information from you. I'm on Twitter (@eSCKWID), so if you follow me and I follow you back I can DM you my email address.

3
Db4ad76f6f307a6f577e175710049172

on March 29, 2012
at 06:11 PM

I think you might have a misconception involving the different types of ketosis. For Type I diabetics, there is the danger of ketoacidosis, which is what happens when the body produces ketone bodies because it thinks there is a low blood glucose due to the lack of insulin, with the excess ketones acidifing the blood. What paleo people talk about here is ketosis, where the body uses ketones for fuel, which is perfectly normal, and safe. Often ketosis is referred to "keto".

I've read some success stories of people doing "primal" and/or paleo while having type I. I did a quick google search, and got some results. What is interesting, is that the type I diabetics eat a lower carb diet, even going into ketosis, and since they keep their blood glucose lower by not eating a lot of carbohydrates, they don't run into trouble with ketoacidosis.

Edit:
Reading the first hit on the google search, you can scroll down to see the amount of carbs he was eating, with him eventually eating below 100, which would mean he would be getting into ketosis, or very close to it.

145d4b0f988af15acc6b26eccc1f4895

(1932)

on March 29, 2012
at 06:51 PM

Yes it's all about the difference between ketosis and ketoacidosis. NOT the same thing! Get the definition of these conditions clear, eSCKWID, and you will see the difference. (But you are totally correct to be concerned until you understand it, as Type 1 is not something to play with!)

Db4ad76f6f307a6f577e175710049172

(2297)

on March 30, 2012
at 07:03 AM

Glad I could help. For me, if I ever became diabetic, type I or II, I#d pretty much go keto right away. To me it makes sense that if the body can't control blood sugar from carbs effectively, then it would be best to just avoid them. But that's me.

53ba4017f8db7f5ebe4af165a3acda93

(30)

on March 30, 2012
at 12:44 AM

I have a BSc degree in dietetics & MSc in bio, I know the difference between ketosis and ketoacidosis. Ketoacidosis results from severe uncontrolled ketosis & my son spent four days in the ICU because of it when his stupid PMP was ignoring me about suspecting he was diabetic.He still has to monitor his ketones as well as glucose. I will check out Bernstein's book and also speak to his endocrinologist from when we lived in Boston (before retirement, he was head of Endocrinology Dept. at Harvard Medical School) to find out if he knows of any research on this diet and Type I's.

53ba4017f8db7f5ebe4af165a3acda93

(30)

on March 30, 2012
at 12:51 AM

Made the call to endocrinologist, read up some more, looks like mild ketosis (as from a ketogenic diet) hasn't turned up any serious problems for Type 1 diabetes, so I will definitely give this serious consideration for my son. Thanks for all the responses!

1
C6fa4a50f9eb757bb0148c79881b519f

on April 10, 2012
at 12:47 AM

The real danger in Ketoacidosis is the insanely high glucose levels, not the ketones. The glucose can kill you - whether or not you're burning ketones.

In a low carb induced ketosis, with normal blood glucose levels, there's no issue - whether it's paleo-low-carb or Bernstein or Atkins...

You can get too many carbs [too many for you, that is] eating a paleo diet, if you focus on higher carb items (fruit, anyone).

For diabetics (T1 or 2), the best diet is low carb - any low carb. [yes, I'm bold enough to say that on a paleo website] This way of eating introduces less glucose into the bloodstream, and therefore requires less correcting (insulin, metformin, etc...).

By adding paleo to low carb -- you get double benefits.

Add exercise... Many (most?) T2's can reverse the disease and complications entirely. Many while reducing or eliminating medications! They don't have a metformin deficency!

For T1's it's a little more complicated, as by definition, they don't produce insulin, should require MUCH LESS insulin -- and reverse many of the related effects (heart disease, high cholesterol/triglycerides, kidney damage, etc)... You have to read Bernstein and the law of small numbers.

As much as I love what I remember about a snickers bar (or even high sugar fruits)... how I feel for a week after is just not worth it - and neither are the long term health effects of eating regularly [too much for me, that is... ymmv].

0
3a022ca837d33625fb9f8666f258260e

on December 09, 2013
at 11:35 AM

spam post removed [edit by Matt 11]

0
3f36e4dc3db4fb0b7aa6085e35f26ecb

on September 20, 2013
at 06:33 PM

@eSCKWID I'd like to get involved with this discussion as well. I am a type I diabetic (although only for a year - LADA), and have been fine tuning my ketogenic diet over the past 7 months. First and foremost - this is a pretty complicated situation, but complicated doesn't mean impossible. I've done a lot of reading and listening to podcasts looking for info on this. I'm very grateful for the whole paleo community for challenging the conventional wisdom - and just like there are many flavors of paleo, there are many flavors of people. And I'm sure that not every type I diabetic's experiences would be the same. I became diabetic at 34 years at a point where I was in very good physical shape as an endurance athlete - that difference alone probably gives me an advantage. But I see many benefits to the diet.

My first point is that diabetic ketoacidosis is different than nutritional ketosis. I just started blood testing my ketones and they range from 0.4 - 3.2mM (for the past two weeks). The higher values are on heavy endurance exercise days - also paired with blood glucose levels between 70 and 95mg/dL. DKA on the other hand occurs when ketone levels are 15-20mM with blood glucose levels >250mg/dL usually resulting from the absence of insulin. I use an insulin pump which allows me to fine tune my insulin to a high degree, which as a highly insulin sensitive athlete is very important. I have to be very careful every time I try a new activity to try to fine the right balance of insulin to balance new demands best. However, there seems to be a much greater stability and ability of my body to remain stable (and perhaps I'm still being hypervigilant over BG values). On a typical day I'm usually 70-110.

My diet which is continually being refined has had less than 50g of carb per day. I'm learning that even a high amount of non-starchy greens can subtly affect me, I've also been learning that now that I've been ketoadapted for a longer time, my protein levels need to be kept much lower than most would recommend. Ketoadaptation seems to have a protein sparing effect, and excess protein converts to bloodsugar. The few times I've binged on protein, as in the one time I indulged in an all you can eat Brazilian grill - resulted in many days of elevated bloodsugar, kicking me out of ketosis and destabilizing me for a long time.

Like I said there is a lot to this - but taking the time to explore and learn with hopefully lead to a healthier life in the long run. I've been writing on my blog about my own personal experiences with this - my disclaimer being that these are MY experiences and I am not a doctor, etc. But as I learn hopefully others can also learn. My blog is koryseder.blogspot.com

0
2a0f1afde303eadc422d015fc22f7512

(1118)

on March 29, 2012
at 05:43 PM

I'm not a nutritionist or a doctor but here is my guess...ketosis sometimes happens for paleo folks that are very low carb but you can benefit from paleo lifestyle without being in ketosis. I think that's about 50-100 carbs a day range in the form of veggies and maybe some fruit if you can tolerate it. Whole30 is a fantastic protocol. I'd focus less on ketosis and more on eliminating bad food and finding good food. Here's a great story http://wholefamilystrong.com/2011/11/01/diabetes-praise-report-2/

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