Is an LCHF diet really a great option for type 1 diabetes? What do people with a lot of experience say?
We were just on the most spectacular trip of the year, the low-carb cruise in the Caribbean. We invited our participating moderators to write guest posts here on the blog. Here’s travel report number three, with important information on type 1 diabetes from our moderator Fredrik Söderlund:
Guest post by Fredrik Söderlund
Type 1 diabetes and LCHF – a great combination
On the cruise I was inspired by both presenters and guests to write a few paragraphs about LCHF and type 1 diabetes. There’s still a fairly common misconception that type 1 diabetics won’t benefit from LCHF or that it may even be dangerous.
One of the presenters was nephrologist Dr. Keith Runyan who himself has lived with type 1 diabetes for 17 years and switched to LCHF three years ago. Today he eats a ketogenic LCHF diet, or LCHFKD.
Among the conference participants were several type 1 diabetics who advocate LCHF; one of them was Hanna Boëthius. She has had the disease for 30 years, since she was 2 years old, and switched to LCHF four years ago. Hanna was convinced of the benefits of the diet when she studied to become a nutrition counselor and now has her own business to help other diabetics worldwide (www.hannaboethius.com.)
Hanna eats a ketogenic LCHF diet with 20–30 g carbohydrates daily and, like Dr. Runyan, she points out the many benefits of the diet that are beneficial for type 1 diabetics. I’m compiling some of the benefits that they both put forward on the cruise, but first some background knowledge.
Type 1 diabetes
Type 1 diabetes is an autoimmune disease that we don’t know how to prevent. The pancreas produces no, or very little, insulin. Insulin is needed to transport glucose from the liver’s production of glucose and from carbohydrates from food into the cells. Thus, insulin must be supplied daily.
The challenge for a type 1 diabetic is to calculate continuously how much insulin needs to be added, usually a basal dose for the entire day and then additional doses associated with each meal. The calculation is sensitive, as very small amounts of carbohydrates, 4 g, may be enough to raise blood sugar by 18 mg/dl (1 mmol/l), while a unit of injected insulin may lower blood sugar by about 36 mg/dl (2 mmol/l) (numbers may vary greatly between individuals.)
High blood sugar and insulin levels will cause damage in the long run to both small and large blood vessels, and a low blood sugar may result in hypoglycemia. This is a serious condition that quickly can lead to unconsciousness. It is estimated that hypoglycemia represents a direct cause of death for 6–10 % of insulin-dependent diabetics which in a scary way underscores the difficulty in calculating how much insulin is needed.
Using LCHF as a treatment
How can an LCHF diet facilitate the treatment of type 1 diabetes (and also insulin-dependent type 2 diabetics)?
First, fat from the food is not converted into glucose, as carbohydrates and even protein are to some extent. LCHF means reducing the amount of carbohydrates in the diet and replacing these with good fats. This significantly reduces the blood-sugar spike from food and thereby the need for added insulin. By working with small amounts of carbohydrates in the diet, the risk of major blood-sugar swings and hypoglycemia caused by incorrectly estimated insulin doses is reduced.
Another factor is that a healthy pancreas secretes an exact amount of insulin that is distributed via the liver into the blood continuously throughout the body. When you inject insulin locally the distribution is significantly more uneven as it’s absorbed and spread differently in the body depending on where, how deep and when in relation to the meal it’s injected. The uptake of injected insulin may vary by about 30 % and constitutes a factor of uncertainty that makes it difficult to make an accurate assessment of insulin requirements. However, if you start with a small amount of carbohydrates the consequences of this uncertainty are reduced. Small amounts of carbohydrates will produce small errors. Large amounts of carbohydrates and insulin will produce large and potentially dangerous errors.
Hanna describes LCHF as an effective tool to facilitate the treatment of diabetes. Blood sugar immediately stabilizes and doesn’t plummet or shoot through the roof as it could do earlier when she estimated incorrectly, as when guessing the amount of carbohydrate in a sauce when eating out. She has chosen to eat a strict LCHF diet, which means that she’s in ketosis most of the time.
The body then uses ketone bodies as its main fuel and doesn’t need to rely entirely on glucose for energy supply to cells. This means that blood sugar won’t fall as quickly as before, which makes it less alarming when you note low blood-sugar levels.
Ketosis sounds scary to many as it’s associated with ketoacidosis, a state of intoxication that occurs if you don’t take your insulin, but Hanna is not concerned. She explains that this can only happen if you’ve been completely without insulin for a couple of hours. If you monitor your blood sugar regularly you don’t have to worry. Thus, ketoacidosis is caused by not taking insulin, not by reducing carbohydrates.
Hanna doesn’t advocate that a ketogenic LCHF diet is best for everyone, it works well with a moderate LCHF and you must find your own level. However, it takes time to adjust to a new diet and for her this meant a lot of additional measurements of blood glucose, adjusting insulin doses and paying attention to trends before she found her sweet spot. She thinks it was well worth the effort and the health benefits are significant with both a lower blood pressure, lower HbA1c and an improved lipid profile. Today, she uses only 20 % of her former insulin dose and feels that her insulin sensitivity has increased gradually on LCHF.
Hanna currently has more energy, zest for life and knows that the disease no longer controls her life, and I can attest that both she and Dr. Runyan beamed up with the sun in the Caribbean!
Thank you for the third cruise report, Fredrik! More coming up.
With insulin-treated diabetes it’s important to monitor your blood sugar closely initially when starting an LCHF diet! A diet including few carbohydrates usually causes a greatly reduced need for insulin. It’s then important to adjust (lower) the doses sufficiently to prevent blood sugar from dropping too low. This should, if possible, be done with the support of your physician or diabetes nurse, especially if you have limited experience of insulin adjustment yourself.
You also need to be diligent about closely checking your blood sugar in the event of an acute illness, please see Type 1 Diabetes.