In type 1 diabetes, people often say that people with diabetes can eat anything. Research and case studies show that the proper diet can help control blood glucose levels much better. Using examples, field reports and case studies, we present diets that significantly improve blood glucose control in type 1 diabetes and, as a result, stabilize blood glucose levels in some cases to the point where the patient no longer needs insulin.
Nutrition in type 1 diabetes
Diabetes type 1 is an autoimmune disease that leads to the destruction of the pancreas’ insulin-producing cells and thus to an insulin deficiency. In diabetes type 1, the treatment concept is based on at least five pillars:
- Administering insulin
- Correct diet
- Individualized nutritional supplements
- Restructuring of the intestinal flora
- Physical activity
In this article of Gazettely, we will look at what diet is suitable for diabetes type 1. Stay tuned.
If you already have diabetes and plan to change your diet, do this in consultation with your physician/diabetologist and have your levels monitored closely for the first few months.
Which goals should the optimal diet for type 1 diabetes achieve?
The optimal diet for type 1 diabetes should achieve the following goals:
- Improved blood glucose control; fewer blood glucose fluctuations (reduce the number of hypo- and hyperglycemias).
- Substantially reduce the risk of typical diabetes complications and sequelae (kidney, eye, and nerve damage)
- Reduce the risk of the most frequent causes of death in type 1 diabetes (in addition to hypo- and hyperglycemia, these include cardiovascular disease)
- Regulating the intestinal flora, as this is regularly disturbed in people with type 1 diabetes (dysbiosis).
- Avoid excess weight, which would otherwise increase the risk of additional type 2 diabetes and other metabolic diseases.
You can achieve these objectives with the help of very different forms of nutrition, from which one chooses the one that is closest to one’s own philosophy and personal tolerances, dispositions and taste preferences. In our view (editorship center of the health), it would be beautiful if ethical aspects would play a role ever more frequently.
The following can be considered good diet for type 1 diabetes
Since insulin is required for the proper digestion of carbohydrates, but this insulin is missing in type 1 diabetes or is available in ever-decreasing amounts, it seems only logical to simply eat low carbs, that is, to consume as few carbohydrates as possible.
For many people, the low carb diet (depending on how it is implemented) can actually be very helpful in controlling blood sugar levels. Other type 1 diabetics, on the other hand, cope better with the other extreme, namely with a diet rich in carbohydrates.
Again, of course, the quality of the carbohydrates is essential. Experience reports also show that a diet with a strong emphasis on raw foods can also be a solution for type 1 diabetes.
Using examples, studies and case studies, we present four dietary models for type 1 diabetes in the following:
- The plant-based diet
It includes plenty of carbohydrates in the form of fresh fruits, vegetables, potatoes, legumes, and whole grains. Still, it is free of sweetened beverages, white flour products (bread, cakes, pastries, pasta), and industrial sugars (and other sweeteners with high glycemic loads).
This diet may or may not be 100 percent vegan. There are many exclusively plant-based, wholesome and healthy meals. You will now find more than 1500 recipes that you can enjoy as a person with diabetes.
- The raw food diet
You eat a large part of the food in raw food quality, especially, of course, vegetables, salads, nuts, oil seeds and sprouts. The raw food diet is more varied than one might think. Thus, there are also cakes, bread, pizza, soups, and much more in the culinary form of raw food nutrition.
- The Low Carb diet
Which contains as few carbohydrates as possible, avoiding sugar and white flour and largely avoiding the carbohydrate sources considered healthy in the whole food diet (fruits, starchy vegetables, and whole grains).
In general, moderately low carb diets can contain up to 150 g of carbohydrates. A more extreme low carb form is often practiced in diabetes: a ketogenic diet, where you eat no more than 30 to a maximum of 50 g of carbohydrates a day (in the form of leafy greens and a few berries).
- The gluten-free diet
As the name suggests, it is free of gluten, which is the protein complex found in many grains (wheat, spelt, barley, rye, kamut, emmer, etc.). Because no grains are eaten in the ketogenic diet, it is also automatically gluten-free.
Raw food diets are also often gluten-free but can be practiced with gluten (e.g., air-dried bread made from sprouted grains). Plant-based/vegan diets usually contain gluten in the form of whole-grain products but can easily be made gluten-free.
Plant-based diet for type 1 diabetes
Researchers from the Physicians Committee for Responsible Medicine (PCRM) published two case studies in the Journal of Diabetes & Metabolism in July 2020 that showed how well a whole-grain, vegetable-based diet improved typical diabetes type 1 markers.
PCRM is a nonprofit organization with a membership list of 12,000 physicians and approximately 130,000 nonphysicians.
Patients in both case studies changed their diets to a plant-based diet rich in whole complex carbohydrates, including fruits, vegetables, whole grains, and legumes.
First case study
In the first case study, the patient had a type 2 diagnosis in 2004 at age 17 and subsequently received oral antidiabetic medications (blood glucose medications to be taken by mouth). From November 2017 to February 2018, HER HbA1c level increased from 5.4 to 8.7 percent. (In healthy people, the level is less than 6.0 percent).
Anti-body tests suddenly revealed type 1 diabetes. Immediately, patients were given insulin. To get her blood sugar levels under better control, she changed her diet to a ketogenic diet – consisting of lots of fat and less than 30 g of carbohydrates per day.
Her staple foods were meat, full-fat dairy products, eggs, avocados, mushrooms and leafy green vegetables. She avoided fruits and starchy vegetables completely.
While her blood sugar levels stabilized as a result (her HbA1c dropped to 5.6 percent), she required more insulin per gram of carbohydrate. In contrast, her cholesterol levels rose from 175 to 221 mg/dl within a few months.
She switched her diet to a plant-based, or in this case vegan, one in January 2019 and eliminated dairy, egg, and meats from her diet. Initially, repeated episodes of hypoglycemia occurred because insulin action was stronger on the new diet.
As a result, patients were able to reduce their insulin dose noticeably. If previously on a ketogenic diet with 1 unit of insulin, she could reduce her blood glucose level by 43 mg/dl; now, with 1 unit of insulin, it was 64 mg/dl. She also saw her HbA1c drop to 5.4 percent and her cholesterol level drop to 158 mg/dl.
Second case study
In the second case study, the subject was a 42-year-old man who had had type 1 diabetes since he was 25 years old. He had taken care not to consume too many carbohydrates at all times. His diet contained about 150 g of carbohydrates per day, corresponding to a moderately low carb diet. (A conventional diet provides about 300 g of carbohydrates at 2500 kcal per day).
Then he changed his diet to a fully vegan diet because he hoped it would improve his general condition. He cut out all animal foods from his diet, along with all convenience foods, and increased his carbohydrate intake to 400 to 450 g per day – in the form of fresh fruits, vegetables, and whole grains.
During the first few weeks, Mr K. experienced several episodes of hypoglycemia, indicating that he was apparently injecting too much insulin. He subsequently reduced his daily insulin dose from 50 to 60 units previously to just 26 units.
He then lost weight (from 95 to 90 kg) and reduced his HbA1c level from 6.2 to 5.5 to 5.8 percent. For two years, weight, Insulin requirements and HbA1c levels have been stable on this diet.
Whole-food diet facilitates blood glucose control
An earlier small study with 10 people with type 1 diabetes had already shown exciting results. Two groups were involved:
- Group 1 ate high carbohydrate (70 percent carbohydrate) but whole food and high fiber (70 g fiber daily).
- Group 2 ate fewer carbohydrates (39 percent carbohydrates. By comparison, the nutrition societies recommend 50 percent, and low carb would be 15 to 30 percent, while ketogenic means 5 to 10 percent carbohydrates).
At four weeks, compared with group 2, the high-carb group had decreased insulin requirements and blood lipid levels.
Randomized clinical trials on this topic would now need to be conducted – PCRM’s authors said – to determine whether the positive results of the individual case studies can be extrapolated to studies with larger numbers of participants.
“We’ve known for decades that a plant-based diet is helpful for type 2 diabetes. Now it seems that the same diet is also an important measure in type 1 diabetes,” the scientists wrote.
Can a vegan diet be used for children with type 1 diabetes?
As type 1 diabetes often occurs in childhood, it must, of course, be examined whether the diets mentioned above can also be implemented in children, as it is not only a matter of good blood glucose control, but also that the children are supplied with all the nutrients necessary for growth and development.
An article on vegetarianism in children with type 1 diabetes appeared in the journal Metabolism Open in 2021. The two researchers from the University of Rome conclude that not only a vegetarian but also a vegan diet can be practiced in children with type 1 diabetes – provided that some nutrients are supplemented, for example, omega-3 fatty acids, iron, zinc, vitamin B12 and possibly calcium (depending on how exactly the individual diet is implemented).
After all, a lack of omega-3 fatty acids or vitamin B12, in particular, could lead to damage to the brain, mainly as type 1 diabetic children are particularly susceptible in this respect due to their blood sugar fluctuations.
Nutritional supplements, though, are beneficial for many normal-eating children as well. Just because a child gets meat and dairy products do not automatically mean that they are getting a healthy diet and is supplied with all the nutrients and vital substances. Quite the opposite.
Here, deficiencies can also occur, just those deficiencies that go hand in hand with low consumption of fruits and vegetables, such as a lack of fiber, carotenoids, folic acid, vitamin C, vitamin E and magnesium.
All of these vital substances have a very positive effect on chronic diseases and also on blood sugar levels – and they are precisely those vital substances with which, again, children who eat plant-based foods are very well supplied.
Which carbohydrates do children with type 1 diabetes need?
Since plant-based diets are automatically usually high in carbohydrates, concerns about diabetes often prevail. But suppose you pay attention to those with a low or medium glycemic load when choosing carbohydrates. In that case, blood sugar control will not be difficult.
The glycemic load (GL) is a value that indicates the impact of a food on blood glucose levels. Lower the value, better.
Below you will find our list with a selection of foods and their glycemic load. As you can see, these are particularly the foods known to be healthy, which do contain carbohydrates but nevertheless do not put excessive strain on blood sugar levels: Fruits, vegetables, nuts, potatoes, and starchy vegetables (carrots, parsnips, etc.).
However, wholemeal bread, wholemeal pasta, brown rice, quinoa, and millet have a higher glycemic load, so they should always be eaten only as a side dish with vegetables. Because the vegetables then lower the GL of the carbohydrate-rich side dish.
It all depends on what bread and rolls you eat with baked goods. Pure flour bread and rolls have a higher GL than breads containing nuts, sunchokes, Chia seeds, flax seeds or even psyllium husk powder or, if you wish, protein powder, like our alkaline bread. Because the fats and fiber of the above ingredients prevent a drastic rise in blood sugar levels.
The following factors influence the blood glucose level after a meal
How blood glucose levels behave after a meal (postprandial blood glucose) is dependent on the following factors, some of which can’t all be directly influenced, but some of which can:
- The glycemic load of the meal
- Fiber and fat content of the meal
- Meal preparation ( for example, don’t eat freshly cooked and still hot potatoes and noodles, let them cool down and – if you do not want to eat them cold – reheat them briefly; always cook noodles only al dente)
- order of eating (eat vegetables before carbohydrates, then the blood sugar does not rise so much)
- the intestinal flora of the respective person (food rich in vegetables and fiber improves the intestinal flora)
- insulin sensitivity (how well the cells respond to insulin; the insulin sensitivity worsens with obesity)
Raw food diet for type 1 diabetes
A person with type 1 diabetes named Matt shares on his blog how he used a plant-based diet to rid himself of his Type 1 diabetes. Mat – married with two children – had his type 1 diagnosis in January 2014 when he was in his mid-thirties. His father also has type 1 diabetes. At the time of diagnosis, Matt’s fasting blood glucose was 300 mg/dl (normal is 100 and below), while his HbA1c was 8.4 percent (normal is below 6.0).
His physicians prescribed insulin. However, Matt wanted to try other ways first. Matt’s brother-in-law then recommended a nutritionist specializing in diabetics. He had a reputation for helping his clients go for years (10 years plus) without medication.
Mat sought out the promising nutritionist and changed his diet over the next few weeks. Initially, he eliminated all sugared foods, eliminated bread, pasta, cereals and soft drinks from his diet, and ate relatively many animal products.
Quickly, he reached a safe fasting blood sugar between 90 and 115 mg/dl. But his endocrinologist said that if the level rose above 140 mg/dl for three consecutive days, he would need to start using insulin.
That same October, though, is when his fasting blood sugar began to rise, hitting levels between 120 and 140 mg/dl. Matt began to search feverishly for a solution because he didn’t want to take medication, so he didn’t want to inject insulin. Matt then came across information about a predominantly raw-food vegan diet, which was said to have “cured” type 1 diabetes in some cases.
That was a whole new world for him. After doing further research, in November 2014, he tried this form of diet for two weeks. Blood glucose levels dropped below 100 mg/dl. Delighted by this result, he continued with it and wrote more than a year later – December 2015 – he was still without any medication.
He had thus exceeded the prophecies of his doctors (needing insulin after 16 months at the latest) by quite a few months.
As time went on, blood sugar leveled off at an average of 107 and HbA1c at 5.6. Matt continued to eat a plant-based diet, but not purely vegan. Eighty-five percent of his diet consisted of low-glycemic-load vegetables, nuts, and seeds-most of it raw, i.e., uncooked.
He wrote an update in 2019 with the info that he was still getting by – now for 6 years – with no medication and no insulin injections. He said his HbA1c was still within range, namely 5.8, and that he was still eating a predominantly raw food diet.
Matt put in a week of 100 percent raw food in 2020. He was able to lower his fasting blood sugar to 80-90 mg/dl – an experiment to see how the raw food-only diet affected blood sugar levels.
He concluded, “Whatever is said about type 1 diabetes, hope exists, and thus opportunities exist to extend the insulin-free phase significantly.
Ketogenic diet in type 1 diabetes
When there was no insulin, Type 1 diabetics were put on a ketogenic diet and could prolong their lives this way.
This is how the ketogenic diet works
Criteria for a therapeutically effective ketogenic diet are as follows:
- 75%-90% of daily calories are consumed in the form of high-quality fats
- Protein is consumed as needed (1 – 2 g per kilogram of body weight) – not too many animal protein sources (possibly choose a predominantly vegan ketogenic diet)
- 5 – 10 percent of daily calories (max. 50 g) may be carbohydrates. This permitted amount of carbohydrates are eaten in the form of low-starch vegetables (so do not eat potatoes, carrots and parsnips, and, obviously, do not polish off the entire daily amount of carbohydrates in a single roll, but rather in the form of leafy greens, cabbage vegetables and fruiting vegetables (tomatoes, cucumbers, zucchini, eggplant, etc.).
- Little salt
- Enough dietary fiber (at least 30 g)
Grams refer to the specific nutrient, and not to the particular food. Example: Raspberries contain about 5 g of carbohydrates per 100 g. Thus, one counts the 5 g, not the 100 g.
Meat and type 1 diabetes
Meat is an important component of most ketogenic diets (exception: vegan ketogenic diet), which may positively affect diabetes.
But when meat is eaten as part of the standard Western diet, it seems to hurt the risk of developing type 1 diabetes.
A 2013 study of nearly 300 children between the ages of 0 and 15 (half had type 1 diabetes) found that a diet rich in meat eaten by the mother during pregnancy and breastfeeding significantly increased the risk of diabetes in the child. No other foods were found to be associated with diabetes except meat.
In a ketogenic diet, ketosis is the goal. Kinetosis is that metabolic state into which the body inevitably enters when it no longer receives carbohydrates, or barely any. It now can only use fats for energy instead of sugar. Fat burning produces ketone bodies, which most of the body’s cells can use as an energy source instead of sugar.
This works only if really very few carbohydrates are eaten (and at the same time a lot of fat). Suppose you would eat plenty of both, as is often the case in the typical Western diet, usually also eating a lot of salt and little fiber. In that case, this does not lead to ketosis.
Rather, this kind of diet damages the intestinal flora so that now even autoimmune processes can be triggered, something you want to avoid at all costs if you already have such a disease or are genetically predisposed to it.
On the other hand, a diet rich in fat without excess salt and with only a few carbohydrates can protect against autoimmune processes. Therefore, implementing the ketogenic diet CORRECTLY is important.
Ketosis or ketoacidosis?
Do not confuse ketosis with ketoacidosis. Ketoacidosis is a threatening condition in type 1 diabetes that can result from hyperglycemia (excess sugar), i.e., if carbohydrates are eaten but insulin is not present.
Blood glucose levels rise, but the cells still starve because insulin is absent and cannot get the sugar into the cells; fat is now broken down to supply the cells with ketone bodies, and fat breakdown is excessively rapid so that too many ketone bodies are produced, the blood becomes acidic (because ketone bodies are acidic). The patient may fall into a coma.
- Ketoacidosis: The concentration of ketone bodies rises to more than 3.0 mmol/l. Simultaneously, blood glucose level reaches values of 250 mg/dl and much more.
- Ketosis: the concentration of ketone bodies remains between 1.0 and 3.0 mmol/l. Blood glucose levels remain within an unremarkable range: max. 100 mg/dl in fasting state.
Nevertheless, it is possible that the fasting blood glucose is also slightly above 100 mg/dl in the morning during the ketogenic diet, then drops during the course of the day.
This increased fasting blood glucose is considered normal on the ketogenic diet. It indicates that the body can produce enough glucose on its own so that the person can start the day fresh and full of energy in the morning.
During the dietary change to a ketogenic diet, a ketone measurement should take place closely (in consultation with the doctor), to be able to take countermeasures in good time in the event of derailments and until the body has become accustomed to the diet and has found its balance.
Ketogenic diet studies and case reports
There have been numerous small studies on the ketogenic diet connected with type 1 diabetes and individual case reports published in scientific journals.
Improved blood glucose levels with a ketogenic diet.
In 2019, Nutrients published a report that management of type 1 diabetes remains suboptimal because blood glucose often cannot be well controlled. Therefore, diets low in carbohydrates would benefit type 1 diabetics, specifically less blood glucose fluctuations and lower HbA1c (long-term glucose) levels.
A small 2016 study enrolled 10 type 1 diabetics. Half were told to eat normally and without restriction (an average of 200 g of carbohydrates per day), and the other half were told to eat a maximum of 75 g of carbohydrates per day.
At the end of 12 weeks, the low carb group had lower HbA1C levels and also needed less insulin. Although weight loss did occur, this was not significant. Nor were there any changes in blood glucose fluctuations.
Another study of 11 type 1 diabetics on a ketogenic diet (less than 55 g of carbohydrate per day) obtained good HbA1c levels, and blood glucose fluctuations also improved. Blood lipid levels, though, deteriorated and hypoglycemic episodes occurred more frequently.
Six children fed a low carb diet because of their type 1 diabetes experienced growth disturbances (because too little calcium and vitamins were consumed), fatigue, constant hunger, and blood values that indicated an increased cardiovascular risk. Complaints were reported to have improved when carbohydrate intake was increased and, for one child, when he was returned to milk.
Blood lipid levels often rise on a ketogenic diet (triglycerides and cholesterol levels), and sufferers are then given cholesterol-lowering drugs). One alternative here would be to have the particle size of the cholesterol determined (the subfractions).
If the cholesterol has large particles, the cardiovascular risk is significantly lower than for cholesterol with very small and dense particles. Higher values of less risky cholesterol are not so problematic and may not require medication.
First case study
A case report about a 19-year-old newly diagnosed type 1 diabetic appeared in the International Journal of Case Reports and Images in October 2014. He was prescribed insulin immediately after diagnosis. Twenty days later, he switched his diet to a ketogenic Paleo diet, which led to him being able to wean off insulin.
When he consistently followed this diet’s guidelines, blood glucose levels remained in the normal range. His physicians noticed a threefold increase in C-peptide levels.
The C-peptide is produced simultaneously with insulin in the pancreas. On the other hand, insulin cannot be measured well in the blood, whereas C-peptide can. Thus, the C-peptide level helps to assess how much insulin the pancreas can still produce.
Therefore, if C-peptide levels rise sharply within 2 months, this indicates that something (in this case, the ketogenic diet) has been able to stop or even reverse the autoimmune process initially.
So, apparently, the pancreas of the 19-year-old had resumed insulin production. When the report was written, this patient had been on a ketogenic diet for 6.5 months. At that time, s/he was free of symptoms and experienced no side effects to date.
Second case study
A case report of a 9-year-old type 1 diabetic child appeared in January 2016, and thanks to a ketogenic diet without insulin injections, the child achieved healthy blood glucose levels without hypo- or hyperglycemia. This new diet also improved the boy’s general well-being. He became fitter, his vulnerability to infections decreased, and his skin eczema improved.
This boy eats only meat, animal fat, eggs, and offal with a fat-to-protein ratio of 2:1. He eats only beef and pork. It eats neither fruits nor vegetables, also no vegetable oils and no sweeteners. He is allowed to eat only some honey.
Diet was changed within 5 days, and the child eats only when he is hungry, which mostly amounts to three meals a day.
This child was scientifically observed for 19 months before his report was published. During these 19 months, there was no change in his condition. Thus, the boy did not need insulin during that time and felt fine.
Healing or honeymoon?
It is emphasized, though, that it is impossible to know whether the child was simply in the honeymoon stage and would therefore need insulin again at some point after all.
The honeymoon phase can last for months (usually 6 to 15 months), in rare cases, even years. The honeymoon phase refers to when people with type 1 diabetes suddenly seem to be healthy again and temporarily do not need insulin.
Often this is the case when type 1 diabetics have been treated with insulin for a few weeks after diagnosis. The pancreas seems to recover to some extent as a result and produces sufficient insulin again. However, eventually, the number of insulin-producing beta cells in the pancreas decreases to such an extent that insulin is needed again after all.
This autoimmune process would have to be stopped. Only then new beta cells could possibly form in the pancreas and start producing insulin again. The above reports suggest that this could be possible.
Gluten-free diet in type 1 diabetes
Some people do not tolerate gluten – a protein complex found in various grains – well. In the case of celiac disease – another autoimmune disease – the consumption of gluten leads to massive symptoms.
As the autoimmune processes of the two autoimmune diseases – celiac disease and type 1 diabetes – show similarities, celiac disease can also be observed significantly more frequently in type 1 diabetes than in the rest of the population. As many as 19.7 percent of people with type 1 diabetes have celiac disease, whereas, in the normal population, the figure is only 1 percent.
Since celiac disease in some cases shows no clear but rather unspecific symptoms, one often does not think of celiac disease and blames the malaise on diabetes or possible secondary diseases, for example, neuropathy.
Forty-eight per cent of people with type 1 diabetes are said to suffer from gastrointestinal disorders for more than 5 years before the celiac disease is finally found to be the cause of their symptoms.
Especially patients who do not develop type 1 diabetes until adulthood also have celiac disease. A study from 2013 states that 42 percent of those who do not develop type 1 diabetes until adulthood also develop the celiac disease within 10 years of their diabetes diagnosis.
Therefore, it is well worth trying a gluten-free diet if you have diabetes and see how your condition changes.
As far as children with type 1 diabetes are concerned, a significant study from Norway involving over 86,000 children was published in March 2020. This study found that the expectant mother’s gluten consumption during pregnancy had no effect on the child’s risk of diabetes but that a higher gluten consumption by the child at an early age increased the risk.
In this context, it is interesting to note that both the ketogenic diet and mostly the raw food diet are gluten-free, so these diets could also positively affect diabetes.
Also, so even if you are eating a plant-based (vegan) diet, you might be able to make that dietary pattern gluten-free. A gluten-free diet is easier than you might think; it tastes great, and it hardly involves any sacrifice after a transition period.
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Conclusion: Proper nutrition for type 1 diabetes helps enormously!
Type 1 diabetes can be influenced enormously by diet. So a change in diet is worthwhile – regardless of whether you try a vegan diet, raw food diet or a ketogenic diet. Mixed forms are, of course, also conceivable, for example, a vegan ketogenic diet.