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I want to start out this post by saying that I have the utmost respect for Robb Wolf. I have followed his podcast and his blog for over a year now, and his book “The Paleo Solution” has inspired me to look further into the Paleo lifestyle.

The Sugary Elephant in the Room
I came across a post a while back about a type 1 diabetic who found a new level of control by adopting the Paleo lifestyle. I think that’s great – but something caught my eye:

I’ve used only 10-12 units of insulin in 30 days versus a MINIMUM of 360 units (based on a minimum of 4 units per meal x 3 meals a day=12 units per day x 30). This is incredible writing down as I hadn’t quite done this math yet. 10-12 units of insulin in a month is unheard of! I’ve contacted my nutritionist and doctor, both of who I’ll see in August, during month three of paleo. In the meantime, my nutritionist suggested incorporating dairy for calcium, which is not something I am interested in doing.
I have had around 10 highs and one low in a month (high of 220 and lowest at 69). During our honeymoon, I was having high sugar readings almost every other day and during the 8 years of being a diabetic, highs were always lingering because matching insulin to food has been the worst guessing game I’ve ever played!

I’ve derived great pleasure from not having to poke myself every day and plan on keeping it that way.

Normally I would just leave it alone… chalk it up to another person misunderstanding the role of insulin in their treatment regiment. What bothered me is remembering about the other posts on Robb Wolf’s site about T1D management with the Paleo diet.

I Felt Compelled To Help
I left a response to the post:

I caution though - and this is a biggie...

You note that you are type 1, but have you had your C-Peptide tests to check the amount of insulin you actually still make? If you were diagnosed 8 years prior, that suggests you are a LADA diabetic.

The reason I feel compelled to write - you may still be in your honeymoon period. (Not from your actual honeymoon, just your pancreas may still be producing your own insulin.)

I feel this is important, because, the preservation of your pancreatic function is paramount to your life with diabetes. I don't think you are taking enough of your basal insulin to preserve that function. (You stated that you are taking 18 units in a month...)

At first, all may seem well, and great! You don't need that insulin, because of a Paleo diet!

What will happen though is your pancreas will start to burn out what function you have left, and then you will need even more insulin.

I wonder why the nutritionist hasn't alerted your endo to what is going on.

People need to be careful - you too, Robb Wolf - with what you are advertising here. Paleo is NOT a cure for T1 diabetes. There is no cure.

The best Paleo can do is to limit the need for insulin, but again, it's NOT a cure.

This story is like thousands that I have read before; a person is in the honeymoon stage of their diagnosis... they drastically reduce their insulin intake - and WOW! Things are great!

Then they get kicked in the ass with reality. They are a diabetic, and now they need EVEN MORE insulin in order to survive.

The Response
Back the hell up and READ the posts on Type 1 on this site. Search Results
All of them. listen to podcast 89. Get informed before you comment on this.

Now, you obviously do not understand that this honeymoon stage is an opportunity to actually restore pancreatic function. This is possible is the autoimmune reaction that is damaging the pancreatic beta cells is reversed. This paper will provide a primer on this concept:
Tight junctions, intestinal permeability, a... [Ann N Y Acad Sci. 2009] - PubMed - NCBI

Now, if folks do not have any pancreatic function they will still benefit from this type of eating as they will require less insulin and will show better A1c’s and signs of systemic inflammation.

I’m sorry I kickeed you in the balls on this but I’m dead tired of the hand-wringing Type-1 crowd that is “convinced” they cannot do anything to improve their situation. If you want to discuss this further please be articulate with the material I’ve provided. If you want to actually be of help to people, please be articulate with the material I’ve provided.
Oh Dear!
Well, Robb kicked me in the balls, (figuratively speaking of course.)

Robb. I respect everything that you do – but the reality is that diabetes is a degenerative disease. I have listened to all of your podcasts, and I have followed your site for over a year now. I just don’t agree with what you say about diabetes.

As for research – I have done more research than most about my condition. I have read all that I can get my hands on from low-carb, paleo, primal, and what the ADA, CDA, and other various associations have to say.

Here is what your abstract boils down to:

This new theory implies that once the autoimmune process is activated, it is not auto-perpetuating, but rather can be modulated or even reversed by preventing the continuous interplay between genes and environment. Since TJ dysfunction allows this interaction, new therapeutic strategies aimed at re-establishing the intestinal barrier function offer innovative, unexplored approaches for the treatment of these devastating diseases.

The “theory” is that removing the grains from the diet will reverse T1D. That’s great, if that’s the only thing that causes T1D. The reality is that there are multiple reasons a person will go into the autoimmune destruction of pancreatic function. Nowhere does this reference or abstract imply that insulin therapy is to be avoided.

Why is there a “fear” of insulin? Pancreatic function *could* be restored, by giving the pancreas a rest. You do that by putting the patient on insulin. There is nothing new about this – in fact, it is the main recommendation of Dr. Bernstein in his excellent book on diabetes, “The Diabetes Solution.” (Robb, if you have not read this book , it is the BIBLE on diabetes!) Trust me when I say to you that I trust a type 1 diabetic who is also a endocrinologist – who has been there, done that. (And also advocates for the Paleo lifestyle as well.)

I am cautious about advocating a “cure” by diet alone when it comes to T1D. It may work for T2D where a person has the chance to manage it by diet alone.

Let’s look at reality here. When you are in your honeymoon phase, your pancreas reacts to the insulin you introduce to your body by functioning more effectively. It is the calm before the storm. The story with T1D is almost ALWYAYS the same, (especially if they are younger at diagnosis.) They find that their insulin ratios go way down; they get the illusion that they don’t need insulin anymore. They stop taking it, and one day their pancreas burns out.

As for hand-wringing? I’ll tell you one thing – I HAVE been active in my treatment.

I have a healthy skeptical mind. I question everything I read, and I’ll tell you that I was the one that took control of my disease, and that I enjoy pancreatic function 1.5 years later AFTER my diagnosis with a combination of diet and insulin. (The usual length of the honeymoon period is 6 months.) This despite a diagnosis with an A1C of 17.1%, and average blood sugars of 24.4 mmol (440 mg/dl.) I managed to get my A1C down to 5.0% in less than 3 months, and maintain a BG level of 4.9 mmol (less than 90 mg/dL) through the combination of insulin/exercise/diet. And yes, I follow a Paleo/Primal WOE.

I plan to keep my pancreatic function for as long as I can (by giving my pancreas a rest.) If I can, it will be until the end of my days.

Why The Fuss? Why Bother?
The last thing I want to see is another person led down a path that they will end up paying for later. The reality is that Robb Wolf is not the one whose life is on the line. If it ends up that the person loses all pancreatic function at a later date despite the option of preservation through insulin therapy, then it will turn out that the recommendation to manage the condition through diet alone will have been an irresponsible one.

In this case, the lady admits that she doesn’t want to “keep playing the ridiculous guessing game of insulin matching.” That suggests to me that she doesn’t have all the information that she needs to make a clear, conscientious choice.

My goal in that response was to get her to THINK. I find that the first reaction of most newly diagnosed diabetics is knee-jerk; they look to avoiding the insulin therapy altogether. They miss out on the opportunity to help themselves – and are looking for ANYTHING as an alternative.



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What do you think, dear reader?
 

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I think, well, maybe you are both right. I know I had a huge recovery in beta cell function (not regeneration) in the first 6 months after diagnosis in DKA. In fact, I got a type TWO diagnosis.

I think the situation is more complex than either you OR Robb make it. Cooksey ("Diabetes Warrior") claims to have stopped his LADA (though he never had antibody testing.

I on the other hand, have eaten low carb -- 30 -60 g per day, for two years, and it has not stopped anything. I use insulin, anyhow.

And, if you die BEFORE you lose more beta cells, I suppose that you are "cured."

We are all different, we all will progress differently, on our own little roller coaster rides. Some faster, some slower, some smoothly, some with lurches. (I am a lurcher from the looks of things).

There is published somewhere (and I have been looking to find it again for two years!) a wonderful graph, a roller coaster-y line rolling below a threshold, and back up again, many times over a lifetime. It represents beta cell mass. If you think of that as the typical pre-diagnostic life of LADA, it explains a lot -- both "failures," and "miracles."

Better to manage your diabetes judiciously, than to believe in either.
 

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My own opinion, even though I come down much closer to the "paleo" side of the Great Diet Debate than the "vegan" side, is that there are True Believers on both sides. That is why I am predisposed to disregard any dietary studies conducted by a True Believer of either side. I'm pretty sure I have also mentioned in another thread on this forum about how frustrated I get with advocates of any lifestyle saying that their way of eating can "cure" type 2 diabetes. Maybe their miracle diet can make an early-diagnosed diabetic virtually asymptomatic, but type 2 diabetes isn't cured, and anyone who makes such a specious claim should set off your internal "True Believer Alert" siren! YMMV, of course. :)
 

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Very true. A major part of my own personal reasons for coming down more toward the "paleo" side is my unbelievably severe carhohydrate intolerance (which for some reason seems to get much worse during the final four months of the calendar-year), especially with regard to what I eat for breakfast. The very thought of having to eat a vegan breakfast every day quite literally strikes terror into my heart, and not for any sort of ideological reason!
 

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Yes, me, too! Horrible carb intolerance, and a limited diet. Add to that, I never know if I am dealing with insulin deficiency or IR, or what proportion of both.

But I am frequently offended by some of the paleos' snarky attitudes toward vegetarianism. I am a vegetarian, and I AM successfully eating low-carb.

I pop in to read recipes once in a while, but generally avoid their pedantical approach, almost as much as the vegans'! :)
 

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Just curious, do you also have a time of year during which your carbohydrate intolerance seems to become more severe? It just seems weird that I should have such an intense problem with this around autumn the way I do.
 

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Autumn, here, too!

I think your body is trying to hibernate and fatten up for winter!

This year I am experimenting so doing a bit better -- more vegetables, more CO, less dairy. So far, so good! I cut back my basal a bit last night in fact.
 

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And of course, my seasonal situation gives me a great excuse for being so utterly helpless in the face of the temptations of the Winter Holidays (though that will probably have to change should I ever have to go on insulin). It's probably because of those very temptations that the institution of the New Years Resolution was invented! :-D

And your theory about why this seasonal thing happens is the same as mine.

Also, the only thing I snark at these days is doctors who blame everything including the cold you caught last month on one's being overweight!
 

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Naughty doc! Mine (internist) tried to start in on my weight, so I told him everything I had tried. He has not brought it up since! LOL.

You must make the yummy Pumpkin Pie! I use a whole can of coconut milk and a can of pumpkin ... very low carb and distracts one from the other holiday temptations!
 

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Feel free to link, post, or PM me the recipe. :)

In my case, my insulin resistance puts a very definite floor underneath how much weight I can lose. I have lost about 25 pounds since I started treating my condition, but apparently that's not good enough. Plus let's face it, starving yourself simply doesn't work in the long haul, and it the fact that doctors refuse to realize this verifies my suspicion that the whole thing is really just bigotry about how people are supposed to look more than concern about health.

Oh dear, I hope we're not breaking any rules by shooting off on all these tangents! :)
 

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I'd need to dig it out ... but it is pretty classic, almost any pumpkin pie recipe will do if you modify it with Coconut milk (instead of milk or cream), and any almond flour pie crust (altho I do not sweeten mine), and sugar equivalent using about 1/3 c erythritol and 2 TBS splenda syrup ... top with whipped cream!

The Libby's recipe is a place to start.
 

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I have to agree with both outcold and foxl...vegan, paleo, atkins, whatever you decide is right for you is what you should go with. Maybe it is a combination of different diets, but the main component I believe of any diet for a diabetic needs to be LC. I have problems with being extremely sensitive to carbs as well. It stinks, but what are you going to do? If the stove is hot, and you don't want to burn yourself, then you don't touch it right? If you must tempt fate, then you get burned. It is that simple. I am on insulin, and although I do not enjoy poking my body with needles, it is a must right now because I HAVE to give my pancreas a rest. That is the whole reason for using insulin. I still struggle with some highs and few lows, but better than the constant highs I was getting, even when I was not eating many carbs at all. Those who believe that diabetes can be cured are kidding themselves; I do not believe you can "cure" diabetes, or even "reverse" it. I believe you can get yourself to a point where you may not need meds to control, but you will never be able to eat things like a none diabetic. If you get to great control with just diet and exercise, you will have to follow that regimen for the rest of your life. You will never go to a non-diabetic lifestyle, without the risk of the big D rearing its ugly head again. This to me is not a cure or reversal. Great control? Yes. Being able to live as a non-diabetic? No, never again.
That is just my two cents worth. Thanks.
 
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