What is Type 1 Diabetes?

Did you know that Type 1 Diabetes, also known as diabetes mellitus, is a chronic autoimmune disease characterized by a deficiency in insulin secretion? Autoimmune diseases are a group of conditions in which our immune system targets and attacks our own body. In the case of Type 1 Diabetes, our body destroys insulin-producing cells (beta cells) in the pancreas. 

Insulin, a hormone created in the pancreas, is released during digestion, and travels through the blood and signals the cells to take up glucose. This means that if you have Type 1 Diabetes, the pancreas does not produce enough insulin to control blood sugar level. As a result, sugar cannot be cleared from the bloodstream, leading to high blood sugar levels. Left untreated, high levels of glucose in the blood can cause excessive urination and dehydration, damage tissues of the body, and ultimately cause severe health issues and even be life threatening.

Type 1 Diabetes Management:  How Diet Can Help

The key to successful Type 1 Diabetes management is to balance when to eat, what to eat and the amount of insulin to take.  This dance helps keep carbohydrate intake and insulin administration in sync. A miscalculation in the estimation of carbohydrate content in meals could result in poor timing of insulin administration and absorption, resulting in complications. For example, if you forget to eat, you can develop dangerous hypoglycemia, low blood sugar levels. On the other hand, if you take too little insulin, or eat too much, you can develop ketoacidosis which can be detrimental to your health. So, finding the optimal interaction between insulin therapy, a healthy diet and exercise is key to Type 1 Diabetes management.

So, what is a healthy diet? What should someone with Type I Diabetes eat? There are numerous competing diets being recommended for people with Type I Diabetes, including a ketogenic diet and a whole-food plant-based diet.

Ketogenic Diet and Type I Diabetes

A ketogenic diet is high in animal-based fat and protein and low in carbohydrates.¹ 

A diet that involves high quantities of animal-based protein and fat can lead to long term chronic conditions,² such as chronic kidney disease,³ insulin resistance, hypertension, high cholesterol, coronary artery disease, and cancer.⁴⁵ So while it has been reported to improve hemoglobin A1c and glycemic variability in some patients with Type 1 Diabetes, the science is showing mixed results, most of the studies or retrospective case reports and series making it difficult to generalize the findings, and data on long-term cardiometabolic effects are limited.⁶⁷⁸⁹

Therefore, while a ketogenic diet may be appropriate for select patients, the adoption of this diet requires thorough discussion between the patient and their healthcare team about the risks and benefits, including the risk of dyslipidemia, diabetic ketoacidosis,¹⁰ and hypoglycemia. Additionally, insulin therapy usually requires adjustments when starting a ketogenic diet, and patients should be closely monitored.

Whole-Food Plant-Based Diet and Type I Diabetes

A whole-food plant-based diet, one rich in vegetables, fruits, legumes, tubers, and grains in their more natural form can help those with Type 1 Diabetes manage the symptoms of the disease.¹¹ Plant-based diets should limit dairy, meat, poultry, and seafood; the bulk of each meal is derived from plants.  

Plant-based diets are gaining in popularity around the world.  In Germany, for example, roughly 4.3–10% of the population are vegetarians and another 1.6% are vegans. In Switzerland, Italy, Austria and the United Kingdom, approximately 9-11% are vegetarians. In the United States, 5% of the population is vegetarian, representing more than 16 million people.¹²

A whole-food plant-based diet is not only rich in antioxidants and full of anti-inflammatory compounds, including carotenoids, folic acid, vitamins C and E, and magnesium, but also:

• Low in cholesterol and unhealthy fats, such as trans fatty acids and saturated fats.
• Rich in complex carbohydrates and low in glucose¹³ when carefully selected and well planned. Foods rich in complex carbohydrates and low in glucose include brown rice, whole wheat, quinoa, fruits with less sugar, such as berries, and fruits that are less ripe,¹⁴ vegetables, beans, and lentils. Complex carbohydrates are filled with nutrients and are rich in protein and fiber.
• Sufficient in quality protein, protein that is both easy to digest and contains all 20 amino acids. Plant-based protein sources, such as peas, tofu, amaranth, soy milk, hemp seeds, and beans,¹⁵ can help keep blood sugar stable, reduce sugar cravings and feeling full after eating.
• Rich in dietary fiber. Some options include avocado, apples, pears, broccoli, artichoke, kidney beans, split peas, chickpeas, quinoa, oats, and many nuts, and seeds. Dietary fiber has a variety of health benefits. Many fiber-rich foods have a low glycemic index, which decreases the chance of a glucose overload. It can normalize bowel movements, maintain gastrointestinal health, lower cholesterol, help with body weight management, and control blood sugar levels, which is key for Type 1 Diabetes symptom management.

A whole-food plant-based diet can benefit people with Type I Diabetes by:

• Helping mediate the inflammatory response of the immune system, crucial to the regulation of any autoimmune disease.
• Decreasing blood glucose variability.¹⁶
• Increasing blood flow to tissues throughout the body, due to its lack of artery-clogging cholesterol and saturated fat. This can help prevent and reverse not only heart disease but also the nerve damage that can lead to pain, numbness, and even amputation and death.¹⁷ 

Takeaway

Foods that are true winners for those managing Type 1 Diabetes are part of the whole-food plant-based diet, rich in nutrients, antioxidants, and anti-inflammatory compounds, and at low risk of glucose overload.

References

1. Yancy WS, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab. 2005;2(1):1-7.
2. Kowalska K, Brodowski J, Pokorska-Niewiada K, Szczuko M. The change in the content of nutrients in diets eliminating products of animal origin in comparison to a regular diet from the area of middle-eastern Europe. Nutrients. 2020;12(10):2986.
3. Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB. Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Ann Intern Med. 2010;153(5):289-298.
4. Lagiou P, Sandin S, Lof M, Trichopoulos D, Adami HO, Weiderpass E. Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. Bmj. 2012;344.
5. Patel KP, Luo FJG, Plummer NS, Hostetter TH, Meyer TW. The production of p-cresol sulfate and indoxyl sulfate in vegetarians versus omnivores. Clin J Am Soc Nephrol. 2012;7(6):982-988.
6. Buehler LA, Noe D, Knapp S, Isaacs D, Pantalone KM. Ketogenic diets in the management of type 1 diabetes: Safe or safety concern? Cleve Clin J Med. 2021;88(10):547-555.
7. Masino SA, Rho JM. Mechanisms of ketogenic diet action. Jaspers Basic Mech Epilepsies Internet 4th Ed. Published online 2012.
8. Zinn C, Rush A, Johnson R. Assessing the nutrient intake of a low-carbohydrate, high-fat (LCHF) diet: a hypothetical case study design. BMJ Open. 2018;8(2):e018846.
9. Feinman RD, Pogozelski WK, Astrup A, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31(1):1-13.
10. Blanco JC, Khatri A, Kifayat A, Cho R, Aronow WS. Starvation ketoacidosis due to the ketogenic diet and prolonged fasting–a possibly dangerous diet trend. Am J Case Rep. 2019;20:1728.
11. Viguiliouk E, Kendall CW, Kahleová H, et al. Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2019;38(3):1133-1145.
12. Nebl J, Schuchardt JP, Wasserfurth P, et al. Characterization, dietary habits and nutritional intake of omnivorous, lacto-ovo vegetarian and vegan runners–a pilot study. BMC Nutr. 2019;5(1):1-14.
13. Chiavaroli L, Lee D, Ahmed A, et al. Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials. bmj. 2021;374.
14. Reynolds AN, Akerman AP, Mann J. Dietary fibre and whole grains in diabetes management: Systematic review and meta-analyses. PLoS Med. 2020;17(3):e1003053.
15. Mariotti F, Gardner CD. Dietary protein and amino acids in vegetarian diets—A review. Nutrients. 2019;11(11):2661.
16. Schreck K, Melzig MF. Traditionally used plants in the treatment of diabetes mellitus: Screening for uptake inhibition of glucose and fructose in the Caco2-cell model. Front Pharmacol. 2021;12.
17. McCarty MF. Favorable impact of a vegan diet with exercise on hemorheology: implications for control of diabetic neuropathy. Med Hypotheses. 2002;58(6):476-486.