
Low carb diet leads to “clinical remission” in 3 cases of type 1 diabetes - colawars
https://www.diabetes.co.uk/news/2019/jul/low-carb-diet-leads-to-clinical-remission-in-three-case-studies-of-adults-with-type-1-diabetes-99607766.html
======
Trasmatta
I'm a type 1 diabetic and find these articles and studies frustrating. Or at
least the way people interpret them.

> Two weeks after adopting the low carb approach insulin was no longer needed.
> After 18 months insulin therapy was once again required at low doses of
> around 16 units per day. HbA1c remained very well controlled on the LCHF
> diet with insulin.

So during the honeymoon period, he was able to live without insulin. This is
pretty normal -- there's about a year after T1D diagnosis where the pancreas
continues to produce insulin. It's common for people to be able to make it
through that period with reduced insulin therapy. And then after 18 months he
had to start on low doses of insulin again, even with the diet.

Low carb diets can help type 1 diabetics, but it's not a cure. Please don't go
around suggesting to your T1D friends that they just need to start on keto,
and can stop taking insulin.

~~~
rhinoceraptor
Hugely reducing insulin dosing is still probably valuable, especially for
Americans since it's so expensive.

~~~
nick0garvey
It's expensive but not as bad as you'd think. I didn't have insurance for half
a year, and I just called the manufacturer and got a huge discount
($200/bottle -> $35/bottle). One bottle lasts a month or so.

This was only due to not having insurance and wasn't need-based - I had earned
FAANG income earlier that year and the year before.

~~~
Kye
Both those prices seem excessive.

~~~
ovi256
The best part of economic freedom is that one is free to start a manufacturer
delivering a cheaper whatever one is complaining is too expensive!

~~~
arexxbifs
"Not only are the big three insulin manufacturers financially opposed to
biosimilars entering the market, they’ve actively taken legal steps to prevent
it."

[https://beyondtype1.org/how-much-does-it-cost-to-produce-
ins...](https://beyondtype1.org/how-much-does-it-cost-to-produce-insulin/)

------
entitydc
Curious if they have any clearer definition of what they mean by “recently
diagnosed.”

Based on the article, it looks like all patients were in their honeymoon
period, which certainly makes for a substantial difference from what most
would think of as remission - the difference between “clinical remission” and
“clinical remission in very controlled circumstances while patients were still
capable of producing some insulin.”

It’s pretty well known that LCHF reduces overall insulin requirements, and
it’s not surprising that in new patients who are still capable of some
production that LCHF would be enough to effectively lengthen the honeymoon
period, but in any case I’d argue that the word remission is a pretty poor
choice of words for describing the effect seen.

~~~
Trasmatta
Yeah, this article was frustrating because there was literally nothing
surprising in it. It basically said that during the honeymoon period they
could get by without insulin on a LCHF diet, and then after the honeymoon
period they had to go back on insulin even WITH the LCHF diet.

That isn't news, and the title of this article is dangerously misleading.

------
jadell
From last year (July 2019), and no follow-up. As someone who has to deal with
T1D every day and carefully monitors news about research, I guarantee you no
endocrinologist is counseling their patients to try this. Cutting carbs can
lead to less need for insulin, but it's not a cure for T1D.

~~~
Trasmatta
Yep. When I've consciously gone low carb, my insulin requirements have gone
down, and my blood sugar was much more manageable. But if I had stopped taking
insulin entirely I would have died or ended up in the hospital with DKA.

~~~
1123581321
With this regimen, you would simply do as your blood sugar numbers direct. It
sounds like these patients were measuring and found their glucose to be too
low if they took any insulin. In that case, it is safe to stop if coordinated
with a doctor. There shouldn’t be any point where a decision is made to drop
insulin permanently while your reads are high.

Even if stopping insulin prematurely, low carb would mean low risk of DKA due
to slowly rising glucose, giving plenty of time to react. Dropping long-acting
insulin would be harder to revert, but frequent small doses of short-acting
would be an effective stop-gap.

A good general principle for us diabetics is to encourage everyone to safely
explore the control they have over their particular flavor of this disease,
and respect whatever those limits turn out to be. :)

~~~
RHSeeger
> With this regimen, you would simply do as your blood sugar numbers direct.

That's true of every regimen, though.

~~~
1123581321
The person I replied to seemed to think that the regimen directed to quit
insulin without support from the numbers, leading to diabetic ketoacidosis.

~~~
Trasmatta
That's not what I think at all. But it's what other people think when they see
articles like the one linked. I've had many, many people tell me in the past
that I can cure my T1D with keto, which is why articles like this one annoy
me.

~~~
1123581321
As a fellow type 1, I understand the frustration.

------
clarkrinker
Reiterating what the diabetics in these threads will tell you:

Type 1 isn't about insulin resistance in your cells, it's about not producing
insulin in your pancreas. Of course type 1 diabetics with rigorous diets will
have less glucose swings, but a stable A1c or daily tests doesn't mean your
eyelet cells grew back. It's a bit like saying a hemophiliac is asymptotic
because they haven't had any cuts lately.

These kinds of articles can come off as callus to diabetics. They're getting
diet advice from their GPs and their endocrinologists. They don't need muggles
telling them to eat better.

------
vbtemp
I was on a low-carb diet for a while. Loved it. Felt great. Was totally fit.
All my digestive problems cleared up. I would never get "hangry". By every
single subjective measure my quality of life and sense of well-being improved.

Then I got my cholesterol checked during a routine blood work and it was
through the roof. WTF? Anyone know better than me about this?

~~~
shipman05
Low carb doesn't have to mean lots of meat, cheese, and fat. Most people would
have positive outcomes from a diet that is 75% whole-food, plant-based no
matter what the remaining 25% is.

~~~
ardit33
Plants are mostly carbs yo...

well, some have more complex carbs... and some have more fat (avocados) and
some have protein, but still "plant based diet" usually means complex carbs...

Healthier for sure, but it can't be considered 'low carb diet'

~~~
gshdg
Not a ton of carb calories in lettuce, kale, spinach, broccoli, etc. They’re
mostly composed of insoluble fiber (from which ruminants can extract calories
but humans can’t) and water.

A “low carb” diet doesn’t exclude high amounts of insoluble fiber. It excludes
high amounts of carbohydrate calories.

~~~
ardit33
This is not getting through...

If you are consuming your 2000 calories diet, and it is coming from plants,
you are still ingesting 2000 calories worth of carbs.....

1 kg of feathers, and 1 kg of iron, weight the same....

The feathers will be large and take more volume, while the iron will be small
and more dense.

Same with foods.... if your plant based diet you are consuming 2000 worth of
bio-available calories, then that is still mostly carbs...

It is healthier for sure than consuming 2000 calories through processed foods
such a muffins, chips and other crap. But, still your 2000 CALORIES will come
through CARBS, but they will be digested slowly due to the fiber.

But if you are ingesting 2000 bio-available calories through plants, it is
most likely mostly carbs (plus some fats and protein). Insoluble fiber just
goes towards your poop, and it is usually not counted under 'carbs'.

~~~
heavyset_go
Tofu, seitan, tempeh made without rice, etc are plant-based, high protein and
low carb. Various fungi fall into the same category, although they aren't
plants. Make a dish with vegetable oil and you'll have a high fat and protein
meal with minimal carbs that is plant-based.

~~~
ardit33
Makes sense, so are avocados, olives ect... (mostly fat), but you are
essentially eliminating 90% of plants out there...

When you say Plant based diet, people assume lettuce, beans, tomatos, carrots,
olives, broccoli, etc.. etc...

~~~
heavyset_go
You eat those on the side, particularly lettuce, spinach, broccoli etc in as
large of quantities as you'd like because they're low in carbs.

------
cbanek
> It is known from the growing evidence base that a low carb approach can help
> put type 2 diabetes into remissio, and now experts are exploring its impact
> on type 1 diabetes.

> showed the benefits of low carb treatment among adult men with newly-
> diagnosed type 1 diabetes. The three men were aged between 36 and 40 years
> old at diagnosis.

First off, spelling error this soon (remissio) raises red flags, but yes, type
1 diabetes is different than type 2, and I thought is usually diagnosed pretty
young, since it is very serious. It seems like in the article the patients are
aged 36-40, which seems pretty late to be diagnosed with type 1 diabetes?

Are there different causes of type 1 diabetes that can happen later in life?
(and are those treated differently?)

~~~
Trasmatta
You can get diagnosed with type 1 diabetes at any age. It used to be called
"juvenile diabetes" because they thought it only hit children, but that was
proven to be false.

We don't know if it's different causes in adults vs children, because we don't
really know the cause. The mechanism is the same though: the immune system
destroying the beta cells in the pancreas.

------
Imanari
Your foot hurts when putting weight on it? Solution: never put weight on it
again, ever. Your foot is now "cured".

That's how LCHF diets "cure" insulin problems. Of course the issue is much
more complex but as long as the patient cannot go back to eating carbohydrates
normally nothing got cured.

------
scared2
Clinical remission was defined as discontinuing insulin treatment for a period
of at least three months.

Worth noting

------
badabadadook
I'm a t1dm, have been for >9y. I'm been doing keto for 6-7, intermittent
fasting / one-meal-a-day for 2.5, carnivore for 1.5. Nonetheless, I started
with all that jazz post-honeymoon. I take insulin, and I don't believe a
'cure' is ever the right word with regard some more complicated diseases.
Treating symptoms != cure.

A lady from Hungary (interview in [1]) and her team have published studies[2]
about several cases of newly diagnosed type-one diabetics fulling forgoing(!)
insulin medication, or any medication for that matter, for relatively long
periods (1-1.5y, I believe she said in the interview), given they strictly fow
the diet- it being a very low carbohydrate one. One had not followed, relapsed
into carbs 2-3w into it and he had to go back to insulin. It's no long-term
study, but it's better than nothing, and from my acquaintances, and online
readings, @1.5y honeymoon phase should have fizzled out.

Anyways, the initial period seems to be crucial, a lot of research focuses on
what can be done then, and the one's who've had it some time [3]. Lowering
insulin is one thing, the other benefits are major too- stable, predictable bg
levels forever; better mood, energy; restriction diets help you notice what
exactly might have previously you bloated, gassy, get heartburn, mouth
dryness, etc.; yadda yadda. The bald puerorican biochemis from [4] gives
rather slowly the details of how a pure carb diet would work - his ins/carb
ratio was something insane-, of both of them, really-, like ~1/26\. Compare
with my ~1/1.7

The interviewer is a bit annoying, but I can't remember off the top of my head
of other sources, so apologies.

[1]
[https://www.youtube.com/watch?v=tlm6dMHnNC0](https://www.youtube.com/watch?v=tlm6dMHnNC0)
[2] [https://www.paleomedicina.com/en/dr-zsofia-
clemens](https://www.paleomedicina.com/en/dr-zsofia-clemens) [3] anecdotally,
research arts with newly diagnoseds are abundant [4]
[https://www.youtube.com/watch?v=U7dyGwnbp1w](https://www.youtube.com/watch?v=U7dyGwnbp1w)

------
robocat
I’ve seen a friend diagnosed with type 2 diabetes return his insulin levels to
normal through diet, exercise and cutting out alcohol. It just takes more
discipline than most people have. Edit: I’m presuming he had T2 because he
didn’t get it as a child, but reading this thread I see T1 can be diagnosed as
an adult: I did not know that.

Honestly I am trying to have the same discipline myself after seeing the
results, because I wish to avoid the harmful effects of a poor diet and get
the benefits of a good one. I am not managing to do it yet - and I’m not sure
a health scare would motivate me enough either...

~~~
jadell
Type 1 and Type 2 are completely different diseases. They present similar
symptoms -- which is why they're both called "diabetes" \--, but their
underlying causes are different.

Many T2 patients can control their blood sugar with diet.

No T1 patients can. It has nothing to do with "discipline", it's an autoimmune
disease. It's actually a bit insulting to suggest it's somehow "their own
fault."

~~~
robocat
I certainly wasn’t trying to imply T1 diabetes was their own fault. I have a
friend with T1 diabetes and diet helps them but it doesn’t cure them (although
they continue to drink wine and are somewhat careless in their sugar level
management sometimes).

The friend with T2 diabetes very likely is caused by an autoimmune reaction:
he had what is commonly an autoimmune disease as a child. Some percentage of
T2 diabetes cases are caused by poor diet, althogh there are many other
factors.

Edit: Also, obviously diet and exercise help avoid many other health issues.
And I feel your comment doesn’t follow the hn guideline “Please respond to the
strongest plausible interpretation of what someone says, not a weaker one
that's easier to criticize. Assume good faith.”

------
hoka-one-one
<I realized I'm wrong and spreading misinformation -- sorry everyone!>

~~~
Trasmatta
They had to go back on low dose insulin therapy _even with this diet_. This
isn't a cure for type 1 diabetes at all.

------
proc0
Balance in diet seems to be the one principal that will never go away. I'm
suspicious of any diet that eats too much of one thing, especially if it
claims the other things are harmful.

~~~
chillwaves
The term "balance" is meaningless unless we know what kind of values are
ascribed to "too much" which is exactly what we are trying to sort out.

No one talks about eating a "balanced" amount of high fructose corn syrup, in
terms of nutritional benefit.

~~~
proc0
I agree, it depends on the definition of the spectrum or range of values that
would then provide a definition of balance. Maybe the food groups could be the
level at which this is defined, so too much or too little of one food group is
probably not good. A good example is the meat-only diet that became a recent
fad. People can claim all kinds of benefits there but in the long run it's
just not balanced, and we're not built like apex predators in nature.

------
venantius
@dang can we have the title changed or something? Most of the diabetics in
this thread (yourself included) agree that the title is misleading at best and
simply false at worst.

------
igotsideas
You basically don’t have a pancreas with type 1. These people still had beta
cell function, which most type 1s don’t have. It was 3 subjects and limited
time. Large scale long term studies would be helpful.

Plus they got diagnosed is late 30s/early 40s. This sounds more like insulin
dependent type 2. It would make sense that the diet could work in this case.

------
ribs
What is this “remission” for type-2 diabetes? Does it mean that someone with
the condition can, after adhering to the diet for some time, then go back to
eating how they used to?

I don’t think so, so “remission” is bogus. The symptoms can be controlled with
diet, but you have to stay on the diet.

------
maweki
So what works for cats (well-known), also works for humans. Good to know.

~~~
DrAwdeOccarim
Interestingly, cats lack the ability to synthesize ornithine which means they
need to get arginine from their diet in order to complete their urea cycle and
excrete ammonia. Their obligate carnivorous diet is distinct from a human
deciding to do it for fun.

[https://academic.oup.com/jn/article-
abstract/108/12/1944/477...](https://academic.oup.com/jn/article-
abstract/108/12/1944/4770338)

[https://bmcvetres.biomedcentral.com/track/pdf/10.1186/s12917...](https://bmcvetres.biomedcentral.com/track/pdf/10.1186/s12917-015-0594-3)

------
raincom
This is known among keto dieters. Check Dave Feldman's cholesterol code:
[https://cholesterolcode.com/](https://cholesterolcode.com/)

------
ivan_ah
link to paper:
[https://www.sciencedirect.com/science/article/abs/pii/S12623...](https://www.sciencedirect.com/science/article/abs/pii/S1262363619300953)
or [https://sci-hub.tw/10.1016/j.diabet.2019.06.004](https://sci-
hub.tw/10.1016/j.diabet.2019.06.004)

------
mrfusion
Have they studied if fasting has the same effects?

------
alkibiades
im not making any comment on whether low carb is good or bad, but figured i'd
mention that just because something is good for a diabetes patient doesn't
mean it's good for all people in all situations.

