Low carb diet leads to "clinical remission" in three case studies of adults with type 1...

[DCUK NewsBot]

Following a low carb, high fat diet shortly after being diagnosed with type 1 diabetes could lead to "clinical remission" from the condition, research suggests. It is known from the growing evidence base that a low carb approach can help put type 2 diabetes into remission, and now experts are exploring its impact on type 1 diabetes. Three different case studies, documented by French researchers at Dijon University Hospital, 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. They all started a low carb, high fat diet (LCHF) shortly after being diagnosed. Clinical remission was defined as discontinuing insulin treatment for a period of at least three months. Referred to as Patient A in the research, the first case study was diagnosed with the condition aged 36. He had no medical history and was a non-smoker. He immediately began daily insulin injections, but a month after his diagnosis he decided to start a low carb, high fat diet diet, restricting his carb intake to just 50g a day. Within 15 days he was able to stop using insulin completely and at the time of writing has not had to since March 2015. The second case study - Patient B - had a similar experience and was able to discontinue insulin after following a low carb diet shortly after their diagnosis. They have only used insulin once following one infectious episode, but they are now insulin-independent. Patient C started a low carb diet nine months after they were diagnosed aged 38. 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. "We report here, for the first time, the cases of three T1D patients who experienced clinical remission after commencing an LCHF diet soon after their diagnosis," said the researchers. "Implementation of such a diet resulted in optimal glycaemic control while the frequency of hypoglycemia was low, although the effect on lipid parameters was variable. In any case, the LCHF diet, if introduced promptly, could preserve beta cell function in patients with residual insulin secretion at diagnosis. "Thus, an LCHF diet appears to be a feasible therapeutic option in self-motivated adults with T1D, provided that their lipid parameters are carefully controlled, and early introduction of the LCHF diet may well lead to clinical remission of T1D." The findings have been published in the journal Diabetes &Metabolism.

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[HSSS]

Could this be a long honeymoon or LADA? Thus reducing demand whilst still producing some small amounts of endogenous insulin is sufficient for a time? Until it’s not. Other than the first I can’t see how long they remained insulin free. Though I would like to think for type 1’s it’s more hopeful than I’m reading it.

 

[WuTwo]

I agree - I think it must have been honeymoon/LADA - I think Case A has slowed onset and taken advantage of his honeymoon period - ( @ert recently went through this and low carbed for quite a while but now is on insulin) - but I'd like to know how Case A manages 15 years on. I do agree that managed carbs = managed diabetes (as far as T1 can be managed, allowing for things like weather, stress, bodily ailment, time of the month etc) and that low carbs help tremendously - see @Mel dCP or @kitedoc - but I note the report says

"The second case study - Patient B - had a similar experience and was able to discontinue insulin after following a low carb diet shortly after their diagnosis. They have only used insulin once following one infectious episode, but they are now insulin-independent.

Patient C started a low carb diet nine months after they were diagnosed aged 38. 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."

 

[zand]

Well I am sceptical about this. I agree it's the honeymoon period or LADA. I remember there was someone posting here a few years ago that he was T1 and off insulin by low carbing so it's not a new thing. It's just become official now someone has bothered to study the anecdotal evidence. Whilst it's a remission I fear it's temporary and the individual needs to weigh up the pros and cons of their own situation as to whether it's worth changing their diet for temporary remission. I very much doubt that all (or many) T1s would be able to do this as they may not be producing enough of their own insulin. However those who are still producing insulin would get the benefit that if they low carb they are less likely to administer too much insulin by mistake, and thereby causing a hypo, if their pancreas was being a little more 'helpful' on some days than others during the honeymoon.

In short it's not really news and it's just delaying the inevitable need for insulin one day.

 

[Robinredbreast]

I agree - I think it must have been honeymoon/LADA - I think Case A has slowed onset and taken advantage of his honeymoon period - @ert recently went through this and low carbed for quite a while but now is on insulin - but I'd like to know how he manages15 years on. I do agree that managed carbs = managed diabetes (as far as T1 can be managed, allowing for things like weather, stress, bodily ailment, time of the month etc) and that low carbs help tremendously - see @Mel dCP or @kitedoc - but I note the report says

"The second case study - Patient B - had a similar experience and was able to discontinue insulin after following a low carb diet shortly after their diagnosis. They have only used insulin once following one infectious episode, but they are now insulin-independent.

Patient C started a low carb diet nine months after they were diagnosed aged 38. 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."

I will take this article with a pinch of salt, but I have noticed over the past few years changes in diabetes, not just the types, so not written in stone, as there will always be rare cases that can turn a medical condition on it's head.
A while back, I posted a couple of pages from my mum's very old Nursing book, from about 1910, regarding management of diabetes. Of course then, Insulin wasn't invented then to help control diabetes and a low carb, or as I call it, a reduced carb intake was given and the patients withered away and died.

 

[Tophat1900]

I think this is clearly honeymoon period stuff and a possibly one of them being a LADA, being it's early into diagnosis. T1's can manage well on LCHF, we know that, but I think this article is somewhat misleading and for newly diagnosed T1's a potentially dangerous perception that LCHF will mean you don't need insulin.

"We report here, for the first time, the cases of three T1D patients who experienced clinical remission after commencing an LCHF diet soon after their diagnosis," said the researchers.

"Implementation of such a diet resulted in optimal glycaemic control while the frequency of hypoglycemia was low, although the effect on lipid parameters was variable. In any case, the LCHF diet, if introduced promptly, could preserve beta cell function in patients with residual insulin secretion at diagnosis.

"Thus, an LCHF diet appears to be a feasible therapeutic option in self-motivated adults with T1D, provided that their lipid parameters are carefully controlled, and early introduction of the LCHF diet may well lead to clinical remission of T1D."

Personally, I just don't view remission as being off insulin for just 3 months and then needing back on it when endogenous insulin inevitably deteriorates to the point of no longer being adequate. Curious to hear what other T1's think.

 

[ert]

I agree - I think it must have been honeymoon/LADA - I think Case A has slowed onset and taken advantage of his honeymoon period - @ert recently went through this and low carbed for quite a while but now is on insulin - but I'd like to know how he manages15 years on. I do agree that managed carbs = managed diabetes (as far as T1 can be managed, allowing for things like weather, stress, bodily ailment, time of the month etc) and that low carbs help tremendously - see @Mel dCP or @kitedoc - but I note the report says

"The second case study - Patient B - had a similar experience and was able to discontinue insulin after following a low carb diet shortly after their diagnosis. They have only used insulin once following one infectious episode, but they are now insulin-independent.

Patient C started a low carb diet nine months after they were diagnosed aged 38. 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."

I think I could manage when my c-peptide, although extremely low, was at between 0.15 and 0.18 nmol/L (less than 0.2 requires insulin) because my insulin sensitivity was at 500%, which would explain my longer so-called-honeymoon. This isn't usual and it wasn't much of a honeymoon, mind you, only eating one LCHF meal a day and a minimum of 2 hours of exercise, including getting up at one am to run to stop the continual rise of my ketones and blood sugars. I doubt many people would have bothered and taken insulin as my specialist insisted I needed or thought it too reckless and dangerous to proceed. But as soon as my c-peptide dropped to 0.126 I just didn't have enough insulin and the game was up. And they found GAD antibodies.

My best guess is that I had two immune responses, once in the beginning, two years ago, and again two months ago, which would explain the c-peptide of less than 0.2 nmol/L on diagnosis, the plateau as well as sudden deterioration. I'm afraid I only have the blood work from the recent GAD positive result from my current episode.

There needs to be more research, but as long as your immune system isn't acting up, you must get some respite. This would go some way towards explaining what is happening in the patients above.

 

[LooperCat]

I’d have given that a bash in the early days of my diagnosis if I’d known about it, that’s for sure. Dr Bernstein talks about it in his book as well.

 

[Circuspony]

I think if they'd diagnosed me earlier rather than as an emergency I could have operated on tiny doses or none if low carb for quite some time. About 4 weeks after diagnosis I was on about 4 units of lantus and hardly any novorapid - unless it was pasta / bread etc.

Even now 2 years down the line I'm grateful for a 1/2 unit pen because if I'm walking around a shopping centre like yesterday then just 1/2 unit got me through lunch of fondant potato and pork.

But I don't count that as remission. Just a very slow decline in my insulin production, a relatively high level of exercise and insulin sensitivity and a diet with low to moderate carbs.