Tag Archives: type 1 diabetes

Olive Oil Helps Control After-Meal Blood Blood Sugars

Steve Parker MD, Advanced Mediterranean DIet

Naturally low-carb Caprese salad: non-paleo mozzarella cheese, tomatoes, basil, extra virgin olive oil

Italian researchers found that extra-virgin olive oil taken with meals helps to reduce blood sugar elevations after meals in type 1 diabetics. This may help explain the lower observed incidence of diabetes seen in those eating a traditional Mediterranean diet, which is rich in olive oil.

Before going further into the weeds, remember that glycemic index refers to how high and quickly a particular food elevates blood sugar. High-glycemic index foods raise blood sugar quicker and higher compared to low-glycemic index foods.

The study at hand is a small one: 18 patients. They were given both high- and low-glycemic meals with varying amounts and types of fat. Meals were either low-fat, high in saturated fat (from butter), or high in monounsaturated fat from olive oil. Meals that were high-glycemic index resulted in lower after-meal glucose levels if the meal had high olive oil content, compared to low-fat and butter-rich meals.

If meals were low in glycemic index, blood sugar levels were about the same whether the diet was low-fat, high in saturated fat, or rich in olive oil.

I don’t know if results of this study apply to those with type 2 diabetes. Probably, but uncertain. (google it!)

Action Plan

If you have type 1 diabetes and plan on eating high on the glycemic index scale, reduce your blood sugar excursions by incorporating extra-virgin olive oil into your meals.

Steve Parker, M.D.

PS: No olive trees were killed to produce my book.

Reference: Bozzetto, Luigarda, et al. Extra-virgin olive oil reduces glycemic response to a high-glycemic index meal in patients with type 1 diabetes: a randomized controlled trial. Diabetes Care, online before print, February 9, 2016. doi: 10.2337/dc15-2189


Listen to Low-Carb Diet Proponents Franziska Spritzler and Dr. Troy Stapleton

Who says low-carb paleo diets are mostly meat?

Who says low-carb paleo diets are mostly meat?

Jimmy Moore posted an interview with Dr. Troy Stapleton and Franziska Spritzler, R.D. These two wouldn’t consider themselves paleo diet gurus by any means. They advocate carbohydrate-restricted diets for management of blood sugars in diabetes, consistent with my approach in the Paleobetic Diet. Dr. Stapleton might argue I allow too many carbohydrates. By the way, he has type 1 diabetes; I’ve written about him before. Franziska is available for consultation either by phone, Skype, or in person.

Steve Parker, M.D.

Another Paleo Diet Success Story For a Type 1 Diabetic

The Joslin Diabetes Blog has details. Lindsay Swanson was diagnosed with type 1 diabetes at age 25. Her initial interest was spurred by years of undiagnosed gastrointestinal issues. She eased into the Paleolithic diet by sequentially eliminating certain food classes, starting with grains, then soy, then legumes. As she did, she felt increasingly better. Lindsay eats few refined carbohydrates. My sense is she doesn’t require much insulin. A quote:

Much to my surprise, my blood sugars completely leveled out, so much so that I rarely need to treat a low blood sugar, and spikes are few and far between….Probably 75 percent of my diet consists of vegetables and plant based food, some with more carbohydrates depending on my activity level. I eat a lot of fat/protein regularly, examples: avocados, coconut oil (in tea and cooking), grassfed meats, bacon (and the reserved fat), oils, nuts, etc.


Effects of a Paleo-Style Diet on One Case of LADA

Dietitian Kelly Schmidt has a blog interview with Intrepid Pioneer, who has LADA—Latent Autoimmune Diabetes of Adulthood. LADA is much closer to type 1 than type 2 diabetes, so he’s on insulin. He was inspired initially by a “Whole 30 Challenge.” He makes room for cheese and home-brewed beer; so not pure paleo. Samples:

I was diagnosed May 2011 during my routine annual physical. At that time my blood sugars were up around 360 and my AC1’s ran around 12.3. At first I was treated as if I was a Type 2 with Metformin. The medicine only helped to control my blood sugars down to around 250 or so. At that time my endocrinologist informed me that I probably have LADA or Latent Autoimmune Diabetes, which basically has been coined type 1.5 Meaning I developed adult on-set Type 1. My father has had Type 1 all his life and was diagnosed as a child.


Since eating the Paleo lifestyle, and I hate it when one calls it a diet because then it feels temporary, I’ve pretty much stop taking my fast acting mealtime insulin. Meaning I only inject fast acting when I know I’m having Pizza for dinner as a treat, or for a thanksgiving meal, etc. My long acting insulin has reduced by over 10 units since starting this diet. All of that said, Paleo is great and it all tastes so good because it’s real food, but I have found that I also need to exercise, eating Paleo combined with exercise has yielded dynamic results. My endocrinologist was blown away by all that I had done, reduced my insulin injections and basically had my A1C’s in check — my last appointment I was 7.3. Still a bit more to go but the last time I was pushing 9 just six months before.

Read the whole thing (it’s brief).

Has Carbohydrate-Restricted Eating Been Studied in Type 1 Diabetes?

Sweden has lots of blondes

Sweden has lots of blondes

Yes, there are few published scientific reports. Let’s take a close look at one today. (See the references below for more.)

In the introduction to the study at hand, the authors note:

The estimation of the amount of carbohydrates in a meal has an error rate of 50%. The insulin absorption may vary by up to 30%. It is therefor virtually impossible to match carbohydrates and insulin which leads to unpredictable blood glucose levels after meals. By reducing the carbohydrates and insulin doses the size of the blood glucose fluctuations can be minimized. The risk of hypoglycemia is therefore minimized as well. Around-the-clock euglycemia [normal blood sugar] was seen with 40 g carbohydrates in a group of people with type 1 diabetes [reference #2 below].

The immediate resulting stable, near-normal blood glucose levels allow individuals to predict after-meal glucose levels with great accuracy.

For individuals with type 1 diabetes one year audit/evaluation of group education in this regimen has shown that the short-time lowering of mean hemoglobin A1c by 1 percentage unit and the reduction in mean rate of symptomatic hypoglycemia by 82% was maintained [reference #3].


There is no evidence for the use of the widely recommended high-carbohydrate, low-fat diet in type 1 diabetes.

Study Set-Up

Swedish investigators educated study participants on carbohydrate-restricted eating from 2004 to 2006 [reference #1]. They recently audited their medical records for results accumulated over four years. At the outset, participants were given 24 hours of instruction over four weeks. My sense is that they all attended the same diabetes clinic. The subjects’ mean age was 52 years and they had diabetes for an average of 24 years. Seven had gastroparesis. Fourteen used insulin pumps. Of the 48 study subjects, 31 were women, 17 were men. The diet regimen restricted carbohydrates to a maximum of 75 grams a day, mainly by reducing starchy food.


As measured three months after starting the diet, HDL-cholesterol rose and triglycerides fell to a clinically significant degree (p<0.05). Average weight fell by 2.7 kg (5.9 lb); average baseline weight was 77.6 kg (171 lb). Hemoglobin A1c fell from 7.6 to 6.3% (Mono-S method).

As measured one year after start, meal-time insulin (rapid-acting, I assume) fell from 23 to 13 units per day. Long-acting insulin was little changed at around 19 units daily.

By two years into the study, half the participants had stopped adhering to the diet. The remainder were adherent (13 folks) or partly adherent (10). We don’t know what the non-adherents were eating.

Four years out, the adherent group had hemoglobin A1c of 6.0%, and the partly adherents were at 6.9% (p<0.001 for both). The non-adherent group had returned to their baseline HgbA1c (7.5%). Remember, at baseline the average HgbA1c for the group was 7.6%.

The authors don’t say how many participants were still adherent after four years. From Figure 2, adherence seems to have been assessed at 60 months: 8 of the 13 adherent folks were still adherent, and 5 of the 10 partly adherent were still in the game. So, of 48 initial subjects, only 13 were still low-carbing after five years later. By five years out, half of all subjects seem to have been lost to follow-up. So the drop-out rate for low-carbers isn’t as bad as it looks at first blush.


The authors write:

An educational program involving a low-carbohydrate diet and correspondingly reduced insulin doses for informed individuals with type 1 diabetes gives acceptable adherence after 4 years. One in two people attending the education achieves a long-term significant HbA1c reduction.

They estimate that this low-carb diet “may be an option for 10-20% of the patients with type 1 diabetes.” Only 17% of their current diabetes clinic population is interested in this low-carb diet. They didn’t discuss why patients abandon the diet or aren’t interested in the first place. Use your imagination.

Major carbohydrate restriction in type 1 diabetics significantly improves blood sugar control (decreases HgbA1c), lowers insulin requirements, and improves cardiovascular disease risk factors (increases HDL cholesterol and lowers triglycerides).

Paleo diets vary in total carbohydrate grams and percentage of calories derived from carbohydrate. Paleo diets tend to be lower in carb than usual Western diets, with 30% of total calories from carbohydrate probably a good rough estimate. The typical American eats 250 to 300 grams of carbohydrate daily, or about 50% of total calories. In the study at hand, the daily carb gram goal was 75, which would be 15% of calories for someone eating 2,000 cals/day.

Low-carb eating wasn’t very appealing to Swedes in the mid-2000s. I wonder if it’s more popular now with the popularity of LCHF dieting (low-carb, high-fat) in the general population there.

Steve Parker, M.D.


1.  Nielson, J.V., Gando, C., Joensson, E., and Paulsson, C. Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit. Diabetology & Metabolic Syndrome, 2012, 4:23. http://www.dmsjournal.com/content/4/1/23

2.  O’Neill, D.F., Westman, E.C., and Bernstein, R.K. The effects of a low-carbohydrate regimen on glycemic control and serum lipids in diabetes mellitus. Metabolic Syndrome and Related Disorders, 2003, 1(4): 291-298.

3.  Nielsen, J.V., Jönsson, E. and Ivarsson, I. A low carbohydrate diet in type 1 diabetes: clinical experience – A brief report. Upsala Journal of Medical Sciences, 2005, 110(3): 267-273.

Life Expectancy for Type 1 Diabetics Much Improved

…but we’ve got a long way to go.

When I started my medical career three decades ago, it was rare to see a type 1 diabetic exceed 60 years of age. Thank God that has been changing for the better! A recent Scottish study found life expectancy in type 1 diabetics, compared to the general population, was 11 years shorter for men and 14 years shorter for women. In 1975, the gap was 27 years. One of the investigators was quoted by the article at MedPageToday:

“There is absolutely no doubt that glucose control is important for long-term outcomes in people with type 1 diabetes.”

From the Framingham Heart Study: Compared to those without diabetes, women and men with diabetes at age 50 died 7 or 8 years earlier, on average. This study population was a mix of type 2 and type 2 diabetes, with type 2 predominating, I’m sure.

Steve Parker, M.D.

“Rich the Diabetic” Is Sold On the Paleo Lifestyle

Click for his testimonial from 2012. Rich is a type 1 diabetic (he uses “diabetic” rather than “person with diabetes”). Rich was influenced by Tom Naughton, Robb Wolf, and Mark Sisson. He dropped his hemoglobin A1c by 2.5 over his first six months of paleo eating. This snippet explains some of his lifestyle changes:

The only thing I changed back in March, was starting to live paleo.  I’ve always worked out regularly, so I’m not really accounting my exercise in this improvement.  I’m probably about 70% paleo overall, but at home I’m 100% paleo.  My home no longer has any processed foods that come in a box, can, or sack.  I buy whole foods (fruits and lots of veggies), a little frozen veggies for convenience and storage time, lots of meat, no dairy, and lots of olive and coconut oil.  I cook a lot now, which means I do a lot more dishes than I want to, but it’s been worth it.

Read the rest.

T1 Shelby Hughes Is Thriving on the Paleo Diet

Dietitian Kelly Schmidt posted an interview with Shelby at her blog. Shelby seems to tolerate a fair amount of carbohydrate (fruit and starchy vegetables) although I don’t know how much insulin she’s taking to process them. Her case of diabetes is a little unusual since she wasn’t diagnosed until age 39. I wonder if she has some residual beta cell insulin production.

Another thing I like about this story is that it illustrates that a paleo diet doesn’t have to be based on meat.

Read the rest.

Type 1 Diabetic Notes Improvement On Paleo Diet

Type 1 PWD (person with diabetes) AllisonN wrote about her one-month paleo diet trial at DiabetesMine. The paleo diet version she followed was the Whole30 program, with which I’m not terribly familiar. Some quotes:

3. I have the best control in recent memory, but it’s not perfect. Like anything that involves tweaking and adjustments, the Paleo diet is hardly a cure. Now that I’m taking less insulin, there are fewer chances for me to go low, and more chances for me to go high. You can never expect anything — not a diet, not a medication, not an insulin pump — to run the show for you.

4. If you eat low-carb, you have to bolus for protein. This was the biggest shock for me. After querying my friends, I discovered that bolusing for approximately half the protein is what I need to do to prevent a post-meal spike. Gary Scheiner, author and CDE at Integrated Diabetes Services, explained, “Since your Central Nervous System needs glucose to function, if your diet is lacking in carbs, the liver will convert some dietary protein into glucose.  So it is usually necessary to bolus for some of your protein whenever you have a meal that is very low in carbs.” For me, a low-carb meal is anything under 30 grams of carbs.


One thing that I kept thinking about during my month-long Paleo experiment was how much of diabetes really is an experiment anyway. Think about how often we have to try out different things to see what works: Changing up bolus ratios and basal rates. Fiddling with different temp basals or snack choices before working out. Alternating what we eat for breakfast. While the Paleo diet may not be for everyone, I wholeheartedly believe that if what you’re doing currently isn’t giving you the results you want, maybe you should consider starting another experiment!

AllisonN wrote that the paleo diet hasn’t been studied scientifically in people. That’s not accurate. A handful of studies have been done, even involving people with diabetes. Search this site and you’ll find them. In addition, Lynda Frassetto’s study at University of California-San Francisco should be published later this year.

Read AllisonN’s post.

Ideas For A Paleo Diabetic Diet

Sirloin steak, salad, cantaloupe, 3 raspberries

Sirloin steak, salad, cantaloupe, 3 raspberries

I’ve been thinking about a paleo-style diabetic diet for over a year.  Here are some miscellaneous ideas for your consideration.

A paleo diabetic diet will have the following major food groups:

  • vegetables
  • fruits
  • nuts and seeds
  • proteins (e.g., meat, fish, eggs)
  • condiments

A paleo diabetic diet could (should?) emphasize salads and low-carb colorful vegetables and only (?) low-carb or low-glycemic-index fruits.


Total calories?  Probably in the range of 1,800 to 3,000 calories daily with an average of 2,000.  Remember that 85% of type 2 diabetics are overweight or obese. Calorie restriction—regardless of macronutrient ratios (% carb, protein, fat)—tends to improve or normalize blood sugar levels.  Weight loss will likely entail some caloric restriction, whether consciously or not.

Type 1 Versus Type 2 Diabetes

Type 1 and type 2 diabetics have many pathophysiologic differences.  Could a single paleo diabetic diet serve both populations equally well?  That’s the goal.


Diabetics have trouble metabolizing carbohydrates, so a paleo diabetic diet should probably be lower-than-average in digestible carbs.  100 g/day?  30 g/day?  I’m leaning toward 60 g ± 25%, so 45–75 g.  Smaller, less active folks could eat 45 g/day; larger, more active guys eat closer to 75 g.

Is there a role for very-low-carb or ketogenic eating patterns?  For most folks, that’s less than 50 g of digestible carbohydrate daily.  Under 30 g for some.  Use that only for those needing to lose weight?  Start everybody at  very low carb levels then increase carbs as tolerated?  On the other hand, there’s a lot to be said for simplicity.  It might be best to avoid very-low-carb (ketogenic) eating entirely.  Anyone not losing the desired amount of fat weight could cut portion sizes, especially carbohydrates.


I encourage fish consumption twice a week, diabetes or no.  Cold-water fatty fish have more of the healthy omega-3 fatty acids than other fish.


I’d encourage 1–2 ounces (28–56 g) of nuts or seeds daily.  Any more than that might crowd out other healthful nutrients.  Nuts are protective of the heart.


Protein-rich foods can definitely raise insulin requirements and blood sugar levels, but not in an entirely predictable way, and not to the extent we see with carbohydrates.  Should insulin users dose insulin based on a protein gram sliding scale?  I’m leaning towards simply recommending the same amount of protein at each meal, perhaps 4–8 ounces (113–229 g).

Fruit and Starchy Vegetables

Could a paleo diabetic diet even be “paleo” without fruit?  The problem with classic fruits is that they spike blood sugars too high for many diabetics.  To prevent that, Dr. Richard Bernstein outlaws all classic fruits (and other starchy carbs), even limiting tomatoes and onions to small amounts.  E.g., a wedge of tomato in a salad.  He doesn’t allow carrots either, unless raw (lower glycemic index than when cooked).  A paleo diabetic diet eater may be able to get away with eating lower-carb, lower-GI (glycemic index) fruits such as cantaloupe, honeydew, strawberries and other berries.  Some paleo diabetic dieters will tolerate half an apple twice a day.

Different diabetics will have different blood sugar effects when eating starchy vegetables and higher-carb fruits.  Type 1 diabetics will tend to be more predictable than type 2s.  Both may just need to “eat to the meter”: try a serving and see what happens to blood sugar over the next hour or two.

Starchy vegetables—potatoes and carrots, for example—may well have to be limited.  Again, eat to the meter.


This is looking to be gluten-free.  How trendy!  It’s a paleo celiac diet.

Use “natural” stevia as a sweetener?  If you read about how the product on your supermarket shelf  is made, it’s not at all natural.

Omega-6/Omega-3 Fatty Acids

A strict focus on omega-6/omega-3 fatty acid ratio will not appeal to many folks, even if it’s important from a health viewpoint.  Reserve this for advanced dieters who have mastered the basics?  Modern Western diets have an omega-6/omega-3 ratio around 10 or 15:1.  Paleolithic diets were closer to 2 or 3:1.  So we have an over-abundance of omega-6 fatty acid or deficiency of omega-3 that may be unhealthy.


To get dieters started, I’d design a week of meals based on 2,000 to 2,200 calories.  If still hungry, eat more protein, fat, and low-carb vegetables (and fruits?).

What do you think?

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.  

PS: See Dr. Bernstein’s “no-no” foods on page 151 of his Diabetes Solution book.

PPS: The paleo diet is also known as the Paleolithic diet, Stone Age diet, caveman diet, hunter-gatherer diet, and ancestral diet.