Thread by @1Paulcoker

Hi my name is Paul and I have been asked to do this tweetorial by @DBelardoMD to share my experiences of using a high carbohydrate low fat whole food plant based diet to manage my diabetes.

@DBelardoMD 1/ I was diagnosed with t1 diabetes in 1977 when I was 5 years old. I have special interests in the things that I can do to maintain my health eg. type 1 diabets & exercise and diabetes & nutrition. In September I will complete my MSc in Diabetes Practise at @SwanseaMedicine

2/ My life with diabetes is an n=1 experiment but I use my skills of data analysis and scientific reasoning to inform my decisions.

3/ Type 1 diabetes is an auto-immune disease, it is diagnosed when the immune system gets confused and destroys the special cells, called the islet of Langerhans Beta Cells, that make insulin.

4/ Insulin is an essential hormone, its main function is to bind to the surface of almost all of our cells and then it acts as a gateway that allows glucose (energy) to move from the outside of the cell to the inside of the cell.

5/ In 1921 a team of 4 scientists in Canada isolated insulin and the first ever insulin injection was given to Leonard Thompson in 11 January 1922, until that time a diagnosis with type 1 diabetes was a death sentence. The earliest treatment for diabetes was a low carb diet

6/ People with type 1 diabetes must take insulin by injection or insulin pump every single day to stay alive. The aim of treatment is to give the right amount of insulin to keep blood glucose levels in the target range (4-10mmols/L or 70-180mg/dL).

7/ Taking too much insulin leads to low blood glucose levels a condition called hypoglycaemia (aka hypo).This is like being drunk without the good bits! I have passed out on a number of occasions over the last 44 years due to hypo's.

8/ Taking not enough insulin leads to high blood glucose levels, if they climb very high this leads to a life threatening condition called Diabetic Ketoacidosis (DKA). Maintaining blood glucose levels that are too high increases the risk of the complications of diabetes.

9/ The insulin that you produce naturally circulates in your blood and starts to become active within a few minutes and within 25-30 minutes it is no longer active. You produce you insulin all of the time, you only switch off insulin production when your blood glucose drops.

10/ Your insulin production will increase when your blood glucose level goes up. 42 different factors have been identified that affect blood glucose levels.
diatribe.org/42factors

11/ One study demonstrated that overnight insulin needs in a single individual with type 1 diabetes varied from -50% to +300% when measured over a two week period. Some Dr’s living with type 1 diabetes have suggested that insulin is the hardest drug to take consistently.

12/ Many people with type 1 diabetes follow a low carbohydrate diet; the thinking is that with small amounts of carbohydrate (glucose) the insulin needs are small and the risk of making an insulin dosing error are also small. I lived this way for 38 years.

13/ For 6 years I followed a protocol of eating just 30g of carbohydrates a day (that is approx. two slices of bread, or an apple and a small banana) and it worked. My blood glucose was easier to manage. I needed 1 unit of insulin for every 1.73g of carbohydrates at this time.

14/ I found ways to manage my blood glucose levels & low carb diet so that I could climb mountains (inc. Kilimanjaro) and run half marathons. This meant limiting my running pace to maintain fat burning & I was always exhausted for weeks & weeks after a longer run.

16/ I read about @NealBarnard work on whole food plant based methods to manage diabetes and I tried to do this and maintain a low carbohydrate diet but I found that it just did not work for me.

17/ So I threw the rule book out of the window and started to eat a diet that was whole food plant based with higher carbohydrates. I noticed that I could eat more carbohydrates and my blood glucose level did not go up as high as I had experienced before.

18/ After a few days I had to start reducing the amount of insulin I was taking even though I was eating more carbohydrates. I almost gave up at this point; I had spent my whole life thinking that carbs are the enemy but now I was eatig more carbs & needing less insulin!

19/ However, with some guidance from @CyrusKPhD I increased my carbs coming from whole food plant based sources (eg unrefined carbohydrates) & the more carbs I ate the less insulin I needed. This contradicted everything I had been taught about diabetes.

19a/ Over the next few months as I adapted to eating more carbohydrates I eliminated all animal products from my diet and reduced my fat and protein intake; eating 70% of my calories from carbohydrates, 15% from protein and 15% from fat.

20/ The results were astonishing my blood pressure dropped from 140/80 to 120/70 and my total cholesterol dropped to 3.1; all of this without any medications. There was a little weight loss but it does not explain the increase in insulin sensitivity (more on this later).

21/ Even more importantly my low blood glucose (hypo) level awareness came back and I when I did go hypo my recovery was faster and I was less likely to have a subsequent hypo, did I mention that I hate hypo’s?

22/ Now for the results:

23/ On my LCHF diet I was eating 30g of carbs per day & I needed 1 unit of insulin for every 1.73 grams of carbohydrates. Now, I eat 370g of carbohydrates per day & I use 1 unit of insulin for 16.8g of carbohydrates a 971% increase in insulin sensitivity.

24/ That sounds impressive, however in 2016-17 I decided to run 40 half marathons in a year to mark 40 years of living with type 1 diabetes and my insulin sensitivity peaked at 1 unit of insulin for every 42.7g of carbohydrates during that campaign.

25/ Let me be clear; I am not talking about bolus insulin; I am talking about basal and bolus insulin combined. Even today with my more sedentary COVID lockdown state I am still giving 1 unit of bolus insulin for 45g of carbohydrates & my weight is now back to 78kg.

26/ My HbA1c is the best it has ever been 48 (6.5%), my time in range is averaging at 86%, my blood pressure is 126/70, my total cholesterol is 3.2. The only medication I take is insulin and I have been living with type 1 diabetes for 43 years and 11 months.

27/ How can I explain this?

28/ There are a number of theories that might describe this increase in insulin sensitivity:

29/ The Randle cycle suggests that fats & insulin compete with each other to bind to the cell membrane. When there is too much fat it ‘queues up’ outside the cell. This blocks the insulin receptor sites at the cell surface & creates a short term insulin resistance.

30/ When there is an excess of fatty acids they are stored, some get stored in the liver and the muscles. Intramyocellular lipids are the very definition of insulin resistance. Some experiments with MRi scanners have demonstrated that this happens within hours of eating a meal.

31/ Ask anybody with t1 diabetes what happens to their blood glucose level after they eat a pizza, they will tell you that around 3 hours later & they typically stay up for around 6-8 hours. Is it a coincidence that this aligns with the intramyocellular lipids model?

32/ It remains unclear if other factors are also at play. There was some consideration about the Microbiome and whole food plant based diets in the American gut project but the results were inconclusive (by Dr Luke Thompson), but more research on the microbiome is needed.

33/ Carbohydrates are not the enemy of diabetes, the complete nutrtional matrix in whole plant foods appear to change the way that whole food plant based carbs are metabolised; instead of restricting carbs we may need to think about refined carbohydrates & unrefined carbs.

34/ Unrefined carbohydrates are packaged with water, vitamins, anti-oxidants, fibre, mineral, phytochemicals & perhaps these are offering some mitigation from post-prandial blood glucose excursions?

35/ It is clear that more research is needed to answer the questions that my experiences have raised & my MSc dissertation will be a literature review on the carbohydrate restriction and insulin sensitivity in type 1 diabetes.

36/ I now help others with diabetes to try a whole food plant based diet that is high in carbohydrates and low in fat as an additional strategy for their diabetes management toolkit.

37/ the results suggest that my own experience is repeatable and my clients typically report improvements in time in range and quality of life perhaps that is all the evidence I need, on the other hand I remain curious!

38/ If you want a free whole food plant based recipe recipe book click here: transformyourdiabetes.com/food-for-thoug…

39/ Why is insulin sensitivity important to me? The more sensitive to insulin I am the more predictable the action profile of my insulin appears to be and this makes my diabetes easier to manage and most importantly that improves my quality of life.

This is the result of eating 118g of carbohydrates at lunch today at 14:30