Last week I went through the basics of type 1 diabetes including what is going on to cause elevated blood glucose levels in a type 1 diabetic, diagnosis, treatments and how being a type 1 diabetic can impact on exercise and training decisions. This week I’m going to look at something far more controversial – ways to improve and possibly even cure type 1 diabetes. Make yourself a cup of tea and get comfortable – this is going to take a while…
Keep an open mind
Robb Wolf has said on one of his podcasts (number 89) that diabetics are one of the few groups of people who are not even prepared to consider that it might be possible to improve their condition with dietary changes. He notes that sufferers will vehemently fight against anyone who suggests that the Paleo diet (or anything else) may provide a solution and will rarely consider trying the Paleo diet for Robb’s trademark 30-day trial period.
I wasn’t sure how much I believed this until I stumbled on a discussion on a diabetes forum about one of the testimonials on Robb’s site. Not only was there a huge amount of misunderstanding about what a Paleo diet is (Note: it is not a low-carb diet, unless you choose to make it so.) but a lot of the responses seem to be knee-jerk reactions, some even suggesting the testimonial is made up with “faked” photos, without really considering the diet properly. As a result I fully expect to be “flamed” for this article despite the fact that I’m going to reference the studies I’ve read.
Please try to keep an open mind as you read this and note that I will moderate any unconstructive comments. However all views are welcomed from both sides of the fence – I’m just gathering together ideas and research here, I don’t have a hidden agenda.
Type 1 diabetes as an autoimmune disease
It is widely accepted that type 1 diabetes is an autoimmune disease in which the body starts attacking itself. Specifically, the body starts destroying the beta cells in the pancreas. The beta cells produce the insulin which the body needs to store glucose – for a reminder on why this needs to happen revisit my introduction article – so if the beta cells have been killed off there won’t be any insulin released when blood glucose levels rise.
Improving type 1 diabetes with supplements
The way to stop this beta cell apoptosis (the proper term for cell death) would be to find a way to stop the body attacking itself and a good place to start is looking at supplements known to help with other autoimmune diseases. I mentioned last week that the John Hopkins site claimed that more than 90% of beta cells will have been destroyed before the clinical symptoms of diabetes develop (1) so if supplements can slow or halt the apoptosis then there may also be a way to halt onset of type 1 diabetes before the production of insulin gets to clinically low levels.
Vitamin D has a reputation for aiding in the treatment of autoimmune diseases and I’ve found studies which are free to access on the internet dating back to 2001 that look at the link between type 1 diabetes and vitamin D.
A thorough study which sets the groundwork for a connection between vitamin D intake and type 1 diabetes was carried out in Northern Finland where sunlight levels are limited, therefore providing some control over non-supplemental vitamin D intake and creation. The study aimed to follow all births in two regions during 1966, recording the vitamin D supplementation levels during the first year of infancy and, afterwards, the onset of type 1 diabetes in those same individuals in the period to December 1997. The results show a clear correlation between those with rickets (caused by vitamin D deficiency) or irregular, low or no vitamin D supplementation in infancy and the onset of type 1 diabetes in later life (2).
These results are further supported by later studies (3) so it appears that vitamin D at a significant level can help reduce the risk of type 1 diabetes for your child, especially if you start this supplementation early (3). However, it’s interesting to note that despite having ploughed through numerous other studies on vitamin D and type 1 diabetes (not referenced here) I’ve not found any studies suggesting that vitamin D supplementation in later life can help prevent the onset of type 1 diabetes or resolve it once it is diagnosed. All those who are pregnant or have young children take note – this seems to be a one-off opportunity to boost the immune system and set it up for life!
Once someone has type 1 diabetes there are all sorts of other problems that may occur as a result of the diabetes, including retinal problems (I mentioned in my introduction that sudden changes to eyesight can be a tell-tale marker of diabetes). There is also a risk of renal complications – while the renal clearance of glucose is usually 0 mL/min (4), diabetics characteristically have sugary urine. The renal system is doing something it isn’t really designed to do all the time which, over time, can damage it.
The good news is that I’ve found a study suggesting that this damage can potentially be mended through oral supplementation of 1,800iu vitamin E (5). The vitamin E was found to normalise blood flow to the retina and also improve renal function.
The gut as part of our immune system
I have mentioned elsewhere on my blog about the role of the gut in our immune system. The gut is the frontline of our immune system as the digestive system presents almost the only access points to the human body and therefore the main way for bad viruses and germs to enter the body and bloodstream. To combat this, our digestive system starts out on life with a barrage of defences ranging from enzymes and good bacteria to combat the bad bacteria through to carefully constructed defence walls which should only be permeable to molecules after they have undergone processing and the body can be sure that they are appropriate and small enough to not cause issues.
Many people will have heard of leaky gut. This is caused when the gut lining is permeated so that larger molecules, such as amino acids which are not yet sufficiently broken down, can get into the bloodstream causing irritation. The body will attack these cells in the blood in an effort to destroy them. (This can often lead to subsequent “allergies” to those particular protein-foods because the body is being irritated by the large particles getting into the bloodstream.)
A common cause of the breakdown in the defences can be yeasts and fungi which can grow on the gut lining, drilling their “fingers” through the wall until they perforate it. Leaky gut, while theoretically easy enough to cause is also relatively easy to heal by removal of the problem foods and reintroduction of healthy bacteria, allowing the gut to heal.
The Paleo Diet: fixing the gut and type 1 diabetes
This is just one example of how foods which adversely impact the digestive system can subsequently lead to autoimmune diseases. It is as a result of this that the Paleo diet, which strips out foods leading to destruction of the digestive system such as gluten and sugar, has had such success in curing auto-immune diseases. By taking away the problem foods the body has time to heal the internal damage and appears to stop attacking itself.
The crucial point to note is that this is not unsupported when it comes to diabetes. Studies have found a link between wheat consumption, gut irritation and type 1 diabetes; although it seems that only approximately 50% of those studied show this link suggesting other causes of the auto-immune behaviour of the body in other type 1 diabetics (6). However, it is encouraging to consider that approximately half of type 1 diabetics could potentially halt the existing destruction of their beta cells (and those who do not yet show clinical symptoms could perhaps prevent the development of type 1 diabetes entirely) by following a diet like the Paleo diet.
In particular, it is worth noting that these studies are only looking at the role of wheat but there are other foods also removed by the Paleo diet which are known to contribute to auto-immune conditions and which might account for a few more diabetics – something to be studied further perhaps? I’m not saying that a strict Paleo diet is the solution. In essence any diet cutting out those sorts of foods (wheat, gluten, sugar etc), whether you put a name to it or not, should have the same effect. However there is plenty of material and support for those starting out on a Paleo diet which is why it might be a helpful place to start.
There are other known causes of immune system problems, such as chronic stress, but I’m not clear how much these then lead to autoimmune conditions rather than just impacting the current effectiveness of the immune system.
Curing type 1 diabetes – regenerating the beta cells
Where does this leave us? In this article I’ve identified some ways to prevent diabetes from ever getting started, by boosting the immune system in infancy. I’ve also identified a potential way to prevent the ongoing attack and apoptosis of the beta cells for a number of type 1 diabetics. However, even preventing the ongoing destruction of the insulin-producing beta cells will not cure a type 1 diabetic if they are already at clinical levels where the body is unable to produce sufficient insulin. So how can there be testimonials of people claiming to have cured their type 1 diabetes?
Something was bothering me as I did the research for this article. In various other pieces of research or technical reading I have frequently come across the concept that the body is capable of regenerating things. It can’t regrow limbs, but there is evidence of incredible levels of regeneration activity, like the body growing new arteries to bypass blockages (7, pp.7-10). If it can do that then why can it not regenerate the beta cells?
The obvious answer seems to me to be that the body is attacking the beta cells so there is no sense in creating more. Instead the beta cells should just continue to dwindle away until there are none left. However a fascinating study by Meier et al suggests that beta cells can and do regenerate (8).
Their conclusion arose through studying pancreatic tissue obtained at autopsy from 42 individuals who had type 1 diabetes. The ongoing destruction of beta cells appeared to be continuing yet the number of beta cells remaining had no correlation to how long a person had had diabetes. If beta cells couldn’t regenerate then you would expect fewer cells in those who had had diabetes for longer. The implication is that the cells can regenerate. I can’t do justice to the study here but I strongly recommend that anyone with an interest in type 1 diabetes takes the time to read it – I’ve included a link in the bibliography.
What I’ve taken away from all of this reading is that there may be a cure out there for type 1 diabetics. Step 1 would be to resolve the autoimmune issue, perhaps through removal of problematic foods and allowing the body’s most essential part of the immune system, the gut, to heal. Step 2 would then be to maintain this state of autoimmune improvement while the beta cells regenerate.
It is important to remember that the clinical conditions only appear when there are fewer than 10% of the beta cells functioning so even if insulin replacement therapy ceases to be needed it doesn’t mean you are fully “cured”. While step 1 may need to be followed for life, it is possible that, in time, the odd diversion from the perfect diet may be taken, such as a celebratory birthday cake, without any issues. The body would produce the insulin needed from the new beta cells and, while the treat might flare up a slight autoimmunity again, the body should quickly recover the situation if the person then goes back to their “autoimmune healing protocol”, whatever that may be.
If you still don’t believe that changing diet can improve type 1 diabetes, then I’ve collected together a few testimonials. See what you think.
- The Paleo Diet – JoAnne
- Robb Wolf – Kyp (this is the one which the diabetes forum was discussing)
- Robb Wolf – Anonymous
- Robb Wolf – Yahaira Gil-Maestro (who you can also find on her own blog, My Diabetic Paleo Experience: Does it work?)
I hope this has provided people with some food for thought. I was surprised by a lot of the material I read as I went through this and consequently I think it would be well worth keeping an open mind.
For those with type 1 diabetes it may well be worth playing with some dietary changes, trying to resolve the auto-immune issues. Try a 30 or even a 60-day Paleo challenge or something similar, stripping out known irritant foods. The worst that can happen is that nothing changes and the best is that you might just start to get better.
Update – 28 May 2014
Someone has brought to my attention some recent research looking at umbilical cord blood and tissue stem cell treatment and type I diabetes. It looks like this is a promising new area of research using umbilical cord stem cells to help reintroduce and improve the regeneration of beta cells in the body. In turn this would provide a “cure” for type I diabetes.
However, I’m not convinced that on its own this would give a long-lasting solution as I’m unclear how this would stop the body continuing to attack the stem cells, unless it is coupled with dietary (and similar) approaches to reduce the body’s autoimmune response to the beta cells.
You can read more at the Viacord website.
- Cihakova D: Type 1 Diabetes Mellitus. John Hopkins Medical Institutions website.
- Hyppönen E, Läärä E, Reunanen A, Järvelin M, Virtanen S: Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. The Lancet 2001; 358:1500-03.
- Zipitis CS, Akobeng AK: Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis. Arch Dis Child 2008; 93:512-517.
- Vander A, Sherman J, Luciano D: Human Physiology: the mechanisms of body function. McGraw-Hill 1998; Ed.7
- Bursell S, Clermont AC, Aiello, LP, Aiello LM, Schlossman DK, Feener EP, Laffel L, King GL: High-dose vitamin E supplementation normalizes retinal blood flow and creatinine clearance in patients with type 1 diabetes. Diabetes Care 1999; 22:1245-1251.
- Knip M: Diet, gut and type 1 diabetes: role of wheat-derived peptides. Diabetes 2009; 58:1723-1724.
- Kendrick M: The great cholesterol con. John Blake Publishing 2007.
- Meier JJ, Bhushan A, Butler AE, Rizza RA, Butler PC: Sustained beta cell apoptosis in patients with long-standing type 1 diabetes: indirect evidence for islet regeneration? Diabetologia 2005; 48:2221-2228.