Type 1 diabetes: low-carb diets dish up radical new hope


By Marika Sboros

Type 1 diabetes is a scary diagnosis, more so for parents when their children are diagnosed with it. Now, US scientists offer a radically different approach to conventional treatment and management of the metabolic condition.

Their study just published in the journal, Pediatrics, strongly suggests that a very low-carb, higher-protein (VLC) diet can achieve “exceptional” blood sugar control. It can do so by significantly reducing use of insulin and other drugs used in conventional treatment and management.

Better still, dietary change can achieve “low rates of adverse events”. This helps to reduce the risk of complications of type 1 diabetes that include kidney disease, blindness, heart disease, limb amputation and premature death.

Dr David Ludwig

The researchers say that it’s time current treatment protocols should change. Leading global experts agree. Senior study author is Stanford-trained, Harvard endocrinologist and nutrition specialist Dr David Ludwig. Ludwig is author of the best-selling book, Always Hungry, Beat cravings and lose weight the healthy way!.

Monstrous challenges

He says that the biggest challenge facing people with any form of diabetes is blood-sugar control around meals. After eating a high-carbohydrate meal, their blood sugar rises (hyperglycaemia) rapidly for one to two hours. Insulin can control that rise but also cause low blood sugar (hypoglycaemia).

The technologies for monitoring blood sugar and administering insulin have improved. Despite this, Ludwig says that most people with type 1 diabetes still face a kind of “Charybdis or Scylla” choice (between high and low blood sugar) after every meal. That’s a reference to Greek mythology of having to choose between two evil monsters.

The new study shows that a low-carb diet could keep both those monsters in check.

One obstacle is that many, if not most, medical doctors and dietitians these days don’t speak much o patients about diet in type 1 diabetes beyond “carbohydrate counting”, says Ludwig. They also have a particular aversion to VLC (very low-carb, ketogenic) diets for children.  They believe that restricting carbs is “dangerous” and can lead to low blood sugar levels and stunted growth.

The new study suggests the opposite.

Nature or nurture?

Many doctors also still believe that type 1 diabetes is not a lifestyle disease. They say that it is a chronic, autoimmune condition that occurs when the body’s immune system turns on itself. That much certainly is true.

As medical experts will tell you, the immune system does attack the insulin-producing beta cells of the pancreas, leaving little or no ability to produce insulin, a hormone that regulates blood sugar. Without insulin, sugar (glucose) and ketones (made from fat) build up in the blood and leads to what doctors call diabetic ketoacidosis. That can cause serious damage to organ systems and can be fatal.

But why the immune system suddenly turns on itself is a mystery that this study may unravel. Ludwig says that the reason may prove to be incorrect diet, in particular, excess carbohydrate.

Ludwig got the idea for the study after meeting US orthopaedic surgeon Dr Carrie  Diulus at a nutrition conference in 2016. Diulus is an orthopaedic surgeon with type 1 diabetes. She follows a vegan diet and has posted before and after pictures of herself on Twitter after she made radical dietary changes.

Different path for type 1 diabetes care

Dr Carrie Diulus – before and after a low-carb diet for type 1 diabetes

Diulius has reported that she is able to maintain normal HbA1c levels on a very-low-carbohydrate (VLC, aka ketogenic) diet. HbA1c refers to glycated haemoglobin (A1c), which identifies average plasma glucose concentration. It is a marker of how well a patient controls blood sugar levels.

Diulus told Ludwig that her diabetes control was the rule, not the exception, in a large social media community of children and adults. All follow the recommendations of Dr Richard Bernstein that are available on the TypeOneGrit Facebook page.

Bernstein developed type 1 diabetes at the of 12 and was having complications by his 30s. He became a medical doctor to learn better how to treat himself. His research led him to support a low-carb diet even though this clashed with conventional medical “wisdom” at the time (the 1990s).

As an endocrinologist, Ludwig has cared for people with diabetes for more than 20 years. During that time, he had not seen someone with T1DM and normal HgA1c after the initial “honeymoon period”. And if he had, he would have expected an unrecognised hormone problem and frequent, severe hypoglycemia.

Being a researcher at heart, Ludwig felt compelled to delve deeper. He believed that an observational study was “the right first step” to overcome scepticism among diabetes experts. He suggested to Diulus that they do a scientific survey of the Bernstein community.

‘Almost too good to be true’

The researchers studied 316 people, 130 of them children. Participants were drawn from the Facebook group TypeOneGrit devoted to low-carb diets for diabetes. They reviewed participants’ medical records and contacted their medical providers.

Results showed that, as hypothesised, participants’ average HbA1c was 5.67 %. That’s in the normal range, says Ludwig. It is also well below the average value of 8.2% for patients with type 1 diabetes.  Some participants even had values in the 4% range, which he calls “quite extraordinary”.

No bad effects

Reassuringly too, participants reported low rates of complications, such as diabetic ketoacidosis and severely low blood sugar. They also found no evidence of any adverse effect on growth among children. And overall, cardiovascular risk factors were “excellent”, Ludwig says.

Crucially, most study participants were satisfied with this approach. They easily accepted the idea of life-long restriction of many high-carb staples of the modern SAD (standard America, Western) diet, Ludwig says.

Click here to read: ‘Cure’ for type 2 diabetes? A doctor’s personal journey


These findings “suggest that a low-carb diet might help prevent the long-term complications of diabetes”. Researchers need to explore this possibility in high-quality RCTs, he says.

That’s already happening. The Sweden-based Dietary Science Foundation is contributing funds to a study that has received ethical approval and will start soon. Uppsala University Hospital will participate.

The real danger for patients?

Ludwig says that a substantial minority of patients have come into conflict with their diabetes-care providers after embracing unconventional dietary changes. Some have lectured patients about the “dangers” of restricting carbohydrate in diabetes. This led some parents to hide the low-carb diet from their child’s doctor for fear of accusations of child abuse.

Ludwig says that this distrust, more than any diet, represents the real danger. It could set the stage for a “catastrophic event” if patients don’t seek professional help at times of need. And if they make diabetes management decisions beyond their competencies.

He hopes that greater awareness of the low-carb diet for type 1 diabetes, will bridge misunderstanding between patients and providers.

Dr Jake Kushner

Leading US type1 diabetes expert Dr Jake Kushner has welcomed the study. Kushner is associate professor of pediatrics at Baylor College of Medicine.

He calls the Pediatrics paper a “landmark work”. It could “radically alter standard health care for people with type 1 diabetes by introducing low-carbohydrate nutrition as a core element of care”, he says.

Till now, many experts believed that this was impossible, Kushner says.  But hundreds of people have been able to follow Bernstein’s methods, he says. Crucially, they have been able to enjoy “far better glucose control than with typical standard-of-care”.

Paradoxically, those who followed Bernstein’s low-carb methods also had significantly reduced risk of life-threatening low blood sugar episodes, Kushner says. As well, there were no other obvious negative sequelae for the patients.

Questions and answers

As with all good research findings, Kushner says that the study brings up “far more questions than it answers”. It remains possible, for example, that the study patients might have self-selected for their ability to follow Bernstein’s protocol.

He wants to see a government entity or philanthropic source fund a prospective RCT. (Ludwig and Lennerz are presently seeking funding for just such a study.) Kushner also wants to know precisely which nutritional strategy doctors can most easily and safely apply to populations of people with type 1 diabetes.

It’s also important to understand the relative pros and cons of low-carb nutrition (and various other nutritional strategies) for any given type 1 diabetic patient population.

Kushner joins growing numbers of endocrinologists who “strongly suspect” that low-carb nutrition is beneficial for diabetes-related burdens. But in the end, “we will need solid evidence to sort out these opposing hypotheses”.

“We must learn much more in order to fully understand which nutritional strategy is most easily and safely applied. That will  people with type 1 diabetes to live long, healthy lives.”



  1. To paraphrase from another eminent source :-
    The plural of anecdotes is not Data, – but the plural of ‘case histories’ IS . . .

  2. I watched a sister-in-law struggle with T1D most of her life. She followed the mainstream advice to eat “normally”, but keep an eye on blood sugar and adjust insulin dosing. When I think about how she looked and felt by the age of 50, I still feel anger roiling inside. She had multiple heart failures/surgeries, kidney failure, loss of vision and looked like a woman in her 80’s by the time she passed away at age 52. I agree wholeheartedly with those commenting above that more studies to ‘prove’ what works are a waste of time and money when the health community could just listen to those who have successfully ‘treated’ their diabetes with a low carb/ketogenic diet. I used to have to see the science all nice and neatly done. But these days, I’ll take the hundreds or thousands of anecdotes over the conflicting studies with their conflicts of interest and selfish agendas anyday..

  3. If diabetes ‘professionals’ regard substantially reducing carbohydrate consumption as a “terrible burden” I wonder how they’d describe chronic ill health, blindness, kidney failure and amputations.

    Strangely enough, I found a low-carbohydrate way of eating to be enjoyable, satisfying and much healthier.

    • They would describe it as “only to be expected”. After all diabetes is a progressive disease, you know.

      While they blame Type 2s for causing the disease themselves, probably by eating too much meat, they also claim that Type 1 – autoimmune – is not the patient’s fault. Over a decade ago I read that the *rate of increase* of Type 1 was actually higher than the rate of increase of Type 2. I don’t know how that has gone since or whether it has been paralleled by increases in other autoimmune diseases. I strongly suspect further effects of the low fat diet and seed oils.

      Yes I thoroughly enjoyed the remains of my last pheasant, stir-fried in EVOO with multicoloured peppers, chillies, garlic and mushrooms – and of course bacon – the least enjoyable part was the tiny amount of quinoa I used to soak up all the fatty juices. Apparently this is dangerous and unsustainable although I’ve been doing it for thirteen years now.

  4. If course our own Prof. Tim Noakes believes in Low Carb Medium Protein
    For good results in controlling diabetes.

  5. It used to be that the dim bulbs, including a pediatrician, claimed that there were “no studies” only anecdotes.

    Following this and Virta for Type 2, their mantra has changed to “they are the wrong studies”.

    Over the last couple of decades I have known many well controlled diabetics including some Type 1s who have better A1c and other numbers than many “nondiabetics” – like Bernstein not a few of them were engineers.

    What remains truly disgusting is that some of these people posted on the American Diabetes Association forum. IF the ADA genuinely wanted to help diabetics they would have studied them years ago. Same for all diabetes associations in most other countries, they sacrifice health for the profits of their sponsors.

  6. Above confirms Prof Tim Noakes’s approach to diabetis. Here in South Africa this study needs to be made available to so many scientists who opposes.

  7. In my view, there is nothing admirable about Ludwig’s restraint. These findings do far more than“suggest that a low-carb diet might help prevent the long-term complications of diabetes”. They support what science has told us possibly as long as we’ve studied diabetes — as you say “Ironically, there is nothing new about the premise on which this research is built.” Researchers do not “need to explore this possibility in high-quality RCTs.” They need to get out there and show how to implement such diets. Then we will forgive them for opposing such approaches at the expense of patients’ well=being.

    • I’m with you, Richard. There is no time to lose. Current Standard Of Care for diabetes is an unmitigated disaster and needs to go the way of the dodo immediately.

      Your 2015 paper should have been enough to make the mountain of objections to keto diets for diabetics into a molehill:
      “Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base”

      Instead, the ADA and diabetologists, endocrinologists, and nephrologists worldwide ignored you and continued along their merry way giving bad advice that slowly, tortuously destroys the lives of their diabetic patients.

      This is no time for restraint. This is the time to BOLDLY embrace ketogenic diets for diabetics and start really saving lives instead of fiddling with the controls of a plane about to slam into a mountain.

      The future is clear. Embrace ketogenic diets for diabetics or watch most of our entire populace dissolve into diabetic lumps before our eyes.

      • @Richard David Fineman; @Ben Fury: Very well said, both of you. This is the attitude that we must all adopt: start letting diabetics know that the ketogenic diet can reverse or greatly control their diabetes and give them their health again. There is NO evidence whatsoever to suggest that the ketogenic diet is ‘harmful’ to humans and in fact it’s likely optimal. Enough with muddying the waters with doubts and contradictions and demands for more and more science to prove it. These obstructionist tactics are based on the fears and self-interest of those in the healthcare community and nothing more. Of course big pharma is terrified that they won’t keep selling as much insulin and diabetes meds, but that’s just too bad.

    • Richard, absolutely correct. How many women would have died … if Semmelweiss had taken the time to persuade, finance arrange and conduct a suitably powered Random Controlled Trial. He also “discovered” what we call “The Semmelweiss Reflex”. Definition: Unreasonable ego-driven attacks upon the Discoverer of an uncomfortable (scientific) truth, the severity proportional to size of the vested interest or professional pride. One only has to consider the “official” mauling of Dr Gary Fettke in Australia or Prof Tim Noakes in South Africa – and the sharks still circling…

  8. I have raised this issue in the past. I feel very strongly that the there is only one group of people to speak to and study to get to the bottom of the vexed issue of treatment for diabetes. The group I am referring to is those people who commit to low carb eating of their own accord and of their own volition after doing personal research into the matter. They are fully committed and need no urging or outside incentive from institutional researchers to follow the program. These people do it because they KNOW it works despite what the multitude of ignorant medical practitioners and dietitians will tell them.

    As far as I am concerned dietary RCTs are often quite irrelevant vanity projects and society must just as well stop wasting money on them when a much cheaper and far more effective paradigm exists…….the wisdom of crowds…….the impetus that is created by the type of people who made this study possible……the people who ignore outmoded palpably wrong medical and dietary advice……people who inform themselves….the people who monitor their own progress and tweak the program when they need to….the people who accept the reality of their sugar addiction…..the people who oppose filling themselves up with toxic medication when lifestyle changes are far more effective

    • Fie on thee, Anton. – how else will be support all those worthy souls depending on a well – funded ‘Research Industry’ for their Daily Bread ? Do you really want to see them cast out on the street…?

      Astronomy for example, owes much to enthusiastic, self-taught ‘amateurs’, and continues to do so. Not only is it cost-effective, but takes out the ‘Human Factors’ of Entrenched Professional Pride and Eminence-based Science.

      Or, with apologies to Gene Hackman’s character.. ” You, (Research Medico-Tribal Chiefs) can’t handle the Truth !”

  9. (Un) Common sense or Sound Thinking… both Diabetes are sides of the the same big fat coin, so the dietary approach that ‘Reverses’ one of them, must yield positive results for the other.
    Low-carb eating pattern for ameliorating Type 1 is NOT a new fad, but was the only workable tool in days gone by, – before Insulin became widely available, and overshadowed the value of Low Carb.

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