Fat Adaption for Better Control of Type 1 Diabetes

All those who read the terrifically exciting November issue of the HypoActive newsletter will remember the author, Gavin Wright's, fascination for finding out more about that select, hidden group of type 1's who are giving up carbs and living off the fat of the land. Gavin called out for anyone to share their experience of this giant experiment, offering the protection of anonymity. One bold, nameless type 1 stepped forward and agreed to be interviewed at a secret location. Here's what came of it.

There have been whispers about type 1's giving up carbs and fueling themselves on fat for a few years. Some even quite big names in the type 1 exercise world were rumoured to be adapted for fat. But getting the low down from any of them proved tricky. It was just the suggestion that this brave step was getting a bit more widespread that set Gavin's journalistic curiosity ball rolling. Pictures started appearing on the HypoActive Facebook group page that seemed to say that otherwise utterly carb-orientated, well known HypoActive volunteers were missing the usual carbohydrates on their plates. Lots of olives - no chips. The meat, but not the potatoes.

So Gavin was over the moon to find a (local) type 1 who was willing to spill the low carb beans. To protect the innocent, we've given this fearless fat eater a false name. Today, for the sake of neatness, he is Oliver.


The Interview

First of all, Oliver, thanks for joining me and talking about these sensitive issues.

Not at all, Gavin, I almost feel like I should be preaching the new fat gospel - it's all made such a big difference to my diabetes, my life really.

I wonder if you could start by telling us all a bit about yourself. How long you've had diabetes, your treatment regimen, how it's all going - without letting the identity cat out of the bag of course.

Okay. I've had type 1 for a very long time. I won't say how long, just a hint - metal and glass. I'm on multiple daily injections. I think it's fair to say I'm highly engaged with my diabetes. When I was finger-pricking (which stopped when the Libre came out) it was 8 to 10 times a day, more when exercising. I'm very active. My HbA1c always used to hover around 7% - for a long time - but since using the Libre I've had two results below 6%. Party time.

Well look, that's pretty good Oliver. Why did you feel the need to make a change?

You've got type 1 Gavin: you know very well that although your endo - bless his little cotton doctor socks - places great importance on this test, the result can hide a lot. It was great to get a 5.4 - I went down to the beach and howled at the waves and the moon - but I knew I was getting a lot of high spikes and also getting hypo far too much. Every day - and I'm only admitting that under this promised anonymity!

Perfect recipe for a great HbA1c

So where did it all start? 

It was funny, really, almost like a revelation. I'd had it drilled into me so much as a kid and I really believed I had to have carbohydrate with every meal. But last year I was taken with an illness, not well at all, and I couldn't do any exercise. Just laying about doing nothing - and you know how bad your bgl's get when you do that. You're pretty active too, aren't you Gavin? You'd know how much a sedentary day mucks with your levels. Well, this was months on end.

And then one day I just thought, I'm fighting this battle - carbs and insulin - every day, every mealtime. Why don't I just stop consuming carbohydrate. So I did, not all the time, just some meals, and it worked really well. I didn't get after-meal highs, because there was no extra glucose buzzing round my blood. No guessing games with insulin, variable metabolic timelines or righteous over-correction. All went quite smoothly, but at the time I didn't really consider taking on fat as my fuel and dispensing with carbohydrate entirely.

So how long ago did you kick into fat and how did you go about it?

It was a little over three months ago. I'd mentioned it to a friend who was very positive and helpful. I got hold of The Art and Science of Low Carbohydrate Performance by Volek and Phinney, which was really helpful up to a point. It all seemed to make sense, although I didn't get the science. Metabolism is really complicated and you have to know a lot of biochemistry to get it really, so the neat and tidy alternative version in the book didn't really cut the mustard for me. 

I mentioned it to my endo and he looked a bit worried, but he said he had a couple of type 1 patients who were on low carb diets and that although their HbA1c's were a little higher than mine, their bgl's stayed almost entirely in their respective target ranges. In short, their diabetic control was better than any of his other patients. Including me. 

I was a bit stunned. I sat looking at him thinking, Endo, I love you, but why haven't you mentioned this before? The truth is, of course, as I know very well, the experience of these people is not evidence and he can't possibly make any recommendations based on it. All he said was that I shouldn't try and give up carbs completely, which I have since learnt would be very difficult indeed.

The book wasn't very clear about the best way to start, so I just dived right in. Just stopped as fully as I could straight away. No more bread, biscuits, rice, potatoes, pasta and many other foods. It wasn't a difficult decision, it was just like diving into a pool - I made the commitment and just jumped in. The difficult thing for me wasn't stopping the carbs, it was finding something to eat instead. I hadn't really thought what was going to be on my plate. At first I wasn't getting enough fibre and I suspected maybe too much protein, but I figured it out pretty quick and now my diet is healthier than ever. Lots of fresh vegetables (generally, it's the ones that grow above ground that are lower carb).

In the first week I can remember feeling a bit giddy a couple of times, but I could have been fighting off flu, don't know. Apart from that I've been feeling fine all the way.

So what are your results? How has it worked out?

A lot of the time I look at the daily graph on my reader and just think wow. People have actually asked me - why do you look at it for so long? On 9 out of 10 days my bgl is within my target range more than 95% of the time. I get long flat lines that are awesome. My target range is between 4 and 9, which is obviously higher than normal, but I can't believe how well it's gone.

I haven't had an HbA1c since I started, but even if it's gone up a bit I don't care - this is much better. I get hypo far less and when I do, I don't go so low and need only about half the glucose to correct. I only buy lollies for hypos and I'm getting through a fraction of the amount I did before.

When I go out training I don't need to take any food, just fluid, I don't get any of that post-exercise hypo stuff. Just doesn't happen.

Are you still taking insulin?

Yes, of course. My basal injections are about 50% of what they were before, which is a lot higher than I expected. Bolus injections are always very small and infrequent.

Any regrets?

Roast potatoes. Croissants with good coffee (I can still have the coffee). Garlic mashed potato. The occasional pie. Hot chips with my steak. Grainy biscuits with cheese. Eating a whole mango. Noodles in my soup. Wholemeal muffins with raspberries and white chocolate. 

But I'll get over it. 


Many thanks to Oliver for sharing his experience with us all. If you have any questions for me or Oliver just shoot them through to me. Please remember that this is Oliver's experience and not a recommendation of either the author or HypoActive. If you decide to make changes to your type 1 management, please make sure you get proper medical advice before doing so.