Low carb diet leads to “clinical remission” in 3 cases of type 1 diabetes | Hacker News Reader

Low carb diet leads to “clinical remission” in 3 cases of type 1 diabetes

diabetes.co.uk

166 pointscolawars142 comments

I'm a type 1 diabetic and find these articles and studies frustrating. Or at least the way people interpret them.

> Two weeks after adopting the low carb approach insulin was no longer needed. After 18 months insulin therapy was once again required at low doses of around 16 units per day. HbA1c remained very well controlled on the LCHF diet with insulin.

So during the honeymoon period, he was able to live without insulin. This is pretty normal -- there's about a year after T1D diagnosis where the pancreas continues to produce insulin. It's common for people to be able to make it through that period with reduced insulin therapy. And then after 18 months he had to start on low doses of insulin again, even with the diet.

Low carb diets can help type 1 diabetics, but it's not a cure. Please don't go around suggesting to your T1D friends that they just need to start on keto, and can stop taking insulin.

Here is the actual study [1]. This is n=3, so we are talking about highly anecdotal data. Nonetheless, I think this statement is misplaced:

> Low carb diets can help type 1 diabetics, but it's not a cure

Likely, as in most cases, the real picture is much more complex. It could be the case that LCHF diets can cure some percentage of individuals, can help some percentage and can be detrimental perhaps even fatal to some percentage. All of these could easily be simultaneously true.

Indeed, in case 1 it seems to have possibly "cured" the patient, though he could have also easily been a false positive or there could have been any number of other confounding factors. I quote from the study:

"He was able to stop insulin completely 15 days later (after diagnosis), and has not used insulin since March 2015." and "In the 4 years since his diagnosis, he has had no diabetes-related complications".

Here is patient #2's summary:

"He stopped insulin therapy at the beginning of the diet and has not used insulin since, except for one infectious episode." and " At 1 year after the diagnosis, he had no diabetes-related complications".

Also of note, both of these patients had started exercising 1-2 h a week, and 2 and 2-3 times a week respectively, before the diagnosis.

1. https://www.sciencedirect.com/science/article/abs/pii/S12623...

It's well understood that insulin production in type 1 diabetics can continue at low levels for ~5 years post-diagnosis; the process of beta cell destruction is a gradual one and diagnosis typically occurs after 80-90% of beta cells function has been lost.

You need a small amount of insulin even during ketocis, otherwise you will go into ketoacidosis. Type 1 diabetics suffer from destruction of b islet cells and thus have reduced to zero insulin production. There are some reasons why you might have a small insulin production( e.g. acute pancreatitis destroying some but not all b islet cells) but those are pretty rare. For most people the destruction happens as a result of an auto-immune disorder and eventually they all get destroyed. So maybe there's a period between the diagnosis( usually around ~90% destroyed cells) and when all cells get destroyed that you can manage it with keto. But it won't last forever and thus is not a cure.

Same feelings as you on this one - not that it isn’t par for the course with most science journalism, but it’s especially frustrating for T1 news.

Perpetually thankful that we’re only five years from a cure.

Yeah, it's always the same. Either we're five years away from the cure, a magical cure was just discovered, or somebody just "discovered" that keto can cure T1D.

Hugely reducing insulin dosing is still probably valuable, especially for Americans since it's so expensive.

It's expensive but not as bad as you'd think. I didn't have insurance for half a year, and I just called the manufacturer and got a huge discount ($200/bottle -> $35/bottle). One bottle lasts a month or so.

This was only due to not having insurance and wasn't need-based - I had earned FAANG income earlier that year and the year before.

Just curious, which manufacturer did you call, Eli Lilly or Novo Nordisk? I think the details of how you were able to get a discount would be beneficial to others. I am a type 1 and I recently heard of another type 1 who recently died at age 40 because he lost his job+insurance and was rationing insulin.

I called Lilly, but both manufacturers have programs to help. These two are need-based. I didn't qualify but still got a sharp discount.

https://www.lillycares.com/aboutlillycares.aspx https://www.novocare.com/diabetes-overview/let-us-help/pap.h...

Both those prices seem excessive.

These prices are not high. I went through a period when I had no health insurance, and I had to rely on generic insulin, the kind you can buy at Walmart for $25 a vial. I have insurance now and the insulin I take now costs me a co-pay of $100 a vial. Paying $35 a vial without insurance is not bad at all.

It's a hell of a lot higher than most developed nations. Here in Ireland, as far as I'm aware, it's free thanks to the long term illness scheme. (We have both public and private healthcare available)

Just because you never see the cost, doesn’t mean it costs “nothing”.

Sure, but to someone who's on unemployment benefits. It's free. To someone who's earning a little bit more than that, it's free. To someone who is earning enough to pay tax, they're paying a tiny amount. To someone who's earning more than 30K€, they're paying a few grand in taxes (which covers other public services also). To someone who's earning 60k€ they're paying even more.

But the important thing is that the person who's earning fuck-all can still afford it, because it costs nothing to them.

I am aware that insulin costs a lot less in other countries. I have read the stories of Americans going to Canada to buy insulin. I have also read the stories of diabetics in the United States who died because they tried to make their insulin last longer by rationing their dose.

If I didn't have insurance my insulin would cost me either $245 (fast-acting) or $700 (basal) a vial.

I was just pointing out that getting insulin for $35 a vial in the United States is a very good deal.

> I was just pointing out that getting insulin for $35 a vial in the United States is a very good deal.

That may very well be the case. But for someone paying 0% tax in Ireland, 0€ on insulin is an even better deal.

I agree, completely.

What's wrong with the cheap generic?

The cheap generic doesn't have the same effect profile. It's much harder to match an insulin bolus for the carbohydrates you're eating at a meal. The combination of fast acting and basal insulin can do a much better job of keeping your glucose readings in a good range.

That said, the same kinds of insulin cost a lot less in many foreign countries than they do in the United States.

The NHS (how much it pays not the patient) annual costs are about £400 so it doesn’t seem excessive

The best part of economic freedom is that one is free to start a manufacturer delivering a cheaper whatever one is complaining is too expensive!

"Not only are the big three insulin manufacturers financially opposed to biosimilars entering the market, they’ve actively taken legal steps to prevent it."

https://beyondtype1.org/how-much-does-it-cost-to-produce-ins...

It's possible the price is too high, but the reason it has that price $35/bottle is the minimum required to sustainably produce it. It's well accepted in economics that price of manufacture is not necessarily the societally optimal price [0]. If this is the case, what needs to be done is government subsidization, and no individual person can just start a company and do it themselves.

Also, the idea that everyone is free to start manufacturing insulin ignores the billions of dollars of capital that is required to create a FDA-compliant insulin production plant, which almost no one on earth has access to.

[0]: https://www.investopedia.com/terms/e/externality.asp

Not with the way the FDA has a pile of rules and regulations that combined have the unintended effect of blocking the market. Drugs of all kinds are not in a market state of economic freedom. There are pros and cons of the situation, but at least please stop pretending that it's a free market.

It’s not without tradeoffs. There’s a substantial overlap between T1 and CHD, and the impacts of keto on CHD in non-normal populations (hyper-responders, metabolic patients) are even more poorly understood than they are in the general population.

Lowering carbs is one thing; LCHF is an entirely different beast (and I say this both as a T1 and a T1 who tried LCHF for nearly a year).

It’s an option for some, but billing it as “remission” is going to make people think it’s a cure-all, when it’s far from that, and isn’t exactly “new” for the treatment of T1 - it’s both part of the general instruction set (“reduce carbs”) and even prior to insulin therapy, was the only treatment for T1, and it had a pretty poor success rate.

What does CHD stand for in this context?

Coronary heart disease. CVD (cardiovascular disease) may be more appropriate as it’s less specific but still covers the linkage between the two conditions.

http://journal.diabetes.org/diabetesspectrum/99v12n2/pg81.ht...

Thank you.

Yes, but any T1D is acutely aware of this fact. The whole treatment regimen is ratioing carbs to insulin.

great point to balance out the hype! This should be mentioned by article authors! I appreciate that comment.

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I’m also a T1D. I assure you, lots of diabetics have tried keto diets. It doesn’t put the disease “in remission”. That’s not how the disease works.

...

You’d be off base in questioning any of that, at least as the central premise that “X person didn’t have Y effects because they ate too much Z macro.”

Keto, when strictly followed, provides a great reduction to bolus needs (in personal experience, 80-90% reduction, depending on protein intake), and a lesser, but still significant, reduction to basal needs (30% in my case); however, both types of insulin are absolutely still needed to prevent high blood sugars in an environment with no insulin, which is a significant risk of DKA (and death). Protein metabolizes into excess sugar in the blood stream as well, so unless you’re eating a pure fat diet, you will still need insulin. In addition to that, there are hormones (cortisol for sure), and other non-macro nutrients and alkaloids (a common report is caffeine, but this very much depends on individual biochemistry) that can cause rises in blood sugar, which require insulin to compensate for.

A type 1 diabetic without honeymoon insulin production will still die after a period of even the strictest of ketogenic diets. It was the treatment prior to the introduction of insulin, and was effective at extending the lives of diabetics; they would typically be able to live up to 3 or 4 years post-diagnosis before eventually dying.

For the record, my body enters keto at or around 45g/day, as measured by the presence and amounts of ketones; anyone who says “you need exactly N grams per day or it isn’t keto” is extrapolating from generalized experience at best.

The problem with keto isn’t that it isn’t effective for some things, it’s that people go a long way to oversimplify both the science behind it and the impacts it can have on other conditions by over applying that lens of simplification. It’s a good diet for some, but it isn’t a free lunch (pun not intended) - and it’s far from something that can eliminate the needs of insulin in type 1 populations, as this article alludes to.

Curious if they have any clearer definition of what they mean by “recently diagnosed.”

Based on the article, it looks like all patients were in their honeymoon period, which certainly makes for a substantial difference from what most would think of as remission - the difference between “clinical remission” and “clinical remission in very controlled circumstances while patients were still capable of producing some insulin.”

It’s pretty well known that LCHF reduces overall insulin requirements, and it’s not surprising that in new patients who are still capable of some production that LCHF would be enough to effectively lengthen the honeymoon period, but in any case I’d argue that the word remission is a pretty poor choice of words for describing the effect seen.

Yeah, this article was frustrating because there was literally nothing surprising in it. It basically said that during the honeymoon period they could get by without insulin on a LCHF diet, and then after the honeymoon period they had to go back on insulin even WITH the LCHF diet.

That isn't news, and the title of this article is dangerously misleading.

From last year (July 2019), and no follow-up. As someone who has to deal with T1D every day and carefully monitors news about research, I guarantee you no endocrinologist is counseling their patients to try this. Cutting carbs can lead to less need for insulin, but it's not a cure for T1D.

Yep. When I've consciously gone low carb, my insulin requirements have gone down, and my blood sugar was much more manageable. But if I had stopped taking insulin entirely I would have died or ended up in the hospital with DKA.

With this regimen, you would simply do as your blood sugar numbers direct. It sounds like these patients were measuring and found their glucose to be too low if they took any insulin. In that case, it is safe to stop if coordinated with a doctor. There shouldn’t be any point where a decision is made to drop insulin permanently while your reads are high.

Even if stopping insulin prematurely, low carb would mean low risk of DKA due to slowly rising glucose, giving plenty of time to react. Dropping long-acting insulin would be harder to revert, but frequent small doses of short-acting would be an effective stop-gap.

A good general principle for us diabetics is to encourage everyone to safely explore the control they have over their particular flavor of this disease, and respect whatever those limits turn out to be. :)

> With this regimen, you would simply do as your blood sugar numbers direct.

That's true of every regimen, though.

The person I replied to seemed to think that the regimen directed to quit insulin without support from the numbers, leading to diabetic ketoacidosis.

That's not what I think at all. But it's what other people think when they see articles like the one linked. I've had many, many people tell me in the past that I can cure my T1D with keto, which is why articles like this one annoy me.

As a fellow type 1, I understand the frustration.

Reiterating what the diabetics in these threads will tell you:

Type 1 isn't about insulin resistance in your cells, it's about not producing insulin in your pancreas. Of course type 1 diabetics with rigorous diets will have less glucose swings, but a stable A1c or daily tests doesn't mean your eyelet cells grew back. It's a bit like saying a hemophiliac is asymptotic because they haven't had any cuts lately.

These kinds of articles can come off as callus to diabetics. They're getting diet advice from their GPs and their endocrinologists. They don't need muggles telling them to eat better.

I was on a low-carb diet for a while. Loved it. Felt great. Was totally fit. All my digestive problems cleared up. I would never get "hangry". By every single subjective measure my quality of life and sense of well-being improved.

Then I got my cholesterol checked during a routine blood work and it was through the roof. WTF? Anyone know better than me about this?

Your assumptions about high cholesterol being bad are wrong, simple as that. Just as a few decades ago, the popular (even as agreed upon within medical industry) assumptions about "low fat" were wrong.

In other words, the measurement you observed was good. Your brain needs that measured value you were tested at to be high. Your health would suffer if it wasn't.

There is tons of research and discussion about this online. The argument goes along with the idea that "statins" are one of the biggest pharmaceutical scams in history, bad for brain health and part of a larger false narrative on cholesterol.

Don't change a thing, you're doing it right.

so. this is so general that it’s not helpful. what ranges are we talking about?

also, when people talk about cholesterol they usually don’t mean cholesterol they mean lipi-proteins that carry the cholesterol through the blood (cholesterol needs this as it’s hydrophobic). LDL from those lipo-proteins is definitely correlated with heart disease.

Here, read about it in more detail than you probably need to know: https://peterattiamd.com/the-straight-dope-on-cholesterol-pa...

>this is so general that it’s not helpful

I think digging into the minutiae of specific numbers is silly, when the better frame is to construct the right diet the comports w/ human evolution and lifestyle, energy, activity and go from there.

Generally low carb (particularly avoiding high glycemic index carb, and sugars) preferring lower starch vegetables, while prioritizing animal fats, meat, fish.

Keto / keto carnivore, low carb etc have been around and well studied for a while now. People should do their own research (I like all of Gary Taubes' books and presentations, there are many others as well and podcasts) but ultimately I summarize the point as our bodies have evolved to follow this diet and observations of societies or time periods when one or the other was more prevalent show stark differentials in health, obesity, diabetes, metabolic syndrome...

I have no idea what my cholesterol numbers are (I'm sure they are "high"), but I certainly would never take a statin which would destroy my brain.. and as the OP mentioned, I know what makes me feel rested, energetic, what provides energy and muscle mass along with workouts in the weight room, what does or does not result in brain fog (sugar), better sleep, lower body fat, etc. All low carb / high fat. The more intense the exercise one does, the more carbs they can consume.

Keto diets have most definitely not been around long enough for anyone's bodies to evolve to follow them. That takes many thousands of years.

Why would our bodies need to evolve to follow them when the mechanisms are already built-in?

Our body already contains the necessary pathways, enzymes and processes to switchover to utilizing fat as fuel. We quite literally evolved to do this...

That being said, I think this adaption was more of an energy conservation mode for when food was scarce rather than our ancestors intentionally eating in a ketogenic compatible manner.

> That being said, I think this adaption was more of an energy conservation mode for when food was scarce rather than our ancestors intentionally eating in a ketogenic compatible manner.

Yeah, that's the point I was trying to make. I am aware that humans have the capability of surviving on a ketogenic diet, but that doesn't support the argument I was replying to that following such a diet is what we evolved to do.

The diet of primitive humans was more similar to keto than to current developed country diets and it was in place for hundreds of thousands of years. The first big change was from agricultural civilizations in neolithic, less than ten thousands year ago. Current diet is at most a hundred years old. And specifically the diet that is causing so many problems is only fifty years old.

primitive humans also lived 20-30 years tops. today at 20 you can eat whatever you want and you’ll mostly be fine short term.

i’m tired of people justifying their life choices by what primitive humans were doing. we’re not primitive humans.

Life expectancy may have been that low, but overwhelmingly due to infant mortality. It's not like primitive humans were dying of old age in their 20s.

not in their 20s but definitely not in their 80s like today. if you reached 50s you were a boss. a lot of things that we consider routine to fix today would have ended your life (broken leg/hand, infections, severe diarrhea, etc). We really under-appreciate how many things we have as tools to expand our lifespan today.

From what I remember, it was more like if you made it past adolescence, making it to 50 was about normal. All kind of beside the point; you seemingly rejected the relevance of the primitive human diet based on their life expectancy. I don't think that follows.

Considering that soldiers in Ancient Greece could only retire after 30 years of service, I think it's fair to say there were plenty of 80 year old "primitive" humans.

I think we're talking prehistory, pre-agriculture here.

that what i also though. at least 10000 years ago if not more

Typical diets these days are pretty bad. But few, if any, societies of anatomically modern humans have lived under conditions where they would almost always be in ketosis, so evolutionary history doesn't provide a reason to think that we are best adapted to that being our normal state.

i don’t like this line of thinking. digging in can help you tailor your diet and lifestyle on the genetics you have. also, decades of medical research cannot just be swept away based on a gut feeling. do know everything? no. do we have some good indicators? definitely.

LDL is correlated but not causative and it's been discovered that HDL is a much better indicator.

Take a look at this book: https://www.amazon.com/Big-Fat-Surprise-Butter-Healthy/dp/14...

It goes into it quite a bit more -- cholesterol is a _terrible_ indicator of overall health. This is well known in the Keto community.

when you use LDL, HDL and cholesterol interchangeably this tells me that you don’t know what you’re talking about. Cholesterol itself is part of the lipid membrane of every cell. It’s essential. When people say “high cholesterol” they usually talk about high cholesterol carrying lipo-proteins in the bloodstream. high ldl is definitely a risk factor for CHD

How do you explain what Dave Feldman refers to as the lipid triad which is common in people that are on a low carbohydrate diet?

In this case, there is not sufficient evidence that those who have elevated HDL, LDL and low triglycerides have higher rates of cardiovascular disease...

https://cholesterolcode.com/a-dialog-on-the-lipid-triad-with...

not familiar with this fellow but if I had to guess I would say that in some cases ldl-c (volume) is high while ldl-p (count) is low leading the ldl not to cause as much damage as it a high number of particles

I didn't use them interchangeably...? Did you mean to refer to someone else?

And the opposite is well known in the Whole Foods Plant-Based community.

I don’t have a horse in this race but appeals to authority when it comes to the science of diet are highly suspect.

Nah, I used to be on a plant-based diet -- have done quite a bit of research. This is _not_ well known in the community, but sure, a few under-researched people in the group might say that has to do with it.

Just an addendum to people who aren't familiar with medical research. This is way outside of mainstream medical practice, and 95% of researchers in the field believe cholesterol matters, statins have saved more lives than any other drug, and they improve cognition in most cases.

You must not know too many people that have taken statins...

Sure, on paper, the LDL number goes down and according to the numbers you have a lower risk of heart attack, but the one common thing I've notice is that everyone complains that they feel terrible. Things like dizziness, nausea, low energy/libido, etc...

Let's not forget that it takes mainstream science time to catch up to new research. There is a lag in existing beliefs while more research is being done and evidence solidified.

That being said, lipidology is extremely complex but in the case of low carbohydrate diets the issue of having high LDL and HDL may not be as bad as mainstream medicine would make it out to be.

For some interesting insights on research being conducted in this field, Thomas Dayspring and Dave Feldman are extremely knowledgable and explain things quite well.

https://twitter.com/Drlipid

https://cholesterolcode.com/

They both have appeared on a number of health/fitness related podcasts but a quality one they both have been on is "The Drive" by Peter Attia:

https://peterattiamd.com/tomdayspring1/

https://peterattiamd.com/davefeldman/

edit: I would also argue that his subjective feelings of good health are a much better indicator than the population-averaged cholesterol numbers...

edit2: to say that this type of research is outside of mainstream medical advice is misleading. Lipodology is a prominent topic and a quick pubmed search for the "lipid" keyword since 2018 shows over 60k results. In medicine there is rarely a such thing as "settled" science. Things are continuously researched with new questions and information is used to update our original hypothesis. To refer to current advice as set in stone is very naive...

> That being said, lipidology is extremely complex but in the case of low carbohydrate diets the issue of having high LDL and HDL may not be as bad as mainstream medicine would make it out to be.

I'd 100% agree with this. But "your cholesterol sky rocketing a good sign" is not something the evidence currently shows.

> that everyone complains that they feel terrible. Things like dizziness, nausea, low energy/libido, etc...

Statins definitely have side effects, just on balance it leads to better cognitive outcomes instead of worse ones.

It's true that it takes time for mainstream science to catch up. But new preliminary research is new and preliminary and when it goes wrong it goes wrong more catastrophically than solid mainstream science.

> I'd 100% agree with this. But "your cholesterol sky rocketing a good sign" is not something the evidence currently shows.

"sky-rocketing" is a definite over-exaggeration here.

I would be curious to see what your response is to the link I posted in another comment here.

I am wondering how people that still reference these dated outlooks on cholesterol can explain why there is insufficient evidence of higher cardiovascular disease rates in those with high LDL in the presence of high HDL and low triglycerides, commonly called the "lipid triad"?

https://cholesterolcode.com/a-dialog-on-the-lipid-triad-with...

What the parent comment initially stated would lead me to believe that he falls into this lipid triad group and if I was in his shoes I would tell any doctor that recommended a statin to f* off if I had just started feeling the best I'd ever had in my life.

Also, can you send me some research for your points about statins having an increase in cognitive function? My understanding was that many were arguing the opposite and some meta-reviews I read on the topic suggested that more evidence was needed to make any clear observations.

Masai all have atherosclerotic plaque build up and it is also present in their children. Childhood with plaque forces various adaptations to blood vessels. They get wider and more elastic to counter the reduced blood flow and rigidity.

Anyone who isn't a child won't be able to make these adaptations and anyone who isn't on a starvation mimicking diet but is trying to gain or maintain weight on diets filled with dietary cholesterol will almost certainly start building up plaque.

Yes, dietary cholesterol has a low effect on blood serum cholesterol after some amount. So yes, increasing the consumption of eggs from 5 to 10 a day won't linearly effect the blood serum cholesterol.

Problem with fasting mimicking diets is that they are not a cure and are not long-term.

Also, consuming only things that are easy to digest makes you digestion more fragile to varying stimuli in the future. Which is why people who are on these "rejuvinating" diets for a longer period of time tend to experience their disease symptoms much quicker when they go back to eating vegetables rich in antinutrients.

Here's a very nice study where all Masai participants had atherosclerosis. Some even died from heart disease being less than 20 years of age: https://academic.oup.com/aje/article-abstract/95/1/26/167903

"These pastoral people are exceptionally active and fit and they consume diets of milk and meat. The intake of animal fat exceeds that of American men. Measurements of the aorta showed extensive atherosclerosis with lipid infiltration and fibrous changes but very few complicated lesions. The coronary arteries showed intimal thickening by atherosclerosis which equaled that of old U.S. men. The Masai vessels enlarge with age to more than compensate for this disease. It is speculated that the Masai are protected from their atherosclerosis by physical fitness which causes their coronary vessels to be capacious."

There is an incredible amount of confusion surrounding cholesterol, mostly because of the incredible amount of bad/old/incomplete science around which many major medical associations base their recommendations.

To put it simply, using "cholesterol" as an indicator for anything is a completely oversimplified view originating in the 50s, when we didn't know enough molecular biology to know better. We've since moved on to breaking out LDL (bad) and HDL (good) cholesterol. However, as it turns out even that is too simplistic. There are further sub-classifications of LDL, such as large fluffy LDL and small dense LDL. If subclasifying LDL - Low-Density Lipoprotein - as "small and dense" seems counterintuitive, I agree. I feel like it's a result of the order in which we learned about all the forms of cholesterol, and a reflection of how complex the system is, and perhaps how much more we have left to fully understand it. As it turns out, so many of the perils of what we thought was caused by "high cholesterol", and then "high LDL/bad cholesterol" seem to be most strongly correlated with the small/dense LDL pattern. The irony is, we've been measuring everything but the main culprits, gaining an incomplete picture of what's actually going on, then ended up with wildly ineffective or harmful dietary recommendations as a result. A low fat high carb diet may reduce your cholesterol, but it can wreak havoc in so many other ways.

Bottom line is, eating a low carb, high fat diet increases all of your cholesterol (subject to individual variation), but seems to exert favorable effects on the overall ratio of the individual particles, which may be the important thing. If you're really interested in what's going on with your cholesterol, ask for a LDL particle size test, then you may be able to draw some more meaningful inferences. [1]

To me, it's a good hint that if every physical and mental aspect of your body improved on a diet, it's unlikely a bad thing. Best to discuss these things with your doctor though. Diet science is still a frustratingly murky field, so it's pretty hard to navigate right now. If you want to understand why, I highly recommend Good Calories, Bad Calories by Gary Taubes.

[1] http://education.questdiagnostics.com/faq/FAQ134

totally. looking at LDL-P is a better indicator that looking at “cholesterol”. There are cases where LDL-C looks okay but you have a large number of particles or cases with elevated LDL-C but with normal number of particles.

I've been on the keto diet for a while.

Two important pieces of info surround this.

1. Your body is burning more fat so it has to be mobilized in your blood.

2. Blood cholesterol is actually poorly correlated with cardiovascular health. Cholesterol plaques are actually a bandaid for the inflammation caused by a high carb diet. No inflammation no problem.

I am not a doc, so do your own research.

As many have said -- cholesterol is not indicative of much, HDL can be useful but still not much. First thing I would do is study a little bit about it, I found this book very informative, The Big Fat Surprise https://www.amazon.com/Big-Fat-Surprise-Butter-Healthy/dp/14...

I've been Keto for 18 months and it's changed my life (I've previous tried Paleo, Vegan, Vegetarian, Pescetarian, and a few others) -- I also got my blood tested 6 months after starting and I was in "perfect" levels according to the nurse -- but cholesterol specificaly is a terrible indicator.

Anecdotal, but the same happened to me. I later fixed it by running for 30 minutes 3x per week, and continue do to so to this day. LDL, HDL, Triglycerides, and blood pressure are all in the healthy ranges. 5.5 years and counting, with no "cheat" days either.

Yep. Exercise is the answer here. Moderate exercise will help your body to produce HDL cholesterol, which aids in removing unhealthy LDL and Triglycerides from your blood stream. According to my doctor, having a higher ratio of HDL to LDL cholesterol is far more important number than the total cholesterol level.

I'm someone with a family history of CVD, so the only way I would try a low-carb diet is if I ate food that doesn't have clinical evidence for raising cholesterol, blood pressure, etc.

That meant eating only a small amount of saturated fat, and limiting palmitic acid in particular, and only small amounts of table salt balanced with other minerals like potassium chloride.

I'd eat a lot of salad, nuts, fish, and the only additional fat I'd eat would be in form of EVOO, avocado oil or other oils high in monounsaturated fats, and some polyunsaturated fats. My blood work was always fine.

Some people think low-carb means that they get to eat bacon for every meal and drink the grease.

Sounds like your following an AIP diet.

Fantastic for dealing with inflammation.

Yeah a lot of low carb diets replace sugar with super high cholesterol foods. It's not uncommon to hear keto influencers talking about how they can eat as much steak and bacon and cheese as they want.

>Then I got my cholesterol checked during a routine blood work and it was through the roof. WTF? Anyone know better than me about this?

Your LDL(bad), HDL (good) or both? And did your doctor do a coronary scan (checking for plaque build up)?

What you don't want is LDL Cholesterol building up as plaque in the arteries, there is some connection to plaque build up and LDL levels.

High HDL cholesterol is associated with low risk of heart disease.

Typically a LCHF diet raises HDL (i.e. lower risk of plaque build up and heart disease). In some people LCHF diets raise both LDL and HDL, but the ratios are typically and overall improvement (meaning less plaque build up). The goal with health isn't low cholesterol necessarily, its low plaque buildup.

> Then I got my cholesterol checked during a routine blood work and it was through the roof. WTF? Anyone know better than me about this?

This is not necessarily a bad sign, but you should talk to your doctor about getting more advanced cholesterol blood tests.

There are different measures of cholesterol, like concentration per particle, number of particles, and size of particles, and regular bloodwork usually only measures one of those (concentration, I believe).

You can have a lot of small, empty particles, or fewer large, dense particles, and so forth. This means a regular test may not paint the whole picture, especially if you’re doing something “non-standard” like a keto diet, fasting, or if you’re losing significant body fat.

Low carb doesn't have to mean lots of meat, cheese, and fat. Most people would have positive outcomes from a diet that is 75% whole-food, plant-based no matter what the remaining 25% is.

Plants are mostly carbs yo...

well, some have more complex carbs... and some have more fat (avocados) and some have protein, but still "plant based diet" usually means complex carbs...

Healthier for sure, but it can't be considered 'low carb diet'

Not a ton of carb calories in lettuce, kale, spinach, broccoli, etc. They’re mostly composed of insoluble fiber (from which ruminants can extract calories but humans can’t) and water.

A “low carb” diet doesn’t exclude high amounts of insoluble fiber. It excludes high amounts of carbohydrate calories.

This is not getting through...

If you are consuming your 2000 calories diet, and it is coming from plants, you are still ingesting 2000 calories worth of carbs.....

1 kg of feathers, and 1 kg of iron, weight the same....

The feathers will be large and take more volume, while the iron will be small and more dense.

Same with foods.... if your plant based diet you are consuming 2000 worth of bio-available calories, then that is still mostly carbs...

It is healthier for sure than consuming 2000 calories through processed foods such a muffins, chips and other crap. But, still your 2000 CALORIES will come through CARBS, but they will be digested slowly due to the fiber.

But if you are ingesting 2000 bio-available calories through plants, it is most likely mostly carbs (plus some fats and protein). Insoluble fiber just goes towards your poop, and it is usually not counted under 'carbs'.

Tofu, seitan, tempeh made without rice, etc are plant-based, high protein and low carb. Various fungi fall into the same category, although they aren't plants. Make a dish with vegetable oil and you'll have a high fat and protein meal with minimal carbs that is plant-based.

Makes sense, so are avocados, olives ect... (mostly fat), but you are essentially eliminating 90% of plants out there...

When you say Plant based diet, people assume lettuce, beans, tomatos, carrots, olives, broccoli, etc.. etc...

You eat those on the side, particularly lettuce, spinach, broccoli etc in as large of quantities as you'd like because they're low in carbs.

Nope, in a low carb plant based diet, most of your calories tend to come from fats with some from protein.

There are plenty of fats in nuts and legumes, which are compatible with a low carb (even if not a zero carb) diet. Seeds are also rich in fats (and are the source of many vegetable oils).

How could you possibly eat 75% whole-food plants on a low carb diet?

Most of them (grains, legumes, fruits and nuts to a certain extent) would fall under high carb when eaten in those quantities

For me (and generally I'd say), low carb is <50g of carbs per day.

> How could you possibly eat 75% whole-food plants on a low carb diet?

It's basically not possible.

If you really want to eat a low carb plant based diet, you'd have to eat almost exclusively processed food like olive oil and Seitan.

Sorry but you're just completely factually wrong.

Potatoes, rice and bananas are whole-food, plant based, and are pretty much the highest carb you can go. And plants without starches and sugars simply don't have many calories at all. You can't survive on broccoli alone.

If you're doing low-carb and getting the calories you need, there's no physically possibly way to get those calories except through protein and fat -- they're literally the only other 2 macronutrients.

So yes, low carb always means lots of meat, cheese and/or fat. Or else you'd basically just be fasting.

The way you frame the third choice as "and/or fat" is disingenuous and undermines the whole comment.

Yes, vegetables are less calories dense. That doesn't mean meat/cheese/bacon have to be eaten. Just an easy example, avocado's are extremely calorie dense, and yes this means fat.

The issue I have is that you just categorize meat, cheese and fat together as if the only way to get fat is via those items, or as if fat itself were unhealthy. The second is just a myth, the first is a myth the person you are responding to is directly opposing.

It's not a great surprise that a diet restricting one of the three food macros will lean heavily on the other two groups.

Hmmm iirc, and don’t take this as medical advice and do your own research/consult your doctor, but in states of ketosis in high fat diet, cholesterol rises but primarily in the form of HDL (high-density lipoprotein) while LDL (low-density lipoprotein) level drop. For heart disease, LDL is the concern as it’s floaty and thus gets stuck and accumulates in arteries, while HDL is considered more “good/harmless” as it doesn’t do that.

You may be one of the unlucky "responders": https://www.hsph.harvard.edu/nutritionsource/what-should-you...

yeah. people don’t really understand that it’s not the cholesterol in food that necessarily matters - most of the cholesterol that circulates in your blood is actually produced by your liver.

also, there are different phenotypes when it comes to cholesterol. For some a LFHC diet does wonders, for others it’s a sure way to have problems down the line if you sustain it for long periods of time.

check ldl-p, ldl-c, and triglycerides.

https://cholesterolcode.com/cholesterol-code-part-ii-the-ldl...

High cholesterol does not cause CHD. My PCP doesn't even check it anymore.

There is a lot of money behind the drugs that require us to believe this.

Show me the clinical evidence that supports your claims, because there are tomes of evidence that suggest the exact opposite.

There's a lot of money behind that "One Weird Trick That Doctors Hate and Your Stomach Will Love", too, but not a lot of evidence.

Had you had it checked before starting the diet?

The Ketoers say this isn't a problem. That cholestorol is misunderstood, and high values are only bad if you eat high carbs. If your low carb then the high value is actually normal and healthy.

But YMMV

sorry but this is bs and straight dangerous. cholesterol itself is not dangerous but the proteins that carry it in the blood stream are. That’s why LDL is bad and HDL is good (supposedly 2 types of cholesterol- but they’re not they’re two types of proteins). The LDL are the smaller ones that actually end up, in time, piercing the lumen (blood vessel wall) and causing inflammation. this is how your arteries narrow and this is how you eventually end up with heart disease.

so the LDL particles (by count not volume) are bad and whoever tells you otherwise is full of crap

“piercing the lumen” is a drastic over-simplification. We don’t know how much LDL is in a healthy lumen (the small amount of research that exists suggests its greater than the serum concentration). Much of it gets there via active transport mechanisms (transcytosis).

Also, why would an endogenously produced protein end up killing you? Seems like evolution run-amok.

haha. it’s amazing how complicated even the simplest forms of organic life are. things do go wrong all the time and there are complex mechanisms to balance things out. that being said systematic imbalance or just “wear and tear” eventually win.

It's anecdotal evidence, but I know of a fairly young person who is now prescribed statins after overeating animal fat for their keto diet.

Statins are poison.

I'm glad you found a diet that works for you, makes you feel healthier, and has improved you QoL.

But it's not a panacea, and it's certainly not a cure for type 1 diabetes.

He never mentioned it being a cure to T1D..

The response is to an article about low carb diets sending diabetes patients into "remission". It's hard not to make the connection.

Well.. I don't actually think the article claims a 'cure' either.

If I get cancer, have treatment for it and am now in remission, who would think these doctors 'cured' cancer? Everyone would understand _my specific instance_ of cancer is reduced to being not a concern anymore.

Being in remission just means a greatly reduced or almost inexistent dependency on insulin.

I'm not saying the conclusions of the article are correct either (low sample size, short period of time), but it's a far cry from claiming 'LCHF cures T1D'

If your definition of 'low-carb diet' includes red meat, cheese, and butter then high cholesterol shouldn't surprise you at all.

People should really look at minimizing their intake of animal fats. Both for ethical and health reasons.

> People should really look at minimizing their intake of animal fats. Both for ethical and health reasons.

I’m all for the ethical angle. Factory farming is horrific.

But why health? I certainly haven’t read every study out there, but I’ve read a lot of studies, and what I can’t find is causal evidence of negative health effects of animal products in the absence of sugar. Do you know of any studies I can read?

> It is known from the growing evidence base that a low carb approach can help put type 2 diabetes into remissio, and now experts are exploring its impact on type 1 diabetes.

> showed the benefits of low carb treatment among adult men with newly-diagnosed type 1 diabetes. The three men were aged between 36 and 40 years old at diagnosis.

First off, spelling error this soon (remissio) raises red flags, but yes, type 1 diabetes is different than type 2, and I thought is usually diagnosed pretty young, since it is very serious. It seems like in the article the patients are aged 36-40, which seems pretty late to be diagnosed with type 1 diabetes?

Are there different causes of type 1 diabetes that can happen later in life? (and are those treated differently?)

You can get diagnosed with type 1 diabetes at any age. It used to be called "juvenile diabetes" because they thought it only hit children, but that was proven to be false.

We don't know if it's different causes in adults vs children, because we don't really know the cause. The mechanism is the same though: the immune system destroying the beta cells in the pancreas.

My wife is a T1 who was diagnosed in her 40s. I sent her this whole comment chain and she wanted me to mention that "...half of all new T1 diagnoses come in ppl over 30."

It's less common but it happens. My dad was diagnosed in his thirties. I remember him going from being slightly overweight to essentially a skeleton in just a few months.

Your foot hurts when putting weight on it? Solution: never put weight on it again, ever. Your foot is now "cured".

That's how LCHF diets "cure" insulin problems. Of course the issue is much more complex but as long as the patient cannot go back to eating carbohydrates normally nothing got cured.

Clinical remission was defined as discontinuing insulin treatment for a period of at least three months.

Worth noting

I'm a t1dm, have been for >9y. I'm been doing keto for 6-7, intermittent fasting / one-meal-a-day for 2.5, carnivore for 1.5. Nonetheless, I started with all that jazz post-honeymoon. I take insulin, and I don't believe a 'cure' is ever the right word with regard some more complicated diseases. Treating symptoms != cure.

A lady from Hungary (interview in [1]) and her team have published studies[2] about several cases of newly diagnosed type-one diabetics fulling forgoing(!) insulin medication, or any medication for that matter, for relatively long periods (1-1.5y, I believe she said in the interview), given they strictly fow the diet- it being a very low carbohydrate one. One had not followed, relapsed into carbs 2-3w into it and he had to go back to insulin. It's no long-term study, but it's better than nothing, and from my acquaintances, and online readings, @1.5y honeymoon phase should have fizzled out.

Anyways, the initial period seems to be crucial, a lot of research focuses on what can be done then, and the one's who've had it some time [3]. Lowering insulin is one thing, the other benefits are major too- stable, predictable bg levels forever; better mood, energy; restriction diets help you notice what exactly might have previously you bloated, gassy, get heartburn, mouth dryness, etc.; yadda yadda. The bald puerorican biochemis from [4] gives rather slowly the details of how a pure carb diet would work - his ins/carb ratio was something insane-, of both of them, really-, like ~1/26. Compare with my ~1/1.7

The interviewer is a bit annoying, but I can't remember off the top of my head of other sources, so apologies.

[1] https://www.youtube.com/watch?v=tlm6dMHnNC0 [2] https://www.paleomedicina.com/en/dr-zsofia-clemens [3] anecdotally, research arts with newly diagnoseds are abundant [4] https://www.youtube.com/watch?v=U7dyGwnbp1w

I’ve seen a friend diagnosed with type 2 diabetes return his insulin levels to normal through diet, exercise and cutting out alcohol. It just takes more discipline than most people have. Edit: I’m presuming he had T2 because he didn’t get it as a child, but reading this thread I see T1 can be diagnosed as an adult: I did not know that.

Honestly I am trying to have the same discipline myself after seeing the results, because I wish to avoid the harmful effects of a poor diet and get the benefits of a good one. I am not managing to do it yet - and I’m not sure a health scare would motivate me enough either...

Type 1 and Type 2 are completely different diseases. They present similar symptoms -- which is why they're both called "diabetes" --, but their underlying causes are different.

Many T2 patients can control their blood sugar with diet.

No T1 patients can. It has nothing to do with "discipline", it's an autoimmune disease. It's actually a bit insulting to suggest it's somehow "their own fault."

I certainly wasn’t trying to imply T1 diabetes was their own fault. I have a friend with T1 diabetes and diet helps them but it doesn’t cure them (although they continue to drink wine and are somewhat careless in their sugar level management sometimes).

The friend with T2 diabetes very likely is caused by an autoimmune reaction: he had what is commonly an autoimmune disease as a child. Some percentage of T2 diabetes cases are caused by poor diet, althogh there are many other factors.

Edit: Also, obviously diet and exercise help avoid many other health issues. And I feel your comment doesn’t follow the hn guideline “Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.”

They had to go back on low dose insulin therapy even with this diet. This isn't a cure for type 1 diabetes at all.

Balance in diet seems to be the one principal that will never go away. I'm suspicious of any diet that eats too much of one thing, especially if it claims the other things are harmful.

I think balance is most definitely the best for healthy individuals. But if we're talking about people with some metabolic/gastro-intestinal disorder then I think trying elimination diets is at least worth a shot.

The term "balance" is meaningless unless we know what kind of values are ascribed to "too much" which is exactly what we are trying to sort out.

No one talks about eating a "balanced" amount of high fructose corn syrup, in terms of nutritional benefit.

I agree, it depends on the definition of the spectrum or range of values that would then provide a definition of balance. Maybe the food groups could be the level at which this is defined, so too much or too little of one food group is probably not good. A good example is the meat-only diet that became a recent fad. People can claim all kinds of benefits there but in the long run it's just not balanced, and we're not built like apex predators in nature.

@dang can we have the title changed or something? Most of the diabetics in this thread (yourself included) agree that the title is misleading at best and simply false at worst.

You basically don’t have a pancreas with type 1. These people still had beta cell function, which most type 1s don’t have. It was 3 subjects and limited time. Large scale long term studies would be helpful.

Plus they got diagnosed is late 30s/early 40s. This sounds more like insulin dependent type 2. It would make sense that the diet could work in this case.

What is this “remission” for type-2 diabetes? Does it mean that someone with the condition can, after adhering to the diet for some time, then go back to eating how they used to?

I don’t think so, so “remission” is bogus. The symptoms can be controlled with diet, but you have to stay on the diet.

So what works for cats (well-known), also works for humans. Good to know.

Interestingly, cats lack the ability to synthesize ornithine which means they need to get arginine from their diet in order to complete their urea cycle and excrete ammonia. Their obligate carnivorous diet is distinct from a human deciding to do it for fun.

https://academic.oup.com/jn/article-abstract/108/12/1944/477...

https://bmcvetres.biomedcentral.com/track/pdf/10.1186/s12917...

I don't see the connection or implication. Cats are true carnivores, while humans are omnivores.

This is known among keto dieters. Check Dave Feldman's cholesterol code: https://cholesterolcode.com/

link to paper: https://www.sciencedirect.com/science/article/abs/pii/S12623... or https://sci-hub.tw/10.1016/j.diabet.2019.06.004

Have they studied if fasting has the same effects?

im not making any comment on whether low carb is good or bad, but figured i'd mention that just because something is good for a diabetes patient doesn't mean it's good for all people in all situations.

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