I’ve touched on the topic of Type 1 diabetes before Here and Here. For those unfamiliar with Type 1 diabetes, it is an autoimmune disease in which the beta cells of the pancreases are damaged or destroyed and the individual looses the ability to produce insulin. Without exogenous (outside) insulin (or very smart nutrition and exercise) the Type 1 diabetic will die. As it is the Type 1 has a hell of a time managing blood sugar levels. There is simply no replacement for the immediate feedback mechanisms which govern normal pancreatic function. This is true not only with regards to monitoring blood glucose highs and lows from food, but also from odd inputs such as exercise and stress.
My Liver! My Liver!
The liver does much more than detox frat-boy livers after a night on the town in Chico, it is also a repository of energy, both in the form of fat and glucose stored as glycogen. Under normal circumstances we have an interplay of the food we eat toping off liver and muscle glycogen stores to be used either immediately or down the road a few hours or even days later. Interestingly, even if we eat a 0% carb diet we still end up with liver and muscle glycogen stores getting filled via a process called gluconeogenesis. In this situation we turn protein into glucose and this is one of the reasons there are no “essential carbohydrates” despite what the vegetardians will have you think. So, what does all this have to do with the Type 1 diabetic and CrossFit? Well, many people have noticed a dramatic improvement in blood glucose levels with a LOW CARB paleo diet. Dr. Bernstein has a great book that is right in line with this concept. A low carb diet pushes the body to use fat as a primary fuel source and this diminishes the need for more glucose to run many of the daily functions of the body.
Think about it this way: if glucose were like electricity and fat was like natural gas we could run our house of one, the other or a mixture of both. Common nutritional wisdom posits that we need to run exclusively off carbohydrate for our preferred fuel. The problem with that is people eat too many carbs, get insulin resistant and have a whole slew of health problems. Several of the Chico State Nutrition professors are remarkably overweight and are die-hard (die-soon?) proponents of the high carb, low fat catastrophe. Anyway, in this example we can shift the body from one primary fuel source (Glucose) to another (fat). Fat is better. Period. Many people have detailed improved blood sugar control until they do what seems to be a good idea: They exercise intensely. You see, high intensity exercise RELEASES GLUCOSE FROM THE LIVER. A lot of it. Folks roll into the gym with normal low blood sugar, hit a WOD and WHAM! Blood glucose levels in the 200-300 levels. Way too high. Then they dose with an insulin bolus to bring things down, create a transient condition of insulin resistance…and have problems bringing things back to normal for several hours.
The solution? REALLY keep an eye on volume and intensity. You may be better served by mild to low intensity activities. Power Lifting, due to the low volume might be a good option. Walking with a vest is a good activity that taxes one pretty well but might be better than standard high intensity training. The type 1 diabetic needs to “map” what volumes and intensities produce what blood sugar responses. Sleep deprivation will worsen this effect. Stress, same deal. If I were Type 1 diabetic I’d:
1-Eat a ketogenic diet. Use the Zone calculator to find your block numbers, then use 42 ways to skin the Zone to bring your carbs to below 50g/day for men, 30g for most women. Adjust fat upwards appropriately for calorie maintenance and when you need to up calories overall for maintenance. I’d add the additional caveat to make this a gluten/dairy free paleo diet. We have seen instance of people REVERSING Type 1 diabetes with a paleo diet because they put their autoimmunity in remission.
2-SLEEP. Screw up your sleep and you are killing your insulin sensitivity. This goes for everyone but especially for the Type 1 diabetic who will battle to keep blood sugar levels normal/low.
3-Chill out. Stress messes with insulin sensitivity AND it releases sugar from the liver. Don’t do it.
4-Ttrain Smart. I mentioned some examples above. Lift heavy, then sit on your ass. Repeat. Intensity (in the puke on your shoes sense) is what drives hepatic glucose release. Take a walk for some “cardio”. Be content with being able to lift a house and have 5% bodyfat, but a shitty Fran time.
5-Train Dumb, but map it. Most of you are CrossFiters and thus, will ignore the most important part of this (number 4) because you will DIE if you do not see God during a WOD. Fine, I’m not going to argue with you on the topic, it’s your life, but at least use your head. Start the intensity low (this may mean stepping back a little…you can do it) and maping your blood glucose response after various WOD’s. How much does Fran elevate your numbers? Helen? Filthy Fifty? You need to build an inventory of what WOD’s do what to you. Then…hope for the best, because every time you do a WOD like this things are different. And you may have a dramatically different response than you might have guessed…hence, recommendation number 4.
I’m not here to preach or prostylitize. I’m not a doctor so you need to use your own good judgment on this. I know someone will have an inspiring story of a Type 1 diabetic who competes in Iron Man triathlon and does great! Well…I guarantee their hb1ac (how high the blood sugar is over time) SUCKS. They are aging far too fast, and that is their decision. The problem is people do not know there are options and this is all I’m trying to do: Provide some information so people can make an informed decision about what they are doing and what the relative cost/benefit looks like.
About the author
Robb,
How does this relate to non-diabetic crossfitters constantly working at a high intensity. While at a low BF% (6-10% for most), can their insulin sensativity get messed up with release of liver glucose, especially when sensativity is at its peak (during intense activity). Could this also cause one on a very low carb keto diet to be increasingly hungry as insulin is being released to combat the high blood glucose, resulting in eating more due to hunger (due to fat storage) and/or inability to IF even though in keto.
Cheers for the great work,
Steve
Steve-
This may be some of the effect we see in the “fat aerobics instructor” scenario although cortisol is a factor here. I posted a bit on this in another question. Too much intensity too often can buggar many things.
hey robb thanks for the info. I am an affiliate ower in utah and I have a college baseball player that has been following the CF Football wod’s in my box and he is type 1. I tried to contact Kelly Starrett last week to ask him about this and maybe he contacted you, I don’t know. Either way this post was very helpful and I will definitely back him down from heavy intensity wod’s and push him more towards just getting stronger. Thanks again. Kade
kade-
This is perfect for a baseball player. he needs to lift big, stay mobile and that’s it. he is perfectly suited to a ketogenic diet. Let me know how it goes.
Robb,
Thanks for the post. I have been told by my doctor that I am pre-diabetic? I’m very active (lifting, tennis, running) and by looking at me you wouldn’t know that I need to lose 15-20 pounds and that I eat so bad. I think I am really addicted to sugar. I have a very hard time not drinking 5 cokes a day!!! I know I need to change to total paleo and I believe in what you’re saying, I’ve tried several times this spring/summer and keep falling off the wagon. Other than just gettting more disciplined, any tips/advice for me?
Also, how much in hours is too much cardio per week for someone with Type-1?
Ricky-
Just do your best. if you drop the liquid sugar that will save your life. Small steps after that. If you are young and showing signs of pre-diabetes you are taking YEARS off you life and feeling like shit every day right now.
Re-read that article, there are no prescriptions here …you need to do work and find specific maping for the type 1.
Wow. Thanks for the post in such a timely manner. By chance we had a newbie come in today that was an IDDM. This could not have come at a more perfect time. We can use this info to help guide her in a productive program.
Nate-
Let me know how that goes!
Rob, you raise a really interesting point, post workout blood sugar spikes are these harmless to the healthy individual? If you see pukie every day is that having a similar effect as chugging a litre of cola daily?
That point in your post really jumped out at me as interesting.
Thanks for the blog it is always good.
Brett-
The transient blood sugar spikes are not the issue IMO. Adrenal fatigue and general burnout are more concerning from a long-term perspective. Intensity is good. Intensity ALL THE TIME is not.
[...] Liver! My Liver! Type 1 Diabetes and CrossFit by Robb [...]
Hey Rob – first time post, real brief question, and it kind of relates back to the low carb post wod post a bit back.
I’m not diabetic, so would my blood sugar be out of control after an intense workout or does this just apply to Type-1 Diabetics? If my blood sugar is high after working out, a low carb post wod shake/meal would be the way to go right?
Anyways – thank you so much for all the info, really looking forward to the book and would be great to get you down to Australia sometime in the future! I’m at a pretty new affiliate and I just keep pointing as many people as I can in your direction. Cheers mate.
Adrian-
Short answer is this does not apply to you, long answer is PWO fueling is specific to one’s current situation and desired outcomes, as i detailed in that piece.
Robb,
very nice write up, can I re-publish this (with link to your blog of course) on my weightlifting club website?
Pierre!!!
Absolutely my friend! and BTW, I’ve had a post in the works about your scaling piece. It is OUTSTANDING and I am seriously bummed by the treatment you received about it. So much for a free exchange of ideas.
Great Post Robb, So during and after high intensity exercise, the liver releases more glucose, I presume to replenish the cells’ depleted stores. But the problem in Type 1 people is that thy don’t produce enough insulin to deal with the now excess blood glucose.
Looking forward to the book and hopefully an East Coast Paleo Seminar in the future.
Robb. This got me thinking about some of the people I am working with. I have several clients who were diagnosed Type 2 (more accurately they were walking corpses that just hadn’t found a good place to die yet) but with a 5-6 weekly WOD training schedule and strict Paleo (with 50g/30g carbs) they have shocked their doctors with their improvements in cholesterol, blood pressure, weight loss and the obvious increase in general fitness. Knowing that they started with severe insulin resistance and it will take a long time for them to normalize (will they ever truly?) could the ideas you present with intensity be part of an explanation for why we hit some plateaus, specifically in regards weightloss? Do you think dialing back intensity could be an answer to the frustrating plateaus? Maybe a more succinct question would be, how do you see CF Intensity affecting a recovering Type 2 compared to a Type 1 and wouldn’t following your Type 1 prescription be a great strategy for them to use with the eventuality that they can eat “normally” after they get their metabolism back in order? Sorry for the rapid fire questions, my mind is spinning with thoughts.
Dan
Dan-Two completely different scenarios. The Type 2 is suffering from an environmental insult not dissimilar from sunburn. They tend to cheat and back slide, they tend to do “everything” wrong (bad sleep habits, artificial sweeteners etc, etc.) the type 2 needs an ass kicking UP TO THIER TOLERANCE. Crossfit is a powerful tool that needs incremental dosing but this is completely different from what the Type 1 is facing. type 2′s need a ton of fish oil.
Very helpful post Robb, I’m at the library using the internet and picked up Dr. Bernstein’s book while I’m here. I’m not diabetic (as far as I know) but have possible liver and adrenal problems. I’m also being treated with LDA therapy right now for candida by an allergist, but he’s not too keen on nutrition. I get awful brain fog in the morning (get’s better throughout the day but I’m never sharp) and tolerate exercise of any intensity dismally. Exercise usually leaves me feeling energized for the remainder of the day but the next day I’m fatigued and in outer space–absolutely useless. I also get rheumatic symptoms like sore knees and carpal tunnel syndrome.
I’ve cut out tomatoes (all nightshades), dairy and nuts as I tolerate all of them poorly, but I’ve cut out grains as well and from time-to-time experiment eggless, but eggs seem to be OK. I’ve been walking a lot which seems to help and am about one month into a mega dose of fish oils (seems helpful but no magic bullet).
What else might I try? I do short fasts here and there–is IF good for this? What about IF for people with adrenal problems? I haven’t had much luck with docs, might a naturopath be helpful? (I’m in Pittsburgh if anyone can suggest any good local resources). I have been slowly improving under my own efforts and my mind is less spacey than say two or three years ago, but I cannot say my tolerance to exercise is any better. I want my mind and body back.
Sorry for the lengthy post. You’re a true benefit to us folks and your work is inspiring.
Craig-
1-ditch the IF for now. cyclic low carb, plenty of protein and good fat. Consistent sleep and fish oil at .75g EPA/DHA/ 10lbs BW.
2-Strength work only. Sprinting ala 100-200m sprints with FULL recovery. Do this for several months.
3-500-1,000mg combo of r-alpha lipoic acid + acetyl L carnitine. Source naturals and Jarrow each have a product. Hit this first thing in the AM before eating. It WILL clear the fog.
keep me posted.
Robb — bloody hell, brother, I don’t understand how you got it so exactly right. This is phenomenal, the accuracy and depth to which you understand Type 1 diabetes and CrossFit. Sure, they say you’re a genius and all, but this astounds me, it’s better than I’d ever have expected.
As a distance runner (I was a distance runner both because I’d accepted the “endurance = superior fitness” philosophy, and because strength always came easily to me, hence I trained my weakness ), I used to jack my blood glucose levels above 300 before a marathon — then watch myself go hypo during the marathon, and down the Gu and other treats as I ran. Low intensity (I generally ran 8:00/mile) high volume work would drive my BG low, both during, then with a big lowering effect for 4-6 hours after, and with a continued effect for another 24 hours after.
Gymnastics workouts did the same thing to me, and my first grand mal seizure hypos were experienced after intense gymnastics days — more noticeably if I hit the major muscle groups, the legs, than on days of rings, high bar or parallel bars.
Before CrossFit, and before adopting a paleo diet, I averaged about 80 units of insulin/day. Right now I am at 55 units/day — and this, with a worse diet than I had when I started paleo. I still eat a lot of dairy, and lately I’ve been abusing ice cream and peanut butter with chocolate chips.
My average BG (126) is reasonable but my STANDARD DEVIATION (65) sucks, so my control overall is not good. My numbers, constantly updated, are publicly available on a Google Spreadsheet, here: https://spreadsheets.google.com/ccc?key=0At-K3H4Tym0ecnBoOTFDbEZTTmVpb1ZkZEp4UDROUkE&hl=en
(Those two numbers – avg BG and STD DEV – tell the overall story of a diabetic’s control, far better than HbA1c. Every diabetic should be tracking these. Your goal is to minimize your STD DEV. I was seemingly alone in arguing this 4 years ago, but a type 1 endo in Seattle began publicly arguing this in 2007. I feel so proud and vindicated I have to tell everyone!)
CrossFit workouts spike my BG high about 9 times out of 10. Two days ago I did 225 lb back squats for 2 sets of 20. An hour later, my BG had gone from 110 pre-workout to 287. 5 hours later I went so severely hypo (it reversed and went low) that, in confusion, I thought my blood glucose was high, and I dosed more insulin – and went to sleep. My grand mal seizure at 3am woke my wife up, and the bed was soaked as if we’d dumped about 2 gallons of water on it. I probably pushed about 10 pounds of water out my skin during that hypo. First time I’ve had one of these in the 3.5 years I’ve been with my wife.
So the intensity of a CrossFit workout spikes BG high usually, but then it radically increases your insulin sensitivity, to the point that you need about 0.5 – 0.7 the usual insulin dose for 4-8 hours after, with lowered insulin needs continuing for 24 and possibly more hours.
And I can’t always nail down these variables. Sometimes the BG control is just inexplicable. I do an intense workout, clients leave, I check my BG, and I’m at 65. WTF? That happens about 1 in 15 times.
Sometimes performance itself is variable. This is no fun. I go hypo, maybe even 2-3 times, in the 18-24 hours before a workout. Then I workout. And I’m weak and my performance sucks. Was it the insulin and BG, the lack of glycogen, or something else? I don’t know.
Another number showing the efficacy of CrossFit & Paleo: my basal rate is the amount of insulin I am trickling into my body, on continuous release, through my pump. Before CF & Paleo, I was at 1.3 – 1.1 units/hour, from 1998-2005! On one long backpacking expedition, I got it as low as 0.8 units / hour (eg. carrying a 70 lbs pack up and down craggy hills from the border of north korea to the south coast of south korea, averaging more than 35 miles/day – I was hiking 5k/hour and jogging down hills about 2 hours/day.)
A year after starting CF and paleo, I re-started the insulin pump. My basal rate is at 0.8 units/hour — and it’s still too much. I’m going chronically hypo in the late afternoons / early evenings and will have to figure out exactly when to lower this basal to 0.7 or 0.75 units/hour. As I said, my diet is far from 100%.
I’m sorry for the verbose, detailed letter, and if you can push this to the bottom to not interfere with other comments, please do. But I want to endorse and corroborate how fantastically accurate your statements are.
Unfortunately, I have to report that easily as many as 60% of the endocrinologists out there have a poorer understanding of this than you do. (I’ve been treated at the Joslin Institute in Boston and at the Whittier Institute at UCSD, so I’ve been around and seen a lot of good endos. At Cornell, my first endo said, “Bah, so you’re running 250+ mg/dl blood sugars. You can live for years with numbers like that. Don’t worry.”)
Robb, keep up the fantastic work. If you come up with a plan to reallocate funds by non-governmental means to realize stem cell cloning of pancreatic beta cells, call me. I’ll be your muscle. Maybe we can host the medical procedures offshore via The Seasteading Institute. You’re invited to the Ephemerisle party which will be hosted in the Sacramento Delta on Oct 4-5th – http://ephemerisle.org/ For you-and-Nikki’s sake eat before you come and be wary of the refreshments… I wouldn’t want you glutting on carbs in a moment of weakness, it seems they intend it to be that kind of party.
Cash-
You are too kind brother. thanks for the props. I suspect 20 years and we will have viable stem cell replacements for type 1. Just need to keep y’all healthy till that happens.
Robb,
Just wanted to say thanks for all the time spent on a great post and then even more so on answering each and every question. The Q and A in the comments are every bit as informative as the actual post and your time spent responding is definitely worth it to all of us.
Jeff Vale
jeff!
You bet. i may need to shift to a podcast or something for some of this…I am over-freaking-whelmed! will figure that out though.
It’s all good, I’ve learned something from the experience, free is only as good as the content (or lack thereof), which is freely exchanged. The absolutely beautiful thing about anything open source is that every good open source project results in forks and divergences.
Often the forks become more successful and productive than the original project. Sometimes the original project outright dies, other times the original project builds itself into a stronger entity by leveraging the resources and capabilities of it’s forks.
I make no predictions, I only position myself to outperform those in my field of choice, long term.
————
Quote: “Intensity is good. Intensity ALL THE TIME is not.”
Intensity Or Volume – Power – Speed – Intensity, this kind of split seems to work best in 90% of cases. 5% of cases respond better to greater volumes (slow twitch dominant folks), 2.5% thrive on intensity all the time. The other 2.5% will only thrive on very powerful explosive type training protocols which indicates they should be either weightlifters, gymnasts or throwers, and this is most likely best determined by the ratio of height vs. wingspan and personal interest. These people need to rest a lot when they train.
Pierre-
I heard about you measuring Matt lalonde. That dude is wired up FREAKY. Tell me more about the height vs wing span.
In addition to the pure barbell strength work, like you recommend for type1 Diabetics, could gymnastics strength skills/routines and short parkour sequences also be used to develop their fitness without inducing the ill effects of lengthy, high intensity crossfit WODs?
Ryan-
yep, strength work is strength work. needs to be approached the same way.
I occasionally measure post-workout blood sugars, and one day after a 12 mile moderately hard run (lots of hills), taking in only water, my blood glucose was 123. I was surprised it was that high after so much work, but that is certainly not a toxic level. I don’t think that level is a problem because of all the newly expressed glucose transporters on the muscle cell surface, ready to suck up the glucose to replenish glycogen stores. Doesn’t seem like I should be in a hurry to replace the carbs post workout though, since blood sugar was already elevated. I’ll have to try measuring it someday after a higher intensity workout like intervals or hill repeats.
Hey Robb,
I noticed in the reply to Craig you mentioned some supplements other than fish oil. Right now I’ve found there is way too much conflicting evidence on the internet about supplementation (other than fish oil which seems to get a good rap everywhere) for health and longevity. It seems everyone who is selling supplements is touting them to be the fountain of youth, and the medical community is denouncing supplements as ineffective or dangerous. All I get is biased information from supplement companies or biased info from the medical community (which is clearly influenced by big pharma). Given that, I was wondering if you will be having a section in your book on supplementation so I might get a non-biased review by someone who actually knows what they’re talking about? Thanks Robb!
Jay-
I appreciate your faith in me but I’m as prone to error and as full of shit as anyone else out there…I am most assuredly biased. It might work, I might be right, but always maintain your own skepticism of the source material. Give it a shot, be open to learning what works, but don’t buy it just because I say it.
Height vs. Wingspan is a topic of long conversation. But here’s a snippet appropriate for this forum. Take a 12 year old kid with wingspan greater than his/her height let’s say H175cm:WS185cm. Assume this kid has a natural standing long jump (SLJ) of 2.5m to 3m. This kid can be a world class Decathlete or Thrower (if he puts on enough weight) if identified and coached properly. Take the same kid with everything else being equal now change his proportions to H175cm:WS170cm and he wont be that great of a thrower but he can be a badass Olympic Weightlifter again with proper coaching and consistency.
M@ is wasting his time doing CrossFit he is wasting useful explosiveness and sucks at anything over 15 minutes in duration anyhow, his H:WS is something like 175:165 and can squat 415 with good upright posture which is not a good indicator of much but a guy that strong with such good proportions should be doing Weightlifting. I also improved his snatch 200% in about 30 minutes so with consistent training he could do surprisingly well and be much more fulfilled, he seems frustrated with CF.
If we can hook him up with a cute little Weightlifter we could breed a few scary smart, badass weightlifters.
Thanks Buddy!!
Robb,
Great post! Do you recommend any good books that go into detail on the effects of cortisol on health? Thanks.
Sean-Cortisol connection seems good…there are a few others but Im not familiar with them.
Robb-
Thanks for the article. I’m a Type 1, diagnosed late in life when I was 33 in 2003. After 2 years of feeling sorry for myself, i started running and ran several half marathons, a 20 miler, and a marathon in 2007(i’m a former shot putter slash powerlifter so I’m definitely not built for running long distance). I had major problems keeping my blood sugar levels UP during that time. Constantly encountering BS lows, which is never pretty.
I pretty much gave up running after that marathon, what the hell was I thinkin, running blows. Hit the globo-gym for awhile then was introduced to CrossFit in August 2008. Short story long, I competed at the Rocky Mountain Regionals this year(i think I only beat 2 guys and they were no shows, but oh well it was fun), but one of the workouts was 3 rounds of deadlifting 300lbs for 8 and sprinting 400 meters. 300# for 8 in the dl is EASY for me, but that day it seemed impossible, that WOD took forever(like 10 min for me). Checked by BS after I finally finished and it was well over 300. The next WOD i guess-timated how much insulin I’d need to perform the same amount of work, and right before it started I took a shot. I ended up KILLING the workout.
Since then, I’ve done nothing but experiment, and have figured out a pretty good system that works for me. Since I know roughly how high my sugars go after 5 to 15 minutes of contant intense exercise, and how much insulin I need to bring myself back to normal, I take that amount BEFORE the WOD starts. I have consistently been able to keep my post-WOD sugars in the 100-150 range, with an occasional f-up on my part, either too much insulin or not enough.(I keep a bag of jelly beans in the car just in case I really blow it with the insulin dose).
My A1C’s are always good. When I’m good about eating paleo, I’m able to eliminate my Novolog(rapid acting insulin) and cut way back on Lantus(slow release insulin).
As much as I’d like to just do strength training, I can’t cut out or cut back on Fran and the gang, too much fun!
Cash-
The only endo i saw SUCKED. I ended up going to a GP that knew more, and was WAY more positive.
Looking at your spreadsheet, I see those 20′s. The last time I recall hitting anything close to 20 I passed out, fell face first on some hardwood floors, and knocked out my two front teeth. I hate the lows. Thanks for sharing your info.
Robb-
Very nice post! But I am wondering ( and maybe some other readers as well), but is the zone block calculator geared towards those following Crossfit style WODS ( high intensity)? Or are the selected activity levels for any particular style of exercise?
Would someone that is following a less intense workout regimen need a block prescription that is geared more towards a workout that consist of lift, rest, lift, rest as opposed to 3,2,1 go!
Example:
A type 1 diabetic following the starting strength routine. The athlete recognizes that the WOD’s completely thrash their blood sugars, so they cut out “met-con” completely. However, this diabetic is still trying to cut their body-fat percentage from 10-15% to 5%. While still getting adequate fuel for recovery and performance?
Troy-
I’m not sure I’m following you…in the post I recommended a ketogenic diet and how to do it…just follow that amigo!
i don’t understand why lifting heavy isn’t intense if your power is up? im guessing by intense you mean metcons?
Andy-
Yep, thinking more met-cons and 20 rep squats type stuff.
Hey Robb,
When I said un-biased I just meant not working for a pharmaceutical company or a supplement company, which generally sways one’s opinion (and studies) based not on researh and science but on how much they can line their pockets by promoting a certain product. I’m sure sometimes you’re full of shit too, but you are trusted and highly regarded in the CrossFit community as someone who knows their stuff on nutrition. I’ll always do my research into a recommendation, the same way I did when someone suggested I start CrossFit, and the same way I did when CrossFit suggested I start eating a certain way, but it all starts from a recommendation from a relatively credible source, and I do believe you’re at least relatively credible.
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Sir i put it to you that i am full of shit in a far greater percentile than you could ever be.
When are you coming to Can-Ardor..seriously ? The roast Lamb dinner at the Main in Vancouver is getting coldy-moldy
Fellows!
Im not sure on BC…we need to get up there asap!!
Hi Robb, I’m a type 1 diabetic and have been on the paleo diet for 7 months. After weeks of going paleo my insulin needs dropped dramatically and after 6 months I quit taking insulin altogether! The paleo diet is a miracle for autoimmune type 1 diabetes! I just started a blog about it:
http://michellestype1diabetes.blogspot.com/
Thanks,
Michelle
Michelle!
that is awesome! Can I pinch a write-up out of you to do a 4th installment on this topic?
I know this is an old post, but how long were you type 1 diabetic before you started a paleo diet? I am also a type 1 for a little over 3 years now. I have been on paleo/whole 30 for only 15 days as of today and crossfit for the same amount of time. Before crossfit was circuit workouts and heavy lifts. I will be playing around with my blood glucose meter for pre and post workout levels but so far I have not had a problem with increasing glucose levels post workout. Am currently only taking 5 units of lantis(long term insulin)still too soon to start experimenting with no insulin and start watching dawn-effect glucose levels, perhaps after I keep a log of my crossfit workouts, I dont want to wither away again with the exception of the little bit of fat that is currently shedding. In the past my a1c has always been 5.1 to 5.9 with the exception of the 17.5 at diagnosis. It will be interesting to see my bloodwork on day 30 of the whole 30. More importantly what my ldl is now.
Kyle-
Not sure if folks will see this due to the age.
Ok, disregard my earlier post. And this is the last post on a really old thread for me. A1C shot to 6.7, only thing I can think of is high intensity workouts and when I tested readings were rarely over 100. Until I started testing before wod and after, was shocked to see results. But the really strange thing was a few of my blood work readings went the wrong way. HDL down, LDL up, A1C up. Flippin sucks, looks like I take it slow and stop crossfit and go into a heavy weight lifting less intensity with a better Glucose log journal. However I did lose around 15 pounds of fat on the whole 30. So with an a1c of 6.7 using 5 units of longterm insulin, rarely over 100 readings morning, afternoon, night. I must have been skyrocketed during the workouts. Here is a question for you Robb, what does normal fatigue feel like, because I think I know what high blood sugar fatigue feels like during a workout and have lost the relationship over the three years I’ve been type 1 to what real fatigue feels like.
Nice piece Robb.
A worthwhile read, and intriguing solutions
Thanks Shaf!!
I want to pick your brain on the 5,3,1 gig here sometime.
ust read th comparison between man, dog and sheep and I noticed they conveniently left out the small intestine comparison. The small intestine, as you know is tremendously important in digestion. It is responsible for absorbtion of nutrients and is very long in herbavores and very short in carnivores.
There’s a good reason he left that out of the comparison. Ours is very very long and dogs are very very short. Here are a few comparisons you might also be interested in.
* Meat-eaters: have claws
Herbivores: no claws
Humans: no claws
* Meat-eaters: have no skin pores and perspire through the tongue
Herbivores: perspire through skin pores
Humans: perspire through skin pores
* Meat-eaters: have sharp front teeth for tearing, with no flat molar teeth for grinding
Herbivores: no sharp front teeth, but flat rear molars for grinding
Humans: no sharp front teeth, but flat rear molars for grinding
* Meat-eaters: have intestinal tract that is only 3 times their body length so that rapidly decaying meat can pass through quickly
Herbivores: have intestinal tract 10-12 times their body length.
Humans: have intestinal tract 10-12 times their body length.
* Meat-eaters: have strong hydrochloric acid in stomach to digest meat
Herbivores: have stomach acid that is 20 times weaker than that of a meat-eater
Humans: have stomach acid that is 20 times weaker than that of a meat-eater
* Meat-eaters: salivary glands in mouth not needed to pre-digest grains and fruits.
Herbivores: well-developed salivary glands which are necessary to pre-digest grains and fruits
Humans: well-developed salivary glands, which are necessary to pre-digest, grains and fruits
* Meat-eaters: have acid saliva with no enzyme ptyalin to pre-digest grains
Herbivores: have alkaline saliva with ptyalin to pre-digest grains
Humans: have alkaline saliva with ptyalin to pre-digest grains
Care to comment on this please ? I know bugger all to make accurate assessments of the above ?
Fellows-
I can’t hammer through all that right now but we show general Omnivore characteristics…taurine dependance, like a carnivore, vit-c dietary dependance like many herbivores.
Robb,
What happens differently in the body with a PWO meal of carbs and protein ( no fat) vs. a PWO meal of protein and fat (few carbs if any) ?
David-
You are just toping off glycogen with the P+C meal. Did you read the PWO psot a week or so ago?
Robb,
Thougthful article. What’s coming up to address the NIDDM population? I’ve had high BS after intense exercise. My former GP just told me “don’t take a reading then.” Had a naturopath tell me I have to reduce my intensity to stop the cortisol production and DHEA imbalances. However, I struggle with what’s intense? If I don’t break a sweat, am I doing any good at all?
Anxiously awaiting your book and additional details on what folks with T2 or not on insulin should think about in their diet and training plans.
Hope you can also address the CFE slant as well.
Cheryl-
Honestly, I think what I outlined is the best strategy at present. Ketogenic diet, and mapping blood sugars PWO. I might generate an e-book on this but it would really just be a re-hashing of this basic theme…if folks feel like it would be helpful I’ll do it at some point, but I think that’s about it.
Lift heavy, take some walks…you can be damn healthy on that schedule. It reflects more the way I like to roll. I keep my met-cons short and infrequent at this point and enjoy life whole lot more.
[...] Type 1 Diabetes and CrossFit [...]
Robb, I would love to!
[...] Type 1 Diabetes, Paleo, and CrossFit [...]
Robb,
Thanks so much for the article. The trainers at my affiliate turned me onto the article (thanks Harry and Ben) and it is eye-opening.
I became a type I diabetic at 29 and am 45 now. I started Crossfit about 3 years ago. My diet is mostly eggs, fish and vegetables, and I eat very little in the way of grains (except when I eat out, maybe once a week), and no milk. My cheats are a few bites of chocolate during the day, crackers with cheese (I eat too much of this), and a bit of agave nectar. My kids laugh at me because of the monotony of my diet (“Dad’s eating salmon and broccolli for dinner, what a surprise!”). Breakfast is the same every morning – three eggs, one Morningstar farms sausage pattie (I know, not a great choice) and a cup of coffee with 1 tsp Agave nectar.
When I started crossfit, I’d have these terrible hypoglycemic episodes. These went away and my blood sugar leveled off. Within the last year, though, my blood sugar started to slowly rise during my workouts. I wear a Continuos Glucose Monitoring System, and I can actually watch a linear rise as I go through the workout. I’d go to the workout with normal blood sugars many days (say 110 – 140) and I’d walk out with 200 – 300. I haven’t tracked this carefully, but I suspect this does not happen during rest days.
Interestingly, my strength has gone way up during the time I’ve done Crossfit, but my metcon performance has moved very slowly. When I started, I could not do almost any of the workouts as rx’d. Now I can, but my times still suck. I’ve been busting my butt and couldn’t figure out why my improvement is so slow. Not only that, but I felt really lousy for hours after metcon workouts. I was also puzzled by the rise in my blood sugars.
I guess I can stop banging my head on the wall. You’ve provided me with a likely answer. I’m going to try lightening up on the metcon and tightening up on the Paleo.
Cash, are you familiar with what Dr. Denise Faustman is doing at Mass General? The solution to Type I may not be stem cells, but a generic, commonly available vaccine called BCG. She’s used it to reverse Type I in mice and then permanently cure them. Her work was published in Science (http://www.faustmanlab.org/docs/academic/Science_2007.pdf)and has been duplicated by several other labs. BCG suppresses the t-cells that attack the Eyelets of Langehorns. She has shown that they will grow back once the t-cells are suppressed. She’s just finishing up Phase I clinical trials on humans. I live in Boston and am going to try to participate in the Phase II trial. Check her out here: http://www.faustmanlab.org/
Kevin-
Really interesting stuff on the vaccine. A paleo diet plus the vaccine might be the ticket…I’m passing that link along to Prof. Cordain.
Thanks Robb,
What’s really interesting is that Dr. Faustmann thinks the treatment might work for other autoimmune diseases besides diabetes, e.g. crohns, MS, rheumatoid arthritis, etc.
Sadly, she is having trouble getting her research funded. Phase I got a big boost from Lee Iacocca’s foundation, but the major charitable organizations like the ADA and JDRF are stonewalling her. She is strapped to fund Phase II.
Kevin-
I forwarded this on to Prof. Cordain. We might champion this research and try to get more focus brought to it.
Robb,
Thank you for all of the work that you put into your blog. I usually read a weeks worth at a time, and I have learned a lot.
I am a Type 1 diabetic, diagnosed at age 11 and am now 28, and a regular crossfitter for the past 20 months. I struggled with hypoglycemia throughout highschool and college. At its worst I was being brought back to conciousness by the EMS at least once per month (always while sleeping). Turns out that the carb-loving doctors kept telling me to increase my Lantus (one of two insulins I take, this one works in the background for 24 hours) when my A1c would come back a little elevated (never over 7.4). I obeyed until one day I realized that I was feeding my insulin, literally like 10 Chips Ahoy cookies before bed so that I wouldn’t have a hypoglycemic seizure. Once I started thinking for myself, I cut my Lantus dose in half and made sure that my morning BS was within 10 mg/dL of what it was at bedtime.
I started CrossFit in January 08, and I have routinely gone to the 6 a.m. class. I would typically go to the gym fasted unless my BS was low, and then I would have an apple or Zone Perfect bar. Like Kevin, I was surprised to see some of my post WOD blood sugar levels at 250-300, and I noticed that I crapped out faster than my friends. I was able to connect the logical dots that my body was producing glucose in an attempt to provide fuel to my muscles, but without insulin, that fuel was unusable. As an illustration of the jump, one morning I had a routine 3-month check up with my endocrinologist where I was to give a fasted blood sample. I woke up at 5 and my BS was 47 mg/dL. I didn’t want to break my fast, so I went to CF and did a WOD. After, it was 150, and by the time I reached the doctor it was 127.
I decided to try to mimic what a normal body does during a WOD, so if I saw that it was intense I would take a bolus of 3-5 units of Humalog 15 to 30 minutes before the WOD. This actually works really well for me, though it is a delicate balance because I absolutely don’t want to take too much. I am happy if my BS is sub 170 after a WOD.
Insulin sensitivity is nuts with CF. I have found that after 1 intense WOD, my sensitivity remains high for up to 30 hours (assuming I sit on my ass at work and sleep all of that time). I take about 1/2 the amout of bolus insulin when I have been on a regular CF schedule than when I am on “vacation”. I have labwork done every 3 months, and for the past 5 years I haven’t had an A1c above 6.6, and 6.4 is my average (Doc says I wouldn’t see any real benefit going lower that would be worth risking low BS).
Kevin, Robb, and anyone who reads this, please help support Dr. Faustmann and the search for a cure in general. I have taken over 24,000 shots in the past 17 years and pricked my fingers over 50,000 times, and I will do anything to prevent my kids (and yours) from experiencing the same.
Stats
Worst shape: 23 y.o./ 200#/15% BF/ A1c 7.4
Best shape: now 28y.o./180#/8% BF/ A1c 6.4
Rob,
I stumbled across your site today after searching for some other stuff on Crossfit blog. I was diagnosed as a Type 1 diabetic about 5 years ago. I love to play basketball and it sends my sugars through the roof and could never understand it. This makes a lot of sense now. I’ve been doing Crossfit and haven’t really noticed it knocking my levels up but will have to start paying attention to it. I’m looking into the paleo diet and am going to give it a try. I do a pretty good job with my diet but know I need to get back to doing better. I feel like I’ve doubled my knowledge of things just perusing around your site.
With the paleo diet, what do you recommended for sugar lows? I’ve eaten some candy in the past but I feel this would defeat the purpose of trying to reset my system especially w/in the first 30 days.
Amen, about the ADA diet. It’s never made any sense to me. It’s always seemed crazy. Sorry for the long post and I look forward to reading more.
Michal-
Grab whatever you can for the lows. Candy in a pinch, dates or raisins if you have those. Main thing is good management and IMO a move towards a ketogenic diet.
Robb,
I attended a Nutrition Cert in May and you said we should be going for .5 grams of fish oil/ 10lbs body weight for healthy individuals, and 1 gram fish oil/ 10 lbs of body weight for sick individuals.
now I see this -
“1-ditch the IF for now. cyclic low carb, plenty of protein and good fat. Consistent sleep and fish oil at .75g EPA/DHA/ 10lbs BW”
from a response to a comment.
This may seem silly, but which one should we go for and suggest for clients.
Also this post makes me think about the Primal Blueprint in terms of work out recommendations, and lifestyle suggestions. What do you think of Mark’s protocol?
- Joseph
ps
Keep up the awesome insights and posts!
Joseph-
Mark Sisson’s approach is spot-fracking-on. I dig it and him. I have a review of the book I need to post. The fish oil recommendation was because that person was kinda fracked up, but not completely. You just need to tinker and see what works.
Robb,
Really interesting article on Type 1 diabetes, now how about a post on type 2 diabetes?
There is a significant contrast in the two diseases, making it hard to apply the lessons learned in your article to the latter. Thanks
-Josh
Josh-
type 2 diabetes is liek sunburn…it’s just too damn many carbs. Reduce carbs, take fish oil, do a little exercise. It’s solved.
Some really great tips for anyone suffering from Type 1 Diabetes, but the tips go for everyone, especially the one about more sleep and a good diet.
Type 1 diabetics need to be able to control their sugar levels. The islet cells within the pancreas produce insulin, which controls blood sugar levels. When an individual suffers from diabetes their islet cells are damaged and cannot produce the necessary insulin their body needs.
Mary
It would seem I’m the minority here, but I find several flaws in this article and your subsequent responses to some of the comments. For one thing, there is absolutely no reason a Type 1 Diabetic can’t run Iron Mans and have an EXCELLENT A1C. Don’t put a guarantee behind your own opinion which has no basis in fact. As a Type 1 diabetic myself, I know it doesn’t have to limit the type of workouts we’re able to do and still have a good A1C…it’s called learning to control your diabetes, not letting it control you. And your comment that Type 2 Diabetes is simply too many carbs? There are many Type 2 diabetics whose pancreases are unable to properly dispense insulin, or whose bodies are unable to utilize the insulin as needed no matter what type of diet they follow. Despite what people often think, Type 2 is not just due to excessive carbs or being overweight, and while it can often be controlled through proper eating and exercise, limiting carbs is not a cure-all.
As for some of the comments from people saying their endocrinologists promoted high-carb diets… I recommend a new doctor. I’ve had diabetes since I was 4 (I’m now 25) and not one of the many endocrinologists I’ve had was a proponent of using MORE insulin unless absolutely necessary. Even in cases where my basal rate needed to increase, the goal was always to achieve better responsiveness to insulin and bring my blood sugars back to a more even keel.
It seems irresponsible to offer a specific daily carb amount for a Type 1 diabetic to maintain when you have limited knowledge of diabetes and no actual background on the subject. A paleo diet may very well be a great option for a diabetic, but I would hope that anyone reading this article does their research before altering their lifestyle based solely on your unsubstantiated opinions.
Additionally, it’s proselytize, not “prostylitize.”
Theresa-
Your post has been addressed on the front page.
Robb -
Thanks so much for the blog. My daugher (6) was diagnosed Sept 10. My husband and I are crossfitters (now), but have been into various types of excercise for years (weight training, powerlifting, etc.). About a week after our daughters diagnosis, we realized too that we were feeding her injections and it seemed like we should clean up her diet and then see where we were at.
We (all 3 of us) went Paleo. And the next thing will amaze you, but her blood sugar readings began to drop like a stone, and we began to reduce her insulin injections in order to avoid so many lows. The poor kid was spending more time in the nurses station eating food to bring her blood sugar up than she was in class. Eventually, we had to stop giving insulin completely, as even 1 unit of Levemir would cause her to have lows all day long.
She has been off of insulin for a couple of weeks and we continue to test her blood every 2 or 3 hours. We have located a new Endo who we hope is open to working with us on her diet (previous guy actually said – “feed her whatever she wants and give her insulin accordingly”).
Perhaps this is the infamous ‘honeymoon’ phase, or she was misdiagnosed (the previous endo did not do c-peptide or antibody test – only looked at her and said “shes 6 years old and thin, she must be a type 1″) but I will tell you that her improvements began the very DAY we started the Paleo diet.
Thank you for making me feel like I am not alone!!!
A Cross Fit Mom.
Joanne-
I’d like to throw this on the front page and expand on it a bit, will do that tomorrow.
Robb – sounds great, I will keep you posted on her progress. She is doing just great! Today her blood sugars were probably better than mine. She ranged between 62 (lowest reading of the day) and 127 (one hour after meal).
We see the new Endo on Oct 16th.
I have apost on this…I’ll get it up asap joanne!
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