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My 20 yr-old son has had Type I diabetes since he was 14. Ketosis is a dangerous physical state for him. I'm still reading more on the diet, but does it recommend (as did Atkins) to be in a state of ketosis or not. I don't think this is safe for an insulin dependent diabetic and I'm not too keen on it for anyone. Seems like enough fruits and veggies would help avoid this?

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If you haven't read it, Dr. Bernstein's book is terrific. He's a Type I and has controlled his diabetes for years using a low-carb keto approach. Certainly you want to watch out for ketoacidosis, and constant monitoring is a must. diabetes-book.com – Rose Mar 29 2012 at 17:45
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Ditto on the Bernstein book. He's low carb, but not paleo. Paleo does not specify macronutrient ratios - it can be low, moderate or high carb, depending on a person's needs or goals. Paleo is really about eating wholesome, nutritious food. But it's probably better for a T1 diabetic to lower carbs to a point where less insulin is required. Insulin is a powerful hormone that has both positive and negative effects. – Dave S. Mar 29 2012 at 17:53

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I think you might have a misconception involving the different types of ketosis. For Type I diabetics, there is the danger of ketoacidosis, which is what happens when the body produces ketone bodies because it thinks there is a low blood glucose due to the lack of insulin, with the excess ketones acidifing the blood. What paleo people talk about here is ketosis, where the body uses ketones for fuel, which is perfectly normal, and safe. Often ketosis is referred to "keto".

I've read some success stories of people doing "primal" and/or paleo while having type I. I did a quick google search, and got some results. What is interesting, is that the type I diabetics eat a lower carb diet, even going into ketosis, and since they keep their blood glucose lower by not eating a lot of carbohydrates, they don't run into trouble with ketoacidosis.

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Reading the first hit on the google search, you can scroll down to see the amount of carbs he was eating, with him eventually eating below 100, which would mean he would be getting into ketosis, or very close to it.

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Yes it's all about the difference between ketosis and ketoacidosis. NOT the same thing! Get the definition of these conditions clear, eSCKWID, and you will see the difference. (But you are totally correct to be concerned until you understand it, as Type 1 is not something to play with!) – GHarkness Mar 29 2012 at 18:51
I have a BSc degree in dietetics & MSc in bio, I know the difference between ketosis and ketoacidosis. Ketoacidosis results from severe uncontrolled ketosis & my son spent four days in the ICU because of it when his stupid PMP was ignoring me about suspecting he was diabetic.He still has to monitor his ketones as well as glucose. I will check out Bernstein's book and also speak to his endocrinologist from when we lived in Boston (before retirement, he was head of Endocrinology Dept. at Harvard Medical School) to find out if he knows of any research on this diet and Type I's. – eSCKWID Mar 30 2012 at 0:44
Made the call to endocrinologist, read up some more, looks like mild ketosis (as from a ketogenic diet) hasn't turned up any serious problems for Type 1 diabetes, so I will definitely give this serious consideration for my son. Thanks for all the responses! – eSCKWID Mar 30 2012 at 0:51
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Glad I could help. For me, if I ever became diabetic, type I or II, I#d pretty much go keto right away. To me it makes sense that if the body can't control blood sugar from carbs effectively, then it would be best to just avoid them. But that's me. – Bristlebeard Mar 30 2012 at 7:03
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Hi! My name's Samantha, I'm 22 and I've had Type 1 diabetes for 18 years. When I first found out about Paleo/Primal nutrition about 2 years ago, I was intrigued. After doing a lot of research, reading many books, and even speaking directly with Robb Wolfe, I decided to try it. I immediately saw great results. My a1c went from mid-9's to a 7.0. I effortlessly lost nearly 30 lbs (put on after years of being a collegiate rower and eating tons of carbs each day). While my body was first adjusting to this vast change in dietary habits, I was producing ketones, although my bg's were always below 200 (and often 80-140). My Endocrinologist (Director of Endocrinology at Georgetown University Hospital) agreed that this was a safe and natural process. (He was wary of the lack of grains in my diet and the high amounts of protein, but I decided to follow the paleo tenets and ended up with great results). As mentioned above, ketosis and ketoacisosis are two very different things (just as Type 1 and Type 2 diabetes are two very different, yet similar-sounding conditions). The biggest challenge for me was determining how much insulin to take for very low-carb, high fat/protein meals!

If you or your son would like to speak further, I'd be happy to give you my email address and/or recommend some resources. I've done a lot of community outreach/counseling through JDRF, so I'd gladly discuss. I wish I had more resources for T1's when I first started Paleo!

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Thanks, Samantha, sounds like we both got positive answers from reliable sources. I would be interested in more information from you. I'm on Twitter (@eSCKWID), so if you follow me and I follow you back I can DM you my email address. – eSCKWID Mar 30 2012 at 0:53
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The real danger in Ketoacidosis is the insanely high glucose levels, not the ketones. The glucose can kill you - whether or not you're burning ketones.

In a low carb induced ketosis, with normal blood glucose levels, there's no issue - whether it's paleo-low-carb or Bernstein or Atkins...

You can get too many carbs [too many for you, that is] eating a paleo diet, if you focus on higher carb items (fruit, anyone).

For diabetics (T1 or 2), the best diet is low carb - any low carb. [yes, I'm bold enough to say that on a paleo website] This way of eating introduces less glucose into the bloodstream, and therefore requires less correcting (insulin, metformin, etc...).

By adding paleo to low carb -- you get double benefits.

Add exercise... Many (most?) T2's can reverse the disease and complications entirely. Many while reducing or eliminating medications! They don't have a metformin deficency!

For T1's it's a little more complicated, as by definition, they don't produce insulin, should require MUCH LESS insulin -- and reverse many of the related effects (heart disease, high cholesterol/triglycerides, kidney damage, etc)... You have to read Bernstein and the law of small numbers.

As much as I love what I remember about a snickers bar (or even high sugar fruits)... how I feel for a week after is just not worth it - and neither are the long term health effects of eating regularly [too much for me, that is... ymmv].

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I'm not a nutritionist or a doctor but here is my guess...ketosis sometimes happens for paleo folks that are very low carb but you can benefit from paleo lifestyle without being in ketosis. I think that's about 50-100 carbs a day range in the form of veggies and maybe some fruit if you can tolerate it. Whole30 is a fantastic protocol. I'd focus less on ketosis and more on eliminating bad food and finding good food. Here's a great story http://wholefamilystrong.com/2011/11/01/diabetes-praise-report-2/

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