Practitioner Perspective: An integrative approach to type 1 diabetes
In recent years the rate of diagnosed cases of type 1 diabetes has increased dramatically. So much so, that according to Laura Neville, ND, if an integrative practitioner doesn’t already care for a patient with type 1 diabetes, they will soon.
An investigation into the prevalence of type 1 diabetes in children and adolescents by the Centers for Disease Control and Prevention (CDC) found from 2001 to 2017 the number of people under 20 years old living with type 1 diabetes rose by 45 percent.
Although there’s a well-established link between genetics and the likelihood of developing the disease, Neville said the rising incidence of type 1 diabetes cannot be explained by genetics alone. Several theories suggest that environmental pressures like toxicity and a lack of vitamin D may play a role in the onset of the disease and could be a significant contributor to the sharp rise in cases, said Neville, who treats those suffering from hormone imbalances and type 1 diabetes.
An autoimmune disease, type 1 diabetes is caused by T cell-mediated destruction of the pancreatic beta cells. As a result, the pancreas is no longer able to produce insulin. The reason for the immune system’s sudden attack on otherwise healthy tissue is most likely multifactorial but it still unclear, as is a lot of other information about the disease, according to Neville.
Not only is it a particularly perplexing illness, but it’s also often overshadowed by the much more common type 2 diabetes, Neville said. According to the CDC, in 2016 only 5.8 percent of all diagnosed cases were type 1 diabetes, whereas 90.9 percent were type 2.
In turn, not as much research focuses on type 1 diabetes. Consequently, many in the integrative healthcare community aren’t fully educated on the condition and don’t know how they can help patients with it. Yet, according to Neville, there’s a lot that natural medicine can offer to those with type 1 diabetes.
“It is an amazingly untapped area,” she said. “Most type 1s are getting, what I think of, as very superficial health support, and the deeper layers of their health and their lives are never really addressed.”
Conventional medicine treats type 1 diabetes through insulin injections. As long as type 1 diabetics are getting an adequate basal rate of insulin and giving themselves the correct bolus dose by counting carbohydrates at each meal, conventional medicine says they can eat whatever they like. The problem, said Neville, is that blood sugar levels are impacted by so many different factors from hormone fluctuations to humidity, and it’s nearly impossible for a type 1 diabetic to eat a carbohydrate-filled diet and accurately dose insulin with consistency.
“No one should be eating the standard American diet, let alone a type 1 diabetic,” said Neville. “Teaching type 1s that it's simply about carbohydrates and insulin dosing is just completely missing the mark.”
One of the biggest factors that can lead to difficult-to-control blood sugar levels are hormones. According to Neville, blood sugar levels can increase at certain times during a women’s menstrual cycle, and/or when they have a hormone disorder such as polycystic ovary syndrome (PCOS). PCOS is linked to high testosterone levels secondary to elevated insulin levels, which can lead to symptoms like hair loss, acne, unwanted hair growth, and irregular menstrual cycles. While PCOS is common among all females, it’s has been shown to disproportionally effect women with type 1 diabetes. A 2006 study published in The Journal of Clinical Endocrinology & Metabolism found the prevalence of PCOS was 40 percent among women with type 1 diabetes. In contrast, only 2.6 percent of the controls, who did not have diabetes, were diagnosed with condition.
The basis of managing type 1 diabetes and PCOS, Neville explained, is a whole foods diet. A whole foods diet provides plenty of fiber which makes glucose rise at a slower rate. Conversely, simple and processed carbs cause blood sugars to spike.
“I suggest staying away as much as possible from simple processed carbs,” said Neville. “Foods like pizza, bagels, and pasta can be frustratingly hard to dose for.”
In addition to helping regulate glucose levels, a whole foods diet increases gut microbial diversity which lowers the risk of additional autoimmune conditions, according to Neville.
“Autoimmunity likes to come in pairs and triplets,” she said. “So, even if we cannot yet cure type 1 diabetes, we can at least calm the immune system, lower the risk of complications and further autoimmune disease development, improve foundations to health, and allow life with type 1 diabetes to be a lot more enjoyable.”
To provide patients with dense nutrients throughout the day, Neville also suggests that her patients with type 1 diabetes drink bone broth, which helps satiate hunger, reduce carb cravings, and regulate blood sugar.
In addition to a whole food diet, Neville recommends that her patients with type 1 diabetes try intermittent fasting. Intermittent fasting gives the body time away from food, allowing it to heal issues deep in the body. According to Neville, it’s also been shown to regenerate pancreatic beta cells in newly diagnosed type 1 diabetics.
For patients with type 1 diabetes, Neville said she always asks about chronic viral illnesses since viruses can significantly impact blood sugar levels and they’re implicated in the disease development. From an integrative standpoint, the goal is not to fight off every virus (the germ) but to strengthen the body’s ability to manage viruses (the terrain). She also tests for vitamins and minerals such as vitamin D, B12, folate and magnesium and then supplements accordingly.
While treating uncontrolled blood sugar levels caused by hormonal changes, whether that be a disorder like PCOS or simply a woman’s natural menstrual cycle, Neville will analyze exercise habits. Research published in the journal Nature Reviews Endocrinology suggested that endurance exercise lowers blood sugar while explosive exercises like jumping and sprinting can increase blood sugar. The study also found that high-intensity interval training (HIIT) and resistance exercises tended to have a modulating effect on blood sugar levels. Depending on whether a patient is experience hyperglycemia or hypoglycemia, Neville may suggest changes to their exercise routine.
Aside from diet and exercise interventions, Neville is a big proponent of using the supplement resveratrol for type 1 diabetic patients. Resveratrol helps increase the Sirt1 protein which is associated with the regulation of estrogen. According to Neville, by maintaining healthy levels of estrogen, resveratrol may also help prevent cardiovascular disease, which women with type 1 diabetes are at a higher risk for.
Results from a preliminary trial published in the journal, Nutrients, showed that a 500 milligram (mg) capsule twice daily of resveratrol reduced fasting blood glucose, hemoglobin A1C, and a marker for oxidative stress, as well as increased total antioxidant capacity in participants with type 1 diabetes.
“It’s basically all the aspects we want for a type 1 diabetic: to lower blood glucose, lower A1C and to increase the body's ability to manage oxidative damage,” Neville said. “And that's happening all through this one treatment of resveratrol.”
Another supplement Neville often suggests for type 1 diabetics is melatonin. Studies have shown melatonin to reduce diabetic complications like retinopathy, nerve damage, depression, kidney issues, heart problems, and impaired wound healing, according to Neville.
Combined with conventional medicine, natural therapies can help fill in the gaps of type 1 diabetes care to improve blood glucose control and reduce daily insulin requirements.
“The goal is not to take insulin away from these patients. The goal is to tap into all those layers beyond insulin dosing and carb counting that rarely get addressed,” said Neville. “Conventional medicine and insulin keep these patients alive, but it’s the deeper, natural therapies that make them well. I hope integrative practitioners fully realize how much they can offer their type 1 diabetic patients.”
About the Expert
Laura Neville, ND, graduated from the National University of Naturopathic Medicine and maintains a private practice in Portland, Oregon with a focus on endocrine health including type 1 diabetes, Hashimotos, and hormone optimization throughout the female lifespan. She sits on the advisory board for Hormone University providing evidence-based alternative medicine research and clinical expertise.
Neville is also a staff physician at Doctors Data where she writes, researches, and consults with physicians around the world on complex cases. She is a frequent speaker at professional conferences around the country on the topics of women's health, testing methodologies, brain health, and type 1 diabetes.
Editor’s note: Practitioner Perspectives is a series where we highlight trending topics through interviews with integrative healthcare professionals. To participate, please email us at [email protected].