Lose Weight with Type 1 Diabetes
Editor’s Note: Cliff Scherb, founder of Glucose Advisors and TriStar Athletes LLC, is a nutrition and fitness expert. He consults through virtually teaching his decision support system —Engine1 the app and its methodologies to aspiring T1 individuals and athletes. Cliff also creates custom training programs and insulin plans for endurance athletes, using Training Stress Modeling and real-time coaching. To inquire about coaching openings, FB LIVE sessions, and general questions please email Cliff@glucoseadvisors.com.
Losing weight can be difficult—add type 1 diabetes to the mix with its daily management demands—and it’s even more of a challenge. I know, because I’ve been a person with type 1 diabetes for 29 years and I’m also an endurance athlete.
The internet is saturated in advice on how to lose weight with or without type 1, so it’s hard to know what is worth while and what will just waste your time —or worse, can negatively impact your health.
I’m not going to declare all out war on carbohydrates, or tell you can or can’t drink your calories in the form of olive oil, or feast and fast with cayenne peppers and maple syrup. No, the real distilled learning from my years of consulting and data analysis shows that a balanced, low-insulin diet with nutrient timing and activity is the best way to lose weight with type 1 diabetes. It also helps you maintain brain and body function as well as energy levels.
If you are reading this you’ve probably already given this some thought and know why it’s important to lose weight and/or lean out, but I maintain it’s all about performance!
Performing means living a longer or healthier life or if you’re an athlete, it can also translate to beating out your competition.
Things that Impact weight loss for T1Ds—
- Basal and bolus amounts and timing
- Insulin on board
- Nutrient shifting and timing (planning out of meals)
- Total daily fat intake and calories
- Total Activity Level
- Sleep quality and duration
- Quantity of sugar in the diet
- Alcohol consumption
- Stress levels
Why high carbohydrate diets alone don’t work
Let’s begin with our protein hormone insulin—the center of discussion. Insulin is a hormone in the body that allows the uptake of glucose into the cells for energy metabolism and blood sugar balance. (For those with type 1 diabetes, their bodies do not make insulin and take insulin supplementation via injection or insulin pump). Higher doses of insulin in the body, whether type 1 diabetic or not, will help to build muscle as well as aid in the storage of adipose tissues (a.k.a. fat).
If you are a person with type 1 diabetes this may seem fairly obvious, that as you increase the carbohydrates in your diet so too does this cause variability in your blood sugar. Consuming 55 percent or more of your total calorie needs from carbohydrate dramatically increases the insulin that you must take. Increased daily doses and round the clock “insulin on board” (active insulin in the body) can lead to more carbohydrate metabolism from foods you eat and from glycogen stored in your muscles. These higher levels of insulin throughout the day leave little time when fat from the body can be burned and or metabolized. Keep in mind, insulin tells the body to “store” fat and “burn” glucose or glycogen from the muscles (uptake sugar from the blood).
This situation will be neither ideal for the person with type 1 diabetes, nor active individual seeking a leaner body composition. Consuming carbohydrate especially prior to being active can cause a rise in insulin levels that burns carbohydrate more exclusively and does a poor job of chipping away at the fat stores we all have. At times, a high carbohydrate diet will provide ample energy, however the blood sugar crashes from insulin spikes also perpetuates a sense of being hungrier due to fast absorption versus slow. This means this nutrient alone is not the silver bullet.
So what is the right amount of carbohydrate then? The human body drives much like your car and carbohydrates are the gas tank. Your tank can only hold say 16 gallons (carbohydrate) of gas and trying to put 17 gallons in a 16 gallon tank will only lead to weight gain. The trick is to strike the right balance to fill the tank. For people with type 1 diabetes who use a pump or track their total daily dose, this gas tank analogy is equivalent to the total daily dose of insulin. Meaning, the average total daily dose (assuming relatively stable blood sugar and no weight gain) is the baseline for knowing if your body is full up at 16 gallons or half-full at 8 gallons (close to “empty”). Non-diabetics need to monitor the total grams of carbohydrate via an app or other tracking method to do the same.
In my experience with athletes with type 1 diabetes, it’s rare that they ever “bonk” as most will learn with coaching how to track their total daily doses and make sure they have enough “gas” in the tank to drive across town. Total carbohydrates should flex up on more active days and ramp down for inactive ones, simple as that.
Note: For those who are very active (greater than eight hours + per week of activity) carbohydrates can ramp up even more dramatically and with a greater focus and emphasis on lean proteins (20-30 percent of daily calorie needs) and modest amounts of good fats (15-25 percent of daily calorie needs).
Why high fat diets alone won’t work
The high fat/low carbohydrate diet has its positives and negatives, yet as a stand-alone nutrient source it doesn’t hold up. Here are two big time pros to this diet strategy:
- Lower insulin levels in general are great for balancing blood sugar levels and sustaining energy. When you consume mostly fats, they are VERY slowly absorbed and it can take up to eight hours for very high fat meals to fully absorb. During this time these fats can slow any carbohydrate absorption and create a slow trickle of energy where the need for insulin is relatively lower.
- Increased fat burning metabolism due to lower levels of total daily insulin. With a lower amount of insulin circulating through the body, it allows for fat to be burned more readily. Think the lower the amount of insulin in your system, the higher the fat burning contribution.
So then why not go all in with fat? Here are two even bigger cons to the singular approach of fat consumption only:
- Fat has nine calories per gram versus carbohydrate and protein. If the goal is to lose weight and lean out, then total calories must be considered. This is more than double when you compare things side-by-side, gram for gram. In addition to having more calories, they are absorbed in a slow way over time and can actually have a sustained insulin need and or effect for many hours. This is especially so if they are consumed with faster burning/absorbing carbohydrates and proteins. No one wins on a high fat high carbohydrate diet!
- High fat diets choke off energy levels. When you consume good fats, due to how slowly they absorb, you may not receive that energy into the blood stream for many hours. This can leave you tired, irritable, yawning and depleted enough that you cannot be as active or active at all. Using the car analogy, it’s as if the car only receives a little injection of gasoline while you are driving and stalls out from time to time.
In addition, fat can satiate and mask hunger which is great, however, at some point the body must receive enough calories and often times this comes in the form of quick energy when we get past hungry and crave sweets and sugar. Not having enough timely carbohydrate energy leaves you fatigued enough that you may not be as active and hence not burn calories as much as you could have, which is also critical to weight loss.
Why a balanced, low-insulin diet with nutrient timing and activity is the best
Given that there are positive aspects of both a high carbohydrate and high fat diet, the combination and timing aspect brings together the better of these two approaches and is furthermore enhanced when you introduce activity. The key is to use insulin timing, which is the same as timing carbohydrates, fats and proteins. Insulin has a leveraged effect at various times of our day and especially around activity. Let’s look at an example:
You plan to do an activity first thing in the morning, whether it’s a walk, a run or bike ride. How much do you eat? What do you eat? For any activity less than 60 minutes, it’s perfectly okay to eat nothing. The reason for this is that your body has an amount of stored up glucose (glycogen) that it can access for approximately an hour. This means you don’t need to consume carbohydrate immediately to sustain this activity and it also means you won’t need insulin prior to or during which means you can burn more fat. (Insulin tells the body to store fat and burn carbohydrates—a resource you are already carrying stored in the muscles.)
If you are in fact hungry and need to eat prior to your activity, you should consume a small amount of good fats (i.e. almonds or sliced avocado) to satiate you until you can have your first meal of the day. Good lean proteins also work well in this way however for type 1s, some amount of insulin may be necessary which can make the fat burning session less successful.
The key is to do the workout slightly fasted and with as little food as necessary to satiate and sustain you. For people with type 1 diabetes, the most important factor to consider before being active is how much insulin is on board from both basal rate and boluses. If there is insulin on board, some amount of glucose will need to be consumed to prevent a low blood sugar. Due to the fact that synthetic insulin has a duration of insulin action from 3.5-4.5 hours, timing a meal and when you are going to be active may take planning.
When you are done being active, you can now bring carbohydrates and protein into the picture. Carbohydrates to replenish muscle glycogen that was lost and protein to balance blood sugars and repair and develop lean muscles. Post activity you are highly sensitized to insulin and its effects of “mopping” up glucose for use. The amount of insulin your body needs to absorb glucose prior to exercise may be 50 percent more versus 50 percent less (And up to 70 percent less) when consumed post exercise. This bodes well for trying to reduce ones total daily dose of free floating insulin and leaning out. It’s also at this time you would want to shy away from good fats in favor of protein and carbohydrate due to the insulin timing. Outside of this recovery window you can transition back to a greater balance of all macronutrients including good fats.
If the activity is very easy in nature, (defined on a scale of perceived effort 1-10, 10 being a maximum type of effort, less than a three would be considered very easy) then its not necessary to have copious amounts of carbohydrates but rather a higher proportion of protein and some good fats post activity with only a modest amount of slow burning carbohydrate. (To see an example of nutrient coaching for low to moderate activity levels, follow here.)
Whether you are very active or lightly active the balanced approach should mix the macronutrients (proteins, fats and carbohydrates) as follows.
Less Active Individuals % of total daily calorie needs (30 minutes to two hours per week of total activity)
- Carbohydrate 30-40%
- Protein 15-30%
- Fat 25-40%
Highly active Individuals % of total daily calorie needs (eight hours + of activity per week)
- Carbohydrate 50-60%
- Protein 20-30%
- Fat 15-30%
To pull it all together isn’t easy, but who said it was?! Life will happen fast and timing insulin and nutrition will be tricky as you are locking into insulin over many hours of the day with varied meals. Only practice and learning with repeated steps and planning can lead to greater success. Ultimately, choosing the balanced low insulin approach via nutrient timing will lead to longer-term weight loss and happiness with enhanced blood sugars.