Want To Control Type-1 Diabetes? Here’s A Strategy Rooted In Human Evolution
It all started with this passage in Peter Attia’s excellent book Outlive:
[…] insulin resistance itself is associated with huge increases in one’s risk of cancer (up to twelvefold), Alzheimer’s disease (fivefold), and death from cardiovascular disease (almost sixfold)—all of which underscores why addressing, and ideally preventing, metabolic dysfunction is a cornerstone of my approach to longevity. […]
the logical first step in our quest to delay death is to get our metabolic house in order. The good news is that we have tremendous agency over this. Changing how we exercise, what we eat, and how we sleep (see Part III) can completely turn the tables in our favor. The bad news is that these things require effort to escape the default modern environment that has conspired against our ancient (and formerly helpful) fat-storing genes, by overfeeding, undermoving, and undersleeping us all. […]
It shocked me and moved something deeper that urged me to start having some thoughts, reading some things, and taking some actions.
Peter Attia is in excellent company though when it comes to delivering information about metabolic health and diabetes management. Other very smart individuals in the world of nutrition such as Robby Barbaro and Cyrus Chambatta, Jessie Inchauspé can provide abundant scientific reasons why you should be obsessed with keeping your blood sugars steady as much as possible too, diabetic or not. There are many others I could mention (Dr. Michael Greger, Dr. Neal Barnard, Dr. Stefano Vendrame…), so go pick the voice that sounds right, they’re all valid and worth listening.
Coming back to Attia’s sentence…to us with type-1 diabetes in particular, chronically elevated blood sugars - previously unknown and now a daily struggle for most human beings, thanks to the wide availability of highly refined industrial foods - are much easier and faster to reach, and their dangers include:
Nerve damage: High blood glucose damages nerves, leading to neuropathy (tingling, pain, or numbness).
Eye complications: Uncontrolled diabetes can harm the blood vessels in the eyes, potentially causing vision loss.
Kidney damage: Elevated blood glucose affects kidney function over time.
Cardiovascular risks: Diabetes increases the risk of heart disease and stroke.
Foot problems: Poor circulation and nerve damage can lead to foot ulcers and infections.
I’d love to say that the first time I heard these things something immediately “clicked” for me and I immediately got to work to reduce the risk of these complications. Truth is, I still am a human being living in the 21st century and all its amenities, and it took me (more than) some time to figure things out and to disentangle myself from the conventions, habits, behaviors and beliefs inoculated in me by societal standards, social pressure, and by the “this is the way things are”.
Hours and hours and hours of reading and studying, more hours of thinking and reflection and close observation of my lifestyle, and I started to grasp one very important concept: what is normal is not natural. And yes thatmodern life is full of normal things that are very much not natural.
Breakfast, lunch and dinner are normal, not natural. Jumping from thing to thing and being always stressed is normal, not natural. Eating pasta and bread in a rush for lunch is normal, not natural. Poor sleep is normal, not natural. Sitting all day in the car, at work, at the restaurant and on the sofa is normal, not natural. Cardiovascular diseases, pains, illnesses, cancers are normal, not natural. And on and on.
The rhythms that regulate our everyday living have corrupted us humans in many ways that don’t match how we have evolved as a species.
One of the most compromised areas is nutrition, which is what I am going to focus on today. I will share how the way I see food has changed, how I’ve transformed from vegan to being truly plant-based, and why this has fed my very welcomed obsession with time in range and insulin sensitivity, two of the most important aspects for anyone living with type-1 diabetes.
“Normal” food consumption
Let me continue with some examples of normality, with a focus on foods and eating habits that constituted the backbone of my relationship with food from my earlier years to my first years as a vegan.
Pizza
I have always been used to “Saturday night pizza”. Eating pizza was normal and socially accepted as a fact of life ever since I was a kid. I never put that into question, not even during the first eight years as a type-1 diabetic. Many pizzas and HUGE blood glucose spikes later, which I was attributing to everything except for pizza, it finally came to me that it could be that pizza was a criminal attack to my health.
Standard mediterranean foods
It took me an additional couple of years to translate my painfully acquired pizza knowledge to all the other products often associated to the typical “mediterranean” cuisine. Yes, Mediterranean eating includes some vegs and fruits, but what locals are prouder to glorify is the huge variety of pasta recipes, cheeses and meats.
I dropped animal products many years ago, but the big pasta bowl? No chance! And of course, in any Italian meal, pasta is accompanied by bread: the tradition is that once you’re done with your (white) pasta, you have to dip the bread and “clean” your plate of any remaining trace of sauce. I used to enjoy complying to this tradition, and the formula was easy: double carbs, double insulin. You can imagine the consequences on my blood sugar stability.
“Protein and fat”-rich vegan foods
When I finally got tired of the huge spikes caused by refined carbs, I of course cut the carbs and focused on fats - of course! Don’t you see the spikes? Carbs are bad! They must be bad... So I traded my pastas for products like peanut butter, tofu, seitan, tahini, oils. Vegetables were part of my plate, but nearly all my calories were coming from processed fats and proteins.
And there I was again at square one, smashing my head against the uncontrollable blood sugar swings caused by an excessive consumption of peanut butter, tahini and tofu. Even one slice of an apple would send my blood glucose to the roof and beyond. Years later I would read the Mastering Diabetes book and realize that fats and proteins make us insulin resistant, but I had no idea back then, so I was going all in, on exactly those two in their most processed forms, while cutting carbs because “carbs raise blood glucose”. I was really convinced I was doing good to myself.
“Enjoying Life”, Paying The Highest Of Prices
I could list ten additional cases, but the ones above should be enough to spot the pattern: processed foods, normal foods, tasty foods. Enjoying life at the highest of prices: my health.
It took me years to see what was going on, and my will to “enjoy life despite type-1 diabetes” often made me ignore and rationalize the abundant signals of dangers my blood glucose monitor tried to bring to my attention on a daily basis.
I was too busy “enjoying life, fck diabetes! Haha!”*
Haha, yes. I was so stupid that I didn’t care about the fact that I was chronically losing my focus after each meal, I was suffering from ups and downs and I couldn’t study or work properly; that my sleep was chronically affected by the excess amount of calories of overabundant meals; that I could not enjoy a workout due to hypoglicemias and if my blood sugar shot high, I’d just inject more; that I was accumulating all the long term life-shortening dangers of metabolic disease.
“No problem, diabetes will not hold me back, life must be enjoyed, you only live once”!
The normal modern foods, the normal modern lifestyles, the normal modern beliefs were literally costing me my own life.
But.
In all that eating myself to death I was still actively listening to podcasts, reading books and watching videos about all things nutrition. Later rather than sooner I saw the paradox I was stuck into, and it all hit me in a couple of days. Nothing happened until it all happened at once, and in a couple of days it finally clicked, I got it.
And I got to work immediately.
The Change
I started by clearing my horizon and focused on a few critical pieces of knowledge. As a type-1 diabetic, the quality of my lifestyle is directly reflected in and explained by two numbers: Time in Range and the amount of insulin I need on a daily basis to manage my carb consumption.
If Time In Range is high (>90%), good. If the insulin requirement is low, especially on a higher carb diet, good.
These numbers don’t lie, and they reflect so much about one’s lifestyle that I chose them as the focus of my obsession. (Yes, I know there are a thousand of other things to consider, but I had to start somewhere, and I had to start simple.)
Knowing what numbers I was optimizing for, I was ready the start the second part of my journey: auditing my lifestyle.
I have always been active and sleeping plenty (thank you, Matthew Walker), so I knew the most problematic macro area to address for me was food. Hence, I put my eyes on what I was eating and noted its quantity and quality, the insulin needed and how my blood sugar levels were impacted every time I put something in my mouth. Every day.
Reading the Mastering Diabetes book by Cyrus Chambatta and Robby Barbaro, I understood that whole carbohydrate rich foods, that are plant-based and naturally low in fats are not the ones to be avoided - as I did in my past when I dropped the evil carbs to embrace fats and proteins.
The real problem lies in processed food itself (carbs, fats and proteins): in practical terms, anything you can easily find at the supermarket or in most people’s kitchen counters. These foods are considered as “normal” by today’s standards, and that has consequences on our health (This episode of the Huberman Lab podcast with Doctor Robert Lusting was a huge boost in my understanding of the topic). That was e huge step because it confirmed why cutting carbs to attack peanut butter and tofu stirs had not resolved, but worsened, my blood glucose management.
It soon became clear that the amount of processed foods I was still including in my vegan diet far exceeded the 20% which I consider an acceptable boundary, due to ultra-processed ingredients being hidden everywhere. In other words, I was vegan, but being plant-based was an entirely different thing, and I surely wasn’t one.
I had to take action, reduce processed foods to almost zero and transform myself from a 21st century trendy “vegan” into someone actually eating whole, unprocessed, healthy plants.
“Vegan” And “Plant-Based”: Very Different Things
When I look back, most of the people I have met who described themselves as “vegan” weren’t eating anything near a healthy diet. I was among them.
When you mostly eat - as I did - processed meat substitutes, vegan spreads, vegan patties, vegan cakes, vegan sandwiches and some iceberg lettuce, you’re really only eating the same combination of refined oils, refined carbs and additives that are at the basis of any processed food at the super market. They recite “plant-based” on their green label, but they are bad for health all the same.
If you try to make up for these - as I did - with fruits and vegetables, let’s just say that iceberg salads, out of season vegetables that have been grown indoors, tropical fruits picked who knows how much time ago on the other side of the globe do not count as good quality foods anymore. They’re still better than most items on the shelf, but industrial foods grown out of their season or preserved far longer than their natural lifespan are no longer nutritious.
I genuinely thought I was eating healthy but I was way wrong, and my high HbA1C (6.9%) low Time In Range (around 74%) and high insulin dosing (50 daily units for 500 grams of carbs, on average) were a mere reflection that. I was eating vegan beef accompanied with a perfectly rounded and red tomato, which only shares the name with a real tomato. I was eating “plants”, but I was not really plant-based.
The nutritional content of my diet was null, and too many refined foods were making managing diabetes impossible.
An Evolutionary Lens On Food
When I started to look at my food consumption through an evolutionary lens, a lens that brings clarity on food just like in any other aspect of lifestyle, I was absolutely shocked. That helped me figure the true meaning of plant-based. Let me explain.
I read that all the diseases we consider as normal today (cancers, tumors, cardiovascular diseases, obesity, diabetes, neuro degenerative diseases, etc) were virtually NON-EXISTENT for almost the entirety of human history. They all started to pop out from all over the place in the last century or so.
To be precise, they emerged right when we started to process our foods, when refined carbohydrates such as sugar and flour became cheap and accessible, when we started to combine sugars with oils into carefully crafted calorie bombs. That’s when we got inflamed, obese and chronically sick.
Today’s food is convenient because we don’t have to wait. We’re hungry and we find something that takes no time to cook. We have ready-meals, pre-cooked meals, snacks and appetizers at every corner at every time of day. We’re not willing to wait for foods to ferment, to wait for the legumes to soak for one or two days, to blend our soy beans and make our own soy milk or yogurt…we’ve got to rush to work or to this or that other chore. We crave tomatoes in winter, so we just import them from the other side of the world and eat them, fully colored and empty of nutrients.
“Plant-Based”, This Time For Real
That is when I transitioned to real plant-based eating with more consciousness and shifted my understanding of food in a more philosophical, deeper way. That had huge benefits for me as a diabetic, too. For instance, I started to flow with seasonality of nature. I rediscovered the joy of eating what’s around in that season, because seasonal food is at the peak of its nutrition. I rediscovered the almost forgotten practice of fermenting foods, so good for the gut microbiome.
I rediscovered the mindfulness of waiting for the beans to soak and cook, a great way to erase the urge of having all the food ready, now.
I rediscovered the joy of picking up edible herbs from the ground in the wild, instead of only relying on the packaged salads at the supermarket, almost empty of nutrients. Plus, I must admit there’s nothing more satisfying than eating the food you have gathered.
In other terms, I committed to eat as much as possible the way we used to eat before industrial foods invaded us: whole, plant-based foods that are naturally rich in carbohydrates and low in fats. No added oils, salt, sugars. Just the food as it is.
The vegan foods I had been eating for many years were made of plant material, but they were still industrial combinations of those very sugars and fats. And as all processed foods, they were screwing my type 1 diabetes (and my health) and my metabolic health with all their 21st-century-violence.
In practice, I dropped seitan for tempeh.
I dropped soy milk unless the ingredients were soy and water, and actually started make my own soy milk at home which is even cheaper.
No more white bread, and bread in general. If I have to eat some, that must be 100% whole.
Same for pizza, pasta and any baked product.
Vegan spreads, cheeses and meat substitutes? Out.
Whole fruits became my “candies” and desserts.
Vegetables, fruits and nuts became my snacks.
Fresh, seasonal vegetables are at the start of every single meal, even breakfast.
Proteins come from a combination of legumes and cereals, who also contribute to my carbs with fresh fruits.
Fats come from seeds rich in omega-3 and any food with added oils is erased from sight.
Our ancestors didn’t have vegan burgers or other processed “luxuries”, they did not eat calorie bombs at every hour of day, and they didn’t get sick. All they had were whole, unprocessed and mostly plant-based foods. They ate roots and plants picked from the ground at the peak of their nutritional density. They got animal products when they were lucky and after endless days of hunting. The frequency of their meals depended in large part from the results of their hunting and gathering, leading to long periods of fasting.
Move a few thousand years forward to your grandma’s generation, and even then most of the foods we find in a supermarket today did not exist. No refrigerators, so they had to ferment foods. No international import-export, so they relied on the locally available whole flours, vegetables, fruits and legumes, and because of the way animals were grown, the quality of the nutrition contained in the meat and dairy products they occasionally consumed was much much much higher. They ate in moderation and with less frequency because food was not as abundant and ubiquitous as it is today. Their meals were simple. No pizza with oil with cheese with prosciutto. No ice cream with sugar and glaze and chocolate. No “healthy snack bar” with syrup, roasted almonds and Himalayan salt. No chips, not even the vegan chips with beetroot flavor. No mid-morning cake after an already abundant breakfast only because it’s your colleague’s birthday. Etcetera.
Radical Improvements, No “Quick Fixes”
With this evolutionary lens in mind, my definition of “plant-based” changed radically and so did my habits. It didn’t took long (literally, five or six days were enough at the beginning) to witness the drastic improvements that cutting the processed and industrial foods from my meals had on my type 1 diabetes management.
Why? To start, eating seasonal fruits and vegetables, and relying on whole grains, soaked legumes and fermented foods for my main meals translates into dishes that are packed with ingredients at the peak of their nutritional value.
Reeducating my tastebuds to real foods means that I have become immune to the salty and sugary and fatty snacks that surround me and that I used to binge on. My gut microbes now only send me hunger signals for the good stuff, and they can happily do without the bad stuff. This means that by default and without effort my diet is cleaner, simply because my gut and brain have been rewired.
As a direct consequence of more stable blood sugars, my cravings have largely disappeared.
I eat less frequently, and this alone means that I inject less often and that the time window my body has to handle glucose is restricted. I now eat one or two larger meals, and then have some whole-foods based snacks, mostly starchy vegetables and nuts, to meet my calorie target (I am still an endurance athlete, after all). My dinner is now a light snack mostly based on some vegetables and some legumes, eaten two to three hours before bedtime.
I eat when I am hungry, I find it easier to stay focused on whatever I am doing, I feel more energetic, I digest food better than ever, I have naturally dropped the excess weight I had accumulated, I run better, longer, faster and I recover better and faster too.
Less processed, more quality food, eaten less often automatically feeds more blood glucose stability, a higher time in range and a constantly improving insulin sensitivity.
My life, in general, is better. And there’s no magic pill behind this, no magic carnivore or keto or fruitarian or juice diet. I am simply eating the way we’ve evolved to eat: seasonally, moderately and when it makes sense to eat.
Our current lifestyles are the equivalent of begging for chronic diseases. The blood sugar spikes induced by the endless occasions to eat industrial foods do play a huge role in their development.
Since I have become obsessed with Time In Range (in part I had to, in part I chose to), not only did it improved, but it has put me on a trajectory that is changing the way I live in a much broader sense. Keeping things simple is what sits at the root of my everyday’s behaviors and choices. Eating simple, moving more, doing fewer things, that are critical, and doing them better, breathing more, staying in nature more, managing the stress of modern life better.
I am no monk. I still work a full time job in an office. I still live around people who invite me for late nights, pizza parties and all the usual things. I just know better where my priorities lie.
Health comes first.
