How did this man get to live with type 1 diabetes for more than 80 years?

I came across this interesting story the other day. It concerns an American, Bob Krause, who has just turned 90. Nothing to extraordinary about that, perhaps, in these days of enhanced longevity. What makes the story interesting is that when he was 5 years old, Bob was diagnosed with type 1 diabetes.

This is condition is characterised by insufficient insulin secretion from the pancreas. As a result, blood sugar levels tend to be higher than normal. The conventional medical treatment for type 1 diabetes is insulin injections. However, despite treatment, many type 1 diabetics die prematurely, often having suffered adverse effects from their diabetes including blindness, nerve damage, kidney disease, skin ulcers and amputation. In comparison, Bob Krause appears in great shape (especially bearing in mind his advanced years).

Read the article I link to above, and what is clear is that Bob has managed his diabetes with meticulous care. What is especially noteworthy is that his eating regime contrasts sharply with the standard advice given to diabetics, namely to:

  1. eat three meals a day
  2. include starchy carbohydrate with every meal

Actually Bob normally eats twice a day. His breakfast is usually made up of nuts with some prunes. His dinner is protein (e.g. meat) plus salad. He doesn’t eat much. And critically, he doesn’t eat much carbohydrate.

Back in the day before insulin was discovered and made available as a medication, diabetes was treated with a diet low in carbohydrate. The doctors back then took the view that if diabetics couldn’t handle sugar, then the best thing was for them not to eat it (in the form of sugar and starch). It makes sense, and even a 6-year-old understands this concept. What a shame many health professionals seem to be blind to what is blindingly obvious. And it’s a shame that leading diabetes charities continue to promote a diet that is, by virtue of its high carb content, actually contraindicated in diabetics. See here for an example from Diabetes UK. I’ve recently been told that Diabetes UK is changing its policy regarding carbohydrate consumption, though if it has, their dietary recommendations are yet to reflect this.

Reading about Bob reminded me of someone I met a few years ago after a presentation I delivered. She was a middle-aged woman who had been diagnosed with type 1 diabetes early in life. In conversation, I asked her what her HbA1c level was (this is a measure of blood sugar control over the preceding 3 months or so). Non-diabetics will usually have a HbA1c level of 5 per cent or below. This lady’s HbA1c was normal – a highly unusual situation with a type 1 diabetic of several decades standing. How had she done it? Not by following standard dietary advice, that’s for sure. Her main meals were generally made up of meat or fish, accompanied by non-starchy vegetables. Not only was her blood sugar control good, but she took tiny doses of insulin in comparison to most type 1 diabetics.

One of the pioneers of effective (low-carbohydrate) nutritional therapy for diabetes is Dr Richard Bernstein, himself a type 1 diabetic and author of The Diabetes Solution. You can learn more about Dr Bernstein and his work here.

In a former life, Dr Bernstein was an engineer. Bob Krause was an engineer too. Is this just a coincidence? Perhaps not. This is purely anecdotal, but I have found that many of the most creative-thinkers in the area of health and nutrition have a background in engineering. What is it about engineering that might make these people great nutrition and health commentators? Here is the opening description of engineering to be found on Wikipedia:

Engineering is the discipline, art, skill and profession of acquiring and applying scientific, mathematical, economic, social, and practical knowledge to design and build structures, machines, devices, systems, materials and processes that safely realize improvements to the lives of people.

Engineers don’t get very far designing bridges that don’t stay up or computer circuits that don’t work. Yet, in healthcare, it seems money can be made from approaches that not only don’t work, but actually jeorpardise health. I think we doctors and other health professionals often have a lot to learn from engineers, to be honest.

15 Responses to How did this man get to live with type 1 diabetes for more than 80 years?

  1. Day 31 May 2011 at 11:44 am #

    One of the sharpest minds in the blogosphere is Dr. Michael R. Eades. I’m sure you’re aware of his site, and would agree with him on most things regarding diet and health. He, too, began his career as an engineer.

    Thanks again for your posts and podcasts.

  2. Lori 31 May 2011 at 6:23 pm #

    One of my engineering professors once said, “Concepts are fine, but if you can’t get the right answer, you’re no use to anyone.”

    Besides caring about results, engineers are taught to analyze whole systems, whereas doctors, I’ve heard, are taught about parts and do a lot of memorization. IMHO, a diet that corrects your lipids, weight, BG levels, and a variety of other bodily functions and health markers probably isn’t going to nonetheless give you a heart attack.

  3. J. Stanton - gnolls.org 2 June 2011 at 12:31 am #

    I am an engineer by training, and I approve this message.

    You’ve basically got it right: engineering is results-driven. Especially in computer-based fields, where the feedback is immediate. The compiler doesn’t care what you meant or what should have worked: if the program doesn’t do what it’s supposed to, you don’t get to go home until it does.

    JS

  4. John S 3 June 2011 at 8:08 am #

    As an engineer I can’t agree more. A MD and pharmacist (and most other health practitioners)will get paid whether their treatment is successful or not. If there are side effects these are ignored. If the treatment does not work other drugs are prescribed. If nothing works then the illness is all in the head.

    But then the patient is also partly to blame cause they just want a pill to cure their every ill. Patients want to carry on with their lifestyle regardless.

    What is lacking in the medical field (and the world) is wisdom.

  5. helen 3 June 2011 at 8:49 am #

    The only reason Low Carb is not used to provide health on all levels is very simply money.

    If everyone were eating low carb & being healthy how would the pharmaceutical companies, doctors and other medical off shoots all supported by the business with illness survive????
    Not to mention the multi billion dollar cancer industry dont be fooled people all of these so called “health” organisations and charities rake in big dollars if “joe public” stay sick and follow their dietry recommendations……….just to ensure the ever increasing profit margin for these con men pretending to care about your health!!!
    If it weren’t for caring true health professionals like Dr Briffa et.al. they would still be getting away with it……..wake up world ……the business with illness only wants your money not your good health.

  6. Alan 3 June 2011 at 9:56 am #

    I agree with all the comments above – we provide engineering solutions and for them not to work is unacceptable – I have the highest regard for engineers.

    Another point in addition to the one above, about the financial implications of being healthy, is how we would feed all the world’s billions of people if they stopped eating high carbohydrate foods – grains etc. Our ‘civilisation’ and the growth of cities were to some extent based around the cultivation of crops. A significant change in eating habits would have massive consequences.

  7. kate 4 June 2011 at 12:44 am #

    ‘Critically, he doesn’t eat much carbohydrate.’

    Critically, he doesn’t eat much. And last time I checked, prunes were carby carbs.

  8. Marly Harris 4 June 2011 at 1:28 am #

    Dr. Bernstein is one of my heroes. Although I am not diabetic, I follow an almost zero-carb diet because I know that I’d be a huge failure as a diabetic. Testing and injecting are not two of my major talents. I’ve lost 130 pounds with 33 more to go and I’m never hungry, have no food cravings, and men my son’s age “hit” on me. Life is good.

    I always look forward to your weekly newsletter.

  9. John Briffa 4 June 2011 at 8:24 am #

    Kate

    While you were checking the carb content of prunes, you could have checked how many prunes this man typically eats in the morning (and also put them in the context of his diet as a whole)…

  10. Chris 7 June 2011 at 1:04 pm #

    Prunes have a GI of 29; reflective of the fact that while they contain around 64g of carbohydrate and around 3g of protein per 100g they crucially also contain around 3g of fibre. Prunes are certainly promoted by the industry belonging to a group of high fibre foods. Prunes do taste pleasingly sweet and of the carbohydrate around 61% would be categorised as ‘sugars’. But the reliable and useful fibrous nature of prunes seems to offset the potential the carb and sugars would have to ‘spike blood’ glucose levels, to the effect that they have a relatively low GI.

    If this man ate five pitted prunes a day at breakfast time along with some nuts the daily serving of prunes would have, so far as I can tell, a GL of around 10. This would not knock out the balance of of a diet of generally low aggregate glycemic load. Crucially the nuts would offer fat and protein. The presence of fats can slow or moderate the process of digestion thus reducing the spiking effect of the sugar and carbs in a meal, and digestion of protein results in natural secretion of glucagon, which may assist in keeping insulin levels in the goldilocks zone.

  11. John Valenty 7 June 2011 at 5:46 pm #

    Why would standard diet for a diabetic include carbs if they have proven to be harmful?

  12. david wilson 9 June 2011 at 12:57 am #

    I’ve been a Type 2 diabetic for 10 years now, but my HBA1c results are consistently non-diabetic normal(around 5.5%) The reason is that I keep carbs to the absolute minimum – about 40-50 grams a day, mainly from vegetables. The great thing about this approach is that as well as keeping blood sugars low, it also reduces most of the major risk factors for cardiovascular disease.

    Health professionals are stuck with a 40-year old policy based on the theory that fats were the big danger, and that advising diabetics to make carbs the main element of every meal would reduce fat consumption. There was at the time no scientific evidence to back this assumption, and every major trial since then has failed to support it.

  13. Peter Dai 11 June 2011 at 3:38 pm #

    As an engineer, I have a different views on the pitted prunes:

    1. It is not necessarily true that the man lived 85 years with Diabetes is because he eats pitted prunes. Without including pitted prunes in his breakfast, he might be doing even better.

    2. He does prove a point that eating pitted prunes doesn’t hurt that much, and the reason for that: he has a fixed breakfast menu (same kinds and amount of nuts plus 5 same sized pitted prunes), so it is possible for him to make a perfect match between the insulin doses and the food, and no blood suger spikes.

  14. Jessica Auletta 5 August 2013 at 1:03 am #

    I am 38 years old & have been a type 1 diabetic for 20 yrs. I was just thinking to myself- “I would love to aspire to be the oldest living diabetic in the world”. I figured longevity runs in my family so why can’t I carry on the family tradition? Right? About a month ago I was eating foods of low glycemic value-& quite honestly I felt great! I dropped about 10 lbs. I unfortunately got sick w/ a strep infection- this always throws my balance off for quite some time…. But I will continue to eat more veggies protein & fruit…keep away from processed junk food & keep my absolute favorite food (pasta & bread) to a bare minimum. I can live very comfortably in this manner….although I’m not so sure I wanna live to be 102 like my grandmother- but I will continue aspire to strive for a healthy life (0;

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