Scientific backup for a grain-free, cow's milk-free diet and type 1 diabetes?

Hi Everyone,

As an update, I've been off insulin injections for four months now! My blood sugars are still in the normal range of 70-120md/dL. Today my sugars were 83 and 72 (before meals). I have been on the paleo diet for over nine and a half months. The newsletter, "The Paleo Diet Update," did an excellent report about my type 1 diabetes and the paleo diet which may help explain as to why the diet is helping. For a free subscription to the newsletter, go to http://www.thepaleodiet.com/newsletter. This specific newsletter came from v5, #35 - "Type 1 Diabetes and the Paleo Diet."

Type 1 Diabetes and the Paleo Diet by Pedro Bastos

We believe that the autoimmune disease type 1 diabetes (T1D) may be preventable through diet if caught early enough. This seems reasonable because it typically takes some time for the complete destruction of beta cells, which make and release the hormone insulin that controls the level of glucose in the blood. The following report from Michelle is very interesting because some type 1 diabetics are "brittle." In other words, the beta cells are completely destroyed and cannot produce insulin. Diabetes becomes apparent when 80-90% of the beta cells have been destroyed. In Michelle’s case, there may have been sufficient function in some residual cells that were allowed to regain function when the change in diet halted the autoimmune response. Here's Michelle's experience and you can follow her progress on her blog. "I'm a type 1 diabetic and have been on the Paleo Diet for 7 months. After weeks of going Paleo, my insulin needs dropped dramatically, and after 6 months, I quit taking insulin altogether! The Paleo Diet is a miracle for autoimmune type 1 diabetes! I just started a blog about it: http://michellestype1diabetes.blogspot.com/." Michelle Dairy and Diabetes Eliminating dairy, as Michelle did by following the Paleo Diet, may remove potential proteins found in cow’s milk that may be involved in T1D, such as: Beta (ß)-lactoglobulin (BLG) BLG is a protein found in the whey portion of cow’s milk (but not in the whey of human’s milk) that has structural homology with the human protein glycodelin, which is responsible for the modulation of T-lymphocytes1. This means that BLG could generate antibodies to glycodelin, and indirectly lead to autoimmunity in genetically susceptible children1, especially if introduced early in life when there is increased intestinal permeability1, 2. Bovine insulin (BI) Cow’s milk, human’s milk, and presumably milk from all mammals contain insulin2. Immunity to BI is common in children who consume cow’s milk or who have been exposed to infant formulas containing cow’s milk2. Because BI differs from human insulin by only three amino acids, it can generate antibodies against human insulin in genetically susceptible individuals with increased intestinal permeability and other gut dysfunctions2 and/or enteral virus infections in their early years2, 3. Bovine serum albumin (BSA) This is another protein in cow’s milk that doesn’t exist in human’s milk. Antibodies against a specific peptide in BSA, called ABBOS, have been found repeatedly in the majority of patients with T1D4-6. This is relevant because there is molecular mimicry between the peptide ABBOS and a beta-cell surface protein p694, one of the autoantigens attacked by T cells in T1D patients. Peptide beta (ß)-casomorphin 7 (BCM-7) BCM-7 results from the breakdown of proteins into peptides and amino acids during digestion of the A1 variant of bovine ß-casein7. Since this peptide has opiate-like activity7, it could “influence the development of gut-associated immune tolerance, or suppress defence mechanisms towards enteroviruses, both of which have been implicated in the aetiology of diabetes mellitus type 1”7. Grain and diabetes By following the Paleo Diet, Michelle also eliminated grains that include gluten (wheat, rye, barley and oats). Gluten is a well-known environmental trigger of another autoimmune disease frequently associated with T1D called celiac disease8. There is an interesting report in medical literature of an adolescent, who had abnormal blood glucose and insulin levels, testing positive for islet cell auto-antibodies (a marker of T1D development) and celiac disease. After following a gluten-free diet for 6 months, the adolescent became islet cell auto-antibody negative, and presented normal glycemia (glucose in the blood) and insulinemia (insulin in the blood).9 It is also known that diabetes progresses faster in rats when gluten is included in their diet early in life10, 11. One research study reported that: "Diabetes onset was delayed and diabetes incidence was significantly reduced in female mice that received the wheat and barley protein-free diet throughout life"12. Similarly, a gluten-free diet in people with a high risk for T1D led to significant improvements in their insulin response during a glucose tolerance test13. The main reason why gluten may be involved in T1D (and other auto-immune diseases), and why celiac disease is normally associated with other autoimmune diseases involves one of the proteins in gluten - gliadin. Gliadin up regulates zonulin14 (a protein expressed in gut tissue), thereby increasing gut permeability (not only in celiac patients, but also in “normals”)14, which is a very important factor underlying T1D2,15-20. Other factors involved in increased intestinal permeability As readers are aware, there are other dietary factors in Neolithic foods that can increase intestinal permeability. This includes lectins (present in legumes and grains), saponins (found in legumes, potatoes, peppers, alfalfa sprouts, root beer, quinoa and amaranth), and alcohol. Fatty acids, vitamin D and diabetes In addition to eliminating dairy and gluten, the Paleo Diet may help stop beta cell destruction by correcting the omega-6/omega-3 ratio21. We also recommend that people optimize their vitamin D status by getting enough sunlight or with supplements. This may also help to halt beta cell destruction and prevent the development of T1D22. Next time, we'll take a look at new research that shows how well the Paleo Diet protects you from disease compared to other diets. We'll also suggest ways to help your kids keep up their great nutrition at school.

References:

1. Goldfarb MF. Relation of time of introduction of cow milk protein to an infant and risk of type-1 diabetes mellitus. J Proteome Res. 2008 May;7(5):2165-7.

2. Vaarala O. Is it dietary insulin? Ann N Y Acad Sci. 2006 Oct;1079:350-9.

3. Mäkelä M, Vaarala O, Hermann R, Salminen K, Vahlberg T, Veijola R, Hyöty H, Knip M, Simell O, Ilonen J. Enteral virus infections in early childhood and an enhanced type 1 diabetes-associated antibody response to dietary insulin. J Autoimmun. 2006 Aug;27(1):54-61. Epub 2006 Jun 6.

4. Karjalainen J, Martin JM, Knip M, Ilonen J, Robinson BH, Savilahti E, Akerblom HK, Dosch HM. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. N Engl J Med. 1992 Jul 30;327(5):302-7.

5. Pérez-Bravo F, Oyarzún A, Carrasco E, Albala C, Dorman JS, Santos JL. Duration of breast feeding and bovine serum albumin antibody levels in type 1 diabetes: a case-control study. Pediatr Diabetes. 2003 Dec;4(4):157-61.

6. Banwell B, Bar-Or A, Cheung R, Kennedy J, Krupp LB, Becker DJ, Dosch HM; Wadsworth Pediatric Multiple Sclerosis Study Group. Abnormal T-cell reactivities in childhood inflammatory demyelinating disease and type 1 diabetes. Ann Neurol. 2008 Jan;63(1):98-111.

7. Kaminski S, Cieslinska A, Kostyra E. Polymorphism of bovine beta-casein and its potential effect on human health. J Appl Genet. 2007;48(3):189-98.

8. McGough N, Cummings JH. Coeliac disease: a diverse clinical syndrome caused by intolerance of wheat, barley and rye. Proc Nutr Soc. 2005 Nov;64(4):434-50.

9. Banin P, Perretta R, Ravaioli E, De Sanctis V. Regression of autoimmunity and abnormal glucose homeostasis in an adolescent boy with silent celiac disease. Acta Paediatr 2002;91:1141-3.

10. Hoorfar J, Buschard K, Dagnaes-Hansen F. Prophylactic nutritional modification of the incidence of diabetes in autoimmune non-obese diabetic (NOD) mice. Br J Nutr. 1993 Mar;69(2):597-607.

11. Scott FW. Food-induced type 1 diabetes in the BB rat. Diabetes Metab Rev 1996;12:341-59.

12. Schmid S, Koczwara K, Schwinghammer S, Lampasona V, Ziegler AG, Bonifacio E. Delayed exposure to wheat and barley proteins reduces diabetes incidence in non-obese diabetic mice. Clin Immunol. 2004 Apr;111(1):108-18.

13. Pastore M-R, Bazzigaluppi E, Belloni C, Arcovio C, Bonifacio E, Bosi E. Six months of gluten-free diet do not influence antibody titers, but improve insulin secretion in subjects at high risk for type 1 diabetes. J Clin Endocrinol Metab 2003;88:162-5.

14. Drago S, El Asmar R, Di Pierro M, et al. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scandinavian journal of gastroenterology 2006;41(4):408-19.

15. Meddings JB, Jarand J, Urbanski SJ, Hardin J, Gall DG. Increased gastrointestinal permeability is an early lesion in the spontaneously diabetic BB rat. Am J Physiol. 1999 Apr;276(4 Pt 1):G951-7.

16. Watts T, Berti I, Sapone A, Gerarduzzi T, Not T, Zielke R, Fasano A. Role of the intestinal tight junction modulator zonulin in the pathogenesis of type I diabetes in BB diabetic-prone rats. Proc Natl Acad Sci U S A. 2005 Feb 22;102(8):2916-21.

17. Neu J, Reverte CM, Mackey AD, Liboni K, Tuhacek-Tenace LM, Hatch M, Li N, Caicedo RA, Schatz DA, Atkinson M. Changes in intestinal morphology and permeability in the biobreeding rat before the onset of type 1 diabetes. J Pediatr Gastroenterol Nutr. 2005 May;40(5):589-95.

18. Sapone A, de Magistris L, Pietzak M, Clemente MG, Tripathi A, Cucca F, Lampis R, Kryszak D, Cartenì M, Generoso M, Iafusco D, Prisco F, Laghi F, Riegler G, Carratu R, Counts D, Fasano A. Zonulin upregulation is associated with increased gut permeability in subjects with type 1 diabetes and their relatives. Diabetes. 2006 May;55(5):1443-9.

19. Bosi E, Molteni L, Radaelli MG, Folini L, Fermo I, Bazzigaluppi E, Piemonti L, Pastore MR, Paroni R. Increased intestinal permeability precedes clinical onset of type 1 diabetes. Diabetologia. 2006 Dec;49(12):2824-7.

20. Vaarala O. Leaking gut in type 1 diabetes. Curr Opin Gastroenterol. 2008 Nov;24(6):701-6.

21. Norris JM, Yin X, Lamb MM, Barriga K, Seifert J, Hoffman M, Orton HD, Barón AE, Clare-Salzler M, Chase HP, Szabo NJ, Erlich H, Eisenbarth GS, Rewers M. Omega-3 polyunsaturated fatty acid intake and islet autoimmunity in children at increased risk for type 1 diabetes. JAMA. 2007 Sep 26;298(12):1420-8.

22. Hypponen E, Laara E, Reunanen A, Jarvelin M-R, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birthcohort study. Lancet 2001;358:1500-3.