Kamalpreet Singh Reversal of Type 1 Diabetes on Raw Vegan Diet: Case Report Abstract Type-1 diabetes (T1D) is an autoimmune disease in which pancreatic beta cells get destroyed, which leads to reduced ability to produce insulin, leading to hyperglycemia. T1D may lead to irreversible health complications such as retinal damage, chronic kidney diseases, peripheral neuropathy, systemic hypertension, and coronary heart disease. The patient gets dependent on insulin injections for his whole life. It was believed that blood glucose readings cannot be brought in non-diabetic range without the support of insulin injections in the case of T1D. However, in the present case we observed the readings of blood glucose in a 13-year-old patient of T1D by putting her on a plant-based diet. The patient was monitored for 150 days. She was successfully able to maintain non-diabetic blood glucose readings and eliminate her insulin dependency within 14 days on a consistent whole food plant-based diet (WFPBD) full of fresh fruits, raw vegetables, nuts, seeds, and sprouts. Keywords:Type-1 diabetes, Plant- based diet, Lifestyle medicine, Disease reversal, Nutrition Introduction Diabetes is one of the most common metabolic disorders that is associated with many life-threatening complications. Diabetes is mainly of two types: type-2 diabetes (T2D) and type-1 diabetes (T1D). T2D is the most common type of diabetes worldwide. In T2D, impaired receptors do not respond to insulin, eventually leading to insulin resistance while in T1D, there is a deficiency of insulin produced in the pancreas. It is caused by pancreatic dysfunction due to autoimmune reaction in the body leading to the destruction of beta cells, eventually leading to insulin deficiency. The exact cause of T1D is a mystery. However, certain studies demonstrate the mechanism by which A1 beta casein from cow milk can lead to T1D1-7. Growing evidence shows the association of the rise in vaccination doses and the rise in T1D around the world8-11. Diet and lifestyle modification can play a pivotal role in reversal of T1D and T2D by restoring the glucose levels to non-diabetic range, thus either reducing or eliminating the requirement of medicine/insulin. Patient information We present a case of a thirteen-year-old girl, weighing 28.5 kgs, who was diagnosed with T1D in Punjab, India in 2019. Before diagnosis, she complained of frequent urination, increased thirst, excessive fatigue, and weight loss. There were extreme fluctuations in blood glucose levels. She was injecting a total of about 25 units of insulin daily to maintain her blood glucose readings. The patient approached the author to assist her in dietary modification. Therapeutic intervention The patient agreed to follow a customised whole food plantbased diet (WFPBD) for an intervention period of 150 days. This diet was divided into breakfast, lunch, and dinner. Breakfast included three different types of fruits which weighed 1% to 1.5% of body weight (in kilograms). In this case it was between 280 and 420 grams of fruit for breakfast. Lunch included three different types of raw vegetables which weighed 0.5% to 1% of body weight along with a customised vegan meal recipe. In this case it was 140 to 280 grams of raw vegetables followed by a customised vegan meal recipe. Dinner was calculated the same way as lunch. The patient’s preference for the cooked meal was chappathies with vegetables and pulses. In addition to this, soaked nuts and sprouts were also a part of the dietary programme and the quantity of these was equal to 0.1% of body weight. In this case it was about 28 grams each. Packed, processed, fried, and refined foods were strictly removed from her diet as they are an identified risk factor in metabolic disorders12-17. Animal food and dairy products were removed from the diet as these have been shown to cause a negative effect on diabetics1-7. Blood glucose readings were regularly monitored and necessary changes in the diet schedule were made as and when required. Follow up The parents were also in touch with the concerned medical doctor for assistance in adjustment of insulin dosage. Results The table represents the daily glucose monitoring data of the patient from 17.02.2023 to 10.03.2023. The patient managed a fasting blood sugar (FBS) of 151 mg/dl and average glucose (AG) of 225.50 mg/dl with 31 units of insulin on 05.02.2022 before starting the dietary modification programme. The patient started the WFPBD programme religiously from 17.02.2023 which consistently regulated her blood sugar levels. On 17.02.2023 she took a total of 13 units of fast-acting insulin and 6 units of longacting insulin and her FBS was 115 mg/dl, PPG was 165 mg/dl, and AG was 161 mg/dl. With each passing day on WFPBD her requirements to administer insulin reduced consistently. On 27.02.2023 she did not inject insulin with breakfast and dinner and maintained normal blood glucose readings. Finally, she was able to eliminate her requirement of injecting insulin entirely on 01.03.2023. Her FBS was 95 mg/dl, post prandial glucose (PPG) was 125 mg/dl, and AG was 135 mg/dl on 01.03.2023. She did not require insulin injections after 01.03.2023 to regulate her blood glucose levels as monitored till 31.07.2023.                 The graph represents the gradual reduction in the daily insulin requirements of the patient. On 17.02.2023 she took 13 units of fastacting insulin and 6 units of long-acting insulin. With each passing day on WFPBD her insulin requirements reduced consistently, and she was able to eliminate her requirement of insulin injections on 01.03.2023. Outcomes Before intervention: : On 05.02.2023, her fasting blood glucose (FBG) was 151 mg/dl, average PPG was 400 mg/dl, and she took 31 units of insulin to manage her blood glucose readings. After intervention: : She started following the prescribed whole food plant-based diet from 17.02.2023. Her average FBG readings were 93 mg/dl and average PPG readings were 134 mg/dl between 01.03.2023 and 10.03.2023. Her average FBG readings were 79 mg/dl and average PPG readings were 165 mg/dl between 03.07.2023 and 12.07.2023. She is maintaining a nondiabetic glucose range by following the diet programme consistently. Her blood glucose readings were regularly monitored till 31.07.2023. Discussion There is a continuous rise in cases of T1D around the world. The potential cause may be genetics triggered by a wrong choice of food habits, including consumption of processed milk of A1 cows, and increasing number of doses in the vaccine schedule. Dietary modification can provide good support in remission of T1D and T2D without causing any side effects. In this case study, we present a comprehensive analysis by stating the difference of blood glucose changes before and after the dietary intervention in a T1D patient. She was diagnosed with T1D in 2019 and has been taking insulin injections since then to manage her blood glucose readings. However, she was able to eliminate insulin dependency within 14 days of adopting a whole food plantbased diet full of fresh fruits, raw vegetables, nuts, seeds, and sprouts. Her glucose levels are also in the non-diabetic range as followed up till 31.07.2023 without insulin administration. Conclusion The effect of dietary modification on type-1 diabetics should be prospectively evaluated in a large multicentre randomised nutrition intervention trial. Nutritional intervention can be a potential tool for remission of type-1 diabetes in the future of clinical practice. References 1. Gerstein HC. Cow's milk exposure and type I diabetes mellitus. A critical overview of the clinical literature. Diabetes Care. 1994 Jan; 17(1):13-9. 2. Dahl-Jørgensen K, Joner G, Hanssen KF. Relationship between cows' milk consumption and incidence of IDDM in childhood. Diabetes Care. 1991 Nov; 14(11); 1081-3. 3. Virtanen SM, Räsänen L, Aro A, et al. Infant feeding in Finnish children less than 7 year of age with newly diagnosed IDDM. Childhood Diabetes in Finland Study Group. Diabetes Care. 1991 May; 14(5):415-7. 4. Perez-Bravo F, Carrasco E, et al. Genetic predisposition and environmental factors leading to the development of insulin-dependent diabetes mellitus in Chilean children. 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