diabetes

Type 2 Diabetes and the ketogenic diet

diabetes

Scope of problem:

The rate of diabetes has been increasing at an alarming rate. In the United States it is estimated that 29.1 million people currently have diabetes. World wide this number is approximately 170 million people, which is expected to reach 366 million by the year 2030. Diabetes is a serious chronic health problem. Having diabetes increases your risk for multiple other medical conditions such as peripheral neuropathy, visual loss, kidney damage, limb amputation, high blood pressure, heart disease, strokes and even Alzheimer’s dementia. People who have diabetes can also have up to 10 years shorter life span than individuals without diabetes. (Westman E. , 2016)

Diabetes 101:

There are two types of diabetes.

  1. Type 1 diabetes, which is also called: insulin dependent or juvenile diabetes. The onset is typically seen in kids. In type 1 diabetes, the body is not able to produce enough insulin.
  2. Type 2 diabetes, which is also called: adult onset or insulin resistant diabetes. Type 2 diabetes is more common, accounting for approximately 90-95% of all cases of diabetes. In type 2 diabetes, the insulin that is present does not function as well. (Al-Khalifa, 2009)

The carbohydrates and sugars that we eat are broken down into glucose causing a raise in blood glucose. When blood glucose increases it causes insulin to be released. Insulin is needed to transport the glucose into the cells so that it can be used. If there is not enough insulin around, or if it does works properly, the body is unable to utilize the glucose as fuel. If the cells are unable to take in the glucose, glucose will build up in the blood or stored as fat. Having high levels of glucose in the blood then can cause damage to the tiny blood vessels in your eyes, kidneys, and nerves.

believe that this rise in obesity and thus diabetes is the direct result of the change in the dietary guidelines that came out in 1977. (DiNicolantonio, 2014) These dietary recommendations, which are still in place today, recommend the Americans should eat less saturated fat along increasing the amount of carbohydrates that we eat. When dietary fats are removed from foods, to improve taste, the fats are replaced with added sugars. Unfortunately this resulted in a huge increase in the amount of sugars that Americans were eating. Which then results in increase risk of obesity. Since obesity is the main risk factor for developing Type 2 Diabetes, the rates of diabetes has also increased. (Westman E. , 2016)

obesity graphDM rates CDC

Treatment of diabetes:

Managing carbohydrate/glucose levels and weight loss is the recommended treatment goal of diabetes. The debate, however, is which diet is the best to do that. A low fat/ low calorie diet is what is most often recommended for patients with diabetes. However, this diet has not been as successful as we would have hoped. Other dietary options include a low carbohydrate/high fat diet, which has been used since the early 1900’s for the treatment of diabetes. The low carbohydrate/high fat diet recently has become more popular since it often associated improved weight loss. (Feinman, 2015) Dating back as far as 1863, Dr. William Banting has been advocating a low carbohydrate/high fat diet has been used for weight loss. (Westman E. , 2016) More recently, studies comparing eating a low carbohydrate diet to low fat diet have shown greater improvements with the low carbohydrate diets on numerous endpoints including, weight loss, abdominal fat loss, glucose levels along insulin levels and insulin resistance. (Volek 2008)

Based on these and other studies showing benefit with a low carbohydrate/high fat diet, a study in 2012 came out comparing a low carbohydrate/high fat ketogenic diet (LCKD) to a low calorie diet in patients with type 2 diabetes. This study showed a beneficial effect of the LCKD over the conventional low calorie diet in patients with diabetes. Specifically they found that those on LCKD had significantly more weight loss and greater improvement in the blood glucose levels and HbA1c levels. The LCKD group also had improvements in the cardiovascular profiles of the cholesterol with significant decrease in triglycerides, total cholesterol and LDL levels whereas the HDL levels were increased. (Hussain, 2012)

Studies have also shown that those eating low carbohydrate ketogenic diet were able to decrease the doses of their anti-diabetic medications. Some were even able to taper off as much as 10 units of insulin per day in eight days, still with maintaining normalization of glucose levels. (Westman, 2008) In some individuals actually able to “reverse” their type 2 diabetes. (Westman E. , 2016)

Thus, as a summary, lifestyle modification that includes reducing carbohydrate intake such as by eating a low carbohydrate/ high fat, ketogenic diet is an effective treatment option in patients with diabetes with the added bonus of weight loss. These changes have also been associated with decreasing the amounts of anti-diabetic medication and insulin, and in some cases being able to get off and medications altogether.   If you have type 2 diabetes and are not currently happy with your control, the fact that you are always hungry and continue to gain weight despite eating a low calorie/high carbohydrate diet, then consider trying a low carbohydrate/high fat diet. What do you have to lose, except some extra weight and possible some medications?

For more information about a ketogenic diet, read my recent blog on ketogenic basics. If you are concerned about what eating ‘all those fats’ might do to your heart, check out my blog on whether a ketogenic diet is safe for your heart. Lastly if you would like some help with the ketogenic diet just fill out the below form and I will try to help.

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Bibliography

Al-Khalifa, A. (2009). Therapeutic role of low-carbohydrate ketogenic diet in diabetes. Nutrition, 25, 1177-1185.
DiNicolantonio, J. (2014). The cardiometabolic consequences of replacing saturated fats with carbohydrates or omega 6 polyunsaturated fats: Do the dietary guidelines have it wrong? Open Heart, 1-3.
Feinman, R. (2015). Dietary carbohydrate restriction as the first approach in diabetes managment: Critical review and evidence based. Nutrition, 31, 1-13.
Hussain, T. (2012). Effects of low-carie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition, 28, 1016-1021.
Volek, J. (2008). Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Progress in lipid research, 43, 307-318.
Westman, E. (2008). Has carbohydrate-restiction been forgotten as a treatment for diabetes mellitus? A perspective on the ACCORD study design. Nutritional Metabolism, 5, 10, 1-2.
Westman, E. (2016). Ketogenic diets as highly effective treatments for diabetes mellitus and obesity. In S. Masino (Ed.), Ketogenic diet and metabolic therapies (pp. 362-375).

The medical information on this site is provided as an information resource only. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.

 

Stethoscope listening to a heartbeat

Is the ketogenic diet safe for the heart?

Stethoscope listening to a heartbeat

I was asked the other day whether or not eating a low carbohydrate, high fat diet such as a ketogenic diet would be safe for the heart. My answer was YES. However, honestly, up until about two years ago this would not have been my answer.

I remember about 15 years ago when the Adkins diet was a popular diet. Some of my family and friends were on this diet and had great results with it. I however, gave them a hard time, ‘yes you will lose weight but you will die from a heart attack’.

The theory was that eating all that saturated fat would increase cholesterol levels, which would increase the risk for atherosclerosis or clogging of the arteries and then heart attacks. We have since learned that this is not true. As I discussed in another blog, it was shown that people who switched from eating saturated fat to vegetable oils, which at the time was thought to be the healthier type of fat, actually had an HIGHER risk of heart attacks and death. (Ramsden 2016) (Ramsden 2013)

Those studies however, just looked at changing the types of fat that were eaten, i.e. stopping saturated fats and start using vegetable oils, not increasing the amount of fats in the diet. So what happens to cardiac risk factors (obesity, specifically waist circumference, hypertension, diabetes, high triglycerides and high systemic inflammatory markers such as CRP) when start eating more fats and fewer carbohydrates as in low carbohydrates diet? Several studies, which were recently published, answered just that question.

The first was a study published in the journal Obesity Reviews in 2012. This study reviewed 23 studies with a total of 1,141 obese patients eating a low carbohydrate diet for weight loss. They found improvement of all major cardiovascular risk factors associated with eating a low carbohydrate diet.   Specifically, the study found a significant decreased in weight, body mass index and abdominal circumference. Systolic and diastolic blood pressures were also decreased.   Markers for diabetes were improved including, fasting plasma glucose levels, gylcated hemoglobin (HgA1c) and insulin levels. Cholesterol levels were also improved; with lower levels of triglycerides and increased levels of HDL. Lastly the marker of inflammatory, CRP levels, were also improved (Santos, 2012)

Another study looked at very low carbohydrate or ketogenic diet specifically. This study reviewed a total of 13 studies, in which a total 1577 individuals were randomized to either very low carbohydrate diet or a low fat diet. The very low carbohydrate diet group had significantly greater weight loss, improvement of diastolic blood pressures, lower triglycerides and higher HDL levels. Fasting blood glucose, insulin levels, HgA1c and CRP all showed improvement in favor of the very low carbohydrate group compared to low fat groups. (Bueno, 2013)

The LDL levels in the very low carbohydrate group were increased, as expected from eating more saturated fats. However, as discussed in a prior post, it is not the LDL particle itself that is the problem: instead, it is the size of the particle that matters. There are actually two different types of LDL based on size. There is small and large size LDL. The small LDL particles are the ones that are believed to be harmful, or more prone to cause the clogging of the arteries that is of clinical concern. When LDL is exposed to high carbohydrates and high triglycerides, it is more likely to become oxidized or damaged, making the LDL a small dense particle. Whereas, it has been shown the type of LDL particles that are elevated when the diet contains a higher saturated fat (not the inflammatory vegetable oils) combined with carbohydrate restriction, are the larger sized LDL particles, which are the less artherogenic than the small dense LDL. (Krauss, 2006)

Then lastly, a study published in the journal Circulation, used carotid ultrasound as a way to measure atherosclerosis. The participants were randomized into a low fat diet, a Mediterranean type diet or a low carbohydrate diet. After 2 years of dietary intervention, they found that all 3 groups had a significant regression of the atherosclerosis plaques. This suggested that the low carbohydrate diet is at least as effective as the other diets in showing regression. The study did not have the power to show differences between the groups, but there was a slight trend for the greatest improvement seen in the low carbohydrate diet. (Shai, 2010)   Thus, based on this study eating a low carbohydrate diet does not increase risk of atherosclerosis disease; instead it may actually decrease it.

So yes I have to apologize to my friends and family who were ahead of the game. They were right all along. Based on these studies and others, I now come to realize that going on a low carbohydrate, high fat diet such as ketogenic diet is indeed safe for the heart. Not only may the ketogenic diet help you lose weight, it may also improve your cardiovascular risk factors and does not increase your risk of atherosclerosis.

Need help with a ketogenic diet? First step is filling out this form and then I will be happy to help.

Your Name: *

Email Address: *

What interests you the most about the ketogenic lifestyle?:

Please leave this field empty.

Bibliography

Bueno, N. B. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition (110), 1178-1187.
Krauss, R. (2006). Seperate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. American Journal of Clinical Nutrition (83), 1025-1031.
Ramsden, C. E. (2016). Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from the Minnesota Coronary Experiment (1968-73). British Medical Journal, 353, 1-17.
Ramsden, C. E. (2013). Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. British Medical Journal, 346, 1-18
Santos, F. (2012). Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews, 13, 1048-1066.
Shai, I. (2010). Dietary Intervention to Reverse Carotid Atherosclerosis. Circulation, 121, 1200-1208.