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Keto Diet Doesn’t Cure Diabetes

Note: this is both a Science Made Simple article and an editorial, where I express my own opinion.

A ketogenic diet and the weight loss that can accompany it is well documented to be both safe and effective as medical nutrition therapy in the treatment of type 2 diabetes. While it can enable individuals to put symptoms of the disease into remission, it is not a ‘cure’.

An article widely circulated on social media earlier this week announced “What If They Cured Diabetes and No One Noticed?”[1] and said;

“So you’d think that if someone figured out a way to reverse this horrible disease, there would be big bold headlines in 72-point type. You’d think the medical community, politicians and popular press would be shouting it from the rooftops.

Guess what? Someone did. Yet it appears no one noticed.

The cure was simple — so simple, in fact, that it involved no medication, no expensive surgery and no weird alternative supplements or treatments.

What was this miracle intervention? Diet. Specifically, the ketogenic diet.”

Of course, the author is entitled to hold this opinion and to express it, however in my opinion, a ketogenic diet does not “reverse diabetes” — it does not “cure” it.  Furthermore, I believe the distinction between “reversing diabetes” and “reversing the symptoms of diabetes” is very important, and more than a matter of semantics.

In an article I posted last year titled The Difference Between Reversal and Remission of Type 2 Diabetes, I wrote that;

“Reversal” of a disease implies that whatever was causing it is now gone and is synonymous with using the term ”cured”.  In the case of someone with Type 2 Diabetes, reversal would mean that the person can now eat a standard diet and still maintain normal blood sugar levels. But does that actually occur? Or are blood sugar levels normal only while eating a diet that is appropriate for someone who is Diabetic, such as a low carbohydrate or ketogenic diet, or while taking medications such as Metformin?

If blood sugar is only normal while eating a therapeutic diet or taking medication then this is not reversal of the disease process, but remission of symptoms.”

Addendum (July 18 2019): Type 2 diabetes is the result of beta cell failure resulting from over-taxing them with a highly refined, carb-laden diet over extended periods of time (you can read more about that here). For something to ‘cure’ type 2 diabetes, there would need to evidence of a restoration of beta-cell function. If someone was indeed ‘cured’ they would have a normal glucose and insulin response on a 3 hour glucose-insulin test (OGTT will added insulin assay at 0 hr, 1 hr and 2 hrs.).  Anything short of that is ‘remission’.

I feel that claiming that a keto diet ‘cures diabetes’ or ‘reverses the disease’ does the public a disservice:

  • Firstly, it implies that there is simple, free ‘cure’ that will work for everybody.  As I outline below; some people are able to achieve partial or complete remission of their symptoms following a keto diet, and others are not.
  • Secondly, it implies that there is a simple, free ‘cure’ available, but that it is being ‘withheld’ for some reason — either because doctors don’t know about or are afraid what colleagues might think, or because the agricultural and pharmaceutical industries have ‘big bucks to lose’ by people limiting their intake of bread, pasta and insulin.

There is no question that physicians (and all clinicians) need to be selective about recommending a keto diet for their patients / clients and to be able to document from the literature that it is safe, effective and best clinical practice for the condition for which it is recommended, and appropriate for the individual.

While falling markets for specific types of food products and drugs certainly have an impact on the economics of both the agricultural industry and pharmaceutic industry, it comes across like a ‘conspiracy theory’ to imply there is a ‘cure’ available out there, but that the public is being ‘denied’ access to it by “big food” and “big pharma”.

  • Finally, it implies that if people are unable to ‘reverse their diabetes’ and get ‘cured’ following a keto diet, that it is their fault; they mustn’t have done it properly.  Even if we substitute the terms and say instead “put their diabetes into remission” or “reverse the symptoms of diabetes”, it is unreasonable and unfair to assume that everyone will be successful in doing so, and if they aren’t, the responsibility falls on them.

Virta Health Data

The on-going study from the Virta Health had over 200 adults ranging in age from 46-62 years of age in the intervention group following a ketogenic diet at the end of two years. At one year, participants in the intervention group lowered their glycated hemoglobin (HbA1c) to 6.3% (from 7.7% at the beginning of the study) —  with 60% of them putting their type 2 diabetes into remission based on HbA1C levels >=6.5% (American Diabetes Association and Diabetes Canada guidelines).  HbA1C rose slightly to 6.7% at two years. The keto group did considerably better than the ‘usual care group’ whose average HbA1C actually rose to 7.6% at one-year (from 7.5% at the beginning of the study), and rose again to 7.9% at two years [3]. 

Fasting blood glucose of the intervention group following a keto diet increased slightly from  127 mg/dl (7.0 mmol/L) at one year to 134 mg/dl (7.4 mmol/l) at two years, which was considerably better than the usual care group, whose fasting blood glucose was 160 mg/dl (8.9 mmol/L) at one-year and 172 mg/dl (9.5 mmol/L) at two years [3].

Data so far from this study demonstrates that a well-designed keto diet can be very effective in reversing the symptoms of type 2 diabetes, and that it is more effective than what was ‘standard care’ (prior to the new ADA guidelines), but it is not a ‘cure’.

Dr. Stephen Phinney and the research team at Virta Health have written on the Virta Health website [3];

“A well-formulated ketogenic diet can not only prevent and slow down progression of type-2 diabetes, it can actually resolve all the signs and symptoms in many patients, in effect reversing the disease as long as the carbohydrate restriction is maintained.” [2]

That is, the Virta researchers say that a well-designed keto diet can resolve the signs and symptoms of the disease in many people, which “in effect” (i.e. ‘is like’) reversing the disease —  as long as the carbohydrate restriction is maintained. They don’t promote the diet as a ‘cure’, but as an effective treatment.

There is no question that Virta’s results are impressive — so much so that their studies have been included in the reference list of the American Diabetes Association’s (ADA) new Consensus Report of April 18, 2019, where the ADA included adopted the use of both a low carb and very low carb (ketogenic) diet (20-50 g of carbs per day) as one of the management methods for both type 1 and type 2 diabetes in adults. You can read more about that here.

In fact, the ADA said in that report that;

”Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia*’

* blood sugar

A keto diet is not a ‘cure’ for diabetes. At this present time, there is no cure for diabetes. There are, however three documented ways to put type 2 diabetes into remission;

  1. a low calorie energy deficit diet [4,5,6]
  2. bariatric surgery (especially use of the roux en Y procedure) [7,8]
  3. a ketogenic diet [3]

Final Thoughts…

I believe that based on what has been published to date, it is fair to say that a well-designed ketogenic diet can;

  • prevent progression to type 2 diabetes, when adopted early in pre-diabetes
  • slow down progression of type 2 diabetes
  • resolve the signs and symptoms of the type 2 diabetes
  • serve in effect like reversing the disease, provided carbohydrate restriction is maintained

…but to claim that a keto diet ‘cures’ type 2 diabetes is simply incorrect.

A ketogenic diet is a safe and effective option for those wanting to put the symptoms of type 2 diabetes into remission.

More Info?

If you would like more information about adopting a low carb or ketogenic diet in an effort to put the symptoms of type 2 diabetes into remission or for weight loss, I’d be glad to help.

You can learn more about my services under the Services tab or in the Shop.

If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
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Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

  1. Steel, P, “What If They Cured Diabetes and No One Noticed? – if the ketogenic diet can reverse diabetes, why isn’t your doctor recommending it?”, The Startup, July 13 2019, https://medium.com/swlh/what-if-they-cured-diabetes-and-no-one-noticed-keto-diet-ketogenic-virta-study-d49c195bf8f5
  2. Phinney S and the Virta Team, Can a ketogenic diet reverse type 2 diabetes? https://blog.virtahealth.com/ketogenic-diet-reverse-type-2-diabetes/
  3. Athinarayanan SJ, Adams RN, Hallberg SJ et al, Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-year Non-randomized Clinical Trial.  preprint first posted online Nov. 28, 2018;doi: http://dx.doi.org/10.1101/476275.
  4. Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia2011;54:2506-14. doi:10.1007/s00125-011-2204-7 pmid:21656330
  5. Steven S, Hollingsworth KG, Al-Mrabeh A, et al. Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders. Diabetes Care2016;39:808-15. doi:10.2337/dc15-1942 pmid:27002059
  6. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet2018;391:541-51.
  7. Cummings DE, Rubino F (2018) Metabolic surgery for the treatment of type 2 diabetes in obese individuals. Diabetologia 61(2):257—264.
  8. Madsen, L.R., Baggesen, L.M., Richelsen, B. et al. Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study, Diabetologia (2019) 62: 611. https://doi.org/10.1007/s00125-019-4816-2

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Now Licensed for Virtual Dietetic Practice Across Canada

If you live almost anywhere in Canada and are looking for a Registered Dietitian with experience providing low carbohydrate or ketogenic diet support, I can help.

Whether you live in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, Newfoundland or Labrador, I am now licensed to provide you with services.

I currently can’t provide Dietitian services to Prince Edward Island (PEI) but if I have enough demand, I will consider becoming licensed in that province, as well.

Registered in British Columbia since 2002

I have been registered with the College of Dietitians of British Columbia since 2002 as an RD(t) and since 2008 as a full registrant. This registration enables me to provide services to people across Canada, with the exception of  Alberta and PEI but since I’ve had several physicians in Alberta who have asked to refer patients to me as well as individuals from Alberta requesting services, I recently applied to- and was accepted into the College of Dietitians of Alberta.

Provincial Registration Requirements for Virtual Dietetic Practice

As can be seen from the table below, Registered Dietitian such as myself that provide virtual Dietetic practice services (Distance Consultation) to other provinces are required to meet very specific registration requirements, as well as observe other regulatory regulations.

Virtual Dietetic Practice (Telepractice) – from the Alliance of Dietetic Regulatory Bodies. August, 2017

In the US or overseas?

I am a member of the College of Dietitians of British Columbia as well as the College of Dietitians of Alberta and am licensed to provide Registered Dietitian services in most provinces in Canada (except PEI), but if you live in the USA or elsewhere, I can provide you with low carb or ketogenic nutrition education services that would not be considered medical nutrition therapy (MNT) and that would be provided for information purposes only.

More Info

If you would like more information, you can find out more under the Services tab or by looking in the Shop. If you have specific questions, please send me a note using the Contact Us form on the tab above and I’d be glad to reply as I am able.

To your good health!

Joy

You can follow me at:

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Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

 

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McGill Professor’s Editorial: Known Benefits of Low-Carb “Keto” Diets

This morning, Dr. Joe Schwarcz, Professor of Chemistry from McGill University and popular radio show host released a follow-up to last week’s opinion article and video that was published in the Montreal Gazette on the cardiovascular risks of a keto diet; this one on the known benefits of low-carb keto diets.

Schwarcz begins by fondly reminiscing about going to the circus with his mother when he was about 7 or 8 years old and the memories of the snack that she packed for him of crusty Hungarian bread, slathered with butter and topped with green bell pepper. He said that he’s loved it ever since, but “now we question such snacks. Why? Because of the carbohydrate content of the bread”.

“I’ve been looking into this for quite a while. There is really a plethora of papers and information that floods us about the keto diets; the very low carbohydrate diets”.

To his credit, Dr. Schwarcz acknowledged (possibly as a result of my written response to his article of last week in the Montreal Gazette) that there isn’t just one “keto diet” (singular) but several very low carbohydrate diets (plural) .

Schwarcz reiterates;

“I would have thought that by having all of that fat in the diet that risk levels for certain cardiovascular factors would go up, but really there isn’t really that much alteration in these factors”.

Low-Carb “Keto” Diets and Diabetes

Transitioning from the lack of cardiovascular risks associated with low-carb keto diets, Schwarcz adds;

“When it comes to Diabetes the information is really overwhelming to the benefit of these low carb diets. There are people — Type 2 Diabetes sufferers, who have been able to give up their medication by following a stringent, low carbohydrate diet.”

Schwarcz dismisses anecdotal reports of people’s “brain fog” resolving and possible benefits for cancer, Parkinson’s disease and Alzheimer’s disease as not being scientifically based but is unequivocal about the known benefits;

“What we do know is that weight loss can be very significant on a low carbohydrate diet and as I said — surprisingly, without any significant risk factors.”

Schwarcz continues;

“On the other hand, the longest terms studies that I’ve seen which were really properly controlled have only been about six months, and that really isn’t long enough.”

NOTE: In this case, Dr. Schwarcz is referring only to randomized, controlled double blind studies — excluding the data from long term studies of other types.

“We also know from dietary studies that after about a year, it doesn’t much matter what diet you’re on when it comes to weight loss — whether it’s low fat, whether it’s low carb, the results tend to be the same as long as you’re cutting out some calories.”

NOTE: While this may be true, what Schwarcz neglects to mention is that the major difference is that in a calorie-restricted low-fat diet, people are deliberately restricting food intake, often feeling hungry — whereas in a low carbohydrate diet, people naturally feel less hungry due to the satiety (hunger-reducing effect of protein and fat) which results in them eating less. In one case people are purposely restricting calories in the the other case, they don’t feel as hungry so they naturally eat less.

Schwarcz reiterates;

“However, for people who are afflicted with Diabetes, I think there is no question that the very low carb diets are worth trying.”

Towards the end of the video Dr. Schwarcz reflects on his childhood snack of crusty Hungarian bread, slathered with butter and topped with a quarter of a green bell pepper and admits that he looks askew at this snack.

“I admit that I’ve been eating less bread — I haven’t cut it out because I don’t think I need to do that, but I’m eating less.”

Schwarcz adds that for those who are gravitating towards a low carbohydrate diet, they can opt instead to eat bell pepper with a dollop of hummus with tahini (ground sesame seeds) or raw broccoli dipped in a bit of hummus.

“It tastes good! I think it is possible to cut down on the bread!”

Since Dr. Schwarcz is presumably not Diabetic and has all the nostalgia of memories of the circus as a child, he concludes the video by happily biting into a slice of crusty Hungarian bread that’s been slathered with butter and topped with a quarter of a green bell pepper…for nostalgia reasons, of course!

Bon appetit, Dr. Schwarcz!

If you would like to know more about the low carb and ketogenic services I offer, please click on the Services tab, and if you have questions related to those, please feel free to send me a note using the Contact Me form located on the tab above.

To your good health!

Joy

You can follow me at:

         https://twitter.com/lchfRD

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https://www.instagram.com/lchf_rd

 

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Reference

Montreal Gazette, February 15, 2019, Dr. Joe Schwarcz, Known Benefits of Low Carb “Keto” Diets” https://montrealgazette.com/category/opinion

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Quebec newspaper: “Keto diets work, but is there a catch?”

This morning, the English language newspaper, the Montreal Gazette published a special article written by Dr. Joe Schwarcz, Professor of chemistry from McGill University titled “The Right Chemistry: Keto diets work, but is there a catch?”, that had an accompanying video.

The article began;

“There is little doubt that cutting way back on carbs results in weight loss. But how does all that fat impact cardiovascular risk factors?”

This is a very good question, however it is incorrectly based on the assumption that a “keto diet” is necessarily very high in fat, especially saturated fat, something which is not necessarily the case.

Dr. Schwarcz stated in the article in the Montreal Gazette that on a “keto diet” there is no bread, pasta, cereal, potatoes, carrots, rice, fruit or beer but that one can;

“gorge on fish, butter, eggs, high-fat cheese, whipped cream, coconut oil and meat to your heart’s delight.”

As mentioned in an earlier article that I wrote titled Misconceptions About the Keto Diet;

“There is no one ”keto diet”, but many variations of ketogenic diets that are used for different therapeutic purposes.

Some therapeutic ketogenic diets are used in the treatment of epilepsy and seizure disorder and are extremely high in fat. Other types of therapeutic ketogenic diets are used in the treatment of various forms of cancer (those that feed on glucose), such as brain cancer. There are ketogenic diets that are used in the treatment of Polycystic Ovarian Syndrome (PCOS), as well as for weight loss and for increasing insulin sensitivity in those with Type 2 Diabetes and insulin resistance.

Even among those using a nutritional ketogenic diet for weight loss and to increase insulin sensitivity, there is no one ”keto diet”.

There are ketogenic diets with a higher percentage of fat than protein, with a higher percentage of protein than fat and mixed approaches which may have different ratios of protein to fat — depending on whether the individual is in a weight loss phase or a weight maintenance phase.

There are as many permutations and combinations as there are people following a keto diet for these reasons.

What makes a diet ketogenic (or keto) is that the amount of carbohydrate relative to the amount of protein and fat results in the utilization of fat as a primary fuel source rather than carbohydrate. “

Assuming that the specific type of “keto diet” that Dr. Schwarcz is referring to is one where one;

(1) avoids bread, pasta, cereal, potatoes, carrots, rice, fruit* or beer

and

(2) indulges in foods high in fat, such as fish, butter, eggs, high-fat cheese, whipped cream, coconut oil and meat,

it is a very appropriate question to ask as to what effect does this type of keto diet have on cardiovascular risk factors.

Note: Most keto diets used for weight loss allow fruit as berries, such as raspberries, strawberries, blueberries, blackberries as well as those fruit that we often think of as vegetables, including tomato, avocado, cucumbers, lemon and lime.  Dr. Schwarcz raised a concern in the video that not eating fruit limits one’s access to the important antioxidants in fruit, which for the most part is incorrect.

The article states that;

“There is little doubt that cutting way back on carbs results in weight loss. The question is, why?

The body’s main source of energy is glucose, generally supplied by starches and sugars [i.e. carbs] in the diet. If consumption of these carbohydrates is drastically reduced, below about 50 grams a day, energy has to be derived from an alternate source. At first, the 65 or so grams of glucose the body needs per day are produced from amino acids, sourced from proteins. But this process itself has a high energy requirement, and furthermore, the body is not keen on using up proteins that are needed to maintain muscle integrity. Fortunately, there is a backup system that can swing into action.

The liver begins to convert fats into ”ketone bodies,” namely beta-hydroxybutyrate, acetoacetate and acetone. These are then shuttled into the mitochondria, the cells’ little energy factories, where they are used as fuel. At this point the body is said to be in ”ketosis,” with excess ketones being excreted in the urine.”

Great explanation!

The article raises a few excellent points;

The article states that the “usual argument” for the more efficient weight loss associated with extremely low carb diets as compared to low fat diets is that (1) low carb diets produce a metabolic advantage because a lot of calories are needed to convert proteins to glucose.  The article adds that not everyone agrees with this premise and states that others suggest that (2) ketone bodies have either a direct appetite suppressant effect or that they (3) alter levels of the respective appetite stimulating and inhibiting hormones, ghrelin and leptin. Lastly, the article states that some argue that (4) ketogenic diets lead to a lower calorie intake which the article’s author believes is “due to the greater satiety effect of protein”.

“No long-term studies of keto diets”

Correctly the article states that;

“There are numerous studies published over the last 20 years that have compared low-fat diets to low-carb diets with the overall conclusion that the low-carb diets are more effective in terms of weight loss, at least in the short term.

…but incorrectly adds;

“Unfortunately, there are no long-term studies of keto diets.”

While there have been 3 long-term clinical trials (2 years) published over the past 10 years involving low carb diets, unfortunately as documented in my earlier article, none of these involved research groups that actually ate a low carbohydrate diet. There is, however the recent two-year data from the Virta Health’s study that was published this past December 2018 which demonstrated the long term safety of a ketogenic diet and that participants on average;

(1) lost 12.4 kg (28 pounds) in two years; most of which was achieved in the first year maintained with only a slight increase of 2.3 kg (5 pounds) in the second year.

In addition to the weight loss, participants in the Virta Health study;

(2) significantly lowered medication use for Type 2 Diabetes (read more here)

(3) lowered glycated hemoglobin (HbA1C) by a full percentage point at two years (7.7% to 6.7%)

(4) lowered fasting blood glucose from 9.1 mmol/L (164 mg/dl) at the start of the study to 7.4 mmol/l (134 mg/dl ) at two years.

High Fat Keto Diet and Cardiovascular Risk Factors

The article concludes with the initial question as to how a diet “high in fat, such as fish, butter, eggs, high-fat cheese, whipped cream, coconut oil and meat” impacts markers of cardiovascular risk.

“As one would expect, LDL, the ”bad cholesterol,” does go up, although the increase is mostly in the ”large particle” sub fraction that is deemed to be less risky.

Triglycerides, a significant risk factor, actually decrease on a very-low-carbohydrate diet, as does the body’s own production of cholesterol.

Levels of HDL, the ”good cholesterol,” increase.

That is, over the short term, markers of cardiovascular risk doesn’t change to any degree.

What about over the long term?

Unfortunately, the article concludes with;

“the problem is that there are no studies of people who have followed a keto diet long enough to note whatever effect such a diet may have on heart disease.”

…but as mentioned above, we do have the two-year data from the Virta Health’s study that was published this past December 2018 and which demonstrates that;

(1)  LDL cholesterol of the intervention group at the start of the study averaged 2.68 mmol/L (103.5 mg/dl) and at two years was slightly higher as expected, to 2.96 mmol/L (114.5 mg/dl), however this level after 2 years was almost identical to what it was at 1 year; 2.95 mmol/L(114 mg/dl). That is, LDL (mostly the large particle sub-fraction) increased as expected the first year but didn’t continue to rise.

(2) At baseline, HDL cholesterol (“good cholesterol”) of the intervention group averaged 1.11 mmol/L (41.8 mg/dl) and after two years was stable at the same level it had risen to at 1 year, namely 1.28 mmol/L (49.5 mg/dl).

(3) At baseline, triglycerides of the intervention group averaged 2.23 mmol/L (197.2 mg/dl) and at two years was down to 1.73 mmol/L (153.3 mg/dl ), only up slightly for the one year average of 1.68 mmol/L (148.9 mg/dl).

Final Thoughts…

While Dr. Schwarcz seemed to be unaware of the publication of the two-year Virta Health study data in December 2018 that demonstrates both long-term safety and efficacy of a ketogenic diet for weight loss and improvement in metabolic health (including markers of cardiovascular risk), the Montreal Gazette article and accompanying video does indicate that a very high fat ketogenic diet does not adversely impact markers of cardiovascular risk.

If you would like to know more about the low carb and ketogenic services I offer, please click on the Services tab, and if you have questions related to those, please feel free to send me a note using the Contact Me form located on the tab above.

To your good health!

Joy

UPDATE (February 15, 2019): a review of Dr. Schwarcz’ follow up to this article is located here.

You can follow me at:

         https://twitter.com/lchfRD

          https://www.facebook.com/lchfRD/

           https://plus.google.com/+JoyYKiddieMScRD

https://www.instagram.com/lchf_rd

 

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Reference

  1. Dr. Joe Schwarcz, “The Right Chemistry: Keto diets work, but is there a catch?” Montreal Gazette, February 8, 2019, https://montrealgazette.com/opinion/columnists/the-right-chemistry-keto-diets-work-but-is-there-a-catch

 

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Curious About Keto?

There isn’t one “keto diet” but rather there are a few different approaches to eating low carb diet that can each be done ketogenically (or “keto”).

Ketogenic diets are used for a variety of clinical conditions, including seizure disorder and epilepsy, specific kinds of cancer, Polycystic Ovarian Syndrome (PCOS), non-alcoholic fatty liver (NAFL) as well as insulin resistance associated with Type 2 Diabetes and Pre-diabetes. It is also sometime prescribed by people’s physicians for use prior to or following bariatric surgery or for weight loss prior to other kinds of surgery.  A well-designed ketogenic diet is not for ‘rapid weight loss’ but for gradual, sustainable long-term weight loss.

Ketosis is the state where a person is burning primarily fat and using ketones to fuel their body rather than using primarily glucose from carbohydrate for that purpose. There are essential fatty acids (fats) and essential amino acids (building blocks of protein) but there are NO essential carbohydrates. The little bit of glucose that the body needs can easily be made from fat or protein in the diet. Ketosis is hardly an usual state, but something everyone experiences when there is a long gap between meals or when they are sleeping.

What makes a low carb diet “keto” is the amount of carbohydrate in grams compared to the amount of total energy in the diet. Since each person’s toleration of carbohydrate is different, how much one can eat and be in “ketosis” varies.

Not all Keto diets result in weight loss

People mistakenly assume that a “keto” diet is automatically a weight loss diet and that’s incorrect. The ketogenic diets that are used in seizure disorder, epilepsy and in the treatment of specific type of cancer and in some forms of dementia that are designed to not result in weight loss.

What makes a diet ketogenic is the amount of carbohydrates, however the amount and types of protein eaten and the amount and types of fat eaten have a large effect on the amount and speed of weight loss. Depending on a person’s health goals and the presence of any medical or metabolic conditions, the ratio of protein to fat will vary.

Is a keto diet one-size-fits-all?

Outside of the clinical application in seizure disorder, epilepsy and cancer , ketogenic diets also have application in Type 2 Diabetes and pre-Diabetes. In these situations, each person’s ability to tolerate carbohydrate is different depending whether they are insulin sensitive, insulin resistant or Type 2 Diabetic. How much carbohydrate each person can eat and still be in ketosis also varies, too.  Someone who is insulin sensitive for example, can eat considerably more carbohydrate than someone who is insulin resistant  without causing a spike in their blood glucose level, accompanied by the release of insulin. For those who are Type 2 Diabetic, both the degree of insulin resistance and the length of time they’ve been Type 2 Diabetic will affect the amount of carbohydrates they can tolerate.

I like to use the analogy of ‘lactose intolerance’ to explain how some people can tolerate more carbohydrate than others.  Some people who are lactose intolerant can manage to drink and eat milk products, provided the  quantities are small and the person doesn’t have it too often. Others who are lactose intolerant can’t even tolerate a small amount of lactose without symptoms. Carbohydrate intolerance is similar.  People who are insulin sensitive or only mildly insulin resistance will be able to tolerate more carbohydrate than those who are very insulin resistant or have had Type 2 Diabetes a long time.

The average intake of carbohydrate in the Canadian and American diet is ~ 300 g per day, which is a lot!  People who are insulin sensitive or mildly insulin resistance may do very well lowering their carbohydrate amount to a moderate ~130 g per day where as others who are ore insulin resistant will very likely need to eat less than that in order to begin to see an effect.

Factors that can affect how much carbohydrate a person beginning to eat a low carb diet include gender (whether they are men or women) and whether they are insulin sensitive or insulin resistant (IR) and to what degree, and whether they have Type 2 Diabetes (T2D). How long a person has been insulin resistant or Diabetic also factors into how much carbohydrate they may be able to tolerate.

Everyone is different and because of this, there is no one way to “keto”.

Different ways to “keto”

There are a few different approaches to eating low carb diet that can each be done ketogenically or “keto”. Three common approaches are;

(1) low carb, higher protein, high fat
(2) a low carb, moderate protein, high fat approach

(3) a higher protein lower fat intake during weight loss, then a moderate protein high fat intake during weight maintenance

Each of the above types of low carb diets can each be done “keto”- with the amount of carbohydrate being individualized based on a person’s gender (male or female) and whether they have any metabolic conditions (including IR or T2D). What is appropriate for each person depends on their clinical conditions, health goals and will vary person to person, depending on their personal food preferences.

Going at it alone

While some people set out to “eat keto” on their own or by following a ‘diet book’ they’ve bought, it can be dangerous for people taking any kind of medication to manage blood sugar or blood pressure to do this. Decreasing carbohydrates suddenly can result in a dramatic drop in blood sugar and/or blood pressure which, depending on the medication that people may be taking, can be very risky. Some types of medication for blood sugar may result in blood sugar dropping too low when following a low carb diet and for people taking medication for high blood pressure, blood pressure can become too low. For people taking these kinds of medications eating a low carb or ketogenic diet must be done with a doctor’s oversight and should ideally be done with a knowledgeable Dietitian such as myself who can decrease carbohydrates gradually, while the person monitors their blood sugar and/or blood pressure daily.

Even for those not on medication, it is also important that people ensure that they are eating a nutritionally adequate diet, not just a low carb or ‘keto’ one. This is where having the help and support of a Dietitian such as myself comes in.

A little bit about me…

I’ve been helping others eat a low carb diet for about 3 years now through my private practice, BetterByDesign Nutrition Ltd. which has been in business for more than a decade providing in-person and remote services to people in the Lower Mainland of Vancouver and beyond.

Since March 5, 2017, I have been eating a low carb (and more recently a keto diet) myself and in May of last year, I opened the LCHF-Dietitian division  to focus on helping people manage a number of health conditions by following a low carb or ketogenic lifestyle.

The photo collage below is of me. The frame on the left was what I looked like when I first learned about a low carb diet, the middle frame is of me in October of 2017 and the frame on the right is what I look like now.
Me on the left 2 1/2 years ago, 4 months ago in the middle, on the right now

I used to be an obese Dietitian with high blood pressure, high cholesterol and 10 years as a Type 2 Diabetic and am now in partial remission from these, as I continue my weight loss journey. You can read my personal story under “A Dietitian’s Journey” on the blog, under the Food for Thought tab.

Also in the blog are articles written about the science behind following a low carb and ketogenic lifestyle, under the category Science made Simple.

Have questions about how I can help you?

Please send me a note using the ”Contact Me” form.

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

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What is a Low Carb High Fat Ketogenic Diet?

A low carbohydrate high fat ketogenic diet supplies adequate, but not excess protein and low levels of carbohydrate that is naturally found in foods such as non-starchy vegetables, nuts and seeds, and certain fruit. A low carb high fat ketogenic diet enables our bodies to burn our own fat stores quite efficiently for energy, while making the glucose needed by our blood and brain, and using ketone (which our body naturally produces as we sleep) for energy for our cells and organs.

Note: Not all low carb diets are ketogenic diets.  There are many types of low carb diets, ranging from moderately low carb diets (130 g carbs) to ketogenic diets (5-10% net carbs) and everything in between. As well, not all low carb diets are high fat diets. Some approaches are low carb higher protein diets and are also ketogenic, because carbs are limited. More on those in a later article. This article is only about a low carb high fat ketogenic diet.

Ketogenic Macronutrient Ratio

Generally speaking, in a low carb high fat ketogenic diet, the percentage of calories (kcals) from carbohydrate (carbs), protein and fat in a ketogenic diet (called the macronutrient ratio) is as follows;

65-75% of calories from fat

~20% of calories from protein

5-10% of calories from NET carbs (which is the carbohydrate in food, minus the insoluble fiber found in that food)

While each person’s energy needs and macronutrient needs are different (based on their age, gender and activity level, as well as any pre-existing medical conditions they may have), most people on ketogenic diets take in 10% or less of their calories from net carbohydrates*, with the amount of fat and protein intake varying from person-to-person within the above range.

* Net carbs are determined by subtracting insoluble fiber contained in food from the carbohydrate content of that food.

By eating low levels of carbohydrate, insulin level falls and glucagon and epinephrine levels in the blood rise.

This causes several things to occur;

  1. Fat stores are burned for energy
    The fat stored in fat cells (called adipocytes) are released into the blood as free fatty acids and glycerol. Since fatty acids contain a great deal of energy, they are broken down in cells that have mitochondria in a sequence of reactions known as β-oxidation, and acetyl-CoA is produced. This acetyl-CoA then enters the citric acid cycle where the acetyl group is burned for energy.

  2. Glucose is made for energy
    When insulin levels are low (or absent) and glucagon levels in the blood are high, glucose is produced via gluconeogenesis (literally, the “making of glucose”) and then released into the blood and used as an energy source. As elaborated on below, while the brain can use ketones for fuel, it has a need for some glucose.

  3. Ketones are produced for energy
    In significant carb restriction over several days, gluconeogenesis is stimulated by the low insulin and high glucagon levels results in acetyl-CoA being used for the formation of ketones (i.e. acetoacetate and beta-hydroxybutyrate and their breakdown product, acetone). These ketones are released by the liver into the blood where they are taken up by cells with mitochondria and reconverted back into acetyl-CoA, which can then be used as fuel for energy, in the citric acid cycle. Ketones can cross the blood-brain barrier, so they are used as fuel for the cells of the central nervous system – acting as a substitute for glucose (which is normally the end result of the body breaking down carbs and sugars found in various foods). After ~ 3 days on a very low carb diet, the brain will get ~ 25% of its energy from ketones and the other 75% from the glucose made via gluconeogenesis.  After ~ 4 days the brain will get about 70% of its energy from ketones. While the brain can use ketones for some or even most of its fuel, it still has requirement for some glucose and that is supplied from gluconeogenesis. The heart ordinarily prefers to use fats as fuel but when carbs are restricted, it effectively uses ketones.

    Ketosis versus Ketoacidosis

    Ketones are naturally produced during periods of low carb intake or in periods of fasting and during periods of prolonged intense exercise. This state is called ketosis. Since the human body is designed to use glucose as a fuel source (in times of plenty) and to use fatty acids and ketones (in times of food shortage), ketosis is a normal, physiological state.

    In untreated (or inadequately treated) Type 1 Diabetics (where the beta cells of the pancreas don’t produce insulin), the ketones that are produced are as the first stage of a serious medical state called ketoacidosis.

    Ketosis, on the other hand is a normal, naturally occurring state that occurs naturally when we sleep for example or miss a meal, whereas ketoacidosis is a serious medical state associated most commonly associated with Type 1 Diabetes. While often confused, these two conditions are very different.

A Low Carb High Fat Ketogenic Diet

A low carb high fat ketogenic diet may appear at first glance to be like the Atkins diet or other low carb high fat diets but the main difference is that in a keto diet, protein is not unlimited. The reason for this is based on the premise that excess protein will be converted into glycogen and have a similar effect on ketosis as eating too many carbs, disrupting ketosis.

Since having too little protein may cause muscle loss, a keto diet is designed to have adequate, but not excess protein.

But why eat a low carb high fat keto diet?

The last 40 years of burgeoning rates of overweight, obesity and Diabetes, provide the motivation. (Please read the next article titled 1977 Dietary Recommendations — forty years on for a summary of those issues).

A low carb high fat keto diet is one low carb approach that is used for clinical reasons, such as to seek to reverse the symptoms of Diabetes by enabling insulin levels to fall, glucagon and epinephrine levels to rise, resulting in the body:

(1) naturally accessing its own fat stores for fuel

(2) manufacturing its own glucose

and

(3) using ketone bodies for energy.

The human body is designed to use either glucose or fatty acids and ketones as a fuel source. Ketosis is a normal, physiological state where our bodies run almost entirely on fat.

Insulin levels become very low, which has benefit to those who are insulin resistant or Type 2 Diabetic. 

As a result, burning of our own body fat stores for energy increases dramatically — which is great for those who want to lose weight, without hunger and a steady supply of energy.

Want to know more?

Feel free to send me a note using the Contact Me form, above.

To your health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Note: Everyone’s results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody’s nutritional needs and health status are different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.