Can Diabetes Be Reversed With a Ketogenic Diet?

Updated: Mar 25, 2019


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Sadly, The average American consumes 152 pounds of sugar and 146 pounds of flour per year. Almost 20 percent of our daily calories come from sugar-sweetened beverages like soda, sports drinks, sweetened coffees and teas, and juice. 60 percent of calories Americans eat come from ultra-processed foods like bread, soda, chips, cookies, and candy. For the first time in history, more humans are losing their live to chronic, and preventable, conditions than to trauma, infectious diseases, and even war. 1 in 2 Americans has a chronic disease, and 1 in 4 has multiple chronic diseases. Life expectancy of the human being is expected to decrease at the hands of chronic diseases of epidemic proportions. In other words, for the first time in human history, children born today are expected to live shorter lives than their parents.


However, as we saw in last week's article, switching to a nutrient dense, plant based, real food diet can have dramatic effects on our health, effectively reversing the onslaught of chronic diseases that we are experiencing in modern society.


What if you are already eating a healthy diet and have still been told by your doctor that you are borderline diabetic (also known as pre-diabetic)? You may be suffering from an underlying insulin resistance that can be reversed with a combination of intermittent fasting and a more aggressive diet that is lower in carbohydrates and higher in healthy fats and proteins. The most aggressive from of this type of diet is called the Ketogenic Diet and has been shown to be a very effective tool that can be used in reversing type 2 diabetes!


What is the Ketogenic Diet?


The ketogenic diet is a nutritional program that trains your body to burn fat instead of blood sugar. How does the diet achieve this? by depleting the stores of sugar in the body, first in the form of circulating sugar in the blood stream, and then by mobilizing and burning sugar stored away in the muscle and organ tissue, called glycogen. When these stores are depleted, the body resorts to mobilizing fat to be burned for energy.


To elaborate further, I will provide a simple cash flow example. Sugar in your bloodstream is like the change in your pocket. You probably don't have a lot of it and you can burn through it pretty quickly when you make a purchase. Similarly, you burn through sugar in your blood stream quickly through normal bodily functions or through exercise. Next, after depleting change in your pocket, you reach for cash in your wallet (your body reaches for stored sugar in the form of glycogen), a place where you can store a larger amount of money. After you deplete cash in your wallet, you make withdrawal from your bank account, where you can store massive amounts of money. Cash in your bank account is like stored energy in the form of fat stores throughout your body. There are upwards of 40,000 calorie stored in your body in the form of fats.


When fat stores mobilize to be burned, it forms molecules called ketones, which is actually the preferred energy source of the brain. This is why many people feel a sense of clarity, energy, and vibrancy when on the ketogenic diet. Ketones also decrease appetite and cravings, which help sustain the a diet over a longer period of time. Ketones are also what allowed one 450 pound man to consume practically nothing but water for over a year while still feeling surprisingly energetic and free of hunger pangs/cravings.


The ketogenic diet reproduces this fat burning effect by drastically reducing dietary carbohydrates, which convert to glucose and glycogen in the body. On a ketogenic diet, carbohydrates are restricted to less than 10% of calories consumed, while fats are increased to 70-80% of calories, and proteins to 10-20% of calories.


Is Keto effective for type 2 Diabetes?


Yes! In fact, per the studies conducted, it has proven to be one of the most effective diets available to reverse type 2 diabetes.


Why is it effective? Since carbohydrates consumption is minimized, blood sugar spikes and consequent peaks of insulin are also minimized. Because spikes in insulin are minimized, the ketogenic diet is also known as a "fasting mimicking diet" because it mirrors the low insulin levels when one is in a fasted state. Just like going on a coffee fast will increase your body's sensitivity to caffeine, going on a ketogenic diet also re-sensitizes your body to insulin, thus reversing insulin resistance. For more on this topic, watch this video and this video.


Let's take a look at the studies:


1. Ketogenic Diet (no control group)- A small, 16-week Pilot Study placed 28 overweight patients with type 2 diabetes on a ketogenic diet. Those who completed the study experienced tremendous results, having decreased weight by 6.6% (or 20 pounds), HbA1C by 16%, and triglycerides by 42%. Of the 21 patients that completed the study, surprisingly 10 reduced the use of medication and 7 completely eliminated medication altogether! Given the small size of this study, however, only limited conclusions can be drawn. Nonetheless, this 2005 study did provide some promising results.


2. Ketogenic diet vs low glycemic index diet- Diabetics are often encouraged to eat a low-glycemic food diet. The lower a food is rated on the glycemic index, the less potential it has to spike your blood sugar. See the table below for the glycemic index of commonly consumed foods.

https://healthiack.com/health/glycemic-index-chart

How does the ketogenic diet fare against a calorie restricted low glycemic diet? In one study, 84 obese patients with type 2 diabetes were randomly assigned to one of the two diets and were tracked for a period of 24 weeks. What happened? Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. However, The keto group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5), body weight (-11.1 kg vs. -6.9 kg) and HDL cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the low glycemic group. Diabetes medications were reduced or eliminated in 95.2% of the keto group vs. 62% of the Low glycemic group.


3. Ketogenic Diet vs Low-calorie diet- This study compared the effectiveness of a low carb ketogenic diet (LCKD) versus a low calorie diet (LCD) for reducing weight in 363 obese patients over a 24 week period. About a third of the patients studied had diabetes. Both groups enjoyed improvements in general health biomarkers. However, the keto group had greater benefits in every single marker measured including cholesterol, body weight, waist circumference, A1c, and blood glucose!

The investigators concluded that "this study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects. The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels." Because of the precipitous drop in blood sugar on this diet, some patients, who were using up to 90 units of insulin daily, were able to completely eliminate insulin use in the study period.


4. Low calorie keto vs conventional low calorie diet - this study, conducted in 2016, split 89 obese men and women into one of two dietary groups. Participants were randomly assigned to eat either a very low carbohydrate ketogenic (VLCK) diet or a conventional low-calorie diet. Overall, the VLCK group lost more weight while also gaining better control over their blood sugar. The study investigators concluded that The VLCK diet is most effective in reducing body weight and in improveming glycemic control compared to the standard hypocaloric diet for diabetic patients.



Lastly, I'd like to highlight the work and the research results from a study from Virta Health, a silicon valley based company that is looking to reverse type 2 diabetes with a ketogenic diet. Their early research is quite impressive. Virta health defines diabetes reversal as "maintaining an HbA1c below 6.5%, with the elimination of all diabetic medications (except for metformin)."

Virta patients enter nutritional ketosis through intensive nutrition and behavioral counseling with digital coaching and an education platform. Participants are also provided close medication management services by a medical professional.

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Virta set out to study whether patients would benefit from such a model of receiving intensive in person and remote education. Surprisingly, in their first study, after just 10 weeks on this program, "47.7% of participants achieved an HbA1c level of <6.5%," indicating a reversal of their diabetes.


In a proceeding study, which tracked patents for a period of one year, "60% of patients attained an HbA1c below 6.5% without the use of diabetes-specific medications." Participants also lost 12% of their body weight on average while also reducing triglycerides by 24% and improving HDL cholesterol by 18%. For comparison, one study found that for diabetics on low-fat diets, which are conventionally recommended for diabetic patients, only 4% of participants achieve reversal after a one year period.



In conclusion, is keto the only way to reverse diabetes? Absolutely not! I would definitely not make a blanket recommendation for everyone to pursue a ketogenic diet; however, it can certainly be an effective tool in combatting the prolific rise in type 2 diabetes we are experiencing today.


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