"Does a Ketogenic Diet Help
Diabetes or Make It Worse?" Ketogenic diets can certainly lower blood
sugars, better than conventional diets, so much so there is a keto
product company that claims ketogenic diets can
reverse diabetes. But they are confusing the
symptom—high blood sugars— with the disease, which is
carbohydrate intolerance. People with diabetes can't
properly handle carbohydrates and this manifests
as high blood sugars. Sure, if you stick to eating mostly fat,
your blood sugars will stay low, but you may actually be making
the underlying disease worse at the same time. We've known for nearly a century that
if you put people on a ketogenic diet, their carbohydrate intolerance can
skyrocket within just two days. Here's the blood sugar response
of someone eating sugar, after two days eating a high carb diet. Here's exposure to the same amount of
sugar after a high-fat diet for two days. Their intolerance to carbohydrates
skyrocketed on a high-fat diet. One week on an 80% fat diet and you
can quintuple your blood sugar spike in reaction to the same carb load,
compared to a week on a low-fat diet.
Even a single day of excessive
dietary fat intake can do it. If you're going in for a diabetes test,
having a fatty dinner the night before can adversely affect your results. One meal high in saturated fat
can make the cause of diabetes, carbohydrate intolerance,
worse within four hours. Now with enough weight
loss by any means, whether from cholera or bariatric surgery,
type 2 diabetes can be reversed, but a keto diet for diabetes may not
just be papering over the cracks, but actively throwing fuel on the fire. I've been trying to think
of a good metaphor. It's easy to come up with things
that just treat the symptoms without helping the underlying disease,
like giving someone with pneumonia aspirin for their fever
instead of antibiotics. But a keto diet for diabetes
is worse than that, because it may treat the symptoms
while actively worsening the disease. So maybe it's more like curing the fever
by throwing that pneumonia patient out into a snow bank. Or maybe "curing" your amputated
finger by amputating your hand. No more unsightly finger stub! One of the co-founders
of masteringdiabetes.org suggested it's like a CEO that makes
their bad bottom-line look better by just borrowing tons of new cash.
The outer numbers look better, but on the inside the company is
just digging itself a deeper hole.
Remember "The Club"? Maybe I just watched too much late-night TV growing up, but it's a
car anti-theft device that attaches to your steering wheel
and locks it in place, so the steering column can
only turn a few inches. Imagine you're in a car at the top of
a hill with the steering wheel locked. Then the car starts
rolling down the hill. What do you do? Oh, did I mention there's also something
stuck under your brake pedal, too? The keto-diet-equivalent-response
to this situation is who cares if you're barreling down into traffic with
no brakes and a locked steering wheel? Just stick to really
straight deserted roads without any stop signs or traffic lights.
If you do that, problem solved! Yeah, the longer you go, the more speed
you'll pick up, and so if you should hit a dietary bump in the road
or start to veer off the path, the consequences could get more
and more disastrous with time.
But if you stick to the keto straight
and narrow, you'll be A-OK. In contrast, the non-keto response would
be to just unlock the steering wheel and dislodge whatever's under your brake.
In other words, fix the underlying problem instead of just whistling past
(and then into) the graveyard. The reason keto proponents claim
they can "reverse" diabetes is that they can successfully wean
type 2 diabetics off their insulin. But that's like faith healing someone
out of the need for a wheelchair by making them lie in bed
the rest of their life. No need for a wheelchair
if you never move. Their carbohydrate intolerance isn't
gone; their diabetes isn't gone. It could be as bad or even worse. Type 2 diabetes is reversed when
you can wean people off insulin eating a normal diet
like everybody else; then and only then do you
not have diabetes anymore. A true diabetes reversal diet
is practically the opposite of a ketogenic diet: diabetics
off their insulin within a matter of weeks, eating more than
300 grams of carbs a day.
The irony doesn't stop there. One of the reasons diabetics suffer
such nerve and artery damage is due to an inflammatory metabolic
toxin known as methylglyoxal that forms at high blood sugar levels. Methylglyoxal is the most potent creator
of advanced glycation end products, so-called AGEs, which are implicated
in degenerative disease from Alzheimer's disease and cataracts
to kidney disease and strokes. You get AGEs in your body
from two sources: eating them preformed in your diet,
or making them internally from methylglyoxal if you have
high blood sugar levels. On a keto diet, one would expect
high exposure to preformed AGEs, since they're found concentrated
in animal-derived foods high in fat and protein, but we would expect less internal new
formation due to presumably low levels of methylglyoxal, given lower
blood sugars not eating carbs.
Dartmouth researchers were surprised
to find more methylglyoxal though. A few weeks on the Atkins diet
led to a significant increase in methylglyoxal levels, and those
in active ketosis did even worse, doubling the level of this
glycotoxin in their bloodstream. It turns out high sugars may not be
the only way to create this toxin. One of the ketones you make
on a ketogenic diet is acetone, known for its starring role
in nail polish remover. Acetone does more than just make
keto dieters fail breathalyzer tests and develop what's been
described as "rotten apple breath." Acetone can oxidize
in the blood to acetol, which may be a precursor
for methylglyoxal.
That may be why keto dieters can
end up with levels of this glycotoxin as high as those with out-of-control
diabetes, which can cause the nerve damage and blood vessel
damage you see in diabetics. That's another way keto dieters
can end up with a heart attack. So the irony of treating diabetes
with a keto diet may extend beyond just making the
underlying diabetes worse, but by mimicking some of
disease's dire consequences..
