A high-fat, very low-carbohydrate diet, otherwise known as the ketogenic diet, may be the key to reversing Type 2 diabetes, says Dr. Tom Bilella, the ANJC Nutrition Council chairman. This eating plan goes against much of the conventional guidelines given to people with Type 2 diabetes. However, it is being proven successful in much of the new research being conducted. Dr. Stephen Phinney MD, PhD, and chief medical officer and co-founder of Virta Health, a clinic specializing in lifestyle-based treatment for diabetes, is very pleased with many of the results of recent research.
Data from a new study by McKenzie A, et al. in JMIR Diabetes reveals the substantial effects the ketogenic diet can have on diabetics. After 10 weeks on the plan, 36 percent of diabetics were able to completely stop their insulin therapy while 51 percent were able to lower their doses significantly. Additionally, mean hemoglobin A1C (a biomarker for long-term glucose damage) plummeted from 7.5 percent to 6.5 percent, while over half of patients even reached below the diagnostic threshold for diabetes. Not to mention, almost 75 percent of subjects in the study lost a clinically significant amount of weight.
Despite the increase in popularity of the ketogenic diet, the science behind it is not new. Research on this diet has been conducted since as early as the mid-70s, however the studies were done in an institutional setting and could not be easily applied to patients in the real world. In the ketogenic diet, the body becomes better adapted at burning fat for fuel instead of carbohydrates. The fat the body burns is in the form of ketones, such as the 4-carbon beta-hydroxybutyrate (BOHB). These ketones are water soluble and are much easier for the body to use for energy metabolism than the typical long-chain fatty acids. These ketones become most abundant when insulin levels are low, glycogen (stored carbohydrates) is depleted, and the fat-burning hormones epinephrine and norepinephrine are high.
The optimal ketone level can typically be obtained by a diet consisting of roughly 70-75 percent healthy fats, 15-20 percent protein and 5-10 percent carbs. However, it is important to note that the majority of carbs should come from non-starchy vegetables such as greens, broccoli, cauliflower, etc. Some fruit is permitted with a focus on dark blue and red berries. Quality protein sources include lean red meats, fish, poultry, eggs and some dairy. Healthy fat sources include avocados, nuts, seeds, olive oil and coconut oil. Food should ideally be from organic, minimally processed sources.
The long-perceived notion that high-fat diets are unhealthy partly stems from the fact that guidelines from the American Diabetic Association are predicated on the assumption that diabetics are on their medications, which would necessitate carbohydrates in the diet to prevent hypoglycemia. This is why the American Diabetic Association currently recommends eating 40 grams of carbs per meal. This recommendation along with other guidelines were created under the assumption that diabetes is irreversible and is a disease that needs to be managed for the rest of patients’ lives.
There can be a learning curve for patients transitioning to a ketogenic diet. This is why education and coaching is critical. Communication between clinicians and their patients is encouraged to keep the patients on track. Deviations from the diet may occur at times and every effort should be made by the clinician and the patient to get back on track. The ketogenic diet can be a life-saving tool for diabetics or anyone wishing to improve their health.
Dr. Tom Bilella, DC, MS, CCN, CNS, DACBN, CISSN, is chairman of the ANJC Nutrition Council. He maintains a successful practice in Red Bank, NJ, where he specializes in metabolic syndrome, peak performance, weight loss, and chronic conditions. His goal is to educate patients in the community to lead a healthier, more productive life without the use of unnecessary drugs or surgery. He also coaches natural clinicians on how to be more successful in practice through his Legends Club program. He can be reached at drtombilella.com.