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Let's face it the ketogenic diet is arguably the most popular dietary trend in our world today, especially for those living with diabetes. It is likely that you've been tempted to follow a ketogenic diet to lose weight, drop your A1c and flatline your blood glucose. Even though it may seem tempting to enter the metabolic state of ketosis it's important to understand the caveats of ketosis, so that you fully understand your risks for developing long-term complications.
What exactly is ketosis, and why is ketosis a popular recommendation for those living with diabetes? A ketogenic diet is a very low carbohydrate diet by design containing a maximum of 30 grams of dietary carbohydrate per day. At the base of the ketogenic food pyramid are eggs, dairy, meat, oil, and fish, which make up the bulk of calories eaten. Starchy vegetables contain too much carbohydrate energy and are avoided while non starchy vegetables or green vegetables are included along with nuts, seeds, and a very limited amount of fruit, mainly berries. Now, the ketogenic diet explicitly prohibits the consumption of grain products, even whole grains as well as pasta, refined sugar, milk, corn, legumes, including lentils beans and peas, as well as rice. When you eat a ketogenic diet your muscles and liver switch from oxidizing glucose as their primary fuel to fatty acids as their primary fuel, and in order to withstand a very low carbohydrate intake your liver manufacturers ketone bodies as an emergency backup fuel for your brain when in the state of ketosis. If you're living with diabetes this may sound like a great idea, because your pancreas is provided with an opportunity to reduce insulin production insulin due to low carbohydrate intake.
Now, millions of people around the world who eat a ketogenic diet achieve a flatline blood glucose profile and greatly reduce or eliminate their need for oral medication and insulin. If You've experienced this yourself you may be thinking "Great! I solved the problem eating! A ketogenic diet is keeping my blood glucose in control and therefore my diabetes health is going up!" In addition, the state of ketosis induces a number of short-term benefits, including rapid weight loss, reduced fasting glucose, reduced post-meal blood glucose, reduced A1c, reduced total cholesterol, reduced LDL cholesterol, and flatlined blood glucose.
The problem is that eating a ketogenic diet significantly increases your risk for chronic disease and premature death in the long term. After researching the advice from the top ketosis gurus we made a list of the seven biggest and most dangerous misconceptions about ketogenic diets in this video. We'll go into detail about the truth underlying ketosis, and refute many common statements backed by misleading science, incorrect biochemistry, and a fundamental lack of understanding of human biology.
Ketosis misconception number one: Insulin is your fat storage hormone. Now, you may have heard people in the ketogenic community refer to insulin as your fat storage hormone, and that by adopting a very low carbohydrate diet you prevent your blood glucose from spiking after a meal. Now, hold on a second, open any biology textbook and you'll find that the primary function of insulin is to help glucose exit your blood and enter tissues. But that insulin also helps fatty acids and amino acids out of your blood and into tissues. It is absolutely critical to understand that the primary function of insulin is to help transport glucose out of your blood and into tissues and a secondary effect of insulin is to help transport fatty acids and amino acids out of your blood and into tissues Simply because insulin has the ability to transport fat into tissues does not mean that it's factually correct to label insulin as your fat storage hormone.
This is a gross exaggeration of the actual role of insulin and it is meant to scare people into believing that any amount of insulin in circulation will make you fat. Insulin triggers macro nutrient uptake in this order: Priority number one: Insulin transports glucose into the tissues to either be burned for energy or to be stored as glycogen for later use. Priority number two: Insulin transports fatty acids into tissues to be immediately burned for energy or to be stored as triglycerides for later use. Priority number three: Insulin transports amino acids into tissues to be synthesized into new protein to be burned for energy or to be converted into other compounds. Understanding this insulin priority hierarchy is very important, because it reinforces the concept that insulin's primary role is to handle all things related to glucose metabolism BEFORE it begins directing fatty acids and amino acids into tissues.
Insulin is the most powerful anabolic hormone in your body, meaning that it promotes more growth and more fuel storage than any other hormone in your body. Ketogenic dieters exaggerate this fact, condemning insulin entirely claiming that even small amounts of insulin will make you fat. Fact: Insulin is the most anabolic hormone in your body, responsible for more fuel storage and cell growth than any other hormone in your body. Fact: Insulin promotes more growth than testosterone. Fact: Insulin promotes more growth than estrogen. Fact: Insulin promotes more growth than growth hormone. Fact: Insulin promotes more growth than IGF-1. The truth is that all mammals secrete insulin because insulin is absolutely required for life. Your dog secretes insulin, your pet hamster secretes insulin, your neighbor's cat secretes insulin, monkeys secrete insulin, raccoons secrete insulin, your non-diabetic co-worker secretes insulin. In fact insulin is so important that if your body stops manufacturing it, you'll die. Without insulin your dog would die, your pet hamster would die, your neighbor's cat would die, your non-diabetic co-worker would die. In truth a physiologically normal amount of insulin is absolutely required to stay alive.
But secreting or injecting excess insulin is what substantially increases your risk for coronary artery disease, atherosclerosis and cardiovascular disease as a whole. Ketosis misconception number two: eating carbohydrates spikes your blood glucose. Proponents of the ketogenic diet often argue that eating any food containing carbohydrate energy will spike your blood glucose and that the only way to avoid dangerous glucose spikes is to avoid carbohydrate-rich foods. Technically speaking, when you eat carbohydrate rich food your blood glucose will rise. Furthermore, reducing your carbohydrate intake will keep your blood glucose more stable. For these reasons ketogenic dieters maintain a total carbohydrate intake less than 30 grams per day, representing less than 10% of total calories on average. What those in ketosis don't understand is that the amount of glucose in your blood is not only determined by the amount of carbohydrate that you eat, but instead a reflection of both your dietary carbohydrate and your dietary fat intake. We have written extensively about the detrimental role that excess dietary fat plays in the development of insulin resistance, leading to high blood glucose, increased insulin requirements, high cholesterol, beta cell death, and increased risk for many chronic diseases.
It's important to understand that only paying attention to how much carbohydrate you eat will mislead you into thinking that this single macronutrient controls your entire blood glucose profile, when in reality your blood glucose is determined primarily by how much fat you eat and, secondarily, by the amount of carbohydrate that you eat. To understand how your blood glucose responds to different macro nutrient profiles, let's explore how a ketogenic diet a standard American diet and a low-fat plant-based whole food diet affect your blood glucose.
When operating in a high fat ecosystem on a ketogenic diet the primary reason why your blood glucose remains flat is because of the near absence of carbohydrate rich foods. In this way eating a high-fat diet is very effective at flat-lining your blood glucose because carbohydrates are kept below 30 grams per day. As long as you avoid carbohydrate-rich foods your blood glucose is likely to stay very stable. But the minute you choose to eat carbohydrate-rich foods such as a banana, a potato, a bowl a quinoa, your blood glucose is likely to increase significantly due to a hidden state of fatty acid-induced insulin resistance.
The standard American diet is a perfect example of a diet that is high in both carbohydrate and high in fat which increases your risk for high blood glucose, insulin resistance and diabetes. Because both fat and carbohydrate are president in large quantities controlling your blood glucose becomes increasingly difficult over time. Because a low-fat plant-based whole food diet is low in dietary fat your carbohydrate tolerance or your ability to eat carbohydrate-rich food increases substantially resulting in maximum insulin sensitivity and the opportunity to completely reverse insulin resistance altogether.
When operating in a low-fat eco system on a plant-based diet it is quite easy to maintain flatline blood glucose as long as your total fat intake is maintained below approximately 30 grams per day and your carbohydrate intake comes from whole foods like fruits, vegetables, legumes and whole grains, and not from products containing refined sugars. Ketosis misconception number 3: Diabetes is carbohydrate toxicity and insulin resistance is a state of carbohydrate intolerance. Those in the ketogenic community often labeling diabetes as a problem of carbohydrate toxicity, suggesting that dietary carbohydrate is the primary cause of the disease process. In addition ketogenic dieters believe that insulin resistance is caused by insulin itself, triggered by an excess consumption of dietary carbohydrate. I cannot tell you how many people tell me: Cyrus, insulin resistance is not caused by fat.
It's caused by insulin. This my friend could not be farther from the truth. In order to make these statements factually correct it's necessary to go back to basic biochemistry principles and understand that the vast majority of people who develop insulin resistance do so by eating a diet containing large amounts of dietary fat as we discussed earlier. The research world has known this for more than 85 years. This was first established in the 1930s by the pioneering work of doctors Rabinowitch and Hemsworth, then further proven by Dr. Kempner in the 1950s and by Dr. Anderson in the 1970s. Despite this the cause of insulin resistance and carbohydrate intolerance remains one of the most debated subjects in the world of diabetes even today. Think of insulin resistance as a series of metabolic dominoes. The dominoes are arranged in this order: number one – you eat a diet containing dietary fat greater than about 15 percent of total calories; number two: you go and eat a banana, a potato or a bowl of rice, and check your blood glucose two hours later to find that your blood glucose meter reads a high number like two hundred and forty six.
You point your finger and say Hey, bad banana, bad potato! I guess these foods are bad for me because clearly when I eat them they increase my blood glucose. The reason this happened is not because bananas and potatoes and rice are bad foods but because insulin receptors in your muscle and in your liver have become dysfunctional due to too much dietary fat. That's right under normal circumstances the glucose from these carbohydrate-rich foods are accompanied by insulin, and insulin job is to say Knock-knock, I have some glucose. Would you like to take it up? Normally cells in your liver and muscle would say Sure bring it in! but when you've eaten your way into insulin resistance, insulin receptors say You got to be kidding me! Do you see how much energy I already have inside? I gotta burn this stuff first! And then and only then will I allow glucose in. For now you stay in the blood. So when glucose becomes trapped in your blood due to these dysfunctional insulin receptors you have a choice: either you avoid carbohydrates like the plague and continue to remain in ketosis, or you drop your fat intake and gain the ability to eat carbohydrate-rich foods.
So if diabetes is not a problem of carbohydrate toxicity but a problem of fat toxicity then the correct statement is this: Insulin resistance is a state of carbohydrate intolerance first created by the consumption of excess dietary fat Ketosis misconception number four: Carbohydrate is not an essential nutrient. The ketogenic world is quick to point out that there is no such thing as an essential carbohydrate in contrast to required nutrients like essential fatty acids and essential amino acids. While this statement is technically true, labelling glucose as a non-essential carbohydrate implies that there is no use for glucose in the human body. Once again, we have to return to basic human physiology in order to understand the truth. Your liver, your muscle and other peripheral tissues are capable of oxidising glucose amino acids and fatty acids for energy. Your brain, however, cannot oxidise either amino acids or fatty acids for energy your brain can only run off of glucose for energy and does not possess the biological machinery to store glucose. As a result your brain must oxidise glucose on demand importing glucose from your blood 24 hours a day.
Since glucose is your brain's principal on-demand fuel, carbohydrate-rich foods are your brains primary fuel source. When you consume a low carbohydrate diet you force your liver to synthesize an emergency backup fuel known as ketone bodies to prevent against brain starvation, and you enter the state of ketosis in which ketone bodies become your brains primary fuel. Ketogenic diets were originally invented for people with epilepsy and are effective at reducing seizure incidents. However ample evidence shows the ketogenic diets come with a laundry list of unwanted side-effects that simply cannot be overlooked, including, but not limited to, diarrhea, nausea, constipation, vomiting, acid reflux, hair loss, kidney stones, muscle cramps, muscle weakness, hypoglycemia, low platelet count, impaired cognition, inability to concentrate, impaired mood, disordered mineral metabolism, stunted growth in children, increased risk for bone fractures, osteopenia, osteoporosis, increased bruising, acute pancreatitis, hyperlipidemia, high cholesterol, insulin resistance, elevated cortisol, heart arrhythmia, myocardial infarction or heart attacks menstrual irregularities, amenorrhea or loss of periods in women, and an increased risk for all-cause mortality or premature death from any cause Yes, that's right, people who eat low carbohydrate diets die sooner and suffer for more disease in the long term If that's not enough to dissuade you from eating a low carbohydrate diet, I'm not sure what is.
Therefore, labelling carbohydrates as non-essential is not only factually inaccurate, it results in a wide variety of chronic health conditions that may ultimately shorten your lifespan decrease your quality of life and accelerate your risk for chronic disease. Ketosis misconception number five: low fasting insulin means high insulin sensitivity. People in the ketogenic community often measure their fasting insulin levels as an indicator of their insulin sensitivity. A fasting insulin test measures the amount of insulin your pancreas must secrete in order to control your blood glucose. The lower the number the less work your pancreas is performing. This is a good thing. Ketogenic dieters often report very low fasting insulin levels and then draw the conclusion that their insulin sensitivity has increased. This could not be farther from the truth. The only way to actually measure your insulin sensitivity is to utilize a glucose challenge in which you either drink a solution containing glucose dissolved in water, or you eat a food containing carbohydrate energy in the clinic. Your doctor may order a glucose tolerance test to measure your insulin sensitivity.
The way that you measure insulin sensitivity using an oral glucose tolerance test is straightforward: Step 1: you drink a solution containing 75 to 100 grams of glucose dissolved in water. Step 2: a medical professional samples your blood at 0, 60, 120 and 180 minutes. Step 3: your blood samples are analyzed for glucose and insulin. Step 4: your performance is measured against a standard to determine your insulin sensitivity. The higher your glucose and insulin area under the curve the worse you perform on the test and the higher your level of insulin resistance The lower your glucose and insulin areas under the curves the lower your level of insulin resistance.
The reason why this test is so valuable for measuring insulin sensitivity is because it measures the ability of your muscle and liver to uptake glucose from your blood when challenged by a food or drink containing glucose. Simply measuring your fasting insulin or fasting blood glucose independent of a glucose challenge is insufficient information to conclude anything about your level of insulin sensitivity. However, many ketogenic dieters and medical professionals fail to understand this concept entirely. If you never challenged your glucose metabolism with carbohydrate rich foods, or with a glucose solution, it is simply impossible to measure insulin resistance. Despite this, those in ketosis often claim that their insulin sensitivity has increased, even though they avoid eating carbohydrate-rich foods at all costs. Ketosis misconception number 6: low carbohydrate diets are not high-protein diets. Let's go into detail to understand the caveats of this statement. The first question to ask is this: What proportion of total calories constitutes a high-protein diet according to the scientific evidence? Now, according to the evidence, diets containing more than 10 to 15% of total calories of protein increase your risk for cardiovascular and diabetes mortality especially if the majority of your protein originates from animal foods.
Now, many studies have shown that protein intakes in excess of 15% of total calories increase your risk for heart disease, for high cholesterol, for atherosclerosis, for diabetes and various forms of cancer. As a result any diet containing in excess of 10 to 15% calories from protein is considered a high protein. It turns out that it is practically impossible for a ketogenic diet to be low in protein Why? It's actually quite simple – because cheese, eggs, meat, butter, poultry, fish, nuts, seeds, vegetable oil, coconuts and avocados make up the bulk of calories in a ketogenic diet. With the exception of vegetable or coconut oil, which is 100% fat every food that I just listed is not only high in fat, but also higher in protein.
Ketosis misconception number 7 Evidence-based research shows that low carbohydrate diets are effective. Low carbohydrate diet advocates are masters of documenting the efficacy of their philosophy, using studies with small population sizes, conducted over short time periods, often over either weeks or months While these studies are helpful at assessing the short-term benefits of ketosis, they fail to document the long-term effects of a ketogenic diet. A classic example of this is a paper that was published in 2017, documenting the results of 10 weeks of a ketogenic diet on 262 patients following a diet containing less than 30 grams of carbohydrate per day and an average of a175 grams of protein per day. Now, the researchers document how ten weeks of ketosis resulted in an average A1c decrease of 1%, an average weight loss of 7.2%, and how more than 56% of participants reduce their need for oral medication. These are all great outcomes. The problem is that the study was conducted in a small cohort over a very relatively short period of time. Now, in order to determine the true effectiveness of any diet you have to do two things: number one – study your diet in large numbers of people, which is tens or hundreds of thousands of people; and number two – study the outcomes of people following your diet over long periods of time – greater than approximately five years.
Studies conducted in tens or hundreds of thousands of people over five plus years indicate that low carbohydrate diets promote the following disastrous outcomes: number one – increased risk for cardiovascular disease; number two – increased risk for hemorrhagic stroke; number three – increased risk for hypertension; number four – increased risk for atherosclerosis; number five – increased risk for diabetes; mortality number six; increased risk for obesity; number seven – increased risk for cancer; number eight – increased risk for all cause mortality, which is premature death from any cause.
No matter how you slice it, low carbohydrate diets trick patients and doctors into believing that ketosis is an excellent long-term dietary strategy, when in reality the long-term consequences are often worse than the initial condition they were designed to reverse. Now the next time you consider adopting a ketogenic diet ask yourself a simple question: Are the long-term consequences worth the short-term benefits? Plant based news (PBN).