Can a keto diet turn pre-and type-2 diabetes around?

[Maca44]

T2D starts off as IR. The classical manifestation is: fat around the liver => decrease in the liver's insulin sensitivity => disruption to the gluconeogenesis regulatory mechanism => the liver keeps churning out glucose made from amino acids, lipids etc (note: *not* from carbs), particularly overnight and when fasting. That's the big reason for having a fasting BG as part of the standard T2D blood test panel: a high fasting BG indicates that gluconeogenesis isn't under control. Metformin's main effect comes from improving the liver's insulin sensitivity => better gluconeogensis regulation => lower fasting BG, lower "baseline" BG.

All that is just standard medicine, but it never gets explained properly at diagnosis, as far as I can see. Note that carbs have very little to do with it, whereas losing visceral fat from the liver is key. Again, this has been well understood for ever, and it's the reason why weight reduction is a key piece of T2D advice.

As T2D progresses, the pancreas starts clapping out & insulin production decreases. Full-blown T2D isn't just insulin resistance; it's also poor insulin response. Roy Taylor's big thing was to show that visceral fat is to blame for this, also, and that clearing fat from the pancreas can restore beta cell function and insulin production in T2D. So losing weight => restored gluconeogenesis regulation + restored insulin response => T2D reversed, in many cases.

Wish they did tell me that when I was diagnosed they told me nothing that's really interesting so thanks.

 

[DaveB]

I was told many times that only carbs make you fat, eating fat won't put on weight?
So if I eat 4000 calories a day in fats, I'll still not put on any weight, and if I don't eat carbs with 4000 calories of fat, I'll still lose weight overall?

I think what you're saying is possibly true but you would have chosen the Calories to have been fat laden which is fine. Many Calorie reduction diets or food labelled Calories don't define the mix or even keep the fats down to keep the calories down (fat has twice the calories of carbs) so you end up having too many carbs even with low-calorie eating.

 

[Inka]

@DaveB Why carbs rather than fats? Or, say, a combination of carbs and fats such as is found in many processed foods?

 

[travellor]

I think what you're saying is possibly true but you would have chosen the Calories to have been fat laden which is fine. Many Calorie reduction diets or food labelled Calories don't define the mix or even keep the fats down to keep the calories down (fat has twice the calories of carbs) so you end up having too many carbs even with low-calorie eating.

So, if I'm overweight, massively, and eat just a massive amount of fat, 4000 calories, provided I low carb, I will always still lose weight?

 

[AndBreathe]

So, if I'm overweight, massively, and eat just a massive amount of fat, 4000 calories, provided I low carb, I will always still lose weight?

As far as I am aware, when it comes to approaches to eating (and many other things) "always" is a brittle concept.

You might always lose/gain/maintain from any given process, whereas other will/could have differing outcomes.

 

[EllsBells]

So, if I'm overweight, massively, and eat just a massive amount of fat, 4000 calories, provided I low carb, I will always still lose weight?

Alas no - you will still gain weight but your big levels may be more stable at least in the short term. Added weight = more pressure on your system. Low calorie diets seem to cause larger fluctuations in bg levels than low carb but will reduce weight and often quicker. Low carb will reduce weight with a counter balance of fats to compensate for the carb lack but still require monitoring and within daily intake guidelines. It's why @Newbie777 was advised to watch his cheese intake! There are no real cheats with this.

With diets like the Atkins I think the carb limit is 20g per day from friends who have done it. That's about an apple - anymore and full ketosis won't kick in. It is not a healthy or sustainable diet. My mate became really quite thin but was turning yellow. And he regained it all once on a normal diet.

 

[Drummer]

With diets like Atkins, the limit is the amount of carbs you can eat - the 20 gm a day is for the two week induction part of the diet - and apples are not part of the induction menu.
I started eating low carb in my early 20s, and I will be 70 in a few weeks. I have had people ranting and raving, threatening even, because I was doing Atkins but I always felt ill on that 'healthy' printout diet - the one with porridge or cereal with skimmed milk or wholemeal bread and low fat spread. When I could get back to the diet that suits me I felt so much better. So many people hear some vague half truths about low carb and can come dangerously close to doing damage to themselves.
There has been some research done on diets, comparing Atkins with a low fat diet for instance. Low fat and 1,100 calories was half as effective as Atkins and unlimited calories - plus none of the low fat group continued with it, unlike the Atkins group where all but one were still sticking to the diet when checked later - I'm not sure how much later, my memory isn't what it was.

 

[DaveB]

@DaveB Why carbs rather than fats? Or, say, a combination of carbs and fats such as is found in many processed foods?

Because as a generalisation fats don't make you fat or raise BS but carbs do. I would suggest we need to remember this in our diet thinking. I'm not suggesting full keto or any extreme dietary position as such but we do need to bear in mind the science of how the metabolism works and what food groups do what. We need to start from a scientific basis and not follow calories just because everywhere we look we see that word used and with very weak science to back up it's use in how we eat.

 

[rebrascora]

I think the thing about eating more fat is that it is self limiting. It is rich and filling and you get to a point where you don't want anymore... ie it is difficult to overeat fats because you would feel sick. Carbs on the other hand often make you want more, particularly at the 2 hour point after eating, when BG levels are dropping, so you need will power to resist the urge to snack between meals and the more carbs you eat, the more the body seems to want.... in my case anyway.
To me this is why following a LCHF way of eating is so much easier and sustainable long term because you feel full and sated and don't crave more.
Losing weight is all very well in pushing diabetes into remission, but the vast majority of people who lose weight through calorie restricted/low fat diets put it back on again. I have done it twice myself. Lost 2-3 stone on a low GI low fat diet and then gradually put it back on because those carb cravings slowly and insidiously take me back to my previous eating habits once the diet is over. I can't afford to do that now, so my new way of eating has to be enjoyable but easy to maintain for the rest of my life without too much will power. LCHF seems to be achieving that.

 

[Inka]

Because as a generalisation fats don't make you fat or raise BS but carbs do. I would suggest we need to remember this in our diet thinking. I'm not suggesting full keto or any extreme dietary position as such but we do need to bear in mind the science of how the metabolism works and what food groups do what. We need to start from a scientific basis and not follow calories just because everywhere we look we see that word used and with very weak science to back up it's use in how we eat.

I meant why do you say that it’s carbs that put on weight and thus cause insulin resistance? I’ve read that it’s actually animal fats that are involved in insulin resistance. Moreover, I believe - as do others - that a combination of low quality carbs and fat causes weight gain.

How come other nations that eat carbs like rice don’t put on weight? That’s a rhetorical question because I think the answer is the lack of processed ‘rubbish’.

And in Type 1 at least fats do cause insulin/BG issues eg the pizza effect.

 

[travellor]

Because as a generalisation fats don't make you fat or raise BS but carbs do. I would suggest we need to remember this in our diet thinking. I'm not suggesting full keto or any extreme dietary position as such but we do need to bear in mind the science of how the metabolism works and what food groups do what. We need to start from a scientific basis and not follow calories just because everywhere we look we see that word used and with very weak science to back up it's use in how we eat.

A bit of a sideline in the posts there maybe?
But, back to my question, no matter how much fat you eat, never the calories, you believe the science of the metabolism will always show you will lose weight, regardless of the amount of fat, even if fat doesn't self limit because you feel sick, as I could live on pork scratchings all day, 4000 calories plus would be no issue?
Even if not on full keto?

 

[EllsBells]

I'm playing devil's advocate to some extent. @Drummer it is great that 40g carbs daily has and continues to work for you. (The apple was an example of what 20g carbs looks like. I confess I did not know that the amount was that 20g for only the first 2 weeks on Atkins). But it is possible to gain weight on a low carb diet (even if it takes some doing). Fats do convert into energy - just differently to carbs - and the fats and protein burned in lieu of carbs can only be as much as you are physically using. It should also be acknowledged that there are different types of fats, some of which are better than others - not for BS/BG but for cardio vascular system, cell wall building etc.

OP mentioned consuming 4,000 calories a day which is almost double a normal adult intake of energy. Irrespective of whether calories as a useful indicator of energy consumption, that is a lot and weight loss would not be optimised in my opinion.

I also stated quite clearly that a low calorie diet is not great for micro BS management but it can help as part of overall weight loss generally. At no point was it mentioned that this would be a permanent dietary solution. It was meant as a means to an end ie weight loss.

 

[travellor]

I think the thing about eating more fat is that it is self limiting. It is rich and filling and you get to a point where you don't want anymore... ie it is difficult to overeat fats because you would feel sick. Carbs on the other hand often make you want more, particularly at the 2 hour point after eating, when BG levels are dropping, so you need will power to resist the urge to snack between meals and the more carbs you eat, the more the body seems to want.... in my case anyway.
To me this is why following a LCHF way of eating is so much easier and sustainable long term because you feel full and sated and don't crave more.
Losing weight is all very well in pushing diabetes into remission, but the vast majority of people who lose weight through calorie restricted/low fat diets put it back on again. I have done it twice myself. Lost 2-3 stone on a low GI low fat diet and then gradually put it back on because those carb cravings slowly and insidiously take me back to my previous eating habits once the diet is over. I can't afford to do that now, so my new way of eating has to be enjoyable but easy to maintain for the rest of my life without too much will power. LCHF seems to be achieving that.

You can always eat yourself back into diabetes in my mantra.
If you see reversing diabetes as simply a quick yoyo diet, that's a personal choice.
LCHF may well be an easier fix as you say, and a way to leave you sated with no pain.
But what if it isn't self limiting? What if you can overeat the fats?

It's personal choice at the end of the day.
And to quote a personal favourite line from a very cheesy film.
"I need my pain"

 

[travellor]

I'm playing devil's advocate to some extent. @Drummer it is great that 40g carbs daily has and continues to work for you. (The apple was an example of what 20g carbs looks like. I confess I did not know that the amount was that 20g for only the first 2 weeks on Atkins). But it is possible to gain weight on a low carb diet (even if it takes some doing). Fats do convert into energy - just differently to carbs - and the fats and protein burned in lieu of carbs can only be as much as you are physically using. It should also be acknowledged that there are different types of fats, some of which are better than others - not for BS/BG but for cardio vascular system, cell wall building etc.

OP mentioned consuming 4,000 calories a day which is almost double a normal adult intake of energy. Irrespective of whether calories as a useful indicator of energy consumption, that is a lot and weight loss would not be optimised in my opinion.

I also stated quite clearly that a low calorie diet is not great for micro BS management but it can help as part of overall weight loss generally. At no point was it mentioned that this would be a permanent dietary solution. It was meant as a means to an end ie weight loss.

I think that is my issue.
Already in this thread, I've been told fat can't make you fat, you say you can gain weight?
And it is a diet for micro BG management, which is one small symptom of diabetes, not the cause?
And if you don't micro manage, as I don't, is it of any use?

 

[travellor]

As far as I am aware, when it comes to approaches to eating (and many other things) "always" is a brittle concept.

You might always lose/gain/maintain from any given process, whereas other will/could have differing outcomes.

We certainly agree on this.
Results of a LCHF diet may not have any guaranteed, or even the desired effect, as you say.

 

[AndBreathe]

We certainly agree on this.
Results of a LCHF diet may not have any guaranteed, or even the desired effect, as you say.

Likewise for IF, Keto, Calorie Counting, Cambridge, Newcastle (or other food replacement) Diet, or even my world fabled Blue Smartie Diet.

If one size fitted all, there would be no need for this place, or others like it.

 

[travellor]

Likewise for IF, Keto, Calorie Counting, Cambridge, Newcastle (or other food replacement) Diet, or even my world fabled Blue Smartie Diet.

If one size fitted all, there would be no need for this place, or others like it.

As I say we finally agreed.
I'm good with that

 

[Drummer]

I can only tell you what I believe I have experienced.
I advise checking and experimenting to find the right menu - it is the only way.
Theoretically on a diet which doesn't cause the release of insulin the cells are not going to make the change to their walls which would allow an influx of molecules from the outside of themselves. It really is a case of 'your name not on the list, you's not gettin' in'.
I believe that quite a bit of fat goes through unabsorbed, if not eaten with carbs.

Dr Atkins did find some people were really resistant to weightloss and required help from supplements - they really were in need of various elements to fix their metabolism, or they were stuck using glucose and required a strong push to start ketosis.
For some the weight just fell off, for others it was a long slow process.
Some can only lose weight on very low carbs, others are able to lose on 90 gm a day - that is the highest carb amount for losing Dr A mentions.
I worked for Allied Lyons when Dr Howard was working on his hospital supervised weightloss program, which became the Cambridge diet. We packed the sachets of his mixtures. I did the storage testing which involved holding the sachets at various temperatures and humidities to see if they deteriorated. I had hundreds of the soups and jellies in the freezer, for the days when the cheesecakes were to be checked, but once my finances were sorted out I switched to calling in at the butcher on the way home, as even the Howard diet was too high in carbs when combined with the products under test. I think that the 3 sachets a day in use for the super obese amounted to 90 gm of carbs - pretty radical in the mid to late 1970s, but I never lost weight eating them.

 

[Eddy Edson]

I meant why do you say that it’s carbs that put on weight and thus cause insulin resistance? I’ve read that it’s actually animal fats that are involved in insulin resistance. Moreover, I believe - as do others - that a combination of low quality carbs and fat causes weight gain.

How come other nations that eat carbs like rice don’t put on weight? That’s a rhetorical question because I think the answer is the lack of processed ‘rubbish’.

And in Type 1 at least fats do cause insulin/BG issues eg the pizza effect.

I think a lot of the "carbs not calories" school of thought is based on what's known as the "carbohydrate-insulin hypothesis" for obesity: carbs => insulin production => food goes to fat accumulation, not energy => you feel hungry even though you're eating a lot. Restricting carbs => less insulin production => food used for energy rather than building fat => you feel full & don't eat as much.

As I understand things, it's an elaboration of the old Atkins-ish message that if you avoid carbs you can eat as much as you want to without getting fat.

Kevin Hall's group at the US NIH has run a series of experiments which for many (including me, fwiw) demonstrate that the carbohydrate-insulin hypothesis is simply wrong.

They have a "metabolic ward" where volunteers are confined so that their food intake and energy expenditure can be precisely measured, as part of randomised cross-over feeding studies, all very rigorous.

The latest study, just published, had volunteers eating as much as they wanted on two different diets, for two weeks each: a keto diet crafted along the lines recommended by Virta Health, the high-profile commercial keto proponents; and a whole-food low-fat diet. *Every single participant* ate substantially more on the keto leg than on the low-fat leg, despite seeing much higher insulin production with the latter.

Previous experiments showed keto diets delivering no advantages in terms of energy expenditure or weight loss, admittedly over limited time frames, but nervertheless providing lots of evidence against the usual low carb canards, ie:

- Carbs make you hungrier than other macros.
- Carbs make you gain weight more than other macros.
- Carbs reduce your energy more than other macros.

I usually hate Youtubes etc but Hall actually presents really well. An overview of the last serveal years work from his lab:

Main publications: https://www.niddk.nih.gov/about-niddk/staff-directory/biography/hall-kevin/publications

 

[Inka]

Kevin Hall's group at the US NIH has run a series of experiments which for many (including me, fwiw) demonstrate that the carbohydrate-insulin hypothesis is simply wrong.

They have a "metabolic ward" where volunteers are confined so that their food intake and energy expenditure can be precisely measured, as part of randomised cross-over feeding studies, all very rigorous.

The latest study, just published, had volunteers eating as much as they wanted on two different diets, for two weeks each: a keto diet crafted along the lines recommended by Virta Health, the high-profile commercial keto proponents; and a whole-food low-fat diet. *Every single participant* ate substantially more on the keto leg than on the low-fat leg, despite seeing much higher insulin production with the latter.

Fascinating @Eddy Edson Thank you for posting