Origins Of The Ketogenic Diet As A Medical Therapy
Original research into a ketogenic diet began in the early 1900s as a way to manage epilepsy and minimize seizure activity. By inducing ketosis, patients had mitigation of seizure activity and improvements in cognitive function, highlighting the capacity for ketones to provide energy to the brain. From the 1960s onwards, very low carbohydrate ketogenic diets have become more commonly known as a methods for obesity treatment. Recent work over the last few decades has provided evidence for the therapeutic potential of ketogenic diets in many pathological conditions, including diabetes, PCOS, acne, neurologic diseases , cancer, and the amelioration of respiratory and cardiovascular disease risk factors. The possibility that modifying food intake can reduce or eliminate need for medications, which often carry significant side effects, calls for serious investigation. Dietary carbohydrate intake has been studied with variable findings, which is often due to lack of standardization of carbohydrate intake and inability to confirm ketosis without checking blood ketone levels.
This review will highlight the current understanding of the role of ketogenic diets for weight and metabolic management, diabetes, coronary vascular disease, and non-alcoholic fatty liver disease .
What You Drink Can Affect Your Risk For Metabolic Syndrome
Your doctor may ask you about your diet, provide you with some guidance, and refer you to a registered dietitian or nutritionist who can tailor a plan to your particular needs. But your doc may not ask you what youre drinking.
Fruit juices and sugary beverages can make your blood sugar and triglyceride levels soar. Alcoholic beverages may cause hypoglycemia and an initial drop in blood sugar, but those numbers will then climb especially if youre consuming mixed cocktails. Water is the best beverage for healthy hydration. And its good to know that tea, coffee, skim or low-fat milk, and fruits and vegetables provide water without extra calories, too.
How Long Does It Take For Insulin Resistance To Reverse
The amount of time it takes to reverse insulin resistance is very individual – it depends on how far it has progressed and the lifestyle changes you implement. Also, when the pancreas cannot produce enough insulin for your body, theres a chance that insulin resistance may no longer be able to be reversed. The sooner you can address your insulin resistance, the sooner you can take steps to reverse it. Research shows that for some people who are newly experiencing insulin resistance, it may take about six weeks to see improvement after making healthy changes.
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Articles On Metabolic Syndrome
Metabolic syndrome is a group of risk factors that include abdominal fat, high blood pressure, high blood sugar, and unhealthy cholesterol levels. Treatment is focused on tackling each of these conditions. The goal is to cut your odds of blood vessel disease and heart disease, as well as diabetes.
In most cases, the best treatment for metabolic syndrome rests with you. Changes to your behavior — such as eating healthier and getting more exercise — are the first things your doctor will suggest. By adopting some healthy habits, you may be able to eliminate your risk factors completely.
Sitting Too Much Puts You At Risk For Metabolic Syndrome
It may sound odd, says Jo-Ann Heslin, RD, the author of Diabetes Counter, but sitting or sedentary activities such as watching TV, using the computer, sitting at work or sitting while commuting have been identified as risks for metabolic syndrome even when you incorporate modest amounts of regular activity into your day. A study published in June 2015 in Diabetologia connected sitting time with a positive risk for diabetes, reporting that for every hour of daily TV viewing, a persons risk for diabetes increased by 3.4 percent.
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Is There An Insulin Resistance Test
Unfortunately, there is no insulin resistance test that is commonly used in medicine. Your doctor can use a blood glucose test or hemoglobin A1C test to evaluate your blood sugar levels. But remember that in the early stages of insulin resistance, your blood sugar levels may still appear normal, so a blood glucose or A1C test is not always a reliable test of insulin resistance.
How Is This Different From Type 2 Diabetes
Once the cells are unable to use the glucose, it remains in the bloodstream. The body senses the high glucose and tells the pancreas to secrete more insulin to deal with the excess glucose. Eventually, over years, the pancreas is unable to keep up. The glucose levels remain high in the bloodstream, and diabetes is then diagnosed by a blood test. When someone is diagnosed as diabetic, the pancreas makes little or no insulin because it can not do it anymore. Medications lower the glucose in the blood to allow the cells to use it. Uncontrolled diabetes can wreak havoc on the body and lead to hardened arteries in the heart, eyes, legs, and kidneys. You can refer to my previous post on the causes of insulin resistance.
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How To Reverse Insulin Resistance
Insulin resistance is a very common condition, affecting approximately 30% of American adults. If you have insulin resistance, you are probably wondering if there is a way to reverse it. Luckily, there are natural ways to reverse insulin resistance and increase insulin sensitivity. Here we go over how to reverse insulin resistance with nutrition, exercise, and lifestyle changes.
Congenital Defects Of Insulin Function
In presence of children with severe phenotypes, an inherited alteration of the action of insulin should be suspected and fasting serum insulin should be measured. If insulin is elevated with normal or high blood glucose, additional studies should be directed to look for insulin receptor mutations, circulating anti-insulin receptor antibodies, or other disorders.
Inherited lipodystrophies are rare disorders in which selective loss of adipose tissue and a predisposition to insulin resistance are typical . Among them, some manifest at birth, such as congenital generalized lipodystrophy and neonatal progeroid syndrome, while others have a later onset, such as familial partial lipodystrophies and mandibulosacral dysplasia manifest later in life. The higher is the extent of body fat loss in these patients, the more severe is the metabolic syndrome by which they are affected. Table 1 lists all subtypes of genetic lipodystrophies classifying them according to their possible inheritance patterns or their possibility to be caused by a de novo heterozygous mutation. The two most prevalent variations are CGL and FPLD. For its complex clinical presentation and severe metabolic complications we will focus on CGL, which has an estimated prevalence of 1 in 10 million.
Table 1. Genetic lipodystrophies listed according to their possible inheritance patterns.
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Accumulation Of Bioactive Lipid Intermediates And Insulin Resistance
Collectively, these findings in rodents warrant further investigation in humans to discern whether SPT-1 and Des-1 are viable therapeutic targets to reverse insulin resistance and restrain T2D progression by diminution of cellular bioactive lipids, including ceramides. Furthermore, it will be important to unravel mechanistic underpinnings of the athleteâs paradox to determine the site of uncoupling related to lipid accumulation for proinflammatory signaling. It is likely that mitochondrial content, lipid droplet localization, the precise molecular species of the lipid and the relative abundance and activity of potent transcriptional regulators of key pathways in metabolism, insulin action, and inflammation converge to explain the discrepancies in human populations and experimental mouse models.
What Does Insulin Resistance Mean
Insulin resistance is a condition in which your cells become resistantor less sensitiveto the insulin your pancreas naturally makes. Research indicates it affects 32% of Americans. Worldwide, the incidence ranges from 15% to 46% of adults.
Why your body may start resisting insulin isnt exactly clear. But when it does occur, glucose doesnt get absorbed into the cells the way it should, so higher-than-normal glucose levels remain in the bloodstream. In response to the elevated blood sugars, the pancreas amps up production of insulin in an effort to get the glucose into the cells.
For a while, that increased insulin production can help keep blood sugar levels under controlwhich is why insulin resistance often doesnt produce symptoms. And if insulin resistance and pre-diabetes is diagnosed and managed early, insulin resistance may never lead to diabetes.
But when insulin resistance continues unabated, the insulin-producing cells in the pancreas eventually stop working properly and conditions like prediabetes and Type 2 diabetesin which your pancreas either doesnt make enough insulin or the body doesnt use it effectivelyemerge. By contrast, Type 1 diabetes is typically an inherited condition in which the pancreas doesnt make any insulin.
According to the CDC, Type 2 diabetes is diagnosed when fasting blood sugar level is 126 mg/dL or above. Prediabetes is when your levels are 100-125 mg/dl.
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Tip For Reversal #: Lower Your Stress Levels
Chronic stress may contribute to the development of insulin resistance. A 2016 study published in the Journal of Epidemiology examined the effects of chronic stress in over 700 workers and found that high levels of stress were associated with higher cortisol and insulin resistance. This makes sense since cortisol is our main stress hormone and activates the fight-or-flight response in times of stress. It also elevates blood sugars and insulin in the body.
Find ways to alleviate stress and help manage your stress levels, whether thats exercise, yoga, meditation, mindfulness exercises, or deep breathing.
Tips To Naturally Reduce Insulin Resistance
Reducing your insulin resistance is not about eating fewer carbs and working out harder. It is about incorporating diet and lifestyle hacks to slowly reverse insulin resistance. It took time for your body to develop it, so it will take time for it to reverse. Diet and lifestyle modifications may work better than medications according to some researchers. Expect it to take about 3-6 months to see changes in your blood work. Lets break down the 10 tips into two categories.
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What Are The Signs & Symptoms Of Metabolic Syndrome
People with metabolic syndrome may have:
- high body mass index and waist circumference
- blood test results that show high triglycerides, low HDL cholesterol, or high fasting blood sugar
- acanthosis nigricans. This darkening of the skin in folds and creases, like the neck and armpits, is a sign of insulin resistance.
Other medical problems associated with metabolic syndrome and obesity include:
- fatty liver
- obstructive sleep apnea
Adipose Tissue As An Endocrine Organ
It is known for over a decade now that adipose tissue dysfunction is a central underpinning link to obesity in the pathogenesis of the MS and T2D . Over the past decade adipose tissue has been redefined as a dynamic metabolic, endocrine organ secreting various cytokines, chemokines and adipokines in a paracrine, autocrine, and endocrine fashion. Much of this work is reviewed in references . Adipose tissue is no longer simply considered a passive energy storage depot, but instead is now recognized as the largest endocrine organ in the body secreting more than a hundred factors including fatty acids, cytokines, chemokines, prostaglandins, and steroids. These factors can exert local paracrine effects or are released into the circulation yielding systemic effects on brain, liver, and skeletal muscle. These adipose-secreted factors regulate such processes such as glucose metabolism, appetite, inflammatory signaling, immune function, angiogenesis, blood pressure, and reproductive function. Given that adipose tissue comprises a heterogeneous mix of cell types, including macrophages and other immune cells, endothelial cells, vascular smooth muscle cells, fibroblasts/preadipocytes, and mature adipocytes, the interplay among these cell types and specific roles of each of these cells in adipose tissue development, substrate metabolism, and production of secretory factors are extremely complex and still not well understood.
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Glycogenesis: Helps To Store Glycogen
Not every time your body needs energy in the form of glucose. Most of the time when your body isnt needing energy right away, the insulin stores the extra blood sugar into muscle cells, fat cells, and liver for later use.
The energy which is stored in these cells is reserved in the form of glycogen which is a multi-branched polysaccharide of glucose.
What Are The Symptoms Of Insulin Resistance
At first, your pancreas tries to fight the effects of insulin resistance by releasing more insulin. Even though your cells are not responding to insulin as well as they should, the fact that there is more insulin in your bloodstream helps keep your blood sugar levels normal. Therefore, you may not have any noticeable symptoms of insulin resistance initially.
Over time, as insulin resistance gets worse, even more insulin wont be able to make up for your cells weak response to insulin. At this point, high blood sugar levels often become the first key sign of insulin resistance. As high blood sugar persists, you may begin to notice symptoms like excessive thirst, frequent urination, and headaches.
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Blood Pressure And Cholesterol Medications
High blood pressure is one of the most common issues among those with metabolic syndrome.
One large study estimated that nearly 28% of those with metabolic syndrome have hypertension. Doctors use several types of medication to control high blood pressure, including :
- Diuretics
- Calcium channel blockers
- ACE inhibitors
Your doctor may prescribe one of these medications if diet and lifestyle changes fail to improve your blood pressure. Similarly, they may suggest statins or cholesterol absorption inhibitors to lower your cholesterol and possibly your triglycerides.
Insulin Index Of Food
The insulin index measures the effects of foods on the blood insulin level during a period of two hours after ingestion.
Therefore, its a better measure when fighting insulin resistance than the glycemic load or index
It was unknown for quite a while and is still often neglected, but protein and fat can stimulate insulin secretion too .
On the contrary, pure fats like extra virgin olive oil arent causing an insulin or blood glucose response.
But seldom they are ingested exclusively. Nevertheless, the effect of fatty acids on insulin is mild.
Amino acids, on the other hand, can have a medium impact on blood insulin. For this reason, many low-carb diets dont work for weight loss.
So, how do fat and protein increase insulin levels without affecting blood glucose?
The stomach secretes two hormones that increase insulin production glucagon-like peptide one and glucose-dependent insulinotropic polypeptide , the incretin hormones.
The incretin effect is triggered by oral intake of glucose, too, where it is responsible for 50 to 70 percent of its overall insulin response.
Moreover, the insulin index considers all foods. Hence, even non-caloric sweeteners like sucralose are significantly raising insulin levels through the incretin effect
But there are various glucose-independent pathways to increase insulin. For example, the artificial sweetener saccharin around your mouth raises insulin even if you spit it out
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Insulin Resistance And Insulin Sensitivity
Insulin resistance and insulin sensitivity are two topsy-turvy terms that confuse a lot of people it is therefore advised to take caution while dealing with these two terms medically.
If your doctor tells you that you have insulin resistance then you have low insulin sensitivity conversely if you seem to have low insulin resistance that your body has high insulin sensitivity which is more or less beneficial for your body as it helps regulate your blood sugar levels and lowers your BMI by keeping your weight in check.
You are at the highest risk of insulin resistance if you are either prediabetic or have a long family history of type 2 diabetes in the family.
Ketones An Alternative Fuel Source
As a species, we have metabolic flexibility with the capability to rely on alternative fuel sources for energy. Humans are not dependent on exogenous sources of glucose for optimal function rather, we have evolved over millennia to adjust to changing conditions and adapt to both scarcity and abundance. As Dr. Randle explained in the Lancet in 1963, Substrate metabolism in the normal human body is flexible. Our bodies have evolved to utilize different fuel sources depending on their availability.
As an alternative to glucose utilization, the body can metabolically flex into a state of ketosis, which relies on fat-derived ketones produced in the liver to provide fuel to nearly every cell in the body . Ketonesacetoacetate, beta-hydroxybutyrate, and acetoneare water-soluble molecules produced by the liver from fatty acids when blood glucose and liver glycogen stores have been minimized. Glycogen depletion occurs and ketone levels rise during periods of fasting, low carbohydrate intake, intense exercise, starvation, or due to complete lack of insulin in untreated type I diabetes.
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A Prescription That Works
Although few people welcome a prescription of diet and exercise, Dr. Hatipoglus recommendations are not difficult to follow:
To lose weight, avoid carbs. Carbohydrates need insulin to be metabolized. Even if you eat a small piece of bread, your need for insulin rises, and it signals the body to hold on to fat, she explains. If you dont prod the insulin, your body will use the fat you have. She advises eating lean protein, nuts, vegetables and low-carb fruits such as berries and melon. Once you reach your desired weight, switching to a Mediterranean diet will help you maintain a healthy weight.
Move it and lift it. I tell patients to do at least 30 minutes of exercise a day, five days a week, but that it wont be enough. I recommend adding weight training twice a week, because muscle mass makes you more insulin sensitive, she says. Walking, swimming, biking, dancing and even vigorous gardening or housecleaning are aerobic activities that can count as exercise. Weight training is easy to do at home. Buy 2- or 5-pound weights and lift them while you are watching TV, Dr. Hatipoglu suggests.
As your weight drops, your blood pressure, blood sugar and blood lipid levels will begin to normalize. Over time, metabolic syndrome will disappear.
Youll be surprised at how well this prescription impacts your overall health, says Dr. Hatipoglu. It brings your youth back fast.
This article originally appeared in Cleveland Clinic Heart Advisor.