Ketogenic Diet Explained – Can it be used to treat Chronic Diseases? (Part 2)

Written by Colleen Rempel, BSc (Human Nutritional Sciences)

Certified Holistic Nutritionist, CHN

PN Lean Eating Coach

There has been substantial evidence to support the benefits of using a very low carbohydrate ketogenic diet (less than 50g net carbohydrates/day) as a therapeutic diet for individuals with type 2 diabetes, obesity, and cardiovascular disease (1). These chronic diseases are increasing in prevalence every year and impacting millions of lives (2). Chronic disease not only decreases lifespan and quality of life of the individuals impacted by them but also places a huge burden on the healthcare system (2, 3, 4).

In Canada alone, it is estimated that treating individuals with chronic diseases cost $39 billion per year, which is around 42% of the total direct medical costs (4). Interestingly, 40% of these chronic diseases are preventable (5). In the United States, 70% of chronic diseases and 50% of premature deaths are preventable by changing behavioural risk factors, such as diet (6). The US currently spends $750 billion dollars annually on pharmaceuticals to treat these diseases (7). If we look at chronic disease from a global perspective, the WHO estimates that up to 80% of premature deaths caused by heart disease, stroke and diabetes could be avoided (8).

What if we could use nutrition to help prevent and treat chronic diseases to save both lives and healthcare costs? Medical nutrition therapy for chronic diseases has the potential to provide the following benefits:

1. Prevent chronic disease and premature death
2. Decrease cost of treating chronic diseases
3. Decrease side effects from medications for chronic diseases
4. Reduce symptoms and improve quality of life for chronic conditions that are not responding to medication

Out of all the chronic conditions out there, there is especially an urgent need for successful, low-cost therapies for type 2 diabetes, obesity, and heart disease, as there are several comorbidities associated with these diseases. Let’s dive into the research explaining how the ketogenic diet could be one of these therapies.

Type 2 Diabetes

From the 1970’s to the 1990’s, the number of individuals with Type 2 Diabetes Mellitus (T2DM) has almost doubled (2). According to the World Health Organization, this number is expected to double again between the years of 2000-2030 (8). Currently, there are 170 million individuals worldwide affected by T2DM and this will increase to 366 million by 2030 (3). By the year 2030, it is estimated that diabetes will be #7 of leading causes of death worldwide (9).

Insulin resistance is a key characteristic of individuals with T2DM and pre-diabetes, which can lead to increased fasting blood sugar, weight gain, high cholesterol, and glycated hemoglobin (10). The ketogenic diet has been found to decrease these biological markers.

Hussain and colleges (2012) studied obese individuals with T2DM and treated them with a low, calorie, high nutritional value diet or a low-calorie ketogenic diet for 6 months (10). At the end of the study, the ketogenic diet was found to have more benefits than the low-calorie diet alone in the following parameters: blood glucose levels, HbA1c (glycated hemoglobin), body weight, body mass index, total cholesterol, uric acid, urea and creatinine (10).  This is especially interesting because these results still occurred after anti-diabetic medications were reduced in approximately half of the individuals in the ketogenic diet group. The most unexpected results occurred with the decrease in glycated hemoglobin (10).

Two other studies that were conducted over a longer period of time (1 year) found even greater improvements in HbA1c than the study by Hussain and colleagues (2012) after following a ketogenic diet compared to a low-calorie diet (11, 12).

Additional studies are needed to determine appropriate adjustments needed in anti-diabetic medication when following a ketogenic diet, as most participants needed a reduction in their medication to avoid hypoglycemia and dehydration (10). Due to the effectiveness of the ketogenic diet in lowering blood sugar, it is strongly advised that diabetic patients who chose to follow a KD be under close medical care to watch blood sugar levels and adjust medication levels, if needed.

But what if we could prevent T2DM from occurring in the first place? Obesity is strongly associated with an increased risk of diabetes and according to CDC, 55% of diabetic patients are obese and 58% are overweight (10, 13). Even moderate amounts of weight loss in overweight and obese individuals have been shown to substantially decrease diabetic risk (10).

Weight Loss

Many individuals who are interested in losing weight chose to do so for aesthetic reasons. I mean, who doesn’t feel better when they are leaner and fit their clothes well? But losing weight has a lot more benefits than feeling good naked!

Being a healthy weight increases energy, productivity, and lifespan while decreasing the risk of chronic diseases that can dramatically decrease quality of life (10, 14). An obese or overweight adult has a life expectancy of three to seven years lessthan an adult with a healthy weight (14). What would you do with an extra 3-7 years of life?

Losing weight in adulthood has been found to be extremely difficult for the majority of the population (15). This is one reason why so many efforts are placed on reducing childhood obesity rates – so these children don’t have to deal with the task of substantial weight loss in adulthood (15). This is where the ketogenic diet comes into play. There is consistent and strong evidence supporting the use of ketogenic diets for substantial weight loss (1). Some of the reasons the ketogenic diet is thought to improve weight loss results compared to other nutrition protocols includes:

1. Appetite suppressing effects of ketone bodies (16),
2. Higher satiety due to effects of appetite control hormones (17),
3. Reduction in fat storage, paired with increased fat breakdown (18),
4. Increased metabolism due to gluconeogenesis (19)

A meta-analysis of 13 randomized control trials found that individuals on a very low carbohydrate ketogenic diet achieved greater weight loss over the long term than those on a low-fat diet (20) The ketogenic diet also provided benefits of reducing diastolic blood pressure and TAG, while increasing HDL-C, which are all important factors for reducing heart disease risk (20).

Cardiovascular Disease

Cardiovascular disease (CVD) is considered a group of diseases that includes hypertension (high blood pressure), myocardial infarction (heart attack), atherosclerosis, stroke, ischemic heart disease, peripheral vascular disease, and heart failure (21). It is the number one killer of men and women in the US and an estimated 1 in 3 Americans have one or more types of CVD (21). Risk of CVD increases with diabetes and obesity (Body Mass Index > 30) (21). As stated previously, the ketogenic diet can be used to reduce weight and biochemical markers of T2DM, which can indirectly help decrease risk of CVD.

According to a review by Paoli and colleagues (2011), there is evidence that the ketogenic diet has beneficial effects on CVD risk (1). This has been questioned by researchers in the past due to the high-fat content of the ketogenic diet compared to other diets with ‘balanced’ macronutrient distributions, and it’s potential to have negative impacts on cholesterol levels in the blood (22, 23).

Interestingly, recent studies have shown that being in physiological ketosis can actually lead to benefits in blood lipid profiles, such as reduced triglycerides and total blood cholesterol and increased HDL-cholesterol (the “good” cholesterol) (1). Additionally, ketogenic diets have been demonstrated to increase the size and volume of LDL-cholesterol, which is considered to lower CVD risk since smaller LDL-cholesterol proteins have a higher chance of accelerated atherosclerosis (24).

Essentially, there is evidence supporting the beneficial effects of the ketogenic diet on cardiovascular disease risk factors and little evidence to support that high dietary fat consumption as part of a ketogenic diet increases CVD risk factors (24, 25)

Long story short, the ketogenic diet has been shown as an effective therapy for weight loss, T2DM, and cardiovascular disease. If we can decrease the prevalence of these diseases, save health care costs, and help individuals live a few more years of productive and healthy lives, what have we got to lose?

A few cautions before adopting the Ketogenic Diet

As much as it would be wonderful if the ketogenic diet was the magic pill to solve all problems related to chronic diseases, the reality is, it is not. It does require careful planning and execution and monitoring by a health professional for it to be safe and effective. It is especially important to consult your health care practitioner before starting the ketogenic diet if you taking any of the following:

1. Insulin
2. Glucose Lowering Medications
3. Blood Pressure Medications

You may need to alter your dose of these medications as your body adapts to the ketogenic diet. Some common, less-serious side effects of going on the ketogenic diet include: lightheadedness, dizziness, fatigue, difficulty exercising, poor sleep, and constipation and are often referred to as the “keto flu”. After 1-3 weeks of being on the diet, these symptoms usually pass. Ensuring you are consuming enough sodium, potassium, and magnesium on the diet by eating whole food based proteins and green vegetables can help minimize these symptoms (26).

References:

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2. Fox C.S., Pencina M.J., Meigs J.B., Vasan R.S., Levitzky Y.S., D’Agostino R.B. Sr. (2006). Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: the Framingham heart study. Circulation; 113:2914–8.
3. Wild S., Roglic G., Green A., Sicree R., King H. (2004). Global prevalence of diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care;27:1047–53.
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