How to reverse diabetes type 2. A more appropriate statement is how to put diabetes type 2 into remission.
A person has put diabetes type 2 into remission when she or he has made significant long-term improvements to their insulin resistance. This will be reflected by normal blood glucose levels. Studies have proved that remissions can take place in obese, or overweight diabetics when they continuously reduce their weight by 15 kg.
Remissions happen in normal weight type 2 diabetics who lose about 10% of their body weight. In both cases the weight loss must be sustained, and it should be done as quickly and safely as possible.
There is overwhelming evidence that by far the best way to lose that weight and consequently put diabetes type 2 into remission as well as mitigate complications from T2D, is the adoption of what is called NUTRITIONAL KETOSIS.
Nutritional ketosis is when someone voluntarily cuts down on the consumption of carbohydrates to speed up the production of ketone bodies and cause a metabolic effect that maintains a steady blood sugar level, and keeps insulin release to a minimum.
The word ketosis comes from ketone bodies which are three compounds made in the liver, and are used as a source of energy in particular conditions. Generally, our energy sources come from a certain quantity of carbohydrates. Carbohydrates are broken down into glucose. The glucose is then used to generate energy.
When our carbohydrate intake is low, the body must use an alternative energy source. That source is ketone bodies. The ketone bodies themselves come from the building blocks of fat, called fatty acids. The liver makes ketone bodies from the fatty acids in their cells as well as from the fatty acids in the blood.
The arguments for the use of nutitional ketosis to put T2D into remission are compelling; and, many of the physiological effects of a ketogenic diet are from the substitution of glucose for ketones as fuel.
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- For T2 diabetics ketone metabolism as an energy source is of par excellence for several reasons. First, insulin release or secretion from the pancreas is greatly reduced. Over time this leads to increased insulin sensitivity, or less insulin resistance which is triggering the events causing theT2D.
- Secondly, as the blood glucose levels lower, less insulin is released and less glucose is deposited as fat in the liver and the pancreas. Remember, this is the fat that is more than the individual can tolerate and which is the root cause of T2 diabetes.
- Thirdly, the lower glucose levels also cause an increase in the release of the hormone glucagon. Glucagon has the opposite effect of insulin, in that it elevates blood glucose levels, but this glucose does not come directly from food; it comes from the glycogen in the liver and fat deposits. This glucose is available for immediate energy and will not be converted into fat.
- This is because glucagon facilitates the burning of fat. Any oxidation of subcutaneous fat is exactly what we want if the objective is to clear the excess fat from the liver and pancreas which is causing insulin resistance.
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- Ketone bodies are used for fuel in almost all of the cells, including those of the brain. Some people even report they have more clarity when they are in nutritional ketosis. It is no secret that ketone bodies have been found to increase cognitive function; over a 100 years ago they were used in treatments to reduce the frequency of epileptic seizures. Eur J Clin Nutr 67, 789–796 (201
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- Weght loss is made easier because ketone bodies suppress hunger. Am J Clin Nutr 87, 44–55 (2008) Indeed, after 24 hours on a 36 hour fast , I am not hungry. The appetite suppressant effects of ketone bodies are shown by people who eat a diet of less than 20 to 50g of carbohydrates a day.
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- Ketone bodies also increase fat burning during exercise. Br J Sports Med 48, 10771078 (2014). Interestingly, for athletes, studies have found that there may also be a performance advantage to the ability to use fat oxidation while on a keto diet.
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- Many people hold the view that low-fat diets are more effective for weight loss. Nonetheless, studies show that very low carbohydrate ketone diets (VLCKD) achieve larger long-term reductions in body weight, triglycerides, diastolic blood pressure, and greater increases in high density lipids HDL, low density lipids LDL and cholesterol compared to a low-fat diet. Br J Nutr 110, 1178–1187 (2013).
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- Studies also show that protein is more satiating than carbohydrate. A study of a keto diet and a non-keto diet with equal amounts of protein found that the keto -diet subjects felt less hungry leading to a greater weight loss.
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- Reduction of carbohydrates to induce nutritional ketosis can result in important changes in blood lipid contents: blood triglyceride levels are lowered, total cholesterol is lowered, the levels of healthy high density lipids HDLs are increased as is cholesterol. There is also a change in the size and volume of small LDLs which can cause artherosclerosis.
- After a carbohydrate restricted diet, studies showed a change from smaller, more dense LDL particles that are more atherogenic, to larger healthier LDLs . They also indirectly showed a decrease in insulin resistance. Lipids 44,297-309 (2009) Many of these changes in the lipid profile are thought to be independent of fat loss and are caused by a reduction in insulin.
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- The relationship between carbohydrate intake and the size and density of LDL particles, appears to be stronger in individuals with diabetes. Smaller and denser LDL particles are known to increase the risk of cardiovascular disease. When there are high plasma triglyceride levels, there are very low density particles which then become dense low density lipids.
- Although Insulin normally acts to suppress VLDL productiion, in diabetics with continuous release of insulin due to high blood glucose levels, the high insulin levels leads to hepatic insulin resistance. As a result, small, dense atherogenic LDL particles become prevalent.
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- The insulin also causes the liver to actually synthesize triglycerides and cholesterol. But nutritional ketosis inhibits this. Ketone bodies are made instead of cholesterol.
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- In addition to the positive impact on weight management, nutritional ketosis has been found to improve glycemic control and reduce medication usage. Even in obese diabetics it can reduce fasting blood glucose levels and improve overall glucose metabolism, by reducing A1c levels and reducing anti-diabetic medications.
- A VLCKD decreases the need for exogenous insulin; the higher the ketone levels, the lower the production of glucose from the liver. This suggests that higher levels of ketones are associated with improved glycemic control. Studies show that diabetics on a very low carbohydrate keto diet compared to a common high carb diet released less insulin and required less insulin to achieve and maintain a lower blood glucose level.
- This suggests greater insulin sensitivity and better glycaemic control. Patients in some of these studies were able to stop or decrease their diabetic medications after switching to the VLCKD intervention. The nutritional ketosis groups also show decreased blood pressure, and inflammation.
So how can we as diabetics get our bodies into nutritional ketosis. We do it by restricting our dietary intake of carbohydrates to accelerate the production of ketones to induce a metabolic effect to stabilize blood sugar and minimize insulin release. An effective daily ketogenic diet comprises of 20 to 50 g of carbohydrate, 1-1.5 g of protein per kilogram of body weight, and enough fat to feel satisfied. After a number of weeks the body adapts to the use of ketones as the principal energy source.
We can enhance weight loss (fat loss) even further by combining a keto diet with intermittent fasting.
It is an important lifestyle change, easier for some than others. It requires a single mindedness of purpose. As we are human, we might relapse because of different pressures: lack of faith in oneself, family worries, stress over money, disencouragement from others who have negative views about keto diets.
Opposition to the keto diet has its origins in the belief that dietary fat leads to bad blood lipid profiles. This came from the diet-heart hypothesis in the 70s. However, up until now the hypothesis has not been proved. In diabetics, fat intake and cardiovascular disease has not been correlated.
What is the takeaway from entering into nutritional ketosis? It is highly effective in the management of weight and the factors involved in T2D. By using ketones, we can reduce the primary cause of insulin resistance which produces T2D and put it into remission. Moreover, nutritional ketosis removes a lot of the risks of the negative consequences of T2D such as end-kidney disease, artheroscleoris, other cardiovascular diseases, and amputations.