Keto Diet and Diabetes

Background

Prior to the advent of exogenous insulin for the treatment of diabetes mellitus in the 1920's, the mainstay of therapy was dietary modification. Diet recommendations in that era were aimed at controlling glycemia (actually, glycosuria) and were dramatically different from current low-fat, high-carbohydrate dietary recommendations for patients with diabetes. For example, the Dr. Elliot Joslin Diabetic Diet in 1923 consisted of "meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, tea" and contained approximately 5% of energy from carbohydrates, 20% from protein, and 75% from fat. A similar diet was advocated by Dr. Frederick Allen of the same era.

So, "keto" or low carb/high fat (LCHF) diets are nothing new to control Type 2 Diabetes.  

(Here is a link to the basics and "what you can eat" list.)

Before insulin became available in the 1920's, the Keto diet WAS the way to control diabetes.

What happened?

It all started back in the 1950s, when there was an epidemic of middle-aged men dropping dead of heart attacks.₂

So the "science" and USDA assumed that there was a link between saturated fat and clogged arteries.  But was there really an "epidemic" of this type?

Nope.

No. Instead, there was an epidemic of men aged 50 and up. In 1900, the average life expectancy of an American male was 48 years....By 1950, however, the average American male was living into his seventies. That means more men were dying of heart attacks simply because more were surviving long enough to have one.₂

And then...the "proof"

Then, when President Dwight David “Ike” Eisenhower had a heart attack in 1955, his cardiologist, the famed Dr. Paul Dudley White, blamed the president’s high-fat diet and put him on a low-fat diet instead. (The fact that Eisenhower had smoked four packs of cigarettes a day up until 1949 didn’t seem to cross anyone’s mind as being a likely cause.) When Ike ran again for president in 1956, the low-fat diet was credited for his recovery and ability to return to work. What never got publicized is that Ike hated his low-fat diet. He felt hungry all the time even as he gained weight and his cholesterol continued to rise. He also continued to have heart attacks—six more after leaving office. The last and fatal attack occurred in 1969.₂

Follow the money...

When the USDA chose the "Basic Four Food Groups" in the 1950's, they invited executives from major food companies to help.  

The dutiful "regulators" reasoned:

"(The USDA) felt that food industry groups would have a vital interest in any food guide sponsored by the Government." ₃

So...farmers, food companies, and  lobbyists and the USDA decided that we needed more carbs.

So...what now?  Back to the National Institutes of Health...

The diet they studied was nearly text-book Atkins.  Subjects started 20 or fewer grams of carbohydrates per day, but (unlike Atkins, which called this "induction" and ended this stage after two weeks) the study waited until the subjects had lost half of their weight OR experienced carb cravings, and then began increasing carbs by 5 per day, until they stopped losing weight.

What did they find?

In this single-arm, 4-month diet intervention, an LCKD resulted in significant improvement of glycemia, as measured by fasting glucose and hemoglobin A1c, in patients with type 2 diabetes. More importantly, this improvement was observed while diabetes medications were reduced or discontinued in 17 of the 21 participants, and were not changed in the remaining 4 participants

Conclusion

The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.

So...When you see somebody in a group tell you that a Keto diet works - listen.  It might not work for you, for various reasons...but the National Institutes of Health...agree with those who are suggesting that low carb is a good way for people with diabetes to get a handle on this disease.

Based on a article for the National Instututes of Health

(2)The FDA’s phony nutrition science: How Big Food and Agriculture trumps real science — and why the government allows it

(3)The Food Pyramid that Made Us Fat