Is a Keto diet harmful??

[kokhongw]

The Accord study looked specifically at patients with T2 diabetes over a 5 year period and reported increased all cause mortality in the intensive control group with somewhat contradictory findings re CVD and the effects of hypoglyceamia resulting from the intensive control.
https://academic.oup.com/jcem/article/97/1/41/2833135
The final 2 sentences of the article are:-

“If ACCORD has taught us anything, it is that there is no single recipe for glycemic management of CVD risk in T2DM. The old principles still hold: treat each patient as an individual (31) and first do no harm”
No s**t sherlock!!,

We have to put into perspective that the ACCORD study/conclusion regarding hypoglycemia due to intensive control...is actually specific to responses due to pharmacological intervention (insulin/insulin secretagouges). The same conclusion cannot be drawn from low stable glucose/insulin levels due to dietary intervention.

 

[Member496333]

Indeed. The primary motivation for a T2 in dietary ketosis, besides losing body mass if the patient is overweight, should be to come off medication. I can’t see a mechanism whereby, without medication, they are likely to become hypoglycaemic. The body does not require carbohydrate in order to supply glucose. The liver will manufacture it in the small quantities that it requires.

 

[Krystyna23040]

We have to put into perspective that the ACCORD study/conclusion regarding hypoglycemia due to intensive control...is actually specific to responses due to pharmacological intervention (insulin/insulin secretagouges). The same conclusion cannot be drawn from low stable glucose/insulin levels due to dietary intervention.

Not sure whether I should post this (and I have refrained from posting this every-time someone says they are T2 and going on insulin). There was a study (not sure if it was the ACCORD study) that said that T2s on insulin had a 260% increased risk of dying early). Have no idea of this was relative risk or absolute risk.

My thoughts are that insulin should only be given to T2s whose beta cells no longer produce insulin. For that group it will most definitely prolong their life - but for someone like me who was insulin resistant and still producing insulin it can cause a helter skelter of highs and lows which are not that good for the body.

The low carb diet certainly put a stop to the hypos and dramatic rises. So for me coming off insulin and going low carb halted and reversed the retinopathy and neuropathy whereas the insulin seemed to be making them worse. So at the moment low carb is likely to be extending my lifespan.

If course - if and when - my beta cells stop working I will gladly go back on the insulin as it will be vital to keep me healthy Until then I will stay low carb.

 

[Member496333]

Not sure whether I should post this (and I have refrained from posting this every-time someone says they are T2 and going on insulin). There was a study (not sure if it was the ACCORD study) that said that T2s on insulin had a 260% increased risk of dying early). Have no idea of this was relative risk or absolute risk.

My thoughts are that insulin should only be given to T2s whose beta cells no longer produce insulin. For that group it will most definitely prolong their life - but for someone like me who was insulin resistant and still producing insulin it can cause a helter skelter of highs and lows which are not that good for the body.

The low carb diet certainly put a stop to the hypos and dramatic rises. So for me coming off insulin and going low carb halted and reversed the retinopathy and neuropathy whereas the insulin seemed to be making them worse. So at the moment low carb is likely to be extending my lifespan.

If course - if and when - my beta cells stop working I will gladly go back on the insulin as it will be vital to keep me healthy Until then I will stay low carb.

Absolutely. Exogenous insulin administered to someone who has hyperinsulinemia is the most reckless treatment possible for a type 2 diabetic. Apart from making them fat, and further decreasing their insulin sensitivity, all it will do is hammer more and more glucose into the tissues. The blood will appear clean but overall mortality from complications will almost certainly increase. But it’s a valid treatment because it sweeps the diabetes under the carpet in the short term...it does nothing to treat it.

Apologies if there are any insulin dependent type 2’s reading this. It’s not my intention to cause offence. In some individuals it may very well be the best treatment, but in my opinion it’s a bad idea for the majority.

 

[Boo1979]

Im am not on insulin, but I think in the context of the UK where tests such as C peptide to asess an individuals level of beta cell function are not done, it is equally reckless to put up posts referring to people dying from taking insulin and hailing diet as being the cure all.
Advice to people to try a dietary intervention and / or get their insulin production assessed before upping the anti on meds is perfectly valid, but demonising any medication based on assumptions that all / the majority of people with T2 diagnosis are hyperinsuleamic is dangerous. I have also noted posts on this forum ripping the Accord studies to bits - again mostly by keto advocates

 

[kokhongw]

I have also noted posts on this forum ripping the Accord studies to bits - again mostly by keto advocates

As they should be when their misleading conclusions are often erroneously applied...to the lowering of HbA1c.

 

[Brunneria]

@Boo1979

Well, there are quite a lot of things that are unhelpful - including throwing out the word 'demonising'.
In fact 'demonising' 'demonising' is doubly counter productive, isn't it?

Both views on insulin for T2s hold merit, depending on the patient's circumstances, and it makes sense to only prescribe any medication when there is a clearly identified need for it.

At the moment, my insulin resistance is such that insulin would not be helpful to me and might increase my risk of health issues in later life due to the increase in insulin resistance that it would cause.
If, at some future point my beta cells deteriorate and my insulin resistance drops, while my blood glucose levels rise, then I will be first in the queue for an insulin presciption.

 

[Member496333]

Im am not on insulin, but I think in the context of the UK where tests such as C peptide to asess an individuals level of beta cell function are not done, it is equally reckless to put up posts referring to people dying from taking insulin and hailing diet as being the cure all.
Advice to people to try a dietary intervention and / or get their insulin production assessed before upping the anti on meds is perfectly valid, but demonising any medication based on assumptions that all / the majority of people with T2 diagnosis are hyperinsuleamic is dangerous. I have also noted posts on this forum ripping the Accord studies to bits - again mostly by keto advocates

If you’re referring to my post, I didn’t assume anything. I stated that exogenous insulin is a bad idea for type 2 diabetics who have hyperinsulinemia. It wouldn’t be my place to make the assumption.

I also added a proviso at the end clearly stating that it may well be the best treatment for some

 

[bulkbiker]

in the context of the UK where tests such as C peptide to asess an individuals level of beta cell function are not done,

Which looks to me exactly where the problem lies..a one-off test to show whether the patient is over or under producing insulin should be given to everyone on diagnosis. Then it would be obvious if exogneous insulin is required or not.

 

[Brunneria]

Which looks to me exactly where the problem lies..a one-off test to show whether the patient is over or under producing insulin should be given to everyone on diagnosis. Then it would be obvious if exogneous insulin is required or not.

But things get a bit more complicated later on, I believe, when an established T2 shows progression, and rising blood glucose while still producing large amounts of insulin - just not enough insulin to overcome their insulin resistance.

I don't pretend to know the full ins and outs of the various tests, but even insulin resistance varies across the day, and so do insulin levels in the blood, so snapshot tests of insulin levels have their limitations too...

It is very complex, and I don't think many health care practitioners dealing with T2s on a non specialist level appreciate the complexity. Actually, I am not sure many of the specialists do either!

 

[Member496333]

Jason Fung believes that a ‘failed’ type 2 pancreas can recover when the fat that is clogging it up is cleared through dietary intervention. Obviously I cannot make a claim as to whether or not this is accurate, but certainly everything else the guy has published so far has proven to be true with regards to my own body.

That aside, there’s also the likelihood that exogenous insulin used to allow more dietary glucose in a patient with hyperinsulinemia could accelerate complete failure of the pancreas.

 

[bulkbiker]

But things get a bit more complicated later on, I believe, when an established T2 shows progression, and rising blood glucose while still producing large amounts of insulin - just not enough insulin to overcome their insulin resistance.

I don't pretend to know the full ins and outs of the various tests, but even insulin resistance varies across the day, and so do insulin levels in the blood, so snapshot tests of insulin levels have their limitations too...

It is very complex, and I don't think many health care practitioners dealing with T2s on a non specialist level appreciate the complexity. Actually, I am not sure many of the specialists do either!

I tweeted Partha Kar on the subject but I think he has me on mute (too many questions..) so expanded it to Dr Nikola Guess and Dr Peter Foley who are about to be doing a low carb trial allegedly...
I have a pet theory that the overproducers of insulin (i.e. most insulin resistant) are the ones who may respond best to a carb cutting diet. The under producers will probably not..
I suggested they do a c-pep on everyone in the trial and then look at who responds best. I think this may explain the "classic" T2 response to low carb and the others who should more probably aligned with T1's in that they have impaired endogenous insulin production and therefore will in the future require exogenous insulin.. there will of course always be outliers but if that diagnosis could be made at the start then insulin production could be monitored throughout treatment for the under producers and could lead to fewer mis-diagnoses.. Just a thought. Who knows...

 

[Mbaker]

Not sure whether I should post this (and I have refrained from posting this every-time someone says they are T2 and going on insulin). There was a study (not sure if it was the ACCORD study) that said that T2s on insulin had a 260% increased risk of dying early). Have no idea of this was relative risk or absolute risk.

My thoughts are that insulin should only be given to T2s whose beta cells no longer produce insulin. For that group it will most definitely prolong their life - but for someone like me who was insulin resistant and still producing insulin it can cause a helter skelter of highs and lows which are not that good for the body.

The low carb diet certainly put a stop to the hypos and dramatic rises. So for me coming off insulin and going low carb halted and reversed the retinopathy and neuropathy whereas the insulin seemed to be making them worse. So at the moment low carb is likely to be extending my lifespan.

If course - if and when - my beta cells stop working I will gladly go back on the insulin as it will be vital to keep me healthy Until then I will stay low carb.

A trial where extra insulin was administered to Type 2's to get the blood sugar lower had disastrous outcomes; it is so important to use the minimal amount required to cover the blood glucose and not think that more is better, it is not.

 

[Mbaker]

Jason Fung believes that a ‘failed’ type 2 pancreas can recover when the fat that is clogging it up is cleared through dietary intervention. Obviously I cannot make a claim as to whether or not this is accurate, but certainly everything else the guy has published so far has proven to be true with regards to my own body.

That aside, there’s also the likelihood that exogenous insulin used to allow more dietary glucose in a patient with hyperinsulinemia could accelerate complete failure of the pancreas.

I also believe Type 2's should where possible limit the use of Sulphonylureas such as Glibenclamide, Gliclazide, Diamicron, Glipizide, Glimepiride, Tolbutamide as these work the Pancreas more - if your Pancreas is marginal already this could be the straw that broke the camel's back, not to worry anyone on these just a cautionary additional info item.

 

[Guzzler]

With respect, I’d suggest, given we are here debating it, that we have approximately three million years of research to prove that the metabolic state of nutritional ketosis doesn’t kill humans

Oh, well said.

And as to long term studies, we certainly know that which does not work. Keto is not new, used as an antiepilepsy approach before the discovery of pharmaceutical treatments and still used today for children who do not react well to said pharmas. As for fibre, what studies were there that were not influenced by the 'Healthy Whole Grains' lobby? Apparently, Keto makes us bunged up, sluggish half wits

 

[Member496333]

Oh, well said.

And as to long term studies, we certainly know that which does not work. Keto is not new, used as an antiepilepsy approach before the discovery of pharmaceutical treatments and still used today for children who do not react well to said pharmas. As for fibre, what studies were there that were not influenced by the 'Healthy Whole Grains' lobby? Apparently, Keto makes us bunged up, sluggish half wits

You and I are going to have to stop agreeing on everything, or people will start to think we’re in cahoots. I added a little second paragraph to my post just for light hearted effect

 

[Guzzler]

You and I are going to have to stop agreeing on everything, or people will start to think we’re in cahoots. I added a little second paragraph to my post just for light hearted effect

I shall endeavour to ignore you forthwith! #NotDeadYet!

 

[Boo1979]

3 Million years of evidence?
https://www.psychologytoday.com/gb/blog/how-think-neandertal/201311/the-truth-about-the-caveman-diet

With respect, I’d suggest, given we are here debating it, that we have approximately three million years of research to prove that the metabolic state of nutritional ketosis doesn’t kill humans

 

[Member496333]

3 Million years of evidence?
https://www.psychologytoday.com/gb/blog/how-think-neandertal/201311/the-truth-about-the-caveman-diet

Thanks. Seen it all before and formed my own opinions. You’re free to form your own

I think we can all agree that the body wouldn’t develop a natural form of metabolism that would do it harm. If it had, the first homosapien in the northern hemisphere wouldn’t have made it through their first winter. Glycolysis is the mechanism by which humans use immediate energy and store any excess. Ketosis is the mechanism by which humans turn to the stored excess. It’s perfectly natural and is the cornerstone of metabolic flexibility. In my opinion

 

[Mr_Pot]

My lightbulb moment in the beginning of my reading was learning one simple fact which is this, there is no such thing as an essential carbohydrate

Essential, probably not, but beneficial for some reason, we don't know. Let's keep an open mind rather than swapping one assumption for another.