Diabetics – Listen Up!

Update:
Ellen’s new book “The Ketogenic Diet for Type 1 Diabetes” is now available.
In response to reader requests, here is the information on how to order both
of these books:


Photo of the cover of the book, Conquer Type 2 Diabetes with a Ketogenic Diet.
Diabetics, listen up! You now have available a new and important book authored by Ellen Davis and Keith Runyan, M.D. entitled Conquer Type 2 Diabetes with a Ketogenic Diet. It is second in a promising series of ketogenic diets for special conditions.(1)

Ellen has a Master of Science degree in Applied Clinical Nutrition, and Dr. Runyan is a practicing physician specializing in obesity, kidney disease, and diabetes who is himself a type-1 diabetic. Despite their expertise and personal knowledge, they strongly advise that your personal physician be involved in review and application of information in this book.

As diabetics well know, the ketogenic diet is only one of a number of diet plans suggested specifically for them. These diet plans run the gamut from the “occasional sweet treats are OK” bribe to the pragmatic “no carbohydrates at all” design. Despite the diversity of suggestions, there is only one absolute: For every molecule of glucose you put in your stomach you MUST provide a tad of insulin to manage it. If your body cannot produce insulin, you must have an outside source. A logical decision is the one that science tells us is the correct one; eat as few carbohydrates (glucose) as possible to put the least demand on your body. And have no illusions about carbohydrates. They are all made almost entirely of glucose.

Before continuing to tell you why Conquer Type 2 Diabetes with a Ketogenic Diet is so very important to your well being, let’s reflect on why we must have so much concern about the amount of glucose we eat. It is because when Man appeared on earth, he was given a circulatory system that served all parts of his body delivering food and removing waste. This circulatory system was part of the deal – Man could not do without it. Glucose happened to be part of the food component of the circulating medium (blood). There would be no problem with glucose if Man were permitted to add all the glucose he wanted to the glucose food component, but the natural laws that govern the science of physiology said “No, there are limits, top and bottom.” There we are; if we want to live, we are required to maintain a blood glucose level roughly between 80 and 120 milligrams per deciliter.

In its relationship with insulin, glucose can be thought of as playing the paradoxical roles of master and servant. The concentration of glucose in the blood governs the release of insulin from the pancreas; in turn, the released insulin governs the concentration of glucose in the blood. Control of the glucose level in the blood is one of the body’s fundamental regulatory mechanisms for maintaining homeostasis, the stability of the internal environment of the body. It is for this reason that the concentration of glucose in the blood must be kept within a relatively narrow range in order to maintain healthy life functions in all of the cells and tissues of the body.

What does glucose have to do with diabetes? Except for people who have diabetes from childhood (type-1), this question cannot be answered by most adults. If you have been diagnosed as having type-2 diabetes, you would be wise to learn as much as you can so you can handle living with diabetes with as much dignity and comfort as possible. You cannot survive in denial or cheat with a forbidden candy bar. You cannot fool Mother Nature.

Part One of the book sets the stage for embarking on a ketogenic diet, including a number of important factors to be considered before making a final decision. Chapter 1 tells the stories of both type-1 and type-2 diabetics who suffered the gamut of problems faced in a life with diabetes and their powerful positive experiences with ketogenesis. These personal stories confirm frequent reports that type-2 diabetes can be well controlled or even reversed. A first-person story describing dismay at being diagnosed with type-2 diabetes, the search for help, and the experiences of the first six months on a ketogenic diet are quite encouraging to people concerned about diabetes and/or ketogenic diets. (2)

Chapter 2 is an information-packed discussion on the nature of diabetes, the benefits of ketogenesis, the errors of dietary myths, and the criteria for judging the appropriateness of a ketogenic diet for the patient in question. It appears that the ketogenic diet is fitting for both type-1 as well as type-2 diabetics, assuming that there is medical supervision and no other health contraindications. Thus, this book has a huge added value of also serving type-1 diabetics who have a much more difficult time than type-2 diabetics in balancing their critical glucose-insulin needs.

Part Two is devoted to implementation of the ketogenic diet. It discusses goals, composition, and personalization of the diet. Very importantly, it includes information on monitoring tools and management of common and uncommon side effects associated with a ketogenic diet

Part Three presents four detailed chapters that deal with managing blood sugar and insulin levels. This section contains medical information relevant to drug treatment, insulin delivery equipment, and other information of value to the attending physician or healthcare provider.

Part Four is the final section: Chapter 10 talks about exercise for diabetics, diabetic athletes, and non-diabetic athletes; Chapter 11 explains the role of ketogenesis in obesity and weight loss; and Chapter 12 concludes the section with a discussion of a number of other important but diverse factors, such as vegetarianism, stress, and skeptical physicians. The book wraps up with about 40 pages of appendices that provide valuable support to the conduct of a ketogenic regimen for type-1 and type-2 diabetic patients.

Lastly, we offer some additional comments that will hopefully stimulate the diabetic reader to muster the courage, discipline, and determination to purchase this book and implement its recommendations.

It is a well known observation that people who have type-2 diabetes are very likely to end their days as victims of Alzheimer’s disease. This association could be due to the stimulation of the enzyme delta-5 desaturase* by insulin, which forces synthesis of arachidonic acid from linoleic acid and promotes chronic inflammation known to be a cause of Alzheimer’s disease. (3, p.180ff)

To reduce or eliminate the adverse effects of linoleic acid: First, follow a ketogenic diet (by eliminating carbohydrate foods a ketogenic diet, will reduce the need for insulin), and second, eliminate the intake of all vegetable seed oils (vegetable oils, such as safflower and canola, are the major source of excessive amount of linoleic in the American diet). Use only animal fats, including fish oil, which are predominantly omega-3 fatty acids, as the dietary fat component.

Another risk for Alzheimer’s disease that is reduced or eliminated by a ketogenic diet relates to brain biochemistry. A ketogenic diet produces ketone bodies that, like glucose, can pass the blood-brain barrier. Ketone bodies are an excellent replacement for glucose as an energy source for the brain. Energy production in the mitochondria of brain cells yields considerable amounts of reactive oxygen species (ROS) when using glucose as fuel, whereas essentially no ROS are produced when using ketone bodies. Unless neutralized, ROS can be lethal to brain cells. The story of the remarkable microscopic powerhouses known as mitochondria is told in a book by Nick Lane.(4)

* An enzyme in the metabolic pathway of the omega-6 and omega-3 essential fatty acids.

References

  1. Conquer Type 2 Diabetes with a Ketogenic Diet – Ellen Davis, Keith Runyan, M.D
  2. Recovery from Type-2 Diabetes: A True Story – Alice Ottobonie, Fred Ottoboni
  3. Modern Nutritional Diseases, 2nd. Ed. – Alice Ottoboni, Fred Ottoboni
  4. Power, Sex, Suicide: Mitochondria and the meaning of life – Nick Lane

15 Responses to “Diabetics – Listen Up!”

  1. Hi Fred & Alice,

    Nice summary – thanks!

    Allow me a little knit-picking: “…essentially no ROS are produced when using ketone bodies”

    I’m not sure that’s quite true – or put another way – not very accurate. I say this because of the signalling role ROS (& NRS) seem to play.

    “How Nrf2 might be activated by consumption of a KD also remains to be determined, but the presence of potential acute and chronic stress in KD-fed rats has been suggested. Since the Nrf2-Keap1 complex can serve as a redox sensor, redox signaling by H2O2 and lipid peroxidation products may serve as activators of the pathway. Although hippocampal mitochondria have been found to produce less ROS in animals fed a KD for at least 1 week (Sullivan et al., 2004; Jarrett et al., 2008), substrate-driven H2O2 production was observed to be increased in hippocampal mitochondria from KD-fed rats compared to controls after only 1 day on the diet (Milder et al., 2010). Acute production of H2O2 may play an important role in the KD, as it has been shown to serve a redox signaling role, in addition to its more notable role as a damaging species (Figure 1). H2O2 has been shown to activate a number of important transcription factors and thereby initiate signaling cascades. One study reported that an array of mechanisms known to activate NF-kappa B were all dependent on production of H2O2, as several thiol antioxidants were found to block NF-kappa B activation (Schreck et al., 1991). Additionally, H2O2 has been shown to increase DNA binding of Nrf2 to the ARE (Wilson et al., 2005).”

    I don’t know if OVERALL the ROS response is lower or if it stays the same but what is certain is that it’s put to different use in terms of what it is signalling and for which reason. Cracking the nut of how R/NRS roles shift according to metabolic contexts is difficult. It goes back to the “1 day anti-oxidants are amazing and another day they’re terrible” kind of chicken-&-egg question.

    Cheers!

    Reply
    • Hi Raphi, good to hear from you again. Do not worry about nitpicking – we actually welcome it because it stimulates us to study more about details of redox activity. We cannot recall exactly where we found the information about ROS production. We think it may have been in a paper that mentioned cellular energy utilization in glial cells of Alzheimer’s patients on ketogenic diets. Or it may have been in Nick Lane’s fascinating book (4). We are checking back to find out.

      In any event, we misspoke in the last paragraph of our review where we said, ”…the mitochondria of brain cells yields considerable amounts of reactive oxygen species (ROS) when using glucose as fuel…” We did not mean that glucose was catabolized in the mitochondria. Glycolysis takes place in the cytoplasm. Mitochondria do not become utilized until pyruvate is ready to enter the Krebs cycle. Do ROSs produced anaerobically behave differently from ROSs produced aerobically? Very interesting.

      Many thanks for the references, Raphi. You are way ahead of us. Our biochemistry is circa 1940-50, when activation was just beginning to be recognized and there were no such things as sensors, signalers, or even eicosanoids. Glycolysis and the Krebs cycle went merrily on their way in all our cells uninhibited by our woeful lack of knowledge of what was really going on. We are happy to have young scientists such as yourself willing to help bring us into the present.

      Reply
  2. Thank you for this nice review! I wanted to comment and let everyone know that Dr. Runyan and I are working on a Type 1 Diabetes book as well. We hope to have it out this year.

    One of the things I’ve learned in researching diabetes for this book is that there is an informational disconnect between healthcare professionals and people with diabetes. At the same time people with diabetes are told to control blood sugar, they are also told to eat 45-60 carbohydrates per meal, an amount that would spike blood sugar for most people. In addition, it seems to me that they consequences of chronically high blood sugar aren’t fully disclosed to them.

    People with prediabetes and even diabetes aren’t told that the root cause of most metabolic and neurological diseases, including cancer, heart disease and Alzheimers is high blood sugar and the elevated insulin levels, glycation and oxidative damage it causes. It is not emphasized that chronic high blood sugar is a slow train to disease processes that will act much more quickly to destroy your life.

    The other fact that I’ve come to understand is that not all cells in the body need insulin to allow glucose to enter the cell. If blood glucose levels are high, some cells don’t have protection from a flood of excess sugar, and these cells are the first to exhibit glycation damage. It’s not surprising that these include the lens of the eye, certain cells in the kidney, cells in the peripheral nerves, the male reproductive system and the pancreatic beta cells. Now I understand why blindness, kidney damage, nerve pain and impotence are the major diabetic complications.

    The worst part is that the American Diabetes Association recommends that diabetics maintain an HbA1c below 7. This translates to an average blood sugar of 155 mg/dL. What they don’t say is that glycation damage has been observed in studies at blood sugars of 125 mg/dL, and the higher that number goes, especially after meals, the more damage accumulates.

    For me, writing this book has clarified an urgent need to help as many people as possible understand the danger of high blood sugar, and to provide information on how to normalize blood sugar and avoid the disease train. My hope is that this book will be tool toward that end.

    Reply
  3. It’s great to see keto getting more exposure as a dietary treatment for diabetes. Its reassuring to see more and more of these kind of well-researched and scientifically-based resources becoming available to mainstream America (and the world!).

    Reply
    • Alice and Fred Ottoboni

      Thank you , Marshall.

      It is very important for people who understand the truth of the science underlying the ketogenic diet to publicly voice their support of ketogenesis in helping the body to heal itself. Heal one inflammatory disease and you will heal all.

      Reply
  4. nadia marmach

    How very exciting to find all this progress. I am Physiotherapist (Australia) and after my last stint in a rehab unit opened my eyes to a medical world unseen 40years ago. My daily question was ‘You are diabetic. Why are you eating that?’ As I sought the answer and all the books on diet and exercise surrounded me I realised that my next job is to write the book and a crash course in biochemistry. Don’t feel so alone anymore. The results obtained utilising ketogenesis are noteworthy. I concur. Heal one inflammatory disease and you will heal all. I’m in the re write of the re write stage and I am not interested in rewriting the process or the mechanism of ketogenesis. Going to have to go on my desire acquire list for just for now. Bravo! I look forward to that time.

    Reply
    • Alice and Fred Ottoboni

      Hi Nadia
      Thank you very much for writing such positive comment. You are so right about the ketogenic diet. It is of great importance to the body’a ability to self heal. We wish you every success in your work in helping people in need.

      Reply
  5. larry

    even on a ketogenic diet my morning blood sugar is above 7 which is the dawn phenomena….does your book address liver making and/or releasing to much glucose?

    Reply
  6. Hello again, Larry,
    We had a note from Ellen saying that the book has a section on troubleshooting elevated blood sugar issues. Go to Chapter Seven on management of blood glucose and then page 104 for specific problems.

    We hope this is helpful to you.

    Reply
  7. Frank P. Araujo, Ph.D.

    Wonderful review of a solid physiological approach. It amazes me how clinicians of all kinds keep insisting that you “have to have” carbs for energy? As a perennial fat-boy who yo-yoed up and down for years with taking it off with low carb diets only to put it back on (usually with interest) when I went back to “normal” eating. Since being diagnosed with type 2 diabetes and not being a big sweets eater, I’ve come home to the realization that I’ll have to be restrictive of my carb intake until I die (i’m 80 now, so that leaves me 20 good years).

    But how and where can I buy this exciting book?

    Reply
  8. Hi Frank,

    Many thanks for taking the time to write and tell us of your interest in Ellen’s book. We admire Ellen very much, not only for her expertise in ketogenic nutrition but also for her dedication to helping people who are ill and need help implementing the ketogenic diets that have proved so extremely beneficial. Ellen’s book is available from her website (http://www.ketogenic-diet-resource.com/diabetes-diet.html). Her e-mail address is bugellen@gmail.com.

    We were delighted by your upbeat comment that at 80 you still have 20 good years left. As two oldsters in our mid-90s, we applaud your attitude and assure you that you can reach 100 if you follow Ellen’s advice. We began eating a low-carbohydrate diet when we retired in the mid-1980s, and switched to a mostly keto diet (no sugar, no starch) about 10 years ago. We both are quite disabled by the infirmities of age, but are able to take care of all our needs and live independently except for assistance with weekly food shopping.

    Our general heath is excellent; neither of us has any chronic disease and thus we need no medications. Nevertheless, we do take lots of supplements including ample vitamin C for immune system support. There are a number of posts on Ketopia that will tell you about our nutritional philosophy. If you would like to know more, the urls are below. Meanwhile, have a happy twenty years following and enjoying Ellen’s book.

    The Perfect Teeth of Prehistoric Humans.
    http://ketopia.com/perfect-teeth-prehistoric-humans/#more-2052
    A Tale of Two Truths.
    http://ketopia.com/a-tale-of-two-truths/#more-2121

    Reply

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