The Ketogenic Diet vs. a Low-Fat Plant-Based Whole-Food Diet: A Comparison of Short-Term and Long-Term Results
Kicking Keto: Patricia
Patricia does not have a typical diabetes diagnosis story, but it is one that is becoming more and more common.
She lived diabetes-free for most of her life, but at age 62 suddenly found herself diagnosed with type 1.5 diabetes, an adult-onset, slow-progressing version of type 1 diabetes that affects people over the age of 30.
As Patricia adjusted to her new reality, she tried hard to manage her blood glucose.
Realizing that the food she ate was an integral part of controlling her blood glucose, she tried one dietary approach after another, searching for one that “worked.” Eventually, she adopted a ketogenic diet that restricted her intake of carbohydrate-rich food drastically while increasing her intake of low-carbohydrate, high-protein foods, including chicken, eggs, fish, and dairy products.
She followed the ketogenic diet religiously, with 100 percent compliance for six months.
But Patricia found that as time went on, she became increasingly exhausted and wasn’t able to lose a single pound.
She ate about 30 to 40 grams of carbohydrate energy and injected 30 units of basal insulin and 5 units of bolus insulin per day, for a 24-hour carbohydrate-to-insulin ratio of about 1:1.
One day, while reading posts in a low-carb group on Facebook, she watched a video that ridiculed Cyrus’s video explaining the power of the Mastering Diabetes Method for people living with diabetes.
Even though it went against what she thought she knew to be true, she was intrigued by the idea of eating the foods that she loved, less meat and more fruits and vegetables.
Excited by the possibility of becoming more plant-based, she decided she had nothing to lose by trying Cyrus’s program.
She approached the program with an open mind, looking to achieve the four following goals:
Lose approximately 30 to 40 pounds
Gain better control of her blood glucose
Reduce her insulin needs
Gain energy
Patricia turned her diet on its head, switching from eating foods low in carbohydrate and high in protein and fat to foods high in carbohydrate and low in protein and fat.
She stopped eating all animal foods, including meat, dairy, and eggs.
She started eating the nutrient-dense plant foods that she craved, fruits, vegetables, intact whole grains, beans, lentils, potatoes (yes, potatoes!), and squash.
In the first four months of her new diet, her A1c dropped from 7.1% to 6.4%, and by eight months her A1c was 5.8%.
She ate as much as 300 grams of carbohydrate per day; decreased her daily basal insulin use from 30 units to 12 units; and injected approximately 8 to 10 units of bolus insulin per day, for a 24-hour carbohydrate-to-insulin ratio of 14:1.
Two years after her transition, Patricia maintains an A1c of 6.3%, has lost a total of 50 pounds, and her LDL cholesterol has dropped by more than 40 percent.
She is eternally grateful for watching Cyrus’s video and listening with an open and hopeful mind to the testimonials of others who completed the program.
Following the Mastering Diabetes Method has helped her gain full control of type 1.5 diabetes, control her blood glucose with precision, and live her life with the vigor that she lacked when eating a ketogenic diet.
Even though she did not experience the dramatic short-term improvements that many experience when they adopt a ketogenic diet, Patricia took the steps that she describes as “miraculous,” dramatically improving both her short-term results and long-term health, backed by almost 100 years of evidence-based science that you’ll read about below.
If you are living with diabetes, you may have been told to eat a low-carbohydrate diet to control your blood glucose or you may have been told to eat a very low-carbohydrate diet, otherwise known as a ketogenic diet. Regardless of which form of low-carbohydrate nutrition you may have come across, in this chapter we’ll discuss the pros and cons of low-carbohydrate and ketogenic diets so that you have the information you need to choose what’s right for you.
In the world of ketogenic diets, people are told to eat a very low-carbohydrate diet in order to achieve a metabolic state known as ketosis , in which your muscles and liver derive the bulk of their energy from fatty acids and amino acids instead of from glucose found in carbohydrates. To do so, people are told to eat 70 to 90 percent of calories of fat from meat, eggs, sausages, heavy cream, cheeses, fish, nuts, butter, oils, seeds, non-starchy vegetables, avocados, coconuts, and small amounts of berries, while avoiding almost all fruits, starchy vegetables, breads, pastas, legumes, milk, and yogurt.
Many people around the world who eat a ketogenic diet are able to lose weight, achieve a flat-line blood glucose profile, greatly reduce or eliminate their need for oral medication and insulin, and reduce their total cholesterol. So why aren’t we recommending this diet ourselves? Because despite these advantages, there are four very important points to take into consideration:
Evidence-based research conducted in large numbers of people over long periods of time consistently demonstrates that eating more animal products increases your risk for premature death, no matter what short-term benefits may unfold in the process. Similar large-scale research demonstrates that eating more whole plant foods reduces your risk for premature death.
The short-term benefits associated with a ketogenic diet can also easily be achieved using a low-fat plant-based whole-food diet, as seen in research dating back to the 1920s.
Low-fat plant-based whole-food nutrition is the only approach shown to reverse heart disease (the leading cause of death of people living with all forms of diabetes), whereas diets high in saturated fat and cholesterol have been shown to promote heart disease.
There are many examples of long-lived societies around the world who eat plant-based diets, and zero examples of long-lived societies who eat a low-carbohydrate or ketogenic diet with a high intake of animal products.
While the ketogenic diet may seem like a logical approach to reducing blood glucose fluctuations, it is based on the outdated and incorrect carbohydrate-centric model of diabetes that we covered in chapter 3, which points a finger at carbohydrates as the cause of insulin resistance and type 2 diabetes, even though overwhelming evidence shows that low-carbohydrate, high-fat diets are actually the cause of insulin resistance and type 2 diabetes. To make sure you’re completely clear on why that is, let’s travel back in time.
The ketogenic diet was originally developed in the 1920s as a treatment to reduce the frequency of seizures in children suffering from intractable epilepsy. At the time, researchers thought that they could induce ketosis as well as a condition known as metabolic acidosis, both of which were known to have anticonvulsant effects.
What researchers also noticed was that a ketogenic diet often stimulated rapid weight loss, flat-line blood glucose, reduced cholesterol, and reduced blood pressure. As a result, researchers and medical professionals began experimenting with a ketogenic diet in people living with metabolic conditions like prediabetes, type 2 diabetes, obesity, fatty liver disease, Alzheimer’s disease, chronic kidney disease, and cancer in an effort to reverse chronic disease.
But that’s not the whole story.
In 2004, researchers in Korea reported on the side effects of 129 epileptic children who were administered a ketogenic diet in a hospital setting.
Within six months, more than half of the patients stopped the ketogenic diet (even those who experienced anticonvulsant benefits) owing to symptoms such as dehydration, nausea, vomiting, diarrhea, and constipation.
About a third of the patients experienced high triglyceride values, and a third were put on cholesterol-reducing medication to counteract increasing cholesterol levels.
The researchers reported a complete list of early- and late-onset side effects that also included acid reflux, hair loss, kidney stones, muscle cramps or weakness, hypoglycemia, low platelet count, impaired cognition, an inability to concentrate, impaired mood, renal tubular acidosis, disordered mineral metabolism, stunted growth, increased risk for bone fractures, osteopenia and osteoporosis, increased bruising, sepsis, pneumonia, acute pancreatitis, hyperlipidemia, high cholesterol, insulin resistance, elevated cortisol, increased risk for cardiovascular disease, increased risk for atherosclerosis, cardiomyopathy, heart arrhythmia, myocardial infarction, menstrual irregularities, amenorrhea (loss of period), and an increased risk for all-cause mortality.
Even though this study demonstrated strong evidence that a ketogenic diet may decrease seizure incidence, it was one of the first to demonstrate a strikingly low adherence rate and comprehensive list of undesirable side effects.
Despite these findings more than fifteen years ago, many doctors today are quick to recommend a ketogenic diet to patients with type 2 diabetes based predominantly on short-term studies.
In 2005, scientists from Temple University followed 10 obese patients living with type 2 diabetes for two weeks and observed that in this condensed time period, patients reduced their A1c by 0.5 percent and increased their insulin sensitivity by 75 percent.
That same year, another team of researchers from Duke University found that sixteen weeks of a ketogenic diet in 28 different overweight patients led to dramatic reductions in A1c, diabetes medication needs, body weight, and triglyceride levels.
In 2006, researchers at the University of Kuwait studied the effect of a ketogenic diet on 66 obese subjects and observed significant weight loss, reduced total cholesterol, reduced LDL cholesterol, reduced triglycerides, and reduced blood glucose. The same research group admitted 64 obese individuals with and without high blood glucose into a study lasting thirteen months to determine the effect of a ketogenic diet on body weight, blood glucose, and cholesterol levels. In this time frame, the participants on average lost 50 to 66 pounds and significantly dropped their total cholesterol, LDL cholesterol, triglycerides, and blood glucose, while increasing their HDL.
And most recently, a team of researchers reported on the effects of an online ketogenic nutrition and lifestyle coaching program in 238 participants with type 2 diabetes over ten weeks.
The researchers found that a ketogenic diet dropped the participants’ A1c by 1.0 percent while reducing or eliminating common oral diabetes medications, along with significant reductions in fasting glucose, body weight, BMI, and triglycerides.
Many of the participants continued to use metformin.
The same researchers extended their findings to 349 people living with type 2 diabetes over the course of a year and found that a ketogenic diet dramatically reduced insulin and oral medication needs, as well as body weight, and led to a 1.3 percent reduction in A1c.