PBS show on Obesity

(Bacon is a many-splendoured thing) #101

I’m not sure how you are defining “successfully” in this context.

I was just reminded the other day that a ketogenic diet was the original standard treatment for Type I diabetes. It only fell out of favour after the development of insulin treatment in 1923.

I can’t imagine that any diet would keep someone alive for too long in the complete absence of insulin, but Type I’s today still say that you can prolong the “honeymoon” period (i.e., the phase after the development of symptoms, but while the pancreas still retains some ability to secrete insulin) by means of a ketogenic diet. And before the discovery of insulin, a ketogenic diet was probably the best hope of avoiding a fatal increase in hyperglycaemia and preserving the patient’s life for as long as possible.

In the case of Type I, it is not likely that anything can keep the immune system from ultimately destroying all the β-cells, but in the case of a late-stage untreated Type II, there is probably no reason that the pancreas couldn’t (slowly) recover, at least to some extent.

(Jane) #102

My 10-yo Type 1 stepson visited us every other weekend back in the mid 90’s. I gave him his insulin shot once a day and followed the dietary guidelines he was given from his doctor, which was eliminate sugar and limit carbs. Imagine that.

As an ex-Atkins’er that was easy and there was practically nothing in my house he couldn’t eat.

Unfortunately when he went home he lived with 3 generations of overweight women who kept the freezer packed with ice cream and a perpetual cake under a glass dome on the counter. Poor kid didn’t stand a chance.

(Bacon is a many-splendoured thing) #103

A couple of the people whose lectures I watch on YouTube (one of them being Gary Taubes) have recently made the point that hypoclycaemia did not exist until 1923, when doctors started treating Type I diabetics with insulin. That was when they discovered that it was easier (for the doctor, at least) if the patient ate whatever he or she wanted, and took a bolus dose of insulin to “cover” it. Naturally, mistakes are easy to make, that way, and so hypoglycaemia was invented.

Dr. Bernstein, himself a Type I diabetic, counsels eating minimal carbohydrate, on the grounds that “small inputs make for small fluctuations,” or words to that effect. A number of Type I ketonians have said that on keto they can pretty much dispense with their bolus doses, and they don’t get hypos.

(BuckRimfire) #104

By successful I guess I mean remaining normoglycemic, if in ketosis being in the nice range of 0.5 to 3 mM, not tending to ketoacidosis (I’m assuming REALLY advanced Type IIs can get into ketoacidosis if off insulin and going far enough off the rails?), having a reasonable body fat percentage and having a good amount of muscle and fitness.

(Doug) #105

Great comment, Paul; makes sense. :slightly_smiling_face:

Additionally, among Type 1 diabetics, longer lifespans seem to be more tied to ‘low insulin’ rather than extreme blood sugar control, i.e. it’s better to use less insulin than to worry about transient fluctuations in blood sugar on the high side.

(Rebecca ) #106

So :pensive: sad

(Bacon is a many-splendoured thing) #107

Ketoacidosis is not a concern for anyone with a pancreas capable of secreting insulin. It is precisely the lack of endogenous insulin that puts Type I diabetics at risk for developing this condition. Again, it is not a concern if the patient takes the insulin properly. But it is feared because it is a deadly condition.

Diabetic ketoacidosis is diagnosed by serum β-hydroxybutyrate above 10 mmol/dL (though symptoms don’t usually start until it reaches 20) plus attendant hyperglycaemia. There is also such a thing as euglycaemic ketoacidosis, but it only occurs in response to certain specific drugs, and in women on a ketogenic diet who fast while pregnant or lactating (the diet is safe, it is the fasting that can cause problems at such a time).

A ketogenic diet has been shown (Hallberg et al.) to be a highly effective treatment for Type II diabetes, since it regularises serum glucose and helps reduce insulin-resistance.

Type II diabetics whose hyperglycaemia goes untreated for enough decades can indeed burn out their pancreas and lose the ability to produce their own insulin. At that point, their diagnosis changes to Type I, of course. By the time the pancreas has given out, the patient has typically lost extremities to gangrene, gone blind, possibly died of a heart attack, etc.

But over most of its course, Type II is a disease of too much insulin, not insulin deficiency, and the hyperinsulinaemia, along with the hyperglycaemia, once glucose control begins to fail, are what cause all the damage. Which is what makes it so ironic that the standard treatment for Type II is to give the patient even more insulin, rather than to reduce the stimulus that makes the hyperinsulinaemia necessary in the first place (i.e., by reducing the dietary carbohydrate load). Fortunately, a ketogenic diet has been shown (Hallberg et al.) to be a highly effective treatment for Type II diabetes, since it regularises serum glucose and helps reduce insulin-resistance.