Almost any diet will result in weight loss and improvement in diabetes. Dieting means making conscious changes to the way you view food and cut out those items that are considered harmful. The big question though is which diet is best in the long term both in terms of health outcomes as well as feasibility in terms of practical implementation, cost, sustainability and environmental impact.
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In this article we will look at the pros and cons of the ketogenic diet. In the next article we will present the diets recommended by our South African diabetic scientific fraternity, and then the following article we will present another alternative science-based approach for your consideration.
The biggest controversy in the management of diabetes today is dietary intervention. Back in the 1960’s a cardiologist by the name of Robert C Atkins began promoting a low carbohydrate, high fat (and by consequence also high protein) diet which came to be called the Atkins diet. It has had a number of modifications over the years, and although very popular in the early 2000s in the USA has somewhat fallen out of popularity. However it still has very strident supporters, even in the medical fraternity, and there are very many short term scientific studies which support its use. It has also become popular in the UK and Europe.
In South Africa Prof Tim Noakes has become the most high profile proponent of the ketogenic diet known locally as the Banting Diet, and has written a number of books and articles and letters in the public domain supporting this approach to nutrition.
Of course the fact that he was disciplined by the Health Professions Council of SA and later absolved for giving medical advice on-line has only served to highlight the subject in the media.
The Atkins and Banting diets are just two of many so-called ketogenic diets which reduce carbohydrate intake so much that the body is forced to switch to ketones (break-down products of fat) for its energy source.
There is no doubt that the Ketogenic diet will result in the following benefits in diabetics:
- Fairly rapid weight loss in most adherents
- Flat-lining of blood glucose
- Drop in HbA1c as blood glucose levels come down
- Reduced need for diabetic medication with lower glucose levels
- Feeling of satiety resulting from ketosis
- Reduction in total cholesterol levels, as well as LDL levels
- Plenty of support from popular media, Banting-friendly food stores and restaurants.
- Many in the medical fraternity by and large supportive of the ketogenic diet
However there are some serious concerns about this diet in the long term:
- Increase in insulin resistance
- Increased risk of cardiovascular disease
- Increased risk of renal failure from high protein content of the diet
- Increased risk of cancers e.g. colon and pancreatic cancer, and also likely breast and prostate as these are associated with high consumption of animal products
- Increased risk of auto-immune conditions
- Negative effect on the micro-biome due to low fibre content of diet
- Increased all-cause mortality
- Negative effect of high animal consumption on environment
Here is an article that discusses some of the misconceptions and long term consequences of the ketogenic diet particularly in the management of diabetes both for type 1 and type 2 diabetes: https://www.masteringdiabetes.org/ketosis-ketogenic-diets-misleading/
(There are many strong supporters of the use of the ketogenic diet in treating cancer, particularly brain cancers. And there seems to be some evidence for prolonging life, but few cures as such. Here is a very comprehensive report on the ketogenic diet in the management of cancer: https://www.chrisbeatcancer.com/dr-gonzalez-dismantles-ketogenic-diet-for-cancer/ for a 30+ year perspective on the subject)
Reading the diabetic literature, and particularly web-based literature, there is no doubt that there are strong proponents on both sides of the low carb ketogenic/ high carb low fat debate.
There are many in the low carb who swear that their diabetes is considerably better controlled since they went onto a ketogenic diet, and claim that this is the only way to go.
And then there are those on the low fat high carb diet who are just as adamant that this is the only way to go.
The human organism is highly complex and there are so many different factors that affect our metabolism and physiology. It may well be the case that some people do better on one than the other. This may have more to do with what people are most willing to commit to, but if it works so be it. I still reserve judgement on what I consider to be the best long term solution and that is based on large population studies and good common sense as we will see in the last of this series on diabetes and dietary management.
To hope in beating the scourge of diabetes, through a healthy diet and lifestyle,
Dave Glass
Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.
He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.
An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.
He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.
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