Passwater: What is the mechanism by which ketosis changes the body from being primarily a sugar-burner to a fat-burner?
Westman: One of the mechanisms by which the body is changed into a fat-burning machine is the reduction in insulin levels. Very low insulin levels facilitate the mobilization of fat (triglyceride) from the fat store (adipose tissue). High fat utilization then creates the ketosis, as ketones are made in the liver.
Passwater: What result can be expected from a keto diet in a typical type-2 diabetic?
Westman: The ketogenic diet is an excellent therapeutic diet for someone with type-2 diabetes because the dietary contribution to elevating the blood glucose is basically eliminated. Because there are only five grams of glucose in the bloodstream at any given moment, small amounts of dietary carbohydrate can raise blood glucose levels. If someone is eating 200–300 grams of carbohydrate per day and then changes the diet to 20 grams of carbohydrate per day, there is an immediate reduction in blood glucose of 50–100 mg/dL. Medication for type-2 diabetes must be immediately adjusted to avoid a low blood glucose (hypoglycemia). This kind of powerful diet requires medical monitoring if someone is taking medication for diabetes or high blood pressure.
Passwater: One of the biggest myths about the keto diet is that because it is high fat and cholesterol, it would cause heart disease. As we mentioned last month, the opposite is true. I remember Dr. Atkins being so heavily criticized about his diet and heart disease, yet he was reporting great improvements in his patients’ heart conditions and risk factors. I thought that you and our readers might appreciate this 1975 photo of Dr. Robert Atkins holding my book Supernutrition: Megavitamin Revolution during one of my guest appearances on his radio show (3).
Dr. Westman is an associate professor of medicine at Duke University Health System in Durham, NC, and director of the Duke Lifestyle Medicine Clinic. At Duke, he specializes in disease prevention, as well as the treatment of obesity, diabetes and tobacco dependence.
Dr. Westman received his M.D. from the University of Wisconsin/Madison, completed an internal medicine residency and chief residency at the University of Kentucky/Lexington, and completed a general internal medicine fellowship, which included a master’s degree in clinical research.
Dr. Richard Passwater is the author of more than 45 books and 500 articles on nutrition. Dr. Passwater has been WholeFoods Magazine’s science editor and author of this column since 1984. More information is available on his website, www.drpasswater.com. Published in WholeFoods Magazine, February 2016