Ketopia Is No Place Good

The best way to understand how ketogenic diets can promote diabetes, is to look at the things that it is accepted happen when you go on a ketogenic diet, and then look at the things that are known to lead to diabetes, and then see how well they match up. If they do, it's a pretty good argument.

In case you didn’t know, a ketogenic diet is a high fat diet, and high fat diets are known to cause all sorts of problems. Making diabetes worse is just one of them. It isn’t rocket science, and I’m not saying there aren’t people out there who can appear to be thriving on keto for periods of time, but I’m not writing this for them. At least not yet.

Now one of the things that happen when you go on a keto diet, is that free fatty acids get released into the blood as alternative fuel, at an increasing rate. It’s possible you have been told this is a good way to lose weight, but actually, it’s a good way to cause blood sugar dysregulation issues, like insulin resistance. And blood sugar issues end up promoting obesity, so the weight you lose will often come back in a worse way.

Elevated free fatty acid level is associated with insulin-resistant state in nondiabetic Chinese people; Diabetes Metab Syndr Obes. 2019; 12: 139–147. 

Free fatty acids (FFAs)…were associated with insulin resistance in nondiabetic subjects, and HOMA-IR [homeostasis model assessment for insulin resistance] in nonobese individuals was more sensitive to FFA changes. Monitoring and controlling plasma FFA levels in obese subjects is significant in decreasing insulin resistance and preventing diabetes.

The low sugar, high fat, keto diet, straight away starts to mess with energy metabolism, and as you might already know, messing with energy systems is a great way to cause metabolic health issues, including diabetes. The keto diet can actually lead to high blood sugar, which is apparently what the people quitting sugar are trying to avoid. At least that’s what I’ve heard.

Try to keep in mind that high blood sugar isn’t such a bad thing all the time, and low blood sugar isn’t always a good thing, and that this needs to be looked at in the right context, not just in isolation. Things that promote chronic inflammation and other metabolic problems need to be understood properly before you can see the big picture more clearly.

High Fat Diet Upregulates Fatty Acid Oxidation and Ketogenesis via Intervention of PPAR- γ; Cell Physiol Biochem. 2018; 48(3): 1317–1331.

Chronic HFD [high fat diet] induction is associated with dysregulated glucose and lipid metabolism and thus, overall dysregulated energy homeostasis. Shifting in the energy balance is the major cause for insulin resistance, obesity and T2DM. HFD treatment for 16 weeks was found to be associated with increased body weight, blood glucose…and FA levels…there were significant reductions in glucose tolerance and insulin responsiveness. These findings establish…the link between HFD intake, obesity and T2DM.

One thing to remember is that the breakdown products of the PUFAs (MDA for example), promote the development of oxidative stress, and oxidative stress promotes insulin resistance and other inflammatory issues, directly connected to the development of diabetes. A keto diet increases exposure to MDA and other breakdown products of the PUFAs, because a keto diet increases the release of the PUFAs into the blood stream as free fatty acids.

There is really no avoiding this, unless you have no PUFAs stored in your tissue, but chances are if that is the case, you wouldn’t be having huge issues with sugar in the first place. Unless when you say sugar, you mean foods with some sugar in them and 350 other ingredients that are actually harmful.

A matter of fat: insulin resistance and oxidative stress; Pediatr Diabetes . 2012 Aug;13(5):392-9. 

Obesity is linked to insulin resistance (IR), which can lead to type 2 diabetes mellitus. Oxidative stress present in early obesity may favor the progression to comorbid conditions…Children with high values of…IR were more likely to have high body fat percentage…However, the BMI Z-score did not correlate to the level of IR…higher values of…IR presented increased levels of markers of oxidative stress in lipids…MDA [malondialdehyde] increased with increasing levels of…IR.

The damage that can occur when you consume sugar, is basically the damage that is occurring as a result of interference with the ability to use sugar. Or in other words, eating a high fat diet interferes with the ability to use sugar, and promotes issues related to diabetes, and that’s especially true when the fat being eaten, or when the fat stored in your tissue, is highly polyunsaturated.

And most people today, especially if they are overweight, have high levels of PUFAs stored in tissue, because the saturated fats are used as fuel preferentially. That’s another reason why younger healthier people, can do reasonably well on a keto diet, at least for a while. But give it time, and accumulation of PUFAs and other inflammatory things in the system, and that’s when the serious issues show up.

Short-Term Low-Carbohydrate High-Fat Diet in Healthy Young Males Renders the Endothelium Susceptible to Hyperglycemia-Induced Damage, An Exploratory Analysis; Nutrients. 2019 Mar; 11(3): 489.

…one week of low-carbohydrate high-fat feeding that leads to a relative impairment in glucose homeostasis in healthy young adults may predispose the endothelium to hyperglycemia-induced damage…Increased susceptibility of the endothelium to hyperglycemia-induced damage provides evidence that the combination of a HFD with glucose ingestion could be detrimental to vascular health.

And just in case you think that avoiding sugar consumption for the rest of your life will solve this problem, it will not. In fact it will likely make the situation far worse over time, depending on a variety of factors which I have gone into in previous articles.

So what to do? I’m not a doctor or health professional, and this isn’t medical advice, but in my opinion and from experience, one of the main things that can help fix the issues that people on high fat/keto diets think they are fixing by going on that kind of diet, starts with avoiding too much fat in the diet, and especially avoiding the PUFAs, and that includes fish oil too.