Welcome to Straight Talk on Health.. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the world of health. Whether it’s research that makes the news, another miracle diet, or a new food fad, I look at the science behind them, and let you know whether it’s real or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
The Ketogenic Diet or Keto for short has enjoyed a renaissance over the past few years. It began with the Atkins Diet in the 1960s. a very low carbohydrate diet. It was revived in the 2000s. There were stores that opened that focused on only low-carb foods. That didn’t last. Now, Keto has experienced another return. You can’t walk down any aisle in a grocery store without seeing Keto or keto-friendly products. With the pervasiveness of social media and internet gurus, there is a lot more Keto (and Paleo) promotion. You can become a certified Keto coach. It’s a real money-maker for some, a way to pontificate for others.
Will the low-carb diet stick this time? Who knows? The key may depend on whether the approach focuses on high-fat or high protein. Okay, let’s get real. It’s really going to depend on the taste of low-carb products. Since this go round, using nut flours like almond and coconut have reduced the dependence on high-carb wheat flour. As a result, the mouth feel is better. That’s great but it doesn’t really address the fat vs. protein issue. Let me explain.
Insulin is the most powerful hormone in the body. From a purely metabolic perspective, insulin is the most powerful hormone in the body because it affects the availability of sugar in our bloodstream. Understand that your blood sugar is regulated within a very tight range, generally 80 to 90 mg/dl. Normal for you might be 75 . Normal for me has been 105 for over 10 years. That's just the way it is but there is no question that it all comes down to how insulin works in your body.
There has been a debate about the role of insulin on whether excess protein intake can contribute to high blood-sugar levels. In the background reading for this podcast, this controversy has gone back a minimum of 30 years and probably longer. It's only until recently that the concept of insulin resistance and prediabetes has come to the forefront. And as we have better diagnostic and testing techniques, we know more today than we used to.
Let's start with the term that you've probably heard before called gluconeogenesis. What it means is making the sugar glucose from carbon remnants. Those remnants come from a variety of sources but they are specially plentiful from the breakdown of proteins into amino acids. Actually, there is still more to the process. The amino acid has to lose the nitrogen group is a process called deamination. Once that’s done, the carbon structures that remain can be used to make glucose.
Back to insulin. One of the things that insulin will do in the liver is prevent gluconeogenesis from occurring. Think about it. The last thing that someone wants is higher blood sugar. It makes absolute sense for the body to do that. However in order to function properly, there have to be active insulin receptors within the liver as that is primarily where gluconeogenesis occurs. In this case, the insulin isn't being used to move sugar from the bloodstream into cells as it is just about everywhere else in the body. Instead, within the liver, it is preventing, by some mechanism, gluconeogenesis from occurring.
The issue that comes from insulin resistance is that the insulin can't stop the liver from producing more sugar via gluconeogenesis. The target cells are resistant to insulin for some reason. As such, when too much protein is eaten, it can be converted into sugar by the liver. So even though someone may not be eating any sugar and relatively few starches, they can still end up with high blood sugar levels if they are insulin resistant.
With 40% of the entire population of the United States obese, by definition that means that they are insulin resistant. They make plenty of insulin; they just can't use it effectively. Cells are resistant to it and that includes the liver cells. Because higher protein can be part of low carbohydrate Keto diets, there are plenty of carbon remnants available. That creates a scenario where the suppressing action of insulin doesn't happen in the liver and the resultant gluconeogenesis increases blood sugar. The result is higher blood sugar even though people have dramatically reduced there carbohydrate intake.
What's going to be the solution to this? The absolute best solution is going to be to lose the weight which should reverse the insulin resistance. That's going to take a long time for most people. One thing that can be done immediately to help with insulin resistance is to start an exercise program under doctor's supervision. There can be changes in insulin resistance in as little as 72 hours. In this case, I know it personally because that's research that I did in grad school.
So the answer to the question that I began with ‘could excess protein intake result in an increase in blood sugar?’ Yes! It is especially relevant to people that are overweight and sedentary. And that's why weight loss via any particular dietary approach should always include an exercise component.
But exercise by itself is not a good way to lose weight--unless you have four to six hours per day to dedicate to exercise. Maybe singers and dancers who practice hours leading up to performances. But you and I just can't burn enough calories to lose that much weight if you have a normal life. However, it is critical to all the other metabolic processes like insulin resistance and lipid metabolism. Exercise is a critical component of any weight loss program. So the next time that you see someone pitching a program for weight loss that doesn't involve exercise, just move right on by.
Back to the Keto diet. In this go-round, the emphasis seems to be on higher fat and about 10-20% of the calories from protein. I think that may work as long as someone doesn’t overeat. The appeal of a higher fat diet is that it can make one feel full longer. With a reasonable protein intake, the dark side of converting protein into sugars can be avoided.
Just understand that the body takes time to change, not just the number on the scale, but also the internal processes that have developed over years of being overweight. Check with your health care professional and ask whether they think an insulin test is warranted. If your insulin levels are too high, that means that you may be insulin resistant on the path to prediabetes. And if so, that would make you prone to elevated blood sugars if your protein intake goes way too high. Better to eat more low-carb vegetables, and there are plenty of them, and moderate protein then to go to any type of extreme. And don't forget, exercise is a critical component as well. You may just avoid the dark side of Keto--and end up leaner and healthier as well.
You didn't ask but I'm going to tell you anyway. What do I think of the ketogenic diet? I think it can be part of an energy training program. Now what do I mean by that? We've all heard that intermittent fasting is a thing nowadays. I’ve used it for a long time since I wrote a program called the optimal performance program. In it, I manipulate what people eat when, and when they eat what. That also includes using exercise the same way. The goal is to have energy exactly when you need it, whether that’s tax season for accountants, flipping a house while still working, or even running a 5k. By manipulating the factors involved, you will have energy when you need it,
The actual “diet” is what I've always referred to as a semi ketogenic diet. I don't obsess about counting carbohydrates; I just focus on eating the right carbohydrates. Those would be green leafy vegetables, the squashes, onions, and anything else that is not a root vegetable but high in water. You can see real improvements in your energy levels in a short time.
Why tell you this? Because I think every type of diet, the Mediterranean, the keto and so on all have some merit in specific situations. It’s understanding that they are tools to attain specific health goals. Then you pick what works from each approach to sustain the results. I think it really beats the “”see food diet. You know that one: see the food, eat the food? Until next time, this is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
Ann N Y Acad Sci. 2018 January ; 1411(1): 21–35. doi:10.1111/nyas.13435.
