Nicolette: 0:01

Welcome to the Health Pulse, your go-to source for quick, actionable insights on health, wellness and diagnostics. Whether you're looking to optimize your well-being or stay informed about the latest in medical testing, we've got you covered. Join us as we break down key health topics in just minutes. Let's dive in.

Rachel: 0:21

You know, for such a long time it really felt like the narrative around type 2 diabetes was kind of fixed. You know a condition you manage mostly with meds and it often gets worse over time.

Mark: 0:31

That was definitely the prevailing view for years. Manage the symptoms, control the numbers as best you can.

Rachel: 0:37

But things are shifting right. There's this growing buzz and actual research now suggesting that maybe it doesn't have to be that way. We're seeing talk of major improvements, even remission.

Mark: 0:47

Exactly Remission, meaning people actually getting their blood sugar back into a non-diabetic range without needing the medications they were on before. Some studies are showing really impressive numbers, like over half the participants achieving this.

Rachel: 1:01

Which is huge. It's moving away from just managing towards potentially reversing the underlying issues.

Mark: 1:06

It's a return to focusing on root causes, particularly metabolic dysfunction, and how lifestyle, especially diet, can fundamentally change things.

Rachel: 1:15

And right in the middle of this conversation is the ketogenic diet, keto. It's getting a ton of attention. It really is so. For anyone not you know super deep into this already. Keto basically means cutting carbs way, way down.

Mark: 1:29

Drastically.

Rachel: 1:30

And bringing healthy fats way up. The idea is to push your body into something called ketosis. Okay, so what's ketosis?

Mark: 1:36

again, Ketosis is where your body shifts its main fuel source. Instead of running primarily on glucose, which comes from carbs, it starts burning fat and producing ketones for energy.

Rachel: 1:48

Burning fat for fuel Okay, and the potential payoff for someone with type 2 diabetes could be pretty significant.

Mark: 1:55

That's what the research is pointing towards. We're talking potentially lower blood sugar, better insulin sensitivity, how well your cells actually listen to insulin.

Rachel: 2:03

Which is the core problem in type 2. Right.

Mark: 2:06

It's a huge part of it. Yes, yeah. And that can lead to needing less medication, sometimes even none. Plus, there are often benefits for weight management too.

Rachel: 2:14

Okay, but let's be honest looking into keto can feel overwhelming. There's so much info, so many opinions.

Mark: 2:20

It can definitely feel like wading through jargon sometimes.

Rachel: 2:23

So that's what we want to do today. Opinions it can definitely feel like wading through jargon sometimes, so that's what we want to do today. This deep dive is about cutting through that noise. We want to give you a clear, practical guide. How does keto actually work for type 2 diabetes? What should you eat? How do you start safely?

Mark: 2:36

And, importantly, grounded in the science. We'll look at what the studies are actually showing.

Rachel: 2:41

Think of it as your roadmap to understanding the essentials without getting lost in the weeds.

Mark: 2:46

We want to make this actionable, give you insights you can actually use if you're considering this path.

Rachel: 2:51

All right, perfect. So let's start right at the beginning. What is the keto diet fundamentally?

Mark: 2:56

Fundamentally, it's a dietary pattern defined by being very low in carbohydrates, moderate in protein and high in fat. The goal, as we said, is to trigger that metabolic shift to using ketones for energy instead of glucose.

Rachel: 3:09

And that state is ketosis. You get there by really limiting the carbs.

Mark: 3:14

Exactly when carb intake drops low enough usually under 50 grams a day, sometimes even lower your liver starts breaking down fats both from your diet and body stores into these molecules called ketone bodies.

Rachel: 3:26

And those become the main fuel.

Mark: 3:28

They become the primary fuel source for many tissues, including the brain, which usually relies heavily on glucose.

Rachel: 3:34

Okay, so in terms of like percentages on your plate, what does that look like? I think I saw some figures from Harvard.

Mark: 3:40

Yeah, the typical breakdown often cited is around 70 to 75 percent of calories coming from fat, then protein is maybe 20 to 25 percent and carbs are really low, just 5 to 10 percent of total calories.

Rachel: 3:51

Now, OK, that's. That's really different from how most people eat, isn't it? The standard diet is much higher in carbs.

Mark: 3:57

Absolutely. A typical Western diet might get 45 to 65 percent of calories from carbs. So keto is a major departure and that strict carb restriction, keeping it consistently below that 50 gram threshold, that's the trigger for ketosis.

Rachel: 4:11

Right. So the body adapts, starts burning fat. Why is this metabolic switch potentially so helpful for type 2 diabetes?

Mark: 4:19

Well, it hits several key areas. Lowering carbs naturally lowers blood sugar. Less blood sugar means less need for insulin. This reduces the strain on the pancreas. Over time, cells can become less resistant, more sensitive to insulin again. Plus, burning fat can lead to weight loss, especially that harmful visceral fat around the organs.

Rachel: 4:39

That deep abdominal fat.

Mark: 4:41

Exactly the fat strongly linked to insulin resistance and inflammation. And this isn't just theory. We're seeing clinical research backing this up for managing and, as we mentioned, potentially reversing type 2 diabetes.

Rachel: 4:53

Which leads us right into the next big question how does keto actually affect the mechanics of type 2 diabetes?

Mark: 5:01

Okay. So type 2 diabetes fundamentally is a state of insulin resistance. Your cells don't respond properly to insulin, so sugar can't easily get from your blood into the cells to be used for energy. This causes blood sugar to rise.

Rachel: 5:14

Right Insulin is like the key, but the locks are jammed.

Mark: 5:17

That's a good analogy. Now, the keto diet tackles this head on because by drastically reducing carbohydrate intake, you dramatically reduce the amount of sugar entering your bloodstream in the first place.

Rachel: 5:27

Less sugar coming in means less sugar needs to be managed.

Mark: 5:30

Precisely, your blood glucose levels naturally tend to decrease and because there's less sugar to deal with, your body doesn't need to pump out as much insulin.

Rachel: 5:39

So the pancreas gets a bit of a rest.

Mark: 5:42

It does, and with lower circulating insulin levels over time, reducing what we call hyperinsulinemia, your cells can actually start to regain their sensitivity to the insulin that is present. The locks start to unjam, if you will.

Rachel: 5:55

So you get better blood sugar control overall.

Mark: 5:57

Yes, improved glycemic control and potentially you're addressing that root cause insulin resistance.

Rachel: 6:04

And the impact can be pretty dramatic based on some of the studies. I think you mentioned one from 2018 earlier.

Mark: 6:11

Yes, the study by Hallberg and colleagues published in Diabetes Therapy. They followed people with type 2 diabetes on a supervised keto diet for a year. The results were striking.

Rachel: 6:19

What did they find?

Mark: 6:20

Get this 94% of the participants who started on insulin were able to either reduce their dose or stop taking it completely 94%. And 60% achieved an HbA1c. That's the measure of long-term blood sugar control below the diagnostic threshold for diabetes without any diabetes meds.

Rachel: 6:40

So effectively. Their diabetes was in remission by that measure.

Mark: 6:44

And clinically over half more than 50 percent met the criteria for diabetes reversal based on their diagnosis.

Rachel: 6:50

That's incredible. Really challenges the old narrative. Were there other benefits besides blood sugar?

Mark: 6:56

Absolutely. Research, including that study, consistently shows other positive metabolic changes Things like lower triglycerides that's a type of fat in the blood you don't want too high and often an increase in HDL cholesterol the good cholesterol Plus, as we mentioned, significant loss of visceral fat, which is so metabolically damaging. Improvements in blood pressure are also commonly seen. These are often measured together in what's called a lipid profile.

Rachel: 7:21

And even major organizations are starting to acknowledge this right, Like the American Diabetes Association.

Mark: 7:27

Yes, the ADA now recognizes low-carbohydrate diets, including keto, as a viable option for managing type 2 diabetes. It's seen as a strategy particularly for people aiming to reduce medication use and improve blood sugar.

Rachel: 7:41

That recognition feels significant.

Mark: 7:43

It shows a shift in mainstream thinking, acknowledging the potential power of these dietary approaches beyond just standard advice.

Rachel: 7:51

And that word again remission. It just sounds so hopeful compared to the traditional outlook.

Mark: 7:56

It really is. For decades, achieving remission without surgery or very intensive drug therapy seemed almost impossible for most. Keto is showing that for many it might be achievable through diet and lifestyle changes. It's a paradigm shift.

Rachel: 8:09

So let's dig a bit more into that research base. You've highlighted a couple of key studies. Are the findings generally consistent?

Mark: 8:16

Yes, Over the last, say, 10 years or so, the volume of research has really grown, and consistently. Studies report improvements in blood sugar control, better insulin sensitivity, significant weight loss and favorable changes in lipids triglycerides down, HDL up.

Rachel: 8:30

And supervision seems important.

Mark: 8:32

It does seem that the best results and the safest implementation happen when it's done under clinical supervision, especially if someone is on medication.

Rachel: 8:42

Let's go back to that Virta health study you mentioned. What were the specific numbers there?

Mark: 8:46

Right the 2018 VRTIS study also in diabetes therapy. They saw average HbA1c drop from 7.6 percent down to 6.3 percent. That's a big move out of the typical diabetic range.

Rachel: 8:58

Huge improvement.

Mark: 8:59

And again that striking number 94 percent of insulin users reduced or stopped their insulin and over half met the criteria for diabetes reversal. They also noted weight loss and better liver enzyme levels.

Rachel: 9:11

Which suggests better liver health potential?

Mark: 9:14

Potentially yes. Reducing litter fat is often reflected in those enzyme levels.

Rachel: 9:18

And wasn't there an older study comparing keto to a low-fat diet?

Mark: 9:21

Yes, back in 2005, yancey and colleagues published in Nutrition and Metabolism. They compared keto to a standard low-fat, calorie-restricted diet. The keto group saw greater improvements in fasting, glucose, triglycerides and HDL.

Rachel: 9:34

And medication use.

Mark: 9:35

They also had greater reductions in diabetes medication needs compared to the low-fat group.

Rachel: 9:40

And it's not just single studies, but analyses of multiple studies too.

Mark: 9:43

Correct Meta-analyses, which pool data from several trials, generally support these findings. A 2017 analysis by Snorgaard, for example, concluded that low-carb and keto diets often lead to greater reductions in HbA1c and insulin levels compared to more conventional dietary advice for type 2 diabetes.

Rachel: 10:03

So acknowledging that everyone's different and sticking with it matters, the overall scientific picture looks quite promising for actually turning diabetes around, not just managing it.

Mark: 10:12

I think that's a very fair summary of where the evidence is pointing right now. It's a potentially transformative approach for many.

Rachel: 10:18

OK, the science is compelling, let's get practical. If someone is thinking all right, maybe I should look into this, what does eating keto actually involve day to day? What are the eat this, not that basics?

Mark: 10:30

The foundation is really shifting to whole unprocessed nutrient-rich foods, while being super strict about keeping those carbs under about 50 grams a day.

Rachel: 10:39

Okay, so what should be on the shopping list? What are the keto staples?

Mark: 10:43

Lots of non-starchy vegetables Think spinach, kale, broccoli, cauliflower, zucchini, asparagus. They're packed with nutrients but low in carbs.

Rachel: 10:51

Good fiber source too.

Mark: 10:53

Definitely, then healthy fats are key Olive oil, avocado oil, avocados themselves, butter, ghee, coconut oil. Fatty fish like salmon, mackerel, sardines are fantastic. Great omega-3s Okay. Meat and poultry, beef, lamb, chicken, turkey ideally grass-fed or pasture-raised, if you can. Eggs are a keto powerhouse.

Rachel: 11:16

Versatile.

Mark: 11:16

Very Nuts and seeds like almonds, walnuts, chia flax, good fats and fiber, but you do need to watch portions as carbs can add up.

Rachel: 11:24

Moderation there.

Mark: 11:25

Yep, some dairy can fit like cheese. Plain full-fat Greek yogurt, heavy cream and, of course, herbs and spices for flavor garlic, turmeric, cinnamon, oregano, basil. They add a lot without adding carbs.

Rachel: 11:35

It sounds like a pretty satisfying way to eat, honestly, lots of real food.

Mark: 11:39

It absolutely can be. It's about fueling your body with fat and protein, keeping you full, supporting ketosis and helping insulin sensitivity.

Rachel: 11:46

Now the flip side. What are the big things to avoid the carb culprits?

Mark: 11:49

This is where the diligence comes in. Obvious ones first. Sugar Soda juice, candy, desserts basically anything sweet is out Makes sense. Grains and starches are major carb sources, so bread, pasta, rice, cereal, oats, corn those need to go. Most fruits are too high in sugar, especially things like bananas, grapes, apples. Dried fruit is very concentrated in sugar. Small amounts of berries might be okay for some, but you have to be careful.

Rachel: 12:18

Berries are lower GI.

Mark: 12:20

Generally lower. Yes, but still count towards your carb limit. Legumes, beans, lentils, peas Also tend to be too high in carbs for strict keto.

Rachel: 12:29

What about processed stuff?

Mark: 12:31

Big category to watch. Avoid low-fat or fat-free products. They often swap fat for sugar. Processed snacks like chips, crackers, granola bars are usually loaded with carbs and unhealthy oils. And speaking of oils, yeah, try to limit vegetable oils high in omega-6s, like soybean, corn, sunflower oil. Stick to the healthier fats we listed earlier.

Rachel: 12:49

So reading labels becomes super important. You really have to check for hidden sugars and carb counts.

Mark: 12:53

Absolutely critical. Even things labeled low-carb or diabetic-friendly can sometimes have surprising amounts of carbs or sugar alcohols that affect people differently. Using a tracking app or just a food journal, especially when you're starting, can be incredibly helpful to see where carbs are sneaking in and how foods affect your blood sugar.

Rachel: 13:12

Okay. So you've got the food figured out. You're ready to start. What are the crucial safety tips and considerations, especially for someone with type 2 diabetes?

Mark: 13:20

This is probably the most important part. Careful planning is essential, particularly if you're on any glucose-lowering medications.

Rachel: 13:27

Because cutting carbs can lower blood sugar fast.

Mark: 13:29

Exactly, sometimes within days. This creates a real risk of hypoglycemia. Dangerously low blood sugar if your medication doses aren't adjusted downwards appropriately.

Rachel: 13:39

So number one rule talk to your doctor before you start.

Mark: 13:42

Absolutely non-negotiable. You must consult your healthcare provider or diabetes team. They need to assess if keto is safe for you and, crucially, they need to guide you on adjusting medications like insulin or sulfonylureas. These are the ones most likely to cause lows when carbs are cut.

Rachel: 13:59

And they'll probably want you checking your blood sugar more often.

Mark: 14:01

Definitely Expect to monitor your glucose much more frequently, especially in the first few weeks, coast much more frequently, especially in the first few weeks. They'll also likely want follow up lab works, HbA1c lipids, maybe kidney and liver function tests to track your progress and safety. Remember that Virta health study Nearly everyone needed med adjustments quickly. This needs medical supervision.

Rachel: 14:22

OK, what about the keto flu? Is that a real thing?

Mark: 14:25

It is for some people. Yes, it's a collection of temporary symptoms like fatigue, headache, maybe some dizziness, muscle cramps, irritability. It usually happens in the first week or so as your body adapts.

Rachel: 14:37

What causes?

Mark: 14:37

it. It's thought to be mainly due to shifts in electrolytes and water balance. As your body switches, fuel sources and glycogen stores deplete. The good news is it typically passes within a few days to a week.

Rachel: 14:49

Any tips to manage it?

Mark: 14:50

Hydration is key. Drink plenty of water. Adding lycrolites can help significantly think sodium like sipping broth, potassium and magnesium. Eating enough healthy fat provides energy during the transition too.

Rachel: 15:02

And how do you know if it's working beyond just feeling okay after the initial phase?

Mark: 15:07

Monitoring Again. Use your glucometer or CGM regularly to see the impact on your blood sugar levels. Some people also like to measure blood ketone levels using a ketone meter. This confirms you're actually in ketosis. Measuring beta-hydroxybutyrate.

Rachel: 15:21

And you might see changes pretty quickly.

Mark: 15:23

Many people with type 2 diabetes notice improvements in their glucose readings, both fasting and after meals. Within maybe two to six weeks, Insulin levels often start coming down too.

Rachel: 15:33

One more thing here Is keto, something you have to do forever.

Mark: 15:37

Not necessarily. It really depends on the individual and their goals. Some people thrive on it long term. For others it might be a shorter term therapeutic tool, maybe six months a year, two years to really reset their metabolism, reverse insulin resistance, lose weight and get off meds. And then maybe transition to carefully reintroduce small amounts of nutrient-dense carbs while still maintaining good metabolic health. It's all about personalization, ongoing monitoring and finding what's sustainable for you.

Rachel: 16:09

Okay. So while it sounds promising, are there cases where keto just isn't a good fit or needs extra caution. People worry about effects on the liver or kidneys sometimes.

Mark: 16:19

That's a really valid point and it's crucial to discuss. No diet is right for everyone and those concerns about liver and kidney health are common, but we need to look at the current evidence.

Rachel: 16:30

All right, let's tackle the liver first. The idea of a high-fat diet does it strain the liver?

Mark: 16:36

It's interesting because the newer research is actually suggesting the opposite for many people, particularly those with non-alcoholic fatty liver disease or NAFLD.

Rachel: 16:45

Which is common with type 2 diabetes.

Mark: 16:47

Very common, often driven by the same insulin resistance. Studies are showing that low-carb, high-fat diets, including keto, can actually reduce the amount of fat stored in the liver and improve liver enzyme levels.

Rachel: 16:58

How does that work?

Mark: 17:00

Well, researchers like Dr Robert Lustig argue that it's often excess carbohydrates, especially fructose, that drive fat accumulation in the liver and contribute to insulin resistance there. By removing those sugars and refined carbs and reducing overall liver fat through fat burning, keto might actually help liver function.

Rachel: 17:19

So less fat in the liver, potentially better function.

Mark: 17:22

Exactly. A 2016 meta-analysis found low-carb diets reduced liver fat in NFLD patients, without signs of liver injury. Another trial showed keto-improved liver function markers. So the old assumption isn't necessarily holding up.

Rachel: 17:37

Okay, what about the kidneys? That's another frequent concern, often linked to protein intake.

Mark: 17:41

Okay, what about the kidneys? That's another frequent concern, often linked to protein intake. Right, the worry is often about high protein, but a well-formulated keto diet is typically moderate in protein, not high. That said, if someone already has diagnosed kidney disease, then yes, careful monitoring is absolutely essential.

Rachel: 17:54

And how we measure kidney function matters too.

Mark: 17:56

It does. The common blood test serum, creatinine, can be influenced by things like muscle mass or even meat intake. It might not be the best indicator, especially for early issues.

Rachel: 18:05

Is there a better marker?

Mark: 18:06

There's growing interest in using cystatin C. It's another protein filtered by the kidneys, but levels are less affected by muscle mass or diet. Estimating kidney function or GFR using cystatin C might give a more accurate picture, especially in detecting early decline. Research in the New England Journal of Medicine supports this.

Rachel: 18:26

So again, it's more about accurate monitoring than automatic exclusion.

Mark: 18:30

Precisely, Instead of just saying no keto. If you have kidney concerns, the approach should be work with your doctor. Use the best available tests like cystatin C alongside standard tests, and monitor closely.

Rachel: 18:42

Got it. Are there any specific groups of people where keto generally needs modification or very close supervision?

Mark: 18:48

Yes, definitely. People with type 1 diabetes need extremely careful management to avoid DKA, diabetic ketoacidosis, which is dangerous. Pregnant or breastfeeding women have higher nutrient needs that might be hard to meet consistently on keto. Anyone with a history of eating disorders should be cautious as the restrictive nature could be triggering without therapeutic support and maybe athletes doing very high intensity or long duration exercise might find they need more carbs, sometimes maybe using a cyclical or targeted keto approach.

Rachel: 19:17

So the big message is personalization, work with your team, use the right tests, tailor it to your situation.

Mark: 19:23

That's exactly it. Individualization, appropriate lab testing including things like cystatin C and liver panels and clinical guidance are key to doing this safely and effectively.

Rachel: 19:33

This has been incredibly thorough, Thank you. So, to kind of wrap this all up, one of the main takeaways for our listeners about keto and type 2 diabetes maybe just recap those key study findings quickly too.

Mark: 19:44

Okay, so the Hallberg study 94% insulin reduction, elimination, 60% HbA1c below diabetic threshold, over 50% remission.

Rachel: 19:53

Impressive.

Mark: 19:53

Virta Health study Similar findings HbA1c dropped from 7.6 to 6.3, 94% insulin reduction. Over 50% reversal criteria met Yancey's older study. Keto better than low fat for glucose lipids med reduction and the meta-analyses confirm keto often outperforms standard diets for lowering HbA1c and insulin.

Rachel: 20:15

Okay, so the big picture.

Mark: 20:16

The big picture is that the ketogenic diet is a potent metabolic intervention for many with type 2 diabetes. By cutting carbs, promoting fat burning and lowering insulin demand, it directly targets insulin resistance.

Rachel: 20:29

Leading to tangible benefits.

Mark: 20:31

Yes, Better blood sugar control. Reduced or eliminated medication needs potential weight loss and, importantly, clinical studies show it can lead to partial or even full remission for a significant number of people. Results vary, Consistency matters, but the potential is undeniable.

Rachel: 20:46

And always, always, with medical guidance first.

Mark: 20:49

Cannot stress that enough, especially if you're on glucose-lowering meds, talk to your doctor, monitor closely, adjust meds as needed. It's crucial for safety. And remember the concerns about liver-kidney health are being re-evaluated, with newer data suggesting potential liver benefits and better ways to monitor kidney function, like cystatin C, and for tracking progress you mentioned a resource. Yes, Services like QuickLab Mobile offer in-home testing for things like fasting insulin, HbA1c lipids, cystatin C, liver enzymes. It can empower you to track your own metabolic health and work with your doctor to personalize your approach.

Rachel: 21:24

So really, when done right, keto isn't just a fad. It can be a legitimate strategy for better energy, fewer drugs, maybe even a completely different trajectory for life with type 2 diabetes.

Mark: 21:35

That sums it up well and just the necessary reminder. Everything we've discussed is for educational purposes. It is absolutely not medical advice and it doesn't create a doctor-patient relationship. Always consult your own qualified healthcare provider for any health concerns or before making any changes to your diet or treatment. Don't rely solely on this info. If you have symptoms, seek medical help immediately. Call 911 in an emergency. We're not liable for outcomes based on this discussion. External links aren't endorsements. Your health is unique. Prioritize professional medical advice.

Rachel: 22:05

So a final thought for you listening has today's conversation maybe challenged your view on managing type 2 diabetes? Given the research on remission and reducing medications with approaches like keto, is it worth having a new conversation with your doctor about what might be possible for you?

Mark: 22:22

We hope this deep dive is giving you valuable food for thought. It's really just the beginning. We encourage you to keep exploring, talk to your provider, maybe even look up some of the research we touched on.

Rachel: 22:32

Because, ultimately, understanding these options empowers you to take a more active role in your own health journey.

Nicolette: 22:47

Thanks for tuning into the Health Pulse. If you found this episode helpful, don't forget to subscribe and share it with someone who might benefit. For more health insights and diagnostics, visit us online at wwwquicklabmobilecom. Stay informed, stay healthy and we'll catch you in the next episode.