One of the more interesting discussions within the topic of diabetes is whether a high fat diet, and one high in saturated fat in particular, is good or bad for diabetics. I have argued this to no end on the internet with the ketogenic crowd, who get the overwhelming majority of their calories from saturated fat, and some tend to do very well on this diet.
So they go ketogenic, which means extremely low carb, low protein, and extremely high fat. In order to get membership to the keto group you have to get at least around three quarters of your calories from fat, which is about three times as much as a diet which many would call high fat would provide.
People generally get about half their calories from carbs, with the rest coming from protein and fat. So you might get a quarter to a third of your calories from fat on a diet people would typically eat these days without restrictions, ad libitium, meaning to one’s pleasure. We’re talking three times this amount though.
It’s not easy getting that percentage of your calories from fat by the way, you can’t just eat meat for instance, as you’d get too much protein from that, although meat is a staple of this diet. People have to resort to things like fat bombs which involves things like coconut oil shakes and such, but there are a lot of people who swear by this diet.
There are others, some diabetics in particular, who don’t do well on a diet like this. I’m one of them, and some of the arguments I’d have with these people is that they would say well that’s impossible, but it’s that they don’t understand the physiology here.
I admit it did take me a while to figure this all out enough, it did seem to be a real mystery at first, how does one virtually cut out carbs and eat mostly fat and have high blood sugar all the time? I did spend quite a bit of time looking at the more esoteric, like mechanisms behind fat oxidation and such, looking for a way to improve this and perhaps improve my diabetes as a result, but the big gorilla in the room has always been insulin levels.
Successful keto people don’t tend to have high internal glucose production, and therefore they do think that one’s blood glucose is a product of what they eat for the most part, and this might be true for them but it certainly isn’t for quite a few diabetics.
If you produce a lot of internal glucose, this in itself will keep your insulin levels up, regardless of what you eat. In some of us, this state is more persistent than others, for instance with me my blood sugar stayed high months into a very low carb diet. This is an unusually long time for that, this is all I was up to trying as I went from normal weight to 40 pounds underweight and in an awful mess, and I had to add carbs and protein to get back to a more healthy weight.
The goal of a keto diet, and we can almost say that this is the singular goal, because it’s that significant, is to reduce insulin levels, to either normal or even below normal. This has a fabulous effect on blood sugar if you can pull that off. If not though, things can get ugly.
There’s a huge debate on the effect of fat on blood sugar, you have these very low carbers saying that it’s neutral, and then you have others, including conventional thinking, saying that it increases insulin resistance.
I remember reading a discussion between some people who were saying trim the fat and others who claimed that this is a myth, and it is true that the reasons why we may need to pay attention to fat intake is a myth, but this doesn’t mean that the idea is a myth.
It’s actually fairly well accepted that a high carb and high fat diet is worse than a high carb and low fat, and this is because in the presence of high insulin, the fat increases insulin resistance and in turn ends up leading to even higher insulin levels.
So the successful low carbers have lowered their insulin to where they can tolerate this high fat diet, and all is well. If you aren’t able to lower insulin enough, the high fat can make things worse.
This also applies to the discussion between high or low fat and cardiovascular disease, which is actually primarily a disease of high insulin, as high insulin is behind the damage that causes this, as it is behind the damage that causes diabetes and a host of other diseases.
We know that body weight and insulin levels correlate really well, so if we did a study to see the effects of a high fat diet on a group of lean and obese people, we would expect to see that the high fat diet would be pretty harmless to the lean folks but not so good with the obese group.
This is exactly what a study did, although I’m pretty sure they didn’t fully appreciate the reasons behind the results, they were probably just curious as to how high fat affects certain groups. They did hit the nail on the head though.
You won’t read much on the insulin fat connection on popular websites though, even though we do understand the science pretty well, there’s so little work or good information on high insulin though, and we could stand some more, even though from what we know already the picture is very clear, high insulin is a very serious health epidemic with many major detrimental outcomes.
People will rightly point out though that a high carb diet in itself leads to high levels of saturated fat through its conversion in the liver, by way of insulin. This fat is even more harmful in excess than dietary fat. This doesn’t mean that we can ignore the dietary fat though, as it adds to the load.
This is another bad effect of high insulin, it’s not so much the amount of carbs you consume as it is the amount of insulin you have to go with it, to convert it to fat in other words.
Insulin acts directly not only on carbs but on fat as well, and the two together raise IL-6 levels, the bad form, the one which is highly inflammatory and a major culprit of insulin resistance, among other things.
Here’s the big thing about this that very few people get. One of the major things that happens when IL-6 goes up is that this increases insulin secretion. So the crowd cheers, isn’t that what we want with type 2 diabetes? Far from it, this is a major mechanism that makes us sick and sicker, as ours is a disease of high, not low insulin secretion.
So from the interaction between high insulin and high palmitate, saturated fat in other words, we get even more insulin resistance and even more insulin secretion. This is what we absolutely don’t want. So people do need to pay attention to their fat intake, and saturated fat intake in particular, although it’s not just as simple as saying that you limit this, or even that you need to. You certainly might though, and this is why.
Of course you can just go to the doctor who will be more than glad to raise your insulin levels further, with drugs or even insulin injections, no one knows or cares what our insulin levels are when we do this though, no one really cares about insulin much at all. This is what we have to change if we ever plan on treating this disease properly, and there are so few of us even aware of the central role hyperinsulinemia plays in modern disease.