Can the Ketogenic Diet Help Reverse Insulin Resistance?

What is Insulin?

Insulin is a fat storing blood sugar regulating master hormone that is involved in multiple body functions beyond its metabolic role. A few examples include triglyceride and fat synthesis, electrolyte balance of sodium and potassium, feeding behaviors and cognitive and emotional brain function.

What is Insulin Resistance?

Insulin resistance (IR), also known as syndrome X or metabolic syndrome, is a cluster of symptoms (weight gain, cravings and increased appetite, skin tags, gum disease, low energy) and health risk factors (abnormal blood sugar, high triglycerides and cholesterol, polycystic ovarian syndrome, high blood pressure) all resulting from abnormal insulin function.

To be insulin resistant means that your body can't properly respond to the insulin it makes. Over tie, this leads to chronically high blood sugar levels.

What is important to know is that just like diabetes, with IR there may be no symptoms at all.

Insulin resistance is an early-stage in Type 2 diabetes but not everyone with IR will develop diabetes. Fifty percent of those with essential hypertension are insulin resistant. ( 1).

How Many People Are Affected by Insulin Resistance?

IR is more common than you may think. In the United States, an estimated 60 to 70 million individuals are affected by insulin resistance. That’s 1 out of 4 people.

More than 40% of individuals older than 50 years may be at risk for insulin resistance; however, it can affect anyone at any age ( 2) especially overweight children and adolescents regardless of race. You can connect with this link to see a table of the prevalence of insulin resistance by country.

Causes of Insulin Resistance 

There are several factors that may play a role in developing insulin resistance:

• Genetics and family history of diabetes, pre-diabetes
• Ethnic origin (African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American)
• Age
• Impaired hormonal regulation
• Pregnancy, including a baby delivered at 9 pounds or more
• Weight gain and obesity
• Medications such as steroids
• Smoking

Am I at Risk of Developing Insulin Resistance?

Insulin resistance or prediabetes is characterized by a high insulin level. N.M. Kaplan names insulin resistance as one of 4 risk cardiovascular risk factors of the "deadly quartet" along with hypertension, hypertriglyceridemia, and low, high-density lipoprotein cholesterol (HDL). ( 3)

Along with these risks, IR is associated with:

• fatty liver possibly leading to cirrhosis and less commonly liver cancer ( 4);
• high blood sugar (>100mg/dl); high blood pressure—140/90 mmHg or above; HDL cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL;
• acanthosis nigricans, a skin condition characterized by areas of dark, velvety discoloration in body folds and creases such as the back of the neck, armpits and groin ( 5);
• male pattern baldness, in women too (6);
• carbohydrate addiction and insatiable hunger ( 7);
• polycystic ovarian syndrome ( 8);
• skin tags and acne ( 9);
• gout as a result of easily converting fructose to uric acid ( 10); 
• gum disease ( 11);
• and/or swollen fingers and ankles with sodium/potassium imbalance ( 12).

Diagnosing Insulin Resistance

The general signs of insulin resistance may make it difficult to pinpoint but it can be diagnosed clinically by taking a fasting insulin level (over 25 ml/U/L) or blood insulin and glucose levels obtained during 120 min of a standard (75 g glucose) Oral Glucose Tolerance Test (OGTT). The table below lists normal insulin levels (13). However, many functional medical doctors believe that a fasting insulin level of less than 5 mI/U/L is optimal (14).

How Does the Ketogenic Diet Improve Insulin Resistance?

Since 100% of the carbohydrates you consume will trigger insulin release, cutting carbs to a ketogenic level of 25-50 grams a day will help lower insulin levels. 

Green leafy low-glycemic vegetables are healthy low calorie sources of carbohydrates. The safety and efficacy of a ketogenic diet is well established in helping to reduce cholesterol and heart disease risk and blood sugar and insulin fluctuations ( 14,  15) while a low fat diet may increase these health risks.

In one randomized study, 13 overweight women followed a low fat diet for 4 weeks and then a ketogenic diet for 4 weeks. "Compared to a low-fat weight loss diet, a ketogenic diet did not lower LDL-C but did prevent the decline in HDL-C and resulted in improved insulin sensitivity in overweight and obese, but otherwise healthy women." ( 16) In other studies, a ketogenic diet helped raise good HDL cholesterol levels in men ( 17).

This is true for children too. For 12 weeks, 10 pre-adolescent children with GLUT-1 deficiency syndrome (a rare genetic disorder involving neurological dysfunction) consumed a ketogenic diet. Insulin levels were significantly lower without medications or adverse effects on inflammation or abdominal fat ( 18). Ketogenic diets are not just for adults. A family can eat healthy while feasting on delicious ketogenic meals to support good health, weight loss and insulin control.

These studies support the role of a high-fat ketogenic diet benefitting heart disease risk factors and insulin levels, without causing weight gain or inflammation in both adults and children. Research has shown many health benefits for ketogenic diets.