The Ketogenic Diet and its Clinical Applications in Type I and II Diabetes

Year 2018, Volume: 2 Issue: 2, 85 - 92, 29.12.2018

Raffaele Pilla

Abstract

Nutritional
ketosis is effective to contrast seizure disorders and other acute and chronic
neurological disorders. Glucose is the primary metabolic fuel for cells,
however many neurodegenerative disorders have been recently associated with
impaired glucose transport and metabolism causing energy deficits, such as in
Alzheimer’s disease, Parkinson’s disease, general seizure disorders, and
traumatic brain injury. Ketone bodies and tricarboxylic acid cycle
intermediates can bypass the rate-limiting steps associated with impaired
neuronal glucose metabolism. After prolonged periods of fasting or ketogenic
diet (KD), the body utilizes energy obtained from free fatty acids (FFAs)
released from adipose tissue. Hepatic ketogenesis converts FFAs into ketone bodies-hydroxybutyrate
and acetoacetate, while a percentage of acetoacetate spontaneously
decarboxylates to acetone. This represents a state of normal physiological
ketosis and can be therapeutic. Therapeutic ketosis leads to metabolic
adaptations that may improve brain metabolism, restore mitochondrial ATP
production, decrease reactive oxygen species production, reduce inflammation,
and increase neurotrophic factors’ function. It has been shown that KD mimics
the effects of fasting and the lack of glucose/insulin signaling, which
promotes a metabolic shift towards fatty acid utilization. KD can only induce a
modest blood ketone level elevation and requires extreme dietary carbohydrate restriction
for maintaining sustained levels of ketosis. Prior to the advent of exogenous insulin
for the treatment of diabetes mellitus in the 1920's, general guidelines for
therapy were represented only by dietary modifications. For example, Dr. Elliot
Joslin’s Diabetic Diet in 1923 consisted of "meats, poultry, game, fish, clear
soups, gelatin, eggs, butter, olive oil, coffee, tea" and contained
approximately 5% of energy from carbohydrates, 20% from protein, and 75% from
fat. A similar diet was advocated by Dr. Frederick Allen. The aim of this work
is to analyze the current literature on therapeutic ketosis and its successful
clinical applications in diabetes type I and II.

Keywords

Ketogenic Diet, Nutrition, ketosis, therapeutic ketosis, ketogenesis, diabetes type I, diabetes type II, cure

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