GOING KETO? ANTHC Diabetes Program February 2020 [email protected] https://www.surveymonkey.com/r/KETOHarper OBJECTIVES

1) Define Ketosis and the Ketogenic Diet 2) Discuss the ketogenic diet efficacy for weight loss and blood sugar control 3) Discuss therapeutic considerations for people maintaining a ketogenic diet PRETEST

Where do we make ketones? a) The brain b) The kidneys c) The pancreas d) The liver

PRETEST

What organ can’t use ketones for fuel? a) Heart b) Kidney c) Liver d) Brain

PRETEST

How long does it take to deplete glycogen stores? a) 2 hours b) 12 hours c) 2 days d) 2 weeks

Insulin! Gluconeogenesis & Glycogenolysis! Glucagon!

Ketosis! Gluconeogenesis & Glycogenolysis! Glucagon! How to Deplete Glycogen Stores DEPLETE GLYCOGEN STORES

Muscle glycogen = 400g x ~4 1) kcal/g glycogen = 1,600kcal ^can only be used by muscle Liver glycogen = 100g x ~4 kcal/g glycogen = 400 kcal available to burn

DEPLETE GLYCOGEN STORES

Muscle glycogen = 400g x ~4 2) kcal/g glycogen = 1,600kcal ^can only be used by muscle Liver glycogen = 100g x ~4 kcal/g glycogen = 400 kcal available to burn

DEPLETE GLYCOGEN STORES

3) <20-50g CHO daily

~70% fat ~25% protein ~5% carbohydrates

Ketone Bodies: acetone, acetoacetate, and beta-hydroxybutyrate (BHB).

Ketone Bodies: acetone, acetoacetate, and beta-hydroxybutyrate (BHB).

EPILEPSY

KETOGENIC DIET EFFICACY

•Epilepsy •Brain Tumor/cancer •Alzheimer’s Disease •Parkinson’s Disease •Traumatic Brain Injury •Mitochondrial Disease •Autism •ALS •Brain Health

WEIGHT MANAGEMENT? Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults A Meta-analysis. JAMA 312(9):923-33 · September 2014. Johnston et. al. EFFECTIVENESS AND SAFETY OF A NOVEL CARE MODEL FOR THE MANAGEMENT OF TYPE 2 DIABETES AT 1 YEAR: AN OPEN-LABEL, NON- RANDOMIZED, CONTROLLED STUDY

N=349; people with type II diabetes; on DM medication

Continuous Care Intervention Usual Care (n=218) (n=87) Baseline, Day 70, 12 months Baseline, Day 70, 12 months A1c, body weight, medications A1c, body weight, medications prescribed prescribed

BODY WEIGHT

-13.8 +/- 0.71%

-1.11 +/- 1.06% A1C

9.4% 9% 8.9%

7.5% 6.7% 7.0% 6.9% 6.5% 6.0% 5.9% 6.0% 5.5%

≥7.5% <6.5% ≥7.5% <6.5% DIABETES MEDICATIONS

DIABETES MEDICATIONS

DIABETES MEDICATIONS

KETOSIS? mg/dL

20

16

11

8

4

0 KETOGENIC DIET & DIABETES MANAGEMENT

“There is not a ‘one size fits all’ eating plan for people with diabetes”

“A variety of eating patterns are acceptable for the management of diabetes.” Usual Dietary Recall B – oatmeal, fruit, milk; coffee with cream and sugar L – sandwich and soup; 12 ounces of orange juice D – meat, rice, vegetable Sn – popcorn Beverages – coffee, 20 ounce Gatorade, orange juice

Planning to go keto for weight loss, on no medications for blood sugar or weight loss

Has diabetes with an A1c of 7.9%

Takes Lantus 20u nightly Metformin 500mg 4 tabs qam Glipizide 5mg BID for blood sugar control

Usual diet B – breakfast sandwich and fruit Sn – trail mix D – Stir fry OR tacos OR spaghetti Beverages – water or black coffee

Plans to ‘go keto’ and just got a job working with heavy machinery

Current Meds: 52yo female Tresiba 62u daily seen 11/2018  PATTY  Novolog 4-30u with meals Type II Diabetes  Metformin 2000mg daily  Actos 30mg daily

A1c 12.4% (7/27/2018) POC A1c 10.4% (11/8/2018)

Weight: 117.3kg BMI: 39.65kg/m2 Plans to add Victoza today for bg control Wants to go keto. Current Meds: 52yo female Tresiba 62u daily seen 11/2018  PATTY  Novolog 4-30u with meals  1:5gCHO, Type II Diabetes  Metformin 2000mg daily education:  Actos 30mg daily carbohydrate counting A1c 12.4% (7/27/2018) POC A1c 10.4% (11/8/2018)

Weight: 117.3kg education – high fat diets, slow GI emptying BMI: 39.65kg/m2 Plans to add Victoza today for bg control Wants to go keto. Current Meds: 52yo female Tresiba 62u daily seen 11/2018  PATTY  Novolog 4-30u with meals  20u TIDAC Type II Diabetes  Metformin 2000mg daily (1/22/2019)  Actos 30mg daily

A1c 12.4% (7/27/2018) POC A1c 10.4% (11/8/2018) A1c 8.1% (1/22/2019)

Weight: 117.3kg 115.9kg BMI: 39.65kg/m2 39.18kg/m2 (1/22/19) Plans to add Victoza today for bg control Wants to go keto. TAKE HOME POINTS

•Consider use of dietary recall to assess actual intake •The ketogenic diet can be used for weight loss and diabetes management, may be similar to other weight loss diets, but more long term research is needed •When utilizing the ketogenic diet, it is important to have frequent contact with a health care team for nutrition and medication management

POSTTEST

Where do we make ketones? a) The brain b) The kidneys c) The pancreas d) The liver

POSTTEST

Where do we make ketones? a) The brain b) The kidneys c) The pancreas d) The liver

POSTTEST

What organ can’t use ketones exclusively for fuel? a) Heart b) Kidney c) Liver d) Brain

POSTTEST

What organ can’t use ketones for fuel? a) Heart b) Kidney c) Liver d) Brain

Greatist.com POSTTEST

How long does it take to deplete glycogen stores? a) 2 hours b) 12 hours c) 2 days d) 2 weeks

POSTTEST

How long does it take to deplete glycogen stores? a) 2 hours b) 12 hours c) 2 days d) 2 weeks

GOING KETO? ANTHC Diabetes Program February 2020 [email protected] https://www.surveymonkey.com/r/KETOHarper

DEPLETE GLYCOGEN STORES

<20-50g CHO daily 3)

~70% fat ~25% protein ~5% carbohydrates