How can a Ketogenic Diet help Hypoglycemia?

One of the questions I get asked a lot in consultations is …
​
“I suffer from Hypoglycemia and almost passing out, since I will be limiting my sugar, wont that make it worse??”

It seems logical to assume that this would be the case, as that is what hypoglycemia means, ‘low blood-sugar’; and since ketogenic diets are low-carb, it is reasonable to come to this conclusion.

However, the main culprit of glycaemic attacks is not sugar, it is insulin, or more specifically, our lifelong, diet influenced, over production of insulin.
When we ingest sugar, it signals the body to produce insulin. The role of insulin is to not only signal the presence of sugar for immediate utilisation as energy, but to also cleverly store excess glucose in our muscles and liver as glycogen, to be called on when we need it.
​
Hypoglycemia occurs when the bodies fuel gauge is ‘set to glucose’ and your fuel tank is getting to empty. Just like a car that is running out of gas, you chug, you splutter and stall.  Your carbohydrate adapted body, releases it normal floods of insulin, as it is used to dealing with a highglycaemic load and you just don’t have the ‘gas’ to take it where it needs to go. It is Insulin asking for more glucose than what we have.

But why do I get hypoglycaemic when I don’t eat?

When our bodies are carb-adapted, and we don’t eat, our blood sugar drops so that we experience hypoglycaemia. We don’t have enough energy for our vital functions BUT, we have the amazing ability to release that stored glycogen that is in the liver and muscle, and create glucose, in a process called gluconeogenesis (translated as the “creation of new sugars”). In turn insulin is released to regulate the release and use of the glucose.  Again, due to lack of intake, the insulin, being used to over production, can call for more sugar than we can produce. Therefore, we often don’t feel better unless we eat something sugary again.

So, why is it different with Ketogenic diets?

When you eat in a ketogenic way, it switches your fuel setting from glucose to Ketones. Essentially, from ‘Sugar to Fat’. 

How does this help?

Interestingly Fat incurs little to no insulin response, with protein a close second in the moderate response range.

Why is this important?

With a limited insulin response, you will have lowered amount free flowing insulin to demand sugar, and this also diminishes its capacity to store sugar.
Your sugar fuel light won’t be flashing as it does in a hypoglycaemic attack, you’ll be more balanced because you have adequate intake and adequate stores of fats.

How long does it take to switch the fuel setting?

Generally, it can take approximately a week to initiate ketosis.  In this time, your body will still be wanting sugar until it realizes that it isn't getting any. This is generally the time that people say they  experience ‘Keto-Flu’, and the transition process is why.

Several studies have been performed proving the efficacy of a ketogenic or controlled low carbohydrate diet, in the improvement of glycaemic control; and given the reduction of glycaemic fluctuation events such as hypoglycemia; even proven to aid in the reduction or cessation of taking glyceamia medications for Type 2 Diabetes.

Providing evidence that lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.
Anecdotally, clients of a ketogenic style, program report less sugar cravings, higher levels of, and a balance of mental and physical energy and regular sustained weight loss.

What about ketone strips? Should I get them?

Don't waste your time and money buying ketone testing strips, there are no such levels of being in low, moderate or deep ketosis. Its more like a pregnancy test, you either are, or you aren't - the intensity of the pink line doesn't matter as long as it is there.  Your plan will be created in a manner that will guarantee the initiation of ketosis, the only thing you need to do is comply, to maintain ketosis.

What about Exogenous Ketones? Am i upping my game and going to get into ketosis quicker? 

No.  Exo Ketones, are another idea in the weightloss and fitness industry. What we must understand is that Ketones are the energy bi-product of the breakdown of dietary or stored fats. Ketones are the fuel that our cells need to run when in Ketosis, they are not what breaks down the fat.  Your body will utilise some for its energy needs and you will expel the remaining, and if your in the pee-stick crowd, you'll think that you are in ketosis, when in fact you are literally pi**ing your money down the drain. They can however give you an energy boost, curb hunger and have been reported to enhance focus. But as for the proof on their efficacy in weight loss, the jury is still out. 

References:

1. Longo DL, et al. Harrison’s Principles of Internal Medicine. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.mhmedical.com/book.aspx?bookid=331. Accessed Dec. 24, 2014.
2. National Institute of Diabetes and Digestive and Kidney Diseases. http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/index.aspx. Accessed Dec. 28, 2014.
3. Gardner DG, et al. Greenspan’s Basic & Clinical Endocrinology. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://accessmedicine.mhmedical.com/book.aspx?bookId=380. Accessed Dec. 24, 2014.
4. Standards of medical care in diabetes — 2015. Diabetes Care. 2015;38 (suppl):s7.
5. Service FJ, et al. Hypoglycemia in adults: Clinical manifestations, definition, and causes. http://www.uptodate.com/home. Accessed Dec. 24, 2014.
6. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/diabetes_mellitus_and_disorders_of_carbohydrate_metabolism/hypoglycemia.html#v989452. Accessed Dec. 24, 2014.
7. Kossoff, E. H., & Hartman, A. L. (2012). Ketogenic diets: new advances for metabolism-based therapies. Current Opinion In Neurology, 25(2), 173–178. https://doi.org/10.1097/WCO.0b013e3283515e4a
8. Meckling, K. A., O’Sullivan, C., & Saari, D. (2004). Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. J Clin Endocrinol Metab, 89. https://doi.org/10.1210/jc.2003-031606
9. Volek, J. S., Sharman, M. J., Love, D. M., Avery, N. G., Gomez, A. L., Scheett, T. P., & Kraemer, W. J. (2002). Body composition and hormonal responses to a carbohydrate-restricted diet. Metabolism, 51. https://doi.org/10.1053/meta.2002.32037
10. Westman, E. C., Yancy, W. S., Edman, J. S., Tomlin, K. F., & Perkins, C. E. (2002). Effect of six-month adherence to a very-low-carbohydrate diet program. Am J Med, 113. https://doi.org/10.1016/S0002-9343(02)01129-4