Ketogenic Diet For Diabetics. The present investigation to develop, seeks to establish results in relation to the application of the ketogenic diet, pretends that through the bibliographic information can be applied in the population of Ensenada, Baja California Mexico.
Those who have been diagnosed with Diabetes Mellitus type 2. The study will be carried out in order to benefit and provide a better quality of life to patients with DM 2.
Diabetes Mellitus is considered a group of metabolic diseases characterized by hyperglycemia, a consequence of defects in the secretion and / or the action of insulin. Chronic hyperglycemia is associated with long-term damage, dysfunction and failure of different organs such as: eyes, kidneys, nerves, heart and blood vessels.
In the world today it is estimated that 347 million people live with diabetes. It has been estimated that the life expectancy of these patients is reduced between 5 and 10 years. During the last decades the number of people suffering from diabetes in Mexico has increased and is currently among the leading causes of death in the country. We have identified 6.4 million Mexican adults with diabetes, that is, 9.2% of adults in Mexico have already received a diagnosis of diabetes (ENSANUT 2012).
This research will try to demonstrate that the ketogenic diet acts in a preventive and curative way before the complications of Type 2 Diabetes Mellitus.
Approximately 80% of diabetic patients are obese and obesity is a risk factor for diabetes. Each unit increase in body mass index (BMI) is associated with an increase in risk of 12%. (Basilio Moreno, 2012)
The distribution of body fat also represents an important risk factor for type 2 diabetes, because centripetal or visceral obesity potentiates insulin resistance.
When there is excess fat, the secretion of adipokines increases, in particular of TNF-a, interleukin 6 and resistin, which lead to a permanent inflammatory state. This situation converts the fatty tissue and, subsequently, the rest of tissues, into resistance to the action of insulin, forcing the pancreas to increase insulin secretion (hyperinsulinism), which eventually leads to failure of the regulation of glycemia and type 2 diabetes.
Protein diets that are very low in calories can be a good dietary option in obese diabetic patients who do not require insulin in their treatment because they produce a rapid weight loss with a short and long term metabolic improvement, allowing to reduce the medication required by these patients.
Most of the studies refer to the benefits obtained in the short term with this type of diet and that include, in addition to weight loss, the reduction of fasting glucose concentrations and medication requirements, the improvement of the lipid profile and decrease in blood pressure figures.
The preliminary data corresponding to the first two months of follow-up indicate that the protein diet achieves better results than the conventional hypocaloric diet in terms of weight loss (-11.32 kg vs -2.95 kg, p <0.001) and the decrease in BMI ( -4.06 vs -1.31; p <0.001) and the waist circumference (-10.33 cm vs 4.77cm). It also shows better metabolic control, with lower HbA1c levels (6.25 vs. 6.80%, p <0.001) and a higher percentage of patients with normalized venous blood glucose levels <110 mg / dL, HbA1c <7%, total cholesterol < 200 mg / dL, LDL cholesterol <130 mg / dL and normalization of the HOMA index of insulin resistance.
The ketogenic diet has been used successfully since the 1920s for the treatment of epileptic seizures in children; however, it has been used as a dieterapeutical proposal for overweight and obesity since the 1970s, provoking an important boom in high protein diets driven by books on the Atkins diet; however scientific reports on the effectiveness of such a diet appeared much later. (Covarrubias Gutierrez, 2013)
Among the advantages that the ketogenic diet can offer us, it is found that it has a greater satiating effect, which can decrease caloric intake, does not affect the lipid profile and may even help to improve it, specifically reducing plasma concentrations of total cholesterol and triglycerides, as well as increasing HDL cholesterol levels.
When a diet has a predominance of carbohydrates, the body uses them as the main source of energy instead of fat. On the contrary, the absence of carbohydrates in the diet accelerates the use of fat. This is because insulin blocks lipolysis (by blocking the adipocyte lipase) and allows glucose to enter the fat cell. This glucose is converted into triglycerides within the adipocyte.
The low glycemic index of ketogenic diets reduces fluctuations in plasma glucose concentrations, which are much more frequent with high-carbohydrate diets. (Pérez-Guisado, 2008)
The proteins have an anorectic effect superior to that of carbohydrates, which could be mediated by an increase in the sensitivity of the central nervous system to leptin.
When they are consumed together with proteins, carbohydrates have the ability to multiply their obesity-inducing effect; when consumed with fat, carbohydrates allow the accumulation of this; and finally carbohydrates have a less satiating effect than lipids and proteins. Therefore, a diet based on proteins and / or fats could be a good option for weight loss, as this would achieve low levels of insulin in blood that would allow a metabolic change in favor of the use of fat in Instead of the carbohydrate, that is, move from a metabolism fundamentally glycolytic to a lipolytic metabolism that directly attacks the fat deposits.
For this reason, from a physiological point of view strategies to lose weight that are based on the reduction of fat intake and maintenance of the proportion of carbohydrates as a main source of energy, could be less effective for weight loss For this reason, from a physiological point of view strategies to lose weight that are based on the reduction of fat intake and maintenance of the proportion of carbohydrates as a main source of energy, could be less effective for weight loss .
Frederick et al (2003) At 6 months, 7 patients belonging to the low-carbohydrate diet group reduced their doses of oral hypoglycaemic agents or insulin. In comparison, 1 patient in the low-fat diet group had a reduction in insulin dose and 1 patient started oral hypoglycaemic therapy.
Willi et al. (2008) also found in their study, that the use of a low carbohydrate diet in adolescents with morbid obesity, was an effective method for weight loss and conservation of muscle mass. Also in another study with adolescents Sondike et al. (2012) found that a diet low in carbohydrates without caloric restriction in fats and proteins was more effective in weight loss and improved blood lipid profile than using a low fat diet.
Samaha et al. (2014) conducted a six-month study in which they found that people with morbid obesity and a high prevalence of type II diabetes or metabolic syndrome, lost a greater weight during this period of time in the low carbohydrate diet than the diet low in calories and fats, with an improvement in sensitivity to insulin and triglyceride levels
Covarrubias et al, considers that ketogenic diets are considered effective in the treatment of diabetes mellitus type II, to prevent or delay the loss of total body lean mass.
Hussain et al., For example, compared a low-carbohydrate diet versus a low-calorie diet over a 24-week period in 102 diabetic patients and 261 non-diabetic patients. Plasma glucose levels decreased significantly in the low-carbohydrate diet group compared to those on the low-calorie diet. After 24 weeks, patients with type 2 diabetes who were given the low-carbohydrate diet decreased on average 1 mg of plasma glucose in contrast to those who took the low-calorie diet. More significantly, the group that took the low-carb diet approached blood glucose levels after 24 weeks, while the group on low-calorie diet levels of glucose stabilized and remained high at week 16. Non-diabetic patients with normal blood glucose levels the low-carbohydrate diet produced only a small effect on glucose. (Feinman, 2015)
To verify the effectiveness of the ketogenic diet in the control of the diabetic patient, as a tool to try to avoid the natural course of the disease and its complications.
The ketogenic diet in the diabetic patient is a control tool to delay the natural course of the disease and its complications.
It will be mainly focused on the population of Ensenada, Baja California, but could reach a national and international magnitude.
Patients with Diabetes Mellitus type 2 will be fully benefited by avoiding and reversing complications, to improve the quality of life in a high percentage, avoiding and decreasing the expenses in hospitalizations and treatments due to the complications of Diabetes Mellitus type 2, also improving the family, state and national economy.
For this diet to work, it must be in a strict regime since any disarrangement on the part of the patient breaks the cycle of the diet. This is the main risk of non-adherence for good management and control of the diet and for this of results.
Carrying out the Ketogenic diet implies a very drastic change in the patient’s diet, since its nutritional base has always been that of carbohydrates. Performing this diet would not imply economic problems but it could be that in some cases if there are.
METHODOLOGY OR METHOD:
The research will be carried out in facilities of the Xochicalco University, in the ISSSTECALI hospital in the city of Ensenada. The research design will be qualitative, descriptive, transversal. The participants will be obese patients with non-insulin-dependent Diabetes Mellitus type 2, without liver and kidney disorders. A systematic review of articles dealing with ketogenic diets in patients with Type 2 Diabetes Mellitus will be carried out, to which the epidemiological method will be applied where: a) Reliable, assertive, updated articles that provide the necessary information will be sought for the research topic. b) Those articles that serve as the basis for the investigation will be selected. c) They will be analyzed to reach a conclusion. For the analysis of the information, the data obtained will be plotted to confirm the hypothesis.
According to Pérez Guisado (2008), the ketogenic diets used for weight loss are effective and safe, so Westman states that obese women who followed a pure ketogenic diet without caloric restriction in fats and proteins (carbohydrates <25 g / day) maintained Weight loss and improved lipid profile. For periods of one year, comparing a pure ketogenic diet without caloric restriction in fats and proteins (carbohydrates <30 g daily) with a conventional hypocaloric diet low in fat-calories-high in carbohydrates (<30% daily energy of fat), The ketogenic diet proved to be healthier since it was associated with greater improvement in cardiovascular risk factors and the glycemic index. In other 14-month clinical trials with a pure ketogenic diet without caloric restriction (carbohydrates <30 g daily) in obese diabetic patients there was a progressive improvement not only in weight loss but also in the lipid, renal and glycemic profile .
According to Basilio Moreno Esteban (2012), weight reduction is one of the most effective therapies for obese diabetics who do not require treatment with insulin. However, obese diabetics have greater difficulties in losing weight than non-diabetic obese patients and frequently, the success rate with conventional diets is low. The development of very low calorie diets in the last 3 decades has provided an alternative approach for the treatment of diabetic type 2 obese patients. The protein diet is a very low ketogenic diet, with a protein intake adjusted to the requirements of the organism, with low intake of carbohydrates and lipids and supplemented with vitamins and trace elements, whose main advantage is that it achieves a very rapid initial weight loss facilitated by the anorectic effect of ketosis, decreased waist circumference, and improvement of the Metabolic control within a few days of treatment. This improvement in blood glucose levels, higher than would be expected due to weight loss, is achieved thanks to a reduction in hepatic glucose production and an increase in insulin sensitivity. By improving glycemic control, very low calorie diets also improve other cardiometabolic risk factors.
According to the results obtained in this research, it is concluded in this research that a diet high in protein and fat is more beneficial than a hypocaloric diet in patients with type 2 DM, because it produces short and long term metabolic improvement In addition, weight loss, reduction of fasting glucose concentrations and medication requirements, improvement of lipid profile and decrease in blood pressure levels and their complications.
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