Ketogenic Drinks Improve Glycemia and Insulin Sensitivity

Becky McCall

February 19, 2018

A ketone supplement, taken as a so-called 'keto drink' half an hour prior to consuming glucose, reduces glycemic response and improves markers of insulin sensitivity without affecting insulin secretion, show data from a small randomized cross-over study in healthy volunteers.

According to the authors, led by Étienne Myette-Côté, PhD candidate, from the University of British Columbia Okanagan, Kelowna, Canada, "ketone monoester supplements could have therapeutic potential in the management and prevention of metabolic disease." The article was published online February 15 in the Journal of Physiology.

So called 'ketogenic diets,' which are high in fat and low in carbs, have increased in popularity because of celebrity endorsement — the latest by actress Halle Berry — and have also been reported to reduce seizures and improve behavior and quality of life in children with drug-resistant epilepsy, as well as reduce migraines.

And a ketogenic diet has been shown to improve outcomes in patients with type 2 diabetes.

Using their coaching platform, the online specialty clinic Virta Health recently published 1-year data in Diabetes Therapy showing that, in 262 trial participants, there was a mean drop in HbA1c of –1.3% at 1 year, with 94% of patients eliminating insulin, and an average weight loss of 12%. As previously reported by Medscape Medical News, however, experts have questioned whether people could maintain a ketogenic diet for as long as a year.

Hence the allure of a ketogenic drink, although the current researchers acknowledge that, at the moment, the beverage tastes terrible.

In a Journal of Physiology press release, coauthor Jonathan Little, PhD, also from the University of British Columbia Okanagan, said, "the ketone supplements do not taste very good and, in order to blind the participants, we had to make a control drink that also tasted distinctly bad."

And he and his coauthors stress that, although the ketone drink attenuated the glycemic response to a standard 2-hour oral glucose tolerance test (OGTT) in healthy volunteers, it's not know what the effects would have been in those with metabolic disease.

Nor did they test the underlying mechanisms responsible for their observations.

Ketone Monoester Ingestion Prior to Glucose Consumption

Researchers decided to use an exogenous ketone monoester to study the isolated effects of elevated ketones without the confounding influence of widespread changes experienced with ketogenic diets or prolonged fasting.

The aim of the study was to investigate whether a single dose of ketone supplement taken half an hour before an OGTT had an impact on plasma glucose levels and/or insulin concentrations and insulin sensitivity.

Twenty healthy individuals participated, half men, aged 18 to 35 years, and after an overnight fast they consumed the ketone supplement or placebo 30 minutes before a 75-gram OGTT. Blood samples were then collected every 15 to 30 minutes over 2.5 hours.

Compared with placebo, after taking the ketone supplement the glycemic response decreased (area under the curve [AUC] –16%; P = .001), accompanied by a decrease in circulating nonesterified fatty acid (NEFA) levels (AUC –44%; P < .001) and C-peptide incremental AUC (iAUC, –21%; P = .005), while the oral glucose insulin sensitivity index improved by approximately 11% (P = .001).

"The decrease in C-peptide iAUC ... also supports the notion that exogenous ketone supplementation may lower glucose via improved insulin sensitivity," write the authors.

In their discussion, Myette-Côté and colleagues explain that a recent publication showed a ketone monoester consumed after a standard meal decreased glucose levels from 5.5 to 4.7 mM over 4 hours.

"This decrease of approximately 15% is of similar magnitude as the 16% decrease in glucose AUC observed in our study."

They point out that their results suggest premeal supplementation with exogenous ketones could reduce the glycemic response.

Little also speculated on the potential effect in people with metabolic disorders.

"Our study was done in healthy young participants, but if the same responses were seen in people with or at risk for type 2 diabetes, then it is possible that a ketone monoester supplement could be used to lower glucose levels and improve metabolic health. We are working on these studies at the moment."

Myette-Côté and Little have reported no relevant financial relationships. Disclosures for the coathors are listed in the article.

J Physiol. Published online February 15, 2018. Abstract

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