Keto Diet and Diabetes: Do They Work Well Together?

By Annie Price, CHHC 

Do a keto diet and diabetes make a perfect match? Some experts and diabetics think so! When you follow a keto diet, your body converts fat, rather than sugar, into energy which may improve blood sugar levels while also reducing the need for insulin. In many ways, a ketogenic diet seems like it’s made for people trying to avoid or manage diabetes because it takes away two of the most concerning aspects of most diets — sugars and carbohydrates. While following this new way of eating, diabetics have seen drastic reductions or even elimination of their medications (more on those studies to come). And don’t worry — this diet doesn’t make you feel deprived. If anything, it has a reputation for making people feel very satisfied and energetic once they reach a state of ketosis. Let’s take a look at whether or not the keto diet may be a healthy choice for you and your diabetes management! Keto Diet and Diabetes For people with prediabetes, type 2 diabetes and type 1 diabetes, minimizing sugar as well as carbohydrate intake is typically recommended to maintain healthy blood sugar levels. The ketogenic diet is a very low-carb diet that changes the body’s “fuel source” from burning glucose (or sugar) to burning dietary fat instead. Making this major switch in dietary habits promotes a state of “ketosis” which means your body is now a fat burner rather than a sugar burner. Research as well as firsthand accounts show that this ketogenic way of eating may help some diabetics to decrease and better control their blood glucose levels. Ketogenic diet for prediabetes Obesity is one of the principle risk factors for diabetes and following a ketogenic diet has been shown to help with weight loss. According to scientific article published in 2014, “A period of low carbohydrate ketogenic diet may help to control hunger and may improve fat oxidative metabolism and therefore reduce body weight.” Many prediabetics struggle with being overweight so a keto diet can help promote weight loss, which can help to decrease the chances of developing full blown diabetes. In addition, as the Harvard School of Public Health points out, “Carbohydrate metabolism plays a huge role in the development of type 2 diabetes, which occurs when the body can’t make enough insulin or can’t properly use the insulin it makes.” When a food containing carbohydrates is eaten, the digestive system has to process these carbs and turns them into sugar which then goes into the bloodstream. The ketogenic diet majorly minimizes carbohydrate intake so prediabetics, as well as type 1 and type 2 diabetics, aren’t challenging their bodies with carbohydrate breakdown that can raise blood sugar levels and create problematic insulin demands for the body. Keto diet and type 2 diabetes

Is a keto diet good for type 2 diabetes? The keto diet can be very helpful for type 2 diabetes since the body is now using fat rather than carbohydrates as its main source of fuel. This way of eating decreases the body’s demand for insulin and helps to keep blood glucose levels at a low yet healthy level. If you’re a type 2 diabetic who takes insulin, then you may likely need less insulin as a result of following the ketogenic diet. A keto diet and diabetes study published in 2012 in the journal, Nutrition, compares low-carbohydrate ketogenic diet (LCKD) with a low-calorie diet (LCD) in improving glycemia (the presence of glucose or sugar in the blood). Overall, the study finds a low-carb keto diet to be more beneficial than a low-calorie diet for obese type 2 diabetics. The study concludes, “The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.” Previous research has also shown that for patients with type 2 diabetes, long-term administration of the keto diet lowered body weight, improved blood sugar levels and can result in a smaller needed dose of antidiabetic medication. Another earlier study published in the journal, Nutrition and Metabolism, finds that both a low-glycemic index, reduced-calorie diet and a low-carbohydrate, ketogenic diet can improve glycemic control, encourage weight loss, and reduce or eliminate the need for diabetic medication over a 24-week period with the lower carbohydrate keto diet being “most effective for improving glycemic control.” Researchers note that subjects taking between 40 to 90 units of insulin before the study were able to completely eliminate their insulin use while also improving blood sugar control! They also point out that this effect happens “immediately upon implementing the dietary changes” so people with type 2 diabetes need to monitor their blood sugar closely and likely adjust their medication dosages/needs with the help of their doctors. Keto diet and type 1 diabetes

An article published in the New York Times in 2018 explores the use of a keto diet and diabetes type 1. The article points out how many diabetes experts will not recommend low-carb diets for type 1 diabetics, especially if they are children, due to concerns over hypoglycemia as a result of carb restriction and the possibility of this having a negative effect on a child’s growth. The New York Times pieces also points out that studies are disproving this concern and making a case for both children and adults with type 1 diabetes to consider a ketogenic diet. Specifically, a 2018 study published in the journal, Pediatrics, which took a look at glycemic control among children and adults with type 1 diabetes who followed a very low-carbohydrate, high-protein diet. The researchers found that both the adults and children who consumed this diet along with smaller doses of insulin than typically required exhibited “exceptional” blood sugar control without high rates of complications. In addition, the study data did not show an adverse effect of a very low-carbohydrate diet on children’s growth, although more research may still be a good idea, according to researchers. Ketogenic Diet Meal Plan for Diabetics If you have diabetes, talk to your doctor before starting a ketogenic diet meal plan. Once you get approval from your doctor, here are some of the key building blocks of the ketogenic diet to get you started: Healthy fats: Examples include saturated fats, monounsaturated fats and some polyunsaturated fats (PUFAs), especially omega-3 fatty acids. It’s best to include all of these varieties on a daily basis, with an emphasis on saturated fats, especially compared to PUFAs.

Protein: A typical recommended keto protein intake is between one and 1.5 grams per kilogram of your ideal body weight. To convert pounds to kilograms, divide your ideal weight by 2.2. It’s important to note that Kidney Disease: Improving Global Outcomes (KDIGO) recommends that adults with diabetes limit their protein intake to less than one gram per kilogram of body weight each day and that adults with chronic kidney disease avoid protein intake greater than 1.3 grams per kilogram per day.

Carbohydrates: Historically, a targeted keto diet consists of limiting carbohydrate intake to just 20–30 net grams per day. “Net carbs” is the amount of carbs remaining once dietary fiber is taken into account. Because fiber is indigestible once eaten, most people don’t count grams of fiber toward their daily carb allotment. In other words, total carbs – grams of fiber = net carbs. That’s the carb counts that matter most.

Water: Drinking enough water can help you to avoid fatigue and is important for good digestion. It’s also needed for detoxification. Aim to drink 10–12 eight-ounce glasses a day.

There no “cheat days” or “cheat meals” on the keto diet. The main reason is that if you eat a meal too rich in carbohydrates, it will take you out of ketosis and then will be like you’re starting all over. Plus, if you do have a cheat meal, you may experience a return of keto flu symptoms that you already made a thing of the past. Ready to dive in to your new keto diet plan? Here are some examples of foods that are top choices for a ketogenic diet and for keeping blood sugar levels down. You’ll definitely want to add many of the following to your next grocery list: Healthy Fats

MCT oil, cold-pressed coconut, palm fruit, olive oil, flaxseed, macadamia and avocado oil — 0 net carbs per tablespoon Butter and ghee — 0 net carbs per tablespoon Lard, chicken fat or duck fat — 0 net carbs per tablespoon

Protein Grass-fed beef and other types of fatty cuts of meat (try to avoid antibiotics in beef) , including lamb, goat, veal, venison and other game. Grass-fed, fatty meat is preferable because it’s higher in quality omega-3 fats — 0 grams net carbs per 5 ounces

Poultry, including turkey, chicken, quail, pheasant, hen, goose, duck — 0 grams net carbs per 5 ounces Cage-free eggs and egg yolks — 1 gram net carb each

Fish, including tuna, trout, anchovies, bass, flounder, mackerel, salmon, sardines, etc. — 0 grams net carbs per 5 ounces Non-Starchy Vegetables

All leafy greens, including dandelion or beet greens, collards, mustard, turnip, arugula, chicory, endive, escarole, fennel, radicchio, romaine, sorrel, spinach, kale, chard, etc. — range from 0.5–5 net carbs per 1 cup Cruciferous veggies like broccoli, cabbage, Brussels sprouts and cauliflower — 3–6 grams net carbs per 1 cup

Celery, cucumber, zucchini, chives and leeks — 2–4 grams net carbs per 1 cup Certain fermented foods like sauerkraut, kimchi, dairy or coconut kefir (also beneficial for gut health) — 1–2 grams net carbs per 1/2 cup Fresh herbs — close to 0 grams net carbs per 1–2 tablespoons Fat-Based Fruit Avocado — 3.7 grams net carbs per half

Snacks Bone broth (homemade or protein powder) — 0 grams net carbs per serving Beef or turkey jerky — 0 grams net carbs Hard-boiled eggs — 1 gram net carb 1/2 avocado with sliced lox (salmon) — 3–4 grams net carbs Minced meat wrapped in lettuce — 0–1 grams net carbs

Condiments Spices and herbs — 0 grams net carbs Hot sauce (no sweetener) — 0 grams net carbs Apple cider vinegar — 0–1 grams net carbs Unsweetened mustards — 0–1 grams net carbs Poppy seeds — 0 grams net carbs Beverages

Water — 0 grams net carbs Unsweetened coffee (black) and tea; drink in moderation since high amounts can impact blood sugar— 0 grams net carbs Bone broth — 0 grams net carbs Looking for ketogenic diet recipes for diabetics? You’ll find many delicious options here: 50 Keto Recipes — High in Healthy Fats + Low in Carbs Keto Diet and Diabetes Precautions Does keto raise blood sugar? Most people see improvements in their blood sugar levels when following a keto diet, but some individuals may notice a rise in fasting blood glucose after being on a very low-carb diet. Let your doctor know if this occurs. Is a low-carb diet safe for diabetics? A low-carb diet like the keto diet can be safe for some diabetics if followed appropriately while being monitored by their doctor. It’s also essential that diabetics continue to follow their doctor’s instructions, including appropriate insulin use, while following any diet. Can keto trigger diabetes? The early findings of one research study published in 2018 finds that short term feeding of a ketogenic diet appears to trigger insulin resistance in rodent subjects. Sometimes ketosis is confused with ketoacidosis. Ketosis is the result of following the standard ketogenic diet. Ketosis takes place when glucose from carbohydrate foods is drastically reduced, which forces the body to find an alternative fuel source: fat. The end result is staying fueled off of circulating high ketones. Ketoacidosis is what happens when “ketosis goes too far.” People with diabetes can experience diabetic ketoacidosis (DKA), when they don’t take sufficient amounts of insulin or when they are sick, dehydrated, or they experience physical or emotional trauma. According to the American Diabetes Association, “Diabetic ketoacidosis (DKA) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death.” This is why following a ketogenic diet when you have diabetes has to be done very carefully and under a healthcare professional’s supervision. People with type 1 diabetes are more likely to develop ketoacidosis. If you experience symptoms of ketoacidosis, your blood sugar level is consistently above 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L), or you have ketones in your urine and can’t reach your doctor, seek emergency medical care. If you are a diabetic following a ketogenic diet, it’s vital that you follow this new way of eating under your doctor’s supervision, check your blood sugar regularly and take insulin as recommended. Insulin dosages often need to be adjusted after changing to a keto diet. It’s also important to monitor the renal function of diabetics while they are following a ketogenic diet.