Diabetes and the Ketogenic Diet

Is the ketogenic diet one more fad—or could it help manage diabetes?

Figuring out a diet that fuels our body’s needs and keeps us healthy without sacrificing taste is a daunting task for anyone. Factor in diabetes and this task can suddenly seem like an insurmountable obstacle overcome only by the most health-conscious fitness guru. Some diets are clearly fads, popping up into existence seemingly overnight, selling books and recipes and often food itself, only to fade into the twilight and be overtaken the next day by yet another set of guidelines by which we are to become, optimistically, the best self we can be.

There are seemingly endless options to curate a diet to meet every notion or need. However, those living with diabetes may find that these diets don’t always work to balance glycemic control and blood sugar. So what about the ketogenic diet? Is it a fad that will one day be supplanted by the next newest way to eat, or will the science behind it ensure it keeps a lifelong and loyal following? And if the latter, what role can it play in the lives of those living with diabetes?

Origins

Ketogenic diets were first proposed as a way to control epileptic seizures in children. Before keto diets, epileptics often fasted to reduce seizures, so the keto diet offered a less restrictive alternative. Though effective, the diet was mostly supplanted by medications—except in a segment of the population suffering from epilepsy that cannot control it with medicine, and for them, the ketogenic diet has had great success. Along with the benefits it offers to epileptics, especially children, the keto diet is also being studied as a possible salve for many neurological conditions and diabetes, too.[1]

What does “ketogenic” mean?

All of our cells need fuel to function. This fuel comes from three sources: fat, carbohydrates and protein, called macronutrients. Too much protein without fat puts us at risk for a handful of complications, so protein can never healthily serve as a primary source of fuel. We are left then with fat and carbohydrates as the main providers of energy—the energy that allow us to do everything from breathing and blinking as we veg out on the couch to swimming the English Channel. Our cells’ preferred fuel comes from carbohydrates, which are easily converted to glucose, which, in turn, is readily converted to energy. This is why athletes “carb load” before they compete. Peak performance occurs when the body has plenty of glucose and glycogen stores available at hand. When glycogen runs out, that’s when the body turns to fat. When there is no more blood sugar for our cells to consume, they seek an alternative form of energy. This energy comes from ketones, which are compounds our body produces from stored fat. So a ketogenic diet is one that is high in fat and very low in carbohydrates, resulting in the production of ketones to be used for fuel instead of glucose.

The word “keto” often has negative associations for people living with diabetes, especially type 1. DKA, diabetic ketoacidosis, is a life-threatening condition arising when the body produces too many ketones. So how does entering ketosis deliberately through a conscientious diet differ from entering it accidentally? The answer has to do with the level of ketones, the former causing “regulated and controlled production” and the latter causing an overabundance.

What does ketogenic have to offer?

The benefits of a ketogenic diet have been well documented for those living with type 2 diabetes. Not only does the diet help manage blood sugar but it promotes weight loss as well. The results for those living with type 1 are less conclusive. Many studies tend to address low carb diets like paleo and Atkins, which focus more on types of low carb food to eat, unlike a keto diet, which pays close attention to macronutrients and staying in ketosis. There seem to be fewer studies exploring the latter, but there is observational information that seems to indicate the diet offers a way to manage A1C levels and glycemic control. Many people with diabetes who abide by the keto diet have found that they significantly reduce their use of insulin.

Meat, meat and more meat

So what makes Keto unlike other diets? Meat, meat and more meat. There is no meat or fish that is off limits on keto, including the usually verboten bacon. Non-starchy vegetables like Brussels sprouts and cauliflower are encouraged, as are oils, butter and lard. Cheese and Greek yogurt can also be staples of a keto diet.

However, this diet isn’t for everyone. If traditional bread, pasta, rice, potatoes and/or fruit are what you live for, then you might just be miserable on keto. However, if you’re open to exploring different tastes, then the good news is there are substitutes for many of these foods. Cauliflower pizza crust, rice and even gnocchi; zoodles (noodles made from zucchini); almond flour bread and almond milk are all readily available from most stores now.  A small amount of berries is acceptable, but for the most part say goodbye to apples, melons, plums and peaches. Booze and sugar are also out, but if you’re living with diabetes, you likely already know how to manage these desires.

Listen to your body … and your doctor

If you are taking insulin, you may immediately need to lower your intake anywhere from 30-50 percent as soon as you enter ketosis. For those living with type 1, this can significantly help with controlling highs and hypos.

As with any diet, precautions need to be taken. Pregnant women and those with kidney disease are not good candidates for this diet, and some people with diabetes may find that the diet increases their insulin resistance. Dairy can often spike blood sugar, so avoiding the dairy in a keto diet and taking a Vitamin D supplement might be a better option for some people. It’s important to pay attention to the way your body responds and realize that no diet is a one-size-fits-all model.

The trick to reaping the benefits of the keto diet is to stay in ketosis, which means keeping your carbs at 5 percent or less of your calories. The 5 percent can fall anywhere between 20-50 grams a day. However, if an insulin shot is missed while in deep ketosis, there’s a good chance you will find yourself quite sick, so it’s probably best to avoid the risk and keep carbs on the upper end of this spectrum.

This diet might be untenable as a long-term way of life for many people, but if you have iron willpower and the desire to try a restrictive diet that still allows you to indulge yourself with fatty meats and oils, a keto diet might very well be the way for you to help manage your diabetes while managing weight.

Learn more about Food and Diabetes.