Everything You Need to Know About the Ketogenic (keto) Diet and Diabetes

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By : Suvarna Sheth

There was the popular South Beach diet, then the Atkins diet, the Paleo diet, and now there is the ketogenic (keto) diet.

It may be considered one of the latest fads of recent years, with numerous celebrities jumping on the bandwagon and claiming their success, but what does the keto diet mean for regular people like you and me that may have Type 1 or Type 2 diabetes?

We’ll take a closer look at the keto diet, what it is, whether it’s safe for someone with diabetes, and whether you should give it a try.

What is the Ketogenic (keto) diet?

The keto diet is an extremely low carbohydrate diet that helps the body to burn fat by forcing it into a state of ketosis, a metabolic process where the body uses fat instead of carbohydrates as its fuel source.

Studies have found that this very low-carb, high-fat diet is effective for weight loss, diabetes, and even epilepsy.

In fact, the keto diet was first used as a therapy to treat epilepsy in children back in the 1920s after studies showed the chemical produced when in ketosis, ketone, could possibly help reduce seizures.

The diet was later adapted for weight loss by Dr. Gianfranco Cappello, a professor at the University La Sapienza in Rome.

Cappello studied the diet between 2006 and 2011. Cappello and researchers found a keto diet helped more than 19,000 participants lose an average of 22 pounds in 25 days.

While Cappello’s famed study looked at the keto diet as an effective treatment specifically for weight loss and not other chronic conditions, he tells dLife the diet can also be helpful to someone with Type 2 diabetes since lowering overall body weight reduces the risk for diabetes as well.

“The keto diet can reverse Type 2 diabetes, and it can be absolutely safe for someone with T2D, but you should stop antidiabetic therapy,” Cappello explains.

He says the keto diet could be dangerous for someone with diabetes, especially when the body goes into ketosis, but for that reason, he says decompensated diabetes should never be treated with a keto diet.

And, he doesn’t believe the keto diet can cause other problems, such as high cholesterol.

As far as the sustainability of the diet, Cappello says a keto diet should last only 10-15 days until the patient loses 10% of his or her weight. “It can be repeated after 10 days all the times you want,” he states.

Cappello says the problem for most diets is not whether you will lose weight. “The problem is that you should maintain the weight you achieve.”

What does a keto meal plan look like?

In a typical keto meal plan, dieters consume 75% of daily calories from fat, 20% from protein and 5% from carbohydrates.

The following are some of the foods you can eat on the keto diet:

  • Meats
  • Butter
  • Olive oil
  • Mayonnaise
  • Low carb vegetables like avocado, spinach, and broccoli
  • Cheese
  • Heavy cream
  • Sour cream
  • Nuts
  • Seafood
  • Eggs
  • Spices
  • Berries
  • Artificial sweeteners like Stevia and sucralose (sparingly)
  • Hard alcohol and dry wine and maybe permitted sparingly

For a more detailed guide, read more about the foods that you can consume on a keto diet here.

Here’s a list of foods that you cannot consume when on a keto diet:

  • Fruits
  • Grains
  • Starchy vegetables such as potatoes, carrots, and beets
  • Breaded or cured meats
  • Legumes
  • Sweeteners
  • Sweets like candy and chocolate
  • Canola, sesame, sunflower
  • Sweetened drinks
  • Low-fat dairy items, which often have added sugar
  • Ketchup, barbecue sauce, some salad dressings
  • Beer, cocktails and mixed drinks

Is the Keto Diet Safe for someone with Diabetes?

Some experts believe the keto diet is safe for people with diabetes, backing up their thoughts with studies that show the keto diet can accelerate weight loss, and improve blood sugar control for patients with Type 2 diabetes.

Dr. Bret Scher, a cardiologist and medical director at Diet Doctor.com, believes the keto diet can be useful to someone with Type 2 diabetes, and even Type 1 diabetes.

“There is plenty of good evidence out there now, showing that it [the keto diet] has a meaningful and beneficial impact on people with diabetes,” Scher tells dLife.

“And not just modifying or managing the disease, but actually helping people put their diabetes into remission based on lab values and helping them get off medication while they are improving control of their T2D,” he adds.

Scher believes getting off medication should be one of the most important goals for someone with diabetes. “Most doctors are taught T2D can be managed, which usually means adding more medications to keep the blood sugar in check,” he says.

What Scher has personally seen is that a low carb or keto diets are far more effective than any diabetes medication.

“Doctors in the medical community have fallen short because the way we’ve looked at treating T2D mostly has to do with increasing insulin, whether it’s actually giving insulin, or whether it’s giving medications that stimulate insulin production,” Scher explains.

In contrast, Scher says what a low carb or keto diet does is control the blood sugar by reducing the need for insulin.

“I think that’s what makes it so powerful and the evidence has shown, that you can get patients off medications and improve blood sugar control,” he adds.

Today, Scher even believes the keto or low carb diet can benefit someone with Type 1 diabetes, contrary to when he first started in the world of keto and low carb.

“When people would ask me whom would I not recommend keto for, I would immediately say, oh people with T1D,” he says, “But over the past couple of years, I’ve had an awakening and I’ve learned so much from people who are actually using it to treat T1D.”

Scher says people who use keto to treat Type 1 diabetes are sometimes the best people to use it because they are so adept at checking their blood sugars, regulating their insulin, and being generally in-tune with themselves.

“If you can use this low-carb lifestyle to dramatically reduce your carbohydrate intake, you can take so much of the guesswork out of managing your diabetes, you can smooth out your blood sugars, and you won’t have to take extra insulin when your sugars go too high,” he explains.

As far as sustainability, Scher does say studies suggest the keto diet is difficult for someone to maintain. In studies, only 60-70% have maintained it long term, which is actually pretty good according to Scher.

“Let’s face it, we live in a very heavy, carb-centric society, which makes it more challenging for people to follow keto or low-carb because you’re surrounded by it and psychologically, it makes it much more difficult,” Scher says.

However, he indicates that with the right support and with people appreciating the benefits that they can see from it, there are numerous examples of people being on it for a decade or more.

“People have to work on it, people have to manage their lifestyle, people have to manage their emotions, their cravings, given the context of our society,” Scher says, “But within that framework, it’s definitely possible to maintain it long term.”

As far as the risks of having diabetes and being on the keto diet, Scher believes being on diabetes medications can be far more dangerous than being on a keto or low carb diet.

What’s the Otherside of the Story?

Of course, there is a camp within the diabetes-nutrition community that believes restricting carbohydrates isn’t what nature intended.

“I am a believer that no diet is good for everyone, especially those with severe restrictions on macronutrients or food groups,” Lauren Harris-Pincus, MS, RDN, a medical nutrition therapist and author of The Protein-Packed Breakfast Club tells dLife.

Harris-Pincus says the keto diet is particularly complicated because most people have no idea what it really means.

“A true ketogenic diet was developed for children to treat epilepsy that was not responding to medication,” she says. “It’s extremely low in carbohydrates (all carbohydrates including veggies), low in protein and very high fat.”

According to Harris-Pincus, the keto diet is based on a 4:1 or 3:1 ratio of fat grams to carbs plus protein combined.

“That’s approximately 90% of calories from fat,” Harris-Pincus explains. “People following today’s ‘keto diet’ are generally far from these percentages.”

And, she says logic says that this is not a reasonable or healthy way to nourish the body without true medical necessity

To know whether the keto diet, in any form, is safe for someone with Type 2 diabetes, Pincus says people should be working with a registered dietitian and their doctor to figure out the safest and most effective dietary plan for them.

“If you are choosing a diet low in refined carbs, that’s not true keto and I find most people simply try to ‘avoid carbs’ versus understanding the macronutrient balance required for ketosis.

Unlike Scher, Harris-Pincus says the keto diet could be dangerous, especially when the body goes into ketosis.

“It’s common to feel lousy at the beginning where people complain about the ‘keto flu’. Every cell in the body is designed to use glucose for fuel so when the body needs to find an alternative fuel, there are consequences,” she says. “That’s why no one with diabetes should undertake keto without medical supervision. Especially those taking medication or insulin.”

Contrary to Cappello and Scher, Harris-Pincus believes being on a very high-fat diet could cause other problems, such as high cholesterol.

“Even healthy fats like olive oil do contain saturated fats so it is possible to increase blood lipids on keto,” she says.

However, Harris-Pincus says the larger problem with keto is a lack of nutrient-dense foods like fruits, whole grains, beans, and other fiber-containing foods.

She adds constipation is a common side effect and there is emerging evidence about the critical impact fiber has on gut health, mental health, cardiovascular disease risk and more.

Lastly, she believes the keto diet is not sustainable, making it very difficult to do when dining out, traveling or eating with friends. “Any diet that needs cheat days is something you should not be doing, in my opinion,” says Harris-Pincus.

While the medical and nutritional community may be split about where they stand on the keto diet and diabetes, the choice ultimately is in your hands.

Scher hopes that at the very least, the keto diet should be a part of the discussion, especially now that the American Diabetes Association has endorsed it as a treatment for T2D.

While the medical community has been slow to come around to the keto diet, those who think a keto is a beneficial approach seek ways to make sure it’s utilized appropriately, just like any of the other life-style changes that they would think about.

However, the lack of research on the long term effects of the keto diet is not known, and therefore, it’s likely that those that are skeptical will remain skeptical.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified nutritional professional. Please contact your physician or medical professional with any questions and concerns about your specific dietary needs.