Did I just say cure?
I use that word so sparingly with any chronic disease, especially when discussing diet. But, in this case it’s true. The right diet really can prevent and cure type 2 diabetes (1, 2, 3). And the ketogenic diet may be the best equipped for the job.
What is Diabetes?
Over 30 million people are diagnosed with diabetes in the United States - that's 1 in 9 people. This means it's highly likely that you or someone you care about suffers from diabetes. But what is it exactly?
Diabetes mellitus is a disease rooted in an impaired ability of the body to process sugar. Because carbohydrates are broken down into sugars after you eat them, they are also referred to as “sugars” in these discussions. Blood glucose is the technical term for sugars in our body.
Glucose is critically important for life - providing your brain, muscles and other organs in your body precious fuel it needs to survive.
But there can be too much of a good thing. Uncontrolled levels of glucose can be deadly.
Insulin & Blood Glucose
Insulin is the hormone in charge of storing excess glucose. Glucose levels are highest after you eat as your food is digesting. It makes sense that insulin should also be the highest after you eat to help control the extra sugars circulating in your body.
Normal blood glucose typically ranges from 80-130. When insulin is doing its job, it keeps these levels regulated by storing excess glucose while still allowing a certain amount to be free in order for your body to function properly. Insulin works so well in healthy individuals that it usually prevents glucose from going above 180, even after eating sugary treats (4).
If insulin isn’t working properly then blood glucose levels can rise dramatically and dangerously - which is what happens in diabetics.
Type 1 Diabetes
People with type 1 diabetes represent only about 5-10% of the population with diabetes mellitus (5) . Their bodies aren’t able to produce insulin. While it’s very important that people with type 1 diabetes carefully monitor their diet, an unhealthy diet wasn't the cause of their diabetes. Instead, their diabetes is due to an autoimmune condition in which the organ that is in charge of producing insulin - their pancreas - was attacked and destroyed.
While often diagnosed at a young age, we aren’t able to predict or prevent who will develop type 1 diabetes. Because they don’t make insulin, people with type 1 diabetes are dependent on giving themselves shots of insulin to survive. In order to determine how much insulin they need, it's important for them to monitor their blood glucose carefully - usually multiple times each day.
While there is no known cure for type 1 diabetes, people with this disease can live very full and healthy lives by carefully controlling their glucose with proper insulin administration and a healthy diet.
Type 2 Diabetes & Insulin Resistance
People with type 2 diabetes encompass more than 90% of those that suffer from diabetes mellitus (6). These individuals actually have insulin, it just isn’t doing its job properly. At one time, their insulin worked well - but it got burnt out and lazy. The good news is that this insulin usually has the potential to function normally again, that is if it’s taken care of in the right way.
While it’s not clear exactly how type 2 diabetes develops, it is known that being overweight and leading a sedentary lifestyle are major risk factors (7) . Smoking and genetics can also contribute to the risk of type 2 diabetes.
Over time, insulin resistance develops in these individuals - meaning that even though there is excess glucose, it can’t be stored like it used to. You can think of insulin as a strong worker that over time becomes tired and overwhelmed with too much to do for too long. It stops caring because it feels hopeless to contain the glucose it’s flooded with (8) .
Health Risks of Diabetes
So why should diabetics care if their sugars aren’t processed perfectly? Well, unfortunately this can have dramatic effects on long term health and wellness.
Diabetes is the 7th leading cause of death in the United States (11).
Because balance is so important in our body, prolonged periods of uncontrolled sugars can lead to many scary consequences, some of which are listed below.
- Impaired Immune Function
- Heart Disease
- Impaired Wound Healing
- Impaired Vision
- Kidney Disease
- Arm & Leg Amputations
- Diabetic Ketoacidosis
What is the Ketogenic Diet?
The ketogenic diet is a very low carbohydrate diet that causes the body to transition into something called ketosis. In a state of ketosis, the body can transition to actively utilizing fat for fuel. Traditionally the macronutrients in a ketogenic diet involve high fat, moderate protein and very low carbohydrate intake. While in ketosis the body theoretically can be more effective at losing weight. While there are a few studies in humans to support this theory, they are relatively small and there hasn’t been enough evidence to conclude it’s superior to other diets.
To learn more about what research is available on the ketogenic diet for weight loss read this: 11 Ketogenic Diet for Weight Loss Studies & New News from Harvard on the Horizon.
Despite the limited evidence that ketosis is key to a diabetic diet, the arguments for its potential to positively influence people living with this condition are intriguing and certainly warrant further investigation.
Why Ketogenic May be the Best Diet for Diabetes
Because the disease is often rooted in diet, type 2 diabetes can actually be cured by controlling what we eat. So how can the ketogenic diet help battle diabetes?
1) Ketosis Helps Insulin Work Better
The theory that ketosis independently improves the function of insulin – if true - would make this diet uniquely fitting for diabetics. Studies have shown improved insulin function and weight loss after people with diabetes consume a ketogenic diet – this effect was greater on a ketogenic diet when compared to traditional calorie controlled diets (12, 13)
One small study suggested a greater improvement in insulin function and weight loss following a ketogenic diet compared to a non-ketogenic low carbohydrate diet ( 14).
While this theory seems promising, more studies are needed to determine if the state of ketosis improves insulin function in diabetics more than other low-carbohydrate diets that don’t involve ketosis. While the influence of ketosis on insulin function does require further investigation, the low carbohydrate nature and successful weight loss still lends it as an attractive (and possibly superior) option for people with type 2 diabetes.
2) Keto Diet is a Low Carbohydrate Diet
The most well established nutritional recommendation for people with type 2 diabetes is weight loss through calorie control (15,16). While there is a general agreement that carbohydrate intake should be controlled in diabetics, there is definitely still debate regarding how low they should actually go in their carbohydrate consumption (17) .
However, many studies have shown positive effects of a low carbohydrate diet in people with type 2 diabetes.
These studies suggest that low carbohydrate diets can help to improve cardiovascular risk factors such as cholesterol levels, HbA1c and insulin sensitivity. ( 18 , 19 , 20 , 21 ) . Therefore, the very low carbohydrate nature of the ketogenic diet may be ideal for people with type 2 diabetes.
3) Keto Diet Leads to Weight Loss
In the end, we know weight loss is key; it has undeniably led to improved insulin sensitivity and can eliminate the requirement of people with type 2 diabetes to take medicine for their disease. Yes, losing weight – and keeping it off – can cure type 2 diabetes in some individuals ( 22 , 23 , 24 ).
Studies support that the ketogenic diet is effective in helping people lose weight.
Some of these studies suggest that the keto diet is more effective than other diets in helping people to lose weight – even when compared to low calorie, low fat, and other low carbohydrate diets ( 25 , 26 , 27 , 28 , 29 , 30 ).
More studies are certainly needed to determine if the ketogenic diet is superior to these other diets for shedding pounds.
Regardless, weight loss is not unique to the keto diet. Appropriate weight loss through any reasonable diet can be beneficial for type 2 diabetes.
In the end, the diet that works will be the diet you consistently follow!
What’s the Difference Between Ketoacidosis and Ketosis?
One of the misconceptions that may have contributed to the keto diet having a bad reputation in some communities is confusion between ketosis and ketoacidosis.
Ketosis is a normal and important function that allows us to continue fueling our body when glucose isn't readily available.
It is a term used to describe a metabolic process the body utilizes to extract glucose from triglycerides. In other words, the body begins to burn fat for energy when there isn’t enough available glucose. Substances called ketones are released during this process and excreted in the urine, which we can measure. These ketones help us to determine when the body is in this state of using fat for fuel.
Goal ketone levels in the ketogenic diet are typically 0.5-1mmol/L. Although some sources recommend up to 3 mmol/L, higher levels aren't often suggested.
Ketoacidosis can occur in diabetics when ketosis gets out of control and acidity increases in the body. Ketone levels are usually greater than 15 mmol/L in ketoacidosis.
Ketoacidosis is a very dangerous condition that often requires hospitalization and intensive medical treatment.
It can lead to death if left untreated – and even when appropriately treated in some severe cases.
Ketoacidosis usually develops in people with type 1 diabetes, however it can also occur in people with advanced type 2 diabetes. Ketoacidosis most commonly occurs when people don’t take their insulin when they should. Other frequent triggers include infections and other major stressors on the body such as heart attacks.
Is Diabetic Ketoacidosis More Common on the Ketogenic Diet?
People with type 1 diabetes are much more susceptible to transitioning into a state of both ketosis and ketoacidosis. And if not carefully monitored, people with type 1 diabetes can more easily develop ketoacidosis while on the ketogenic diet. This is another reason it is so important for people with type 1 diabetes (and insulin dependent type 2 diabetics) to talk to their doctor before embarking on this diet.
It is frequently recommended that if type 1 diabetics choose to start the ketogenic diet they do so with a more gradual transition into a low carbohydrate diet in order to reduce the risk of ketoacidosis and hypoglycemia. For example, a common recommendation for type 1 diabetics is to start at 50 grams of carbohydrates daily with close monitoring. If your blood sugar is ever greater than 240, the American Diabetes Association recommends checking your ketone levels ( 31 ).
Risks of the Ketogenic Diet for People with Diabetes
While many studies have supported the ketogenic diet as overall safe for both children and adults, there are increased risks of the ketogenic diet in people with diabetes.
Hypoglycemia & Keto Diet Effects on Glucose
Hypoglycemia is the term used to describe the state when blood sugar gets too low (<70) (32). Glucose is vital for your body to function properly. Hypoglycemia can lead to many scary conditions including:
- Vision Changes
While your body does have the potential to extract glucose from fat and other resources, this process takes time. Therefore a fast drop in blood sugar that doesn’t allow you the time to make more glucose can be very dangerous.
Any low carbohydrate diet can contribute to an overall lower blood sugar.
The ketogenic diet may contribute to a more significant decrease in glucose due to it’s very low carbohydrate nature and the potential to independently improve insulin sensitivity.
Type 1 diabetics and diabetics on medications can be more susceptible to hypoglycemia while on the ketogenic diet.
Diabetics on Insulin
Diabetics who take insulin are at the highest risk for hypoglycemia while on the ketogenic and other low carbohydrate diets. If prescribed insulin isn’t adjusted to take into consideration a very low carbohydrate diet then there is a high risk of administering too much insulin. Because insulin injections work quickly, there is not enough time to extract glucose from fat and other resources and the body is left without enough free glucose to function. As mentioned above, ketoacidosis is also a risk – particularly to type 1 diabetics.
Therefore, it’s very important all diabetics on insulin injections consult with their doctor before starting the ketogenic diet.
The good news is that insulin requirements can dramatically decrease while on the keto diet - and type 2 diabetics have the potential to stop requiring any insulin injections at all!
Diabetics on Oral Medicine
Oral medications - especially a medication class called sulfonylureas (ie: glipizide, glimepiride and others) - can also cause dangerous hypoglycemia. So similar to insulin injections, it’s important to talk with your doctor about potentially adjusting your oral medications when dramatically changing your diet.
Diet Controlled Diabetics
If you haven’t yet been prescribed any medication and are attempting to control your diabetes with diet, going keto could be the way to go. Because there is no “extra insulin” that you’re giving yourself, you should not be at risk for significant hypoglycemia. You may however find that your sugars are soon well controlled!
Bottom line: the ketogenic diet can lead to progressive improvements in blood glucose. If you take medication to control your glucose, you may require less overtime. You may eventually be able to stop taking your medication completely.
Are Carbohydrates Healthy?
When eliminating such a large food group from your diet it’s important to ask the question: Is there something I’ll be missing? Could you be depriving yourself of nutrition by so significantly restricting carbohydrates?
Carbohydrates can offer many health benefits. There is a plethora of evidence supporting the benefits of carbohydrate loaded whole grains including reducing the risk of heart disease, diabetes, obesity and even some cancers (33,34,35,36,37,38,39). The right carbohydrates also offer many micronutrients including vital vitamins, minerals and fiber.
However, it’s very possible to consume all of the micronutrients you need without carbohydrates – but you need to know where to look. Because carbohydrates are so commonly consumed by the masses, vitamins and minerals that are easily missed in diets have been added to the mass production of common grains. The word “fortified” is used to describe adding these nutrients to food products. For example, many grain products are fortified with B vitamins and iron to decrease these deficiencies in the general population.
It's important to continue including all of the necessary micronutrients in your diet when significantly limiting carbohydrate intake.
You can also still get your heart healthy whole grains while following a ketogenic diet by choosing to consume these as your limited daily carbohydrate intake.
How Diabetics Can Safely Start the Keto Diet
If you're a diabetic, what are the most important steps to safely starting the ketogenic diet?
1) If You Take Medications, Talk to Your Doctor First
Because the keto diet can be so powerful for people with diabetes, it’s critically important to talk to your doctor if you take any medications that help control your blood sugar. These medications may need to be adjusted when starting the diet and may need to be lowered as you continue your diet journey.
2) Get the Lowdown on Keto
Like any major undertaking, it’s always best to be prepared and arm yourself with information. Learning more about what the ketogenic diet involves will help you on your pathway to success.
To get started read: The Keto Diet Explained by a Doctor and a Dietitian.
3) Plan Your Keto Meals
So, this diet can feel really complicated for most people - because, well it is! It’s important to plan your meals to set yourself up for weight loss victory while on the diet.
Looking for a meal delivery system to make eating keto easy? Check out Trifecta Nutrition, an organic meal delivery service that brings fully cooked meals to your doorstep.
4) Track Your Keto Macros
Science supports writing down what you eat! Studies have shown that people who keep a food log can lose up to twice as much weight as people who don’t (40). Because the keto diet involves careful macronutrient balance, doing the diet right depends on developing a good way to keep track of what you consume.
To learn all about how to count your macros on the keto diet read this: Keto Macros Calculating & Tracking Success Guide.
5) Get Regular Blood Tests
Because this diet can so dramatically influence your blood glucose and health, it’s important to regularly check your sugars if you have diabetes. Your doctor may also discuss the possibility of checking other blood markers more frequently - such as triglycerides and HbA1c while you're on the diet.