Do you need to go on keto diet to control diabetes?
First, what is the keto diet? The ketogenic or “keto” diet is a diet that is high in fat and low in carbs which can be beneficial for diabetics since it can potentially change the way your body stores and uses energy. The diet was originally created in 1924 as a treatment for epilepsy patients but has since been researched for other diseases and disorders such as type 2 diabetes.
How does ketogenic diet induce weight loss?
Low carbohydrate or ketogenic diets are thought to lower insulin, a critical hormone that produces an anabolic state inducing weight gain. Keto diets may questionably and indirectly improve cardiometabolic function and induces weight loss.
Ketogenic diets restrict carbohydrate to cause nutritional ketosis and typically limits carbs to 20-50 grams daily. Restricting carbs induces glycogen depletion and ketone production from the mobilization of fat stored in fat tissue.
Following a ketogenic diet may improve blood sugar levels while also reducing the need for insulin. However, as with most diets, the keto diet is no exception and carries its own risks. Be sure to discuss it with your doctor or the SugarMDs team before making any drastic dietary changes. Especially patients who are on insulin have to be extremely careful and consult with an endocrinologist.
A precursor for type 2 diabetes is being overweight. With that being said, the vast majority of type 2 diabetic patients are overweight. So, a high fat diet seems a little odd right?
Well, the ultimate goal is to reduce total daily calories. Purpose of the ketogenic diet is to make the body use fat for energy versus carbohydrates or glucose by creating ketosis. During transition from glucose metabolism to fat metabolism you will feel hunger but once you are in ketosis hunger will dissipate. This will help you consume less calories. On the other hand carbohydrates especially simple carbs with minimal fiber content is rapidly absorbed and turned into fat unless that immediate source of energy is used by the body. Since body does not want to go into ketotic state you will feel hunger and continue to eat carbs which will turn into vicious cycle causing a lot of weight gain. On the other hand, fats are absorbed much slower and allow body to go into ketosis when energy is needed as there have been no carbohydrates available to begin with. While on the keto diet, you will obtain most of your energy from fat with little coming from carbohydrates.
What type of fats is the Keto diet referring to anyway?
This diet doesn’t mean you should eat your way through all those saturated fats. The best fats are heart healthy fats which are key to maintain your overall health. Some healthy fats that are commonly included in the ketogenic diet are:
1. eggs
2. fish such as salmon
3. cottage cheese
4. avocado
5. olives and olive oil
6. nuts and nut butters
7. seeds
Effects of ketogenic diet on blood glucose
The ketogenic diet has the potential to decrease blood glucose levels. Managing carbohydrate intake is often recommended for people with type 2 diabetes because carbohydrates turn to sugar and, in large quantities, can cause blood sugar spikes.
However, carb counts should be determined on an individual basis with the help of your doctor or your dedicated SugarMDs team.
If you already have high blood glucose, eating too many carbs can be dangerous. By switching the focus to fat, some people can experience reduced blood sugar.
The Keto diet sounds great! So, what the catch?
When you change your body’s primary energy source from carbohydrates to fat it causes an increase in ketones in the blood. This “dietary ketosis” is different from ketoacidosis, which is an extremely dangerous condition that diabetes can face.
When you have too many ketones, you may be at risk for developing diabetic ketoacidosis (DKA). DKA is most prevalent in type 1 diabetes when blood glucose is too high and can arise from a lack of insulin. Although rare, DKA is possible in type 2 diabetes if ketones are too high. Being ill while on a low-carb diet may also increase your risk for DKA.
If you’re on the ketogenic diet, be sure to test blood sugar levels throughout the day to make sure they are within their target range. Also, consider testing ketone levels to make sure you’re not at risk for DKA.
The American Diabetes Association recommends testing for ketones if your blood sugar is higher than 240 mg/dL. You can test at home with over the counter urine strips.
DKA is a medical emergency. If you’re experiencing the symptoms of DKA, see your doctor immediately. Complications can cause diabetic coma.
The warning signs of DKA include:
- Consistently high blood sugar
- Dry mouth
- Frequent urination
- Nausea
- Breath that has a fruit-like odor
- Breathing difficulties
What not to eat on ketogenic diet:
To eat a healthy diet, there are some things you should avoid or limit.
They include:
A. Fats – There are different types of fats. Some types of fats are better for your body than others.
B. Trans fats are especially unhealthy. They are found in margarines, many fast foods, and some store-bought baked goods. Trans fats can raise your cholesterol level and your chance of getting heart disease. Try to avoid eating foods with these types of fats.
C. The type of “polyunsaturated” fats found in fish seems to be healthy and can reduce your chance of getting heart disease. Other polyunsaturated fats might also be good for your health. When you cook, it’s best to use oils with some healthier fats, such as olive oil and canola oil.
Monitoring your diabetes
The ketogenic diet seems like any other diet, eat specific types of food and avoid certain foods…simple enough. Right? Well, unlike a typical low-calorie diet, however, a high-fat diet requires careful monitoring as mentioned above.
Your doctor or SugarMDs team needs to monitor both blood glucose and ketone levels to make sure that the diet isn’t causing any harmful effects. Once your body adjusts to the diet, you still need to see your doctor for testing and any potential medication adjustments.
Even if your symptoms improve, it’s still important to keep up with regular blood glucose monitoring. For type 2 diabetes, testing frequency varies. Be sure to check with your doctor or SugarMDs team to determine what testing schedule is best for you.
Any evidence to back up this Keto benefit?
“In 2008, researchers conducted a 24-week study to determine the effects of a low-carbohydrate diet on people with type 2 diabetes and obesity.
At the end of the study, participants who followed the ketogenic diet saw greater improvements in glycemic control and medication reduction compared to those who followed a low-glycemic diet.”
“A 2013 review Trusted Source reported that a ketogenic diet can lead to more significant improvements in blood sugar control, A1c, weight loss, and discontinued insulin requirements than other diets.”
“A 2017 study also found the ketogenic diet outperformed a conventional, low-fat diabetes diet over 32 weeks regarding weight loss and A1c.”
The verdict…
Reducing CHO intake with an ketogenic diet is effective in reducing body weight and, in patients with type 2 diabetes, improving glycemic control, with a stronger effect with a very low carb diet. On the other hand, keto diet may not be appropriate for all individuals. Especially in patients with type 2 diabetes, it is necessary to balance the potential increase in cardiovascular risk because of the unfavorable lipid profile observed with unhealthy fats with the benefits deriving from weight loss and improvement of glycemic control. Moreover, long-term compliance with low carb diets is still an issue.
In type 1 diabetes, there is no present evidence that an keto diet delay or prevent the onset of the disease. These diets have the potential to improve metabolic control, but caution is needed because of the risk of DKA, of worsening the lipid profile.
Even in studies in the general population where a higher CHO intake was associated with worse outcomes, healthier macronutrients consumption was associated with decreased cardiovascular and non-cardiovascular mortality. When healthy low fat diet was compared to healthy low carb diet, good results in terms of weight loss were observed with both diets. Therefore, macronutrients source, i.e., quality of carbs and fat, are not negligible factors, and preferring fibers and nutrient-rich foods is a good option for everyone. For this reason, when designing future studies on nutrition, it will be important to evaluate not only the amount of CHO, but also their type.
To summarize, the ketogenic diet may offer some help to people with type 2 diabetes who have difficulty controlling their symptoms or losing weight. Not only do many people feel better with fewer diabetic symptoms, but they may also be less dependent on medications.
Still, not everyone has success on this diet. Some may find the restrictions too difficult to follow over the long term. American Diabetes Association does not recommend any particular diet due to lack of evidence. We are in support of this view as individual needs may vary.
Please also keep in mind, that “fat” dieting can be dangerous for your diabetes, so you should only start the ketogenic diet if you’re sure you can commit to it. Your dietician, doctor or SugarMDs team can help you determine the best diet choice for managing your diabetes.
You may want to begin the Keto diet as soon as possible but be sure to discuss the diet with your doctor or SugarMDs team first. The diet may throw off your blood sugar levels, causing further issues, especially if you’re on medications for diabetes.
