Keto And Diabetes: A Healthy Relationship?

The ketogenic diet, or keto, is a high-fat, low-carb diet that has been linked to improvements in insulin sensitivity and higher rates of weight loss. It was created in the 1920s as a treatment for epilepsy, but its effects are now being studied for type 2 diabetes. The keto diet may be beneficial for people with type 2 diabetes as it can help manage blood sugar and lead to weight loss. However, it is not suitable for everyone, and there are some potential risks and side effects associated with it.

The keto diet can help with weight loss for people with diabetes

The keto diet is a very low-carbohydrate diet, with typically 10% or fewer daily calories coming from carbohydrates. For a 2,000-calorie diet, this equates to 50 grams or fewer worth of carbs per day. The diet also consists of approximately 55-60% fat and 30-35% protein.

The keto diet can be an effective strategy for managing blood glucose levels and achieving a healthy weight. It can be particularly beneficial for people with type 2 diabetes, as it may improve blood glucose (sugar) levels while also reducing the need for insulin.

By drastically reducing carbohydrate intake, the keto diet induces a state called ketosis, where the body breaks down stored fat into ketones, which are used for energy instead of carbohydrates or glucose. This process can lead to weight loss, as the body has to work harder to convert fats into energy compared to carbohydrates.

Research has shown that the keto diet can be effective for managing type 2 diabetes by lowering blood sugar and promoting weight loss. A study of 363 people, including 102 individuals with type 2 diabetes, found that a ketogenic diet improved blood glucose, weight, and cholesterol more effectively than a standard low-calorie diet. Another small study of adults with type 2 diabetes and obesity showed similar results, with the keto diet being more effective for weight loss and glucose control.

Additionally, a 2013 review 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 that the keto diet outperformed a conventional, low-fat diabetes diet over 32 weeks in terms of weight loss and A1C.

While the keto diet can be beneficial for weight loss and blood sugar control, it is not without its drawbacks. It is a highly restrictive diet that can be challenging to follow in the long term. It may also lead to important nutritional deficits, such as inadequate fiber intake, and potentially risky low blood sugar episodes, especially for those with type 1 diabetes.

Furthermore, the keto diet can cause spikes in cholesterol, and there is a risk of developing heart disease or other cardiovascular issues. It is crucial to consult with a healthcare professional before starting the keto diet, especially for individuals with diabetes, to ensure proper monitoring and medication adjustments.

It can also help with blood sugar management

The keto diet is a very low-carbohydrate diet, typically with 10% or fewer daily calories coming from carbohydrates. This low-carb content supports the keto diet's main feature: ketosis. In ketosis, the body breaks down stored fat into its backup energy source – ketones – after the body's stored glucose supply is used up.

Normally, the hormone insulin brings glucose from the blood into cells where it's used for energy. But because of its low-carb content, the keto diet induces a state called ketosis, which is when there's not enough glucose to use for fuel or insulin to bring glucose into cells. During ketosis, your liver breaks fat down into fatty acids and turns these acids into ketone bodies, a process called ketogenesis. These ketones are used for energy by your cells in the same way as glucose is used for energy.

The keto 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. If you already have high blood glucose, eating too many carbs can be dangerous. By switching the focus to fat, some people experience reduced blood sugar.

Research has confirmed the keto diet is effective for managing Type 2 diabetes by lowering blood sugar and promoting weight loss. A 2013 review 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.

In a study of 363 people – 102 of whom had type 2 diabetes – a ketogenic diet was better than a standard low-calorie diet for improving blood glucose, weight, and cholesterol. Another small study of adults with type 2 diabetes and obesity showed similar results, with the keto diet being more effective for weight loss and glucose control.

However, it's important to note that the keto diet can be notoriously difficult to stick with, and research on its long-term effectiveness and risks is still ongoing. As a severely restrictive diet, keto can be challenging to maintain in the long term, and yo-yo dieting can hinder your ability to develop healthy habits that will help keep your diabetes well-managed.

Additionally, the keto diet may lead to important nutritional deficits, and people following this diet may need to supplement with thiamin and other vitamins, including B6, C, D, and E. It's also worth noting that the keto diet can cause spikes in cholesterol, and people with diabetes are already at risk for high cholesterol and heart disease.

Therefore, while the keto diet can help with blood sugar management, it's not suitable for everyone, and it's important to consult with a healthcare professional before making any drastic dietary changes.

The keto diet may reduce the need for insulin

Additionally, the keto diet can lead to weight loss, which can also help manage blood sugar. The high-fat, moderate-protein, and very low-carbohydrate composition of the keto diet may seem counterintuitive, especially since many people with type 2 diabetes are overweight. However, the keto diet can lead to a spontaneous reduction in calorie intake due to the filling nature of the foods consumed. This calorie deficit can contribute to weight loss, which in turn can help improve insulin sensitivity and reduce the need for insulin.

Furthermore, the keto diet can specifically target visceral fat, which is linked to increased insulin resistance. Visceral fat, which accumulates around the abdominal region, acts as an endocrine organ, secreting signalling molecules that can directly and indirectly increase insulin resistance. By reducing visceral fat through the keto diet, individuals may be able to lower insulin resistance and, consequently, their need for insulin.

The impact of the keto diet on insulin levels has been demonstrated in several studies. One study found that obese subjects with type 2 diabetes who followed a keto diet experienced a 75% improvement in insulin sensitivity. Another study compared the keto diet to a moderate-fat diet and found that the keto diet lowered fasting insulin levels by 33% compared to a 19% reduction with the moderate-fat diet.

While the keto diet has shown potential in reducing the need for insulin, it is important to consult with a healthcare professional before making any drastic dietary changes, especially for those taking insulin or other medications for diabetes. Additionally, the keto diet may be challenging to maintain in the long term due to its restrictive nature.

It can be difficult to stick to the keto diet long-term

The keto diet can be difficult to stick to long-term due to its restrictive nature. It requires a drastic reduction in carbohydrates, limiting intake to 20-50 grams per day, which can be challenging to maintain. This restriction may lead to the elimination of fruits, most dairy, starchy vegetables, whole grains, and legumes, making the diet difficult and uncomfortable.

The keto diet is also high in fat, with 60-80% of calories derived from fat. This includes saturated fats from oils, lard, butter, and cocoa butter, which are encouraged in high amounts. Such a high-fat diet may be unappealing or unpalatable to some, making it challenging to sustain over time.

Additionally, the keto diet can be challenging due to the potential for negative side effects. In the short term, some people may experience ""keto flu," which includes symptoms such as extreme fatigue and foggy-headedness. Long-term side effects may include an increased risk of nutrient deficiencies, kidney stones, and an elevated risk of fatty liver disease.

The restrictive nature of the keto diet and the potential for adverse effects can make it difficult for people to adhere to the diet over the long term. It is recommended to consult with a healthcare professional before starting the keto diet and to carefully monitor any negative effects.

The keto diet may not be suitable for people with type 1 diabetes

Diabetic ketoacidosis vs nutritional ketosis

There is a fine line between nutritional ketosis and diabetic ketoacidosis. Nutritional ketosis is a metabolic state in which the body burns fat instead of carbohydrates as its primary fuel source. Diabetic ketoacidosis is a serious complication in type 1 diabetes in which blood sugars run high and excess ketones are produced. Diabetic ketoacidosis is a medical emergency that occurs mostly in people with type 1 diabetes if they don't take insulin. Without insulin to transport blood sugar into the body's cells, blood sugar and ketone levels rise rapidly, disrupting the blood's acid-base balance.

Risk of hypoglycaemia

The keto diet can considerably lower blood sugar levels in people with type 1 and 2 diabetes. Without proper insulin adjustments, blood sugar levels may become too low, leading to potentially serious complications, such as confusion, dizziness, slurred speech, and loss of consciousness.

Weight loss

The keto diet can promote weight loss. While some people with type 1 diabetes may want to lose weight, this may not be safe or desirable for everyone.

Insulin reduction

The keto diet may require a reduction in insulin intake. For people with type 1 diabetes who use short-acting insulin, a drastic reduction in carb intake, such as with the keto diet, means blood sugar levels trend much lower, requiring less insulin to manage them. Insulin dosing must be adjusted properly to avoid hypoglycaemia (low blood sugar), a serious side effect.

Close medical supervision required

The keto diet is not recommended for people with a history of chronic low blood sugar levels, those who are underweight or have an eating disorder, people undergoing or recovering from a medical procedure, children or adolescents under 18, pregnant or breastfeeding mothers, and cholesterol hyper-responders. For people with type 1 diabetes, close medical supervision is crucial.

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