Is the Ketogenic Diet a useful tool for improving diabetes outcomes?

The newly popularized diet, Ketogenic diet, isn’t anything new. It has been around for almost a century. Originally used for the treatment of epilepsy in the 1920s, this high-fat and low carbohydrate diet is becoming well known for another reason.

“There’s growing research showing that the ketogenic diet is effective for managing blood sugar in people with diabetes,” says William Yancy, MD, program director at the Duke Diet and Fitness Center in Durham, North Carolina.

However, since most studies have been conducted only over a 2-3 year period, there is no way of knowing long-term impact. Regardless, this diet’s popularity is picking up steam.

What exactly is the ketogenic (keto) diet? 

The core of the keto diet is low carbohydrate with extremely high fat content. Here is a macronutrient breakdown:

  • Fat – 65 to 80% of daily caloric intake.
  • Protein -15 to 25% of daily caloric intake
  • Carbs – 5-15% of daily calories (about 20 to 50 gms a day)

How could this work?

Typically the body converts glucose into fuel however with the keto diet you are converting fat into ketones – which results in a state of “ketosis.” Ketosis is a “fat-burning” state and is believed to suppress appetite.

This might sound familiar to Diabetes Educators. Prior to the discovery of insulin, an extremely low-carb and high fat diet was used to manage glucose levels in those with diabetes. This has sparked interest in scientists to research the keto diet today and it’s effects on those with diabetes

What does science say?

Many healthcare professionals are reluctant to recommend fad diets. However, there is substantial research indicating the keto diet helps with weight loss, can reduce the need for medication and in some cases, gets the A1C within target range.

“…those on the keto plan reduced their A1C from 7.6 to 6.3 percent, shed 12 percent of their body weight, eliminated their need for sulfonylurea medication, and lowered or reduced their need for insulin by 94 percent. The results were published in 2018 in the journal Diabetes Therapy.”

If people are able to lower blood sugars by decreasing carb intake, this could reduce the need for diabetes medications. Changing diet can have a huge impact on medication needs and research suggests this may be a benefit of the keto diet for those with Type 2 diabetes.

The Dangers of Keto and A1c Reduction

It is important to consider the short-term safety of those switching to the keto diet, as a swift reduction carbohydrate intake can lead to hypoglycemia. To prevent blood sugar lows, close monitoring and frequent medication down adjustments are required.

Understanding the Drawbacks

Similar to any popular diet strategy, it is important to be aware of “drawbacks” as outlined below:

  • Lack of nutrients. Take away whole grains, fruit, beans, and potatoes, and it’s nearly impossible to consume enough potassium for healthy blood pressure or enough fiber to stay regular.
  • Cost. The diet may require participants to buy high priced items such as meat and dairy vs. low-cost items such as pasta, rice, bread and potatoes.
  • Kidney. It is important to consider kidney health on a protein high diet such as keto. Health professionals need to carefully evaluate those with chronic kidney disease.
  • Dehydration. Since the intake of water-binding carbs decreases, it is important to be aware of water consumption through out the day.
  • Low carb diet not appropriate for pregnant or lactating women, children, those with renal disease or disordered eating or those taking SGLT2 Inhibitors.


Thinking Long-Term

Impact on heart health is the most-cited long term impact. Considering most calories come from fat, cardiovascular disease is a big risk.

“…people who consumed less than 40 percent of their calories from carbohydrates were significantly more likely to die from heart disease than those whose diets contained 50 to 55 percent of calories from carbs—especially if the foods that replaced those carbs were rich in animal fats and proteins.”

One way to avoid heart risk while on the keto diet, is to coach participants to be aware of which types of fats they are consuming. Encourage them to avoid bacon and butter and consume heart-healthy fats such as seeds, nuts, olives and avocados.

Although there is always a hesitation to recommending a popularized diet, the substantial research suggests that if done right, the keto diet can have positive health affects on those with diabetes.

Here is an general approach to the Keto Diet

Eat These

  • avocados
  • cheese
  • full-fat Greek yogurt (small portions)
  • chicken and turkey
  • fish and shellfish
  • pork and beef (small portions)
  • nuts and nut butters
  • sunflower and pumpkin seeds
  • blackberries, strawberries
  • low-carb vegetables such as: spinach, kale, and lettuce; broccoli and cauliflower
  • unsweetened fortified almond milk
  • olive, canola, avocado, and nut oils

Limit These

  • milk, bread, pasta, cereal, beans, fruit (other than berries), root vegetables (such as carrots and potatoes), corn, alcohol

To learn more: What You Need to Know About the Ketogenic Diet – Diabetes Forecast 2019