Is keto diet good for diabetics? – Overview
Ketogenic diet, or keto diet is a very popular way to lose weight. The main principle behind it is to restrict carbohydrates and consume fats. When our body does not have enough carbs for energy, it starts to break down fat. Ketones generated as a result of this process become the primary fuel source.
Is keto diet a safe way to lose weight for diabetics? How does ketosis affect blood sugar levels? What are possible risks and benefits? We will answer these and more questions below.
First of all, let’s briefly discuss the normal physiology of insulin. Within our pancreas we have beta cells. Their main function is to produce insulin in response to any carbohydrates we consume. Insulin molecules flow all around our body and allow our liver, muscle and fat cells to absorb glucose, which is then used for fuel.
The next step is to understand the role of insulin in diabetes and how type 1 and 2 diabetes differ. This is crucial, because the keto diet has different effects on these conditions. Ketoacidosis is a dangerous condition that happens when there is not enough insulin and ketones accumulate. Ketosis is an everyday process in our body and involves much lower levels of ketones.
In type 1 diabetes the immune system destroys beta cells, the source of insulin. This is why type 1 diabetics need to take exogenous insulin for blood sugar control. Type 2 diabetes is a condition of insulin resistance, which means that our cells (muscle, fat, liver) do not properly respond to insulin molecules. These patients might even have elevated insulin levels to cope with the resistance. So the risk of ketoacidosis is much lower in type 2 diabetes than in type 1.
Now we can go into a ketogenic diet, which is a low-carbohydrate, high-fat eating plan and forces our body fuel to switch from glucose to fats. The main effect of this diet is that it minimizes insulin production: in other words, there is no stimulus for beta cells to produce insulin. For diabetics, it already means reduced needs for insulin and other blood sugar lowering medications, and better diabetes control. Cutting body weight multiplies this effect.
Benefits of keto diet for type 2 diabetes
The study published in 2017 took a look at 260 people with type 2 diabetes. They consumed less than 30 grams of carbohydrates per day and lots of fat. The main indicator for measuring the effects was A1c levels. This is also how success of treatment is determined in the real world. Doctors can have a quick look at the figure in the test and it’s already clear for them how high blood glucose levels were during the previous 3 months. A normal A1C level is below 5.7%, in diabetic it should be less than 6.5%.
Scientists found that at the end of a 10-week period of study, patients on a ketogenic diet ended up reducing their A1c levels on average by 1% (on their lab tests, not in total). And the number of people who were able to get a healthy level of A1c ( under 6.5%) increased by 56%.
90% of participants were receiving some kind of treatment for diabetes ( insulin, meds or both). The study also showed the reduced use of these medications in more than 50% of participants. This once again reflects the scientifically proven fact that keto diet relieves the load on pancreas, giving beta cells an ability to recover and do their job better.
Ketogenic diet helps our body to burn fat and lose weight. Obesity is one of the risk factors for type 2 diabetes and it also has an impact on disease management. Even moderate weight loss improves glycemic control. Apart from improved insulin sensitivity and weight loss, other benefits include: improved management of blood pressure; reduced reliance on medication; rise in high-density lipoprotein (HDL).
Risk associated with keto diet
Switching to different sources of energy can lead to some short-term side effects. These include: keto-flu (symptoms resembling flu), changes in bowel habits, loss of energy, muscle cramps, headaches, frequent urination and mental fogginess. But as a rule, these effects do not last long and are temporary.
Long-term side effects are more serious and include:
Hypoglycemia: Since you are consuming less sugar, you are at higher risk for hypoglycemia, especially if mediation doses are not adjusted properly. Therefore it is important to consult with your doctor first.
Kidney problems: Eating lot of animal food can lead to more acidic urine and this increases the risk of kidney stone development
Increased risk of dyslipidemia and cardiovascular disease: Since this diet includes high fat intake, there is a risk of buildup of fats in the arteries. This is especially true for people who consume much unsaturated fat, which raises cholesterol and LDL. Diabetes itself already makes people more prone to development of cardiovascular diseases. So make sure you are getting monounsaturated and polyunsaturated fats.
Bad for bones: Decreases bone density and increases risk of bone fractures due to acidosis
Possible lack of nutrients: Proper management of diet plan with your dietitian is important, otherwise you might not get proper vitamins and fiber.
Getting off might be challenging: Adding carbohydrates all at once might worsen glycemic control
Keto diet for type 1 diabetes
Type 1 diabetics are much more prone to ketoacidosis than type 2 diabetics due to lack of insulin. If we try to further induce a ketogenic state this might lead to more serious health risks. So if you are type 1 diabetic you should always consult with your doctor before beginning any type of diet. More studies need to be conducted before we can make any definitive conclusions.
So should you try a keto diet? For people who really need to cut weight, this type of diet can offer some benefits, but for others it can make things worse, especially for type 1 diabetics. Health authorities in the United States do not recommend the keto diet as a way to manage diabetes. There are simply too many variables for a non-medical person to deal with.