Tim Tebow Explains How The Keto Diet Breaks Down Fat
Does the Ketogenic Diet Work for Type 2 Diabetes?
While celebrity health trends can be questionable, the ketogenic diet actually may offer some benefits if you have type 2 diabetes. But before you try it, know the pros and cons.
By Amy Gorin, RDN
Medically Reviewed by Kelly Kennedy, RD
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You’ve probably seen dozens of headlines about the ketogenic diet by now, which has made its way into popular culture largely by celebrities and supermodels giving the long-standing fad diet a repeated stamp of approval. Is keto the diet to follow if you have diabetes? Studies suggest the answer isn’t so simple. Some science shows its meal plan may be helpful, while other research, like one study published in September 2019 in Nutrients, highlights the importance of whole grains in the diets of people with diabetes — a restricted food category in the ketogenic diet.
While the keto diet can offer many potential benefits for diabetes management, following it requires pretty serious commitment. So take a beat before you take the plunge — and consider these questions that can help you and your medical team determine if it’s right for you:
How Does the Ketogenic Diet Work Exactly?
There’s a good reason the ketogenic diet is also referred to as a low-carb, high-fat diet. Indeed, following the ketogenic diet means reducing carbohydrate intake to typically less than 50 grams (g) of carbohydrates per day, while increasing fat and protein intake, according to a review published in August 2013 in the European Journal of Clinical Nutrition.
To put that into perspective, an individual on an average, non-restricted diet can easily eat more carbohydrates than that in one typical meal — for instance, a turkey, cheese, and veggie sandwich on whole-grain bread with a small, 1 ounce (oz) bag of classic potato chips would come in at around 51 g of carbs. These dietary changes drive down insulin levels, eventually leading your body into a state of ketosis, during which it is burning fat rather than carbohydrates.
What Are Some of the Potential Benefits of a Ketogenic Diet for Diabetes?
Here’s how the ketogenic diet may help if you’re managing type 2 diabetes: “With a higher protein and fat intake, individuals may feel less hungry and are often able to lose weight since protein and fat take longer to digest than carbohydrates,” says Lori Zanini, RD, CDE, author of . It may also help keep energy levels up.
Other potential benefits exist, too. A review published in September 2019 in the Journal of Obesity & Eating Disorders suggests that, for a person with diabetes, a keto diet may help improve your A1C test results, which show a three-month average of your blood sugar levels, better than a low-calorie diet. It could also help lower triglycerides more than a low-fat diet, which is a benefit for people with diabetes who are at a greater risk for heart disease.
Furthermore, a keto diet may be three times more effective for weight loss than a low-fat one — important because losing as little as 10 pounds could help you decrease your reliance on medication used to control blood sugar levels, according to the Obesity Society. Also, a review published in August 2013 in the European Journal of Clinical Nutrition found that a ketogenic diet could help improve cholesterol levels and fasting blood sugar levels.
Is the Keto Diet the Best Diet for Diabetes?
But that doesn’t necessarily mean the ketogenic diet is the best for people with diabetes. Some studies suggest other eating plans, like the Mediterranean diet — which is rich in lean meats, fish, nuts, fruits, vegetables, olive oil, and whole grains — can be beneficial for people with the disease. For example, a review published in April 2014 in Nutrients found that some research links following a Mediterranean diet to a reduced risk of developing type 2 diabetes.
A randomized controlled trial published in January 2011 in Diabetes Care also suggests that following a Mediterranean diet without calorie restriction may help ward off the disease. The eating style may also aid people already diagnosed with diabetes: The review cites some cross-sectional studies that associate following a Mediterranean diet with better blood sugar control.
Plus, the ketogenic diet comes with some risks. The aforementioned 2019 study in the Journal of Obesity & Eating Disorderssuggests that people with type 2 diabetes taking oral medication to lower blood sugar levels may be more at risk for hypoglycemia, or low blood sugar, when following a ketogenic diet. And a ketogenic diet could cause other unpleasant effects — including bad breath, dizziness, nausea, headache, fatigue, confusion, excessive thirst and hunger, fast heartbeat, fever, and chills.
What’s the Best Way to Start a Keto Diet?
If you decide to start the ketogenic diet, you shouldn’t go at it alone. Consult with your diabetes medical team — including your endocrinologist and a registered dietitian who is also a certified diabetes educator — before trying this eating plan. You’ll want to start the diet slowly, cutting carbohydrates gradually, Zanini says. Dramatic reductions could lead to hypoglycemia, especially if you’re on oral diabetes medications or insulin. If your blood sugar levels severely dip, even the emergency medication Glucagon may not bring them back up enough, notes Sylvia White, RD, CDE, who works in private practice in the Memphis, Tennessee, area.
You’ll want to regularly test both your blood sugar and ketone levels to prevent serious side effects. “Doing so is very important for avoiding diabetic ketoacidosis, or DKA,” says White. “Warning signs of DKA include consistently high blood sugar, high ketone levels, dry mouth, nausea, vomiting, and frequent urination — and complications can cause a diabetic coma.”
You’ll also want to make sure you’re taking in a balance of nutrients — all of those important vitamins, minerals, fiber, and more — as well as the proper amount of calories and healthy fats. “Healthy fats include monounsaturated fats (MUFAs) and omega-3s, which may help reduce inflammation in the body and improve cholesterol levels,” says White. Look to fatty fish like salmon for omega-3s and avocado, almonds, peanut butter, and sunflower seeds for monounsaturated fats.
If you’re not sure what to reach for, ask your dietitian. “While this sounds so simple, often people are only thinking about what not to eat,” says Zanini. “They don't pay attention to the nutritious foods they should be including, like nonstarchy vegetables, healthy monounsaturated fats, lean proteins, and more.” Don’t have a dietitian? You can find one who is a certified diabetes educator through the Academy of Nutrition and Dietetics.
How Do You Stick to the Low Carb Count?
“Simply put, it is not easy to eat just 20 to 60 g of carbohydrates per day, which is how many carbs are permitted on the ketogenic diet,” says Zanini. “To follow this strict guideline, one must not only change the food they’re eating, but their entire lifestyle.”
Foods that are a typical part of the American diet, like foot-long subs, Big Macs, and milkshakes won’t easily fit into the food plan — and foods considered staples of a balanced diet such as sweet potatoes and whole-grain bread may need to be limited. These changes can be tough to implement, even for people who’ve already started making their diets healthier. Tracking what you eat can help. You can do so either with a paper food diary or through various apps on your smartphone.
You can’t take days off of the diet, though. You must stick with the diet if you want to see the benefits — otherwise you’re really just eating a high-fat, high-protein diet.
Is the Ketogenic Diet Safe for Everyone?
This also isn’t the diet for you if you have kidney disease, as you’d want to limit protein in that case, Zanini says. And you might want to skip it if you have type 1 diabetes, as most of the diabetes research on the ketogenic diet has been on the type 2 version. Ketones (produced by the body during ketosis) are also a risk factor for DKA, which is more common in people with type 1 diabetes than people with type 2 diabetes, according to the American Diabetes Association. You’d need to be very diligent about monitoring other potential symptoms of DKA, notes White.
Last, if you have a history of struggling with an eating disorder, work with your doctor to determine if this is the right diet for you. “Because of the severe carb limits imposed by the ketogenic diet, the risks of bingeing, compulsive overeating, and other eating disorders is much higher,” says White.
A Ketogenic Diet Food List for Beginners
If you and your healthcare team determine that the ketogenic diet is safe for you, follow this handy beginner’s menu for the ketogenic diet. When in doubt, keep in mind that you will want to avoid or limit any foods that are high in carbohydrates, while loading up on foods that are high in protein and healthy fat.
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