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The ketogenic diet (keto diet for short) has gained a lot of attention because of its benefits for effective weight loss. Initial research shows that the keto diet can help people lose more weight than both low-calorie and low-fat diets in the short and long-term.
However, physicians and registered dieticians are becoming increasingly interested in the potential therapeutic effect of the ketogenic diet for people with metabolic disorders, like insulin resistance and type 2 diabetes.
Can a ketogenic diet help to treat, or even reverse type 2 diabetes? Here, I will go over the latest scientific research to help answer this question.
To understand what the effects of any diet are on diabetes, it is important to understand the illness and how what we eat can have an impact on its progression.
The American Diabetes Association defines diabetes as “a problem with your body that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. Type 2 diabetes is the most common form of diabetes”.
People with type 2 diabetes cannot use insulin as it should (a condition called insulin resistance). Insulin is a hormone produced by the pancreas that helps get energy, in the form of glucose, into the cell. As a result, your body starts making more insulin to try and get your cells the energy they crave. Over time, your pancreas can experience damage, your body cannot make enough insulin to get your cells the energy they need, and your blood glucose levels can get dangerously high.
Blood glucose is also referred to as blood sugar. It is a numeric measurement of the glucose in your blood. People without diabetes have a fasting blood glucose between 70 and 99mg/dL. If you have more than this, you may be diagnosed with pre-diabetes (between 100-125mg/dL fasting glucose) or diabetes (more than 126 mg/dL fasting glucose).
People with pre-diabetes or diabetes have higher blood glucose levels because their insulin is not able to transport the glucose into cells. Their cells crave energy, but they aren’t able to access what is circulating the blood.
While type 2 diabetes can be caused by genes, of the most common causes of type 2 diabetes is lifestyle factors that lead to chronically high blood sugar levels. This happens when people eat a diet high in refined sugars and refined grains and don’t do enough exercise. This is often referred to as the Standard American Diet (SAD).
Since type 2 diabetes can be triggered and aggravated by high blood sugar levels, there has been ample interest in identifying diets that keep glucose levels from going up to dangerous levels.
Many of the most popular diets for people with diabetes are those that are based on the glycemic index. The glycemic index is a relative ranking of how much different foods raise your blood glucose levels. Following a glycemic index for all the foods you eat can be complicated, and it has several limitations.
For example, as Dr. Ananya Mandal points out, “The glycemic index of different types of foods can vary according to several factors. For example, the ripeness of a fruit may influence its glycemic index as can the variety of fruit and the preparation method used”.
So, with the practical complications that a low-glycemic diet can bring about, is the keto diet a solution?
If you look closely at the foods that a ketogenic diet cuts out, like grains, flours, sugars, and most fruit, you’ll see that these are also the foods that have the highest glycemic index. In laymen’s terms, these are the foods that are highest in sugar. They also those that are most vulnerable to significant variations due to different factors like ripeness and cooking method, for example.
However, the body doesn’t need to use sugar from carbohydrates to function. There are two other sources of energy: protein (which break down into amino acids, then glucose) and fats (which break down into ketone bodies, or ketones). Protein breakdown also ends up as glucose (though our body prefers to use protein for other things, like building muscle). So that leaves us with fats.
The keto diet cuts out foods that are moderate and high in carbohydrates so that your body is able to make the switch from being dependent on glucose, to now depending on another form of energy – ketones.
So with the keto diet, there isn’t a risk of your blood sugar rising because you have very limited amounts of carbohydrates in your diet. Instead, your brain and muscles turn to ketones for their daily function. This state is called ketosis.
One of the most exciting clinical applications of the ketogenic diet is precisely in the field of diabetes management.
This is what the research says:
A study with 360 overweight and obese patients, of which 102 had type 2 diabetes, chose between a low-calorie or low-carbohydrate ketogenic diet to follow for 24 weeks. There were more pronounced improvements in several measurements for people following the low-carbohydrate ketogenic diet over the low-calorie diet, including:
Researchers recruited 28 overweight participants with type 2 diabetes for a 16-week pilot of the effects of the ketogenic diet for diabetes treatment. The study concluded the following:
The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.
84 people with type 2 diabetes, of which 49 completed the study, volunteered to take on a low-carbohydrate keto diet or a low-glycemic reduced-calorie diet. While both diets led to some improvement, the keto diet led to much more significant improvements in patients, due to the lower carbohydrate intake.
The study concluded that lifestyle changes involving low-carbohydrate diet, especially the ketogenic diet, are effective for “improving and reversing type 2 diabetes”.
One of the most challenging aspects of diabetes is the insatiable hunger that a person can feel as a result of not getting enough energy into the cells. One study looked specifically at the effect of a high-protein ketogenic diet to help manage hunger and appetite in people with diabetes .
The researchers found that in the short term and high-protein, low-carbohydrate diet can help to reduce hunger and lower food intake much more than high-protein non-ketogenic diets.
The ketogenic diet has shown a lot of promise to help to reverse some of the health indicators that are hardest to manage in type 2 diabetes. While type 2 diabetes doesn’t have a cure, it can be effectively managed with diet, exercise, and proper medical follow up.
Remember that type 2 diabetes is a serious condition. If you have type 2 diabetes and would are interested in trying the ketogenic diet to improve your health, talk to your physician and registered dietitian about making the transition. Since we still have limited data about the effects of the ketogenic diet on diabetes patients in the long term, you should be carefully monitored by your physician and your registered dietician to make sure you are eating foods in the right proportions, getting enough nutrients, and don’t lapse into diabetic ketoacidosis.
For many people with diabetes, carefully-designed and ketogenic diet, together with exercise and proper monitoring, could result in significant benefits for your health, and lead you to live a normal life without having to worry about drastic changes in blood glucose levels.