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Talk of the ketogenic diet doesn’t appear to be slowing down anytime soon. Originally known for success in the treatment of epilepsy, the ketogenic diet continues to be a growing area of research, more popularly, in the area of weight loss. Efforts are also being made to determine whether or not the ketogenic diet can improve outcomes for certain chronic diseases, such as type 2 diabetes. With type 2 diabetes affecting almost one in 10 adults over the age of 20 years, use of the ketogenic diet is certainly something to be considered, especially if it can prove to be beneficial to those living with type 2 diabetes.
So, what’s the correlation?
First, let’s talk about the ketogenic diet. The ketogenic diet is an extremely high-fat, low-carbohydrate, moderate protein diet that changes the way the body converts food into energy. When compared with an average American diet, which is approximately 50 percent carbohydrates, 16 percent protein, and 34 percent fat, a traditional ketogenic diet is 75 percent fat, 20 percent protein and 5 percent carbohydrates. That equates to roughly only 10–50 g of carbohydrates per day.
In normal metabolism, the body breaks down carbohydrates consumed at each meal and converts them into something called glucose, which is the body’s primary source of fuel. Insulin, a hormone made by the pancreas, is what allows your body’s cells to utilize this glucose for energy. It also helps keep our blood sugar level from getting too high or too low. Quite the opposite holds true with a ketogenic diet, however. With this diet, 75–90 percent of total energy will come from fat, depending on what variation of the ketogenic diet one is following. With a carbohydrate intake nearly non-existent, the body is forced to utilize another form of energy. This is where dietary fats come into play. The liver has the ability to convert these fatty acids from your diet into something called ketones, which become the body’s main source of energy.
For additional information on the ketogenic diet, check out these previous blog posts:
The Ketogenic (Keto) Diet: What is the Internet Telling Us?
What is the Ketogenic Diet?
Now moving on to type 2 diabetes, a disease characterized by insulin resistance and an abnormal glucose response. People with type 2 diabetes have the ability to make insulin as explained above, but their bodies don’t use it as efficiently as they should, hence, they are insulin resistant. Insulin resistance doesn’t allow glucose to be absorbed efficiently by the body’s cells, even in the presence of insulin. Since the glucose can’t enter the cells, it remains in the blood and is why we see high blood sugar in people with diabetes.
Can the Ketogenic Diet Treat Type 2 Diabetes?
To answer this question, we must look at the relationship between the ketogenic diet and type 2 diabetes. By restricting carbohydrates, the ketogenic diet bypasses impaired insulin sensitivity by shifting the body into something called nutritional ketosis. This is when the body uses ketones instead of glucose for energy. The key idea is that this nutritional ketosis would be expected to lower a patient’s blood glucose. For type 2 diabetics, this is an extremely important piece of the puzzle for treating the disease, as uncontrolled high blood sugars can lead to serious complications, such as nerve and kidney damage, cardiovascular disease, and eye disease.
What does the research say?
While the theory sounds good, it is essential to look at the scientific evidence. There are a range of studies that report positive results of a ketogenic diet for type 2 diabetes. Studies have shown improvements in blood glucose control and a reduction in symptoms related to cardiovascular disease. These studies, however, come with weaknesses. At this time, higher quality studies are needed before drawing any solid conclusions and recommending this type of diet. In addition, the American Diabetes Association states that diabetic diets should be individualized and that there is no “on size fits all” eating pattern. They also state that “evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes.”
With that said, should the ketogenic diet be recommended to treat type 2 diabetes?
Despite promising results of a ketogenic diet for the treatment of diabetes, there is still a lot that remains unknown, specifically, the long-term effects. In addition to this “unknown” aspect, those with type 2 diabetes need to decide whether or not this diet is sustainable long-term. The ketogenic diet is known for being extremely strict, eliminating entire food groups, and is one that is difficult to maintain. It is also one that requires great consistency in order for it to work the way that it should. It is important to be realistic about whether this diet will align with the lifestyle you want. More often than not, people find that diets such as the ketogenic diet are too restrictive and don’t stick with them for long periods of time. In addition, when restricting certain foods and whole food groups, it’s important to ensure nutrient needs are still being met. Much of the time, supplementation of the ketogenic diet is required to ensure overall health is being maintained. Supplementation may include: vitamin D3, multivitamin, calcium, phosphorus, salt, and potassium as these are nutrients that are significantly reduced in the diet. If you are considering the ketogenic diet, it is best if it’s done under the care of a dietitian and with approval from your healthcare provider.
So, what is recommended?
Dietary modifications are still the first recommendation made for people diagnosed with type 2 diabetes. Guideline-driven diet modifications center around eating the same amount of carbohydrates at each meal, increasing healthy fat intake, portion control, and consuming an overall healthier meal and diet when compared to food intake prior to diagnosis. Aligning with the American Diabetes Association, we recommend the Mediterranean Diet. This is a well-studied diet, rich in fruits, vegetables, whole grains, legumes, and olive oil. It also features lean proteins, such as chicken and fish.
The Mediterranean Diet is not only satisfying and extremely healthy, it is one that can be followed long-term for the treatment of type 2 diabetes. You can continue to enjoy the foods that you love, while continuing to control your blood glucose and maintain a healthy weight. Team up with a registered dietitian and/or certified diabetes educator to develop an individualized carbohydrate count for you.
References
Blomme, C. Evolution of the Ketogenic Diet. MNPG. Volume 34 – 4.
Association AD. Standards of Medical Care in Diabetes-2013. Diabetes Care. http://care.diabetesjournals.org/content/36/Supplement_1/S11. Published January 1, 2013.
NDEI.org. ADA Diabetes Guidelines Lifestyle Changes Diet Exercise | NDEI. http://www.ndei.org/ADA-diabetes-management-guidelines-lifestyle-changes-medical-nutrition-therapy-physical-activity.aspx.html.
Diabetes type 2 – meal planning. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/007429.htm.
