Carbs and diabetes have a complicated relationship. Since carbohydrates make the biggest impact on blood sugar, those diagnosed with diabetes and high blood sugar often limit their intake of carb-containing foods. So, it makes sense that if you’re living with type 2 diabetes, you’d want to look into different diets that could help you lower and manage blood sugar fluctuations. Enter the low-carb diet, and the many iterations of low-carb diets that exist.
One of the most popular ways to go low-carb? The keto (or ketogenic) diet, which significantly limits carbohydrate and sugar intake, while increasing the proportion of calories you get from fat. The idea is to shift your body into a state of ketosis, where the body is using fat as the main energy source instead of glucose (the energy form of carbohydrates).
And there are plenty of potential positives for diabetes. Many people report lower blood sugar and weight loss when following the keto diet, which is why it’s become a diet of interest for people diagnosed with type 2 diabetes.
Though it may seem trendy to many people, the keto diet isn’t new. In fact, it was developed in the 1920s as a form of nutrition therapy for people suffering from epilepsy and other neurological conditions, with many successful outcomes. Since it is a version of a low-carb diet, researchers, nutritionists and home experimenters have also been studying the effects of a keto diet on people with type 2 diabetes.
So, should you try keto if you’re diagnosed with type 2 diabetes?
Research shows that following the keto diet for a period of time (study periods range from two weeks to one year) can help control hunger and may improve fat loss to reduce body weight. However, someone with type 2 diabetes should examine the following points before diving head first into the keto diet.
Keto may be a better choice than a low-carb, low-calorie approach
In 2008, researchers conducted a study on volunteers with obesity and type 2 diabetes. The participants followed either a low-carb keto diet or a low-carb and low-calorie diet for 24 weeks. While both groups show successful reduction in fasting blood glucose, weight loss and A1C (a measure of glucose in the blood), the group following the low-carb keto diet had greater improvements in lowering A1C and body weight.
Additionally, nearly 96% of the participants on the low-carb keto diet were able to reduce or eliminate their diabetes medications during the study, whereas 62% did the same from the low-carb and low-calorie group.
Type 2 diabetes is different for everyone
While understanding that what you eat has an impact on your blood sugar control is important for every person with diabetes, there’s also no single diet or carb count that’s just right for every diabetic.
Recommended carb intake is different for every person, and can be determined by working with a registered dietitian (RD/RDN) or certified diabetes educator (CDE). Some people with diabetes may just need to adjust the types and amounts of carb foods they are eating and may not respond well to an extreme low-carb approach like the keto diet.
Some people with diabetes should avoid the keto diet
People with type 1 diabetes tend to have higher levels of ketones in their blood as a result of their bodies not making any or very much insulin. They are at higher risk of developing a dangerous condition called diabetic ketoacidosis, a medical emergency.
Additionally, people with type 2 diabetes who use insulin therapy should also approach the keto diet with caution, since dosing needs to be adjusted based on diet. Note that ketoacidosis is different from ketosis, the state of using fat for energy from an extremely low-carb diet. The American Diabetes Association recommends that people with diabetes test for ketones if their blood sugar is higher than 240 mg/dL, which can be done at home with a urine test.
Not everyone who follows keto will lose weight
The keto diet isn’t a guaranteed weight loss strategy for everyone. Each person will need to make adjustments based on their health and lifestyle.
If weight loss is the goal and you’re not losing weight, it could be because you’re still eating too many calories, despite them coming mostly from fat. Other reasons could be you’re not eating enough calories or not addressing other lifestyle factors that contribute to weight, such as stress and poor sleep.
The keto diet is often temporary
While sticking with the keto diet isn’t impossible, it is a hard (and extreme) plan to follow. It doesn’t allow for cheat days or working in many carbohydrates, even healthy ones, here or there, because then your body doesn’t maintain a state of ketosis.
Many people find that they use the keto diet to kick off weight loss before transitioning into a more sustainable plan. Yo-yo dieting, however, is inadvisable for everyone, and even more so for people with type 2 diabetes because it can worsen blood glucose. After researching how to follow a keto diet in the most healthful manner, don’t start the keto diet if you’re not sure you can commit to it.
Choose healthy fats
People with diabetes should also be mindful of their heart health, since the two conditions intertwine. So, while the keto diet may be tempting because it allows for indulgent high-fat foods, like cheese, bacon and butter (which other diets often restrict), it’s best to lean into sources of heart-healthy monounsaturated fats and omega-3 fats for the most part.
Foods high in these forms of fat and other healthy fats include olives and olive oil, avocados, seeds, nuts and nut butters, eggs, fatty fish like salmon, cottage cheese, coconut meat and coconut oil.
Tell someone you’re going keto
Since type 2 diabetes is a serious medical condition, be sure to tell everyone involved in your treatment plan – from your healthcare providers to your friends and family – that you want to pursue the keto diet. At some hospitals, you may even be able to start the keto diet under the supervision of a dietitian who can provide advice for what and how much to eat, as well as how often to test your blood glucose. And at the very least, you’ll gain the important support of loved ones and caregivers who want to see you succeed.
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