Ketogenic Diet and Diabetes: A Good Mix?

Butter, nuts and eggs

If you have prediabetes or type 2 diabetes, you know the importance of focusing on your diet to enjoy a healthy life for years to come. People with type 2 diabetes might consider trying the ketogenic diet. But, does the ketogenic diet and diabetes make for a healthy mix? Kathy Pertzborn, RD, LD, UnityPoint Health, helps answer that question and explains why it is a good topic to address with your provider.

What is the Ketogenic Diet?

The ketogenic diet was first developed in the 1920s to help children with epileptic seizures. While it’s still being used for that purpose today, the philosophy of more healthy fats and less processed carbohydrates is being adopted by many as a way to become healthier.

Also known as the “keto” diet, this approach is high in fat and low in carbohydrates. When fat is metabolized, different broken-down structures, called ketone bodies, are produced, and the body uses these to keep itself working.

“When you go without food for a while and fast or starve, your body has a mechanism to break down fat that is stored in the body, which makes ketone bodies,” Pertzborn says. “The ketogenic diet mimics fasting or starvation without actually fasting or starving.”

Pertzborn says when we eat fat, our blood sugar stays level or may decrease, and the pancreas doesn’t trigger a release of insulin, which is what occurs when you eat carbohydrates or sugars. A diet with healthy fats also may make you feel fuller.

What Do People Eat on a Ketogenic Diet?

Just because you’re supposed to eat fat, doesn’t mean you should eat all fats.

“The ketogenic diet doesn’t mean you can go to a fast food restaurant and eat French fries because fat is OK. That fat is hydrogenated vegetable oil, which is high in omega-6s and pro-inflammatory,” Pertzborn says.

Eating a ketogenic diet focuses on reducing highly-processed carbohydrates and increasing healthy fats, like olive oil, grass-fed butter, avocado, seafood and nuts. Pertzborn says it might be a good option for people who’ve been on low-calorie diets but aren’t seeing results.

“If someone comes to me and says, ‘I’ve been doing a 1,500 calorie per day, low-fat diet and I can’t lose weight.’ That tells me what they’re doing isn’t working for them or their metabolism. So, not everyone needs to change their diet, but if you aren’t thriving, it might be worth consideration,” Pertzborn says.

Is the Ketogenic Diet Like the Atkins Diet?

According to Pertzborn, the Atkins Diet is a little more flexible version of the ketogenic diet, but the concepts are similar. The Atkins Diet was developed about 40 years after the ketogenic diet.

“Atkins took out the fruits and vegetables, but the nutrients in fruits and vegetables are just too important to leave out,” Pertzborn says.

Since the ketogenic diet focuses on less processed foods, Pertzborn says it’s also very similar in philosophy to Paleolithic (paleo) eating and Whole30.

The Ketogenic Diet and Diabetes

“Really, type 2 diabetes is like carbohydrate intoxication. The body has been so overwhelmed by carbohydrates for a long period of time that you have insulin resistance. The cells are saying, ‘Please, no more sugar.’ When someone transitions to a much higher fat diet, very low carb diet, what happens is the body is not going to release all this insulin, and the insulin resistance has a chance to correct itself,” Pertzborn says.

Pertzborn believes people with type 2 diabetes should consider a lifestyle change, like a reduced carbohydrate diet, before taking medication or adding insulin. She says this change in diet may help reverse type 2 diabetes.

“The eating that got you into this is not going to get you out,” Pertzborn says. “You must change how you eat and the food choices you make.”

However, she warns that if you have already been diagnosed with type 2 diabetes and you’re on medication or insulin, talk to your provider first about how your insulin levels may respond to the keto diet. Pertzborn says most people who commit to the diet could start seeing small changes to blood sugar levels in four or five days, and by 21 days, could notice a significant shift.

Pros & Cons of the Ketogenic Diet and Diabetes

Pertzborn gives her three pros and three cons of the ketogenic diet and diabetes.

Ketogenic Diet and Diabetes Pros

  1. Fat is OK again. That means you don’t have to do low-fat salad dressings anymore.
  2. Blood sugar management. You might be able to get off medications or insulin.
  3. Natural weight normalization. Instead of feeling like you’re “on a diet,” you’ll focus on eating the amount of food that is right for you.

Ketogenic Diet and Diabetes Cons

  1. Misunderstanding by your health care provider. He/she might not agree this diet can change your treatment.
  2. Lack of support. Friends and family members might not want to make a drastic eating-style change with you.
  3. Confusion about the diet. The ketogenic diet isn’t meant to be a long-term solution for those with type 2 diabetes.

“Anyone trying the ketogenic diet to help with type 2 diabetes should use the diet as a phase, for a limited amount of time. Then, talk with your care team about how it worked, the changes you noticed and work together to identify a sustainable way of eating,” Pertzborn says.

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