Is the Keto Diet Good for Diabetics?

When someone receives a diagnosis of prediabetes or diabetes, one of the first things they are told is that a healthy diet will play a major role in diabetes management. Specifically, they’re told to eat a low carbohydrate diet or low glycemic index diet. The general consensus is that aside from managing diabetes, a diabetes diet has other benefits too because it can reduce your cardiovascular risk.

There is no doubt that a healthy eating plan is one of the best ways to keep blood sugar levels under control in people with diabetes. However, scientists, researchers, and healthcare professionals are now looking beyond the traditional approach of a low-carb diet. The ketogenic diet (keto diet) is one such eating plan that could potentially be beneficial for diabetics. But is the keto diet simply a fad diet? Or should people with diabetes try the keto diet to help with blood sugar management? Keep reading to learn more about what science says.

What is the keto diet?

The keto diet is an eating plan that focuses on increased fat intake and reduced daily carb intake. Meaning, you eat foods that have a high amount of fat, moderate protein, and very low amounts of carbs. Different information sources offer varying percentages, but in general, ketogenic diets involve obtaining around 55-70% of your daily calories from fat, 25-35% from protein, and around 5-10% from carbohydrates.

Many people find that a low carbohydrate ketogenic diet to be fairly restrictive. That’s because most people are used to a higher daily carb intake. In other words, eating a keto diet requires a major shift in eating habits. Experts recommend that if a ketogenic diet does not feel doable, you can try eating a more balanced low-carb diet, which allows slightly more carbs than a keto diet and therefore more variations in dietary options.

How does a keto diet work?

A ketogenic diet works by getting the body into “ketosis.” This is a metabolic state in which the body burns fat instead of carbohydrates for energy.

Most diets that are used to manage diabetes focus on weight loss. So, eating a ketogenic diet, which is a high-fat diet, might seem counterintuitive for people with type 2 diabetes. However, scientists believe that a keto diet can potentially change the way the body stores and uses energy. Meaning, the body starts converting fat instead of carbohydrates (glucose or sugar) into energy.

Studies have shown that reducing fat in your diet is not necessarily the best approach. Low-fat diets can backfire because they can lead to an over-consumption of refined carbohydrates, sugars, and processed foods, and avoidance of nutrient-dense foods like nuts, seeds, vegetable oils, and avocados that are rich in healthy unsaturated fats.

The truth is that we need a balanced diet that includes eating foods that contain healthy fats as an energy source. So, while the ketogenic diet may sound contradictory, science says that high-fat foods can be healthy, excluding saturated and trans fats.

What foods can you eat in ketogenic diets?

If you are thinking about going keto for better blood sugar control or even general health and wellness, the key thing is to make smart food choices. Remember, people lose weight only if their calorie intake is less than the calories burned on a daily basis.

It’s important to understand that high-fat low-carbohydrate diets like the ketogenic diet do not involve overeating fats or eating unhealthy saturated fats. The focus should be on consuming moderate amounts of heart-healthy fats and monounsaturated fats, such as those found in eggs, cottage cheese, fish, avocado, nuts, seeds, and olive oil. If you combine this with very low carbohydrate intake, it can create a large calorie gap that will lead to quick weight loss, which, in turn, is good for blood sugar control.

Another thing to keep in mind is that exercise and diet are both equally important components of your diabetes therapy with lifestyle changes. No amount of smart food choices will help with losing weight if you don’t get regular exercise.

How long can you eat a ketogenic diet?

Most people eat a ketogenic diet for a few months and then tweak the eating plan to include a few more carbohydrates. Slowly adding back carbs is a more feasible approach to prevent weight gain in the long term. Also, there are no studies showing the safety or efficacy of ketosis (burning fat for energy) in the long term. Most people won’t stay in ketosis forever, anyway.

Is a ketogenic diet good for type 2 diabetes?

In some cases, the ketogenic diet can be good for patients with type 2 diabetes short-term. To fully understand whether a keto diet is good for diabetics, we need to understand what goes on in the bodies of people with diabetes.

Diabetes is a condition in which there are high blood glucose levels. In people with type 1 diabetes, the body doesn’t make any insulin--the hormone that regulates blood sugar. Type 1 diabetes is usually diagnosed in childhood and requires lifelong diabetes medication. The more common form, type 2 diabetes, occurs if there are low insulin levels or the body does not use insulin properly due to changes in insulin sensitivity.

When we eat carbohydrates, our body breaks them down and turns them into sugars that enter the blood. The higher the blood sugar levels, the more insulin is needed. Given that people with diabetes don’t make enough insulin or don’t use insulin properly, you can see how very low carb diets like the keto diet might be beneficial for blood sugar control.

Should diabetics eat a keto diet for blood sugar control?

You should know that the American Diabetes Association (ADA) doesn’t recommend the ketogenic diet versus other diets. It is also important to understand that while the keto diet could help with blood sugar control and glycemic control, it is not a magic cure. With that said, many people have found that a ketogenic diet helps with weight loss, which, in turn, can help to reverse or reduce the impact of diabetes, along with diabetes medications if needed.

On the other hand, the ketogenic diet can pose serious risks to diabetes patients. When you change from a regular diet to a low carbohydrate diet such as the keto diet, it can lead to an increase in the amount of ketone levels in the blood (this is how the body achieves ketosis). This can potentially lead to diabetic ketoacidosis (DKA), which is a medical emergency and can be fatal. People with type 1 diabetes are at greater risk, but people with type 2 diabetes are also at risk of DKA.

It is also worth noting that there is limited evidence about the safety and long-term effects of a ketogenic diet. People with diabetes should not make drastic dietary changes without talking to their doctor first because it can lead to fluctuations in blood sugar levels, including blood sugar spikes or low blood sugar, potentially leading to serious complications like diabetic coma.

If you have been advised to undertake the keto diet for diabetes, do it only under the supervision of a healthcare professional or certified diabetes educator and make sure you are medically reviewed at regular intervals.

Can the keto diet reverse diabetes?

No, a keto diet will not reverse type 2 diabetes but can help maintain better blood sugar control, therefore managing the disease. It’s important to note that the keto diet is never for people with type 1 diabetes because they don't have insulin and, therefore, cannot metabolize ketones. Talk to your doctor about the best treatment plan to manage blood sugar, potentially lose weight, and get regular updates on your health status.

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