Is it possible to eat more fat and lose weight? The answer is yes according to all the “keto” claims. The keto diet craze is the latest diet hype, but it isn’t a new diet. The ketogenic diet originated as a treatment for epilepsy in the 1920s. While the diet is still used for epilepsy, it is also now used for weight loss, improved brain function and memory, cancer therapy, and type 2 diabetes.

However, the keto diet can be confusing for people with type 2 diabetes. You have probably heard of the dangers of ketosis with diabetes. Keep reading to learn more about the types of ketosis and the keto diet.

Is ketosis safe?

Normally your body uses glucose for energy. When there is not enough glucose, your body can use ketones. Ketosis is simply the presence of ketones in your blood.

Let’s start by clarifying the difference between nutritional ketosis (NK) and diabetic ketoacidosis (DKA). NK is when the body shifts to using fat instead of glucose for energy, such as after a prolonged fast. The liver converts fat into ketones which can be used by the brain for energy. So, ketones are produced, but at a low level, and blood glucose levels are also low in people without diabetes.

Typically DKA happens when blood glucose levels are elevated (>250 mg/dL) with a lack of insulin. Ketone levels can be 20 times higher in DKA compared to the levels in NK. DKA causes dehydration and electrolyte (sodium and potassium) and acid imbalances in the blood. DKA is a life-threatening situation and requires immediate medical attention. DKA is more common in people with type 1 diabetes, but it can happen in people who have type 2 diabetes.

So, ketosis is safe for most people with type 2 diabetes, but ketoacidosis is not.

What is the keto diet?

The keto diet is a high-fat, moderate-protein, and very low-carbohydrate diet. Around 75% of daily calories are from fat, 20% from protein, and 5% from carbs. The keto diet is not a high-protein diet. When protein is digested some amino acids can be converted to glucose, so too much protein can take you out of ketosis. Total carbohydrates are limited to 20-50 grams to induce ketosis. Carbohydrates need to be spread throughout the day and not all consumed at one time.

Typical foods on a keto diet include eggs, meat, poultry, seafood, oils, butter, avocado, olives, nuts, seeds, cheese, plain full-fat Greek yogurt, cottage cheese, and coconut.   So, what about carbohydrates? Carbohydrate intake should come from non-starchy vegetables such as leafy greens, broccoli, cauliflower, peppers, asparagus, mushrooms, and green beans. Higher carb foods like rice, pasta, bread, cereal, potatoes, and fruit are out.

Keto benefits

The keto diet has been associated with lower blood glucose, decreased insulin resistance, decreased hunger and cravings, weight loss, decreased triglycerides, increased HDL (“good” cholesterol). People with type 2 diabetes have been able to decrease the use of diabetes medication. Most of these benefits are from short-term studies. The keto diet may not be the best diet in the long run.

Keto pitfalls

One problem with the keto diet is that there are many versions of the diet. This can lead some people to follow an unhealthy high-fat diet and not be in ketosis. The lines get blurred between low-carb and keto diets. It’s also true that people can be in ketosis with different levels of protein and carb intake.

The keto diet may alter the gut microbiome. The diet is low in fiber and restricts some nutrient-dense foods including whole grains, fruits, legumes, and starchy vegetables. There are however conflicting studies about the keto diet and gut health.

The keto diet has been associated with an increase in LDL (“bad” cholesterol), but again there is conflicting research. This may mean that it’s not the best diet for some with high cholesterol.

Due to a lower carb intake, people with diabetes may experience hypoglycemia if they don’t make appropriate changes to their diabetes medications.

The bottom line

The keto diet may work in the short-term for some people with type 2 diabetes, but it’s not the only way to lose weight and manage glucose. The American Diabetes Association states that different eating patterns including Mediterranean-style, vegetarian, low-carbohydrate (26-45% of total calories), and very low-carbohydrate (<25% total calories) have all been shown to lower A1C levels. More long-term studies are needed with the keto diet.

If you are considering a keto diet, talk with your medical team to see if this diet is a good fit for you.   People with diabetes starting a keto diet should be under medical supervision.

If you are not ready for keto, but interested in following a lower carbohydrate diet, consider replacing some high carb foods with healthy fats such as nuts, seeds, nut butters, olives, and avocado. Another great way to control carbs and eat more non-starchy vegetables. The right eating pattern for you is when you can manage glucose and feel good.


by Christine McKinney, RD LDN CDE 


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