You might be surprised to know that the ketogenic diet has been around for over 80 years. It was originally used to treat people with epilepsy. The ketogenic diet is very high in fat, extremely low in carbohydrate with a moderate amount of protein. The severe restriction of carbohydrate resulted in improvements in the seriousness and frequency of seizures. The diet is also associated with weight loss, improvement in risk factors for diabetes and enhanced brain health.
How the Ketogenic Diet Works
Carbohydrate is the body's primary source of energy. When following a very low carbohydrate diet, the body is forced to burn stored fat for energy. But fat isn’t clean fuel: it leaves an acidic waste in your blood stream called ketones. Your body can get rid of some, but not all, of the ketones by excreting them in the urine. This process is known as nutritional ketosis.
It is not the same as diabetic ketoacidosis, which can be fatal. In diabetic ketoacidosis, ketones build up to much higher levels than those found with nutritional ketosis. The blood glucose levels are also extremely high in diabetic ketoacidosis due to insufficient insulin. Research shows when the body is in a state of nutritional ketosis there is a decrease in hunger and longer satiety after eating, resulting in weight loss.
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Are Low Carb Ketogenic Diets Safe?
Before the discovery of insulin therapy in the early 1920s a ketogenic type diet was used for people with diabetes. However, after the discovery of insulin therapy and oral hypoglycemic medications, recommendations for carbohydrate intake gradually increased. Today the question about how much carbohydrate is a source of controversy. Some diabetes experts say limit carbohydrate for better diabetes control and others say higher carbohydrate—noting concerns about safety.
There’s an emerging body of evidence showing the benefits and safety of carbohydrate restriction in people with diabetes.
Since 2013 there have been eleven large studies showing benefits associated with low carbohydrate and very low carbohydrate ketogenic diets. Carbohydrate levels in these studies ranged from 20 g to 130 g per day. Improvements in blood glucose, insulin resistance, high blood pressure, high triglycerides and unhealthy LDL cholesterol levels were observed. A ketogenic diet also helps to reduce overweight and obesity – major risk factors for diabetes.
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In a 2016 study, researchers evaluated the short-term safety and tolerability of a ketogenic diet with less than 50 g of carbohydrate per day in individuals with type 2 diabetes. Participants in the study were randomly assigned to either a ketogenic diet or standard low calories diet for 45 days. Both groups were evaluated by a physician, assessed by a registered dietitian, and participated in group meetings. Participants also received individual counseling to support lifestyle and behavioral modification throughout the study.
At the end of the study, the ketogenic diet was found to be most effective in reducing body weight and improving blood glucose control than the standard low calorie diet with safety and good tolerance for T2DM patients.
Most of the available research on low-carbohydrate diets is on individuals with type 2 diabetes. However, there are a growing number of people with type 1 diabetes following low-carbohydrate diets. More healthcare providers are also recommending low carbohydrate diets. A recent study in which individuals with type 1 diabetes were instructed to maintain a diet with 70 to 90 g of carbohydrate per day for up to four years found a significant decrease in HbA1c, a dramatic reduction in hypoglycemic (low blood glucose) episodes, and improvement in lipid profiles.
Bottom Line
There’s no ideal way of eating that will work for all people with diabetes. Meal planning must be individualized for each person to be effective. The quantity and type of carbohydrate in food influence your blood glucose levels and the total amount of carbohydrate eaten is the primary predictor of your blood glucose control.
Before attempting to follow a ketogenic or low carbohydrate diet you should speak to your healthcare provider, particularly if you take insulin or oral medications for diabetes that stimulate insulin secretion. You may need an adjustment in your medication before reducing your carbohydrate intake.
Constance Brown-Riggs, MSEd, RD, CDE, CDN is a registered dietitian, certified diabetes educator, national speaker and author of The African American Guide to Living Well with Diabetes.. She is Dannon One Yogurt Every Day Nutrition Advisor.
