Ketogenic Diet And Diabetes Type
Ketogenic diets have risen in popularity in recent years as a strategy for weight loss and treatment of a variety of diseases. For patients with type 2 diabetes mellitus, the diet can lead to clinical improvement, including better glycemic control, lower cholesterol, and weight reduction.
The diet is also becoming popular among patients with type 1 diabetes, but its clinical impact remains unclear, as much of the literature consists of retrospective case reports and series. The subject has not been well investigated, likely because of concern about inducing ketoacidosis and hypoglycemia in patients already at high risk for these complications.
This article reviews potential risks and benefits of a ketogenic diet for managing type 1 diabetes based on available evidence.
Tip #3 Focus On Whole Foods And Avoid Processed Foods
When you think of a high-fat diet, the image of bacon, butter, and cheese drenched dishes may pop into your head. Although these are all keto-friendly foods, its important to also incorporate plant-based fats in your diet, in addition to a variety of low-carb, nutrient-rich foods. The healthiest keto diet for diabetics is built around whole, single-ingredient foods, including:
- Healthy proteins: wild-caught fish, grass-fed beef, poultry, eggs
- Nuts and seeds: almonds, pecans, walnuts, chia seeds, sunflower seeds
- Healthy oils: avocado, coconut, extra-virgin olive, flaxseed, walnut, sesame
- Minimally processed, high-fat dairy: whole-milk yogurt, cream, butter, ghee
- High-fat produce: avocados, coconut
- Non-starchy vegetables: green peppers, spinach, artichokes, broccoli, greens
- Low-carb fruits: berries, lemons, kiwis, plums
Having a variety of whole foods at your meals helps to provide your body with essential minerals, vitamins, fiber, antioxidants, and electrolytes needed to prevent nutrient deficiency and diet fatigue.
Whole foods can be defined as those that are as close to their natural form as possible. Although whole foods are preferred for a healthy diet, its important to note that not all processed foods are bad in fact, most food we get at the grocery store has been processed in some way through canning, cooking, freezing, dehydration, or milling.
Effects On Lipids Mixed
Concerns have been raised regarding the ketogenic diet and adverse lipid profile changes, but the literature is inconsistent, and few publications have assessed the issue specifically in type 1 diabetes. Effects of ketogenic diets such as decreased total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels and increased high-density lipoprotein cholesterol levels have been reported.
Yancy et al, compared a low-carbohydrate diet to a low-fat diet in a randomized control trial of 120 overweight patients with hyperlipidemia. The low-carbohydrate diet led to greater decreases in serum triglyceride levels compared with patients on a low-fat diet and greater increases in high-density lipoprotein levels , but no significant differences were seen in low-density lipoprotein levels .
Using an online survey of a social media group for children and adults with type 1 diabetes who were following a very low carbohydrate diet, Lennerz et al found that 51 of 316 respondents reported having a diagnosis of dyslipidemia .
In a retrospective chart review of 30 patients with either type 1 or type 2 diabetes on a low-carbohydrate diet , ONeill reported that low-density lipoprotein levels decreased by 17%, from 155 to 130 mg/dL , and triglyceride levels decreased by 31%, from 107 to 74 mg/dL .
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Adherence Can Be A Problem
If you have tried keto , even for a day, you can probably resonate with this. You hang in through the first few hours. Maybe through the first day. Maybe even day two or three. Maybe its been three months. It really doesnt matter it is inevitable that eventually, the cravings startand they are STRONG.
Oh, I can have some carbs now, it wont matter much, you justify to yourself. You cave.
The results are like the pop-up ads on your Internet browser. Congratulations! Youve just restarted the keto adaptation process. Anything you previously did is now for naught. Thanks! *browser closed automatically*
Granted, the longer youve been keto, the easier the re-adaptation process, but during that initial transition, it is IMPERATIVE that one maintains the correct macronutrient split or the adaptation will not occur.
Since that process is neither glamorous nor comfortable, not many can push through with near perfect consistency, myself included.
As you can hear, I found keto to be rough going but, again, your experience may be different.
Is The Ketogenic Diet One More Fad Or Could It Help Manage Diabetes
Figuring out a diet that fuels our bodys needs and keeps us healthy without sacrificing taste is a daunting task for anyone. Factor in diabetes and this task can suddenly seem like an insurmountable obstacle overcome only by the most health-conscious fitness guru. Some diets are clearly fads, popping up into existence seemingly overnight, selling books and recipes and often food itself, only to fade into the twilight and be overtaken the next day by yet another set of guidelines by which we are to become, optimistically, the best self we can be.
There are seemingly endless options to curate a diet to meet every notion or need. However, those living with diabetes may find that these diets dont always work to balance glycemic control and blood sugar. So what about the ketogenic diet? Is it a fad that will one day be supplanted by the next newest way to eat, or will the science behind it ensure it keeps a lifelong and loyal following? And if the latter, what role can it play in the lives of those living with diabetes?
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What Does Ketogenic Have To Offer
The benefits of a ketogenic diet have been well documented for those living with Type 2 diabetes. Not only does the diet help manage blood sugar but it promotes weight loss as well. The results for those living with Type 1 are less conclusive. Many studies tend to address low carb diets like paleo and Atkins, which focus more on types of low carb food to eat, unlike a keto diet, which pays close attention to macronutrients and staying in ketosis. There seem to be fewer studies exploring the latter, but there is observational information that seems to indicate the diet offers a way to manage A1C levels and glycemic control. Many people with diabetes who abide by the keto diet have found that they significantly reduce their use of insulin.
Dka Or Desired Ketosis
Differentiating DKA from desired nutritional ketosis for a patient following a ketogenic diet poses a challenge when interpreting monitored test results. According to Volek and Phinney, blood ketone levels ranging from 0.5 to 3.0 mmol/L are expected in nutritional ketosis, with the upper end being optimal . Although such levels are not high enough to indicate DKA, they can be a warning sign. As such, the clinical picture should be considered. Patients should be educated regarding symptoms of DKA, including nausea, vomiting, and difficulty breathing.
Safety ranges of serum ketone levels.
Based on data from reference .
Diligent and more frequent blood glucose monitoring should be a mainstay in patients with diabetes on a ketogenic diet. Although euglycemic DKA is possible while following a ketogenic diet, blood glucose levels above 250 mg/dL may be seen and are a sign of potential DKA.
Glucose monitoring can also be helpful for preventing hypoglycemia, a potential consequence of reduced carbohydrate intake. Clinical studies indicate that a continuous glucose monitor can be a useful tool in reducing hypoglycemia.,
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What Happened In Type 2 Diabetes Study: Saslow
“If you follow the ketogenic diet, it’s a very efficient way of losing weight and managing your blood glucose and getting off your glucose-lowering medicine,” says Dr. Saslow, PhD, the study leader.
The study was a follow-up to earlier research in which she and her team also found that those on the ketogenic diet lowered their HbA1c while those on the conventional low-fat diet did not.4 Just as in the current study, those on the low-carb keto diet also lost more weight.
The more recent study was conducted online to ascertain if this online approach proved effective in eliciting weight loss.1 Dr. Saslow’s team randomly assigned the 12 participants to the Keto diet and lifestyle improvement group and another 13 individuals to the traditional low-fat diet known as the Plate Method,1 supported by the American Diabetes Association.
For the ketogenic eating plan, participants were instructed to reduce non-fiber-containing carbohydrates to between 20 and 50 grams a day, with no calorie restriction. The group following the plate method were told to eat their meals on a nine-inch plate, filling half of it with non-starchy vegetables , ¼ of the plate with whole grains and adding lean protein to the last quarter of the plate.1
What Is Ketosis And How Does The Process Work
Ketosis is a natural state that occurs when you start to metabolize fat instead of sugar, says Michael Greenfield, MD, endocrinologist and chief medical officer at El Camino Hospital in Palo Alto, California. It occurs often when people fast and use up the stores of sugar in their body.”
To understand ketosis, it helps to understand how the body burns energy. Carbohydrates and fat are both energy sources, and the body typically burns carbs first, and then fat. If there arent enough carbohydrates in your system, it begins to break down fat for energy, which puts your body into a state of ketosis.
While in this state, the body becomes a fat-burning machine. For this reason, ketosis is the goal of many diets, particularly those that restrict carbohydrate intake and rely on fat for energy, such as the ketogenic diet.
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What The Science Says
Several comprehensive studies and meta-analyses have demonstrated that after a few months or even a year of a low carb diet versus a moderate/high carb diet, there are no significant differences in the amount of weight lost . I will say, however, most of these diets are NOT keto and are simply lower carb . Also, long-term effects are not often studied due to budgetary constraints, so interpret results as you wish.
Verdict: A keto diet is not inherently better for weight loss than other diets but can be very effective if it:
- Helps you manage your blood sugar better than other diets
- Is easier for you to follow than other diets
- Works for your general lifestyle
As with most other diets, the main criteria for success is whether or not you can follow the diet for the long term. If you like the keto lifestyle, the diet works great. If you hate it, it probably wont work for you.
Conserve Time With Keto
Here are some rules that will help you compose delicious keto dinners for everyone. Step 1: arrange a long time Sunday, Monday or sometime throughout the week so you can invest a long time preparing food for the remainder of the week. Action 2: bring all of supper onto one pan on Sunday night, make bacon, eggs or chicken on another night of the week, and grocery shopping can be done on one day. Action 3: Dont hesitate of a little late-night snacking from time to time..
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How Difficult Is A Keto Diet To Follow
This is the most important, but also most subjective, question about any diet. If you dont feel physically and mentally well on a diet, it wont lead to long-term results, because you wont adhere to it.
The keto diet is probably one of the post polarizing diets when it comes to peoples opinion on how easy it is to follow. Some people love it almost from day one while others experience major food cravings and even physical discomfort.
This is what my experience with a keto diet was like. Yours may be different:
Meat Meat And More Meat
So what makes Keto unlike other diets? Meat, meat and more meat. There is no meat or fish that is off limits on keto, including the usually verboten bacon. Non-starchy vegetables like Brussels sprouts and cauliflower are encouraged, as are oils, butter and lard. Cheese and Greek yogurt can also be staples of a keto diet.
However, this diet isnt for everyone. If traditional bread, pasta, rice, potatoes and/or fruit are what you live for, then you might just be miserable on keto. However, if youre open to exploring different tastes, then the good news is there are substitutes for many of these foods. Cauliflower pizza crust, rice, and even gnocchi zoodles almond flour bread and almond milk are all readily available from most stores now. A small amount of berries is acceptable, but for the most part say goodbye to apples, melons, plums and peaches. Booze and sugar are also out, but if youre living with diabetes, you likely already know how to manage these desires.
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Remember That It Takes Time
At first with keto, youll lose a significant amount of water weight, and this can be really exciting. After a while, youll notice that it tapers off and you may get demotivated, says Lele. Dont worry about it just keep doing what youre doing.
Lele is the first to admit that adjusting to a new dietary regimen and making the considerations she needed to in order for it to work took time.
I knew that not injecting insulin meant that I had to really be careful about what I eat from now on, she says. The mentality of, Oh, I guess Ill inject myself extra insulin to cover that carb-loaded foodthat way of thinking was gone for me. It was great not having to do that anymore, but at the same time it took a while to get used to.
If youre living with type 2 and you want to try keto, I would highly suggest talking to your doctor and seeing if they can work with you, suggests Lele. Keto has been life-saving for me, in more ways than one.
Its never too late to change your life.
When To See A Doctor
A doctor can use blood or urine tests to determine whether a person is in ketosis or ketoacidosis. These tests measure the levels of ketones, glucose, and acidity in the body.
Nutritional ketosis is not a medical condition and does not require a diagnosis. However, ketoacidosis is a life-threatening condition, and anyone with symptoms should seek immediate medical attention. People with signs of malnutrition should also see a doctor.
Doctors often provide urine test strips to people with type 1 diabetes to allow them to check their ketone levels.
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Symptoms Of Type 1 Diabetes
Type 1 diabetes signs and symptoms can appear relatively suddenly and may include:
- Increased thirst
- Irritability and other mood changes
- Fatigue and weakness
- Blurred vision
If you see any of the above symptoms in you or your child, then consult your doctor right away. If not, symptoms may progress to diabetic ketoacidosis the most common cause of death in children who have type 1 diabetes.
Does Keto Work If You Have Diabetes
Research suggests that people with type 2 diabetes can slim down and lower their blood sugar levels with the keto diet. In one study, people with type 2 lost weight, needed less medication, and lowered their A1c when they followed the keto diet for a year.
If youâre insulin resistant — which means you have higher blood sugar levels because your body isnât responding properly to the hormone insulin — you could benefit from nutritional ketosis, because your body will need and make less insulin.
There are fewer studies looking at the keto diet for people with type 1 diabetes. One small study found that it helped people with type 1 lower their A1c levels, but we need a lot more research to get the full picture of the dietâs effects.
Keep in mind that most studies have only looked at the short-term results of the keto diet. Itâs unclear if it works as a long-term way to manage your diabetes.
If you decide to try the keto diet, be aware that it may be hard to stick to. The very low amount of carbs in the plan is a big change for many people. It also can make you feel tired for a few weeks until your body adapts. To make it a success, itâs a good idea to make a meal plan you can follow, including keto-friendly meals and snacks to keep on hand.
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Is There A Specific Diet For Type 1 Diabetes
The goal of managing type 1 diabetes is to keep blood sugar at normal levels to ward off future problems. “Taking control of your blood sugar is the only way that you’re going to save yourself from a lot of trouble later on,” Sandra J. Arevalo, RDN, national spokesperson for the Academy of Nutrition and Dietetics, tells Health.
All people with type 1 diabetes will need to take insulin for the rest of their lives, but diabetes is a highly individual disease. Every person will need different amounts of insulin at different times, and the insulin must be carefully calibrated with not just food but also exercise, stress, sickness, your body size, and metabolismall of which can affect blood sugar. In the beginning, there’s a trial-and-error period to find the right combinations of insulin and diet . “It takes time to find that magic number,” says Arevalo. Type 1 diabetes is also not static, she adds. It will change as time goes on. For this reason and others, there is no one “diabetes diet.”
- 2 or more milks. This could also be low-fat or non-fat yogurt or cheese
- 4 to 6 ounces of meat or another protein
- Up to 3 fats
Alcohol, sweets, and fatty foods should only be taken in moderation.
The plate method can simplify things. Half of your plate should be non-starchy vegetables. Meat or another protein occupies one-fourth, and the final one-fourth is a grain or starch.