Safety In Pediatric Patients
There is a lack of observational and prospective studies in children following a ketogenic diet, but several case reports have discussed its benefits in children with type 1 diabetes.,, They have found reductions in glycemia and glycemic variability and improvements in HbA1c level, growth rate, and lipid profiles, and many have been without severe adverse effects, like DKA and hypoglycemia.
Henwood et al described a 4-year-old girl with pyruvate dehydrogenase deficiency, seizure disorder, and type 1 diabetes who was treated with a ketogenic diet. During 28 months follow-up, she had improved activity, better glycemic control, significant developmental advances, and an increase in linear growth from less than 5th percentile to 50th percentile. However, the diet was discontinued when she developed severe DKA.
Other case reports have revealed concerns about the diets safety in children with and without diabetes. de Bock et al described 6 children with type 1 diabetes who were treated with carbohydrate-restrictive diets for epilepsy . Some children experienced weight loss and growth delay. Commonly observed effects were fatigue, reduced enjoyment in physical sports, and eating disorders. Ultimately, most families opted to return to a more liberal carbohydrate-containing diet.
Tips For Low Carb Dieting For Diabetics
Many people incorrectly believe that only sugar causes type 2 diabetes. In reality, the insulin resistance associated with type 2 diabetes can be thought of as carbohydrate intolerance type 2 diabetes is a side effect of consuming too many carbohydrates relative to a persons carbohydrate tolerance, which can cause blood sugar to spike.
While diabetics should be mindful of sugar intake, its possible to manage type 2 diabetes by living a low carb lifestyle. Some people with type 2 diabetes have found low carb living to be so effective that they can manage their condition without medication.
How Low Carb Is A Low
The lower your carbohydrate intake, the more powerful the effects may be on weight and blood sugar.15 For that reason, we recommend initially following the dietary advice fairly strictly. When youre happy with your weight and health, you may carefully try eating more carbs if desired .
Here are three examples of what a low-carb meal can look like, depending on how many carbs you plan to eat per day:
A strict low-carb diet is often called a keto or ketogenic diet. Its not a no-carb diet, but it contains less than 20 grams of carbs per day.
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Keto And Diabetes: What The Research Says
Because the keto diet limits carbs, it makes sense that it would lower blood sugar. And numerous studies confirm that it does.
A 2017 study compared two online interventions for overweight adults with type 2 diabetes where one group followed a low-carbohydrate ketogenic diet and the other followed a program based on the American Diabetes Association’s “Create Your Plate” diet. After 32 weeks, or about 7 months, the keto group lost more weight and had lower A1C and triglyceride levels. While this is compelling, no long-term follow-up was conducted so it’s unclear if participants kept up with this diet and maintained the results over time.
Another study compared a low-carbohydrate diet to a low-glycemic, reduced-calorie diet in obese adults with type 2 diabetes. Both groups had improved blood glucose control and weight loss, but the low-carb group saw better blood sugar control. The keto diet often leads to weight loss, which alone can improve blood sugar control, but this study found that the low-carb group had improved blood sugar control independent of weight loss. So it could be beneficial to reduce daily carb intake below the standard recommendation of 45-50 percent of calories from carbs, the researchers said.
Condiments Herbs And Spices
Beware of added sauces and flavorings to your food. Ketchup, barbecue and soy sauce often have a high amount of added sugar and can throw off what is otherwise a low-carb meal.
So take care what you top your food with and focus your flavor adding efforts on herbs and spices. Herbs and spices add not only great taste but wonderful nutritional and health benefits to your diet. Plus, they can help you adjust to less sugar.
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Oh Snap Pickling Co Dilly Bites
One serving has 0 calories and 0 grams carbohydrate. Yes, you read that correctly. There are 320 milligrams sodium in a serving, though, and each bag delivers 3 servings. But you can’t beat a ZERO-carb snack. If you can’t find this particular brand or product, don’t sweat it: pickles in general are low-carb with dill versions having fewer carbs than “Bread & Butter” varieties. Get the variety pack, which includes six packs of Dilly Bites and six packs of Hottie Bites .
Related: Learn more about if pickles are healthy and how they can fit into your diet.
Diet Lowers Blood Glucose Sometimes Dangerously
Leow et al investigated the effects of a ketogenic diet in 11 adults with type 1 diabetes who self-initiated the diet before study recruitment. Mean HbA1c of study participants was excellent at 5.3%, and participants spent an impressive average of 74% of time within target range. However, many had a disproportionately high frequency and duration of hypoglycemic episodes.
Lennerz et al evaluated the effect of a very low carbohydrate diet on 316 patients with type 1 diabetes, using an online survey of a social media group. Average carbohydrate intake was 36 ± 15 g of carbohydrates per day for an average duration of 2.2 ± 2.9 years. Patients achieved good glucose control and reported high satisfaction. The rate of severe adverse events was low and included 7 patients with diabetes-related hospitalizations and 4 with DKA.
In their small, randomized crossover study, Ranjan et al compared 1 week each on a low-carbohydrate diet and a high-carbohydrate diet in patients with type 1 diabetes using insulin pump therapy. The low-carbohydrate diet group had significantly lower average daily blood glucose levels , longer time in euglycemia , less glycemic variability , lower total daily insulin dose , and fewer daily units of bolus insulin administered .
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Keto Diet For Type 2 Diabetes: Pros And Cons
Ketogenic diet is a catch-all term for any diet that pushes your body into the natural metabolic state of ketosis, which means burning fat for fuel instead of carbohydrates. Though theres no set formula for keto, generally, the diet works by cutting back on carbohydrates, to about 20 g of net carbs to start, and replacing those with mostly fat and a moderate amount of protein, according to the popular website Keto Connect. Net carbs are the total number of carbs minus the fiber and sugar alcohols, according to the Atkins website.
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When Stephanie Lofton was diagnosed with type 2 diabetes in 2015, she knew she needed to make some big changes to her diet. But after cutting her carbohydrates down to just 60 g per meal didnt help her lose weight or manage her blood sugar, she turned to a more intense diet.
Lofton, a medical biller in Marysville, Washington, says she decided to try keto in spring 2017 after seeing how some of her Facebook friends had lost weight on the diet. She was desperate to try something different because she couldnt get her blood sugar under control even with insulin and after trying several types of diets, she says.
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Im feeling fuller for longer periods of time, she says, and I dont feel like Im deprived at all. I dont miss rice, I dont miss potatoes I dont miss those things.
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Definition Of Low Carbohydrate Diets
One of the issues with the term low carbohydrate is uncertainty about what this means in terms of carbohydrate intake. Ketosis readily occurs at carbohydrate intakes below 50 g/day , and these very low carbohydrate, ketogenic diets appear to have more pronounced effects than other, less restricted carbohydrate diets . The taxonomy for diets containing various amounts of dietary carbohydrate has been suggested in a recent paper , see Table . In practice, most Atkins-style diets are designed to be very low in carbohydrate and high in protein and fat , and other diets, e.g., the Zone and the South Beach Diet , promote a moderate carbohydrate restriction together with high protein and low fat intakes.
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Is Keto Safe If You Have Diabetes
That depends on the type of diabetes you have. In general, people with type 2 who are overweight seem to get good results safely. If you have type 1 and want to try the keto diet, itâs essential that you talk to your doctor first. Youâll need to carefully monitor your health and watch for signs of ketoacidosis. For either type, itâs a good idea to work closely with your doctor, since you may need to change your medications.
The keto diet has some side effects that are worth knowing about, too:
Hypoglycemia: Though the diet can lower A1c levels, that may mean youâre at a higher risk of blood sugar that dips too low, especially if youâre also taking medicine for your diabetes. Let your doctor or diabetes educator know if you try the keto diet. They can advise you about checking your blood sugar, taking your medicines, and what to do when your blood sugar drops too low.
Lack of nutrients: Since many foods are off-limits, including some fruits, vegetables, and dairy products, you could miss out on the important nutrients youâd get from them. Work with a nutritionist familiar with nutritional ketosis to make sure your body gets what it needs.
Liver and kidney problems: These organs help your body process fat and protein. Some experts worry that the keto diet could overwork them. Others say that if your organs are healthy, youâre probably fine.
Constipation: Since youâre not eating foods like whole grains and beans, you could miss key sources of fiber.
Diet Was Standard Treatment Before Insulin
Eating a low-carbohydrate diet was the standard treatment for diabetes as far back as the 1700s before the discovery of insulin, capable of curing type 2 diabetes in adults or extending life, in some cases for years, in type 1 diabetes in children.
After insulin came a huge sigh of relief, says Dr. Belinda Lennerz, an endrocrinologist at Boston Childrens who also conducts diabetes research in the Ludwig laboratory. The thinking went, we have a treatment for this and we dont have to be on a low-carb diet anymore.
But within 20 years, the pendulum swung so that high-carbohydrate diets became the norm simply because insulin allowed people to eat carbohydrates without immediate complications.
In addition, modern technology such as continuous blood glucose monitoring, specialized versions of insulin, and other drugs for diabetes complications, has greatly improved the lives of people with diabetes.
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Low Carb Dos And Donts
The Mediterranean, DASH or plant based diets have all shown benefits in people with diabetes beyond diabetes management, like lower cholesterol, better blood pressure and overall heart health, according to Patterson, also a diabetes educator in the Adult Diabetes Education Program.
She adds that the Mediterranean and DASH diet offer a great variety of foods with very little restriction the emphasis being on portion control, balance and healthy food choices.
Similarly, plant-based diets offer many different plant sources of protein to replace animal products.
Very low carb diets, like the keto diet, have also shown benefits for blood sugar. However, many find the lack of flexibility difficult to stick with, leading to frustration and yo-yo dieting, which can be harmful to health in the long run, Patterson says.
Benefits Of Following A Low
One of the main benefits of following a low-carb diet is weight loss. For people with type 2 diabetes, this helps to reduce HbA1c and blood fats such as triglycerides and cholesterol. For people who dont have diabetes, losing weight can reduce your risk of developing type 2 diabetes, and a low-carb diet is one option to help you do this.
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The Role Of Low Carbohydrate Diets In Treating Type 2 Diabetes
Treating type 2 diabetes is challenging, encompassing as it does management of glycemia, cardiovascular disease risk factors, obesity, and other co-morbidities by a combination of lifestyle strategies , behavioral and psychological interventions, pharmaceutical treatment, and bariatric surgery. Medical management of type 2 diabetes has led to cynicism about the efficacy of lifestyle management, particularly dietary strategies, and at present the components of the most effective diet remain unknown. A recent systematic review and meta-analysis suggested that low carbohydrate, low glycemic index , Mediterranean, and high protein diets all showed greater improvements in glycemic control than control diets . Despite criticism of the statistical analysis due to heterogeneity of the studies included , this review supports the premise that improvements in glycemic control, CVD risk, and weight loss are achievable with different diets with varying amounts of carbohydrate, and that low carbohydrate diets are not necessarily superior in effect.
Low Carbohydrate Diets And Diabetes
BSc, MNutrDiet, PhD, Grad Cert Diab Edn & Mgt
Advanced Accredited Practising Dietitian & Credentialled Diabetes Educator
Northside Nutrition & Dietetics
Kate is a CDE and Advanced APD and is the current editor of the Australian Diabetes Educator and Chair of the Editorial Advisory Group . She is a Fellow of the ADEA and the Australasian Society of Lifestyle Medicine .
Kate currently divides her time between clinical practice and health and medical writing, and has a private practice in Sydney where she works mostly with individuals with diabetes and women with PCOS .
Kate has been a member of the EAG since 2005 and chair since 2015. She is also a long-time editorial board member for Diabetes Management Journal and a board member of ASLM. Kate writes regularly for Diabetic Living magazine and the limbic Diabetes Educator/Endocrinology. She also works as a freelance writer for Diabetes Australia.
Kate has published articles in a number of other consumer publications and medical journals, written four consumer books and has contributed the dietary chapters to several textbooks on the topics of diabetes, vegetarian and plant-based diets, PCOS, insulin resistance, glycemic index and pregnancy. She also speaks regularly on these topics to both health professionals and consumers and is a guest lecturer on PCOS at The University of Sydney.
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A Word About Allergies
Check product for ingredients related to any food allergies that you may have to any of the ingredients, including nuts, seeds, wheat or eggs, among others.
Take home
We all know that breakfast as the first meal of the day is the most important meal. It gets our metabolism up and provides us with needed energy for the coming day.
We also know that with diabetes, we need to self-manage our condition. Keeping our blood sugars in a target range is important day in and day out. Its good to have some tools at your disposal that help you to keep things in line.
Thats why we developed this guide for you, so that you can choose the right way to start your day off when you have diabetes. If you start the entire day off on the right foot, the rest of your day will go smoothly.
Whisps Parmesan Cheese Crisps
These contain just 1 gram carbohydrate per serving, making them a great choice for those trying to manage their carb count, and also just one ingredientcheesefor those who like to keep it simple. “Whisps are also perfect for travel or keeping in your office desk drawer so that you guarantee you have a decent snack. I also like that they don’t come with additives or unnecessary flavors,” says Chris Mohr, PhD, RD, of MohrResults.com. Their crunchy nature might also make it so that you don’t need to pair your cheese with a cracker, which will save you some carbs.
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Plan Ahead For Healthy Meals
Planning healthier meals and snacks can go a long way to helping you reach your goals. Talk to your registered dietitian or health-care team about the amount of carbohydrates that are right for you and for help with meal planning. A weekly meal plan will help you shop for the right foods and encourage more cooking at home.
A Note On Insulin Changes
For comparison, I deliberately kept my basal insulin and food bolus settings consistent between the two phases. Educator Jen Block pointed out that my insulin settings might be optimized to cover the lower-carb meals I usually eat . Over a longer period of time, I could have changed my insulin settings to fine-tune them for the higher-carb diet. Its hard to know how much that would have improved the glucose results.
Theres also an experience component here the higher-carb diet added meals I have less experience taking insulin for. Even though I was counting the carbs accurately , there is no substitute for experience. Its possible that if I kept at the high carb diet for long enough, I would have improved.
On half the nights during the low-carb phase, I wore overnight closed-loop from midnight to 7am . There are four reasons why I dont think it had a major influence on the results: the real difference between high carb and low carb appeared during the day, where the two phases were directly comparable on basal insulin the closed-loop system used my pre-programmed basal rates as a guide, and those did not change between the two phases my average 7am blood sugar was nearly identical between low carb and high carb phases the range of blood sugars at 7am was very similar between low carb and high carb .
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