How the Ketogenic Diet Affects Type-2 Diabetes – A Comprehensive Review

It seems as though there are a ton of dietary plans available in this day and age that are ultimately nothing more than temporary fixes or popular fads, but the ketogenic diet, a diet that stands above the rest and delivers safe, reliable health benefits, is certainly not one of them. For people who currently have or who are currently at risk for Type-2 Diabetes, the ketogenic diet can help the body shed weight and regulate the internal production of insulin, glucose, and fatty acids more closely.

Not only can the low-carb diet help in weight loss, but it can also help create an internal balance for individuals with type-2 diabetes, and ensure that people at risk for the disease will be significantly less likely to suffer from diabetes in the long run.

The diet can also help sharpen mental faculties and keep individuals focused and ready to go at all hours of the day, without any of the lethargy or fatigue that is usually so familiar to those that suffer from type-2 diabetes.

While it was originally created in the early 1920’s to help patients who suffered from epilepsy or other neurological disorders, the ketogenic diet has a multitude of health benefits and applications for modern life that make it the perfect solution for anyone who’s tired of letting their weight or their physical health hold them back—those who currently suffer from diabetes, those who are worried about their risk of developing diabetes, or even just for individuals who are looking to lose a few pounds and stay as trim and as fit as possible!

Type-2 Diabetes Facts

Type-2 Diabetes is a metabolic disorder that affects over eight percent of adults worldwide, and is usually characterized by a lack of insulin, high blood sugar, and a resistance of the body to respond to the insulin that is produced. Usually occurring as a result of improper diet or exercise, or as the result of a genetic predisposition towards the disorder, type-2 diabetes can affect any adult, regardless of gender or of ethnic background (although women are statistically more likely to be at risk), and is starting to be diagnosed in children as well as in adults.

Symptoms of Type-2 Diabetes

Some common symptoms of this disorder include a feeling of fatigue or tiredness, unexplained weight loss or weight gain, increased hunger, frequent urination, and sores that refuse to heal in a normal time span. Because several of these symptoms may come on slowly, or can be explained away by a variety of different factors, the early stages of type-2 diabetes can be difficult to notice, and often go undiagnosed until the disorder is fully developed.

Causes of Type-2 Diabetes

While a genetic predisposition towards type-2 diabetes can play a key role in the development of the disorder—as can several medical conditions that can contribute to development—it usually develops as a result of an unhealthy or sedentary lifestyle.

Individuals with a body mass index greater than 25, individuals who do not exercise on a regular basis, individuals who eat an unhealthy diet, as well as individuals who live in a high stress, typically urban environment, are at an increased risk of developing type-2 diabetes.

To be even more specific, individuals who drink an above-average amount of sugary beverages, or eat an above-average amount of white rice, are especially at risk—but ultimately, individuals who live an inactive lifestyle are at the greatest level of risk, as a lack of exercise is estimated to play a major role in at least seven percent of reported occurrences of diabetes.

Treatment of Type 2 Diabetes

Contrary to what would be expected, the prescribed method of treating type-2 diabetes prior to medication was actually to increase the amount of fatty foods consumed, with the average prescribed diet in 1923 mostly consisting of eggs, butter, olive oil, and various high-fat meats.  However, once insulin because available as medication, the diet changed to one of low-fat, high carbohydrate, and it remains as the popular dietary treatment today.

With that being said, some in the medical community are finding the old way may have been correct.  A new emphasis on a low-carbohydrate, high-fat diet has been recommended by at least four clinical studies.[i] In these studies, it has been shown to greatly improve the outlook of patients with diabetes, as well as to help suppress or tone down some of the more life-impacting symptoms and side effects of individuals who suffer from type-2 diabetes.

Both men and women, with participants from multiple geographic locations, showed a marked improvement under a diet that emphasized low carbs, only an average amount of proteins, and a low-fat diet. It is this lifestyle that the ketogenic diet helps promote, and the impact the keto diet can have on diabetes patients is truly life-changing.

How The Ketogenic Diet Helps Treat Type-2 Diabetes

Mechanisms of the Ketogenic Diet

The ketogenic diet is high fat, low carb and only adequate protein.  There are several mechanisms in the body that allow the ketogenic diet to benefit those with type-2 diabetes.  If you want to get to the root of the problem, instead of simply using medication to help it, but never solve it, then read on about what the keto diet does in the body.

Lower Glucose, More Stable Blood Sugar

Stabilizing the amount of glucose in the blood is crucial for those who suffer from type-2 diabetes, and the keto diet can help stabilization in a major way. The keto diet drastically reduces the amount of glucose that those on the diet consume, which obviously decreases the amount of glucose that is consumed by the body and is therefore in circulation in the blood.[ii]

A study conducted on the effects of the keto diet in 2009 showed that a low-carbohydrate ketogenic diet goes a long way towards stabilizing hyperglycemia, or an overabundance of glucose in the blood, and so is a promising treatment for those who struggle with diabetes.[iii] In the study, the keto diet was shown to significantly reduce the amount of sugar in the blood, bringing it closer to normal parameters, and also to greatly increase the amount of weight lost by the study participants.

Hyperglycemia causes an increase in thirst as well as in urination as the body tries desperately to dilute or regulate the amount of glucose in the blood, as well as even more dangerous symptoms like blurry vision, nausea, and dizziness, and even faintness. The keto diet used in the study showed a decrease in food and water consumed by study participants, as well as a decrease in fluids lost throughout the course of the study, which gave the researchers cause to believe that it had an overwhelmingly positive effect on the study participants.

Because hyperglycemia is the root cause of so many of the more dangerous symptoms of type-2 diabetes, any diet that does as much to combat hyperglycemia as the keto diet does is one that is certainly an attractive option for those who are looking for healthy, safe, and natural ways to combat their diabetes.

Increased Insulin Sensitivity

Insulin is an activator that helps the body store and release energy, and also helps stop the retention of fat tissue throughout the body. Individuals who suffer from diabetes in any form have a resistance to insulin that stops the biological pathways from being activated, and prevents the body from using its energy in an efficient and controlled way.

The keto diet helps target insulin sensitivity, with a study conducted in 2013 finding that the keto diet resulted in a dramatic improvement in the insulin sensitivity of those who participated in the study.[iv] A reduction in carbohydrates, as proposed by the ketogenic diet, leads to a decrease of glucose, which, in turn, leads to a decrease in blood sugar levels, which allows the body to return to a usual metabolic level.

Because this insulin resistance is the result of a tolerance that the body builds up against the too-high sugar levels in the blood, the decrease in blood sugar that the keto diet helps prompt leads to a dramatic improvement in insulin sensitivity, as the body is able to re-learn how to regulate the amount of insulin and glucose that it is supposed to be creating and consuming.

While insulin resistance doesn’t necessarily have any noticeable symptoms, it plays a major role in the prevalence of other diabetic symptoms, including inexplicable weight loss or gain, fatigue, and dizziness, and is usually considered the underlying cause of both types of diabetes. The ketogenic diet, then, is able to cut off diabetes symptoms at their root, which can greatly increase the quality of life for diabetics, and is both an effective and an entirely natural treatment for those who suffer from type-2 diabetes, or for those who are worried about their risk of developing diabetic symptoms.

Weight Loss

As mentioned earlier, type-2 diabetes is typically associated with an increase of fat tissue in the midsection or just across the board, anywhere on the body.[v] The keto diet, like many diets available today, can help with weight loss—but unlike all of the fad diets that are out in the market, the keto diet can help with weight loss while specifically targeting the symptoms of diabetes in the ways described above.


Obesity, usually defined by the National Institutes of Health as a Body Mass Index of 30 or above, or any marked weight gain, can lead to the formation and development of type-2 diabetes. An increase in the amount of adipose (fat) tissue present in the body can impair the parts of the cell that work with insulin, which leads to an increased resistance to insulin in the body and an inability to regulate the body’s blood sugar levels in the same way that a normal, healthy body can do.

Because the keto diet is so low in carbs but still allows for consumption of proteins and healthy fats, the body can work to shed unwanted weight while simultaneously fighting off all of the negative effects that diabetes can have, all while still consuming the amount of caloric intake that the body needs to stay in top shape.

Weight loss can certainly help in diabetes prevention, for those who are worried about the risk of developing type-2 diabetes.  But even for those who already have been diagnosed with the disorder, a diet like the keto diet can go a long way in trimming off unwanted pounds, particularly around the midsection and internal organs.

The keto diet helps in many ways in treating the effects of type-2 diabetes that make the disorder such a massive inconvenience for the patient.


How a Ketogenic Diet Should Be Used for Type-2 Diabetes Treatment

Following the diet as it’s been described for nearly a hundred years will certainly be effective, but the keto diet can be modified specifically to suit the needs of those who suffer from type-2 diabetes.  In addition, a person just starting out on the keto diet should calculate their macros before beginning.

Healthy Fats

Those who suffer from diabetes and are determined to stick to this diet should be certain to avoid trans fats, and stick to healthy fats instead—foods like avocados, peanuts, coconut oil, and most other nuts are recommended on the diet; while doughnuts, cookies, crackers, or most fried foods in general are out. In addition, soybean oil has a rich abundance of linoleic acid.  Linoleic acid can actually induce greater insulin resistance, and so should absolutely be avoided at all costs.[vi]

Most hydrogenated oils—margarine, vegetable shortening, and the majority of premade baked goods or ready-to-use-dough—should also be strictly avoided.  Hydrogenated oils are very high in saturated fats and can have grave health implications.

Not all fats are bad, however, and the foods mentioned above, in addition to olives, olive oil, nuts, salmon, and other fatty fishes, are an excellent addition to the keto diet that work perfectly with the high-fat, low-carb mentality that the diet promotes.

Supplementation on Keto

While the keto diet will still supply the dieter with most of the foods needed to keep them going throughout the day, there are some areas that may require extra supplementation, and the most prominent addition to the diet is magnesium.

Magnesium - Eating according to the ketogenic diet may require additional magnesium, since magnesium is not naturally found in many foods, and the diet restricts that small amount even further. Magnesium supplements can provide extra energy, decreases the oxygen requirements of cells during exercise, reduces anxiety, helps with digestion, and helps the body achieve a healthy metabolism.

Some foods that are especially rich in magnesium include almonds, spinach, Swiss chard, tuna, almond milk, and, of course, the ever-present avocado!

High Fiber Foods - In addition to an increase in magnesium, the conscientious dieter may want to look into adding more fiber to their daily meals as well. Foods that are ultra-high in fiber, but still low in carbs include:

  • bok choy
  • asparagus
  • zucchini
  • radishes
  • in addition to the spinach and Swiss chard mentioned above—in general, dark green, leafy vegetables

On the other hand, psyllium husk fiber is a viable dietary supplement that can be mixed into a glass of almond milk, juice, or water, for a more immediate dosage of daily fiber!

ACV - Another liquid that makes a vital addition to the ketogenic diet—albeit a less common one than water—is apple cider vinegar. With a vast array of health benefits ranging from skin care to reduced heartburn, apple cider vinegar, more importantly for those on this diet, can help with weight loss and has been clinically shown to reduce blood glucose and insulin spikes. Apple cider vinegar can also reduce the risk of cardiovascular disease, and can help to neutralize what would otherwise be a relatively acidic diet.

Even though apple cider vinegar is primarily made up of acetic acid, acetic acid is metabolized as an alkaline, which helps neutralize the acidity found in a lot of cheese and red meats, which the keto diet encourages. While it may not be nearly as palatable as a glass of bubbly water, apple cider vinegar can be mixed into a cup of tea or water, or added into a favorite sauce or salad!

Liquids/Hydration

Water is a fairly simple thing, but it often gets overlooked when it comes to starting a new diet. It’s important to stay hydrated while the body readjusts to the new foods and vitamins that it’s receiving, and drinking the regularly prescribed 8-10 glasses of water per day can give the body the extra support that it needs during the transitional stage.

In place of sugary drinks like soda, carbonated water or flavored waters like La Croix or other substitutes can provide a fun burst of flavor and just enough bubbles to make up for the lack of acids and unhealthy sugars.


Going Beyond the Ketogenic Diet

The ketogenic diet is naturally suited to help diabetic individuals and can go a long way into treating any symptoms of the metabolic disorder.  But there are also some modifications to an individual’s lifestyle that will help combat the effects of diabetes.

Weight Loss

Weight loss is a key part of any diet, and the keto diet can help through careful regulation of food intake, but any diet is only as good as the exercise that the dieter puts in.

Exercise

The Department of Health and Human Services recommends at least 75 minutes of high-aerobic exercise—or 150 minutes of moderate activity, or some combination of the two—per week in order to maintain current weight. More than the prescribed 75 minutes is usually recommended for weight loss, and so, while the ketogenic diet can help with weight loss, diabetic dieters are also strongly encouraged to get out and get moving.

Reduce Alcohol and Smoking

While the ketogenic diet doesn’t specifically address alcohol or nicotine use, it is a documented fact that consumption of either substance can stall an individual’s ability to effectively lose weight—especially if that individual is diabetic.[vii],[viii]

For this reason, it is strongly recommended that those who are about to start using a ketogenic diet abstain from or at least reduce their use of alcohol, and that they stop smoking altogether.

Herbs

Another method of lowering blood sugar that isn’t specifically addressed in the ketogenic diet, but that functions in a supplementary category, is the use of cinnamon and other herbs that are known to have an effect on blood sugar. Cloves are another super-herb that have a whole host of other healthy side effects, including anti-inflammatory properties, digestive aid, and antiseptic and germicidal properties. Some other herbs or spices that can help lower blood sugar levels include:

  • rosemary
  • oregano
  • curry leaves
  • garlic
  • ginger
  • turmeric
  • cayenne

Diabetic dieters that may be worried about having to sacrifice flavor for health shouldn’t be concerned, as a number of super-savory herbs and spices that crop up in nearly every recipe can be a great way of lowering blood sugar!

Sleep

There are a variety of other lifestyle changes that aren’t necessarily covered by the diet plan, but that can still have an enormous positive impact of the life of those who follow the ketogenic diet, diabetic or otherwise. An increase of sleep can make sure that the body is ready to face the day, and has had adequate time to adjust to all the stresses or pressures of the day before—people who get the full seven to eight hours of recommended sleep are shown to have a much higher level of mental acuity, as well as a lower blood sugar level, than those who don’t.[ix],[x]

Hydration

Finally, drinking at least 500 mL of water per meal has been shown to help with weight loss, which in turn can go a long way towards fighting the symptoms of diabetes and improving the life of diabetic individuals beyond the simple diet.


Common Myths and Misconceptions about Keto and Diabetes

Ketoacidosis ≠ Ketosis

Ketoacidosis is a dangerous condition for diabetics (usually type-1 diabetics) where the ketones in the blood are at extremely high levels which can be toxic.  It is caused when your body cannot produce enough insulin, which causes the body to create too many ketones as a replacement for the glucose it can't use.

In comparison, nutritional ketosis, the metabolic condition purposefully brought on by a ketogenic diet, has low to moderate levels of ketones in the blood.  These levels of ketones are not toxic.

These are two very different terms that the medical community has gotten confused, and therefore given the ketogenic diet a bad rap for diabetics.

 
Ketone Levels in Blood
Conditions
Timing
Ketoacidosis
>1.5 mmol/L Corresponding with high blood sugarCan occur within 24 hours
Nutritional Ketosis
0.1-5.0 mmol/LCorresponding with low carb dietTakes a few days on a low carb diet

Eating More Fat Is Bad for Diabetics

A high-fat diet may seem strange for someone struggling with an illness that's usually linked to obesity, but, because this diet forces the body to use fat for energy, instead of carbs or glucose, it can actually help diabetic dieters lose weight in a way that is safe, healthy, and controlled!

It’s Just Like the Atkins Diet!

While the Atkins Diet is another weight loss regimen that is currently a subject of renewed interest and can help with weight loss, the two diets are far from equal. The low-carb, high-fat diet is one that was explicitly designed to help individuals with diabetes control their symptoms and alleviate some of the stronger effects of the disorder, and so is the safest option for diabetic individuals who are looking for a way to treat their condition.

The Atkins Diet also promotes eating an increased level of protein, which, according to some studies[xi], can actually increase insulin resistance, and is bad news for anyone looking to control their diabetic symptoms.

It’s the Same for Everyone

While the low-carb diet can be a miracle worker for those who suffer from type-2 diabetes, it is not intended for those with type-1 diabetes. While some positive results[xii] have been seen from type-1 patients, the dietary needs of the two types are drastically different, and a personal physician must be consulted before attempting to use the diet as a treatment for type-1 diabetes.

It’s a Replacement for Medication

Again, while this diet has had lots of positive results for people struggling with diabetes, it is not intended as a replacement for serious diabetes medication. The diet should be used simultaneously with diabetes medication, not in place of it.


A Very Good Place to Start

Measuring Blood Glucose/Ketone Levels

As with any diet, it’s important to continue to monitor any changes in blood sugar levels or ketones. Daily measurements should always be taken with a blood glucose/ketone meter, easily found available for purchase online, in order to determine the next step of the diet or whether a personal care physician should be consulted.

Two popular ways to measure both your blood glucose and ketone levels are the Precision Xtra or Novamax Plus blood meters.

Wean Off Sugary Foods

For the diabetic dieter who’s looking for a good place to start, it may be difficult to wean off of sugary foods and a high sugar diet—so the start of any diet is as good a place as any to get creative! Some may be able to quit cold turkey, but for those who can’t, the fruits with the lowest amount of carbs and the highest amount of natural sugars include pears, watermelon, pomegranates, and the old standby, the apple.


Soda, as mentioned above, can be swapped out for fizzy or bubbly fruit flavored water, and there are a variety of natural sweeteners, most of which are significantly sweeter than regular sugar, which can safely be used in the diabetic diet. Dark chocolate can be a great addition to the diet (try our keto chocolate recipe), or even low-carb ice cream. For a salty snack, try dry-roasted almonds or there are tons of flavored almond recipes!

Keto Meal Plan

If you're still confused about this diet, don't be.  You can literally purchase a meal plan that will walk you through every meal and every macro.  Check out our monthly meal plans here.  

Conclusion

The idea of using a low-carb, high-fat diet isn’t exactly a new one—it’s been around since at least the 1920’s, with the development of the ketogenic diet as a potential cure for epilepsy and diabetes, and some of the health tips offered in this article can be found as far back as ancient Roman times! However, as the prevalence of type-2 diabetes continues to rise in the increasingly pressurized and urbanized modern world, more and more people are starting to look for a healthy, natural way of combating the disorder that doesn’t rely solely on pharmaceutical supplements—a way of treating an illness that’s simple, reliable, and easy to adhere to, even in these busy times.

This diet is a fresh, fun, and all-natural way to help keep the symptoms of diabetes under control, or even to prevent the development of late-onset diabetes altogether. Some things stand the test of time, and this diet works just as well today as it did one hundred or even one thousand years ago!


[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/
[ii] https://ac.els-cdn.com/S0899900709001774/1-s2.0-S0899900709001774-main.pdf?_tid=7ee60059-d773-4d64-b5d8-cb3c18f11689&acdnat=1524604289_d6ed60a77ac8d03bdfab6b2f88c7d0a4
[iii] https://www.ncbi.nlm.nih.gov/pubmed/19818281
[iv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826507/
[v] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259868/
[vi] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511588/
[vii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338356
[viii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401671
[ix] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656292/
[x] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084401
[xi] https://www.ncbi.nlm.nih.gov/pubmed/27732859
[xii] https://www.ncbi.nlm.nih.gov/pubmed/22250030

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