Everyone’s still talking Keto right?

If you haven’t heard, the “Keto Lifestyle” is gaining popularity. “Keto” is short for Ketogenic, and is being touted as the best weight loss diet around. It is also being promoted on social media sites as a cure for diabetes, heart disease, and arthritis. It may be discussed using the hashtags, #keto, #HCLF, or #carnivore, even though these diets may not actually be ketogenic.

Since it’s National Diabetes Month, I thought it would be a good idea to talk about what the Ketogenic Diet is exactly, and whether or not it can be beneficial for treating or preventing diabetes.

The American Diabetes Association doesn’t endorse one particular diet plan for treatment. Diet does however, play a very important role in diabetes management.

History of the Ketogenic Diet

A ketogenic diet is a very high fat, very low carbohydrate diet. It was first discovered as an effective treatment for seizures in epilepsy, especially for children whom didn’t respond to medications.

Simply put, a ketogenic diet is a very high fat diet (70-80% of calories) with only 50 grams, or less, of carbohydrate permitted daily. With the focus on fat, it’s somewhat limited in protein (about 10-20% of calories). When you consume such a low carbohydrate, high fat intake, your body begins to burn stored fat for fuel. It also turns fat into ketones which results in the build up of ketones in the blood and urine.

There are side effects though. Many people experience headaches and fatigue, or muscle loss on a Keto diet. More and more research is placing concern on loss of lean body mass for people following a Keto diet for weight loss.

Similar Low Carb Diets

A ketogenic diet is much more strict than a typical “low carb” diet, such as the Atkins or Paleo Diets.  Clinicians will also sometimes prescribe a “modified Atkins” diet for seizures, but a ketogenic diet is even more strict than that.

The Paleolithic Diet (Paleo) recommends a reduction in specific carbohydrates (no wheat, dairy, legumes, corn, alcohol or sugars allowed). Protein, approved vegetables, nuts, seeds, and certain oils (corn, soybean and safflower oils are not permitted) are the focus of the Paleo diet. There’s limited research that people with diabetes can manage their blood sugar following this diet. But the downside is that the diet eliminates many nutrient-rich food options (like wheat and dairy), including some with fiber (legumes). Very specific foods, e.g. grass-fed beef, cage-free-organic eggs, only olive and coconut oils, limit your choices on the diet. These “rules” also exclude foods that are perfectly safe to eat (conventionally raised eggs and beef for instance), and also increases your food budget. When diets exclude whole food groups, or large groups of foods, the chances of long-term adherence aren’t great.

More Extreme: The “Carnivore Diet” is another high fat, low carb popular trend. It’s unclear who is responsible for inventing this diet plan, but a few doctors have adopted it, making it popular on social media. Followers claim it’s cured everything from arthritis to depression to diabetes. This diet excludes just about everything except meat, fish, eggs and some dairy (butter, heavy cream), and there’s not clinical evidence for it. Most followers focus on eating beef and eggs only.

Is the Ketogenic Diet for Everyone?

A very low carbohydrate diet will likely improve blood glucose control by lowering blood sugar and insulin levels. Anedotal evidence exists that some with type 2 diabetes were able to eliminate medications with a  ketogenic, or very low carb, high fat diet. But, is it right for everyone?

For people who are able to actually adhere to a ketogenic diet for diabetes, this may be a good short-term fit. If you choose to try a ketogenic diet plan, you should let your physician know so that he or she can monitor your bloodwork and other measurements.

On the other hand, many people with diabetes can manage their blood sugars, while including more carbohydrate in the diet. A “low carbohydrate diet” does not have to be as low as the ketogenic diet. The Dietary Guidelines for Americans recommend a carbohydrate intake of 45-55% of total calories, provided by foods that include grains, fruits and vegetables. Diet plans like DASH Diet or a Mediterranean style diet are reasonable diet plans for most people with diabetes. Spacing carbohydrates throughout the day, and limiting portions, is a mainstay of diabetes management. This doesn’t mean that you can’t include an occasional treat, or include a variety of healthy carbohydrate foods into meals. Sugary drinks should be eliminated (unless to treat hypoglycemia), and sugary foods should be limited.

One Size Does Not Fit All

As I always say, one size does not fit all when it comes to diet. Managing your diabetes does not require an extreme diet. It does require attention to your food intake, inclusion of regular activity, regular doctor visits, and blood glucose monitoring.

I am not a fan of extreme dietary measures unless absolutely necessary. Adopting a ketogenic diets for weight loss or diabetes has risks, and certainly may take away any enjoyment in eating. If you enjoy eating a mostly-meat diet, then the “carnivore lifestyle” may suit you,  but I feel that most people can achieve their health goals with less extreme dietary measures.

Don’t feel pressured into joining the latest fad diet cult, even if there are anecdotal stories of people having short term success with it. In other cases, there may be some science behind the diet therapy. But if you don’t enjoy eating that way, and the stress of maintaining it takes its own toll, then it’s not worth it.

Chew the Facts on Ketogenic Diets

  • A ketogenic diet can be prescribed as an effective treatment for some people with epilipsy.
  • A ketogenic diet requires extreme restriction of carbohydrate (less than 50 grams daily) in order to remain in ketosis.
  • Long-term ketosis can lead to kidney stones. Other side effects of adhering to a ketogenic diet include fatigue, nutrient deficiencies and increased risk of heart disease.
  • Ketones in the body also result in bad breath. You will exhale acetone, giving the breath a fruity, but weird, smell.
  • If you want to pursue a ketogenic diet for diabetes, do so only under your doctor’s supervision. It will require very close monitoring of blood sugar, and your insulin regime or oral medications will need to be adjusted.
  • These types of restrictive eating plans also lead to social isolation. Adhering to these diets prohibits you from participate in normal social gatherings such as office parties or special occasions. They may even lead to disordered eating.
  • Learn more about diabetes and meal planning by checking out these resources  and other books written by dietitians, including this book written by a registered dietitian and certified diabetes educator.