The “keto” (ketogenic) diet has been a “thing” for a while now, and its severe restriction to carbohydrates in the diet might suggest it’s a “thing” that could work for diabetes. See what Toby has to say about the “keto” diet.
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So, the Keto diet is the thing lately, and because it’s a low carb thing and followers tend to show improved glucose control it seems to be a natural fit for diabetes, right? And, you’ll see claims to that effect everywhere ….reverse diabetes!! So, let’s talk about the keto diet.
To understand this diet you have to start by accepting this biological fact…. Humans are built to get our “fuel” from the glucose we get by eating carbohydrate foods. That can be a frustrating idea for people with diabetes since we have issues keeping glucose in balance, but it is true….glucose from carbohydrates is our preferred and source of energy. Got that?
OK….a good thing is that we have emergency backup systems. When necessary we can use protein or fat to make fuel. This emergency plan is the anti-starvation plan – using stored fat and protein, even protein from muscle, to avoid starvation. When fat is the emergency fuel, our body produces substances called “ketones” to substitute for glucose, and when these ketones become our major source for energy we are in a state called “ketosis.” Of course, that’s where the word “Keto” comes from…..ketosis. The “keto” diet is forcing your body into the emergency plan that uses fat as the fuel source by strictly limiting carbohydrates and protein in the diet and eating lots of fat.
Emergency plans of any sort tend to have some issues. That’s why emergency plans are never actually the main plan, right? Ketosis, our emergency anti-starvation plan has some issues too. The most serious is a slight risk for ketoacidosis, where the blood becomes acidic enough to damage organs or even be deadly. Keto dieters also report “brain fog”, a lousy feeling they call “keto flu”, nausea, fatigue, diarrhea… and in ketosis your breath will smell like nail polish remover….the ketone acetone. Supposedly these symptoms pass, but only if you remain in ketosis….eat a little too much protein or too many carbohydrates and you can start all over.
The diet itself is extraordinarily restrictive, some plans suggesting only 5% of calories from carbohydrates and 80% of calories from fat. On a 2,000 calorie-per-day diet that’s 25 grams of carbohydrate….one banana. Most people find ultra- restrictive diets difficult to sustain over time. And many health professionals are concerned about the missed nutrients so plentiful in fruits, whole grains, beans and lentils and vegetables as well as long-term health effects. Some studies show that very low carbohydrate diets are associated with higher death risk from heart disease and cancer.
Bottom line for me…..limiting carbs to some extent and spreading them out over your meals and snacks may help you control blood glucose more effectively. In fact, individualizing the carbohydrate portion of a healthy diet is a legitimate medical “standard of care” for diabetes. But, deliberately putting yourself into ketosis…a state of metabolic emergency….with all of the other risks already associated with diabetes? Find another way. At some point you might even consider working with a professional registered dietitian nutritionist, but if it’s just the thrill and challenge of ultra-restrictive fad diets you enjoy, wait for the next one….it won’t be long.