The conventional approach for Type 2 Diabetes is to manage the condition with medications and diet, based on the American Diabetes Association guidelines, which still includes a lots of high carb foods, along with a low-fat diet and processed vegetable oils. Unfortunately, both science and real-life results show that this protocol just simply does not work. At best, this approach may be better than a junk food diet (but not much better), and have a small shift in blood glucose and other diabetes blood markers if the person has really been abusing their body with junk foods. However, diabetes drugs can often have harmful side effects, and research tells us that the damage to the blood vessels can still occur, even with glucose-lowering diabetes drugs.
While most of general public still keep their bodies fueled on glucose in the form of processed grains, starches, and sugar, (Standard American Diet), others have begun to adopt reduced carb Paleo–and even ketogenic diets that actually reprogram their bodies to the fat burning/fat-fueled machines that our ancestors once had. These kinds of diets are very effective in lowering the amount of glucose circulating in the body, and bringing back insulin sensitivity once again.
What is the difference between a Paleo diet and a Keto diet?
The Paleo diet has been popular the last few years and it is generally a reduced carbohydrate diet compared to the standard Amercian Diet, however “paleo” is only a template for healthy eating, and doesn’t have a specific ratio of carbs like Keto does. However, paleo emphasizes eating foods that our primal ancestors ate: no grains, no dairy, no legumes, no processed foods, and no refined sugar. Paleo does however allow some carbs in the form of sweet potatoes, fruits, starchy vegetables, natural sweeteners like honey, maple syrup and dates. Paleo diets also include grass-fed pastured meats, poultry, eggs, wild caught fish, game and healthy saturated fats.
Is a Paleo diet effective for type 2 diabetes? It is a far cry from the ADA-recommended low-fat/high carb diet and far healthier with its emphasis on fresh veggies, naturally raised proteins, and unprocessed foods, but the Paleo diet can contain variable amounts of carbohydrates and natural sugars, depending on the types of paleo foods you choose to eat. Many versions of Paleo diets include sweet potatoes, or desserts sweetened with dates, honey, molasses, or maple syrup. So, yes, a Paleo diet is a much better choice over the SAD diet, or even the ADA recommended diet, but it’s not always the absolute best choice to lower blood sugar and insulin, depending on the quantity of carbs one chooses to eat on a paleo diet.
On the other hand, the ketogenic diet takes Paleo a step further by restricting carbohydrates to a much larger degree. A keto diet restricts most carbohydrates and all sugar, keeping the resulting glucose in the body consistently low, and forcing your body to burn fats for energy instead of carbs. Keto diets are even more restrictive than Paleo diets as far as carbs go, so in many ways, a keto diet is almost a perfect diet for a diabetic. A keto diet generally allows 20-50 grams of carbohydrates per day. While that is super low compared to the average diet, it can be done, and is easier than you may think.
How a ketogenic diet works for type 2 diabetic
Type 2 diabetes starts when a person is eating large amounts of sugar and carbohydrates. This in turn elevates the body’s serum glucose, creating an increased need for insulin. Over time, the body’s insulin cannot effectively lower the circulating glucose in the body, creating ever higher levels of glucose, insulin, increased body weight, and rising levels of triglycerides. Higher than normal levels of glucose damage blood vessels causing heart disease, kidney disease, blindness and other health issues.
How does a keto diet affect insulin and blood sugar?
When we look at one of the best ways to manage type 2 diabetes, the best and healthiest method is to lower blood sugar by restricting carbohydrates and sugars, in addition to increasing antioxidants and other nutrient-dense foods.
Since a keto diet is a very low carb, low sugar diet, blood sugar stays low, people generally lose weight and the body once again becomes more sensitive to insulin. A keto diet, in comparison to a Paleo diet, allows less carbohydrates and proteins, and adds in more high-quality fats. Because of this drastic dietary transformation, the body quits requiring glucose for energy and instead becomes more efficient in breaking down both dietary fats along with body fat to utilize for energy.
There are many variations on a Paleo diet, but in general a keto diet contains these components:
- 60-75% of calories from fat (or even more)
- 15-30% of calories from protein
- 5-10% of calories from carbohydrates.
The ketogenic diet is not a new dietary fad; it has existed since the 1950’s as a treatment for epilepsy and other health issues. It has recently gained popularity as a way to improve health, increase physical stamina, and lose body fat. A few scientific studies have been conducted on ketogenic diet and diabetes already. Let’s take a look, shall we?
The first study was performed by researchers at Duke University in 2005. Researchers recruited 28 participants with type 2 diabetes who were also overweight. The study lasted 16 weeks. The subjects consumed a low carbohydrate keto diet, aiming for less than 20 grams carbs per day. Diabetics also reduced their medications with medical supervision. There were twenty-one subjects who successfully completed the study. Here’s what they found after only 16 weeks:
- HbA1c 16% decrease
- Average 20 lb weight loss
- Triglyceride levels 42% decrease
- Ten patients reduced medications, seven stopped medication.
The conclusion of the study was that at keto diet is highly effective at lowering blood glucose, but there should be medical supervision to adjust medications accordingly.
A second study conducted by Stephen Phinney and Jeff Volek, who wrote The Art and Science of Low Carb, showed the positive effects of low carb diet as well. This particular trial shows convincing evidence that a low-carb diet improves blood sugar levels and helps speed weight loss in adults with type 2 diabetes. In almost 60% of participants, diabetes medication was decreased or stopped altogether.
The study, conducted at Indiana University, and published in Journal of Medical Internet Publications, looked at 262 people with type 2 diabetes who were overweight. Participants cut carb intake to 30g a day, while increasing their fats and protein. Patients were also provided nutritional and behavioral counseling, along with digital coaching and medical supervision for medications. Findings after only 10 weeks:
- HbA1c had a 6.5% decrease
- BMI decreased by 7%
- 112 reduced diabetes medications, 21 totally eliminated diabetes medications
Another study of 84 people, looked at the effectiveness of a low-glycemic diet compared to a ketogenic diet, and after 24 weeks looked at key diabetes markers of fasting blood glucose, body mass index (BMI), weight, and Hb A1C. While a low carb, low-glycemic diet is good for controlling diabetes, obviously a keto diet is better.
- Fasting glucose down 16%
- BMI decreased by 3, average 15lb weight loss
- .5 reduction in HbA1c
- Fasting glucose down 20%
- BMI decreased by 4, average 24.5lb weight loss
- 5 reduction in HbA1c
And this study of 363 overweight or obese participants in the United Arab Emirates looked at the effects of a ketogenic diet on weight loss and diabetes symptoms. 102 of the subjects had type 2 diabetes. One group consumed a low-calorie diet and the other consumed a keto diet. Both groups had nutritional trainer and exercise.
Study subjects were measured on:
- Body weight
- Waist circumference
- Blood glucose
- Cholesterol, LDL, HDL, triglycerides
- Uric acid, urea, creatinine
After 24 weeks, both groups had improved in all metrics but the keto group had far more significant results. Diabetic medications were decreased to half and some were discontinued for those on the ketogenic diet.
It is important to note for those beginning a ketogenic diet, the drop in glucose can be quick, so it is very important to monitor blood glucose frequently and to have a physician monitor the diabetes medications.
Ketogenic diets are higher in saturated fats, something the American Diabetes Association actually warns diabetics to avoid. Research, however, shows favorable lipid results on a high fat diet.
In another study, researchers looked at 83 subjects who were divided into three groups of equal calories. One group followed a very low-fat diet, one group followed a diet high in unsaturated fats, and the third group ate a very low carb and high saturated fat diet.
At the end of the 12-week study, all three groups had lost similar amounts of body fat and weight. However, the Low Carb Ketogenic diet group also had the lowest triglyceride levels, higher HDL, and lower glucose and insulin levels.
Very Low-Fat Group:
- Triglycerides decreased by 4%
- Insulin levels decreased by 15.1%
High Unsaturated Fat Group:
- Triglycerides down by 9.6%
- Insulin levels decreased by 18.7%
Ketogenic Diet Group:
- Triglycerides decreased by 40%
- Insulin levels decreased by 33.6%
Key results indicate that ketogenic diets do not increase the risk of heart disease or high cholesterol. Keto diets have shown to significantly decrease harmful lipids including triglycerides and LDL cholesterol, compared to other equal calorie/low fat diets.
Conventional Diabetic Diets vs. Ketogenic Diets
In spite of all the positive research on ketogenic diets for diabetes, most doctors and dietitians still recommend high carb diets to manage diabetes. A typical medically supervised diet recommended for a type 2 diabetic would include 45-60g carbohydrates at every meal, plus 15-30g of carbs for snacks. Seriously??
Most dietitians and doctors feel that even though the ketogenic diet is effective, most people will not be able to stick to it. And yes, this is somewhat true, although with the emerging popularity of the ketogenic diet, more and more options are available, including recipes, books, blogs, cooking classes, etc. that feature delicious keto meals and snacks. The nature of a keto diet is to keep blood sugar in a low and stable range, and because of this, it is much easier to control appetite and the “munchies”.
Ketogenic diets can be crucial to the successful healthy management of type 2 diabetes. In a recent critical evaluation of literature on carbohydrate restriction and diabetes, a group of 26 leading researchers compiled 12 points of evidence published in the January 2017 Journal of Nutrition, pointing to the use of low carbohydrate diets as the primary dietary treatment of type 2 diabetes. Key points include:
- Dietary carbohydrate restriction has the greatest effect on decreasing glucose levels.
- The current epidemic of obesity and diabetes has been caused almost entirely by an increase in carbohydrates.
- Type 2 diabetics can adhere to a ketogenic diet at least as easily as they can most other diets, and often better.
- Measured saturated fats in the blood are affected more by dietary carbohydrate intake, than dietary lipid intake.
- Dietary carbohydrate restriction is the most effective way to reduce serum triglycerides, LDL cholesterol and increasing HDL cholesterol.
Bottom line is that lowering glucose by strictly reducing carbohydrate intake in a ketogenic diet has the most positive effects on diabetes markers, without any of the negative side effects of pharmacological treatments.
All of the available evidence thus far suggests that a keto diet is one of the safest and most effective ways to control or reverse type 2 diabetes. Diabetes patients should always notify their physicians of dietary changes and have medications and blood sugar monitored closely.
Following a strict carbohydrate-restricted, ketogenic diet is key initially, but once your body is adept at fat burning, you may be able to ease up slightly on the daily carbohydrate count. Generally, following a strict keto diet for about 2 months will help your body adapt to burning fat. Rather than stressing out about keeping carbs consistently below 20-30g, it may be easier to give yourself a safe zone to follow. Perhaps one day you eat less, another day you eat more. As long as you generally stick to low carbohydrates, (below 50-60g per day) your body will continue to be fairly efficient in burning fat for energy and keep blood glucose low.
The end result is a healthier body, weight loss and a clear head. Note that while transitioning to a higher fat ketogenic diet for a type 2 diabetic, you must work closely with your physician to monitor and consistently lower your insulin needs. With less carbs, you’ll need less insulin. If you follow keto closely and keep limiting carbs, most Diabetics can get off all medications at some point in time, but it needs to be carefully monitored.
Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014.
American Diabetes Association. “Nutrition Recommendations and Interventions for Diabetes–2006 A position statement of the American Diabetes Association.”Diabetes care 29.9 (2006): 2140-2157.
Emerging Risk Factors Collaboration. “Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies.” The Lancet 375.9733 (2010): 2215-2222.
O’Gara, Patrick T., et al. “2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.” Journal of the American College of Cardiology 61.4 (2013): e78-e140.
Aguiree, Florencia, et al. “IDF diabetes atlas.” (2013)
“Update 2014”. IDF. International Diabetes Federation. Retrieved 29 November 2014.
Geiss LS, Wang J, Cheng YJ. Thompson TJ, Barker L; Li Y, Albright AL, Gregg EW. Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012. JAMA 2014; 312:1218-1226.
Yancy Jr, William S., et al. “A low-carbohydrate, ketogenic diet to treat type 2 diabetes.” Nutr Metab (Lond) 2 (2005): 34.
Westman, Eric C., et al. “The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus.” Nutr Metab (Lond) 5 (2008): 36.
Hussain, Talib A., et al. “Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes.” Nutrition 28.10 (2012): 1016-1021.
Noakes, Manny, et al. “Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low ‘saturated fat diets on body composition and cardiovascular risk.” Nutrition & metabolism 3.1 (2006): 7