Medically reviewed by Shahzadi Devje, Registered Dietitian (RD) & Certified Diabetes Educator (CDE)
You’ve probably heard of the ketogenic – or “keto” diet. It’s been rising in popularity as a means to lose weight and keep blood sugar levels in check.
Eating a healthy, balanced diet is one way to keep your blood sugar and insulin levels within a healthy range, especially for those with Type 2 Diabetes.
Most dietary guidelines recommend limiting sugary foods and reducing portion sizes of carbohydrate-rich food, like bread and pasta, which also increase your blood sugars.
If you have Type 2 Diabetes and are struggling to maintain normal blood sugars, you may find yourself wondering which foods are safe to eat and whether you’ll be able to ever eat sweets or carbohydrates again!
With so many seemingly compelling health claims in the media these days – you know the ones with testimonials to the tune of “I’ve lost 15 lbs in 2 weeks doing keto and my sugars are below 6 mmol/L”, naturally you may be tempted to try the keto diet for yourself.
Let me break it down for you and help guide you in making this impactful decision.
What is the Ketogenic Diet?
The ketogenic diet is a very low carbohydrate, high fat diet. You eat mostly fat (about 80% of total calories), some protein (about 15% of total calories), and very little carbohydrate (around 5%).
A keto diet includes plenty of meats, cheese, eggs, fish, nuts, seeds, oils, butter and non-starchy vegetables.
High-carb foods, like grains (bread, cereal, pasta, rice, oats, etc.), potatoes, beans, milk (dairy), sweets, and most fruits, are eliminated on a keto diet.
If this sounds restrictive, it’s because it is!
Although the ketogenic diet may seem trendy, it was originally created in the 1920’s to help manage seizures in patients with epilepsy.
KETOSIS: Here’s What Happens When You Eat Mostly Fat
In normal human metabolism, glucose from carbohydrate-containing foods, like grains, beans, potatoes, and fruit — is the main source of energy for your body. It’s also the preferred energy source for your brain.
When you eat lots of fat, with little to no carbohydrates, this prompts your body to switch to a type of metabolism called ‘ketosis’.
In ketosis, dietary fat and stored body fat are broken down and converted into ketones by the liver. Ketones are then used for energy instead of glucose.
Ketogenic Diet & Weight Loss
Since your fat stores are broken down in ketosis, those who follow a very low carbohydrate keto-type diet indeed experience rapid weight loss.
Several studies have found participants who follow a keto diet experience greater weight loss than those following low-fat diets.
In addition to weight loss, many studies have found following a keto diet also results in reductions in triglycerides and diastolic blood pressure, and increases in HDL cholesterol (that’s the good kind!).
Yes, these are all important factors in preventing heart disease, however, LDL cholesterol (that’s the bad kind!) also seems to increase on a keto diet.
Besides body fat stores breaking down, weight loss on a ketogenic diet occurs for a couple of different reasons:
- Participants in several research studies reported feeling less hungry and eating less food overall, likely because fat and protein fill you up more than carbohydrates do.
- High amounts of ketones in your body may also suppress the hormones responsible for controlling appetite.
While you might think this sounds rather appealing, Dr. David Katz, MD said this about what being in ketosis really means:
The historical case for ketogenesis – denying the body its customary fuel sources so that glucose is in short supply, and instead it metabolizes fat preferentially, and generates ketone bodies as fuel – resides in starvation.
Rather predictably, starvation has profound effects on all aspects of metabolism. The body effectively turns to auto-digestion to sustain itself during a protracted fast. Fat and protein stores in the body are converted to fuel, and metabolism then does run on ketone bodies.”
In case you didn’t catch that part about the body eating itself…that’s what actually happens! This is why the loss of body weight that you would initially experience when starting a keto diet is mostly water and muscle tissue.
What are the Long-term Effects of the Keto Diet?
Reduced-calorie, low-glycemic index, high-protein, or the Mediterranean Diet also results in weight loss, improved heart disease risk factors, and are effective at lowering blood sugars and reducing the need for diabetes medications.
However, several studies have found that a very low carbohydrate “keto-style” diet seems to promote a greater reduction in blood sugars (measured by HbA1C), and triglycerides and hence, more weight loss when compared to other diets.
Changes in blood sugar levels can occur quickly on a ketogenic diet. If you’re taking blood sugar-lowering medication, it’s important to work with a healthcare professional and Dietitian while on the diet to make sure your levels don’t drop too much – as this can be just as dangerous as being too high.
While quick weight loss and lowered blood sugar levels may sound very appealing to you, there are many concerns about the safety and sustainability of the keto diet.
Here are some of the most notable drawbacks of the ketogenic diet:
- Benefits May Be Temporary
Most of the studies on the ketogenic diet follow small groups of participants for a few weeks or months, meaning the long-term effects of eating a high fat, low carb diet are largely unknown. One study found weight loss from a ketogenic diet seemed to plateau after one year.
- Food Restriction
A ketogenic diet limits the types of foods you can eat, which might make it hard to stick to. Avoiding carbohydrate foods may leave you feeling like you’re missing out at meal times and create anxiety around eating. As you’ve likely experienced, this can be very emotionally draining.
- Keto Flu
Your body needs some time to adjust when switching from carbs to mostly fat. You might experience uncomfortable side effects, like fatigue, headaches, brain fog, and bad breath.
(Yep, it’s keto breath smell – think rotting apples, from acetone!)
- High Saturated and Trans Fat Intake
Since the focus in a ketogenic diet is on fat, your intake of saturated and trans fats may increase.
But, let me point out something that often gets overlooked: eating fried mozzarella sticks is far from a “good healthy fat” choice as compared to using a tablespoon of virgin olive oil to saute your veggies.
Try my deliciously easy Grilled Mixed Vegetables recipe – the perfect side dish for your fresh Spring meal!
Not all fats are created equal!
Eating too many of these types of fats promotes inflammation and increases the risk of heart disease – something people with Diabetes are already at an increased risk for.
Whether you decide to try the ketogenic diet or not, enjoying healthy, unsaturated fats from nuts, seeds, avocados, olive oil, and fish, is your best bet for a healthy heart.
DID YOU KNOW? That one of the primary causes of insulin resistance – the hallmark of Type 2 Diabetes, is ‘lipotoxicity’?
This metabolic syndrome is when there is an accumulation of excess fat in the tissues of the body where it shouldn’t be – like the liver, heart, pancreas, and muscles.
Lipotoxicity, in turn, is thought to be exacerbated by very high dietary intake of saturated and trans fatty acids — a concept that has been well-documented by Dr. Michael Greger, MD.
Therefore, a diet that reduces inflammation and cell damage is key to preventing toxic fat!
Which leads us to…
- Not Enough Nutrient-dense Foods
Avoiding fruit, some vegetables, and grains on a keto diet means you might be lacking fibre, some vitamins and minerals, and missing out on important inflammation-fighting antioxidants.
It’s been proven that you do not need to completely cut out carbs to effectively manage Diabetes!
Diets that include plenty of plant foods and whole, unprocessed grains, much like in the Mediterranean diet, have been well studied and are linked to increased lifespan and decreased rates of Diabetes, heart disease, and cancer.You do not need to completely cut out carbs to effectively manage #Diabetes! #Keto #Diet #LowCarb #HighFat Click To Tweet
Final Thoughts on the Keto Diet for Those With Type 2 Diabetes
If you know that you can eat all these wonderful things and still control your blood sugars, why the heck would you want to torture yourself with severe restriction?! Like I said, just a thought 😉
If you’re trying to keep your blood sugar levels in check, simply reducing the number of refined carbohydrates you eat can help immensely. By ‘refined’, I mean the processed and packaged varieties, like breakfast cereals, most crackers and pretty much any snack food!
Including plenty of nourishing, nutrient-dense foods, like fruits and vegetables, has many health benefits, including decreased inflammation, preventing constipation, and less risk of heart disease.
Although there seems to be a short-term advantage of the ketogenic diet for weight loss, the advantage seems to “shrink” at the one year mark. No significant difference in weight loss was observed at one year between a low carbohydrate diet and a conventionally “healthy, balanced” diet.
There’s also insufficient research to make firm conclusions about the long-term effects of the ketogenic diet on weight loss and other health parameters. The long-term safety is yet to be determined.
Let me be clear though – I don’t hate it! But, isn’t it interesting how the very foods that have shown time and time again to lead to less Diabetes, less heart disease, less cognitive decline, and less cancer are the ones being excluded in the keto diet?
The bigger question we should be asking is: does it confer an advantage over other dietary approaches – specifically aimed at weight loss while managing Diabetes?
In my opinion, and based on the current research, I don’t think so.
There are real people living healthy happy lives who are proof of this, and this to me, is beyond the research. It’s real life – those in the so-called “blue zones” eat unrefined whole grains, healthy fats, high-quality protein AND they live the longest in the world, not to mention, have the least disease.
There’s insufficient research to make firm conclusions about the long-term effects of the #ketogenic diet on #weightloss and other health parameters. The long-term safety is yet to be determined. #keto #lowcarb #diets Click To Tweet
Are you cutting carbs and feeling deprived and overwhelmed?
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Shahzadi is an award-winning registered dietitian (RD) regulated by the College of Dietitians of Ontario and certified diabetes educator (CDE), approved by the Canadian Diabetes Educator Certification Board. A YouTuber and notorious foodie, she’s dedicated to helping you end your cooking wars, transform your health, and be the best version of yourself! Shahzadi is an on-air nutrition expert for CTV Your Morning and a regular contributor for Global News and other national media outlets.