Type 2 Diabetes and the ketogenic diet


Scope of problem:

The rate of diabetes has been increasing at an alarming rate. In the United States it is estimated that 29.1 million people currently have diabetes. World wide this number is approximately 170 million people, which is expected to reach 366 million by the year 2030. Diabetes is a serious chronic health problem. Having diabetes increases your risk for multiple other medical conditions such as peripheral neuropathy, visual loss, kidney damage, limb amputation, high blood pressure, heart disease, strokes and even Alzheimer’s dementia. People who have diabetes can also have up to 10 years shorter life span than individuals without diabetes. (Westman E. , 2016)

Diabetes 101:

There are two types of diabetes.

  1. Type 1 diabetes, which is also called: insulin dependent or juvenile diabetes. The onset is typically seen in kids. In type 1 diabetes, the body is not able to produce enough insulin.
  2. Type 2 diabetes, which is also called: adult onset or insulin resistant diabetes. Type 2 diabetes is more common, accounting for approximately 90-95% of all cases of diabetes. In type 2 diabetes, the insulin that is present does not function as well. (Al-Khalifa, 2009)

The carbohydrates and sugars that we eat are broken down into glucose causing a raise in blood glucose. When blood glucose increases it causes insulin to be released. Insulin is needed to transport the glucose into the cells so that it can be used. If there is not enough insulin around, or if it does works properly, the body is unable to utilize the glucose as fuel. If the cells are unable to take in the glucose, glucose will build up in the blood or stored as fat. Having high levels of glucose in the blood then can cause damage to the tiny blood vessels in your eyes, kidneys, and nerves.

believe that this rise in obesity and thus diabetes is the direct result of the change in the dietary guidelines that came out in 1977. (DiNicolantonio, 2014) These dietary recommendations, which are still in place today, recommend the Americans should eat less saturated fat along increasing the amount of carbohydrates that we eat. When dietary fats are removed from foods, to improve taste, the fats are replaced with added sugars. Unfortunately this resulted in a huge increase in the amount of sugars that Americans were eating. Which then results in increase risk of obesity. Since obesity is the main risk factor for developing Type 2 Diabetes, the rates of diabetes has also increased. (Westman E. , 2016)

obesity graphDM rates CDC

Treatment of diabetes:

Managing carbohydrate/glucose levels and weight loss is the recommended treatment goal of diabetes. The debate, however, is which diet is the best to do that. A low fat/ low calorie diet is what is most often recommended for patients with diabetes. However, this diet has not been as successful as we would have hoped. Other dietary options include a low carbohydrate/high fat diet, which has been used since the early 1900’s for the treatment of diabetes. The low carbohydrate/high fat diet recently has become more popular since it often associated improved weight loss. (Feinman, 2015) Dating back as far as 1863, Dr. William Banting has been advocating a low carbohydrate/high fat diet has been used for weight loss. (Westman E. , 2016) More recently, studies comparing eating a low carbohydrate diet to low fat diet have shown greater improvements with the low carbohydrate diets on numerous endpoints including, weight loss, abdominal fat loss, glucose levels along insulin levels and insulin resistance. (Volek 2008)

Based on these and other studies showing benefit with a low carbohydrate/high fat diet, a study in 2012 came out comparing a low carbohydrate/high fat ketogenic diet (LCKD) to a low calorie diet in patients with type 2 diabetes. This study showed a beneficial effect of the LCKD over the conventional low calorie diet in patients with diabetes. Specifically they found that those on LCKD had significantly more weight loss and greater improvement in the blood glucose levels and HbA1c levels. The LCKD group also had improvements in the cardiovascular profiles of the cholesterol with significant decrease in triglycerides, total cholesterol and LDL levels whereas the HDL levels were increased. (Hussain, 2012)

Studies have also shown that those eating low carbohydrate ketogenic diet were able to decrease the doses of their anti-diabetic medications. Some were even able to taper off as much as 10 units of insulin per day in eight days, still with maintaining normalization of glucose levels. (Westman, 2008) In some individuals actually able to “reverse” their type 2 diabetes. (Westman E. , 2016)

Thus, as a summary, lifestyle modification that includes reducing carbohydrate intake such as by eating a low carbohydrate/ high fat, ketogenic diet is an effective treatment option in patients with diabetes with the added bonus of weight loss. These changes have also been associated with decreasing the amounts of anti-diabetic medication and insulin, and in some cases being able to get off and medications altogether.   If you have type 2 diabetes and are not currently happy with your control, the fact that you are always hungry and continue to gain weight despite eating a low calorie/high carbohydrate diet, then consider trying a low carbohydrate/high fat diet. What do you have to lose, except some extra weight and possible some medications?

For more information about a ketogenic diet, read my recent blog on ketogenic basics. If you are concerned about what eating ‘all those fats’ might do to your heart, check out my blog on whether a ketogenic diet is safe for your heart. Lastly if you would like some help with the ketogenic diet just fill out the below form and I will try to help.

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Al-Khalifa, A. (2009). Therapeutic role of low-carbohydrate ketogenic diet in diabetes. Nutrition, 25, 1177-1185.
DiNicolantonio, J. (2014). The cardiometabolic consequences of replacing saturated fats with carbohydrates or omega 6 polyunsaturated fats: Do the dietary guidelines have it wrong? Open Heart, 1-3.
Feinman, R. (2015). Dietary carbohydrate restriction as the first approach in diabetes managment: Critical review and evidence based. Nutrition, 31, 1-13.
Hussain, T. (2012). Effects of low-carie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition, 28, 1016-1021.
Volek, J. (2008). Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Progress in lipid research, 43, 307-318.
Westman, E. (2008). Has carbohydrate-restiction been forgotten as a treatment for diabetes mellitus? A perspective on the ACCORD study design. Nutritional Metabolism, 5, 10, 1-2.
Westman, E. (2016). Ketogenic diets as highly effective treatments for diabetes mellitus and obesity. In S. Masino (Ed.), Ketogenic diet and metabolic therapies (pp. 362-375).

The medical information on this site is provided as an information resource only. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.