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Ketosis and Diabetes: What's Their Connection?

Published on: August 29, 2019

Ketosis and Diabetes: What's Their Connection?

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Each year, 1.5 million Americans are diagnosed with diabetes. Diabetes is also the 7th leading cause of death in the United States [1]. In our search for a proven intervention to manage diabetes, we often hear about nutritional ketosis. What is the connection between nutritional ketosis and diabetes? Can it reverse this metabolic disorder?

Let’s take a deeper dive into this topic in today’s article.


Is Ketosis Safe for People with Diabetes?

Before we answer this question, we need to have a brief recap about ketosis. Ketosis is a normal metabolic state or process where your body’s glucose supply gets depleted, and your body utilizes ketones for fuel instead. Ketones result from fat breakdown. These ketones fuel your heart, muscle tissues, kidneys, and brain [2].

So, as a natural phenomenon, nutritional ketosis is generally safe. But is it safe for people with diabetes? It depends on the type of diabetes, which we’ll dive into later.

If you use nutritional ketosis to manage diabetes, it’s essential to be medically supervised by a trained physician who can plan a well-formulated ketogenic diet for you and make adjustments to your medications [3, 4].

A well-formulated ketogenic diet has ten defining characteristics. These characteristics include dietary carbohydrate reduction based on individual carb tolerance,  consumption of mostly whole foods and adequate macronutrient intake to preserve lean body mass [4].


ketosis-can-reverse-type-2-diabetes

Can ketosis reverse diabetes?

The short answer is yes - and this applies only to Type 2 Diabetes. Ketosis can reverse Type 2 Diabetes. However, we need to make it clear that the word “reversal” does not imply “treatment” [5, 6].

Reversal refers to significant long-term improvement in your health.

This means that you no longer meet the diagnostic criteria for Type 2 Diabetes. Your blood glucose levels stay within the normal range without you needing to take diabetes-specific hypoglycemic medications (except for metformin) [6].

That said, diabetes will come back if you fail to adhere to the necessary lifestyle changes such as a well-formulated ketogenic diet plan.

Here’s a successful 2-year non-randomized clinical trial that demonstrates diabetes reversal:

In a 2-year trial, participants with Type 2 Diabetes who received continuous care intervention (CCI) which included nutritional ketosis showed improvement in their clinical markers. Reductions were observed with their fasting blood glucose, HbA1c, fasting insulin, and weight [7].

the-two-ypes-of-diabetes

Their continuous care intervention included telemedicine, health coaching, and nutritional ketosis using a personalized low-carbohydrate diet [7].

Another study revealed that an individualized program that incorporates nutritional ketosis effectively controls blood glucose levels and decreases medication use among adults with Type 2 Diabetes. Take note that these diabetic patients ate dietary fats to satiety, consumed non-starchy vegetables and drank adequate fluids and minerals [8].

At the start of the study, 89.3% of the participants were taking at least one prescribed medicine for their diabetes. At 10 weeks into the program, 56.8% of the participants were able to reduce or eliminate their medication [8].

In the next section, we’re going to show you how ketosis impacts Type 2 Diabetes, and whether it helps with Type 1 Diabetes and Gestational Diabetes.


ketosis-and-type-1-diabetes

Ketosis and Type 1 Diabetes (Insulin Dependent)

Type 1 Diabetes is one of the two main types of diabetes - Type 1 and Type 2. While individuals with Type 1 and Type 2 Diabetes have higher than normal blood glucose levels, those with Type 1 produce little to no insulin at all [9].

It’s an autoimmune disease, which means that the person’s immune system attacks its own cells that produce insulin. As a result, they need to take insulin injections regularly [9].

According to a 2018 study, low-carbohydrate diets benefit people with Type 1 Diabetes by providing glycemic control [10].

Results showed that true low carbohydrate diets (TLCD) comprising of at least 50 grams of carbs per day, and very low carbohydrate ketogenic diets (VLCKD) comprising of less than 50 grams of total carbs per day reduce HbA1c. Note that your HbA1c reading reflects your 3 month average blood sugar level [10].

However, the same study concluded that further research should be done to consider the consequences of interventions that lower HbA1c in people with Type 1 Diabetes. An intervention can only be considered effective if it helps lower HbA1c without putting a person at risk for severe hypoglycemia [10].

This is a huge concern when it comes to using nutritional ketosis to manage Type 1 Diabetes. Ketosis may not work in this case because it can make a person prone to diabetic ketoacidosis. If that person constantly misses his or her insulin dose or meals, blood sugar levels could get too high and lead to the build up of ketones[11].

If you decide to try nutritional ketosis, definitely speak with a physician first. You may be asked to follow a low-carbohydrate diet that will or will not result in ketosis.


ketosis-and-diabetes-type-2

Ketosis and Type 2 Diabetes (Non‑Insulin Dependent)

Type 2 Diabetes, also known as non-insulin-dependent diabetes, is characterized by insulin resistance. This means that the cells stop responding to insulin. Glucose cannot enter the cells properly and build up in the bloodstream [12].

It’s not an autoimmune disease. Risk factors that contribute to Type 2 Diabetes include obesity, a sedentary lifestyle, and a diet that is high in refined carbohydrates [13]. These are the same risk factors that can be eliminated by achieving nutritional ketosis [14].

Nutritional ketosis has more promising effects on Type 2 Diabetes, and this is where a well-formulated ketogenic diet comes into play. Type 2 Diabetes can also be reversed by nutritional ketosis as long as a person sustains nutritional ketosis over the long term [6].

The effects of ketosis on Type 2 Diabetes include improved insulin sensitivity, decreased HbA1c, reduced inflammation and lowered blood pressure [6, 15].

Since nutritional ketosis can significantly impact your blood glucose and blood pressure, you should still get medical supervision. This is especially true if you are taking diabetes medication. Your doctor may have to adjust your dosage while you are following a well-formulated ketosis plan [15].



Ketosis and Gestational Diabetes

Gestational diabetes is characterized by above-normal blood glucose levels during pregnancy. Blood glucose normalizes after a woman gives birth [16].

A woman can be at risk for gestational diabetes if she has a family history of diabetes, has an advanced age (35 years or older), is overweight, has abdominal obesity or polycystic ovary syndrome (PCOS) [16, 17].

Hormonal changes that happen in pregnancy increases insulin resistance, affecting the ability of glucose to enter the cells [18].

Now, we ask the question: Will ketosis help women with gestational diabetes? Like Type 1 Diabetes, Gestational Diabetes may not benefit from ketosis for the following reasons [19]:

  • Accelerated starvation occurs, especially during the second and third trimesters since the fetus needs more glucose to support its growth.
  • Vomiting and dehydration during pregnancy can lead to ketoacidosis.

While controlling the amount of carbohydrates is vital to normalize blood glucose levels and improve HbA1c in gestational diabetes, medical nutrition therapy (MNT) does not recommend ketosis [20].

diabetes-and-ketosis

There aren’t a lot of studies published on ketosis for gestational diabetes. With that, there is no definitive answer as to whether one should manage gestational diabetes by following a low-carbohydrate ketogenic diet.

Never attempt nutritional ketosis without consulting your obstetrician.


Conclusion

While ketosis is a natural physiological state and desirable for its numerous benefits on the body, especially for blood glucose control, it isn’t a one-size-fits-all approach.

If you do your research, you will find plenty of evidence that supports the effectiveness of reducing carbohydrates for diabetes.

However, with nutritional ketosis, there are more studies to support its efficacy on Type 2 Diabetes. In fact, when done correctly, nutritional ketosis can reverse Type 2 Diabetes. The subject becomes tricky with Type 1 Diabetes and Gestational Diabetes.

Regardless of the condition you have, speak with a doctor who understands and knows how to create a personalized nutritional ketosis plan before you attempt it.


References:

  1. American Diabetes Association. Statistics About Diabetes. - http://www.diabetes.org/diabetes-basics/statistics/
  2. Masood W, Uppaluri KR. Ketogenic Diet. 2019 January - https://www.ncbi.nlm.nih.gov/books/NBK499830/
  3. Phinney S, Virta Team. Is a ketogenic diet safe? - https://blog.virtahealth.com/is-keto-safe/
  4. Phinney S, Bailey B, Volek J.... View all references

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