A study that was published recently in the Journal of Physiology discovered that the ketogenic diet leads to insulin resistance in mice. The study quickly made headlines, with news outlets claiming that going low-carb can make you diabetic. But can it really?
Similar research showed conflicting results in the past, and when such studies are done in humans, the results were mostly positive. Truth is that we really know little about the long-term impact of keto on diabetes risk. But for now, most studies done in humans seem promising.
If you want to learn more about the keto diet and diabetes risk, then keep scrolling. We explain what research has to say so far and if there's a valid reason to worry about going keto when you're diabetic. For simplicity's sake, "diabetes" in this article, for the most part, refers to type 2 diabetes, unless stated otherwise.
Let's first discuss how the keto diet came to be.
The ketogenic diet has its origin in the centuries-old use of fasting as an epilepsy and diabetes (type 1) cure [1, 2]. Because people can only fast for a limited time, researchers looked for a way to get the benefits of fasting without food restriction.
Then, in the 1920s, they discovered that a diet too high in fat and too low in carbohydrates leads to the same metabolic changes brought on by starvation. Not long after, the keto diet was born . However, the discovery of insulin in the 1920s and anti-seizure medication in the late 1950 sidelined the keto diet for a while.
But then, starting in the 1970s, and by the mid-1990s, the keto diet went through a massive resurgence. Researchers and the public are now looking into this diet as a treatment for some of the most common and difficult to manage problems of today: excess weight and type 2 diabetes.
Diabetes compromises the body's ability to deal with carbs and glucose, leading to constantly high blood sugar. It's usually the result of a diet too high in bad carbsand calories combined with not enough physical activity.
Studies carried out over the years found that a Mediterranean-style diet rich in monounsaturated fats (MUFAs), whole grains, lean protein, and vegetables was the least likely to cause diabetes . And as a result, doctors recommend diabetic patients adopt this kind of diet to manage their condition.
However, the problem with this is that it works great as a preventive measure. But once a person is insulin resistant, a carbohydrate-based diet can lead to a faster progression to type 2 diabetes according to some studies . The Mediterranean diet is a carb-based diet, with 60% of its calories coming from carbohydrates.
And it really makes sense when you think about it: a person who has become insulin resistant already has trouble using glucose from carbs to make energy. It would be more logical to cut back on carbohydrates and focus on boosting fat adaptation and insulin sensitivity instead. One way that would be possible is by adopting a ketogenic diet.
But because the ketogenic diet goes against conventional wisdom, the food pyramid, and everything you've ever heard about healthy eating, your doctor is not likely to recommend this dietary strategy to help manage a disease as serious as diabetes.
The ketogenic diet has gained a bad rap, partially due to flashy headlines linking the diet to catastrophic outcomes like the ones we mentioned earlier in this text. Yes, the ketogenic diet is unusual, and yes, we need more research to confirm its safety. But for now, the diet seems promising as far as research is concerned. Just check out some of the claims below.
Studies noted improvement in hemoglobin A1c in diabetics after 6 -12 months on the diet . Some of these patients were even able to reduce their antidiabetic medication, which researchers believe is helpful in optimizing glycemic control.
One 5-week crossover study involving 8 men with type 2 diabetes noted greater improvement on a low-carbohydrate diet compared to a low-fat diet . The mean daily blood glucose at the end of the study was 126 mg/d on the keto diet.
A study on obese patients with diabetes found that, after only 2 weeks on the diet, the patients experienced improvements in hemoglobin A1c and insulin sensitivity .
Note that all these studies were done in humans. When keto diets are given to mice, the results often vary, with many studies showing worsening of glucose metabolism [8, 9]. But humans are metabolically quite different from mice. Besides, results from animal studies don't necessarily apply to humans.
The ketogenic diet can help people with diabetes by lowering blood glucose, improving metabolic health, boosting weight loss, increasing insulin sensitivity, and promoting insulin secretion. Here's how that looks in practice.
A diet that's low in carbs will naturally cause blood glucose levels to drop. That's because your body needs carbohydrates and glucogenic proteins to make glucose – the ketogenic diet limits both in a way that makes glucose production difficult.
The ketogenic diet enhances metabolic flexibility, which is the body's capacity to adapt fuel burning to fuel availability. Metabolic flexibility is extremely important for metabolic health. We know that people with diabetes are metabolically inflexible , and that keto can help boost their metabolic flexibility.
The ketogenic diet also improves metabolic health by improving mitochondrial numbers, size, and functioning . Mitochondria are the powerhouses of the cells, and studies show that changes in their size and activity lead to metabolic syndrome .
Losing only 1-5 pounds can make a huge impact on metabolic control for people with diabetes, and the keto diet is effective in this regard. As already explained, the keto diet mimics starvation, forcing the body to start burning fat instead of glucose.
People with diabetes are often told that reversing insulin resistance is not possible, making the diagnosis sound like a death sentence. However, documented cases of keto reversing insulin resistance do exist . The ketogenic diet improves health at the cellular level, and this is extremely important for people with diabetes.
There's evidence that ketone bodies promote insulin secretion . And because the ketogenic diet helps people lose weight and eat less, it can help normalize pancreatic beta cell functioning according to some studies .
The study from the Journal of Physiology was carried out by researchers in Zurich, Switzerland . It involved feeding mice two types of diets over 3 days, and one of those diets was a high-fat, ketogenic diet.
Although the mice looked healthy by the end of the study, they developed insulin resistance in the liver. The researchers concluded that there may be an increased risk of insulin resistance and diabetes with this type of diet. However, they also said they need to see whether this is a physiological adaptation and not a disease.
This is not the first study of this kind or with similar results. The reason such results are not alarming is because, as already said, the study was done in mice. Human studies on keto show different outcomes.
Still, you don't want to take any major dietary change lightly, especially if you're diabetic. Caution is necessary and there's a valid reason you may feel worried when making dietary decisions that could have a massive impact on your disease progress.
It all really boils down to prioritizing your concerns: is a ketogenic diet more dangerous than long-term, poorly managed diabetes? But then again, will going keto derail your diabetes treatment? These are all valid questions. For now, keep in mind that many things point out to the keto being a safe and effective remedy for diabetes.
And if you want real life examples, take a look at Dr. Keith Runyan's story. Dr. Runyan is a retired physician who treated his own type 1 diabetes with the keto diet. He also co-authored The Ketogenic Diet for Type 1 Diabetes: Reduce Your HbA1c and Avoid Diabetic Complications.
If you are diabetic (type 1 or 2) and you want to adopt a ketogenic diet to manage your condition, there are steps you need to take to ensure safety and efficiency:
Your doctor needs to know when you're making massive dietary changes, so they can monitor your condition carefully. You may also need to adjust your insulin dose more frequently after starting a low-carbohydrate diet since it will impact your fasting blood sugar.
If you're on diabetes medication, and especially insulin, it's a good idea to reduce carb intake gradually to avoid hypoglycemia. Try reducing carbs by 10-20g a day until you reach the maximum 50g a day mark. This approach can also help you stick to your diet and lead to less severe keto flu.
Fiber also helps with glycemic control, and the American Diabetic Association recommend eating at least 14g per every 1,000 calories a day . You can get all the fiber you need from low-carb vegetables, berries, low-carb fruit, nuts, seeds, nut butters, and fiber supplements.
Those with type 1 diabetes are at a greater risk of ketoacidosis, a dangerous condition of uncontrolled ketone production. Going low-carb can further increase your risk if you don't take enough insulin. Make sure to monitor your ketone levels as advised by your medical practitioner.
Besides reducing refined carb intake and losing weight, doctors also recommend exercising as a diabetes treatment. As you probably already know, inactivity puts people at risk of developing diabetes because it makes muscles resistant to insulin. On the other hand, exercise makes the body more sensitive to insulin, so do add it to your weekly regimen.
Supplements containing natural ingredients known to promote healthy blood glucose levels can also be a good addition to your keto diet regimen. Out Keto Stabilize capsules, for example, contain apple cider vinegar among other things because studies show it increase glucose uptake in people with type 2 diabetes .
The ketogenic diet is a promising treatment for a range of conditions, diabetes included. Many human studies conducted over the past 100 years show that going keto can help lower blood glucose, promote weight loss, and even boost insulin sensitivity. However, researchers don't know everything about the keto diet and diabetes risks.
What we do know is that many diabetics were able to manage their condition with this low-carb, high-fat diet that puts the body in ketosis. Compared to many other diets, keto is also more effective for weight loss, and there's evidence it can make your cells more effective at making energy both from carbs and from fat.
If you want to learn more about the keto diet and diabetes, read our other articles covering this subject. We also recommend our free Ketocademy course that will teach you everything you need to know about starting a ketogenic diet.