These days, you can’t scroll through your newsfeed or Pinterest without seeing info about the ketogenic diet (aka the keto diet). It’s been used to treat seizures for years and lately, it’s been gaining a lot of momentum for weight loss and diabetes management. That said, there are many ideas about what the diet should look like, how to test for it, and who should (or shouldn’t) choose this diet.
As a dietitian I’ll do my best to keep my biases in check and share with you what the experts are saying. I’m not alone in my cautionary reporting; even the Diabetes Council had this to share about the keto lifestyle approach to living with diabetes. But, based off my recent article on carbohydrate counting, we understand that many readers are interested in this diet for the treatment of diabetes.
What does the research say?
Brittanie Volk, PhD, RD of Virta Health strongly supports the use of the keto diet for the treatment of Type 2 diabetes, because she frequently sees success in her program. Volk and Virta Health support the emerging research, such as this critical review of why a very low carbohydrate diet should be the first approach in diabetes management. Research shows how the keto diet can be beneficial, but is it sustainable? Can you follow this diet for an extended period of time? Read on for more.
Who should consider the keto diet?
Across the board, experts agree this diet should be focused on clients with Type 2 diabetes, and not Type 1 diabetes. Additionally, folks following this diet with the intent of reducing medications and improving blood glucose control should all be followed closely by a medical team. This isn’t the kind of diet you want to kick off without speaking to your doctor first.
Cautions to keep in mind
Although the research has some strengths, there is always the question of whether this diet is right for everyone, or if it’s even sustainable long term.
You may become short on certain nutrients
Julie Stefanski MEd, RDN, CSSD, LDN, CDE, owner of Stefanski Nutrition Services, has worked in keto-focused treatments for over 8 years. She’s concerned that key nutrients, like vitamin C, vitamin D, calcium, selenium, folate, fiber and other B vitamins, just aren’t delivered in sufficient amounts in foods like butter, cream and bacon. If you choose the keto diet, it will be important to schedule in a daily multiple-vitamin and mineral. Check out our list of keto-friendly foods.
Your blood sugar may need extra monitoring
Additionally, Stefanski strongly recommends a full blood panel to evaluate cholesterol and triglyceride levels, HgA1c, Vitamin D, fasting insulin and magnesium levels. She notes that medications will need to be adjusted prior to beginning the diet. Here’s why: Another diabetes educator and dietitian, Toby Smithson, MS, RDN, LD, CDE recently had a client who was exhibiting signs of extremely low blood sugars, and she had her immediately take her blood sugar (measuring an unsafe level of 46 mg/dL) and drink orange juice to correct it. After some questioning, Smithson’s client revealed she had started the keto diet. Her client hadn’t spoken to her doctor or dietitian first, and instead went off the advice of a friend. This adds to the cautionary note of being followed closely by a care team.
Your gut biome may need enrichment
One additional health concern is connected to gut health. Research is beginning to emerge with concerns on weakened gut health when following a keto diet. Adding in a probioitic—or eating fermented foods—would be a wise decision.
It takes money and effort—and lots of it
Right off the bat, you’ll be saving money if medications are no longer necessary. On the downside, meat is getting more expensive and sustainable coconut and palm oil are more difficult to come by. The keto diet is a lifestyle change, and may require coaching on how to navigate eating out and food shopping.
Spend time educating yourself on which foods are the most nutrient dense (like avocados, salmon, sardines and nuts) to get additional nutrients you may lack in a fat-focused diet. Living off bacon may sound fun to some, but it will quickly lead to nutrient deficiencies. Ask yourself, is one healthful outcome worth the downfall of another?
The decision is yours
Only you can decide if this is the right diet for you. There are many resources available to people living with diabetes, from American Diabetes Association to The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center. Plus, research has shown that diets aren’t necessarily successful long term—in fact, they are seen as a predictor of weight gain.
Ask yourself if you can live a ketogenic lifestyle permanently. If the occasional beer or glass of wine is not appealing, or digging into a birthday cake isn’t important, then keto could be a good fit. But if you think this diet is your only option, that’s not true. A recent comparison found little to no difference between various diet choices. Meaning, choose which will work best for you. Take a deep breath, have a long chat with your health care provider, and look forward to living your best life.