Living with diabetes can be a real struggle. There are actually four types of diabetes, not the two most people talk about. There is Type 1, which is where people are diabetic from birth. Their body under-produces insulin, sometimes never produces it at all. There is no set cause, and no known cure. Many Type 1 diabetics rely on blood sugar monitors and insulin pumps to get by. There is Type 2, caused by lifestyle factors. If you eat badly, are overweight, or suffer a metabolic disorder, then you could be at risk of developing it. There is pre-diabetes, which is the start of the metabolic problems that eventually lead to Type 2. And finally, there is pancreatic diabetes, where due to removal of part of the pancreas, a person cannot produce much, if any, insulin. Every day for diabetics can be a battle. Some need to perfectly combine sugars with fats and proteins to keep their glycemic load low. Many can rarely if ever eat out, because they cannot tell what effect the food would have on them. Others end up on such restricted diets that they need to take a range of supplements.
Discovering ketogenic diets can really be a life saver. Initially many are not sure, as this diet is not often recommended for healthy people. However, after talking to doctors, consultants, and doing research, it is clear there are safe ways to adapt a ketogenic diet for diabetics. You could find yours, however there will be a lot of trial and error. But, on the plus side, the potential benefits are amazing. Consider this article your introduction to ketogenic diets for fighting diabetes.
What Is A Ketogenic Diet?
A ketogenic diet is any diet that allows you to enter ketosis. Ketosis is a process by which your body produces ketones as a replacement for glucose. How does this happen?
Normally your body runs on glucose in your blood stream. Your body digests carbohydrates, which break down into glucose. Our blood picks up this glucose and carries it around our bodies. Our insulin then pushes it into either organs, muscle tissue, or fat cells. Our organs get top priority. If we are being active, our muscles demand the spare glucose. If we are not active, our body needs to keep its glucose levels low, so our insulin moves the spare glucose into our fat cells for storage.
But, like all animals, humans would go through times when we were not able to find fresh foods. What happens then? In these situations, our bodies live off our fat. That’s what it’s there for, after all. But the glucose has already been turned into fat cells, and our organs and muscles can’t burn fat. So, we have to turn it back into a type of sugar. That type of sugar is called ketones. Ketones are made by the body when no glucose is available. Our bodies take fat and protein and mix them up into a type of sugar that will give us energy.
Although this normally happens when no food is around, we get the same effect when we eat very little carbohydrate. If we eat little, or no carbohydrate, our bodies have to work just like they do when we aren’t eating at all! By keeping your carbohydrate intake under 45 grams a day, you are encouraging your body to make ketones instead of use glucose. This is what we call a ketogenic diet.
How Do Ketogenic Diets Regulate Blood Sugars?
Blood sugars come from only two places: what we have just eaten, and stored glucose. Although our fat cannot store glucose as a sugar, our muscles and liver can. This is why we don’t enter ketosis between meals. If lunch is a little late, our bodies release glucose to keep us going.
This is also why maintaining a healthy blood sugar balance can be so hard for diabetics. Not only are you at risk of hyperglycemia from eating too much and hypoglycemia from eating too little, but sometimes if you avoid hypoglycemia, your liver will release a load of sugar and make you hyperglycemic again! This results in a lifetime of snacking, treating candy bars as medicine, and insulin shots, or even an insulin pump.
Ketogenic diets can help where both sources of glucose are concerned. By not eating many carbs, you are preventing yourself from becoming hyperglycemic. If you aren’t eating sugar, you can’t have too much sugar in your blood from your diet. And you can’t be in ketosis when you have spare glucose in your muscles or liver. So, if you are in ketosis, you know you aren’t at risk of becoming hyperglycemic from your liver releasing too much glucose into your blood.
But what about hypoglycemia? Does being in ketosis put you at increased risk of having low blood sugar? After all, if you’re eating no sugar, then surely your blood sugar is low? Actually, ketosis does all the opposite. Because you are running on ketones, when they run too low your body just makes more from your own muscle and fat. And if you have too many ketones, your body gets rid of them through your urine. When in ketosis, you will have exactly as much fuel in your blood as you need, never too much or too little.
How Do I Know If I Am In Ketosis?
Naturally, once you are in ketosis you can be pretty safe. But if you haven’t entered ketosis yet, then you could be at more risk of high or low blood sugar than ever before. This is because if you are having enough carbohydrate to stay out of ketosis, but not enough to properly fuel your body, you will find your blood sugar is swinging wildly. This is not safe.
Some people have a hard time entering ketosis. You may think that eating less than 45 grams of carbohydrate a day is more than enough. And for most people it is. But sometimes it isn’t that simple. If your body is very efficient with carbohydrates, then you may stay out of ketosis even at that. Or you might have a lot of stored glucose. Or you might be getting so many incidental carbohydrates in the form of things like tomato, eggs, or even organ meat, that you are eating more carbs than you thought. This means that the number of grams of carbohydrate you are eating is not enough to tell you whether or not you are in ketosis.
If you want to make sure you are in ketosis, there is only one way to be completely certain. Remember how I mentioned that if you have too many ketones your body expels them in your urine? There is a product called keto sticks, which comes under various brand names, and will tell you how many ketones are in your urine. Just place it mid-stream, or dip it in a sample. As long as your ketones measure above “trace”, then you are in ketosis.
Is There Only One Way To Go Keto?
Absolutely not! The key to a ketogenic diet is just to enter ketosis. Believe it or not: all weight loss diets that last over a few days are ketogenic! After two or three days, you will have burnt all your glucose up, and will be burning your own fat and muscles to stay alive. So even a high carb weight loss diet is ketogenic if you are burning fat.
To go truly ketogenic, all you need is to eat under 45 grams of carbs a day, until you are producing ketones in your urine. You could be eating whole foods, junk foods, even a vegan or vegetarian diet, as long as you enter ketosis. Although we would recommend a whole foods approach with plenty of greens, some low carb berries, and rich protein and fat sources. Fast food keto may be a recipe for digestive disaster!
Is A Ketogenic Diet Highly Restrictive?
Many people do find ketogenic diets very restrictive, because they are. You cannot eat any main sources of carbohydrates. This means no starches, like potatoes; no grains, such as bread or pasta; no fruits, such as apples or bananas, and no brown pulses, like chick peas. This diet, as you can see, eliminates a lot of common foods, and will make eating fast foods very difficult.
Alcohols and some “no sugar” sweeteners are also out. Alcohol turns to sugar when it is processed by our livers. And many “no sugar” sweeteners are made with different types of sugars, such as lactose or alcohols, which turn to glucose in our livers too.
That said, you can have a few incidental carbohydrates, and some carbohydrates that are low on the glycemic index and low in glycemic load can be eaten from time to time. Many people on a ketogenic diet still enjoy tomatoes, green peas, avocado, and yam on a weekly or even daily basis without trouble.
If you do eat carbs, remember that this will push you out of ketosis. This means that you may need to keep your insulin to hand, and that you will need to start your ketogenic diet over from step one. A little carbohydrate won’t hurt, but if you eat over your maximum allowance it will start your body burning glucose again.
Finally: just because a ketogenic diet means eliminating several types of foods does not mean it cannot be a varied diet. You have at your disposition all muscle meats, all fatty foods, all leafy greens, many green pulses and many non-sweet fruits. You can also eat a variety of yams and roots, and some people can also eat organ meats, eggs, and dairy. On a ketogenic diet you could eat ratatouille, a spinach curry, bacon and eggs, some ice cream, some tofu, bone broth, nuts and seeds, etc.
What Are Common Side-Effects Of Going Keto?
Like with any dramatic diet change, there will be side effects when you start a ketogenic diet. Some of them may be good or bad depending on the circumstances, others are definitely good or definitely bad. In the case of keto, some common side effects are:
Weight loss. This could be good or bad, depending on whether you need to lose weight or not! Usually, because protein and fat is so satiating, people can end up eating fewer calories than before whilst on a ketogenic diet. And as your body will seamlessly swap onto burning your own fat and muscle, you may not experience hunger when the fuel in your stomach runs out. To prevent weight loss, simply measure what you eat for three days, average it, and try and eat more than the average every day.
Sweats. Many people on very low carb and ketogenic diets experience the dreaded “meat sweats”. This may or may not be accompanied by “keto breath”. The smell is actually the smell of uric acid, from excess protein, and is a bad sign. Too much uric acid leads to gout. Swap red meats for fish, and reduce your protein intake until your body odors mellow out.
Improved mood. Eating too many carbs can make your mood erratic, and even make you grumpy. A lot of people think that not eating carbs is making them angry. In fact, the opposite is true. Remember how carbs can make you hungrier and tempt you to binge? When you don’t binge, or change your eating schedule, your body goes into panic mode and becomes angry. When you’re eating too many carbs, every time you don’t eat them before your body demands them, your panic button will activate, making you angry or depressed. As a ketogenic diet provides a steadier supply of nourishment, you will not suffer moods on it.
More stable cycles. Likewise, the estrogen-promoting properties of a high carb diet might be amazing for someone with high testosterone, or ovarian cysts. Some post-menopausal women enjoy high carb diets too. But if you have normal cycles, uneven cycles, or are the other type of post-menopausal woman, you might need more testosterone to help regulate your hormones. And high protein, high fat diets promote the release of free testosterone, which can help regulate and control your estrogen.
Hunger pangs. Unfortunately, not everyone finds protein and fat satiating. Some people hit their “stop point” before they have consumed enough. They still want to fill their belly, but they don’t want any more protein or fat. This is very common at the start of a ketogenic diet, when you are learning about your body. Try eating more protein, drinking water, or eating leafy greens to calm your hunger. If the problem doesn’t go away after a few weeks, this diet isn’t for you.
Reduced bloating. Many people experience water retention when they eat carbs. This is especially true of simple carbs, like the ones found in cakes and fruits. Remember how we mentioned that your body stores glycogen in your muscles and liver? When your body stores glycogen, it stores up to three grams of water for every gram of sugar. This isn’t bad when it’s a bit of water, but if you find yourself shedding 10 kilos when you switch to keto, you may want to ask yourself whether it is healthy to carry 2.5kg of sugar and 7.5kg of extra water around.
Irritable Bowel Syndrome. Unfortunately, many people find out the hard way that they are eating too much fat on keto. Between high fiber greens and too much fat, their gut can become inflamed, resulting in cramps, constipation, or loose stools. If this happens to you, cut out all nightshade plants (from the family of potatoes and tomatoes) and all nuts and seeds, and slowly reduce your fat intake until you are comfortable. Then reintroduce the plants you quit eating. After doing this, many people find their sudden bout of IBS goes away.
Will Ketogenic Diets Work For All Types Of Diabetes?
In theory, no matter what type of diabetes you have, you can go keto. Even people who are not diabetic, or who are pre-diabetic, can go on a ketogenic diet, as it will help them control their blood sugars and potentially lose weight. As ketogenic diets swap your body from glucose onto ketones, this takes the burden off your pancreas, meaning you are no longer relying on insulin to keep your energy levels optimal. Whether you have type 1 diabetes, type 2 diabetes, pancreatitis, or pre-diabetes, a ketogenic diet could work for you.
That said, as we will shortly discuss, there are situations where a ketogenic diet can be dangerous, and there are many things you should not do if you are diabetic and eating a ketogenic diet. Whether you are in doubt, or totally confident about starting a ketogenic diet, consult with your doctor first. Make sure your doctor is knowledgeable about ketogenic diets and their benefits for diabetics, as many doctors are ill-informed and against ketogenic diets no matter what the reason, and no matter what your health condition. Ask your doctor about ketogenic diets before saying you are considering one. If they are less informed than you are, spare your time and find a doctor who knows about this type of diet. However, if a knowledgeable doctor advises against it, listen to them.
Will A Ketogenic Diet Let Me Stop Taking My Medication? Will It Cure My Diabetes?
A ketogenic diet could well result in physical changes that make some of your medications unnecessary. This is because if you aren’t eating carbs, and especially not simple sugars, you don’t need to take anything to control them. However, it will not cure your diabetes any more than a prosthetic cures a missing leg. If you try and eat sugars without your insulin, even after years on a ketogenic diet, you will suffer hyperglycemia.
Always consult with your doctor about any changes that happen whilst you are on a ketogenic diet. You will need a series of appointments and tests before any of your medications are formally discontinued. Keep taking them until your doctor says otherwise.
Are Ketogenic Diets Safe For Everyone?
Although ketogenic diets are a great tool for controlling diabetes, some people are more at risk of side effects than others. Do not adopt a ketogenic diet if you are:
• Pregnant or breastfeeding. You may need the carbs to nourish your child.
• Missing a gallbladder. You need a gallbladder to process fat.
• Suffering pancreatitis which has affected your ability to digest proteins or fats. If you have suffered pancreatitis but can still eat proteins and fats, then you’re good to go.
• Elderly or infirm. You may need the carbs to keep you healthy.
• Suffering kidney disease. You may not be able to digest the proteins.
Even if you are perfectly healthy, always consult with your doctor before adopting a radical diet change.