ketogenic diet diabetes metabolism keto mojoMost versions of low-carbohydrate and ketogenic diets result in lower blood sugar and insulin levels. So it’s pretty obvious how this could help diabetes. Surprisingly, this is not a new concept at all!  Low carb diets have been well described since the 1800’s, with William Banting promoting the most popularized version at that time. In 1919, Drs. Allen, Stillman and Fitz described a low carbohydrate treatment of diabetes. (Monographs of the Rockefeller Institute for Medical Research No. 11.)  Recently, many popularized versions of low carb diets have emerged. This includes the Atkins diet, South Beach diet, keto diet, etc.

Low carb diets for types 1 & 2 diabetes

More specifically to diabetes, Dr. Bernstein has promoted a low carbohydrate regimen. Specifics for the treatment of both Types 1 and 2 Diabetes are in his book, “Dr. Bernstein’s Diabetes Solution.” The good news is that many of these approaches will work to lower blood sugars and improve diabetes. The bad news is that most people can’t get themselves to stick to these diets. As Dr. Bernstein warns, medical supervision is important for diabetics attempting to control blood sugar with carb restricted diets. For any patient using insulin, medical supervision is mandatory.

Studies shows low carb diets help with diabetes

A 2017 meta-analysis of low carbohydrate diets (LCD) for the treatment of diabetes  analyzed 10 randomized trials. In total these trials studied 1,376 participants, and found the following:

  • In the first year of intervention, LCD was followed by a 34% lower HbA1c (3.7 mmol/mol) compared with high carb diets.  
  • The greater the carbohydrate restriction, the greater the glucose-lowering effect
  • Yet, at 1 year or later HbA1c was similar in the 2 diet groups.
  • The effect of the 2 types of diet on BMI/body weight, LDL cholesterol, QoL, and attrition rate was similar throughout the interventions.

Tough staying on for the long run without support

So these studies found that low carb diets DO improve diabetes, but people can’t or won’t stay on the diets over the long run.

Complicating factors – diabetes and depression

Part of the challenge may be the high overlap between diabetes and depression.  Does this connection go beyond simply stress, society and psychology? For more insight see Chris Palmer, MD’s recent Psychology Today article, Diabetes and Depression: Which Comes First? – These two illnesses have more in common than you probably realize.

Risks – Work with a knowledgeable healthcare team

This is where working with a knowledgeable healthcare team can help! It’s almost never as easy as reading a book, or talking to friends. People often need more support and education to find a system that works for them over the long run. Adjustments to the diet often need to be made. The type of diet you choose, and the foods you allow yourself to eat, can make all the difference in the long run. When you have guidance the diet is sustainable as well as enjoyable!

For diabetics on medications, it’s critically important to work with a knowledgeable healthcare professional when starting a low-carbohydrate or ketogenic diet. Blood sugars can drop rapidly, and medications often need to be adjusted rapidly with close monitoring. People often experience weakness, dizziness, lightheadedness, and other worrisome symptoms while adjusting to a low-carb diet. These same symptoms can also be seen with hypoglycemia (very low blood sugar), which can be dangerous, especially in diabetics on medications. Distinguishing between these can be difficult, if not impossible for most people, so working with a knowledgeable healthcare team is essential.

My thanks

This article is based on Chris Palmer, MD‘s presentation at Low Carb USA’s West Palm Beach 2019 conference.  My thanks to Nurse Christie‘s medical review and extensive edits. 

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