You’ve probably seen dozens of headlines about the ketogenic diet by now. Called keto for short, it has made its way into popular culture largely through the celebrities and supermodels who have given the long-standing fad diet a repeated stamp of approval. Is the keto diet the plan to follow if you have diabetes?
While the keto diet may offer many potential benefits for diabetes management, following it requires a pretty serious commitment. So take a beat before you take the plunge — and consider these questions that can help you and your medical team determine if it’s right for you.
How the Ketogenic Diet Works
Possible Benefits of the Ketogenic Diet for Type 2 Diabetes
Here’s how the keto diet may help if you’re managing type 2 diabetes: “With a higher protein and fat intake, individuals may feel less hungry and are often able to lose weight, since protein and fat take longer to digest than carbohydrates,” says the Manhattan Beach, California–based Lori Zanini, RD, CDCES, the author of Eat What You Love Diabetes Cookbook. It may also help keep your energy levels up.
The diet may offer additional benefits. A review published in January 2021 in BMJ suggests that a low-carbohydrate diet like keto may help bring a person with diabetes into remission, which is defined as having an A1C test result of less than 6.5 percent or fasting glucose of less than 7.0 mmol/L, with or without the use of diabetes medication. (A1C shows a three-month average of blood sugar levels.) That remission is not extremely likely, and whether it is permanent is unclear — long-term diet adherence is typically required for maintenance of remission.
Health Risks of the Ketogenic Diet for Type 2 Diabetes
Overall, study findings on the potential benefits — and risks — of the keto diet for diabetes are mixed. More studies are needed before scientists understand the long-term implications of the eating plan for this group.
People With Diabetes Who Shouldn’t Try the Keto Diet
What’s certain is this diet isn’t for you if you have kidney disease — one reason being that you want to limit protein in that case, Zanini says.
Last, if you have a history of struggling with an eating disorder, work with your doctor to determine if this is the right diet for you. Despite what you may have read online, the keto diet and a personal history of binge eating disorder do not mix. In fact, “Because of the severe carb limits imposed by the ketogenic diet, the risks of bingeing, compulsive overeating, and other eating disorders is much higher,” says White.
How to Start the Keto Diet if You’re Living With Type 2 Diabetes
If you decide to start the keto diet, don’t go it alone.
You’ll also find heat-and-eat keto meals that you can order online at Factor. Subscribe and you get a complimentary session with a registered dietitian.
Above all, if you’re interested in trying keto to manage diabetes, talk with your diabetes medical team — including your endocrinologist and a registered dietitian who is also a certified diabetes care and education specialist — before trying this eating plan. Start the diet slowly, cutting carbohydrates gradually, Zanini recommends. Dramatic reductions could lead to hypoglycemia, especially if you’re on oral diabetes medications or insulin.
Regularly test both your blood sugar and ketone levels to prevent serious side effects. “Doing so is very important for avoiding DKA,” says Sylvia White, RD, CDCES, who works in private practice in Memphis, Tennessee. “Warning signs of DKA include consistently high blood sugar, high ketone levels, dry mouth, nausea, vomiting, and frequent urination — and complications can cause a diabetic coma.”
Consume a balance of nutrients — all those important vitamins, minerals, fiber, and more — as well as the proper amount of calories and healthy keto-friendly fats. “Healthy fats include monounsaturated fats and omega-3s, which may help reduce inflammation in the body and improve cholesterol levels,” says White. Look to fatty fish like salmon for omega-3s and avocado, almonds, peanut butter, and sunflower seeds for monounsaturated fats.
If you’re not sure what to reach for, ask your dietitian. “While this sounds so simple, often people are only thinking about what not to eat,” says Zanini. “They don’t pay attention to the nutritious foods they should be including, like nonstarchy vegetables, healthy monounsaturated fats, lean proteins, and more.” Don’t have a dietitian? You can find one who is a certified diabetes educator through the Academy of Nutrition and Dietetics “Find an Nutrition Expert” tool.
Tips for Sticking to the Low Carb Count on the Keto Diet
“Simply put, it is not easy to eat just 20 to 60 g of carbohydrates per day, which is how many carbs are permitted on the ketogenic diet,” says Zanini. “To follow this strict guideline, people must not only change the food they’re eating but their entire lifestyle.”
Foods that are a typical part of the American diet, like sandwiches, burgers, and milkshakes, won’t easily fit into the food plan, and foods considered staples of a balanced diet, such as sweet potatoes and whole-grain bread, may need to be limited. These changes can be tough to implement, even for people who’ve already started making their diets healthier. Tracking what you eat can help. You can do so either with a written food diary or through various apps on your smartphone.
You can’t take days off the diet, though. You must stick with the diet if you want to see the benefits — otherwise you’re really just eating a high-fat diet.
A Diabetes-Friendly Keto Diet Food List
When in doubt, keep in mind that you will want to avoid or limit any foods that are high in carbohydrates while loading up on foods that are high in protein and healthy fat.
Here are some common foods in a keto diet plan that can also be diabetes-friendly:
- Poultry and meat
- Nuts and seeds
- Non-starchy veggies
- Olive oil
Here are some foods to limit or avoid in a keto diet plan, regardless of whether you have diabetes:
- Grains, including healthy whole grains, like brown rice, and whole-wheat bread and pasta
- Fruit, especially high-carb fruits such as tropical fruits
- Sugar in all forms (granulated sugar, brown sugar, corn syrup, baked goods, candy)
- Processed food, including crackers and corn or potato chips