The hot topic of the decade is the Ketogenic diet.
If you have diabetes, I’d bet a million dollars that I don’t have (CDEs aren’t in this for the money!) that you have heard of, or personally thought about, this plan. Specifically as it is related to its potential benefit for tightly controlled glucose with a lot less variability and A1C in the non-diabetic range…without hypoglycemia!!
There is a lot to consider and there are a lot of perspectives on its potential benefit. It is important to put assumptions and personal beliefs aside, so we’d like to break it down to provide an unbiased and completely informative resource for anyone interested, contemplating or in the initial stages of starting this management strategy.
Is the Keto Diet good for people with Diabetes? Let’s take a look:
1. First, evaluate your current diabetes strategy:
What is working for you? What isn’t working? As I say to everyone I work with who asks about nutrition and wants to know what is “The Best” for life with diabetes – “YOUR DIABETES MAY VARY”! The strategy for management needs to reflect what you can and are willing to do LONG TERM. This is especially important in terms of nutrition as old habits are hard to break. It is even harder when those habits came from years of education that focused in one direction – mostly about carbohydrates.
I emphasize this because there is no quick fix. There is a lot of work to diabetes management, regardless of the way you choose to eat or exercise or meditate. In the beginning, change is hard, and for most adults it takes about a month to get in the groove of this adjustment.
2. Second, start with some basics to think about and do:
Learn all you can about the plan – in this case the Ketogenic plan (see below for some resources)
The Keto diet is one that focuses on using fat as the body’s main fuel source. When fat is burned for energy this is called ketosis, hence the diet’s name. First we have to understand a few basic things before we can understand how different the keto approach is.
Through food, most often we get our calories from three different macronutrients: carbohydrates, protein, and fat. The typical nutrition breakdown usually favors carbohydrates taking up most of the percentage of our daily calories, followed by a split between fat and protein depending on individual goals.
In the world of keto, the game is completely changed. To make a keto diet work and force your body to use fat as the main source of energy (instead of carbs), you will have to consume 70%+ of your total caloric intake from fat alone and keep carb intake to under 50g per day. That leaves small percentages for both protein and carbohydrates. You’ll notice protein does NOT make up a lot of the caloric value on this plan. It is lower than you may think. Most often protein is only about 20-25% of the intake with carbs being 5-10%. If your caloric needs were 1800kcal/day this would break down to about 45g carb (10%), 90g protein (20%) and 140g fat (70%).
You may be now thinking one of two things or maybe both.
One: Yay, I love foods with fat so bring it on.
Two: Wow, I could try it, but, can I maintain that long-term? Like any change in lifestyle, education is key. The keto diet is no different. You can’t jump in blindly and just start putting a stick of butter in your coffee and eat bacon around the clock and assume all will be good. There are many things to learn about this diet and many things to consider.
Evaluate your lifestyle – including your family or spouse/partner in this evaluation. Major adjustments in terms of food will affect everyone in your family and may require more time commitment on your part if no one wants to follow the new path with you.
Create a Pro/Con list for yourself
Create a list of your most common foods/meals eaten along with portions– usually there are about 20-25 foods on this list.
Evaluate common recipes or meal plans to see the food you WILL be eating (this is a good resource to give you some starting ideas – dietingwellketo.com )
Compare your list of common foods to the Ketogenic plan
Evaluate your ability to prepare food – if you hate to cook or have limited time, evaluate how this will work in your life and where you may need to adjust. Consider cost to buy prepared keto friendly foods versus self-preparation.
Evaluate social life – Consider if you can adjust to the restrictions long term – successful glucose control on a ketogenic diet means not varying off the plan.
Potentially create another pro/con list specific to food – give hard thought to how you will need to adjust LONG TERM to make it work for you
3. Third: Learn about ketones.
When living with diabetes we have heard over and over about avoiding ketones and DKA. However, ketones are something you WANT if you are aiming for nutritional ketosis. So what should you know?
There is a difference between ketosis and ketoacidosis.
Ketoacidosis occurs when BG levels rise high and there is a deficit of insulin. This makes the body break fat down for energy but it results in ketones that will make the blood very acidic. The pH of the blood drops and ketone levels are often much higher (>7-10mmol) than in ketosis.
When you are on a ketogenic diet, your body has transitioned to actually using the fat for fuel efficiently and there is no change in blood pH. Most important is to know how to test as well as what the levels mean. There is the right amount and the wrong amount and a clear way to test to ensure you aren’t in DKA. resource: how to test your blood for ketones.
Finally, know that things will change!
It is important to know that weight often changes as well as doses of insulin (or oral meds for those using them). These will need to be adjusted pretty quickly in the first few weeks of a Keto diet so be prepared to test more frequently, make use of smart features of insulin pumps such as extended boluses and temporary basals, and keep records to make sense of data.
If you feel you’d love more info about a ketogenic diet or have questions related to your diabetes management strategy since you started the keto plan, give us a call at Integrated Diabetes Services! We’d be happy to help you navigate healthfully!
Integrated Diabetes Services is the worldwide leader in one-on-one consulting for people who use insulin. Diabetes “coaching” services are available in-person and remotely via phone and the internet for children and adults.