The Keto Diet and Diabetes


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A question I was asked recently was about diabetics and how they do on a keto diet. Let’s break it down and see just how beneficial keto may be for diabetics to follow.

Some of the most important general recommendations that I make to diabetic patients include make sure to include healthy fats in your diet such as nuts, olive oil, flax seeds, fish oils, avocados. Include fresh and frozen fruits and vegetables in your meal plan, (avoid processed foods as much as possible), whole fruits, fish, lean meats, whole grain breads and high fiber cereals.


 Carbohydrate counting is also very important as to keep track of the carbs in your meals and snacks. Incorporating in regular physical activity and being mindful of proper portions sizes are also key to successful management of diabetes!


If a diabetic patient is put on a keto diet, most of what they eat is fat. Keto is a low carbohydrate/ high fat eating plan. About 20-30% of the diet is protein, strict low carbohydrate (less than 50 grams – ex: an apple has about 25 gms of carbohydrates).


Choose from complex carbs such as beans, whole-grains, milk, fresh and frozen fruits and vegetables.  A Strict low carbohydrate meal plan (no more than 20g- 50 g of carbohydrates)  is essential focused on high fat and about 20-30% protein (from a variety of sources).


Research does show that people with type 2 diabetes can benefit from a keto diet (Not type 1 diabetes as  much due to danger of ketoacidosis and limited studies of long term effects) and lose weight, reduce and lower A1C levels.


In essence, patients with type 2 diabetes can lose weight on a keto diet; however since it so restrictive and low in carbohydrate, it can be very hard to stick to for the long term.  


Several side-effects following a keto diet can occur that include:


Hypoglycemia:- this may mean you’re at higher risk of blood sugar going too low- even if you are taking medicine.


Heart Disease- Since keto emphasizes a lot of fat- like bacon and butter and can raise your bad cholesterol (LDL)- which contributes to heart disease.


Lack of nutrients





A true keto diet, unlike other low-carb diets, which focus on proteins and a keto plan centers on fat which supplies as much as 90% of daily calories. The keto diet aims to force your body into ketosis  where you start burning fat as fuel, instead of sugar (glucose). A keto diet focuses on low carbohydrate (20-50 grams).


An example of a keto plan would be – a daily 2,000 calorie diet it might look like 165 gms of fat, 40 gms, and about 75 gms of protein.



Although I do not push a keto diet on diabetic patients due to it being very restrictive and difficult to follow for the long term. I encourage low carbohydrate (but not necessarily as restrictive as less than 50 grams). I encourage lifestyle changes to go along with diabetic meal planning.


Some of these lifestyle changes include:


Carbohydrate counting (having a solid idea of amount of carbs one is taking in). For people taking mealtime insulin, it’s important to know the amount of carbs in your food- so you can get the proper insulin dose. Always speak to your doctor prior to starting the diet (if one chooses to follow the keto plan)!


Know your portion sizes– Invest in a measuring cup, food scale, to really know how much you are taking in. Refer to correct portion size guidelines for accurate carbohydrate count.


Make meals well-balanced


Exercise- Incorporate physical activity (any activity you enjoy doing) into your routine as it has tremendous benefits on your health journey.



Research finds keto may aid weight loss and the diet can lead to changes in the digestive tract. Although keto is difficult to sustain for the long term, due to it being so restrictive, it has also been found to have adverse GI effects such as diarrhea and constipation. Therefore, due to these side effects, I do not recommend keto regularly, but more of a less restrictive, low carbohydrate paleo plan focused on complex carbohydrates, protein and healthy fats.


Overall, keto is a diet used for weight loss and may be beneficial for short term use; however, due to it being so restrictive, it is not sustainable for the long haul and may cause unwanted side effects.












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