Is The Keto Diet Right For A Type 1 Diabetic?

What’s up warriors! I hope everyone is doing well and staying healthy! Keeping on track with our theme of debunking different diets I thought we’d dive right into Keto. If you’ve been following along with our Facebook live videos inside The Warrior’s Tribe, you saw my not so brief intro to the keto diet. 

Keto Basics

Keto is short for Ketosis, a metabolic state where the body is burning fat as a method to run on alternate “fuel.” See normally the body runs, and prefers to run, on glucose but in times of famine or other shortage of food, the body has the ability to switch gears and metabolize fat to ensure survival. This came in handy during the caveman and hunter-gather eras of life, but in our current, modernized society we’ve moved away from this pattern of eating. 

Keto has been traditionally used for people with epilepsy—those who have uncontrollable and unpredictable seizures. For some reason, keto works for these people, though the science is still being fine-tuned to explain exactly why this works. 

So what exactly does the keto diet entail? At its foundation, it forces the body into ketosis, by limiting the amount of carbohydrate you eat. Typically it requires participants to eat between 20-50 grams of carbs daily, however, the exact number of carbs will vary for each person. In some cases, participants eat 90% of their daily calories from fat products. While it may sound similar to paleo or Atkins, it is different in that it truly requires the individual to achieve a state of ketosis. This can be difficult to truly confirm, again as each person is different. However eating just a few grams of carbs over your daily allowance can throw you out of ketosis. 

The idea behind it is that you are burning fat in your body which will aid in weight loss. For diabetes, weight loss typically results in an increase in insulin sensitivity and better blood sugar control. These are the facts and I will offer my opinion on these statements in the below sections. 

Pros

FULL DISCLOSURE, like I said in our live video in The Warrior’s Tribe I am not a fan of keto whatsoever. I do not recommend it for my diabetic patients, I do not recommend it for my patients wanting to lose weight, and anyone who tells me they’re on it, I immediately discourage them from continuing it. I have to tell you this because this blog may come off more biased than the others that I have written and I want to be as transparent as I possibly can with you. There is no judgement and if keto is working for you, please know that I recognize different things work for different people. 

Weight loss is achievable with this diet and at times that can be a motivating factor to help us continue our journey. It can encourage us to continue exercising or drinking more water, which are both great things. 

By limiting carbs, we are essentially reducing our blood sugars. Please read below on my snippet about insulin resistance though because these can be two conflicting ideas so it is difficult for me to write about this. This statement “keto produces lower blood sugars” is very subjective, meaning it will vary from person to person. Maybe for you it will work, for others it may not. But I MUST do my due diligence and say there is a possibility it can lower your blood sugars. 

While I apologize for this section being so short, please know I am actively researching for positive evidence to put here. 

Cons

This diet is extremely restricting, not only with carbs but with fruits and vegetables since they also contain carbs. You do unfortunately have to watch protein intake as well because the body in all it’s glory can in fact metabolize protein into glucose..shocking I know, but it is called gluconeogenesis. Again another built in backup system in case there is a shortage of food but yet another reason and nutrient to cut out of your diet. 

Speaking of limiting nutrients, since this diet forces you to essentially cut out fruits and limit vegetables, you are looking at severe malnutrition or deficiencies. As diabetics we are already at risk to lose vitamins and minerals to high blood sugars. The higher our sugars, the more our body forces us to pee it out, and when we go to the bathroom more frequently this results in higher loss of vitamins and minerals. While it's true you can supplement these back into your diet, it is my opinion that it is preferable to eat the natural foods first. Plus fruits and veggies are high in fiber which promotes digestion and movement of your intestines. This is a fancy way to say they keep you regular. By limiting high fiber foods, you risk damaging your gut health and increase your chances of becoming constipated. 

The keto diet does promote healthy fats, however, it places a large emphasis on saturated fats which are associated with heart disease. Keto has also been shown to increase LDL cholesterol which is a type of bad cholesterol. Now, I am big on talking about patients as an ENTIRE person not just one part. So just because we have diabetes doesn’t mean we ONLY focus on our diabetes. Because we are diabetics we have increased risks for high blood pressure, high cholesterol levels and other comorbidities. Opting for a diet that is high in fat, specifically high in saturated fat will only increase those risk factors. I don’t know about you but I am trying very hard not to have a heart attack as I age. 

Speaking of comorbidities, we have to make sure we are paying attention to ALL organs in the body. For example, one of the liver’s many jobs is to metabolize fat. If you have an existing liver condition or are at risk to develop one, eating a high-fat diet will put more stress on your liver which can lead to more problems. 

The kidneys on the other hand help to metabolize protein and while you aren’t supposed to overdo it on keto, you are still increasing the amount you’re normally eating to supplement for the lack of carbs. With the same reasoning as above, being a diabetic with elevated blood sugars puts more stress on the kidneys to filter the sugar out of the blood and into the urine. If we are then further taxing them by consuming more protein, we are increasing our risk of nephropathy, aka kidney damage. NOW this is not to say the keto alone will wreck your kidneys or cause your liver to stop working but if you have risk factors, which we do as diabetics, the keto diet is not your best bet. 

The last thing I want to bring up, which I also addressed on our live Facebook video in The Warrior’s Tribe, is the insulin resistance that is associated with an increase in fat consumption. Meaning the more dietary fat we eat the less our body responds to the insulin in it. Whether you have type 1, 2, or gestational diabetes, insulin resistance is NOT a good thing and is the main cause of diabetes in both type 2 and gestational diabetes. There have been numerous studies showing how diabetics require MORE insulin when eating high-fat meals. Two groups have been compared and are given the same amount of carbs with different amounts of fat. The low-fat group had better results with blood sugar compared to the high-fat group. While this is NOT testing a keto diet specifically, I think it is fair to make some inferences based on the results of these studies. 

What does it all mean?

Honestly, this probably isn’t the best route to go HOWEVER I recognize my biases and limitations and so I encourage you to do your research and find someone who is the EXACT opposite of me (pro-Keto), as well as a neutral explanation of it. This will be the best way for you to make your decision. 

That being said, my goal isn’t only weight loss, it is overall health and wellness, both physically, mentally, and blood sugar wise. To me, this diet just seems to lack and is a temporary fix. 

Choosing a well balanced, varied diet is the best way to go. Of course when combined with adequate hydration and exercise, our bodies are going to thrive. And that’s what it’s all about right? Thriving!

Let me know your thoughts below in the comments, and I look forward to seeing you for our next LIVE Facebook video! Stay happy and healthy. 

-Taylor Gann, PA-S, T1D