If you are living with diabetes, you may have been told to eat a low-carbohydrate diet to control your blood glucose or you may have been told to eat a very low-carbohydrate diet, otherwise known as a ketogenic diet. Regardless of which form of low-carbohydrate diet you may have come across, understanding the pros and cons of low-carbohydrate and ketogenic nutrition for people with diabetes will give you the information you need to choose what’s right for you.

What Is a Ketogenic Diet?

A ketogenic diet involves eating between 30 to 50 grams of carbohydrates per day in order to achieve a metabolic state known as ketosis, in which your muscles and liver derive the bulk of their energy from fatty acids and amino acids instead of from glucose found in carbohydrates. To do so, those adopting ketogenic diets are told to get 70 to 90 percent of their calories from fat—from meat, eggs, sausages, heavy cream, cheeses, fish, nuts, butter, oils, seeds, non-starchy vegetables, avocados, coconuts, and small amounts of berries, while avoiding almost all fruits, starchy vegetables, breads, pastas, legumes, milk, and yogurt.

Are Ketogenic Diets Good for People with Diabetes?

Many people around the world who eat a ketogenic diet are able to lose weight, achieve a flat-line blood glucose profile, greatly reduce or eliminate their need for oral medication and insulin, and reduce their total cholesterol. So why aren’t we recommending this diet ourselves? Because despite these advantages, there are four very important points to take into consideration:

• Evidence-based research conducted in large numbers of people over long periods of time consistently demonstrates that eating more animal products increases your risk for premature death, no matter what short-term benefits may unfold in the process. Similar large-scale research demonstrates that eating more whole plant foods reduces your risk for premature death.
• The short-term benefits associated with a ketogenic diet can also easily be achieved using a low-fat plant-based whole-food diet, as seen in research dating back to the 1920s.
• Low-fat plant-based whole-food nutrition is the only approach shown to reverse heart disease (the leading cause of death of people living with all forms of diabetes), whereas diets high in saturated fat and cholesterol have been shown to promote heart disease.
• There are many examples of long-lived societies around the world who eat plant-based diets, and zero examples of long-lived societies who eat a low-carbohydrate or ketogenic diet with a high intake of animal products.

While the ketogenic diet may seem like a logical approach to reducing blood glucose fluctuations, it is based on the outdated and incorrect carbohydrate-centric model of diabetes, which points a finger at carbohydrates as the cause of insulin resistance and type 2 diabetes, even though overwhelming evidence shows that low-carbohydrate, high-fat diets are actually the cause of insulin resistance and type 2 diabetes. 

Are the Short-Term Benefits of a Ketogenic Diet Worth It for People with Diabetes (or Those at Risk for Developing It)?

Some doctors today are quick to recommend a ketogenic diet to patients with type 2 diabetes based predominantly on short-term studies, such as a 2005 study in which scientists from Temple University followed 10 obese patients living with type 2 diabetes for two weeks and observed a 0.5 percent reduced A1c (a measure of average blood glucose) and a 75 percent increase in insulin sensitivity. 

Indeed, based on the short-term evidence, a ketogenic diet is a very effective tool at promoting short-term improvements in body weight, blood glucose, A1c, and triglyceride levels. In the long term, however, a ketogenic diet is unlikely to provide the same results, and it’s more likely to pose risks, as is the general class of low-carbohydrate diets. In large-scale studies performed over long periods of time, the evidence-based literature consistently shows that low-carbohydrate diets worsen long-term health, increase the risk for many chronic diseases, increase the risk for infectious diseases, and increase mortality.

Take, for example, the 2014 study in which researchers from Loma Linda University summarized the results of three separate Adventist health studies (covering more than 100,000 people): In comparison with their meat-eating counterparts, lacto-ovo-vegetarians were 38 to 61 percent less likely to develop diabetes, and vegans were 47 to 78 percent less likely to develop diabetes. They concluded that vegetarian and vegan diets offer significant protection against death from cancer, heart disease, and diabetes, and that those who chose to eat more meat and dairy products in the long term significantly increased their risk for death.

In a 2016 study, researchers from Massachusetts General Hospital and Harvard Medical School analyzed data of more than 130,000 participants from the Nurses’ Health Study and Health Professionals Follow-Up Study. They found that for those who were already living with diabetes, eating more animal protein raised the risk of all-cause mortality, whereas eating more plant protein reduced that risk. 

Most mainstream diabetes recommendations encourage eating more animal protein as a means of losing weight and “stabilizing blood glucose,” but large-scale research shows exactly the opposite.

A more recent paper showcasing the effect of a ketogenic diet in 262 people living with type 2 diabetes demonstrated that only 14 percent of patients were able to maintain a ketogenic diet over a 2-year period. In addition, after 2 years patients had an elevated fasting glucose, elevated fasting insulin, elevated A1c, elevated total cholesterol, and elevated LDL cholesterol, despite significant reductions in their use of oral medications and insulin. 

The Takeaway

If a ketogenic diet was the only way to improve your metabolic health in the short term, then the benefits would certainly outweigh the prospect of no improvements at all. However, practically all “diets” work in the short term, because diets prompt you to pay attention to the quality of the food that you’re eating, how much you’re eating, when you’re eating, and how you feel between meals. The difference between dietary approaches becomes much more apparent over the course of time, and those that create long-term sustainable habits and provide lasting metabolic fitness will always beat out those that are unsustainable as well as those that negatively impact your long-term metabolic health.

And this is exactly why we strongly caution you against adopting a ketogenic diet without understanding that the short-term metabolic improvements can easily trick you into believing that it is a smart long-term option, when the evidence-based research demonstrates that people who reduce their intake of carbohydrate-rich foods and substitute more fat-and more protein-rich foods from animal sources are at a greater risk for chronic disease and premature death.

Now for the good news: Unlike ketogenic diets that haven’t been studied in depth for long periods of time, almost a hundred years of evidence-based research has demonstrated that a low-fat plant-based whole-food diet is an excellent option for simultaneously maximizing your overall metabolic health, reversing insulin resistance, and dropping your chronic disease risk.

Adapted from MASTERING DIABETES by arrangement with Avery, a member of Penguin Group (USA) LLC, A Penguin Random House Company. Copyright © 2020, Cyrus Khambatta and Robby Barbaro.

The post The Truth about the Ketogenic Diet and Diabetes appeared first on Forks Over Knives.

But what if you’re living with insulin-dependent (type 1 or 1.5) diabetes? Since there’s no known cure for autoimmune diabetes, and eating a low-fat WFPB diet can’t replace insulin injections and frequent blood glucose monitoring, what’s the point of changing your diet at all?

Both of us live with type 1 diabetes and have been eating a low-fat, WFPB diet for more than a decade, and we’d like to reassure you that eating this way holds plenty of benefits for you, too. We, along with hundreds of our clients with type 1 diabetes, are living proof that people with type 1 diabetes experience extraordinary results from following a low-fat, WFPB lifestyle. Here are just a few of them:

1. A significant boost in insulin sensitivity: In our coaching practice, we teach people living with all forms of diabetes how to reverse insulin resistance using a WFPB diet, using a very similar approach as Drs. Ward and Anderson from the late 1970s. Our insulin-dependent clients reduce their insulin use by an average of 35 percent in only four days, which then increases to an average of 45 percent reduced insulin use over six months.

It’s true, insulin resistance does not cause type 1 diabetes, but it is present in an overwhelming majority of people living with diabetes, especially those who eat a low-carbohydrate, high-fat, high-protein diet. That’s important because insulin resistance is a major risk factor for chronic diseases like heart disease and cancer. In fact, heart disease is the No. 1 cause of death in people living with all forms of diabetes.

Our Western medical system focuses on managing biomarkers—like high blood glucose and high A1c levels—rather than treating their underlying cause: insulin resistance. Following a low-carb diet or taking medication can bring down these numbers, but it won’t reverse insulin resistance or make you healthier.

2. Blood glucose levels become more predictable: When people with insulin-dependent diabetes follow a low-fat, WFPB lifestyle, their blood glucose variability goes down. But wait, you might ask: Doesn’t a low-carbohydrate, high-fat diet work just as well? It’s true that you can flatline your blood glucose and achieve an A1c level less than 5.3 percent by following a truly low-carbohydrate diet (<30 grams of total carbohydrates per day). But this approach can also lead to conditions including increased insulin resistance, hypertension, high cholesterol, coronary artery disease, and cancer.

3. Reduced risk of diabetic neuropathy: Because a low-fat, WFPB diet increases blood flow to tissues throughout the body (due to its lack of artery-clogging cholesterol and saturated fat), it can help prevent and reverse not only heart disease but also diabetic neuropathy, the nerve damage that can lead to pain, numbness, and even amputation and death.

4. Protection against kidney disease: If your blood glucose levels are perfect but you’re eating a lot of animal-based protein, you may still have kidney problems. A low-fat, WFPB diet that excludes animal products reduces the burden on your kidneys because of its relatively low (but nutritionally sufficient) protein content. If untreated, chronic kidney disease can lead to dialysis and/or kidney transplant.

5. The ability to eat a lot and still lose weight: When you learn the simple principles of calorie density and start eating the foods highest in water, fiber, and nutrients, you will see for yourself how eating more can help you weigh less. If you have weight to lose, it will drop off quickly … and permanently! Never again will you need to stop eating before you’re full to keep your body weight at an optimal level. And if you don’t have weight to lose, you will maintain healthy body weight effortlessly, without giving a thought to portion control.

6. Guilt-free indulgence in some of the world’s most delicious “comfort” foods: Luscious, juicy fruits (like mangoes, papayas, and bananas) and starchy whole plant foods (like potatoes, beans, and brown rice) are encouraged in large quantities on a low-fat, WFPB diet. When you’re not eating the (high-fat) foods that paralyze insulin, the carbohydrate energy found in whole, unprocessed plant foods prevents elevations in blood glucose.

7. You get a ton of energy—and many other benefits: You will feel amazing on this diet! As your energy increases, you will find yourself far less lethargic and more capable of movement. And more exercise means better blood-glucose management and greater health and vitality overall. People who eat this way can look forward to a seemingly endless list of benefits that affect every aspect of life. Our clients report better sleep, better digestion, better mood … even increased happiness.

Don’t forget to poke around in the Forks Over Knives articles to see both peer-reviewed research and testimonials from countless people living with diabetes and others who have experienced these benefits (and many more) after changing their diets!

Ready to get started? Check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path. To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer.

The post The Incredible Benefits of a Plant-Based Diet for People with Type 1 Diabetes appeared first on Forks Over Knives.