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Keto diet / No carbs For Diabetes

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Keto diet / No carbs For Diabetes

Diabetes overview: 

Diabetes is a chronic disease characterized by high glucose levels in the blood, also known as blood sugar. Glucose is the body’s main source of energy and is a critical element in cellular function. 

Insulin, a hormone made by the pancreas, normally transports glucose into the cells. However, when the body is unable to produce enough insulin or use it properly, blood glucose levels increase, leading to diabetes.

If left untreated, diabetes can lead to several health complications especially for the eye, kidney, nerves, as well as can cause heart diseases.

Type I diabetes is an autoimmune disorder where the body produces little to no insulin. Without insulin, glucose cannot be transported to the cells that need it.  When cells do not use glucose, insulin sends it to be stored in the liver.

Type 2 diabetes is the most common type of diabetes. In this form of diabetes, the pancreas produces insulin, however, the body is unable to use it properly because of insulin resistance.

What are the causes of diabetes that can be managed by the keto diet?

When a normal person consumes carbohydrates, the liver metabolizes it into glucose so it can be used for energy by the body and cells. 

Accordingly, when we consume carbohydrates, blood sugar levels tend to rise in the body.

This increase triggers an insulin spike, which is a hormone released to regulate the blood sugar. 

In type I diabetes, the body produces an immune response to attack beta cells in the pancreas. Beta cells are responsible for producing insulin. As a result, people with type I diabetes produce very little to no insulin which is not enough to transport the glucose from the blood into the cells. Thus, because their beta cells are damaged, people with type I diabetes have high blood sugar levels. 

In contrast, people with type II diabetes can produce insulin. However, their bodies are insulin-resistant, meaning that they do not respond or ignore the insulin signal telling the cells to transport glucose out of the bloodstream to use it for energy. Thus, blood glucose levels remain high, causing type II diabetes. 

Furthermore, being overweight and obese make people more likely to develop diabetes. Hence, it is important to maintain a healthy weight.

Why keto diet helps for diabetes?

The keto diet is a type of diet that restricts carbohydrates intake while optimizing the consumption of protein, and promoting fat. This would result in less production of glucose in the body.  Hence, blood glucose level would remain low. This will help control glucose production and maintain it within the normal range. 

Supporters of this diet believe that following a low carbohydrates diet, below the normal recommended amounts, is the optimal solution for patient with type 2 diabetes as it results in less release of glucose in the body. 

Furthermore, the Keto diet promotes weight loss. This aspect, by itself, is another beneficial factor for diabetic patients as it helps in regulating and balancing blood sugar levels as well. 

A study titled “Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up” showed that following a low carb diet had beneficial effects such as reduced body weight and glycemic control as compared to a regular carbohydrate diet.

It was also recorded that these changes were maintained for over 3 years while following this type of diet throughout that period of time.

Is it only sugar that causes diabetes or all carbs? 

There’s a common misconception about diabetes because many individuals believe that it is mainly sugar that triggers blood sugar levels (glucose) to rise. 

While this is actually true, it is not ONLY sugar that increases glucose in the blood but all carbohydrates that consist of starches, dietary fiber, and sugar.

And as these carbs get metabolized in the body, the liver converts them into glucose.  

Why this misconception between sugar and carbs for diabetes: 

Many companies have contributed to this wrong perception by promoting bread and biscuits products as “sugar free or no added sugar - suitable for diabetes”. 

This made people wrongly believe, in a way or another, that it is only the sugar that causes glucose levels to raise in the blood for diabetic patients, not carbohydrates in general.

From the low carbs diet perspective, the truth is while actually "sugar free products" might not contain sugar but they consist of carbohydrates. Accordingly, they are not a good choice for diabetic patients because at the end, they are metabolized into glucose in the blood.

Nevertheless, the main benefit of "sugar free products" is that they can help lower calories intake which helps patients better manage their weight. This contributes to lower glucose levels. 

Accordingly, it is important to understand that sugar is only one type of carbohydrate sources and there exist many other types. Yet, all carbs are harmful for diabetes.

Furthermore, consumption of carbohydrates triggers an insulin spike in order to reduce glucose level in the body. This would lead to more hunger and more food consumption, hence contributing to weight gain.  

Carbohydrates sources include all types of grains, fruits, bread, many vegetables, and low fat dairy products. While people have always heard that fruits and grains are healthy but this is not the case for type 2 diabetes patients. 

How the keto diet works for diabetes?

When carbohydrates are consumed by an individual, they are metabolized in the body and converted into glucose. Glucose being the main source of energy and nutrition used to feed the body and the brain cells.

The keto diet is a regimen that limits carbohydrates to only 5% per day, while limiting protein consumption to a maximum of 20%, and allowing between 70% to 80% of fat.

Hence, by following this diet that is very low in carbohydrate, the body gets depleted from its carbohydrate reserves in few days, and the liver will be only able to produce glucose in limited quantities which help regulate blood sugar levels in the body and treating diabetes.

Furthermore, the other beneficial factor for diabetes that results from following the keto diet is weight loss. Losing weight for a diabetic patient is considered a positive aspect as it decreases blood sugar levels. Hence, it can help further in treating this condition. 

This is based on the fact that weight loss leads to normal body weight ranges, especially if the patient is overweight or obese. Accordingly, the blood glucose levels will improve and cause better outcomes in diabetic patients.

How the keto diet helps promote weight loss?

The keto diet provides this weight loss through two contributing factors that include 1- fat burning and satiety, and 2- low insulin levels. If you wish to learn more about this, visit our keto for weight loss knowledge center. 

1-    Fat burning and satiety: the keto diet restricts carbohydrate intake, thus forcing the body to find another source for energy in order to survive instead of carbohydrates. The alternative energy source is the body’s fat stores that can provide energy when carbohydrate stores are depleted. When the body starts burning fat for energy such as the case in the keto diet, this would result in greater weight loss.

Furthermore, the diet promotes satiety because of the high fat content, and this is an additional contributing factor to weight loss because fewer calories are consumed.
 
2-    Low insulin levels: insulin is a hormone that affects fat storage as such: when insulin levels are high, which is the case when carbohydrates are consumed in high amounts, the storage of fat is increased. On the other hand, when insulin levels are low, which is the case when carbohydrates are consumed in low amounts, fat storage will be reduced and the fat burning process is promoted. 

The keto diet program guidelines for diabetes:

The ketogenic diet suggests consuming 70% to 80% of fat, 10% to 20% of protein and around 5% of carbohydrates only (less than 50 grams per day). 

There are no specific guidelines about the duration of the diet. However, it is generally recommended to follow it for at least three months. 

Currently, there’s not enough data related to the long-term effects of the keto diet. Accordingly, it is not agreed yet whether this diet can be adapted as a lifelong eating plan or it should be applied only for specific durations.

It is recommended also to consume enough proteins to preserve the tissues and muscles. However, it is important to maintain the protein amounts within moderate limits of 20%. Any excess of protein can be converted into glucose in the body. Hence, this would push the body out of ketosis. 

What are macros:

It is very common to encounter the word “macros” while reading about the ketogenic diet. This term is short for macronutrients that include carbohydrates, fat and protein. These three substances provide our body with energy (calories) when we eat. 

Accordingly, if you wish to follow a ketogenic diet and make sure to maintain the “state of ketosis”, it is imperative for you to understand what are these macronutrients, and what you should do to balance them properly. 

Below is a brief explanation about each macronutrient and its main functions:

 

Carbohydrates:

Carbohydrates are made up of sugar and starches, and they are the body’s first source of energy. However, it is possible to survive on minimal quantities since fat and protein become the sources of energy when carbohydrates are not available. 

It is important to count net carbs as the total carbohydrate intake. Net carbs or impact carbs are common terms used in the ketogenic diet. It is the amount of carbs directly absorbed by the body that will contribute to calories, while indigestible (unabsorbed) carbohydrates that we know as dietary fiber, are subtracted from this amount.  In other words, the amount of net carbs is the total amount of carbohydrates minus the dietary fiber.

1 g of carbohydrates = 4 calories

Protein: 

Proteins have many important functions in the body since they play different roles as antibodies, enzymes and hormones. They are needed for immunity, growth, tissue repair and to preserve lean body mass.

Amino acids are what makes proteins and they are known to be the building blocks of proteins. There are twenty amino acids, nine out of them are considered to be the essential ones. These are not produced by the body, instead they come from the food we eat. 

Any deficiency in proteins intake may lead to several health conditions. That’s why the ketogenic diet requires to consume enough protein in order to preserve lean body mass. 

The general requirements are 0.8 grams per kilogram of body weight to preserve muscle mass and 0.8-1.2 grams per kilogram of body weight in order to gain muscle mass. It is important to note 0.8 g/kg is the minimal requirement to maintain good health.

1g of protein = 4 calories

 

Fat:

Fats provide energy for the body and support cells growth. They help the body absorb fat-soluble vitamins (vitamin A, D, E, K) and nutrients. They also help protect the organs and keep the body warm.

Fats are made up of fatty acids and glycerol. There are two essential fatty acids called linoleic acid and linolenic acid (omega 3 and 6) that the body cannot produce. Accordingly, these should come from the food we eat. 

Consuming fats is also known to influence satiety as it gives a feeling of being full for longer.

1 g of fat = 9 calories

Keto Diet Macro Calculator:

1-    Calculate your BMR ((Basal Metabolic Rate): The Mifflin equation

The number of calories required by the body per day is called the Total Daily Energy Expenditure (TEE). This is equal to the sum of the Basal Metabolic Rate (BMR), which is the number of calories the body needs to function at rest, plus the amount of physical activity achieved daily.

To maintain your current weight, you should fulfill your TEE needs. In order to lose weight, you should subtract calories from your calculated TEE. Make sure to always check with a health professional regarding the number of calories you can reduce from your diet.

The Mifflin equation is used to calculate the BMR. It works as such:

Women

BMR (Basal Metabolic Rate) = (10 x weight in kg) + (6.25 x height in cm) – (5 x age in years) -161

Men

BMR (Basal Metabolic Rate) = (10 x weight in kg) + (6.25 x height in cm) – (5 x age in years) +5

2-    Calculate the TEE (Total Daily Energy Expenditure)

To calculate the TEE, the activity level should multiply the BMR.

Activity Factor

Definition

1.2

Very little exercise. Desk job

1.375

Light exercise. 1-3 days per week

1.55

Moderate exercise. 3-5 days per week

1.725

Hard exercise. 6-7 days per week.

1.9

Extreme exercise on a daily basis.

3-    Calculate your macros:

Once the TEE is determined, the macronutrients can be calculated accurately.

Example of macronutrients calculation: 

TEE = 1,600 for a woman.

Fat = 75 % = 1,200 cal = 133.3 g (each gram of fat is 9 calories)

Protein = 20% = 320 cal = 80 g (each gram of protein is 4 calories)

Carbohydrate = 5% = 80 cal = 20 g (each gram of carbohydrate is 4 calories)

This is a typical example of how many grams should be consumed daily depending on the TEE and percentage requirement of each macronutrient. The goal is to be able to choose foods properly that meet these needs.

Keto diet food types for diabetes:

The various food types incorporated in the keto diet are high in good fat and very low in carbohydrates. Maintaining the proper proportions is critical to maintain the state of ketosis. Proportions should be done as per the macro calculation provided in the diet structure section. 

Below is a list of the various food types for Keto diet: 

- Healthy fats: incorporate healthy high fat foods daily such as some oils (coconut, olive), avocadoes, nuts (macadamia, walnuts, almonds, pecans), and seeds (sunflower, pumpkin, sesame, flax). 

- Meat: it is suggested to consume grass-fed beef instead of grain-fed, and free-range poultry because they contain higher amounts of omega-3. Pork, bacon and organ meats can be consumed in moderation.

However, it is important to avoid eating too much meat in order to maintain the protein restrictions. It is also important to note that processed meats like sausages and cold cuts contain added carbohydrates. You should avoid them.

- Dairy: some dairy products are allowed such as butter, high fat cheese, and high fat yogurt, because of their low lactose content. Low fat dairy products should not be consumed as they tend to be higher in carbohydrates.

- Fish: it is suggested to consume fatty fish like salmon, wild-caught fish being the best option. Avoid breaded fish because it contains carbohydrates. 

- Non-starchy vegetables: non-starchy vegetables (low carb) include leafy greens (kale, Swiss chard, spinach, lettuce), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber and celery. Mostly, all vegetables that grow above the ground are lower in carbohydrates, and hence can be consumed.

- Fruits: fruits that are low in net carbs such as berries are allowed. 

- Nuts: nuts can be consumed in moderation as a snack. Avoid cashews and peanuts since they are high in carbohydrates.

- Dark chocolate: 90% dark chocolate and cocoa powder are allowed. Only higher than 70% dark chocolate can be consumed. For example, one ounce (28 grams) of unsweetened chocolate (100% cocoa) has 3 grams of net carbs.

- Drinks: water is the best choice in order to stay hydrated since it has no carbohydrates. Unsweetened coffee and tea can also be consumed. It is critical not to add any sugar. For example, 1 teaspoon of sugar is equivalent to 4 grams of carbohydrates. Hence, this will make it so difficult to remain within the recommended carbohydrates amount if you add any sugar.

Keto diet for diabetes: recommendations to follow

- Always check food labels: some hidden carbs may be present in spices, vegetables, and drinks. Always read food labels carefully before you buy any product.

- Always stay hydrated: make sure you always drink enough water to stay hydrated. Carbohydrates retain water in the body, so a low-carb diet can lead to dehydration and constipation.

- Consume enough salt, electrolytes, and magnesium: minerals can be lost along with water while following a keto diet. It is important to consume enough salt and take electrolytes or magnesium if necessary.

- Restrict your calories consumption: always restrict your diet within the allowed daily calories requirements. Do not exceed the recommended calories, otherwise this will result in weight gain.

Keto diet for diabetes: what you should avoid?

- Limit grains and starches: avoid wheat-based products like rice, pasta and cereals since they are high carbohydrate sources. 

- Limit sugary foods: avoid soda, beverages and juices with added sugars, smoothies, cake, and candies.

- Limit fruits: avoid fruits that are not considered low net carbs and all fruit juices because they are high carbohydrate sources.

- Limit beans and legumes: avoid eating beans, lentils and peanuts because they have high carbohydrate content.

- Limit root vegetables: avoid potatoes, sweet potatoes, carrots and parsnips because they are high in carbohydrates.

- Limit high lactose dairy: while dairy can be high in fat, most are also high in lactose sugar. Be aware of the amounts of carbohydrates present in the dairy products consumed. Avoid highly processed dairy such as ice cream because they are higher in sugar content.

- Avoid low fat or diet products: pay attention to low fat products because they are usually high in carbohydrates.

- Limit unhealthy fats: while a high fat diet is recommended, avoid consuming too much bad fat found in processed vegetable oils and mayonnaise.

- Limit alcohol: avoid full carbohydrates wine, beers, and cocktails with added sugars.

- Avoid processed food: processed foods should be avoided even if they are low in carbohydrates. They are composed of bad fats and increase the risk of several diseases.

- Be aware of sweeteners and sugar: sugar is naturally present in fruits and dairy, and hence these should be consumed in limited amounts. Watch out for sweeteners as well, and go instead for keto-friendly sweeteners or Stevia.  

- Avoid eating farmed fish: While eating fish is great for keto but you should avoid eating farmed fish because of the fewer benefits they might have and the chemical additives they might contain. Check out this video about farmed fish.

Keto diet benefits:

The ketogenic diet includes many benefits besides its ability to treat diabetes. For instance, the diet is known for its ability to reduce weight, control blood sugar, increase mental performance, increase energy, reduce blood pressure, and reduce cholesterol. The diet can also help in Alzheimer’s disease, type 2 diabetes, and solving acne problems. 

Below is a list of the keto diet various benefits:

- Weight loss: the diet is quite effective for reducing weight as it increases the amount of fat burned in the body which contributes to weight loss. Plus, the diet triggers satiety much quicker. Hence, fewer calories are consumed, resulting in additional weight loss. 

- Improve physical performance: the body has large amounts of fat stores that are not used effectively. However, when the body starts burning fat efficiently for energy instead of carbs, it can benefit from large fat fuel reserves available. 

Hence, a long-lasting energy burning process. Accordingly, this diet can sustain improved energy and physical performance. 

- Heart disease: the diet can protect against heart diseases by reducing the risks factors associated with heart diseases such as overweight, triglycerides, hypertension, and blood sugar levels. The diet can also increase the good cholesterol (HDL) in the body and lower the bad cholesterol level (LDL). This would balance the cholesterol ratio in the body and help further in reducing the risks of heart disease. 

- Triglycerides: the diet reduces drastically the triglyceride levels found in the blood. High levels of triglycerides are associated with heart disease.

- Cholesterol: the diet increases the level of good cholesterol called HDL and reduces bad cholesterol. High levels of HDL cholesterol lower the risk of heart diseases, because it helps in balancing the cholesterol ratio. 

- Blood pressure: the diet may also decrease blood pressure levels. Hypertension is associated with many diseases such as heart disease and kidney failure. 

- Epilepsy: the diet reduces significantly seizures in epileptic patients, especially children. Studies have shown that a keto diet can reduce epilepsy, 50% among adults, and 90% among children.

- Alzheimer’s disease: the diet can reduce symptoms and slow down the progression of the disease. This is mainly due to the ketones that can be used as an alternative source of energy and nutrition for the brain.

Other conditions: following a keto diet has also shown to have beneficial effects for other conditions such as cancer, Parkinson’s disease, acne, and polycystic ovary syndrome (PCOS). However, more research and findings are needed in order to support these statements further.

Keto diet for diabetes: what are the precautions to take?

Before you start your keto diet, it is important to take some precautions in case you are taking some medication or if you have any medical condition. Always consult with a health expert especially if you have any of the following conditions or you are taking any medication.

- Blood-pressure: a combination of blood pressure medication and a low carb diet is risky because there’s a possibility of decreased blood pressure from the diet. Low blood pressure may occur within the first days and sometimes might take months to happen. If low blow pressure occurs, it is important to contact a doctor.

- Diabetes: the keto diet will reduce blood sugar levels due to the reduced carbohydrate intake. If you are taking any diabetes medication such as insulin to reduce blood sugar levels as well, it is important to discuss this with your doctor before starting the diet to avoid any possible complications. 

- Pregnancy / breast feeding: it is not advised to restrict any food groups if you are pregnant or breast feeding. A balanced diet is highly required for developing babies. Since the keto diet eliminates completely some food groups, this can be risky for them. Always make sure to discuss this with a specialized nutritionist before starting any diet to make sure you avoid any sort of nutrient deficiencies. 

- Nutritional deficiencies: it is important to watch out for any possible nutritional deficiencies since the keto diet does not include all food groups. Other reasons that may lead to deficiencies are fewer calories that are consumed because they are subtracted from the TEE in order to promote weight loss or because less food is consumed due to increased satiety. Always make sure to follow up with a nutrition expert before starting this diet.

Keto diet for diabetes: is there any side effects?

The ketogenic diet is mainly safe, however there are some side effects that need to be taken into consideration:

- Keto flu: the keto flu is a series of symptoms such as fatigue, headache, nausea and cramps that are experienced by some people following the keto diet. These symptoms are quite common especially at the beginning of the diet.

However, this problem will be resolved in few days by the time the body starts adapting to lower carbohydrate intake and starts burning fat properly. To avoid these symptoms, it is recommended to reduce carbohydrates gradually out of the diet so that the body gets used to this gradually.

- Cramps:  leg cramps are common with the keto diet. It’s an indication of mineral deficiency, mainly magnesium. This is because carbohydrates retain water in the body. Hence, less carbs mean less water retention, resulting in fewer electrolytes as well. It is important to stay hydrated and consume enough salt as this helps retain magnesium in the body. 

- Constipation:  the main cause behind constipation is dehydration, due to less water retention from the reduced carbohydrates intake. It is important to drink enough water while making sure the vegetables consumed contain some fiber.

- Heart palpitations:  during the transition period, the heart may beat faster and harder. This is quite common especially because of dehydration and lack of salt. Accordingly, you should always make sure to have enough water and salt. This should usually solve this problem. However, if this situation continues, you should immediately seek medical assistance. 

- Fatigue: at the initial stages of ketosis while the body is shifting to using fat for energy instead of carbohydrates, people would feel tired. Their physical performance might be affected as well. However, this should be resolved once the body adapts to the new process and starts burning fat properly to produce the required energy. 

- Ketoacidosis: this happens when the buildup of ketones results in higher levels of acids in the blood (byproduct of burning ketones). Ketoacidosis can affect the livers, kidneys, and the brain.

Ketoacidosis can occur for people following a low carbohydrates diet, though it is very rare. However, this can be a more common problem for people that suffer from diabetes. Accordingly, if you have diabetes, it is important to contact your doctor before starting the keto diet.

- Hypoglycemia: this is when glucose levels become very low in the blood. Accordingly, people might experience blurred vision, headaches, and confusion. This might become dangerous if left untreated as it can cause seizures. In some cases, it can even be fatal. Hypoglycemia happens mainly because our bodies are not used to run on ketones from fat instead of glucose from carbohydrates, this might lead in some cases to hypoglycemia.

Published September 2020