So a few months ago I started the keto diet and the overall results have been good. Basically, I’ve lost 30 lbs, my A1C went from 7.2 to 5.7 and my bg went from a 180-240 average to an awesome 90-105 average and even my cholesterol went down to high normals (but not great). Additionally, I’ve been so low that my doctor has pulled me off insulin but still taking met. Downside my triglycerides have remained super high but I assume this to being part of my work in progress and of course I don’t have total support from the majority of the doctors I see.
I was wondering what everyone’s thoughts were about this diet? I’d also like to hear about the success and struggles anyone has had with the diet, their PCP’s or information they have learned that could help people just starting a diet like this.
I am enthusiastic about the result so far, but I have concerns with the amounts of fat and or health risks of such a diet. I recently found myself in a state of depression and fear when thinking about my mortality and want to know that I’m picking the right diet, taking the right meds, getting the right exercise etc.
Any advice, thoughts, concerns, are welcome.
Thank you so much.
hey sean
what type of diabetes do you have?
if you are type 2 I believe keto is good because that is curable but if you are type 1 then it isn’t a good thing. I actually was just reading an article about this on this website under resources. it was about a guy who did that and didn’t eat any carbs he got so good with the keto diet and lost a lot of weight but he got real weak and sick and his doctor told him he needed carbs. since you’re seeing a doctor i’m assuming that it’s working for you and that is totally awesome! I’m a type 1 and am new to a pump. I’ve also gained some weight so I have been researching the keto diet but low carb seems great for everyone at this point.
At the moment I am classified as a type 2 and living as such, but my endo believes that I maybe LADA based on some of my test results. We just keep a close watch on how things are changing. Yes, a low carb diet is truly something I believe is the diabetic safe zone. My overall plan was to use Keto to help with weight loss then transition to a low carb diet. I was actually going to check out Dr. Bernstein’s book too. I wish you luck on your transition to the pump.
I have a friend who lost a lot of weight on the keto diet. He says he feels fantastic. He does take a lot of precautions to make sure that he’s getting enough vitamins while on the diet. He does not have diabetes (disclaimer).
Next, sorry for my long response below. I’ve been thinking about this a lot lately, and I am considering adjusting my diet a little bit.
I’ve done a lot of research recently on the development of complications as a result of T1D. In the Joslin medalist study, they found that the development of complications was highly associated with certain advanced glycation end products (AGEs). Our bodies tend to create AGEs at higher glucose levels. In fact, an A1c is simply a measure of glycated hemoglobin. A higher A1c indicates more glucose is attaching/glycating to hemoglobin and other proteins.
The result of those conclusions is that we want to limit the AGEs in our body. The most straightforward way, in my opinion, is keeping our blood sugars in the “normal” range and acheiving a “normal” A1c. However, in my recent research, I’ve discovered that we actually ingest AGEs and AGE inhibitors on a day-to-day basis. Highly processed foods contain AGEs whereas foods high in antioxidants tend to have AGE inhibitors. An AGE inhibitor essentially assists your body in blocking the development of AGEs. This is described in the study below.
Some of the AGEs and perhaps AGE inhibitors we ingest may be filtered out. Still, the research article above provides a convincing enough argument (by listing studies) that we should be thinking about AGEs and AGE inhibitors when we think about the “ideal” diet. Polyphenols are an excellent source of AGE inhibitors and luckily many foods have poyphenols. Here’s one list: Polyphenols Food List: Seasonings, Berries, and More. Foods high in antioxidants tend to have some AGE inhibitors as well, and that’s pretty easy to figure out.
All of this is to say that from my perspective as simply another person with T1D, eating foods high in vitamins and AGE inhibitors is the ideal diet for someone with T1. That also includes avoiding highly processed foods high in AGEs.
I would think that is possible on the keto diet, but I’ve honestly never tried the diet so I couldn’t say. You could definitely keep these things in mind though as you decide if the keto diet is right for you.
Shortly after I was first diagnosed, I asked my nutritionist about AGEs and she looked at me like I was nuts. This is an RD who is brilliant, but she had no idea what I was talking about, that, or she didn’t want to get into a conversation about it. Knowing her as I do now, I’m inclined to believe the latter is true!
I have to run shortly, but I do have some info to add to this topic (Keto Diet?) and I’ll try to get to it tonight!
My blood sugar is good eating keto. I’ve tried it a bunch of times because I want it to work but I feel so horrible on it that I can’t sustain it. I’m T2, although they haven’t completely ruled out LADA.
I was actively eating a keto style diet for several months and it works great and I had no concerns about my health or getting enough nutrients while on it. The only problem I have with keto is it is really hard to get enough fat to experience the full benefit from it and while you can be in nutritional ketosis without your diet having 70% fat it just doesn’t seem quite as effective.
I’m thinking that I might need to go back on it though because I’m having some BG issues from things not really related to diabetes, and the very high fat will help tamp down on the things my body can absorb and do crazy things with. While I agree that some people do not do well on high fat diets I don’t think it’s a matter of being type 1 or 2. I think if you listen to your body it will quickly tell you if your diet is affecting you badly and you should do what it says. Since a keto diet seems to be working really well for you then I see no reason not to continue.
I think you are on the right track with your current eating style since your weight, BG control, and cholesterol outcomes all improved. You can’t argue with success.
I would not worry about your fat consumption as long as you don’t eat trans-fats found in processed foods and margarine. I believe the fat hysteria going back to '60s and '70s was a total mistake from a public health perspective. Diabetes and obesity are up. Heart disease is also up. As a society, we did reduce our fat intake during the last 40-50 years but our overall health deteriorated significantly.
In the past, I’ve found that I cannot go into nutritional ketosis without eating less than 20-30 grams of carbs per day. I currently eat about 60-75 grams, so I’m not in ketosis or on a “keto” diet. I would describe my way of eating as low carb, high fat, and mostly whole foods.
I say keep doing what you’ve been doing as your body is telling you to keep it up!
Keto is great for BG. Mine is so stable when I am in Ketosis and it makes life so less stressful. The only problem… Very difficult to sustain long term for me and many others. I also question how healthy it is to have a diet that is not well rounded. I eat a lot of veggies while on Keto but the rest is just meat, cheese, and nuts. It gets old really quick. These days I just try to keep my carbs to 30 or less per meal and find i have much less problems (lows and highs) if I stay in that range.
My husband and I have been doing keto for about three months now and love it.
Our family doctor and my endless list of specialists (including my endo, cardiovascular, cardiologist, rheumatologist,…) all know we are following a keto lifestyle and are fine with it. My cardiovascular surgeon is following a keto lifestyle himself.
Ninety-five percent of the time we’re following the basic keto macros, give or take a few percents, of low carb (5-10%), moderate protein (10-15%), and high fat (75-80%). Our carbs come from fresh vegetables, greens, or berries, not breads or grains. We use butter, olive oil, whole milk, half n’ half, heavy cream (vs the 2% we used to use), full-fat cheese,… good fats. I’m a salmon eater, always have been. My husband enjoys red meat, pork, and chicken, which I eat as well. We eat pretty much the same as before, just without the potato, spaghetti, bread, and starchy vegetables. I log my meals, so I am able to calculate (with the help of fit-bit) my macros. Off-topic, but as a side rant, fit-bit is using the old ADA nutrition macros, and warned me I was off-kilter. Shortly after we started keto, my fit-bit report said, “Your calorie composition from protein, fat, and carbs is a little out of balance. It’s recommended that you get 10-35% of your calories from protein, 20-35% from fat, and 45-65% from carb. Your fat intake is high at 73% and carb intake is low at 6% .”
Besides learning about keto and the ins and outs, I’m also learning how to make meals and desserts using swerve (and stevia), almond or coconut flour, heavy cream,… there are a lot of delicious recipes out there for keto! My husband loves ice cream and we have made some good and -not-great-yet- batches. We keep adjusting the quantities of whole milk, half n half, and heavy cream, and flavoring. We’re happy, it’s refreshing, cold on a hot summer night, low carb/high fat, and most of the time, tasty. LOL. We do eat out often and find that keto is generally available anywhere.
Possibly the best advice I could offer now, as a novice (I’m still quite new at this), is to get enough salt in your diet. Having a cup or three of broth a day will help. I made my own electrolyte drink until Gatorade Zero came into town! I’ve read (and experienced) going keto you’ll exrete a lot of water and sodium, which effects the level of potassium. It was amazing how ill we both felt and it came on strong and but only lasted only a few days. We were very tired and I was dizzy and nauseated. We didn’t pay enough attention to our salt intake and once we adjusted that and we became accustomed to keto, we were fine.
I use an OmniPod and Dexcom G5. I find that I don’t need to bolus much, if at all, for these low carb/carb free meals and I’m more than satisfied and I stay within range. I gradually lowered my basal, not wanting to go low, but I’m finding that my basal is fine and I am back to my normal settings. I could stand to lose more weight, but I have lost 14 pounds!
My husband is Type 2. He’s lost 35 pounds (and I’m stricter than he is - sheesh!) He uses basal insulin and metformin. His Lantus has dropped, a lot, 72%. He is still on metformin. Our family doctor told him that he may soon be off of insulin. I’m not sure about that. I’d like to find some answers as to if it is smarter to reduce metformin or insulin. They both have their benefits.
We were on vacation a few times this summer and found it easy to find something to eat and we also allowed ourselves a few excursions away from our regular keto macros, so we could participate in the local flair of where we were. The vacations were why I said we follow a keto plan 95% and not 100% of the time. That and we do indulge a little here and there at special times, birthdays and such. When my husband lost 25 pounds I made him homemade spaghetti to celebrate, his favorite. It was very hard for him to give that up, but he’s doing it! It was easy returning to our keto lifestyle when we returned home from vacation and we didn’t experience the keto flu, as we did when we first started, for which we were very thankful, but I’m guessing that’s because we know about the salt intake now!
Get some books (or websites) and read. We’re reading The Art and Science of Low Carbohydrate Living by Jeff S. Volek, PhD, RD and Stephen D. Phinney, MD, PhD.
That is so cool that you have someone to do the diet with. I know my partner is doing the “dinner’” part with me but they eat normal meals at work (lucky). I try so hard not to take it personally lol.
Thank you so much for the advise, I have picked up a few books from Costco already that’s loaded with recipes and good information. I was wondering if you guys have had any blood work done since you have started Keto? If so did you see any improvements or drawbacks? Congrats to both of you on losing weight period. It’s such a pain to lose weight nowadays.
I was also wondering if you saw a difference in bg spikes when you guys indulged a little? Was it just a here and there thing? or did you go a few meals (when i break from the diet its usually for a weekend)? I’ve had interesting bg results from both situations. I have noticed that if I break from the gym and have cheat meals I see a spike especially with desserts (my favorite thing since being diagnosed). However, if going to the gym and have a cheat “weekend” I stay in the 100-120 range. I know I’m doing a 30% deficit right now 10-20 carbs a day, 150ish fat, and about 145ish protein = 1900kcal, I definitely am feeling the struggle. Plus im going to the gym doing 45min weights and 45 min cardio. THE STRUGGLE IS REAL LOL!
Last question, since you have 2 perspectives have you faced any hypos since being on the diet? The last 2 weeks after the gym I drop to 65ish
Thanks for the reply, yes the first few weeks of getting into keto is a pain. I also try to incorporate veggies as much as possible, but this diet is so restrictive. If you do want to try it again I’d recommend the Simply Keto book from Costco (I’m sure it’s at other places), it’s full of easy practical recipes that can keep things changed up. As an example they have like Keto Chili which is similar to southwest style chilis for one meal, then the next recipe or meal is chili dogs.
Thank you for the words of encouragement. Yes, it is very interesting that as the Keto diet gains popularity more studies are starting to surface or looked at that prove low carbs diets are the best way to go for basically everyone. If you look hard enough you can see the fear in processed/fast food companies lol.
I think my biggest struggle it is “fear” of being left out when hanging out with friends and family while they eat. Unfortunately, this also leads to my “weekend” breaks where and there from the diet. The only plus to the breaks is that in general, its a way of carb cycling which has helped with the weight loss just not the BG #'s
That’s awesome that it worked for you the first time, and I highly encourage you to try again, especially if it helps. As I’m learning it seems to be easy to add fat if you use coconut oil in a lot of stuff, as well as MCT oil (I recommend the flavored ones). I think my biggest struggle is getting the protein. If you can afford it you can always try Exo-ketones, to boost your ketones, they work pretty well, but the price is the drawback.
I’ve had extensive blood work done since diagnosis (originally as Type 2, re-diagnosed as LADA), and I started eating keto about 2 weeks after I was diagnosed in 2016. I’ve since transitioned to more of a “ketogains” type diet when strictly controlling carbs or (as Terry suggested) a “low carb” diet with about 50g net carbs per day. Here’s what I know about the blood work for me:
my LDL and VLDL cholesterol has dropped through the floor, but it took time (about six months of eating low-carb)
my Triglycerides went from high to at the very bottom of the normal scale in about the same time frame (six months), but they’ve come back up since I’ve started working out and trying to gain weight. They’re “ideal” now according to my doctor, but that’s from the combination of eating low(ish)-carb, taking therapeutic doses of niacinamide, and working out like crazy (power- and Olympic weighlifting)
rest of my non-pancreas related blood work is usually perfect since I changed the way I was eating, with a couple of exceptions: because I work out and eat a ton of protein (150-180g per day), my kidney function tests every once and a while show mildly elevated numbers; my doctors don’t worry about it, given how I’m eating and why. Also, I have issues with fasting insulin and c-peptide too low and immune function tests all over the place, but those are consequences of autoimmune disease rather than diet.
Like others have mentioned, strict keto (less than 25g of net carbs per day) was very good for getting my BG rapidly under control after diagnosis. I’ve seriously struggled with being that strict over the long run, and I tend to vacillate between very low- and low-carb consumption depending on other factors. I’ve personally found that increasing my strength-based training has had as much or more of an effect on overall blood work and health than the diet, but they work best (for me) in tandem.
Finally, don’t believe anyone who tells you “you must eat carbs to be healthy.” That’s just biologically inaccurate, and the reason doctors and nutritionists sometimes say it is because (assuming they aren’t just ignorant) they do know that low-carb diets are very difficult for most people to adhere to over the long-run, so they encourage moderate-carb diets in combination with medication. Nothing wrong with that, but I wish they were honest about it… The biological truth is fairly straightforward: you must consume a minimum amount of both protein and fats per day in order to have normal metabolic function; your body is really good at converting stored or eaten protein and fat into glucose (i.e., carbs) when they are needed. As long as you get enough calories, protein, fat, and minerals/vitamins, your internal biochemistry will take care of the rest. Is it fun to eat zero carbs? No. Is it perfectly healthy to do so? Yes, so long as you’re getting the rest of your macro- and micro-nutrients.
Side note: Keto is pretty popular for people losing weight these days, largely because it helps to minimize the amount of insulin the body needs to produce (leading to reduced feelings of hunger, etc.). It also helps many people to feel full while eating a lot less than they are used to. Those things are great if you need to lose weight. One of the real drawbacks of keto (or other strict low-carb diets) is that for those of us who are insulin deficient, it can lead to dramatic and uncontrollable weight loss (similar to what happens with untreated “typical” Type 1s immediately before diagnosis). For some people like myself who want to gain weight (muscle weight, that is), eating low-carb and being insulin deficient makes life difficult
@ Sean_O_039_Dizzel Yes, it is nice to have someone to do things with, I agree! Except for salmon and a few vegetables, we generally like the same foods.
The books surely do help, don’t they!
We had labs taken a few weeks after we began keto, so the next labs will be more reflective of keto, vs just low carb, which my husband had started a few months prior.
Thanks for the congrats on the weight loss too! Talk about struggle! LOL
As for bg spikes, yes, he did go up (too high), if he ate a high carb side or dessert. We were very diligent in taking his bg an hour and two hours after meals. With my cgm and pump I just bolused for the food I was eating and had no trouble.
We went off keto here and there while we were on vacation, but it wasn’t a wild free-for-all or anything. We didn’t waver too much really. I remember being very disappointed with one dietary excursion … I pre-bolused for a piece of pie we were splitting at a local restaurant/bakery, thinking it would be this awesome flaky pastry, thick, velvety chocolate mousse, mounded with meringue … and when the pie came, it wasn’t anything like that. It was flat, ½ inch, no meringue, and more like a graham cracker crust. I was so sad. LOL Otherwise, except for a few birthday type events, we stay on keto. I have a tendency to eat meals once or twice a day with a snack at night (like some cheese or keto ice cream or berries or nuts or … chocolate! (I have a keto chocolate mousse recipe we really like), …) Surprisingly, neither of us gained any weight while on the first, longer vacation. Probably because of all the extra activity. I don’t want to talk about the second, much shorter vacation!
There is a lot of discussion on the internet about 5/2 meal plans. That’s wonderful that it is working so well for you! It is interesting that you aren’t as effected when taking two days instead of just one meal/dessert. Is that normal for that type of plan? I think we are more geared to keto as a lifestyle choice, but do allow the occasional diversion, so we are more a 95/5, but without any structure. Many who follow keto, don’t allow for diversion. I agree fully with … whatever works, for you, do it … and an occasional diversion works for us. Keto, low carb, paleo, intermittent fasting, … they each have their own pluses and minuses, but I am smitten with keto!
Yes, exercise helps, a lot! I see the same thing you are, even before keto … if I indulged, with carbs, without exercise, my bolus wasn’t as responsive, as when I would exercise. Plain and simple, exercise helps. I’m not sure if you were around during the Big Blue Exercise Test on TuDiabetes, but wow, it showed what a little, a lot, and anything in between, can do! Even a walk helps me, without the harder exertion we get from the gym. Our workouts at the gym aren’t as strenuous as yours are! You are a lot lower in kcal than I would have thought, for the workouts you’re doing - a struggle to say the least! We use the treadmill, bike, and some resistance/weights machines. I don’t know their names, I just move from one piece of equipment to the other. I’ve set fit-bit for a 500kcal deficit, and most days I’m in range. And, logging helps me to understand why, if I didn’t meet my goal. I log a lot more than just food though, bg, bolus, basal, exercise, stress, activities, … My husband doesn’t log, except for his bg. His exercise and activity is much higher than mine and he eats breakfast and lunch, where I may or may not.
My husband hasn’t had any lows. He is generally in the 80s-120s – now. I’ll drop into the low 60s – Dex makes the announcement and I respond in kind. This isn’t unusual for me (but it isn’t common/daily either), and it isn’t from keto, but from other variables, such as activity/exercise and for other odd, sometimes inexplicable, reasons. My basal stays nice and flat when I don’t eat. Low carb definitely helps keep the lows and highs at bay. Highs happen sometimes too, but I am so glad to not be dealing with constant highs from not absorbing properly! Now if I’m high, I (generally) have an idea why. I can honestly say that keto has made life better for us, more than low carb ever did.
The DOC speaks a lot about the Diabetic Athlete’s Handbook by Sheri Colberg. I have yet to read it myself, but if you do a search here you’ll find a lot of good reviews. Reading it might help with how/when to reduce/pause your basal during exercise.
I think if more people knew about how to properly increase their salt intake and how to make/enjoy some easy, high fat meals/treats, they would do much better, for much longer. That and the willpower to get beyond craving carbs, which is accomplished by not having any! So far, so good, for us.
I hope this helps you some more, Sean. It sounds like you’re on a good track!
Question - for those on the keto diet, who may go low (BG), what do you do/consume? I suppose in that case, it’s necessary to eat a refined carb, no? Thanks!
I was dagnosed with LADA 2 1/2 years ago. I started the low carb/keto diet then. I have lost 75 pounds, am a normal weight for the first time in 40 years (I’m 65). I eat 20 grams of carbs a day and my blood sugar is still normal with no meds, although it is inching up slowly. My labs are all normal, other than my antibodies. I also have Hashimoto’s and underactive thyroid. This is easy for me and I can be keto forever !
LOL Otherwise, except for a few birthday type events, we stay on keto. I have a tendency to eat meals once or twice a day with a snack at night (like some cheese or keto ice cream or berries or nuts or … chocolate! (I have a keto chocolate mousse recipe we really like), …) Surprisingly, neither of us gained any weight while on the first, longer vacation. Probably because of all the extra activity. I don’t want to talk about the second, much shorter vacation!