It’s no secret that the keto craze has become popular in the dieting world as of late. A quick Google search reveals nearly 76 million results with many websites peddling cookbooks, supplements, and meal plans, and touting their advice as the “ultimate guide to keto.” But let’s back up for a second, what does keto even mean? And what does it have to do with diabetes?
What is Keto?
The Ketogenic or low carb diet is an eating pattern where carbohydrates are restricted. This phenomenon is not new. It began in the 1920s as a treatment for epilepsy but with the rise of seizure drugs, this practice became less common. You may remember keto diets as the Zone Diet or Atkins Diet. These diets were created to mimic the body’s response to starvation, by taking away the main source of energy – carbohydrates. This forces the body into using fat for energy.
So, how many carbs do we need?
The Dietary Reference Intakes (DRI) recommend eating 45-65% of calories through carbohydrates. If you’re eating 1500 calories a day, this comes out to around 170g of carbs. DRIs also state fat should be 20-35% of energy, and protein 10-35%. It’s hard to develop nutrient requirements to suit a whole population because each person is extremely different.
Anecdotal evidence about low-carb diets
If you’ve done any research about type 1 diabetes online, low carbohydrate diets have likely come up. When you read people’s stories, it seems like this is the answer to all of the frustrations of living with diabetes; the pesky high blood sugars, inaccurate carb counting, or trying to figure out the right dose of insulin. The key is to take all of this information with a grain of salt (pardon the food pun). Most of these stories come from individuals own experiences where they may be attributing cause and effect where it may not be present.
For example, let’s say I have a friend named Joe. Joe has had type 1 diabetes for 10 years and has ‘fallen off the bandwagon’ with his diabetes management. He used to count carbs and carefully calculate his insulin dose, but he has gotten so used to doing it, he often finds himself absentmindedly guessing his bolus, forgetting to take insulin until after he’s done eating, and going long periods of time without testing. During his appointment at the diabetes clinic, he discovers his A1c is way out of range, and says to himself, “something has to change!” Joe decides to try a low carb diet as a last resort. He now finds himself paying more attention to food labels, being conscious of what he is eating, and testing more often. Joe attributes his lowered A1c with the new diet, but perhaps he is seeing better blood sugars because of all the other changes he has made.
What does the research actually say about low carb diets and type 1 Diabetes?
The majority of the research is geared toward type 2 diabetes and weight loss. Low carb diets in these studies have shown mixed results, and the jury is still out on whether they are significantly different from other types of interventions. In terms of type 1 diabetes, there isn’t much research out there, and there is even less focusing on long term effects of low carb diets.
Unfortunately, the takeaway here is that more research is needed, and we don’t have enough evidence to change current recommendations. We also need to think about the implications of these types of diets. Perhaps in a few years, low carb diets will be considered the best way to manage diabetes, but we need to make sure they’re safe before putting them into practice guidelines.
As a Registered Dietitian, I follow a code of ethics and practice standards. I have to make sure my practice is evidence-based and rooted in science This means I can’t recommend something that isn’t rooted in solid research. With that being said, research takes time. As a person living with type 1 diabetes, I understand feeling absolutely defeated by this disease, and getting so fed up that you’ll do almost anything to get those perfect blood sugars. Despite being an expert in nutrition, I believe that my clients and patients are experts in their own lives. I am a huge advocate of finding what works best for you and your own management with the help of your diabetes team.
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