Have you ever considered following KETO?
Do you think it will work with Diabetes?
If so this quick read is a must for you.
Let’s start by classifying some key terms.
- Purposeful reduction of carbohydrate to less than 50g. Protein ~0.7 – 1.5g/kg and, ~70-80% of energy intake through fat.
- Purposeful reduction of insulin, BUT still taking background insulin and usually small boluses for protein. YOU STILL TAKE INSULIN. There is enough insulin to prevent excessive ketone production and therefore stops acidic blood which is the main issue with DKA.
- Blood ketones ~0.6-3.0mmol/l (can go up to 7mmol/l if extremely strict with the diet and in a negative energy balance, but unusual) – Because the liver has to convert fat into ketones to provide fuel for the brain and muscles, because fat in its original state cannot be burned quick enough to provide the requisite energy.
- Most people following a diet they believe to be KETO are not in nutritional ketosis. Especially type 1 diabetics, because their circulating background insulin is higher than people without. The only way to know is to test blood ketones daily to see if in the sweet spot of ~0.6-3.0mmol/l. It’s easy to knock out of nutritional ketosis from treating hypos, eating too much protein, having a background insulin too high. Don’t fool yourself thinking you are there. Keeping in nutritional ketosis is as much art as it is science!
- A normal blood PH (measure of acidity)
Diabetic Ketoacidosis (DKA)
- Lack of insulin or, no insulin in the body.
Can be from:
- The person not taking purposefully. (teenagers mainly)
- Insulin is faulty and the person does not know.
- Severe illness when insulin requirements ramp up massively.
- Blood ketones greater than 7mmol/with a very acidic PH in the blood.
Risk of death if insulin is not given quickly, requires hospital treatment.
PROS of Nutritional Ketosis (Keto)
- Will get a very good HbA1c – low carb = low fluctuation.
- Some people find a ketones level of ~0.6 – 3.0mmol/l helps curb appetite and support fat loss efforts.
- Often people like the tight feeling of not carrying extra water that is accompanied with high glycogen stores in the muscle and liver.
- Can help with keeping to a calorie deficit because the food choice is very limited.
- Can be effective for long distance and ultra-long distance endurance events – iron man etc. due to the energy systems involved.
CONS of Nutritional Ketosis (Keto)
- Highly Restrictive Diet. A challenge for most usual social occasions unless you are in a keto community.
- Reduced performance. Particularly, for individuals participating in activities that require fast energy burn, team sports, bodybuilding, 10k run, track cycling. Due to the carbohydrate-dependent (glycolytic) nature of the activities, individuals consuming a keto based diet will not be able to perform OPTIMALLY. They will still be able to perform well, but not OPTIMALLY, because they do not have the glycogen (stored carbohydrate) to fuel those activities.
- Electrolyte deficiencies in potassium, magnesium, and sodium can be common, especially in the early stages. Supplementation is worthwhile.
- If you aim is to gain muscle mass and size, the results will be slower. This is because the protein intake has to be capped at 1.5g/kg, full muscle glycogen stores signal greater muscle protein synthesis, and you will not be able to push out those last few reps to get as much progressive overload.
- Dyslipidaemia – Unfavourable fatty acid levels in the blood. If you are genetically susceptible and choose saturated fats primarily, your LDL cholesterol may rise high, which is negative if the particle number increases. Choosing monounsaturated fat options can help prevent this – macadamia nut oil, olive oil and avocados etc.
- Potential to downregulate thyroid function, especially reverse T3. It is important to monitor this Biomarker when on a ketogenic diet.
Personal Case Studies
Phil Graham – Founder Diabetic Muscle and Fitness
The idea of eating fatty foods like bacon, whole eggs, steak, chicken with the skin on, nuts, whole butter and cream, whilst getting lean sounded too good to be true. I was desperate to experiment.
In 2014 I went all in and lived the ketogenic life for 6 months in between Magazine Photoshoots and Bodybuilding Contests.
At the time, my body fat wasn’t high. In fact, it was relatively low. I was just after competing and wanted to use the ketogenic diet to maintain low levels of body fat between my events.
I had experience of eating low carb before, especially in the final weeks leading up to my contests, where calories where ultra-low. Carbs where the main macronutrient I cut out. I always liked the dry look low carb eating brought to my physique. For those of you not familiar with bodybuilding language. ‘Dry’ simply refers to low levels of water retention and bloat.
The ketogenic diet took my lower carb experiences a step further. I kept my intake strictly under <50g CHO for 6 months flat with the odd re-feed day every once in a while (when I felt like it).
Let me bullet point my experience.
- My blood glucose control was the best ever. My HBA1C was 5.5%.
- My blood glucose levels would go high the odd time. This was mostly due to acute periods of stress from training and after consuming red meat. Regardless, I always corrected.
- The food choices where awesome (at the start), but I admit I did get bored quick. The last 3 months where a mental challenge. I missed fruit, oats, bread and milk massively.
- My performance dropped. I struggled to get a pump when weight training.
- My muscles did not look as full and pronounced.
- Social events were awkward. I felt awkward going to dinner parties and dinners. I always had to ask, ‘What had my meat been cooked in?’, ‘May I have the sauce separate please.’ Etc.
- My hunger was blunted to a degree. But, in no way did the ketogenic diet bulletproof my hunger in the long term.
- I took one full day to refeed carbs when I felt I needed it. Getting back into ketosis after this was relatively easy. I did look forward to the carb re-feeds.
I personally do not recommend Ketogenic dieting for highly active people with type 1 diabetes who have a goal of building muscle and strength. It can be used in the short term to drop some body fat. But, don’t expect miracles.
John Pemberton – Head Coach Diabetic Muscle and Fitness
I followed KETO for 6 months in 2016 and results were:
- HbA1c 5.3% – the best it’s ever been.
- Low frequency of hypos because just had background insulin covering most of needs (80%) with small boluses for protein (20%)
- Weight stable at 92kg with a ripped look at 6% body fat. Good for the beach.
- Gym performance average, 1 RM decreased as did my 4-8RM – I did not like this.
- My LDL rose from 2.5 to 5.5 but after changing to monounsaturated fats back to 3.5 (my dad has cholesterol of 9.0 so likely a genetic issue)
Contrary, following a 35% protein, 40% carb, 25% fat for the last year led to the following observation:
- HbA1c 6.0% – A slight increase but still in a very good range
- More hypos because of bigger insulin doses at meal times and therefore more unpredictability. But still only 3-4 a week which I can manage with some dextrose.
- Weight 102kg at 9% body fat – gained 8-9kg lean tissue (probably 2-3kg water and glycogen).
- Big improvement in 1 rep max (RM) and 4-8RM on all lifts
- Can engage easily in social functions, rather than glugging olive oil at the back. This was due to my lack of imagination with food choices. I am a simple man.
- Not always looking as ripped by the end of the day – water accumulation.
I think the best questions you can ask yourself when considering starting a Ketogenic diet are:
- Are my aims gains and high energy performance, and am I happy to put more effort into diabetes management?
If so, KETO is probably not for you. You need more carbs.
- Is my focus optimal on diabetes control with less requirement for management, whilst knowing my physique progress will not be optimal but can still perform?
If so KETO may be worth a trial for you.
There is no right or wrong answer, just the one that suits you.
Just be sure to do your homework before you try, and consult with a professional who has experience in type 1 and KETO.
If you liked this article and want to learn more about nutrition and living with diabetes. You need to check out the Diabetic Muscle and Fitness Training Lab.
It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet. You’ll gain valuable new found knowledge on diabetes, nutrition, training, mindset and more.