The Keto Diet: Is It Safe for Diabetics?

nuts spelling out "KETO" surrounded by keto-friendly foods: avocado, fish, etc.

There have been plenty of variations of low-carb diets over the years, including South Beach, Atkins, and paleo – aka, eating foods similar to those our hunter-gatherer Paleolithic ancestors ate.  The most recent member of the club is the ketogenic or keto diet.  You may have seen the terms “keto” or “keto friendly” begin to appear on tortillas, snack foods, and other items at the grocery store.  You may remember seeing keto magazines at the checkout counter or keto cookbooks at Barnes & Noble.  You might even have friends and members of your family who have “gone keto” and talk about benefits ranging from weight loss to feeling less tired.

So what exactly is this “keto” thing all about, and is it safe for diabetics to try?

pie chart showing the "basic 7" food groups

During WWII, the USDA introduced the “basic 7” food groups to encourage nutritious diets amid the war rationing.

Keto 101


We’re all familiar with the “food pyramid” that developed out of the necessity of rationing during the World Wars.  In 1992, the USDA took the “Basic 7” campaign of the wars and transformed it into the grain-heavy triangle that became ubiquitous on cereal boxes and in school nutrition classes.


USDA food pyramid


It’s become clear over the years that the 6-11 servings of carbohydrates a day recommended by the pyramid is probably excessive if you’re not a pro athlete or marathon runner.  The USDA later introduced “MyPlate,” a more balanced visualization with smaller grains and larger vegetable portions.  


USDA MyPlate guideline image


Keto takes things one step further: it inverts the traditional food pyramid so that fats become the largest component of your diet and carbs become the most restricted category.  That’s a major reversal from what most of us are used to, so let’s dig a little deeper into what makes keto tick.


Breaking Down the Keto Approach


According to Boston Children’s Hospital, the keto diet concept has actually been around for over 100 years!  It’s initial comeback began as a therapy to help control seizures in children with epilepsy.  As with any major dietary change and especially as a true ketogenic diet is quite restrictive, you should not start down this path without consulting and working with your doctor.

People who are following a strict keto diet may obtain up to 90% of their calorie intake from fats.  The principle idea behind this extreme change from a “normal” diet is to move your body away from running on glucose that it gets by burning carbohydrates, and training it to consume fat instead.  This process of “ketosis” produces ketones, fat-based acidic compounds that the body can use as fuel.

Since the body is being trained to run on fat instead of carbohydrates, it follows that a keto diet recommends a much lower carb intake than our familiar food pyramid.  Harvard Health explains that in order to reach and maintain ketosis, one’s daily carbohydrate intake needs to be below 50 grams.  To put things in perspective, a single piece of fruit like an apple or banana contains about 26 grams of carbs.  And standard carb counting guidelines for type 2 diabetics recommend 15-20 grams of carbohydrates for snacks and 45-60 grams for meals.  Quite a contrast!

selection of keto-friendly foods: bacon, cheese, legumes, nots, avocado


Is It Right for Me?


As everyone’s experience with diabetes is different, there is no simple “yes” or “no” answer as to whether you ought to try a ketogenic diet.  Some scientific studies (like this one published by the British Journal of General Practice in 2019) suggest that a lower carbohydrate diet like keto can be an effective method of keeping type 2 diabetes in check.  On the other hand, some type 2 diabetics have tried keto and found that it doesn’t work for them.  Keto can be associated with serious side effects like hypoglycemia and nutritional deficiencies, so keeping an eye out for symptoms of these side effects is crucial.

If you are considering the diet, we strongly encourage you to talk with your physician first.  Ketogenic eating could impact any diabetes medications you are currently taking, so weighing the pros and cons of the diet versus the medication is an important conversation to have with your medical care team.  Your doctor’s office may also provide referrals to nutritionists and other helpful resources for making the dietary adjustments.

Even if you don’t go “full keto,” certain aspects of the diet can be good general dietary guidelines.  Heart-healthy fats, like those found in avocados and nuts, make for nutritious and tasty snack options.  And most medical professionals would agree that vegetables that get the keto stamp of approval (such as Swiss chard, Brussels sprouts, and their cruciferous cousins) are healthy options to include in one’s meals.  So if you’re keto-curious, check out your preferred recipe website and try out a keto dish for the holidays.  Who knows, it could become a new family favorite!

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