- Some research has found that the keto diet may help people with diabetes manage their symptoms by cutting carbs and replacing the calories with fats.
- A startup called Virta Health has led pilot programs finding that blood-sugar levels could be reduced to pre-diabetic levels on the keto diet.
- However, some experts are concerned about the unknown side effects of keto in the long term, including on cholesterol levels.
- Visit Insider’s homepage for more stories.
Some research has found that high-fat, low-carbohydrate keto diet may be able to help treat people with diabetes.
Companies like Virta Health are testing the diet as a treatment for veterans, in partnership with the US Department of Veterans Affairs, based on evidence that the diet could help people with diabetes manage their blood sugar and ease symptoms.
Here’s how it could work.
Keto could reduce symptoms of diabetes by managing blood glucose, but it isn’t a cure
Diabetes is an inability to balance blood sugar. When you eat carbohydrates, your body converts them into glucose, which raises blood sugar. People without diabetes can produce enough insulin to balance their blood-sugar levels, but for people with diabetes, the body doesn’t produce enough (Type 1 diabetes) or has become resistant to its effects (Type 2 diabetes).
Reducing carbs targets the source of the problem by preventing blood sugar from rising in the first place, said Dr. Mark Cucuzzella, a professor at the West Virginia University School of Medicine, a US Air Force reservist, and a marathon runner who has published several studies on keto and diabetes.
“The most impactful thing on your blood glucose is the amount of carbs in your diet. The low-carb diet is effective because it lowers the insulin load,” Cucuzzella, who is not affiliated with Virta, told Insider in an interview. “Insulin is the master switch.”
Medications, including insulin injections, can help mitigate the symptoms of diabetes by managing blood-sugar levels. But the keto diet could help people with diabetes reduce those medications, said Dr. Sarah Hallberg, Virta’s medical director. Eating carbohydrates causes blood sugar to rise, but eating fats does not. It means people with diabetes could get their daily calories without needing to use insulin to balance spiking blood-sugar levels.
“Standard treatment puts people on a one-way street of progression for diabetes, with temporary pharmaceutical treatment that will have to be added on to,” Hallberg told Insider. “We’re able to give people another lane going the other way by bringing blood sugar into non-diabetic range while reducing and eliminating medication.”
However, that doesn’t mean keto can cure diabetes.
Virta refers to its treatment as “diabetes reversal,” meaning it’s in remission, Cucuzzella said. The treatment would work only as long as the low-carb diet is maintained; if it isn’t, the same problems with blood sugar and insulin could emerge.
What makes a good keto meal plan
A keto diet is any eating plan that pushes the body into a state of ketosis, when it begins producing substances called ketones, said Dr. Ethan Weiss, a cardiologist who developed a ketone-detecting device. (Weiss previously served as a medical advisor for Virta.)
Keto typically refers to eating plans in which most daily calories come from fat and some protein and 5% to 30% come from carbohydrates. It’s often been described as a way for people to lose weight without sacrificing rich foods like butter, bacon, and burgers.
People with diabetes could cut their carb intake to as low as 30 grams a day and still be healthy, Cucuzzella said. (A medium banana has about 27 grams of carbs.)
But the key to medical keto is focusing more on the quality of foods you’re eating in a day than counting the amount of macronutrients like fats, carbs, and protein in them.
Hallberg described a “well-formulated ketogenic diet” as one focused on whole-food sources of fats and designed to cut carbs without eliminating nutrient-rich foods like veggies. Hallberg said this means at having least five servings a day of non-starchy vegetables, using healthy fat sources like olive oil, and definitely not eating bacon for every meal.
“The idea that this is all meat sticks and heavens knows what else is not true,” she said.
This is in contrast to some fad forms of keto or those without medical supervision that involve heaps of bacon, cheese, and fast food. These types of diets concern nutritionists because they eliminate nutritious carb-containing foods like fruits and starchy vegetables and replace them with low-quality fats.
Critics say the ‘enthusiasm outpaces evidence’ when it comes to long-term effects of keto
The long-term health effects of the keto diet are unclear.
The Physicians Committee for Responsible Medicine, a group of medical experts advocating a plant-based diet, sent a letter to Veterans Affairs officials in April asking them to reconsider the partnership with Virta and the keto treatment, citing evidence that a high-fat, low-carb diet — and particularly diets high in saturated fats — might increase the risk of diabetes.
People have also noted that most of the data suggesting that keto can treat diabetes is from studies led and funded by Virta itself. And there is barely any hard data on keto’s health effects beyond two years on the diet.
However, keto advocates have said that the quality of health outcomes on keto greatly depends on what’s included in the diet and that focusing on healthier unsaturated fats might be a way to convey the benefits with fewer risks.
Weiss, who follows a keto diet, said that rising levels of LDL cholesterol, or “bad” cholesterol, were indeed a potential issue for keto. Research may be starting to suggest otherwise, but Weiss said he wasn’t willing to risk going against conventional wisdom about saturated fats just yet.
“There’s no evidence that LDL cholesterol after keto diet is dangerous, but I’m not waiting around to take that chance,” Weiss said. “There are many ways to do that diet, and people don’t have to eat all that saturated fat.”
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