Veto The Keto! Here’s Why It ISN’T A Cure-All For Diabetes

“What If They Cured Diabetes And No One Noticed?” is a headline that’s total clickbait. It was published here and well-written by Piper Steele. The purported “cure”? Keto.

“Cure” is a touchy word. Before using it, you’d really better have all your ducks in a row. (Ducks are carb-free, by the way.) “Cure” implies it works and should be the premier treatment for a disease or condition, in this case, diabetes. We speak here of type-2 diabetes, the kind that is usually “acquired”, and that’s by far, the most common in adults.

Keto Isn’t Just “Low-carb”

It takes other low-carb diets like Atkins and “kicks it up a notch”. It’s a high fat diet, to the tune of at least 70% of the calories (often even more) provided by various fat sources. Even protein is limited, so it’s more than just eating high-fat foods like cheese and bacon. Your veggies (mostly green leafies, and even those aren’t unlimited) need added oils and butter.

The premise: the body has difficulty dealing with carbohydrates, so you give it fewer carbs to deal with, substituting fat. The fat is metabolized by the body into “ketones” which can also be used for fuel, even by the brain, even though the body would prefer to use glucose.

Does It “Cure” Diabetes?

According to Steele, it’s a no-brainer. The study she points to makes it look promising. Two groups: the “continuous care intervention” group on the keto diet, and the “usual care” group that just received routine counseling at visits of unspecified frequency. The latter functioned more as a control group.

SURPRISE! The keto group lost more weight and many more came off their insulin meds, compared to the control group. The study went on for two years and the results were sustained.

The Catch – And there Is One

The keto group also received different non-diet intervention. Indeed, they were treated to the following:

• And online app, giving access to “telemedicine communication, online resources and biomarker tracking tools.” The participants were able to upload their body weight, blood glucose levels, and ketone levels.

• The uploaded information allowed for daily feedback and individual instruction to participants. This is intensive intervention, well above that provided to the control group.

• The app facilitated remote communication with a health coach and medical provider, who also recommended modification to diabetic and hypertensive medications.

• Education modules for achieving and maintaining a state of ketosis.

• Clinic-based group meetings, weekly for 3 months, then bi-weekly, then monthly, then quarterly.

• Online peer social support with fellow participants.

If the “usual care” group was also treated to the same, would the outcome have been different? That is, are the outcomes strictly the result of the diet or did the continuous care intervention play a role? My guess is the latter is true, or else why use it for this group only?

Are we seeing the results of weight loss alone? If the control group had experienced similar weight loss, would the metabolic results have been similar?

Are Carbs the real “Devil’s Food?”

It’s ridiculous to place all carbs into one bucket. Dismissing foods such as beans, whole grains, and high-fiber vegetables and fruits is to dismiss some of the healthiest foods known. Their health benefits are indisputable. A diet that lacks these nutrient-rich, anti-inflammatory foods has to be viewed cautiously, especially if adopted on a permanent basis.

Steele doesn’t think caution is warranted here. She writes, “The publication of this study should be enough for doctors and the medical associations to recommend a ketogenic diet for diabetics.” Huh? A responsible practitioner would NEVER recommend a permanent dietary change on the basis of a single study.  Indeed, this recent study advises caution, when “enthusiasm outpaces evidence,” especially when a true keto diet may have long-term side effects, given the avoidance of so many nutrient-rich foods.  

Cut-To-The-Chase-Nutrition Advice

A keto diet for treating diabetics might be one way up the mountain, but it’s not the only way and it may still not be the best way. A more varied, nutritionally rich eating style, low in “empty-calorie” carbs, that includes daily physical activity consistent with one’s abilities – an absolute must in my book.  And get support, ideally from a certified diabetes educator, or “C.D.E.“, trained specifically to help diabetics. You may find such efforts are more sustainable (and enjoyable!) over the long-term – and with excellent results.  

I’ve seen people get off insulin after over two decades of daily injections, just by losing enough weight on a balanced, low-calorie diet with regular exercise.   

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