Ketogenic Diets & Diabetes

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The Diabetes Council asked me to comment on whether I would recommend ketogenic diets and diabetes.  To see my response click here and scroll down to number 31.

Unfortunately my references had not copied over and the formatting is skewed.  So to see the full article I wrote, see below:


Do you recommend a ketogenic diet to someone with diabetes?  Why or why not?

Currently there is a lot of debate around carbohydrate intake -specifically low carbohydrate diets- in those with diabetes.  The theory behind this is that these are the most suitable for those with diabetes.

First let’s look at what a ketogenic diet is…

A ketogenic diet is a high fat and low in carbohydrate diet.  There are different definitions of the amount of carbohydrate to include in a ketogenic or very low-carbohydrate diet.  These vary from 20g per day to 50g per day (or less than 10% of overall energy intake)1.  To put this into context current intakes of carbohydrates in the diet in America & the UK are around 50% of overall energy intake (this equates to 250g to 330g per day – dependent on age & gender)1,2,3.

Ketogenic diet & diabetes

A reason this is such an area of interest is because carbohydrates have the biggest effect on a person’s glucose levels.  Restriction of carbohydrate has shown the greatest reduction on glucose levels1.  There has also been a large body of research within this area, however as many studies contradict each other it can be difficult to know what the evidence means.

Type 1

There have been studies which have shown that by adopting a low carbohydrate diet of <75g per day, has resulted in significant improved HbA1c levels, and as a result reduced insulin doses.  Though promising, these were small studies.  In addition, there have been studies that have shown no significant difference in glycaemic control when following a low carbohydrate diet4.  Due to the lack of evidence and lack of long term data, DiabetesUK & the American Diabetic Association do not recommend low carbohydrate diets for type 1 diabetes.  The current evidence suggests that to improve glycaemic control in type 1 diabetes is by carbohydrate counting5,6,7.

Type 2

Data from systematic reviews and meta-analysis have shown that a low carbohydrate diet is effective for weight loss, improved glycaemic control and reduced cardiovascular risk7,8,9,10.  This type of evidence is a lot stronger than that for type 1 diabetes.  However, it is worth noting that ketogenic diets were not found to be superior to other methods of weight loss11.  In addition, though ketogenic diets were found to produce the greatest weight loss compared to other diets, in the long term there was no difference12.  This means ketogenic diets are not superior to other weight reducing methods.  Both Diabetes UK and the American Diabetes Association recommend long term weight loss and for individuals to find the right lifestyle changes that suit them.  This could include a low-carbohydrate diet as we know it is safe for those with diabetes, or another diet5,6.

It is not recommended to use low-carbohydrate diets in children as this can lead to growth failure and nutritional deficiencies13.

If you choose to go low-carb:

  • Inform your healthcare professional as it is likely your diabetes medication may need adjusting.
  • Consider the amount of carbohydrates you want to include; many studies that have shown beneficial effects have been because of low to moderate carbohydrate intakes (130g-225g per day) rather than very low carbohydrate intake (around 20g-50g per day).
  • Monitor glucose levels closely, if you are experiencing hypoglycaemia or hyperglycaemia, you should seek advice about the diet and managing your glucose levels by a healthcare professional.
  • Often by reducing the carbohydrate in your diet means the fat in your diet may increase. Choose fat sources that are unsaturated such as avocados, olive oil, olives, rapeseed oil, unsalted nuts, seeds and oily fish.  Avoid saturated fats such as butter, lard, ghee, suet, coconut oil or cream, fat on meat, full fat dairy products, processed foods such as cakes, biscuits, pies, pastries and takeaways.
  • Carbohydrates will still be in your diet (even if in small amount) – consider wholegrain options (such as brown rice, granary breads and wholegrain pasta) and include fruit and vegetables. Avoid including refined carbohydrates such as white bread, white rice and pasta.



[1] Feinman et al. 2015. Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base, Nutrition, 1-13.

[2] Scientific Advisory Committee on Nutrition (SACN). 2015. Carbohydrates and Health.

[3] Public Health England. 2016. Government Dietary Recommendations.

[4] Dyson et al. on behalf of Diabetes UK Nutrition Working Group. 2011. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med.1282–8.

[5] Diabetes UK. 2017 Position Statement; Loew-carb diets for people with diabetes.

[6] Diabetes Care. 2017. Standards of medical care in Diabetes – 2017, The Journal of Clinical Applied Research and Education, 40.

[7] Dyson. 2008. A review of low and reduced carbohydrate diets and weight loss in type 2 diabetes. Journal of Human Nutrition & Dietetics, 530–8.

[8] Kirk et al. 2008. Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. Journal of American Dietetic Association, 91–100.

[9] Castaneda-Gonzalez et al. 2011. Effects of low carbohydrate diets on weight and glycemic control among type 2 diabetes individuals: a systemic review of RCT greater than 12 weeks. Nutricion Hospitalaria, 1270–6.

[10] Naude et al. 2014. Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PLOS One.

[11] Dyson. 2015. Low Carbohydrate Diets and Type 2 Diabetes: What is the Latest Evidence? Diabetes Ther, 411-424.

[12] Foster et al. 2003. A Randomized Trial
of a Low-Carbohydrate Diet for Obesity, The New England Journal of Medicine, 2082-90.

[13] de Bock M, Lobley K, Anderson D, Davis E, Donaghue K, Pappas M, Siafarikas A, Cho YH, Jones T, Smart C. Endocrine and metabolic consequences due to restrictive carbohydrate diets in children with type 1 diabetes: An illustrative case series. Pediatr Diabetes. 2017.




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