Improve Diabetes with Low-Carbohydrate and Ketogenic Diets

For people with diabetes, strict sugar control is a daily reality which may lead them to consider following a low-carbohydrate or keto diet. Its rise in popularity is science-driven as a nutritional solution clearly revealing benefits for diabetics, both insulin-dependent (aka type 1) and type 2 (also called fatty, sweet, or non–insulin-dependent). In this context, a wave of institutional recognition is spreading worldwide, with Diabetes UK in 2017, then Diabetes Australia and the American Diabetes Association. This year, Diabetes Canada took a stand in favour of this nutritional therapy which is now considered a full-fledged component of quality diabetes care. Indeed, the evidence for its effectiveness—and cost-effectiveness—is particularly strong in light of blood-sugar management, weight control, and the reduced need for medication.

But what exactly is a “low-carbohydrate diet”? The Canadian report places the upper limit on carbohydrate intake at 130 g/d and acknowledges that very-low–carb diets—defined as providing less than 50 g/d of carbohydrates—would be even more effective. The ketogenic diet is placed in this category, with carbohydrate intakes between 20 and 50 g/d depending on personal profiles, so it bodes well for the diabetic population, especially insulin-dependent (type 1) diabetes. The restrictive nature of this diet as well as the risks of hypoglycemia and deficiencies in certain nutrients make the ketogenic diet a “naturopathic must” for type 1 diabetes, yet following it requires the professional monitoring of a health-care practitioner. As for type 2 diabetes, it should be approached from a nutritional point of view with a low-carbohydrate diet—which is less strict than the ketogenic diet—or a Mediterranean diet. Finally, physical activity, stress management, as well as quality sleep and a clean environment ideally complement the lifestyle required to improve the wellbeing of anyone with diabetes.