Is keto safe for type 1 diabetics? Ah, the million dollar question. I see (and hear) the topic of keto and T1D being brought up a lot, especially lately. Unfortunately there is just as much misinformation being spread about it as there is curiosity. So let’s dive into everything you need to know about keto and T1D.
What is Keto?
Keto, short for Ketogenic, is a way of eating that puts your body in a state of nutritional ketosis. Sounds fancy, but it simply means that your body is burning fat for fuel instead of glucose.
Most experts will argue that fat is the body’s preferred source of fuel (and every expert agrees that it’s the brains & the hearts preferred source of fuel) and that eating a ketogenic diet allows your body to function the way it has evolved to function.
Typically, to enter a state of ketosis a person would be consuming less than 100g of total carbs per day. Which in my experience, if you cut out processed foods (especially breads, pastas, and cereals) and are clean eating, it’s pretty hard to go above that mark anyways.
Fun Fact: Before insulin was invented, or even widely used, doctors would put their type 1 diabetic patients on a ketogenic diet to prolong their life. Makes sense right? Why feed sugar to a person who can no longer break down sugar. Of course we have basic bodily functions that secrete glucose, which is why we need background insulin, so although their sugars still weren’t perfect, this diet did wonders back in the day for patients that really had no other options.
But Doesn’t Eating Keto Produce Ketones?
Yes, eating keto does produce ketones. But wait, don’t nix this way of eating just yet!
Ketones in general are not bad for you. Ketones are simply a byproduct of burning fat for fuel. And there are a few different ways your body will produce them:
- Low Carb Eating
- Intense Exercise
Fun Fact: In the brain, ketones are used to make long-chain fatty acids!
As diabetics we have been taught to fear even trace amounts of ketones. But why? Clearly ketones do not live in a black and white world, so why paint them with such a broad brush?
Like in so many other areas of health & nutrition, it’s misinformation and a lack of knowledge.
Doctors, like endocrinologists, are not trained in nutrition nor do they study it, which is why many will not recommend keto/low carb eating…they don’t want to recommend something that they know little about. And nutritionists, for the most part are taught that the Standard American Diet (SAD) is the gold standard of eating. So even if you do find a nutritionist that doesn’t believe in the SAD BS (which, bravo! by the way) they still might be scared to tell a type 1 diabetic to eat low carb because that’s an area that they know little about.
See how we’re caught in a medical/nutritional limbo?
So, just how many ketones are produced on a Keto Diet?
The amount of ketones produced on a low carb carb diet is only about 1-3 mmol/l.
Ketones only become a problem in the body when they are produced in large amounts, making them acidic. This would be DKA (ketones over 20 mmol/l).
DKA (diabetic ketoacidosis) is essentially a severe form of internal starvation. Most of the time this internal starvation is caused by high sugar levels, but sometimes it can be cause by actual starvation or illness.
But let’s talk about DKA from high sugar levels first.
– DKA from high BG levels
Insulin is a hormone that allows your body to pull glucose from the bloodstream and put it into your cells. Your cells are being ‘fed’ with glucose and insulin is the ‘fork’ that feeds them.
Without adequate insulin, however, glucose cannot enter your cells and remains ‘stuck’ or ‘locked’ in the bloodstream. This typically will happen at a BG around 240mg/dL.
Because your cells aren’t getting ‘fed’ the body thinks it is literally starving, so in a panic it starts breaking down fat and protein (and muscles) at an alarming rate – which we know produces ketones – far above what is seen in nutritional ketosis. In this state, the level of ketones being produced is over 20 mmol/l (compared to the 1-3mmol/l being produced when you’re in a state of nutritional ketosis).
– DKA from Starvation & Illness
This is the kind of DKA you may hear from T1D’s saying, “I was in DKA with a blood sugar level under 200 mg/dL”.
Now, while I don’t know everyone’s personal situation, this is usually a result of either illness or starvation and you get there from actual starvation.
Let me ask you a question…How many of us lose our appetite when we’re sick? And how many of us have crazy blood sugars when we’re sick? This combination of lack of food and high blood sugar (even if it doesn’t ever hit the 240 mg/dL mark) can be just enough to signal to your body that is in a state of starvation. Triggering the break down of fat and protein (and muscles) at an accelerated rate. So while this way of getting into DKA isn’t NEARLY as common, it does happen, which is why it’s important to be vigilant of ketones during illness.
Just like with everything else, balance is what we should strive for. And the same is true with ketones.
Ketones by nature are not bad. Ketones in excess are. Just like a strong immune system is not bad, but an overactive one is.
Eating ketogenically will not put you in DKA because nutritional ketosis only produces 1-3 mmol/l of ketones, and DKA occurs when over 20mmol/l of ketones are produced.
The high levels of ketones seen in DKA can only be produced when there is a presence of extremely high blood sugar levels or illness (sometimes also paired with high sugar & starvation).
I personally have been eating low carb for years! It is one of the many lifestyle changes I attribute to achieving my DREAM a1c of a 5.7. (Read about how I got my dream A1c here).
I am very fortunate to have a endo team that fully supports a low carb/ketogenic style of eating, because I know that’s not easy to find.
My endo herself is a T1D who eats ketogenically and is a huge advocate for this eating style for both types of diabetes.
If you’re interested in learning more, a great resource is Dr. Bernstein’s book The Diabetes Solution (you can find Dr.Bernstein’s book here on Amazon)
This post contains affiliate links. Thanks so much for supporting T1D Living!!
Bernstein, Richard K., The Diabetes Solution. Little, Brown and Company, 2011