Ketogenic Diet for Type 1 Diabetes [Safety, Benefits, & Research]

In today’s video, I’m gonna talk about the Ketogenic Diet for Type 1 Diabetes.  I will answer questions such as is the ketogenic diet safe for type 1 diabetics?  What are the benefits of using this diet?  Is there any good research to support the use of the ketogenic diet in type 1 diabetes?  I’ll discuss that and a lot more, so make sure you stick until the end.  By the way, if you’re new to my YouTube channel, my name is Greta, and I’m an online nutritionist and a holistic health coach.  If you haven’t yet, consider subscribing to my YouTube channel for weekly videos about insulin resistance, detox, diabetes, all the other chronic health conditions, and improving your general health.  So, if you want to be healthy, you should definitely subscribe.  And by the way, this is not medical advice, my videos are for educational purposes only.  You can take what you learn here, and discuss it with your doctor.  What is type 1 diabetes?  Type 1 diabetes is an autoimmune disease in which the pancreas can’t make insulin because the immune system attacks it and destroys the cells that produce insulin.  With type 1 diabetes, your pancreas does not produce enough insulin or doesn’t produce insulin at all.  Without adequate insulin, blood sugar can't get into cells and builds up in the bloodstream instead.  Type 1 diabetics are recommended to get around 45-60% of their daily calories from dietary carbohydrates.  Of all macronutrients, carbohydrates have the greatest impact on our blood glucose levels.  And eating carbs requires insulin the most.  When eaten, sugary and starchy carbohydrates are broken down into a simple sugar called glucose.  This glucose requires insulin to get into the cells where it can either be used for energy or stored for later use.  In the case of type 1 diabetes, lack of insulin could cause blood sugars to reach harmful high levels, called hyperglycemia, which can lead to serious long-term health complications.  A type 1 diabetic would have to inject the right amount of insulin to deal with this glucose spike each time after eating.  Unfortunately, it’s not always possible.  It’s easy to make mistakes, because food labels are not as accurate, and it’s not always possible to know the exact weight of foods.  It is common to inject too much or too little insulin and get into hyperglycemia or hypoglycemia,  which are both dangerous.  The target HbA1c for type 1 diabetics is less than 7.0%.  However, only a small proportion of type 1 diabetics manage to achieve this target.  We know that the normal healthy HbA1c range should be between 4.0% and 5.6%.  And that the most optimal range, would be 5.2% or less.  Can a type 1 diabetic achieve these numbers?  Well, most type 1 diabetics struggle to achieve 7.0% with the current dietary advice of 45  to 60% of calories from carbohydrates.  Let’s quickly look into the most common methods used to manage type 1 diabetes.  Most people think it’s you either take insulin or you die.  I’m not saying it’s wrong, but before using insulin, type 1 diabetes was managed with a low-carbohydrate ketogenic diet.  Reducing carbohydrate intake can help to eliminate the spikes and crashes in blood sugar levels,  making your blood glucose levels a lot more stable.  Why are stable blood glucose levels important?  Besides the obvious benefits, staying in the healthy blood glucose range means preventing long-term health complications.  Stable blood sugar, also means you are way more likely to have stable energy and mood and have less hunger and food cravings.  What about the safety of using insulin?  And our own insulin.  When talking about type 1 diabetes, we tend to focus on elevated glucose.  Excess glucose is bad.  And we assume that excess insulin is fine.  It is true that we would die without insulin.  It’s an important hormone with many functions.  However, excess insulin is just as bad, maybe even worse, than excess glucose.  Excess insulin promotes growth, like weight gain, or cancerous cell growth, it promotes inflammation and increases the risk of other diseases.  What do I mean by excess insulin?  We can have excess insulin either naturally produced by our bodies or injected insulin,  required when following a high carbohydrate diet.  A high carbohydrate diet is a high insulin diet.  Our insulin levels, natural, or injected, are high, when we eat too frequently, and eat a lot of carbohydrates.  And our insulin is low, if we eat less frequently, and we eat less carbs.  Let’s look at this systematic review study.  It found that elevated insulin or hyperinsulinemia is present in obesity, diabetes, hypertension, dyslipidemia, renal failure, nonalcoholic fatty liver disease, PCOS, sleep apnea, some types of cancer, atherosclerosis, and cardiovascular disease.  Meaning people who get these conditions, also happen to have elevated insulin.  Maybe this insulin causes it, who knows.  Then, if we look at a few other studies,  1.  Insulin use and increased risk of mortality in type 2 diabetes: a cohort study.  It’s in type 2 diabetics, but still, it’s a human study looking at the connection between taking insulin and dying.  They found that the highest mortality rates were in the high insulin exposure group, and the lowest in the no exposure group.  Meaning, that insulin increases your risk of death, and the more insulin you take, the greater your chances of dying.  https://pubmed.ncbi.nlm.nih.gov/19788429/  Then another study, again in t2 diabetes.  Insulin Therapy Increases Cardiovascular Risk in Type 2 Diabetes.  https://pubmed.ncbi.nlm.nih.gov/28958751/  There's a strong dose-dependent association between injected insulin with increased CV risk and worsened mortality.  Meaning, more insulin – more deaths.  And dose-dependent- proving that insulin increases your risk of death, and the more insulin you take,  the higher the risk.  In another study, Insulin use, and cancer risk in patients with type 2 diabetes: a systematic review and meta-analysis of observational studies  https://pubmed.ncbi.nlm.nih.gov/23159131/ their findings: Using data from more than 1 million people, found that the new In use In of In In In In In insulin or insulin In glargine was associated with an increased risk of pancreatic and prostate cancers.  There are many more studies, showing how insulin harms our health.  One of the biggest health benefits of the low carbohydrate ketogenic diet is that it keeps your blood glucose and insulin low.  In type 1 diabetes, this would mean your glucose is naturally much lower, and you need way less insulin.  The fewer carbs you eat, the less glucose you have, and the less insulin you will need.  Now, what is the low-carb diet?  The low carbohydrate diet and the low carbohydrate ketogenic diet are quite similar.  They are both low-carbohydrate diets, but the ketogenic diet is a lot stricter when it comes to your daily carbs.  And it’s a lot more effective.  What exactly is the ketogenic diet?  It’s a low carbohydrate, high fat, moderate protein diet.  The goal of this diet is to lower your daily carbohydrate intake to the point where your body starts using ketones, instead of glucose, as your main source of fuel.  And no, glucose is not our preferred fuel source.  We use the most toxic or the most useless fuel first.  Let’s say if you give your body a choice between protein, fat, carbs, and alcohol.  All of them contain calories, and our bodies can make energy from them.  Our bodies would use alcohol first, then glucose, then protein and fat.  Does that mean that alcohol is our preferred fuel source?  No.  It means, alcohol and glucose don’t have much use in the body and are simply burned for energy, to get rid of it first.  Some of the glucose is also turned into fat, and stored for later.  Protein and fat have many more functions in the body.  We need only a small amount of glucose daily.  And this glucose can be made from protein and fat through the process called gluconeogenesis.  Back to ketones.  Ketones, or ketone bodies, including acetate, beta-hydroxybutyrate, and acetone, are by-products of the body breaking down the dietary fat that we eat, and our stored body fat for energy.  When you reduce your daily carbohydrate intake to around 50g of carbohydrates a day, or around  5% of your daily calories; and increase your dietary fats, you reach the state of ketosis.  Ketones are a cleaner fuel.  They create more energy, ATP, and less free radicals, when compared to glucose.  It’s our rocket fuel.  Is ketosis safe?  Don’t confuse ketosis and ketoacidosis.  When you’re in the state of ketosis, your glucose is in the normal healthy range, and your ketones are in the normal healthy range too.  Optimal blood ketone ranges for nutritional ketosis are 0.5 – 3 millimoles per liter  (mmol/L).  Now let’s look at ketoacidosis, or diabetic keto acidosis.  Ketoacidosis is a life-threatening condition.  Your risk for diabetic ketoacidosis increases when your ketone levels are elevated, and your blood glucose is above 250 mg/dL or 14 mmol/L. So, you’re at risk, if your blood ketones are above 3.0mmol/l, and your blood glucose is above 14 mmol/L.  The primary focus here should be to never allow your glucose to reach 14 mmol/L. I understand that it might happen sometimes, but this condition is primarily caused by consuming too many carbohydrates.  I don’t think it’s fair to demonize the ketogenic diet, which results in optimal blood ketone levels, for causing ketoacidosis.  Elevated glucose is a much bigger problem here.  Nutritional ketosis is safe and should not be confused with ketoacidosis, a severe complication of diabetes that is primarily caused by too much glucose.  But not all ketogenic diets are created equal.  There are many variations of the ketogenic diet.  Some are healthy and some are not.  What I’m referring to, is a nutrient-dense, therapeutic ketogenic diet, with plenty of non-starchy veggies, berries, fermented foods, nuts, seeds, healthy fats, and healthy animal products in correct amounts.  So, what are the benefits of the low-carb ketogenic diet in type 1 diabetes?  The benefits of the low-carb ketogenic diet for type 1 diabetes, include reduced HbA1c,  more stable blood glucose, fewer hypos, and fewer hypers, more stable energy, and mood,  less hunger, and cravings, reduced need for insulin, reduced risk of errors, such as you will eat fewer carbs and require less insulin if you do a mistake with insulin amount, it’s not as bad, and, the last benefit is reduced insulin resistance.  Yes, type 1 diabetics can develop insulin resistance.  Insulin resistance is a side effect of the high carbohydrate diet.  When you consume too much carbohydrates, you have too much glucose, and then you need too much insulin, excess insulin causes insulin resistance and severe health complications.  So, reducing your need for insulin, by changing your diet to a low-carbohydrate ketogenic diet is a good thing.  There was a recently published 2021 paper for families and medical providers, summarising how to safely use the low carbohydrate ketogenic diet for managing type 1 diabetic children.  Unfortunately, the article is not free access.  But, it shows us that finally there is some interest in using dietary interventions.  Now, let’s look at some studies, where the low carbohydrate or the low carb ketogenic diet was used in type 1 diabetics.  From this systematic review study, we see significant improvements with the use of the low-carb diet or the low-carb keto diet.  We see reduced hypos and reduced daily insulin, these are with the low-carb diet.  And then, if we look at the low-carb ketogenic diet, we see even greater results.  A 2012 study with 48 participants, following a low-carb diet with 75g of carbs a day for  4 years, showed HbA1c changes from 7.6% to 6.9%.  Which is within the recommended target range.  And the last two, very small studies, one with 1 and the other with 8 participants,  following the ketogenic diet, saw HbA1c change from 16.8 to 5.3%, which is optimal, and from  6.8 to 5.5% which is also optimal.  These are normal nondiabetic results.  Which shows us that it is possible.  Then, there was an online survey conducted, that looked into 316 type 1 diabetic participants who followed the very low-carb ketogenic diet.  Following a Very Low Carbohydrate Ketogenic Diet for a duration of 2 or more years, resulted in the average reported HbA1c values of 5.67%.  There were only 7 reported diabetes-related hospitalizations in the past year, including  4 for ketoacidosis and 2 for hypoglycemia.  That’s out of 316 people, in 1 year.  I guess the benefits outweigh the risks.  Sadly, we lack large, high-quality randomized controlled trials.  It seems that no one is interested in conducting this type of research.  And one very important fact I wanted to share.  Some studies found, that a fasting-mimicking diet, which is a low-calorie, low-protein, and low-carbohydrate but high-fat diet, was able to cause βeta-cell regeneration, in  T1Diabetes animal models.  A fasting-mimicking diet promotes the regeneration of insulin-producing βeta cells.  And there are some case study reports having similar results in humans.  In one study, a 19-year-old male with newly diagnosed type 1 diabetes was put on a ketogenic diet for 6.5 months.  He was able to discontinue insulin use and restore some of the insulin production in his pancreas.  That’s quite impressive.  Some people manage to reduce their need for insulin by around 80%, and some other people,  who still produce a small amount of insulin, manage to improve it even further, to the point where they no longer need to use insulin.  That’s another reason why the ketogenic diet should be studied further.  How should you start a low carbohydrate or a low carbohydrate ketogenic diet?  Consult with your doctor or nutritionist first.  Ask them to help you.  If you are starting a low-carb diet, it may be safest to lower your carbohydrate intake gradually to minimize the risk of hypos.  Using a CGM or continuous glucose monitor would also help.  You should be very careful, and move your way to around 50 grams of carbohydrates a  day over a few months period.  Adjusting your insulin along the way.  You should start with the low-carb diet first, and then transition into the low-carb keto diet.  You can watch my video explaining how to start a low-carb diet, and the other one explaining how to start a low-carb keto diet.  Of course, ignore the parts where I say, you don’t need to count carbs or macros, as you do need to count them.  And again, this is not medical advice, this video is for educational purposes only.