Is Keto the way to go?

How low in carbohydrate is the keto diet?

The goal for the keto diet is to get the body into a state of ketosis, where it is producing ketones (from fat stores) as an energy source. Because everyone is different, the threshold for total amount of carbohydrate per day to stay in ketosis will be different. However, the suggested range of carbohydrate per day is between 20g - 50g per day. It is near impossible for someone to eat zero carbohydrate per day. This is because foods such as non-starchy vegetables, such as peas, carrots, beetroot, and capsicum still contain small amounts of carbohydrates.

Below are some definitions, including the recommended total amount of carbohydrates per day as a guide:

• Very low or keto: Less than 50g carbohydrate per day
• Low: Between Less than 130g carbohydrate per day
• Moderate: Between130g and 230g carbohydrate per day
• High: More than 230g carbohydrate per day

What can you eat on a keto diet?

Since carbohydrates are off the menu, they need to be replaced with higher amount of fats and a moderate amount of protein. This makes following the keto diet challenging, as most foods available do contain some amount of carbohydrate. It is easier to mention the foods that are ok to eat on a keto diet, as the list is quite short.

For example, foods high in fat include:

• Oils, such as olive, canola, coconut, vegetable
• Butters and margarines
• Avocados
• Nuts and seeds
• Cheese and cream
• High fat meats

For example, foods high in protein include:

• Meats
• Chicken
• Fish
• Eggs
• Cheese
• Tofu

Low starch vegetables are also allowed, such as leafy greens, mushrooms, cabbage, green beans, snow peas, along with berries and citrus fruits.

Is the keto diet safe?

The primary goal of all diabetes management is to manage blood glucose levels (BGLs) and keep them as close to target as possible. Diabetes management also aims to protect heart and blood vessels by making sure fat in the blood and blood pressure stay within healthy ranges.

Following the keto diet may improve BGL management, as what has the biggest impact on BGLs is the total amount of carbohydrate consumed at any time. However, the mistake often made when following such a very low carbohydrate diet, is choosing too much of the wrong type of fats. A diet too high in saturated fats can lead to heart disease and increase cholesterol levels. So, choose the healthier mono-unsaturated fats found in extra virgin oil, avocados, nuts and seeds and poly-unsaturated fats found from oily fish.

A concern for any dietary approach that encourages total elimination of a food type, is the risk of nutrient deficiencies. The keto diet encourages removing all grains, legumes, dairy foods (except cheese) and starchy vegetables like potato, sweet potatoes and corn. Most of these foods are also a good source of dietary fibre. Reducing dietary fibre in the diet can lead to an increase in cardiovascular disease and colorectal cancer.

For people living with type 1 diabetes or type 2 diabetes requiring insulin or taking certain oral medications, there are some risks following a very low carbohydrate diet. These include:

• Increased risk of hypos if insulin or sulphonylurea medication (e.g. Gliclazide) isn’t adjusted accordingly.
• Increased risk of diabetic ketoacidosis (DKA) if there isn’t enough insulin in the body to prevent ketones building up in the blood.

DKA is a life-threatening condition for people with type 1 diabetes, this occurs when blood ketone levels are elevated and toxic. A keto diet alone will not cause DKA, however, if not monitored correctly, ketones can rise quickly in someone with type 1 diabetes.

For those taking a certain class of medications called SGLT2 inhibitors there is also an increased risk of DKA. Common SGLT2 inhibitor medications include Dapagliflozin (Forxiga), and Empagliflozin (Jardiance). If you are taking these medications, please speak to your doctor before trying a low carbohydrate or ketogenic diet.

The final say:

The ketogenic diet is an extreme version of a low carbohydrate diet and is another option for managing type 2 diabetes. The key is finding the right balance in total carbohydrates for BGL management and healthier fats for reducing heart disease risk, along with including good sources of dietary fibre.

For personalised nutrition advice, we recommend seeking support from an Accredited Practising Dietitian (APD). If you would like to make a booking to see a dietitian, you can book online at the Diabetes Victoria Clinic, or please call 1300 153 123. 

For more general advice and enquiries, contact NDSS Helpline on 1800 637 700.