UPDATED BY FRANZISKA SPRITZLER, RD, CDCES
The Prevalence of Diabetes
Diabetes is a global threat to human health. Unfortunately, contemporary diabetes treatments do not treat the root cause, leading to suboptimal control and skyrocketing costs related to medical treatments and prescriptions. However, there is potential for drastic improvement in our nation’s health. Recent studies show the ketogenic diet can not only control the disease without medication but also, in some cases, completely reverse it.
U.S. Diabetes by the Numbers
According to the US Centers for Disease Control (CDC), as of 2024:
- 38.4 million Americans (11.6% of the U.S. population) have diabetes
- 97.6 million Americans (more than 1 in 3) have prediabetes
Global Diabetes by the Numbers
According to the International Diabetes Federation, as of 2021:
- 537 million people are living with diabetes worldwide––roughly 1 in 10 of the world’s adult population. And that figure is expected to rise to 643 million people by 2030.
Diabetes Defined
Diabetes is a metabolic disorder that results in elevated blood glucose levels. It appears in two main forms: type 1 diabetes (T1D) and type 2 diabetes (T2D). Untreated, both forms of diabetes can be life-threatening.
Type 1 Diabetes
Type 1 diabetes is an autoimmune disorder that targets and destroys the beta cells in the pancreas responsible for producing insulin. Insulin is a hormone essential for regulating blood sugar (glucose) levels. In the absence of insulin, blood glucose can quickly climb to life-threatening levels, leading to severe illness within hours and potentially fatal outcomes within a few days. Since individuals with type 1 diabetes cannot produce insulin on their own, they must administer it through a wearable pump or multiple daily injections to manage their blood sugar levels effectively.
Type 2 Diabetes
Type 2 diabetes occurs when the body becomes resistant to insulin or the pancreas fails to produce enough insulin to meet the body’s needs. Although the exact cause of type 2 diabetes remains unclear, a combination of genetic and environmental factors is known to contribute to its development. These factors include age, race, family history, high blood pressure, being overweight or obese, and leading an inactive lifestyle.
Diabetes Symptoms
The following is a list of common symptoms of diabetes, many of which are not always present:
- Increased hunger (especially after eating)
- Increased thirst
- Dry mouth
- Fatigue
- Headaches
- Blurred vision
- Numbness or tingling in the feet or hands
- Sores that do not heal
- Unexplained weight loss
- Frequent urination
Diabetes-Related Complications
- Hypoglycemia (blood glucose < 70 mg/dL or 3.9 mmol/L)
- Diabetic retinopathy
- Diabetic neuropathy
- Chronic kidney disease
- High blood pressure
- Cardiovascular disease: heart attack, stroke, coronary heart disease (atherosclerosis)
- Gastroparesis
The Cost of Diabetes
In 2022, the American Diabetes Association (ADA) reported that the total estimated economic burden of diagnosed diabetes in the U.S. reached $412.9 billion, which included $306.6 billion in direct medical expenses and $106.3 billion in indirect costs associated with diabetes. According to the ADA, people diagnosed with diabetes spend an average of $19,736 per year on medical costs, more than half of which is related to treatment, including the cost of diabetes medication.
Today’s Most Common Diabetes Treatments
While there is no “cure” for diabetes, there is an effective way to control both type 1 and type 2 diabetes in order to dramatically lower the risk of developing diabetes-related complications: a ketogenic or very-low-carbohydrate diet.
The History of Treating Diabetes Through a Ketogenic Diet or Very-Low-Carbohydrate Diet
Before the advent of insulin, some physicians promoted carbohydrate restriction to control blood sugar levels. In the 1770s, Dr. John Rollo, a surgeon in the English army, used an animal-based, no-sugar diet to treat soldiers with diabetes.
Later, New Jersey-based physician Frederick Allen (1879-1964) realized that diabetes was more than a problem with blood glucose; rather, it was a global disorder of metabolism. He went on to develop the best therapy for diabetes available before insulin: a very-low-calorie, ketogenic diet providing mainly fat and protein, with the minimum amount of carbohydrates needed to sustain life. Between 1914 and 1918, he treated 100 people with diabetes at New York City’s Rockefeller Hospital with this diet. Many other physicians began prescribing it, including Elliott Proctor Joslin, the first U.S. doctor to specialize in diabetes and the founder of today’s Joslin Diabetes Center.
Although Allen’s diet was far from ideal — relying on extreme calorie restriction that pushed patients to the edge of starvation to manage the disease — it managed to prolong the lives of some individuals with severe diabetes until insulin became accessible. Moreover, it highlighted a critical insight: diet plays a significant role in diabetes management.
The Ketogenic Diet and Diabetes Today
While Dr. Allen’s approach was ketogenic, today’s well-formulated ketogenic diet is not a starvation diet. It is characterized by adequate calories –– based on an individual’s weight, age, and other factors ––high fat, moderate protein, and very low carbohydrate intake. However, even with greater caloric intake, a ketogenic or very-low-carb diet has been found markedly improve blood glucose levels, leading to reversal in many cases of type 2 diabetes and insulin reduction in type 1 diabetes.
A variety of clinical studies prove the reduction of carbohydrates, a key factor in the ketogenic diet, can lead to a variety of benefits in people with type 2 diabetics, including:
- Improved blood glucose regulation
- Decreased blood pressure
- Improved insulin sensitivity
- Decreased insulin levels
- Increased high-density lipoprotein (HDL) levels
- Decreased triglyceride levels
- Decreased small, dense low-density lipoprotein (LDL) particles
- Weight loss
- Reduction or elimination of diabetes medication*
*It’s important for patients and doctors to discuss any dietary changes while on medication. Consuming too few carbohydrates without a decrease in certain glucose-lowering medication can be dangerous.
The Future of Diabetes Treatment
Due to the results of clinical studies and ongoing success stories, the momentum behind treating diabetes with a ketogenic diet is building.
Digital clinic Virta Health, founded in 2014 with the goal to “reverse” type 2 diabetes without medications or surgery by utilizing a low-carbohydrate ketogenic diet, is becoming an influence in the healthcare industry. Virta provides diabetes patients online access to physicians, health coaches, peer support, and ongoing information and feedback. In addition, Virta researchers are conducting an ongoing study on the impact of a ketogenic diet in patients with type 2 diabetes. Their recently published 5-year data demonstrates that some individuals can achieve long-term diabetes reversal or remission through this approach.
These positive results combined with a growing population in need of affordable, manageable long-term solutions for diabetes suggest the ketogenic diet will continue to become an important part of the treatment plan for and mitigation of diabetes in the coming years.
Note: Speak with your doctor before making any dietary changes, particularly if you take insulin or other diabetes medication.
