The current treatment model for type 2 diabetes is broken. Patients aren’t getting better; they’re getting worse. Meanwhile, rates of this metabolic disorder continue to rise. But recent research suggests a path forward: the ketogenic diet. The keto diet is powerful diabetes medicine. It lowers blood sugar, improves insulin sensitivity, and promotes weight loss. Thankfully, the ketogenic diet is moving its way into mainstream diabetes treatment. Following, we share all about how it helps with type 2 diabetes. But first, a brief review on the scope of the problem. 

The Problem of Type 2 Diabetes

Type 2 diabetes is marked by high blood sugar, high insulin, high blood pressure, high triglycerides, and obesity—all risk factors for chronic disease. Specifically, type 2 diabetes increases the risk of heart disease, cancer, Alzheimer’s, and—unsurprisingly—death.

Worldwide, there are about 380 million cases of type 2 diabetes. This wasn’t always the case. In the US, for instance, rates of diabetes have increased by a factor of seven in the past fifty years. Why? American diets and lifestyles have changed. Americans now eat more sugar and move less frequently than ever before. These changes are driving the diabetes epidemic. Unlike type 1 diabetes—which results from autoimmunity in the pancreas—type 2 diabetes is largely lifestyle driven. 

Here’s how type 2 diabetes develops:

    • A high-carb diet combined with a sedentary lifestyle leads to high blood-sugar levels (hyperglycemia).
    • Hyperglycemia provokes the release of insulin, resulting in high insulin levels (hyperinsulinemia).
    • Hyperinsulinemia promotes weight gain because insulin is an energy storage hormone.
    • Hyperinsulinemia also creates insulin resistance, the underlying metabolic issue in type 2 diabetes.

Insulin Resistance and Its Role in Type 2 Diabetes

Insulin resistance refers to a desensitization of insulin—an impaired ability of this hormone to store blood-sugar in muscle and liver cells. Insulin resistance creates a feedback loop. The pancreas produces more insulin to handle the same blood-sugar load, insulin resistance worsens, more insulin is churned out, and the cycle continues. Eventually, type 2 diabetics lose their ability to make insulin, and supplemental insulin is needed to prevent hyperglycemia.

To reverse diabetes, the insulin resistance loop needs to be broken. The ketogenic diet can help.

How the Ketogenic Diet Helps with Diabetes

The ketogenic diet requires you eat a certain number of daily calories based on personal factors like weight, age, activity level, etcetera. But not just any calories. The critical piece to the keto diet is the types of calories you consume. Specifically, you need to divide the daily calories into consumption of 70 to 75 percent fat, 20 to 25 percent protein, and 5 to 10 percent carbohydrates. 

Eating fat, protein, and carbs in these proportions keeps blood sugar and insulin levels low. In turn, low insulin signals the liver to beta-oxidize (break down) fatty acids and produce ketones.

Ketones, like glucose, can be used by cells (especially brain cells) to make energy in the form of adenosine triphosphate (ATP). The ketones are produced when the body recognizes it doesn’t have glucose to use for energy. When the body produces and uses ketones rather than glucose for fuel, this is a state called ketosis, which is a survival mechanism and backup energy program used in times of glucose scarcity. 

Ketosis is also an antidote for the Standard American Diet (SAD). By eliminating carbs, the ketogenic diet does an about-face to the SAD and in doing so eliminates a major driver of diabetes (carbs/sugar).

The keto diet helps change the type 2 diabetic tides by addressing its causes:

  • Weight loss

Weight loss through calorie restriction is a pillar of current diabetes treatment. Unfortunately, the method of simply losing weight hasn’t been very effective for people with type 2 diabetes.

Why not? For one, because calorie restriction lowers basal metabolic rate. When normal portions are resumed, energy expenditure stays low and the weight comes back.

The keto diet may be a better option. For instance, one study found that healthy women on keto lost more weight than women on a calorie-restricted diet.

Also, high-fat diets reduce appetite-stimulating hormones like ghrelin and neuropeptide YThese hormonal shifts prevent overeating and enable sustainable weight loss.

  • Less carbohydrates

The main clinical indicator of type 2 diabetes is high blood sugar. This is usually measured by fasting blood glucose or HbA1c, a measure of average blood glucose. Carbohydrates are the main culprit elevating blood sugar. Researchers have found that high-carb diets exacerbate hyperglycemia in non-insulin dependent diabetics.  A ketogenic diet restricts carbohydrate intake through its recommended macronutrients or “macros” (daily recommended caloric intake broken down into percentages of fat, protein, and carbs).

Keto diets have been shown, in multiple studies, to significantly lower blood glucose in type 2 diabetics—even to the point of reversing the diagnosis.

  • Improved insulin function

Those with advanced type 2 diabetes often need insulin injections to maintain normal blood sugar levels. But insulin therapy is more of a bandaid than a cure, and only worsens the problem of insulin resistance.

The ketogenic diet can break the insulin resistance spiral. Blood sugar stays low, insulin levels drop, and insulin function slowly returns. In a study published in BMC Medicine, the majority of type 2 diabetics enrolled were able to drop their insulin medication after 24 weeks of ketogenic dieting.

A New Model of Diabetes Treatment

The standard model for treating diabetes is shifting. According to a recent consensus report in the journal Diabetes Care, carbohydrate reduction has “the most evidence for reducing glycemia” in those with type 2 diabetes.

Yet challenges remain. For instance, many patients on medications (like metformin or insulin) require medical supervision to prevent dangerous hypoglycemia on a low-carb diet. Finding this supervision isn’t easy. 

A San Francisco-based company called Virta Health has addressed this problem by creating an online, doctor-supervised program for reversing type 2 diabetes. The program is designed, through a series of regular check-ins, to keep patients in nutritional ketosis (0.5 to 3.0 mmol/L). 

Here are some highlights from a one-year controlled study (published in 2018) on 218 type 2 diabetics enrolled in the Virta Health program:

    • 60 percent of patients reversed their diabetes (average HbA1C declined from 7.6 percent to 6.3 percent) 
    • 94% of patients reduced or eliminated insulin therapy
    • Average weight loss was 30.4 pounds
    • Average triglycerides decreased 24 percent

This data demonstrates that a properly-supervised ketogenic diet can reverse diabetes. And more results are surely coming. 

The Final Word

Millions of people have type 2 diabetes. It’s a health crisis driven by high-sugar diets and sedentary lifestyles. 

To treat type 2 diabetes, researchers are increasingly turning to the ketogenic diet. The keto diet promotes weight loss, lowers blood sugar, improves insulin function, and even helps patients get off their medications. 

To achieve therapeutic success, supervision is crucial. Along these lines, Virta Health has developed a remote-care program with proven results. After just one year, a full 60 percent of patients reversed their diabetes through nutritional ketosis.

Results like these show that type 2 diabetes, in many cases, is curable. Perhaps it’s time to roll out this treatment program on a larger scale. 




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