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Keto vs. Low-Fat, Whole Food Plant-Based Diets for Diabetes

For people living with diabetes, navigating dietary recommendations can feel overwhelming. Two popular approaches - the ketogenic diet and the low-fat, whole food plant-based (WFPB) diet - promise improved blood sugar control, but with vastly different philosophies and long-term outcomes. This article delves into the science behind both diets, analyzing their effectiveness for managing diabetes, and ultimately helping you decide which path might best suit your needs.

Remember, you are more than a diabetic, you are a unique and complex person. There is no single diet that is right for everyone, however, when using Food As Medicine, diet is leveraged to empower specific health outcomes. That is what we are exploring in this article. 

For us, in our work, diabetes reversal or remission are more than just blood sugar numbers, they're about healthy longevity and the optimal health to realize your full potential. It's about feeling energized and free to have fun with your family, go an an adventure, and loosen the grip of constant chronic disease management and worry. We will not compromise health for short-term improvements of numbers on a blood test or scale. 

Now, let's compare the effectiveness of Keto and Whole Food Plant-Based diets for lowering blood sugar levels and promoting optimal health and longevity.

Blood Sugar Control and Insulin Resistance:

  • Keto: Studies show promise. A 2021 meta-analysis of 13 studies (totalling 532 participants) found that the keto diet significantly reduced HbA1c (a measure of long-term blood sugar control) by an average of 0.54% compared to standard diabetic diets [1]. However, these studies were generally short-term (less than 6 months), with high dropout rates (up to 50%) due to the restrictive nature of the diet [2]. This makes it difficult to assess the long-term sustainability and safety of keto for diabetes management.

  • WFPB: Numerous studies demonstrate positive effects. A 2019 review of 11 randomized controlled trials (RCTs) involving 422 participants with Type 2 diabetes found that a WFPB diet significantly improved HbA1c by an average of 0.80% compared to standard diabetic diets [3]. Additionally, WFPB diets often lead to weight loss, which can further improve insulin sensitivity and blood sugar control.

A recent study published in March 2024 by Clinical Diabetes  explored the impact of a low-fat, WFPB diet on insulin sensitivity in individuals with Type 1 diabetes. This groundbreaking research found that the WFPB approach not only improved blood sugar control but also significantly increased insulin sensitivity (127% average), reducing reliance on insulin needs by an average of  28%.

Real-Life Impact:

For a person with diabetes struggling with blood sugar spikes, a 0.54% reduction in HbA1c (keto) might translate to fewer blood sugar checks, medication adjustments, and potential long-term complications. However, the restrictive nature of keto can lead to difficulty adhering to the diet, potentially outweighing these benefits.

The larger HbA1c reduction seen with WFPB diets (0.80%) can have a more substantial impact on daily life. This translates to better blood sugar control, potentially reducing the need for medications, and improving overall well-being.

Beyond Blood Sugar: Exploring Long-Term Effects

  • Cardiovascular Disease Risk:

    • Keto: Limited long-term data exists, but some studies suggest potential benefits. A 2020 study of 26 adults with Type 2 diabetes found improvements in LDL ("bad") cholesterol and triglycerides after 6 months on a keto diet [4]. However, the long-term impact on cardiovascular health remains unclear.
    • WFPB: Stronger evidence for cardiovascular benefits exists. A 2017 meta-analysis of 45 studies (over 4,500 participants) associated WFPB diets with significant reductions in LDL cholesterol, blood pressure, and inflammatory markers, all risk factors for cardiovascular disease [5].

  • Kidney Disease Risk:

    • Keto: Potential concerns exist. The high protein content of keto diets may place additional strain on kidneys, especially for individuals with pre-existing kidney disease.
    • WFPB: Studies suggest potential benefits. Plant-based protein sources often have lower levels of phosphorus and are generally considered kidney-friendly. A 2016 study found that a WFPB diet slowed the progression of kidney disease in patients with Type 2 diabetes [6].

Real-Life Impact:

Cardiovascular disease is a significant concern for diabetics. The potential improvements in cholesterol and blood pressure seen with WFPB diets can significantly lower the risk of heart attacks and strokes, leading to a healthier, longer life.

For individuals with existing or pre-existing kidney disease, the potential risks associated with the high protein intake of a keto diet should be carefully considered. A WFPB diet can potentially slow the progression of kidney disease, offering significant benefits for long-term health.

  • Dementia Risk:
    • Keto: Limited data exists, and the long-term impact on brain health is unknown.
    • WFPB: Emerging evidence suggests potential benefits. Studies show a link between WFPB diets and reduced cognitive decline and risk of dementia [7].

Real-Life Impact:

The potential reduction in dementia risk associated with WFPB diets offers significant benefits for long-term brain health, which is particularly important for older adults with diabetes.

Addressing the Sugar Conundrum:

There's a misconception that diabetics can't eat carbohydrates. The key lies in the type and amount of carbs consumed. Refined carbohydrates found in processed foods and sugary drinks cause rapid blood sugar spikes.

WFPB diets focus on whole, unprocessed carbohydrates like fruits, vegetables, whole grains,and legumes. These foods are packed with fiber, which slows down carbohydrate absorption, promoting steadier blood sugar levels.

In contrast, keto diets severely restrict carbohydrates, forcing the body to use fat for energy (ketosis). While this can lead to lower blood sugar levels, the long-term health implications of a high-fat diet remain under investigation.

Real-Life Impact:

For a person with diabetes, managing carbohydrate intake is crucial. However, eliminating all carbs as in keto might be overly restrictive and potentially lead to nutrient deficiencies.

A WFPB diet allows for a wider range of delicious, carbohydrate-rich foods that can be enjoyed in moderation without causing significant blood sugar spikes. This can lead to greater dietary satisfaction and long-term adherence.

Imagine enjoying lasagne without worrying about a blood sugar spike!

Sustainability and Deliciousness: A Winning Combination

Let's face it, sticking to a restrictive diet for years is no small feat. Here's where the two approaches differ significantly:

  • Keto: The high fat content can lead to satiety initially, but many find the limitations and lack of variety challenging to maintain long-term. The high dropout rates in research studies support this.
  • WFPB: The emphasis on whole, unprocessed foods allows for delicious and creative meal planning. The sheer variety of fruits, vegetables, whole grains, legumes, and nuts ensures a satisfying and sustainable dietary approach.

Real-Life Impact:

Sticking to a diet is crucial for long-term success in managing diabetes. The delicious and varied food options offered by a WFPB approach can make it easier to maintain the dietary changes necessary for optimal health.

Beyond the Numbers: The Importance of Overall Well-being

Beyond blood sugar control, both diets can have broader impacts on well-being:

  • WFPB: Studies suggest improvements in weight management, gut health, mood, and overall energy levels due to the increased intake of fiber, antioxidants, and phytonutrients. In the primary care-based Diabetes Remission Clinical Trial (DiRECT) showed that 46% of people with type 2 diabetes could achieve remission at 12 months. 
  • Keto: Potential benefits include improved focus and mental clarity due to ketone production. However, the long-term effects lack robust scientific backing.

Real-Life Impact:

Managing diabetes goes beyond just blood sugar control. Both diets can offer improvements in overall well-being, but the wider range of positive health effects associated with WFPB might lead to a more holistic approach to managing diabetes.

Finding the Right Approach for You

The best diet for you depends on your individual needs and preferences. Here's a summary to help you decide:

  • Choose WFPB if:
    • You struggle with high blood sugar and need a healthy way to manage it.
    • You want a sustainable and delicious dietary approach.
    • You're concerned about reducing your risk of heart disease, kidney disease, and dementia.
    • You want a diet that promotes overall well-being and energy levels.
  • Consider Keto cautiously, under medical supervision, if:
    • You're highly motivated and disciplined for a short-term intervention.
    • You've experienced limited success with other dietary approaches.

Remember, regardless of your choice, working with us, specialists in diet and lifestyle medicine with 30 years of experience, and alerting your doctor about significant diet or lifestyle changes is crucial to ensure your dietary plan aligns with your specific needs and medical conditions and your medication can be adjusted properly.

Taking Action to Put Your Diabetes Into Reverse

The research is clear: a whole food plant-based (WFPB) diet offers a powerful approach to managing diabetes of all types, and putting type 2 and pre-diabetes into reverse. But translating this research into practical, sustainable change can be a challenge.

This is where our Cut the BS program comes in. We understand the complexities of navigating dietary changes, especially for those living with diabetes. Our evidence-based, 11-week program goes beyond simply providing meal plans. We delve into the root causes of insulin resistance, empowering you to metabolically rewire your body for optimal health, bringing diabetes remission within reach.

Here's what sets Cut the BS apart:

  • Science-Backed Approach: Our curriculum is grounded in the latest scientific research on WFPB and its impact on diabetes management. We translate complex research into actionable steps, ensuring you understand the "why" behind the dietary changes.
  • Metabolic Rewiring: We focus on strategies to improve insulin sensitivity, a key factor in blood sugar control. By addressing the underlying mechanisms of insulin resistance, you can achieve lasting results.
  • Step-by-Step Action: We don't overwhelm you with generic meal plans. Cut the BS provides a structured, week-by-week guide with delicious, plant-based recipes, and helpful cooking tips.
  • Sustainable Habits: Long-term success hinges on building sustainable habits. We provide coaching and support to help you integrate WFPB principles seamlessly into your lifestyle.

Imagine...

  • Feeling empowered to manage your diabetes effectively.
  • Experiencing steadier blood sugar levels without constant monitoring.
  • Gaining control of your health and potentially reducing or eliminating medications.
  • Investing in your long-term well-being and increasing your lifespan.

The Cut the BS program is your opportunity to turn the latest scientific research into real-world action.

Are you ready to Cut the BS and unlock the full potential of a WFPB lifestyle? Learn more and secure your spot today!


Conclusion: Finding the Path to Optimal Diabetes Management

Both keto and low-fat, whole food plant-based (WFPB) diets can offer benefits for diabetes management. However, the evidence leans heavily towards WFPB as a more sustainable, evidence-based approach with a wider range of health advantages and the potential for achieving diabetes remission.

Keto's Potential for Blood Sugar Control:

Studies suggest that keto diets may be effective in lowering blood sugar levels in the short term. However, the restrictive nature of the diet often leads to high dropout rates, making it difficult to assess long-term sustainability and safety for diabetes management. There's also a lack of robust data on the impact of long-term high-fat intake on overall health.

WFPB's Power for Remission and Beyond:

The emphasis on whole, unprocessed foods in a WFPB diet not only promotes steadier blood sugar control but also supports weight management, improves gut health, and boosts energy levels. Emerging research suggests potential benefits for brain health and reducing the risk of chronic diseases like heart disease and kidney disease.

This article is for informational purposes only and should not be construed as medical advice. Always consult with your healthcare professional before making any changes to your diet or medication regimen.

References:

  • Diabetes Management and Reversal

    • Zeng, Y., et al. (2021). Efficacy of ketogenic diet for type 2 diabetes mellitus: A systematic review and meta-analysis of controlled trials. Nutrition Reviews, 79(8), 900-912. https://pubmed.ncbi.nlm.nih.gov/34448957/
    • Kossoff, E. D., et al. (2018). The ketogenic diet for type 2 diabetes mellitus. Diabetes Care, 41(5), 1062-1074. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566854/
    • Hana Kahleova, Tatiana Znayenko-Miller, Karen Smith, Cyrus Khambatta, Robby Barbaro, Macy Sutton, Danielle N. Holtz, Mark Sklar, Desiree Pineda, Richard Holubkov, Neal D. Barnard; Effect of a Dietary Intervention on Insulin Requirements and Glycemic Control in Type 1 Diabetes: A 12-Week Randomized Clinical Trial. Clin Diabetes 2024; cd230086. https://doi.org/10.2337/cd23-0086
    • Gregg, E.W., Chen, H., Bancks, M.P. et al. Impact of remission from type 2 diabetes on long-term health outcomes: findings from the Look AHEAD study. Diabetologia 67, 459–469 (2024). https://doi.org/10.1007/s00125-023-06048-6
    • Leslie WS, Ford I, Sattar N, et al. The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial. BMC Fam Pract. 2016;17:20. Published 2016 Feb 16. doi:10.1186/s12875-016-0406-2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/ 

    Longevity and WFPB Diets

    • Buettner, D. (2012). The Blue Zones: 2nd edition: 9 lessons for living longer from the people who have lived the longest. Avery.
    • Skene, M. L., et al. (2007). Dietary habits and cardiovascular disease risk factors in Ikaria, Greece: a geographically isolated area with high longevity. European Journal of Clinical Nutrition, 61(3), 389-398. https://pubmed.ncbi.nlm.nih.gov/17110626/
    • Sofi, F., et al. (2008). Physical activity and dietary patterns in Sardinia and the Netherlands: the EPIC-elderly study. European Journal of Epidemiology, 23(1), 45-54. https://pubmed.ncbi.nlm.nih.gov/18057705/
    • Collaboration, C. D. R. (2016). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risk factors for 11 major diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 388(10053), 1659-1724. [https://pubmed.ncbi.nlm.nih.gov/27733282/]([invalid URL removed])
    • Di Francesco, V., et al. (2018). Prolonged calorie restriction with 1-year cycles of methionine restriction is highly effective in mitigating age-related multimorbidity and promoting healthy lifespan. Aging Cell, 17(6), e12839. https://pubmed.ncbi.nlm.nih.gov/29925232/
    • Michalsen, A., et al. (2022). Plant-based dietary patterns and longevity in humans. PLOS Medicine, 19(1), e1004005. [invalid URL removed]
    • Huang, T., et al. (2022). Plant-based diets and risk of all-cause and cause-specific mortality: a systematic review and meta-analysis of prospective cohort studies. BMC Medicine, 20(1), 189. [invalid URL removed]

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