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Can people with diabetes or high blood pressure follow the Keto Diet?

I have been getting this question a lot and the short answer is…YES! 👑

And now, here’s why:

Managing Blood Sugar with the Keto Diet

The Ketogenic Diet (KD) has been proven to be very effective for managing blood sugar (glucose) levels in people with Type 2 diabetes (estimated to be 90 to 95% of the people with diabetes in the US), Metabolic Syndrome, and pre-diabetes. The common causes of these metabolic disorders are insulin resistance, in combination with high levels of insulin (hyperinsulinemia)1.

What is insulin resistance and what are its causes?

Insulin resistance occurs when our cells ‘resist’ the action of the hormone insulin and are unable to use it effectively, which leads to high blood sugar. In response to the rising levels of blood sugar, or glucose, our pancreas releases even more insulin, leading to high insulin levels, or hyperinsulinemia. This rise in insulin also appears to be one of the underlying factors leading to weight gain, and is often both a result—and a driver—of insulin resistance.

The opposite of insulin resistance is insulin sensitivity, which determines how effectively the body utilizes carbohydrates and how much insulin needs to be released in order to process the glucose in a healthy and balanced way. There appears to be an inverse relationship between insulin sensitivity and the body’s storage of energy in the form of fat – so the higher your insulin sensitivity, the less energy your body will tend to store in the form of fat.

There are several mechanisms by which the Keto Diet can counter insulin resistance, improve insulin sensitivity, optimize blood glucose control, and help manage weight. For one, the very low carbohydrate content of the KD can improve blood sugar control in individuals with type 2 diabetes, Metabolic Syndrome, and pre-diabetes2 3. The reduced impact on blood sugar following a low carbohydrate meal can also result in a ‘blunted’ insulin response, minimizing insulin ‘spikes’, a potential contributor to weight gain and obesity4. In addition, the nutritional ketosis occurring on the KD is known to promote weight loss in the form of fat. This loss of fat can lead to a decrease in inflammation, which has the beneficial effect of both reducing insulin resistance and increasing insulin sensitivity5Both the production and metabolism of ketones during nutritional ketosis has also been shown to have the effect of reducing insulin resistance through several metabolic pathways6.

Managing High Blood Pressure with the Keto Diet

Just as there exists a strong association between insulin resistance and metabolic disorders such as Type 2 diabetes, a strong link has also been demonstrated between insulin resistance and high blood pressure, or hypertension. (8) Both of these health conditions are not mutually exclusive, given that a large majority of type 2 diabetics (~80%) are also being treated for hypertension and 50% of individuals with hypertension also have insulin resistance or hyperinsulinemia, two of the main characteristics of Type 2 diabetes7. Hyperinsulinemia can cause the kidneys to increase both sodium and water retention and also plays a role in the narrowing of blood vessels, resulting in elevated blood pressure8. As in the case of prolonged insulin resistance, chronic high levels of insulin are also associated with increased inflammation.

One the most effective ways to manage high blood pressure in this population is to actually get blood glucose in good control. So, in essence, the KD has the potential to effectively control both blood glucose and blood pressure levels in Type 2 diabetics or in pre-diabetics who also have hypertension. And, for individuals who are diagnosed with high blood pressure but do not have diabetes, the weight loss associated with the KD can also lead to improved blood pressure.

Not only does weight loss itself produce a healthy reduction in blood pressure, but it appears that a very low-carbohydrate diet such as the ketogenic diet has an additional blood pressure-lowering effect caused by metabolic, chemical, and hormonal shifts9.

Key Takeaway

Diet is a fundamental tool for managing both Type 2 Diabetes and high blood pressure, and should be considered a ‘first-line’ treatment in combination with other beneficial lifestyle changes. Through its mechanisms of overcoming insulin resistance and optimizing insulin sensitivity, the ketogenic diet has been shown to be effective in managing both blood sugar and blood pressure. Although the ketogenic diet may not be the best method for everyone, for some, it may be the key to finally achieving recommended blood glucose and blood pressure targets.

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  1. Hyperinsulinemia and Insulin Resistance: Scope of the Problem: https://insulinresistance.org/index.php/jir/article/view/18/25
  2. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633336/
  3. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes: https://www.ncbi.nlm.nih.gov/pubmed/15767618
  4. Hyperinsulinemia: a Cause of Obesity? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487935/
  5. The Effects of a Low-Carbohydrate Diet vs. a Low-Fat Diet on Novel Cardiovascular Risk Factors: A Randomized Controlled Trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586572/
  6. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism: https://www.plefa.com/article/S0952-3278(03)00221-7/fulltext
  7. Insulin Resistance and Hyperinsulinemia: http://care.diabetesjournals.org/content/31/Supplement_2/S262
  8. Link between insulin resistance and hypertension: What is the evidence from evolutionary biology? https://dmsjournal.biomedcentral.com/articles/10.1186/1758-5996-6-12
  9. The Effects of a Low-Carbohydrate Diet vs. a Low-Fat Diet on Novel Cardiovascular Risk Factors: A Randomized Controlled Trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586572/
Mary Paley

Fearless Dietitian; 30+ years as a professional dietitian; Master’s Degree in Nutrition and Dietetics at the MGH Institute of Health Professions; Lead research dietitian for several major pharmaceutical companies; Currently focused on health and wellness and the benefits of ketogenic diets for both obesity and diabetes management. MS, RDN, CDE, LD/N

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