Keto diet for diabetes and high blood pressure

So you have high blood pressure and you want to try a low-carb or keto diet? Congratulations! It may be the most effective thing for lowering your blood pressure naturally.1 In some cases it may even normalize your blood pressure completely.2

However, there are two minor potential issues you may need to be aware of before you start.

1. Blood-pressure medication

If you’re on blood-pressure medication and start a low-carb diet, there’s a risk of the diet working too well! That could mean you experience low blood pressure. Yes, it’s true. You may become too healthy for your current dosage of medication.3

This blood-pressure lowering effect with low carb nutrition can happen within days, but it may also take months or even a year to reach full effect.4

If you feel symptoms of low blood pressure, such as feeling weak, tired or dizzy, you should immediately check your blood pressure. If it’s low, e.g. below 120/80, you should contact your doctor to discuss if lowering or stopping your medication is appropriate for you.

This is something most doctors should be able to handle. But if you need to find a doctor with good knowledge about the handling of medication on a low-carb diet, check out our low-carb doctors map and directory.

We also have a detailed guide about blood pressure drugs.

2. Salt and bouillon

When starting a low-carb diet we often recommend getting extra fluid and salt, perhaps in the form of bouillon – especially during the first two weeks. The reason is to minimize early side effects that can otherwise be troublesome when starting low carb, e.g. headache.

You should only take this bouillon if your blood pressure is well controlled, as for some it may increase blood pressure marginally.5

If your blood pressure is high despite medication you should not take extra salt or bouillon. Doing so could raise the blood pressure even higher, and it is not wise to risk that.

The good news is that any side effects will usually pass within days to a couple weeks as your body switches from using glucose to using fat as its main fuel.6

Learn more

How to normalize your blood pressure

Find a low-carb doctor

A low-carb diet for beginners

A keto diet for beginners

Low carb for doctors

Are you a doctor or do you know one? Here’s our low carb for doctors resource, with information on how to safely handle medications on a low-carb diet:

Disclaimer: Discuss any changes in medication and relevant lifestyle changes with your doctor. Full disclaimer

Starting low carb or keto with high blood pressure - the evidence

This guide is written by Dr. Andreas Eenfeldt, MD and was last updated on June 17, 2022. It was medically reviewed by Dr. Michael Tamber, MD on March 8, 2022.

The guide contains scientific references. You can find these in the notes throughout the text, and click the links to read the peer-reviewed scientific papers. When appropriate we include a grading of the strength of the evidence, with a link to our policy on this. Our evidence-based guides are updated at least once per year to reflect and reference the latest science on the topic.

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July 27,2021 |

The ketogenic diet, commonly referred to as the keto diet, is a way of eating that focuses on consuming low-carb, high-fat foods. The goal of the keto diet is to change the way that your body stores and uses fat. Normally, your body will use glucose from carbs as energy. In the keto diet, your body is depleted of glucose and therefore is forced to extract energy from body fat or fat that’s consumed. In this state of nutritional ketosis, your body relies on fatty acid substances called ketones for energy extraction. Here, we’ll discuss how the ketogenic diet works for type 2 diabetes.

Clarifications on Fat Intake in the Keto Diet

While the keto diet focuses on consuming higher amounts of fats instead of carbohydrates, it’s important to differentiate between different types of fat. The key is incorporating high amounts of heart-healthy fats, not saturated or trans fats. This means eating more eggs, fatty fish, avocados, olives or olive oil, nuts, nut butter, seeds, and cottage cheese. Avoid or limit processed foods alongside trans-fat, saturated fat, and fats from deli meats. Similarly, fried food is high in unhealthy fat and can lead to other problems like heart disease and health conditions.

The Ketogenic Diet and Type 2 Diabetes

Type 2 diabetes is a condition where your body does not properly regulate and use glucose for energy. The pancreas may not produce enough insulin to regulate sugar consumption and your cells tend to respond poorly to insulin. Over time, this leads to an accumulation of sugar in the bloodstream, which increases your risk for complications of the circulatory, nervous, and immune system. Eating foods that are high in sugar (carbs) causes an increase in blood glucose. For people living with diabetes, this increases the speed of sugar saturation throughout your circulatory system. There are a number of ways in which a ketogenic diet can impact type 2 diabetes management, but everyone is different. Always talk to your doctor prior to trying a keto diet, especially if you’re living with diabetes.

Nutritional Ketosis vs. Ketoacidosis

One thing that’s important to understand is the difference between nutritional ketosis and ketoacidosis. Both conditions involve ketones, a by-product of the breakdown of fat. Nutritional ketosis is when you intentionally restrict carbs so that your body utilizes ketones for metabolic benefits. Ketones are kept at a safe level, which can improve weight loss efforts and lower A1c for those living with diabetes.

Diabetic ketoacidosis, on the other hand, is a dangerous condition where there is an over production of ketones that build up in the blood. This is paired with inadequate insulin levels and can be life threatening. If you notice any signs of excessive thirst, frequent urination, weakness, fatigue, or confusion, seek medical help immediately.

How a Keto Diet Affects Blood Glucose

Utilizing the keto diet can help your body maintain lower, more healthy glucose levels. It can reduce the occurrence of blood sugar spikes throughout the day, which can subsequently lower your need to take insulin. When the keto diet is followed in a healthy manner, you may notice reduced blood sugar, more energy, and easier diabetes management. However, you will still need to monitor your blood glucose levels to ensure that you’re properly managing your diabetes.

Impact of Keto on Medication

Since the keto diet helps to lower blood sugar, some people with type 2 diabetes may find that they don’t need to take insulin as often. As mentioned, you still need to monitor your levels throughout the day as the diet may lead to hypoglycemia or low blood sugar. If this occurs, consuming more carbohydrates is necessary to avoid dangerous situations such as diabetic ketoacidosis.

Weight Loss and Ketogenic Diet

The keto diet is well known in the weight-loss community as it helps your body burn fat. This, in turn, helps a person lose weight. Since type 2 diabetes is intricately linked to obesity, the keto diet can help the overall management of diabetes. Always speak to your doctor about how to proceed on a keto diet and monitor any changes to your health.

There have been studies performed to determine the benefits of following a ketogenic diet for individuals with type 2 diabetes. It was found that ketogenic diets can result in lower blood pressure, improved insulin sensitivity, reduced dependency on medication, improvements in cholesterol levels, and a drop in insulin. However, that doesn’t mean that the ketogenic diet is for everyone and there may be risks involved. Never start any new diet or exercise regimen without consulting your doctor first, especially if you’re living with diabetes.

Potential Risks Involved in the Keto Diet and Diabetes

Undergoing any change in your diet or exercise regimen requires monitoring and aid from a medical professional. This is the best way to reduce your chances of experiencing dangerous risks or complications. The primary risk of the keto diet is unintentional diabetic ketoacidosis. While this is more common in people living with type 1 diabetes, it can happen in those with type 2 diabetes who are experimenting with the keto diet. Continue to test your blood sugar levels throughout the day and consider adding urinary ketone testing to your maintenance plan—especially when you first begin the diet. There are urine strips available to help you monitor your ketones. Some of the other potential risks include:

• Hypoglycemia – since you limit your carb intake on the keto diet, you are at a higher risk of low blood sugar. This can be just as dangerous as high blood sugar, especially if you’re still taking insulin. Always talk to your doctor about your risk for hypoglycemia and understand what to do if you experience any symptoms.
• Heart Disease – if you eat the wrong kinds of fat on keto diets (trans or saturated), you’ll increase your risk for developing heart disease. This is why it’s important to focus on eating heart-healthy fats, especially when living with type 2 diabetes. Since diabetes is already linked to heart disease, talk to your doctor about your specific risk factors before starting a keto diet.
• Lack of Nutrients – there are many essential vitamins and minerals in foods that are considered “off-limits” in a keto diet. Make sure that you are supplementing these nutrients and monitoring your health by partnering with a professional.
• Organ Problems – organs that process fats and proteins may be overworked during a keto diet, which can lead to problems.
• Constipation – a lack of fiber found in healthy carbohydrates can lead to constipation problems. Talk to your doctor if you’re experiencing constipation on the keto diet.

The Difference Between Keto and Atkins

Since both the keto diet and the Atkins diet focus on consuming fewer carbs, many people get confused between the two. However, they’re quite different at the core. Both diets have the potential to help manage type 2 diabetes, but the Atkins diet focuses on low-carb, high-protein intake while the keto diet focuses on low-carb, high-fat intake. The Atkins diet does not discuss increasing fat intake and there are fewer studies regarding its benefit in controlling type 2 diabetes.

Properly Monitoring Diabetes on the Keto Diet

This cannot be stressed enough: the keto diet does not mean that you can stop monitoring your diabetes. While there are many potential benefits that can help you decrease your reliance on insulin and stabilize your blood sugar over time, there are also risks. This means that you need to take the proper precautions and monitor your blood glucose levels regularly in addition to ketone levels. Your doctor may recommend increased visits at the beginning of the keto diet to ensure that your body is responding well. Don’t expect results to happen overnight. Be patient, work with your doctor, and if there are any signs that the keto diet is affecting you negatively, discontinue it immediately. Your doctor may also recommend beginning the keto diet in a controlled setting to monitor for any initial short-term side effects. If at any point you notice signs of diabetic ketoacidosis, or are not feeling well while on the diet, seek medical help immediately.

Creating a Long-Term Plan

Finding a long-term plan that will help you manage your diabetes and live a happy, healthy life is the goal. For some, the keto diet works. For others, it doesn’t. Always listen to your body and don’t try to force anything. To make sure that you’re staying healthy and properly managing your diabetes regardless of which diet you choose, Byram Healthcare has the diabetes supplies and support you need. 

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