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Ketogenic Diets for Prediabetes

April 23, 2018
Ketogenic Diet for Prediabetes: How it Works - Lark Health

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Low-Carbohydrate and Ketogenic Diets for Prediabetes

Low-carbohydrate diets have gotten a lot of attention recently as strategies for reversing prediabetes (impaired glucose tolerance). The carbohydrates in your diet that provide calories include sugars and starches. Starches are in grains and flour, beans, and starchy vegetables. Added sugars include sugars in sweets, sweetened foods such as flavored oatmeal and ketchup, and sugar-sweetened beverages such as soda, which can be dangerous if you are insulin sensitive. There are also natural sugars, which are found in nutritious foods such as dairy products and fruit.

Are you at risk for type 2 diabetes? Lark Diabetes Prevention Program is a personalized program to help you lower your risk by making healthy lifestyle changes, such as losing weight and increasing physical activity. Your personal Lark coach is available to support you 24/7 on your smartphone. Lark can help you make small changes that fit into your lifestyle and have big results for your health!

Proponents of low-carbohydrate weight loss diets, such as Atkins, claim that the diet can help you lose weight because instead of burning dietary carbohydrates for fuel, you burn body fat because you are eating so few dietary carbohydrates. The diet can help you cut calories by:

  • Eliminating or severely restricting high-calorie foods such as sweets and refined carbohydrates.
  • Promoting satiety by increasing protein and fat, which are filling nutrients.
  • Reducing appetite by reducing the food choices available to you.

What Is a Keto Diet?

A ketogenice, or "keto," diet puts your body into ketosis. That means your body burns fat for fuel instead of carbohydrates. The idea is that being in ketosis forces your body to burn body fat so you lose weight.

To get into ketosis, you follow a ketogenic diet. This diet is very low in carbohydrates.

How Many Carbs on a Keto Diet?

You might have 20 to 40 grams of carbohydrates per day on a keto diet. You will need to use ketone strips to see whether your body is in ketosis. You can work with your healthcare provider to find the number of grams of carbohydrates that keeps you in ketosis.

These are some carbohydrate comparisons for a 2,000-calorie diet.

Ketogenic diet Moderately low-carbohydrate diet according to the American Diabetes Association (ADA) Average American carbohydrate consumption from the Centers for Disease Control and Prevention (CDC) Recommended amount from the Dietary Guidelines for Americans
% calories from carbohydrates
5 to 10% of total calories
26 to 45% of total calories
47% of total calories
45 to 65% of total calories
Grams of carbohydrates on a 2,000-calorie diet
20 to 40 grams
130 to 225 grams
235 grams
225 to 325 grams

Food List for a Keto Diet

A keto diet has carb-free and low-carb foods. It is likely to be high in fat and/or protein.

These foods are free from carbs. They form the bulk of a keto diet.

  • Meat, fish, most shellfish, and poultry
  • Butter, oils, margarine, and lard
  • Eggs

A keto diet may have small amounts of these low-carb foods.

  • Cheese
  • Cream
  • Peanuts, nuts, and seeds
  • Avocado
  • Lettuce, greens, other non-starchy vegetables
  • Berries
  • Yogurt
  • Cottage cheese

A keto diet does not have much room for these types of foods.

  • Whole grains
  • Beans and lentils
  • Starchy vegetables
  • Most kinds of fruit
  • Sugar-sweetened foods and beverages
  • Refined grains
  • Processed and snack foods

Low-Carb Diets

Sugars and starches that you get from your diet enter your bloodstream as a type of sugar called glucose. In prediabetes, your body has trouble managing the glucose in your blood due to resistance to a hormone called insulin, which can lead to a risk of developing type 2 diabetes. Normally, insulin is able to help your body keep blood glucose levels in check, but the effect is weaker if you have impaired insulin resistance, so blood glucose rises.

There is research supporting reduced-carbohydrate diets in the treatment of prediabetes. Reducing your sugar and starch intake may lower blood sugar levels by preventing as much sugar from going into your blood. It can also help reverse insulin resistance.

Reduced-carbohydrate diets range from moderate to very low-carb. The rest of your calories come from protein and fat, so you might depend more heavily on high-protein and high-fat foods than the average person.

Low-Carb and Ketogenic Diets for Prediabetes

Foods to Emphasize

Zero-Carb Foods

  • Meat, poultry, and fish
  • Eggs
  • Oils
  • Butter

Low Carb Foods

  • Non-starchy vegetables
  • Full-fat cheese and yogurt
  • Avocados
  • Cheese
  • Nuts and seeds
  • Cream
  • Tofu

Moderate Carb Foods (Low-Carb Diet)

  • Fresh fruit, especially berries
  • Beans, peas, and lentils


  • Has been shown to lower insulin resistance and blood glucose levels (A1c) among individuals with diabetes and prediabetes.
  • Can aid in weight loss due to:
  • Calorie reduction from eliminating sweets and other high-calorie foods.
  • Increased fullness from protein and fat.
  • Reduced appetite from limited food choices.
  • Can be simpler to follow since food choices are more "black or white" – off limits or allowed.
  • Avoids unhealthy processed, sugary, and fried foods.
  • Avoiding sugars and starches can help some people avoid sugar cravings.

Foods to Limit or Avoid

  • Fruit juice and dried fruit
  • Most fruit (esp. ketogenic diet)
  • Starchy vegetables (e.g., peas, winter squash, corn, and sweet potatoes)
  • Beans, peas, and lentils (esp. ketogenic diet)
  • Reduced-fat dairy products, including sweetened yogurt (esp. ketogenic diet)
  • Grains (e.g., bread, pasta, rice, cereal, oatmeal, crackers, and pretzels)
  • Processed snack foods, such as potato chips, tortilla chips, and
  • Fried foods, such as doughnuts, French fries, and fried chicken.
  • Sweets (e.g., candy, cake, ice cream, pie, pastries, and cookies)
  • Sugar-sweetened beverages (e.g., soft drinks, energy drinks, sugar-sweetened coffee and tea, and sports drinks)
  • Alcoholic beverages


  • Difficult to limit carbohydrates so much.
  • They taste good.
  • They are in many common foods.
  • Lack of long-term data on health outcomes:
  • Is the high protein content tough on kidneys and the liver?
  • Is it really healthy to give up nutrient-dense foods such as whole grains, legumes, and fruit, which are linked to lower risk for certain diseases, include heart disease and even diabetes?
  • Potentially low in fiber, which aids with fullness, blood sugar control, and heart health.
  • Will you regain weight and reverse health benefits if you add carbs back into your daily menu?
  • Difficulty in following the diet long-term:
  • What will you eat at restaurants and at social events?
  • Are you able and willing to give up so many foods‚Ķforever?
  • Risk of eating too much saturated fat from fatty meat and poultry with skin.
  • Can be cumbersome to count grams of carbohydrates.
  • Possibility of trouble exercising due to low energy from lack of glycogen, which is the storage form of carbohydrates in your body.

Ketogenic Diet

A ketogenic diet is a type of low-carbohydrate diet that is on the extreme end. The goal is to limit carbohydrates so much that the body does not have enough glucose – a type of carbohydrate – to fuel the brain normally. Instead, the body shifts to a metabolic state called ketosis, and produces ketone bodies to fuel the brain's activities.

The theory behind a ketogenic diet for prediabetes is that when your body is in ketosis, you can be sure that you do not have excess carbohydrates in your diet. Since carbohydrates in your diet are broken down into glucose that goes into your bloodstream, being in ketosis assures that you are not inundating your bloodstream with excessive amounts of glucose due to the foods you eat.

A ketogenic diet might include about 20 to 50 grams per day of non-fiber carbohydrates, or about 5 to 10% of total calories from carbohydrates. The rest of your calories come from fat and protein. The food choices on this diet are similar to those on other low-carb diets, but you may need to further restrict some of the moderate-carbohydrate options that might be easier to fit in on a more moderate low-carb diet. Examples include fruit (an apple has 24 grams of non-fiber carbohydrates) and starchy vegetables (a half-cup of corn has 15 grams of non-fiber grams of carbs).

See the best prediabetic diet plans and recipes.

Is Following a Keto Diet a Good Way to Lose Weight?

Best Ketogenic Snacks

Cauliflower Turkey Hash

(Serves 4)


  • 1 lb. cooked fresh or frozen cauliflower, chopped
  • 1 lb. lean ground turkey
  • 1 tablespoon olive oil
  • 1 onion, chopped
  • 1/2 teaspoon dried thyme
  • 1/4 teaspoon pepper
  • 4 eggs


  • Heat the oil in a pan
  • Add the onion and ground turkey; stir until the turkey is browned
  • Add the spices and cauliflower
  • Add the eggs and stir until the eggs are cooked

Spinach Cheddar Frittata

Ketogenic spinach Cheddar Frittata

(Serves 4)


  • 1 tablespoon of olive oil
  • 10 oz. frozen cooked or fresh spinach
  • 8 oz. sliced zucchini
  • 4 eggs plus 8 egg whites
  • 4 oz. cheddar cheese


  • Cook the vegetables in a hot pan with oil
  • Mix with the eggs and cheese
  • Pour into a greased pan, and bake at 400 degrees until the eggs are set, or about 25 minutes.

Chicken Chili

Chicken Chili

(Serves 4)


  • 1 lb. chicken breast, cubed or shredded
  • 1 T. olive oil
  • 1 onion, diced
  • 1 clove garlic, chopped
  • 1 jalapeno pepper, seeded and chopped
  • 1 cup low-sodium chicken broth
  • 1 cup low-sodium canned white beans
  • 1/2 teaspoon cumin
  • 1/2 cup fresh cilantro
  • 2 oz. shredded cheese
  • 1 avocado, sliced


  • Heat the oil in a pan and add the chicken, garlic, onion, and jalapeno and cook.
  • Add the broth, beans, and cumin, bring to a boil, then simmer for 15 minutes.
  • Stir in the cilantro.
  • Serve, topped with cheese and avocado.

Other Low-Carb Ketogenic Snacks

Here is a quick list of snacks that are keto-friendly and easy to make:

Dark chocolate and keto diet
  • 1/4 cup cantaloupe and 1 string cheese stick
  • 1 cup cucumber sticks and 1/2 cup plain Greek yogurt
  • 1 oz. almonds
  • 1 cup bell pepper strips and 2 tablespoons hummus
  • 1 string cheese stick or 1 oz. other cheese
  • 1 hard-boiled egg
  • 1 cup cooked broccoli florets with 1 oz. cheese melted on top
  • 1 oz. unsweetened 100% dark chocolate
  • Caprese salad with 1 oz. mozzarella cheese in small cubes, plus 1/2 cup cherry tomatoes, fresh basil, and 1 teaspoon of olive oil
  • 1/2 can tuna mixed with 2 tablespoons of yogurt and 1 tablespoon of diced celery, spread on hollowed-out cucumber halves or hard-boiled egg white halves.
  • 1 small avocado
  • Mini skewers with 2 oz. of skinless cooked chicken breast and 1 oz. of mozzarella cheese, both cubed, and button mushrooms.

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