Rethinking Fat: A Ketogenic Approach to Type 2 Diabetes Management
For decades, we’ve been told that fat is the problem. That eating fat makes us gain weight, clogs our arteries, and increases our risk for chronic disease.
But what if this long-standing advice has missed the mark, especially when it comes to managing Type 2 diabetes?
In recent years, both research and clinical experience have begun to challenge the idea that fat is the primary driver of metabolic disease. Instead, attention has shifted toward insulin resistance and the role that carbohydrates play in blood sugar dysregulation. This shift has opened the door to renewed interest in low-carbohydrate and ketogenic dietary approaches for Type 2 diabetes.
A Different Perspective on Dietary Fat
The documentary Fat Fiction explores how dietary fat became misunderstood in modern nutrition guidance.
The 2020 documentary Fat Fiction takes a critical look at how modern dietary guidelines came to be and asks an important question: Have “low-fat, heart-healthy” recommendations actually improved metabolic health?
Featuring physicians, researchers, and journalists including Dr. Sarah Hallberg, Dr. Jason Fung, Dr. Mark Hyman, and Nina Teicholz, the film explores how saturated fat became the villain while sugar and refined carbohydrates were largely overlooked.
Rather than simply critiquing the past, Fat Fiction points toward a different framework, one that may be especially relevant for people struggling with insulin resistance and Type 2 diabetes.
“Reversing Type 2 Diabetes Starts with Ignoring the Guidelines”
One of the most influential voices featured in Fat Fiction is Dr. Sarah Hallberg, whose widely viewed TEDx talk, Reversing Type 2 Diabetes Starts with Ignoring the Guidelines, helped change how many clinicians and patients think about diabetes care.
Her message was both simple and radical:
Type 2 diabetes is not a disease of insulin deficiency. It is a disease of carbohydrate intolerance.
Dr. Hallberg highlighted a fundamental contradiction in standard dietary advice. While the body has essential requirements for amino acids (protein) and fatty acids (fat), there is no minimum dietary requirement for carbohydrates. Yet traditional diabetes guidelines have long encouraged people to consume a significant percentage of their calories from carbohydrates, the macronutrient that most directly raises blood sugar and insulin levels.
In her clinical work, Dr. Hallberg demonstrated that when carbohydrate intake was reduced and replaced with adequate protein and healthy fats, many patients experienced dramatic improvements. In one study, patients following a low-carbohydrate, higher-fat approach were able to significantly reduce or eliminate insulin use, while those following conventional dietary recommendations often required increasing medication.
Perhaps most importantly, she emphasized that reversal and remission should be a goal, not just long-term management.
Understanding the Metabolic Connection
At its core, Type 2 diabetes is a condition of insulin resistance.
When carbohydrates are consumed, blood glucose rises and insulin is released to move that glucose into cells. Over time, repeated glucose spikes can lead cells to become less responsive to insulin’s signal. The body compensates by producing more insulin, creating a cycle of elevated blood sugar, elevated insulin, and worsening insulin resistance.
A ketogenic or very low-carbohydrate approach addresses this cycle directly.
By significantly reducing carbohydrate intake, the demand for insulin decreases. The body begins to rely more heavily on fat and ketones for fuel, which can improve insulin sensitivity and stabilize blood sugar levels over time.
What the Research and Clinical Experience Show
A growing body of research suggests that low-carbohydrate and ketogenic approaches may:
Improve fasting blood glucose and HbA1c
Reduce post-meal blood sugar spikes
Decrease the need for diabetes medications (under medical supervision)
Support weight loss when appropriate
Improve triglycerides and HDL cholesterol
Reduce markers of inflammation
Clinicians like Dr. Hallberg documented these outcomes repeatedly in real-world practice, often in patients who had struggled for years despite following standard dietary advice.
What Does a Ketogenic Approach Look Like?
A therapeutic ketogenic or low-carbohydrate approach for Type 2 diabetes typically emphasizes:
Foods to Prioritize
Healthy fats such as olive oil, avocados, nuts, seeds, and fatty fish
Adequate protein from high-quality sources like eggs, poultry, meat, and seafood
Non-starchy vegetables rich in fiber and micronutrients
Full-fat dairy if tolerated
Foods to Minimize
Refined carbohydrates and added sugars
Sugary beverages and snacks
Grains and starches, or significantly reduced portions
Highly processed “low-fat” foods
Macronutrient ratios are not one-size-fits-all. Some people thrive with a strict ketogenic approach, while others do best with a more moderate reduction in carbohydrates. Personalization matters.
Important Safety Considerations
A ketogenic approach should be undertaken thoughtfully, particularly for individuals who use insulin or blood sugar-lowering medications. As blood sugar improves, medication needs often decrease, sometimes rapidly.
For this reason, dietary changes should always be coordinated with a healthcare provider, and ideally supported by a qualified nutrition professional.
This approach is not about extremes or perfection. It’s about using food strategically to support metabolic health.
A More Empowering Conversation About Diabetes
What makes the ketogenic conversation compelling isn’t that it claims to be the only solution, but that it reframes the problem.
Instead of asking how to manage rising blood sugar indefinitely, it asks:
What is driving insulin resistance?
How can we lower insulin demand?
How can nutrition support metabolic healing rather than constant correction?
For many people, this shift brings not only better lab values, but a renewed sense of agency and hope.
Type 2 diabetes does not have to be a progressive, irreversible condition. With the right approach, meaningful improvement, and in some cases remission, is possible.
Curious to Learn More?
If you’re interested in exploring this perspective further:
Watch Fat Fiction to better understand how dietary fat became misunderstood
View Dr. Sarah Hallberg’s TEDx talk, Reversing Type 2 Diabetes Starts with Ignoring the Guidelines, for a clear, accessible explanation of the low-carbohydrate approach
If you’re navigating Type 2 diabetes or prediabetes, personalized guidance matters. Sustainable change happens when good information is paired with individualized support and careful monitoring.
