J Korean Diabetes.  2019 Dec;20(4):244-250. 10.4093/jkd.2019.20.4.244.

Ketogenic Diet and Glucose Control

• Lee YH

• KMID: 2468013
• DOI: http://doi.org/10.4093/jkd.2019.20.4.244

Abstract

There is not a set percentage of calories from carbohydrate, protein, and fat for all people with diabetes. It is recommended that diet be individualized according to each patient's eating patterns, preferences, and metabolic goals. Overweight or obese patients with diabetes could improve their insulin sensitivity, glycemia, blood pressure and dyslipidemia via weight loss. Therefore, various dietary patterns have been tried for weight and glucose control. The Ketogenic diet includes very low-carbohydrate and high fat and is known to be effective for weight loss in a short period of time. Short-term studies have demonstrated the effects of the Ketogenic diet on weight loss and glycemic control improvement, but long-term studies are not yet sufficient. In addition, various side effects such as hypoglycemia and nutritional imbalances are concerns, so there is a lack of evidence with respect to recommending this diet as nutrition therapy for diabetics.

Keyword

Carbohydrate-restricted; Diet; High-fat; Ketogenic; Nutrition therapy for diabetes mellitus

MeSH Terms

Blood Pressure
Diet
Dyslipidemias
Eating
Glucose*
Humans
Hypoglycemia
Insulin Resistance
Ketogenic Diet*
Nutrition Therapy
Overweight
Weight Loss
Glucose

Reference

1. World Health Organization. Diet, nutrition and the prevention of chronic diseases. Geneva: World Health Organization;2003.

2. Korean Diabetes Association. Treatment guideline for diabetes. 6th ed. Seoul: gold's Planning and Development;2019. p. 43–48.

3. American Diabetes Association. Executive summary: standards of medical care in diabetes--2014. Diabetes Care. 2014; 37:Suppl 1. S5–S13.

4. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346:393–403.

5. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344:1343–1350.

6. Look AHEAD Research Group. Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010; 170:1566–1575.

7. Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care. 1994; 17:519–522.

8. Brouns F. Overweight and diabetes prevention: is a low-carbohydrate-high-fat diet recommendable? Eur J Nutr. 2018; 57:1301–1312.

9. Kanikarla-Marie P, Jain SK. Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes. Free Radic Biol Med. 2016; 95:268–277.

10. Hall KD. A review of the carbohydrate-insulin model of obesity. Eur J Clin Nutr. 2017; 71:323–326.

11. Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, Accurso A, Frassetto L, Gower BA, McFarlane SI, Nielsen JV, Krarup T, Saslow L, Roth KS, Vernon MC, Volek JS, Wilshire GB, Dahlqvist A, Sundberg R, Childers A, Morrison K, Manninen AH, Dashti HM, Wood RJ, Wortman J, Worm N. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015; 31:1–13.

12. Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L, Uelmen S, Urbanski PB, Yancy WS Jr. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019; 42:731–754.

13. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, Chun C, Khang YH, Oh K. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014; 43:69–77.

14. The Korean Nutrition Society. Dietary reference intakes for Koreans 2015. Sejong: Ministry of Health and Welfare;2016.

15. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003; 348:2074–2081.

16. Yancy WS Jr, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005; 2:34.

17. Westman EC, Yancy WS Jr, Mavropoulos JC, Marquart M, McDuffie JR. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond). 2008; 5:36.

18. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Blüher M, Stumvoll M, Stampfer MJ. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008; 359:229–241.

19. Goldstein T, Kark JD, Berry EM, Adler B, Ziv E, Raz I. The effect of a low carbohydrate energy-unrestricted diet on weight loss in obese type 2 diabetes patients – a randomized controlled trial. E Spen Eur E J Clin Nutr Metab. 2011; 6:e178–e186.

20. Elhayany A, Lustman A, Abel R, Attal-Singer J, Vinker S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obes Metab. 2010; 12:204–209.

21. Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009; 8:35.

22. Yamada Y, Uchida J, Izumi H, Tsukamoto Y, Inoue G, Watanabe Y, Irie J, Yamada S. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Intern Med. 2014; 53:13–19.

23. Snorgaard O, Poulsen GM, Andersen HK, Astrup A. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2017; 5:e000354.

24. Daly ME, Paisey R, Paisey R, Millward BA, Eccles C, Williams K, Hammersley S, MacLeod KM, Gale TJ. Short-term effects of severe dietary carbohydrate-restriction advice in type 2 diabetes--a randomized controlled trial. Diabet Med. 2006; 23:15–20.

25. Guldbrand H, Dizdar B, Bunjaku B, Lindström T, Bachrach-Lindström M, Fredrikson M, Ostgren CJ, Nystrom FH. In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia. 2012; 55:2118–2127.

26. Jonasson L, Guldbrand H, Lundberg AK, Nystrom FH. Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet. Ann Med. 2014; 46:182–187.

27. de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, Uleryk E, Budylowski P, Schünemann H, Beyene J, Anand SS. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ. 2015; 351:h3978.

28. Davis NJ, Tomuta N, Schechter C, Isasi CR, Segal-Isaacson CJ, Stein D, Zonszein J, Wylie-Rosett J. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care. 2009; 32:1147–1152.

29. Korsmo-Haugen HK, Brurberg KG, Mann J, Aas AM. Carbohydrate quantity in the dietary management of type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2019; 21:15–27.

30. Leow ZZX, Guelfi KJ, Davis EA, Jones TW, Fournier PA. The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia. Diabet Med. 2018; 35:1258–1263.

31. McClean AM, Montorio L, McLaughlin D, McGovern S, Flanagan N. Can a ketogenic diet be safely used to improve glycaemic control in a child with type 1 diabetes? Arch Dis Child. 2019; 104:501–504.

32. Hu T, Mills KT, Yao L, Demanelis K, Eloustaz M, Yancy WS Jr, Kelly TN, He J, Bazzano LA. Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol. 2012; 176:Suppl 7. S44–S54.

33. Cani PD, Bibiloni R, Knauf C, Waget A, Neyrinck AM, Delzenne NM, Burcelin R. Changes in gut microbiota control metabolic endotoxemia-induced inflammation in high-fat diet-induced obesity and diabetes in mice. Diabetes. 2008; 57:1470–1481.

34. Kennedy ET, Bowman SA, Spence JT, Freedman M, King J. Popular diets: correlation to health, nutrition, and obesity. J Am Diet Assoc. 2001; 101:411–420.

35. Noto H, Goto A, Tsujimoto T, Noda M. Lowcarbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS One. 2013; 8:e55030.