Is the ketogenic diet an effective and safe approach to type 2 diabetes management and weight loss?

Abstract

The use of ketogenic diets (KDs) for the management of type 2 diabetes mellitus (T2DM) and in weight-loss programs is long established, but high-quality data supporting them are limited and they remain controversial. In recent years there has been a trend towards individual, patient-centered medical nutrition therapy in which KD regimens have been adapted to the specific needs of individuals. Every patient with type 1 diabetes mellitus (T1DM) or T2DM should have a dietary regimen that is specific to their needs in addition to their continuing medications, and KD may have an important role in this aspect of disease management. KD regimens consist of low carbohydrate intake (<5%) with high fat (70-75%) and moderate protein (20-25%). The low carbohydrate content assists with weight loss and glycemic control while the relatively high protein content can increase satiety and thus assist adherence to the diet, reduce food intake, and decrease weight. These factors are beneficial in individuals with reduced insulin secretion or reduced response to insulin. In KDs, the oxidation of fat mass in the body is desirable but leads to ketone body generation and potentially to ketosis. This and raised levels of free fatty acids, can cause negative cardiovascular, renal, bone mineral, liver, and other effects, which discourage some physicians from recommending this diet for their patients. The KD, however, has reported positive neurological effects and is used in the treatment of epilepsy and some other neurological conditions in addition to weight-loss and diabetes regimens. It is clear that more studies are needed to provided better evidence in support or against a KD in diabetes therapy. Until this is available, KD use is likely to remain a matter of opinion and its true potential value, particularly in T2DM management, may not be realized.