Article

Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes

Al Shaab Family Medicine Medical Center, Ministry of Health, Kuwait.
Nutrition (Impact Factor: 3.05). 06/2012; 28(10):1016-21. DOI: 10.1016/j.nut.2012.01.016
Source: PubMed

ABSTRACT Effective diabetic management requires reasonable weight control. Previous studies from our laboratory have shown the beneficial effects of a low-carbohydrate ketogenic diet (LCKD) in patients with type 2 diabetes after its long term administration. Furthermore, it favorably alters the cardiac risk factors even in hyperlipidemic obese subjects. These studies have indicated that, in addition to decreasing body weight and improving glycemia, LCKD can be effective in decreasing antidiabetic medication dosage. Similar to the LCKD, the conventional low-calorie, high nutritional value diet is also used for weight loss. The purpose of this study was to understand the beneficial effects of LCKD compared with the low-calorie diet (LCD) in improving glycemia.

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    • "Furthermore, the reduction of several inflammation markers in overweight men and women with atherogenic dyslipidemia was reported (Forsythe et al. 2008). It was also shown that a ketogenic diet was capable to lower blood glucose levels in obese diabetic patients more effectively than overall CR (Hussain et al. 2012). In contrast, a Swedish study in over 43.000 middle-aged women found a significant increase in cardiovascular diseases following a ketogenic diet (Lagiou et al. 2012). "
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    • "Ketogenic diets (KDs) are characterized by a very low carbohydrate (CHO, <30-50 g/day) and compensatory high fat content that lead to low insulin and subsequently increased ketone body levels in serum, also termed ketosis. Ketosis seems to have beneficial effects in certain pathological conditions, most notably epilepsy where it is the treatment of choice for patients with drugresistant intractable seizures [1] [2], but also metabolic syndrome [3] [4] [5] , cancer [6] and possibly Alzheimer's and other neurodegenerative disorders [7]. In addition, KDs have gained much popularity as weight-loss diets, where they have been shown to be at least as effective or even superior to traditional low-fat diets in obese individuals [8] [9] [10] [11] [12] with the additional benefit of favourably influencing risk factors for cardiovascular disease. "
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    ABSTRACT: Background: Ketogenic diets (KDs) have gained some popularity not only as effective weight-loss diets and treatment options for several diseases, but also among healthy and physically active individuals for various reasons. However, data on the effects of ketosis in the latter group of individuals are scarce. We therefore collected pilot data on the physiological response to a self-prescribed ketogenic diet lasting 5-7 weeks in a small cohort of healthy and physically active individuals. Methods: Twelve subjects (7 males, 5 females, age 24-60 years) who followed moderate to intensive exercise routines underwent blood testing, bioelectrical impedance analysis (BIA) and spiroergometry during an incremental treadmill test. On the next day, they went on a self-prescribed KD for a median of 38 days (range 35-50 days), after which the same tests were performed again. Ketosis was self-monitored by urinary ketone strips. Subjective feeling during the diet was assessed by a questionnaire after the intervention. Due to the small and heterogenous sample, the results are interpreted in the context of the already existing literature. Results: The KDs were tolerated well by the majority of individuals. Impaired recovery from exercise remained the most frequently reported side effect until the end of the study. Most blood parameters remained stable during the intervention. However, there were significant elevations of total and LDL cholesterol concentrations (p<0.01) and a trend towards increased HDL-cholesterol (p=0.05). The drastic reduction of carbohydrates had no statistically significant influence on running performance judged by the time to exhaustion, VO2max and respiratory compensation points. BIA measurements showed significant increases in phase angle (p=0.01) indicating improvements of body composition with an estimated decrease of 3.4 kg of fat mass (p=0.002) and gain of 1.3 kg of fat free mass. We discuss the validity of these estimates taking into account a possibly altered hydration status due to the KD. Conclusions: Active healthy individuals will probably experience no major problems during a short term KD lasting several weeks. The drastically reduced carbohydrate content of the diet seems to be no limiting factor for running performance. In addition, improvements in body composition can be expected. While most biochemical parameters are not influenced by the diet, there seems to be an impact on the blood lipid profile that could be considered problematic with respect to cardiovascular disease risk. However, the predictive role of cholesterol levels alone in individuals undergoing regular physical activity remains to be elucidated.
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    • "Cinnamon also has been shown to reduce both glucose and SBP in rodent studies [17]. Moreover, cinnamon could be included with low-carbohydrate ketogenic diets (LCKD) to improve glycemia and BP, as LCKD showed positive effects on HbA 1c , body weight, waist circumference, serum triglycerides, and glycemic control in participants with T2DM [24]. However, Table 2 Effect of cinnamon on systolic and diastolic blood pressure "
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