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: 2.93). 06/2012; 28(10):1016-21. DOI: 10.1016/j.nut.2012.01.016
Source: PubMed


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.

Three hundred and sixty-three overweight and obese participants were recruited from the Al-Shaab Clinic for a 24-wk diet intervention trial; 102 of them had type 2 diabetes. The participants were advised to choose LCD or LDKD, depending on their preference. Body weight, body mass index, changes in waist circumference, blood glucose level, changes in hemoglobin and glycosylated hemoglobin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, uric acid, urea and creatinine were determined before and at 4, 8, 12, 16, 20, and 24 wk after the administration of the LCD or LCKD. The initial dose of some antidiabetic medications was decreased to half and some were discontinued at the beginning of the dietary program in the LCKD group. Dietary counseling and further medication adjustment were done on a biweekly basis.

The LCD and LCKD had beneficial effects on all the parameters examined. Interestingly, these changes were more significant in subjects who were on the LCKD as compared with those on the LCD. Changes in the level of creatinine were not statistically significant.

This study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects. The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.

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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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