Benefits of the Ketogenic Diet in Diabetic Patients

Abstract

Ketogenic diets, which are known for low carbohydrate and high-fat levels, are reported to confer protection against hyperglycemia in diabetes. Therefore, healthcare providers can advise diabetic patients to consume this diet. However, there is a need to back up such recommendations with adequate scientific proof. The goal of this study is to verify the benefits of ketogenic diets in diabetic patients. The objectives included searching the literature for recent articles on the use of ketogenic diets in diabetes. A literature review of original research articles published within the last five years was conducted. All the papers reviewed showed that the consumption of ketogenic diets led to improved health outcomes such as proper glycemic control, lower hemoglobin A1c levels, and reduced incidence of diabetic complications in patients on ketogenic diets compared to those who consumed regular foods. The study concluded that ketogenic diets were beneficial to patients with diabetes and should be recommended by healthcare providers.

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Introduction

Diabetes mellitus is a longstanding endocrine disorder marked by insulin deficiency or impaired functioning. The key symptoms of the disease include polyuria, polydipsia, and polyphagia. Laboratory tests in diabetic patients usually show elevated blood glucose levels. The World Health Organization (2019) reports that the global incidence of the disorder quadrupled from about 108 million in 1980 to 422 million in 2014. In adults aged 18 and older, the incidence of the disease has almost doubled from 4.7% to 8.5% within that period. Middle and low-income countries have also recorded a marked increase in the incidence of diabetes, which has led to increased healthcare costs as well as high rates of morbidity and mortality. Diabetic complications include foot ulcers, blindness, ketoacidosis, retinopathy, and nephropathy. The management of diabetes involves a healthy diet, regular exercise, and medication adherence. Studies have shown that diet alone plays a vital role in managing the condition and decreasing the need for medications (Gupta et al., 2017). Further investigations into the correct diet for diabetic patients have led to the discovery of ketogenic diets.

A ketogenic diet can be defined as one containing very low levels of carbohydrates and high quantities of fat. The development of this diet entails substituting a significant portion of carbohydrates with fats, which reduces blood sugar levels and minimizes the need for the hormone insulin. Consequently, the body redirects its metabolism from that of carbohydrates to fats and ketone bodies (Kesl et al., 2016). Numerous studies have demonstrated that ketogenic diets enhance weight loss and are beneficial in disorders such as Alzheimer’s, epilepsy, cancer, and diabetes. The detailed findings are summarized below in Table 1. With this knowledge, there is a need to establish the efficiency of this diet in the management of diabetes.

Table 1: Literature review matrix.

Author(s) and year Objective Main findings
Saslow et al., 2017a. To compare the effect of a ketogenic diet with lifestyle modifications versus an online diet on glycemic control and other health attributes in obese patients with type 2 diabetes. At 32 weeks, the treatment group had low hemoglobin A1c levels, greater weight loss, and reduced triglyceride levels.
Goday et al., 2016. To assess the short-term safety and tolerability of a ketogenic diet in patients with type 2 diabetes mellitus. There were no significant differences in laboratory parameters (such as urine albumin-to-creatinine ratio, creatinine, and blood urea nitrogen) between the treatment and control group (standard low-calorie diet). The treatment group had better glycemic control and a greater decline in body weight. No adverse effects were reported.
Saslow et al., 2017b. To determine the impact of a ketogenic diet on metabolic measures and the need for medication in patients with type 2 diabetes at 12 months. Greater reductions in hemoglobin A1c levels and more weight losses were observed at 12 months in the treatment group compared to the control. The ketogenic diet minimized the need for medications, particularly sulfonylureas and dipeptidyl peptidase-4 inhibitors in the treatment group than the controls.
Gomez-Arbelaez et al., 2017. To find the impact of nutritional ketosis on HbA1c, body weight, and liver enzymes in patients with type 2 diabetes. A year of comprehensive continuous care intervention involving a ketogenic diet enhanced the surrogate scores of non-alcoholic fatty liver disease and liver fibrosis in patients with type 2 diabetes.
Meng et al., 2017. To evaluate the efficiency of a low carbohydrate diet (LCD) in patients with type 2 diabetes. LCD reduced HbA1c levels, promoted weight loss and reduced the risk for cardiovascular disease by lowering triglycerides and increasing HDL cholesterol concentration. However, the diet did not alter LDL or total cholesterol levels.

The purpose of this paper is to determine the benefits of the ketogenic diet in diabetic patients. It is hypothesized that eating a ketogenic diet lowers the likelihood of diabetic complications and contributes to the management of the disease. Therefore, the information provided in this paper is expected to be useful in guiding diabetic patients towards healthy diets to reduce the morbidity and mortality associated with the disease. This paper contains a methods section indicating how data were collected, a results section showing the ensuing data, a discussion of the outcomes, and concluding remarks.

Methods

A literature review was conducted to determine the available base of evidence to support the use of ketogenic diets in diabetic patients. Databases such as PubMed, CINAHL, EBSCOhost, and Google Scholar were searched using the search terms ketogenic diet and diabetes management. The search was limited to original research articles published within the last five years. Full-text articles were retrieved and reviewed to obtain pertinent data regarding the benefits of ketogenic diets in diabetic patients. The information was then summarized in a literature review matrix. Important details that were included in the matrix were authors, year of publication, objective, and outcomes.

Results

The findings showed that ketogenic diets enhanced glycemic control in patients with diabetes. Other benefits included decreased bodyweight, low hemoglobin A1c, and reduced triglycerides. Furthermore, studies to establish the safety and tolerability of ketogenic diets revealed that there were no significant differences in laboratory safety parameters between patients on ketogenic and conventional diets.

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Discussion

The major accomplishment of this work is verifying the effectiveness and safety of ketogenic diets in diabetics. It has been shown that ketogenic diets are more effective than regular low-calorie diets in the management of diabetes mellitus. Specific benefits include improved glycemic control, more weight loss, low hemoglobin A1c, and reduced triglycerides (Goday et al., 2016; Gomez-Arbelaez et al., 2017; Meng et al., 2017; Saslow et al., 2017a; Saslow et al., 2017b). These findings align with the American Diabetes Association practice recommendations regarding the standards of care in diabetes (ADA, 2018). ADA asserts that medical, nutritional therapy is a crucial part of lifestyle management in diabetes. A low carbohydrate intake combined with high levels of fat, particularly polyunsaturated fatty acids, is endorsed. However, ADA cautions that there is no specific macronutrient proportion for all diabetic patients. There is a need to customize the precise portions based on individual needs. Therefore, a competent dietitian should be involved in diet customization. Nonetheless, ADA (2018) suggests that ketogenic diets are only beneficial for three to four months due to the lack of adequate studies demonstrating their long-term benefits or dangers. As much as Saslow et al. (2017b) show that ketogenic diets are safe and effective at 12 months, diabetic patients considering the long-term use of this diet should undergo regular tests to determine its safety.

An interesting observation is that ketogenic diets do benefit not only diabetic patients but also people with obesity. However, Kanikarla-Marie and Jain (2016) suggest that ketogenic diets lead to the production of high levels of ketones, thereby contributing to hyperketonemia and ketosis. The authors further assert that hyperketonemia elevates oxidative stress and increases the susceptibility of patients with type 1 diabetes to complications.

Ethical approval will be obtained from the learning institution’s research ethics committee before commencing the study. The purpose of ethical approval will be to ensure that the study does not lead to any unintended harm. The expected time frame for the study is approximately four weeks. However, no budget will be required because the study will involve conducting a detailed literature review using library resources that are available at the institution’s library.

Conclusion

The purpose of this study is to determine the benefits of the ketogenic diet in diabetic patients. It is hypothesized that eating a ketogenic diet lowers the likelihood of diabetic complications and contributes to the management of the disease. A preliminary literature review indicates that a ketogenic diet enhances glycemic control and minimizes health complications associated with diabetes. However, future studies should examine the relationship between ketogenic diets, hyperketonemia, and ketosis in patients with type 1 and 2 diabetes.

References

American Diabetes Association. (2018). 4. Lifestyle management: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S38-S50.

Gupta, L., Khandelwal, D., Kalra, S., Gupta, P., Dutta, D., & Aggarwal, S. (2017). Ketogenic diet in endocrine disorders: Current perspectives. Journal of Postgraduate Medicine, 63(4), 242-251.

Kanikarla-Marie, P., & Jain, S. K. (2016). Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes. Free Radical Biology and Medicine, 95, 268-277.

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Kesl, S. L., Poff, A. M., Ward, N. P., Fiorelli, T. N., Ari, C., Van Putten, A. J.,… D’Agostino, D. P. (2016). Effects of exogenous ketone supplementation on blood ketone, glucose, triglyceride, and lipoprotein levels in Sprague–Dawley rats. Nutrition & Metabolism, 13(1), 9. Web.

Saslow, L. R., Mason, A. E., Kim, S., Goldman, V., Ploutz-Snyder, R., Bayandorian, H.,… Moskowitz, J. T. (2017a). An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: A randomized controlled trial. Journal of Medical Internet Research, 19(2), e36. Web.

Saslow, L. R., Daubenmier, J. J., Moskowitz, J. T., Kim, S., Murphy, E. J., Phinney, S. D.,… Moran, P. (2017b). Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutrition & Diabetes, 7(12), 304. Web.

World Health Organization. (2019). Diabetes. Web.

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