Debating Diabetic Diets: Considering Keto for Patients with Diabetes

Written by John Buse, M.D., Ph.D.
ReachMD Host

Debating Diabetic Diets: Considering Keto for Patients with Diabetes 

I think in general, in the setting of type 2 diabetes, ketogenic diets clearly result in improvements in glycemic control and weight loss, to a greater extent than you see with other diets that are aimed at calorie restriction. Ketogenic diets have much lower carbohydrate content than other diet plans. All carbohydrates consumed are broken down to simple sugars through digestion and then adsorbed into the blood stream. To get those sugars out of the blood stream and into tissues requires insulin. So less carbohydrates consumed translates into less insulin required to maintain normal blood sugar. In the setting of diabetes, this is really very helpful to minimize the need for endogenous insulin secretion, or perhaps the need for exogenous insulin in the form of insulin injections. Ketogenic diets are also associated with weight loss in most cases, as well as greater weight loss than you see with other diet plans particularly over shorter 6-to-12 month studies.

The remaining question about the ketogenic diet is its long-term safety and efficacy. There is a concern, particularly in the setting of type 1 diabetes about diabetic ketoacidosis, which can also be a potential complication in type 2 diabetes. The long-term safety of this diet in regard to cardiovascular risk and bone health is not well-studied. I do believe that if the source of fat in a ketogenic diet is largely from plants that there may be fewer issues with regards to long-term adverse effects. But that remains to be studied, in long-term trials.

So, for now, I think as a short-term exercise, there are clearly benefits. I think the main thing that a provider and patient need to decide together is whether or not the patient is going be able to continue the ketogenic diet in the long run. If they aren’t, they need to understand this is a short-term fix, and have a strategy for how to maintain weight loss and glycemic control, as people often come off the ketogenic portion of the diet over time.