Brief Literature Review: Glycemic Control With Ketogenic Diet in People With Diabetes.

Abstract

Evidence does not support a clear preference for a specific eating pattern for people with diabetes, yet recommendations should be evidence-based, standardized, and individualized. Current nutrition guidelines focus on whole foods and dietary patterns rather than specific nutrients (1). The ketogenic eating pattern was initially used as adjunctive therapy for epilepsy (2). However, recent evidence suggests that a ketogenic eating pattern may improve glycemic control in people with type 2 diabetes (2). The macronutrient intake of people on a ketogenic diet predominantly consists of 55–60% fat, 30–35% protein, and <26% carbohydrates, with daily carbohydrate intake ranging from 20 to 50 g based on total caloric intake of 2,000 kcal/day (1–3). The key aspect of the ketogenic eating pattern is the restriction of carbohydrates, which limits the body’s energy intake from glucose. To compensate for the lack of energy derived from glucose, the body produces ketone bodies from fatty acid oxidation to provide an alternative source of energy. The ketone bodies synthesized from fatty acid oxidation include β-hydroxybutyrate, acetoacetate, and acetone. These specific molecules are all able to cross the blood-brain barrier and provide energy to the brain. Additional use of these ketone bodies for energy production can be seen in the kidneys, heart, and muscle tissue (2). The success of the ketogenic eating pattern in people with epilepsy (4,5) has garnered attention for people with other disease states such as type 2 diabetes. Interestingly, ketogenic diets were being developed for treatment of diabetes in the 1910s, at the same time as they were being developed as a treatment for epilepsy (6). Studies have shown patients experiencing rapid weight loss, as well as reductions in A1C and fasting blood glucose (FBG) levels (2). Because of the popular interest in the ketogenic eating pattern among …