By: Lydia Parker, LWDI Intern

Effects of a Low Carbohydrate and Ketogenic Diet on Type 2 Diabetes and Obesity

When I look up “what is the best diet to be on” on Google, there are numerous nutrition programs such as Noom, Nutrisystem, and Weight Watchers that are suggested. However, diets such as Atkins, DASH, and the ketogenic diet also appear in the search. So, what really is the best diet? As I have been asked this question multiple times, my answer is different for each individual.

 

In my current outpatient rotation I am working alongside an obesity medicine physician who specializes in medical weight loss. On a day to day basis, appetite-suppressant medications are prescribed to help patients who are overweight or obese, lose weight and to reverse comorbid conditions like diabetes, hypertension, and fatty liver disease.

Although medication is considered one of the four pillars of the treatment of obesity, diet is another that has been researched for years due to its importance. The physician I work alongside stresses the importance of a low-carbohydrate diet or a ketogenic diet due to its effects on weight loss. A low-carbohydrate diet is defined as consuming less than 130g of carbohydrate a day whereas a ketogenic diet would be defined as consuming less than 50g of carbohydrate a day (1). The ketogenic diet as a whole consists of 70 to 80% from fat, 10 to 20% from protein, and 5 to 10% from carbohydrates (2). So what are the true benefits of a lower carbohydrate, or ketogenic diet and how does it work? 

In this kind of diet, the body enters a process known as ketosis. Ketosis occurs when the body produces ketones and fatty acids from the liver for its fuel source rather than using glucose. In using this alternate fuel source, a loss of fat is observed, thus resulting in overall weight loss and positive effects on individuals with type 2 diabetes as explained below.

In an article written by Athinarayanan et al called the “Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes”, researchers focused on the long-term effects of ketosis. Over the course of 2 years, they found that greater than 50% of patients following a very low carbohydrate diet were able to reverse type 2 diabetes, lose greater than 10% of their body weight, improve lab work such as hemoglobin A1C, fasting glucose, and triglycerides and also reduce dependence on medications like sulfonylureas and insulin (3). Additionally, another study was released where researchers followed individuals with type 2 diabetes on a ketogenic diet for 12 months. At the end of the twelve month period, greater than 50% of patients following the ketogenic diet reversed their diabetes, improved their lab values such as hemoglobin A1C, and reduced the number of medications they were on to none or only Metformin (1).

 

As any diet presents with difficulties and side effects, this one does as well. If an individual is following a low carbohydrate diet, they are less likely to experience more severe effects than those following a very low carbohydrate diet. It is typical to experience fatigue, lightheadedness, and weakness within the first few weeks in addition to muscle cramps, constipation, and even hypokalemia (4). With any restriction of carbohydrates, those prone to gout are at increased risk for having an arthritic attack. Later onset side effects include cholestasis, hair loss, and dry skin according to Vernon et al (4). On a positive note, many of these side effects can be prevented and relieved through simple fixes such as supplementation, medication, and increased fluid intake (4). For patients with diabetes, hypoglycemia is one of the biggest concerns for those following a keto or low carbohydrate diet. In the studies I have presented here, there were little to no hypoglycemic events reported (3, 5).

 

As I mentioned previously, I truly do not believe one diet fits all. I have been studying nutrition for over 5 years now and have always been apprehensive about this diet due to the higher fat intake requirement to reach ketosis. However, in my current rotation and the research I’ve done about the keto diet and its effects on type 2 diabetes and obesity, I’ve been able to witness first-hand how effective and life-changing it is. I’ve seen many patients reverse their hypertension, diabetes, metabolic syndrome, and non-alcoholic fatty liver disease and even get off a number of medications by cutting out a majority of their carbohydrate intake. Although this diet can mean something different for everyone, the research is there and the patients are the evidence. 

I encourage you all to do your own research about nutrition topics before believing what you see in one singular piece of evidence. The internet is filled with so much information, and most often is difficult to tell right from wrong. Ask your providers, reach out to RD’s, and never be afraid to share what you learn. Knowledge is power! 

By: Lydia Parker, Lagniappe Wellness Dietetic Intern

References-

1. Volek, J.S.; Phinney, S.D.; Krauss, R.M.; Johnson, R.J.; Saslow, L.R.; Gower, B.; Yancy, W.S., Jr.; King, J.C.; Hecht, F.M.; Teicholz, N.; et al. Alternative Dietary Patterns for Americans: Low-Carbohydrate Diets. Nutrients 2021,13,3299. https:// doi.org/10.3390/nu13103299
2. Diet Review: Ketogenic Diet for Weight Loss, Harvard School of Public Health, The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/ 
3. Athinarayanan, SJ; Adams, RN; Hallberg, SJ; McKenzie, AL; Bhanpuri, NH; Campbell, WW; Volek, JS; Phinney, SD; and McCarter, JP; et al (2019). Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Front. Endocrinol. 10:348. doi: 10.3389/fendo.2019.00348
4. Vernon, MC; Westman, EC; Wortman, JA. Dietary Treatment of the Obese Individual. Obesity: Evaluation and Treatment Essentials, 2016. Dietary Treatment of the Obese Individual.
5. Yancy, WS Jr; Foy M; Chaleck, AM; Vernon, MC; Westman, EC; et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005;2:34. Published 2005 Dec 1. doi:10.1186/1743-7075-2-34