Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 28; no. 10; pp. 1016 - 1021
• Main Authors: Hussain, Talib A., M.B., Ch.B., R.C.G.P, Mathew, Thazhumpal C., M.Sc., Ph.D., F.R.C.Path, Dashti, Ali A., M.Sc., Ph.D, Asfar, Sami, M.B., Ch.B., M.D., F.R.C.S., F.A.C.S, Al-Zaid, Naji, B.Sc., Ph.D, Dashti, Hussein M., M.D., Ph.D., F.I.C.S., F.A.C.S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-10-2012; Elsevier; Elsevier Limited
• Subjects: Adult; Biological and medical sciences; Blood; Blood glucose; Blood Glucose - metabolism; Body Mass Index; Body weight; Caloric Restriction; Cholesterol; Creatinine - blood; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diet therapy; Diet; Diet, Carbohydrate-Restricted; Diet, Ketogenic; Drug dosages; Energy Intake; Feeding. Feeding behavior; Female; Food; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Glycated Hemoglobin A - metabolism; Hemoglobins - metabolism; Humans; Ketogenic diet; Lipid profile; Lipids - blood; Low-calorie diet; Male; Middle Aged; Nutritive value; Obesity; Obesity - blood; Obesity - complications; Obesity - diet therapy; Risk factors; Studies; Urea; Urea - blood; Uric Acid - blood; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Waist Circumference; Weight control; Weight Loss; Kuwait; Blood glucose; Lipid profile; Obesity; Body mass index; Low-calorie diet; Ketogenic diet; Endocrinopathy; Type 2 diabetes; Nutrition disorder; Metabolic diseases; Lipids; Glucose; Blood; Feeding; Vertebrata; Mammalia; Diet; Low; Carbohydrate; Nutritional status; Comparative study; Low calorie diet
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2012.01.016

Abstract Objective 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. Methods 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. Results 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. Conclusion 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.