In recent years, the ketogenic diet has gained increasing attention as a dietary strategy for managing blood glucose, especially in patients with type 2 diabetes and insulin resistance. This nutritional regimen, characterized by an extremely low carbohydrate intake (generally less than 10% of daily caloric intake), a high fat consumption and an adequate protein intake, induces a metabolic state known as ketosis. During the state of ketosis, the body uses the so-called ketone bodies (acetoacetate and beta-hydroxybutyrate) as the primary energy source in place of glucose, which can have a significant impact on carbohydrate metabolism and insulin sensitivity.
Numerous studies have shown that the ketogenic diet can lead to a rapid and substantial reduction in fasting plasma glucose, glycemic variability and glycated hemoglobin (HbA1c) levels, key parameters in the control of diabetes. Scientific evidence suggests that, in the short term, the ketogenic diet may be particularly effective in improving glycemic control. A study published in Diabetes Therapy found that patients with type 2 diabetes who followed a ketogenic protocol for 12 weeks showed a significant reduction in fasting blood glucose and improved insulin sensitivity compared to those who followed a standard diet.
Other studies have reported substantial reductions in insulin resistance and improved pancreatic beta-cell function, suggesting a potential benefit for early diabetes treatment. However, the long-term effects of this diet on metabolic health remain controversial. Some studies indicate that chronic carbohydrate restriction may lead to adverse effects, including increased cardiovascular risk due to high saturated fat intake, alterations in gut microbiota, and possible nutritional deficiencies. Furthermore, the sustainability in the long term of the ketogenic diet represents a significant challenge, with many people struggling to maintain adherence due to the rigidity of dietary restrictions.
Despite the benefits observed in the short term, nutritional recommendations for the management of type 2 diabetes suggest a more balanced and personalized approach, taking into account individual needs, food preferences, and long-term sustainability. In this context, it may be useful to combine the favorable metabolic effects of the ketogenic diet with less restrictive dietary strategies, such as the low-glycemic Mediterranean diet or intermittent fasting. Further research is needed to evaluate the long-term impact of the ketogenic diet and to determine its optimal role in managing diabetes and overall metabolic health.
- Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Sientific references
Hallberg SJ et al. Diabetes Ther. 2018; 9(2):583.
Feinman RD et al. Nutrition. 2015; 31(1), 1-13.
Taylor R. Diabetes Care. 2013; 36(4):1047-1055.
