by Lewis Chang, PhD
An editorial perspective, recently published in the Journal of American Medical Association (JAMA) obesity-themed issue, helps to explain the growing interest in the ketogenic diet for weight and type 2 diabetes (T2D) management .
Many people successfully lose weight via diet over the short haul; however, because of physiological adaptations, it becomes much more difficult to maintain that weight loss in the long run. As a result, a majority of people regain their weight—and sometimes more. Interestingly, accumulating evidence suggests that the ketogenic diet may be different from other diets.
A ketogenic diet is a dietary approach that promotes nutritional ketosis by restricting carbohydrates (usually to less than 50 g per day) and increasing the intake of fat with adequate consumption of protein A recent meta-analysis based on 13 randomized controlled trials (study duration of 1 year or longer) demonstrated that individuals assigned to ketogenic diets achieved a greater long-term weight loss than those assigned to low-fat diets .
What makes a ketogenic diet different? Scientists believe the following factors may be contributory:
- higher fat content in the ketogenic diet contributes to satiety
- changes in appetite-regulating hormones help decrease hunger
- ketone bodies generated during ketosis may directly suppress appetite
- ketogenic diet may not lead to a slowdown in metabolism as seen in low-fat diet
In addition to a higher success rate in long-term weight loss, ketogenic diets may be invaluable for T2D management. Ketogenic diets have been shown to improve glycemic control, increase insulin sensitivity, reduce requirement for T2D medications, and decrease HbA1c [3, 4]. In fact, ketogenic diets have been used as the first-line therapy for obesity and T2D at the Duke Lifestyle Medicine Clinic (Durham, NC) for a decade.
However, experts caution that a ketogenic diet is not a ‘do-it-yourself’ diet, particularly for individuals with T2D. Without supervision, individuals taking insulin or T2D medications may end up experiencing serious hypoglycemia. In order to achieve long-term success and safety, individuals should choose an organized ketogenic program with monitoring and proper education.
Why is this Clinically Relevant?
- Accumulating evidence suggests that a ketogenic diet may be more effective than other diets in weight loss and T2D management
- However, ketogenic diet is not a DIY diet
- It is critical that individuals work with an organized program for long-term safety monitoring, especially in cases of T2D, in order to adjust T2D medications during diet
 Abbasi, J., Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes. JAMA, 2018. 319(3): p. 215-217.
 Bueno, N.B., et al., Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr, 2013. 110(7): p. 1178-87.
 McKenzie, L.A., et al., A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes, 2017. 2(1): p. e5.
 Boden, G., et al., Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med, 2005. 142(6): p. 403-11.