Efficacy of Ketogenic Diets on Type 2 Diabetes: a Systematic Review
Tóm tắt
To assess the pleiotropic effects of ketogenic diets (KD) on glucose control, changes in medication, and weight loss in individuals with type 2 diabetes, and to evaluate its practical feasibility KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year. This is associated with a reduction in glucose-lowering medications. The weight loss observed after a short time period seems to be maintained with a long-term diet. Adequate support (supportive psychological counseling, enhancing positive affectivity, reinforcing mindful eating) is necessary to achieve a benefit and to assure adherence. Despite the documented decrease in HbA1, a definitive causal effect of KD remains to be proven. KD should be performed under strict medical supervision. Future research should clarify how compliance can be maximized and how ketosis can be optimally monitored.
Tài liệu tham khảo
• American Diabetes A. 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S53-S72. https://doi.org/10.2337/dc21-S005. Most recent American guidelines for lifestyle management in prediabetes and diabetes.
Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065–79. https://doi.org/10.2337/dc16-1728.
Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255–323. https://doi.org/10.1093/eurheartj/ehz486.
•• Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019;42(5):731–54. https://doi.org/10.2337/dci19-0014Most recent guidelines for nutrition management in prediabetes and diabetes.
Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999;15(6):412–26. https://doi.org/10.1002/(sici)1520-7560(199911/12)15:6<412::aid-dmrr72>3.0.co;2-8.
Atkins RC. Dr Atkins’ diet revolution: the high calorie way to stay thin forever. New York: Bantam Books; 1973.
Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. 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):1178–87. https://doi.org/10.1017/S0007114513000548.
Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013;67(8):789–96. https://doi.org/10.1038/ejcn.2013.116.
Yancy WS, Jr., Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005;2:34. https://doi.org/10.1186/1743-7075-2-34.
Mobbs CV, Mastaitis J, Isoda F, Poplawski M. Treatment of diabetes and diabetic complications with a ketogenic diet. J Child Neurol. 2013;28(8):1009–14. https://doi.org/10.1177/0883073813487596.
Dashti HM, Mathew TC, Al-Zaid NS. Efficacy of low carbohydrate ketogenic diet in the treatment of type 2 diabetes. Med Princ Pract. 2020;30:223–35. https://doi.org/10.1159/000512142.
Westman EC, Yancy WS Jr, Mavropoulos JC, Marquart M, McDuffie JR. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond). 2008;5:36. https://doi.org/10.1186/1743-7075-5-36.
Kosinski C, Jornayvaz FR. Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies. Nutrients. 2017;9(5). https://doi.org/10.3390/nu9050517.
Yurista SR, Chong CR, Badimon JJ, Kelly DP, de Boer RA, Westenbrink BD. Therapeutic potential of ketone bodies for patients with cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2021;77(13):1660–9. https://doi.org/10.1016/j.jacc.2020.12.065.
Luukkonen PK, Dufour S, Lyu K, Zhang XM, Hakkarainen A, Lehtimaki TE, et al. Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease. Proc Natl Acad Sci U S A. 2020;117(13):7347–54. https://doi.org/10.1073/pnas.1922344117.
Watanabe M, Tozzi R, Risi R, Tuccinardi D, Mariani S, Basciani S, et al. Beneficial effects of the ketogenic diet on nonalcoholic fatty liver disease: a comprehensive review of the literature. Obes Rev. 2020;21(8):e13024. https://doi.org/10.1111/obr.13024.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41. https://doi.org/10.1016/j.ijsu.2010.02.007.
Wong K, Raffray M, Roy-Fleming A, Blunden S, Brazeau AS. Ketogenic diet as a normal way of eating in adults with type 1 and type 2 diabetes: a qualitative study. Can J Diabetes. 2021;45(2):137–43.e1. https://doi.org/10.1016/j.jcjd.2020.06.016.
Webster CC, Murphy TE, Larmuth KM, Noakes TD, Smith JA. Diet, diabetes status, and personal experiences of individuals with type 2 diabetes who self-selected and followed a low carbohydrate high fat diet. Diabetes Metab Syndr Obes. 2019;12:2567–82. https://doi.org/10.2147/dmso.S227090.
Walton CM, Perry K, Hart RH, Berry SL, Bikman BT. Improvement in glycemic and lipid profiles in type 2 diabetics with a 90-day ketogenic diet. J Diabetes Res. 2019;2019:8681959–6. https://doi.org/10.1155/2019/8681959.
Romano L, Marchetti M, Gualtieri P, Di Renzo L, Belcastro M, De Santis GL, et al. Effects of a personalized VLCKD on body composition and resting energy expenditure in the reversal of diabetes to prevent complications. Nutrients. 2019;11(7). https://doi.org/10.3390/nu11071526.
Myette-Côté É, Durrer C, Neudorf H, Bammert TD, Botezelli JD, Johnson JD, et al. The effect of a short-term low-carbohydrate, high-fat diet with or without postmeal walks on glycemic control and inflammation in type 2 diabetes: a randomized trial. Am J Phys Regul Integr Comp Phys. 2018;315(6):R1210–r9. https://doi.org/10.1152/ajpregu.00240.2018.
Barbosa-Yañez RL, Dambeck U, Li L, Machann J, Kabisch S, Pfeiffer AFH. Acute endothelial benefits of fat restriction over carbohydrate restriction in type 2 diabetes mellitus: beyond carbs and fats. Nutrients. 2018;10(12). https://doi.org/10.3390/nu10121859.
Hallberg SJ, McKenzie AL, Williams PT, Bhanpuri NH, Peters AL, Campbell WW, et al. Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study. Diabetes Ther. 2018;9(2):583–612. https://doi.org/10.1007/s13300-018-0373-9.
Saslow LR, Daubenmier JJ, Moskowitz JT, Kim S, Murphy EJ, Phinney SD, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutr Diabetes. 2017;7(12):304. https://doi.org/10.1038/s41387-017-0006-9.
Saslow LR, Mason AE, Kim S, Goldman V, Ploutz-Snyder R, Bayandorian H, et al. An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: a randomized controlled trial. J Med Internet Res. 2017;19(2):e36. https://doi.org/10.2196/jmir.5806.
Wycherley TP, Thompson CH, Buckley JD, Luscombe-Marsh ND, Noakes M, Wittert GA, et al. Long-term effects of weight loss with a very-low carbohydrate, low saturated fat diet on flow mediated dilatation in patients with type 2 diabetes: a randomised controlled trial. Atherosclerosis. 2016;252:28–31. https://doi.org/10.1016/j.atherosclerosis.2016.07.908.
Goday A, Bellido D, Sajoux I, Crujeiras AB, Burguera B, García-Luna PP, et al. Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus. Nutr Diabetes. 2016;6(9):e230. https://doi.org/10.1038/nutd.2016.36.
Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert GA, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr. 2015;102(4):780–90. https://doi.org/10.3945/ajcn.115.112581.
Hussain TA, Mathew TC, Dashti AA, Asfar S, Al-Zaid N, Dashti HM. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition. 2012;28(10):1016–21. https://doi.org/10.1016/j.nut.2012.01.016.
Goldstein T, Kark JD, Berry EM, Adler B, Ziv E, Raz I. The effect of a low carbohydrate energy-unrestricted diet on weight loss in obese type 2 diabetes patients - a randomized controlled trial. e-SPEN. 2011;6(4):e178-e86. https://doi.org/10.1016/j.eclnm.2011.04.003.
Devaraj S, Dasu MR, Jialal I. Diabetes is a proinflammatory state: a translational perspective. Expert Rev Endocrinol Metab. 2010;5(1):19–28. https://doi.org/10.1586/eem.09.44.
Hukshorn CJ, Lindeman JH, Toet KH, Saris WH, Eilers PH, Westerterp-Plantenga MS, et al. Leptin and the proinflammatory state associated with human obesity. J Clin Endocrinol Metab. 2004;89(4):1773–8. https://doi.org/10.1210/jc.2003-030803.
Catalan V, Gomez-Ambrosi J, Ramirez B, Rotellar F, Pastor C, Silva C, et al. Proinflammatory cytokines in obesity: impact of type 2 diabetes mellitus and gastric bypass. Obes Surg. 2007;17(11):1464–74. https://doi.org/10.1007/s11695-008-9424-z.
Shimazu T, Hirschey MD, Newman J, He W, Shirakawa K, Le Moan N, et al. Suppression of oxidative stress by beta-hydroxybutyrate, an endogenous histone deacetylase inhibitor. Science. 2013;339(6116):211–4. https://doi.org/10.1126/science.1227166.
Pinto A, Bonucci A, Maggi E, Corsi M, Businaro R. Anti-oxidant and anti-inflammatory activity of ketogenic diet: new perspectives for neuroprotection in Alzheimer’s disease. Antioxidants (Basel). 2018;7(5). https://doi.org/10.3390/antiox7050063.
Bae HR, Kim DH, Park MH, Lee B, Kim MJ, Lee EK, et al. beta-Hydroxybutyrate suppresses inflammasome formation by ameliorating endoplasmic reticulum stress via AMPK activation. Oncotarget. 2016;7(41):66444-54. https://doi.org/10.18632/oncotarget.12119.
Forsythe CE, Phinney SD, Fernandez ML, Quann EE, Wood RJ, Bibus DM, et al. Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids. 2008;43(1):65–77. https://doi.org/10.1007/s11745-007-3132-7.
• Murdoch C, Unwin D, Cavan D, Cucuzzella M, Patel M. Adapting diabetes medication for low carbohydrate management of type 2 diabetes: a practical guide. Br J Gen Pract. 2019;69(684):360-1. https://doi.org/10.3399/bjgp19X704525. A recent practical paper about management of glucose lowering medication in T2D on a low-carb diet.
Brownlee M, Hirsch IB. Glycemic variability: a hemoglobin A1c-independent risk factor for diabetic complications. JAMA. 2006;295(14):1707–8. https://doi.org/10.1001/jama.295.14.1707.
Suh S, Kim JH. Glycemic variability: how do we measure it and why is it important? Diabetes Metab J. 2015;39(4):273–82. https://doi.org/10.4093/dmj.2015.39.4.273.
Monnier L, Colette C. Glycemic variability: should we and can we prevent it? Diabetes Care. 2008;31(Suppl 2):S150–4. https://doi.org/10.2337/dc08-s241.
Zaccardi F, Pitocco D, Ghirlanda G. Glycemic risk factors of diabetic vascular complications: the role of glycemic variability. Diabetes Metab Res Rev. 2009;25(3):199–207. https://doi.org/10.1002/dmrr.938.