Skip to Main Content

++

Lifestyle management, including dietary changes, exercise, and weight loss, is a cornerstone in the management of Type 2 diabetes.  However, there is no consensus about the ideal diet for Type 2 diabetics.  The American Diabetes Association (ADA) notes that a variety of diets have been effective in diabetes, but they do not recommend a specific diet1. In regards to carbohydrate intake, the ADA only recommends monitoring carbohydrate intake with the amount of carbohydrates being patient dependent1,2. On the other hand, the American Association of Clinical Endocrinologists (AACE) recommends patients eat a heart healthy diet with a target of 7-10 servings of healthy carbohydrates per day and an adequate amount of protein3.  Very low carbohydrate diets (≤50 grams of carbohydrates per day) or a ketogenic diet forces the body to go into nutritional ketosis so that it relies on fatty acids and ketones as the source of energy instead of glucose. A recent review discussed evidence that low carbohydrate diets can improve glycemic control4. It is important to note that nutritional ketosis is physiologically different from ketoacidosis.  There is a need to explore different diet options for Type 2 diabetics to find an optimal diet plan to best control blood glucose levels.

++

Saslow and colleagues conducted a single site, parallel group, randomized trial to compare a medium carbohydrate, low fat, calorie-restricted, carbohydrate counting diet following the ADA guidelines (MCCR) to a very low carbohydrate, high fat, non-calorie restricted diet whose goal is to induce nutritional ketosis (LCK) in Type 2 diabetics over 3 months.  Participants were at least 18 years old, had a diagnosis of Type 2 diabetes (glycated hemoglobin (HbA1c) ≥6.5%) or prediabetes with an HbA1c >6.0% at the beginning of the study, BMI ≥ 25, and were willing to follow either diet and the strict intervention instructions.  Exclusion criteria included patients with a substance abuse, mental health or medical condition that would make it difficult to participate in the intervention, current use of oral glucocorticoids or weight loss medications, current or planned pregnancy in the next 12 months, breastfeeding or <6 months postpartum, history of or planned weight loss surgery, vegan, unwilling to do home glucose monitoring, and currently using insulin or taking >3 oral hypoglycemic medications.

++

Participants then participated in thirteen 2-hour classes weekly, and by the fourth class, they were required to change all of their meal options to meet requirements of the new diet.  The MCCR diet consisted of obtaining 45-50% of their calories from carbohydrates daily (goal of approximately 165 grams per day).  They were to maintain protein levels from prior to the study and to lower fat consumption; they were encouraged to eat 500 fewer kilocalories per day than required to maintain weight based on age, height, current weight, and physical activity.  The LCK diet consumed approximately 20-50 grams of carbohydrates per day, not including dietary fiber, to induce nutritional ketosis. Participants were to monitor blood ketone levels twice weekly to maintain a blood beta-hydroxybutyrate level between 0.5 and 3 mM.  Protein levels from prior to the study were maintained and ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.