Is the Keto diet safe for diabetics? Is it only good for short-term weight loss? Does it increase cholesterol?

Recently saw a 23 year old obese girl (weight 92 kg, BMI 33 kg/m²). She smiled, but looked uncertain. She told me, “Doctor, I’ve been on a ketogenic diet for the past two months and I’ve lost 10 pounds. I still have fever, tiredness, dizziness, cramps, insomnia, and my breath is bad. And I eat it every day. Those high-fat, high-oil diets have difficulty.” So while she lost weight, she also suffered some long-term side effects.

What is a ketogenic diet?

The history of the ketogenic diet began with the Atkins diet, which quickly became popular. “Dr. Atkin’s New Diet Revolution:

The High-Calorie Way to Stay Slim Forever has sold 12 million copies and remains a bestseller today. Mainly non-vegetarian Westerners enjoy this diet (breakfast: greasy ham, bacon, and eggs; lunch, steak with lots of cheese; dinner, fish, crab, and chicken cooked in lots of butter). This diet causes many people to lose weight rapidly. Low carbs (less than 30 grams per day, about one and a half roasts) prompt the body to find alternative ways to get energy from acidic ketone bodies (hence the name ketogenic diet). These ketone bodies effectively provide energy and suppress appetite. Since then, several similar diets have emerged for two reasons. First, it is difficult to eat very low-carb, high-fat, and high-protein foods on a daily basis, so increase your daily carbohydrate intake on a modified diet.Second, it is not possible for vegetarians to eat a diet designed by Atkins, hence, ghee, coconut oil etc have been added in surplus.

This diet has several advantages. Rapid weight loss can be achieved, sometimes even beyond a standard calorie-restricted diet. In people with diabetes, blood sugar levels and insulin sensitivity are improved, and the need for antidiabetic drugs is reduced. This diet can also help people with polycystic ovaries by improving their metabolic environment. Interestingly, there is strong evidence that these diets are known to reduce seizures in high-dose-resistant children. Additionally, there is compelling evidence for the effects of these diets on acne. Despite attempts, there is no apparent benefit for cancer, Parkinson’s and Alzheimer’s.

But many scientists aren’t ready to embrace this diet because they don’t know the benefits and drawbacks. There are several known side effects, some unknown or unproven. While short-term weight loss is slightly better than traditional weight loss diets, the long-term effects are unclear. In animals, this diet is known to increase fat density in the liver (exacerbating fatty liver disease), which remains a concern in humans in the absence of good data. Recent reports show that these diets increase bad LDL cholesterol, which may be bad for heart health. Lastly, Indians with poor livers (a lot of fatty liver) and LDL cholesterol (blood full of fat that can lead to dense deposits in arteries that can cause blockages) have not been well studied.

Who shouldn’t be on a ketogenic diet?

First, these diets are contraindicated in patients with heart failure and cardiac arrhythmias. Second: Patients with impaired kidney and liver function and known inflammation of the pancreas (pancreatitis) avoid this type of diet. People with diabetes need to take extra precautions when using these diets. If you have type 1 diabetes or have diabetes, you shouldn’t even try this. Many people with diabetes who take SGLT2 inhibitors (empagliflozin, dapagliflozin, and canagliflozin) should eat cautiously because these drugs have an additive effect on ketone production that can reach dangerous levels. Finally, those using blood thinners (vitamin K-dependent anticoagulants) should avoid the ketogenic diet.

Is the short-term gain worth it?

It doesn’t look like the ketogenic diet is a panacea for weight loss, only marginally better than a traditional weight loss diet in the short term. Therefore, a low-carbohydrate ketogenic diet is a reasonable option for rapid weight loss in young obese individuals without organ dysfunction. This should be tried for three to six months under the supervision of a dietitian and doctor. Cholesterol and liver analysis should be performed to check for extreme reactions. Likewise, in obese young and recently diagnosed diabetic patients (not using SGLT2i), this diet is a reasonable option for controlling elevated blood sugar or even reversing diabetes. Finally, the effects of very low-carb ketogenic diets on longevity are unclear, and one study suggests they are not beneficial.

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