The ketogenic diet has grown in popularity significantly over the past several years. Those who follow this diet report benefits such as rapid weight loss, a greater feeling of fullness, more energy, and improvements in their cognitive abilities. Originally, this diet was designed for people living with seizures. When a person follows this diet, they consume less than 10% of their energy in the form of carbohydrates, 15-20% of their energy in the form of protein, and 75-80% of their energy in the form of fat. This text shows the possible side effects, then some points related to diabetes will be discussed.
Possible side effects
Positive
Rapid weight loss (mostly loss of water, not fat mass);
Like any other diet, if there is significant weight loss, for those with type 2 diabetes or with cardiovascular disease, there may be an improvement in the metabolic profile (2);
Studies show people assigned to the ketogenic diet have greater weight loss (0.9 kg) than those assigned a low-fat diet after 1 year (3).
Negative
Increased risk of suffering from kidney stones, malnutrition (nutritional deficiencies), constipation, diarrhea, rash, alterations in lipid profile, weakness, headache, metabolic acidosis (2) and halitosis;
Deprivation on many life's pleasures (restaurants, meals with family and friends, etc.).
Diabetes
To date, the ketogenic diet is not recommended for people with diabetes. No diet had a clinically significant effect on fasting blood sugar (4). In fact, the probability of dropping out is 13% to 84% (3). On the other hand, it has been shown that for patients living with type 2 diabetes and obesity, a diet low in carbohydrates (40% of the total energy consumed), rich in lipids and proteins can improve in the short term (no sustained improvement at 12 months), glycated hemoglobin and triglycerides (5).
Medications
Since some medications increase the risk of hypoglycemia, some prescriptions need to be adjusted when a person wants to follow the ketogenic diet. This is the case for insulin, sulphonylureas (glibenclamide, gliclazide, glipizide, glimepiride, tolbutamide) and glinides (repaglinide, nateglinide) (6). SGLT2 inhibitors are also contraindicated with the ketogenic diet since they may increase the risk of euglycemic diabetic ketoacidosis (7).
Dietitian's Role
On the one hand, one must explain the possible side effects. Then the patient can be asked if he can follow this diet for life. If he wishes to do it, we support him by advising him on the best foods to choose while trying to reduce the possible consequences of this diet.
Conclusion
The best diet is one that we can follow for life, that satisfies us mentally and physically. The ketogenic diet is very restrictive and generally not recommended. For more information, talk to your healthcare professional.
Karine Drouin, RD
Références
(1) Matt. (Novembre, 2020). Keto Food Pyramid For Ketogenic Diets. Retrouvé en ligne le 30 septembre 2021 au https://www.myketokitchen.com/keto-resources/keto-food-pyramid-ketogenic-diets/
(2) Gouvernement du Canada. (Novembre, 2019). Qu'est ce que la diète cétogène? Retrouvé en ligne le 11 Juin 2021 au https://www.canada.ca/fr/ministere-defense-nationale/organisation/rapports-publications/sante/qu-est-ce-que-la-diete-cetogene.html
(3) Ting R. et al. (Décembre, 2018). Ketogenic diet for weight loss. Canadian Family Physician. 64. Retrouvé en ligne le 29 septembre 2021 au https://www.cfp.ca/content/64/12/906
(4) Meng Y., Bai H., Wang S., Li Z, Wang Q., Chen L. (Septembre, 2017). Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: A systematic review and meta-analysis of randomized controlled trials. Diabetes research and clinical practice.;131:124-31.
(5) Korsmo-Haugen H.K., Brurberg K.G., Mann J., Aas A.M. (Août, 2018). Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta-analysis. Diabetes Obesity Metabolism. 21(1):15-27. doi: 10.1111/dom.13499.
(6) Diabetes.co.uk - the global diabetes community. (Janvier, 2019). Medication on Low Carb. Retrouvé en ligne le 29 septembre 2021 au https://www.diabetes.co.uk/diet/low-carb-and-medication.html
(7) Plewa M.C., Bryant M., King-Thiele R. (Juin, 2021). Euglycemic Diabetic Ketoacidosis. StatPearls. Retrouvé en ligne le 30 septembre au https://www.ncbi.nlm.nih.gov/books/NBK554570/