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Global Translational Medicine Keto diet in management of Type 2 diabetes

Table 1. Recommended and restricted foods in the ketogenic diet [17,18]
Recommended Examples Restricted Examples
foods food
Protein Fish: sardines, tuna, lobster, prawns, and shrimps Carbohydrates Bread, cakes, flour, honey,
macaroni, noodles, potatoes,
rice, spaghetti, sugar, and sweets
Poultry: Eggs, chicken Fruits/drinks All kinds of fruit juices and all
kinds of soft drinks
Cheese: Full-fat cheese
Meat: Kabab, minced, sausages
Oil Flaxseed oil and olive oil mixed with salad (5 tablespoons)
Vegetables/fruits Avocado, artichoke, 10 berries per day, carrot, cabbage, celery, cauliflower,
coriander, cucumber, eggplant, green pepper, lemon, leek, lettuce,
mushroom, mint, mulberry, okra, parsley, spinach, radish, tomato, 10 – 15
olives per day, six strawberries per day, and watercress

2. Methodology carbohydrate is at 4:1 by weight. In this diet, approximately
80 – 90% of total energy is derived from fats, with the
An extensive literature review was conducted to identify remaining 10% encompassing the necessary protein
pertinent original research and review papers. The search percentage to meet daily requirements and the estimated
spanned various databases, including Science Direct, carbohydrate consumption calculated from the remaining
Google Scholar, Pub Med, Hindawi, Web of Science, and calories. This highly carbohydrate-limiting approach
the Cochrane Library. Several keywords were employed in facilitates the rapid induction of ketosis. Individuals
the literature review, encompassing “Keto diet and Type-2 following CKD must curtail protein consumption to
diabetes,” “Very low carbohydrate diet,” “Low carbohydrate prevent the decomposition of amino acids and subsequent
diet,” “Ketogenic diet,” “High fat diet,” “Obesity and keto glucose formation. Due to its restrictive character, CKD has
diet,” and “Advantages and disadvantages of keto diet.” predominantly been employed in the treatment of epilepsy.
Maintaining objectivity was a paramount consideration Its application necessitates significant commitment, with
throughout this review. No specific research database, patients required to undergo 50 h of dietetic counseling,
group, publisher, or country was given preferential incurring substantial expenses . Parenteral and oral
[19]
treatment during the search and review process. Research formulas designed for newborns and children are also
articles were searched with unbiased titles, ensuring available and can be adapted for adult use. Despite its
a balanced approach. There was a deliberate effort to potential benefit, CKD poses significant challenges due
neither exaggerate nor emphasize any particular aspect, to its overall carbohydrate restriction, demanding a
whether merit or demerit, of keto diets concerning weight higher degree of patience and careful consideration in
management. Therefore, with a considerable number of its implementation, which can be deemed undesirable by
randomly selected original research articles, the potential some individuals.
for bias in this review is deemed minimal. In addition,
this narrative review incorporated highly cited research 3.2. Atkins diet (AD)
articles on KD and T2DM from multiple reputable Dr. Robert Atkins introduced the AD as a measure to
journals, excluding papers from predatory journals and prevent weight gain. In 1972, Dr. Atkins was the first to
[20]
those unrelated to KD and T2DM. Following the extensive elucidate the principles of the AD . This dietary program
review, 85 papers were initially selected. After eliminating restricts carbohydrate intake while permitting a moderate
duplicate papers, invited editorials, short reports, and amount of protein. The AD is divided into four distinctive
unrelated papers, a refined set of 30 papers formed the phases. In the initial phase (Phase 1), carbohydrate intake
basis for this study. Figure 1 illustrates the sorting process. is highly limited, with fewer than 20 g permitted each day.
As the program progresses to Phase 2, carbohydrate intake
3. Classification of KD is increased to a range of 30 – 55 g daily. During Phase 3,
individuals are allowed more than 80 g of carbohydrates
3.1. Classical KD (CKD)
per day. This phase is generally repeated until the targeted
The more restrictive variant of KD is known as the CKD. body weight is achieved. In Phase 4, individuals can
In this regimen, the ratio of fat to combined protein and consume around 105 – 110 g of carbohydrates per day.

Volume 2 Issue 4 (2023) 3 https://doi.org/10.36922/gtm.1361