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Global Translational Medicine Keto diet in management of Type 2 diabetes

Figure 1. Articles selection process.

This cyclical approach is designed to facilitate sustained bound (C7 – C13) triglycerides in comparison with long-
weight loss. Throughout the progression of AD, the chain triglycerides. This preference may stem from the fact
regulatory framework becomes more flexible, allowing for that decanoic and octanoic acids, abundant, and easily
the inclusion of a broader range of foods and increased digestible, are efficiently transported to the liver, where
carbohydrate intake. It is noteworthy that the state of they undergo β-oxidation to produce β-hydroxybutyrate,
[23]
ketosis, a characteristic of the initial phase, is no longer acetoacetate, and acetone . As the ketogenic potential
a primary focus as the individual advances through the intensifies, MCTKD demands a lower intake of saturated
phases. fats to sustain an equivalent level of ketosis as observed in
CKD, enabling a reduction in the ratio of fat to combined
3.3. Modified Atkins diet (MAD) protein and carbohydrate. Intermediate triglycerides
In contrast to CKD, the MAD was developed by Johns should constitute about 65% of total calorie intake, allowing
Hopkins Hospital as a less restrictive approach to for increased carbohydrate consumption and yielding a
treating epilepsy. Similar to AD, there is an emphasis on more palatable diet. Notably, a significant complication
maintaining the initial phase for an extended duration in associated with MCTKD is a higher prevalence of gastric
MAD, avoiding a transition to less restrictive stages and problems, such as indigestion, diarrhea, and vomiting .
[20]
thereby allowing for the persistent state of ketosis. Notably, As a consequence, several enhancements to MCKTD
MAD, like AD, was not developed with the primary goal have been recommended, involving an additional
of weight loss. Therefore, the major restrictions pertain implementation stage characterized by an increase
to low carbohydrate intake and calorie content, with no in the proportion of intermediate triglycerides and a
prohibitions on liquids or protein consumption. Whether dynamic balance between intermediate to long-chain
adhering to a carbohydrate limit of <20 g/day or adopting triglycerides . Individuals have been deemed capable of
[24]
a flexible supply of peptides, the predicted carbohydrate- receiving 40 – 50% of their energy from medium-chain
to-protein ratio is approximately 1:1, resulting in a more triglycerides without experiencing adverse effects .
[23]
palatable diet . It is important to note that dietary fiber is Studies suggest that this diet may improve the efficacy
[20]
not factored into the overall carbohydrate count, although of chemotherapy in the treatment of cancer and the
sugar alcohols should be considered in the calculation . prevention of recurrent cancer .
[21]
[25]
3.4. Medium-chain triglyceride KD 3.5. Low glycemic index treatment (LGIT)
In 1971, Huttenlocher developed a form of KD aimed at The LGIT, established in 2002, represents the least
improving adherence among individuals with epilepsy . restrictive form of KD . Carbohydrate consumption
[26]
[22]
This approach, known as the medium-chain triglyceride is set at 40 – 60 g daily, with an emphasis on choosing
KD (MCTKD), relies on a sophisticated process that only carbohydrates with a low glycemic index (<50) .
[27]
facilitates the utilization of moderately ketone body- As part of the LGIT protocol, high-glycemic meals such

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