Page 15 - GTM-2-4

Global Translational Medicine Keto diet in management of Type 2 diabetes

as rice, beer, and white bread, as well as starchy foods, are that carbohydrates should contribute 45 – 50% of energy
to be avoided. Instead, the focus is on incorporating low- in consumable diets. However, European and United States
glycemic-index foods such as leafy greens, beans, grains, regulations prescribe a broader range of 45 – 65% for these
lactose, and animal fat into the diet (Table 2). constituents in individuals with diabetes. This variation
appears to be associated with potentially significant
4. Dietary management for Type 2 diabetes changes in blood sugar control, the maintenance of
patient healthy body weight, and the regulation of triglyceride
The KD revolves around minimizing carbohydrate intake levels among adults with diabetes. This recommendation is
while emphasizing a high consumption of good, healthy particularly relevant to carbohydrates derived from high-
fats. Simultaneously, dietary guidelines emphasize the fiber foods such as vegetables, whole grains, breads, and
importance of incorporating plenty of fruits and vegetables. cereals. Individuals with T2DM frequently receive this
A well-rounded diet should ideally include macronutrients management approach along with a low-carbohydrate
such as carbohydrates, proteins, and fats. Conventionally, diet. The term “low-carbohydrate diet” is used to refer to
it has been proposed that a normal diet consists of various dietary approaches that may vary in carbohydrate,
approximately 50 – 65% carbohydrates, 10 – 15% proteins, protein, and fat consumption (Table 3).
and no more than 30% fat . The American Diabetes 5. Mechanisms of production and
[1]
Association has established a dietary pyramid specifically
targeting diabetic patients (Figure 2) . Current utilization of ketone bodies
[29]
regulations from the Polish Diabetes Association stipulate The body produces ketone bodies due to a lack of sufficient
carbohydrates. Historically, ketone bodies were thought to
result from abnormal respiration caused by inadequate fat
oxidation due to a lack of glucose intake . These ketone
[33]
bodies acquired labels such as “diabetic trash” or “oxidative
baddies” due to this perspective. Although ketone bodies are
present in circulation during both fueled and starved phases,
blood concentrations are typically small under normal
circumstances in humans, ranging between 0.1 and 0.4 mM.
Blood levels of ketone bodies in individuals vary,
ranging from 1 mM to 5 mM after brief fasting (3 – 4 days)
to 8 – 9.5 mmol after prolonged fasting (17 – 24 days) .
[34]
Individuals typically generate blood ketone body contents
of 1 – 2 mM after workouts . Plasma concentrations of
[35]
ketone bodies can exceed 5 mM when individuals consume
limited carbohydrates or adhere to KDs .
[35]
Ketone bodies are compounds featuring a carbonyl
carbon, and their geometry is indicated by the formulae
RC(=O)R’, wherein R and R’ can represent a multitude
Figure 2. The American Diabetes Association’s food pyramid for diabetes of carbon-containing methyl groups. These bodies are
[29]
patients .
primarily produced within the mitochondria of the
Table 2. Guideline for recommended carbohydrate intake Table 3. Nutrient levels in diverse types of diets [21,30]
and energy supply in ketogenic diets [28]
Diet Macronutrients
Description Recommended Carbohydrate Carbohydrate Protein Fat (%)
carbohydrate supply energy (%) (%) (%)
intake per day (g) Atkins diet* 3 – 16 28 – 34 55 – 65
Ketogenic diet <20 – 50 <10 Kwasniewski diet 9.2 14 76.8
(very low-carbohydrate diet)
Zone diet 40 30 30
Low-carbohydrate diets <130 <26
Guidelines for balanced 55 – 65 10 – 15 25 – 35
Moderate carbohydrate diets 130 – 230 26 – 45 nutrition [31,32]
High carbohydrate diets >230 >45
Note: *This proportion range is calculated based on individuals’ scenarios.

Volume 2 Issue 4 (2023) 5 https://doi.org/10.36922/gtm.1361