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Global Translational Medicine Keto diet in management of Type 2 diabetes

carbohydrate diet lacking in vegetable fiber can adversely 8. Conclusion
affect the growth of gut bacteria .
[89]
For patients with obesity or T2DM, current
Consuming a low-carbohydrate diet for a brief duration recommendations support the utilization of low-
has subsequently rendered the long-term implications carbohydrate diets as an alternative to traditional low-fat
of this dietary approach nearly impossible to predict. diets. Our review findings demonstrate the effectiveness of
Furthermore, the increased serum uric acid concentration a KD in glycemic regulation for individuals with obesity
resulting from ketosis is another noteworthy concern ,as and T2DM who are also hyperlipidemic. In addition to
[90]
it may foster hyperuricemia and accelerate nephropathy weight loss and improvements in lipid levels, there was
growth . To facilitate uric acid excretion during the a marked enhancement in HbA1c levels, accompanied
[91]
intervention, adequate water intake is imperative. In cases by a significant reduction in the use of insulin or orally
requiring it, sodium bicarbonate may also be administered administered antidiabetic medications. It is important
to alkaline urine . Renal impairment becomes more to note that these positive outcomes are typically
[90]
prevalent following the excessive intake of protein in one’s observed after a short duration of utilizing this dietary
diet. Studies indicate that patients with T2DM exhibit pattern. While the potential for significant weight loss
elevated ammonium content in their blood . Lower in patients with concurrent T2DM and obesity should
[82]
protein intake has been demonstrated to delay glomerular be carefully considered, this type of diet does exhibit a
filtration and prevent excessive kidney problems, a vital positive influence on anthropometric parameters in the
consideration for individuals with T2DM, often reported short-term, facilitating the effective reduction of excess
as a nephrological disorder . It is worth mentioning that weight. Low-carbohydrate diets have the potential to
[77]
protein intake in these individuals should consistently be regulate glucose levels by minimizing insulin demand
0.8 g/kg/day, constituting <10% of the total energy input . and reducing glycosylated hemoglobin content. Moreover,
[92]
A low-carbohydrate diet may result in hypovitaminosis, the findings of studies indicate that low-carbohydrate
rendering this dietary approach inadequate. It is advisable diets improve the serum lipid profile, notably triglyceride
for the general population, and especially those with and HDL cholesterol levels, in individuals with T2DM.
diabetes, to refrain from adopting such a diet . Low- While the benefits of low-carbohydrate diets are evident,
[1]
carbohydrate meals characterized by lower dietary fiber potential negative impacts need to be acknowledged. These
content can result in increased bile acid concentrations. food-restricted diets may increase the risk of mineral
This heightened concentration of bile acid, when converted deficiency. Similarly, a shortage of fiber in combination
to secondary bile acids, may contribute to the progression with limited carbohydrates, especially in high-protein,
of congestion and potentially cause colorectal cancer . low-carbohydrate diets, is associated with a heightened
[93]
To counteract potential nutritional deficiencies, Type 2 risk of renal dysfunction. An increased protein intake
diabetic patients who adhere to low-carbohydrate diets with low carbohydrate intake can contribute to water
receive fortification with vegetable fiber. In addition, during and electrolyte abnormalities, alongside modifications to
the initial weeks and months of a KD, reduced insulin osteoclast genesis, potentially resulting in osteopenia and
levels induce increased natriuresis, kaliuresis, and diuresis. osteoporosis. In assessing the advantages and disadvantages
of a low-carbohydrate diet for individuals with T2DM, it is
These effects lead to the loss of water and electrolytes in the essential to recognize that there is no conclusive evidence
body, contributing to electrolyte imbalance .
[94]
supporting only one side of the argument.
In Type 2 diabetic patients, a low-carbohydrate diet
induces short-term alterations in bone remodeling and Acknowledgments
may contribute to the progression of both osteopenia and None.
[95]
osteoporosis . The prescribed heavy reliance on such
a diet is especially crucial for postmenopausal Type 2 Funding
diabetic women, as their bone deterioration is further None.
exacerbated by a limited carbohydrate intake. In addition,
this dietary pattern increases the risk of gallstones. Conflict of interest
Although previously described benefits of several lipid
profiles in what appears to be a low-carbohydrate or high- The authors declare that they have no competing interests.
fat diet include a decreasing trend in cellulose fibers, these
advantages have also been associated with an increment in Author contributions
LDL cholesterol levels both in patients with T2DM and Conceptualization: Sabrina Zaman and Tamsel Ahammed
[96]
individuals without carbohydrate abnormalities . Writing – original draft: All authors
[97]
Volume 2 Issue 4 (2023) 11 https://doi.org/10.36922/gtm.1361