Scientists from King Saud University have found that a very low-carbohydrate ketogenic (keto) diet may offer short-term benefits for people with type 2 diabetes.
The findings, led by Mohamed Rafiullah and colleagues and published in Nutrition Reviews, suggest that strict carbohydrate restriction can improve several metabolic health markers, especially during the first six months.
What is the ketogenic diet?
The ketogenic, or “keto,” diet is a low-carbohydrate, high-fat eating pattern that has been used in medicine for over a century.
It was first introduced in the 1920s as a treatment for children with epilepsy whose seizures did not respond to medication.
Since then, it has been tested in closely supervised settings for several conditions, including obesity, type 2 diabetes, polycystic ovary syndrome (PCOS), and Alzheimer’s disease.
A typical ketogenic diet derives around 70% to 80% of its energy from fat, includes a moderate amount of protein, and contains very little carbohydrate.
In recent years, there has been renewed interest in using very low-carb ketogenic diets to help manage type 2 diabetes. However, the results of clinical studies have been mixed, creating uncertainty about their long-term value and safety.
In this study, the researchers aimed to compare the effects of a very low-carb ketogenic diet on blood sugar control, body weight, blood lipids, medication use, and study dropout rates with those of standard, recommended diets for people with type 2 diabetes.
The researchers conducted a systematic review and meta-analysis of published clinical trials involving adults with type 2 diabetes.
They included studies that compared a very low-carb ketogenic diet (defined as less than 50 grams of carbohydrates per day or less than 10% of total daily energy from carbohydrates) with a control diet recommended for diabetes management.
In total, eight studies involving 648 participants were included in the analysis. The studies followed participants for 12 weeks or longer.
The analysis showed that, compared with control diets:
- The very low-carb ketogenic diet led to greater reductions in blood sugar levels, particularly in the short term.
- Participants following the keto diet experienced significantly greater weight loss at both 3 and 6 months.
- However, this advantage was no longer seen at 12 months, suggesting that the long-term effects may be less pronounced.
- The diet was more effective at lowering triglyceride levels and raising HDL (or “good”) cholesterol for up to 12 months.
- Participants on the keto diet were also able to reduce their use of anti-diabetic medications during the study period.
Overall, the findings suggest that a very low-carb ketogenic diet can improve blood sugar control and support weight loss for up to six months in people with obesity and type 2 diabetes, with additional benefits for blood lipid levels lasting up to a year.
Despite these positive findings, the researchers emphasised that the quality of the available evidence is not yet strong enough to recommend very low-carbohydrate ketogenic diets as a standard treatment for type 2 diabetes.
One of the main limitations identified was poor long-term adherence. Many participants found it difficult to maintain such a strict restriction on carbohydrates over time, which may explain why the benefits were less clear after 12 months.
Anyone considering a ketogenic diet — especially people with diabetes — should do so under medical supervision, as dramatic changes in carbohydrate intake can affect blood sugar levels, medication needs, and overall health.
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