Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus

Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force

“…13 Some individuals may experience symptoms described as the ''keto flu'' within 2 to 4 days of beginning a VLCHF/KD, which may occur as the body adapts to using ketone bodies for fuel, may last a few days to one week, and include lightheadedness, dizziness, fatigue, difficulty exercising, poor sleep, and constipation. 1 Other adverse effects that have been reported in individuals strictly following VLCHF/KDs include headache, 30,45 skin rash, 45 muscle cramps, weakness, diarrhea, dehydration, hypoglycemia, 100 increased levels of blood uric acid, and vitamin/mineral deficiencies. 30 Increased urination can lead to reduced levels of electrolytes, including sodium, magnesium, and potassium, and may be associated with symptoms of hypovolemia, as well as dizziness related to the need to reduce hypertension and/or hyperglycemia medications.…”

“…30 Increased urination can lead to reduced levels of electrolytes, including sodium, magnesium, and potassium, and may be associated with symptoms of hypovolemia, as well as dizziness related to the need to reduce hypertension and/or hyperglycemia medications. 100 Educating individuals to consume protein from whole foods vs supplements will promote an adequate intake of sodium, potassium, and magnesium. 1 Ensuring adequate fluid and electrolyte intake is essential to avoid symptoms of initiating a VLCHF/KD.…”

“…1 Ensuring adequate fluid and electrolyte intake is essential to avoid symptoms of initiating a VLCHF/KD. 13,100 People with certain diseases and disorders may have additional safety concerns to consider with the use of low-CHO diets and VLCHF/ KDs.…”

“…Patients and clinicians must be aware that individuals with diabetes who choose to follow a very-low-CHO diet or KD are at an increased risk of hypoglycemia because of the effect of the severe CHO restriction on glycemic control and potential need for medication adjustment; thus, individuals following a very-low-CHO diet for T2D management should be medically supervised. 100 OHAs and/or insulin may need to be reduced or discontinued after initiation of a very-low-CHO or KD. 22,45,100,108 Patients should be instructed to monitor their blood glucose levels before taking OHAs or insulin to prevent hypoglycemia.…”

The mystery of the ketogenic diet: benevolent pseudo-diabetes

“…KDs are successfully being used in the treatment of obesity, non-alcoholic fatty liver disease, neurological diseases and cancer [6,7,[9][10][11]16]. They are also being used in the treatment of type 2 diabetes [8,9,[11][12][13][17][18][19][20][21][22][23]. When consuming the same numbers of calories, KDs are more effective than standard calorie restrictive diets for body weight reduction and improvement of glycemic control in diabetic patients [24][25][26][27][28], and enable discontinuation or reduction of medications in some diabetic patients [18,27,29].…”