Dr. V Mohan, an expert in diabetology answers questions on the Keto diet and if it should be considered as a useful and sustainable diet for obese patients with diabetes or pre-diabetes. Obesity is on a rapid rise in India, but the medical interventions available to tackle it are few. However, lifestyle interventions to tackle the condition are plenty because obese individuals are also more prone to developing type 2 diabetes and heart disease. Among the many available interventions, one that can be termed as ‘extreme’ is the Keto diet, gaining a lot of popularity in the country now.
Dr. V Mohan and his research partner recently published a paper* titled, ‘Keto diets: Boon or bane?’ in The Indian Journal of Medical Research (November 2018) which tried to analyse if the diet could actually be beneficial to obese people with diabetes or pre-diabetes. Here, he answers a few more questions, specifically connecting keto diet efficacy and sustainability to diabetes. What advice should I give my obese, diabetic patient who wants to go on a k eto diet?
Dr. Mohan: Keto diet obviously helps in both weight reduction as well as in sugar control. Many patients with diabetes are able to go off medications, or at least reduce the dose of medications. However, the problem with the keto diet is that it is not sustainable in the long run. In almost all the patients, I have seen them regain their weight.
The other problem is that because it is a very high-fat diet, the LDL (bad) cholesterol tends to shoot up leading to a heart problem. There are also studies showing some nutritional deficiencies in patients on the keto diet. Hence my recommendation would be that if at all possible one should follow a balanced diet rather than go on these extreme diets. Would you recommend a keto diet to a diabetic patient for blood sugar control?
Dr. Mohan : I have answered this partly in my earlier question. There is a small risk of diabetic patients developing ketosis and ketoacidosis particularly if they are insulin deficient, as they need a certain amount of carbohydrate to prevent ketosis.
Secondly, while reduction of blood glucose and HbA1c levels do occur, they are not sustained in the long run, as most people cannot sustain a very low carbohydrate diet for very long. Moreover, the adverse effects of keto diets on lipids and on the heart have to be kept in mind. What is the correct advice about keto diet for a pre-diabetic?
Dr. Mohan: The same thing applies for people with pre-diabetes also. It is okay to cut down on carbs for some time but one must think of a more sustained plan for reduction of weight and hyperglycemia. My advice would be to take about 40% carbohydrate, 20 to 25% protein and the rest as fats.
This fat has to be mostly of monounsaturated fats which will come from oils like groundnut oil, gingili oil, or mustard oil and nuts and seeds. If one is able to reduce the carbohydrate and include lots of green leafy vegetables and some fruits, this would be a much more healthier and sustainable diet pattern than going on an extreme diet like the keto diet.
*Reference: Shilpa J, Mohan V. Ketogenic diets: Boon or bane ?. Indian J Med Res [serial online] 2018 [cited 2019 Jan 22];148:251-3. Available from: http://www.ijmr.org.in/text.asp?2018/148/3/251/245289
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This write-up is contributed by Dr. V Mohan, an eminent Indian Diabetologist who has been working in the field of diabetes for over 30 years in Chennai, Tamil Nadu.
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