Research

A growing collection of scientific research papers that address the ketogenic low carb diet in relation to health conditions. Use the links to navigate to the section of interest.

Diabetes

Using a low-carbohydrate diet to treat obesity and type 2 diabetes mellitus

Low-carbohydrate diets have been utilized clinically for many years to treat obesity and T2DM and can be used alongside effective monitoring to safely deprescribe dispensable medications for these diseases. Read more

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

Expert commentary: While the current treatment of T2DM emphasizes drug treatment and a higher carbohydrate diet, the ketogenic diet is an effective alternative that relies less on medication, and may even be a preferable option when medications are not available. Read more

Implicating the effect of ketogenic diet as a preventive measure to obesity and diabetes mellitus

The present review, therefore, recommends the use of the ketogenic diet (KD) in obesity and diabetes treatment. The KD involves a diet that replaces glucose sugar with ketone bodies and is effective in numerous diseases, such as metabolic disorders, epileptic seizures, autosomal dominant polycystic disease of the kidney, cancers, peripheral neuropathy, and skeletal muscle atrophy. Read more

Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base

We present major evidence for low-carbohydrate diets as first approach for diabetes. Such diets reliably reduce high blood glucose, the most salient feature of diabetes. Benefits do not require weight loss although nothing is better for weight reduction. Carbohydrate-restricted diets reduce or eliminate need for medication. There are no side effects comparable with those seen in intensive pharmacologic treatment. Read more

The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus

The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes. Read more

Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet

CONCLUSIONS: Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a very low carbohydrate diet. The generalizability of these findings requires further studies, including high-quality randomized controlled trials. Read more

Clinical Use of a Real-World Low Carbohydrate Diet Resulting in Reduction of Insulin Dose, Hemoglobin A1c and Weight

Conclusion: In patients with T2DM on a LCD, it is possible to reduce and even discontinue insulin use while facilitating weight loss and achieving glycemic control. A Low Carbohydrate Diet should be offered to all patients with diabetes, especially those using insulin. Read more

A Pragmatic Approach to Translating Low- and Very Low-Carbohydrate Diets Into Clinical Practice for Patients With Obesity and Type 2 Diabetes

Using best-available evidence, clinical acumen, and individuals’ preferences and needs, we can thoughtfully help our patients navigate a path toward better health with strategies that may include dietary carbohydrate restriction. Read more

Low Carbohydrate Dietary Approaches for People With Type 2 Diabetes—A Narrative Review

Conclusion: Available evidence supports the safety and efficacy of LCDs for the management of Type 2 diabetes, with findings consistently demonstrating such approaches to be at least as effective as other ways of eating for improving blood glucose control and reducing cardiovascular disease risk. Further, LCDs appear to be superior to other dietary approaches for reducing the requirement for diabetic medications and, potentially, for placing Type 2 diabetes into remission. Existing evidence does not appear to support the assertion that LCDs are more difficult to adhere to than other dietary approaches. LCDs should therefore be promoted as a possible option for the management of Type 2 diabetes, and where patients make an informed choice to adopt a LCD they should be supported by their healthcare team to help maximise their chances of achieving their health goals. Read more

Type 2 Diabetes Mellitus: A Pathophysiologic Perspective

Carbohydrate-restricted diets have been used effectively to treat obesity and T2DM for over 100 years, and their effectiveness may simply be due to lowering the dietary contribution to glucose and insulin levels, which then leads to improvements in hyperglycemia and hyperinsulinemia. Treatments for T2DM that lead to improvements in glycemic control and reductions in blood insulin levels are sensible based on this pathophysiologic perspective. Read more

Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet

The American Diabetes Association in their Standards of Medical Care in Diabetes–2021 acknowledges low carbohydrate nutritional therapy (LCD) as a viable option in the management of Type 2 Diabetes (T2D). Thus, the goal of our paper is to help close the gap between the clinical evidence, basic science, and pharmacology of T2D medications to the practical application and teamwork needed to facilitate safe medication reduction in the primary care setting when applied to a LCD. Read more

Treating Diabetes Utilizing a Low Carbohydrate Ketogenic Diet and Intermittent Fasting Without Significant Weight Loss: A Case Report

Results: At the end of the 4 months, the average levels of A1C dropped 5.2 points from 11.9 to 6.7, and the average weight loss was 8.7 pounds in all three patients while discontinuing all diabetic medications, including insulin and metformin. Read more

Has carbohydrate-restriction been forgotten as a treatment for diabetes mellitus? A perspective on the ACCORD study design

Prior to the discovery of medical treatment for diabetes, carbohydrate-restriction was the predominant treatment recommendation to treat diabetes mellitus. In this commentary we argue that carbohydrate-restriction should be reincorporated into contemporary treatment studies for diabetes mellitus. Read more

Ketogenic Diet as a Normal Way of Eating in Adults With Type 1 and Type 2 Diabetes: A Qualitative Study

The main motivation to start the diet was to improve blood glucose control or to reduce/stop taking diabetes medications, followed by weight loss and diabetes reversal. Participants reported benefits of the diet, such as improved glycemic control, weight loss and satiety, which appeared to strongly prevail over challenges, such as lack of support from health-care professionals and lack of information sources. Most participants considered the ketogenic diet as a normalized way of eating that they would continue for the rest of their lives. Read more

Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes

This study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects. The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels. Read more

Therapeutic role of low-carbohydrate ketogenic diet in diabetes

This study indicates that LCKD has a significant beneficial effect in ameliorating the diabetic state and helping to stabilize hyperglycemia. Read more

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Obesity

European Guidelines for Obesity Management in Adults with a Very Low-Calorie Ketogenic Diet: A Systematic Review and Meta-Analysis

The VLCKD can be recommended as an effective dietary treatment for individuals with obesity after considering potential contra-indications and keeping in mind that any dietary treatment has to be personalized. Read more

Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials

Our study findings confirmed that ketogenic diets were more effective in improving metabolic parameters associated with glycemic, weight, and lipid controls in patients with overweight or obesity, especially those with preexisting diabetes, as compared to low-fat diets. Read more

Very-Low-Calorie Ketogenic Diet as a Safe and Valuable Tool for Long-Term Glycemic Management in Patients with Obesity and Type 2 Diabetes

The study confirms a valuable therapeutic effect of VLCKD in the long-term management of obesity and T2DM and its potential contribution to remission of the disease. Read more

Efficacy and safety of very low calorie ketogenic diet (VLCKD) in patients with overweight and obesity: A systematic review and meta-analysis

The present review supports the use of VLCKD as an effective strategy for the management of overweight and obesity. Read more

Efficacy of a 2-Month Very Low-Calorie Ketogenic Diet (VLCKD) Compared to a Standard Low-Calorie Diet in Reducing Visceral and Liver Fat Accumulation in Patients With Obesity

Conclusion: Patients undergoing a very low carbohydrate diet (VLCKD) achieved superior weight loss, with significant visceral adipose tissue and liver fat fraction reductions when compared to the standard low calorie diet. The weight loss and rapid mobilization of liver fat demonstrated with VLCKD could serve as an effective alternative for the treatment of non-alcoholic fatty liver disease. Read more

Reduction of Cardio-Metabolic Risk and Body Weight through a Multiphasic Very-Low Calorie Ketogenic Diet Program in Women with Overweight/Obesity: A Study in a Real-World Setting

Conclusions: The findings of a multi-center VLCKD program conducted in a real-world setting in a cohort of overweight/obese women indicate that it is safe and effective, as it results in a major improvement of cardiometabolic parameters, thus leading to benefits that span well beyond the mere body weight/adiposity reduction. Read more

MRI estimated changes in visceral adipose tissue and liver fat fraction in patients with obesity during a very low-calorie-ketogenic diet compared to a standard low-calorie diet

Conclusion: A very low carbohydrate diet resulted in greater weight loss than a standard low-calorie diet and in significantly greater reduction in liver proton density fat fraction. Read more

Very-Low-Calorie Ketogenic Diet as a Safe and Valuable Tool for Long-Term Glycemic Management in Patients with Obesity and Type 2 Diabetes

We conclude that, when conducted under the supervision of healthcare professionals, a VLCKD is an effective and safe treatment for weight loss in patients with obesity, including those affected by mild kidney failure. Read more

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Cancer

Obesity and tumor growth: inflammation, immunity, and the role of a ketogenic diet

Obesity is becoming more prevalent and its link to cancer is clearly established providing a rationale for the implementation of dietary interventions as an adjuvant therapeutic strategy for malignancy. A number of clinical trials have demonstrated the feasibility of a high-fat, low-carbohydrate diet as an adjuvant treatment for cancer. Read more

Cancer Treatment With the Ketogenic Diet: A Systematic Review and Meta-analysis of Animal Studies

Conclusion: In summary, the pre-clinical evidence pointed toward an overall anti-tumor effect of the KD in animals studies currently available with limited tumor types. Read more

Implementation of a low-carbohydrate diet improves the quality of life of cancer patients – an online survey

Study participants were asked to fill out an online questionnaire. More than two-thirds of the respondents stated that a LC or KD improved QoL and that it had a normalizing effect on body weight. There was an obvious gap between the patients’ need for professional counseling and what is currently offered in the health care setting. In the future, efforts should be made to invest in nutrition experts who are trained in the KD to support cancer patients in KD implementation. Read more

Ketogenic diet in the treatment of cancer – Where do we stand?

The ketogenic diet probably creates an unfavorable metabolic environment for cancer cells and thus can be regarded as a promising adjuvant as a patient-specific multifactorial therapy. The majority of preclinical and several clinical studies argue for the use of the ketogenic diet in combination with standard therapies. Read more

A ketogenic diet consumed during radiotherapy improves several aspects of quality of life and metabolic health in women with breast cancer.

While [cancerous] breast symptoms increased significantly in both groups, the increase was less pronounced in the ketogenic diet group. There was no hint of a detrimental effect of the ketogenic diet on either liver or kidney function; in contrast, biomarkers of metabolic health (gamma-glutamyl-transpeptidase, creatinine, triglycerides, IGF-1, free T3) significantly improved in the ketogenic diet, but not the standard diet group. These data support the hypothesis that consuming a ketogenic diet during radiotherapy is safe for women with breast cancer and has the potential to improve quality of life and metabolic health. Read more

Effects of Ketogenic metabolic therapy on patients with breast cancer: A randomized controlled clinical trial

Ketogenic diet lead to a reduction in tumor size in the ketogenic diet group compared to the control (27 vs 6 mm, P = 0.01). Stage decreased significantly in patients with locally advanced disease in the ketogenic group after 12 weeks (P < 0.01). No significant differences in response rate were observed in patients with metastatic disease. Ketogenic metabolic therapy in breast cancer patients might exert beneficial effects through decreasing TNF-α and insulin and increasing IL-10. Ketogenic diets may result in a better response through reductions in tumor size and downstaging in patients with locally advanced disease; however, more studies are needed to elucidate the potential beneficial effects of ketogenic diet in patients with metastases. Read more

The effect of a ketogenic diet and synergy with rapamycin in a mouse model of breast cancer

Conclusions: The study provides proof of principle that a ketogenic diet a) results in serum insulin reduction and ketosis in a spontaneous breast cancer mouse model; b) can serve as a therapeutic anti-cancer agent; and c) can enhance the effects of rapamycin, an anti-cancer drug, permitting dose reduction for comparable effect. Read more

Cancer Treatment With the Ketogenic Diet: A Systematic Review and Meta-analysis of Animal Studies

In summary, the pre-clinical evidence pointed toward an overall anti-tumor effect of the KD in animals studies currently available with limited tumor types. Read more

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Digestion

A Very Low-Carbohydrate Diet Improves Symptoms and Quality of Life in Diarrhea-Predominant Irritable Bowel Syndrome

A very low carbohydrate diet provides adequate relief, and improves abdominal pain, stool habits, and quality of life in IBS-D. Read more

Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms

Conclusion: Idiopathic constipation and its associated symptoms can be effectively reduced by stopping or even lowering the intake of dietary fiber. Read more

Effect of dietary fiber on constipation: A meta analysis

Conclusion: Dietary fiber intake can obviously increase stool frequency in patients with constipation. It does not obviously improve stool consistency, treatment success, laxative use and painful defecation. Read more

Prevalence and factors associated with gluten sensitivity in inflammatory bowel disease

Conclusion: Gluten sensitivity was common in irritable bowel diseases and associated with having had a recent flare. Gluten sensitivity may be transient for some patients, whereby dietary recommendations during and after a flare could focus on the avoidance of specific food triggers with possible reintroduction of these foods over time. Read more

A Study Evaluating the Bidirectional Relationship Between Inflammatory Bowel Disease and Self-reported Non-celiac Gluten Sensitivity

Conclusions: Self-reported non-celiac gluten sensitivity is not only exclusive to irritable bowel syndrome but also associated with irritable bowel diseases, where its presence may be reflecting severe or stricturing disease. Read more

Crohn’s disease: Maintenance of remission by diet

20 patients with Crohn’s disease took part in a controlled trial in which remission was maintained by either an unrefined carbohydrate fibre rich diet or a diet which excluded specific foods to which a patient was intolerant. 7 out of the 10 patients on the exclusion diet remained in remission for 6 months compared with none out of the 10 on an unrefined carbohydrate fibre rich diet (p<0·05, Fisher’s exact test). In an uncontrolled study an exclusion diet allowed 51 out of 77 patients to remain well on the diet alone for periods of up to 51 months, and with an average annual relapse rate of less than 10%. Read more

Treatment of active Crohn’s disease by exclusion diet: East Anglian Multicentre Controlled Trial

Food intolerances discovered were predominantly to cereals, dairy products, and yeast. Diet provides a further therapeutic strategy in active Crohn’s disease. Read more

Differentiation between Celiac Disease, Nonceliac Gluten Sensitivity, and Their Overlapping with Crohn’s Disease: A Case Series

The symptomatologies of all three patients improved significantly after 12 months of gluten-free diet plus other modalities. Read more

The Characterization of the Repertoire of Wheat Antigens and Peptides Involved in the Humoral Immune Responses in Patients with Gluten Sensitivity and Crohn’s Disease

Based on these findings, we propose that for the early detection of immune activation in atypical or silent celiac disease and patients with irritable bowel disease or Crohn’s disease … in addition to gluten-free diets for patients with Crohn’s disease who are ASCA (Anti-Saccharomyces cerevisiae mannan antibodies) positive, yeast-free diets may also be recommended. Read more

Fiber Menace: The Truth About the Leading Role of Fiber in Diet Failure, Constipation, Hemorrhoids, Irritable Bowel Syndrome, Ulcerative Colitis, Crohn’s Disease, and Colon Cancer Read book

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Inflammation

Effect of Very-Low-Calorie Ketogenic Diet on Psoriasis Patients: A Nuclear Magnetic Resonance-Based Metabolomic Study.

Our data show that a low-calorie ketogenic diet can be considered a successful strategy and therapeutic option to gain an improvement in psoriasis-related dysmetabolism, with significant correction of the full metabolic and inflammatory status. Read more

Very low-calorie ketogenic diet (VLCKD) in patients with psoriasis and obesity: an update for dermatologists and nutritionists

VLCKD leading to both weight loss and reduction of systemic inflammation may decrease the exacerbation of the clinical manifestations or even it may block the trigger of psoriatic disease. This dietary pattern could represent a potential first-line treatment in psoriatic patients with obesity. Read more

Ketogenic diet attenuates oxidative stress and inflammation after spinal cord injury by activating Nrf2 and suppressing the NF-κB signaling pathways

Highlights: Ketogenic diet (KD) promotes functional recovery after spinal cord injury (SCI). KD attenuated oxidative stress and inflammation in SCI by activating Nrf2. KD reduced NF-κB pathway activity and expression of inflammatory cytokines. These findings provide a putative mechanism for KD-associated recovery in SCI. Read more

Ketogenic diet effects on inflammatory allodynia and ongoing pain in rodents

These data suggest that ketogenic diets or other ketogenic treatments might be useful treatments for conditions involving inflammatory pain. Read more

Mental Health

Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature

We report the unexpected resolution of longstanding schizophrenic symptoms after starting a low-carbohydrate, ketogenic diet. After a review of the literature, possible reasons for this include the metabolic consequences from the elimination of gluten from the diet, and the modulation of the disease of schizophrenia at the cellular level. Read more

Ketogenic therapy in neurodegenerative and psychiatric disorders: From mice to men

The preclinical literature provides strong support for the efficacy of ketogenic diet in a variety of diverse animal models of neuropsychiatric disorders. However, the evidence from clinical studies, while encouraging, particularly in Alzheimer’s disease, psychotic and autism spectrum disorders, is limited to case studies and small pilot trials. Read more

The Effects of Ketogenic Diets on Psychiatric Disorders Involving Mitochondrial Dysfunction: A Literature Review of the Influence of Dieting on Autism, Depression, Anxiety, and Schizophrenia

Mitochondrial dysfunction has been linked to many psychiatric disorders. Ketogenic diets have been shown to reduce mitochondrial dysfunction and thus may be helpful to patients who suffer from these disorders. Read more