Jennifer Abbasi, senior staff writer at JAMA, wrote a perspective on the increasing interest on the ketogenic diet for weight loss and Type 2 Diabetes just two days ago (Jan. 16, 2018).
She first presents some of the findings from a recent controlled feeding study where the coprincipal investigator is David S. Ludwing of the Harvard Medical School. Lustig is known for his opposition to the sugar industry. Having a neuroendocrinology background, some of his arguments appear solid, despite the fact that many scientists, researchers, and strong voices consider him an extremist.
Anyway, this posts and Abbasi's perspective is not about that, it's about the ketogenic diet and how it may help with T2D. She goes into detail about a meta-analysis of 13 studies which suggested that the ketogenic diet may have some advantage over a low-fat diet for weight loss over the long term. Two main arguments in favor of the keto diet are with respect to the changes it elicits in appetite regulation hormones and with a potential metabolic advantage (by not reducing BMR).
I'd say these effects are synergistic. As pointed out by Abbasi:
"There’s also increasing interest in the ketogenic diet for diabetes management. Insulin sensitivity improves on the diet—although the mechanisms are not entirely clear—along with glycemic control." [source]
By no means I am against drugs, but if there is a potentially strong antidiabetic effect with the ketogenic diet, why not start implementing it along with other lifestyle interventions, before taking drugs?
I'm going to answer this myself...Because many people would simply prefer a drug or a pill instead of diligently and drastically reducing carbohydrate intake and being vigilant about each gram of carbohydrate they put in their mouths. It's easier to pop a pill and keep eating a high carbohydrate diet. There's nothing with carbohydrates as the principal supplier of metabolic energy in people who are insulin sensitive, healthy, and fit.
There are other potential benefits of the ketogenic diet that go beyond weight loss and T2D. However, there are many caveats as well. One is that the diet can be very hard to follow at first, reason being most quit in the first 2-3 weeks of trying it.
Second is that it can lead to nutritional deficiencies if one does not inform themselves well at first. A well formulated ketogenic diet that's highly nutritious and energy sufficient can be conceptualized with the help of a nutritionist or an expert knowledgeable on the subject. And there's a scarcity for this person at the moment...
Thirdly, its very different nature and principles may make it very inconvenient socially. However, ll these and the rest of the potential drawbacks can be mitigated and/or minimized with appropriate sufficient information on the subject and on all of its details.
I diverged...The focus of this post was Abbasi's perspective in JAMA. JAMA is known not to be in favor of 'low-carb' and 'keto' diets in the circles of research for these diets, which is why I found it interesting they had this piece as part of their 'medical news and perspectives'. You can read it below:
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Cristi Vlad Self-Experimenter and Author