Eddy Edson
Well-Known Member
- Relationship to Diabetes
- Type 2
New little RCT: https://drc.bmj.com/content/12/5/e004199
Research design and methods 29 overweight obese subjects were randomized to one of three dietary interventions for 10 days: (1) Weight-maintaining standard diet; (2) Weight-maintaining ketogenic diet; (3) Weight-maintaining ketogenic diet plus supplementation with the ketone ester of beta-hydroxybutyrate (β-OH-B), 8 g every 8 hours. At baseline, all subjects had oral glucose tolerance test, 2-step euglycemic insulin clamp (20 mU/m2.min and 60 mU/m2.min) with titrated glucose and indirect calorimetry.
Results Body weight, fat content, and per cent body fat (DEXA) remained constant over the 10-day dietary intervention period in all three groups. Plasma β-OH-B concentration increased twofold, while carbohydrate oxidation decreased, and lipid oxidation increased demonstrating the expected shifts in substrate metabolism with institution of the ketogenic diet. Glucose tolerance either decreased slightly or remained unchanged in the two ketogenic diet groups. Whole body (muscle), liver, and adipose tissue sensitivity to insulin remained unchanged in all 3 groups, as did the plasma lipid profile and blood pressure.
Conclusion In the absence of weight loss, a low carbohydrate ketogenic diet has no beneficial effect on glucose tolerance, insulin sensitivity, or other metabolic parameters.
In summary, our study demonstrates for the first time that a 10-day ketogenic diet, with or without exogenous ketone supplementation, while maintaining constant body weight does not improve glucose tolerance, insulin sensitivity, plasma lipid profile, or blood
pressure in obese patients with T2D.
The experimental design here had patients eating to maintain their body weight. Previous studies have shown metabolic improvements with keto diets but also weight loss, which itself will cause these same improvements. So by keeping weight stable this experiment could investigate whether keto has benefits not related to weight loss.
See the Discussion section for discussion about obvious questions about things like study size and 10 day exposure window.
OGTT studies:
Keto results in significantly worse fasting glucose tolerance, I think in line with what you'd expect from previous work.
Abstract
Introduction Low carbohydrate ketogenic diets have received renewed interest for the treatment of obesity and type 2 diabetes. These diets promote weight loss, improve glycemic control, and reduce insulin resistance. However, whether the improvements in glycemic control and insulin sensitivity are secondary to the weight loss or result from a direct effect of hyperketonemia is controversial.Research design and methods 29 overweight obese subjects were randomized to one of three dietary interventions for 10 days: (1) Weight-maintaining standard diet; (2) Weight-maintaining ketogenic diet; (3) Weight-maintaining ketogenic diet plus supplementation with the ketone ester of beta-hydroxybutyrate (β-OH-B), 8 g every 8 hours. At baseline, all subjects had oral glucose tolerance test, 2-step euglycemic insulin clamp (20 mU/m2.min and 60 mU/m2.min) with titrated glucose and indirect calorimetry.
Results Body weight, fat content, and per cent body fat (DEXA) remained constant over the 10-day dietary intervention period in all three groups. Plasma β-OH-B concentration increased twofold, while carbohydrate oxidation decreased, and lipid oxidation increased demonstrating the expected shifts in substrate metabolism with institution of the ketogenic diet. Glucose tolerance either decreased slightly or remained unchanged in the two ketogenic diet groups. Whole body (muscle), liver, and adipose tissue sensitivity to insulin remained unchanged in all 3 groups, as did the plasma lipid profile and blood pressure.
Conclusion In the absence of weight loss, a low carbohydrate ketogenic diet has no beneficial effect on glucose tolerance, insulin sensitivity, or other metabolic parameters.
In summary, our study demonstrates for the first time that a 10-day ketogenic diet, with or without exogenous ketone supplementation, while maintaining constant body weight does not improve glucose tolerance, insulin sensitivity, plasma lipid profile, or blood
pressure in obese patients with T2D.
The experimental design here had patients eating to maintain their body weight. Previous studies have shown metabolic improvements with keto diets but also weight loss, which itself will cause these same improvements. So by keeping weight stable this experiment could investigate whether keto has benefits not related to weight loss.
See the Discussion section for discussion about obvious questions about things like study size and 10 day exposure window.
OGTT studies:
Keto results in significantly worse fasting glucose tolerance, I think in line with what you'd expect from previous work.
