People with autoimmune issues are at greater risk for elevated blood sugar and blood lipids than the general public. More people are using a ketogenic diet to improve blood sugar metabolism, and there are more and more research clinical trials examining the impact of a ketogenic diet on blood sugar metabolism and type-2 diabetes.
When there are multiple studies on a certain intervention, researchers can complete a meta-analysis that looks at the studies together to see if there is clear evidence that either the intervention or the control is effective.
I was pleased to see this meta-analysis (PMID: 35469570), which looked at ketogenic diets with and without exercise to improve blood sugar control in pre-diabetes and diabetes patients. The hypothesis being tested was whether a ketogenic diet combined with exercise was superior to ketogenic diet alone for improving blood sugar control in patients with type 2 diabetes.
Researchers found 12 studies that met criteria for inclusion in their analysis:
- 3 trials that included ketogenic diet and exercise,
- 5 studies that compared ketogenic diet to another diet,
- 2 that examined ketogenic diet alone for controlling blood sugar,
- 1 that examined blood sugar metabolism in patients with pre-diabetes,
- and 1 that examined ketogenic diet in patients with pre-diabetes and type 2 diabetes.
- 11 of these studies were of human subjects, and 1 was a mouse study.
- 9 were randomized controlled studies, and 1 was a prospective cohort study.
Every study demonstrated that a ketogenic diet showed marked improvement in blood sugar metabolism. Every trial utilizing a ketogenic diet and exercise had greater improvement in blood sugar control. One study found improved blood sugar metabolism was also linked to problems with lipid metabolism and the development of fatty liver issues. Notably, studies that combined exercise and ketogenic diet avoided problems with lipid metabolism and liver issues. The authors conclude that there is good evidence that ketogenic diets improve blood sugar metabolism. However, the studies were relatively brief and did not explore the effect of a ketogenic diet over many years. Nor did the studies consistently examine the effect on the liver. Additional studies spanning several years are needed. In addition, more studies that combine ketogenic diet and exercise are needed.
My take on these findings is that the combination of a ketogenic diet and exercise is superior to diet alone. It is not surprising to me that a multi-modal intervention that combined diet and exercise led to superior results. The practical side of these findings for those with pre-diabetes and type 2 diabetes is that a ketogenic diet, ideally with exercise, is gaining traction as a treatment option for improving blood sugar control, though lipids also should be monitored.
Those who want to improve their blood sugar control should add an exercise program and consider targeted supplements to further support improved blood sugar metabolism. For those with elevated blood lipids, a supplement that contains bergamot and amla may be very helpful.
Because pre-diabetes and diabetes have no symptoms, millions of people have no idea that they are pre-diabetic or diabetic.
Ask your primary care team to check your hemoglobin a1c level.
- The goal is to have your a1c level be under 5.4%.
- If it is higher than 5.4% but still under 5.6%, I tell my patients to lower the carbs in their diet.
- If it is higher than 5.6%, I tell my patient that they are pre-diabetic and I work more closely with them to lower the carbohydrates in their diet, improve their sleep, and improve their physical activity.
I also often add targeted supplements that contain either berberine or bergamot to improve blood sugar control. If they have elevated cholesterol then I generally recommend adding a bergamot containing supplement.
The combination of diet, lifestyle interventions, and supplements are effective at helping people get better control of blood sugars and cholesterol. They are often able to reduce the reliance on prescription medication for diabetes, achieve a normal hemoglobin a1c, and get off of lipid-lowering medication.
Ask your primary care team to check your hemoglobin a1c. There are no symptoms of elevated blood sugar, which can occur even in thin people. Monitor your hemoglobin a1c and cholesterol yearly to prevent worsening disease and stay healthy.
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