A new study compared a ketogenic diet to a Mediterranean diet. Which diet is better for diabetes? for glucose control, lipids and weight loss?

Keto-Med. Mediterranean Diet incl. legumes, fruit, whole grains. keto avoided those except berries

Mediterranean Diet also had olive oil and fish. keto diet had more animal foods like meat, eggs, cream etc

keto: 43g/d of carbs

were they in ketosis? ketone bodies mostly above 0.5mmol/L. light ketosis. above 1.5 is optimal ketosis

Virta specializes in low carb diets, led by leaders of low carb and keto. they shot for ketones above 0.5, same range as Keto-med. by 2years 14% were in ketosis. early on, in light ketosis. difficulty not specific to low carb

33 pre diabetic or diabetic subjects. half did keto 1st, Mediterranean Diet 2nd, other half did the other way around

glycated hemoglobin or HbA1c (avg of glucose levels over previous 3mos). Both diets lowered HbA1c

In type 2 diabetes, there’s an inefficiency to process carbs. we can avoid exaggerated glucose peaks while the machine is defective. end goal is to fix the machinery, by moderating calories and losing excess fat mass

any diet that helps with weight loss can help fix the machine. some people say a low fat diet reversed diabetes, low carb, vegan, paleo. eliminating junk food helps moderate calories

I thought keto would moderate postprandial peaks. Diabetes is one situation there are studies showing low carb is a valid tool to help control glycemia. to minimize hypoglycemia, pts on glucose lowering meds were told to reduce them. but on the Mediterranean Diet they reduced 50% and on keto cut them completely

So Mediterranean Diet had more meds than keto diet

matching for glucose lowering medssuggested keto lowered HBA1c more

CGM parameters: both diets improved CGM specs, keto did a bit better

keto may have an edge in terms of glucose control. if they were deeper into ketosis it might have been even stronger

blood lipids: Keto was better for triglecrydes but worse for LDLcholesterol. common in low carb trials

weight loss on both diets, maybe a bit more on keto

in the followup phase people ate more Mediterranean

Mediterranean lowered HbA1c, keto probably lowered it more but worse for ldl-cholesterol, Mediterranean was better for cholesterol but keto was better for triglycerides

Low carb diet requires high LDL-cholesterol? no. keto diet had 2x saturated fat intake and half the fiber, no wonder cholesterol went up but a Low carb diet can have more fiber and unsaturated fat

low carb diet rich in unsaturated fat helps lower cholesterol. this idea that low carb diets jack up ur cholesterol is a misconception

LDLcholesterol is a marker for apoB, high apoB raises Cardiovascular risk

saturated fat: fatty meats, butter, coconut oil. unsaturated: nuts, seeds, avocado, fatty fish, most veg oil

maybe unsaturated fats are better for cholesterol but worse for glucose or triglycerides?

trial on different keto diets: saturated vs unsaturated. unsaturated keto diet had lower cholesterol, triglycerides, glucose and better insulin sensitivity

polyunsaturated fat ketogenic diet may be superior to saturated fat keto for chronic administration

Long-term data on low carb? low carb diets been around for a while but no cohort studies on really low carb

keto diet is optimizable. so is Mediterranean diet, if triglycerides or glucose aren't ideal, e.g. replacing some whole grains with unsaturated fat or protein. Nuts & seeds, legumes, fatty fish.

some do better on low carb others low fat, others on neither

the Mediterranean-Keto diet, a blend of both

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References:
https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqac154/6596279
https://www.mdpi.com/2072-6643/13/3/967/htm
https://link.springer.com/article/10.1007/s13300-018-0373-9
https://www.frontiersin.org/articles/10.3389/fendo.2019.00348/full
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/415074
https://academic.oup.com/jcem/article/89/4/1641/2844241


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0:00 New study: Keto vs Mediterranean
3:52 Diet and Glucose control
7:44 Blood lipids
9:07 Which diet "won"?
9:57 Low carb without high cholesterol
12:54 Optimizing the Mediterranean diet
14:51 The best diet for YOU