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Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis
AIMS: Adopting a low‐ or very low‐carbohydrate (LCD or VLCD) diet in type 1 diabetes mellitus (T1D) is a controversial intervention. The main fear is that these diets may increase the risk of diabetic ketoacidosis. However, there is little data about the ketoacidosis risk and the level of physiologi...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663138/ https://www.ncbi.nlm.nih.gov/pubmed/37454371 http://dx.doi.org/10.1111/dme.15178 |
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author | Ozoran, Hakan Matheou, Michael Dyson, Pam Karpe, Fredrik Tan, Garry D. |
author_facet | Ozoran, Hakan Matheou, Michael Dyson, Pam Karpe, Fredrik Tan, Garry D. |
author_sort | Ozoran, Hakan |
collection | PubMed |
description | AIMS: Adopting a low‐ or very low‐carbohydrate (LCD or VLCD) diet in type 1 diabetes mellitus (T1D) is a controversial intervention. The main fear is that these diets may increase the risk of diabetic ketoacidosis. However, there is little data about the ketoacidosis risk and the level of physiological nutritional ketosis in individuals following these diets. We aimed to define the level of ketosis in those with T1D following carbohydrate restricted diets in a real‐world observational study. METHODS: Patients with T1D who had self‐selected dietary carbohydrate restriction were enrolled from local clinics and were compared to those following an unrestricted regular carbohydrate control diet (RCCD). Participants completed a 3‐day diary, documenting food intake, ketones, and blood/interstitial glucose concentrations. RESULTS: Participants were divided into three groups according to mean carbohydrate intake: VLCD (<50 g carbohydrates/day) n = 6, LCD (50–130 g carbohydrates/day) n = 6, and RCCD (>130 g carbohydrates/day) n = 3. Mean beta‐hydroxybutyrate (BOHB) concentrations were 1.2 mmol/l (SD 0.14), 0.3 mmol/l (SD 0.12) and 0.1mmol/l (SD 0.05) in the VLCD, LCD and RCCD groups, respectively (p = 0.02). Post hoc Dunn test demonstrated this reached statistical significance between the VLCD and RCCD groups (p = 0.02). CONCLUSION: Carbohydrate restricted diets, in particular VLCDs, are associated with a higher BOHB level. However, the degree of ketosis seen is much lower than we expected, and significantly lower than the level typically associated with diabetic ketoacidosis. This may suggest the risk of ketoacidosis is lower than feared, although safety will need to be evaluated further in large scale randomised trials. |
format | Online Article Text |
id | pubmed-10663138 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-106631382023-11-22 Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis Ozoran, Hakan Matheou, Michael Dyson, Pam Karpe, Fredrik Tan, Garry D. Diabet Med Research: Pathophysiology AIMS: Adopting a low‐ or very low‐carbohydrate (LCD or VLCD) diet in type 1 diabetes mellitus (T1D) is a controversial intervention. The main fear is that these diets may increase the risk of diabetic ketoacidosis. However, there is little data about the ketoacidosis risk and the level of physiological nutritional ketosis in individuals following these diets. We aimed to define the level of ketosis in those with T1D following carbohydrate restricted diets in a real‐world observational study. METHODS: Patients with T1D who had self‐selected dietary carbohydrate restriction were enrolled from local clinics and were compared to those following an unrestricted regular carbohydrate control diet (RCCD). Participants completed a 3‐day diary, documenting food intake, ketones, and blood/interstitial glucose concentrations. RESULTS: Participants were divided into three groups according to mean carbohydrate intake: VLCD (<50 g carbohydrates/day) n = 6, LCD (50–130 g carbohydrates/day) n = 6, and RCCD (>130 g carbohydrates/day) n = 3. Mean beta‐hydroxybutyrate (BOHB) concentrations were 1.2 mmol/l (SD 0.14), 0.3 mmol/l (SD 0.12) and 0.1mmol/l (SD 0.05) in the VLCD, LCD and RCCD groups, respectively (p = 0.02). Post hoc Dunn test demonstrated this reached statistical significance between the VLCD and RCCD groups (p = 0.02). CONCLUSION: Carbohydrate restricted diets, in particular VLCDs, are associated with a higher BOHB level. However, the degree of ketosis seen is much lower than we expected, and significantly lower than the level typically associated with diabetic ketoacidosis. This may suggest the risk of ketoacidosis is lower than feared, although safety will need to be evaluated further in large scale randomised trials. John Wiley and Sons Inc. 2023-07-26 2023-10 /pmc/articles/PMC10663138/ /pubmed/37454371 http://dx.doi.org/10.1111/dme.15178 Text en © 2023 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research: Pathophysiology Ozoran, Hakan Matheou, Michael Dyson, Pam Karpe, Fredrik Tan, Garry D. Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis |
title | Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis |
title_full | Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis |
title_fullStr | Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis |
title_full_unstemmed | Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis |
title_short | Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis |
title_sort | type 1 diabetes and low carbohydrate diets—defining the degree of nutritional ketosis |
topic | Research: Pathophysiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663138/ https://www.ncbi.nlm.nih.gov/pubmed/37454371 http://dx.doi.org/10.1111/dme.15178 |
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