- About 590 million people worldwide have diabetes, with more than 90% living with type 2 diabetes.
- Although there is currently no cure for type 2 diabetes, it is possible to go into remission by making healthy lifestyle choices, such as eating a healthy diet.
- A new study found that people with type 2 diabetes following the keto diet may have a better chance of reversing their diabetes than those just following a low-fat diet.
Researchers estimate that about 590 million people globally live with diabetes, with more than 90% having type 2 diabetes.
Although there is currently no cure for type 2 diabetes, it is possible to go into remission, which is primarily accomplished through weight loss, regular exercise, and following a healthy diet that is usually low-calorie and low–carbohydrates.
Now a new study published in the Journal of the Endocrine Society has found that people with type 2 diabetes following the keto diet, which is high-fat and low-carb, may have a better chance of reversing their diabetes than those just following a low-fat diet.
For this study, researchers recruited 51 adults between the ages of 55 and 62 with type 2 diabetes. Participants followed either the keto diet or a low-fat diet for 12 weeks.
Scientists focused on how both diets impacted participants’
“Carbohydrate-restricted diets have been shown to elicit several beneficial effects in patients with type 2 diabetes, including lowering HbA1c, systolic blood pressure, and triglycerides,” Marian Yurchishin, MS, pre-doctoral training fellow in the Department of Nutrition Sciences at the University of Alabama at Birmingham and lead author of this study, told Medical News Today.
“By identifying its therapeutic effects, we want to show that a ketogenic diet could serve as a complementary aspect of lifestyle therapy which could contribute to better glycemic control as a result of improved beta-cell function,” Yurchishin explained.
“Other than bariatric surgery or large-volume intentional weight loss, interventions for improving beta-cell function in type 2 diabetes, particularly in the absence of weight loss, do not currently exist. Further, these therapies may not be feasible or sustainable for most individuals. While the potential to restore beta-cell function is possible in early disease states, effective therapies and useful markers for gauging effectiveness of treatments are not known.”
– Marian Yurchishin, MS
At the study’s conclusion, researchers found that while study participants both lost weight following either the keto or low-fat diet, those following keto experienced a decrease in the proportion of proinsulin secreted to a greater extent, a change that was associated with an improvement in beta-cell function.
“The pancreas has to go through several steps to make insulin,” Yurchishin explained. “When beta cells are under significant stress, as seen in type 2 diabetes, they secrete a lot of proinsulin.”
”Proinsulin is a precursor to insulin, so elevated proinsulin levels indicate that beta-cells are overwhelmed and secreting ‘unfinished’ molecules as an attempt to keep up with the body’s increasing demands for insulin,” she continued. ”A larger decrease in proinsulin suggests that the ketogenic diet reduced this stress and allowed beta-cells to work more efficiently, as evidenced by the improvements in beta-cell function.”
What might it be about the keto diet that would allow it to help improve beta-cell function?
“One process that may contribute to beta-cell failure is their loss of glucose sensing and glucose responsiveness, which is thought to result from the beta-cells’ chronic exposure to glucose (e.g. glucose toxicity),” Yurchishin told us.
“Removal of this exposure via a carbohydrate restricted diet may therefore provide an environment for beta-cells to repair their secretory mechanisms, but more research is needed to identify the specific mechanisms behind this effect,” she noted.
“As beta-cells are responsible for secreting insulin in response to increases in blood glucose, restoration of their function allows these cells to produce adequate insulin to sustain adequate blood sugar levels,” she added.
MNT had the opportunity to speak with Pouya Shafipour, MD, a board-certified family and obesity medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, about this study, who commented he was not surprised by its findings.
“For early cases of diabetes, keto can do miracles if people adhere to it well, and if they’re doing Mediterranean, higher fiber keto,” Shafipour, who was not involved in this research, said.
“But the biggest challenge with keto is that a lot of people do carnivore keto. They don’t necessarily eat the right type of fat and protein, and also adhere to it. This study […] is 12 weeks, and in 12 weeks it’s easier to adhere to it,” he pointed out.
According to him, another big challenge is that “people go on keto for 2, 3 months, get results, and then they start getting bored of it”.
“We’re living in a world that’s just flooded with carbohydrates, and once you get out of it, it’s hard to get back into a ketogenic state. It requires a lot of discipline, a lot of saying no to a lot of temptations. So keto is fantastic and miraculous, it’s just that adherence is a little bit challenging,” said Shafipour.
For the next steps in this research, Shafipour told us he would like to see a bit longer study duration and what type of specific keto diet participants are following.
“Because keto to one person might mean just like the old school Atkins [diet], that you’re eating a lot of bacon and cheese,” he explained. “But now we found out that those inflammatory fats are not necessarily Healthy, even though they cause weight loss, but they can increase tumor markers and inflammatory markers in the blood.”
“[With] longer study adherence — you follow patients six months to a year to see how much they can adhere, and then you measure their C-peptides, A1C, and pancreatic cell function. We want to make sure with diabetes management, we’re not just managing the blood sugar, but we’re preserving pancreatic cell function and we’re actually reducing the IL6, the TNF alpha, all these inflammatory markers that are in the background destroying the body in a diabetic person.”
– Pouya Shafipour, MD
For those who may want to give following the keto diet a shot, Monique Richard, MS, RDN, LDN, a registered dietitian nutritionist and owner of Nutrition-In-Sight, offered some expert tips.
“It is most important to prioritize a way to look beyond initial outcomes and consider sustainability, access, nutritional adequacy, and impact on overall health, especially cardiovascular health, which is closely tied to, or increased, in those with type 2 diabetes,” Richard said.
“The research established so far conveys that while low-carb and ketogenic diets may improve glycemic control in the short term, they may not be consistently superior over time compared to other balanced dietary patterns, or, not without their own side effects and shortfalls — i.e. gallbladder Health, arterial inflammation, impact on liver function,” she advised.
While lowering carbs can help blood sugar levels, Richard said that how this is done and what they are replaced with matters just as much, if not more.
Some general recommendations for those interested in exploring the keto diet include:
- Focusing on food quality, not just macros: Not all keto diets are created equal, Richard said. Replacing carbohydrates with highly processed meats, ultra-processed foods marketed as “keto-friendly,” and saturated fats may negatively impact heart health, while emphasizing unsaturated fats (olive oil, nuts, seeds, avocado) and non-starchy vegetables supports better outcomes.
- Be strategic and mindful: It’s not about restriction, elimination, or excess of one or more particular food groups or macros.
- Consider moderate carbohydrate reduction rather than extreme restriction: Even decreasing the frequency of refined carbohydrates, or portions consumed, in addition to the amount of added sugars can significantly improve glycemic control, Richard said.
- Keep the variety, hold the towering fat and protein stack: A double bacon cheese burger with extra bacon sans the bun is a lot for the digestive system to process, in addition to the excess sodium, preservatives, and lack of beneficial nutrients this combo contains, Richard explained. Restrictive and imbalanced diets can limit fiber, phytonutrients, and gut microbiome diversity which are all important for metabolic health.
“The best nutrition plan is the one that works for your biology and your life,” Richard added.
“As with most things in nutrition, there is no one-size-fits-all approach. The goal isn’t just to lower blood sugar — it’s also to support long-term health, quality of life, and sustainable habits. If someone is considering a ketogenic approach, I always emphasize doing so with guidance from a registered dietitian nutritionist (RDN) and healthcare team, especially because medications often need to be adjusted,” she advised.
