Recent Update: Keto vs. Mediterranean Diet for Diabetes, Which one is better?
Everyone should maintain healthy diet, including those who suffer from diabetes. However there might be a slight difference of diet between normal people and those with diabetes. What kind of diet is suitable for diabetics?
Diabetes is a chronic disease caused when the pancreas does not produce enough insulin, or the body cannot use the insulin it produces effectively.
Insulin is a hormone that regulates blood sugar in our body. Data from the World Health Organization (WHO) shows that there were 422 million adults living with diabetes in 2014, almost four times as much as in 1980.
Lifestyle changes as recommended by the Diabetes Association include regulating food intake and physical exercise. Regulation of food intake includes hours, amount and type of food. The recommended food sources are foods that are not high in calories or simple sugars, or foods with preservatives or processed foods.
There are two types of diet that is recommended for diabetics patients which Keto Diet and Mediterranean Diet. What’s actually the difference? Both diets are stitch to the concept of low carbohydrate which is recommended by diabetes association. The diets also restrict added sugar and limit refined grains but include non starchy vegetables. The only difference was that the keto diet avoids most fruits, whole grains, and legumes, which are allowed in the Mediterranean diet.
The ketogenic diet is an ultra-low-carb, very high-fat diet that involves a drastic reduction in carbohydrate intake. The Mediterranean diet is a low-carb, moderately high-fat diet that emphasizes vegetables, legumes, fruits, whole grains, olive oil, and fish.
A study by the American Diabetes Association (ADA) showed the Mediterranean diet was able to improve fasting blood sugar in diabetic patients. In another study, the Mediterranean diet gave better blood sugar reduction results than a low-fat diet alone.
2022 Recent Study
On the most recent study from American Journal of Clinical Nutrition, the primary outcome was the percentage change in HbA1c from baseline after 12 weeks on each diet; secondary outcomes included fasting insulin and blood lipid values. Both diets succeed in controlling HbA1c and aiding weight loss, but the ketogenic diet was lower in several nutrients and fiber, and was more difficult for study participants to follow in the long run.
How was the research conducted?
The participants of this study were 33 adults with prediabetes (HbA1c 5.7 –6.4 percent or fasting glucose 100–125 mg/dL) or adults with type 2 diabetes (HbA1c ≥6.5 percent or fasting glucose ≥126 mg/dL) who were randomly assigned to the keto or Mediterranean diet for 12 weeks.
A group of participant on the keto diet were instructed to maintain nutritional ketosis — a metabolic state in which the body primarily uses fat for energy instead of sugar — by limiting carbohydrates to 20–50 g/day and proteins to 1.5 g/kg ideal body weight/day, with the calories coming from fats. They were also told to consume >3 servings/day of non starchy vegetables and maintain adequate mineral and fluid intake for the ketogenic state, with about 3–5 g of sodium and 3–4 g of potassium daily.
Those on the Mediterranean diet were advised to avoid added sugars and refined grains, while adhering to a chiefly plant-based diet that included legumes, fruits, whole intact grains, nuts, and seeds, with fish as the primary animal protein and olive oil as the primary fat.
In both diets, whole foods were promoted. All processed foods and added sugars were strongly discouraged. On average, participants consumed 250–300 fewer calories daily compared with baseline.
What was the result? Similar but not the same!
Twelve weeks after completing both diet phases, the participants maintained decreased HbA1c values, fasting glucose levels, and weight . HDL cholesterol levels were higher at follow-up than at baseline.
The percentage change in HbA1C decrease significantly for participants on both diet. There was a 9-percent decreased in HbA1c values with the keto diet relative to a 7-percent decreased with the Mediterranean diet.
There was a more significant reduction in triglyceride levels on keto diet — 16 percent reduction vs. 5 percent reduction on Mediterranean Diet. However, the greater decrease of triglyceride concentrations on the keto diet led to the increased of LDL cholesterol. The increase of LDL cholesterol on keto diet was 10 percent, comparing on the Mediterranean Diet which was decreasing by 5 percent. Increases in LDL cholesterol and decreases in triglycerides on keto diet are common effects of low-carb diets. HDL-cholesterol increased by 11 percent on keto diet and 7 percent on Mediterranean Diet. Weight loss was similar (8% on keto and 7% on Mediterranean).
Those on the keto diet missed out on nutrients, given their lower intake of fiber, thiamine, vitamins B6, C, D, E, and phosphorus. However, vitamin B12 levels were higher with the keto diet. These potential harms likely relate to avoiding legumes, fruits, and whole, intact grains on the keto diet.
The lower you go with carbs, the more you’re wiping out nutrient-dense and healthy food groups. Restricting added sugars and refined grains and inclusion of vegetables should be the focus. — Gardner
