Can Ketogenic Diet Improve Diabetic Retinopathy?

December 12, 2023

What Is Diabetic Retinopathy?

Diabetic retinopathy is the most common microvascular complication of both type 1 and type 2 diabetes and one of the leading causes of blindness in the world.^1–3 Its prevalence is related to the duration of diabetes and the level of glycemic control.⁴ Suboptimal diabetes management and sustained hyperglycemia (ie, high blood glucose levels) can lead to microvascular damages to the retina and swelling in the eyes.^5,6

Can Ketogenic Diet Improve Diabetic Retinopathy?

The ketogenic diet is a diet that focuses on consuming very low amounts of carbohydrate and high amounts of fat.^7,8 Although there is a dearth of studies that have specifically studied the impact of ketogenic diet on diabetic retinopathy, one case study showed promising results. A case report in 2020 of a 40-year-old woman with type 2 diabetes mellitus and diabetic retinopathy on insulin therapy has shown that ketogenic diet can improve or even reverse retinopathy.⁹ The patient reported that she adopted a coconut oil-rich ketogenic diet and lost 55 pounds of body weight and achieved a hemoglobin A1c of 5.3% without insulin therapy. After two years, her affected eye regained stable vision and her macular detachment from retinopathy was completely resolved.

Although this case study reports a rare case of a complete reversal of diabetic retinopathy following a ketogenic diet, studies have demonstrated that healthy weight loss in individuals with diabetes can show significant health improvements.^7,8,10–13 Various research has shown that the ketogenic diet can effectively promote weight loss and improve various metabolic profiles such as insulin resistance, hemoglobin A1c, lipid profiles, weight and waist circumference, and body mass index. Given the importance of glycemic control and weight management in reducing the risk of diabetes-related micro- and macrovascular complications, the favorable effects of the ketogenic diet on metabolic health may potentially extend to improving diabetic retinopathy. However, it should be noted that more rigorous studies need to be conducted to establish the safety and efficacy of the diet in managing diabetic retinopathy.

References:
1. American Diabetes Association Professional Practice Committee. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2021;45(Supplement_1):S185-S194. doi:10.2337/dc22-S012
2. Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci. 2018;19(6):1816. doi:10.3390/ijms19061816
3. Bhatwadekar AD, Shughoury A, Belamkar A, Ciulla TA. Genetics of Diabetic Retinopathy, a Leading Cause of Irreversible Blindness in the Industrialized World. Genes (Basel). 2021;12(8):1200. doi:10.3390/genes12081200
4. Solomon SD, Chew E, Duh EJ, et al. Diabetic Retinopathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(3):412-418. doi:10.2337/dc16-2641
5. Henriques J, Vaz-Pereira S, Nascimento J, Rosa PC. [Diabetic eye disease]. Acta Med Port. 2015;28(1):107-113.
6. Eye Care for People with Diabetes. Am Fam Physician. 1999;60(3):1001.
7. Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. In: StatPearls. StatPearls Publishing; 2022. Accessed August 10, 2022. http://www.ncbi.nlm.nih.gov/books/NBK499830/
8. Alarim RA, Alasmre FA, Alotaibi HA, Alshehri MA, Hussain SA. Effects of the Ketogenic Diet on Glycemic Control in Diabetic Patients: Meta-Analysis of Clinical Trials. Cureus. 12(10):e10796. doi:10.7759/cureus.10796
9. Chandrasekaran P, Rani PK. Reversal of Diabetic Tractional Retinal Detachment Attributed to Keto Diet. BMJ Case Rep. 2020;13(10):e235873. doi:10.1136/bcr-2020-235873
10. Yuan X, Wang J, Yang S, et al. Effect of the Ketogenic Diet on Glycemic Control, Insulin Resistance, and Lipid Metabolism in Patients With T2DM: a Systematic Review and Meta-analysis. Nutr Diabetes. 2020;10(1):1-8. doi:10.1038/s41387-020-00142-z
11. Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep. 2018;7(3):97-106. doi:10.1007/s13668-018-0235-0
12. Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489-2496. doi:10.1001/jama.2012.67929
13. Koenigsberg MR, Corliss J. Diabetes Self-Management: Facilitating Lifestyle Change. AFP. 2017;96(6):362-370.

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