Can I Combine the Ketogenic Diet With Intermittent Fasting?

Can I Combine the Ketogenic Diet With Intermittent Fasting?

Ketogenic Diet vs Intermittent Fasting 

The ketogenic diet involves the consumption of very low amounts of carbohydrate and high amounts of fat,1 whereas intermittent fasting prescribes caloric restriction over various intervals of time.2 In essence, one approach specifies what to eat (ie, ketogenic diet), whereas the other specifies when to eat (ie, intermittent fasting).3 

The Mechanism Behind the Diets 

Both the ketogenic diet and intermittent fasting are currently well-known and popular dietary methods aimed to promote weight loss.4,5 They both work by promoting ketogenesis, the process of utilizing ketone bodies rather than glucose as energy source,2,6,7 and various studies have found each diet to be effective in facilitating weight loss and improving metabolic profiles including insulin sensitivity, fasting blood glucose, hemoglobin (Hb) A1c, and lipid levels.8,9 As the two diets share similar biological mechanisms, combining them can – in theory – promote ketogenesis, facilitate weight loss, and improve metabolic profiles more effectively than using one dietary approach alone. 

Studies on the Combined Diet

Although not many studies have been conducted on the efficacy and safety of ketogenic diet combined with intermittent fasting among individuals with type 2 diabetes mellitus (T2DM), some trials seem to suggest that the combination may be effective in combating obesity and insulin resistance.3,10,11 One case study on a normal weight woman with T2DM found a 2.9% drop in HbA1c levels (from 9.3% to 6.4%) during 4 months of dietary intervention.3 The favorable change was found despite minimal reduction in weight, and the authors concluded that the combination may be more effective than using only one dietary approach. Another case report studied the effects of intermittent fasting with a low-carbohydrate diet on three men with T2DM using diabetic pharmacotherapy.11 The study highlighted that all three participants experienced 10-18% weight loss, reductions in HbA1c levels, and discontinuation of insulin therapy after several months of intervention.

Despite some preliminary evidence suggesting that the combined diet may be effective in improving glycemic control and weight in individuals with T2DM, more studies are needed to determine its efficacy and safety. 

Potential Risks of Combining the Diets

Individuals with T2DM should speak with their health care team and nutritionist before starting on a ketogenic diet combined with intermittent fasting. It is important to consider the risks and side effects of each diet. Although intermittent fasting is generally safe in individuals with controlled T2DM, they should be aware of the risk of developing hypoglycemia, which is especially high in those on insulin and/or sulfonylurea.2 Additionally, individuals may experience the “keto flu” during the initial period of adjustment, also known as the keto induction.3 Symptoms may include headache, fatigue, dizziness, gastrointestinal discomfort, nausea, and decreased energy, which normally resolve within the first month.12

1. Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. In: StatPearls. StatPearls Publishing; 2022. Accessed August 9, 2022.
2. Li Z, Heber D. Intermittent Fasting. JAMA. 2021;326(13):1338. doi:10.1001/jama.2020.15140
3. Lichtash C, Fung J, Ostoich KC, Ramos M. Therapeutic Use of Intermittent Fasting and Ketogenic Diet as an Alternative Treatment for Type 2 Diabetes in a Normal Weight Woman: a 14-Month Case Study. BMJ Case Reports CP. 2020;13(7):e234223. doi:10.1136/bcr-2019-234223
4. Grajower MM, Horne BD. Clinical Management of Intermittent Fasting in Patients With Diabetes Mellitus. Nutrients. 2019;11(4):873. doi:10.3390/nu11040873
5. 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
6. de Cabo R, Mattson MP. Effects of Intermittent Fasting on Health, Aging, and Disease. N Engl J Med. 2019;381(26):2541-2551. doi:10.1056/NEJMra1905136
7. Zhu H, Bi D, Zhang Y, et al. Ketogenic Diet for Human Diseases: the Underlying Mechanisms and Potential for Clinical Implementations. Signal Transduct Target Ther. 2022;7:11. doi:10.1038/s41392-021-00831-w
8. Patikorn C, Roubal K, Veettil SK, et al. Intermittent Fasting and Obesity-Related Health Outcomes: An Umbrella Review of Meta-analyses of Randomized Clinical Trials. JAMA Network Open. 2021;4(12):e2139558. doi:10.1001/jamanetworkopen.2021.39558
9. 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
10. Arbour MW, Stec M, Walker KC, Wika JC. Clinical Implications for Women of a Low-Carbohydrate or Ketogenic Diet With Intermittent Fasting. Nurs Womens Health. 2021;25(2):139-151. doi:10.1016/j.nwh.2021.01.009
11. Furmli S, Elmasry R, Ramos M, Fung J. Therapeutic Use of Intermittent Fasting for People With Type 2 Diabetes as an Alternative to Insulin. Case Reports. 2018;2018:bcr. doi:10.1136/bcr-2017-221854
12 .Bostock ECS, Kirkby KC, Taylor BV, Hawrelak JA. Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet. Front Nutr. 2020;7:20. doi:10.3389/fnut.2020.00020



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