Ketogenic Diet and Insulin Resistance

Ketogenic Diet and Insulin Resistance

How Does Ketogenic Diet Improve Insulin Resistance?

The ketogenic diet, a very-low-carbohydrate and high-fat diet, has been shown to effectively promote weight loss and improve metabolic profiles, gaining increasing attention among the diabetic community.1,2 This article will focus on the current understanding of the effect of ketogenic diet on insulin resistance.

Improvements in Body Weight & Other Metabolic Profiles 

Although there is a need for more rigorous trials to specifically study the effect of the ketogenic diet on insulin resistance among individuals with type 2 diabetes mellitus (T2DM), various studies have demonstrated that the ketogenic diet improves insulin resistance among obese individuals.3 A 2020 meta-analysis of 13 trials studying the effect of the ketogenic diet on individuals with T2DM found that the diet significantly improved fasting blood glucose, hemoglobin A1c, triglyceride, lipid profiles, weight, waist circumference, and body mass index. Additionally, insulin resistance measured by the homeostatic model assessment showed improvements after the ketogenic diet intervention.

As insulin resistance – a key clinical characteristic of T2DM – is closely related to obesity, it has been postulated that the ketogenic diet’s effectiveness in reducing body weight may confer beneficial effects on insulin resistance among obese individuals with T2DM.3,4

Improvements in Insulin Sensitivity, Independent of Weight Loss

In addition to improving weight and other metabolic profiles, studies have shown that the diet may reduce insulin resistance independent of weight loss.4–7 For instance, a study comparing the effect of carbohydrate-restricted diet to calorie- and fat-restricted diet in obese individuals found that in addition to other metabolic improvements (eg, weight loss and triglyceride levels), individuals assigned to the carbohydrate-restricted diet had significantly greater improvements in insulin sensitivity than those assigned to the calorie- and fat-restricted diet.5 Importantly, insulin sensitivity was shown to be improved even after adjusting for weight loss. Other studies have demonstrated that the carbohydrate-restricted diet reduces hyperinsulinemia independent of weight loss.4

The exact mechanisms of how the ketogenic diet improves insulin resistance independent of weight loss is still being elucidated, but it is hypothesized that by reducing carbohydrate intake, the ketogenic diet reduces circulating glucose and induces ketogenesis.8 This promotes the sensitivity of insulin receptors and also leads to a decreased fluctuation and secretion of insulin, eventually resulting in increased insulin sensitivity.3,8


1. Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. In: StatPearls. StatPearls Publishing; 2022. Accessed August 9, 2022.
2. 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
3. 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
4. Westman EC, Tondt J, Maguire E, Yancy WS. Implementing a Low-Carbohydrate, Ketogenic Diet to Manage Type 2 Diabetes Mellitus. Expert Rev Endocrinol Metab. 2018;13(5):263-272. doi:10.1080/17446651.2018.1523713
5. Samaha FF, Iqbal N, Seshadri P, et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. N Eng J Med. 2003;348(21):2074-2081. doi:10.1056/NEJMoa022637
6. Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes. Ann Intern Med. 2005;142(6):403-411. doi:10.7326/0003-4819-142-6-200503150-00006
7. Westman EC, Yancy WS, Mavropoulos JC, Marquart M, McDuffie JR. The Effect of a Low-Carbohydrate, Ketogenic Diet Versus a Low-Glycemic Index Diet on Glycemic Control in Type 2 Diabetes Mellitus. Nutr Metab. 2008;5(1):36. doi:10.1186/1743-7075-5-36
8. 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



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