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Keto diets in people with diabetes

Keto diets have gained popularity due to the associated rapid reductions in weight, blood pressure and glucose levels. Be aware that keto diets may be unsafe in some patients including in type 1 diabetes, empagliflozin use, children, youth, pregnancy, breastfeeding, the elderly, or those at high risk of cardiovascular disease (CVD). Caution is also needed in those on insulin and/or sulfonylureas to prevent hypoglycaemia. 

Studies have failed to consistently show any long-term benefits of keto diets on weight or HbA1c, but potential risk due to increased LDL cholesterol.  This is why all major diabetes and obesity guidelines do not currently recommend keto diets, but rather others such as Mediterranean and plant-based diets due to their long-term reduction in weight, HbA1c and CVD.

Further studies are required to assess the long-term efficacy, tolerability, and safety of keto diets. Until then, best practice advice on healthy eating in Aotearoa NZ can be found at Eating and Activity Guidelines for New Zealand Adults.

This Gem was written by Dr Ryan Paul, Diabetologist and Endocrinologist.

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