Could a keto diet replace diabetes meds? New research explores the possibilities

Could a ketogenic diet help you lose weight and ditch diabetes meds? New research reveals how cutting carbs may also ease inflammation and boost mental health — but experts say more trials are needed.

Review: Ketogenic Diets for Body Weight Loss: A Comparison with Other DietsReview: Ketogenic Diets for Body Weight Loss: A Comparison with Other Diets

In a recent review article published in the journal Nutrients, researchers reviewed the existing literature to assess the advantages of ketogenic diets (KD) over other dietary approaches for weight loss and other health benefits.

Their findings indicate that KD may be effective for hunger control, faster weight loss, improved insulin and blood sugar regulation, reduced inflammation, and heightened mental well-being, among other things. These diets could also reduce reliance on obesity medications and may outperform not only low-fat but also other low-carbohydrate diets in managing blood sugar and insulin levels. However, further research, particularly clinical trials, is needed to establish these benefits.

Addressing obesity with KD

Obesity is a growing but often neglected public health issue around the world, despite dietary guidelines and recommendations. Patients and clinicians increasingly turn to dietary strategies such as KD, originally developed to treat epilepsy, for weight loss.

These diets require consuming few to no carbohydrates (less than 10% of one’s daily energy intake), moderate amounts of protein, and high amounts of fat. Carbohydrate restriction forces the body into ketosis, where instead of burning glucose for energy, it burns fat instead. When the body is in ketosis, insulin levels also fall.

Despite evidence that KD leads to rapid weight loss, reports note that it does not rank highly in terms of overall diet quality. This is partly due to poorly formulated KDs that rely on processed low-carb foods and may undermine the diet’s benefits or have adverse health effects in the long term. However, there are healthier varieties of KD that focus on natural and minimally processed foods.

KD for weight loss and associated benefits

Traditional diets, which rely on calorie restriction, lead to weight loss but also increase hunger. People following these diets find it challenging to adhere to them long-term, as they may crave high-calorie but low-nutrient foods.

On the other hand, KD suppresses the hunger hormone ghrelin and increases the release of satiety hormones. These effects are thought to be mediated in part through ketone bodies, such as β-hydroxybutyrate (BHB), which influence appetite-regulating hormones and may contribute to the reduced sense of hunger. A study in which individuals with type 2 diabetes reported feeling less hungry while following a KD, even as they lost weight and improved their health markers, demonstrated this.

Since KD naturally reduces hunger and drives energy deficits without calorie counting, it offers similar or greater weight-loss benefits as appetite-suppressing drugs or those that block fat absorption without documented adverse effects such as nausea and diarrhea.

Following KD can initially lead to rapid weight loss, up to 4.5kg in the first two weeks, because of water loss. However, this initial drop is largely due to water loss from glycogen depletion and may vary between individuals. This is due to the depletion of stored glycogen and reduced insulin, which reduces the retention of sodium and may lower blood pressure.

Blood sugar levels strongly influence hunger and satiety, and fluctuations, particularly spikes and dips in glucose after carbohydrate-heavy meals, can trigger increased appetite and energy intake.

KD has benefits for glycemic stabilization, as it is low in carbohydrates, thus stabilizing insulin levels and blood sugar. Importantly, KD has been shown to be more effective than other low-carbohydrate diets for glycemic control in some studies, likely due to deeper levels of carbohydrate restriction and ketosis. For people with type 2 diabetes, KD outperforms low-fat diets for managing weight, blood sugar, and insulin. Specifically, KD improves insulin sensitivity by reducing the insulin resistance index and fasting insulin levels. In one trial, people following KDs were able to discontinue taking diabetes medications.

However, responses to KD can vary among individuals, and people with chronic conditions should adopt this diet under medical supervision. Experts also emphasize that long-term adherence and individual variability, including differences in gender and metabolic responses, can influence outcomes on KD.

Another benefit of KD is its anti-inflammatory effects. Obesity is associated with chronic inflammation, increasing the risk of metabolic diseases, but KD has been shown to reduce the levels of inflammation markers, particularly in obese individuals. Following this diet could have similar benefits as the medications used to treat inflammation but with fewer side effects. However, these anti-inflammatory effects are better supported when KD is based on whole, unprocessed foods rather than processed low-carb products. Emerging evidence suggests that ketone bodies such as BHB may play a direct role in reducing inflammation, although more human studies are needed to confirm these pathways.

KD and mental health

Psychological factors have a significant impact on weight. Research has shown that there are links between stress, unhealthy eating behaviors, and obesity. Repeated attempts to diet and associated weight fluctuations can increase anxiety and depression. However, studies suggest that KD strengthens cognitive function, reduces sleepiness, and improves mood. Some of these effects may be due to reduced neuroinflammation and oxidative stress, although more clinical trials are needed to confirm these benefits.

Beyond weight loss, KD reduces oxidative stress and neuroinflammation, improving brain health. One study found that individuals adopting KD show significant improvements in psychosis and depression symptoms after three weeks, while preliminary analyses suggest that KD could also reduce anxiety. However, experts emphasize that the evidence for mental health improvements is still preliminary and should be interpreted with caution until more large-scale trials are conducted. Researchers call for more studies to assess these effects in diverse populations over longer periods.

KD is also being investigated for its potential in treating substance use disorders and addiction. It shows potential for reducing alcohol consumption, cravings, and withdrawal symptoms. Similarly, KD may reduce cravings and dependency on ultra-processed foods by stabilizing glucose and insulin levels, which are thought to contribute to addictive eating patterns.

It may also support people with food addiction due to its documented effects in reducing food cravings, thus lessening dependence on ultra-processed foods. Case studies show that people with binge eating disorders or food addictions experienced significant improvements and fewer binge episodes when they followed a KD. However, much of the research on KD and addiction is still in the early stages, and larger comparative studies are needed to confirm these benefits.

Side effects of KD

KD is not suitable for individuals with rare metabolic disorders or certain severe conditions such as acute pancreatitis. People with chronic conditions such as hypertension or diabetes should consult medical professionals before adopting this diet. Because individual responses to KD can vary, personalized guidance from healthcare providers is important to ensure safety and effectiveness.

KD also has short-term adverse effects that have been termed 'keto flu,’ including symptoms of dizziness, constipation, nausea, fatigue, and headaches as the body adjusts to ketosis. Some people, including those with type 1 diabetes, are also at risk of diabetic ketoacidosis, a rare phenomenon in which blood sugar and ketones rise to dangerous levels.

Conclusions

Current evidence indicates that KD has several benefits beyond weight loss, including improved mental health. In some cases, KD has the same effects as medications but with fewer side effects. However, KD's health effects can depend on the quality of food choices within the diet, and poorly formulated versions may not provide the same benefits.

While further studies are needed to gain insights into the mechanisms of KD's effects on the body, it does appear that these diets may be superior to others that involve restricting fats or counting calories. Researchers also call for clinical trials that assess not only weight loss but broader outcomes such as psychological health, metabolic markers, and inflammation to fully understand KD's potential and safety in diverse populations.

Journal reference:
  • Ketogenic Diets for Body Weight Loss: A Comparison with Other Diets. Dyńka, D., Rodzeń, Ł., Rodzeń, M., Pacholak-Klimas, A., Ede, G., Sethi, S., Łojko, D., Bartoń, K., Berry, K., Deptuła, A., Grzywacz, Z., Martin, P., Unwin, J., Unwin, D. Nutrients (2025). DOI: 10.3390/nu17060965, https://www.mdpi.com/2072-6643/17/6/965
Priyanjana Pramanik

Written by

Priyanjana Pramanik

Priyanjana Pramanik is a writer based in Kolkata, India, with an academic background in Wildlife Biology and economics. She has experience in teaching, science writing, and mangrove ecology. Priyanjana holds Masters in Wildlife Biology and Conservation (National Centre of Biological Sciences, 2022) and Economics (Tufts University, 2018). In between master's degrees, she was a researcher in the field of public health policy, focusing on improving maternal and child health outcomes in South Asia. She is passionate about science communication and enabling biodiversity to thrive alongside people. The fieldwork for her second master's was in the mangrove forests of Eastern India, where she studied the complex relationships between humans, mangrove fauna, and seedling growth.

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