Contrasting Ketogenic and Mediterranean Diets in Individuals With Type 2 Diabetes and Prediabetes: The Keto-Med Trial

Stanford University

Status: Completed

Conditions: Diabetes Mellitus, Type 2; PreDiabetes

Treatments: Behavioral: Well-Formulated Ketogenic Diet (WFKD); Behavioral: Mediterranean Diet (Med-Plus)

Study type: Interventional

Funder types: Other

Identifiers

NCT03810378

49218

Details and patient eligibility

About

The objective of this study is to compare two metabolically distinct diets, WFKD vs Med-Plus, in order to examine the potential benefits, and unintended consequences, of going beyond a focus on maximally avoiding added sugars and refined grains, to also avoiding legumes, fruits, and whole grains.

Full description

The proposed randomized clinical trial will investigate differential population-specific effects of two low-carbohydrate (low-carb) diet patterns, addressing a gap in the evidence base in this area that will lead to 1) improved treatment strategies for common adverse clinical conditions, 2) improved health for these individuals, and 3) long-term decreases in health care costs. This impactful research will advance the field of personalized and precision medicine.

Enrollment: 61 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Age ≥18
• Diagnosed with type 2 diabetes mellitus, OR prediabetes (defined as HbA1c </= 5.7% OR Fasting Glucose of >100 mg/dL)

Identify exclusion criteria.

• Weight < 110 lb
• BMI > 40
• LDL-C >190 mg/dL
• Blood pressure: SBP > 160 mmHg OR DBP: > 90 mmHg

Exclusion criteria

• Weight < 110 lb
• BMI ≥ 40
• LDL-C >190 mg/dL
• Systolic blood pressure (SBP) > 160 mmHg OR Diastolic blood pressure (DBP) > 90 mmHg
• Diagnosed with type 1 diabetes or history of ketoacidosis
• Uncontrolled and untreated diabetes (by discretion of study physician)
• Active cardiovascular disease (in past year with myocardial infarction, coronary stent or bypass surgery)
• Kidney disease (eGFR less than 50 mL/min per 1.73 m2)
• Liver disease (liver transaminase higher than 3 times the normal range for the laboratory)
• Symptomatic gallstones
• History of bariatric surgery
• Anemia
• Taking any of the following medications in past 3 months: SGLT-2 inhibitors, GLP-1 receptor agonist, Insulin, Amylin analog, Alpha-glucosidase inhibitor, Dopamine agonist, Bile acid sequestrant.
• Taking any medications for weight loss
• History of active cancer in the past 3 years except for squamous or basal cell carcinomas of the skin that have been medically managed by local excision
• Unstable dietary history as defined by major changes in diet during the previous month, where the subject has eliminated or significantly increased a major food group in the diet.
• Recent history of chronic excessive alcohol consumption defined as more than five 1.5-ounce servings of 80 proof distilled spirits, five 12-ounce servings of beer or five 5-ounce servings of wine per day; or > 14 drinks/week.
• Women: Pregnant currently or planning to become pregnant during the course of the study, and/or breastfeeding
• Regular/frequent use of smoking or chewing tobacco, e-cigarettes, cigars or other nicotine-containing products
• Regular use of prescription opiate pain medication

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Double Blind

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61 participants in 2 patient groups

Mediterranean Diet (Med-Plus)

Experimental group

Description:

Participants will follow a Mediterranean-type diet (Med-Plus) for 12 weeks. This diet will maximize the intake of vegetables, legumes, fruits and nuts, whole intact grains/cereals and fish; and minimize the intake of meat, poultry, and dairy. It will exclude added sugars and refined grains.

Treatment:

Behavioral: Mediterranean Diet (Med-Plus)

Well-Formulated Ketogenic Diet (WFKD)

Experimental group

Description:

Participants will follow a Well-Formulated Ketogenic Diet (WFKD) for 12 weeks. This diet will maximize the intake of non-processed beef, pork, and poultry (preferably organic/grass-fed), fish, heavy cream, low-lactose, high-fat cheeses, animal fats, oils (avocado, coconut, or other nut oils), non-starchy (above ground) vegetables and limited amounts of some fruits (berries). It will exclude legumes, grains, sugars, starchy (below ground) vegetables, most fruits, and polyunsaturated oils (soy, sunflower, peanut, cottonseed, canola, etc.). It will aim for an intake of 20 g of carbohydrates/day at start, with the goal to have no more than 50 grams/day to maintain ketosis.

Treatment:

Behavioral: Well-Formulated Ketogenic Diet (WFKD)