A low-carbohydrate diet is generally recommended for people who have Type 2 diabetes or who are at risk of developing the disease. A new trial by investigators at Stanford Medicine has compared two popular low-carb diets — ketogenic and Mediterranean — in their effect on blood glucose, cardiometabolic risk factors, weight loss and nutrition, as well as how easily people can adhere to them.

The ketogenic diet is an ultra-low-carb, very high-fat diet that involves a drastic reduction in carbohydrate intake.

The Mediterranean diet is a low-carb, moderately high-fat diet that emphasizes vegetables, legumes, fruits, whole grains, olive oil and fish. Both diets received high marks in controlling blood glucose levels and aiding weight loss, but the ketogenic diet was lower in several nutrients, particularly fiber, and was more difficult for study participants to follow in the long run, according to findings published May 31 in the American Journal of Clinical Nutrition.

To manage or prevent diabetes, the American Diabetes Association recommends the Mediterranean diet and other low-carb diets, as long as they minimize added sugars and refined grains and include non-starchy vegetables. The ultra-low-carb ketogenic diet fulfills these criteria. But its dramatic rise in popularity in recent years has nutritionists like Gardner concerned.

In the new study, conducted from June to December , Gardner and his team recruited 40 adults with Type 2 diabetes or prediabetes to try both the ketogenic diet and the Mediterranean diet. Half the participants started with the ketogenic diet, and the other half with the Mediterranean diet. After 12 weeks, the groups switched and tried the other diet for 12 weeks.

This crossover design allowed participants to act as their own controls. In the ketogenic diet phase, participants followed a version known as the well-formulated ketogenic diet. They were asked to consume at least three servings of non-starchy vegetables a day.

In the Mediterranean diet phase, participants were advised to follow a mostly plant-based diet that included vegetables, legumes, fruits, whole grains, nuts and seeds, as well as fish for animal protein and olive oil for fat.

Both diets encouraged eating lots of vegetables and eliminating added sugars and refined grains as much as possible. The main question, Gardner said, was whether the keto diet offered additional health benefits from eliminating legumes, fruits and whole grains.

To set the participants up for success, the study sent ready-to-eat food to both groups during the first four weeks of each diet through the food delivery service Methodology. Short of feeding people all their meals in a lab, this approach was the best way to maximize adherence to the diets, Gardner said.

For the remaining eight weeks, participants were responsible for choosing and preparing their own food, giving researchers insight into how people realistically follow the diets.

The participants were encouraged to be honest in reporting how well they were following the diets. At various points, researchers collected blood samples to evaluate blood glucose control, lipid control, body weight and other clinical measures.

Throughout the study, participants also were interviewed on their adherence to and satisfaction with the diets. Thirty-three participants completed the study, with several dropping out due to COVID disruptions. Each diet had one other statistically significant benefit: LDL cholesterol increased on the keto diet and decreased on the Mediterranean diet — a point for Mediterranean.

Triglyceride decreased on both diets, but it dropped more on the keto diet — a point for keto. In nutrient levels, the ketogenic diet provided less fiber; thiamin; vitamins B6, C, D and E; and phosphorus.

According to research, deaths occur more often in older adults or those who have illnesses that trigger the condition. In children, the trigger is often a brain injury or cerebral edema.

You can monitor blood sugar and ketones with over-the-counter test kits. You can monitor your blood sugar using a blood test strip and test for ketones using a urine test strip. Some blood glucose meters like Nova Max Plus and Abbott Precision Xtra also have the ability to check for blood ketones.

You should see your doctor or go to the emergency room immediately for evaluation and treatment if you have diabetes or if you take care of someone with diabetes and notice any DKA symptoms.

Call if the symptoms worsen quickly. Your doctor will perform a physical exam. The blood test results can help your doctor determine if you have DKA or other diabetes complications.

Your doctor may also order:. Ketosis is not harmful unless lack of nutrition is the cause. DKA can improve with treatment within 24 to 36 hours. The first step after DKA recovery is reviewing your recommended diet and insulin management program with your doctor.

Talk with your doctor to learn what you can do to keep your diabetes in a well-managed range. They can also answer questions about anything you may not be sure about. Keeping a log can help you monitor your diabetes and alert you to any warning signs of possible DKA in the future.

If you have a cold, the flu, or any other infection, be especially watchful for any possible DKA symptoms. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

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Small Moderate Large. Blood Ketone Levels 0. Normal After prolonged exercise After two days of fasting After three weeks of fasting After three weeks on ketogenic diet DKA seek medical attention immediately. Frequently asked questions. How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations.

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Apr 19, Written By Marjorie Hecht. Aug 2, Medically Reviewed By Kelly Wood, MD. Share this article. Read this next.