By Dave DeFusco
At the Katz School鈥檚 Graduate Symposium on Science, Technology and Health, Ilana Rouhani, a student in the M.S. in Physician Assistant Studies, will present a systematic review of the evidence surrounding one of the most pressing questions in chronic disease management: Can a high-fat, low-carbohydrate diet outperform standard approaches in managing Type 2 diabetes?
Her research, 鈥淓fficacy of the Ketogenic Diet in Reducing Hemoglobin A1c for Glycemic Control in Overweight Type 2 Diabetics,鈥 confronts a dietary strategy that鈥檚 sparking debate in both clinical and popular spheres: the ketogenic diet.
Type 2 diabetes, a metabolic disorder marked by insulin resistance and impaired glucose regulation, affects more than 500 million people worldwide, reaching pandemic proportions. In overweight individuals, where obesity compounds insulin resistance, the challenge of achieving effective glycemic control becomes even more urgent.
Central to diabetes management is the biomarker hemoglobin A1c, a measure of average blood glucose levels over a two- to three-month period. Elevated A1c is directly associated with complications ranging from neuropathy to kidbney disease. Standard medical therapy typically involves medications such as metformin, GLP-1 receptor agonists and SGLT2 inhibitors鈥攅ach with their own side effects and limitations. But for patients and clinicians alike, questions remain about how best to complement pharmacologic treatment with nutritional strategies.
Enter the ketogenic diet: a regimen that flips conventional dietary wisdom on its head. By drastically reducing carbohydrate intake and promoting the consumption of healthy fats and moderate protein, the keto diet pushes the body into a metabolic state known as ketosis. In this state, fat鈥攏ot glucose鈥攂ecomes the primary energy source, potentially smoothing out blood sugar spikes and promoting weight loss.
While preliminary studies suggest benefits for glycemic control, Rouhani sought to determine whether the evidence holds up under rigorous analysis. 鈥淭here鈥檚 a lot of public interest in keto, but much of it is anecdotal,鈥 said Rouhani. 鈥淥ur goal was to see what the science really says, especially for overweight patients who are at heightened risk for complications.鈥
Rouhani conducted a systematic literature review using the PubMed database, targeting studies published between 2004 and 2024. She filtered for randomized controlled trials, prospective cohort studies and meta-analyses, focusing on populations diagnosed with Type 2 diabetes and a high body mass index (BMI).
Among the studies included in Rouhani鈥檚 review was a 2012 clinical trial by Talib Hussain et al., which compared the effects of a low-carbohydrate ketogenic diet with a low-calorie diet over 24 weeks. The results were striking: Participants on the ketogenic diet experienced significantly greater reductions in A1c levels than those on the low-calorie diet.
In fact, across all the trials Rouhani analyzed, ketogenic diets consistently outperformed standard dietary interventions in lowering A1c levels. This suggests a potent glycemic benefit, which could help reduce reliance on medications and mitigate long-term complications.
Despite these promising results, Rouhani emphasized the importance of viewing the ketogenic diet through a clinical lens. Patients often experience gastrointestinal side effects early in the transition to ketosis, and the elimination of many common foods can lead to social and psychological barriers.
鈥淭he efficacy is there,鈥 she said, 鈥渂ut the restrictive nature of keto makes long-term adherence a challenge.鈥
Healthcare providers, said Rouhani, must monitor patients closely for adverse effects and support them in making sustainable dietary choices. 鈥淜eto isn鈥檛 for everyone,鈥 she said, 鈥渂ut for the right patient, it could be transformative.鈥
The conclusion of Rouhani鈥檚 review calls for cautious optimism. While current evidence indicates that ketogenic diets can significantly reduce A1c levels in overweight individuals with Type 2 diabetes, more large-scale, long-term studies are needed. These should examine not only efficacy, but also sustainability, safety and patient-reported outcomes over time.
Margaret Ewen, Rouhani鈥檚 advisor and a clinical assistant professor in the PA program, said Rouhani鈥檚 research adds to a growing conversation around personalized nutrition in diabetes care鈥攐ne that balances innovation with clinical prudence.
鈥淚t鈥檚 about giving patients options that are backed by evidence,鈥 said Ewen. 鈥淎s physician assistants, we need to be on the front lines of that conversation.鈥
