Ketogenic Diet in Obesity and Diabetes

A ketogenic diet (KD) is a low-carbohydrate, high-fat dietary approach. Beyond treating neurologic disorders, KD has attracted significant media attention for its potential to improve obesity and diabetes. The diet induces a metabolic shift from glucose toward fatty acid oxidation and ketone body production. This shift leads to ketosis, which may reduce hunger, cause weight loss, and improve glycaemic control and insulin sensitivity. In particular, the positive effects of KD lower insulin demand and may thereby improve β-cell function. However, the long-term efficacy, safety, and sustainability of KD, especially for diabetes, remain debated. This review offers current insights into the effects of ketogenesis and ketosis and the potential mechanisms underlying them. We examine the metabolic effects of KD in obesity and diabetes, drawing on preclinical and clinical studies, and suggest that combining KD with antidiabetic agents may provide synergistic benefits. We explore how KD alters the composition of the gut microbiota, thereby impacting host metabolism and systemic inflammation. We conclude by highlighting challenges and future directions for optimizing KD-based therapies through personalized nutrition and pharmacological combination treatments.