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The Keto diet may be able to help people avoid weight gain

Shutterstock / Brent Hofacker

People with type 2 diabetes who stop using weight-loss drugs like Ozempic or Wegovy can avoid regaining the lost pounds if they adopt the ketogenic diet. The finding, which comes from a small study, challenges the notion that people must take these medications indefinitely to prevent unwanted weight gain.

Ozempic and Wegovy belong to a class of medications called GLP-1 agonists, which reduce appetite and boost the release of insulin. They are commonly prescribed to help people with type 2 diabetes regulate blood sugar and lose weight. However, the assumption has been that people must remain on the drugs long-term otherwise they regain the lost weight.

Shaminie Athinarayanan at Virta Health – a US telehealth company that treats type 2 diabetes – and her colleagues decided to test that assumption. Their inspiration for doing so came from previous research showing that low-carbohydrate diets, like the ketogenic diet, help manage blood sugar levels and weight in people with type 2 diabetes.

The researchers tracked weight and blood sugar levels in 308 adults living in the US with type 2 diabetes who received nutrition therapy at Virta Health. All of them were using GLP-1 agonists when they enrolled. Participants were advised to follow the ketogenic diet – meaning they were told to eat less than 30 grams of carbohydrates daily, or less than 50 grams if they were vegan, and about 1.5 grams of protein per kilogram of bodyweight. They were encouraged to eat until they felt full, regardless of calories. Health coaches and licensed medical professionals virtually communicated with participants as needed.

Between three and nine months later, half of the participants discontinued using GLP-1 agonists. All participants continued to follow the ketogenic diet for an additional year. At this point, the researchers found there were no significant differences in weight or blood sugar levels between the two groups. On average, participants who stopped taking GLP-1 agonists only gained about a kilogram of weight. By comparison, those who continued taking the medications gained about two kilograms. Most of the participants in both groups also had blood sugar levels below the threshold for diagnosing diabetes.

“This study suggests that the continued use of GLP-1 agonists is not necessary for many people if [they] have the right intervention,” says Athinarayanan. “You can discontinue [these medications] safely and effectively and maintain weight and blood sugar outcomes.”

This may be helpful for people who can’t take these medications due to shortages or side effects, says Priya Jaisinghani at NYU Langone Health. However, people must speak with their doctor before beginning a low-carb diet since it can carry risks, especially for those with underlying conditions like kidney disease or an eating disorder, she says. She also points out that the study was sponsored by Virta Health and only included a small number of participants. So, “It is not the end all be all”, says Jaisinghani. “But it shows the difference diet can make.”

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