Science Update

New study demonstrates improvement in sleep with ketogenic diet in patients with insulin resistance

Sleep disruption is commonly associated with type 2 diabetes and obesity due to the effect of dysglycemia. This altered glucose metabolism is associated not only with poor sleep but also shorter sleep duration and an increased risk of sleep apnea.

Weight reduction is an effective way to improve overall sleep and treat patients with sleep apnea. Researchers have investigated dietary manipulation of macronutrients on sleep quality and duration. Some research has demonstrated a decrease in slow wave sleep and an increase of rapid eye movement sleep in people consuming a high carbohydrate diet. Other research has exhibited that a high carbohydrate diet can help reduce the onset of sleep.

According to a new study published last month in Sleep Medicine, researchers demonstrated that nutritional ketosis improves sleep quality and quantity in patients with type 2 diabetes.

This study consisted of 465 participants ranging from 21 to 65 years of age. There were 262 patients with type 2 diabetes and 116 with prediabetes that followed a ketogenic diet, and 87 patients with type 2 diabetes that followed a regular diet. Each individuals’ clinical data was assessed at baseline, 70 days, and at one year, including weight, fasting glucose, HA1c, HOMA-IR, Hs-CRP, and BHB levels. Sleep quality was assessed using the Pittsburgh Sleep Quality Index.

As a result, overall sleep quality improved in the patients following a ketogenic diet. The subgroup of patients with poor sleep quality had a significant improvement after one year. There were also correlations between the sleep questionnaires with changes in glucose, ketone levels, and inflammatory markers. This improvement in sleep appeared to be due to the improved glucose control in these individuals. There were also reductions in daytime sleepiness with the implementation of the ketogenic diet.

Transitioning to a ketogenic diet can be a challenge in some individuals, as the body is switching from burning glucose to fat for fuel. Some people may experience fatigue, nausea, dizziness, and irritability during this transition. In these individuals, exogenous ketones can be a great tool for those transitioning to a ketogenic diet. Exogenous ketones help to increase blood ketone levels which may directly suppress appetite as they lower plasma ghrelin levels and reduce cravings. All in all, recommending a ketogenic diet for patients with insulin resistance may help yield great – and much appreciated – benefits in sleep quality for these individuals.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Siegmann MJ, Athinarayanan SJ, et al. Improvement in patient-reported sleep in type 2 diabetes and prediabetes participants receiving a continuous care intervention with nutritional ketosis. Sleep Med. 2019 Jan 3;55:92-99.