SGLT-2 inhibitors and ketogenic diet

SGLT-2 inhibitors help lower blood glucose levels. They do so by causing the kidneys to spill sugar out into the urine that otherwise would have been absorbed back into the bloodstream. They have become extremely popular because a large trial showed that if you have a heart attack, then this medication really improves chances of survival.   Some experts even suggest that they should replace metformin as the go-to medication for Type 2 diabetes.  

One of the reasons they’re so popular is that researchers have discovered so many secondary benefits, they seem like a kind of miracle drug. SGLT-2 inhibitors seem to lower blood pressure, trigger weight loss (particularly the dangerous visceral fat) prevent kidney disease, and reduce triglycerides, improve HDL, and improve the quality of LDL . And guess what? SGLT-2s increase ketones! And I think they are a great solution for someone who does not wish to change the way they eat.  But lifestyle changes are much more powerful.  

While SGLT-2s can decrease weight on average by 2 kgs, the ketogenic diet decreases by 9 kgs after 6 months. And while SGLT-2s modestly decrease glucose levels, the ketogenic diet can normalize blood sugars in at least 50% of patients.

If you are eating a low carb diet, there’s one very good reason to be cautious about SGLT-2 inhibitors: because they artificially lower insulin levels, they can significantly increase the risk of a very dangerous condition known as ketoacidosis, not to be confused with ketosis, which is what we strive for. This is probably one of the most confusing points for doctors and patients. While nutritional ketosis aims for a concentration of 0.3 to 3mmol/L of ketones in the blood, diabetic ketoacidosis may show levels of greater than 10. 

I usually stop SGLT-2 medications when starting a ketogenic diet.  Of course, each patient is individual, so if they happen to be extremely insulin resistance and the patient is reliable, then I may keep it on as part of the regimen every other day and  measuring their ketones to make sure there is no risk of ketoacidosis.

For more posts

What You Can Eat on the Keto Diet

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Dec 22, 2020

Got Diabetes? 8 Reasons to consider the Keto diet

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Nov 22, 2020