"Your brain runs on glucose (a simple form of carbohydrates)," notes Adrien Paczosa, R.D., L.D., a registered dietitian and eating disorder specialist. "When you cut out carbs, your body has to 'make' carbs from breaking down other parts of the body. This results in what I like to call a hungry brain. You experience slower cognition, memory loss, headaches, and confusion." That doesn't sound so great, right? "Also, those who suffer from depression and anxiety may have higher levels of those periods when not eating carbs on a regular basis." Because of this, keto might not be the best choice for those with mental health issues.

Researchers believe that genetics likely plays a role here, making some people more susceptible to liver problems when following low-carb, high-fat diets. Is the keto diet bad for your kidneys? According to an article released by Harvard Medical School, “Patients with kidney disease need to be cautious because this diet could worsen their condition.”
According to Dr. Sarah Hallberg, an advocate of diabetes reversal with dietary intervention, low-carb diets are the only ones that can possibly reverse this disease. Most studies examining the possibility of diabetes reversal focus on general exercise and reducing calorie intake. Nonetheless, these studies found that lifestyle changes normalize beta cell functioning, meaning reversal is possible.

Several comprehensive studies and meta-analyses have demonstrated that after a few months or even a year of a low carb diet versus a moderate/high carb diet, there are no significant differences in the amount of weight lost (2,3,4,5).  I will say, however, most of these diets are NOT keto and are simply lower carb (i.e. 20%).  Also, long-term effects (beyond 1 year) are not often studied due to budgetary constraints, so interpret results as you wish.

Obesity is one of the principle risk factors for diabetes and following a ketogenic diet has been shown to help with weight loss. According to scientific article published in 2014, “A period of low carbohydrate ketogenic diet may help to control hunger and may improve fat oxidative metabolism and therefore reduce body weight.” Many prediabetics struggle with being overweight so a keto diet can help promote weight loss, which can help to decrease the chances of developing full blown diabetes.


You can absolutely be in ketosis and eat 50g of net carbs a day. Maybe not everyone, but many people can maintain ketosis at that level of carb if fat/protein intake is OK. I have experienced this myself, and tested with blood keto meter. It would be interesting to test people who have been on the WB diet to see how me many are also in ketosis. I would bet a significant portion cycles into ketosis very regularly, and some are ketotic most of the time.
In addition, recent papers within the last few years investigating the effect of ketogenic dieting on obesity conclude that it’s an extremely effective way to not only lose fat, but spare muscle loss while curbing many disorders related to obesity as well (many of which have been discussed above), including the set of symptoms and risk factors known as Metabolic Syndrome (i.e. abdominal obesity, diabetes, hypertension, and elevated cholesterol)
Familial Hypercholesterolemia. Familial hypercholesterolemia is a condition where one or more of the genes for the LDL receptor are defective, making it more difficult for them to clear cholesterol from the blood. If a person with familial hypercholesterolemia is then put on a high-fat diet, they will become even more vulnerable to heart disease as the increased saturated fat and cholesterol content of the diet provokes higher cholesterol levels. To counteract these genetic vulnerabilities, it is may be best to follow a low to moderate fat diet with plenty of whole foods, fiber, monounsaturated fats, polyunsaturated fats (especially omega 3s), and limited saturated fats. This, as well as a lifestyle that prioritizes physical activity, stress relief practices, and plenty of sleep, should keep their cholesterol levels under control.
Financial disclosures: There were no conflicts of interest reported except for Dr Bernstein who has received royalties for books on the management of diabetes (which were used by members of the online social media group surveyed in this study). Dr. Hallberg who holds stock options and receives research support from Virta Health, and consulting fees from Atkins. Dr. Rhodes is the site principal investigator in clinical trials for pediatric type 2 diabetes that are sponsored by Merck and AstraZeneca. Dr. Westman has an ownership interest in companies using low-carbohydrate principles, and he receives royalties for books related to low-carbohydrate diets. Dr. Ludwig has received royalties from books on nutrition and obesity; and Dr. Galati is author of Eating Yourself Sick: How to stop obesity, fatty liver, and diabetes from killing you and your family (2018). 

Dr. Campos, it is unfortunate that you retain the medical community’s negative stance on the ketogenic diet, probably picked up in medical school when you studied ketoacidosis, in the midst of an obesity and type II diabetes epidemic that is growing every year, especially among populations who will never see the Harvard Health Letter. The medical community has failed in reversing this trend, especially among children, and the public is picking up the tab, in the form of higher health insurance premiums to treat chronic metabolic diseases which doctors cannot cure. The ketogenic diet does not bid its adherents to eat unhealthy processed meats, and the green leafy vegetables that it emphasizes are important in a number of nutritional deficiencies. People lose weight on the ketogenic diet, they lose their craving for sugar, they feel more satiety, they may become less depressed, their insulin receptors sensitivity is improved, and these are all the good outcomes you fail to mention. There is a growing body of research which demonstrates the neuroprotective effects of the ketogenic diet to slow cancer progression, as well as diseases like Parkinson’s and Alzheimer’s, for which there are no effective medical treatments. Please respect your patients by providing them with evidence-based medical outcomes, not opinions.
"Keto is not a great long-term diet, as it is not a balanced diet," Nancy Rahnama, M.D., M.S., an internal medicine and bariatric specialist, told Reader's Digest. "A diet that is devoid of fruit and vegetables will result in long-term micronutrient deficiencies that can have other consequences. The keto diet can be used for short-term fat loss, as long as it is under medical supervision."
You eat less than 50 grams of net carbs a day on keto. Cutting down on carbs increases your high-density lipoprotein (HDL) levels. HDL is known as the “good” cholesterol — it turns on anti-inflammatory pathways and protects your heart from disease. The keto diet also lowers blood triglycerides[12] — fat molecules in your bloodstream. High levels of blood triglycerides are linked to coronary heart disease.[13]
When your brain uses ketones for fuel, you don’t experience the same energy slumps as you do when you’re eating a lot carbs. On keto, your brain won’t start to panic, wondering when it will get its next hit of energy. When your metabolism is in fat-burning mode, your body can simply tap into its readily available fat stores for energy. The result? No more energy crashes or brain fog.
so I won’t repeat it all here. The original study that claimed calcium supplements caused heart disease was widely publicized when it came out but unless you had a subscription to the British Medical Journal you wouldn’t be aware of the serious objections published in subsequent issues. In particular, Lappe & Heaney reported the complete opposite result – calcium supplementation REDUCED heart disease versus placebo.
I’ve been type 2 for about 15 years was pretty stable with diet and Metformin for 10 years. But eventually started trying more aggressive treatment like Victoza and without fail in 4 years I was on slow acting insulin. I lost weight lowered carb intake to 40mg or less in the morning my breakfast has been no carbs. People need to realize every diabetic is different you must manage it how it keeps you with good A1C levels. I myself got off insulin for a year and half but my fasting levels slowly increased again. Reversing diabetes is not possible. Reducing the effects is possible and more likely the better you monitor yourself and do what you need to do. Depending on medications or diets or counting carbs will all help but not cure the diabetes. These all are things that reduce its ability to affect your health negatively.
Hypothyroid Related Issues. Thyroid hormones and cholesterol levels are intimately linked. When our thyroid hormone levels are low, LDL receptors will be less active, leading to high cholesterol levels and an increased risk of heart disease. If you have a history of hypothyroid issues, you may be struggling with unhealthy cholesterol levels — and the keto diet can make them even worse. However, for those of you who are being treated for your hypothyroid condition or who have an autoimmune thyroid condition, you may be able to follow the keto diet without any problems. In fact, many keto dieters with autoimmune thyroid conditions have found that the keto way of eating improves their quality of life more than any other diet.
I came here to say similar things, OP. Whoever wrote this article obviously has an agenda and is conveniently over-looking evidence and stories from people like you. I especially like the part where she claims keto isn’t sustainable because “Oh My God, I can’t not like eat bread, like for the rest of my life, lol” and “YOU’LL GAIN ALL THE WEIGHT BACK IMMEDIATELY IF YOU HAVE A CHEAT DAY!!” This article was a great laugh. I came here to get educated but am quickly learning you can’t always believe what a random dietician says on the internet. Happy KETO and congrats on your success! 

I was a Corpsman (not a corpse-man as some recent somewhat fanatical president would say), and I can tell you many stories of Marines and Sailors who maintained restrictive diets (aka picky eaters). Most obvious was lack of sustaining energy (hypoglycemia) at mile 15 (with 80lbs of gear including a 6.5lb rifle and 200 rnds of ammo, etc.) and depletion of essential vitamins, electrolyte imbalance. They were always the first to collapse and have to hear me scold “see I told you so.” An IV of D5W usually does the trick (D is for dextrose, OMG!)
This concept was previously unthinkable as modern nutritional science was led to believe that the body’s metabolism relied on gluconeogenesis to create ATP as energy for the body’s metabolic processes. Glycogen derives from dietary carbohydrate intake, so by removing it from the diet, nutritionists expected devastating health results to emerge in practitioners of the diet.
If you experience symptoms like fatigue, intense hunger and cravings, light-headedness, or heart palpitations, this may be a sign your blood sugar has dropped too low. Use a blood glucose monitor to track your body’s response to the diet change and make sure your body is adapting properly. If necessary consult your physician for necessary medication changes. 

At some point, the pancreas is literally burned out and can’t produce enough insulin to keep even basic blood sugar under control, let alone after a high-carb meal. This state is end-stage of type 2 diabetes where insulin injections become necessary [7]. Type 2 diabetics do not produce less insulin than normal, but the insulin resistance increases the need for insulin. A diabetic pancreas is eventually unable to supply this increased demand.

There is quite a bit of research that has been done on the effects of a ketogenic diet, and the findings show a general reduction in blood pressure. This could be due to a higher concentration of potassium and a lower amount of sugar in the foods common to this diet. It may also be due to the weight loss benefits, as obesity is a causative factor in hypertension.
Carbs turn into glucose (aka sugar) in the body. Eating too many carbs causes your blood sugar to spike. When you switch from carbs to fat for energy, you stabilize your blood sugar. Keto can be particularly beneficial for diabetics, who have high blood glucose levels. The keto diet may even cure diabetes — many diabetics are able to come off their medication when switching to keto. Find out more about keto and blood sugar here.
But all those studies were very small, and not all research on the keto diet is as promising. One American Society for Clinical Nutrition study of 20 participants found that those on the diet didn’t lose more weight than those on a non-keto diet. But they did have fouler moods and higher levels of inflammation, which has been linked to a variety of conditions, including heart disease and cancer.

But this state of metabolic derangement is not actually possible in a person who can produce insulin, even in small amounts.  The reason is that a feedback loop prevents the ketone level from getting high enough to cause the change in pH that leads to the cascade of bad problems.  A person who is said to be “keto-adapted,” or in a state of nutritional ketosis, generally has beta-hydroxybutyrate levels between about 0.5 and 3.0 mM.  This is far less than the levels required to cause harm through acid-base abnormalities.
I am sorry you had this experience. I feel that this educator was not giving you good advice. All my women who want to lose weight are recommended to consume 30 grams of good carbohydrates at each meal, and 15 at each snack. If you were not trying to lose weight, I would have recommended 45. I find this is all it usually takes to begin to lose some weight as you start to get active. Patients set their own goals with motivational help from their Certified Diabetes Educator. Our intent is never to insult, and you should not have gone through that. It sounds that you have now found the right path. There are many CDEs who could help you, so see what tools and motivation others may offer. I wouldn’t let one bad apple spoil the whole bunch. Many CDEs are also diabetic.

Holy cow Batman i started keto diet on the 9th of January within 4 days I was no longer on bydureon (weekly insulin) levemir 60units 2x daily and no more Novolog 25 units3x daily all that and metformin 10002x and this all didn’t have my sugars under control amazingly keto diet got sugars in check within four days I’ve been on diet now for 15 days and have honestly never fealt better I’m still green on diet and have had some issues while my body is healing itself (keto flu,low electrolytes very sluggish) .. My aunties actually have been on diet for a year now and were the ones that referred me to it after seeing there transformation i was on Board I’m having my first cheat day cause it’s my bday and other family members haven’t and don’t need the diet so I eat what they make a couple times a year this diet had been literally a life saver to me I’m down to my metformin 2x a day and sugars are at 90-140 depending on when I test after/before a meal with all the meds sugars haven’t been under 200 for the last two years so woot woot to Keto I’ll keep y’all posted thanks for the article my doctor is concerned about ketoacidosis so she’s not on Board and I need forums like this to help me move forward


Con: Results can vary depending on how much fluid you drink. By drinking more water, you dilute the concentration of ketones in the urine and thus a lower level of ketones will be detected on the strips. The strips don’t show a precise ketone level. Finally, and most importantly, as you become increasingly keto-adapted and your body reabsorbs ketones from the urine, urine strips may become unreliable, even if you’re in ketosis.
2 days from grains my stomach bloat was gone and I knew at that point everything this article and American diet was a lie. I’ve been on keto for over 16 months. Down 50lbs. In 6 months. I am ripped. Haven’t lost any muscle mass. I eat greens protein and healthy fat. I whole juice to get macros and yes I add watermelon or berries fo palatability purposes. I still eat carbs just healthy choices. I’ve become carb tolerant.. your liver will produce all glucose without ever eating 1 carb. This is biased and poor representation of keto lifestyle. When your starving and no carbs to choke keto will still thrive on either or fuel.
ME: It is not essential. You can be fully ketogenic without any intermittent fasting. However, most people find it natural to do intermittent fasting as their hunger is reduced to where they don’t need a third meal. Keeping feeding time reduced to a smaller window during the day enables the body to use stored body fat for fuel longer, which benefits weight loss. My husband Craig and I still do intermittent fasting every day as maintenance. It just makes life easier only having to make two meals a day instead of three.
While sometimes it might feel like things are getting worse before they get better, these symptoms should resolve within a few weeks to months of following the tips and program mentioned above. This is especially true if you try to remain active (walk, ideally outside, for at least 20–30 minutes daily), sleep well and decrease stress. Drink plenty of water, herbal tea or bone broth to prevent dehydration, and go easy on exercise if you’re feeling under-fueled.
3. Lower levels of physical performance; when you have just started taking a keto diet, you will likely notice limitations in your physical performance. However, this is just your body adapting to the diet. As you continue with the diet and your body gets used to it, this side effect will go away and your strength and persistence will get back to normal again.
Type 1 diabetes is not caused by insulin resistance, but it still makes sense to lower the need for insulin. Because type 1 diabetics hardly produce any insulin, they rely on external insulin when following a standard high-carb diet. Through carb restriction, a ketogenic diet decreases the need for insulin. In some type 1 diabetics, their insulin production is sufficient when following a ketogenic diet. Others still need to inject insulin, but much less than on a high-carb diet. Overall, it is much easier to control blood sugar levels with injected insulin on a ketogenic diet because blood glucose raises only mildly after meals.
“It’s unhealthy and unsustainable,” they say. “How can a high-fat diet help you lose weight? It’s dangerous for the heart, increases the risk of ketoacidosis, leads to poor mineral intake and electrolyte imbalance,” they say. But the ketogenic diet has a well-established history of aiding in disease treatment. It has been used to help people with epilepsy (especially children) since the early 1900’s, and more recently, it has been used to manage type-2 diabetes (since it lowers the need for insulin therapy).1
Con: Results can vary depending on how much fluid you drink. By drinking more water, you dilute the concentration of ketones in the urine and thus a lower level of ketones will be detected on the strips. The strips don’t show a precise ketone level. Finally, and most importantly, as you become increasingly keto-adapted and your body reabsorbs ketones from the urine, urine strips may become unreliable, even if you’re in ketosis.
Getting 80-90% of your calories from fat, which is what’s generally required for true ketosis, is fairly difficult. Keto is not just low-carb, it’s also moderately-low protein. That requires filling your plate with avocado, coconut oil, fatty meats, gravy — and very few carbohydrates. While the range for carbohydrate intake vary from person to person, 25-30g is usually the maximum amount allowed to stay in ketosis. That’s the equivalent of one medium apple.

You can receive the FULL benefit of the 3-Week Ketogenic Diet without adding any exercise during the 3-weeks you'll be following the plan. If you choose to incorporate at least an hour of metabolic exercise during the week using my personal-trainer guided exercise videos, you'll see up to THREE times the results. Exercise contributes to hormonal balance, blood sugar stability, and lean muscle growth.

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When you eat foods high in carbohydrates and fat, your body naturally produces glucose. Carbohydrates are the easiest thing for the body to process, and therefore it will use them first – resulting in the excess fats to be stored immediately. In turn, this causes weight gain and health problems that are associated with high fat, high carbohydrate diets (NOT keto).

🙌🙌 thank you for some great info! USC just had an article about Keto, saying they don’t know the impact on bone health. So I’m not sure why all these articles are written without the documentation to prove the claims. We all know too much calcium supplementation can cause problems but every Dr wants you to supplement calcium. Most people could do a lot worse than doing Keto! The SAD will cause more problems for you than eating whole, unprocessed Keto food! Sugar seems to be the real issue along with aspartame and stressful living.
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