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.
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).

Research is continuing. This was just a pilot study,1 Dr. Saslow says, so we could test the effects in a small group in order to see if working with patients online offered an effective way to have people follow a weight loss program. In her next study, she plans to break down the components of a program to determine which elements are responsible for the weight loss and the decrease in blood glucose and HbA1c.
I have been working more seriously on my health after a major health crash 5 years ago, possible Rocky Mountain Spotted Fever/Lyme. Organ functions are getting better including heart, liver and gallbladder. Pancreas is at stage 3 insufficiency. I’m concerned about a high fat, protein diet. Still have IBS and gut infections. Thinking that just bone broth and easy to digest foods might be good at this point for healing?
Controls glucose and reduces diabetic symptoms. In a randomized study of overweight adults with type 2 diabetes, the participants were divided into two groups. The first group followed a 32-week ketogenic diet program while the second group followed the conventional low-fat, diabetes diet plan. At the end of the study, the ketogenic diet group improved their glycemic control and lost more weight than the other group. The research showed that the ketogenic diet improved the participants’ blood glucose levels while also reducing the need for insulin.
Bulk buy and cook. If you’re someone who doesn’t like to spend a lot of time in the kitchen, this is the best of both worlds. Buying your food at bulk (specifically from wholesalers) can reduce the cost per pound tremendously. Plus, you can make ahead food (bulk cook chicken thighs for pre-made meat, or cook entire meals) that are used as leftovers, so you spend less time cooking.
Note that as a general rule it’s easier to err on the low side, and if your blood glucose goes a bit high you can take more insulin later if needed. That’s OK. If instead you overdose and get low sugar that is potentially far more dangerous. You’ll also have to quickly eat or drink more carbohydrates, and that obviously reduces the effect of the low-carb diet.
Following a ketogenic diet puts your body into a state of “ketosis,” which is a metabolic state that occurs when most of the body’s energy comes from ketone bodies in the blood, rather than from glucose from carbohydrate foods (like grains, all sources of sugar or fruit, for example). This is in contrast to a glycolytic state, where blood glucose (sugar) provides most of the body’s fuel (or energy).
We recently published an article documenting the grim long-term effects of low-carbohydrate diets, in which we explain the evidence-based research showing that low-carbohydrate diets high in fat and protein including meat, dairy products, eggs, fish, and oil actually worsen diabetes health, increase cancer risk, increase cholesterol, increase atherosclerosis, harden blood vessels, and increase all-cause mortality.

Eating cholesterol has very little impact on the cholesterol levels in your body. This is a fact, not my opinion.  Anyone who tells you different is, at best, ignorant of this topic.  At worst, they are a deliberate charlatan. Years ago the Canadian Guidelines removed the limitation of dietary cholesterol. The rest of the world, especially the United States, needs to catch up.


Often caused by lymph node removal or damage due to cancer treatment, lymphedema occurs because there’s a blockage in the lymphatic system and results in the swelling in leg or arm. A 2017 study involved patients who suffered from obesity and lymphedema and who embarked on a 18-week ketogenic diet. Weight and limb volume was significantly reduced. (5)
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There are various ways to practice intermittent fasting on keto, including some that are less likely to trigger side effects like fatigue or cravings. Crescendo fasting gives you a break from fasting throughout your week, but is still very helpful for achieving the benefits of IMF. Dr. Cabeca and other experts, such as Amy Shah, M.D., advise their patients to check their urinary ketone levels (using ketone strips) and to aim for testing positively for ketones about three days per week.
Restricting carbohydrates.  Studies show that after three or four days without carbohydrate consumption, your body starts tapping its fat storage also known as ketosis. You’ll want to stay between 25–35 grams of carbs to get into ketosis, and that requires bucking mainstream, carb-heavy, and supposedly nutrient-rich foods like fruit and grains. There are good carbs you can eat that will help you stay in ketosis. Be sure to look over these more keto diet friendly fruit options.
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.
She has found that when women stick to eating a lighter dinner, and then abstain from eating for about 13–15 hours between dinner and breakfast, they experience improvements in their weight, blood sugar control, etc. She recommends that women try avoiding eating after 8 p.m. or experiment with eating only two meals per day, with tea or broth between meals to help curb hunger. Another option is to try skipping dinner altogether on 1–2 days per week. For most women, when attempting IMF, it’s not recommended to snack between meals unless the woman is very active (such as an athlete in training) or dealing with a hormonal issue such as adrenal burnout.
Glucose is stored in your liver and released as needed for energy. However, after carb intake has been extremely low for one to two days, these glucose stores become depleted. Your liver can make some glucose from amino acids in the protein you eat via a process known as gluconeogenesis, but not nearly enough to meet the needs of your brain, which requires a constant fuel supply.
"The diet was introduced in the 1920s as a way to treat epilepsy and then sort of fell out of popularity with the introduction of anti-seizure drugs," Turoff says. What's more, ketosis (the goal of keto, a state where the body uses fat for energy instead of carbs) is something seen in people during periods of starvation—including in people with anorexia nervosa. "The body is deprived of carbohydrates and thus has to turn to ketone bodies as a fuel source," Turoff explains. "People really need to understand that it's not just a low-carbohydrate, high-fat diet—it actually changes the way your body uses fuel."

WOW. I guess I must be a very special, highly motivated patient then. I, of course, would never have said that about myself. My high motivation is trying to get over the hatred of food that being Diabetic gave me. I don’t feel that way anymore, and am finally happy cooking, again. (My doctor DID tell me exactly that, BTW. Even to the extent of telling me to not include the tsp of agave that I was having in my coffee once a day because sugar is sugar.)
The average person's diet contain about 55% carbohydrates, 30% fat, and 15% protein. On the keto diet, you eat a whole lot more fat, and a lot less carbs: 80% of the diet is comprised of fat, 15% is protein, and a mere 5% of calories come from carbohydrates. For someone on a 1,500-calorie diet, that translates to 19 grams of carbohydrates per day, which is less than what you find in one medium-sized apple.

Common complications of diabetic ketoacidosis include very low blood sugar, or hypoglycemia, and swelling of the brain (cerebral edema). As such, when a person is in ketoacidosis, there is such a high level of ketones produced that can push a person into cardiac arrest (heart attack) or kidney failure. Hence, the very important reason for taking occasional keto breaks go give your body a bit more nourishing carbs. 
Most people already know about the keto flu, which can happen when you start the diet. It’s a result of the body adapting to the low-carb state. Lowering carb intake forces the body to burn ketones for energy instead of glucose. Once the body is in ketosis — burning fat instead of glucose — the keto diet is working. But you may not feel so great at first, hence the term keto flu.

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A second counterintuitive approach to healing the gut for children who are having a hard time gaining is to encourage a nice long ‘fast’ over night.  When the gut is less full, and the body can digest the food that’s in there completely and then it can repair an inflamed or leaky gut better.   If the gut is inflamed, food may be passing right through without being absorbed.  In addition, growth hormone raises during periods of fasting.


The ketogenic diet doesn’t put a cap on saturated fat or even trans fats. The latter are fats you should always avoid. Read ingredient labels and avoid any food with partially hydrogenated oils, aka trans fats. These fats heighten your LDL (“bad”) cholesterol levels and lower your HDL (“good”) cholesterol levels. They also raise your risk of heart disease and stroke, according to the American Heart Association.
“the mitochondria – work much better on a ketogenic diet as they are able to increase energy levels in a stable, long-burning, efficient, and steady way. Not only that, a ketogenic diet induces epigenetic changes[6] which increases the energetic output of our mitochondria, reduces the production of damaging free radicals, and favours the production of GABA”
If you do try the diet outside of medical supervision, Kizer says it’s important to test your urine with urinalysis ketone test strips to ensure your ketone levels don’t become dangerously high. Ketone urine test strips are also used by people with diabetes to determine if they’re at risk for ketoacidosis (DKA), a life-threatening complication that occurs when an individual doesn’t have enough insulin in their body. (Healthy ketosis is considered 0.5 to 3.0 mM blood ketones.)

In either case, think about that for a second: Mancella says a 4% carbohydrate consumption translates to roughly 20-50 grams of carbs per day. And given that a single cup of cooked pasta contains roughly 45-grams of carbs by itself, and a single English muffin has about 30-grams of carbs, a single, poorly-planned meal could undo your efforts to achieve and maintain ketosis in a hurry.
The bottom line? If you’re thinking about trying the ketogenic diet, run it by your doctor first — regardless of any preexisting health conditions. And consult a registered dietitian nutritionist (find one at EatRight.org) to find a nutrition professional who can work with you to create a meal plan you can stick to. People with kidney disease or a history of disordered eating should avoid the diet, and people with type 1 diabetes may want to avoid it, as well. If you have risk factors for heart disease, you’ll want to speak with your doctor before considering the diet.

Instead of thinking about the total carbs you’re eating, assess what those carbs provide to you. Do the majority of your carbs come from fruit and vegetables, with a payload of fiber and disease-fighting antioxidants? Fantastic. Or are you consuming them in the form of added sugars (cookies, candy, soda) or refined flour? If you are, you know what to do.
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.
There are different reasons people might want to achieve ketosis. For certain medical conditions, such as epilepsy, it might be necessary to see the benefits of the diet. For everyday dieters, it might be for the more anecdotal side effects, such as a clearer head. But it can be risky for certain folks, like those with kidney issues, according to experts at the Keck School of Medicine of USC.
Initial research has found that the diet can help maintain lean muscle mass in active women — even as they shed pounds — and may also lead to increased appetite suppression. "A keto diet is an option for people looking to lose overall weight, lower fat mass, and even build muscle. As a dietitian who focuses on sports nutrition and weight loss, I also recommend it for my clients who need a strong break from their sugar cravings, as it lessens blood sugar spikes and the cravings that can accompany high sugar intake," Nisevich Bede says.
No one is trying to diminish your success, but it does not work for everyone, and studies show it can have long term negative effects on your overall health. If you look at the Meta-analysis it shows a calorie restricted diet and Keto for 12 weeks had the same weight loss. There are also many studies that suggest looking back at people after one year those on a calorie restricted diet kept more of their weight off. The only one it does better than is just a low fat diet, which Dieticians stopped suggesting long ago. And as Health Care professionals we read the “REAL SCIENCE” not the internet articles, You Tube, Blog, book writers. One of the books written about it by Dr. Jason Fung. Have you looked him up on PUBMED? He has not written one article published in a real medical journal to be such an expert. It is not magic, it is not a cure. If you like the diet and it does not mess up your cholesterol then so be it but promoting it to others not knowing their medical history can be dangerous. What people don’t realize is that for year’s we have known that if you lose 7-10% of your own body weight your blood sugars will improve, cholesterol, and blood pressure. But you don’t have to do the fasting and put more burden on your Liver or potentially increase your risk for cardiac problems eating such high fat. If you do high fat at least do plant fats and not animal fats. But of course everyone is happy with your success but just keep a tab on your lab work.
Your liver oxidizes fatty acids to produce three ketone bodies — β-hydroxybutyrate, acetoacetate and acetone — that provide an alternative to glucose to fuel your brain and other tissues. And most organs, including your brain, thrive on ketones. Increased ketone levels replace glucose as your primary energy source, reducing need for gluconeogenesis and sparing protein breakdown. (4)

Purnell JQ, Hokanson JE, Marcovina SM, Steffes MW, Cleary PA, Brunzell JD. Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT. Diabetes Control and Complications Trial. JAMA. 1998;280:140–146. doi: 10.1001/jama.280.2.140. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Cancer cells express an abnormal metabolism characterized by increased glucose consumption owing to genetic mutations and mitochondrial dysfunction. Previous studies indicate that unlike healthy tissues, cancer cells are unable to effectively use ketone bodies for energy. Furthermore, ketones inhibit the proliferation and viability of cultured tumor cells.
However, the ketogenic principles can absolutely be abused. I’ve seen many people use this way of eating as an excuse to fill their plates almost entirely with bacon and butter from conventionally raised cattle. So make no mistake, an ideal ketogenic diet is a predominantly plant-based diet with healthy fats at its core. Eating a variety of whole foods that are high in healthy fats is essential to “doing keto” the right way.
However, the complete opposite occurred, practitioners began to lose excess body fat, feel healthier, and in some cases, issues of diabetes even began to subside. Nutritionists began to study the effect of a fat-based diet and its impact on human health, years later; the modified ketogenic diet emerged from the research and had been used with success in modern society.
No one is trying to diminish your success, but it does not work for everyone, and studies show it can have long term negative effects on your overall health. If you look at the Meta-analysis it shows a calorie restricted diet and Keto for 12 weeks had the same weight loss. There are also many studies that suggest looking back at people after one year those on a calorie restricted diet kept more of their weight off. The only one it does better than is just a low fat diet, which Dieticians stopped suggesting long ago. And as Health Care professionals we read the “REAL SCIENCE” not the internet articles, You Tube, Blog, book writers. One of the books written about it by Dr. Jason Fung. Have you looked him up on PUBMED? He has not written one article published in a real medical journal to be such an expert. It is not magic, it is not a cure. If you like the diet and it does not mess up your cholesterol then so be it but promoting it to others not knowing their medical history can be dangerous. What people don’t realize is that for year’s we have known that if you lose 7-10% of your own body weight your blood sugars will improve, cholesterol, and blood pressure. But you don’t have to do the fasting and put more burden on your Liver or potentially increase your risk for cardiac problems eating such high fat. If you do high fat at least do plant fats and not animal fats. But of course everyone is happy with your success but just keep a tab on your lab work.
"The diet was introduced in the 1920s as a way to treat epilepsy and then sort of fell out of popularity with the introduction of anti-seizure drugs," Turoff says. What's more, ketosis (the goal of keto, a state where the body uses fat for energy instead of carbs) is something seen in people during periods of starvation—including in people with anorexia nervosa. "The body is deprived of carbohydrates and thus has to turn to ketone bodies as a fuel source," Turoff explains. "People really need to understand that it's not just a low-carbohydrate, high-fat diet—it actually changes the way your body uses fuel."
Hi. I have been on the keto diet for 6 weeks and have not lost any weight but even more concerning, my gerd is much worse. I’m taking ppi’s just to stay on the diet. Constipation which has always been an issue for me is now much worse, hello laxatives! For these reasons, I have decided to go back to a more balanced diet leaning towards vegetarian. Keto works for some, I’m not one of them. I appreciate your info.
The ketogenic diet has recently been investigated a great deal for how it may help prevent or even treat certain cancers. One study found that the ketogenic diet may be a suitable complementary treatment to chemotherapy and radiation in people with cancer. This is due to the fact that it would cause more oxidative stress in cancer cells than in normal cells.

Inadequate calories: Keto’s satiating qualities are a double-edged blade. They help us eat less and lose body fat without really even trying, but they can also sometimes lead us to eat too little. This can cause a reaction in your body to slow down metabolic function and make you feel generally less energetic at rest. One solution is to cycle periods of generally increased caloric intake, and increased intake of nutritious carbs by default. This suggestion is totally different from the suggestion to engage in purposeful carb refeeds, where you binge on nutrient-devoid carbs in the name of a cheat day. This is never advised for any reason.
Registered dietitian Julie Stefanski is based in York and has specialized in the ketogenic diet for more than a decade. She also advocates for anyone starting keto, especially individuals who have not seen a doctor in more than a year, to first see a physician and/or registered dietitian to have their lab work checked and monitored. She also notes there are certain medications that cannot be used while on a ketogenic diet.  
Wait, what?! How could a diet rich in meat, butter, and cheese do anything but increase the chances of a heart attack? Well, the tables might be turning in defense of fat. While it’s still unclear how the keto diet impacts heart health long-term, especially for those predisposed to heart disease, research has found that the keto diet may help improve triglyceride, HDL, and LDL levels, and improve overall cardiovascular risk factors. Pass the cheese, please!

Others consider the keto diet a short-term solution for weight loss. Tyler Drew, a 34-year-old real estate broker from Los Angeles, first read about the diet on Reddit and used it to lose 45 pounds in six months before returning to a traditional diet. While on the keto diet, Drew’s cholesterol levels improved, even though a typical day of eating involved bacon at both breakfast and dinner.
That’s why many health experts are concerned about people on the keto diet, especially those who try it without the guidance of a doctor or nutritionist. Doctors say that high-fat diets like this one may raise cholesterol levels, and some studies suggest that they increase the risk of diabetes. Some have even called it a “cardiologist’s nightmare.”
Probably, and there are a few reasons why the keto diet usually equals weight-loss gold, says Keatley. For starters, people usually reduce their daily caloric intake to about 1,500 calories a day because healthy fats and lean proteins make you feel fuller sooner—and for a longer period of time. And then there’s the fact that it takes more energy to process and burn fat and protein than carbs, so you're burning slightly more calories than you did before. Over time, this can lead to weight loss.
One of the keto side effects people may complain about is keto breath.  Although this is not quite related to the three major causes we’ve discussed so far, keto breath is something that many people experience in the early stages of keto adaptation. When you begin producing ketones, you produce them in several different forms. The ketone that is released through the breath is acetone and is responsible for the keto breath that some people experience.
Despite its explosive popularity, there’s a lot of confusion about what the ketogenic (keto) diet really is. “Many people think they’re following a keto diet when they’re really just consuming a low-carbohydrate diet,” says Patti Urbanski, MEd, RD, CDE, a certified diabetes educator with St. Luke’s Hospital in Duluth, Minnesota. “So one person’s ‘keto diet’ may look very different than another’s.”
Certain Cancers Keto may be used in combination with chemotherapy and radiation, some studies have suggested, including one published in November 2018 in the journal Oncology. (12) But ultimately more studies are needed to determine if keto can play a role in cancer therapy, and patients should not use it as a stand-alone treatment or without a doctor’s consent.
Well… what are many people on a Keto diet trying to do? Lose weight right?  I would guess that prior to discovering the Keto diet many of these people were caught in the trap of low fat dieting.  This lead to months or years of low fat intake and consequentially low gallbladder activity.  The gallbladder wasn’t needed to digest fat and so it sat idle and stones were more likely to form.  Once they made the shift to a ketogenic lifestyle and their fat consumption increased upwards of 1000%, the gallbladder kicked into high gear.  If the previous period of low fat dieting had caused stone formation they are going to have to deal with flushing those stones out now while on a high fat Keto diet.
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