The comments defending the keto diet suggest that the individuals are successfully using the keto diet to help them maintain a healthy weight and a healthier A1C level. The individuals also suggest that they view it as a way of life rather than a diet. This is good news for many of us who are facing the question of whether it will be helpful and necessary to reduce carbohydrate intake to keto producing levels in order to halt or reverse the onset of type II diabetes. I think like those individuals, Tami is speaking from her own personal experience where she had success losing weight, but had difficulty maintaining the keto diet long-term. I am sure that though you have been successful, you can understand that there are many who might find it difficult to maintain. I too have been given very bad guidance by Medical Doctors who lean on old Med School information to practice medicine rather than continuing to broaden their knowledge base and learn more about nutrition. I cannot get back the 20+ years of suffering with a debilitating disease that could have been cured because my doctors were not well informed or willing to listen to information that disagreed with their limited knowledge base. Those years are gone and the destruction to my body is not reversible. So I understand the anger you feel toward a system that isn’t working in the best interest of the patient. But I think that expressing anger toward those who disagree with our personal experience, is not solving the problem. Hopefully we can change the ADA guidelines by respectfully urging them to reconsider their position based on the sheer volume of the comments they receive from successful people like you, who are living the keto diet lifestyle and living better. I commend you for becoming your own best health advocates. Thanks for your encouragement and your passion. And thanks to Tami as well for sharing her personal experience and the information she had collected. We all have to be true to what we believe and we all have a right to come to our own conclusions. It is good to know that there are success stories out there. I wish you all good health and continued success. I also hope that one day medical training will do a much better job of preparing doctors to become their patient’s best advocates, actively learning and searching for cures rather than treating symptoms in ways that cause even more disease to develop. The system is failing so many of us.

What is diabetic ketoacidosis? When a diabetic (usually a Type I diabetic, but sometimes this occurs in very late-stage, insulin-dependent, Type II diabetics) fails to receive enough insulin, they go into an effective state of starvation.  While they may have all the glucose in the world in their bloodstream, without insulin, they can’t get any into their cells.  Hence, they are effectively going into starvation.  The body does what it would do in anyone – it starts to make ketones out of fat and proteins.  Here’s the problem: the diabetic patient in this case can’t produce any insulin, so there is no feedback loop and they continue to produce more and more ketones without stopping.  By the time ketone levels (specifically, beta-hydroxybutyrate) approach 15 to 25 mM, the resulting pH imbalance leads to profound metabolic derangement and the patient is critically ill.
An extensive review published in 2013 looked at the research and evidence of ketogenic diets enhancing fertility (long story short, it looks promising). Studies also show that Polycystic Ovary Syndrome (PCOS) can be treated effectively with low-carb dieting, which reduces or eliminates symptoms such as infrequent or prolonged menstrual periods, acne, and obesity.
Multiple sclerosis is a condition that affects the nervous system, and some people believe that a ketogenic diet may slow the progression of the disease or control its symptoms. The ketogenic diet is low in carbohydrate, moderate in protein, and high in fat. There is currently not enough evidence to recommend it for everyone with multiple sclerosis.
I would just like to share with you that my patients are HORRIFIED if their physicians ask them to cut out “everything white” in their diet. This is what some doctors ask for…essentially asking for the Ketogenic diet and most of my patients are in shock! Not only would I never want to skip a year of my birthday cake, but I wouldn’t ask my patients to either! One slice of cake is certainly not going to harm anyone with diabetes and hopefully you know enough about carbohydrates and their short term effect on BG levels to know this too! I am not a Registered Dietitian, so I couldn’t speak to this diet in regard to children with epilepsy. Are you a Neuro RN? TheDiabetesCouncil did just post another article where 25 Registered Dieticians weighed in regarding the Ketogenic Diet, so I would encourage you all to check that out!
Considering these risks, people who have kidney damage (including those with type 2 diabetes), plus individuals with or at risk for heart disease, and pregnant or breastfeeding women, shouldn’t try the keto diet. Also, people with type 1 diabetes shouldn’t follow the plan because of the risk for hypoglycemia (low blood sugar), and anyone who has had their gallbladder removed should avoid it because the diet is so high in fat.
When we eat this carby kind of food multiple times per day with little time in-between meals, insulin levels are consistently high throughout the day. Over the years, cells react to this constant overflow of glucose and fat by shutting down their insulin receptors. With fewer insulin receptors, cells become less sensitive to the action of insulin. For the same amount of glucose to be taken up, the pancreas has to produce more insulin.
"That being said, using this diet as a kick start for two weeks and then following it with a healthier way of eating is not a bad thing," Amselem says. "For example, one can start on the ketogenic diet for a two-week period and then follow a plan that is healthy and sustainable for life by limiting the high-fat red meat and dairy and adding fish, olive oil, fruit, and healthy carbohydrates such as whole grains, sweet potato, brown rice and quinoa."

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And that’s the kicker -- most people “going keto,” may not actually be following a true ketogenic diet since it’s hard to know for sure if your body’s in ketosis. Mancella explains that the only formal and valid method of determining if your body is in ketosis is if there are ketone bodies being excreted in your urine. “There are strips for purchase at local drug stores that are available to determine this,” she says. “Otherwise, we’re not actually sure if we’re in ketosis, and we’re just following a ‘low carbohydrate’ diet.”
Clinical improvement was observed in Alzheimer’s patients fed a ketogenic diet, and this was marked by improved mitochondrial function. (15) In fact, a European Journal of Clinical Nutrition study pointed to emerging data that suggested the therapeutic use of ketogenic diets for multiple neurological disorders beyond epilepsy and Alzheimer’s, including headaches, neurotrauma, Parkinson’s disease, sleep disorders, brain cancer, autism and multiple sclerosis. (16)
Practicing intermittent fasting. This works wonders to help patients get into ketosis. Ideally, you’ll go 13.5–15 hours between dinner and breakfast to help your body find energy reserves beyond stored glucose. (Your body can only store reserves for about 24 hours, so if you are eating much less, intermittent fasting will allow you to drop your storage levels way down, requiring your body to burn fat instead.)
Here’s another controversial yet promising area of study: Research suggests that when patients with diabetes take on a low-carb diet (like keto), they experience improvements in insulin sensitivity by up to 75 percent, as well as a reduction in blood sugar control medications. What we aren’t sure of, however, is whether these improvements are due specifically to the effects of ketosis or to weight loss in general, so similar results could theoretically be found with any successful diet.
Until recently, ketosis was viewed with apprehension in the medical world; however, current advances in nutritional research have discounted this apprehension and increased public awareness about its favourable effects. In humans, ketone bodies are the only additional source of brain energy after glucose (23,24). Thus, the use of ketone bodies by the brain could be a significant evolutionary development that occurred in parallel with brain development in humans. Hepatic generation of ketone bodies during fasting is essential to provide an alternate fuel to glucose. This is necessary to spare the destruction of muscle from glucose synthesis.
It is generally believed that high fat diets may lead to the development of obesity and several other diseases such as coronary artery disease, diabetes and cancer. This view, however, is based on studies carried out in animals that were given a high fat diet rich in polyunsaturated fatty acids. In contrast, our laboratory has recently shown that a ketogenic diet modified the risk factors for heart disease in obese patients (12).
Since carbohydrates do increase insulin and insulin is a storage hormone many people have made large leaps of logic to point the finger at carbohydrates as the primary cause of fat gain and obesity as opposed to overall caloric intake. They also point out that in a keto diet, carbohydrates are not being used as fuel hardly at all whereas fats become the primary fuel.
The catch, of course, is that if it sounds too good to be true, it probably is. And that’s exactly what hopeful dieters need to keep in mind when approaching the ketogenic diet (if we're calling it by its formal name). It’s not that this high-fat, moderate-protein, low-carbohydrate approach to eating can’t deliver weight loss in a delicious package, but it’s a restrictive, sometimes complicated affair that isn’t sustainable for most people.
“If someone with diabetes is [taking insulin or oral type 2 meds in the sulfonylurea or meglitinide class and is] following this diet, they need to know that their blood sugar can drop really quickly, so it’s critical that they check it more frequently,” says Toby Smithson, MS, RDN, CDE, author of Diabetes Meal Planning & Nutrition for Dummies. “Don’t wait for it to happen. Meet with your doctor or diabetes educator in advance so that you can troubleshoot exactly what to do if your blood sugar drops.” If it’s an infrequent occurrence, you may be advised to treat with fast-acting glucose. But frequent lows may require medication adjustments or the addition of more carbs to your eating plan.
Second point, I have never tried ketogenic dieting and also I did my calculations based on a 4:1 ratio and I was amazed at how much fat I would need to consume even at my size and the foods I would have to 1. Get rid of to achieve that and 2. Add in my diet to get there and , no thank you. My heart goes out to the families with children who do have to be on this diet.
Our bodies are incredibly adaptive to what you put into it – when you overload it with fats and take away carbohydrates, it will begin to burn ketones as the primary energy source. Optimal ketone levels offer many health, weight loss, physical and mental performance benefits.1There are scientifically-backed studies that show the advantage of a low-carb, ketogenic diet over a low-fat diet. One meta-analysis of low-carbohydrate diets showed a large advantage in weight loss. The New England Journal of Medicine study resulted in almost double the weight loss in a long-term study on ketone inducing diets.
Depriving the body of dietary carbohydrates for a period, long enough to deplete the body of its glycogen reserves, produces a ketogenic state. This depletion typically takes three to seven days to occur. During this time, you will notice that your energy level becomes consistently diminished as your body consumes energy with no new source of fuel added. You will also find that you begin to drop water-weight, as glycogen is bound to water and then excreted.
After seeing thousands of patients now for years and from personal experience, I still believe it comes down to staying away from processed foods and cooking at home whenever possible. Eating a variety of fresh fruits, vegetables, proteins, and fiber. Also, cutting out any sugary liquid calories; staying away from sodas, juices and the infamous sweet tea! Keeping stress levels under control and incorporating exercise into your routine will also be key to breaking through challenging times when you are having trouble with continued weight loss.

One of the keto researches commented, (I think it was Steve Phinney) that change will come about only because enough of the the public will be become educated about this and will demand that the ADA change their recommendations because those recommendations are just wrong. What is the proof they are wrong? If you eat 45-60 g of carb daily, you will continue to have diabetes, and the epidemic will continue as it has for the last 25 years.


“If someone with diabetes is [taking insulin or oral type 2 meds in the sulfonylurea or meglitinide class and is] following this diet, they need to know that their blood sugar can drop really quickly, so it’s critical that they check it more frequently,” says Toby Smithson, MS, RDN, CDE, author of Diabetes Meal Planning & Nutrition for Dummies. “Don’t wait for it to happen. Meet with your doctor or diabetes educator in advance so that you can troubleshoot exactly what to do if your blood sugar drops.” If it’s an infrequent occurrence, you may be advised to treat with fast-acting glucose. But frequent lows may require medication adjustments or the addition of more carbs to your eating plan.
This is ALL so confusing and overwhelming. I am not diabetic. I am trying to be proactive about it. I am borderline obese (by US standards) and obese (by Asian standards). I am 50 years old. I was addicted to fat and sugar (especially combined!) through my teens and twenties. I decided to get healthy in my 30s, so I became a Vegan (but an unhealthy/careless one, so my weight yo-yo’ed a lot in my 20s and 30s). In my 40’s I reintroduced animal products into my diet and a number of my health issues went away, but I am still fat. I am considering Keto/Carnivore, but I am concerned that I may just be falling prey to more extreme diets which could set me up for problems (e.g. diabetes) down the road. I guess I am what most would refer to as pre-diabetic (metabolic syndrome). Should I try keto or am I taking too much of a risk?
Consider Using Exogenous Ketones:  Providing pre-formed ketones takes stress off of the body and improves the bodies ability to use ketones as a fuel sources.  This, in turn, improves the bodies ability to make its own ketones and speeds up the keto adaptation process.  The best is when you take exogenous ketones with adaptogens which help stabilize blood sugar, improve the stress response and support your brain.  I recommend Keto Edge as the best all round exogenous ketone, adaptogen mix.
If you're new to keto, watch out for hidden carbs. Generally, dairy products and nuts are a good way to meet your daily fat intake, but know that some of those items may contain more carbohydrates than you think. For example, yogurt topped with nuts may seem like a great keto-friendly snack, but a 5.3 ounce serving of plain yogurt has 12 grams of carbohydrates. Vanilla flavored yogurt has 24 grams of carbohydrates. Add an ounce of cashews, weighing in at nearly nine grams of carbs, and you’re up to 21 to 33 grams of carbs for that snack, which could knock you out of ketosis. Be sure to read nutrition labels carefully and pay careful attention to serving sizes. Track foods using a keto-specific app like Senza or KetoDiet can help you stay within your recommended daily carb intake.
One study from 2005 followed 22 people with Type 1 Diabetes for 12 months. The difference here however is they consumed 70-90 grams of carbohydrates per day versus the restrictive less than 20 grams per day on the Ketogenic Diet. Remember my motto? Moderation is the key! The results were positive; less hypoglycemia, insulin requirements were reduced and their A1c dropped from 7.5% to 6.4%.
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