Great post, Abbey!! Thank you for taking the time to write this and share it with us! This diet may work in some cases as you pointed out but i find it very dangerous, eventhouh i’m not a dietician. I tried it and i felt horrible. I felt depressed, constipated, pain in my right side which i think was my gallbladder. Couldn’t sleep, terrible breath. AWFUL!!
“Tremendous Results”….guess that’s why the diabetes nationwide gets worse every year, because of the stellar advice your kind is giving out. I’ve been on the virta clinic for two months and already went off insulin, Janumet and Jardiance, which I’ve been on for 10 years, with blood sugars between 80 and 150. The advice you give makes people get sick slower. The ketogenic approach deals with the real issue, carbohydrate intolerance. If you are lactose intolerant you stop ingesting lactose. Type two diabetes is simply carbohydrate intolerance. Stop eating the carbs and the symptoms go away. I think you meet to cite some of the other research out there I’ve read in other books and the work the Virta Clinic has done. In my opinion you’ve cherry picked data to suit your preconceived beliefs.
Many CDEs actually have diabetes…it’s what draws them to choose this career…to help others with diabetes, to share their knowledge. Most already wear an insulin pump and continuous glucose sensors (CGMs) also. When I first became certified on each new pump and CGM, I would wear them (and check my BG 4-6 times per day) for 2-3 weeks, not only to learn the technology really well, but to gain a sense of how my patients must feel having to wear them 24 hours per day. Since, I’ve started a 6 month old baby on a insulin pump and CGM all the way up to a 89 year old…there are no boundaries for people with diabetes!

Twenty-one of the 28 participants who were enrolled completed the study. Twenty participants were men; 13 were White, 8 were African-American. The mean [± SD] age was 56.0 ± 7.9 years and BMI was 42.2 ± 5.8 kg/m2. Hemoglobin A1c decreased by 16% from 7.5 ± 1.4% to 6.3 ± 1.0% (p < 0.001) from baseline to week 16. Diabetes medications were discontinued in 7 participants, reduced in 10 participants, and unchanged in 4 participants. The mean body weight decreased by 6.6% from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg (p < 0.001). In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A1c. Fasting serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001) while other serum lipid measurements did not change significantly. 

Lower carbohydrate diets (varying amount of carbohydrates in each study) have shown promise in improving A1c and weight management in Type 2 diabetes, is shown to be better than low-fat diets in improving blood pressure and lipid levels, and more. Along with that, more ketosis studies on different disease states are out there and growing. Ketosis has also been explored for its promise, at least in the short term, for metabolic disease, Alzheimer’s disease, and diabetes.
Ketosis: What is ketosis? Ketosis is a metabolic process, and it involves the body burning stored fat instead of glucose. Some people try to induce this with a low-carb diet, which can be healthy. However, ketosis also produces acid, and high levels of this can cause severe complications, especially for people with diabetes. Learn more here. Read now
I have been on a low carb keto diet for more than a year. As T2DM my A1C dropped from 9% to 5.4% & I discontinued meds. All my lipids improved even with ample healthy saturated fat. More than a year now so I wonder why this would be a short term improvement when its obvious that I will not go back to a high A1C and taking 3 diabetes medications including sulphonylureas. It is clear from this article that you lack the necessary experience that would be gained from wholeheartedly trying the diet or monitoring patients doing it properly like me. I would be probably be facing my first amputation if I believed the negativity in your article. So for people with diabetes who may be dissuaded by your article. Ignore it and take back your health by restricting carbs (<25 g a day) or as low as you reasonably can below 130g while being satisfied that you are getting adequate nutrition.

This means that instead of generating tons of ketones from the very beginning, most people experience hypoglycemia for a period of time. With hypoglycemia comes a disruption in cortisol signaling which is what accounts for the HPA axis dysfunction. Finally, HPA axis dysfunction leads to an increase in secretion of minerals from the body in the urine.


Ketoacidosis, on the other hand, is a complication of poorly managed diabetes. It results in uncontrolled production of ketone bodies that can change the pH of the blood, which can prove fatal. Ketoacidosis is more common with Type 1 diabetes rather than Type 2. It’s also important to note that the keto diet cannot cause ketoacidosis – but rather puts the body into the beneficial state of ketosis.
I must tell you when looking at this link they say the American Diabetes Association Guidelines call for 60-75 carbohydrates per meal and that is simply not true. The ADA has recommended since 2013 we use our best clinical judgement in recommending a low carbohydrate diet for people with diabetes, recognizing it needs to be individualized. 60-75 grams is the carbohydrate amount I would give to a very tall, large boned man or perhaps an active teen or young adult. I would never recommend that many carbohydrates for an average size man who was trying to lose weight; he would get 45-60 grams of carbohydrates per meal and 15-30 grams for snacks. A women trying to lose weight would get 30-45 grams of carbohydrates per meal and 15 grams for snacks.

Hi Eric, nice to see you. Some do well on whey instead of protein powders. They do have carbs so be careful. I have learned every little change helps and no beating up allowed. Every improvement helps. It takes 2 weeks to get sugars out of the body. Then cravings will be gone. Good foods also lessen the craving. Apples are great, lol. Good health to you.
John Staughton is a traveling writer, editor, and publisher who earned his English and Integrative Biology degrees from the University of Illinois in Champaign, Urbana (USA). He is the co-founder of a literary journal, Sheriff Nottingham, and calls the most beautiful places in the world his office. On a perpetual journey towards the idea of home, he uses words to educate, inspire, uplift and evolve.
Sleep enough – for most people at least seven hours per night on average – and keep stress under control. Sleep deprivation and stress hormones raise blood sugar levels, slowing ketosis and weight loss a bit. Plus they might make it harder to stick to a keto diet, and resist temptations. So while handling sleep and stress will not get you into ketosis on it’s own, it’s still worth thinking about.
Losing essential micronutrients is another concern raised by keto diet skeptics. People say eating a diet based on fat and protein from animal sources means losing those micronutrients found in higher-carb grains, legumes, fruits, and vegetables. Some also claim low-carb diets contain too little fiber, and thus may cause long-term constipation. That’s inaccurate.
Parkinson’s Disease Because these patients are at a higher risk for dementia, researchers like Robert Krikorian, PhD, professor of clinical psychiatry and the director of the division of psychology at the University of Cincinnati College of Medicine in Ohio, are studying how inducing nutritional ketosis may be used to preserve cognitive functioning.
A ketogenic diet could be an interesting alternative to treat certain conditions, and may accelerate weight loss. But it is hard to follow and it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. We also do not know much about its long-term effects, probably because it’s so hard to stick with that people can’t eat this way for a long time. It is also important to remember that “yo-yo diets” that lead to rapid weight loss fluctuation are associated with increased mortality. Instead of engaging in the next popular diet that would last only a few weeks to months (for most people that includes a ketogenic diet), try to embrace change that is sustainable over the long term. A balanced, unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life.
Earlier this year Seattle family doctor Dr. Ted Naiman, who has been helping patients with low-carb or ketogenic diets for 20 years, described how his own obsessive compulsive disorder was resolved almost instantly — never returning — on a low-carb high-fat diet. Naiman over the years has seen dramatic mental health improvements in his patients who adopt low carb ketogenic diet. “Definitely bipolar, depression, anxiety, OCD, are all much, much better on a low-carb diet,” he says.

The key of these miraculous healing effects relies on the fact that fat metabolism and its generation of ketone bodies (beta-hydroxybutyrate and acetoacetate) by the liver can only occur within the mitochondrion, leaving chemicals within the cell but outside the mitochondria readily available to stimulate powerful anti-inflammatory antioxidants. The status of our mitochondria is the ultimate key for optimal health and while it is true that some of us might need extra support in the form of nutritional supplementation to heal these much needed energy factories, the diet still remains the ultimate key for a proper balance.”


A ketogenic diet is very low in carbs, high in fat and moderate in protein. For a weight stable person, no more than 5% of calories should come from carbs, 70-80% from fat and 20-30% from protein. With this macronutrient-distribution, individuals do not rely on glucose as a major source of energy but use fat for fuel instead. Fat is used to produce ketone bodies, which are used for energy or to regulate certain genes. Two ketone bodies circulate in in your blood: Acetoacetate (AcAc) and Beta-hydroxybutyrate (BHB). A third ketone, acetone, is spontaneously created from Acetoacetate. It is not a source of energy but is useful for ketone measurement. Check our ketone measurement guide to learn more.

It’s not totally clear whether weight loss achieved on the keto diet can be maintained by most adults once the diet ends, both because the diet can be hard to follow and due to the body adapting metabolically. Long-term studies conducted on animals show that weight loss tends to level off after about six months on the diet, and sometimes may start to creep back up.

Eating a keto diet can have some short-term health perks. But in the long run, it also has the potential to create some serious health problems. That’s why many experts say you shouldn’t attempt it on your own. “In general, if a person follows a ketogenic diet, they should only do so for a brief time and under close medical supervision,” says Hultin.
Keto changes the way your body fuels itself. When you limit carbs, your body starts to burn fat, rather than glucose, for energy. You go into ketosis — when your liver converts fatty acids into molecules called ketones, an alternative source of fuel. Learn more about keto and how it works with this beginner’s guide. Burning ketones carries all kind of benefits: 
When the body's glycogen stores begin to get depleted, rates of beta-oxidation increase, resulting in the mobilization of free fatty acids from fat tissue. This is where the metabolic state of ketosis comes in. During beta-oxidation, ketone bodies are released from the liver—because they cannot be utilized by the liver—and travel to the brain to be used for fuel. The free fatty acids can then be turned into a usable energy substrate.
Vegan ketogenic diet or vegetarian diet: Yes, both are possible. Instead of animal products, plenty of low-carb, nutrient-dense vegan and/or vegetarian foods are included. Nuts, seeds, low-carb fruits and veggies, leafy greens, healthy fats and fermented foods are all excellent choices on a plant-based keto diet. There’s also a similar plan called ketotarian, which combines keto with vegetarian, vegan and/or pescatarian diets for supposedly greater health benefits.
I’m in ketogenesis now – 3 weeks in. Lost over 10kg. Protein shakes. Great. But what I wanted to add was that i’m Diabetic (2) and quite badly so. I was Injecting insulin twice a day – Novomix (part immediate, part slow acting). But since I went into keto, my blood sugar has been steady between 5-9, normal range. No injections needed. And no hypo attacks either – that occurs below a reading of 4, for me. This is NOT a cure of course – it’s directly related to low carb intake. But I do wonder if discontinuing insulin is partly responsible for my improvement in alertness, activity level and so on. Magnesium tabs, 1000 units twice a day, have also been helpful – I suffer leg and foot cramps due to spinal arthritis – but they had worsened until I upped the dose.
The researchers hypothesized that the positive effects that the ketogenic diet has on migraines are due to how ketone bodies inhibit neural inflammation and enhance brain mitochondrial metabolism. The ketone bodies do this by blocking high concentrations of glutamate (commonly found in both migraine and epilepsy sufferers) and reducing oxidative stress.
If you are on medication, Dr. Ede recommends you work closely with your psychiatrist or mental health care provider. “Ketogenic diets cause profound shifts in brain and body chemistry rather quickly. These changes are almost always positive and healthy, but they can have a major impact on medication levels, dosages and side effects that require close medical supervision,” she says.
So rather than giving one-size-fits-all dietary advice or weaponizing the word “balanced” it might be better if the medical community suggested that there are Individual differences that need to be considered. This might also help those lay folk who have had success with one dietary lifestyle or another also realize that what’s valid for them may not be good advice for others.
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.

Adding salt to food might be new to you, since most people are used to being told to limit salt intake. However, when you’re eating a ketogenic diet of less than 60 carbohydrates each day, you’ll need to make up for this loss of salt. That being said, those with high blood pressure who take medication should check with their doctors before making a change.
Multiple sclerosis diet tips Multiple sclerosis (MS) is a chronic condition that can lead to weakness and memory loss, among other symptoms. Some studies suggest that making dietary changes may help boost a healthy gut flora, which could improve symptoms. Find out more about which foods to eat and which to avoid, and get some lifestyle tips, too. Read now

Many people and even some doctors confuse nutritional ketosis with (diabetic) ketoacidosis. Ketoacidosis occurs in uncontrolled diabetes when the pancreas cannot secrete enough insulin to exert its action in cells, so blood glucose levels and blood ketones both skyrocket to dangerously high levels. Ketoacidosis has nothing to do with nutritional ketosis which is when ketones are produced from all the dietary fat you’re relying on and can thus keep your blood sugar levels under control at low and stable levels.
This was very confusing and disappointing to read from Dr. D. Wheatbelly IS ketogenic. In fact, I got kidney stones while following it, along with some other weird symptoms like hair loss and very cold hands and feet. Granted I was probably dehydrated and lacking in some nutrients……but still. I never had those issues while following SAD. On SAD I never worried about drinking enough water or whether I was getting the right scientifically controlled combination of vitamins, minerals, pro/pre biotics. Never had to eat a raw potato or, dear God, a hard, chalky, green banana (who can do that for life? No one). I never got a kidney stone (or the other mentioned symptoms) on SAD. And they all went away when I stopped doing Wheatbelly. Very disappointing because I was losing weight on Wheatbelly and have gained it all back. Anyway, the diets are very similar. If you restrict carbs the way Dr. D says you should…. for life, you will be in ketosis long term.
And, it's important to recognize that both study teams acknowledge that as exciting as their findings seem, a large, randomized controlled trial is still needed to more closely assess a variety of components that may be contributing to the successes found in both studies before the findings can be recommended to anyone outside the study groups1,2  he says.
When carbohydrate consumption is limited, your body has to use an alternate fuel source to keep your brain going. This is the general premise behind the ketogenic diet. “The ketogenic diet is a high fat diet with low carbohydrate and moderate protein content,” says Gabrielle Mancella, a Registered Dietitian with Orlando Health. “Carbohydrate is depleted to provide an alternative fuel source, known as ketones, to the brain. The body converts from burning carbohydrates to burning fats, known as ketosis.”
The keto diet has a massive fan base that has grown at least in part due to the popular Netflix documentary The Magic Pill, which touts a trove of promising keto health benefits. But the fact of the matter is that most of the studies on the keto diet are premature. Meaning: They’re in small populations of humans, or they’re in rats. (And you are very different from a rat.)
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?
The basis of the muscle wasting argument stems from a misunderstanding of the brains glucose requirements.  If ketones didn’t exist the brain would require much more glucose than it does in the presence of ketones.  During a low carb diet the brain would be forced to break down protein to obtain this glucose.  It would do this through either dietary protein or in the absence of sufficient dietary protein, it would go after body muscle.  Fortunately, once ketosis kicks in the brain is able to obtain 70-75% of its energy requirements from ketones.  The remaining 25% is much more easily obtained from dietary protein and thus body muscle is spared.
Because it lacks carbohydrates, a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables. Because it is so restrictive, it is really hard to follow over the long run. Carbohydrates normally account for at least 50% of the typical American diet. One of the main criticisms of this diet is that many people tend to eat too much protein and poor-quality fats from processed foods, with very few fruits and vegetables. Patients with kidney disease need to be cautious because this diet could worsen their condition. Additionally, some patients may feel a little tired in the beginning, while some may have bad breath, nausea, vomiting, constipation, and sleep problems.
The keto diet is known for helping people lose a few pounds very quickly, says Becky Kerkenbush, RD, a clinical dietitian at Watertown Regional Medical Center. Carbs hold on to more water than protein or fat, so when you stop eating them, your body releases all that extra H2O by making you pee more. As a result, the scale might read a few pounds lower, and you may look a bit leaner. 

I am a T2D, finally fully keto starting at the end of March. I am down 28 lbs. My goal is 50, so I am feeling encouraged and fitting into smaller sizes already. In May my A1C was 5.6. This morning, according to a home test kit I purchased from CVS, my A1C is 5. I believe that is fairly accurate based on my blood sugar readings, which are staying well below 100.

“The major benefit of the keto diet is that it does work so you lose weight,” says Ms. Zarabi. “But then again, it is a diet and like all diets, it is a short term solution, something you do, then you stop. It is not really a sustainable diet in real life situations. More importantly, your goal is not just to lose weight—anyone can lose weight. The more necessary goal is to keep the lost weight off.”  
A recent pilot study put five patients on the ketogenic diet (less than 20 grams per day of carbohydrate). At the end of six months, the average weight loss was 28 pounds (but this wasn’t the most surprising finding). Each patient underwent a liver biopsy, and four of the five patients had a reduction in liver fat, inflammation, and fibrosis. However, this is a small pilot study that also used supplements, so the results are not conclusive. What does the rest of the research say?

Losing heart muscle may not be the only heart-associated risk with the keto diet, Derocha says. “If you have high blood pressure and are taking medication, the prescription mixed with the diet may cause abnormally low blood pressure test results,” Derocha says. Before you start the keto diet, she suggests you talk with your doctor to avoid low blood pressure, which can be dangerous, even deadly.


A: The amount of weight you lose is entirely dependent on you. Obviously adding exercise to your regimen will speed up your weight loss. Cutting out things that are common “stall” causes is also a good thing. Artificial sweeteners, dairy, wheat products and by-products (wheat gluten, wheat flours, and anything with an identifiable wheat product in it).
But what does the science say? Results are mixed. In one Spanish study of 20 obese adults, participants were put on a low-calorie keto diet and lost an average of 40 pounds over four months. Another small experiment had a similar outcome. In a six-month Experimental & Clinical Cardiology study of 83 obese adults, those on the keto diet lost an average of 33 pounds, while lowering their bad (LDL) cholesterol levels and increasing their good (HDL) cholesterol.
I had type 1 diabetes for 30+ yrs; CKD/ESRD x8 yrs and did peritoneal dialysis for 5 yrs before getting a kidney pancreas transplant nearly 5 years ago. Then had a below knee amputation and a rather sedentry life since-need to lose weight. Is this a safe diet for me? I am terrified of ketosis (DKA nearly killed me when i was 12 yrs old) so anything messing with stuff like that really makes me nervous. TIA!
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.
For some, ketosis can cause more negative than positive side effects. Dorena Rode, a 52-year-old author, and speaker from Occidental, California, tried the diet for a month and experienced heart palpitations and dizziness. Unlike Drew, Rode says her cholesterol increased from 192 to 250 mg/dL after she introduced more fat into her diet. (Less than 200 mg/dL is considered desirable, while anything over 240 mg/dL is considered high.)
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We are all supposed to be eating 5 servings of fresh fruit and vegetables per day. That provides you with all the essential vitamins and nutrients needed to run a healthy body along with the protein you choose to consume alone with them. I guess if you can fit those into a Ketogenic diet and make that work for you for a lifetime, I would have to say that is absolutely wonderful! I just know, I have a lot of willpower and I only made it 1 year back when I tried. It was just too restrictive. I see too many stories like that. The blogger I wrote about, all the studies, most participants had dropped out at 6 months. No study I have seen has shown anyone who has stayed on it for 10 years, 15, 20, 30, 40 years. If you know one, please let me know!
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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