This whole post must have taken so much effort and I think it’s incredible that you do this. The issue with these diets is that people hear about it, think it sounds good and do it. No questions! We are so lucky to have dietitians like you actually laying out all the research, the good, the bad, and everything in between about these diets, so THANK YOU!
Proponents of the keto diet say that when and followed precisely, it does not “starve” the body.  “A well-formulated keto diet includes all the food groups and therefore provides adequate intake of micronutrients,” says Dr. Goss. “There is ample scientific evidence from randomized clinical trials supporting the therapeutic effects of the diet in treating a number of chronic disease conditions besides epilepsy, including type 2 diabetes [node/59538], non-alcoholic fatty liver disease, even obesity.”
Hormonal shifts. By restricting carbs, you will change the balance of glucagon and insulin. This will cause many changes throughout the body, especially regarding the function of your thyroid and adrenal glands. Most people can handle these changes without any issues, but there are a select few that may struggle to adapt without increasing their carb intake.
Your kidneys flushing out all that water is also part of the reason people see dramatic scale drops in the beginning of their keto journeys. "I wish people knew that the weight loss they will initially experience on this diet is largely due to water loss," Brown says. That means you're most likely not actually losing fat in the first couple of weeks, but instead losing water that will come back in the form of glycogen stores if and when you start eating carbs again. (BTW, Here's How to Safely and Effectively Come Off the Keto Diet.)
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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.
Where is the science? And if insolin intolerance is a diabetic problem why keep trying to regulate insolin? The stuff isn’t working because your patients are not getting better just deteriorating slower while you make more money keeping them on drugs!!!!! Your hole point is ketosis is bad cause they don’t have to see you after they adjust off the medication that keeps them having to see people like you!!! I have been eating keto for 6 months and feel amazing!!! These people are twisting the truth to keep you sick for there own pockets!!!!!!
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.
My son started the Keto Diet (not perfectly) with the ok of his Dr and a Different Oral Chemo at the same time. Last Tuesday an MRI indicated no new growth or no new tumors. We don’t know if the new Chemo, Keto diet, lots of prays or what has stopped the tumors from growing.I found your site after looking for possible adverse reactions to Keto Diets, and appreciate your research. His platelets are low now and never have been low before. This is stopping the next Chemo treatment. I understand that being on Chemo for 12 months could have created the low platelets and now the possibility that the Keto Diet could also be causing low platelets is frustrating. They will do a new blood test Tuesday to see if the platelets have increased. Any suggestions about how if possible to increase the platelets on the Keto Diet would be helpful.
Difficulty. Many experts question how long a person can realistically give up carbs. “This is a very restrictive diet that requires a drastic change in eating behaviors and even taste,” says Sandra Arevalo, MPH, RDN, CDE, a certified diabetes educator and spokesperson for the Academy of Nutrition and Dietetics. “It isn’t very practical or easy to maintain, for people both with and without diabetes.” That’s not saying you can’t stick with it, but before you commit, make a plan and set measurable goals to help you stay on track. Being prepared with the right foods can also help. Urbanski recommends making a shopping list that focuses on a few basic keto-friendly meals and snacks, so you’ll always have the right foods on hand to ensure success.
People With a History of Eating Disorders Going on a strict diet that eliminates food groups could trigger a relapse if you have a personal history of having an eating disorder. And while there’s a growing popularity in treating binge eating disorder (BED) with keto, experts strongly advise against it. Treatment of BED requires regular, adequate food intake without restriction, says Sumner Brooks, MPH, RDN, a certified eating disorder dietitian in Portland, Oregon.
Examples include non-starchy fruits and vegetables such as leafy greens, mushrooms, bell peppers, and berries. The trace minerals and vitamins found in grains can also be obtained at higher percentages in good-quality meats and dairy products. Moreover, compounds such as phytates and tannins in grains hinder the bioavailability of several minerals.13
In the study, the researchers fed mice a ketogenic diet for several days and expected to find a favorable outcome — perhaps weight loss or another indication of improved health. Instead, they found that the liver began resisting insulin almost immediately and the mice were unable to regulate their blood sugar levels after only three days on the diet. (Insulin resistance, meaning that cells in the body don't respond to insulin, is a key characteristic of type 2 diabetes.)
What is the ketogenic diet exactly? The classic ketogenic diet is a very low-carb diet plan that was originally designed in the 1920s for patients with epilepsy by researchers working at Johns Hopkins Medical Center. Researchers found that fasting — avoiding consumption of all foods for a brief period of time (such as with intermittent fasting), including those that provide carbohydrates — helped reduce the amount of seizures patients suffered, in addition to having other positive effects on body fat, blood sugar, cholesterol and hunger levels. (1)
First – let’s admit that there are several different types of diets that produce dramatic improvements in weight loss and diabetes. The vegan diet is one of them (and one which also reduces risk in most other diseases better than the others) – but it is by unquestionably by far the very best diet for the environment and the survival of the planet. High protein (high meat and/or dairy) diets are absolutely TERRIBLE for the environment and are not sustainable in any way. A vegetable diet will END world hunger because we DO have enough earth to grow enough vegetables for everyone and we definitely do NOT have enough earth for meat eaters even at current levels.
People With a History of Eating Disorders Going on a strict diet that eliminates food groups could trigger a relapse if you have a personal history of having an eating disorder. And while there’s a growing popularity in treating binge eating disorder (BED) with keto, experts strongly advise against it. Treatment of BED requires regular, adequate food intake without restriction, says Sumner Brooks, MPH, RDN, a certified eating disorder dietitian in Portland, Oregon.
If you're healthy and eating a balanced diet, your body controls how much fat it burns, and you don't normally make or use ketones. But when you cut way back on your calories or carbs, your body will switch to ketosis for energy. It can also happen after exercising for a long time and during pregnancy. For people with uncontrolled diabetes, ketosis is a sign of not using enough insulin.
At the core of the classic keto diet is severely restricting intake of all or most foods with sugar and starch (carbohydrates). These foods are broken down into sugar (insulin and glucose) in our blood once we eat them, and if these levels become too high, extra calories are much more easily stored as body fat and results in unwanted weight gain. However, when glucose levels are cut off due to low-carb intake, the body starts to burn fat instead and produces ketones that can be measured in the blood (using urine strips, for example).
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.
On a “strict” (standard) keto diet, fats typically provides about 70 percent to 80 percent of total daily calories, protein about 15 percent to 20 percent, and carbohydrates just around 5 percent. However, a more “moderate” approach to the keto diet is also a good option for many people that can allow for an easier transition into very low-carb eating and more flexibility (more on these types of plans below).
Carbohydrate facts: Simple = bad, complex = good? Carbohydrates provide energy for the body, but the health benefits they offer depend on the type of carbs we consume. Complex carbs, found in brown rice, for example, contain more nutrients than simple carbs, such as white rice. Refined carbs, such as sugary drinks, are best avoided, as their nutritional value is low. Read now
Even if you don't have a history with eating disorders, keto can still leave some people (although certainly not everyone!) with negative feelings around food. "For the vast majority of people, keto is not sustainable, meaning they don't stick with it for more than a few months," Brown says. "Not 'succeeding' with this diet and returning to one's usual eating habits can trigger feelings of guilt and failure." Those two feelings can actually trigger disordered eating in some people in the worst-case scenario, says Brown. (Also, We Seriously Need to Stop Thinking of Foods As "Good" and "Bad")
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. 

It should be noted that the concept that fat can be eaten ad libitum and still induce weight loss in obese subjects is not a recent one (13–33). Ketosis occurs as a result of the change in the body’s fuel from carbohydrate to fat. Incomplete oxidation of fatty acids by the liver results in the accumulation of ketone bodies in the body. A ketogenic diet maintains the body in a state of ketosis, which is characterized by an elevation of D-b-hydroxybutyrate and acetoacetate.

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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. 

Has adding more water, salt and fat not helped very much? Are you still feeling achy, tired and off? We recommend you try to endure it for a few more days until the symptoms pass. Research has shown that a very-low-carb diet is best for weight loss and metabolic issues like type 2 diabetes.Keto flu symptoms are only temporary – they’ll be long gone when you are a fat burner.
In general, men tend to do better on a long term ketogenic diet than women do. From my own research and experimentation, women can follow a keto diet, but with some adaptions. Most women will do well with a cyclical ketogenic diet when they stay on ketogenic diet most of the time and eat starchy carbohydrates occasionally to spike calories and carbs.
The main role of the gallbladder is to store bile (which is made in the liver), and in turn, the role of bile is to digest fat. People assume eating a lot of fat is somehow linked to an increased risk of gallstones, which are solid deposits of cholesterol and bile that can form in the gallbladder. But most of the cholesterol in the bloodstream is made inside the body (as part of a tightly regulated process inside the liver), not derived from the diet.

In addition, as the Harvard School of Public Health points out, “Carbohydrate metabolism plays a huge role in the development of type 2 diabetes, which occurs when the body can’t make enough insulin or can’t properly use the insulin it makes.” When a food containing carbohydrates is eaten, the digestive system has to process these carbs and turns them into sugar which then goes into the bloodstream. The ketogenic diet majorly minimizes carbohydrate intake so prediabetics, as well as type 1 and type 2 diabetics, aren’t challenging their bodies with carbohydrate breakdown that can raise blood sugar levels and create problematic insulin demands for the body.


Type 1 diabetes causes the same blood sugar control issues as type 2 diabetes, but in an entirely different way. Type 1 diabetics cannot produce enough insulin or any insulin at all, which requires them to have insulin administered exogenously. On top of that, the perfect diet will not be able to reverse this disease as the ketogenic diet can for type 2 diabetes.
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.
As someone who is prediabetic, Keto has been a godsend! I thought I was just a glutton, but now I’m certain I am actually insulin resistant. I am on Keto and can manage half a cup of blackberries without coming out of ketosis, but almost any other carb/sugar and I become a mindless food consuming zombie. I literally feel like I have zero control over my ability to stop eating. Also before trying Keto, if I was not able to eat constantly throughout the day I became grumpy and tired. Like none tired where it felt like I had lead running through my veins. On Keto, I can go a good 5-7 hours without eating and I don’t feel off at all. I am hoping to lose weight, but mostly I do not want to become diabetic and my problem is that I am insulin resistant. I do plan eventually to eat more black beans, vegetables and fruits again. Maybe a little chocolate on holidays and cake and ice cream on my

While these findings are preliminary, in one study of mice, the keto diet helped reduce anxiety. The research suggests this could be due to the protective brain benefits of intake of healthy fats and low levels of sugar. A follow-up study found that mice exposed to a ketogenic diet while in utero showed less susceptibility to anxiety and depression than mice born to mothers who were not on the keto diet. Here’s what it’s really like to follow the keto diet.
“Rapid, significant weight loss is a common side effect of the keto diet because of the water losses that occur as carbohydrate stores are depleted,” says Clark. In a study in the American Journal of Clinical Nutrition, obese men following a modified version of the ketogenic diet, with high protein and low carbs, lost about 14 pounds in one month, compared with the control group, which lost about 10 pounds on a high-protein, medium-carb diet.

Lele says that it’s important to remember that, while keto is a “high fat” diet, the goal is to use your body fat as an energy source, not the fat that’s on your plate. “You don’t need to necessarily add more fats to your diet to adhere to keto. For instance, if your dinner consists of avocado, bacon, and eggs, you really don’t need to add butter to that to make it ‘more keto’,” she says.

I can buy clothes off the rack. Better than being obese. My brain is sharper. I get more stuff done. I don’t sit around. I feel like I can feel the fat melting off. I have trouble sometimes eating enough. After 40 years if being very obese on and off, I think I am better off. I hope to use it when I need it after I reach my goal. The blood tests will prove it.


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.
Other potential risks include kidney stones, several vitamin and mineral deficiencies, decreased bone mineral density, and gastrointestinal distress. (7) Here’s why: When you’re eliminating certain food groups (like fruits, legumes, and whole grains) and severely limiting others (like many vegetables), it’s not uncommon to experience nutritional deficiencies. A lack of fiber, for instance, can make it more likely you’ll experience constipation.

Yancy has seen similar results in his practice. “Carbohydrate intake is the main driver of blood sugar. So if you’re able to lower blood sugar by reducing carbohydrate intake, then you may be able to reduce diabetes medication,” he says. “We’ve seen people come off of hundreds of units of insulin just by changing the way they eat, and that can happen really quickly, in just a few weeks.” 

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.
Diabetes is actually a metabolic problem. It’s characterized by the hormone insulin no longer exerting its important actions appropriately. Your cells and tissues don’t ‘hear it knocking’ so to speak. So you produce more and more insulin, which eventually fatigues your pancreas. This deluge of insulin (hyperinsulinemia) you now find yourself bathing in also causes your fat stores to release fat inappropriately. This ultimately swamps your liver with excess fat (energy). To reduce the excess energy, your liver handles starts frantically producing and pumping out lots of blood glucose. This task (gluconeogenesis) is costly and momentarily solves your liver’s crisis of energy excess. The longer-term cost however are serious consequences like high blood sugars, unstable energy levels, damaged tissues (via glycation and ROS), neurodegeneration and worse body composition (with fat usually stored in the wrong places), etc.
Oh how I miss you, delicious high-fat smoothie 😫 🌿🌱🍃Day 15 on carnivore and I am feeling quite amazing though! 🥩 ~ UPDATE: I don’t have “recipes” I make food to taste but if I recall this was something like: -a handful of blueberries -half a carton of coconut milk -macadamia nuts -a couple glugs of @perfectketones MCT oil -some chunks of cacao butter -some chunks of coconut butter -half avocado -spinach, kale, cabbage -some ice and maybe a little water to get consistency right MUST use a badass blender (I use blendtec) -toppings: you can see them. Put what you like to eat on top.
But there is evidence that low-carb diets may increase metabolism, according to a paper published November 14 in BMJ. Researchers found that overweight adults who lowered carbohydrates and added more fat into their diets burned about 250 calories more each day than people on high-carb, low-fat diets. The study is impressive because it's the largest, most expensive, and controlled study of its kind.
You’re transitioning. Your body is equipped to process a high intake of carbs and a lower intake of fat. Your body needs to create enzymes to be able to do this. In the transitional period, the brain may run low on energy which can lead to grogginess, nausea, and headaches. If you’re having a large problem with this, you can choose to reduce carb intake gradually.
Great article Doc! Question: One of the world top experts in high fat low carb diet, Dr Tim Noakes has stated that top level athletes actually perform better on keto, as himself an extreme marathoner , cured his type 2 diabetes by going keto. In the light of what we know today about keto, would you still assert that athletes shouldn’t adopt ketosis as their desired state?

It is important to understand that the statement that carbohydrates are “nonessential” is not only factually inaccurate, it results in adopting a low-carbohydrate diet or ketogenic diet that increases your risk for a wide variety of chronic health conditions that may ultimately shorten lifespan, decrease your quality of life, and accelerate your risk for chronic disease.


I think what bothered me most about the article was the way in which the writer has put her own fears about living without cake onto the shoulders of any diabetic she might treat. In the same way an epileptic might choose a life without cake in order to remain seizure free I choose a life without cake to remain “undiabetic”. I must admit that when I was researching this diet I did worry that I would not have the stamina, but the thought of going blind is a useful motivator.

Hello Dr. Jockers, in the past few months I have been working on cleaning up my diet. Eating gluten & dairy free as much as possible. I started taking exogenous ketones at the same time. I got a juicer for Christmas and about 3 weeks ago I added celery juice ( 1st thing in the AM) and a carrot, apple, turmeric juice in the afternoon. Some days I am fine and other days I have sudden diarrhea within an hour of drinking the celery juice. I’ve read so much about the benefits of drinking it but am wondering if the ketones are reacting to it adversely? Please let me know your thoughts on this.

This was a great read. I aim to restrict carbs always because I believe most are why the American population is obese. I would very much like to hear more about carb restriction excluding the discussion on processed meats and processed high salt content foods because I consume neither. I also don’t consume dairy or eggs. So can you provide some substance.
If not treated or reversed, dehydration can lead to acute kidney injury, Dr. Rahnama says. That’s not the only way the keto diet can put your kidneys at risk, however. “Kidney stones or damage to the kidney may also be a side effect,” Grace Derocha, RD, a certified diabetes educator and certified health coach at Blue Cross Blue Shield of Michigan says. High levels of nitrogen created by excess protein can also increase pressure in your kidneys. This can lead to the formation of more stones and damage your kidney cells.
Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...
A study published in the American Journal of Clinical Nutrition established that a low-carb approach is far more useful for weight loss than a high-protein diet which is also rich in carbohydrates. Moreover, a study developed in 2013 outlined that the ketogenic eating plan annihilates the function of the hunger hormones much more efficiently than other diets.
Type 1 diabetes causes the same blood sugar control issues as type 2 diabetes, but in an entirely different way. Type 1 diabetics cannot produce enough insulin or any insulin at all, which requires them to have insulin administered exogenously. On top of that, the perfect diet will not be able to reverse this disease as the ketogenic diet can for type 2 diabetes. 

"Many of the richest sources of fiber, like beans, fruit, and whole grains are restricted on the ketogenic diet," registered dietician Edwina Clark told Everyday Health. "As a result, ketogenic eaters miss out on the benefits of fiber-rich diet such as regular laxation and microbiome support. The microbiome has been implicated in everything from immune function to mental health." 
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