Thank you for your wonderful comments Marcia. To share more about me personally with you all…I am not a completely non-diabetic Certified Diabetes Educator. I found out I had Prediabetes 15 years ago when I became a Diabetes Educator. I tested my own A1c and found it was 5.8%. The incredible news? There have been years when my A1c dropped to a normal level of 5.4%…out of the prediabetes range. My last A1c in May was 5.8%, so I still have Prediabetes 15 years later, but not diabetes, and without any medication, just the sensible diet I’ve discussed and exercise, so I really am living with this. I feel it everyday, I wonder what my A1c is going to be just like you every 6 months when I go to have it drawn.
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.”
Studies suggest that the KD helps improve metabolic health markers in several ways: the diet tends to reduce overall caloric intake, increases satiety (fullness after eating), may increase the thermal effect of eating (calories we burn digesting food) due to higher protein intake, and increases gluconeogenesis, which is increased with carbohydrate restriction and is energy demanding.
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.

To say that the keto diet has become one of the most popular diets of recent years is a complete understatement. Case in point: There are more than one million searches on Google every month for the keto diet. It’s unique because the fad diet has captured the interest of people who want to lose weight — and there’s no shortage of reported success stories to be found.
I won’t comment on the diet itself but dietitians do not simply rely on guidelines handed to them, nor on anecdotal cases. This article refers to specific studies all throughout, some that support the diet and others that don’t. The goal of a dietitian is to help clients reach their optimal health while still enjoying a high quality of life. I’m sure Abbey is genuinely happy for those it has helped. That does not mean this diet is best for everyone regardless of their unique circumstances, goals and medical history. Sadly there is not enough high quality research that Keto promotes sustained weight loss in the general population. Maybe there will be in the near future, but right now it would be unethical to recommend such a restrictive diet to the broad audience of a blog. I am truly happy it has worked for some people and I wish them luck on their journey. Thank you Abbey for a great article!

Keto is often suggested for children who suffer from certain disorders (like Lennox-Gastaut syndrome or Rett syndrome) and don’t respond to seizure medication, according to the Epilepsy Foundation. (1) They note that keto can decrease the number of seizures these children have by half, with 10 to 15 percent becoming seizure-free. In other cases, it may also help patients reduce the dose of their medication.
Weight loss is the primary reason my patients use the ketogenic diet. Previous research shows good evidence of a faster weight loss when patients go on a ketogenic or very low carbohydrate diet compared to participants on a more traditional low-fat diet, or even a Mediterranean diet. However, that difference in weight loss seems to disappear over time.

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.
The modified ketogenic diet emerged in the late nineties as a re-work of the original ketogenic diet. The original ketogenic diet was inspired by the Atkins diet of the early to mid-nineties that saw practitioners eliminate any form of carbohydrates from their food intake. These practitioners relied solely on fat and protein as their macro nutrients.
Studies suggest that the KD helps improve metabolic health markers in several ways: the diet tends to reduce overall caloric intake, increases satiety (fullness after eating), may increase the thermal effect of eating (calories we burn digesting food) due to higher protein intake, and increases gluconeogenesis, which is increased with carbohydrate restriction and is energy demanding.
🙌🙌 thank you for some great info! USC just had an article about Keto, saying they don’t know the impact on bone health. So I’m not sure why all these articles are written without the documentation to prove the claims. We all know too much calcium supplementation can cause problems but every Dr wants you to supplement calcium. Most people could do a lot worse than doing Keto! The SAD will cause more problems for you than eating whole, unprocessed Keto food! Sugar seems to be the real issue along with aspartame and stressful living.
Carbohydrates: Historically, a targeted keto diet consists of limiting carbohydrate intake to just 20–30 net grams per day. “Net carbs” is the amount of carbs remaining once dietary fiber is taken into account. Because fiber is indigestible once eaten, most people don’t count grams of fiber toward their daily carb allotment. In other words, total carbs – grams of fiber = net carbs. That’s the carb counts that matter most.
Like the stress response, ketosis is a natural, physiological adaptation designed for short-term responses. In other words, an acute stress response to some danger or threat that involves increased adrenaline and cortisol release, increased heart rate and blood pressure, and heightened alertness is normal and can even save your life. But, if the stress response becomes chronic, as it may with divorce, prolonged caretaking of an impaired child or demented adult, PTSD, financial struggles, etc., then the stress response can have terrible health implications that include increased risk for Alzheimer’s dementia, heart disease, dysbiosis, inflammation, diabetes, and cancer. The same applies to ketosis: Acutely, ketosis is a normal physiological adaptation that serves us during periods of carbohydrate or calorie deprivation. Chronically, however, peculiar things happen with consequences that range from constipation, to selenium deficiency and cardiomyopathies, to colon cancer.
The modified ketogenic diet emerged in the late nineties as a re-work of the original ketogenic diet. The original ketogenic diet was inspired by the Atkins diet of the early to mid-nineties that saw practitioners eliminate any form of carbohydrates from their food intake. These practitioners relied solely on fat and protein as their macro nutrients.
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.
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.
One of the most-cited worries about the keto diet is the long-term impact it may have on heart health—especially because people with diabetes are at greater risk for heart disease. In the small Diabetic Medicine study that found people with type 1 improved their A1Cs on a keto diet, participants had higher triglycerides and LDL (“bad”) cholesterol. This raises concerns about the diet’s longer-term heart health implications, as do the results of research published last year in The Lancet. That study followed more than 15,000 adults for 25 years and found that people who consumed less than 40 percent of their calories from carbohydrates were significantly more likely to die from heart disease than those whose diets contained 50 to 55 percent of calories from carbs—especially if the foods that replaced those carbs were rich in animal fats and proteins.

Reduces mitochondrial free radial production, which decreases oxidative stress. Research demonstrates that the ketogenic diet reduces free radical levels in the brain. Furthermore, studies in cardiac tissue have suggested that ketones reduce oxidative stress, a pathogenic process implicated in many disorders ranging from atherosclerosis (plaque in the arteries) to other diseases more specific to the nervous system.
It is important to point out however, that type 2 diabetes also improves during any form of caloric restriction and it is likely that a keto diet is not unique in that aspect, rather it is causing a caloric deficit by severely restricting carbohydrate intake. We have helped numerous clients lose fat while on a moderate carb intake in a caloric deficit.

The ketogenic diet is a high-fat, very-low-carb diet plan. The goal of the diet is to reach a “ketosis” state. The more restrictive you are on your carbohydrates (less than 15g per day), the faster you will enter ketosis. Once in this state, rapid weight loss begins. Research does indicate that the ketogenic diet is most effective in weight loss by reducing visceral (body) fat.
Hi . I have hypothyroidism for too long i have tried every pill out there even the saxenda injections nothing worked to get my fat reduced .would these pills actually do something with this condition or i should not get my hopes up? Just for you to know i am waiting for my order to come havent got it yet but i want to know if it will work with my condition or no so i dont have high expectations and at the end i get depressed
Reduce daily net carb intake to less than 20 grams: Although it’s possible that you may not need to be this strict, eating fewer than 20 grams of net carbs every day virtually guarantees that you’ll achieve nutritional ketosis. What does 20 grams of carb look like? Use our visual guide to find out, or simply try our keto recipes and meal plans that limit carbs to less than 20 grams per day.
They focus on what to eat instead of what not to eat, according to Dr. J. Michael Gonzalez-Campoy, medical director and CEO of the Minnesota Center for Obesity, Metabolism, and Endocrinology, who worked on healthy eating guidelines with the American Association of Clinical Endocrinologists, the American College of Endocrinology, and The Obesity Society.
In a study of 51 obese people using an extremely low fat low calorie diet (just one gram of fat a day!) the gallbladder was examined by ultrasound before the diet and after one and two months. After one month four of the 51 participants had developed new gallstones. After two months more than one in four (13 people) had new gallstones! This on an almost fat free diet. Three participants needed to have their gallbladder removed during the study.
Heart disease. The connection between the ketogenic diet and cardiovascular disease risk factors is complicated. Many studies have found that the keto diet can lead to significant reductions in total cholesterol, increases in HDL cholesterol levels, decreases in triglycerides levels, and reductions in LDL cholesterol levels, as well as potential improvements in blood pressure levels.
You work out for a few months and get in shape and fall back to the old habits because you were not conditioned mentally, only physically. Physical fitness is only a part of journey, fitness is over 75% percent mental. Gyms, nutritionists, and personal trainers give most people a temporary Band-Aid but never address the actual issue. The 3-Week Ketogenic Diet includes secret mindset strategies to make your journey so much easier.
It sounds as if you may have been following a very strict keto protocol. I’m not, and have not followed a ketogenic diet, but am interested in it. I’ve been reading up on it a bit on the blog called Mark’s Daily Apple.* I’ve been following it for several years now, even before Mark tried keto. Based on some of his blog post, both keto related and otherwise, it seems that women do better with slightly more carbs than men. He’s written several blog post specifically for women, including one called 7 Keto Tips for Women, which you may want to read. https://www.marksdailyapple.com/7-keto-tips-for-women/ Then there is this one Where I Part Ways with the Popular Keto Movement https://www.marksdailyapple.com/where-i-part-ways-with-the-popular-keto-movement/ Perhaps the problem wasn’t the keto diet in and of itself, but that you went too low carb for you. It’s worth considering. I’ve also found this site to be pretty interesting https://peterattiamd.com/ Here’s a link to his section on keto https://peterattiamd.com/category/ketosis/ He followed a ketogenic diet for a number of years, though as of 2016 was no longer ketogenic, but definitely eating lower carb than most. (That is under Articles, on the drop down menu, click on Personal.)
I have enough carbs in a day for all my needs. Just eating proteins alone raise the insuline level, enough for muscles preservation. And I top it with vegetables. I have more than enough. I just to be clear, I don’t think the human body is dumb enough to burn a lot of muscles when you have 100 pounds of stored fat. Why the body don’t store proteins, if it prefers that? Modern nutrition take our body – and us – for fools!
Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more

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!


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.
Diabetes, whether type 1 or 2, are diseases extremely susceptible to the therapeutic level effects of diets that lower insulin. If those diets are also nutrient dense, evolutionarily matched to humans and produce a more generally preferable shift in metabolism, then all the better. This sort of dietary treatment for diabetes holds great promise in their potential for helping out in other diseases like cancer, Parkinson’s and Alzheimer’s disease.

In a survey of both children and adults, researchers found that a very low carbohydrate diet promotes “exceptional glycemic control” in those with type 1 diabetes mellitus. When it comes to type 2 diabetes, the Journal of American Medical Association recently published a review examining the effective use of the ketogenic diet in those with type 2 diabetes.


Type 1 diabetes is not caused by insulin resistance, but it still makes sense to lower the need for insulin. Because type 1 diabetics hardly produce any insulin, they rely on external insulin when following a standard high-carb diet. Through carb restriction, a ketogenic diet decreases the need for insulin. In some type 1 diabetics, their insulin production is sufficient when following a ketogenic diet. Others still need to inject insulin, but much less than on a high-carb diet. Overall, it is much easier to control blood sugar levels with injected insulin on a ketogenic diet because blood glucose raises only mildly after meals.
As per heartburn, studies done have shown that a ketogenic diet can have beneficial effects for those who have Non Alcoholic Fatty Liver Disease. A 2006 paper published in the Journal of Digestive Diseases and Sciences found that ‘Six months of a low-carbohydrate, ketogenic diet led to significant weight loss and histologic improvement of fatty liver disease’
The good news is, it is not necessary to stay on a ketogenic diet at all times to reap this benefit. Our ancestors went through fast and feast cycles and the body is designed for flexibility. We may be able to reduce cancer risk, prolong life, improve brain function, and benefit from ketosis otherwise by being in ketosis or fasting a few days a week.
Constipation is the rule–as virtual elimination of dietary carbohydrates also means virtual elimination of prebiotic fibers that nourish bowel flora. Over time, this leads to metabolic distortions including a drop in HDL cholesterol, rise in triglycerides, rise in small LDL particles that lead to heart disease, rise in insulin resistance and blood sugar, rise in blood pressure, even if these parameters initially improved on the diet. This is also due to dysbiosis and lack of prebiotic fibers. While this has not yet been tracked in children, in adults we can expect that these distortions in bowel flora will, over time, also lead to heightened inflammation (bowel and elsewhere), diverticular disease (.e.g., diverticulitis), and colorectal cancer. Yes: prolonged ketosis can add substantially to risk for colon cancer. Other peculiar gastrointestinal complications of prolonged ketosis have also been observed, such as protein-losing enteropathies.
Lorraine Turcotte,  a metabolism researcher at the USC Dornsife College of Letters, Arts and Sciences, said that although it’s less trendy, long-term healthy eating is the tried-and-true solution. She’s not sure why people prefer “difficult dietary manipulations than to say ‘I’m just going to eat moderately — a well balanced diet, lots of fruits and vegetables.’”

While there have not been large studies that show the relationship between the ketogenic diet and cancer, we will be publishing a case study about that topic. The author failed to comment that pediatric patients with epilepsy are on the diet for usually about 2 years with no harmful effects. Before the false studies about heart disease and fat, the low carb diet was a respected way to lose weight. Studies into our metabolism show we can use both fat and carbohydrate as fuel. So stepping away from our high carb diet- I am sorry to say that we eat more carbs since the 70s with most of it processed and we now use high fructose corn syrup to sweeten products and we have a wide spread childhood obesity problem. If cholesterol is a concern try plant sterols and stenals to block cholesterol from the receptors in the body. So much more can be said about a keto diet than this article states


Circulating ketone bodies make the blood too acidic, which will draw calcium from the bones as a buffer response. While there are relatively few studies on long-term (more than 6 months) effects of a non-therapeutic keto diet, studies of children on the diet show high calcium levels in the blood, increased bone demineralization and increased risk of kidney stones.


A related clinical diet for drug-resistant epilepsy is called the medium-chain triglyceride ketogenic diet, in which MCT oil is extensively used because it’s more ketogenic than long-chain triglycerides. (13) Another dietary therapy for epilepsy called Low Glycemic Index Treatment (LGIT) was developed in 2002 as an alternative to the keto diet. LGIT monitors the total amount of carbohydrates consumed daily, and focuses on carbohydrates that have a low glycemic index.) (14)
The keto diet can be an effective way to reduce excess body fat but there are several cons that should be noted by anyone wanting to follow this eating plan, says Ms. Zarabi says. In fact, the keto diet has serious risks. For one thing, it’s high in saturated fat, which has been linked to heart disease. Additionally, a nutrient deficiency and constipation could occur since the keto diet is very low in fibrous foods such as fruits, vegetables, and whole grains.
This concept was previously unthinkable as modern nutritional science was led to believe that the body’s metabolism relied on gluconeogenesis to create ATP as energy for the body’s metabolic processes. Glycogen derives from dietary carbohydrate intake, so by removing it from the diet, nutritionists expected devastating health results to emerge in practitioners of the diet.
Shifts in blood sugar levels. Most people will benefit from the blood sugar lowering effect of keto diets. However, for those who have type 2 diabetes, type 1 diabetes, and/or take blood sugar controlling medications, it is crucial to check with a doctor before cutting carbs. If this cautionary step is not taken, then people with these conditions will increase their risk of having dangerously low blood sugar levels when they start keto.
I can tell how passionate you are about this subject. As you can see on one of my reply’s above, CDE’s do not recommend the same number of carbs for every person we see; we use an individualized approach. It varies depending on the person’s height, bone structure/muscle mass, amount of weight they may need to lose (or gain) and the amount of exercise they may or may not do per day/week.
Thank you for your wonderful comments Marcia. To share more about me personally with you all…I am not a completely non-diabetic Certified Diabetes Educator. I found out I had Prediabetes 15 years ago when I became a Diabetes Educator. I tested my own A1c and found it was 5.8%. The incredible news? There have been years when my A1c dropped to a normal level of 5.4%…out of the prediabetes range. My last A1c in May was 5.8%, so I still have Prediabetes 15 years later, but not diabetes, and without any medication, just the sensible diet I’ve discussed and exercise, so I really am living with this. I feel it everyday, I wonder what my A1c is going to be just like you every 6 months when I go to have it drawn.
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
Several comprehensive studies and meta-analyses have demonstrated that after a few months or even a year of a low carb diet versus a moderate/high carb diet, there are no significant differences in the amount of weight lost (2,3,4,5).  I will say, however, most of these diets are NOT keto and are simply lower carb (i.e. 20%).  Also, long-term effects (beyond 1 year) are not often studied due to budgetary constraints, so interpret results as you wish.
Ketosis Isn’t Forever.  It’s recommended that you follow this diet to arrive at a state in which your body adapts to burning fat and glucose stores for fuel. Then you’ll want to take an occasional ketosis holiday, adding a serving of unprocessed, whole grains to allow your body to chance to work less hard. Staying in ketosis long-term—without breaks— can cause muscle aches, nausea, and fatigue.
The one important caveat: Eating keto also ups the risk for diabetic ketoacidosis, a life-threatening condition where fat gets broken down too fast and causes the blood to become acidic. It’s much more common in people with type 1 diabetes, but if you have type two and are eating keto, talk with your doctor about what you should be doing to diminish your risk.

This concept was previously unthinkable as modern nutritional science was led to believe that the body’s metabolism relied on gluconeogenesis to create ATP as energy for the body’s metabolic processes. Glycogen derives from dietary carbohydrate intake, so by removing it from the diet, nutritionists expected devastating health results to emerge in practitioners of the diet.


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.
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.
The keto diet is notorious for delivering a quick initial slim down. That’s because carbs hold on to more water than protein or fat, says Becky Kerkenbush, RD, a clinical dietitian at Watertown Regional Medical Center. So when you stop eating them, all that extra H2O gets released through urination. As a result, the scale might read a few pounds lower, and you may look a bit leaner.
 Ketones are a cellular “superfuel” and one in particular – beta-hydroxybutyrate (BHB) – drives powerful, beneficial processes. Beta-hydroxybutyrate is important for the regulation of important genes, inflammation regulation, immune system activity, and even antioxidant function. This important ketone is one of the fundamental reasons the keto diet is so beneficial.
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
Nine healthy young males participated in this study, which appears in the journal Nutrients. The researchers asked them to follow a 7-day high fat, low-carbohydrate diet that was similar to the keto diet, consisting of 70 percent fat, 10 percent carbohydrates, and 20 percent protein. They also had to consume a 75-gram glucose drink before and after the diet.
In summary, the LCKD had positive effects on body weight, waist measurement, serum triglycerides, and glycemic control in a cohort of 21 participants with type 2 diabetes. Most impressive is that improvement in hemoglobin A1c was observed despite a small sample size and short duration of follow-up, and this improvement in glycemic control occurred while diabetes medications were reduced substantially in many participants. Future research must further examine the optimal medication adjustments, particularly for diabetes and diuretic agents, in order to avoid possible complications of hypoglycemia and dehydration. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.
In the absence of glucose, which is normally used by cells as a quick source of energy, the body starts to burn fat and produces ketone bodies instead (it’s why the keto diet is often referred to as the ketone diet). Once ketone levels in the blood rise to a certain point, you enter into a state of ketosis — which usually results in quick and consistent weight loss until you reach a healthy, stable body weight. See this keto diet review, a before and after trying keto for 30 days.

Make sure you consult with your doctor and track relevant biomarkers before you start the ketogenic diet. This is a big adjustment for your body and your life, so do not take it lightly. If you follow our beginner’s guide, join the Ruled.me community, and have check-ups with your doctor, then you will be able to get all the benefits of the ketogenic diet and take your health back.

Other experts say the long-term accumulation of ketones could be harmful. “Those ketones are emergency fuel sources, and we’re not meant to run on them long-term,” says Kristen Kizer, a registered dietitian at Houston Methodist Hospital. “Ketones are negatively-charged molecules, which means they’re acidic. When you build up ketone bodies in your system, you’re building up acid. One of the ways your body buffers acid is by pulling calcium from your bones.” Kizer also notes that the diet isn't very balanced and involves a very high intake of animal products, which generally do not protect against cancer, diabetes, or other diseases.
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.
Although fat is the centerpiece of any keto diet, that doesn't mean you should be subsisting on butter-topped steaks, says Kristen Mancinelli, RD, author of The Ketogenic Diet. “A big misconception is that you should just put meat at the center of your plate and add more fat on top,” she says. You also shouldn't be relying on fatty meats to hit your fat quota, she adds.

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.


I have enough carbs in a day for all my needs. Just eating proteins alone raise the insuline level, enough for muscles preservation. And I top it with vegetables. I have more than enough. I just to be clear, I don’t think the human body is dumb enough to burn a lot of muscles when you have 100 pounds of stored fat. Why the body don’t store proteins, if it prefers that? Modern nutrition take our body – and us – for fools!
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.
Participants returned every other week for 16 weeks for further diet counseling and medication adjustment. When a participant neared half the weight loss goal or experienced cravings, he or she was advised to increase carbohydrate intake by approximately 5 g per day each week as long as weight loss continued. Participants could choose 5 g carbohydrate portions from one of the following foods each week: salad vegetables, low-carbohydrate vegetables, hard or soft cheese, nuts, or low-carbohydrate snacks. Diabetes medication adjustment was based on twice daily glucometer readings and hypoglycemic episodes, while diuretic and other anti-hypertensive medication adjustments were based on orthostatic symptoms, blood pressure, and lower extremity edema.

To be clear, most of the hype you’ll hear about how the ketogenic diet can ward off cancer is taking things too far. While there is a fair amount of research regarding cancer, studies have been limited to animals. One review published in Redox Biology highlighted some of them, indicating promising results for colon, gastric, and prostate cancers. Maybe more interesting are the few case studies involving human subjects. Bear in mind, we’re talking about a handful of people. In these cases, implementing a ketogenic diet seemed to halt disease progression.
It wasn’t until my waist started pushing 35 inches that I decided I needed to do something. That something just happened to be a slight change in life style. I gave up eating processed carbs, i.e. cereals, bread, rice, pasta, pizza, beer (yes pizza And Beer!), and continued eating such things as meat, nuts, cheese, vegetables. Foregoing the processed carbs is really not that much of a loss when you consider the benefits. The impact of processed food industry didn’t hit America til the early part of the 20th century. And I dare say that it had anything to do with increasing longevity. I’ve been living a ketogenic life style for about six months and plan to continue. But for those of you thinking that its a quick fix, I’m inclined to say that, in my case, your wrong. This wasn’t exactly quick a fix. It took all of those six months to reduce my waist size to a leaner 33 inches. I’d like to think that I’m not done yet. I drink half my body weight in ounces of water (nothing to do with the ketogenic life style, but thought i’d mention it). I’m far from hungry, don’t see a down side to this, and I’m looking forward to my yearly physical and blood work results. I’m glad that I stepped outside the normal dieters box.
My biggest beef with this diet is that it focuses on how much and what you can eat and less about the quality of the food you eat. A recent 2018 study found that people who focused on eating plenty of vegetables and whole foods and less on counting calories and limiting food groups, lost a significant amount of weight over the course of a year. This continues to echo the notion that the key to successful weight loss is diet QUALITY and not QUANTITY. And now, there’s research that actually supports that!

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If you’re a part of our community on Facebook, you may remember seeing a study I recently posted regarding the long-term impacts of the ketogenic diet in a study of obese patients. The study, available thanks to the US National Library of Medicine and the NIH, had some very interesting findings on the impact of diet on brain and body health, and my post on the subject saw a lot of traction. Because of that, and because the findings have such importance, I wanted to share the research with you here. The study shows that the ketogenic diet has efficacy as a treatment for Alzheimer’s, epilepsy, depression, migraines, and many other illnesses that plague huge portions of our population. I encourage you to read this study and to learn more.
The following measurements were made every other week: anthropometric and vital sign measurements; urine testing for ketones; and assessment for hypoglycemic episodes and other symptomatic side effects. Weight was measured on a standardized digital scale while the participant was wearing light clothes and shoes were removed. Skinfold thickness was measured at 4 sites – the average of 2 measurements at each site was entered into an equation to calculate percent body fat [12]. Waist circumference was measured at the midpoint between the inferior rib and the iliac crest using an inelastic tape; 2 measurements were averaged in the analysis. Blood pressure and heart rate were measured after the participant had been seated quietly without talking for 3 minutes. Certified laboratory technicians assessed urine ketones from a fresh specimen using the following semi-quantitative scale: none, trace (up to 0.9 mmol/L [5 mg/dL]), small (0.9–6.9 mmol/L [5–40 mg/dL]), moderate (6.9–13.8 mmol/L [40–80 mg/dL]), large80 (13.8–27.5 mmol/L [80–160 mg/dL]), large160 (>27.5 mmol/L [160 mg/dL]). Hypoglycemic episodes and symptomatic side effects were assessed by direct questioning of the participant and by self-administered questionnaires.

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.


Fat accumulation in the liver is commonly associated with prediabetes and type 2 diabetes. In serious cases, fatty liver disease can damage the liver. Doctors test for the condition by measuring levels of liver enzymes using blood tests. “These enzymes were significantly reduced after one year in the clinical patients, indicating less risk of developing fatty liver disease,” Dr. Phinney says of the diabetes study. If you’ve been told you’re at risk for fatty liver, you may want to give this diet plan a try. Before you embark on any new eating plan, arm yourself with knowledge. You’ll want to read this: 11 hidden dangers of the keto diet.
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.
“These diets are so unsustainable and in the long term, just not worth it!” Most definitely in your opinion. I did a LOT of research on Keto before I started it in 2009. I lost 130lbs. It’s not a diet, it’s changing the way you think about food and fuel for your body. And once you do that you understand food freedom. I eat mostly Keto but if I want a beer and a piece of Watermelon I will let myself have one. True it’s not for everyone, not everyone has the willpower to control what they put in their mouth. We tend to reward ourselves with food instead of using it what its for, nourishment and fuel. It’s why our country is dying of obesity. Awesome that a size 10 women can put what she wants in her mouth everyday, exercise, and it not affect her weight but guess what, you are becoming the minority.
The weight and body mass index of the patients decreased significantly (P<0.0001). The level of total cholesterol decreased from week 1 to week 24. HDL cholesterol levels significantly increased, whereas LDL cholesterol levels significantly decreased after treatment. The level of triglycerides decreased significantly following 24 weeks of treatment. The level of blood glucose significantly decreased. The changes in the level of urea and creatinine were not statistically significant.
It’s important to note, however, that most of the research is being done on diseases and disorders, not specifically weight loss. That doesn’t mean there hasn’t been evidence of weight loss as a benefit of the eating pattern, just that the studies performed specifically for the benefits for long-term weight loss are limited. There’s anecdotal evidence out there, of course, but there was evidence of weight loss associated with a low-fat diet in the '90s… until that farce came falling down around our collective shoulders as the long-term evidence came rolling in to the contrary.
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.
We all have different meanings for “quality of life” for me it means feeling good, with energy, no bloating, no heartburn, on my weight, normal glucose levels… for you it means having “white stuff” to eat, enjoy it while you eat it and then feeling bad about it, ’cause if you’re a diabetes educator you know (or at least you should) the harm it does to your body! I’m glad no one believed this biased article! It means everyone out there know what is real and what is not…
Unfortunately, there’s no long-term data on ketogenic diets versus other diets. In a 2015 Italian study, those on a ketosis diet lost 26 pounds in three months. About half of the participants stayed on the diet for a year but lost little additional weight in the next nine months. People in a 2014 Spanish study who followed a very-low-calorie ketogenic diet lost an average of 44 pounds in a year—but a third of them dropped out, possibly because it was too hard to maintain.
Skin conditions like eczema, acne, and psoriasis are often rooted in chronic inflammation or autoimmunity. Often, inflammatory processes unnecessarily attack different structures of the skin which results in various conditions. For example, acne is associated with inflammation of the sebaceous glands in the skin whereas eczema is generalized inflammation of the skin cells.
High-protein ketogenic diet (HPKD): This version of the keto diet is often followed by folks who want to preserve their muscle mass like bodybuilders and older people. Rather than protein making up 20 percent of the diet, here it’s 30 percent. Meanwhile, fat goes down to 65 percent of the diet and carbs stay at 5 percent. (Caution: folks with kidney issues shouldn’t up their protein too much.)
Dr. Reynolds reviewed numerous research studies on ketogenic diets,6 and he has found that most studies show that the drop in blood sugar is typically short-term—only lasting during the initial three months or so—but does not last.  "So it is very hard to encourage ketogenic diets when we have no evidence that they work over longer periods of time," he tells EndocrineWeb.
Over the past century, ketogenic diets have also been used as natural remedies to treat and even help reverse neurological disorders and cognitive impairments, including epilepsy, Alzheimer’s symptoms, manic depression and anxiety. Research shows that cutting off glucose levels with a very low-carb diet makes your body produce ketones for fuel. This change can help to reverse neurological disorders and cognitive impairment, including inducing seizure control. The brain is able to use this alternative source of energy instead of the cellular energy pathways that aren’t functioning normally in patients with brain disorders.
The possible benefits of the diet are impressive, but there are a few potential downsides to note. One is it’s tough to stick to. In fact, in a review of 11 studies involving adults on the keto diet, which was published in January 2015 in the Journal of Clinical Neurology, researchers calculated a 45 percent compliance rate among participants following the approach with the aim of controlling epilepsy. (13) “The diet is pretty hard to follow because it’s a complete shift from what you’re used to,” Nisevich Bede says. Slashing your intake of carbs can also make you feel hungrier than usual — a feeling that can last until you’re three weeks in.
The relation between a high fat diet and cancer is not conclusive. Recent epidemiological studies (17,58–60) could not explain a specific causal relationship between dietary fat and cancer. It has been found that altered energy metabolism and substrate requirements of tumour cells provide a target for selective antineoplastic therapy. The supply of substrates for tumour energy metabolism can be reduced by dietary manipulation (eg, ketogenic diet) or by pharmacological means at the cellular level (eg, inhibitors of glycolysis or oxidative phosphorylation). Both of these techniques are nontoxic methods for controlling tumour growth in vivo (61). Sugar consumption is positively associated with cancer in humans and test animals (58–61). This observation is quite logical because tumours are known to be enormous sugar absorbers. It has also been found that the risk of breast cancer decreases with increases in total fat intake (16). Further studies on the role of a ketogenic diet in antineoplastic therapy are in progress in our laboratory.
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.”
After your body enters this carb-deficient state, it begins burning fat to provide energy, and this burning of fat causes a release of ketones. Ketones are dense sources of energy that can stimulate critical parts of the body, such as the brain. By drastically shifting your diet from carbohydrate dependence to fat dependence, you can enjoy a number of impressive health benefits, in addition to weight loss.
AND i’m losing weight! I’m losing about 1 lb per week and actually have the energy again to workout regularly. If you have diabetes, you know how fatiguing of a disease it can be. I feel less sluggish, more “awake”, just better in general, while restricting my carb intake. Yeah, I miss some fruits, but I sure as heck don’t miss what I felt like after eating them. Besides, berries are allowed on keto 🙂

These findings were confirmed in another interesting study. Researchers compared the effects of the low-carbohydrate diet to the effects of a combination of a low-fat diet and orlistat (a weight-loss and blood pressure lowering medication) on blood pressure. The researchers stated that the low-carbohydrate dietary intervention “was more effective for lowering blood pressure.”
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.
Nonetheless, Fung told Live Science that she thinks the study clearly demonstrates the potential for a ketogenic diet to have a detrimental effect in humans. And, until researchers better understand the risks of those detrimental effects, she suggested that people consider other ways of accomplishing their health goals, such as trying a less-restrictive diet.
The side effects of extreme low-carb diets are still a mystery. "The first major drawback is the fact that we really don't have any long-term research about how keto followers fare 10, 20, 30 years down the line," Turoff says. "What will the results look like? Will they regain the weight? Will they suffer health consequences? We also thought smoking and diet pills were a good idea, until long-term studies showed us that we were wrong."
“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.
Thank you Dr Jockers! I recently came across your website and i absolutely love what you do. I am an advanced practice nurse and just started a part time keto coaching practice.I am already amazed by the changes i see in my clients. Do you have by chance a training program for keto coaches. If not, is there one out there that you recommend? Thank you in advance.
Those issues can be part of what's known as the “keto flu,” Warren says. Other side effects of the keto diet, all of which are tied to carb withdrawal, can include lightheadedness, nausea, mental fog, cramps, and headaches, in addition to tiredness. Luckily, the keto flu doesn't usually last more than a week—which is coincidentally about when people start to see the number on the scale go down, says Warren.
In the first few days of the keto diet, it’s not uncommon for people to experience the “keto flu,” a brief period in which you may have headaches, fatigue, confusion, and nausea. These symptoms are a sign that your body is making the switch from burning glucose (sugar from carbs) for energy to burning fat—a process called ketosis. The changeover can leave you feeling depleted for a day or two, but once you break through to the fat-burning phase, you may find you have much more energy and greater endurance. “You are able to do more without hitting ‘the wall,’ says Carrie Burrows, PhD, a health and fitness expert. “When we use fat as fuel, our endurance improves and is more sustainable.” That extra energy will carry over to your workouts, Dr. Burrows says. Here are more things you need to know before starting the keto diet.

When we eat, we consume either protein, carbs, or fat. Carbs increase blood sugar levels. Protein and fat do not. So eating a low-carb diet IS healthy for diabetics because you eliminate a lot of what causes glucose to rise. I’m not referring to a no-carb way of eating, but a lower carb diet. I’m type 2 and have been eating keto for three weeks. My blood sugar levels are great. No swings — highs or super lows. I was injecting 60 units of insulin prior to each meal. Now I inject 5-10 units. I’m not losing weight, but I feel better and my sugar levels are under control. Most nutritionists and many doctors still haven’t caught up with the science. Low-carb/keto is the best way to eat for a diabetic.
He has been on keto diet for at least 3 years now. I think that he is some proof that yes, it does work. And it may be that some people do need keto. However, I don’t believe that everyone needs keto diet to get reversal. I have had reversal with regular ADA diet in my clinic. Not just a few! Many have reversed. However, I just want for keto dieters to find a clinical trial. We do need more information. We must understand what happens in the long term on keto diet. I personally did Atkins years ago, which was 20 grams. I had a very hard time to stay on it. I lost 20 pounds, and then I did gain it back. I just could not live without some more carbohydrates than this allowed. I don’t know about being on 60 to 70 carbs, and staying in ketosis. It seemed I was out of it at 22 carbs. Anyway, this was not for me. Maybe it is for you. No one is saying that one should never go on a keto diet, but we are wary of it. We need more science behind it. Therefore, I am just going to put this out here now. I will paste it down the page so that others may see it. They are taking participants. If you fit the criteria, please help us to get more than people’s opinion about this diet. Then we can be more positive about it, and recommend it if the science is there. Here is the link to the clinical trial. Thanks for your comments:
Note: Because you'll be excluding some major food groups on the keto diet (grains, many fruits) you should definitely think about taking a multivitamin—especially one that contains folic acid, which helps your body make new cells and is often found in enriched breads, cereals, and other grain products, says Julie Upton, R.D., cofounder of nutrition website Appetite for Health.

Look for natural sources of electrolytes or take an over-the-counter supplement. “Avocados, leafy greens, asparagus, and cruciferous veggies are great for providing important electrolytes, says Josh Axe, DNM, DC, CNS, a certified doctor of natural medicine and clinical nutritionist. Dr. Axe also suggests a magnesium supplement to help you sleep and avoid cramps or constipation.

Technically speaking, you're in ketosis when your blood ketones are higher than 0.5 mmol/L, but the optimal level for fat-burning purposes is 1.5 to 3 mmol/L. Nisevich Bede says that seasoned keto dieters report that they can actually feel a difference in this state, citing that they're less hungry and experience mental clarity once they reach ketosis.
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