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!
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.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
Although we love them to death, our Mom’s typically have zero authority on the subject.  When Mom heard you were going on a ketosis diet the first thing she did was head to google hell bent on finding any information about the dangers of the diet.  Sure enough, 10 pages into google she found what she was looking for… Never mind the first 9 pages filled with information about the safety and merits of the diet.
What about fruits and vegetables? All fruits are rich in carbs, but you can have certain fruits (usually berries) in small portions. Vegetables (also rich in carbs) are restricted to leafy greens (such as kale, Swiss chard, spinach), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber, celery, and summer squashes. A cup of chopped broccoli has about six carbs.
“If someone with diabetes is [taking insulin or oral type 2 meds in the sulfonylurea or meglitinide class and is] following this diet, they need to know that their blood sugar can drop really quickly, so it’s critical that they check it more frequently,” says Toby Smithson, MS, RDN, CDE, author of Diabetes Meal Planning & Nutrition for Dummies. “Don’t wait for it to happen. Meet with your doctor or diabetes educator in advance so that you can troubleshoot exactly what to do if your blood sugar drops.” If it’s an infrequent occurrence, you may be advised to treat with fast-acting glucose. But frequent lows may require medication adjustments or the addition of more carbs to your eating plan.
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.
Originally developed in 1924 to treat epilepsy, the ketogenic diet has most recently rose in popularity as the latest and greatest miracle weight-loss plan. Additionally, proponents of the ketogenic diet—or keto diet, as it’s commonly known—advertise health benefits ranging from glucose control to treatment of Alzheimer’s. But, what does the research really show?
Ketogenic diet for diabetics is a highly controversial topic, but we will break down everything here for you! As a Certified Diabetes Educator (CDE), I have to tell you from the start I will have a biased view here. Sorry, but I feel that I need to be completely honest right up front! I will however, present all the evidence that is available currently on the subject.
There are so many tricks, shortcuts, and gimmicks out there on achieving optimal ketosis – I’d suggest you don’t bother with any of that. Optimal ketosis can be accomplished through dietary nutrition alone (aka just eating food). You shouldn’t need a magic pill to do it. Just stay strict, remain vigilant, and be focused on recording what you eat (to make sure your carb and protein intake are correct).

Obesity is one of the principle risk factors for diabetes and following a ketogenic diet has been shown to help with weight loss. According to scientific article published in 2014, “A period of low carbohydrate ketogenic diet may help to control hunger and may improve fat oxidative metabolism and therefore reduce body weight.” Many prediabetics struggle with being overweight so a keto diet can help promote weight loss, which can help to decrease the chances of developing full blown diabetes.

The high-fat, very low-carb keto diet lets you enjoy lots of avocado, butter, bacon and cream—but requires cutting way back on added sugars, most processed foods, sweets, grains, and starchy veggies (whew). The eating plan is mega-popular among Hollywood A-listers (including Halle Berry, Megan Fox, and Gwyneth Paltrow); but if you don’t have a private chef who can futz with fats to make delicious meals and snacks, the carb-restricted lifestyle can be extremely challenging to follow. 
The benefits above are the most common ones. But there are others that are potentially even more surprising and – at least for some people – life changing. Did you know that a keto diet can help treat high blood pressure, may result in less acne, may help control migraine, might help with certain mental health issues and could have a few other potential benefits?
“When you start the keto diet, you lose sodium and other electrolytes in the urine due to reductions in insulin,” says Yawitz. “This is a major contributor to symptoms of keto flu.” So it’s important to replenish sodium through the diet, especially if you exercise or sweat a lot. “This can help ward off more serious side effects that are seen with long-term sodium deficiencies,” says Yawitz. These include lethargy and confusion — and in extreme cases, seizures, coma, and death, according to the Mayo Clinic.
I’m following the ketogenic diet and I find it very easy, pleasant and varied. I can even say that my diet today is more varied than the previous one. I do not intend to leave this diet and I cannot really see why. My initial focus was not to lose weight, I’ve always been lean, but to feel better, well disposed. And I got it! I am very pleased, I have read a lot about it (including scientific literature) and I have influenced other people who need to lose weight or improve some aspects of their health. But from the beginning I went on my own way, without the help of a nutritionist because I did not want to suffer the influence of others’ ideas.
On keto, I’ve adjusted my basal rates and I barely need to bolus at all. My blood glucose numbers have definitely improved and what I find really extraordinary is that I’m needing about 60% less total daily insulin, than I did before starting keto. What’s even more fascinating to me is seeing a steady straight line across my pump for 6, 12, and even 24 hours – no crazy spikes or dips in my blood sugar.
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.
Through experimentation, I have found that the best way to get into the metabolic state of ketosis is by starting off using a fairly high-fat intake with smaller amounts of protein. After your body gets into ketosis, the fat intake can be reduced and the protein intake can be increased. Keep in mind that keto-adapation takes about three weeks, so be patient!
We are brazilian, living in Brazil. My daughter, Isabel, 21y. o., born in 1996, has syndrome of deficiency of Glut1. She was diagnosed around her first year of life. At that time her baby bottle, her begining diet meal, was 50ml water plus 50ml oil plus vitamin. Since then, which means, for 20 years, she is under this diet. For almost 18 years under 4:1 proportion. At this right moment 3:1. The only problem she had since started the diet were kidney stones in 2002. Nothing else. Grateful to the diet she doesn’t take any kind of medicine to avoid seizures. Her health is perfect, no colesterol at all. We are at your will for any issues related to her health.
By now, most of us have heard about the ketogenic diet. Whether it's because of the benefits of eating high-fat and low-carb, or because you can eat cheese all day long, it's officially become one of the hottest diets of the year. It may not be easy to cut out all the carbs, but emerging research suggests that eating fat can actually help burn fat. So, for anyone trying to lose weight, you may find it worth the carb cut. Beyond weight loss, recent research has found some other serious health benefits of keto that may impact your life later on. Let's take a look at what the research has to say.
While body weight decreased significantly (-8.5 kg) in these 21 diabetic participants, the mean weight loss was less compared with what we observed in the LCKD participants of an earlier trial (-12.0 kg) [18]. Given that the diabetic participants had a higher baseline mean weight than the LCKD participants of our previous trial (131 kg vs. 97 kg), this translates into an even more dramatic disparity in percent change in body weight (-6.6% vs. -12.9%). This lesser weight loss might result from several factors. First, in the current study, most of the participants were taking insulin and/or oral hypoglycemic agents that are known to induce weight gain[20,21] Second, these same agents, particularly insulin, inhibit ketosis, which is strived for in the earliest phases of the LCKD; while it remains unclear whether ketones actually play a role in weight loss on the LCKD, previous research in non-diabetic patients has shown a positive correlation between level of ketonuria and weight loss success [22]. Lastly, compared with our previous study the participants in the current study had more comorbid illness, lower socioeconomic status, and a shorter duration of follow-up (16 weeks versus 24 weeks), all of which are associated with reduced success on any weight loss program [23].
“When I was taught about biochemical fuel-burning, I was taught that glucose was “clean” and ketones were “smokey.” That glucose was clearly the preferred fuel for our muscles for exercise and definitely the key fuel for the brain. Except here’s the dirty little secret about glucose – when you look at the amount of garbage leftover in the mitochondria, it is actually less efficient to make ATP from glucose than it is to make ATP from ketone bodies! A more efficient energy supply makes it easier to restore membranes in the brain to their normal states after a depolarizing electrical energy spike occurs, and means that energy is produced with fewer destructive free radicals leftover.”
“As soon as you start consuming a normal amount of carbohydrates again, you immediately go out of ketoacidosis or the fat burning state”. I am sure you know the difference between nutritional ketosis and ketoacidosis yes? One is the natural fat burning state, and the other is toxic. Right now i am in ketosis but not ketoacidosis. One has a natural balance of Ph level, the other not. Once you make that statement, i have a sick feeling i am not getting the right information here.
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As both study groups acknowledge, additional research is needed to tease out any and all of the factors that may be producing the weight loss and decrease in HbA1c, says Dr. Gonzalez-Campoy, for example  there may be other mechanisms of action that are helping these individuals to achieve weight loss, including changes in the gut microbiome, increased insulin sensitivity, enhanced leptin response, and decreased ghrelin levels, each of which contribute to weight loss.
The keto diet is an extremely effective way to lose weight over a short period of time—even better, according to some research, than low-calorie and low-fat diets. There a few reasons for this: When you’re in ketosis, your body stores less fat. Dieters feel fuller for longer, partly because of the rich food they’re eating, and partly because ketosis changes your hunger hormone levels.
84 obese diabetes patients were randomized to either follow a ketogenic diet (<20 g Carbs/day) or a reduced-calorie, low-glycemic diet (55% calories from carbs, 500 kcal deficit). The ketogenic group had greater improvements in HbA1c, body weight, and HDL cholesterol compared to the low-glycemic group. Diabetes medications were reduced or eliminated in 95.2% of the ketogenic group and 62% of the low-glycemic group.

Dehydration. With fewer water-binding carbohydrates in the diet, the body is less able to hold onto fluids, which can lead to dehydration. Eating more salt can help offset this, but it can also raise blood pressure, creating a whole new set of issues. If you plan to follow a keto diet, hydration is key. To know how many ounces of fluid you need each day, Yancy recommends dividing your body weight in half. Then think of the resulting number as your daily fluid goal in ounces. So if you weigh 200 pounds, strive for 100 ounces of water a day.


Multiple sclerosis is a condition that affects the nervous system, and some people believe that a ketogenic diet may slow the progression of the disease or control its symptoms. The ketogenic diet is low in carbohydrate, moderate in protein, and high in fat. There is currently not enough evidence to recommend it for everyone with multiple sclerosis.
While it's not necessarily dangerous, bad breath is a known side effect of entering ketosis. When you’re taking in a lot of fat, your liver metabolizes it and eventually converts it into smaller ketone bodies. These ketones (including acetone — yep, like nail polish remover acetone) will circulate in your body and diffuse into your lungs. Your body wants balance, so you'll exhale ketones to avoid build-up in your bloodstream. Those compounds are what cause keto breath: a metallic-tasting, somewhat stinky side effect.
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.
Since carbohydrates do increase insulin and insulin is a storage hormone many people have made large leaps of logic to point the finger at carbohydrates as the primary cause of fat gain and obesity as opposed to overall caloric intake. They also point out that in a keto diet, carbohydrates are not being used as fuel hardly at all whereas fats become the primary fuel.
The 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.”

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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.
You increase your production of these ketones through a process called ketosis. To get and stay in ketosis, you increase your dietary fat intake while modifying protein and dramatically limiting carbohydrate consumption, and you incorporate intermittent fasting. Human adults have little need for dietary carbohydrates, and reducing intake to shift into mild ketosis can provide dramatic benefits. (5)
“Keto is not a great long-term diet, as it is not a balanced diet,” says Nancy Rahnama, MD, MS, an internal medicine and bariatric specialist in Los Angeles. “A diet that is devoid of fruit and vegetables will result in long-term micronutrient deficiencies that can have other consequences. The keto diet can be used for short-term fat loss, as long as it is under medical supervision.”
Jalali says people following the diet have the best chance of keeping the weight off if they stay on it long term. And that’s not always easy to accomplish. The weight may come back if you go back to your regular eating habits. And regaining weight may lead to other negative effects. “Chronic yo-yo dieting appears to increase abdominal fat accumulation and diabetes risk,” notes Clark.

Most dieticians I have met are over rated and under educated. This article somewhat proves me out. Congratulations on your accomplishments. I have been in Ketosis for a couple of months now. I have lost 28 pounds. I feel great. No sugar No Bread Nothing from a box lol. Only good fats and Meats and good veggies(dark greens mostly) and a few macadamia nuts now and again and a few berries now and then. I think even the dieticians being human are also addicted to sugar and unable to give it up so they play down ketosis unconsciously because they are just jealous! lol
You may be able to tell that you're in ketosis by a change in your breath (many report halitosis, or bad breath, due to higher levels of the ketone acetone coursing through the body). Others experience the keto flu for anywhere from one day to two weeks as the body cranks up the ketones. Symptoms of the keto flu are very similar to the influenza virus, including nausea, fatigue, vomiting and diarrhea. Hydrating well and starting slowly can reduce your risk for this.
Another thing we know about diets and weight loss is that the results are not easily maintained. I’ve written about this in depth with regards to the participants on the Biggest Loser. This was evident in a study  analyzing 31 long term studies on dieting, which found 2/3 of dieters put back the weight they lost. Other research has reported the failure rate may be as high as 95%. This isn’t specific to the keto diet but rather, any diet that is restrictive and unrealistic may be nearly impossible to sustain.
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 ketogenic diet may seem like the latest weight-loss craze, but it’s actually been around for nearly a century. Developed in the 1920s, this ultra-low-carb, high-fat eating plan was originally used to treat seizures in people with epilepsy. Today, it’s getting some serious attention for an entirely different reason. “There’s growing research showing that the ketogenic diet is effective for managing blood sugar in people with diabetes,” says William Yancy, MD, program director at the Duke Diet and Fitness Center in Durham, North Carolina. “However, because we don’t have studies [lasting] longer than two or three years, we don’t know what can happen with regard to complications over longer periods of time.”
The average person's diet contain about 55% carbohydrates, 30% fat, and 15% protein. On the keto diet, you eat a whole lot more fat, and a lot less carbs: 80% of the diet is comprised of fat, 15% is protein, and a mere 5% of calories come from carbohydrates. For someone on a 1,500-calorie diet, that translates to 19 grams of carbohydrates per day, which is less than what you find in one medium-sized apple.

🙌🙌 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.
Finally, wait it out. Certain folks who do everything by the book and follow every bit of good advice may still get a few symptoms of the keto flu. This usually comes in the initial three weeks of entering nutritional ketosis, and things get much better very quickly. Trust that your lull will pass and your energy will increase substantially—usually within a few days.

Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.
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.
Increases in cholesterol levels need discussion too. We do see temporary increases in cholesterol levels often as individuals transition onto a ketogenic diet. However, when you examine lipid particle size (a more important way to look at the cardiovascular risks), the risk pattern doesn’t seem to increase with a ketogenic diet. Harvard Health has written about lipid particle size here before: http://www.health.harvard.edu/womens-health/should-you-seek-advanced-cholesterol-testing-
.. it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. What is unhealthy about red meat. We should know that acrilamides, pyrroles in burnt meat (and veges) from BBQ and over-heated cooking inflames the colon. According to Clark H R, PhD ND an inflamed part allows easy entry for the cancer nucleus and cancer complex, to start and fuel a malignancy at that location.
Keto diets are high in healthy fats and protein also tend to be very filling, which can help reduce overeating of empty calories, sweets and junk foods. (4) For most people eating a healthy low-carb diet, it’s easy to consume an appropriate amount of calories, but not too many, since things like sugary drinks, cookies, bread, cereals, ice cream or other desserts and snack bars are off-limits.
Don’t be surprised if you find yourself parched while you’re on the keto diet. Excreting all that extra water will likely cause a spike in thirst—so make it a point to drink up, Mancinelli advises. There’s no hard and fast recommendation for how much water you should be having on a keto diet. But in general, aim to drink enough so your urine is clear or pale yellow. If it’s any darker, bump your intake.
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.
He also told me that I was in horrible shape, that I would need a lot of medication, and that because I was T2, insulin would do nothing for me. I still remember walking out of the building after. I felt like shooting myself. My brother had just gone blind from retinopathy 2 months earlier. There was no hope for me. High numbers were inevitable. Complications were inevitable.
And it’s not just this study, either. Several other studies have found  that keto leaves rodents unable to process carbs,[7] leads to insulin resistance,[8] and, more long-term, causes non-alcoholic fatty liver disease, which is when your liver accumulates lots of fat and begins to shut down.[9][10] Triglycerides and inflammation go way up, too.[11]
Additionally, you may find it difficult to eat adequate calories on a daily basis because fat is so filling. Some people even opt to fast for several hours each day. While this may help with weight loss, your body needs those calories for proper maintenance. Without them, it may turn to burning muscle for energy, and that can accelerate muscle loss.
What about heart health and the keto diet? Previous older schools of nutrition would purport that a diet rich in fats (specifically saturated fats) would be detrimental for heart health, but more recent research suggests that saturated fat is not as bad as previously believed.  There is actually a tiny little bit of evidence that a keto diet may improve triglyceride, HDL and LDL levels. Like here and here. An even more recent study found that a keto diet improved triglyceride, HDL and LDL levels. We’ll definitely have to wait to see how that research unfolds because there is definitely a lot of competing elements at play.
This diet also entails weight loss because it gets rid of excess water content in the body due to a lower amount of insulin produced. The food is broken down into simple sugars, with excess energy stored as complex sugars. The pancreas produces insulin that helps regulates sugar breakdown in the body. The body needs less sugar in switching to higher intake of fat. The liver can break down fatty acids to energy in ketogenic diets. Due to eating less carbohydrate or sugars, the production lowered. In a study, 90% of all type 2 diabetics were able to lower or completely eliminate their diabetic medication after 6 months of being on a low carbohydrate diet.
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