Carbs are still the primary fuel for the body during high-intensity exercise. A ketogenic diet may be better suited to athletes performing endurance sports (like marathon running or cycling). Athletes engaged in more intense cardio (like sprinting, hockey, football) may perform better with a higher percentage of carbohydrates. These athletes may experience a decrease in high-intensity output while following a ketogenic diet, but ultimately, a lowered carbohydrate intake as isn’t “dangerous” for athletes.
Considering these risks, people who have kidney damage (including those with type 2 diabetes), plus individuals with or at risk for heart disease, and pregnant or breastfeeding women, shouldn’t try the keto diet. Also, people with type 1 diabetes shouldn’t follow the plan because of the risk for hypoglycemia (low blood sugar), and anyone who has had their gallbladder removed should avoid it because the diet is so high in fat.

She adds that the research supports the safety and effectiveness of following a keto diet even in older adults with obesity as it seems to help improve body composition and improve metabolic health.6 “We saw significant reduction in body fat while lean mass was preserved and significant improvements in insulin sensitivity and the lipid profile in response to a ketogenic diet when compared to a standard ‘balanced’ diet,” Dr. Goss explains.


This was simply the best response to this article. The doctor who wrote it has no idea of the life changing benefits of keto. Bravo to you for speaking up. Congratulations on reversing your diabetes. I dont have diabetes and am not obese but I switched to keto to live a longer healthier life. I’ve never felt better. Must mention that I am 32. I want to prevent disease. Let the food be the medicine.
Often caused by lymph node removal or damage due to cancer treatment, lymphedema occurs because there’s a blockage in the lymphatic system and results in the swelling in leg or arm. A 2017 study involved patients who suffered from obesity and lymphedema and who embarked on a 18-week ketogenic diet. Weight and limb volume was significantly reduced. (5)
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.
If the liver is resistant to insulin, that's a bad sign for the rest of the body and could mean there's an increased risk of developing type 2 diabetes, the researchers said. What's more, these results are concerning because overweight patients seeking to reduce their risk of type 2 diabetes by following a ketogenic diet could unintentionally be increasing their risk for developing the disease, at least in the first few days of their diet. 
The study concludes, “The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.” Previous research has also shown that for patients with type 2 diabetes, long-term administration of the keto diet lowered body weight, improved blood sugar levels and can result in a smaller needed dose of antidiabetic medication.
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.
The typical American consumes about 52% of calories from carbs, 33% from fat, and 16% from protein, according to a study published in The American Journal of Clinical Nutrition. This macronutrient breakdown is fairly close to current dietary recommendations from the United States Department of Agriculture, which recommend 55 to 60% complex carbs, 30 percent fat and 15% protein to help prevent cardiovascular disease.
Nutritionists frequently advise clients to reach for more healthy fats and protein to stay full throughout the day. With this in mind, it makes perfect sense that a ketogenic diet would be about as good as it gets for staying satiated. One study from the American Journal of Clinical Nutrition found this type of low-carb approach was more effective for weight loss and managing hunger than a similar high-protein diet with a greater percentage of carbohydrates. One 2013 study even suggested the eating plan may suppress hunger hormones more effectively than other weight-loss programs.
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.

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.


One of the mechanisms of a ketogenic diet in epilepsy may be related to increased availability of beta-hydroxybutyrate, a ketone body readily transported through the blood-brain barrier. In support of this hypothesis, it was found that a ketogenic diet was the treatment of choice for glucose transporter protein syndrome and pyruvate dehydrogenase deficiency, which are both associated with cerebral energy failure and seizures (26).
Sustainable is Key. Thank you for the article, it explained so much! I have been inclined to follow this diet but what has worked for me before is a diet that’s called “The AntiDiet” and is simply starting your day with fruits, while strictly separating complex carbs and proteins during lunch and dinner, and still being opened to consume all kinds of food. I had been trying the Whole30 for so long and so many times and I simply can’t, does not make sense for me and so does Keto in the sense of overloading on fats and meat. Thank you!
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.
Obesity Compared with those on a typical low-calorie diet, obese individuals on a very-low-calorie ketogenic diet lost more weight and inflammatory visceral (belly) fat in one study, published in December 2016 in the journal Endocrine. (9) It may also help preserve lean body mass during weight loss, according to an article published in February 2018 in the journal Nutrition & Metabolism. (10)

I have T2D and IBS and my blood sugar readings were degrading. I was going to have to take a second daily dose of Metformin and the first one already played havoc with the IBS. I started a low-carb diet because my T1D husband had been inspired by a podcast by Sam Harris with scientist Gary Taubes, author Why We Get Fat, Good Calories, Bad Calories and the Case Against Sugar, and started dumping the majority of his carbs a month previous. He had cut his insulin use literally in half and lost 15 pounds. He was feeling better and visibly had more energy. I was resistant to the diet and even the idea of it. I have been on Atkins and Sugar Busters and while I did fine on Sugar Busters back in the day, Atkins was too fat-based and that was the opposite of how I had been raised to think about dieting. I knew that the Diabetic diet given to me by the Diabetic Educator had never been enough and I get carby binge cravings even though it offers plenty of carbs and calories. I also knew that it’s a cycle for me-eat more carbs, want more carbs, and never really feel satisfied. On top of that, when my stomach hurts I seek carbs, and it hurts quite often. I did Weight Watchers and the Diabetic diets because they let me “cheat” and have my carbs while dieting. To be fair, just the act of tracking my food improved my outcome on either. But I got mad at WW when they upped the points for carbs on their system and made it so I couldn’t eat cake for lunch if I wanted to. Not that I made a practice of it, but it was principle of the thing. Long story short, I was pretty doubtful that I would be very successful on Atkins or Keto. To humor my husband I began a low-carb diet that started out as Atkins 20 or Keto and has morphed to more of an Atkins 30-40 for my personal comfort while using Keto, Atkins, and Paleo recipes and ultimately cutting all gluten. That means 30-40 net carbs per day, rather than per meal and a lot of natural non-processed foods. The first week was quite terrible. But even through the Keto Flu I recognized that my IBS symptoms felt better. I started to suspect that if I felt that bad just from quitting carbs that maybe there was more to the idea of sugar addiction than I wanted to believe. I’m six weeks in now and I’m losing a steady pound a week plus my sugars have dropped radically. A pound a week might not sound like much but it’s more than I’ve lost in 10 years. I have PCOS and insulin resistance so I’ve had a fasting blood sugar that ranged from 109-113 since my early twenties. It was flying high around 160-170 before the diet, now I’m reading between 119-139. Even more than that, my IBS symptoms stabilized. I’ve been tracking all my food using the free Atkins meal tracker so I started trying to narrow the foods that caused flare ups. I’m lactose intolerant but I knew that and used lactose free products or Lactaid for the cream based dishes. I had my gall bladder removed and so have always put down my symptoms to an inability to process dairy and fats. Big surprise to find that a higher fat, higher dairy diet was making my symptoms disappear. Gluten is the only common factor so far. Celiac? Just a food sensitivity? I don’t know, but that will be the next investigation. It is an investigation that I would never have thought to start on the Diabetic diet. Like the author, I’m very fond of cake and carbs. Luckily there are low-carb, no-gluten recipes for muffins and cakes. They aren’t exactly the same and some are definitely better than others, but they are out there. Plus, there is nothing wrong with having true birthday cake once a year if that is really what you need and if you don’t have a reason to avoid it, like binge symptoms or IBS flare ups. My husband let himself have a piece of cheesecake the other day and felt physically awful for two day after, plus he had to use a lot of insulin to counter the spike. It’s a pretty good deterrent. Just a side note but I had other symptoms of inflammation as well. My ankles were swelling to golf ball size and painful, it was difficult for me to stand and walk comfortably when this happened. While they haven’t stopped completely, the discomfort has gone way down as has the swelling and frequency. What’s my point? I’m not a salesman for a particular diet. Everyone is different and some people might respond very well to Keto and/or Atkins while others may not need anything that extreme. I’m not knocking the Diabetic diet. My dad lost 150 pounds 38 years ago on a very low calorie/low carb Diabetic diet that gradually increased and he has kept the weight off all this time and kept his blood sugar steady with medication, but has not had to go to insulin even at age 84. Also, he was a smoker, a diabetic, had hemochromatosis and was over 300 pounds with an apple body shape. He has had some fall out from this-he didn’t stop the smoking until a heart attack 20 years ago and that didn’t help. But he has made it to 84 and when he walked into his doctor’s office 40 years ago I’m guessing the doctor wouldn’t have put any money on that survival rate. Unfortunately, it looks like I need the lower carb version and will continue to need it to manage my symptoms. I didn’t want it, that’s for sure. But Diabetics are locked in a death struggle with Diabetes and it won’t give up just because we are tired or want our sugar. So for me, it has to be Very Low Carb for Life. Others may find they need this too and discouraging them from trying it is not doing them any favors. Hopefully I will continue to find this sustainable. I just need to keep reminding myself that I am more fond of my feet and my vision than my birthday cake.


Getting 80-90% of your calories from fat, which is what’s generally required for true ketosis, is fairly difficult. Keto is not just low-carb, it’s also moderately-low protein. That requires filling your plate with avocado, coconut oil, fatty meats, gravy — and very few carbohydrates. While the range for carbohydrate intake vary from person to person, 25-30g is usually the maximum amount allowed to stay in ketosis. That’s the equivalent of one medium apple.
You’re a diabetic counselor and are talking about being worried about not being able to eat birthday cake? Hell I’ve been on keto since July 2016 and haven’t felt any urge to go back, simply because I feel so much better. Also the diet is really not all that restrictive, you can make desserts using stevia/erythritrol, coconut/almond flour, etc. I had ketogenic pizza the other night and it turned out great. Lots of great resources out there for food options. I’m not diabetic myself, but I used to be prone to hypoglycemia and keto has eliminated the issue since I’m not dependent on glucose. There are a lot of wrong ways to do keto though, and doing the diet correctly has a moderate learning curve.

Dr. Anna Cabeca is an Emory University trained gynecologist and obstetrician, a menopause and sexual health expert and international speaker and educator. She created the top selling products Julva® — an anti-aging feminine cream for women, MightyMaca™ Plus — a superfood hormone balancing health drink, and online programs Magic Menopause, Women’s Restorative Health and SexualCPR.  Read her blog at DrAnnaCabeca.com, and follow her on Facebook, Twitter and Instagram.


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’s not a good idea to include a lot of dairy in a ketogenic diet because the protein in dairy can deactivate Sirtuin, the anti-aging pathway, and create an insulin spike. While butter and ghee (from quality pastured sources) generally don’t cause this effect, high-fat cheeses and heavy creams do. In addition, dairy products can be inflammatory for many people.
I’ve been type 2 for about 15 years was pretty stable with diet and Metformin for 10 years. But eventually started trying more aggressive treatment like Victoza and without fail in 4 years I was on slow acting insulin. I lost weight lowered carb intake to 40mg or less in the morning my breakfast has been no carbs. People need to realize every diabetic is different you must manage it how it keeps you with good A1C levels. I myself got off insulin for a year and half but my fasting levels slowly increased again. Reversing diabetes is not possible. Reducing the effects is possible and more likely the better you monitor yourself and do what you need to do. Depending on medications or diets or counting carbs will all help but not cure the diabetes. These all are things that reduce its ability to affect your health negatively.
Figuring out a diet that fuels our body’s needs and keeps us healthy without sacrificing taste is a daunting task for anyone. Factor in diabetes and this task can suddenly seem like an insurmountable obstacle overcome only by the most health-conscious fitness guru. Some diets are clearly fads, popping up into existence seemingly overnight, selling books and recipes and often food itself, only to fade into the twilight and be overtaken the next day by yet another set of guidelines by which we are to become, optimistically, the best self we can be.
For children, fill up an adult-sized water cup with each meal and request they finish it before they leave the table. Usually they will be thirsty and this is not an issue. If you are concerned that they are not drinking enough, stevia flavor enhancers can encourage this, carb-free.  Ice chips are popular in my house as well, and an additional way to get liquids into children.  Don’t force or encourage excessive water consumption, but rather give children the down-time to drink to thirst rather than rushing back to play, ignoring their thirst.
So yes, the ketogenic diet is safe for diabetics. However, they still need to be closely monitored because diabetes medications including insulin, blood pressure, and beta blockers will have to be adjusted down when following a ketogenic diet. Therefore, the diabetic should do this with supervision from a doctor who is up to date with the nutritional literature.
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