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.
Just as people can vary dramatically in their response to carbs, I would not be surprised if that’s the case for some people. Might this be another case of copy numbers of AMY1 SNPs? But most people need to assume that WB/Undoctored is not a full-time KD. The goal of the 50g/day, 15g/interval is not for elevated ketone levels; it’s for ideal average and peak blood sugars.
Dr. Josh Axe, DNM, DC, CNS, is a doctor of natural medicine, clinical nutritionist and author with a passion to help people get well using food as medicine. He’s the author of the books “Eat Dirt: Why Leaky Gut May Be the Root Cause of Your Health Problems,” “Essential Oils: Ancient Medicine” and the upcoming “Keto Diet: Your 30-Day Plan to Lose Weight, Balance Hormones, Boost Brain Health, and Reverse Disease” (February 2019, published by Little, Brown Spark). He’s a co-founder of Ancient Nutrition, a health company where the mission is to restore health, strength and vitality by providing history’s healthiest whole food nutrients to the modern world.
I must note here, that as a nutrition professional who has worked in pediatrics and seen children who must follow this diet, it is incredibly challenging for both the child and family. Most people who must follow this diet for therapeutic medical reasons have trouble actually reaching ketosis with diet alone, and need to drink poor-tasting formula drinks to keep their carb-to-fat ratio in tight control. Many of these individuals must follow this way of eating to survive or have any sort of quality of life.
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Ketoacidosis, on the other hand, is a complication of poorly managed diabetes. It results in uncontrolled production of ketone bodies that can change the pH of the blood, which can prove fatal. Ketoacidosis is more common with Type 1 diabetes rather than Type 2. It’s also important to note that the keto diet cannot cause ketoacidosis – but rather puts the body into the beneficial state of ketosis.
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.
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!
I have great respect for Harvard Medical School. I notice that they support their readers posting comments and I am most appreciative of the article and all the many thoughtful comments by the readers. The readers seem to have the most expertise here and I hope that the doctor who wrote the article will think long and hard about the comments by readers. After 35 years of clinical practice in mental health, I notice that all issues of emotion involve medical issues, nutrition, and the gut bacteria. I would say that these issues and all of the executive brain functions seem to improve with ketogenic principles. For those that apply it in a flexible and smart manner, it appears to improve every area of their lives. I strongly encourage the author of the article to take one class via The Institute for Functional Medicine. If he is open to more learning he can take more classes and get certified. I’m sure a fine doctor, he will be an even better doctor and personally healthier, if he gets more training. Are we all open to new learning(especially us healthcare providers)?
People With a History of Eating Disorders Going on a strict diet that eliminates food groups could trigger a relapse if you have a personal history of having an eating disorder. And while there’s a growing popularity in treating binge eating disorder (BED) with keto, experts strongly advise against it. Treatment of BED requires regular, adequate food intake without restriction, says Sumner Brooks, MPH, RDN, a certified eating disorder dietitian in Portland, Oregon.
Some people have trouble with the concept of high-fat and a moderate amount of protein. I have to admit. It was hard for me to wrap my head around it at first. Now I have even given up artificial sugar substitutes and diet products of any kind. It's even hard for me to call this a diet. After researching this eating style, I've learned it's a way of life.
We recently published an article documenting the grim long-term effects of low-carbohydrate diets, in which we explain the evidence-based research showing that low-carbohydrate diets high in fat and protein including meat, dairy products, eggs, fish, and oil actually worsen diabetes health, increase cancer risk, increase cholesterol, increase atherosclerosis, harden blood vessels, and increase all-cause mortality.
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Prior to the advent of exogenous insulin for the treatment of diabetes mellitus in the 1920's, the mainstay of therapy was dietary modification. Diet recommendations in that era were aimed at controlling glycemia (actually, glycosuria) and were dramatically different from current low-fat, high-carbohydrate dietary recommendations for patients with diabetes [1,2]. For example, the Dr. Elliot Joslin Diabetic Diet in 1923 consisted of "meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, tea" and contained approximately 5% of energy from carbohydrates, 20% from protein, and 75% from fat . A similar diet was advocated by Dr. Frederick Allen of the same era .
Thank you for your objective review of the Keto Diet. I am not overweight but decided to try the Keto lifestyle because I have a lot of inflammation issues, including asthma and osteoarthritis. I had also been experiencing uncomfortable intestinal issues. I have been following the Keto lifestyle for 4 1/2 weeks, and I feel so much better- especially my stomach! I am eating a ton of leafy greens, broccoli and cauliflower. I am also enjoying Brussel sprouts, whole avacados and zucchini. I think the reason this is working well for me is because my body chemistry loves all the vegetables, good fats and protein. I also think that taking away sugar has had a big impact on how I feel. I’m just not eating grains and sugar. lots more veggies, berries, and consciously incorporating healthy fat. My stomach is flat again, and I have no more bloating or constipation. I have only lost 5 pounds, but I think my system is clean and operating better than it has in years. My point is that every person’s body chemistry is different. The Keto lifestyle seems to be what My body needed to feel my best. I did experience “the Keto flu” about a week into it, but it was short lived. I think that to be successful it is really important to eat a wide variety of veggies and good fats every day.
“Despite its temporary side effects, we have always suspected that the ketogenic diet is relatively safe long term, and we now have proof,” says senior investigator Eric Kossoff, M.D., a pediatric neurologist and director of the ketogenic diet program at Hopkins Children’s. “Our study should help put to rest some of the nagging doubts about the long-term safety of the ketogenic diet,” he adds.
Fats produce more energy as compared to proteins or carbohydrates and this quality of theirs renders them very helpful in ensuring that the body is sufficiently energized. Since your body is using up fat for providing energy for the whole reaction system, the fat content decreases over time. This happens since the fats are not in the adipose tissues now. Instead, they are being broken up as they are ingested. This further prevents obesity.
“What many diabetics aren’t aware of, is that it is the fat that is the problem when it comes to type 2 diabetes. Nearly 100 years ago, healthy volunteers were split into two groups – half were fed a fat-rich diet, and the other half on a carb-rich diet. Within just two days, the fatty diet groups’ glucose intolerance skyrocketed to amounts twice as high as those fed a carbohydrate-rich diet (9).
Fatty acid production in fat tissue is stimulated by epinephrine and glucagon, and inhibited by insulin. Insulin is one of the hormones the pancreas secretes in the presence of carbohydrates. Insulin's purpose is to keep blood glucose levels in check by acting like a driver, pushing the glucose into cells. If insulin were not to be secreted, blood glucose levels would get out of control.
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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!