In another study looking at ketogenic diets as a treatment for cancer,5 this research team concluded, “based on the results of rigorous preclinical and clinical studies performed thus far, the KD would appear to be a promising and powerful option for adjuvant therapy for a range of cancers. Cancer-specific recommendations await the findings of randomized controlled clinical trials.”

The same goes for people with type 2 diabetes. While some preliminary research suggests the keto diet may be safe and effective for certain people with type 2 diabetes, there’s still the risk for low blood sugar, especially for those on insulin, and the keto diet omits certain food groups known to benefit those with this disease. For example, a study published in September 2016 in the journal Nutrients highlights the importance of whole grains for helping to control weight as well as episodes of high blood sugar. Whole grains are off-limits on the ketogenic diet.

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


Sofia Norton is a driven, dedicated and team-oriented professional with more than 6 years of experience providing wellness and nutritional support in various capacities. After Sofia learned about "food deserts" as a kid, she became determined to devote her life to like to making healthy foods accessible to everyone, regardless of income or location. Sofia has traveled around the world, teaching nutrition to communities in extreme poverty. In her spare time, Sofia loves long bike rides and exploring local farmer's markets.
if this is true how did humans survive before agriculture? high carbohydrate foods simply didn’t exist in abundance before the agriculture age. Hundreds of thousands of years of evolution where humans would hunt for their food, and in between hunting eat whatever berries grew nearby….going days at a time or even weeks without food our bodies HAD to evolve into a state where they could conserve and store it’s energy then supply us with that energy burst for when that deer wandered by. Ketones are that energy source. Glucose simply doesn’t last long enough for us to survive and still have the energy to hunt. A little over 10,000 years of agriculture cannot undo hundreds of thousands of years of evolution.
The keto diet involves a very high consumption of dietary fats, and very low carbohydrate consumption. Through these nutritional changes, the body reduces its use of glucose for fuel, and increasingly uses ketones (derived from fats). The diet was first used to control epileptic seizures, but there is growing body of research showing positive effects on Alzheimer’s disease, Parkinson’s disease, traumatic brain injury, inflammation1, and diabetes.
Weight loss isn't the only benefit of this way of eating. Here is a piece from my friend Sybille Bellamy. We each have a child with Angelman Syndrome, which can lead to seizures. Our children not only have a better life on Ketogenic foods, but their brain function has also improved. Studies show similar benefits for people with epilepsy. Ketogenic diets may also help children on the autism spectrum.
Researchers are divided over whether the keto diet is good for people who don’t need to follow it for medical reasons. Since it doesn’t differentiate between saturated and unsaturated fats, dieters are at risk of raising their cholesterol levels. And because the heavily restrictive diet cuts out most fruits and vegetables, it can also lead to nutrient deficiency. The Harvard Health Letter warned that with so much fat and protein to metabolize, keto practitioners may experience liver and kidney problems as well.  
There are various ways to practice intermittent fasting on keto, including some that are less likely to trigger side effects like fatigue or cravings. Crescendo fasting gives you a break from fasting throughout your week, but is still very helpful for achieving the benefits of IMF. Dr. Cabeca and other experts, such as Amy Shah, M.D., advise their patients to check their urinary ketone levels (using ketone strips) and to aim for testing positively for ketones about three days per week.
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder, and it affects women of reproductive age. Symptoms include obesity, hyperinsulinemia and insulin resistance. A pilot study took 11 women through 24 weeks of a low-carbohydrate ketogenic diet (20 grams or less per day). Among the five who completed the study, they lost 12 percent of their weight on average and reduced fasting insulin by 54 percent. Additionally, two women who previously experienced infertility problems became pregnant. (6)
"Your brain runs on glucose (a simple form of carbohydrates)," notes Adrien Paczosa, R.D., L.D., a registered dietitian and eating disorder specialist. "When you cut out carbs, your body has to 'make' carbs from breaking down other parts of the body. This results in what I like to call a hungry brain. You experience slower cognition, memory loss, headaches, and confusion." That doesn't sound so great, right? "Also, those who suffer from depression and anxiety may have higher levels of those periods when not eating carbs on a regular basis." Because of this, keto might not be the best choice for those with mental health issues.
"Muscle loss on the ketogenic diet is an ongoing area of research," Clark told Everyday Health. "Small studies suggest that people on the ketogenic diet lose muscle even when they continue resistance training. This may be related to the fact that protein alone is less effective for muscle building than protein and carbohydrates together after exercise."
Many people and even some doctors confuse nutritional ketosis with (diabetic) ketoacidosis. Ketoacidosis occurs in uncontrolled diabetes when the pancreas cannot secrete enough insulin to exert its action in cells, so blood glucose levels and blood ketones both skyrocket to dangerously high levels. Ketoacidosis has nothing to do with nutritional ketosis which is when ketones are produced from all the dietary fat you’re relying on and can thus keep your blood sugar levels under control at low and stable levels.
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.
Instead of thinking about the total carbs you’re eating, assess what those carbs provide to you. Do the majority of your carbs come from fruit and vegetables, with a payload of fiber and disease-fighting antioxidants? Fantastic. Or are you consuming them in the form of added sugars (cookies, candy, soda) or refined flour? If you are, you know what to do.
“Rapid, significant weight loss is a common side effect of the keto diet because of the water losses that occur as carbohydrate stores are depleted,” says Clark. In a study in the American Journal of Clinical Nutrition, obese men following a modified version of the ketogenic diet, with high protein and low carbs, lost about 14 pounds in one month, compared with the control group, which lost about 10 pounds on a high-protein, medium-carb diet.
Thanks to a very-low carb eating plan, the keto diet is effective when it comes to quick weight loss and stabilizing blood sugar levels. However, carbs are not just pasta and bread, they are beans, legumes, fruits, vegetables and whole grains. These foods contribute vitamins, minerals, antioxidants and fiber to the diet that’s hard to get without them. If you’re planning on trying out the keto diet, focusing on plant-based fats like nuts, seeds, avocados, coconut and olive oil will help to get some of the micronutrient losses back in.
You eat less than 50 grams of net carbs a day on keto. Cutting down on carbs increases your high-density lipoprotein (HDL) levels. HDL is known as the “good” cholesterol — it turns on anti-inflammatory pathways and protects your heart from disease. The keto diet also lowers blood triglycerides[12] — fat molecules in your bloodstream. High levels of blood triglycerides are linked to coronary heart disease.[13]
I suffered through a year on 20 grams of carbs per day and it was the worst year of my life. Yep, I lost weight, but at my current weight of 130 lbs and eating 30 carbs per meal and remaining in a prediabetes state for 15 years, I am healthy AND happy now. None of us know the long term effects of most of what is offered to us…medications, diet drinks, processed foods, restrictive diets. The point I was trying to make was eating healthier, more natural foods will be better in the long run, I believe we all have the common sense to agree on that, even if we can’t agree on how many carbs we will eat!

The backbone of a keto plan is its extraordinarily high fat content, making up 65 to 80 percent of calories daily. Protein—which can raise blood glucose, though not as much as carbohydrate does—makes up 15 to 25 percent of calories on the keto diet. And carbs are even more heavily restricted to just 5 to 15 percent of calories. That’s only about 20 to 50 grams a day (compared with the average 245 grams daily), or the amount in a small apple or a cup of cooked brown rice, respectively.
The more recent study was conducted online to ascertain if this online approach proved effective in eliciting weight loss.1 Dr. Saslow's team randomly assigned the 12 participants to the Keto diet and lifestyle improvement group and another 13 individuals to the traditional low-fat diet known as the Plate Method,1 supported by the American Diabetes Association. 
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.
The keto diet restricts carbs so much that anyone who is on blood sugar lower medication or who has type 1 or type 2 diabetes must consult his or her doctor before making such a severe dietary change. As the body adapts to low-carb dieting, medication dosages and treatment plans will have to be revised, and blood sugar levels must be carefully monitored.
That makes a lot of sense. Keeping up insulin pathways when you aren’t eating carbs would be like keeping the lights on when it’s daytime outside — it’s a waste of energy. You aren’t using insulin on keto, so your body probably downregulates your insulin pathways. As a refresher, insulin is a hormone produced by your pancreas that tells your cells to absorb glucose to use as fuel. When you eat carbs, insulin production begins. In the absence of carbs, there’s less need for insulin.

Another way to test the body’s response to nutritional ketosis is through breath acetone levels. This essentially shows how much of the ketones are being utilized by the body. I used a Levl meter (use the code wellnessmama at this link for $25 off) to test breath acetone levels. This device is more pricey but does not require strips so it can be used more often. I used it to test my response to certain foods or exercises and to see if they pulled me out of ketosis.
Eating in a restrictive way can be socially isolating, Brown says. "You may avoid parties and other gatherings because you may worry about what food will be available for you, or even what foods may tempt you. Having to plan and control what you are eating so closely may lead to increased anxiety and stress. And who doesn't want to enjoy a beer with a friend or a piece of cake on your birthday?" As you probably know, emotional well-being and physical health are closely linked, which is all the more reason to choose foods that make you feel good both mentally and physically. If keto does that for you, great! But if it doesn't, know you're not alone.
One reason it's hard to determine the exact health effects of diets is that it's often unclear whether any observed effects come from the diet or from a combination of other factors, like stress, environment or genetics. Still, that doesn't mean all the bold claims about the keto diet are wrong, but rather that you should approach them with a healthy degree of skepticism.
There is quite a bit of research that has been done on the effects of a ketogenic diet, and the findings show a general reduction in blood pressure. This could be due to a higher concentration of potassium and a lower amount of sugar in the foods common to this diet. It may also be due to the weight loss benefits, as obesity is a causative factor in hypertension.

You can absolutely be in ketosis and eat 50g of net carbs a day. Maybe not everyone, but many people can maintain ketosis at that level of carb if fat/protein intake is OK. I have experienced this myself, and tested with blood keto meter. It would be interesting to test people who have been on the WB diet to see how me many are also in ketosis. I would bet a significant portion cycles into ketosis very regularly, and some are ketotic most of the time.

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.”
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.”
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.
Instead of thinking about the total carbs you’re eating, assess what those carbs provide to you. Do the majority of your carbs come from fruit and vegetables, with a payload of fiber and disease-fighting antioxidants? Fantastic. Or are you consuming them in the form of added sugars (cookies, candy, soda) or refined flour? If you are, you know what to do.

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!


"The diet was introduced in the 1920s as a way to treat epilepsy and then sort of fell out of popularity with the introduction of anti-seizure drugs," Turoff says. What's more, ketosis (the goal of keto, a state where the body uses fat for energy instead of carbs) is something seen in people during periods of starvation—including in people with anorexia nervosa. "The body is deprived of carbohydrates and thus has to turn to ketone bodies as a fuel source," Turoff explains. "People really need to understand that it's not just a low-carbohydrate, high-fat diet—it actually changes the way your body uses fuel." 

This suggests that we should cycle in and out of ketosis by periodically increasing carbs to avoid this hypothyroidism. Incidentally, the more I read of the much-maligned Bob Atkins’ writings the more impressed I become. He clearly was extremely well-read in the scientific literature and modified and expanded his protocols as he got more information. If you read his Age-Defying Diet book, apart from Dr D’s absolute prohibition of grains, it isn’t too different from WB principles. See this quote (page 290)
The ketogenic diet has emerged suddenly almost as a fad diet where people are showcasing their dramatic weight loss results all over social media. What is different about the ketogenic diet, however, is that it actually creates remarkable beneficial changes in the body that drastically improve wellbeing. There are foundational physiological changes that occur in the body that attribute for the benefits of a ketogenic diet. These benefits make this style of eating much more profound than any old fad diet.

In January 2017, at 63 years of age, I was diagnosed with type 2 diabetes. I had probably been living with it unknowingly for years. In 2009 my doctor recommended the South Beach diet because I was showing blood-sugar levels that were considered pre-diabetic. I stayed on it for a while but then, as with all other diets I’ve tried in my life, I failed and put all the weight back on, plus some. When I was officially diagnosed last year with type 2 diabetes I was a whopping 284 pounds (129 kg). I was always fatigued, could barely walk a block without getting tired and my health was failing.


What is more common throughout the history of the human race is fasting. Islamic Ramadan is a 28- to 30-day fast where food and drink are prohibited during the daylight hours. Christianity also has a strong fasting foundation, and in the Bible, Jesus fasted to have higher and clearer communication with God. Greek Orthodox Christians fast for a total of 150–200 days each year!
“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.”
Diets require discipline, and it is not always easy for people to follow them without indulging in a "cheat day." One day may not make a big difference in the long-term, but a recent study from the University of British Columbia in Okanagan, Canada (UBCO), found that when it comes to the keto diet, a single dose of carbohydrates may have dangerous side effects.
At the core of the classic keto diet is severely restricting intake of all or most foods with sugar and starch (carbohydrates). These foods are broken down into sugar (insulin and glucose) in our blood once we eat them, and if these levels become too high, extra calories are much more easily stored as body fat and results in unwanted weight gain. However, when glucose levels are cut off due to low-carb intake, the body starts to burn fat instead and produces ketones that can be measured in the blood (using urine strips, for example).
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.
This general “muscle wasting” assertion often comes from trainers and dietitians who really have not studied the science on muscle preservation. They will tell you that the brain requires at least 100 grams of carb per day and if you don’t get those carbs in the diet, your body will break down your muscles to get it. This is true when one’s diet is high carb, and no ketone bodies are available as an alternative source of brain fuel.
I must tell you when looking at this link they say the American Diabetes Association Guidelines call for 60-75 carbohydrates per meal and that is simply not true. The ADA has recommended since 2013 we use our best clinical judgement in recommending a low carbohydrate diet for people with diabetes, recognizing it needs to be individualized. 60-75 grams is the carbohydrate amount I would give to a very tall, large boned man or perhaps an active teen or young adult. I would never recommend that many carbohydrates for an average size man who was trying to lose weight; he would get 45-60 grams of carbohydrates per meal and 15-30 grams for snacks. A women trying to lose weight would get 30-45 grams of carbohydrates per meal and 15 grams for snacks.

“With the start of the keto diet, the body switches from using sugar as a source of energy to using the body’s stored fat,” Rahnama explained. “In the process of breaking down fat, the body produces ketones, which are then removed by the body through frequent and increased urination. This may lead to dehydration and flu-like symptoms, such as fatigue, dizziness, irritability, nausea, and muscle soreness.”


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.
The biggest issue is that some people consider keto to be a free pass to skip the green stuff. Either that, or they assume “vegetable=carb” and avoid them. Without plants, it’s tough to eat enough fiber, especially the fermentable, prebiotic kind that sustains our gut bacteria. We don’t need bowel-rending quantities of fiber. We shouldn’t take pride in the ability to fill the toilet bowl with perfect coils of crucifer corpses. These are unnecessary at best and downright harmful at worst.
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!
When Steve contacted TheDiabetesCouncil, he wanted to know where to find information on meal plans for the Ketogenic Diet. There are many resources online where you can search for meal plans for the Ketogenic Diet. There are also many books you can purchase at your local bookstore. The Atkins Diet is the most well- known Ketogenic Diet in its Induction Phase which is the first 2 weeks in this diet.
The low-carb diet induces ''nutritional ketosis," Dr. Saslow tells EndocrineWeb, which is not the same as ketoacidosis. Ketones are a chemical your body produces when you burn stored fat; if you are on a low-carb diet you may be ''in ketosis.'' Ketoacidosis is different; it is a life-threatening condition in which levels of ketones and blood sugar are dangerously high, which may occur in people who have poorly controlled diabetes.
Although many people find that their energy and stamina improve on a keto lifestyle, trying to do too much in the early stages can worsen keto flu symptoms. Well-known ketogenic researcher Dr. Steve Phinney has conducted studies in endurance athletes as well as obese individuals demonstrating that physical performance decreases during the first week of very-low-carb eating. Fortunately, his research also shows that by week 4, people typically perform better than before they started keto.
The author wrote this out of angst because she failed at the ketogenic diet. It’s not a “hard” diet and you don’t have to give up all forms of desserts. You just have to learn to cook using stevia, almond or coconut flour instead of the white refined flours the author is addicted to. The information presented is false as well. The ketogenic diet has great benefits for the type two diabetic or prediabetic specifically.
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.
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