The primary outcome, hemoglobin A1c, decreased from 7.5 ± 1.4% at baseline to 6.3 ± 1.0% at week 16 (p < 0.001), a 1.2% absolute decrease and a 16% relative decrease (Table ​(Table4).4). All but two participants (n = 19 or 90%) had a decrease in hemoglobin A1c (Figure ​(Figure1).1). The absolute decrease in hemoglobin A1c was at least 1.0% in 11 (52%) participants. The relative decrease in hemoglobin A1c from baseline was greater than 10% in 14 (67%) participants, and greater than 20% in 6 (29%) participants. In regression analyses, the change in hemoglobin A1c was not predicted by the change in body weight, waist circumference, or percent body fat at 16 weeks (all p > 0.05).
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.
But Jini’s doctor — intelligent though I’m sure he was — fell victim to the common confusion between nutritional ketosis and diabetic ketoacidosis, the latter of which being a life-threatening complication of Type 1 diabetes, where ketones are produced rapidly, overwhelming the body’s acid-base buffering system. This is a common misconception or myth about keto diets that I seek to dispel. 
Financial disclosures: There were no conflicts of interest reported except for Dr Bernstein who has received royalties for books on the management of diabetes (which were used by members of the online social media group surveyed in this study). Dr. Hallberg who holds stock options and receives research support from Virta Health, and consulting fees from Atkins. Dr. Rhodes is the site principal investigator in clinical trials for pediatric type 2 diabetes that are sponsored by Merck and AstraZeneca. Dr. Westman has an ownership interest in companies using low-carbohydrate principles, and he receives royalties for books related to low-carbohydrate diets. Dr. Ludwig has received royalties from books on nutrition and obesity; and Dr. Galati is author of Eating Yourself Sick: How to stop obesity, fatty liver, and diabetes from killing you and your family (2018).
When the body's glycogen stores begin to get depleted, rates of beta-oxidation increase, resulting in the mobilization of free fatty acids from fat tissue. This is where the metabolic state of ketosis comes in. During beta-oxidation, ketone bodies are released from the liver—because they cannot be utilized by the liver—and travel to the brain to be used for fuel. The free fatty acids can then be turned into a usable energy substrate.
And what benefit you will have with “moderate” diets that let you eat bread and others carbohydrates but high insulin ? remember that it is critical to not only look after glucose levels on blood, it is very very important to reduce your intake of insulin to avoid a lot of diseases including metabolic syndrome for high insulin and insulin resistance.
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]
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.
Case in point, Steve Richert has Type 1 Diabetes and his September 1, 2015 blog The Ketogenic Diet and Type 1 Diabetes: What I Eat. He gave it the good old college try and has fearlessly came back and showed us all his results. His cholesterol increased, which just like mine, was due genetic factors, but was exacerbated by the Ketogenic Diet. So, what’s the best part of Steve’s story? He’s coming close to being right in line with what I would recommend for him! Moderation and the mediterranean diet; he’s currently trying a modified ketogenic diet or really a modified mediterranean diet. Brilliant and exactly what we all should be doing!
There are several medical studies — such as two conducted by the Department of Radiation Oncology at the Holden Comprehensive Cancer Center for the University of Iowa, and the National Institutes of Health’s National Institute of Neurological Disorders and Stroke, for example — that show the ketogenic diet is an effective treatment for cancer and other serious health problems. (12)
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.
Controlling your blood sugar levels helps you control your cravings, Dr. Burrows says. “When we are not on a sugar roller coaster from processed carbohydrates, most people make better food choices because they are not looking for their next hit of food,” she says. You may also find you’re able to go longer periods without eating, he says. Intermittent fasting is a common practice among dieters who’ve been eating keto for a while. Learn how one woman totally kicked her sugar habit by trying the keto diet.
Holy smokes what a great article! Thank you for such a thorough read. I have been doing a “keto diet” (keeping carb’s under 40 g/day-I use a tracker) since the beginning of January and felt “fluish” at first like you state. That passed and this past week (It is now Feb 11)my weight loss has stalled so I am experimenting with even lower carb’s (15-20g/day). This change has really interrupted my sleep the past 3 nights, hence me typing this at 4:44 in the am after deciding to do some research the past hour. Will this too pass? Or is it time for a Mg supplement? And if so can I use a pill rather than a drink? Between all the water and the bone broth I am unsure how more I will want to drink ha! But if I have to then I will, just thought I would ask. Again, thank you for all you are doing and such a fantastic read!

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).
So where did the ketogenic diet come from? Interestingly enough, this fad diet didn’t spark from a celebrity endorsement or some guy missing a medical license. There’s evidence of the keto diet being used back in the early 1920s to treat severe childhood epilepsy and it’s still being used today for that purpose. Research suggests that the production of ketones may influence neurotransmitter activity in neurons allowing for a reduction in seizure attacks. A recent Cochrane Review demonstrated a 30-40% reduction in seizures compared with non-keto diet controls. One thing to keep in mind, however (which is a theme when discussing the keto diet) is that it’s generally difficult to adhere to and difficult to tolerate for a lot of people. In other words, people go on it and then come off it pretty damn quick.
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.

“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.


I would just like to share with you that my patients are HORRIFIED if their physicians ask them to cut out “everything white” in their diet. This is what some doctors ask for…essentially asking for the Ketogenic diet and most of my patients are in shock! Not only would I never want to skip a year of my birthday cake, but I wouldn’t ask my patients to either! One slice of cake is certainly not going to harm anyone with diabetes and hopefully you know enough about carbohydrates and their short term effect on BG levels to know this too! I am not a Registered Dietitian, so I couldn’t speak to this diet in regard to children with epilepsy. Are you a Neuro RN? TheDiabetesCouncil did just post another article where 25 Registered Dieticians weighed in regarding the Ketogenic Diet, so I would encourage you all to check that out!

Celebrity endorsements is the WORST reason to start a diet. And yes, it is a diet. Why? Because it’s not long term sustainable. Anyone can lose weight; ask an overweight person. They’ve lost weight hundreds of times. Keeping it off is a whole other ballgame and depriving yourself of carbs can lead to kidney damage. Educate yourself on the dangers of high protein diets that were largely debunked in the 70’s. Get with the program, girl!

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.
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.

I was diagnosed in 2004 with Brittle Type 1 diabetes, peripheral and autonomic neuropathy, and Hypothyroidism. A short time later with Gastroparesis due to the nerve damage from diabetes. Since then, I had followed every guideline and rule that the Endocrinologist and Primary Care Doctors had told me to follow. NOTHING WAS GETTING BETTER. In fact, I was gradually getting worse. So many ups and downs. Extreme highs (250-500 bgl ) to seizures from crashes (drop from 300 to 13 in no time). It was a constant battle with adjustments in insulin intake (and different insulins NPH, R, Novolog, Humalog, Lantus), carb intake, exercise and one contributing factor was the Gastroparesis. Meds were taken for the Gastroparesis but I always had side effects from meds. To my point. I was kicking a dead horse and I told them this. My sister and mom had come across the ketogenic way of eating and it dramatically improved thier lives. Mom was diagnosed way back with Type 2 and within a week or two she was off of her meds completely. I was totally interested. So, I decided to go for it on April 17, 2017. I did go through some rough patches of what they call Keto Flu. It did pass after a couple weeks. I was gaining so much energy like never before as well as mental focus. The even greater aspect of this all was, I had DRAMATICALLY LOWERED MY INSULIN INTAKE TO ALMOST NONE! My Lantus was always being adjusted from 30-40 units daily (and changed from AM to PM to splitting it to half AM, other half PM). I was on a sliding scale of Humalog or Novolog. From 4-6 units per meal and then there were the corrections throughout my day (some daily totals could be up to 40 UNITS)! Very exciting for me to only take 2 units of Lantus in the AM and daily totals of Humalog/Novolog….1.5-3 units! Other great things I began to notice, neuropathy pains were fading and finally GONE. No more nights up stinging, burning and RLS (restless leg syndrome). So, in my life, there are no questions or hardships on whether I can get off of this way of eating. It’s either do or die. If someone truly wants to have a better life, they can. The sad thing is, doctors and nutritionists aren’t being educated in the real facts. My primary care doctor isn’t willing to help me with all the labs I need nor listen. Always telling me “You need carbohydrates and insulin to live.” All that know me see the dramatic change for the better. I’m doing the Ketogenic way of eating with intermittent fasting for the rest of my life. The alternative IS NOT WORTH a lifetime of illnesses and suffering.
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.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Something that makes the keto diet different from other low-carb diets is that it does not “protein-load.” Protein is not as big a part of the keto diet as fat is. Reason being: In small amounts, the body can change protein to glucose, which means if you eat too much of it, especially while in the beginning stages, it will slow down your body’s transition into ketosis.

That doesn’t mean keto causes diabetes; it’s amazing for most diabetics. However, if your cells are great at processing fat, but suck at processing glucose or carbohydrates, you won’t be able to run at full power, and parts of your body that prefer glucose over fat — like the glial cells in your brain that handle immune function and synaptic pruning — don’t work as well over time.
You even have root vegetable and a picture of a carrot. Carrots are not part of a keto diet and as far as I have seen never were. They have 2 much sugar content and are discouraged except in very small amounts. Are you sure you tried it? Sorry. Great article in many ways but outdated in others. I don’t think people go into thinking they will “do it forever” How long can I last? I think that is missing the point entirely. So many people are getting their triglycerides down, losing weight reducing stroke possibilities lengthening their very lives. It is just not fair to not at least point out a few of these things as much as the risks you made sure to point out. albeit they are very important. How about the risks of not doing something? How about the list of people that found this and turned their lives around. Also, I know several people who have been doing keto for years.

If you want to use a ketogenic diet as a health tool, it would be wise to do so for no more than a few weeks at a time, as nobody knows how long is too long. And, of course, the period of time during which ketosis is safe can vary from individual to individual. Breaking ketosis is as easy as upping protein intake or having a glass of wine or whole piece of fruit.
The keto diet may also be beneficial for adults with epilepsy, though the Epilepsy Foundation notes that it’s less frequently recommended for this group because it is so restrictive and difficult to stick with. (1) One study, published in May 2016 in the journal Epilepsy & Behavior, found the diet reduced the frequency of seizures for many study participants, 7 percent of whom were seizure-free at the four-year mark. (2) And though it wasn’t the goal for this study, nearly 20 percent of the participants lost weight while following the diet.
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