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-

"Those with type 1 diabetes should avoid a ketogenic diet," warns Joseph Galati, MD, a hepatologist at the Liver Specialists of Texas in Houston, "Many patients with type 1 diabetes have some degree of renal impairment, and handling the build-up of ketones and acids in the body may cause too much stress on the kidneys. Of course, any pregnant women with diabetes, especially those requiring insulin should avoid such an extreme diet given the low glucose levels will be a constant [health] threat."
Before the discovery of neuroplasticity, scientists believed that a damaged brain cannot regenerate. However, by improving mitochondria health, reducing inflammation, and stimulating cellular cleanup, ketogenic diets can help a damaged brain repair itself. Thus, the ketogenic diet is almost a miracle for many brain diseases that were thought of as incurable.
However, this diet isn’t for everyone. If traditional bread, pasta, rice, potatoes and/or fruit are what you live for, then you might just be miserable on keto. However, if you’re open to exploring different tastes, then the good news is there are substitutes for many of these foods. Cauliflower pizza crust, rice, and even gnocchi; zoodles (noodles made from zucchini); almond flour bread and almond milk are all readily available from most stores now.  A small amount of berries is acceptable, but for the most part say goodbye to apples, melons, plums and peaches. Booze and sugar are also out, but if you’re living with diabetes, you likely already know how to manage these desires.
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.
It’s best to approach this change in eating as a way to feel better and become healthier, rather than as a “fad diet” or weight loss quick-fix. Dr. Cabeca recommends giving it six months to test the effects, keeping in mind that some trial and error is expected along the way. The diet should ideally be approached in step-wise fashion, focusing on alkaline first before adding in fasting and the keto aspect.
“The human digestive tract is simply not well designed for digesting grains. The proteins in grain, especially the gluten, are very difficult to digest, even if you don’t have apparent gluten problems. Too much grain, especially of the highly refined kind, is behind many of the cases of food allergies, irritable bowel, chronic indigestion, and yeast overgrowth that I see every day.”

In the brain, there are some parts that can only take glucose to burn for fuel, which is usually derived from carbohydrates. However, when the body is on a ketogenic diet, the body will enter ketosis, which is a process that produces proteins called ketones from fatty acids in the liver. The brain can surprisingly also take in these special ketones to function. Past studies have shown that children affected with epilepsy who are on this diet have a 50% lower chance of reducing seizures. 16% of that group have also shown to be seizure free. This diet is for individuals with Parkinson’s disease and Alzheimer’s to see if ketogenic diets can also help.


One study from 2005 followed 22 people with Type 1 Diabetes for 12 months. The difference here however is they consumed 70-90 grams of carbohydrates per day versus the restrictive less than 20 grams per day on the Ketogenic Diet. Remember my motto? Moderation is the key! The results were positive; less hypoglycemia, insulin requirements were reduced and their A1c dropped from 7.5% to 6.4%.
Bulk buy and cook. If you’re someone who doesn’t like to spend a lot of time in the kitchen, this is the best of both worlds. Buying your food at bulk (specifically from wholesalers) can reduce the cost per pound tremendously. Plus, you can make ahead food (bulk cook chicken thighs for pre-made meat, or cook entire meals) that are used as leftovers, so you spend less time cooking.

Registered dietitian Julie Stefanski is based in York and has specialized in the ketogenic diet for more than a decade. She also advocates for anyone starting keto, especially individuals who have not seen a doctor in more than a year, to first see a physician and/or registered dietitian to have their lab work checked and monitored. She also notes there are certain medications that cannot be used while on a ketogenic diet.  
Work towards cycling fasting days so you’re fasting on 2–3 nonconsecutive days per week (e.g. Tuesday, Thursday and Saturday). Stick to only light exercise or yoga on fasting days to reduce feeling exhausted or hungry, keeping higher intensity activities for your non-fasting days. This approach allows for more dietary and lifestyle “moderation” because the goal isn’t to eat 100 percent “perfectly” all the time.

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.
In order to transition and remain in this state, aiming for about 30–50 net grams is typically the recommended amount of total carbs to start with. This is considered a more moderate or flexible approach but can be less overwhelming to begin with. Once you’re more accustomed to “eating keto,” you can choose to lower carbs even more if you’d like (perhaps only from time to time), down to about 20 grams of net carbs daily. This is considered the standard, “strict” amount that many keto dieters aim to adhere to for best results, but remember that everyone is a bit different.
WOW. I guess I must be a very special, highly motivated patient then. I, of course, would never have said that about myself. My high motivation is trying to get over the hatred of food that being Diabetic gave me. I don’t feel that way anymore, and am finally happy cooking, again. (My doctor DID tell me exactly that, BTW. Even to the extent of telling me to not include the tsp of agave that I was having in my coffee once a day because sugar is sugar.)
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?
Doctors can measure levels of inflammation in the body using blood tests for high-sensitivity C-reactive proteins (hsCRP) and white blood cell (WBC) counts. In Dr. Phinney’s study, “patients experienced a hsCRP reduction of 39 percent, and white blood cells were reduced by 9 percent,” Dr. Phinney says. “Similar results were demonstrated in a two-year study, which showed a 29 percent decrease in hsCRP following a low-carbohydrate diet.” Inflammation, Dr. Phinney notes, is directly associated with many different health conditions, such as heart disease, diabetes, arthritis, and autoimmune conditions. “It is very possible that reducing inflammation through nutritional ketosis could improve a whole host of conditions,” he says. These 10 keto diet recipes are reason enough to give it a try.
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]
The main limitations of our study are its small sample size, short duration, and lack of control group. That the main outcome, hemoglobin A1c, improved significantly despite the small sample size and short duration of follow-up speaks to the dramatic and consistent effect of the LCKD on glycemia. For other effects, however, such as the rises in serum LDL and HDL cholesterol, the small sample size might be the reason statistical significance was not reached. Future studies of larger samples and containing a control group are needed to better address questions about the effect of the LCKD on serum lipids in patients with type 2 diabetes.
You sound weak I have given up all carbohydrates and fast acting insulin and had no issue with it ( real food is so delicious and satisfying)… and I don’t miss bread pasta and sugar at all… your mind is poisoned. It also has an added side effect , I now have no fat on my body. You uneducated money grubbing doctors and the sugar industry are the real problem here. My endocrinologist didn’t even bother to tell me about nutritional ketosis at all. I eat 80 to 85% good saturated fats out the 4000 calories I consume each day… not that difficult getting rid of crap sugar and carbs… these “doctors “ are lying to us and no one cares! It’s really disgusting …. I have no problem living without sugar…. and no studies done at all.. what the hell are these doctors doing, it seems pretty obvious to me$$$$.
Still, research on the relationship between the keto diet and mental clarity, as well as anxiety and depression, is still in its early stages, and not all people who try the keto diet report noticeable changes in the ways they think. In fact, some people report an increase in brain fog after switching to the keto diet, though this might be explained by the "keto flu", which describes the flu-like symptoms people tend to experience in the first few weeks after beginning the keto diet.
It may seem unusual that a diet filled with fats could be a positive for your heart, but that’s exactly what Dr. Phinney suggests. “In the one-year study, 22 of 26 cardiovascular risk factors significantly improved. Most notably, these patients experienced a mean fasting triglyceride reduction of 24 percent, an 18 percent increase in good HDL cholesterol, and significant reductions in both systolic and diastolic blood pressure.” For all of these findings, Dr. Phinney notes that research into the benefits of keto is still in its earliest stages. “The fact is, there is not yet any long-term, peer-reviewed data that connects some of these improvements to nutritional ketosis,” he says. Read more about the 11 hidden dangers of the keto diet.

Make things yourself. While it’s extremely convenient to buy most things pre-made or pre-cooked, it always adds to the price per pound on items. Try prepping veggies ahead of time instead of buying pre-cut ones. Try making your stew meat from a chuck roast. Or, simply try to make your mayo and salad dressings at home. The simplest of things can work to cut down on your overall grocery shopping.
The most obvious sign that your electrolyte/mineral balance is being affected is an increase in urination. On a low-carb diet, insulin levels drop which promotes the secretion of sodium in the urine. Sodium pulls more water into the urinary system which then is excreted as well.  This is a very normal one of the keto side effects and a positive sign you are moving towards keto adaptation.

Brain fog and a lack of focus can be caused by having too much glutamate and very little GABA. This will happen if your brain has to use glutamate and glutamic acid for fuel, which leaves little left over to be processed into GABA. By giving the brain another form of energy when you break down ketones, you’re able to balance out the neurotransmitter production.

Thanks for this inputs. 20 years ago I gain 17 pounds a year for 5 years. I was healthy but my dr told me start diet, any diet just come back in a month I want to see you start loosing… I started Atkins and lost 7 pound in a month. She was checking my progress every six months and checking my condition. I lost 64 pounds in 3 years. Now I started eating out of control. I am eating healthy but too much… I gain 40 pound back after 20 years. Now I will start again my Atkins to take off 30 pounds…
In 2006, Czech researchers placed men on either a diet containing red meat or one without red meat, then had them sweat. Women smelled and rated the sweat. Across the board, the red meat dieters produced less attractive body odor. When they had everyone switch to the other diet, the results persisted: Those who had switched to a no-red meat diet produced better-smelling sweat.

Some studies have shown a positive connection between ketosis and lower levels of ketosis, but as Paoli et all conclude in their paper Beyond Weight Loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets, there is persuasive, although not yet conclusive, clinical and physiological evidence that the ketogenic diet could be effective in reducing the severity and progression of acne and randomized clinical trials will be required to resolve the issue.
Thanks for reading Roxanne! You could try the following: eating more frequently, using MCT oils, consuming plenty of salts, and potentially using an HPA axis supporting formula such as adapt-strong: https://store.drjockers.com/products/adapt-strong we also have an awesome magnesium lotion with melatonin that could be helpful in this case: https://store.drjockers.com/products/magnesium-lotion-goodnight-with-melatonin
However, the lower calorie Keto Diet also features a reduction in fats as well. In doing so, this Keto Diet accelerates fat loss and is better suited for losing weight. After all, between 2 Ketogenic Diet types, with one having a higher caloric intake than the second, which do you think would be the better choice for weight loss? Obviously the lower calorie diet. By reducing fats, your caloric intake is also reduced. As a result, the dieter’s weight loss will occur more rapidly.
thank you Dr. Jockers for the informative article. I have hypothyroidism from 3 parathyroid cysts being removed along with 80% of my thyroid. It is under control with Levothyroxine and liathyronine. I have been on the keto diet for almost 4 weeks and am still experiencing heart palpatations, dizzyness and low energy. I have been quite strict and feel disappointed. I have Chronic Lymphocytic Leukemia and my oncologist was ok with me going on it. I feel like this diet would help me have more energy and help my overall health. Any advise would be appreciated. thank you, Inika
At any given intensity, a keto-adapted athlete burns more fat and less glycogen than a sugar-burning athlete. Long-term elite keto athletes can burn up to 2.3 times more fat at peak oxidation and 59% more fat overall than non-keto athletes, and they do it at higher intensities. They remain in the predominantly fat-burning zone at 70% of VO2max, whereas non-keto athletes switch over from predominantly fat burning to a spike in sugar-burning at 54.9% VO2max.
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains, and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter.[1] Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[4][5]

Missing Nutrients. One of the biggest concerns for dietitians is the keto diet’s lack of key foods. Many question the eating plan’s impact on the development of certain chronic diseases. Without milk, for example, getting enough calcium and vitamin D for sturdy bones becomes a challenge. Take away whole grains, fruit, beans, and potatoes, and it’s nearly impossible to consume enough potassium for healthy blood pressure or enough fiber to stay regular. And unless you’re eating lots of low-carb, leafy green vegetables, you miss out on vitamins A, C, K, and folate, too. 


All of our cells need fuel to function. This fuel comes from three sources: fat, carbohydrates and protein, called macronutrients. Too much protein without fat puts us at risk for a handful of complications, so protein can never healthily serve as a primary source of fuel. We are left then with fat and carbohydrates as the main providers of energy – the energy that allow us to do everything from breathing and blinking as we veg out on the couch to swimming the English Channel. Our cells’ preferred fuel comes from carbohydrates, which are easily converted to glucose, which, in turn, is readily converted to energy. This is why athletes “carb load” before they compete. Peak performance occurs when the body has plenty of glucose and glycogen stores available at hand. When glycogen runs out, that’s when the body turns to fat. When there is no more blood sugar for our cells to consume, they seek an alternative form of energy. This energy comes from ketones, which are compounds our body produces from stored fat. So a ketogenic diet is one that is high in fat and very low in carbohydrates, resulting in the production of ketones to be used for fuel instead of glucose.
Thank you for your wonderful comments Marcia. To share more about me personally with you all…I am not a completely non-diabetic Certified Diabetes Educator. I found out I had Prediabetes 15 years ago when I became a Diabetes Educator. I tested my own A1c and found it was 5.8%. The incredible news? There have been years when my A1c dropped to a normal level of 5.4%…out of the prediabetes range. My last A1c in May was 5.8%, so I still have Prediabetes 15 years later, but not diabetes, and without any medication, just the sensible diet I’ve discussed and exercise, so I really am living with this. I feel it everyday, I wonder what my A1c is going to be just like you every 6 months when I go to have it drawn.
Reduce daily net carb intake to less than 20 grams: Although it’s possible that you may not need to be this strict, eating fewer than 20 grams of net carbs every day virtually guarantees that you’ll achieve nutritional ketosis. What does 20 grams of carb look like? Use our visual guide to find out, or simply try our keto recipes and meal plans that limit carbs to less than 20 grams per day.
John Staughton is a traveling writer, editor, and publisher who earned his English and Integrative Biology degrees from the University of Illinois in Champaign, Urbana (USA). He is the co-founder of a literary journal, Sheriff Nottingham, and calls the most beautiful places in the world his office. On a perpetual journey towards the idea of home, he uses words to educate, inspire, uplift and evolve.
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