As I wrote in op-eds for the Wall Street Journal61 and Medscape,62 the Lancet Public Health study is based on very thin data. The questionnaire underlying the report left out questions regarding popular foods, such as pizza and energy bars, and did not consider alcohol consumption. Moreover, the “low-carb” diet group in this study included people eating up to 37% of calories as carbohydrates—not low-carb according to the latest science. Ultimately, this is the kind of data that can show association but not establish causation, which means it is the kind of data one can use to generate hypotheses but not prove them. This kind of data would never be considered sufficient to approve a drug, for instance. The same standards should be applied to diet. Quite a few researchers, including myself, had our critiques published in Lancet Public Health.63 The authors replied but did not respond to most of the criticisms.
Some of the concerns are around micronutrients — supplementation of electrolytes, vitamins, and fiber is often required on low-carb diets, Zeratsky says. And sometimes, these diets can actually lower the blood sugar of a person with diabetes to the point where it’s too low, which is also dangerous. (Low-carb diets are not recommended for those people with type 1 diabetes or anyone on insulin due to that risk, experts note.)

Dash to a healthier you! Voted by health experts as the best overall diet three years in a row, the DASH Diet – originally developed to fight high blood pressure – is a safe and easy-to-follow eating plan that fights diseases and can even help you lose weight. Incorporate this two-phase plan from Marla Heller’s The DASH Diet Weight Loss Solution with bonus sample day menus for both phases. Find out if the DASH Diet is right for you. For more meal ideas, try these recipes!
MEME WAS TALKING ABOUT DIETS. I GOT THE BOOK ON THE DASH DIET AND I RLY LIKE IT. IT'S A DIET, YEAH, BUT IT'S ALL FOCUSED ON FEEDING YOURSELF GOOD THINGS, FOCUSING ON HITTING TARGETS FOR GETTING THE NUTRITION YOU NEED (A CERTAIN AMOUNT OF SERVINGS OF VEGGIES, FRUIT, LOW-FAT DAIRY, WHOLE GRAINS, ETC.) INSTEAD OF ON CALORIES. BUT CALORIES ARE STILL PART OF THE EQUATION, SO IT'S ALL SO FUCKING REASONABLE. IL IT.
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those that have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram (EEG) shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and it has been suggested that children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[45]
Use fat as a lever.  We’ve been taught to fear fat, but don’t! Both keto and low carb are high fat diets. Fat is our source of energy as well as satiety. The key to understand, though, is that fat is a lever on a low carb or keto diet. Carbs and protein stay constant, and fat is the one you increase or decrease (push the lever up or down) to gain or lose weight, respectively. So if your goal is weight loss, eat enough fat to be satisfied, but there’s no need to “get your fats in” once you’re satisfied.

Although you'll be cutting way back on carbohydrates and sugar, some fruits are still okay to eat on the keto diet (though you'll still want to be mindful about quantity in order to remain in ketosis). The fruits that make the cut contain far fewer carbs than their off-limits cousins such as apples, pears, bananas, pineapples, papayas, grapes, and fruit juices in general.

Although white potatoes offer some potassium and fiber, sweet potatoes reign supreme in the nutrition department, meaning you should consider adding sweet potatoes to your diet. A large sweet potato contains around 4 grams of satiety-boosting protein, 25 percent of the day’s belly-filling fiber, and 11 times the recommended daily intake of vitamin A. What’s more? It’s less than 200 calories.
The ketogenic diet is a mainstream dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.[Note 2] Although popular in the 1920s and 30s, it was largely abandoned in favour of new anticonvulsant drugs.[1] Most individuals with epilepsy can successfully control their seizures with medication. However, 20–30% fail to achieve such control despite trying a number of different drugs.[9] For this group, and for children in particular, the diet has once again found a role in epilepsy management.[1][10]
Taub-Dix suggests slowing down and listening to your stomach, not your brain. “Believe it or not, your stomach is about the size of two of your fists. When you eat some bread and butter, a glass of wine, an appetizer, a main dish, and dessert and cappuccino—your mouth and mind will feel satisfied, but your stomach might have wanted to go home halfway through your meal!”
In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet.[10] Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term ketogenic diet to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.[10]
The ketogenic diet is not a benign, holistic or natural treatment for epilepsy; as with any serious medical therapy, there may be complications.[27] These are generally less severe and less frequent than with anticonvulsant medication or surgery.[27] Common but easily treatable short-term side effects include constipation, low-grade acidosis and hypoglycaemia if there is an initial fast. Raised levels of lipids in the blood affect up to 60% of children[37] and cholesterol levels may increase by around 30%.[27] This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and, if persistent, by lowering the ketogenic ratio.[37] Supplements are necessary to counter the dietary deficiency of many micronutrients.[3]
Here’s what we do know: The keto diet may be useful in treating symptoms of epilepsy, a seizure disorder. “The use of keto in treating epilepsy has the most evidence,” Angelone says. One study conducted by Johns Hopkins Medicine, for example, followed epileptic patients on the keto diet and found that 36 percent of them had a 50 percent reduction in seizures after three months on the diet, and 16 percent were seizure-free. However, experts aren't entirely sure why the keto diet has this affect, she adds.
I was hypoglycemic as a teen because I avoided eating most carbs because obesity and diabetes runs in my family. When I got pregnant the dietician scared the he’ll out of me by telling me I was going to starve my baby if I continued to eat like I was. I immediately added good carbs into my diet and developed grata Iona’s diabetes and had a hell of a time controlling it. After I had my baby I went back to avoiding carbs and got back from yo where I was before my pregnancy. My brother died from complications due to his diabetes and at my mothers urging I went to a dietician and talked about food and what’s healthy and what’s not. I was once again scared that I was making a grave mistake and added in the carbs, I never should have. I developed diabetes and 80+ pound weight gain. After trying like hell to control my diabetes their way I’m back to my way. I’m tired of beating myself up for not being able to “apply” their recommendations correctly and the condescending attitude of the dietician when I tried asking about my old way of eating. I know me best and that’s it.
At first glance the ketogenic (keto) diet may seem like a crazy idea for type 2 diabetics. After all, many patients are put on diets to help them lose weight. The keto diet is high in fat, but it is very low in carbs, and this combination can help change the way your body stores and uses energy. With this diet your body converts fat instead of sugar into energy, which can improve blood glucose levels while reducing the need for insulin.
^ Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358–63. doi:10.1542/peds.102.6.1358. PMID 9832569. https://web.archive.org/web/20040629224858/http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM Lay summary]—JHMI Office of Communications and Public Affairs. Updated 7 December 1998. Cited 6 March 2008.

Speaking of standout breakfast foods, Greek yogurt is another option worthy of the spotlight thanks to its high-protein content. Per study in the journal Appetite, researchers from the University of Missouri compared the satiety effects of high-, moderate-, and low-protein yogurts on women aged 24-28, and found Greek yogurt, with the highest protein content, to have the greatest effect. What’s more? Probiotics in items such as yogurt and fermented foods, like pickles and sauerkraut, help good bacteria in the gut process food more efficiently. Hello, weight loss! If you want to get even more protein in your yogurt, check out Icelandic yogurts, which can have two to three more grams of protein per serving compared to Greek.
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Like peanuts, lentils also contain genistein, but their weight loss powers don’t end there. In one four-week Spanish study, researchers found that eating a calorie-restricted diet that also included four weekly servings of legumes aided weight loss more effectively than an equivalent diet sans the pulses. Those who consumed the legume-rich diet also saw improvements in their “bad” LDL cholesterol levels and systolic blood pressure. Next time you’re cooking something starchy for dinner, consider eating fiber and protein-packed lentils instead.
I’ve been doing low-carb-high-fat (LCHF) for more than nine years. I’m not diabetic and never was so far as I know, nor was I particularly overweight. I simply became convinced over time that this way of eating is the best way to limit the damage which can be done by a lifetime of exposure to the standard American high-carb, starchy, sugary diet. I love my fatty meat, egg yolks, butter, sour cream, and more. I suppose I am fortunate I never had “carb-cravings”.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
I think the larger question is why we are seeing such a sudden rash of anti-keto stories. So many of them quote no experts sources and do not provide citations for their claims. Skeptics with little acquaintance with the diet are quoted exclusively instead. From a journalistic perspective, this lack of balance of viewpoints and the failure to back up claims with evidence falls below basic reporting standards. Offenders on this list include even the Harvard School of Public Health, which recently published more than one  unsourced, one-sided article on the keto diet (This is in addition to the Lancet Public Health article cited above, by Harvard researchers, which suggests that a low-carb diet kills you). These stories could reflect lazy reporting or they could very well be scare tactics to steer people away from the keto diet.  Why would reporters or scientists at Harvard be doing such a thing? That’s material for another post. Stay tuned.
In the 1960s, it was discovered that medium-chain triglycerides (MCTs) produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides).[15] MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system.[16] The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on twelve children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children.[15] The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.[10]
Anna Taylor, RD, CDE, a licensed dietitian at the Cleveland Clinic in Ohio, says very-low-carb diets can hurt people with type 2 diabetes if done incorrectly. She and Keratsky say it’s important that anyone with diabetes who wants to try a low-carb or ultra-low-carb diet meet with a dietitian or physician to create a plan and make sure their eating style won’t react negatively with their current medicines.
Grains and beans are high in lectins, and it’s no surprise that the top allergen foods also have a high lectin content. The lectins in nightshade vegetables can be troublesome for some people, while others handle them just fine. Cooking and peeling removes some of the lectin content in vegetables (but not grains, they’re pretty heat stable), but some super-sensitive people have to avoid them completely.
What a great post. I thought i would add about the selection of food you eat on keto and that everyone is different. Some food gives you energy and some doesnt, this varies person to person. I started and quit keto 3 times before i managed to find my balance. The first few times it made be poorly, from the shock of diet change. However, you can wean yourself into the diet which i did the last time when i had the most success.
Thank you for this info. I will be copying the link to send to some folks ready to jump on this new trend. In fact I had a resident (I am a CDM) come in to our re-hab facility in pretty bad shape. He was unable to speak with me so I spoke with his wife. The man had come in after having a TIA. He was a diabetic, as well. The wife told me that she had her husband 9and herself) on a keto diet. When she saw the size my eyes got for some reason she got angry and very defensive and screamed “Forget everything you have been taught. It is all crap”. I understand when folks are worried abut their loved ones they can get pretty emotional. I asked my standard question about chew/swallowing, UBW and food allergies and quickly left. I spoke with the RD (a CDE) about what had happened. She tried to speak with the resident and his wife and got the same treatment. The RD said to me “He will have another stroke in a week”. He had one in 3 days. Unfortunately with this stroke, he got anew diagnosis of severe dysphagia. SLP tried and tried but he would aspirate on everything. He had to be pegged. He was brought back to the facility. The wife was taught how to feed him through the tube. He left the facility and passed quietly about 3 weeks later. I reached out to the wife on his second stay and we became fairly close. She said she thought she was doing the best thing for him because he was over weight. I get it. She only wanted a healthy husband. She apologized for being so quick when we met. I thanked her for actually educating me on this diet. I was not aware there was such a thing.
I recently had one of my previous cooks post that she was going to do this diet and should she start with 20 grams or 30 grams. She has been a cook in the healthcare business for about 8 years so she understands the different diets but not the physiology behind them (yet. I am trying to talk her into taking the CDM course). I told her to consult the RD at her facility before she embarks on such a trend. She won’t because all her friends posted their weight loss stories.

I’ve been following a ketogenic based “Way of Eating” or almost a year now, and I’ve never felt better. Fats are the main source of calories with it—NOT protein. Fats and proteins ARE essential for the body. Carbohydrates are not. The 20g of carbs are for net carbs, NOT total carbs. This means you can have a great deal of fiber from very nutrient filled veggies that don’t spike your blood sugar.


You’re very welcome, Judy! I’m glad it’s helpful. If you are keto (as opposed to low carb), unfortunately peaches would not allow you to stay in ketosis. You can check my keto food list to help determine what is keto friendly. Of course, there are worse things than fresh fruit 🙂 but in the end our bodies still see the sugar. That being said, it doesn’t mean you sabotaged the whole day. Just pick up again – you got this!! (And for next time, try some fresh berries in moderation when you’re craving fruit.)
Like a marathoner stretching before the big run, eating half a grapefruit before a meal can enhance your body’s fat-burning performance. A study published in the journal Metabolism found that this “warm-up” tactic can help whittle your middle—by up to an inch—in just six weeks! The scientists attribute the powerful effects to the grapefruits’ fat-zapping phytochemicals. The fruit can interact negatively with certain medications, so as long as you get the green-light from your M.D, plan to have half of a grapefruit before your morning meal and add a few segments your starter salads to reap the benefits.
We have all heard of essential fatty acids (EFAs) and essential amino acids (EAAs), but have you ever heard of essential carbohydrates? No. The human body is capable of burning fat for fuel. If the body can burn fat for fuel, why would you ingest a substance (carbohydrate) that raises your blood sugar, raises your insulin levels, and makes you sick? Why would the ADA advocate the very diet that made us sick in the first place? When are they going to admit they’ve been wrong and start doing what is in the best interest of diabetics?
There’s been no poultry or red meat so far in the menu, so plan for two dinners a week incorporating these animal foods instead of fish. Eat with family or friends, whenever possible, and listen to music instead of watching TV. Enjoy a glass of red wine with your meal; a moderate intake gives you polyphenols -- natural compounds in grapes -- that may protect you from heart disease, cognitive problems and even cancer.
There’s also some evidence that it might help with type 2 diabetes. “An emerging body of research is finding that a keto plan may have some real benefits thanks to its ability to improve the body’s ability to use insulin and also help control appetite, which can result in easier weight loss,” says Karen Ansel, R.D.N., co-author of Healthy in a Hurry.
A keto diet has shown to improve triglyceride levels and cholesterol levels most associated with arterial buildup. More specifically low-carb, high-fat diets show a dramatic increase in HDL and decrease in LDL particle concentration compared to low-fat diets.3A study in the long-term effects of a ketogenic diet shows a significant reduction in cholesterol levels, body weight, and blood glucose. Read more on keto and cholesterol >
It appears that a ketogenic diet is generally safe when implemented correctly. One must be careful to obtain all the necessary nutrients by eating a variety of foods, such as non-starchy vegetables, seeds, and nuts, and also consume adequate protein and essential fatty acids. Provided that the need for vitamins, minerals, amino acids and fatty acids is met, there is no reason to suspect that the ketogenic diet is unsafe.
There is a lack of scientific research when it comes to the long-term effects of the keto diet. When it comes to healthy eating and weight loss, creating sustainable, lifelong changes will result in the best outcomes. Most importantly, think about how this restrictive eating plan will fit into your lifestyle, and if you are willing to give up what may be some of your favorite foods. It’s important to make time for yourself to prepare meals at home and get regular exercise. Strive for progress, not perfection.
First, that study, which was reported upon widely, was on mice. Mice are not like humans in the way they fatten or contract metabolic diseases. Journalists/media should stop reporting on mice stories as if they were applicable to humans, especially when there is such a large body of clinical trial data on humans. Let’s be clear: rigorous clinical trial data on humans trumps any data on mice. Every time. And what does the rigorous data on humans say?

If Doctor’s recommend Keto to their patients that less drugs and no kick back from pharmaceutical companies, they need to keep people medicated because pharmaceuticals run this entire country. I followed a strict diabetic diet when my husband was diagnosed with Type 2 NEVER could keep his blood sugars under control still would be 220 after a meal.. Keto has brought that down to 95-98 AFTER a meal.
It is completely wrong to discuss “average lifespan”. The average lifespans of pre-industrial peoples is heavily reduced by infant and early childhood mortality, which has nothing to do with lack of fresh fruit. Once you remove this bias in the numbers, pre-industrials can have lifespans almost as long as ours. And usually without many of the degenerative diseases that bother our middle and old ages.
A myriad of different teas have been shown to aid weight loss, and green tea is no exception. In fact, a study published in The Journal of Nutrition found that after just two weeks, those who sipped four to five cups of the green brew each day, in addition to working out for 25 minutes, lost more belly fat than those who didn’t imbibe. Scientists attribute green tea’s ability to shrink waists to the beverages catechins, a type of antioxidant that hinders the storage of belly fat and facilitates rapid weight loss.

The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients.[3] Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been ineffective.[9] Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug.[1] There is some evidence that adolescents and adults may also benefit from the diet.[9]
Because this is an eating pattern – not a structured diet – you're on your own to figure out how many calories you should eat to lose or maintain your weight, what you'll do to stay active and how you'll shape your Mediterranean menu. The Mediterranean diet pyramid should help get you started. The pyramid emphasizes eating fruits, veggies, whole grains, beans, nuts, legumes, olive oil, and flavorful herbs and spices; fish and seafood at least a couple of times a week; and poultry, eggs, cheese and yogurt in moderation, while saving sweets and red meat for special occasions. Top it off with a splash of red wine (if you want), remember to stay physically active and you're set.
Yet it’s an incredibly well-rounded way to lose weight that ditches gimmicks and doesn’t require calorie or macronutrient counting as other diets do. And with the emphasis on healthy fat, it’s satisfying, too. That said, the 2019 U.S. News & World Report Best Diets ranked the Mediterranean diet as No. 1 for Best Diets Overall and it ranks 17 in their list of Best Weight-Loss Diets. (3) The reviewers note that it’s not a slam dunk, and all depends on how you eat. Even healthy diets like the Mediterranean aren’t free-for-all eating plans.
The trick here is not only to avoid all obvious sources of carbohydrate (sweets, bread, spaghetti, rice, potatoes), but also to be careful with your protein intake. If you eat large amounts of meat, eggs and the like, the excess protein will be converted into glucose in your body. Large amounts of protein can also raise your insulin levels somewhat. This compromises optimal ketosis.
In fact, patients with gastroesophageal reflux disease (GERD) have been shown to improve after eating very low carbohydrate diets.31, 32 Another study found increased carb-intake worsened GERD, while a high-fat, low-carbohydrate diet reduced symptoms.33 And two studies have linked esophageal diseases, including Barrett’s esophagus (BE)34 and GERD,35 to sugar and carbohydrate intake.
The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients.[3] Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been ineffective.[9] Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug.[1] There is some evidence that adolescents and adults may also benefit from the diet.[9]

The cost of the Mediterranean diet, like most aspects of the diet, depends on how you shape it. While some ingredients (olive oil, nuts, fish and fresh produce in particular) can be expensive, you can find ways to keep the tab reasonable – especially if you're replacing red meats and meals with plant-based home cooking, some research suggests. Your shopping choices matter, too. Can't spring for the $50 bottle of wine? Grab one for $15 instead. And snag whatever veggies are on sale that day, rather than the $3-a-piece artichokes.
Dash to a healthier you! Voted by health experts as the best overall diet three years in a row, the DASH Diet – originally developed to fight high blood pressure – is a safe and easy-to-follow eating plan that fights diseases and can even help you lose weight. Incorporate this two-phase plan from Marla Heller’s The DASH Diet Weight Loss Solution with bonus sample day menus for both phases. Find out if the DASH Diet is right for you. For more meal ideas, try these recipes!
We do recommend everyone eat something every 4-5 hours to maintain a healthy metabolism. If your meals are more than 4-5 hours apart, a snack consisting of a protein and a carbohydrate is a great choice. The protein will help fill you up quicker and keep you feeling satisfied between meals. The protein also has a slower effect on your blood glucose than most carbohydrates, so when paired with carbohydrates, your blood sugar will not spike nearly as high. We recommend eating a protein with every meal and snack.
We really do only want to try and share the knowledge we have through seeing thousands of different patients with complex issues over decades with all of you. Physicians jump at the chance to have a CDE see their patients in their practice or in the hospital because they know our value. They know how thorough we are when assessing their patients and often find issues that may have been overlooked for years. It’s all we do all day, so it’s our specialty…diabetes. We live and breathe it and are very passionate about helping people overcome their hurdles. I do hope sharing some of my personal experience with all of you will help, but I am here if you all have more questions anytime!

You’re very welcome, Judy! I’m glad it’s helpful. If you are keto (as opposed to low carb), unfortunately peaches would not allow you to stay in ketosis. You can check my keto food list to help determine what is keto friendly. Of course, there are worse things than fresh fruit 🙂 but in the end our bodies still see the sugar. That being said, it doesn’t mean you sabotaged the whole day. Just pick up again – you got this!! (And for next time, try some fresh berries in moderation when you’re craving fruit.)
At the end of this 12 week study, scientists observed similar loss in body fat and overall body weight in all three diets. However, they noted that the VLCARB ketogenic diet was “more effective in improving tracylglycerols, HDL cholesterol, fasting and post-meal glucose and insulin concentrations. More specifically, triacylglycerols decreased by 39.9% in VLCARB subjects, 4.0% in VLF subjects, and 9.6% in HUF subjects. [11]
First, a little background: Eric Westman, MD, director of the Duke Lifestyle Medical Clinic, explained to Health in a previous interview that in order to successfully follow the keto diet, you need to eat moderate amounts of protein, reduce your carb intake, and increase fats. When you reduce your carb consumption, your body turns to stored fat as its new fuel source—a process called ketosis. To stay in ketosis, followers of the keto diet must limit their carbs to 50 grams a day, Dr. Westman says.
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