If you’re science oriented, you can also try his 2008 book “Good Calories, Bad Calories”. For a more journalistic view on the events that led to fat phobia starting in the 1950’s (as well as the joke that is the Mediterranean Diet), there is also Nina Teicholz’s 2014 book “The Big Fat Surprise.” Be sure to check out youtube for some of these folks’ lectures and discussions. They are not advocating whacky stuff.
WH Verdict: While it’s unlikely to be popular with those who’ve chosen a plant-based lifestyle for ethical reasons, the principal of eating real, whole food is sound. And combining two ways of eating certainly makes it easier to get enough protein and vital nutrients. But it’s still pretty restrictive, so consult a nutrition professional to make sure you aren’t at risk of nutritional deficiencies.
Hi Barb, That can definitely be it. Losing when you are close to goal can be more difficult. It could also be that your body’s healthy weight is a little higher than what you’d like – which doesn’t mean you can’t lose, but makes it more difficult. If just eating Keto foods isn’t working, double check the macros for your weight and see if the amount you’re eating needs to be adjusted. You’ll find more help and support in our support group here.
Thanks for posting this Edward. While I agree that the thought of a lifetime without any sweets or any grains sounds miserable, it’s even more miserable every time I see a number above 120 on my meter, which is guaranteed to happen every time I eat even a few bites of one of those foods. Yeah, it’s stressful (and cortisol is just as much of a pain as T2D), but I want a better life and a life off of drugs. I was on three orals and two shots of insulin daily.
For those who want to follow a ketogenic-type diet, Dr. Reynolds says it is important to first talk to your doctor and to discuss your goals so you can be sure that this approach is suitable for you given your medical and health history. Ongoing monitoring is needed if you do decide to adopt this very carb approach to eating. Seeing your doctor regularly is important to make sure that your blood pressure, lipids, blood sugar, mood, and medications are within normal ranges as you lose weight. Adjustments are likely going to be necessary from time to time.
From baseline to week 16, the mean body weight decreased significantly from 131.4 ± 18.3 kg to 122.7 ± 18.9 kg, BMI decreased from 42.2 ± 5.8 kg/m2 to 39.4 ± 6.0 kg/m2, and waist circumference from 130.0 ± 10.5 cm to 123.3 ± 11.3 cm (Table ​(Table3).3). The percent change in body weight was -6.6%. The mean percent body fat decreased from 40.4 ± 5.8% to 37.0 ± 6.0%. Systolic and diastolic blood pressures did not change significantly over the 16 weeks. The mean heart rate decreased from 81.2 ± 12.9 beats per minute to 74.6 ± 14.0 beats per minute (p = 0.01).
Switch to Lighter Alternatives. Whenever you can, use the low-fat versions of salad dressings, mayonnaise, dairy products, and other products. "You can trim calories effortlessly if you use low-fat and lighter products, and if the product is mixed in with other ingredients, no one will ever notice," says Magee. More smart substitutions: Use salsa or hummus as a dip; spread sandwiches with mustard instead of mayo; eat plain roasted sweet potatoes instead of loaded white potatoes; use skim milk instead of cream in your coffee; hold the cheese on sandwiches; and use a little vinaigrette on your salad instead of piling on the creamy dressing.
Conklin's fasting therapy was adopted by neurologists in mainstream practice. In 1916, a Dr McMurray wrote to the New York Medical Journal claiming to have successfully treated epilepsy patients with a fast, followed by a starch- and sugar-free diet, since 1912. In 1921, prominent endocrinologist Henry Rawle Geyelin reported his experiences to the American Medical Association convention. He had seen Conklin's success first-hand and had attempted to reproduce the results in 36 of his own patients. He achieved similar results despite only having studied the patients for a short time. Further studies in the 1920s indicated that seizures generally returned after the fast. Charles P. Howland, the parent of one of Conklin's successful patients and a wealthy New York corporate lawyer, gave his brother John Elias Howland a gift of $5,000 to study "the ketosis of starvation". As professor of paediatrics at Johns Hopkins Hospital, John E. Howland used the money to fund research undertaken by neurologist Stanley Cobb and his assistant William G. Lennox.[10]
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet (MAD) or the low-glycaemic index treatment (LGIT) diet, because they find the difficulties too great.[41]
Rich in low-starch vegetables, fruit, healthy fats (mostly from olives and olive oil), nuts, seeds, whole grains, legumes, and fish, the Mediterranean diet eschews simple sugars and refined starches and is low in red meat. Interested in embarking on the diet for yourself? Read through to see a Mediterranean diet shopping list, what it's like to be on the diet, and why it's so easy to follow.
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!”
Choose Liquid Calories Wisely. Sweetened drinks pile on the calories, but don't reduce hunger like solid foods do. Satisfy your thirst with water, sparkling water with citrus, skim or low-fat milk, or small portions of 100% fruit juice. Try a glass of nutritious and low-calorie vegetable juice to hold you over if you get hungry between meals. Be careful of alcohol calories, which add up quickly. If you tend to drink a glass or two of wine or a cocktail on most days, limiting alcohol to the weekends can be a huge calorie saver.
If you are pregnant or are nursing, you should not follow a Ketogenic diet. You will not receive enough of the recommended carbohydrates, vitamins and nutrients necessary for yourself and your growing baby on this diet. Your obstetrician will recommend how many carbohydrates you should consume per meal and for snacks during each phase of your pregnancy. They will likely refer you to a Certified Diabetes Educator for nutritional counseling as well. Please check out The Diabetes Council’s FAQ’ About Gestational Diabetes for all your gestational diabetes related questions.
You’re transitioning. Your body is equipped to process a high intake of carbs and a lower intake of fat. Your body needs to create enzymes to be able to do this. In the transitional period, the brain may run low on energy which can lead to grogginess, nausea, and headaches. If you’re having a large problem with this, you can choose to reduce carb intake gradually.
Dr. Reynolds reviewed numerous research studies on ketogenic diets,6 and he has found that most studies show that the drop in blood sugar is typically short-term—only lasting during the initial three months or so—but does not last.  "So it is very hard to encourage ketogenic diets when we have no evidence that they work over longer periods of time," he tells EndocrineWeb.
At the conclusion of the intervention, both groups had improved in all metrics but “these changes were more significant in subjects who were on the LCKD as compared with those on the LCD.” [10]. As a result, the researchers supported the study outlined above and concluded that their “…study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects.” [10]
At the conclusion of the intervention, both groups had improved in all metrics but “these changes were more significant in subjects who were on the LCKD as compared with those on the LCD.” [10]. As a result, the researchers supported the study outlined above and concluded that their “…study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects.” [10]
If you have health reasons that make you want to try it and eating bacon, eggs and steak salads every day sounds amazing, maybe you could swing it. If nothing makes you happier than a fresh piece of sourdough, or if beans are one of the protein sources you rely on, there’s no point in trying a diet that’s not going to work. (And, by the way, sourdough toast with mashed avocado for breakfast and black bean soup for lunch are really delicious and healthy.)
The comments defending the keto diet suggest that the individuals are successfully using the keto diet to help them maintain a healthy weight and a healthier A1C level. The individuals also suggest that they view it as a way of life rather than a diet. This is good news for many of us who are facing the question of whether it will be helpful and necessary to reduce carbohydrate intake to keto producing levels in order to halt or reverse the onset of type II diabetes. I think like those individuals, Tami is speaking from her own personal experience where she had success losing weight, but had difficulty maintaining the keto diet long-term. I am sure that though you have been successful, you can understand that there are many who might find it difficult to maintain. I too have been given very bad guidance by Medical Doctors who lean on old Med School information to practice medicine rather than continuing to broaden their knowledge base and learn more about nutrition. I cannot get back the 20+ years of suffering with a debilitating disease that could have been cured because my doctors were not well informed or willing to listen to information that disagreed with their limited knowledge base. Those years are gone and the destruction to my body is not reversible. So I understand the anger you feel toward a system that isn’t working in the best interest of the patient. But I think that expressing anger toward those who disagree with our personal experience, is not solving the problem. Hopefully we can change the ADA guidelines by respectfully urging them to reconsider their position based on the sheer volume of the comments they receive from successful people like you, who are living the keto diet lifestyle and living better. I commend you for becoming your own best health advocates. Thanks for your encouragement and your passion. And thanks to Tami as well for sharing her personal experience and the information she had collected. We all have to be true to what we believe and we all have a right to come to our own conclusions. It is good to know that there are success stories out there. I wish you all good health and continued success. I also hope that one day medical training will do a much better job of preparing doctors to become their patient’s best advocates, actively learning and searching for cures rather than treating symptoms in ways that cause even more disease to develop. The system is failing so many of us.
Because the diet isn’t as restrictive as a traditional vegan or vegetarian diet, it may be simpler to stick with — hence its No. 2 ranking in U.S. News & World Report’s Easiest Diets to Follow category. Because you’ll be eating meat some of the time, you may also be at a lower risk of the aforementioned nutrient deficiencies that vegetarians and vegans may face.
Hi Cyn, The numbers are general guidelines but will vary depending on many factors, such as activity level, insulin resistance, weight and more. There is no single magic number, just conventional recommendations that are a good starting point. I will have a macro calculator coming soon that will help determine what is best for each person, but even then it’s an approximation. The only way to know for sure is to test. If keto is your goal, it’s usually best to start lower and then see if you can stay in ketosis when increasing.
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!
Recently, four studies have re-examined the effect of carbohydrate restriction on type 2 diabetes. One outpatient study enrolled 54 participants with type 2 diabetes (out of 132 total participants) and found that hemoglobin A1c improved to a greater degree over one year with a low-carbohydrate diet compared with a low-fat, calorie-restricted diet [5,6]. Another study enrolled 8 men with type 2 diabetes in a 5-week crossover outpatient feeding study that tested similar diets [7]. The participants had greater improvement in glycohemoglobin while on the low-carbohydrate diet than when on a eucaloric low-fat diet. The third study was an inpatient feeding study in 10 participants with type 2 diabetes [8]. After only 14 days, hemoglobin A1c improved from 7.3% to 6.8%. In the fourth study, 16 participants with type 2 diabetes who followed a 20% carbohydrate diet had improvement of hemoglobin A1c from 8.0% to 6.6% over 24 weeks [9]. Only these latter three studies targeted glycemic control as a goal, and two of these were intensely-monitored efficacy studies in which all food was provided to participants for the duration of the study [7,8]. Three of the studies [6,8,9] mentioned that diabetic medications were adjusted but only one of them provided detailed information regarding these adjustments [9]. This information is critical for patients on medication for diabetes who initiate a low-carbohydrate diet because of the potential for adverse effects resulting from hypoglycemia.
Similar to our results, three studies noted that diabetes medications were reduced in some participants[6,8,9], although details were provided in only one study. We also discontinued diuretic medications during diet initiation because of concern for additional diuresis incurred by the diet. This concern was based on the theoretical effects of the diet [17], observed effects of the diet on body water by bioelectric impedance [18], and practical experience with the diet [19]. Until we learn more about using low carbohydrate diets, medical monitoring for hypoglycemia, dehydration, and electrolyte abnormalities is imperative in patients taking diabetes or diuretic medications.
The ketone bodies are possibly anticonvulsant; in animal models, acetoacetate and acetone protect against seizures. The ketogenic diet results in adaptive changes to brain energy metabolism that increase the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitochondria is increased. This may help the neurons to remain stable in the face of increased energy demand during a seizure, and may confer a neuroprotective effect.[55]
Eat Breakfast Every Day. One habit that's common to many people who have lost weight and kept it off is eating breakfast every day. "Many people think skipping breakfast is a great way to cut calories, but they usually end up eating more throughout the day, says Elizabeth Ward, MS, RD, author of The Pocket Idiot's Guide to the New Food Pyramids. "Studies show people who eat breakfast have lower BMIs than breakfast-skippers and perform better, whether at school or in the boardroom." Try a bowl of whole-grain cereal topped with fruit and low-fat dairy for a quick and nutritious start to your day.
The herbs and spices associated with the Mediterranean diet shine at dinner. Meal options include fish like grilled salmon or pan-seared trout, seasoned with lemon and dill; chicken baked with a little olive oil and rosemary; grilled lamb chops with mint; mussels cooked in a tomato, garlic and wine broth; chili made with ground turkey, kidney beans and cayenne, or vegetarian-style with a mix of beans; and scallops sauteed with mushrooms and leeks. Have a 4-ounce serving of protein, and fill the rest of your plate with cooked veggies, like cauliflower, broccoli, brussels sprouts, or green beans.
The following measurements were made every other week: anthropometric and vital sign measurements; urine testing for ketones; and assessment for hypoglycemic episodes and other symptomatic side effects. Weight was measured on a standardized digital scale while the participant was wearing light clothes and shoes were removed. Skinfold thickness was measured at 4 sites – the average of 2 measurements at each site was entered into an equation to calculate percent body fat [12]. Waist circumference was measured at the midpoint between the inferior rib and the iliac crest using an inelastic tape; 2 measurements were averaged in the analysis. Blood pressure and heart rate were measured after the participant had been seated quietly without talking for 3 minutes. Certified laboratory technicians assessed urine ketones from a fresh specimen using the following semi-quantitative scale: none, trace (up to 0.9 mmol/L [5 mg/dL]), small (0.9–6.9 mmol/L [5–40 mg/dL]), moderate (6.9–13.8 mmol/L [40–80 mg/dL]), large80 (13.8–27.5 mmol/L [80–160 mg/dL]), large160 (>27.5 mmol/L [160 mg/dL]). Hypoglycemic episodes and symptomatic side effects were assessed by direct questioning of the participant and by self-administered questionnaires.
Think of each almond as a natural weight-loss pill. A study of overweight and obese adults found that, combined with a calorie-restricted diet, consuming a little more than a quarter cup of the nuts can decrease weight more effectively than a snack comprised of complex carbohydrates and safflower oil—after just two weeks! (And after 24 weeks, those who ate the nuts experienced a 62% greater reduction in weight and BMI!) For optimal results, eat your daily serving before you hit the gym. A study printed in The Journal of the International Society of Sports Nutrition found that almonds, rich in the amino acid L-arginine, can actually help you burn more fat and carbs during workouts. Fill up, but don’t fill out: Use these Eat This, Not That!-recommended 10 Daily Habits That Blast Belly Fat.

Hi Maya. I LOVE your site!! Interesting, informative with fab recipes and ideas. Hubby and I have just started eating low carb and I have to say, we are not finding it too difficult and I already feel sooo much better!! I find the hardest part is choosing low carb veg, I feel as if we are not eating enough. Any suggestions on how to get more veggies into our diet?


"The eating plan focuses on reducing sodium intake and eating more fruits and vegetables," says Amy Gorin, MS, RDN, owner of Amy Gorin Nutrition in the New York City area. "It also emphasizes eating whole foods — such as fruits, vegetables, whole grains, fish, poultry, beans, nuts, and vegetable oils — and limits foods high in saturated fat. That includes fatty meats, full-fat dairy, and tropical oils like palm kernel oil, palm oil, and coconut oil. It also limits sugar-sweetened beverages and foods."
A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed; 24% occasionally prescribed the diet as a last resort; 24% had only prescribed the diet in a few rare cases; and 16% had never prescribed the diet. There are several possible explanations for this gap between evidence and clinical practice.[33] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[30]

“It came to another frustration point that medication really isn’t helping,” Lofton says. “I had tried many other things, like a weight loss program. I tried looking into bariatric surgery, and was very frustrated that all these things — like watching my food intake and my servings, 60 grams (of carbs) per meal — all of that wasn’t really making a difference.”

You’ll find that in their meals, they emphasize a plant-based eating approach, loaded with vegetables and healthy fats, including olive oil and omega-3 fatty acids from fish. It’s a diet known for being heart-healthy. (1) "This diet is rich in fruits and vegetables, whole grains, seafood, nuts and legumes, and olive oil," says Nancy L. Cohen, PhD, RD, professor of nutrition at the University of Massachusetts in Amherst. On this plan, you’ll limit or avoid red meat, sugary foods, and dairy (though small amounts like yogurt and cheese are eaten).
The NY Times Best Sellers, The DASH Diet Action Plan and The DASH Diet Weight Loss Solution, provide real life solutions to make it easy for people to follow the DASH diet. They each have 28 days of meal plans, recipes, guidance for weight loss, how to eat at restaurants, fast food places, etc. and still stay on track. It shows you how to stock up your kitchen for the DASH diet, and how to read food labels to make good choices. And, of course, the meal plans and recipes are all low sodium/low salt. The books show you how to add exercise and other lifestyle changes to help lower blood pressure. The books help you design your own personal "DASH Diet Action Plan" and your own "DASH Diet Weight Loss Solution."

Cons: Eating this way perpetuates the outdated idea that dietary fat is the enemy of body fat. And it isn’t necessarily better than other diets: One study in the American Journal of Clinical Nutrition compared high-protein, normal protein, high-fat, and low-fat diets, and found no significant difference in fat loss among the groups at six months or two years (though all did result in some fat loss). What’s more, while the low-fat group was supposed to keep its intake of the macro at 20%, actual intake was closer to 26-28%, suggesting that sticking to a strict low-fat diet is rather difficult and potentially unrealistic for most.
Y. Wady Aude, MD; Arthur S. Agatston, MD; Francisco Lopez-Jimenez, MD, MSc; Eric H. Lieberman, MD; Marie Almon, MS, RD; Melinda Hansen, ARNP; Gerardo Rojas, MD; Gervasio A. Lamas, MD; Charles H. Hennekens, MD, DrPH, “The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat,” Arch Intern Med. 2004;164(19):2141-2146. http://archinte.jamanetwork.com/article.aspx?articleid=217514.

3. Diabetes prevention. In a new Annals of Internal Medicine study, 215 type 2 diabetics were asked to follow either a low-fat or a Mediterranean diet. After four years only 44 percent of the Mediterranean group needed diabetes medication -- but 70 percent of the low-fat eaters did. The Med dieters also lost more weight. Other research shows that the diet helps people with pre-diabetes lower their blood sugar enough to avoid developing full-blown type 2 diabetes.

Close the Kitchen at Night. Establish a time when you will stop eating so you won't give in to the late-night munchies or mindless snacking while watching television. "Have a cup of tea, suck on a piece of hard candy or enjoy a small bowl of light ice cream or frozen yogurt if you want something sweet after dinner, but then brush your teeth so you will be less likely to eat or drink anything else," suggests Elaine Magee, MPH, RD, WebMD's "Recipe Doctor" and the author of Comfort Food Makeovers.
The 2-week turbocharge is a great way to kick off the plan: all the claims about resetting your body's expectations proved true for me. In the 3 months I've been on this plan I started a new job; celebrated my anniversary, Halloween, my birthday, & Thanksgiving, and now find myself surrounded by all the Christmas treats...and still find it easier than it's ever been to make conscious choices about what I eat.

The ketogenic diet is a medical nutrition therapy that involves participants from various disciplines. Team members include a registered paediatric dietitian who coordinates the diet programme; a paediatric neurologist who is experienced in offering the ketogenic diet; and a registered nurse who is familiar with childhood epilepsy. Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented.[5]
Coffee jumpstarts your metabolism, making the non-decaf stuff a worthy weight loss ally. According to a study published in the journal Physiology & Behavior, the average metabolic rate of people who drank caffeinated coffee was 16 percent higher than that of those who drank decaf. In addition to caffeinating your coffee, it’s also crucial to keep it black and avoid adding any unhealthy creamers and artificial sweeteners, both of which are enemies of weight loss.

Below is a quick graphic of a meal plan on the traditional Mediterranean diet, it is the same meal plan that I also follow. Under the graphic you can find details, tips and links to the recipes. I provide a variety of choices for meals that you can mix and match with links to the recipes. For more ideas just head over to the Recipe Index and you will find a large selection of Mediterranean recipes.


The nerve impulse is characterised by a great influx of sodium ions through channels in the neuron's cell membrane followed by an efflux of potassium ions through other channels. The neuron is unable to fire again for a short time (known as the refractory period), which is mediated by another potassium channel. The flow through these ion channels is governed by a "gate" which is opened by either a voltage change or a chemical messenger known as a ligand (such as a neurotransmitter). These channels are another target for anticonvulsant drugs.[7]
Although some studies have indicated that a ketogenic diet is associated with dyslipidemia (cholesterol and triglyceride perturbations), many of these results were obtained from studies on rodents and did not always agree with what the data show in human studies. A recent review summarized the controversy, highlighting the discrepancies in the literature. In part, the discordance is likely due to the exact composition of the diet, specific study design, as well as the metabolic differences between rodents and humans.
The MIND diet, or Mediterranean-DASH Intervention for Neurodegenerative Delay, is a sort of hybrid between the DASH diet and the Mediterranean diet. It features foods meant to slow the progression or development of Alzheimer’s disease, the most common form of dementia and an incurable neurodegenerative condition that more than 5 million Americans are living with, according to the Alzheimer’s Association. (12) Some research backs up this notion, including a study published in September 2016 in Alzheimer’s Dementia that found a link between following the MIND Diet and a reduced risk of the disease. (13)

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.
Being in optimal ketosis for a prolonged period of time (say, a month) will ensure that you experience the maximal hormonal effect from eating a low-carb diet. If this doesn’t result in noticeable weight loss, you can be certain that too many carbs are NOT part of your weight issue and not the obstacle to your weight loss. There are, in fact, other causes of obesity and being overweight. The next three tips in this series might help you.

The keto diet changes the way your body converts food into energy. Eating a lot of fat and very few carbs puts you in ketosis, a metabolic state where your body burns fat instead of carbs for fuel. When your body is unable to get glucose from carbs, your liver converts fatty acids from your diet into ketones, an alternative source of energy. Burning ketones in place of glucose reduces inflammation and spurs weight loss.[1]
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