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]
You may have noticed a bit of an explosion of gluten-free offerings on your grocery store shelves. Some may call it a trend, but over the last 70 years there’s been a steady increase in the number of people who don’t tolerate gluten or other grain proteins.[19] People with a sensitivity, intolerance or full-on Celiac disease experience any combination of brain fog, inflammation, fatigue, joint pain, and gut issues – and they tend to resolve simply by avoiding grains.[20]

Several recent studies indicate that a low-carbohydrate diet is effective at improving glycemia. A few studies have shown that in non-diabetic individuals, low-carbohydrate diets were more effective than higher carbohydrate diets at improving fasting serum glucose [13,14] and insulin [6,14-16], and at improving insulin sensitivity as measured by the homeostasis model [6]. One of these studies also included diabetic patients and noted a comparative improvement in hemoglobin A1c after 6 months (low fat diet: 0.0 ± 1.0%; low carbohydrate diet: -0.6 ± 1.2%, p = 0.06) [6] and 12 months (low fat diet: -0.1 ± 1.6%; low carbohydrate diet: -0.7 ± 1.0%, p = 0.019) duration [5]. In a 5-week crossover feeding study, 8 men with type 2 diabetes had greater improvement in fasting glucose, 24-hour glucose area-under-the-curve (AUC), 24-hour insulin AUC, and glycohemoglobin while on the low-carbohydrate diet than when on a eucaloric low-fat diet [7]. In a 14-day inpatient feeding study, 10 participants with type 2 diabetes experienced improvements in hemoglobin A1c and insulin sensitivity as measured by the euglycemic hyperinsulinemic clamp method [8]. Hemoglobin A1c also improved in an outpatient study of 16 participants who followed a 20% carbohydrate diet for 24 weeks [9].
Without peer-reviewed clinical trials, many of the benefits remain anecdotal. For instance, Weiss himself has been on a low-carb high-fat (though not strictly ketogenic) diet for more than six months, and claims he does feel much better. But he’s clear about what he knows and what he doesn’t. He’s lost weight and his borderline pre-diabetes is gone.  

“Acknowledge that health is an onion; it's layered and complex, and isn't just about nutrition,” Moreno says. “Map out your health and wellness path by creating lists of issues vs. goals in your life within the realms of nutrition, movement, sleep, stress, spiritual, social, and medical issues. You’ll learn to see yourself as an amalgam of health traits and not just a roster of foods you ate in the last week.”
Also, reducing sodium doesn’t restrict you to boring, bland food, nor does it mean you have to toss out the salt shaker. Yes, reducing the amount of salt you use and choosing lower-sodium products are key, but opting for fresh foods or whole foods instead of boxed, canned, and ready-to-heat items makes a big enough impact. Experiment with spices and herbs, and use a little salt to enhance flavor. Salt should never be the sole flavoring or seasoning in any in dish.

This research found the weight loss was slightly greater in the group fasting for two days compared to the other group. It’s worth noting that the participants in these studies were given a huge amount of support, which wouldn’t happen if you were just picking up a book on the 5:2 diet. Overall, there isn’t actually much evidence and we need more data on the long-term success of these diets.’

Participants were asked to follow one of three diets; a control diet that was low in fiber and minerals like potassium, calcium, and magnesium, but had a “typical American” fat and protein profile, an experimental diet that was similar to the control diet, but included more fruits and vegetables and fewer sweets, and a third diet that was abundant in fruits, veggies, low fat dairy, lean protein, whole grains, and fiber, but lower in fat, red meat, and sugar.

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).

The low-carb diet induces ''nutritional ketosis," Dr. Saslow tells EndocrineWeb, which is not the same as ketoacidosis. Ketones are a chemical your body produces when you burn stored fat; if you are on a low-carb diet you may be ''in ketosis.'' Ketoacidosis is different; it is a life-threatening condition in which levels of ketones and blood sugar are dangerously high, which may occur in people who have poorly controlled diabetes.

But the best part about the Mediterranean diet isn't that it's a concrete plan or dedicated to helping you drop pounds; rather, it's a way of eating that incorporates healthy fats, lots of fresh produce, and whole grains. Translation: You can do it for your entire life and never feel like you're actually dieting. (In fact, studies show you can lose weight on the Mediterranean diet without cutting any calories.)


It’s easy to get keto and paleo confused since many of the same foods are encouraged in both diets. The keto diet is specifically crafted as a very low carbohydrate diet to get the body into a state of ketosis. The paleo diet focuses on bringing eating back to the basics and eating like our hunter-gatherer ancestors with less emphasis on where the calories are coming from: carbs, fat or protein. The paleo diet includes lean meats, seafood, seasonal veggies, some nuts and fruit and eliminates grains, dairy, processed foods, and certain oils. 
"We recommend against 'dieting', which is invariably a short-term solution," Dr. Gonzalez-Campoy, tells EndocrineWeb, "and since weight loss may be accomplished by a reduction in calories by any means, a ketogenic diet that restricts carbs is simply shifting the calories away from foods that typically demand insulin as in both of these studies.1,2  
I am a big fan of the ketogenic diet and many of my patients have had huge success on it. Having said that, it’s not necessarily for everyone. This should be looked at as a long-term strategy, not a short one. Some people simply find the dietary restrictions too difficult to commit to. Since yo-yo dieting is bad for everyone, and can be downright dangerous for diabetics, you should only begin the ketogenic diet if you feel you can stick to it.
Sleep enough – for most people at least seven hours per night on average – and keep stress under control. Sleep deprivation and stress hormones raise blood sugar levels, slowing ketosis and weight loss a bit. Plus they might make it harder to stick to a keto diet, and resist temptations. So while handling sleep and stress will not get you into ketosis on it’s own, it’s still worth thinking about.
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