Hello, I am hoping someone can reach out to me and explain something. My son who is T1D just started the keto diet 4 days ago. At first we were doing great numbers were good, then out of nowhere we are having highs! He is correcting and it’s not bringing him down into normal range. I am going into a panic, I don’t know what to do, or who to ask for help. His doctor would be no help, and thinks the Standard American Diet is fine. I don’t see eye to eye with him. I hope someone can tell me why this might be happening. Thanks in advance for your time!

Hi, Esther! Thank you so much for your kind comment. I am so glad you found The Mediterranean Dish and hope you’ll enjoy cooking some of the recipes here! I should preface my answer here by saying that I am not a dietitian or a nutritionist, what I share here is mainly from my experience as someone who grew up in the Mediterranean area and have continued to eat the Mediterranean way now as an adult living in the USA. So please always check with your health care provider or a registered dietitian if you are looking for professional advice or a specific diet plan to follow. But I’ll answer your questions as best as I know how.


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]
Ranging from just-juice to just-tea cleanses, these typically short-term plans can be dangerous. “Detoxes and cleanses are usually low in calories, protein, and fiber, all nutrients that our bodies need to function,” says Alissa Rumsey, RD, who is in private practice in New York City. “These plans leave you feeling hungry and cranky, causing a rebound food binge once you stop the detox.”
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]
You have about 160,000 Kcals of fat available to burn – producing your own glucose in the process when needed (for anaerobic bursts). In contrast you only store around 400 to 500 Kcals of glucose/glycogen ready for use so if you are not adapted to burning fat then you are physically dependent and addicted to eating carbs. When you hear of a runner “hitting the wall” it’s only because of their unnatural carb addiction – an efficient fat burning athlete can run all day and will never have this problem. The human body is specifically designed to run long distance and can outrun almost every other animal on this planet – we can even run though intense heat because we sweat.

This is ALL so confusing and overwhelming. I am not diabetic. I am trying to be proactive about it. I am borderline obese (by US standards) and obese (by Asian standards). I am 50 years old. I was addicted to fat and sugar (especially combined!) through my teens and twenties. I decided to get healthy in my 30s, so I became a Vegan (but an unhealthy/careless one, so my weight yo-yo’ed a lot in my 20s and 30s). In my 40’s I reintroduced animal products into my diet and a number of my health issues went away, but I am still fat. I am considering Keto/Carnivore, but I am concerned that I may just be falling prey to more extreme diets which could set me up for problems (e.g. diabetes) down the road. I guess I am what most would refer to as pre-diabetic (metabolic syndrome). Should I try keto or am I taking too much of a risk?
In a 24-week long intervention study, researchers recruited 84 obese subjects with type 2 diabetes and randomly divided them into two groups. The first group of 42 received a low-glycemic diet with a 500 calorie/day deficit. The second group ate a very low carbohydrate ketogenic diet with less than 20 grams of carbohydrates per day without calorie restriction.
Of the 1,580 survey participants, more than half reported staying on a low-carb diet for at least one year, and 34% reported more than two years. Further, those on the diet for two years or more said that they had largely maintained their weight loss. This is a self-selected sample, with an obvious bias for people who are experiencing success (dieters are less inclined to report on their failures). However, this data does show that long-term adherence is possible.
After 32 weeks, those in the keto diet group lowered their HbA1c more than those in the plate group with more than 50% achieving a reduction to less than 6.5%, basically reversing their diabetes. None in the plate group did this well. As for weight loss, those in the keto low-carb group lost on average of 28 pounds, while those in the plate group lost an average of 6.6 pounds.1
"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  

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]


I told the nurse that I would not take the medications, and I would manage it with diet. She looked at me skeptically, and said “I would not recommend that.”. They had me scheduled for a follow up in a month and a half, so I told her that I would do my own thing for that time, and if my numbers did not improve, we could discuss the medication further.

If it all feels a little bit 90s, that’ll be because this was basically the diet that kept Rachel from Friends looking, well, like Rachel from Friends. Think of it as the 20th-century version of no carbs before Marbs. Thankfully though, the old premise of each as much as you want, as long as you don’t go near a carb, has had a makeover. The New Atkins diet reintroduces carbs in phases.
On day 1, lunch is 3 cups of spinach topped with 3 ounces of salmon or sardines; the greens are loaded with vitamins A and K, plus iron, while the fish supplies protein and omega-3 fats. Include some chopped veggies on your salad, like tomato, broccoli and bell pepper for fiber and vitamin C to help you absorb the iron. Have a salad again on day 5, but use romaine lettuce this time, and substitute cannellini beans for your protein and choose cucumber, carrots and asparagus tips as veggies. Opt for olive oil and red wine or balsamic vinegar for your dressing.
Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome,[34] which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[35] On the other hand, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria and other rare genetic disorders of fat metabolism.[9] A person with a disorder of fatty acid oxidation is unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their body would consume its own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[36]

Some antidepressant medications can cause weight gain, especially the older tricyclic antidepressants (TCAs) such as Tryptizol, Saroten, and Clomipramine; as well as newer drugs such as Remeron (Mirtazapine). Lithium (for manic-depressive disorder) often causes weight gain. The most common antidepressants known as SSRI’s (for example Citalopram and Sertraline) usually don’t impact weight significantly. More on depression
What is your opinion on the conflicting opinions about whether or not wine is healthy or harmful? It seems there is a daily article touting research that proclaims wine is health alternating with another article about research that indicates that even moderate intake of wine is associated with cancer or dementia. I’m trying to understand all of this conflicting data with the reality/evidence of Mediterranean cultures that include daily intake of wine. Is it the amount drunk that is key?
“Instead of using a heavy salad dressing, try a drizzle of thick balsamic glaze along with a squeeze of fresh lemon or lime juice” Taub-Dix says. “By cutting the fat in your diet, you can not only save calories, but you can also leave room for healthier fats like avocado or nuts, which are toppings you can actually chew and enjoy with greater satisfaction.”
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]
At the first visit, participants were instructed how to follow the LCKD as individuals or in small groups, with an initial goal of ≤20 g carbohydrate per day. Participants were taught the specific types and amounts of foods they could eat, as well as foods to avoid. Initially, participants were allowed unlimited amounts of meats, poultry, fish, shellfish, and eggs; 2 cups of salad vegetables per day; 1 cup of low-carbohydrate vegetables per day; 4 ounces of hard cheese; and limited amounts of cream, avocado, olives, and lemon juice. Fats and oils were not restricted except that intake of trans fats was to be minimized. Participants were provided a 3-page handout and a handbook [11] detailing these recommendations. Participants prepared or bought all of their own meals and snacks following these guidelines.
The DASH diet was created when researchers were looking for ways to effectively reduce hypertension, but this was over 20 years ago! Though it’s still often marketed as a treatment for high blood pressure, the DASH eating plan is really an ideal way to eat for overall health, weight maintenance, and chronic disease prevention. In fact, studies suggest that DASH lowers risk for heart disease, type 2 diabetes and metabolic syndrome, and some cancers.
When carbohydrates are used by the body as an energy source, the blood sugar levels become unstable. As the energy source is not consistent it is difficult for your brain to stay focused for long periods of time. On the other hand, when you are in ketosis and the brain uses ketones as a fuel source, which has a consistent fuel source and you can focus for longer periods of time. Hence, you also tend to feel more active and alert.
“Regardless of how solid they are, your diet and exercise plans won’t work if you aren’t sticking to them. You’ve made a commitment to yourself, so come through with it,” Roussell says. As you plan your meals or snacks, Roussell suggests putting an X over it on your menu map. If you skip a meal or eat something that isn't in your plan, circle that meal. At the end of each week, count the number of meals you ate according to your meal plan and divide that number by the total number of meals, snacks, and post-workout smoothies you had planned, then multiply it by 100.

Selecting the right food will be easier as you become accustomed to the Keto approach. Instead of lean meats, you’ll focus on skin-on poultry, fattier parts like chicken thighs, rib-eye steaks, grass-fed ground beef, fattier fish like salmon, beef brisket or pork shoulder, and bacon. Leafy greens such as spinach, kale and lettuce, along with broccoli, cauliflower and cucumbers, make healthy vegetable choices (but you’ll avoid starchy root foods like carrots, potatoes, turnips and parsnips). You can work in less-familiar veggies such as kohlrabi or daikon.

×