What the expert says: ‘Like with atkins, you will lose weight quickly. The ketogenic diet is used in medicine, but under strict supervision and for set periods of time, so with appropriate support it can be safe in the short to medium term. The brain does use glucose as its fuel of choice, so ‘brain fog’ lethargy are common side effects. You’ll known when your body is running off ketones by your breath – it’s known as ‘keto breath’, and it’s bad. It also can affect your ability to exercise by due to a lack of quickly accessible energy.
The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. There is some evidence of synergistic benefits when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.[3]
When your body burns its stores of fat, it can be hard on your kidneys. And starting a ketogenic diet -- or going back to a normal diet afterward -- can be tricky if you’re obese because of other health issues you’re likely to have, like diabetes, a heart condition, or high blood pressure. If you have any of these conditions, make diet changes slowly and only with the guidance of your doctor.
The struggle as a prescriber is that you have to follow the “standard of care,” lest you open yourself up to a lawsuit. So I talk to my patents about what “the” recommendations are, and then I talk to them bout what the evidence says and what my experience says. Plain and simple, patient’s trust the government’s recommendations and can’t wrap their head around the idea of not eating carbs because they have learned their entire lives that the body “needs” carbs to survive.
Be choosy about carbs. You can decide which ones you eat, and how much. Look for those that are low on the glycemic index (for instance, asparagus is lower on the glycemic index than a potato) or lower in carbs per serving than others. Whole grains are better choices than processed items, because processing removes key nutrients such as fiber, iron, and B vitamins. They may be added back, such as in “enriched” bread.

DASH stands for "Dietary Approaches to Stop Hypertension." The diet was developed out of a study by the National Institutes of Health after researchers noticed that vegetarians tended to have lower rates of high blood pressure. Understanding that sodium intake affected blood pressure, researchers also believed that these levels may also be impacted by other nutrients in plant-based diets.


Emerging evidence suggests that eating this way may offer protective effects for those with and at risk for type 2 diabetes. For one, Mediterranean eating improves blood sugar control in those already diagnosed with the condition, suggesting it can be a good way to manage the disease. What’s more, given those with diabetes are at increased odds for cardiovascular disease, adopting this diet can help improve their heart health, according to a paper published in April 2014 in the journal Nutrients. (4)
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As for individuals with type 2 diabetes, Dr. Galati says, "a very low carbohydrate diet could be tolerated, albeit with extreme caution. Transitioning to a ketogenic diet will require several lifestyle changes as well as careful monitoring of both your food intake and glucose levels and adjustments to your medications. Also, you should increase your water consumption." 
Recently, there been some controversy surrounding the Mediterranean diet and its potential benefits. In 2013, a landmark study found that people put on a Mediterranean diet had a 30 percent lower chance of heart attack, stroke or death from cardiovascular disease than people on a low-fat diet. However, in June 2018 it was reported that the initial study was flawed. Though researchers re-evaluated the data and determined the results to be the same, this is something to consider when determining with your doctor whether the Mediterranean diet is best for you.
While 1,200 may be the right number for some, it can be super restrictive for others, says Jaclyn London, MS, RD, CDN, Nutrition Director at the Good Housekeeping Institute. Try basing your meals and snacks off this plan and double up on veggies at any opportunity — more fruit at snack time works too! You can also add an extra ounce or two of protein at all meals if you find yourself feeling hungry. The combo of fiber from produce and lean protein makes this an adaptable strategy that’ll help you lose weight safely — one meal (and snack) at a time!
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.

Normal dietary fat contains mostly long-chain triglycerides (LCT). Medium-chain triglycerides are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,[3] leading to more food choices and larger portion sizes.[4] The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil.[15] Consuming that quantity of MCT oil caused abdominal cramps, diarrhoea and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.[9] The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by insurance companies.[3]


The remaining calories in the keto diet come from protein — about 1 gram (g) per kilogram of body weight, so a 140-pound woman would need about 64 g of protein total. As for carbs: “Every body is different, but most people maintain ketosis with between 20 and 50 g of net carbs per day,” says Mattinson. Total carbohydrates minus fiber equals net carbs, she explains.
High blood sugar levels coupled with high blood ketones, on the other hand, will mean that you have a pathologically low level of insulin – something non-diabetics do not suffer from. This can lead to ketoacidosis – a potentially life-threatening condition. If this happens, you’ll need to inject more insulin; if you’re at all unsure of what to do, contact a medical professional. Coveting really high blood ketones for weight control is not worth the risk for type 1 diabetics.
Keto decreases inflammation and improves brain function — so much so that Alzheimer’s patients who switch to a keto diet actually begin to recover their brain function, which up until now was unheard of.[20][21][22][23][24] So there’s that. (Dale Bredesen and Mark Hyman have discussed these on the Bulletproof Radio podcast. Check out Dale’s episode here, and Mark’s here.)  
When it comes to managing diabetes, it is reasonable that reducing carbohydrate intake can help to lower and stabilize blood glucose levels. The positive effects of the ketogenic diet on diabetes control have been demonstrated in animal models, as well as in humans. We recently reported on several studies that demonstrated substantial metabolic benefits.
As it turns out, almonds aren’t the only superstar nuts around. Studies have shown pistachios aren’t bad to snack on either. UCLA Center for Human Nutrition researchers divided study participants into two groups, each of which were fed a nearly identical low-cal diet for three months. One group was given 220-calories of pretzels as an afternoon snack, while the other sect munched on 240-calories worth of pistachios. About a month into the study, the pistachio group had reduced their BMI by a point and improved their cholesterol and triglyceride levels, while the pretzel-eaters stayed the same.
The struggle as a prescriber is that you have to follow the “standard of care,” lest you open yourself up to a lawsuit. So I talk to my patents about what “the” recommendations are, and then I talk to them bout what the evidence says and what my experience says. Plain and simple, patient’s trust the government’s recommendations and can’t wrap their head around the idea of not eating carbs because they have learned their entire lives that the body “needs” carbs to survive.
When you eat foods high in carbohydrates and fat, your body naturally produces glucose. Carbohydrates are the easiest thing for the body to process, and therefore it will use them first – resulting in the excess fats to be stored immediately. In turn, this causes weight gain and health problems that are associated with high fat, high carbohydrate diets (NOT keto).
The DASH diet is especially recommended for people with hypertension (high blood pressure) or prehypertension. The DASH diet eating plan has been proven to lower blood pressure in studies sponsored by the National Institutes of Health (Dietary Approaches to Stop Hypertension). In addition to being a low salt (or low sodium) plan, the DASH diet provides additional benefits to reduce blood pressure. It is based on an eating plan rich in fruits and vegetables, and low-fat or non-fat dairy, with whole grains. It is a high fiber, low to moderate fat diet, rich in potasium, calcium, and magnesium. The full DASH diet plan is shown here. The DASH diet is a healthy plan, designed for the whole family. New research continues to show additional health benefits of the plan.
The researchers agree that the diet itself isn’t inherently dangerous. But, cautions Weiss, “If you have any medical condition, if you take any medicine at all – there are lots of things that change how medicines work in our bodies, and nutrition is definitely one of them. If you’re making a real change in your nutrition, you really should talk to your doctor.”

"The DASH diet: the weight-loss plan approved by doctors. When doctors devised an eating plan to fight high blood pressure, cholesterol and diabetes, weight loss was an added bonus. An eating programme devised by doctors to fight high blood pressure has become the latest weight-loss phenomenon and named America's healthiest diet two years in a row." - from the Weekend London Times


What to know about diet soda and diabetes Sugary drinks are a known cause of obesity and blood glucose problems, such as diabetes. Diet options are available, but are they good for people with diabetes? Artifical sweeteners may be linked to diabetes development. This MNT Knowledge Center article gives information on diet soda, sweeteners, and alternatives. Read now

Add mint to your usual oven-roasted chicken, and it becomes a whole new meal with a Mediterranean diet twist. Plus, it has perks: Mint has been known to alleviate digestion issues. Olives add flavor for very few calories (five olives only have 26 calories), while figs add a natural sweetness. This chicken dish by Russell Bry, concept chef of Yalla Mediterranean in California, just might become your new go-to.


Meh. This book is more fad diet than anything else, which I might have judged from the cover, if I was that type of person. When I read that DASH stood for Dietary Approaches to Stop Hypertension I was hopeful, but the reasonably good information could have been delivered more concisely in a pamphlet. Aside from that, Heller actually points out that the previous DASH diet recommendations have basically been recalled; as early as pg. 4 the author says that the earlier DASH plan recommended far mo ...more
It's important to note that the drop-out rate was substantial and reports of symptomatic hypoglycemia 1-5 episodes) were experienced by 69% of those in the study. The mean carbohydrate intake was 35 grams (+/- 15) daily. Based on self-reported results, the change in HbA1c was -1.45% (+/- 1.04, P < 0.001) with an average HbA1c of 7.2%  associated with greater hypoglycemia; yet, these results are comparable to other study findings. The average blood glucose levels were 104 mg/dL (+/- 16). 2  Final lipid profiles were mixed. The results were similar for adults and children.
"The DASH diet: the weight-loss plan approved by doctors. When doctors devised an eating plan to fight high blood pressure, cholesterol and diabetes, weight loss was an added bonus. An eating programme devised by doctors to fight high blood pressure has become the latest weight-loss phenomenon and named America's healthiest diet two years in a row." - from the Weekend London Times
“Tremendous Results”….guess that’s why the diabetes nationwide gets worse every year, because of the stellar advice your kind is giving out. I’ve been on the virta clinic for two months and already went off insulin, Janumet and Jardiance, which I’ve been on for 10 years, with blood sugars between 80 and 150. The advice you give makes people get sick slower. The ketogenic approach deals with the real issue, carbohydrate intolerance. If you are lactose intolerant you stop ingesting lactose. Type two diabetes is simply carbohydrate intolerance. Stop eating the carbs and the symptoms go away. I think you meet to cite some of the other research out there I’ve read in other books and the work the Virta Clinic has done. In my opinion you’ve cherry picked data to suit your preconceived beliefs.
I agree!! I too..have /had Diabetes II..at age 66 and retired RN, we were taught for so long the WRONG way to eat and I taught that way, the high carb, grains, etc, way to eat. KETO saved me. Dropped my A1C and I feel great. The author of this page is wrong when saying 5-10 percent of our diet, carb eating, should be root veggies like ‘carrots”…so wrong. For goodness sakes, get KETO right by educating yourself, Tammy Shiflet~ Horribly wrong! There are so many studies and physicians, brain scientists, etc out here who understand what this diet is about. Read, and educate yourself….Please! Diabetes is a symptom of the Government’s education mistakes. Sugar, Wheat, Grains…horrible for us. Get with it, we live in 2018 and the information is out there; if you need a list, just ask.
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.
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.)
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!
I am sorry you had this experience. I feel that this educator was not giving you good advice. All my women who want to lose weight are recommended to consume 30 grams of good carbohydrates at each meal, and 15 at each snack. If you were not trying to lose weight, I would have recommended 45. I find this is all it usually takes to begin to lose some weight as you start to get active. Patients set their own goals with motivational help from their Certified Diabetes Educator. Our intent is never to insult, and you should not have gone through that. It sounds that you have now found the right path. There are many CDEs who could help you, so see what tools and motivation others may offer. I wouldn’t let one bad apple spoil the whole bunch. Many CDEs are also diabetic.
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.  
Meat products make up a big part of the keto diet, but experts stress the importance of choosing quality. "Since the keto diet is based a lot on animal proteins, it's important to buy organic poultry and grass-fed, organic beef," says Aimee Aristotelous, RD. "Not only do organic selections help with limiting environmental toxins, but grass-fed options of red meats even change the composition of fats." The result, she explains, is that your body is able to better absorb those healthy fats.

Some diet plans, such as the MIND diet and the DASH diet, are meant to focus on certain areas of health — and weight loss may be a bonus. Others are created with weight loss as a primary goal. “It is important to remember that we are all very unique individuals,” says Kyle. “We all have different states of health and different lifestyles, which could affect what diet plan is best for us. That means that you should not be considering what is working for your friends or family members — and instead should pay attention to what works for you individually.”
But again, when it comes to salt, there's a blood pressure-weight link that can't go ignored. A diet rich in sodium may lead to the development of obesity, according to one study, and salty foods are more likely to promote overeating, which obviously also leads to weight gain, per another study. And by now, it's more than evident that excess fat and sugar intake can contribute to caloric surpluses, blood sugar and insulin spikes, inflammation, and, yes, more weight gain, she says.
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Have Protein at Every Meal and Snack. Adding a source of lean or low-fat protein to each meal and snack will help keep you feeling full longer so you're less likely to overeat. Try low-fat yogurt, small portion of nuts, peanut butter, eggs, beans, or lean meats. Experts also recommend eating small, frequent meals and snacks (every 3-4 hours), to keep your blood sugar levels steady and to avoid overindulging.


H. Guldbrand, B. Dizdar, B. Bunjaku, T. Lindström, M. Bachrach-Lindström, M. Fredrikson, C. J. Östgren, F. H. Nystrom, “In Type 2 Diabetes, Randomisation to Advice to Follow a Low-carbohydrate Diet Transiently Improves Glycaemic Control Compared with Advice to Follow a Low-fat Diet Producing a Similar Weight Loss,” Diabetologia (2012) 55: 2118. http://link.springer.com/article/10.1007/s00125-012-2567-4.
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.)

Con: Results can vary depending on how much fluid you drink. By drinking more water, you dilute the concentration of ketones in the urine and thus a lower level of ketones will be detected on the strips. The strips don’t show a precise ketone level. Finally, and most importantly, as you become increasingly keto-adapted and your body reabsorbs ketones from the urine, urine strips may become unreliable, even if you’re in ketosis.
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