“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.
“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.”
In regard to serum measurements, the mean fasting glucose decreased by 17% from 9.08 ± 4.09 mmol/L at baseline to 7.57 ± 2.63 mmol/L at week 16 (p = 0.04) (Table (Table4).4). Serum sodium and chloride levels increased significantly, but only by 1% and 3%, respectively. Uric acid level decreased by 10% (p = 0.01). Serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001). Increases occurred in both high-density lipoprotein (HDL) cholesterol (8%) and low-density lipoprotein (LDL) cholesterol (10%) but these changes were of borderline statistical significance (p = 0.08 and p = 0.1, respectively). The following blood tests did not change significantly: total cholesterol, potassium, bicarbonate, urea nitrogen, creatinine, calcium, thyroid-stimulating hormone, and hemoglobin.
In the 21 subjects the successfully completed the study, scientists observed a 16% decrease in Hemoglobin Ac from baseline to week 16.  Subjects experienced an average decrease in body weight of 8.7 kg (19.2 lbs.).  Additionally, their average blood glucose levels decreased a total of 16.6% and their average triglyceride levels decreased 41.6%. 
Participants were recruited from the Durham Veterans Affairs Medical Center (VAMC) outpatient clinics. Inclusion criteria were age 35–75 years; body mass index (BMI) >25 kg/m2; and fasting serum glucose >125 mg/dL or hemoglobin A1c >6.5% without medications, or treatment with oral hypoglycemic agents (OHA) and/or insulin. Exclusion criteria were evidence of renal insufficiency, liver disease, or unstable cardiovascular disease by history, physical examination, and laboratory tests. All participants provided written informed consent approved by the institutional review board. No monetary incentives were provided.
The ketogenic diet tries to bring carbohydrates down to less than 5 percent of a person’s daily caloric intake – which means eliminating most grains, fruit, starchy vegetables, legumes and sweets. Instead, it replaces those calories with fat. That fat is turned into ketone bodies, which are an alternative energy source: besides glucose derived from carbohydrates, ketones from fat are the only fuel the brain can use.
Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.
At your favorite Greek restaurant, order lamb souvlaki. Have a bar-of-soap-size amount of lamb (or chicken if you prefer) and a baseball-size amount of couscous or rice. Go ahead and eat all of the vegetables that come with your order, and if there is a salad, top it with 1 tablespoon of dressing. Package up the remaining lamb and rice or couscous for Sunday's lunch. Serve with 1/2 glass (2 ounces) of wine.
Reynolds, AN. "Comment on 'An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals with Type 2 Diabetes: A Randomized Controlled Trial." Journal of Medical Internet Research. 2018; 20(5):e180, May 2018. Available at: http://www.jmir.org/2018/5/e180/ Accessed May 4, 2018.
The Keto diet versus Plate Method study triggered some challenges and a bit of criticism. In an editorial, Andrew Reynolds, PhD, a postdoctoral research fellow at the University of Otago, New Zealand, suggests that the much better results in those on the ketogenic diet may be due not to the diet itself but to the lifestyle changes and ongoing support that keto diet group received.5
Some people on a keto or low carb diet choose to count total carbs instead of net carbs. This makes it more difficult to fit in more leafy greens and low carb vegetables (which are filled with fiber), so you should only try that if you don’t get results with a net carb method. And, start with reducing sugar alcohols and low carb treats before deciding to do a “total carbs” method.
– When eating the Mediterranean way, you’ll notice that we don’t eliminate any food groups. But we do rely more on vegetables, fruits, legumes and grains to supply more of what we eat. We also eat mostly lean proteins. So with that, if eating tempeh or other soy-based foods or if drinking green tea is something you enjoy, then that is up to you…and I would again encourage figuring that out with an RD or someone who can better assess your specific needs and advice you accordingly.
The other nutritional remedy for T2 diabetes is carbohydrate restriction. In a large, ongoing university-based study, 60% of patients with Type 2 diabetes reversed their diagnosis of diabetes after just one year on a ketogenic diet, supplemented by support via a mobile phone app.11 On this protocol, 94% of participants reduced or eliminated their need for insulin medications while improving the vast majority of cardiovascular risk factors.12
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.
The DASH diet has sometimes even been described as an Americanized version of the famous Mediterranean diet, according to the official DASH diet website. But as healthy as the DASH diet is, it's certainly not restrictive. It includes an eating plan rich in fruits, vegetables, low-fat and nonfat dairy, lean meats, fish, poultry, nuts, beans, seeds, heart-healthy fats, and limited amounts of whole grains. These delicious and nutritious foods join forces together to help your overall health improve. An added perk? You can also shed some unwanted pounds on the DASH diet — especially if you follow the DASH Diet Weight-Loss Solution plan.
Nuts, the second food to watch, contain a fair amount of carbohydrate, and it’s very easy to unwittingly scarf down large quantities. Cashew nuts are among the worst carb-wise – you’ll find that they contain around 20% carbohydrate by weight. For someone following a strict keto diet with a 20 grams of carbs per day allowance, this means that consuming 100 grams (which happens in a flash!) will have filled their daily quota. Peanuts tend to be around 10-15% carbohydrate – not putting them in the clear either.
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.
As both study groups acknowledge, additional research is needed to tease out any and all of the factors that may be producing the weight loss and decrease in HbA1c, says Dr. Gonzalez-Campoy, for example there may be other mechanisms of action that are helping these individuals to achieve weight loss, including changes in the gut microbiome, increased insulin sensitivity, enhanced leptin response, and decreased ghrelin levels, each of which contribute to weight loss.
Insulin is released in the blood and used to control blood sugar levels including signaling the liver to stop producing sugar. If this system is impaired and the body does not use insulin properly, which is called insulin resistance, individuals are likely to develop high blood sugar levels. In this study the researchers showed that for ketogenic diets this process for controlling blood sugar levels does not work properly and there was insulin resistance in the liver. When the liver is unable to respond to normal levels of insulin to control blood sugar levels this may lead to an increased risk of Type 2 diabetes.
“Unlike many popular diets, there’s really not a huge focus on eliminating starches,” Srinath says. “What most studies have found is that dieting is really about sustainability—so the people who lose the most weight are those who are able to maintain a diet and keep up with it," she says. "A big issue with a lot of the low-carb diets out there is that it’s really, really hard to limit carbs completely. That’s why I think DASH is more palatable to people." Yaaas, carbs!