As far as the Ketogenic Diet is concerned, I think I am going to have to make a full about-face. As you said, for some people like yourself, you were unable to eat in moderation and feel it is due to your genetic makeup. This is probably true…to add insult to injury, in addition to genetics, it could also be an inflammatory process going on due to the sugary drinks and processed foods we are eating causing obesity and a host of other issues.
Iwould hope to meet a diabetic nurse in the uk who was open minded about keto, but that has not been my experience as a patient. As a nurse speaking to colleagues as an equal and frmy experience has been very different. I have not spoken to one nurse with personal/professional interest in this subject that has said if they were diabetic they would follow the guidance of our health service. All have said they would do keto.
Now, I know what you are going to say, “I can take a break from the diet anytime.” What do you think happens when you take that “break”? As soon as you start consuming a normal amount of carbohydrates again, you immediately go out of ketosis or the fat burning state, and your body starts storing fat again immediately. In other words, you immediately start gaining weight. So whatever weight you lost on the diet, you gain back right away. How healthy do you think it is for your body to be in a starvation mode, then in a feeding frenzy, making up for lost time?
Starting on a ketogenic diet can influence your exercise performance in multiple ways, both positive and negative. During the first 1-2 weeks (the “adaption period,” which I will get back to later), you will most likely see a decrease in energy and athletic performance across the board while your body adjusts to the new diet. This is perfectly normal and should NOT be a cause for concern or make you abandon the diet.
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter.[1] Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[4][5]
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.
Because this is an eating pattern – not a structured diet – you're on your own to figure out how many calories you should eat to lose or maintain your weight, what you'll do to stay active and how you'll shape your Mediterranean menu. The Mediterranean diet pyramid should help get you started. The pyramid emphasizes eating fruits, veggies, whole grains, beans, nuts, legumes, olive oil, and flavorful herbs and spices; fish and seafood at least a couple of times a week; and poultry, eggs, cheese and yogurt in moderation, while saving sweets and red meat for special occasions. Top it off with a splash of red wine (if you want), remember to stay physically active and you're set.
This could be because the body increases insulin secretion in anticipation that sugar will appear in the blood. When this doesn’t happen, blood sugar drops and hunger increases. Whether this chain of events regularly takes place is somewhat unclear. Something odd happened when I tested Pepsi Max though, and there are well-designed studies showing increased insulin when using artificial sweeteners.
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.
"Those with type 1 diabetes should avoid a ketogenic diet," warns Joseph Galati, MD, a hepatologist at the Liver Specialists of Texas in Houston, "Many patients with type 1 diabetes have some degree of renal impairment, and handling the build-up of ketones and acids in the body may cause too much stress on the kidneys. Of course, any pregnant women with diabetes, especially those requiring insulin should avoid such an extreme diet given the low glucose levels will be a constant [health] threat."

“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.”


If you want to lose weight, you’d better avoid special “low-carb” products that are full of carbs. This should be obvious, but creative marketers are doing all they can to fool you (and get your money). They will tell you that you can eat cookies, pasta, ice cream, bread and plenty of chocolate on a low-carb diet, as long as you buy their brand. They’re full of carbohydrates. Don’t be fooled.
The DASH diet, the Dietary Approaches to Stop Hypertension diet, is mainly used to lower blood pressure and cholesterol, but it may also help you to lose weight. This diet emphasizes the consumption of foods that are low in cholesterol and saturated fat. It encourages eating a lot of fruit, vegetables, whole grains, and low-fat dairy foods. If you are looking to lose weight with the DASH diet, all you need to do is understand how the diet is structured and modify the diet to suit your weight loss needs. You will start seeing results in a few weeks to months’ time.[1]
One study, published in the journal Nutrition & Metabolism, found a group of 28 people with type 2 diabetes overall lost about 6 percent of their body weight and lowered their blood glucose levels when they followed a keto diet for 16 weeks. The authors recommended individuals on this diet who have diabetes be under close medical supervision, and noted more research is needed on the diet’s long-term effects because the study was small and short term.
We really do only want to try and share the knowledge we have through seeing thousands of different patients with complex issues over decades with all of you. Physicians jump at the chance to have a CDE see their patients in their practice or in the hospital because they know our value. They know how thorough we are when assessing their patients and often find issues that may have been overlooked for years. It’s all we do all day, so it’s our specialty…diabetes. We live and breathe it and are very passionate about helping people overcome their hurdles. I do hope sharing some of my personal experience with all of you will help, but I am here if you all have more questions anytime!
Type 2 diabetes is one of the most pressing challenges of our time and its ultimate cause has not been fully understood. Ketogenic diets, which are low in carbohydrate and high in fat, are known to lead to weight loss and have been considered to be healthy. These findings raise new questions about ketogenic diets and whether or not they are actually healthy.
"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
Achieving ketosis is a pretty straightforward, but it can seem complicated and confusing with all of the information out there.4If you want to learn more about ketosis and the scientific process around it, you can visit a very in-depth discussion about on Dr. Peter Attia’s website. Here’s the bottom line on what you need to do, ordered in levels of importance:
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While studies have demonstrated the weight-loss benefits of the diet, Grandl says, several recent studies that apply more rigorous research techniques to study insulin resistance have suggested detrimental effects. The new study, published in August 2018 in the Journal of Physiology, aimed to better understand the basic biological processes that contribute to the development of type 2 diabetes and the early effects of the ketogenic diet. What people eat impacts the release of glucose, or sugar, in the bloodstream. High glucose levels can, over time, cause insulin resistance. Insulin is the substance released in the body to help manage and regulate sugar in the blood at healthy levels.


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.
As far as the Ketogenic Diet is concerned, I think I am going to have to make a full about-face. As you said, for some people like yourself, you were unable to eat in moderation and feel it is due to your genetic makeup. This is probably true…to add insult to injury, in addition to genetics, it could also be an inflammatory process going on due to the sugary drinks and processed foods we are eating causing obesity and a host of other issues.
Moreover, the ketogenic diet also reliably raise the “good” HDL-cholesterol, while also improving most other cardiovascular markers, including blood pressure, as this study shows.24 Thus, the overall effect on cholesterol and other markers for heart disease is positive. In some lean hyper-responders, a keto diet will increase LDL particle number, and this effect needs further investigation.
In her book, Susan highlights one of the major problems with dinner time today: quality time. Does everyone else remember when dinner time was family time? When we would all sit down together, share our day, talk, laugh, and leave when the meal was done? Susan and I shared our childhood dinning experiences when we discussed her call for embracing the the Mediterranean lifestyle — incorporating exercise, relaxation, and family meals back into our daily routines. This book is looking for someone who is looking to make a lifestyle choice. The way that you eat, sitting down with your families at the dinner table. No more meals on the go, no more meals with the TV. I wanted to bring back the importance of food in our households,” noted Susan.
There is research that supports the ketogenic diet for diabetes management, while other research seems to recommend opposing dietary treatments like a plant-based diet. Research from 2017 confirms that people with diabetes who followed a plant-based diet experienced significant improvements in blood sugars and A1c, cardiovascular disease risk factors, gut bacteria that is responsible for insulin sensitivity, and inflammatory markers like c-reactive protein.
Adherence to the DASH-style pattern may also help prevent the development of diabetes, as analyzed in a recent meta-analysis, and kidney disease as found in the Atherosclerosis Risk in Communities (ARIC) cohort that followed more than 3700 people who developed kidney disease. [8, 9] Dietary components of DASH that were protective in the ARIC cohort included a high intake of nuts, legumes, and low-fat dairy products. A high intake of red meat and processed meats increased kidney disease risk.
Upon starting the diet, some patients report symptoms like fatigue, headaches, and muscle aches. However, these short-lived symptoms are, in fact, a sign that the diet is working, and the body is switching over from burning glucose as fuel to burning fat. This transition involves upregulating certain enzymes and down-regulating others; it is a profound shift for the human body that can have uncomfortable symptoms. However, these side effect usually last only 3-4 weeks. They can be ameliorated in most cases, by drinking several cups of bouillion broth during the day until the transition is completed.15

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?
Today, make half of this GH exclusive Mediterranean Grilled Sea Bass recipe and reserve half of that for Thursday lunch. Increase your vegetable intake by serving half a bag of baby arugula leaves with this meal (save the other half for Thursday). Serve with one ear of corn and 1 cup cooked sugar snap peas topped with 2 teaspoons trans-fat-free light margarine. For dessert, have one frozen fruit juice bar (limit 80 calories for the bar).
A ketogenic diet helps control blood sugar levels. It is excellent for managing type 2 diabetes, sometimes even leading to complete reversal of the disease. This has been proven in studies. It makes perfect sense since keto lowers blood-sugar levels, reduces the need of medications and reduces the potentially negative impact of high insulin levels.
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