Throughout this article, we looked at the data and the principles behind how low-carb dieting affect patients with diabetes, but we never addressed what you can do about it directly. If you’d like to learn about practical strategies that may help you reverse insulin resistance and improve your blood sugar and HbA1C levels, I recommend reading these articles:
The first modern study of fasting as a treatment for epilepsy was in France in 1911.[12] Twenty epilepsy patients of all ages were "detoxified" by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. The diet improved the patients' mental capabilities, in contrast to their medication, potassium bromide, which dulled the mind.[13]
This high-fat, adequate-protein, low-carb fad diet sends the body into a state of ketosis, in which the body uses stored fat for energy. Research published in Clinical Cardiology suggests the ketogenic, or “keto,” diet can be an effective weight loss method, but to be successful, you must follow the plan consistently with no cheat days — otherwise, you’re just eating a high-fat diet that may be high in unhealthy fats for no reason. (1) (A pro tip? If you're planning on doing the diet, consider perusing this complete keto food list and reading up on the healthiest fats for keto diet followers.)

U.S. News’s Best Diets rankings are put together by a panel of nutritionists, dietary consultants, and doctors specializing in diabetes, heart health, and weight loss. Each member of the panel scored all 41 diets in seven different areas, including how easy they are to follow, how well they protect against chronic disease, and how likely it is that followers will actually lose weight and keep it off.
The primary outcome was the change from baseline to week 16 in hemoglobin A1c. Changes in all variables were analyzed by the paired t-test or Wilcoxon signed-ranks test, as appropriate. Linear regression analysis was used to examine predictors of change in hemoglobin A1c. A p value of 0.05 or less was considered statistically significant. Statistical analysis was performed using SAS version 8.02 (SAS Institute, Cary, NC).
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.”
While it’s true that low-carb diets do raise the so-called bad LDL-cholesterol in some people, it’s important to note that LDL-C, when influenced by diet, has never been shown to have any effect on cardiovascular risk. Large clinical trials and observational studies show that one’s level of LDL-C and the lowering of LDL-C through diet is not reliably linked to cardiovascular outcomes.21, 22, 23
Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%.[9][30][31] The diet can be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy and tuberous sclerosis complex.[9][32]
Dash to a healthier you! Voted by health experts as the best overall diet three years in a row, the DASH Diet – originally developed to fight high blood pressure – is a safe and easy-to-follow eating plan that fights diseases and can even help you lose weight. Incorporate this two-phase plan from Marla Heller’s The DASH Diet Weight Loss Solution with bonus sample day menus for both phases. Find out if the DASH Diet is right for you. For more meal ideas, try these recipes!

Carbohydrate Restriction. To help people with diabetes manage their blood sugar levels, doctors will typically prescribe a diet that mostly consists of low glycemic index foods. [23] However, according to the research, restricting overall carb intake to the point of following a keto diet may be the best way to improve the many biomarkers relevant to diabetes. [24] In fact, this dietary strategy has been proven to be helpful for the management of type 2 diabetes and type 1 diabetes.
It also may help stave off chronic diseases, like heart disease and type 2 diabetes, as well as act protectively against certain cancers. (34) The diet is also a boon to mental health, as it’s associated with reduced odds of depression. (34) There’s even some data to suggest it can be supportive in relieving symptoms of arthritis, according to a paper published in April 2018 in the journal Frontiers in Psychology. (35)
One downside to a ketogenic diet for weight loss is the difficulty maintaining it. “Studies show that weight loss results from being on a low-carb diet for more than 12 months tend to be the same as being on a normal, healthy diet,” says Mattinson. While you may be eating more satiating fats (like peanut butter, regular butter, or avocado), you’re also way more limited in what’s allowed on the diet, which can make everyday situations, like eating dinner with family or going out with friends, far more difficult. Because people often find it tough to sustain, it’s easy to rely on it as a short-term diet rather than a long-term lifestyle.

“We have basically no evidence that this diet is consistent with human health over time,” says Dr. Katz. (Its heavy emphasis on animal protein isn’t ecologically sustainable, either, he adds.) “All of the evidence we have points toward a plant-predominant diet with an emphasis on vegetables, whole grains, fruits, nuts, and seeds—all of the very things that the ketogenic diet avoids.”
The "all meat all the time" low-carb approach or strict veganism can be great options for people who thrive on clear diet rules (and those two are actually the most popular diets out there) but these extremes are not for everyone. If you prefer more of a moderate approach, the Flexitarian diet is the clear winner. The "flexible vegetarian" mindset allows you a healthy balance of plant-based foods, responsibly sourced meats, and quality fats. The best part? It's not super restrictive, so you have plenty of nutritious food options. (Start here: How to Adopt a Flexitarian Diet)
Think of each almond as a natural weight-loss pill. A study of overweight and obese adults found that, combined with a calorie-restricted diet, consuming a little more than a quarter cup of the nuts can decrease weight more effectively than a snack comprised of complex carbohydrates and safflower oil—after just two weeks! (And after 24 weeks, those who ate the nuts experienced a 62% greater reduction in weight and BMI!) For optimal results, eat your daily serving before you hit the gym. A study printed in The Journal of the International Society of Sports Nutrition found that almonds, rich in the amino acid L-arginine, can actually help you burn more fat and carbs during workouts. Fill up, but don’t fill out: Use these Eat This, Not That!-recommended 10 Daily Habits That Blast Belly Fat.
Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed.[18] Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula.[30] Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet.[3] KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding.[50] Other formula products include KetoVolve[51] and Ketonia.[52] Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.[52]

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]
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What the expert says: ‘There have been a number of cases where GPs have said, “You’ve got IBS, go on the low-FODMAP diet”,’ says Dr Megan Rossi (@theguthealthdoctor). ‘The only support they give you is a printout with a limited explanation of the diet from the internet. I’ve had clients come into my practice who’ve been given a list of 10 “friendly” foods to survive on, which is nutritionally dangerous.’
Using the Bulletproof Diet, including Brain Octane Oil every day for long periods of time, and eating carbohydrates some of the time but not always, avoiding inflammatory foods, and using Bulletproof Intermittent Fasting, I was able to recently test with perfect insulin sensitivity — I scored a one on a scale of 1 to 120 (see my numbers below). I also had above average glucose tolerance. That’s metabolic flexibility by the numbers!
What the doctors never tell you is that you could also just eat completely different and take none of this crap. So that’s what I did. I stopped all of them all at once. Sure I don’t recommend that, but this damn disease and my disgusting visceral fat filled stomach ruined every aspect of my life-professional, relationships, sexual, mental. I am now 41 living back at home having to start from the bottom. I don’t want what the book recommends. I want every disgusting piece of fat off this body so I can excel again. If staying in ketosis every moment for the rest of my life will get me there then that’s what I’m going to do.
“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.
The Ketogenic Diet is a low carbohydrate diet, consisting initially of less than 20 carbohydrates per day. Not per meal, yes, you heard me correctly, per day. It is not for the faint of heart and yes I am writing from experience. Of course I have tried it! Hasn’t everybody in America at some point who has wanted to lose weight? Does it work you ask? Of course it does! The problem is how long can you keep it up?
“For any individual considering a ketogenic diet, there are laboratory values that a knowledgeable physician should check prior to starting and throughout the course of the diet,” she says. “The best approach is to work with a registered dietitian that is knowledgeable in ketogenic diet therapies and can educate you on ways to make healthier choices on this plan than what dieters would randomly select on their own, along with appropriate supplements that are absolutely necessary on this type of diet.”

Though we singled out quinoa above, whole grains in general (we’re talking cereal, rice, pasta, and more) are conducive to weight loss, especially when they’re used in place of refined—white—grains. In fact, a study published in the American Journal of Clinical Nutrition found that substituting whole grains for refined grains in the diet increases calorie loss by reducing calories retained during digestion and speeding up metabolism. Unlike refined grains, whole grains are packed with satiating, heart-healthy fiber.
The 2-week turbocharge is a great way to kick off the plan: all the claims about resetting your body's expectations proved true for me. In the 3 months I've been on this plan I started a new job; celebrated my anniversary, Halloween, my birthday, & Thanksgiving, and now find myself surrounded by all the Christmas treats...and still find it easier than it's ever been to make conscious choices about what I eat.
The Mediterranean diet is easy to find in the grocery store, contains nutrients that are known to enhance longevity and has other health benefits that are backed by peer-reviewed, scientific studies. Broccoli makes the list because it's one of nature's most nutrient-dense foods, with only 30 calories per cup. That means you get a ton of hunger-curbing fiber and polyphenols -- antioxidants that detoxify cell-damaging chemicals in your body -- with each serving.
As a Certified Diabetes Educator, I was taught to educate my gestational diabetes and pregnant patients with diabetes to avoid fruits and dairy before noon. I know this is hard! That’s when you all are craving that glass of orange juice, but that’s the whole point here. We need you to give up that orange juice for the next six or so months for the sake of your baby. Instead, you can have a real orange with lunch; try it with a spinach salad with tuna salad and whole wheat pita. The nutritional value is pumped up by all those vitamins and the spike on your blood glucose will be reduced dramatically by the fiber in the real fruit combined with the protein you had in your lunch. You can even have a glass of milk; you’ve included all of your necessary food groups, and you are still only at 45 carbohydrates for the whole meal!

Despite the promising evidence, we must remain skeptical. A few studies can only provide us with clues as to what might be the better dietary intervention for people with type 2 diabetes. To find out if carb restriction can take the throne as the most effective type 2 diabetes diet, we must look at the bigger picture of the data with the help of high-quality meta-analyses.


As I wrote in op-eds for the Wall Street Journal61 and Medscape,62 the Lancet Public Health study is based on very thin data. The questionnaire underlying the report left out questions regarding popular foods, such as pizza and energy bars, and did not consider alcohol consumption. Moreover, the “low-carb” diet group in this study included people eating up to 37% of calories as carbohydrates—not low-carb according to the latest science. Ultimately, this is the kind of data that can show association but not establish causation, which means it is the kind of data one can use to generate hypotheses but not prove them. This kind of data would never be considered sufficient to approve a drug, for instance. The same standards should be applied to diet. Quite a few researchers, including myself, had our critiques published in Lancet Public Health.63 The authors replied but did not respond to most of the criticisms.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.

There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.[7]
What the expert says: ‘There is a large amount of evidence to suggest that following the MD reduces your risk of cardiovascular disease,’ says registered Dietitian and British Dietetic Association spokesperson Kirsty Barrett. ‘Significantly, a meta-analysis of randomised-control trials in 2011 found that the MD was effective for weight loss, though results were better when the diet was combined with energy restriction and physical activity. It has also been found to reduce LDL (bad cholesterol) more than low fat and low carb diets.’
On day 2, cook a cup of oatmeal with an ounce of chopped walnuts and 1/2 cup of sliced apples for a breakfast high in fiber and protein; sprinkle in a teaspoon of cinnamon and maple syrup. Have this breakfast again on day 5, but vary the add-ins -- try 1/2 cup of strawberries with thinly sliced almonds. If you like milk with your oatmeal, opt for unsweetened almond or soy.

As Tammy points out, diets are diets, and many people nowadays think/feel that diets are a “time/value-based goal”. “If I just get my weight down, or if I just fix this, then I’ll be all set…” WRONG!!! There in lies the first problem. How long can it be maintained? Well that’s a good point. The real question is, how long is one committed to changing their life, and how strong is their desire to do it. ALL things that one wants to change in life, require a change in to the way their living and/or perceiving life. They require a life-style change. One could attempt a Mediterranean diet, and yet relapse back to “normal” eating after 3mos, 1yr, 3yrs, etc.. It doesn’t really matter if the change isn’t first on the mental and emotional level. Unfortunately, many first-world daily diets (namely American) incorporate many foods that are addictive which can cause cravings. And yes, the cravings are scientifically prove-able, and have been proved. We grow up thinking that it’s “normal” to have your cake (since its the carb of debate lol) and eat it too, because why?… Well because that’s how they were raised. Simply as that. Conditioned living if you will. There are many cultures on this planet that DO NOT grow up eating as many carbs and sweets as the American Diet, and do perfectly fine without all the sugars and carb cravings. And incidentally, they also lead healthier lives too… Go figure.
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:

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.
The fad military diet consists of low-calorie, odd food pairings such as bun-less hot dogs with banana, carrots, and broccoli. “Any diet like the military diet that severely limits the amount of calories you consume or eliminates one or more entire food groups puts any individual at risk for nutrient deficiencies,” says Kyle. “This can be more harmful than holding onto those 10 extra lb you’re trying to lose.” (32)
Kamut is an ancient grain native to the Middle East that is an excellent source of heart-healthy omega-3 fatty acids, protein, and fiber, while simultaneously being low in calories. In fact, a half-cup serving of the stuff has 30 percent more protein than regular wheat and just 140 calories. What’s more? A study published in the European Journal of Clinical Nutrition found that eating Kamut reduces cholesterol, blood sugar, and cytokines (which cause inflammation throughout the body). Kamut’s ability to stabilize blood sugar and reduce inflammation make it a great weight loss staple, especially if it is used in place of nutritionally lacking refined grains.
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.
Sesame seeds likely aren’t one of those foods you pay any mind to, but the crunchy little buggers have been shown to play a crucial role in weight maintenance and deserve to be tossed into a salad or whole wheat noodle dish. Researchers suspect its the lignans—plant compounds—found in sesame seeds (and flax seeds) that makes them so special. In a 2015 study, women who consumed high levels of lignans tended to weigh less and gain less weight over time when compared to women who didn’t consume these compounds in high amounts.
When the data were examined, it was clear that people who ate a diet where fruits and vegetables, grains, beans, and fish were the basis of daily meals were healthiest. Topping the chart were residents of Crete. Even after the deprivations of World War II – and in part, perhaps, because of them –  the cardiovascular health of Crete residents exceeded that of US residents. Researchers attributed the differences to diet.
“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.
^ Ketogenic "eggnog" is used during induction and is a drink with the required ketogenic ratio. For example, a 4:1 ratio eggnog would contain 60 g of 36% heavy whipping cream, 25 g pasteurised raw egg, saccharin and vanilla flavour. This contains 245 kcal (1,025 kJ), 4 g protein, 2 g carbohydrate and 24 g fat (24:6 = 4:1).[17] The eggnog may also be cooked to make a custard, or frozen to make ice cream.[36]
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].
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.

Our science-backed SmartPoints® system guides you to eat more fruits, veggies, and lean protein, while keeping track of foods with added sugar and unhealthy fats. Making smart decisions just got simpler, so you can live your best life. We meet you where you are— this plan works for men, brides, new moms, really anybody looking for inspiration to create healthier habits.
It’s only dangerous to not get enough carbs at each meal if one is taking too much meds or insulin for the amount of carbs they are eating! Restricting carbohydrates doesn’t lead to hypoglycemia unawareness, but having lots of lows and lots of highs will (and decreasing insulin and carbs leads to way fewer highs and fewer lows, or at least it can). On the other hand, being in ketosis does make low blood sugars less negative as an experience. I still feel my lows just fine, but they are less of an emergency because my brain still works (feeding on ketones) and by body doesn’t freak out and release tons of adrenaline that then makes me want to eat a house. Mind you, I still wake up and know immediately if I’m low, I know from experience and how it feels in my head and body but without the crazy shakes. This is not unawareness but it is less reactive.
We recently published an article documenting the grim long-term effects of low-carbohydrate diets, in which we explain the evidence-based research showing that low-carbohydrate diets high in fat and protein including meat, dairy products, eggs, fish, and oil actually worsen diabetes health, increase cancer risk, increase cholesterol, increase atherosclerosis, harden blood vessels, and increase all-cause mortality.
“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.
For me, I chose to become a CDE because I had worked as a Registered Nurse first on a medical unit, then in a Medical ICU. These are the units where most of the people with diabetes are, so I had seen every horrific complication that diabetes can cause. When I had a chance to become a Diabetes Educator…to actually help PREVENT some of those horrible complications…I jumped at the chance!
You still have to cap alcohol. The hallmark of a Mediterranean diet is that drinking red wine socially is thought to be one reason why the diet is so healthy. But women should still stick to one glass, and men two glasses. If you have a history of breast cancer in the family, know that any alcohol consumption raises that risk. (31) In that case, talk to your doctor to find out what’s right for you.
At first glance the ketogenic (keto) diet may seem like a crazy idea for type 2 diabetics. After all, many patients are put on diets to help them lose weight. The keto diet is high in fat, but it is very low in carbs, and this combination can help change the way your body stores and uses energy. With this diet your body converts fat instead of sugar into energy, which can improve blood glucose levels while reducing the need for insulin.

Several comprehensive studies and meta-analyses have demonstrated that after a few months or even a year of a low carb diet versus a moderate/high carb diet, there are no significant differences in the amount of weight lost (2,3,4,5).  I will say, however, most of these diets are NOT keto and are simply lower carb (i.e. 20%).  Also, long-term effects (beyond 1 year) are not often studied due to budgetary constraints, so interpret results as you wish.


In the study, the researchers fed mice a ketogenic diet for several days and expected to find a favorable outcome — perhaps weight loss or another indication of improved health. Instead, they found that the liver began resisting insulin almost immediately and the mice were unable to regulate their blood sugar levels after only three days on the diet. (Insulin resistance, meaning that cells in the body don't respond to insulin, is a key characteristic of type 2 diabetes.)

The good news here is no! All the evidence points to the fact that a low carbohydrate diet actually does lower blood glucose and A1c levels and does contribute to weight loss. The problem is we do not yet have enough large studies, over enough sustained years to support evidence that people with diabetes can remain on a highly restrictive Ketogenic Diet for the rest of their life and also not have other consequences to their health.


Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more
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