One meta-analysis18 incorporating data from 447 participants found that low-carbohydrate diets not only helped individuals lose weight, but also improved their cholesterol. And another meta-analysis,19 citing 17 clinical trials, found that low-carb diets protected against major cardiovascular risk factors. A third study20 including 119 participants found that low-carbohydrate dieters had lower cholesterol than low-fat dieters after one year.
“During physiological ketosis ketonemia reaches maximum levels of 7/8 mmol/L with no change in pH while in uncontrolled diabetic ketoacidosis it can exceed 20 mmol/L with a concomitant lowering of blood pH. Blood levels of ketone bodies in healthy people do not exceed 8 mmol/L precisely because the central nervous system (CNS) efficiently uses these molecules for energy in place of glucose,” researchers summarize.
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.
There are so many tricks, shortcuts, and gimmicks out there on achieving optimal ketosis – I’d suggest you don’t bother with any of that. Optimal ketosis can be accomplished through dietary nutrition alone (aka just eating food). You shouldn’t need a magic pill to do it. Just stay strict, remain vigilant, and be focused on recording what you eat (to make sure your carb and protein intake are correct).
Many CDEs actually have diabetes…it’s what draws them to choose this career…to help others with diabetes, to share their knowledge. Most already wear an insulin pump and continuous glucose sensors (CGMs) also. When I first became certified on each new pump and CGM, I would wear them (and check my BG 4-6 times per day) for 2-3 weeks, not only to learn the technology really well, but to gain a sense of how my patients must feel having to wear them 24 hours per day. Since, I’ve started a 6 month old baby on a insulin pump and CGM all the way up to a 89 year old…there are no boundaries for people with diabetes!
The keto lifestyle sounds daunting, but it really is not. One thing many fail to mention is the hormonal shifts that occur that regulate your appetite. Give this a little time, and you will be astounded at how easy it becomes to pass on the stuff you found addictive previously. There are many factors that influence one’s success or failure, and the key is to get the information and support you need, and to stick with it long enough to see the benefits. I fine this way of eating completely sustainable, and I’m in for life.

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DASH stands for "dietary approach to stop hypertension" and was created by the National Institutes of Health (NIH) as a way to help reverse national trends of obesity and heart disease. Scientists combed through decades of research to come up with an expert-backed list of diet tips, along with a prescription for exercise. And it worked: The DASH diet has topped nearly every diet list for nearly a decade. Doctors particularly recommend it for people looking to lower high blood pressure, reverse diabetes, and lower their risk of heart disease. (Here's the basic list of DASH diet-approved foods.)

Benefits It packs lycopene, a powerful antioxidant that is associated with a reduced risk of some cancers, like prostate and breast. Other components in tomatoes may help reduce the risk of blood clots, thereby protecting against cardiovascular disease, according to a review published in December 2013 in the journal Annual Review of Food Science and Technology. (9,10)


Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those that have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram (EEG) shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and it has been suggested that children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[45]
Spinach is a great source of iron, which is a key component in red blood cells that fuel our muscles with oxygen for energy. But researchers in Sweden identified another way in which these greens might keep you charged: Compounds found in spinach actually increase the efficiency of our mitochondria, the energy-producing factories inside our cells. That means eating a cup of cooked spinach a day may give you more lasting power on the elliptical machine (or in your daily sprint to catch the bus).
“Just because the scale isn’t moving, doesn’t mean that you are making zero progress toward your fitness goals and dream body,” explains Mike Roussell, PhD, co-founder of Neutein, a dietary supplement meant to improve memory and performance. “It’s easy to think you’ve hit a plateau when you don’t see additional weight loss on the scale, but that’s not always truly the case."
The Mediterranean Diet (or Med Diet) reflects a way of eating that is traditional in the countries that surround the Mediterranean, but you don’t need to travel any further than your local supermarket to discover its delicious flavors and fresh foods. It’s easy to bring the remarkable health benefits and affordable Mediterranean style of eating to your kitchen cupboards, your refrigerator, your countertops, your stovetop, your oven, and your table every day. Embracing the Med Diet is all about making some simple but profound changes in the way you eat today, tomorrow, and for the rest of your life.
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?
I recently had one of my previous cooks post that she was going to do this diet and should she start with 20 grams or 30 grams. She has been a cook in the healthcare business for about 8 years so she understands the different diets but not the physiology behind them (yet. I am trying to talk her into taking the CDM course). I told her to consult the RD at her facility before she embarks on such a trend. She won’t because all her friends posted their weight loss stories.
The ketogenic diet seems straightforward. Unlike a typical low-calorie diet, however, a high-fat diet requires careful monitoring. In fact, you may start the diet in a hospital. Your doctor needs to monitor both blood glucose and ketone levels to make sure that the diet isn’t causing any adverse effects. Once your body adjusts to the diet, you may still need to see your doctor once or twice a month for testing and medication adjustments.
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.
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.
Changing your body’s primary energy source from carbohydrates to fat causes an increase in ketones in the blood. This “dietary ketosis” is different from ketoacidosis, which is an extremely dangerous condition. When you have too many ketones, you may be at risk for developing diabetic ketoacidosis (DKA). DKA is most prevalent in type 1 diabetes when blood glucose is too high and can arise from a lack of insulin. Although rare, DKA is a possibility in type 2 diabetes if ketones are too high. Being ill while on a low-carb diet may also increase your risk for DKA.
What the diet advocate says: 'The key components of a Mediterranean diet are lots of vegetables, olive oil, oily fish and nuts, with no calorie restrictions. Combine that with cutting down on sugar, which was traditionally a rarity in the region, and you’ve got the base of the Mediterranean diet right. And if you get the base right you can eat a little of whatever else you like,' says Consultant Cardiologist Dr Aseem Malhotra.
Have rest of frittata from Wednesday's breakfast. Serve with 2 cups baby spinach leaves, topped with 2 tablespoons balsamic vinegar, and 1 cup fat-free milk. Have one slice of whole-wheat toast topped with 2 teaspoons light trans-fat-free margarine. For dessert, have one 2-inch-square piece of baklava, a traditional Greek pastry with flaky fillo dough and walnuts. Athens Brand Frozen Baklava Pastry is available in many groceries nationwide. It's a great choice because the portions are tiny, and no baking or heating is required. (Have two squares if choosing Athens brand.)
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]
The ketogenic diet is not a benign, holistic or natural treatment for epilepsy; as with any serious medical therapy, there may be complications.[27] These are generally less severe and less frequent than with anticonvulsant medication or surgery.[27] Common but easily treatable short-term side effects include constipation, low-grade acidosis and hypoglycaemia if there is an initial fast. Raised levels of lipids in the blood affect up to 60% of children[37] and cholesterol levels may increase by around 30%.[27] This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and, if persistent, by lowering the ketogenic ratio.[37] Supplements are necessary to counter the dietary deficiency of many micronutrients.[3]
U.S. News & World Report ranked the keto diet at the very bottom of their list of the best and worst diets of 2018. A panel of 25 nationally recognized experts, including Registered Dietitians, Professors, and Clinicians, looked at 40 diets and evaluated their nutritional completeness, ability to produce short-term and long-term weight loss, how easy it is to follow, its safety and potential for preventing and managing diabetes and heart disease.  While keto ranked the worst, the DASH diet and Mediterranean diet ranked the best. Keep reading for more info on these diets.
Roussell explains that when we get too hungry, our bodies secrete a hormone called, ghrelin, which controls our hunger and appetite. If too much ghrelin is released, we get hangry and will grab pretty much anything. Before bed, however, Roussell says going to sleep a bit hungry can actually be beneficial. “Going to be hungry may actually help you sleep better as ghrelin makes your body more responsive to compounds in your brain that aid in sleep.”
These carbohydrate recommendations are not PER DAY, they are per meal. This is the major difference between Ketogenic diets and a consistent, low carbohydrate diet CDEs advocate for. 30-45 carbs per meal is considered a low carb diet. Eating this in the form of a Mediterranean diet is what I recommend and what my article outlined. In a perfect world, we try to have people steer clear of anything artificial or processed when possible. Just eat fresh foods, like our grandparents did, who never had these types of health problems.
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.
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]
After seeing thousands of patients now for years and from personal experience, I still believe it comes down to staying away from processed foods and cooking at home whenever possible. Eating a variety of fresh fruits, vegetables, proteins, and fiber. Also, cutting out any sugary liquid calories; staying away from sodas, juices and the infamous sweet tea! Keeping stress levels under control and incorporating exercise into your routine will also be key to breaking through challenging times when you are having trouble with continued weight loss.

Bonnie J. Brehm, Randy J. Seeley, Stephen R. Daniels, and David A. D’Alessio, “A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women,” The Journal of Clinical Endocrinology & Metabolism: Vol 88, No 4; January 14, 2009. http://press.endocrine.org/doi/full/10.1210/jc.2002-021480.
“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!
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!

In the first week, many people report headaches, mental fogginess, dizziness, and aggravation. Most of the time, this is the result of your electrolytes being flushed out, as ketosis has a diuretic effect. Make sure you drink plenty of water and keep your sodium intake up.6One of the fathers of keto, Dr. Phinney, shows that electrolyte levels (especially sodium) can become unbalanced with low carb intake.
When you’re eating the foods that get you there (more on that in a minute), your body can enter a state of ketosis in one to three days, she adds. During the diet, the majority of calories you consume come from fat, with a little protein and very little carbohydrates. Ketosis also happens if you eat a very low-calorie diet — think doctor-supervised, only when medically recommended diets of 600 to 800 total calories.
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