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.
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.

For those who want to follow a ketogenic-type diet, Dr. Reynolds says it is important to first talk to your doctor and to discuss your goals so you can be sure that this approach is suitable for you given your medical and health history. Ongoing monitoring is needed if you do decide to adopt this very carb approach to eating. Seeing your doctor regularly is important to make sure that your blood pressure, lipids, blood sugar, mood, and medications are within normal ranges as you lose weight. Adjustments are likely going to be necessary from time to time.
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.
With this eating style, you’re looking at a lot of menu planning and preparation. A review published in August 2017 in Nutrients suggests the diet could lead to weight loss, but the Academy of Nutrition and Dietetics warns the plan could also cause certain nutrient deficiencies, such as in calcium and vitamin D. (3,4) And, therefore, according to an article published in the January–February 2016 issue of the Royal Australian College of General Practitioners, anyone at risk for osteoporosis should avoid it. (5)

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.
What if we told you that you could make 20 percent of your belly disappear this year—poof, just gone? Penn State University researchers compared those who consumed avocado oil with those who consumed a flax-safflower oil blend. Those on the avocado oil diet—just three tablespoons daily did the trick—lost nearly 2 percent of their belly fat in just one month. For more ways to enjoy big, bold flavors, burn flab with these 8 Fatty Foods That Make You Skinny.
The keto diet did jump considerably in one specific category, however: This year it tied with several other diets for No. 2 in Best Fast Weight-Loss Diets (after the HMR Diet, a commercial plan that replaces most meals with pre-packaged nutrition bars and shakes), up from No. 13 last year. “Yes, you can do this for quick weight loss,” says Dr. Katz, “but I wouldn’t recommend it.”
Hi Sara. It’s meant to be a guide, as each person’s (calorie) needs varies depending on age, gender activity level etc. However, the link to the Greek Nutrition Guidelines that I have also included at the end of the post provides serving sizes. Adding the link here too: https://www.olivetomato.com/eat-like-greek-greek-dietary-guidelines-a-better-choice/
After 32 weeks, those in the keto diet group lowered their HbA1c more than those in the plate group with more than 50% achieving a reduction to less than 6.5%, basically reversing their diabetes. None in the plate group did this well. As for weight loss, those in the keto low-carb group lost on average of 28 pounds, while those in the plate group lost an average of 6.6 pounds.1
What the diet advocate says: ‘It essentially means scaling your carbohydrate intake up and down in accordance with your activity levels,’ explains performance nutritionist Liam Holmes (phnutrition.co.uk). He uses the principles of nutrient timing to get elite athletes and CrossFit enthusiasts to their leanest before competitions. ‘The body works harder when it doesn’t have carbs as fuel, so it learns to become a more efficient burner of the fuel once it is there.’
People this is crap. There is no Keto drink that will get you into ketosis within an hour. The main factor of eating Keto is to eat WHOLE UNPROCESSED foods. Which definitely does not include a magic fix drink. People that eat Vegan, Paleo and Keto have one core thing in common… to try their best to eat whole, natural, unrefined and unprocessed foods. We may not agree with what we eat per say, but I believe that we can all agree that drinking a “magic drink” or taking a “magic pill” to get us into any state is absolutely ridiculous. It’s exponentially offensive to those of us that are trying to educate and help others and especially offensive to those that have lived and succeeded living a whole lifestyle. Travis, get off this feed. Your doing nothing but trying to capitalize on people’s vulnerability.

Great article! Sustainability is key and Keto diet is extremely restrictive compared to others. Many of the comments I see don’t understand the importance of many years of research before stating something has a “significant difference” than the recommendations that are already in place. Also, understanding the pro/carb/fat balance in each meal instead of focusing on just carbohydrates. We have practiced the same modified Mediterranean diet at my practice where someone can enjoy life, eat complex carbohydrates and years later they are still successful and hundreds of pounds have been lost for good 🙂 Thank you for the reminder (and the comparison of Adkins supported research).


Yet it’s an incredibly well-rounded way to lose weight that ditches gimmicks and doesn’t require calorie or macronutrient counting as other diets do. And with the emphasis on healthy fat, it’s satisfying, too. That said, the 2019 U.S. News & World Report Best Diets ranked the Mediterranean diet as No. 1 for Best Diets Overall and it ranks 17 in their list of Best Weight-Loss Diets. (3) The reviewers note that it’s not a slam dunk, and all depends on how you eat. Even healthy diets like the Mediterranean aren’t free-for-all eating plans.

From intermittent fasting to the keto diet to teatoxes, there's a plethora of diet advice out there. Maybe the keto diet worked wonders for your co-worker, but it’s just not conducive to your nutritional needs. Or not eating after 7 p.m. helped your sister lose 20 pounds, but you like doing evening workouts. The truth is losing weight is hard—and it takes patience—so if it's too good to be true, then it probably is. “Adopting healthy habits is not easy, but most things in life that are worthwhile take work,” explains Bonnie Taub-Dix, RDN and author of Read it Before You Eat It - Taking You from Label to Table. But losing weight doesn't need to be complicated. Following these simple nutritionist-backed tips will help point you in the right direction and reach your goals.


Body Fat Reduction. According to the current research literature, both visceral and subcutaneous fat play a role in the development of type 2 diabetes. [22] To keep our fat cells from fighting against us, we must adopt a healthier lifestyle that prevents us from being in a calorie surplus and gaining weight. The keto diet is one lifestyle change that has been proven time and time again to help us lose fat and improve metabolic health.  [24]

Cons: That same study on the perks of being a keto athlete also found those same dieters had a lower exercise economy (how efficiently you use oxygen while moving). And whereas pretty much every other diet offers flexibility in the macro range, eating a few too many grams of carbs or protein will knock your body out of ketosis, so you have to be pretty committed to see the perks of this one. Lastly, the low protein count required to stay in ketosis may be holding you back here: A study analysis in Nutrition, Metabolism, and Cardiovascular Diseases found upping protein on a keto diet by just 5% tripled fat loss.
Finally, the ketogenic diet has been shown to be an effective adjuvant for the treatment of certain cancers. The beneficial effects have been demonstrated for various cancer types, including prostate, colon, and brain cancer, such as glioblastoma. Its efficacy has been documented in animal models as well as in humans, including in pediatric patients.
In addition, on the day the diet was initiated, diabetes medications were reduced – generally, insulin doses were halved, and sulfonylurea doses were halved or discontinued. Due to the possible diuretic effects of the diet soon after initiation, diuretic medications were discontinued if of low dosage (up to 25 mg of hydrochlorothiazide or 20 mg of furosemide) or halved if of higher dosage. Participants were also instructed to take a standard multivitamin and drink 6–8 glasses of water daily, and were encouraged to exercise aerobically for 30 minutes at least three times per week.
Hi Maya. I LOVE your site!! Interesting, informative with fab recipes and ideas. Hubby and I have just started eating low carb and I have to say, we are not finding it too difficult and I already feel sooo much better!! I find the hardest part is choosing low carb veg, I feel as if we are not eating enough. Any suggestions on how to get more veggies into our diet?
Susan answered, “White bread is so refined that the nutrients are stripped down, again it’s a simple carbohydrate where when a diabetic eats something, there blood sugar will rise and you get a boost of energy. This is the difference between a whole grain and a white-refined bread, once you consume that bread your blood sugar will rise for a little while and you’ll feel energized but the whole grain has better effect on your blood sugar, sustaining that energy over a longer period of time, avoiding the ‘crash and burn’ some feel when eating white bread. Keep in mind that in white bread all of the nutrients have been processed out of the food.” The other difference, you can literally, “Taste the difference when you eat one over the other.”
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]
And, it's important to recognize that both study teams acknowledge that as exciting as their findings seem, a large, randomized controlled trial is still needed to more closely assess a variety of components that may be contributing to the successes found in both studies before the findings can be recommended to anyone outside the study groups1,2  he says.
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function. However, if there is little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Almost half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] The most common adverse effect is constipation, affecting about 30% of patients—this was due to fluid restriction, which was once a feature of the diet, but this led to increased risk of kidney stones and is no longer considered beneficial.[2][3]
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]
The Mediterranean diet might help you lose weight. While some people fear that eating a diet like the Mediterranean diet that is relatively rich in fats (think olive oil, olives, avocado and some cheese) will keep them fat, more and more research is suggesting the opposite is true. Of course, it depends on which aspects you adopt and how it compares to your current diet. If, for instance, you build a "calorie deficit" into your plan – eating fewer calories than your daily recommended max or burning off extra by exercising – you should shed some pounds. How quickly and whether you keep them off is up to you.
I have T2D and IBS and my blood sugar readings were degrading. I was going to have to take a second daily dose of Metformin and the first one already played havoc with the IBS. I started a low-carb diet because my T1D husband had been inspired by a podcast by Sam Harris with scientist Gary Taubes, author Why We Get Fat, Good Calories, Bad Calories and the Case Against Sugar, and started dumping the majority of his carbs a month previous. He had cut his insulin use literally in half and lost 15 pounds. He was feeling better and visibly had more energy. I was resistant to the diet and even the idea of it. I have been on Atkins and Sugar Busters and while I did fine on Sugar Busters back in the day, Atkins was too fat-based and that was the opposite of how I had been raised to think about dieting. I knew that the Diabetic diet given to me by the Diabetic Educator had never been enough and I get carby binge cravings even though it offers plenty of carbs and calories. I also knew that it’s a cycle for me-eat more carbs, want more carbs, and never really feel satisfied. On top of that, when my stomach hurts I seek carbs, and it hurts quite often. I did Weight Watchers and the Diabetic diets because they let me “cheat” and have my carbs while dieting. To be fair, just the act of tracking my food improved my outcome on either. But I got mad at WW when they upped the points for carbs on their system and made it so I couldn’t eat cake for lunch if I wanted to. Not that I made a practice of it, but it was principle of the thing. Long story short, I was pretty doubtful that I would be very successful on Atkins or Keto. To humor my husband I began a low-carb diet that started out as Atkins 20 or Keto and has morphed to more of an Atkins 30-40 for my personal comfort while using Keto, Atkins, and Paleo recipes and ultimately cutting all gluten. That means 30-40 net carbs per day, rather than per meal and a lot of natural non-processed foods. The first week was quite terrible. But even through the Keto Flu I recognized that my IBS symptoms felt better. I started to suspect that if I felt that bad just from quitting carbs that maybe there was more to the idea of sugar addiction than I wanted to believe. I’m six weeks in now and I’m losing a steady pound a week plus my sugars have dropped radically. A pound a week might not sound like much but it’s more than I’ve lost in 10 years. I have PCOS and insulin resistance so I’ve had a fasting blood sugar that ranged from 109-113 since my early twenties. It was flying high around 160-170 before the diet, now I’m reading between 119-139. Even more than that, my IBS symptoms stabilized. I’ve been tracking all my food using the free Atkins meal tracker so I started trying to narrow the foods that caused flare ups. I’m lactose intolerant but I knew that and used lactose free products or Lactaid for the cream based dishes. I had my gall bladder removed and so have always put down my symptoms to an inability to process dairy and fats. Big surprise to find that a higher fat, higher dairy diet was making my symptoms disappear. Gluten is the only common factor so far. Celiac? Just a food sensitivity? I don’t know, but that will be the next investigation. It is an investigation that I would never have thought to start on the Diabetic diet. Like the author, I’m very fond of cake and carbs. Luckily there are low-carb, no-gluten recipes for muffins and cakes. They aren’t exactly the same and some are definitely better than others, but they are out there. Plus, there is nothing wrong with having true birthday cake once a year if that is really what you need and if you don’t have a reason to avoid it, like binge symptoms or IBS flare ups. My husband let himself have a piece of cheesecake the other day and felt physically awful for two day after, plus he had to use a lot of insulin to counter the spike. It’s a pretty good deterrent. Just a side note but I had other symptoms of inflammation as well. My ankles were swelling to golf ball size and painful, it was difficult for me to stand and walk comfortably when this happened. While they haven’t stopped completely, the discomfort has gone way down as has the swelling and frequency. What’s my point? I’m not a salesman for a particular diet. Everyone is different and some people might respond very well to Keto and/or Atkins while others may not need anything that extreme. I’m not knocking the Diabetic diet. My dad lost 150 pounds 38 years ago on a very low calorie/low carb Diabetic diet that gradually increased and he has kept the weight off all this time and kept his blood sugar steady with medication, but has not had to go to insulin even at age 84. Also, he was a smoker, a diabetic, had hemochromatosis and was over 300 pounds with an apple body shape. He has had some fall out from this-he didn’t stop the smoking until a heart attack 20 years ago and that didn’t help. But he has made it to 84 and when he walked into his doctor’s office 40 years ago I’m guessing the doctor wouldn’t have put any money on that survival rate. Unfortunately, it looks like I need the lower carb version and will continue to need it to manage my symptoms. I didn’t want it, that’s for sure. But Diabetics are locked in a death struggle with Diabetes and it won’t give up just because we are tired or want our sugar. So for me, it has to be Very Low Carb for Life. Others may find they need this too and discouraging them from trying it is not doing them any favors. Hopefully I will continue to find this sustainable. I just need to keep reminding myself that I am more fond of my feet and my vision than my birthday cake.

Keto Diet is NOT strictly 20 grams of carbs per day. Not only are you biased but you are not being truthful. 20 grams per day is just the recommended guideline for maintaining ketosis. Many people can consume 40, 50 even 60 and 70 grams of carbs per day and stay in ketosis. It depends on the person. Age, size lifestyle and exercise all factor into how many carbs can be allowed and maintain ketosis. It is ok to not recommend a diet but when you leave out important aspects you do both your readers and yourself an injustice. Don’t base your article on one or two 3 page leaflets you read on ketosis written 20 years ago.


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.
A 2012 CDC study found that the average adult consumes about 100 calories worth of alcohol daily, but favoring a glass of wine instead of beer or sugary cocktails can drastically reduce that figure and make your waistline slimmer. In addition to having fewer calories than most alcoholic beverages, red wine, in particular, is a good source of those waist-shrinking flavonoids that are also found in red fruits. Resveratrol, a particular flavonoid found in red wine, is believed to have heart health benefits because it helps prevent blood vessel damage and reduces your ‘bad cholesterol.’ Just remember to imbibe in moderation.
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.

In the study, researchers fed mice (!) a keto diet for three days (!), and then ran a glucose tolerance test. They noticed that while the mice on a keto diet had a lower fasting blood glucose, it got higher after the glucose tolerance test and there were signs of a reduced effect of insulin compared to mice on regular mouse chow. That’s basically it.
Whole grains: They contain more vitamins, minerals, and protein than white-flour products and have a stabilizing influence on blood-sugar levels. Experiment with nutrient-dense, nutty-tasting exotic whole grains such as barley, amaranth, quinoa, and faro. But watch your intake: One cup of cereal equals two servings, as do two slices of pumpernickel bread.

Eggs are on the menu for days 3 and 6. Have a frittata made with two eggs, red bell pepper, scallion and 2 tablespoons of Parmesan cheese the first day. The next time you have eggs, break an egg into half an avocado, sprinkle with a little Romano cheese and bake. This not only cooks up fast, but offers you the heart-healthy monounsaturated fats of avocado.
One of the keto researches commented, (I think it was Steve Phinney) that change will come about only because enough of the the public will be become educated about this and will demand that the ADA change their recommendations because those recommendations are just wrong. What is the proof they are wrong? If you eat 45-60 g of carb daily, you will continue to have diabetes, and the epidemic will continue as it has for the last 25 years.
"The eating plan focuses on reducing sodium intake and eating more fruits and vegetables," says Amy Gorin, MS, RDN, owner of Amy Gorin Nutrition in the New York City area. "It also emphasizes eating whole foods — such as fruits, vegetables, whole grains, fish, poultry, beans, nuts, and vegetable oils — and limits foods high in saturated fat. That includes fatty meats, full-fat dairy, and tropical oils like palm kernel oil, palm oil, and coconut oil. It also limits sugar-sweetened beverages and foods."
Sleep enough – for most people at least seven hours per night on average – and keep stress under control. Sleep deprivation and stress hormones raise blood sugar levels, slowing ketosis and weight loss a bit. Plus they might make it harder to stick to a keto diet, and resist temptations. So while handling sleep and stress will not get you into ketosis on it’s own, it’s still worth thinking about.
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